International Archives of Integrated Medicine

10-17

Authors: Kamalakar Karampudi, J Ashwin

Background: Spinal anesthesia is oldest and all over the world till date one of the most frequently employed methods of regional anesthesia. The addition of opiates like the lipophilic opioid Fentanyl to local anaesthetics produces many of its clinical effects very early after intrathecal administration. Aim: The study was designed to compare the efficacy of intrathecal Fentanyl along with Bupivacaine and Bupivacaine alone and their effect on prolonging the duration of postoperative analgesia in lower segment caesarean section without any adverse effects. Materials and methods: Fifty ASA physical status I and II patients scheduled for elective lower segment caesarean section surgery were studied. Patients were randomly divided into two groups i.e., group FB and group B consisting of 25 patients each. Patients in group FB were given 8.5 mg of 0.5% hyperbaric Bupivacaine plus 25 µg of Fentanyl (0.5 cc) and group B received 8.5 mg of 0.5% hyperbaric Bupivacaine plus 0.5 cc of normal saline to adjust the final volume to 2.2 cc. Results: It was found that addition of 25 µg of Fentanyl to 8.5 mg of 0.5% hyperbaric intrathecal Bupivacaine had no effect on the onset of analgesia to pin prick, maximum level of analgesia and time to achieve maximum level. Fentanyl did not prolong the Bupivacaine sensory block but there was a significant prolongation of postoperative analgesia with addition of Fentanyl. Fentanyl 25 µg did not enhance the onset and duration of sensory block produced by 8.5 mg of 0.5% hyperbaric intrathecal Bupivacaine. Fentanyl however, prolonged post-operative analgesia and lowered the incidence of shivering. The incidence of pruritus was high, but it was usually mild in Fentanyl 25 µg along with 8.5 mg of 0.5% hyperbaric Bupivacaine. Conclusions: Intrathecal Fentanyl with Bupivacaine is very much safer than other opioids like morphine which has more postoperative complications like intense, intermittent respiratory depression.

27-35

Authors: Sethi P, Betkerur J, Sethi P, Adhlakha B, Kulkarni M, Murthy KC

Background: Primary pyodermas are one of the most common dermatological diseases. Staphylococcus aureus (S. aureus) is frequently isolated. It has developed resistance to many antimicrobials and Methicillin Resistant Staphylococcus aureus (MRSA) is a major problem. The precipitous usage of topical antimicrobials especially Mupirocin and Fusidic acid has increased the development of multi-resistant strains of S. aureus and in India, few studies have shown susceptibility profile to these drugs. Aim: This study aimed at the clinical and bacteriological profile in primary pyoderma patients, prevalence of MRSA and the resistance pattern of S. aureus to Mupirocin and Fusidic acid. Materials and methods: Patients with primary pyodermas from community were recruited. Gram stain and culture sensitivity was done with swabs taken from the lesions. Antibiotic susceptibility for S. aureus was tested using VITEK- 2. Mupirocin and Fusidic acid susceptibility was determined by E-strip method. Observations: A total of 107 patients of primary pyodermas were included. Pyoderma were common in young age group (P = 0.001). Poor hygiene was the main predisposing factor. Furunculosis (45.8%) was the most common pyoderma followed by impetigo and folliculitis (16.8% each). Culture was positive in all except 3. S. aureus was isolated in 61.7% and polymicrobial flora in 13.1%. Prevalence of MRSA was 39.5% (P= 0.066). All strains of S. aureus demonstrated 100% susceptibility to Mupirocin and Fusidic acid. Conclusions: Furunculosis still has the highest incidence in adult population with a high prevalence of MRSA (39.5%). Despite extensive usage of Mupirocin and Fusidic acid, no resistance was found in this part of India.

46-53

Authors: Kontham Praveen, Farida Begum, Kandukuri Mahesh Kumar

Introduction: Gastro Intestinal Tract (GIT) is an important site for wide variety of lesions which include congenital, inflammatory, neoplastic conditions. The invention of flexible fiber-optic endoscope is a very good achievement towards the diagnostic field. With the use of this facility direct vision of diseased mucosa and biopsy of mucosal lesions, therapeutic induction and photographic visualization of the lesions are made possible. Aim: Aim of this study was to know the incidence of Gastro intestinal lesions with reference to age, sex and site and to study the histopathological types of Gastro Intestinal lesions. Materials and methods: The present study included 180 GIT biopsies (gastro intestinal biopsies) between the period August 2013 to August 2015 .Clinical details and case histories were obtained from the patients presented to the gastroenterology department. Biopsies were obtained by the gastroenterologist with fiber optic forward viewing endoscope. Results: Among all the GIT biopsies, esophageal biopsies were 11 (6.11%), gastric biopsies were 31 (17.22%), gastro esophageal junction 4 (2.22%), and small Intestinal 67 (37.22%) and 67 (37.22%) was from large intestine. Conclusion: Endoscopy and subsequent biopsy for histopathology can detect early malignant lesions. In the absence of endoscopic screening, detection of these lesions may be missed. Such patients may present with advanced stage of disease in later life. In endoscopic biopsy only mucosa is seen, the level of invasion cannot be ascertained.

61-68

Authors: Sreenivasaiah Bharathi, Kotte Chiranjeevi

Background: Various studies have shown the correlation between Magnesium, Zinc and Copper levels in Serum and Cerebrospinal fluid (CSF) and occurrence of Febrile Convulsions. Hypomagnesaemia is characterized by hyper excitability of the central nervous system leading to convulsions. Hence the study is undertaken to find out the Serum Magnesium levels and its correlation with febrile convulsions. Aim: To Study the Serum levels of Magnesium in children: 6 months - 5 years of age with febrile convulsions and to establish the correlation between serum Magnesium levels and febrile convulsions. Materials and methods: This study was done in the Department of Pediatrics, Gandhi Medical College, Secunderabad from July 2015 to July 2016. It was an Observational Prospective study. A total of 120 children 6 months to 5 years of age admitted with history of fever and convulsions diagnosed as febrile convulsions were included in the study. Serum Magnesium levels were measured using catalyst method by Synchron CXR systems. Informed Consent was taken from Parents of all the children. Detailed Clinical History was taken along with thorough Clinical examination. Complete Blood Counts, Serum Magnesium levels, Serum Electrolytes, Blood Glucose and Serum Calcium levels were done. CT scan brain was done wherever required Results: Out of 120 total cases: 104 (86.67%) were Typical Febrile Convulsions. 16 (13.33%) were Atypical Febrile convulsions. Hypomagnesemia was seen in 19 (16%) children. Out of these, 9 (47.36%) cases were Males and 10(52.64%) cases were Females. Out of 104 Typical Febrile convulsions: 17 cases were shown hypomagnesemia, 87 were shown Normal magnesium levels. Out of 16 Atypical Febrile convulsion cases: Only 2 cases were having hypomagnesemia and 14 were having Normal Magnesium. Conclusion: No association was found with Gender, Age, and Temperature of the patient and subtype of febrile convulsions. Statistically significant association was found with hypomagnesemia and ‘Typical Febrile convulsions’. No such association was found with Atypical Febrile convulsions. Therapeutic value of administration of Magnesium in children with febrile convulsions associated with hypomagnesemia to be established. This requires further interventional studies. Larger clinical studies are required to establish the association of hypomagnesemia and febrile convulsions. Further studies are suggested to determine the effect of Magnesium administration for the prevention of febrile convulsions.

78-82

Authors: Sabhnani G, Tomar S

Giant peptic ulcer perforation is a life threatening surgical emergency with high mortality rate. This study compares two different surgical techniques Omentopexy and Omental plugging for the treatment of giant peptic perforation. A prospective non-randomized study of 36 patients with giant peptic perforation (>=2 cm in diameter) was carried out over a period of 24 months .The highest incidence was seen in males over 50 years of age. Biliary leak rates were 22.22% in the omentopexy group compared to no leak in the omental plugging group. This rate when calculated on standard error of proportion was significant at 5% level (p<0.05).Mortality rate was higher in omentopexy group compared to omental plugging group.

88-93

Authors: C. Amulya, T. Sasikala, V. Poornima

Background: Hypertensive disorders complicate 5-10% of all pregnancies and together they form one member of the deadly triad, along with haemorrhage and infection that contribute greatly to maternal morbidity and mortality rates. Materials and methods: Antihypertensive drugs taken into the study were Tab. Labetolol, 100-300 mg three times a daily, max dose 2400 mg per day and T. Nifedipine, 10 mg three times a day, max dose 120 mg per day. The study was a randomised control clinical trial, the study period started from Nov 2014 to June 2016, in the Department of Obstetrics and Gynecology, KGH, Andhra Medical College, Visakhapatnam, India. Results: Age distribution, Gravidity, Gestational age at the time of admission, Distribution of cases as per type of hypertension, Duration of therapy before delivery in study group, Changes in blood pressure, Maternal side effects in the study group, Mode of delivery, APGAR score of the babies at the time of delivery were tabulated. Conclusion: Labetolol gave good control of BP with single agent, when the dose was titrated appropriately, till the BP was controlled. The control of BP was consistent with labetolol, and also could be used for longer duration without any additional therapy whereas with nifedipine, control of BP was inconsistent and required additional medication for proper control of BP.

103-111

Authors: PSV Rama Rao, M. Vijayakanth, Mohammad Feroz

Introduction: Pain is one of the most important factors that is responsible for many adverse outcomes during surgery and in postoperative period. Effective pain control can also facilitate rehabilitation and accelerate recovery from surgery. Aim: To compare ultrasound-guided TAP block versus patients receiving no Transverse abdominis plane (TAP) block as regards the degree of pain relief in patients undergoing laparoscopic appendectomy. Materials and methods: Prospective single blinded randomized control study. Patients were randomly allocated (computer coded sealed envelopes) to receive either TAP block or no TAP block with regular analgesia. Patient will be observed for 24 hours post operatively. 60 patients divided equally into 2 groups cases were TAP (transverse abdominis plane block) group (n =30), Control group (n= 30). Results: The age between the two groups was analysed using student-t-test , the average age group in control group was found to be 32.64 years and TAP group 29.4 years. There was no significant difference in age between the two groups. The percentage of Males in TAP group was more when compare with Control, whereas in Control group the females were more but the difference was not statistically differ. Pain score between two groups was analysed using Maan-Whintney U test. The p-values of the Mann-Whitney U-test for the 2nd, 6th and 12th hours showed significant (p value – 0.000), which revealed that the mean rank for the pain scores of Control group was significant greater than the TAP group. Whereas for the 24th hour the mean rank for the pain score for both the groups were almost similar. Conclusions: Ultrasound guided TAP block with 0.375% ropivacaine bilaterally can be used effectively for post operative analgesia for patients undergoing laparoscopic appendectomy.

