Panacea Journal of Medical Sciences

112-116

Authors: Kasturi Krishnatreya, Mondita Borgohain, Jayanta Kr. Das.

Biopsy and histopathology plays an important role in establishing the cause of lymphadenopathy. Knowledge of the characteristic histopathological findings and causes of lymphadenopathy may spare patients from unnecessary and management. To study the most frequent cause of enlarged lymph nodes in our set up. To assess the spectrum of lymphadenopathy in various age groups. The study was a hospital based cross-sectional study. Total 75 numbers of patients from July 2015 till June 2016 were recruited. All specimens of lymph node biopsies damaged specimens, known cases were excluded. The diagnosis of was made on the basis of gross morphology and light microscopic features. Ziehl Neelson staining, immunohistochemistry were done whenever required. There were more male cases. Most frequently affected age group was between 40-49 years. The cervical region was most commonly affected. Benign cases were more common. Out of 44 benign cases, 55 % were reactive hyperplasia, 43% were granulomatous lesions and Castleman’s disease in 1 case. Tubercular lymphadenitis was the most frequent entity among granulomatous lesions. Of 31 malignant lesions, 55% were non-hodgkin’s lymphoma 26% were hodgkin’s lymphoma and 19% were metastatic. Lymph node biopsy remains a valuable diagnostic tool as it allows for the architecture of the gland to be viewed thereby given an accurate and concise diagnosis with minimal risk to the patient.

121-126

Authors: Nouman Saleem, Zikria Saleem, Syed Atif Raza, Maryam Qamar, Hamza Masood.

The kidney plays a vital role in homeostatic function by regulating the salts/water balance in the body. Renal function is compromised due to various factors internal and external conditions such as diabetic nephropathy (8.3%), hypertension (HTN) (42.2%), diabetes and hypertension (22.9%), drugs, age, and immune-related. Dialysis is the only option for end-stage renal disease (ESRD) beside kidney transplantation. This retrospective study was based on the collection of data from the profiles of patients undergoing dialysis in order to find the variations in physiological parameters such as; hemoglobin (Hb), bilirubin, serum creatinine, urea level, and blood pressure(B.P) both pre- and post-dialysis. Patients had concomitant diseases; hepatitis B virus (8.3%), hepatitis C virus (42.2%), diabetes mellitus (29.4%) and HTN (78.9%). Blood pressure was higher than the standard about 6-9mmHg systolic pre-dialysis and 10mm Hg post-dialysis. Whereas, the diastolic B.P was lower about 5mmHg pre-dialysis while it was up to the standards after dialysis. The Hb levels were within range showing the minor variation of about 0.2-0.3g/dL. Serum creatinine levels were higher 7.1985±3.26930 to7.9761±2.46952 and BUN was also higher than normal with the mean difference of about 0.2-5mg/dL. In conclusion, the blood pressure, hemoglobin, serum creatinine and blood urea nitrogen decreases which were raised earlier to dialysis. The weight of patient also decreased after dialysis. However increased in body weight have been observed in patients with kidney disease accompanied with diabetes. These parameters must be properly controlled to improve the health outcomes.

131-135

Authors: Nitin Deosthale, Sonali Khadakkar, Neeti Kedia, Vivek Harkare, Priti Dhoke, Kanchan Dhote

The present study was carried out to evaluate the hearing status in chronic mobile phone users and alteration in hearing status depending on years of mobile usage, per day use and longest dialogue duration in a day. This was a cross sectional observational study. Preliminary questionnairewas asked to MBBS students of a medical college and 60 volunteers were selected who were using mobile phones for at least 1 year and not having any other causes of hearing loss. In the study group, dominant ear of the subjects was included and non-dominant ear was considered as a control group. Pure tone Audiometry was done to evaluate the hearing status. Out of 60 subjects, in 76.66% subjects, right ear was dominant and in 23.33% of subjects, left ear was dominant for mobile use 52 (86.66%) dominant ears had normal hearing and 8 (13.33%) had hearing loss in high frequencies (4000 and 8000 Hz). Hearing was normal in non- dominant ear of all subjects. Mean hearing threshold in dominant ear was 10.54 + 5.75 dB while in non-dominant ear, it was 6.67 + 3.76 dB. The difference was statistically significant (p value <0.05). Hearing loss in the dominant ear was seen in subjects who were using mobile phones for 1-3 hours per day, with total duration of use > 3years and in those with longest call duration of >30 minutes. Our conclusion is that hearing threshold increases in dominant ear with long term use of mobile phone and hearing loss is more in higher frequencies in such subjects.

140-146

Authors: Tanay Tekade, Tanuja Manohar.

