International Archives of Integrated Medicine

1-5

Authors: Kamdar DJ, Shah NA, Patel DJ, Parmar H

Background: MDR-TB is defined as resistance to isoniazid and rifampicin with or without resistance to other drugs. India is one of the countries with largest burden of MDR TB in the world. Second line Anti-tuberculous therapy is now available for patients with MDR-TB under the RNTCP Category IV. But there are many challenges for MDR- TB control in India. This study was done to analyses the RNTCP data for MDR-TB maintained at a TU, in the city of Ahmedabad, Gujarat, and to compare it with the data available in literature. This study also aimed to identify challenges faced while treating MDR-TB and to address the same. Material and methods: We had retrospectively analyzed 353 patients referred to the TU from the respective Direct Microscopy Center (DMC) with suspicion of MDR-TB during a period of January 2014 to December 2014. Results: Of the 353 suspected MDR-TB patients referred to the TU, 48 patients (13.597%) were diagnosed to have MDR-TB. Of these 48 patients, 46 patients had pulmonary TB (95.833%) and 2 patients had extra-pulmonary MDR-TB (4.166%). Of the 48 patients, 08 (16.67%) patients were transferred to their respective TU and 40 patients (83.33%) were enrolled for Cat IV from our TU. Of the 40 patients enrolled at our TU, 30 patients (75%) were continuing Category IV at the end of 2014 (25 were on intensive phase and 05 were on continuation phase), 03 patients (7.5%) died during treatment, 01 patient (2.5%) defaulted treatment, 05 patients (12.5%) refused treatment and 01 patient had XDR-TB (2.5%). Of the 40 patients, 05 patients (12.5%) had ofloxacin resistance. No patients had intolerance to any oral or injectable ATT. None of the diagnosed MDR-TB patients had HIV co- infection. Conclusion: Drug resistance in tuberculosis is a “man-made problem”. Anti-TB chemotherapy must be given optimally by (i) ensuring adequate absorption of drugs, (ii) timely diagnosis and management of drug toxicities and (iii) treatment adherence. To ensure that all patients get adequate treatment and to have a close follow-up of defaulters and patients who refuse treatment; we need to strengthen our existing management information system and also incorporate private sectors into our system.

11-15

Authors: Ahmad Z, Singh A, Goel S, Gupta A, Panesar S, Surana A, Rajesh DR, Chitti Babu G, Bharat M, Singh LK

Background: Sinusitis causes inflammation of the middle ear mucosa with increased and persistent mucoid/ mucopurulent discharge and remains as a active mucosal disease. Without correcting the sinusitis the management of ear including surgery has frequently led to failures and poor prognosis. Objectives: To establish the role of Sinusitis as Focal sepsis in Chronic Otitis media active mucosal disease. An additional objective was to accentuate the need of proper diagnostic endoscopic evaluation and improvement in middle ear mucosal disease status after functional endoscopic sinus surgery. Material and methods: A total of 50 patients aged 18-49 years with Chronic otitis media active mucosal disease (Tubotympanic type of C.S.O.M.) patients with persistent ear discharge even following culture directed topical and systemic antibiotics with 3 months and more of ear discharge seeking care at Otorhinolaryngology outpatient department were included in this study. Results: Mean age of patients was 42.5 ± 10.6 years. 76% subjects were found having septal deviation/ turbinoseptal deformity which was the most common anatomical variant, 34% had enlarged middle turbinate, 32% had medialised uncinate, 30% had enlarged bulla, 22% had enlarged bulla with prominent agger and 18% had paradoxical middle turbinate. Of these 22 patients had the accessory ostium in the posterior fontanel and 10 patients had accessory ostium in the anterior fontanel. Majority (26, 52%) of subjects had Grade I disease i.e. minimal disease limited to Osteo Meatal Complex followed by Grade II 24% i.e. moderate incomplete opacification of one or more sinuses. On otoendoscopy, 36 patients (72%) had a large central perforation, while 14 patients (28%) had a subtotal central perforation. Conclusion: A thorough diagnostic nasal evaluation of all Chronic Otitis Media active mucosal type of patients is essential in comprehensive management of the disease. Deviated nasal septum, enlarged middle turbinate, medialised uncinate predispose to sinusitis.

25-29

Authors: Ahmad Z, Singh A, Goel S, Gupta A, Panesar S, Surana A, Pathania D, Singh AK, Shamsi MS, Singh LK

Background: Despite having a well documented relationship of cleft palate with middle ear effusion, little data exists regarding otopathology in Indian children with cleft palate. Objectives: Therefore, the present study was planned with an objective to determine the various otological manifestations that occur in patients with cleft palates seeking care at a tertiary care teaching hospital. Material and methods: The present study was carried out in the Department of Otorhinolaryngology of a tertiary care teaching hospital of northern India during June 2012 to May 2014 among 30 cases of cleft palate. On the first visit, history and thorough clinical examination are undertaken. Next, common and special investigations are undertaken to evaluate and assess the status of disease. X-ray mastoids, Pure tone audiometry and Tympanometry were also carried out. Results: The ears are found affected in 86.7%, 60.1% ears had an intact but dull tympanic membrane whereas 16.7% ears had CSOM with a central perforation. On pure tone audiogram (n=18) 33.33% had a hearing loss in one ear and 44.44% had a hearing loss in both ears in the form of a mild or moderate degree of conductive deafness. On tympanogram, 23.3% had an ‘A’ type of tympanogram whereas 44 ears had a `B’ type of tympanogram indicative of recurrent effusions in the middle ear. Majority from this sub-group >80% had associated conductive hearing loss-mild to moderate degrees. Conclusion: Cleft palate individuals should always be evaluated for possible otological manifestations.

36-41

Authors: Kumar A, Dasgupta A, Biswas D , Sahoo SK, Das S, Preeti PS

Introduction: Snake bite is a very common problem in rural India which even today leads to a large number of deaths. This is because the uninformed community members take recourse to harmful traditional healing measures which cause loss of vital time which is very important for the survival of the patient. Objectives: To assess the knowledge of the study population on snake bite and to elicit any association of this knowledge with their demographic and socioeconomic characteristics. Material and methods: An observational, cross-sectional study was done in a village in the Singur Block of Hooghly district of West Bengal. The head of the family or in his absence the senior most members was interviewed with a pre- designed, pre-tested schedule. Results: Farming was the occupation of the majority (36%) followed by business (20.6%) and service (17.7%). 45% belonged to the social class I and II (modified B.G. Prasad) while 39% were in the social class IV and V. Only 58.85% of the study population were aware that the incidence of snake bite can be reduced. 68% were aware of immobilisation of the affected part was the initial first aid measure and only 4% had the correct knowledge that application of collar was unnecessary and harmful. . Correct knowledge on the availability of specific treatment was present among 85.1% and 77.1% knew where specific treatment is available. Education OR 2.51 (1.26 – 5.00), Occupation OR 4.44 (2.35-8.40), PCI OR 2.05 (1.12-3.76) were significantly associated with good knowledge. Conclusion: There is a paucity of knowledge on different domains of snakebite. Hence dissemination of correct knowledge is necessary to remove their misconceptions.

49-54

Authors: Hosapatna M, Bangera H, D Souza A, Das A, Supriya, D Souza AS, Ankolekar VH

Introduction: The description of development of human kidney given in various textbooks doesn’t include detail microscopic appearance of kidney at various fetal ages. So an attempt was made in this study to gather information on this topic. Material and methods: The present study was carried out on 15 human fetuses of known gestational age (GA). The sections of kidney were processed and were stained using Hematoxylin and Eosin. Results: At 12th week of GA various stages of developing glomeruli were observed in the substance of the kidneys. In the cortex, various cut sections of the tubules were observed without any differentiation as proximal (PCT) and distal tubules (DCT). The second trimester section showed well differentiated the PCT and DCT by 16th week. Distinct brush border was observed in PCT by the 16th week. Immature duct system was observed in the medulla. The nephrogenic zone was appreciated till 36 weeks. By 28th week the sections of DCT were observed adjacent to the renal corpuscles indicating the developing juxtaglomerular apparatus. Conclusion: As it is essential to know the developmental morphology of kidney, the present study explains every component of it in detail.

69-75

Authors: Tomar S, Sharma A, Shukla Y, Saxena V

Aim: To identify histopathologic features of HSV keratitis and correlate them to their clinical findings following penetrating keratoplasty for suspected HSV keratitis and predict the graft outcome on oral Acyclovir treatment. Material and methods: A clinical study of 20 patients who presented to us with clinical picture suspected of HSV keratitis that underwent penetrating keratoplasty at a teaching hospital situated in rural area of India. Out of 20 patients 18 were primary grafts and in 2 patients repeat penetrating keratoplasty was done following graft failure due to rejection. A detailed review of the histopathology of the excised corneal button was performed to identify associations between clinical data (disease activity, vascularity, graft outcome) and histopathologic data (inflammation, neovascularization, gross). Patients with features of HSV keratitis on histopathology were started on oral prophylactic acyclovir therapy post penetrating keratoplasty. Results: All patients had clinically quiescent disease for at least 6 months before surgery. The visual outcome was better in 14 patients on oral acyclovir post penetrating keratoplasty in suspected HSV keratitis positive on histopathology including 2 repeat keratoplasty which were not earlier started on oral acyclovir. Histopathology of 12 cases including 2 repeat Penetrating keratoplasty revealed active corneal inflammation with epithelial irregularities along with patchy loss of Bowman’s membrane, infiltration of anterior stroma by lymphocytes, leukocytes and plasma cells. Diffuse fibrosis and neovascularisation of stroma was present which was correlated clinically. No recurrence was seen in these patients on follow up of 1 year. Of the 6 patients without any histopathologic inflammation in their corneas, only 1 experienced an allograft rejection. Conclusion: Histopathological inflammation is a marker for HSV status and its correlation helps in judicious use of acyclovir and reduces the risk of recurrence of HSV keratitis. Oral acyclovir therapy post penetrating keratoplasty acts as adjunct to improve the visual outcome in patients with positive histopathological changes.

82-86

Authors: Shamsi MS, Goel S, Singh A, Gupta A, Bhardwaj A, Goel S, Chhoker VK, Surana A, Singh LK

Background: Acne vulgaris is one of the most common skin disorders in puberty. The widespread and indiscriminate use of antibiotics in the treatment of acne has resulted in the spread of resistant bacterial strains and treatment failure. Aim: The study aimed to analyze the microbiological spectrum in acne vulgaris and to evaluate its susceptibility to the antibiotics widely used for acne. Material and methods: The present cross sectional study was carried out by the Department of Microbiology and Dermatology, MSDS Medical College, Fatehgarh among the patients seeking care for acne vulgaris with pustular and nodulocystic skin lesions in the Dermatology OPD of a rural medical school from western Uttar Pradesh. Patients with pregnancy or endocrinal problems like hirsutism, menstrual dysfunction or adrenal dysfunction and those taking drugs or contraceptives were excluded. The samples were cultured individually on blood agar and Muller-Hinton media. The cultures were then incubated under both aerobic and anaerobic conditions for 2-7 days. Bacteria were identified and their resistance to common antibiotics was evaluated according to the standard procedures. After compilation of collected data, analysis was done using Statistical Package for Social Sciences, version 21 (IBM, Chicago, USA). Results: Aerobically, Staphylococcus aureus, Staphylococcus epidermidis, Propionibacterium acne and Micrococcus spp were detected in 44%, 47%, 1% and 46% of samples respectively whereas anaerobically these were 39%, 21%, 34% and 1% respectively. Propionibacterium acne, Staphylococcus epidermidis and Staphylococcus aureus were more sensitive to rifampin (almost 90%) compared to other drugs. Neomycin was found to be least sensitive. Conclusion: The study highlighted the need to discourage antibiotics' abuse. Rifampin is a suitable antibiotic for acne patients, but to achieve a better result, combination of rifampin with other antibiotics should be tried. It is also suggested that studies with bigger sample size on evaluation acne vulgaris treated by rifampin should be undertaken.

93-98

Authors: Jai Krishna, Singh AK, Goel S, Singh A, Gupta A, Panesar S, Bhardwaj A, Surana A, Chhoker VK, Goel S

Background: A medication error is an episode associated with use of medication that should be preventable through effective control system. Investigating the incidence, type, and nature of medication errors are very crucial to prevent them. Aim: The study aimed to analyze and ascertain profile and pattern of medication errors among admitted patients in a tertiary care teaching hospital. Material and methods: The present prospective study was carried out by the Department of Pharmacology in collaboration with the Department of Internal Medicine and Office of Medical Superintendent, MSDS Medical College, Fatehgarh, among the patients admitted to the General medicine ward during October 2013-February 2014. Hospital/medical records, Case sheet of the study subjects, a 46 item self administered questionnaire and Medication error reporting and documentation form served as study tools. Results: Overall incidence of medication errors was found to be 28.3%. 31.4% were ‘Errors in medication ordering and transcription’, 24.4% were ‘Errors in medication dispensing’, whereas 44.2% were observed as ‘Nursing errors in medication administration’. Most frequent nursing errors in medication administration was found to be ‘Medication not given’ i.e. Omission error. 67.4% were due to nurses, 22.1% were due to pharmacists and remaining 10.5% were due to physicians. Most of the nurses attributed cause of this error to ‘Repeated distraction’ and ‘High activity duty hours’ 41.4% and 39.6% respectively. Conclusion: A robust surveillance system to detect such medication errors is need of an hour. Competencies of pharmacology department hibernating in a tertiary care teaching institution could be utilized in the early detection and prevention of medication errors and thus can improve the delivery of care quality to the patients.