118-128

Authors: Ramulu Pulimaddi, Amruth Rao Parveda, Dhanunjaya Dasari

Introduction: Non-alcoholic fatty liver disease (NAFLD) is a condition characterized by excess accumulation of fat in the liver occurring in people who consume little or no alcohol. This study was aimed at estimating the prevalence of fatty liver in type 2 diabetic patients using ultrasonography and to also to study the correlation between coronary risk factors, coronary artery disease and fatty liver. Materials and methods: This was a cross-sectional study conducted on 150 patients above the age group of 30yrs who were already diagnosed of type 2 diabetes mellitus and on treatment for T2DM were recruited according to inclusion criteria Results: In the present study it was observed that 54 % of the diabetic patients had fatty liver and 46 % had no fatty liver disease on ultrasonography. Out of the 81 diabetic patients who had fatty liver, grade I fatty liver or mild steatosis was observed in 69.1 % cases while 44.9% of cases with no fatty liver disease and 49.4% of cases with non-alcoholic fatty liver disease and were in the age group of 51- 60 yrs with male predilection. 88 patients out of 150 were hypertensive, in patients with no fatty liver disease 59.4 % patients presented with hypertension and 58% hypertensive patients with non-alcoholic fatty liver disease. Mean BMI, waist circumference, HBA1c and liver enzymes (AST and ALT) were significantly higher in patients with fatty liver than in patients without fatty liver. The mean total cholesterol levels (178.18), the mean triglyceride levels (154.9) and mean LDL cholesterol (103.8) were significantly higher in patients with fatty liver when compared to those without fatty liver. Mean HDL cholesterol in patients with fatty liver was 43.3 which were significantly lower than mean HDL cholesterol of 46.21 in patients without fatty liver. The prevalence of metabolic syndrome (66.7%) and CAD (59.3%) were significantly higher in the NAFLD subgroup. Conclusion: The prevalence of NAFLD in type 2 diabetics is very high. NAFLD is associated with higher prevalence of metabolic syndrome and coronary artery disease. There is clustering of traditional coronary risk factors in patients with NAFLD.

136-142

Authors: Joshi K, Bhatt M, Saxena R

Background: Thyroid dysfunction is the second most common endocrine disease in pregnant women. Hypothyroidism is a more common dysfunction encountered in pregnancy. Aim: To study the incidence of thyroid dysfunction in antenatal cases and its effect on fetomaternal outcome. Materials and methods: Total 50 cases of pregnancy with thyroid disorder were selected. Detailed history was taken and full clinical and general examination was performed using a predesigned proforma including clinical feature suggestive of thyroid dysfunction. Serum TSH, T3, T4, fT3, fT4 was measured by CLIA (Chemiluminescence Immunoassay) in all the cases as initial hormonal screening investigations. Results: The overall percentage in our study was 15.97% and out of this 74% was without any symptom i.e. subclinical and only 26% had symptoms. Caesarian section rate was (30% v/s 0%), 18% with subclinical hypothyroidism were detected. In controls, 9% with subclinical hypothyroidism were detected. The most common complication associated with hypothyroidism was abortion (14%) and PIH (16% v/s 56%) hyperemesis gravidarum (9% v/s 3%) and hemorrhage in early pregnancy (22% v/s 8%) We also observed that hypothyroidism is associated with more complications even if it is subclinical (42%). Conclusion: The study concludes that thyroid dysfunction in pregnancy is often significantly associated with maternal complications most commonly abortions, anemia, preterm labour and abruption. Higher caesarean rates are also observed among hypothyroid mothers. Low Apgar scores, increased NICU admissions, low birth weight mainly due to prematurity are usually noted in the neonate. The early administration of treatment and maintenance of a normal level of thyroid hormones significantly minimize the risk of maternal and fetal complications.

151-153

Authors: Rathva A, Jaiswal SK, Gupta K, Zala S

Hydatid involvement of the kidney accounts for only 2–4% of all cases of hydatid disease it is very rare and again primary involvement of the kidney without involvement of liver parenchyma or lung parenchyma that makes it extremely rare. The purpose of this article is to review the imaging features of hydatid disease of the kidney and thus show the role of radiography, excretory urography, sonography, CT, and MRI in the diagnosis of Hydatidosis. Hydatiduria accompanies only 10 to 20 % of all cases of renal Hydatidosis and usually microscopic ,here we are reporting a 65 years old female with abdominal lump in right hypochondriac region with pain on USG finding suggestive of hydatid cyst of liver with indentation and possible involving right kidney but MDCT suggest it is a primary right renal hydatid large exophytic cyst having multiple daughter cysts involving upper pole of kidney with breech in the cortex and it extends to involve right renal pelvis which indenting to inferior surface of liver.

164-170

Authors: Neki NS

Salivary diagnostics is an emerging field that has progressed through several important developments in the past decade, including the publication of the human salivary proteome and the infusion of federal funds to integrate nanotechnologies and microfluidic engineering concepts into developing compact point-of-care devices for rapid analysis of this secretion. In this article, we discuss some of these developments and their relevance to the prognosis, diagnosis and management of periodontitis, as an oral target, and cardiovascular disease, as a systemic example for the potential of these biodiagnostics. Our findings suggest that several biomarkers are associated with distinct biological stages of these diseases and demonstrate promise as practical biomarkers in identifying and managing periodontal disease, and acute myocardial infarction. The majority of these studies have progressed through biomarker discovery, with the identified molecules requiring more robust clinical studies to enable substantive validation for disease diagnosis. It is predicted that with continued advances in this field the use of a combination of biomarkers in multiplex panels is likely to yield accurate screening tools for these diagnoses in the near future.

7-16

Authors: G Ravindra, Dashetwar AM

Background: An Atrial Septal defect is an abnormal hole of variable size in the atrial septum, which generally permits left to right shunting of blood at the atrial level. ASD is one of the most common congenital cardiac anomalies, present in 10-15 percent of patients with congenital heart disease. Aim: To study the clinical profile, diagnostic modalities used, post operative morbidity and mortality of patients operated for atrial septal defect in a major teaching hospital in Telangana. Materials and Methods: This study was based on a patient population of 50, admitted to undergo surgical correction for atrial septal defect. Results: The incidence of ASD is more in females. The male to female ratio was 1:2.1 in this study. The majority of the patients were symptomatic (96%). The commonest symptom was dyspnoea on exertion (76%). Most of the patients were in NYHA class II (62%). Consanguineous marriage of parents was present in 28% of patients. Most of the patients were in sinus rhythm (94%). ASD were of fossa ovalis type (96%). In 74% of the patients, the size of ASD was between 2-4 cm in diameter. 78% of the patients were repaired by direct closure of ASD. Most of the patients (96%) were supported by ventilation, out of which 62% (31/50) of patients were ventilated for 1-6 hours. Patients (70%) were discharged by 9th –12th post operative day. Mortality was 2% in this study. Conclusion: Surgical repair of atrial septal defects is a safe procedure which is associated with excellent results and low morbidity.

21-26

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

Background: Refractive errors are one of the known cause of visual impairment and a main cause of blindness worldwide. In children, refractive errors make us learning disabilities and also prevent academic progression. Aim: To study the prevalence of refractive errors in children of school going age. Materials and methods: This was a descriptive study in which children were screened for refractive errors. Children aged 4 to 15 years whose parents were willing to sign the informed consent form. This study was done from 2011 to 2015. Results: Total 531121 children were screened in which 13206 having refractive errors, incidence of 2.4% in the present local area. The most common age group affected is 8-11 years of these were boys 2706 (20.4%) and 3491 (26.4%) girls. Conclusion: The major cause of visual impairment worldwide is refractive errors and have immediate and long term consequences in children.

36-41

Authors: Maratha V,Kapil M,Kumar S, Dhamija A, Manchanda J

Background: One of the indispensable components of spine surgeries is the relieving of post-operative pain. When used as an adjuvant in regional anaesthesia, α2 adrenergic agonists have both analgesic and sedative properties. With the addition of alpha agonist to epidural local anesthestics, the degree of pain relief increases because of their analgesic properties and augmentation of local anaesthetic effects. Hence, we comparatively evaluated the effect of ropivacaine versus dexmedetomidine and ropivacaine in epidural anaesthesia in lower limb orthopedic surgeries. Materials and methods: The present study included 200 patients in the age group of 25 to 65 years. The patients who were scheduled to undergo lower limb orthopedic surgeries under epidural anaesthesia were included for the present study. All the patients were randomly divided into two study groups; Group I and group II with 100 patients in each group. Pre-operatively pulse rate, non-invasive systolic and diastolic blood pressure (DBP) and respiratory rate was recorded. Assessment of sensory block was done was observing the loss of sensation to pin prick in the midline. Assessment of the motor block was done by analyzing the modified Bromage score. Assessment of analgesia was done by analyzing VAS score. Post-operative values of the parameters were also recorded after surgery. Adverse effects and complication like hypotension, bradycardia, headache, dry mouth, nausea and vomiting etc were noted in the first 24 hours after surgery. All the results were analyzed by SPSS software and chi square test was used for assessment of level of significance. Results: Mean age of the patients in group I and II were 40.45 and 41.23 years respectively. No significant results were obtained on comparing the mean age and mean weight of the patients. Majority of the patients in both the groups were males while rest were females. 74 % of the patients in group I belonged to ASA grade 1 while in group II, 69 percent of the patients belonged to ASA grade 2. Conclusion: For shorter surgical procedures, dexmedetomidine may be undesirable as it produces prolonged duration of motor block and sedation.

48-54

Authors: Jain K, Pandey A, Gupta S, Rahul

Introduction: This study was aimed to assess the hearing outcome after type I tympanoplasty using temporalis fascia graft, to assess the factors which influence the outcome and to evaluate the result of our study and to compare our data with similarly published study. Materials and methods: The study was conducted at NSCB Medical College and Hospital, Jabalpur in the Department of Otorhinolaryngology after obtaining approval from the institutional ethics committee, from October 2014 till October 2015. Patients, aged 15 to 45 years, presenting with perforated tympanic membrane were consented. Audiological evaluation was done preoperatively, 1 month and 3 month after tympanoplasty. Results: During the study period 45 type I Tympanoplasty were performed using temporalis fascia as graft, 24 males. 21 cases below the age of 26 years showed graft take up of 84% and the mean hearing gain of 11.37 dB. 77% of those belonging to low socioeconomic group showed graft take up of 76.9% with mean hearing gain of 12.03 dB and 88% of those belonging to high socio economic group showed graft take up of 87.5% with mean hearing gain of 11.14 dB. Out of 21 cases which had perforation size <50% 20 showed graft take up of 95.23% with mean hearing gain of 11.77 dB. Conclusions: Graft uptake is independent of gender, age of the patient. Pre operative dry ear status is directly related to the outcome of surgery. Graft take up is better in perforation size less that 50% but hearing gain will be more in perforation size of more than 50%.

62-69

Authors: M. Virgin Joena, R. Ananda Xavier Pragasam, Benita Florence

Background: Increasingly many studies across the globe in the recent past have documented increase in prevalence of burnout among various cadres of health care professionals at very young age. Even though the burden, influencing factors and adverse consequences of burnout on professional and personal life have been documented by many studies from the west, there are very few studies conducted on the subject in Indian health care providers. The current study has been undertaken to assess the prevalence of burn out and factors influencing it among clinicians in an urban tertiary care hospital in a state of Tamil Nadu. Materials and methods: The current study was a cross sectional of 73 clinicians working in a single tertiary care teaching hospital, who were selected by convenient sampling. Burn out was assessed by Maslach Burnout Inventory scale. Results: The proportion of overall burnout reported in the study was 34.2%. Among the all the potential factors, which were assessed for their association with burnout in the study population, the factors which have shown statistically significant association were experience less than 4 years (Odds ratio 3.24, 95% CI 1.16 to 8.99), Hours of sleep < 6 hours (OR 7.45, 95% CI 4.98 to 9.92) and regular night duties (OR=3.25, 95% CI 1.17 to 9.02). Conclusion: The prevalence of burnouts in south India is around 34.2% is slightly lower compared to the prevalence reported in western studies. Limited experience, regular night duties and sleep duration less than 6 hours were associated with burnout.