Prognostication is an important part of management of any critically ill patients. It helps in predicting the reliable outcome of a patients’ current standing. SOFA (Sequential Organ Function Assessment) score is a prognostic scoring system used to track a person’s status during the stay in an intensive care unit. It is based on functions of 6 organ systems-respiratory system, cardiovascular system, Hepatic system, coagulation system, excretory system and nervous system. Although it contains many parameters which are difficult to remember, one can use the readymade calculators present on internet. This study was undertaken with the objective to study the utility of SOFA scores in predicting outcome in critically ill patients. Outcome measures being ICU mortality and length of ICU stay. This prospective observational hospital based longitudinal study was carried out over a period of 2 months in a tertiary care hospital catering more of rural population. Adult critically ill patient irrespective of underlying cause were included in study after taking written consent from patient or his akin. Patient’s demographic profile, the main diagnosis leading to hospitalization in the ICU, previous interventions, complications and hospital outcomes were recorded for each patient. Appropriate investigations were done. SOFA score was calculated in period 0-24 hrs (SOFA 1), 24-48 hrs (SOFA 2) and 48-96 hrs (SOFA 3) from admission to ICU. SOFA scores were correlated with outcome measures ICU mortality and length of ICU stay. The non survivors had high initial, mean and highest SOFA scores as compared to survivors. Initial and highest scores of more than 15 corresponded to mortality of more than 75%. The predictive value of the mean score had negligible relation and therefore was independent of the length of ICU stay. Length of stay is not significant and independent of mortality. Increasing SOFA score in first 48 hrs gives a mortality rate of >50%. The SOFA scoring system is useful in predicting outcomes in ICU. High SOFA scores, and increasing trend in SOFA scores were found to be significantly associated with mortality and length of ICU stay.

58-61

Authors: Kirtan Tankshali, Zulfikar Patel, Kaushal Patel, Akash Shah.

Olecranon process is the proximal expansion of ulna bone which takes part in formation of elbow joint and is essential for elbow joint movements. Therefore, fractures of olecranon are to be treated by stable fixation and early mobilization. We have, in our study, tried to identify the best treatment option for the olecranon fracture. This is a prospective cohort study of 35 patients treated at Civil Hospital Ahmedabad for olecranon fracture between 1st January, 2015 to 31st December, 2015. Adult patients with traumatic closed isolated olecranon fractures were enrolled in our study. Post-operatively, all the patients were followed up to 6 months and their functional outcomes compared. Olecranon fractures are more common in elderly with male predilection. Post-operatively, range of movements ranged from full extension to full flexion in majority of patients but not in all. Complication like implant impingement, infection and restricted range of motion were noticed in our study. There was 100% union rate achieved at the end of 6 months. Treatment of choice for olecranon fracture depends on fracture type. Simple two-part transverse fracture is best treated with K-wiring and tension band wiring whereas oblique or comminuted fractures are best treated with olecranon plating.

65-67

Authors: Rameshbabu Kalyanasundaram, Geetanjali Narendran

Tympanoplasty results depend on the severity of middle ear disease present preoperatively. Various grading systems were developed for this. The present study was carried out to determine the Middle Ear Risk Index (MERI) score and categorise the patients into mild, moderate and severe MERI and study the relation between MERI and outcome of tympanoplasty. The study consisted of 50 patients undergoing tympanoplasty for mucosal or squamous type of CSOM. The MERI score was calculated. The patients were categorised into those with mild, moderate and severe MERI. The graft uptake status was assessed. The relation between MERI score and graft status was assessed by T test. The overall graft uptake was 76%. Patients with a high MERI score had low graft uptake. This study shows that MERI score is a prognostic indicator of tympanoplasty results. It is inverserly proportional to graft uptake.

72-76

Authors: Parthasarathi Roy, Asim Chakrabarti.

The development of concomitant squint is a function of personality trait of a child. It is also a known fact that the personality trait of a child is carried forward to his adult personality. Therefore a hypothesis that phoria is correlated with personality was postulated. The objective of the study is to examine how exophoria is correlated with neuroticism- Stable and Extravert- Introvert dimensions of personality. After taking proper informed consent, fifty-eight undergraduate and postgraduate medical students with atleast -2.00 D spherical equivalent myopia were evaluated in a tertiary eye hospital in West Bengal for their Personality on Neuroticism (N) and Extraversion (E) scales by Maudsley Personality Inventory (MPI) 48 questionnaires. Maximum and minimum possible scores on each scale was 48.00 and 0.00 respectively. Their Phoria status (hetrophoria/ orthophoria) was also evaluated. Out of a total of fifty eight (58), thirty two (32) students were male and twenty six (26) were female. The age range of the 58 students was 18-30 years (24.53 +/- 3.45). 37 (thirty-seven, 63.79%) of them had exophoria and the rest 21 (twenty-one, 36.20%) had orthophoria. Mean, Standard Deviation of the scores on Neuroticism (N) and Extraversion (E) scale for 58 students were23.82+/- 8.45 and23.06 +/- 8.78 respectively. The students were grouped into two, one with ‘Phoria’ (n=37) and other with ‘No Phoria’ (orthophoria, n=21) and were compared with two outcomes, N-scores 24 (neurotic personality tendency, n= 21) by Fisher Exact Test. The test showed exophorias were correlated with stable personality pattern (P =0.0005). However phoria was not found to be correlated with Extraversion-Introversion dimension of personality (P = 0.2836). Exophoriais correlated with stable personality pattern, a fact, which to authors’ belief, is probably discovered for the first time by this study.