105-115

Authors: Siddharam Jamgond, Liyakhath Ali, Manjunath M.

Background: Supraglottic airway devices (SAD’s) have revolutionized airway management both inside and outside the operating room ever since the invention of the LMA Classic. Objectives: Objective of this study was to compare efficacy of LMA classic, Ambu Aura laryngeal mask and I-gel in terms of ease of insertion, fiberoptic bronchoscopic assessment of the glottic view, oropharyngeal leak pressure, intra and post-operative complications. Material and methods: Ninety patients of ASA Grade 1 or 2, aged 18–70 years, scheduled for elective short surgical procedures requiring general anesthesia were randomly divided in to three groups as LMA Classic, Ambu Aura40 laryngeal mask and I-gel group whose airway were secured with these devices. Anesthetic technique was standardized and maintained on spontaneous breathing. The number of attempts for the correct positioning (at least 6 square Etco2 traces on the capnograph and 4 ml/kg tidal volume) of the device were counted. Glottic view was noted by fiberoptic bronchoscope passed into the supraglottic device and graded as 1 = Vocal Cords entirely visible, 2 = Vocal Cords or Arytenoids Cartilages partially visible, 3 = Epiglottis only visible, 4 = No laryngeal structures visible. Oropharyngeal leak pressure (OPLP) was measured. Intra and post-operative complications were looked for and recorded. Results: Ambu Aura40 could be positioned successfully in a single attempt in 90% of the patients (27 out of the 30), whereas it’s only 80% in both the LMA Classic and the I-gel groups without a statistical significance (P = 0.518). Successful positioning during the next or second attempt was more with I-gel compared to LMA classic (20.0% and 16.7% respectively). 63.3% of Ambu laryngeal mask group had a glottic view grade of 1 while only 46.7% and 13.3% of patients in the LMA classic and the I-gel group had a similar glottic view respectively which was statistically significant (P = 0.000). Significantly higher mean OPLP with I-gel 36.23 ± 3.00 and least with LMA classic 30.90 ± 2.15 (p=0.000). 3 patients (10%) in the LMA Classic group complained of sore throat in the post-operative period which was statistically significant (P = 0.045). Conclusion: Over all Ambu Aura40 laryngeal mask airway device is superior in comparison to the other devices with respect to parameters studied. I-gel due to high oropharyngeal pressure leak could be useful in positive pressure ventilation. The LMA Classic is associated with a minimal incidence of sore throat in our study.

121-123

Authors: Patel D

Laparoscopy is an important milestone in the history of surgery. Almost all abdominal surgeries can now be approached laparoscopically. Laparoscopic perforated duodenal ulcer (DU) repair has been shown to be feasible. However, whether its superior to open repair is yet to be established and has not become the standard of care. Laparoscopy offers better visualization and early recovery.

127-131

Authors: Ravishankar P, Suba Ananthi K, Radhakrishnan PL, Muthusamy R

This paper aimed to report a rare case of fusion of 6th and 7th cervical vertebrae, called as block vertebrae. Block vertebrae was observed in the Department of Anatomy, SRM Dental College. The bodies of C6 and C7 were completely fused. Anterioposterior radiograph of the fused vertebrae bodies showed hypoplastic inter vertebral disc. Lateral radiograph showed partial fusion of articular processes on left but remain unfused at the right side. Congenital cervical vertebral fusion results due to non-segmentation of sclerotomes. It may be asymptomatic or may result in various clinical symptoms with limitation of neck movements. Knowledge about the variations in vertebrae especially in cervical region is essential for orthopedic surgeons, oral- maxillofacial surgeons and physical therapists for planning any surgeries involving the neck region.

137-140

Authors: Rathod GB, Jain A

Periarticular nodules may not be recognized as tophi because the clinical diagnosis of gout in many instances is not straightforward. In such a setting, fine needle aspiration cytology (FNAC) of gouty tophi would facilitate the clinical diagnosis and treatment. FNAC is valuable in confirming the nature of periarticular nodules especially in case of gouty tophi as compared to the histopathology. Thus FNAC is the gold standard for the diagnosis of gouty tophi presenting as periarticular nodules.

147-151

Authors: Dhakre A, Yengkhom I, Nagori H, Kurele A, Patel SB

Adenocarcinoma of the gastro-esophageal junction (GEJ) remains a significant clinical problem that is increasing in incidence and is associated with a poor prognosis. The majority of patients present with advanced disease and less than 50% undergo curative treatment. To diagnose GE junction mass with conventional procedure like Barium swallow where endoscopy cannot be performed, CECT is done to access the potential spread of disease.

157-161

Authors: Deepak MB, Mahsheena KM, Begum CRS, Hana Abdul Kareem

Basaloid squamous cell carcinoma (BSCC) in tonsil is a rare and aggressive variant of squamous cell carcinoma. The tonsil is an uncommon site of BSCC and just fourteen cases have been accounted for in the worldwide writing. Most common tonsillar malignancies are squamous cell carcinoma and lymphoproliferative lesions. We have presented here a rare case of incidental finding of BSCC in a 62 years old female patient who presented with unilateral enlargement of tonsil without ulceration and no preceding history of associated high risk factors like tobacco chewing, cigarette smoking or alcoholism. It is for these rarities we are presenting this aggressive tumor of tonsil.

1-8

Authors: Akpan Sylvia Iquoabasi, Megbelayin Emmanuel Olu

Background: World sight day is marked yearly and provides the opportunity to create awareness about eye health. The global event can also serve as an avenue to appraise impacts of health promotions and interventions on blindness prevention. Aim: To determine the prevalence of blindness and common ocular conditions among the studied population. Materials and methods: It was a cross-sectional study involving workers at Uyo Mechanic Village and University of Uyo Teaching Hospital. Instrument was developed in line with study’s objectives. Subjects’ responses to questionnaires and ocular assessment formed the core of data generated which was analyzed by Statistical Package for Social Sciences (version 20.0) Observation: A total of 121 males and 280 females with a ratio of 1:2.3 were analyzed. Age range was from 18 years to 66 years with a mean of 39.8+9.2 years. Prevalence of blindness was 1%. Intraocular pressure, indicated in 81 subjects, ranged from 11 to 33 mmHg with a mean of 16.2+4.8 mmHg. Absolute glaucoma was recorded in 5 patients (1.2%), 71 patients (17.7%) were glaucoma suspects and 19 patients (4.7%) had glaucoma. Refractive error 167 (41.6%) was the commonest finding. Statistical analysis of data revealed no significant relationship between sex and diagnoses (p value = 7.967, X2= 0.826, 95% CI = 0.821-0.836) or age and diagnoses (p value = 509.522, X2= 0.601, 95% CI = 0.591-0.510). Conclusion: Refractive errors were the commonest ocular finding in the population studied.

14-19

Authors: K N Prasad, M Kamali, S Kanimozhi, G Kanmani, M Kannan, A Karthikeyan, R Kaviyarasi

Introduction: Food intake is diminished among old age people due to ill health, disability, co-morbid condition. Hence the quality of life of elderly affects nutrition & protein deficiency contributes to high percentage of DALY. Objectives: To know the calorie deficiency and nutritional status among elderly people Material and methods: This was a cross sectional and community based study done on 300 elderly people among 17079 in rural village of Puducherry during March and April 2015. Data were collected by two methods (questionnaire, basic anthropometry measurement) at their residence. Data was analysed for calorie deficiency and body mass index. Results: There were equal number of men and women. Sixty percent of the subjects were aged between 60-70 years and 7% were aged more than 80 years. Caloric deficit was more in males than females and 35% of them were either overweight or obese according to body mass index. Conclusion: There were no serious micro nutrient deficiency individuals but more than 35% are already obese/ overweight and 50% are suffering from age related problems. The rehabilitation service of old age group is strongly recommended in order to give quality of life.

28-39

Authors: Prakash Gurudevarahalli Madegowda, Sanju R

Background: Stroke is a leading public health problem, it is second to heart disease as a worldwide cause of death and a leading cause of long term disability. The treatment for patients with ischemic stroke is still not very effective and prevention of stroke is a better option. The incidence of stroke can be reduced by adequate control of risk factors. Aim: To evaluate the risk factors in patients with ischemic stroke. To find out the prognosis of ischemic stroke with reference to risk factors. To identify the patients having modifiable risk factors so that preventive care can be taken to improve the prognosis and prevent recurrences. Materials and methods: 65 patients with ischemic stroke who met the inclusion criteria were evaluated with a comprehensive clinical history and detailed physical examination and relevant investigations. Their prognosis during the hospital stay was also determined. Results: At the end of the study it was noted that the incidence of stroke in males was 58.46%. 50.9% of stroke occurred in people aged above 60 years. The most common risk factors were smoking (46.2%), hypertension (38.46%), dyslipidemia (18.46%), alcohol consumption (15.39%), diabetes mellitus (13.09%), heart diseases (10.7%), tobacco chewing (9.23%), history of recent delivery (1.6%) and family history of stroke (1.6%). It was also noted that 72.3% of patients had multiple risk factors of which 7% had complete recovery while 22.2% of patients with single risk factor had complete recovery. Conclusion: It was found that stroke was more common in males when compared to females and increasing age (>60 years) was associated with increased incidence of stroke. Most common modifiable risk factors were smoking, hypertension, dyslipidemia, alcohol consumption and diabetes mellitus. The most common non modifiable risk factors were increasing age, male sex and family history of stroke. Prognosis depends on the number of risk factors present. It was also found that increasing age, hyperglycemia and multiple risk factors were associated with poor prognosis.

47-53

Authors: Gulamus sibtain asad, Himanshu Singla, Ankit vasoya, P. J. Jhala

Aim: To evaluate the features, pattern and extension of the different pathologies affecting the knee joint with help of MRI scans. Materials and methods: This study was performed using MRI scan 1.5 tesla of knee joint in 65 patients. Routine blood investigations were documented in all patients. Results: Distribution of pathologies according to patient’s age, sex, site of involvement and etiology was observed and p-value of knee joint tears by using MRI as gold standard was calculated. Conclusion: MRI scans have proved to be successful modality in evaluating the knee joint; MRI results increased the physician’s confidence in the diagnosis. MRI is an excellent noninvasive modality in imaging of the knee and a noninvasive replacement for arthrography and non-therapeutic arthroscopy.

64-68

Authors: Dharita Manubhai Khatri, Neeta Jayprakash Vyas, Megha Sandeep Sheth

Introduction: Knee osteoarthritis (OA) is a major public health problem. Knee OA leads to impaired balance and reduction in speed of walking, which is accentuated under dual-task conditions. Walking relies on continuous visual processing to obstacles as one navigates through a visually defined environment. Objectives: The study aimed to compare the speed of walking with and without visual distraction in subjects with OA knee and with normal individuals. Material and methods: Fifteen subjects with OA knee and 15 without OA knee of same age and gender were selected. Subjects were selected according to inclusion and exclusion criteria. Experiment was carried out over straight path of 50 m length and 2.5 m width. Subjects walked on two consecutive days at preferred speed 3 times back and forth covering total distance of 300 m. Charts were shown on either of the two days. Subjects passed 12 times through charts of various objects held by two assistants. Some objects were kept upright or inverted and subjects needed to reply by saying ‘yes’ or ‘no’. Charts of various colors were also shown and they were asked to identify them. The speed was noted. They also walked same distance without distraction. Level of significance will be kept at 5%. Results: Wilcoxon test was used for within group analysis for speed of walking with and without distraction. Significant difference was seen for both subjects with OA knee (W=-2.897, p=0.004) and normal subjects (W=-3.266, p=0.001). Mann Whitney U test was used for between groups analysis. With distraction groups showed significant difference (W=-2.219, p=0.026). But there was no significant difference in analysis in between groups without distraction (W=-1.701, p=0.089). Conclusion: Visual distraction leads to reduction in speed of walking in subjects with OA knee as compared to normal subjects.