74-78

Authors: Khurana E, Oommen ER

Background: Cardiovascular fitness refers to the ability of circulatory system to supply oxygen to working muscles during sustained physical activity. Objectives: To determine the cardiovascular fitness (using predicted VO2 max) among young healthy medical students in the age group of 17-19 years. Materials and methods: On the basis of physical activity performed subject were categorized into 3 category light, moderate, vigorous exerciser. Cardiovascular fitness was assessed by using treadmill exercise as per Bruce protocol. Results: Data were analyzed using the paired t-test.Conclusion.it was observed in the study that vigorous exerciser had better cardiovascular fitness than moderate and light exerciser. Conclusion: Students who had more physical activity were having better cardiovascular fitness. Hence, it is suggested that some physical activity should be mandatory in the curriculum of medical education which would help us to maintain cardiovascular fitness and reduce the risk of cardiovascular morbidity and mortality in the long run of their careers.

87-93

Authors: Rahul, Gupta S, Pandey A, Jain K

Introduction: This study aimed to clinically correlate adenoid facies with various clinical features related to ear, nose and throat and to broadly study the various sequelae of adenoid hypertrophy on the physical, mental as well as the social conditioning of children. Materials and methods: After taking approval of the institutional ethics committee the study was carried out in the department of Otorhinolaryngology and Head and Neck Surgery Netaji Subhash Chandra Bose Medical College and Hospital, Jabalpur from January 2012 till December 2012. Patients who presented to the outpatient clinic or were admitted in the indoor ward with adenoid facies were included in the study. After detailed history taking and clinical examination, data was analysed with appropriate statistical methods. Results: 30 patients with adenoid facies of varying degrees were included in the study. Nasal block was the most commonly presenting symptom. Pain in throat was complained of by 66.66% of cases. In 50% of cases the parents complained of irregular dentition. Decreased airflow upon functional examination of the nose was seen to be bilateral in majority of cases. A hitched upper lip was found in 100% of cases. High arched palate was seen in all cases, grade III tonsil enlargement was seen in 63.33% cases while grade II tonsil enlargement was seen in 30%. It was seen that mastoid pneumatization was affected by adenoids, being partial cellular in 48.33% of the cases and sclerosed in 18.33% ears. Conclusions: This study concluded that adenoids affect each part of ear nose and throat system, thus its effect can actually be quite devastating in growing children.

100-104

Authors: S. Dhanraj Reddy, M. Sandhya Rani

Background: Prostatic carcinoma is one of the most important causes of mortality in elderly men mainly because of the late detection despite of the fact that it is a potentially curable disease. Fine needle aspiration cytology (FNAC) is an easy to perform outpatient procedure requiring no expensive equipment or anesthesia. Objectives: The present study was carried out in an attempt to evaluate the fine needle aspiration cytology in the diagnosis of carcinoma prostate. Materials and methods: The present study was performed on 27 patients admitted in the surgical wards, with complaints suggestive of prostatic disease, in whom there was found to be a suspicion of malignancy of the prostate gland. Results: Among 27 patients, 14 patients were diagnosed as prostatic malignancy on per rectal FNAC whereas, 19 patients were confirmed with prostatic cancer histologically. Out of 19 histologically confirmed cancer cases, 16 were also positive on FNAC i.e. 84.21% accuracy of FNAC in detecting prostatic malignancy. Conclusion: Fine needle aspiration cytology is easily available and inexpensive procedure. It is a reliable method in the diagnosis of prostatic cancer. Its positive results are relatively more reliable than the negative ones. It is an effective method in follow up of the cancer cases.

111-116

Authors: P. Renuka, K. Aruna Kumari, Akhila

Background: Obstetric emergencies faced in India are much different from those faced by the western world. Out of them, Abruption leading to hemorrhagic shock is a major obstetric emergency, which requires adequate management to avoid catastrophic events including maternal death. Aim: To assess the various modalities of treatment for abruption and its outcome, to assess maternal and perinatal outcome in patients with abruption, to determine the association and influence of various maternal factors on the outcome of pregnancy. Materials and methods: The study was conducted at GMH, Nayapool which serves as a tertiary referral Center having approximately 18000-24000 deliveries per annum. The study was conducted during June, 2006 to July-2007. During this period there were 18950 deliveries. Out of this 296 cases were selected. Results: Out of 18,000 deliveries, 1.64% (n-296) of the patients were complicated by abruption. The mean maternal age was 22-25 years with maximum incidence in both extremes of age. (20-25 years-64.80%, 31-35 years-28.37%). Multiparous women (83.10%) were more affected compared to primigravida (16.89%). A staggering 89.86% or women had no antenatal care and 91.21% of patients belonged to low socio-economic status. 41.21% of women were in 28-32wks of gestation and 35.81% were in 32- 36 weeks. Bleeding per vaginum was the presenting complaint in 89% of patients. 66.22% of patients came with IUD. Maternal complications were frequent. There were 6 maternal deaths, 4 due to hypovolemic shock, 1 due to DIC, 1 due to status Eclampticus. Duration of time between onset of bleeding and seeking medical advice was significant. 2 patients developed PPH. The average induction-delivery interval was 5.2hrs, 82.43% of patients had vaginal delivery and Cesarean section was done in 17.56% of patients. 62.5% of patients received blood transfusion and 55.74% of patients were given FFP's Maternal mortality rate was 2.36% Perinatal Mortality was 61%. Out of these 66.21% of the patients came with IUD, 7.43% had early neonatal deaths, 7.42% had stillbirths. Conclusion: The possibility of abruptio placentae should be considered by the clinician when managing pregnant women with any of those characteristics. Abruptio placentae should be managed in centers where there is advanced maternal and neonatal facilities.

125-138

Authors: Gummadivandanaushasree, Sreenivasaiah Bharathi, Jampalavenkateshwar Rao

Background: An increasing number of HIV infected children have been reported as spread of HIV in adults are showing increasing trend in India. We reported the clinical manifestation, laboratory parameters and follow up of these children. Aim: To study the clinical profile follow up of paediatric patients admitted with HIV in the age gruop18 months to 13 years for a period of 1 year. Materials and methods: This Prospective study was conducted at tertiary care centre at Gandhi Hospital in association with ART centre, Ganhi Hospital, Secunderabad over a period of one year (January 2013 - December 2013). Over 100 consecutive patients suspected and later confirmed by TRIDOT & HIV EIA COOMB were included in the study after obtaining written consent from guardian of the patients. A detailed history, thorough clinical examination and laboratory investigations were carried out. ART & ATT therapy were given according to guidelines and followed up. Results: Of the 100 cases, 55 were males and 45 were females. Immunization status of these children included 20%completely immunised, 52% partially immunized and unknown in 28. Clinical manifestation like, anemia was seen in 95 cases, 91 cases had PEM with 47.25% were in gr 4, PGL (38), fever (36), respiratory (28), diarrhoea (15). Less commonly seen were CNS and chronic ottorhea. Most common opportunistic infections were tuberculosis (16) and candidiasis (16) with giardiasis (3) and herpes zoster (2). Of the 100 cases enrolled, 11 were lost to follow up and 3cases died. Mean weight gain after 6 months 1.6 SD and 2.8 SD at 12 months. On laboratory investigations 95 cases had Hb <2SD, 21 had mantoux positive (>5 mm), abnormal chest X-ray in 23 cases. Conclusion: Most children were in the age group of 1-5 years with mean age of presentation of 5.5 years. Mild bias towards male patients is noted. Perinatal mode is the only mode of transmission, no other modes noted. Most of the children presented to us in a partially immunized status and others’ status was not known. Common presentations - PEM, anemia, skin manifestations, nutritional deficiencies, prolonged fever, systemic manifestations – PGL; respiratory infections like pneumonia, TB; chronic diarrhoea. CNS manifestations were uncommon and renal problems, malignancies were not noted in our study. Amongst opportunistic infections, TB involving various organs and candidiasis were seen in maximum number of patients. Our study concluded that administration of nevirapine based ART regimes for HIV-1 infected children is feasible in resource limited settings. There was improvement in growth parameters with the use of this therapy and prevention of deterioration in immune status.

146-152

Authors: B. Rekha, J. Rajeshwari

Introduction: The intrapartum assessment of fetal well being has become an integral part of the management of labour. Aim: The objective of this study was to evaluate the predictive value of admission test in detecting fetal asphyxia at the time of admission in labour and to correlate the results of admission test with perinatal outcome in high risk obstetric cases compared with low risk obstetric cases. Materials and methods: This was a prospective observational study conducted in the labour and maternity ward of Govt. Gandhi hospital in Secunderabad, during the period 2012 to 2013 with a sample size 50 high risk obstetric cases and 50 low risk obstetric cases. All women were subjected to an admission CTG, which included a 20 minute recording of FHR and uterine contractions. Results: The majority of women were primigravida in the 18-23 years age group in both high risk and low risk groups. Admission test was reactive in 35 cases (70%) in high risk group, 42 cases (84%) in low risk group where as non reactive in 15 cases (30%) in high risk group and 8 cases (16%) in low risk group. In cases with reactive admission test spontaneous vaginal deliveries were more in low risk group than in high risk group. Operative deliveries were more in high risk group than in low risk group in both reactive and non reactive admission test. Indication for caesarean section in both reactive and non reactive admission test was more in high risk group i.e. 1 case (25%) and 6 cases (66%) respectively. Perinatal outcome was abnormal in high risk groups in both reactive and non reactive admission test. Specificity and Negative predictive value in high risk group is less than that in low risk group. Conclusion: The admission CTG appears to be a simple non-invasive test that can serve as a screening tool in both high-risk and low risk obstetric patients with significant results.

158-161

Authors: Madhu Mohan Reddy B, Rajanikanth Amrutham, Nagababu Pyadala

Background: Acute pancreatitis is an inflammatory disease of the pancreas, develops over a short period of time. Aim: To evaluates the clinical presentation in different age group, gender, aetiology, mortality, morbidity and outcome of management of patients with acute pancreatitis in surgical unit of MNR Teaching Hospital. Materials and methods: A prospective study was conducted in MNR Medical College Hospital over a period of 3 years. Patient details, clinical examinations, laboratory reports, treatment options, complications and mortality rate were recorded during study period. Results: Among 46 patients, 29 (63.04%) were males and 17 (36.95%) were female. Most common age group with acute pancreatitis was 21-30 years (45.65%). All patients had pancreatic oedema. 26.08% acute pancreatitis was due to gallstones, 15.2% had pseudo cyst, 17.4% had ascites and 15.21% had hepatosplenomegaly. Fatality rate was 6.5%. Conclusion: Conventional conservative approach for the management of acute pancreatitis has better outcome.

174-178

Authors: Aasim Farooq Shah

Studies of dietary effects on saliva were common in the early part of this century, but it is now understood that such studies are of little value because the effects of other physiologic variables, such as time of day, were seldom controlled in the experimental design. The main salivary factors that, from theoretical considerations, might be expected to influence the process of caries are flow rate and the concentrations of calcium, phosphate, bicarbonate, hydrogen ions, fluoride, urea, and protein (particularly amylase). As the mankind has evolved, a drastic change has been seen in the dietary fermentable carbohydrate which eventually is associated with increased prevalence of dental caries. Milk is consumed with sugar syrups or honey to add flavor which eventually increases sugar content of milk, putting the children at a higher risk of dental caries. This study was conducted to evaluate and compare the acidogenic potential of milk as compared to milk and sugar at various time intervals. A total of 230 children aged 12 to 15 years were examined, 60 children which equal number of males and females (30 each) who satisfied the inclusion criteria were randomly selected and assigned to two groups, Group I: Plain milk (250 mL) and Group II: Milk and sugar (250 mL + 1 table spoon sugar =12.50 gm). After recording the resting pH, the change in the salivary pH in the respective groups after consuming the test meal was recorded after 5 minutes, 10 minutes, after 15 minutes, after 30 minutes and 120 minutes. The results show that there was no statistical significant difference in pH between the two groups. Statistically significant difference was seen at 10, 15, 30 minutes with highest at 15 minutes (p = 0.001) between plain milk (group I), milk and sugar (group II). The milk group showed a significant decrease in pH at 10 minutes. However, pH returned to normal at 15 - 30 minutes in group II. The study concluded that milk when added with sugar as did not pose a risk of demineralization as there was no decrease of pH below the limit of critical pH of 4.5 to 5.5.