77-82

Authors: Anupsingh Dhakre, Harshin Nagori, Harsh Shah, Anil Rathwa, Chinmay Parikh, Dhara Patel

Background: To recognize different pathologies affecting the shoulder joint with the help of ultrasound and MRI scans and to evaluate the features, pattern and extension of the different pathologies affecting the shoulder joint with help of ultrasound and MRI scans so as to help the clinician for further management. Aim: To estimate role of ultrasound and MRI in examination of shoulder joint. Material and methods: Study comprised of an observational hospital based study. Out of 65 patients, 20 underwent only ultrasound investigation, 25 underwent only MRI scans whereas 20 patients were evaluated by ultrasound and MRI. These were performed by 3-5 MHZ curvilinear probe and 8-10 MHZ linear probe on HD 7 and HD 9 Philips ultrasound machines and 1.5 T Philips MRI machine. MR arthrography was performed as a follow up in some of the patients in outside centre. Results: USG study also showed that the most commonly occurring rotator cuff tears were supraspinatus tears whereas alone infraspinatus and subscapularis tears were very rare. MRI study showed supraspinatus tears were the most frequently occurring in the rotator cuff whereas subscapularis and infraspinatus tears were rare. MRI is 100% confirmative in almost all cases of Rotator cuff tears but may sometimes need extra imaging by MR arthrography in partial bursal tears. Conclusion: Rotator cuff tears are the most common pathologies affecting the shoulder joint according to this study. It was proved that, there is no evident difference in the accuracy of ultrasound and MRI in detecting this pathology, even though MRI has proved to be more accurate in evaluating almost all other pathologies as compared to ultrasound.

91-97

Authors: Parikh Hemant Chimanlal

Introduction: Happiness is a very subjective feeling and may mean absence of sorrow to indefinite pleasure; to different persons! Material and methods: We derived happiness index of teenagers by asking them 20 questions having score of 1 – 5. We measured happiness amongst teenagers studying I year M.B.B.S., I year B.Sc. nursing and I year physiotherapy. Comparison of happiness levels, was done between these groups. Results: Many of the physiotherapy students were happy with their present. Nursing students were the least happy with present day turmoil. Medical students had reasonably good count on many criteria. However they were involved in lowest social activity. Conclusion: 32 – 40 percent individuals in our study had happiness index less than 73. They were given tips for happiness enrichment.

108-115

Authors: Jai Krishna, G. Chitti Babu, Shewtank Goel, Abhishek Singh, Aakansha Gupta, Sanjeet Panesar, Avinash Surana, Deepak Pathania, Lalit Kumar Singh

Background: The wide and indiscriminate use of drugs has increased the incidence and the modes of presentation of cutaneous drug reaction. Understanding the nature of ACDRs may help narrow down the search for the offending agent. Aim- The study aimed to evaluate incidence, assessment of causality, severity and preventability of Adverse Cutaneous Drug Reactions as a part of Pharmacovigilance from a rural northern Indian medical school. Material and methods: The current survey was executed by the department of Pharmacology in collaboration with Department of Dermatology, MSDS Medical College, Fatehgarh among 7692 patients attending Dermatology OPD during March-December 2014. CDSCO ADR Reporting Form, WHO causality assessment scale, Hartwig and Siegel’s Assessment scale and Modified Schomock and Thronton’s preventability assessment scale were used as study tools. All the doctors, residents, interns and students were encouraged to notify any suspected ACDRs. Patients were screened and recruited if they presented with visible skin lesions suspected to be drug related. As per Modified Schumock and Thornton Scale, 43.5% of ACDRs were ‘Definitely preventable’ followed by ‘Probably preventable’ (30.4%) and ‘Not preventable’ (26.1%). Results: 23 patients (0.3%) were detected to have one or other type of ACDRs. Fixed drug eruption was most common form (34.8%) of ACDRs followed by Acneform eruption and Urticaria in 21.7% and 13% respectively among study subjects. The most common drugs responsible for ACDRs were prednisolone, betamethasone and isoniazid for Fixed drug eruption, while metronidazole, cotrimoxazole and paracetamol for acneform eruption. Antimicrobials, other steroids and NSAIDs were responsible for other spectrum of ACDRs. On assessment of Causality of ACDRs, it was noted that more than half (52.2%) of them fall under probable category. Severity assessment of ACDRs revealed that majority (65.3%) of them was moderate in nature. Conclusion: Awareness on part of the physician can help in timely detection of cutaneous reactions, thereby restricting damage from them. Pharmacovigilance activity is significantly effective in increasing the reporting of ADRs. Study with long-term follow-up and monitoring of the patients with bigger sample size is warranted.

123-135

Authors: Nirav Patel, Niket Domadia, Konark Sarvaiya, Anil Rathwa

Background: Diagnosis of abdominal trauma is a real. Diagnostic tools that help the treating doctor in optimum management of abdominal trauma include; Focused Assessment with Sonography for Trauma (FAST), Diagnostic peritoneal lavage (DPL) and CT scan. Objectives: The aim of this communication was to define the recent role of FAST and CT scan of the abdomen in the diagnosis of abdominal trauma. Material and methods: This study aimed at evaluating patients who came to the Radiology Department of Dhiraj General Hospital, by using USG and CT scan. This study comprised of 50 patients. Results: Out of 50 patients of abdominal trauma, 12 patients (24%) were in age group 21-30 years with male to female ratio of approximately 5.2: 1. The commonest mode of trauma was road traffic accident according for 54% of total cases. Spleen and liver were the most common organs injured, followed by kidney. USG showed overall sensitivity 57.48%, specificity 97.77%, positive predictive value 88.9125, negative predictive value 97.185 and accuracy of 90.75%. CT scan showed highest sensitivity of 95.35%, specificity of 100%, positive predictive value of 100%, negative predictive value 77.78% and accuracy 96%. Conclusion: FAST is useful as the initial diagnostic tool for abdominal trauma to detect intra abdominal fluid. With proper training and understanding the limitations of ultrasound, the results of FAST can be optimized. DPL is indicated to diagnose suspected internal abdominal injury when ultrasound machine is not available, there is no trained person to perform FAST, or the results of FAST are equivocal or difficult to interpret in a hemodynamically unstable patient. In contrast, in hemodynamically stable patients the diagnostic modality of choice is CT with intravenous contrast. It is useful to detect free air and intra peritoneal fluid, delineate the extent of solid organ injury, detect retroperitoneal injuries, and help in the decision for conservative treatment. Helical CT is done rapidly which reduces the time the patient stays in the CT scan room. Furthermore, this improves sagittal and coronal reconstruction images which are useful for detecting ruptured diaphragm.

145-150

Authors: Meeravali SK, Dasaraiah CV

Background: Study was designed to analyze the effects of surgical management of fractures of both bones of forearm with dynamic compression plate with screw fixation. Material and methods: From August 2008 to October 2010, data from 56 patients with fractures of both the radius and ulna were collected and evaluated retrospectively. Patients were managed with early surgical debridement, open reduction and internal fixation with a DCP. All patients had complete functional and radiographic assessments. Results: Patient regained full range of movements within 6-8 weeks. At 12-14weeks check X-ray showed good radiological union. In this series out of 56 cases 42 (75%) cases are graded excellent, 7 (12.5%) cases are graded good, fair 5 (9%) cases and poor 2 (3.5%) cases. Conclusion: Our study has proven that open reduction and internal fixation of diaphyseal fractures of radius and ulna can be best done with dynamic compression plating technique which has given a good result. The technique of DCP fixation is a simple procedure which can be done by the junior orthopedic surgeon with an excellent result.

160-171

Authors: Eyad AlShammari, Rafia Bano, Shahida Banu, S. Bushra Fatima, Asma Sattam

Objectives: Adequate nutrient intake during pregnancy is important to fetal and maternal health. The purpose of this study was to investigate the factors affecting pregnancy outcome and to provide basic data to promote more favorable pregnancy outcomes. Material and methods: Data were collected from 100 pregnant women at two hospitals in Hail region of Saudi Arabia. Demographic characteristics, anthropometric measurements and health related habits were obtained using a questionnaire at the hospital visit soon after the delivery. Data on pregnancy outcomes, including birth weights and gestational ages, were obtained from hospital records. Birth weights were divided into three groups, a low birth weight group (birth weight <2.5 kg), a normal birth weight group (2.5 - 3.9 kg) and a high birth weight group (≥4 kg). Results: The Socioeconomic status was significantly with the birth weight (p<0.05), with high birth weight group babies belonging to high income group and low birth weight babies from lower income groups only. Weight and BMI of the mothers before pregnancy, total weight gain during pregnancy and hemoglobin levels were found to be significantly correlated with the birth weight.(p<0.05). Few health related habits and risk factors were significantly different among the three groups. Birth weight or sex of the baby was not significantly affected by gestational age. Conclusion: Birth weight remained an important factor affecting the neonatal infant and childhood mortality and morbidity. Low birth weight babies are more likely to have disabilities in four of developmental delay, poor growth and mental disabilities. For reducing the prevalence of low birth weight, public health strategy needs to focus attention on better maternal nutrition and education.

183-191

Authors: Ishita Sarkar, Aparajita Dasgupta

Background: Declining sex ratio is an issue of major concern. In spite of legal rules and regulations prenatal sex determination and sex selective abortion is going on in this country. The root of the problem is male child preference and unawareness about the rules forbidding prenatal sex determination. Aim: To elicit the gender preference and perception regarding prenatal sex determination among rural ever married women and to find out the contextual factors influencing the perception. Material and methods: This community based cross-sectional study was undertaken under the rural field practice area of All India Institute of Hygiene and Public Health, Kolkata. All ever married women in that area was line listed out of which the required number of women (i.e. 96) was selected by simple random sampling. A predesigned and pretested semi structured schedule was used for data collection. Firstly a univariate analysis was done. The variables which were found to be significant were entered into the multiple logistic regression model. P value of <0.05 was considered significant. Results: 90.6% of the study population felt that at least one male child is necessary in a family and 59.37% agreed with prenatal sex determination. Multivariate analysis showed that women with higher education had better perception of prenatal sex determination techniques and the PNDT Act with Adjusted Odds Ratio (Confidence Interval) 19.25 (5.58-66.34). Conclusion: Intensive IEC campaigns to increase awareness and enforcement of law are the need of the hour to check this social problem.

197-204

Authors: Tejal C Nalawade, Shyam D Ganvir

Background: Postural control involves controlling body’s position in space for dual purpose of stability and orientation. Postural stability or balance is defined as the ability to maintain the projected Center of motion (COM) within the limits of Base of Support (BOS). During quite stance there is a separate Center of Pressure (COP) under each foot. The net center of pressure lies between the feet and depend on each limb support. Normally no one stand erect, instead the body sways in small amount, mainly forward and backward. Thus quite stance is characterized by small amount of spontaneous postural sway. The device (sway meter) consists of inflexible 40 cm long rod with vertically mounted pen at its end. The rod was mounted 20 cm wide metal plate which will be fitted at the level of PSIS (Posterior superior iliac spine) over lower back region of participants by firm belt. A low tech Sway meter was designed to address the needs of clinicians and researchers with limited resources (e.g. no access to force plates or motion laboratories). It is a useful field test, as it is compact, lightweight, has short administration and data processing time. Unlike other lightweight and easily applied systems, such as accelerometers and gyroscopes, the Sway meter involves no electronics or computer processing. Thus, assessment can be conducted in a variety of community settings and health care facilities. Several research groups have found the Sway meter to be feasible for use in different populations of young and older people. The Sway meter has been used in numerous studies of balance as well as retrospective and prospective investigations of falls risk in older people. The purpose of study was to find out normative data of postural sway by using sway meter in among young adults and the validity of the Sway meter against the floor and foot print. Aim and objectives: To study the normative data of postural sway by using sway meter among young healthy adults, to study the normative data of postural sway by using sway meter among young healthy adults with eye open and eye close, to study the normative data of postural sway by using sway meter compare with the normal values of the lord’s and Sherrington’s study. Material and methods: The subjects were instructed to keep their hand by their sides during standing. Subjects were informed about procedure before starting. Duration of each trial was 30 second. A starting point was marked on the graph paper. At end of the 30 seconds, the rod of the sway meter was taken away from the graph sheet. 5-10 seconds rest was given during trial, but they were not allowed to move away from the foot print. The procedure was repeated for each trial. A total of six trials were taken including, 3 trial with eyes opened and 3 for eyes closed. Maximum duration for all trial was 6-7 minutes and maximum deviation in 3 trials was taken for analysis. Results: In eye open condition, in anterior direction, total 60 (100%) subjects are had sway in 0.1 to 2 cm. In Posterior direction, total 60 (100%) subjects are had sway in 0.1 to 2 cm. In right lateral direction, total 59 (98%) subjects had sway in 0.1 to 2 cm; remaining 1 (2%) subject had sway in 2.1 to 3 cm. In left lateral direction, total 56 (95%) subjects had sway in 0.1 to 2 cm; remaining 2 (3%) subjects had 2.1 to 3 cm sway and 2 (2%) subjects had 3.1 to 4 cm sway in left side. In eye closed condition, in anterior direction 57 (95%) subjects had 0.1 to 2 cm sway in anteriorly, but remaining 2 (3%) subjects had 2.1 to 3 cm sway, and 1 (2%) subject had 3.1 to 4 cm sway. In posterior direction 59 (98%) subjects had 0.1 to 2 cm sway in posterior; rest 1 (2%) subject had nil sway in posterior. In right lateral direction 56 (93%) subjects had 0.1 to 2 cm sway, and rest of the 2 (4%) subjects had nil sway, and 2 (3%) had 2.1 to 3 cm sway in right direction. In left lateral direction 57 (95%) subjects had 0.1 to 2 cm sway, and 1 (2%) subjects had nil sway, rest 2 (3%) subjects had sway in 2.1 to 3 cm. Conclusion: It has been concluded that this study support the self constructed sway meter as a clinical tool for identifying sways in various directions (anterior, posterior, right lateral and left lateral). Similarly 100% of sway was seen in anterior and posterior direction with eye open.

210-213

Authors: Makhela J, Kaushal K, Choraria S, Ranka M, Patel S B

The mucopolysaccharidoses (MPS) are a group of inherited metabolic disorders that result in widespread skeletal, visceral, and mental abnormalities. A defect in metabolic degradation leads to the storage of mucopolysaccharide macromolecules in the nervous system and other body tissues. The MPS are classified into various types, and there are additional diseases, such as the mucolipidoses and a gangliosidosis, that demonstrate similar clinical and radiologic findings. We hereby present 3 cases of Hurler Syndrome, Type I mucopolysaccharidoses, and enumerate there radiological characteristic radiological findings.

220-222

Authors: Jacob K J, Mini K, Sreeja K.R.

Twin pregnancy with a complete mole and a coexisting healthy fetus is a rare condition. There is increased risk of developing severe complications and development of persistent trophoblastic disease. A 28 years old 2nd gravida, with 1st vaginal delivery reported to the hospital at 20 weeks gestation as a case of dichorionic twin pregnancy. On routine USG, it showed a complete mole with a coexisting live fetus. The patient had features of anemia and severe preeclampsia. After explaining the risk to the patient and bystanders, they requested to terminate the pregnancy. She was induced for the same and delivered a normally appearing fetus. This was accompanied by evacuation of the mole. Diagnosis of complete mole was confirmed by histopathology. Twin pregnancy with a complete mole and a coexisting healthy fetus is a rare condition. The decision regarding management of this condition is difficult due to the various complications associated especially development of choriocarcinoma.

227-231

Authors: Ashish Devgan, Amit Batra, Shivani Dua, Vivek Bansal, Sudhir Punia, Shubham Joshi, Harnam Singh Madan, Vinit Verma, NK Magu

Patellar tumors are rare and are usually benign as opposed to malignant tumours. The most frequent benign lesions of patella are giant cell tumor (common in adults), chondroblastoma and osteoid osteoma. A solitary exostosis is the most common benign bone tumor which occurs around the growth plate of long bones. The treatment of choice is extra periosteal resection of exostosis and ensuring complete removal of cartilaginous cap. Indications of surgery are when the exostosis is interfering or disturbing the growth of extremity, malignant transformation, presence of bone erosion, neurovascular compression, interference with joint motion, bursitis, fracture through the stalk and cosmesis. We report a rare case in an adult patient with an extra-articular skeletal osteochondroma of the patella located antero- superiorly which presented as an enlarged bursa and a bony swelling over knee joint.

236-239

Authors: TH Kalidas Singh, Gunvanti B. Rathod

Fine needle aspiration (FNA) of the breast has gained significant credibility in the diagnosis of breast diseases especially malignancy. Fat necrosis of the breast is a phenomenon that occurs within breast adipose tissue following exposure to trauma. It can mimic breast cancer clinically or radiologically. FNA of fat necrosis is a useful tool in directing management and treatment of the patients and avoiding unnecessary surgeries although histopathological examination is the gold standard for the final diagnosis.

1-4

Authors: Nilesh D. Patel, Rakesh M. Rajat, Rajesh S. Katara

Introduction: Salmonella typhi is widely prevalent in India and it causes endemic and epidemic typhoid fever. Early and proper antibiotic administration is necessary to reduce morbidity, complication and mortality of typhoid. Material and methods: A total of 1006 febrile patients, receiving treatment at Guru Govindsingh Hospital, Jamnagar, were included in this study. 1006 blood culture samples for S. typhi were collected from these patients. Blood cultures were tested for clinical bacteriology, as per standard protocol. Results: 30 blood cultures grew positive for S. typhi with the isolation rate of 2.98%. 60% S. typhi isolates were resistant to chloramphenical, ampicillin, and co-trimoxazole and hence, were multidrug resistant S. typhi. Ciprofloxacin was the most effective drug with 93.33 % sensitivity. Conclusion: Ciprofloxacin remains the drug of choice for treatment of typhoid fever. Unchecked use of ciprofloxacin antibiotic should be rationalized, since selection pressure has now emerged as ciprofloxacin resistance in S. typhi.

10-17

Authors: S. Govindu, B. Gopi Krishna, G. Ravi Prabhu

Background: The National Urban Diabetes Survey in India (2010) has reported an age standardized prevalence of diabetes to be 12.1%. The prevalence of diabetes mellitus is known to vary with lifestyle factors. Aims and objectives: The present study was conducted to find the prevalence of diabetes mellitus among adults and its association with certain life style factors like current smoking, alcohol intake, saturated fat intake and physical exercise. Material and methods: This present study was a cross sectional and analytical study carried out in 900 adults in the age group of 30 years and above during June 2014 to December 2014. A random blood sugar test was conducted among the selected study subjects and the prevalence of diabetes mellitus was estimated using the cut off level of 180 mg%. Those subjects who were already known to be diabetics with or without treatment were also classified as diabetics. The findings were analyzed using Epi-info software 7 version (CDC, Atlanta, USA). Results: The prevalence of diabetes mellitus in the present study was found to be 12.4%. Significantly higher proportion of current smoking was found in diabetics (17.0%) than in non-diabetics (6.1%). Current alcohol intake was significantly higher in diabetics than in non-diabetics (8.0% vs 2.4%); current saturated fat (ghee) intake was similar in diabetics and non-diabetics (5.4% and 5.5% respectively). Paradoxically higher proportion of physical exercise was found in diabetics (15.2%) than in non-diabetics (5.1%). Conclusion: The prevalence of diabetes mellitus showed significant association current smoking and current alcohol intake.

26-29

Authors: Vani Isukapalli, Radhika M

There is a substantial rise in diabetes complicating pregnancies in south Asian countries especially India. Until many decades, insulin eras thought to be the only management option to maintain euglycemia in these cases. But metformin can be a safe and convenient alternative in such cases. In this background we have conducted a study I 40 women with diabetes complicating pregnancies and studied the outcome of the mother and neonate in important parameters. Metformin was found to be a safe, effective and cheap alternative to insulin therapy in pregnant diabetic women.

37-42

Authors: Jignesh Jethva, Pallav Patel, Jaydeep Gadhavi, Hiren Parmar

Background: Fistula-in-ano forms a good majority of treatable benign lesions of the rectum and anal canal. 90% or so of these cases are end results of crypto glandular infections. Despite the easy of diagnosis, establishing a cure is problematic on two accounts. Firstly, many patients tend to let their ailment nag them rather than being subject to examination, mostly owing to the site of this disease. The more important second factor is that a significant percent of these diseases persist or recur when the right modality of surgery is not adopted or when the post-operative care is inadequate. Aim and objectives: To know the usefulness of investigative procedures in early and accurate diagnosis of fistula in ano. To study the efficacy of different modalities of surgical approach with reference to post-operative hospital stay and complications like pain, bleeding and sphincter incontinence and outcome in respect to persistence/ recurrence of fistulae. Material and methods: A total of 25 patients with clinically diagnosed fistula in ano were included in the study. Clinical history was obtained in all the patients. Clinical examination including per rectal examination and proctoscopy was done in all the patients. All the patients were processed by routine investigations, ECG, chest X - ray etc. prior to surgery. Patients were followed up to a period of 1 year. Results: 6 patients i.e. 24% had similar illness out of them two previously operated for fistula with recurrence, and four patients with similar illness and resolved without treatment. In this study, 72% of patients had low level of fistula and another 28% of patients had an internal opening situated above the ano rectal ring. Patients with low level fistula were treated with fistulotomy and fistulectomy and patients with high level fistula were treated with seton placement. In this study 60 % of patients underwent fistulotomy, 12 % of patients fistulectomy and another 28% seton placement. Patients with low level fistula were treated with fistulotomy and fistulectomy and patients with high level fistula were treated with seton placement. Conclusion: Fistula-in-ano is an important, commonest disease due to crypto glandular infection (anal glands) and has a complication of ano rectal abscess. It is curable disease by the treatment of surgery and higher antibiotics, local antibiotics with good post-operative wound management, like sits bath for twice a day without closing the wound.

48-55

Authors: Jignesh Jethva, Jaydeep Gadhavi, Pallav Patel, Hiren Parmar

Background: Hernia is a common surgical problem which requires good surgical skill as well as good knowledge about anatomy and various repair of hernia. Hernia is a protrusion of a viscous of part of viscous through a normal or abnormal opening in the wall of its containing cavity. Inguinal hernioplasty can be done under general anesthesia, spinal/epidural and local anesthesia. The choice of anesthesia depends upon a variety of factors viz patient's acceptance, surgeon’s wishes, safety, feasibility and cost etc. Recently there has been revival in the use of local anesthetic technique for hernioplasty. Aim: To study comparison of local anesthesia v/s spinal anesthesia for per-operative and post-operative outcome measures. Material and methods: We have done comparative study of total 100 patients (50 patients under local anesthesia and 50 patients under spinal anesthesia), with follow up period of 60 days. The present study included male patients of uncomplicated inguinal hernia with ASA grade 1 to 3. Patients were selected without bias of type (Direct/Indirect) and extent. All patients were explained about both the methods of anesthesia for hernioplasty, those who willing for local anesthesia were selected for this group and similarly spinal anesthesia group selected (Total 100, 50 in each group). Results: All patients were explained about both the methods of anesthesia for hernioplasty, those who willing for local anesthesia were selected for this group and similarly spinal anesthesia group selected (Total 100, 50 in each group). In local anesthesia group 7 (14%) patients had intra-operative discomfort in form of pain. 64% of patients of local had mild pain and 38% had moderate pain. None of the patients belonged to serve pain group. In spinal anesthesia, 6% of patient had serve pain, 22% patients had mild pain and 72% patients had moderate degree of pain. Local anesthesia was associated with less post-operative complication, in our study no patient develop complication like nausea, vomiting, urinary retention, or headache. Conclusion: hernioplasty under local anesthesia was an acceptable alternative to spinal anesthesia for hernioplasty especially with regard to operative condition, patient’s surgeon’s satisfaction, post-operative pain relief, complications and cost effectiveness.

63-71

Authors: Ravikumar Edwin, Harish Babu R, Subrahmanyam G, Ramalingam K, Mahaboob V Shaik

Background: Cardiovascular disease/Coronary artery disease (CAD), leading cause of global morbidity and mortality covers any disease of the circulatory system. In-vivo antioxidant nutrients which include vitamin C, trace elements such as Se, Zn and Cu play a crucial role in defending against oxidant damage. Objective: The aim of the present study was to investigate the changes occurring in the levels zinc (Zn), copper (Cu), and Selenium (Se) in coronary artery tissues of patients with CAD. Material and methods: Coronary artery samples collected from these patients during bypass surgery from known CAD patients. These samples were analyzed for Se, Zn, and Cu; results are expressed in terms of wet weight. Normal Healthy serum Se, Zn, and Cu levels were also analyzed to compare with coronary artery samples. Results: The levels of Zn, Cu and Se in patient’s coronary artery samples were observed to be very low when compare to Zn, Cu and Se levels of healthy person’s serum samples. In addition, our study showed that the levels of Zn and Cu in coronary artery samples were low when they compared to heart tissue Zn and Cu levels from CVD patients from other studies. Whereas, Se levels in coronary artery samples in our study are same as heart tissues samples in previous other studies. Yet, there was limited/no observational studies were published to identify levels of trace element levels in coronary artery samples. Hence our present observations interpreted the levels of Zn, Cu and Se in coronary artery samples with 20 numbers of sample size only; further, higher number of samples needed to formulate the standard reference ranges of these trace elements in setting up a newer biochemical marker in correlation/interpretation of CVD/CAD. Conclusion: The finding of our results showed that Se levels in coronary artery observed to be same as heart tissue levels from other study. The myocardial clinical manifestation seems to be due to alteration of levels of these trace elements in serum, tissue levels in patients. In our studies, however, the patients with coronary heart disease had, in general, lower concentrations of Zinc, copper in serum than the healthy controls.