185-191

Authors: Uppala Veeramma, D. Rajeswari, N.V. Sundarachary

Background: Thrombosis of the cerebral venous sinuses (CSVT) is not an uncommon form of stroke. Usually affects young individuals. Aim: To compare the clinical profile of Cerebral venous thrombosis patients. Materials and methods: It was an observational study, comparing the epidemiological and etiological profile of patients with CVT during two time periods Results: This study group consisted of 130 patients, 63 patients in cohort 1 (2013/14), and 67 Patients in cohort 2 (2015-2016), were male noted in 27% and female were noted in 73% in cohort 1 (2013-14. In cohort 2 (2015-2016) male were noted in 39% and female were 61%.The data in rural were 81.5% and urban were 18.5% in cohort 1 and in cohort 2, Rural were noted in 66% and urban 34%.Common risk factors were postpartum status 31 were noted in cohort 1 and 18 were noted in cohort 2. In MRI brain Parenchymal changes cohort 1 consisted 51 and cohort 2 consisted 38. Headache was the common clinical presentation in the patients and next followed by altered sensorium. Time of onset of symptoms in the both cohorts was at 6-10 days in most of the patients, risk factor associated in both cohorts was postpartum status. Conclusion: CSVT is a multi-factorial condition with gender-related specific causes. Fifty years ago, CSVT was a mortal condition, but with the introduction of neuroimaging, the mortality rates have become minimal. CSVT is effective and economical.

199-203

Authors: Devanatha Reddy P, Madan Mohan Rao GV, Nagababu Pyadala

Background: Country like India patellar fractures is more common due to the activity of daily life. 1% of all skeletal injuries due to patellar fracture by direct or indirect mechanism. Aim: This present study focus on advantages and complications associated with fixation technique for the management of patellar fracture. Material and Methods: 50 patients with patellar fractures treated by cannulated cancellous screw with tension band wiring. Result: The most common age group in our study was 41-50 years. Among 50 patients 37 were male and 13 were female. Fracture due to indirect injury was 64% and direct trauma was 36%. Outcome of our study was 90% as excellent, 8% as good and 2% poor. Conclusion: According to our study management and early mobilization of displaced transverse patellar fracture by cannulated cancellous screw and tension band wiring showed better result.

212-220

Authors: C. Venkateshwarlu, B. Praveen Kumar, Md. Yousuf Khan

Background: Recently much of attention is focused on the diastolic function of the heart. Since the systolic performance of the heart in hypertensive patients has been examined so far, but the study of the diastolic function of heart has emerged as a newer mode of study. Aim: To study non-invasively the diastolic function of left ventricle in patients with systemic hypertension. Materials and methods: Twenty patients either admitted or as outpatients in outpatients Department, Gandhi Hospital with isolated systemic hypertension. (HTN) who satisfied inclusion and exclusion criteria were taken up for the study with five age matched individuals who along served as controls assessed by Doppler Echo-cardiography and their findings were compared with five normotensive age matched controls. Results: Bedside post valsalva maneuver, this test was positive in 7 5% of the test subjects. Of the 25% who had a negative test, 40% had evidence of diastolic dysfunction as assessed by pulsed wave Doppler. Left ventricular hypertrophy was present in 55% of the patient subgroup and all (100%) of these patients had significant diastolic dysfunction. The rest of the 45% of the patients did not have left ventricular hypertrophy. 75% of these non-hypertrophic hypertensives had diastolic dysfunction as seen by PWD. Increased left ventricular mass index has been observed in 85% of the hypertensives but has not correlated statistically with either severity of blood pressure or diastolic filling variables or isovolumic relaxation time. The left atrial size an indirect indicator of LV diastolic function was increased in 50% of the hypertensive subjects when compared with the controls but the statistical difference was insignificant. LV diastolic function as assessed by PWD mitral flow velocity profile and isometric volume relaxation time was abnormal in 85% of the hypertensive subgroup and was highly significant statistically (P value <0.005). The deceleration time (MS) was similar in both the controls and the hypertensives making it an insignificant parameter for assessing LV diastolic function. The peak filling rate was reduced in the hypertensive subgroup and was of moderate statistical significance. Conclusion: Doppler Echocardiography, an easily available non invasive technique today, can be utilized for identifying hypertensives with diastolic dysfunction and thus treat this group with specific therapy (Beta Blockers) so as to arrest or reverse the pathological changes produced in left ventricle due to hypertension.

228-234

Authors: S. Sujit, M. Bathragiri, K. Chandra

Introduction: Transplantation returns the majority of patients to an improved life-style and an improved life expectancy, as compared to patients on dialysis; however, careful prospective cohorts studies have yet to be reported. Infection is a leading cause of morbidity and mortality in transplant recipients, with more than 80% suffering at least one episode of infection in the first year. The risk for infection is strongly determined by an interaction between epidemiologic exposures and net state of immunosuppression. Aim and objectives: To study the prevalence of infections in the post renal transplant recipients, to find out the most common cause of infections in post renal transplant patients, to find out the frequency of infections in early and late phase of renal transplantation. Materials and methods: Patients who reached end stage renal disease and who underwent Renal Transplantation in our hospital was prospectively followed up for infections for a period of 1 year. Results: A total of 77 transplant recipients were included in our study. Out of which, 50 recipients (69.44%) had infections during follow up. 32 recipients (64 %) had infections involving more than one system. The infectious were common within the first 6 months of surgery and most of them occurred within the first month of surgery. Conclusions: Urinary Tract infection was the most common confection occurring in the post renal transplant recipients.

239-244

Authors: Rajeshwary P, M. Nagaprasanth, Salma Mahaboob R, G. Obulesu

Reproductive failure is a significant public health concern. Recently, ROS have been shown to have an important role in the normal functioning of the reproductive system and in the pathogenesis of infertility in females. Oxidative stress affects both natural and assisted infertility. Treatment that reduces OS may help infertile women with the disease that is caused by imbalance between free radicals and antioxidants. MDA is an end product of lipid peroxidation which can be used as a biomarker to measure the level of oxidative stress. TAC measures the low molecular weight non enzymatic antioxidants. Increase in MDA and decrease in TAC indicates an increase in oxidative stress. In the present study, it was observed that there was a statistically significant increase in serum MDA levels in female factor infertility and unexplained infertility when compared to controls. There was a statistically significant decrease in serum TAC in female factor infertility and unexplained infertility when compared to controls and statistically significant increase in serum LDH in infertile women with unexplained infertility compared to the control group and female factor infertility signifying the apoptotic damage in the unexplained infertility.

251-258

Authors: Y. Kishore Kumar, Ajay Kumar Basod, G. Obulesu

Background: Hearing impairment is a major problem worldwide, significantly delaying acquisition of speech in children. Unfortunately delayed detection of hearing impairment especially in rural and remote areas, adds a significant burden to the society and the nation. Hence early detection of hearing impairment is imperative and the need of the hour lies in developing an easy, cost effective and reliable method for testing large number of neonates and infants. This study was to assess the effectiveness and utility of Tympanometry as a screening tool for assessment of middle ear pathology in neonates and infants. Middle ear disorders are significantly prevalent in young children. Aim: Investigating and comparing the results of visual inspection of the tympanic membrane to the results of Tympanometry with traditional probe tone (226 Hz) and high frequency probe tone (678 Hz) in” ears without effusion” and “ears with effusion” and to establish their sensitivity and specificity to detect middle ear disorders as a database in clinical practice. Materials and methods: Subjects were evaluated for the stable middle ear/ Eustachian tube function. Ears with no sign of effusion in the middle ear on otoscopy were labeled as “ears without effusion” and those who showed the presence of fluid in the middle ear were labeled as “ears with effusion”. Blinded to otoscopic ear exam results, Tympanometry was conducted with conventional probe tone of 226 Hz and high probe tone 678 Hz by audiologist using standard procedure. Results: Otoscopic examination results of ears for all age groups were evaluated and ears without effusion and with effusion were tabulated. Conclusion: The tympanometric parameters obtained with 226 Hz and 678 Hz probe tones have statistically significant differences in detecting the ears without effusion and with effusion. Compliance values also proved to be statistically different with the different probe tones.

268-271

Authors: B. Madhu Mohan Reddy, Banothu Srinivas

Background: Continued chronic pain after inguinal hernioplasty is the most important current issues. Factor responsible for pain development mechanisms are still unclear. Influence of age as well as other factors is still controvertible. Objectives: To study the incidence of occurrence of postoperative pain in relation to age and duration of hernia. Materials and methods: A cross sectional prospective study includes 220 patients between 18-80 years. Participants willing for scheduled follow up of 7th, 30th, 90th and 180th day were considered for this study. All patients were explained for surgery and probable complications. Results: Study of chronic pain had shown that 12 (10.9%) had mild pain, 2 (1.4%) had mild pain but occasional taking drugs and 2 (1.4%) had moderate pain but not taking any drug on 90th day. On 180th day, 7 (6.4%) had chronic pam of which 6 (5.5%) had mild pain while 2 (0.9%) patients had moderate pain but none of the patients were taking any analgesics. Conclusion: There was significant association between age of the patients and pain. Chronic pain and the severity of pain decrease with advancing age.

280-289

Authors: P. Malathi, D. Anupama, P. Habitha

Background: The achievement of safe child birth by caesarean delivery (CD) was one of the greatest medical advances of the 20th century. Indeed, CD is now the most frequent operation performed, consulting approximately one third of all deliveries annually. Aim: To evaluate the effect of preoperative administration of Injection tranexamic acid on blood loss during and 2 hrs after elective caesarean delivery. Materials and methods: This study was a prospective observational study for a period of 15 months; randomized controlled trial was conducted among 200 women scheduled for elective Cesarean delivery. Results: A comparative study was undertaken to study the effect of inj. TXA on blood loss during and after Cesarean delivery. The mean age in tranexamic group was 23.40±3.06 while in control group was 23.59±3.56. 64% fall in age group 21-25 years. In Gravida Distribution, majority of the patients in both the groups are of Gravida 2 (Group A 65% and Group B 64%). The mean ± SD was 2.17 ± 0.65 in study group and 2.2 ± 0.56 in control group. Comparison of blood loss between two groups, intra-operative blood loss was lower in the study group than in the control group 375±69 vs 410±79.9 and is statistically significant. The mean postpartum blood loss was also in the study group than in the control group 52±30 Vs 131±42 and was statistically significant. Conclusion: Tranexamic acid injection significantly reduces the perioperative blood elective Cesarean section, if given prior to the skin incision, without significant adverse effects.