79-87

Authors: SK Reddi Basha, A Penchalaiah, Y Venu Gopala Sarma

Background: Helminthic infestation is common in children because of their habits and opportunity for exposure. The present study was undertaken in the Narayana Hospital, Nellore to determine the incidence of various helminthes, the symptomatology and clinical manifestations of various helminthes and to correlate type of helminthic infestation. Material and methods: This is a prospective study, was done in 1 to 15 years children who attended O P D or admitted to the pediatric ward, Narayana Hospital, Nellore. The material for the study comprises of 500 children’s, who attended OPD or admitted to the Pediatric ward belonging to 1 to 15 years age groups. A detailed clinical examination including stool examination was done for all the 500 children. Blood examination was done for knowing the degree of anemia. Results and discussion: Out of 500 children examined in various age groups, 275 children’s were found to be positive for one or other helminthic ova in the stool samples examined giving an overall incidence of 55%. Number of stool samples examined Number of stool samples infested with Helminths. Out of 500 children examined, 235 were males and 265 were females, of which 130 males and 145 females were found to be infested for one or other helminthic ova. Out of 500 stool examples examined 275 were positive for one or other helminthic ova, 160 were positive for ascariasis, 20 were positive for Hookworm, 40 were positive for Trichuris trichura, 10 were positive for hymenolepis nana and 5 was positive for Taenia infestation. Out of 500 children studied, 130 children belong to class V Socio –economic class, 150 children belong to class IV socio – economic class, 120 children belong to class III Socio – economic class and 100 children belong to class II Socio – economic class, giving a percentage of infestation according to socio –economic class as 80% in class V, 63.3% in class IV, 41.7% in class – III and 30% in class II respectively. Anemia in hookworm infestation was of mild degree in all 15 children. Anemia in mixed infestation was of mild degree in 20 children and moderate degree in 5 children. Out of 500 children studied 300 children had normal nutritional status a nd positive percentage of helminthic infestation in them was 26.7%, 140 children had Grade – I malnutrition and positive percentage of helminthic infestation in them 96.4. 40 children had Grade-II and 20 children had Grade – III malnutrition. Positive percentage of helminthic infestation in Grade – II and Grade – III malnutrition was found to be 100%. Conclusion: This study confirms the finding of the other authors all over India regarding helminthic infestations in respect to epidemiology, clinical manifestations and relation with nutritional status. There was a high co-relation with poor nutritional status.

95-103

Authors: Sridhar Reddy S, Praveen Kumar K, Mastan Valli B, Madhav Desai

Background: Sepsis is the most common trigger for acute kidney injury (AKI) in critically ill patients. This study is to monitor changes in urine neutrophil gelatinase- associated lipocalin (uNGAL levels between septic and non-septic AKI and also to evaluate differences between septic and non-septic AKI with uNGAL. Material and methods: This was a prospective observational study of critically ill patients with acute kidney injury (AKI) Patients were evaluated for presenting complaints and on evaluation those who satisfied for SIRS criteria are taken up for study. In those patients with evidence of infection and positive for at least two criteria for SIRS are taken up as cases (n=30) and rest are taken as controls (n=30). All the patients were serially monitored for urine output, renal parameters, urine NGAL, APACHE II score and SOFA score. Patient urine was collected immediately after admission followed by 12, 24 and 48 hours for measuring NGAL. Results: Mean change in NGAL (ng/ml) at 12 hour, 24 hour and 48 hour was -12.5±5, -20.5±6.74 and -29.3±10.25 respectively in septic AKI and was -0.94±6.08, -0.92±6.31 and -0.10±6.12 respectively in non septic AKI. Within group analysis showed statistically high significance (p<0.0001) in septic AKI but not in non septic AKI group (P=0.97). On evaluating between group analysis, we found significantly high difference of NGAL in septic AKI at 12 hrs, 24 hrs and 48 hrs as compared to non septic AKI (P<0.0001) Conclusion: Septic AKI patients have higher detectable urine NGAL compared with non-septic AKI patients. These differences in NGAL values in septic AKI may have diagnostic and clinical relevance as well as pathogenetic implications.

112-120

Authors: Manjeet S Dhanda, Nadeem Ali, Abedullah Bhat, Firdous A Bangroo, Sansar C Sharma, Mehreen Maqsood, Sagar Parashar, Arti Dhingra

Background: Fractures of the proximal humerus have been a challenge to orthopaedic surgeons with treatment modalities changing from time to time. Locking plates have revolutionised the treatment of these fractures. Currently proximal humeral locking plates (PHLP) and proximal humeral interlocking osteosynthesis (PHILOS) are two types of locking plates available for fixation of these fractures. Aim of this study was to evaluate the results of proximal humeral locking plate (PHLP) for Neers’s two and three part proximal humerus fractures. Material and methods: Neer’s two and three part fractures treated by open reduction and internal fixation with proximal humeral locking plate from August 2012 to April 2014 were retrospectively evaluated for complications, time to radiological union and final functional outcome using Constant-Murley Score (CMS). Results: Twenty (12 male; 8 female) patients with 8 Neer’s 2-part and 12 Neer’s 3-part fractures managed by open reduction and internal fixation with proximal humeral locking plate (PHLP) with an average follow up of 23.2 months were evaluated. All the fractures united at an average of 16 (12 to 20) weeks. Eight complications were seen in 5 (25%) patients, namely, inadequate anatomical reduction (n = 1), superficial wound infection (n = 1), deep infection (n = 1), subacromial impingement (n = 1), axillary nerve neuropraxia (n = 1), adhesive capsulitis (n = 1) and secondary varus collapse (n = 2). There was no patient who developed avascular necrosis (AVN), non-union, primary or secondary screw perforation, implant failure and vascular injury. Average Constant-Murley Score at final follow up was 84.75 ± 11.6. 85% patients had very good and good functional results. No patient had poor functional results. Conclusion: Proximal humeral locking plate (PHLP) is an excellent implant in Neer’s two and three part fractures of the proximal humerus. Complications can be minimized by meticulous surgical technique and proper placement of screws and plate. In case of medial comminution, use of PHILOS with placement of medial support screws and bone grafting should be preferred to prevent varus collapse.

129-134

Authors: R. Sambasiva Reddy, Y. Venugopal Sarma

Objectives: To compare the demographic profile of mothers who delivered term low birth weight babies with that of mothers who delivered normal birth weight babies and study the association between the demographic variables of mother and the delivery of low birth weight babies. Material and methods: Study conducted at Department of Pediatrics and Department of Obstetrics of Narayana medical college hospital, Nellore, India. Participants were 120 postnatal mothers who delivered babies in the preceding 7days. 60 mothers who delivered term low birth weight babies and 60 mothers who delivered normal birth weight babies were include in the study. Five demographic variables: age of the mothers at the time of conception, educational status of the mothers, monthly family income, occupation of the mothers and presence or absence of consanguinity were recorded. Using chi-square test these variables are compared between two groups of mothers and association of these demographic variables with the delivery of low birth weight babies is studied. Results: Significant association was found between the family income and low birth weight (P-value 0.002) and between consanguineous marriage and low birth weight (P-value 0.000). Significant association was not found between the age of the mothers and low birth weight (P value 0.924), between occupation of the mother and low birth weight (P value 0.15) and between educational status of the mother and low birth weight babies (P value 0.062). Conclusion: Low family income and consanguineous marriage have significant association with delivery of low birth weight babies.

140-146

Authors: Ankur Mittal, Ramprasad R, Biju R, Siva Prasad Y, Ganesh Kumar Reddy M

Introduction: Risk of Nonunion, residual shoulder disability and symptomatic malunion are higher in conservative treatment of displaced midshaft clavicle fractures which are reportedly decreased by operative method but plating these fractures, however, have hardware-related problems. Low-profile anatomically precontoured plates may reduce the rates of plate prominence and hardware removal. Objective: To assess the rate of plate prominence, rate of hardware removal, rate of complications, radiological and functional outcome of a pre-contoured congruent clavicle plate in the treatment of acute, displaced, mid-shaft clavicle fractures. Materials and methods: This study presented the results of 50 patients treated with an anatomical congruent clavicle plate for acute displaced, mid-shaft fractures of the clavicle from October 2011 to December 2013 admitted in Narayana General Hospital. Results: The fracture united in all cases with minimal complications and high patient satisfaction on the Disability of the Arm and Shoulder (DASH) score, American Shoulder and Elbow Surgeons score (ASES) and Pain Visual analogue score (VAS). The results compare favorably with other published studies Conclusion: A congruent clavicle plate prove to be a better option for mid shaft clavicle fracture in terms of patient compliance, hardware complication, radiological and functional outcome.

152-155

Authors: Pankaj Chhikara, Dinesh Chillar, S K Dhattarwal

Unnatural deaths of married women amongst the total female deaths have shown an increasing trend in Indian society during the recent years. These unnatural deaths may be suicidal, homicidal or accidental but suicidal deaths are most common. In India, dowry is an persistent evil, even among educated societies, there is no escape from the brutality of in-laws if expectations are not met and some of these oppressed young women choose to commit suicide, either by burning, poisoning or by some other means. The burden of finding the cause of death lies on the shoulders of forensic experts. In this peculiar case, history and findings were confusing and inconclusive. Then as the ray of hope, flies of autopsy room came to teach us importance of patient observation in Forensic Medicine.

160-163

Authors: Bhartiya SK, Bhattacharya SK, Basu S, Srivastava A, Shukla VK

Venous aneurysm is saccular or fusiform dilatation of vein, usually congenital origin. Among acquired variety post intravenous cannulation leading to venous aneurysm is extremely rare entity. Non invasive diagnostic procedure MRI and duplex scanning are very useful modality for anatomical localization of the aneurysm. Although an ascending venogram is an invasive test and should take a backseat for diagnosis of such aneurysm. Symptometic case needs surgical management. Anatomical delineation is an important pre requisite for planning surgery. Aneurysmorrhaphy preserves the affected venous segment because it does not produce luminal compromise.

168-173

Authors: Menon Narayanankutty Sunilkumar

Parotid gland is one of the major salivary glands and when there is infection/inflammation of the parotid gland, the condition of parotitis ensues. A parotid abscess (PA) results as a complication of the primary parotitis. Literature review has revealed that it is very rare in the pediatric population and many predisposing factors are present for the formation of a PA in children. PA is seen often in the adults when compared to the paediatric subset. The management with intravenous broad spectrum antibiotics, drainage of the PA and surgery is the main stay of treatment in an adult patient. In this case report, a seven year old female child who detected to have a PA and managed only conservatively has presented and discussed.

178-182

Authors: Bhavani K, Vani Isukapalli, Nagamani T, Silpa Hasa S

Endometrial stromal tumors (EST) arise from stromal component of endometrium and are rare and common in peri or postmenopausal age group. EST are partially estrogen dependent tumors and their histopathology resemble the stromal cells of normal proliferative endometrium. They present in varied forms pathologically ranging from most benign to most malignant variants. Diagnosis essentially is by histopathology and prognosis is based on the mitotic activity of the tumor. We have presented here a case of EST presenting in a young nulliparous woman.

187-194

Authors: M.C. Songra , Sanjay Jain, Romil Jain, Rahul Ahluwalia, Naveen Patbamniya, Pragyey Nawalakhe

Catecholamine-secreting tumors that arise from chromaffin cells of the adrenal medulla and the sympathetic ganglia are referred to as pheochromocytomas and extra adrenal catecholamine-secreting paragangliomas (extra adrenal pheochromocytomas), respectively. Bladder paragangliomas are rare entities with initial non-specific presenting symptomatology. Differentiation of urinary bladder pheochromocytomas from other bladder tumors has important treatment implications. We have presented here the case of a 55 year old female who presented to our outpatient urology clinic with complains of hematuria for 3 months and headache for 1 month. Cystoscopy revealed diffusely thickened bladder wall with a well circumscribed smooth surfaced mass protruding from the right lateral wall of the bladder. Multiple biopsies were taken and sent for histopathology. After cystectomy, diagnosis of paraganglioma of bladder was done by histopathology and immunohistochemistry.

200-204

Authors: Yogesh M Borse, Rashmi V. Bengali, Rajesh D. Subhedar, S.A. Thorat

Pheochromocytoma is a rare catecholamine secreting neuroendocrine tumor. It is bilateral in 10% of cases. A 24 year lady with bilateral Pheochromocytoma operated for resection under epidural with general anesthesia. Diagnosis was confirmed with 24 hour urinary VMA levels, USG, CT scan and MIBG scan. Tumor resection was incomplete on left side so patient underwent reexploration. Preoperative BP controlled with Phenoxybenzamine and Prazocine. Intra-operative BP fluctuations managed with sodium nitropruside and esmolol. Post operative hypotension was tackled with higher doses of Dopamine and Noradrenaline due to down regulation of adrenergic receptors. Patient was discharged on oral steroids after 3 weeks.

210-212

Authors: Harish Kumar Y, Sridhar K, Srinivas MG, Thankappan KR

A 50 year female presented with dysphagia for 2 months and she denied pain during swallowing, retrosternal pain, drooling of saliva, nasal regurgitation, cough, breathlessness, hoarseness of voice, abdominal pain, vomiting, loss of weight or loss of appetite. Upper gastrointestinal (UGI) endoscopy revealed a web at 17 cm from incisors. Post endoscopy patient developed pain over the upper abdomen which worsened during swallowing and breathing. Because of rapid development of these symptoms we suspected esophageal perforation/dissection. Complete blood picture suggestive of neutrophilic leukocytosis and other parameters were normal. Thin barium study showed pseudo lumen in esophagus and confirmed the diagnosis of esophageal web with esophageal dissection. Patient was treated conservatively with nil per oral and parenteral fluids and antibiotics. Web was dilated after 2 weeks with Salivary-Gilliard dilators and procedure was uneventful and oral feeding was initiated.

218-224

Authors: Ambesh Kumar Rai, Bipin Kumar Yadav

The implementation and execution of effective infection control protocols among all health care communities cannot be overstressed. Infection control becomes even more significant in dentistry as more microorganisms are found in the oral cavity than in any other part of the body. Saliva is about half as infectious as blood, and the most likely modes of transmission in dental offices are through puncture wounds, skin abrasions, or lesions. Dental aerosols, splattering, and instrument contamination can also transmit virus, which can survive for several weeks at room temperature. With Orthodontists showing the second highest incidence of hepatitis B among dental professionals, the need of stringent infection control protocol in an orthodontic office becomes mandatory. This article discusses various sterilization protocols with their relevant scientific data keeping the instruments longevity in mind to facilitate the discerning orthodontist in make an informed decision towards their implementation.

1-4

Authors: Usha Kataria, Sunita Siwach, Dinesh Chhillar

Background: Vaginal discharge is a common symptom of genital infection in woman. Identifying its source can be challenging as large number of pathogens causes vaginal and cervical infection and several other infections may coexist. Aim: To find out the possible causes of vaginal infection in sexually active woman. Material and methods: One hundred sexually active females in the age group of 20-45 years with complaints of vaginal discharge were selected for the study. A detailed clinical history and a thorough clinical examination were carried out. After making the clinical diagnosis appropriate test for diagnosing candidiasis, trichomoniasis, gonorrhea and bacterial vaginosis were done. Results: The present study showed 34% incidence of bacterial vaginosis, 30% vulvo-vaginal candidiasis, 14% trichomoniasis, 2% gonorrhea, 2% normal physiological discharge and 18% non specific urogenital infections. Conclusion: Every patient, who complains of vaginal discharge, should be thoroughly interrogated, examined and investigated properly.

11-16

Authors: Alpesh B. Amin, Rajesh D. Patel, Chirag Doshi, Amit V Bhuva

Objective: To compare the effectiveness of conservative medical treatment versus minimal invasive surgical techniques like percutaneous catheter drainage (PCD) and percutaneous needle aspiration (PNA) in the management of liver abscess. Material and methods: All patients with liver abscess who were admitted in Surgery from October 2013 to June 2014 were included in this study and were exposed to four different treatment modalities. The patients were first treated with combination of medicine (Option - A). If they failed to respond to this treatment then they were subjected to ultrasound guided aspiration (Option - B). If Option - B failed they were exposed to pig tail catheter placement (Option - C). Final option was surgical drainage (Option - D) if it was rupture liver abscess and if the patient presented with co morbid conditions like septicaemia and peritonitis. PNA was repeated every third day if the cavity size had not declined to 50% of the original for up to three times. Persistence of cavity or of clinical symptoms was considered failure of treatment. Results: Out of 51 patients, 14 patients responded to drug therapy alone. 34 patients required ultrasound guided aspiration and Pig tail catheter placement and 3 patients required open surgical drainage. A combination of drug therapy and ultrasound guided needle aspiration was effective for majority of 83% patients Duration of hospital stay was similar in the two groups. Conclusion: Minimal surgical interventions like PCD and PNA are better than conservative treatment for the management of liver abscesses of size >5 cm, in terms of duration to attain clinical relief and duration for which parenteral antibiotics are needed. Pyogenic liver abscess are less common than amoebic liver abscess. Right lobe of the liver is most commonly involved in both types of abscesses. Radio-imaging techniques like ultrasonography (US) and computerized tomography (CT) are the modalities of choice for investigation purposes. Treatment modalities of these abscesses, first emphasizes on medical treatment, but if it is unsuccessful then only the surgical intervention should be taken up. Laparotomy and Drainage or Laparoscopic Drainage remains the standard of care for ruptured liver abscess.

27-33

Authors: M S Sulakshana, S M Ahmed, A R Raghupathi

Aim: To study the bone marrow changes in elderly patients (above 60 years of age). Material and methods: Bone marrow records from the pathology laboratory in the Department of Pathology, Bangalore Medical College, Bangalore, from March 2012 to June 2013, were searched, and cases from all patients at least 60 years old at the time of bone marrow study were retrospectively reviewed. Results: During the 16 months period, 164 bone marrow examinations were performed, and out of these, 50 patients were at least 60 years old. The age range of the patients was 60 to 82 years, 27 were males and 23 were females. 47 cases (94%) yielded specific diagnosis. 27 cases (54%) had nutritional anemia, 6 cases (12%) were diagnosed as myeloma, 3 cases (6%) had aplastic anemia, 3 cases (6%) had chronic lymphocytic leukemia/ small lymphocytic leukemia infiltrating the bone marrow; 2 cases (4%) had acute myeloid leukemia, 2 cases (4%) had hypocellular marrow with myelofibrosis - grade 3, 2 cases were diagnosed to have monoclonal gammopathy of undetermined significance (4%), 1 case (2%) had metastatic deposits from prostatic carcinoma and 1 case (2%) had metastatic deposits from renal cell carcinoma - clear cell variant; 1 case (2%) of myelodysplastic syndrome - refractory cytopenia with multi lineage dysplasia and ringed sideroblasts was diagnosed. Conclusions: In this study we found that after nutritional anemia, plasma cell dyscrasias were the most common findings in bone marrow studies in elderly patients. Diagnosis of plasma cell dyscrasias prompt for early institution of treatment resulting in reduced morbidity and mortality in such patients.

39-51

Authors: M.S. Siddegowda, Mahadeva Nayaka, S. Shivakumar

Introduction: Thyroid lesions are rare in children and youth. Compared to adults, they show high malignancy rate. Peak incidence is between 20 to 24 years of age. Objectives: To evaluate the utility of Fine Needle Aspiration Cytology (FNAC) of thyroid lesions in children and youth by “The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC)”. Materials and Methods: A prospective study was conducted over a period of 18 months. FNAC was performed on 106 children and youth of 1 year to 24 years age and classified according to TBSRTC. Results: Median age was 18.9 years. Majority (57.5%) were females in 20 years to 24 years age group. Out of 106 patients, 4.7%, 85.8%, 4.7%, 1.9%, 0.9% and 2% were distributed among diagnostic categories I, II, III, IV, V and VI of TBSRTC respectively. Six (5.6%) patients underwent surgery and histopathological study was done. The sensitivity, specificity and accuracy rates were 100%, 97.8% and 98% respectively. Conclusion: TBSRTC for FNAC of thyroid is a definitive diagnostic test to triage patients on the requirement of surgery and to differentiate malignant from non-malignant lesions in children and youth.

57-63

Authors: Manpreet Kaur, Manjeet Singh Dhanda, Abhishek Singh, Bikramjeet Singh, Pooja Goyal, Shewtank Goel, Avinash Surana, Sanjeet Panesar, Anurag Ambroz Singh, Richa Chaturvedi, Lalit Kumar Singh

Background: Voluntary eye donation depends on the awareness levels of various stakeholders in the community. Today’s medical students are tomorrow’s stakeholders of the community. Medical professionals can enhance eye donation rates by educating and motivating the relatives in case of patient's death. Aim: Hence the present study was undertaken with an objective of assessing the promoting factors for eye donation among medical students. Material and methods: The present descriptive cross sectional study was carried out among undergraduate students of a medical college in western Uttar Pradesh in the month of February 2014 using pretested self administered questionnaire. Results: 77% students knew about eye donation. 51% of them were willing to donate their eyes. Only 39% students knew that the ideal time for eye donation is within 6 hours of death. 64% had knowledge about vitamin A’s important role in prevention of childhood blindness. TV, newspaper or other media were the most important channels of getting information for majority (60%) of the students. Regarding perceived promoting factors for eye donation by them, noble cause (57%), pleasure to help the blind (51%) and inspired by advertisement on television (42%) were 3 top most promoting factors. Conclusion: Inclusion of different preventive and promotive aspects of corneal blindness along with basic eye health care into the course curriculum is the need of the hour.

70-77

Authors: Junu Devi, Kunja Lal Talukdar

Background: Accounting for less than 2% of all human neoplasms, salivary gland tumors are relatively uncommon and it comprises a morphologically diverse group of rare tumors. FNAC has been employed in pre-operative diagnosis of salivary gland tumor as essential diagnostic tool to diagnose swelling in major and some minor salivary glands. Superficial locations of salivary glands make them suitable for FNAC. Objectives: To find out the frequency of different types of salivary gland tumors in a hospital based samples and make clinicopathological correlation. Material and methods: FNAC of all 84 patients was done using 22 gauge needle and 10 ml syringe applying negative pressure, smears were either wet fixed or air dried and stained by Papanicolau and Giemsa stains respectively. Histopathological examination was done whenever available and was compared with FNAC diagnosis. Results: In this study, overall male predominance with male to female ratio was 1.4: 1. Maximum number of cases of salivary gland neoplasms occurs in 3rd decade of life. Incidence of malignant and benign parotid neoplasms was 32.14% and 67.86% respectively. Parotid was the most commonly affected salivary gland. Benign tumors were more common in parotid gland however, malignant tumor were more common in submandibular gland. Pleomorphic adenoma (60.71%) was most common benign tumor and mucoepidermoid carcinoma (22.02%) was the most common malignant tumor. Conclusion: FNAC is a simple quick inexpensive and minimally invasive technique to diagnose different types of salivary gland tumor. It could easily differentiate benign from malignant neoplasms and can be helpful for management of patient. Thus, FNAC can be recommended as first line of investigation in the diagnosis of salivary gland tumors.

83-89

Authors: Shama Prakash, Manpreet Kaur, Bikramjeet Singh, Abhishek Singh, Pooja Goyal, Avinash Surana, Shewtank Goel, Sanjeet Panesar, Anurag Ambroz Singh, Richa Chaturvedi, Lalit kumar singh

Background: Identification of factors affecting utilization of primary eye health services would help the government and other eye care providers to address inequity issues in their eye care program. Aim: Therefore this study was planned to find out barrier to utilization of eye health services among people living in rural western Uttar Pradesh. Material and methods: The current community based cross-sectional survey which involved both qualitative and quantitative methods, was conducted among the residents. A total of 216 study subjects participated in the study. Factors in the supply side influencing utilization of eye health services by people from the community were sought through Focus Group Discussion (FGD) and Key Informant Interview (KII). Results: Almost 80% of the respondents had agriculture as their major occupation and > 1/4th were from lower caste community. Regarding the seeking of eye care services, 52.4% respondents who gave a positive history of an eye problem in the family told they attended the nearest health facility; CHC, PHC or SC while 19.2% did actually go to the eye health center. Only 4.8% respondent did not seek any service. Among 112 respondents who were aware of one or other eye diseases, 74.6% identified dirty things fallen into the eyes as the cause of an eye problem followed by 50.3% of the respondents who pointed out injury to the eyes as the culprit. For emergency problem in the eyes 79.2% respondents told that they sought services from health facilities without delay, while 15.4% gave priority to starting household treatment. Conclusion: Raising awareness of the community about eye diseases and the services available together with strengthening of primary eye health services available at the local health facilities could help bring eye health services in closer proximity to the rural population.

96-113

Authors: Mahim Koshariya, M.C. Songra, Rohit Namdeo, Arpan Chaudhary, Sumit Agarwal, A. Rai

Hospital-acquired urinary tract infection (UTI) is the most common infection acquired in hospitals. Up to 25% of hospitalised patients undergo urinary catheterisation, a similar proportion of patients cared for in residential homes will have long term indwelling catheters. Although often necessary intervention, indwelling urinary catheters are a leading cause of nosocomial infections and have been associated with both morbidity and mortality. The urinary tract accounts for more than 40% of total number of nosocomial infections. Most nosocomial infections associated with urinary tract follow instrumentations, usually with the catheter. Results of several studies demonstrated that this antibiotic drug prophylaxis has increased the rate of isolation of resistant organisms. To ensure appropriate therapy, current knowledge of organisms that cause UTI and the antibiotic susceptibility is mandatory. The aim of present study was to assess the bacterial profile for catheter associated UTI and the antimicrobial sensitive to most commonly used antibiotics, used in the therapeutic or prophylactic settings before the results of the urine culture are available. In our study, the incidence of infection in catheterized patients was found to be 27% which was low but comparable to studies done in India and Western studies. E. coli was the most common cause of catheter associated infection and highest sensitivity was found to Amikacin.