6-12

Authors: Nanda GS, Singh H, Sharma B, Arora A

Introduction: Tuberculosis (TB) causes enormous social and economic disruption and hampers nation’s development. DOTS strategy under RNTCP is one of the largest public health programs found to be beneficial against TB. Adverse drug reactions lead to decrease in patient compliance and adherence. Good patient adherence to the treatment regimen is the foundation stone to effective anti-tubercular therapy. Noncompliance is cited as the major problem to the control of the tuberculosis at the level of public health which finally leads to drug resistance in case of TB. Aim and Objectives: To identify the occurrence and pattern of Adverse Drug Reactions (ADRs) associated with anti-tubercular drugs in TB patients under DOTS therapy during Intensive phase of treatment. Materials and methods: A prospective observational study was conducted in 2 randomly selected DOTS centers of Jalandhar. A total of 102 patients of categories I and II who were registered in third quarter of 2014 were selected for study. The follow up period was during the intensive phase of DOTS regimen. All patients on ATT were followed up at the end of 1 week, 1 month and after the completion of intensive phase or if/ when self reporting was done due to adverse drug reactions. Detection and monitoring of adverse drug reaction was done by interviewing patients, consulting with physicians about the patient’s clinical problems, reviewing laboratory test and medical records. The data so collected was entered and analyzed using SPSS 21 software. Results: The Incidence of adverse drug reaction was observed in 20.4% i.e. 21 out of 102 patients. Total number of adverse reactions developed in 21 patients were 31, with most common being GIT system (38.7%), followed by skin problems (29%). History of alcoholism, associated co-morbidities, pulmonary TB and DOTS treatment Category II were found to be significantly associated with occurrence of ADRs. Conclusion: The present study highlighted the importance of developing strategies to ameliorate ADRs both to improve the quality of patient care and to control TB safely. In addition, a proper educational counseling may promote more ADR reporting by patients. These strategies may improve the patient adherence to treatment and therapeutic outcome.

18-23

Authors: Rathod GB, Jain M, Vachhani D, Chandra A, Balar M

Introduction: Cervical cancer is the third most common type of cancer among women worldwide, following breast cancer and colon cancer. The micronucleus test is a simple and widely used technique to evaluate genetic damage due to exposure to carcinogenic or mutagenic agents. We undertook this study to compare the MN (micronucleus) score in the whole spectrum of cervical lesions. Materials and methods: In this retrospective study, we had compared the MN score in the whole spectrum of cervical lesions which comprised of seven different groups like normal (20), inflammatory (30), ASC-US (20), ASC-H (13), LSIL (20), HSIL (10) and IC (19) over a period of 1 year (January 2014 to December 2014) which included a total of 132 cases. Results: In the present study, there was a stepwise gradual increase in MN count from inflammatory to ASC-US to LSIL to HSIL group, followed by a slight increase in IC. The mean MN count was most significant in the LSIL and HSIL group. Thus micronucleated cells as well as the total number of micronuclei show increasing trend towards malignization. Conclusion: Our study showed that MN counting can be a helpful screening tool in conjunction with conventional Pap test for screening of cervical cancer.

29-35

Authors: Pullishery F, Panchmal GS, Siddique S, Abraham A

Introduction: Bio-medical wastes are of great importance due to its potential environmental hazards and health problems. The waste produced in the course of health care activities carries a higher potential for infection and injury than any other type of waste. It is estimated that annually 0.33 million tons of hospital waste is generated in India. The objective of this study is to analyze the medical waste management practices in different health care settings, analyze the risk perceptions of health care personnel and assess the attitude towards the waste management policies. Materials and methods: A cross-sectional study is conducted using a pre-tested questionnaire to assess the awareness, knowledge and practices on medical waste management among health care personnel in different health care settings in Mangalore city. Results: Doctors, nurses, and laboratory technicians have better knowledge than sanitary staff regarding biomedical waste management. Knowledge regarding the color coding and waste segregation was found to be better among nurses and laboratory staff as compared to doctors. Conclusion: The management of hospital waste requires its segregation and removal from the health care establishments in such a way that it will not be a source of health hazards to those who are directly or indirectly related to the hospital environment. The segregation of waste in almost all hospitals is not satisfactory. Proper and judicious handling of Bio-medical waste continues to be a matter of serious concern for health authorities in India.

46-50

Authors: Naik N, Patel G, Parmar H

Background: Acute pancreatitis occurs in only 3-7% of patients with gallstones. But gallstones were implicated in about 27% cases of acute pancreatitis reported in a decade prior to 1980. The relative risk of developing acute pancreatitis varies from country to country, and within a given country it is influenced by socio-economic, ethnic, and cultural factors. The present study evaluated the incidence of the disease, age-sex distribution, clinical manifestations methods, and management of gallstone pancreatitis. Aim and objectives: To diagnose a case of gallstone pancreatitis by various investigations like blood investigations, USG or by CT scan, age-sex distribution, to observe the varied clinical presentations of biliary pancreatitis with regards to symptoms and signs, to study the management protocol of gallstone pancreatitis. Material and methods: 50 cases of gallstone pancreatitis were studied during the period from May 2012 to July 2014, from all surgical units at our institute. Inclusion criteria: All patients admitted in surgical wards in a given particular unit who have diagnosed as having gallstone pancreatitis. Exclusion criteria: Patients having pancreatitis other than biliary cause. This study included all the age groups and both the sex. Results: In our study, most (34%) of male patients at the age group of 50-70 years, biliary pancreatitis was more predominant. Most (34%) of female patients at the age group of 40-60 years had biliary pancreatitis. In our study, most (92%) of the patient’s serum amylase was 3 fold above normal value, alkaline phosphatase was raised in 88% of patients, 68% of them had increased AST, and 22% of them had had elevated serum bilirubin levels. Normal value of serum amylase ranges from 40 to 140 U/L, Alkaline phosphatase from 45 to 115 U/L and AST from 8 to 48 U/L. In our study, out of 50 patients, 28 patients underwent laparoscopic cholecystectomy and 8 patients underwent open cholecystectomy during same admission. In 9 patients endoscopic retrograde cholangiopancreatography (ERCP) plus endoscopic sphincterotomy (ES) was done and remaining patients managed conservatively. Conclusion: Gallstone pancreatitis represents the most severe form of disease. The diagnosis is based in history and physical examination, an elevation of serum amylase 3 fold above the normal level, and ultrasound and CT scans. Endoscopic retrograde cholangiopancreatography is one of the tools in less certain cases of the absence of an agent that can abort progression of the disease; therapy should consist of adequate resuscitation, nutritional support, and careful monitoring to detect early complications.

58-66

Authors: Shukla M, Tyagi S, Agarwal M

Background: Adequate infant and young child feeding (IYCF) practices are essential to ensure optimal survival, health, growth, development and overall nutritional status of children. Objective: The objective of the present study was to assess the IYCF practices among mothers with children aged 0-23 months attending immunisation clinic at a tertiary care hospital of Lucknow, capital of Uttar Pradesh. Materials and methods: A hospital based cross-sectional study was conducted at immunisation clinic, King George’s Medical University from January 2015 to September 2015. Systematic random sampling was used and a total of 240 mothers with children 0-23 months old attending immunisation clinic were interviewed with the help of pre-designed, pre-tested and semi-structured questionnaire. Results: Breastfeeding (BF) was initiated within one hour of birth in 18.3% of children. Early initiation of BF was significantly associated with educational and socioeconomic status of mother and type of delivery. Pre-lacteal feeds were given to 23.4% of the children, children born at government health facility and with birth order ≤2 received pre-lacteal feeds more often. Colostrum was given by 67.9% of the mothers. Children born at private institutions or home were more likely to receive colostrum (p< 0.05). The prevalence of exclusive breastfeeding for at least 6 months was 53.8%. It was higher in children belonging to low socioeconomic group (p< 0.05). Complementary feeding was initiated at 6 months in 32.8% of children. Children of mothers belonging to upper socioeconomic class, nuclear family and delivered at government institution through normal delivery were more likely to be started on timely complementary feeding (p<0.05). Conclusion: The study revealed that inadequate IYCF practices are still quite prevalent in the community and therefore emphasis should be given to IYCF education sessions.

74-84

Authors: Rao PR, Narayana SS

Sexually transmitted diseases (STD) consist of different group of endemic diseases of varying clinical presentation, characterized epidemiologically as sexually transmitted infections. Sexually transmitted diseases in individuals have far reaching health, social and economic consequences. Sexually transmitted infections are very important because of their potential complication and interaction with HIV/AIDS. Recognition of HIV/STI cases has tremendous contribution for targeted intervention in the hospital. By evaluating the HIV/STI cases it will be a signal to know the affected groups and major determinants. In this Paper, the study was conducted to evaluate the clinical, epidemiological and laboratory characteristics of the sexually transmitted diseases (STD) found in the government general Hospital, Nizamabad in the year 2013.

90-96

Authors: Prasanna B, Jhansi CB, Swathi K, Shaik MV

Aim: The present study was designed to study the ectopic pregnancy risk factors and their clinical presentation in ectopic pregnancy attending to a tertiary care center. Material and methods: It was a prospective study with 50 cases of ectopic pregnancy conducted in the Department of Obstetrics and Gynecology, Narayana Medical College and Hospital, Nellore for a period of 2 years were included. Detailed history suggestive of risk factors for ectopic pregnancy, menstrual and obstetric history was taken. General, systemic, abdominal and vaginal examination was done. Results: A total of 2777 pregnancies were confirmed during the study period, of which 50 cases of ectopic pregnancies were diagnosed, giving an incidence of 1.8%. 74% were in the age group of 21-30 years. 84% of women were multigravidae and 16% were primigravidae. 80% of the patients had identifiable risk factors, of which past history of PID in 26%, history of previous abortion in 16%, infertility in 10%, uterine anomalies in 4%, history of previous ectopic pregnancy in 6%, usage of IUCD and OCP in 6% each and tubectomy in 6% were noted. 96% had amenorrhea, followed by pain abdomen in 90%, bleeding PV in 68%, fainting and syncopal attack in 16% of the patients. Pallor in 56% of the cases, 18% presented with shock was noted. Percentage of haemoglobin was <7gm% in 28% observed. Evidence of 41 patients with ruptured ectopic were recorded. 7 were unruptured ectopics and 3 were tubal abortions recorded. Conclusion: Increasing awareness regarding safe sexual practices and contraception decrease abortions and reduces the risk of ectopic pregnancy. All high risk women should be screened at the earliest with serum β-hCG and TVS. The impact on future fertility can be improved by focusing on primary prevention and early diagnosis before rupture.

105-109

Authors: Vasa VK, Chowdary DB, Kalyani OM

Background: Gullian-Barre Syndrome (GBS) is an acute inflammatory demyelinating polyneuropathy (AIDP) with autoimmune background. The clinical management of GBS is by nerve conduction velocity (NCV) and supportive care, intravenous immunoglobulin’s (IVIG) and Plasmapheresis. We have studied the clinical outcome of Gullian-Barre Syndrome patients visiting to the tertiary care hospital in Andhra Pradesh. Material and methods: A cross sectional study was conducted in a tertiary care teaching hospital at Andhra Pradesh in 50 patients over the period of 2 years. Neurological examination like higher mental functions, cranial nerves, motor system, sensory system and autonomic system was done for all patients. Descriptive analysis of clinical presentation, type of GBS, occurrence of complications and final outcome was also done. Results: A total of 50 participants were included in the study. Majority (52%) of the study participants were aged below 40 years. Diabetes mellitus (DM) and hypertension (HTN) were the most common co-existing illnesses reported in 8% and 6% of study population respectively. Conclusion: The majority of the Guillain-Barre Syndrome patients recovered smoothly without going for complications. Prognostic outcome was poor in our study with increasing age and co-existing illness like diabetes mellitus or ischemic heart disease.