119-125

Authors: Madhureema Das, Aparajita Dasgupta

Introduction: Unregulated fertility not only has adverse impact on the health of a woman and her child but also disrupts the economy of society and nation. Thus appropriate knowledge and practice of contraception by couples can help in reducing population burden in a major way and thus markedly improve both health and economy of the nation. Aim: This study was undertaken to determine the knowledge and practice of contraception among married women in rural West Bengal and association of practice with female literacy. Material and methods: A cross-sectional, clinic-based study was conducted using a pre-designed semi-structured questionnaire on 104 married women in the reproductive age group, attending the outpatient department of a rural health centre at Singur block, West Bengal. Pregnant women were excluded from the study. Results: Majority of the women had knowledge about permanent methods (99.03%), oral pills (95.19%) and condoms (94.23%) but very few knew about emergency contraceptives (8.65%) and none about female condoms, diaphragms and implants .Social circle (41.3%) and health personnel (31.7%) served as the major sources of information. 85.57% were currently using some form of contraception. Most of the current users (49.04%) had undergone tubal ligation but none adopted male sterilization. Completion of family was the main reason of usage (57.3%) and fear of side effects (46.7%) and desire for children (40%) were the main reasons behind non usage. Husbands mostly decided the method of contraception (64.04%). Education served as a significant determinant of contraceptive use. Conclusion: Elimination of stigma related to vasectomy and women empowerment and literacy will improve contraceptive use.

137-152

Authors: Rajeev R. Shah, Meeta Gupta

Background: AIDS emerged as one of the most important public health issues of the late twentieth and early twenty-first centuries. The AIDS epidemic has prompted wide-reaching changes in public health, clinical practice, and scientific research, and has had a great impact upon societies throughout the world. Aim: This article gave an insight into beak up of mode of transmission seen in our studied area of Gujarat, which highlighted in which area one should focus more at least to control the prevalence of HIV. Material and methods: In the present study, 961 HIV sero-positive patients (T group) were screened with respiratory tract infections and more 300 HIV sero-positive patients but without respiratory tract infections (C2 group) had been inquired and collected their information about mode of transmission and other demographic characters like age, literacy, financial status, gender etc. Results: The highest patients had acquired HIV by hetero-sexual mode of transmission. In T group it was found to be in 773 (80.43%), while in C2 group it was seen among 257 (85.67%) HIV infected patients. But when both groups are merged which we consider TC2 group, this hetero-sexual mode of transmission was noted in 1030 (81.68%) HIV infected patients, followed by mother to child transmission (MTCT) which was found in 101 (10.51%) patients of T group while MTCT was seen in 29 (9.67%) HIV infected patients of C2 group. Conclusion: If anybody knows exact percentage of acquiring HIV in the particular area, one can work on this direction, to reduce that particular mode of transmission so that at least prevalence of HIV could certainly be decreased tremendously in that particular area, state, country and ultimately from globe. Minimum transmission of HIV can be achieved by widespread of ABC (Abstinence, behavioral change, condoms) policy and with additional maximum and quick implementation of TasP (Treatment as prevention), PrEP (Pre-exposure prophylaxis) and PEP (Post exposure prophylaxis) as and when required in the all ART Centres of our country.

156-160

Authors: J Janardhan, P Venkateshwar, K Sreedhar Rao

A 10 years prepubertal age girl presented with huge 17 X 14 cm painless breast lump of four months duration. Based on the cytological, imaging and clinical findings a preliminary diagnosis of benign proliferative breast lesion closest to giant fibroadenoma was offered. Giant fibroadenomas are rare in young girls and are difficult to differentiate from low grade phylloides tumor by cytology/ imaging. Giant fibroadenomas have to be differentiated from phylloides tumor by the lack of leaf-like structures and stromal cell atypia and from the breast hamartoma and asymmetric breast hypertrophy in girls by the lack of mammary lobules. Giant fibroadenoma should take its due place in the diagnostic algorithm of the breast tumors. Marginal excision with nipple areola sparing and close follow up should be the standard of treatment in young girls.

166-169

Authors: Annie Jain, Gunvanti Rathod

Oncocytomas are benign salivary gland tumors composed of oncocytes, cuboidal to columnar epithelial cells with abundant eosinophilic cytoplasm secondary to the accumulation of excessive number of mitochondria. In 1894, the German pathologist Hurthle first described these granular cells in normal canine thyroid glands, while the term "Oncocyte" was coined by Hamperl in 1931. Fine Needle Aspiration Cytology (FNAC) has increasingly been used as a primary screening tool for salivary gland lesions with high levels of sensitivity and specificity. However, caution should be exercised when interpreting aspirates with predominant oncocytic population. Final diagnosis is assisted by CT and/or magnetic resonance imaging (MRI) of the neck and histopathologic examination.

175-178

Authors: Nataraj Naidu R, Shreeharsha Mallappa Awati

A 32 years old healthy male, married for 6 years presented with infertility. Clinical examination revealed normal external genitalia with underdeveloped empty scrotum. Radiological investigations reported bilateral intra abdominal testis with left testis showing features of teratoma. Intra-operative findings showed bilateral intra abdominal testis along with uterus and fallopian tube and left testis with features of teratoma. Histopathology confirmed the presence of uterus, cervix, right adnexa with atropic testis with tube, seminal vesical, epididymis, and left adnexa ovotestis with mature teratoma, tube and epididymis. Cytogenetics reported 46, XY karyotype. This case is rare presentation of combination of male phenotype true hermaphrodite with presence of teratoma.

182-186

Authors: Nupur Singla, Gunvanti Rathod, Disha Singla

Adenoid cystic carcinoma (ADCC) is a relatively rare malignant salivary gland tumor comprising less than 1% of all malignancies of head and neck. It can arise in any salivary gland site, but approximately 50–60% develops within the minor salivary glands. On fine needle aspiration cytology (FNAC), hyaline globules surrounded by neoplastic cells forming a cell ball are the diagnostic. Adenoid cystic carcinoma, being rare, was not suspected at the first instance. The final diagnosis was made from the cytological, radiological, and histopathological reports.

190-194

Authors: Meraj Rentia, Krunal kalaria, Himanshu Singla, Shreedevi Patel, B.N. Patel

Slipped capital femoral epiphysis is a disorder of the hip that affects children in late childhood and early adolescence, characterized by medial and posterior displacement of the proximal femoral epiphysis on the metaphysis. Although the diagnosis and treatment of slipped capital femoral epiphysis have been well described, the search for its cause and a method of early identification continues. We have reported here an interesting case of a bilateral slipped capital femoral epiphysis as an unusual presentation in one family - father and two siblings, had no record of any hormonal imbalances or endocrine abnormalities; had good nutrition; and presented with atypical characteristics of slipped capital femoral epiphysis.

199-202

Authors: Vani D, Giri Punja M, Geetanjali S, Bharathi M, Dayananda TR

Syringocystadenoma papilliferum, a distinct dermatologic entity, is an exceedingly rare benign skin neoplasm and seems to have arisen from apocrine or eccrine adnexal structures. The diagnosis is clinically suspected and histologically confirmed due to its non-distinct clinical findings and varied presentations. Since it usually appears at birth or during puberty and adolescence, it is called as Childhood tumor. Complete surgical excision is the treatment of choice followed by detailed histologic examination, to avoid the risk of malignant degeneration. Herein, we have reported a rare case of Syringocystadenoma papilliferum of eyelid in an adolescent female.

207-210

Authors: Mahim Koshariya, Vivek Sharma, Arvind Meravi, Krishna Kanwar, Shivang Saxena, S. Shukla, M.C. Songra

A hemangiopericytoma is a rare tumor that originates in the pericytes in the wall of capillaries. It is usually benign in nature and is located in the soft tissues. These tumors can originate anywhere in the body where there are capillaries. The most common locations reported are the brain, lower extremities, pelvic area, head, and neck and abdominal cavity. We have reported here a case of hemangiopericytoma in inguinal region in a 70 year old male patient, who presented with right inguinal mass, which was masking the occurrence of right indirect inguinal hernia and diagnosed as hemangiopericytoma by histopathology.

217-222

Authors: Malay Kumar, Akhtar Riaz, Pushpam Dwivedi, Thippeswamy SH, Abhisheik Khare, Renuka Verma

The practice of placing a small amount of chewing tobacco or snuff in the oral cavity and leaving it in place for extended periods of time appears to be finding its way into young and middle aged adults as a socially acceptable and popular habit. Cancer development at the site of placement and other oral mucosal lesions caused by these products has been described from several population groups. As the composition and the pattern of use of the product vary, evaluation of each type of smokeless tobacco (ST) has to be undertaken with caution. This review thus, highlights the use of ST and its significance as the causative for oral cancer.

1-7

Authors: Romsha Ratan Purohit, Neeta Jayprakash Vyas, Megha Sandeep Sheth

Introduction: Hippo therapy is a form of physical, occupational and speech therapy in which a therapist uses the characteristic movements of a horse. The horse's pelvis has a similar three-dimensional movement to the human's pelvis at the walk. This movement provides physical and sensory input which is variable, rhythmic and repetitive which leads to improvement in spasticity and balance. Objective: The study aimed to find the effect of hippo therapy on balance and function in children with spastic diplegia. Material and methods: A quasi-experimental study was conducted at College of Physiotherapy, Ahmadabad. Sixteen children (8 in control group (A) and 8 in experimental group (B) with spastic cerebral palsy, aged 3 to 10 years with GMFCS level 1, 2, body weight less than 35 kg were included. Children with history of botulism toxin injection within 6 months, selective dorsal rhizotomy or orthopedic surgery within 1 year, moderate to severe intellectual disability, uncontrolled seizures, and poor visual or hearing acuity were excluded. Both groups were given neuro developmental technique (NDT), group B was given additional hippo therapy (riding on horse with minimal support as required) for 15 minutes twice a week. Outcome measures were Pediatric balance scale (PBS), GMFM 66, 88, Modified Ashworth scale. Level of significance was kept at 5%. Result: Within group, analysis did not show significant difference in GMFM scores in group A (W = 1.84, p = 0.066), but showed significant difference in PBS score (W = 2.214, p = 0.027). Within group analysis for group B showed significant difference in both GMFM score (W = 2.207, p = 0.027) and PBS score (W = 2.214, p = 0.027). Between group analysis for GMFM score showed significant difference (U = 0.500, p = 0.005). But there was no significant difference in between group analysis for PBS score (U = 12.00, p = 0.321). Conclusion: Hippo therapy and NDT both have similar effect for improving balance in spastic diplegic children. But Hippo therapy has an additional effect for improving gross motor function.

14-20

Authors: Anurag Ambroz Singh, Manpreet Kaur, Abhishek Singh, Shewtank Goel, Avinash Surana, Anu Bhardwaj, Sanjeet Panesar, Virender K Chhoker, Richa Chaturvedi

Background: Better management of patients cannot be ensured and the antibiotic policy cannot be designed till one knows the profile of prevalent strains along with their antimicrobial resistance pattern. Objective: To assess the strategic patterns of the organisms and its resistance patterns that were isolated from the patients admitted in various ICUs in a tertiary care hospital. Material and methods: The present study was undertaken based on reports of bacterial isolates of various clinical specimens from different ICUs of a tertiary care teaching hospital, that were submitted to the Microbiology laboratory for culture and sensitivity during the period of October 2012 to September 2014. All the organisms were identified morphologically and biochemically by standard laboratory procedure and antibiotic susceptibility pattern was determined by disc diffusion methods. Results: Out of the total samples (2920) received; organisms were isolated from 66.57%. One organism was isolated in 71.19% samples whereas 2 or more organisms were obtained in 28.8% samples. The most frequently isolated bacteria were P. aeruginosa (38.17%). Among P. aeruginosa, tobramycin had the highest susceptibility rate (94.2%) followed by meropenem (93.93%), carbenecillin (79.11%), and levofloxacin (73.45%). Most of the frequently isolated organisms like K. pneumoniae, Acinetobacter anitratus, Enterobacter were highly resistant to ampicillin, cephalexin, cefepime, ciprofloxacin. Conclusion: Appropriate antibiotic utilization in ICU is crucial not only to ensure an optimal outcome, but also to prevent the emergence of multi drug resistance. Antibiotic policies and effective surveillance are needed for better management of ICU infections with resistant organisms. Alteration and rotation in antibiotic prescribing patterns would decline the antibiotic resistance.

28-39

Authors: Arthiie Thangavelu, Sugumari Elavarasu, Thangakumaran Suthanthiran, Karthikeyan Sengottuvel, Saranya Selvaraj, Jayashakthi Saravanan

Aim and objectives: The aim of the present study was to compare autogenous bone graft (Group - 1) and xenograft combined with PRP (Group - 2). The clinical and radiographic healing was evaluated after a period of six months in periodontal intra bony defects. Material and methods: A split mouth design was followed, where two sites in the contra lateral quadrants with probing pocket depth of ≥ 5 mm with radiographic evidence of bone loss at baseline were chosen. Patients were grouped as Group - 1: 7 intra bony defects treated with autogenous bone grafts, Group - 2: 7 intra bony defects treated with xenogenic grafts and platelet rich plasma (PRP). Results: The mean plaque index score, oral hygiene index score, gingival index score showed statistically significant difference from baseline to 6 months. On comparison between Group - 1 and Group - 2 from baseline to 3rd and 6th month, mean PPD, CAL, defect fill was statistically highly significant with p-value <0.001. The percentage of mean PPD, CAL, defect fill was also assessed. Conclusion: The surgical reconstructive treatment of intra-osseous defects with autogenous bone graft (Group - 1) resulted in clinically and statistically significant higher probing pocket depth reduction, clinical attachment level gain and radiographic bone fill compared to xenograft mixed with PRP (Group - 2).

47-53

Authors: Abdul Hamid, Syed Tariq, Mohammad Ishaq, Farooq Ahmad Ganie, Shagufta Roohi, Shazia Akhter, Mohsin Rashid

Objective: To determine the renal size in normal North Indian children by renal sonography. Design: Hospital based (outpatient based) cross sectional observational study. Material and methods: Total 1198 normal children aged 1 month to 12 years were included in the study. Sonographic assessment of renal size (length, width and thickness) was performed using Philips, multi frequency (3.5, 5 and 7.5 Mhz) linear and convex probes in B-mode. The mean renal dimensions and volume were calculated for each age group with ± 2SD. The renal length and calculated renal volume were correlated with somatic parameters like age, weight, height, and body surface area (BSA). Linear Regression equations were derived for each variable. Results: A strong correlation was seen between renal size and renal volume with various somatic parameters (age, weight, height, BSA), (coefficient of correlation = 0.9). Conclusion: This study provides values of renal size (mean ± 2SD) in normal North Indian children and its correlation with age, weight, height, and BSA. Renal size can be easily calculated by derived linear regression equation.

57-67

Authors: N Vinoth, CRM Karthikeyan, Hiren Parmar

Background: Inguinal hernia surgery is the most commonly performed surgery worldwide. Lichtenstein tension free repair using polypropylene mesh is the gold standard procedure for inguinal hernioplasty. Wound infection is the most common complication encountered in any surgical procedure. Antibiotic prophylaxis for open inguinal hernioplasty in minimizing wound infection has been a subject of debate since the beginning of mesh repair. We have conducted a randomized clinical trial in our hospital to analyze the usefulness of antibiotics in open inguinal hernioplasty. Material and methods: 60 patients were included in this prospective randomized control trial. 30 of them received 1 g of Injection Cefataxim half an hour before surgery and remaining 30 received injection Multivitamin infusion. Lichtenstein tension free hernia repair using polypropylene mesh was done. Superficial SSI was diagnosed according to CDC criteria. Results: Totally 5 patients developed SSI (8.33%). Out of the five, 2 (6.67%) were in antibiotic group and remaining 3 (10%) were in placebo group (p = 0.64). Odd’s ratio was 0.6429 (CI=0.0995 to 4.1531). All 5 had only superficial SSI; there was no deep surgical site infection (SSI). 2 patients were managed with dressing alone and remaining 3 with antibiotics. After 2 weeks, 2 had wound gapping and at four weeks wound was normal in all patients. 2 out of 5 were above 60 years of age and no SSI occurred >30 years of age (p value = 0.59). Conclusion: Routine use of antibiotics is not necessary in all open inguinal hernioplasty. Antibiotics can be reserved only for patients who are in high risk of SSI. Regularizing the use of antibiotics will have a good cost benefit and decrease the emergence of drug resistant organisms.

73-78

Authors: Satish Kumar Bansal, Sham Singla, Gopal singal, Sanjay Gupta

Background: Since the introduction of male sterilization by surgery on vas deferens, several techniques have emerged to improve the results in terms of time, invasiveness, post operative infection, complications and success rate. Introduction: Vasectomy was introduced by Sharp in 1897. No scalpel vasectomy was introduced in China by Dr. Li Shun-Qiang in 1974. Intact fascial sheath helps in restoration of vas lumen and fascial sheath interposition prevents recanalization of vas by prevention of meeting of epithelialization from cut end of vas. Material and methods: The study was performed at PGIMS, Rohtak by performing surgery and follow-up up to one year of 326 subjects of no scalpel vasectomy. Clients were allocated in two groups. Group - A (155) with fascial sheath interposition and Group – B (171) without fascial sheath interposition. Surgeries were performed as a routine surgical procedure after full preparation of client including consent. Results: Majority of clients (56.1%) in Group - A were in age group 31-40 years followed by 22-30 years (28.4%), 41-50 years (14.8%) and 0.7% in age group more than 50 years. In Group – B, majority were also in age group 21-30 years (63.7%), followed by 31-40 years (29.8%), 41-50 years(5.9%) and 0.6% were of above 50 years. In Group – A, fascial sheath interposition was not possible in 17.2% clients due to non separation of sheath from vas. Sperm granuloma formation was observed in 8.6% in Group - A and 5.6% in Group - B. In comparison of 100% success rate in Group - A failure rate of 1.8% was observed in Group - B. Conclusion: The present study supports the existing literature that fascial sheath interposition adds a little more to the operating time of vasectomy, increases chances of wound infection and granuloma but has a less failure rate of vasectomy.

87-95

Authors: M. Mamatha, S. Chandra Sekhar, H. Sandhya Rani, S. Sandhya Anil, G. Vandana

Aim and objectives: To compare the conventional and the Bethesda system for reporting thyroid cytopathology (TBSRTC), to correlate the cases with histology wherever available and to determine the sensitivity, specificity and false positive rates of both the methods. Material and methods: A Total of 240 patients who presented with thyroid gland swelling were subjected to thyroid fine needle aspiration cytology (FNAC) and the smears were made followed by H&E staining and reporting was done. The conventional system used at our centre includes description of microscopic findings of the case along with an impression at the end. The categorization according to the Bethesda system of reporting thyroid cytology were done using criteria published in the atlas and related literature. The cytological diagnosis was correlated with the histological diagnosis wherever it was available. The sensitivity, specificity, false positive rates were calculated considering cytology as screening test for differentiating between neoplastic and non-neoplastic lesions. Results: When the results of the conventional system were compared with the Bethesda adapted method was found to be more superior. Sensitivity of Bethesda system was significantly high (100%) as compared to conventional system (77%). Specificity of Bethesda system was also significantly high (82.5%) as compared to conventional system (69%). Conclusion: Our findings were consistent with others who used the Bethesda cytopathology reporting system.

103-107

Authors: Dhaval Patel, H.V. Patel

Laparoscopic abdominal surgery is conventionally done under general anesthesia. Spinal anesthesia is usually preferred in patients where general anesthesia is contraindicated. We have presented here our experience using spinal anesthesia as the first choice for laparoscopic surgery for over 2 years with the contention that it is a good alternative to general anesthesia.

119-125

Authors: Debkumar Ray, Debashis Roy Burman, Indranil Dhar, Soumik Ghosh, Debabrata Nandy

To detect presence of high molecular weight com¬plexes of IgG and fibronectin, plasma of patients with Acute Myeloid Leukemia was examined by polyethylene glycol (PEG) precipitation, analytical ultracentrifugation, and immunoaffinity chromatography. Ultracen¬trifugation identified abnormal circulating high molecular weight IgG in all patients. This was precipitated by PEG and was shown by exclusion chromatography to contain IgG in a high molecular weight form. Exam¬ination of plasma by immunoaffinity chromatography supported evidence for complex formation between IgG and fibronectin and further showed that abnormal high molecular weight IgG complexes are a prominent feature of Acute Myeloid Leukemia and implicate IgG fibronectin complex formation.

134-141

Authors: Ritu Singroha, Usha Verma, Sudha Chhabra

Background: Dissection of the dead human body has been central to medical education since Renaissance. First year medical students normally experience a variety of emotional reactions and mixed feelings, when they encounter human cadavers for the first time. Aim: In order to assess the impact of anxiety and physical symptoms from the experience of dissection room, a questionnaire was prepared which provide an insight into the difference in attitudes and dissection hall experience of the male and female medical students. Material and methods: Total 181 students were given a questionnaire within 3-4 days of the start of dissection in the dissection hall. The students were asked to answer in either ‘Yes’ or ‘No’ option. Observation: No statistical significant difference was found between the responses of male and female students except regarding the previous exposure to dead body, which was more in males and statistically significant (p<0.05). Difficulty in consuming food and shivering of hands were more common in males in comparison to females. Conclusion: A better teacher – student interaction, pre-education sessions will help in improving the attitudes of students towards cadaveric dissection, which will in turn offer a stable mental status for medicos to handle higher levels of stress in their clinical career, thereby reducing the drop-out rates.

146-150

Authors: Vijayalakshmi S, Mahendra G, Naga Prathyusha, Ravindra Pukale, Sekhar Durgam, Subrahmani

Cervical agenesis is a very rare condition often associated with atresia of vagina. Clinical diagnosis is usually difficult before surgery. Transverse vaginal septum or vaginal agenesis is also a rare condition that results from incomplete fusion between vaginal components of the mullerian ducts and urogenital sinus. Here we presented case of 16 years old girl who presented with primary amenorrhea and cyclical lower abdominal pain for 6 months. Abdomino-pelvic scan showed hematometra with bilateral hematosalpinx with mild free fluid in pouch of Douglas with collapsed vagina and cervix. MRI pelvis confirmed USG findings giving differential diagnosis of high vaginal septum or cervical agenesis. She was operated for cervical recanalization and vaginoplasty.

155-160

Authors: Tushar M. Kalekar

Localized nodular synovitis is an uncommon entity with different presentations. It is a benign proliferative disorder that originates from a small area of the synovium. This disorder is found most frequently in the tendon sheaths of the small joints of the fingers and toes. We reported here a case of localized nodular synovitis in a 30 years young man who came with complaints of discomfort in the knee joint. Swelling in the infrapatellar region was diagnosed on physical examination. On MR imaging, a solitary ovoid mass lesion was identified in the infrapatellar region involving the infra patellar fat of pad. Mild enhancement within the lesion was observed after administration of intravenous gadolinium. There was mild to moderate joint effusions in the suprapatellar bursa. Mild synovial enhancement was demonstrated. No meniscal or ligament tear was identified. Prospective diagnosis based on MR imaging was localized nodular synovitis.

165-168

Authors: Kandukuri Mahesh Kumar, Ch. Krishna Reddy, Chintakindi Sravan, T. Divyagna, Harshini Reddy, Medak Harika

Primary gastric adenosquamous carcinomas are rare and constitute less than 0.5% of all gastric malignancies. They are common in males and seen in sixth decade of life. These tumors are composed of both adenocarcinoma and squamous cell carcinoma in varied proportions. Here we have presented such a rare case in a 47 years old male patient who presented with complaints of abdominal pain and bleeding. Routine investigations were normal except for mild anemia. Upper gastrointestinal endoscopy revealed ulcerartive lesion in the pyloric antrum. Histopathological examination confirmed the diagnosis of adenosquamous carcinoma. They are aggressive tumors and have worse prognosis compared to adenocarcinomas hence, follow up is necessary.

175-178

Authors: Bharathi M., Giri Punja M., Shilpa K., Geetanjali S.

The thymus, a lymphoepithelial organ, during the early fetal life originates from the superior neck and descends to the mediastinum. Embryological maldescent may lead to ectopic rests of thymic tissue along the pathway of its descent, neck being the most common site of ectopic thymic rests. Ectopic cervical thymoma is an extremely rare entity, showing a striking female preponderance whereas a mediastinal thymoma has a slight female preponderance. We characterized a case of ectopic cervical thymoma using conventional light microscopy and immunohistochemistry in a 40 years old male patient who presented with a neck swelling simulating a thyroid neoplasm clinically.

183-187

Authors: Mobeen Alwani, Gunvanti B. Rathod

Anaplastic thyroid carcinoma [ATC] is a rare highly malignant tumor that arises from the follicular cells of the thyroid gland. It accounts for 1% to 2% of all thyroid carcinomas and patients with ATC uniformly have a poor prognosis. Majority of ATCs show spindle cell, giant cell and squamoid cell patterns; these 3 subtypes frequently coexist and they are not predictive of the patient’s outcome. Patients often present at an advanced stage, making curative surgical resection not feasible. Recognizing the cytological finding of the ATC and making the prompt and proper cytological diagnosis are helpful to determine the treatment plan for the patients who suffer with this entity.

193-196

Authors: Satendra Kumar, Arindam Roy, Seema Khanna, Sanjeev Kumar Gupta

Situs inversus totalis (SIT) is a rare anomaly characterized by transposition of organs to the opposite side of the body in a mirror image of normal anatomy. Location of symptoms and signs arising from a diseased organ may vary. The diagnosis as well as to operate any pathology in such patient is difficult. Laparoscopic cholecystectomy in patient with situs inversus totalis is a challenge but not a contraindication. We have reported here case of an adult woman who presented with on and off pain located at the epigastrium. Clinical examination and laboratory investigations were unremarkable. During radiological evaluation, the patient was found to have situs inversus totalis and features of chronic cholecystitis with cholelithiasis. Laparoscopic cholecystectomy was safely performed with the three-port technique in a reverse fashion by right handed surgeon. In conclusion, Laparoscopic cholecystectomy in these patients is technically more demanding and needs reorientation of visual-motor skills.

203-205

Authors: P. Venkateshwar, J. Janardhan, Sreedhar Rao, U. kiran

Entrapment of penile foreskin between zipper teeth and zip slider is a common injury in children. It is seen in boys of age group 5-12 years who usually do not wear underpants. About 80% of these injuries occur accidentally while zipping up. Here, we have described a technique which is simple, quick, pain less and require no special instruments.