116-118

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

Lipomas are most common benign tumours derived from adipose tissue. Lipoma breast is somewhat difficult to diagnose clinically because of fatty consistency of breast. Lipoma breast measuring more than 10 cm in diameter or weighing more than 1 kg is called giant lipoma of breast which is infrequently observed because of rarity in size and location, with only very few case reports available in literature. Here, we have reported a case of this rare entity in 80 years old female who presented with complaints of painless lump in her right breast at our hospital.

122-126

Authors: Dhiman P, Bhatia S

Background: Dengue is the most common arboviral illness in humans. It is transmitted by mosquitoes of the genus Aedes, which are widely distributed in subtropical and tropical countries. The dengue virus has four related but antigenically distinct serotypes: DENV-1, DENV-2, DENV-3, and DENV-4. Many patients with dengue experience a prodrome of chills and facial flushing, which may last for 2-3 days. Other symptoms may include headache, retro-orbital pain, severe myalgias, nausea and vomiting, maculopapular or macular confluent rash over the thorax with islands of skin sparing, weakness, altered taste sensation, anorexia, sore throat, hemorrhagic manifestations (e.g. petechiae, bleeding gums, epistaxis and hematuria) and lymphadenopathy. The incubation period is 3-14 days. Criteria for the diagnosis of dengue hemorrhagic fever, according to the World Health Organization (WHO), are as follows: Fever, Hemorrhagic manifestations (e.g. hemoconcentration, thrombocytopenia, and positive tourniquet test), Circulatory failure, such as signs of vascular permeability (e.g. hypoproteinemia, effusions) and Hepatomegaly. Aim: To know the atypical manifestations of Dengue such as acute liver failure, seizures and encephalopathy. Material and methods: Study material obtained from Columbia Asia hospital Patiala along with all the records and detailed history of the patient. The study was carried out in Intensive Care Unit of the hospital where the patient was admitted. Observation and conclusion: In our case, patient presented with Dengue Hemorrhagic Fever. He developed acute liver failure which was considered to be due to dengue infection as antigen for the same was positive and other viral markers were negative. Acute liver failure manifested in the form of raised liver enzymes, coagulopathy, and encephalopathy. Dengue can lead to mild to moderate elevation of liver enzymes but complication of acute liver failure is rare.

132-135

Authors: Nath AL, Nair S, Pal R, Chakraborty A

A case of Peters anomaly with bilateral post axial polydactyly, convex soles, ocular hypertelorism, a low nasal bridge, retrognathia, undescended testis, microphthalmia and club foot was examined in a neonatal Indian baby girl who had been delivered in the hospital and admitted to the newborn unit. She died aged five days. There were no cases of Peters anomaly recorded in India according to a literature search. In addition, available data point to the majority of the principal associations in Peters anomaly to be genitourinary anomalies, making this case a rare one in its isolated collection of musculoskeletal associations. A Indian baby girl of who was born through a Cesarean section presented in the new born unit of our hospital with bilateral corneal opacities, bilateral polydactyly, camptodactyly and club foot. This is a rare case of Peters anomaly and its association with Patau syndrome makes it special.

11-19

Authors: Prajapati J, Parmar H

Background: Spinal anesthesia is most frequently used for transurethral prostatectomy (TURP), because it permits early recognition of transurethral resection of prostate (TURP) syndrome and bladder perforation. In this study, we compared the effects of low dose bupivacaine (5 mg) with fentanyl (25µg) and conventional dose of bupivacaine (7.5 mg) in elderly patients undergoing TURP. This comparative study was conducted to evaluate the efficacy of addition of fentanyl 25 µg intra thecally to bupivacaine 5 mg and bupivacaine 7.5 mg alone for transurethral prostatectomy. Material and methods: The patients were randomly allocated into 2 groups, each having 30 patients. Group-A: Inj. Bupivacaine 5 mg (0.5%) (1ml) + Inj. Fentanyl 25 µg (0.5 ml). Group-B: Inj. Bupivacaine 7.5 mg (0.5%) (1.5 ml). A standard subarachnoid block was performed in L2-L3 / L3-L4 Space in sitting / lateral position with 22G/23G BD spinal needle (Quinky type, 3.5 inch long) under all aseptic and antiseptic precautions after local infiltration of skin and subcutaneous tissue with 2 cc 2 % lignocaine. Drugs were injected after checking of free flow of CSF and according to group selected. All the observations were recorded and all the results were analyzed statistically. Results: The mean time of onset sensory blockade was significantly shorter in group A than group B. Group A took less time to reach the peak sensory level (3.57 min) as compared to group B (5.8 min). Onset of motor blockade was delayed in group B as compared to group-A, and the differences were statistically significant. Changes in pulse rate of all groups are statically not significant and comparable. The incidence of hypotension and shivering was significantly higher in group B as compared to group A. Conclusion: It was observed that intra thecal bupivacaine 5 mg combined with fentanyl 25 µg provided adequate anesthesia for TURP in elderly patients and is associated with lower incidence of hypotension and shivering than a conventional dose of bupivacaine. The addition of fentanyl improves the quality of block, increases duration of sensory block and makes the blockade hemodynamically more stable than conventional dose of bupivacaine.

26-32

Authors: Patel P, Parmar H, Vaghela G

Background: Although incidence of ureteric stricture, in general population, is not known, proper evaluation of and treatment is essential to preserve the renal function and rule out malignancy. Strictures of the upper urinary tract are either congenital or acquired. With the exception of primary UPJ obstruction, most ureteral strictures are acquired and usually are iatrogenic. Before the development of endourological instruments and techniques, ureteral strictures were managed by open repair. The management of ureteric stricture has changed dramatically over the last decade in conjunction with new developments in endourology. Material and methods: This bi-directional study was performed on 30 patients, diagnosed as a benign ureteric stricture by various modalities of diagnosis, which underwent open or laparoscopy surgical procedures. Data, with respect to patient’s demographic information, etiology, mode of presentation, stricture location and length, diagnostic modalities, operative procedures and their follow-up were recorded, analyzed and plotted on master chart. Various surgical treatment modalities are used according to length and location of strictures like: Upper and mid-ureteric stricture: Ureteroureterostomy 2-3 cm, Uretero calycostomy/ pyeloureterostomy for long upper ureteric stricture, 4-5 cm with intra renal or scarred pelvis, Buccal mucosal graft ureteroplasty. Lower ureter: Ureteroneocystostomy 4-5 cm, Psoas hitch 6-10 cm, Boari flap 12-15 cm, Ileal ureter replacement for long segment defect > 10-15 cm, in every patient, we keep closed drainage system. Usually, drain was removed after 72 hours. We were keeping double j stent in every patient, which were removed after 1 month. Follow up the patient after 21 days of double j stent removal and thereafter 6 monthly for 2 years, then every yearly for 5 years. Results: Among 30 patients, main causes are genitourinary TB 8 (26.66%), Iatrogenic 8 (26.66%). 46% strictures involve, lower ureter with length >3-5 cm, which correlates with characteristics of tuberculosis, involving multiple sites and long segment of ureter, 54% stricture involving upper ureter are < 3-5 cm which correlates with iatrogenic and impacted ureteric calculus related strictures. Among 30 patients, with 33 renal units 2 patient’s surgery failed, among which one required nephrectomy, and another required redo surgery, one patient who lost follow up was also considered as a failure. Conclusion: In era of endourology and minimal invasive surgery, open reconstructive surgery has its own place.

40-46

Authors: Rathod VJ, Patel P, Patel N

Background: Over 50% of patients with upper limb paresis resulting from stroke face long-term impaired arm function and ensuing disability in daily life. The incidence of stroke increases dogmatically with age, doubling in the decade after 65 years of age. Early rehabilitation treatment in the first phase of stroke is currently advice in clinical guidelines and little evidence is available on such treatment for improving arm/hand function in the same period. Unfortunately, the number of effective treatments aimed at improving arm function due to stroke is still low. Aim: This study aimed to evaluate a new therapy for improving upper extremity function in sub-acute stroke patients based on mental practice theories and functional task-oriented training, and to study the predictors for a positive treatment result. Material and methods: 30 sub-acute stroke patients with upper limb paresis were selected by simple random sampling in this study. The experimental group undertook 12 week, individually tailored therapy regime focused on improving upper extremity function using mental practice. Primary outcome measures assessed upper extremity functioning with Action Research Arm Test, Fugl Meyer Test, and Modified Asworth Scale. ANOVA was used in this study. Null hypothesis with alpha level was set at 0.05. Conclusion: Mental imagining training resulted in significant improvement in upper extremity function in sub acute stroke patient. However the improvement obtained in upper extremity function found no significant difference after mental imagining training between the groups.

51-60

Authors: Shah RR

Background: Individuals with HIV infection are at increased risk for tuberculosis (TB) and other respiratory tract infections (RTIs). The altered CD4 T-cell homeostasis induced by HIV infection may play a key role in the development of respiratory tract infections in HIV-infected patients. Aim: Finding out of mean CD4 count of HIV patients at which they were at higher risk of developing various RTI and accordingly when HAART is to be started in this part of the world. Material and methods: All the 961 HIV infected patients and 300 HIV sero-negative patients’ three early morning sputum were screened for routine bacterial and fungal pathogens and even examined for AFB and few of the samples were even cultured on LJ medium. All sputum samples’ smears were also examined for PMNLs in Gram’s staining. Results: Out of all these 961 HIV patients, in 349 patients with probable viral RTI etiology, the mean CD4 count was found to be 474.62 + 114.89, followed by mixed polymicrobial RTI (80 patients) with mean CD4 about 392.26 + 87.14. The patients with pure fungal etiology (66), the mean CD4 count was found to be 377.29 + 268.29 followed by 466 patients with pure monomicrobial bacterial RTI the mean CD4 count was about 223.07 + 83.21. Conclusion: Very vague co-relationship between pattern of RTIs and CD4 counts had been attempted. Only Fungal and Bacterial RTIs were seen first to establish in even HIV infected patients at very high mean CD4 counts of about 377 + 268.29 and 223.07 + 83.21 respectively, but in both very high prevalence rate had been observed when compared with HIV non-infected patients with probability values of <0.05 and <0.001 respectively. Probable viral etiology of RTI was significantly high in HIV-non infected subjects when compared to HIV-infected RTI patients with probability value P < 0.001.

65-69

Authors: Vijaya Sekhar MV, Ramprasad KV, Kavita K

The incidence of head injuries is increasing worldwide. The associated skull fractures are also increasing with rise in vehicular traffic. In the present study, a total of 214 cases of head injuries which were admitted into a Rangaraya Medical College Hospital from the time period of 2 years, were taken for the study. Out of them 124 cases presented with skull fractures ranging from simple linear to stellate, depressed, comminuted, compound and compound comminuted depressed fractures. Some fractures were extending to the base of skull and some to the vault and some were associated with facio-maxillary injuries. 17 cases out of the 124 open skull fractures, presented with cerebro-spinal fluid leak and brain matter seen directly herniating through the wound. The wounds in all the cases were contaminated, with many cases harboring hair, sand particles etc. Majority of them were secondary to road traffic accidents, but assaults and some directly hitting injuries under the influence of alcohol were also included. As there was an evident CSF leak and brain matter already present in the wounds, all the cases were taken up for emergency surgery. In spite of the grossly contaminated wounds, thorough wound debridement and closure of defects and duraplasty wherever feasible, resulted in very good improvement in all the cases. No mortality or procedure related morbidity was observed in any of these cases.

77-81

Authors: Vijaya Sekhar MV, Giri Rao DK, K. Babji

Ventriculo-Peritoneal shunt is the most commonly performed surgery for hydrocephalus, universally. Many complications are reported, of which the shunt malfunction and infection are most commonly encountered. These common complications can be minimized, by precautions like – senior surgeons operating shunt cases, as the first case in the operation, with minimal personnel in the operation and thoroughly scrubbing the part for minimum five minutes. However, in few cases, – even in the experienced hands and with all precautions, some rare complications like extrusion of the lower end through anus, vagina, into scrotum were described. In our experience of over 15 years, wide range of complications was seen apart from malfunction and infection. Exposure of the part of shunt system, with excoriation of overlying skin, peritubal leaks, disconnection of shunt system with CSF leaking out, loculation in between the loops of bowel/ omentum, extrusion of the lower end through anus etc. were encountered and probable factors for these unusual complications were discussed.

88-93

Authors: Y. Umasatyasri, I.Vani, P. Shamita

Serum LDH is abnormal in a host of disorders, therefore the total serum LDH is highly sensitive but nonspecific test. In preeclampsia also LDH may be elevated and can indicate the prognosis for both mother and fetus. The present study was intended to assess the prognostic significance of the value of serum LDH as a marker of preeclampsia – eclampsia and its severity. Higher serum LDH levels were associated with increased incidence of maternal complications like abruption placenta, renal failure HELLP syndrome, cerebrovascular accidents etc. in the present study. There was an increase in maternal morbidity with increasing serum LDH levels. To conclude high serum LDH levels have significant association with severity of disease and maternal and fetal outcomes in patients of preeclampsia and eclampsia and can be considered as a supportive prognostic tool from early third trimester.

102-110

Authors: Manjunath SM, Nagesh Raju G, Srinivas TR, Someswara GM

Background: Pharmacology, like any other branch of medicine, is progressing by leaps and bounds. Consequently, reforms in undergraduate teaching are the need of the hour. Objectives: To determine the medical students’ perception and receive feedback on teaching and learning of pharmacology in our institution. Material and Methods: This was a cross-sectional study based on the questionnaire. A pre-validated, predesigned questionnaire containing 23 points was administered to fifth term medical students. Results: 73.43% wanted the faculty members to make more use of Audio-Visual aids for effective learning. 98.43% students wanted to include case based learning in the curriculum and 90.62% students wanted more of the clinical pharmacology to be introduced in the curriculum. 70% participants wished recent advances to be included in the curriculum and almost 80% were in favour of MCQs to be included in assessment of their academic performance. Only 26% participants felt rabbit eye experiments was appropriate and relevant to the present days of practical pharmacology reflecting a need for reforms. Only 10.93% students were willing to consider pharmacology as one of the subject for post-graduation. About 25% students felt the ideal teaching method for learning pharmacology was didactic lectures and group discussions and 81% thought the ideal teaching/learning media for pharmacology was the combination of LCD projector and blackboard. The most difficult system to understand was Autonomic Nervous System (53%). Conclusion: The study revealed the perception and feedback of the students regarding learning pharmacology were positive and constructive. It also revealed the priority areas for improvement.

116-118

Authors: Pawar CA

A 64 years postmenopausal woman approached emergency department due to acute abdominal pain and vomiting. Gynecological history of mild postmenopausal bleeding and increased vaginal discharge was noted since 10 days. Per abdomen was very tender distended, muscle rigidity. Emergency Explorative laparotomy was performed under the diagnosis of perforation of gastrointestinal (GI) tract. The uterus was found to have posterior wall perforation of 2x1 cm dimension and purulent material exuding from the uterine cavity was identified. Thus was diagnosed as perforated uterus due to pyometra. A total abdominal hysterectomy with bilateral salpingo-oophorectomy was done uneventful. Patient recovered completely without any complications and was discharged. Perforation of uterus due to pyometra can cause the peritonitis in postmenopausal females with signs of acute abdomen as an unusual but serious condition.

124-128

Authors: Kandukuri Mahesh Kumar, V. Indira, V. Hari Shanker

Kikuchi-Fujimoto disease (KFD) is also known as histiocytic necrotizing lymphadenitis. It is a benign, systemic lymphadenitis, self limiting disease first described independently by Japanese Pathologists Kikuchi and Fujimoto in Japan in 1972. The incidence of KFD is unknown. KFD is up to 4 times commoner in women. It presents as lymphadenopathy mainly involving the posterior cervical region, but can occur in any lymph node and even in extra nodal sites. Fever is associated with lymph node enlargement in half of the cases. Though viral and autoimmune cause is suggested by some studies, the exact etiology remains uncertain. There have also been reports of a relation between KFD and systemic lupus erythematosus. Most of the preoperative diagnostic tests are inconclusive. Definitive diagnosis depends on the histopathological examination of the lymph node biopsy. Clinically it has to be differentiated from other lesions like malignant lymphoma, mononucleosis tuberculosis and SLE as treatment and prognosis differs. Here we submit a case of Kikuchi-Fujimoto disease in an inguinal lymph node in a young adult auto driver.

135-140

Authors: Pandey V, Kandukuri Mahesh Kumar, V. Indira, V. Hari Shanker

Primary caecal lymphoma or the colonic lymphoma is a rare tumor of the gastrointestinal (GIT) tract and comprises only 0.2-1.2% of all colonic malignancies, both in adults and pediatric age group. The most common variety of colonic or caecal lymphoma is Non-Hodgkin’s Lymphoma (NHL) which arises from the lymphoid elements of the intestine. GIT is the most frequently involved site, accounting for 50-60% of all extra nodal lymphomas, and most of them are NHL. In adults, the stomach is the most common location of GIT lymphomas, followed by the small intestine, but the most common GI site of NHL in children is the terminal ileum and the ileo-caecal region. Diagnosis is difficult since lymphoma presents with vague abdominal pain with loss of weight and appetite. It may present as lump abdomen with complications such as intestinal obstruction, bleeding, perforation and peritonitis and intussusseption. Histologically it is B or T cell type with small or large cell variation, but frequently encountered is diffuse large B- cell lymphoma (DLBCL). DLBCL has low incidence but favorable outcome in young adults, lesions localized to one area or organ and children below 5 years of age, but has an aggressive course in children between 10-15 years of age and also in adults above 55 years of age. DLBCL or GIT Lymphomas in general have male preponderance. We present a rare case of caecal lymphoma (DLBCL) involving appendix and right ovary in a 12 year old girl who presented with vague symptoms of abdominal pain and abdominal mass. Clinically and radiologically, provisional diagnosis of Ileo-caecal tuberculosis with possibility of adhesions leading to a mass lesion was considered. Histopathological examination (HPE) revealed the diagnosis and prognosis of the case.

144-147

Authors: Billakanti Prakash Babu, Huban Thomas

During routine dissection in Anatomy Department, KMC Manipal, anomalous origin of superior laryngeal artery arising from external carotid artery was observed on the right side in an adult male cadaver. Superior laryngeal artery normally is a branch of superior thyroid artery. It supplies laryngeal muscles, mucosa and glands. The origin of lingual and facial arteries from external carotid artery was normal. The courses of nerves in the carotid triangle are also normal. No variations were observed in the left carotid arterial system. Variations in the origin of the superior laryngeal artery are very rare. It may arise from lingual, facial, ascending pharyngeal, external carotid artery or even from the common carotid artery. There are reports of rare variation of the common trunk of origin of superior laryngeal and inferior thyroid artery from the external carotid artery at the same level as origin of common linguofacial trunk. Though embryogenesis of this variation is not clear, but may be important for reconstruction surgery of the larynx, laryngeal transplantation and it will also be useful to the surgeons in minimizing the post-operative complications in a bloodless surgery. Clinicians must be aware of these variations in the super selective intra arterial chemotherapy for laryngeal and hypo laryngeal cancers.

152-156

Authors: Khatawkar AV, Awati SM

Multi-nodular goiter is a common endocrine disorder worldwide. It is endemic in certain populations. It is more common in women and presents mainly in 4th and 5th decades of life. Various factors have been implicated for the development of multi-nodular goiter, most common being Iodine deficiency. Nodular goiter results from uni or multifocal hyperplasia of follicular cells which may have autonomy of growth and autonomy of function. The process can be divided into five stages which result in the classic appearance and histology of multi-nodular goiter. Present article deals with epidemiology, etiology, pathogenesis and pathology of multi-nodular goiter based on relevant articles searched on pubmed.

165-171

Authors: Khatawkar AV, Awati SM

Thyroid gland is an important endocrine organ. Its hormone thyroxine is essential for life. The structure and function of thyroid gland were discovered during 17th to 20th centuries. Thyroid surgery is being done since early 19th century, perfected by Theodre Kocher in early 20th century. Thyroid is the first endocrine gland to develop in embryo and is endodermal origin. The surgically important anatomical relations of thyroid are recurrent laryngeal nerve, parathyroid glands and external laryngeal nerve with variations. Thyroid gland secretes thyroxine hormone which contains Iodine. Thyroxine has effects on all organs of body and its secretion is regulated by Pituitary. Present article throws light on some historical aspects, embryology, anatomy and physiology of thyroid gland based on relevant articles and textbooks.

13-16

Authors: Rathod GB, Singla D

Background: Cervical cancer is the major health burden in India. For detection in early stage, the screening test is Pap smear. To check the sensitivity and specificity of Bethesda system, the cytological findings have to be correlated with histology considering histopathology as gold standard. Material and methods: The study was retrospective review of Pap smears in Dhiraj General Hospital in the period from November 2013 to December 2014. They were correlated with corresponding follow-up biopsies using revised 2001 Bethesda System. Results: Most of patients were of group 41-50 years which were 106 (42.4%), followed by group 51-60 years which was 53 (21.2%). Majority of cases were of parity 3 which were 71 (28.4%) followed by of parity 4 which were 53 (21.2%), with mean parity of patient was 3.30. Conclusion: The Pap smear has good sensitivity and specificity in detecting pre-neoplastic and neoplastic lesions of uterine cervix.

24-29

Authors: Mundhra SH, Mundhara KS, Thakkar RM, Ninama K, Parmar H

Background: In Rheumatic heart disease, mitral valve is most commonly affected. Approximately 25% of all patients with rheumatic heart disease have pure mitral stenosis. 10% of all rheumatic heart disease patients have pure mitral regurgitation and 40% have combined mitral stenosis and mitral regurgitation. This study is the correlation between clinical status and common pulmonary functions in patient with mitral valvular disease and improvement in pulmonary functions after surgery in mitral valvular heart diseases. Aim and objectives: To study the pulmonary function test (PFT) in patients with mitral valvular heart diseases, to study PFT in patients with mitral valvular heart diseases with various age groups, to study clinical features and investigatory profile of mitral valvular heart disease patients, to study PFT in various stages of mitral stenosis and mitral regurgitation, to compare the pulmonary function test results before and after treatment of mitral stenosis (MS) and mitral regurgitation (MR). Material and methods: This present study was carried out of total fifty patients of mitral valve disease to determine the changes in Spirometric pulmonary function. Out of this, forty patients were of mitral stenosis and ten patients were of mitral regurgitation. These patients were selected from indoor as well as outdoor cases of Civil Hospital, Ahmedabad and U. N. Mehta Cardiology Institute, Ahmedabad. The diagnosis was made by clinical features, X-ray, electrocardiography and echocardiography studies and all Patients, selected for study, were underwent operative procedure. Results: Mean age of cases in this study was 30.46 years. So that present study showed that younger age groups were more affected in rheumatic mitral stenosis and regurgitation. Present study showed that mean value of FEV1/FVC% was 84.69 % in NYHA class II, 88.49% in NYHA class III and 81.51% in NYHA class. Present study showed that mean value of FEV1/FVC% of all classes were 86.06% preoperatively and after operation 89.94%. Present study showed that mean value of FEF 25-75% was 2.47 liter/sec preoperatively and after operation 2.81 liter/sec. Conclusion: In all cases of mitral valve disease, pulmonary function tests abnormality predominantly reveals restrictive pattern of lungs.

38-44

Authors: Mundhra SH, Mundhara KS, Trivedi NS, Shah Y, Parmar H

Background: Literature on the spectrum of opportunistic disease in human immunodeficiency virus (HIV)-infected patients from developing countries is sparse. HIV-related opportunistic infections (OIs) continued to cause morbidity and mortality in HIV-infected individuals. Objectives: The objective for this study was to elucidate the prevalence and spectrums of OIs in HIV-infected patients in the Gandhinagar Civil Hospital. Material and methods: The evaluation of the prevalence and spectrums of OIs was conducted by using the clinical data of 834 HIV-infected patients in the Gandhinagar Civil hospital from November 2012 to December 2013 those who were attended physician OPD for OIs. Results: The prevalence and spectrums of OIs varied contingent on sex, age, CD4 levels and treatment with ART. We found that tuberculosis was most common OI with prevalence being 20.50%, followed by Pneumocystis pneumonia (PCP) (5.16%) mycobacterium avium complex (MAC) (1.80%), candidiasis (1.56%), cytomegalovirus (CMV) infection (0.24%), progressive multifocal leukoencephalopathy (PML) (0.12%). Males (31.85%) were more prone to get OIs than females (27.85%). Pulmonary OI infections were the most prevalent morbidity and mortality in patients in the AIDS stage including pulmonary tuberculosis (7.43%) and PCP (5.16%). Fungal OIs were one of most prevalent morbidity in patients in the AIDS stage, including oral candidiasis (1.79). EPTB (13.07%) was more common than PTB (7.43%). OI in AIDS is more common in 41 to 60 years (32.93%) of age group. OI was more common in patients with CD4 count from 51-100 (86.96%) followed by 101 to 150 (69.05%). OI was more common in patients who were not on ART (72.33%) than those on ART (27.67%). Conclusion: The prevalence and spectrums of OIs, was discussed in this study. It would help to increase the awareness for physicians to make a diagnosis and empirical treatment sooner and plan good management strategies, especially in resource limited regions.

55-58

Authors: Jeeva Priya T, Vidyasankar, Sankaran PK, Kishor Kumar C

Background: Oral cancer is the most common malignancy in nearly half of Indian population. The main causes of oral carcinoma are tobacco, alcohol, poor diet and infective agents. These agents damage the chromosomes to form several secondary nuclei known as micronuclei. This study identifies the occurrence of micronuclei and also evaluates the frequency of micronuclei in stained smears of oral exfoliative cells from healthy subjects and alcoholic subjects. Materials and methods: A total number of 60 alcoholic subjects were referred to the Department of Anatomy, SRM Medical College and Research Center, SRM Nagar for micronucleus assay from the Department of Dentistry. Equal numbers of controls were included with normal looking oral cavities. Results: Out of 60 alcoholic subjects 43 showed presence of micronuclei and out of 60 control subjects, only 6 showed micronuclei. With these observations, alcohol is one of the predisposing factors of oral carcinoma. Conclusion: It is evident from our present study, it is clear that in alcohol consumption, the buccal mucosa, which are at high risk for development of oral cancer, show an increase in the MN frequencies.

71-77

Authors: Goel S, Goyal P, Singh A, Goel AK, Gupta A, Surana A, Bhardwaj A

Background: It is usually difficult to diagnose brucellosis clinically in the absence of specific clinical features. Hence serological testing forms the mainstay of diagnosing the disease. Seroepidemiological determinants of brucellosis in rural western Maharashtra have not been closely investigated. Aim: The present study was therefore conducted to determine the incidence and to analyze seroepidemiological determinants of Brucellosis in cases of pyrexia of unknown origin (PUO) in rural western Maharashtra. Material and methods: The present hospital based cross sectional survey was carried out in Rural Medical College, Loni on 500 cases of PUO. SPSS version 20.0 was used for analysis. The serum samples were subjected to serological tests like Rose Bengal Plate Test (RBPT) and Standard Tube Agglutination Test (STAT). The inoculated agar plates were watched daily for the presence of growth Brucella on culture. Results: Males (51.6%) outnumbered females (48.4%) in the study sample. Out of 500 cases 10 samples showed the presence of Brucella agglutinins. The male female ratio in the seropositive cases was 2.33:1. Headache and joint pain was observed in 5 and 3 cases respectively. 50% samples yielded the growth of Brucella on culture. All the culture positive samples had titer of 640 IU or more. Conclusion: Agglutination test if properly performed can be used as a very dependable laboratory procedure for rapid diagnosis of Brucellosis.

81-93

Authors: Sonawane AA, Patil VM, Patil PJ

Introduction: The incidence of twinning has been increasing due to availability and increased use of ovulation inducing drugs and assisted reproductive technology. Despite substantial concerns over the well-being of the second twin with regard to intra partum events, outcome studies on this issue are conflicting. Some have reported no increase in perinatal complications, while others showed significant associations between labor and delivery of the second twin and increased perinatal morbidity and mortality. Material and methods: 106 cases of twin pregnancy fulfilling of age 18 - 35 years, at more than 32 weeks gestation, first twin with cephalic presentation and selected for vaginal delivery were included in the study. Intrauterine death of either one of the twins before the onset of labour, pregnancies complicated or fetal malformations and those with contraindication to vaginal birth were excluded. After thorough screening of included cases delivery was performed according to fixed protocol. After delivery, mode of delivery, cry, APGAR score, birth weight, complications, birth injury, time interval between deliveries, NICU admission and condition on discharge of each baby was noted. Results: 106 twins were included as delivered vaginally, including 3 patients who were delivered by vaginal delivery for 1st twin followed by caesarean delivery for 2nd twin. Stillbirth and early neonatal deaths resulted in 24 deaths. There is no significant difference between mortality of 1st and 2nd born twins. The neonatal mortality was equal in first and second twin. Neonatal morbidity was more in 2nd twin than 1st twin (27.65% v/s 15.95%). There were 41 NICU admissions (19.34%), out of those 36.6% were for first twin (n=15) and 63.4% for second twin (n=26), (p value 0.056). Incidence of RDS, invasive ventilator support, NICU Stay >7 days is significantly higher in second twin as compared to first twin. Breech presentations were associated with 10% neonatal mortality for second twin compared to none for first twin. Most common group for neonatal mortality and morbidity was birth weight 1000-1499 gm. Neonatal morbidity was 100% for discordancy 30 to 40% group while 85.71% for discordancy 20 to 30% group. These results are significant when compared for heavier twin v/s lighter twin (p value 0.001).Neonatal mortality and morbidity between first and second twin is statistically significant when compared according to Apgar score (p value 0.037). Incidences of stillbirth + early neonatal death for 2nd twin less in early preterm group but increased in in late preterm group. Neonatal outcome of 2nd twin was better in dichorionic pregnancies 11% v/s 16.67% in monochorionic pregnancies (p>0.05). Conclusion: Twin vaginal delivery is safe in first cephalic presentation in twin pregnancy. Caution should taken while delivering babies < 1500 gm, birth discordancy > 20% , gestational age < 34 weeks, as vaginal delivery in these conditions is associated with increased early neonatal morbidity and neonatal mortality.

99-104

Authors: Patel DN, Patel PB, Patel HV, Gandhi TJ

Introduction: Fine Needle Aspiration Cytology (FNAC) is a simple, quick and inexpensive method in the head and neck region. It also affords a practicable and means of rationally planning surgery and causes minimal trauma to the patient and carries no risk of complications. Aim and objectives: The aim of this study was to see the frequency of various pathological conditions detected on FNAC in patients presenting with head and neck swellings and to evaluate the role of FNAC in diagnosis of head and neck swellings. Material and methods: A retrospective study was conducted in Department of Pathology, SMIMER Medical College, Surat from July 2014 to June 2015which included 250 patients with head and neck swellings presenting to Outpatient clinics. Fine Needle Aspiration Diagnosis was correlated with detail of relevant clinical findings and investigation. Results: Maximum incidence was observed in the age group 31-40 years with higher incidence among males. Out of 250 cases, 160 cases of lymph node lesions were diagnosed of which non-specific lymphadenitis was the commonest diagnosis (47%) followed by Tuberculous lymphadenitis (25%). 57 cases of thyroid lesions were diagnosed, in which incidence rate of benign thyroid lesions was (84%). 12 cases of salivary gland lesions were found, among which pleomorphic adenoma was common (67%). Conclusion: It was concluded that non-specific lymphadenitis is the commonest condition in patients presenting with neck swellings. FNAC is a simple, safe and inexpensive tool for the assessment of patients with head and neck swellings. It could differentiate the infective process from neoplastic one and avoids unnecessary surgeries. Thus, FNAC can be recommended as a first line of investigation in the diagnosis of head and neck swellings.

109-114

Authors: Patel K, Kumar VH, Gandhi D, Aswani H, Savjiani N, Kumar D

Lupus vulgaris (LV) is the most common form of cutaneous tuberculosis which usually occurs in patients previously sensitized to Mycobacterium tuberculosis. We present a case of a 12 years old boy who was diagnosed as lupus vulgaris clinically as well as histopathologically simultaneously. He had well demarcated, irregularly bordered, pink, infiltrated plaques on the nose showing apple-jelly appearance on diascopy with multiple lymphadenopathy on bilateral submandibular and cervical group of lymph nodes. The histopathological examination showed tuberculoid granulomas with Langhans type giant cells. The Mantoux test showed positive reaction (20 mm) and no acid-fast bacilli was found in the lesion, either by direct stained smears or by culture. The lesions showed significant improvement on anti-tuberculosis treatment. The main purpose of this case report was to emphasize that histopathological examination has diagnostic value in clinical suspicion of LV on face, when direct analysis or culture is negative.

119-123

Authors: Kandukuri MK, Reddy K, Medak H

Castleman’s disease (CD) is a rare disease primarily involving lymph nodes and lymphatic system. Other synonyms used for the Castleman’s disease are giant lymph node hyperplasia, and angio-follicular lymph node hyperplasia (AFH). CD is not a true cancer and is a lympho-proliferative disorder which means there is an abnormal overgrowth of cells of the lymphatic system that is similar in many ways to lymphomas (cancers of lymph nodes). Even though CD is not officially a true cancer, one form of this disease (known as multi-centric Castleman’s disease) acts very much like lymphoma. In fact we can call it as premalignant condition as many people with this disease eventually develop lymphomas. Multi-centric CD is more common in people infected with HIV. In recent years, it’s become clear that another virus, known as human herpesvirus-8 (HHV-8) or Kaposi sarcoma herpes virus (KSHV), is often found in the lymph node cells of people with multi-centric CD. In fact, HHV-8 is found in the lymph nodes of nearly all CD patients who are HIV positive. We present a case of unicentric plasma cell type of Castleman’s disease involving central nervous system (CNS) or brain parenchyma in a young male patient which is a rare occurrence.

130-133

Authors: Chhillar D, Dhattarwal SK, Kataria U

The postmortem room is a source of potential hazards to the health of forensic experts, pathologists and mortuary technicians. Infectious pathogens in cadavers that present particular risk include mycobacterium tuberculosis, HBV, HCV, HIV and prions that cause transmissible spongiform encephalopathies such as Creutzfeldt-Jakob disease (CJD) and gerstmann-strausster-sheinker syndrome (GSS). This review focuses specifically on these hazards associated with the autopsy of infected patients.