83-88

Authors: Sanjay Mehta, Dimple Mehta, Kunjan Kikani.

The present study was conducted on faculties from a medical college setup to evaluate their attitudes and practices towards research. The study tries to measure the research utilization and outputs of faculties by analysis of research presentations and publications. A forty point questionnaire was prepared for evaluation and assessment of attitudes and practices towards research amongst the faculties. Randomly, 50 members of the faculties were selected for the project study. Out of total 50 faculty members 49 (98%) were interested in research, 37 (74%) had conducted research in the past, 21 (42%) had published the research work which they had carried out in the past. At the time of study 18 (36%) faculty members were engaged in research work, out of whom 12 (24%) were engaged in research as a part of their further study while only 6 (12%) were doing the research for the purpose of research. All 50 faculty members felt that research needed improvement. The attitude towards the research is quite healthy as compared to actual practice. There is a lack of utilization of research related infra-structure and facilities. There is less than desirable research output in the form of poster / paper presentation in academic meets and research publications in the journals by medical faculties in teaching institution.

92-94

Authors: Sarita Kanth, Ajay Verma, Ajay Madan

Cholelithiasis is very common in the Northern part of India. Lifestyle and food habits are contributing factors for this disease. This study aimed at the pattern, presentation, management and type of gall bladder stones in this rural population of Haryana and how the patient centric decision (when patient decides for themselves regarding types of operation either mini-laparotomy cholecystectomy or laparoscopic cholecystectomy), affect the outcome. This study includes 152 patients of cholelithiasis. Clinical presentations were noted including their dietary habits. For the definitive diagnosis, liver function test (LFT) and ultrasonography (USG) were relied upon. We have informed them about the availability of operations of cholecystectomy that is either mini-laparotomy or laparoscopic, and depending on their choice, we operated and observe the outcome. The distribution of gall bladder stones examined by USG and LFT was 75.6% in female and 24.3% in male, ranging from 18 to 65 years of age. Most (93.4%) of all gallstones were cholesterol stones except few mixed stones. Given the option of operation, a high number of patients selected mini-laparotomy cholecystectomy, apparently because of the cost involved. As this is a patient-centric decision making about the operation of choice study (either mini-laparotomy cholecystectomy or lap cholecystectomy), therefore showing that most cases can be managed through mini-laparotomy cholecystectomy (under high spinal) without any major complication, and this is naturally guiding us towards cost effectivity in the rural setup.

99-103

Authors: Alpana Priya Rabha.

Reduction in maternal mortality rate (MMR) has been an articulated goal of the Child Survival and Safe Motherhood (CSSM) Programme and Reproductive and Child Health (RCH) Programme-II has incorporated evidence-based strategies in specific contexts to reduce the MMR. The provision of good quality care is the main thrust of the RCH programme. Greater emphasis is given to better quality of services, as compared to the previous National Family Planning Programme. The study had been conducted in 5 PHCs and 10 Sub-Centres to assess the quality of maternal health care services at Primary health care level. The study instruments were quality assessment checklists for PHCs and S/Cs. The data was collected from records, interviews of the health personnel and exit interview with the clients availing the maternal health care services and by observation methods. The quality of maternal health care services was assessed by three dimensions of quality measurement using a system approach—input, process and output. The quality of maternal health services was found to be average at primary health care level.

107-109

Authors: Sonali Khadakkar, Vivek Harkare, Nitin Deosthale, Priti Dhoke, Kanchan Dhote.

Chondromyxoid fibroma (CMF) is a relatively rare benign bone neoplasm. CMF of the sinonasal tract is very rare. A 30-year-old male presented with nasal obstruction, right nasal mass with headache since two months. A Computed Tomographyscan showed locally aggressive hypodense, mildly enhancing lesion of size 10.3 cm x 5 cm x 5.1 cm involving right maxillary, ethmoid and frontal sinus with extension into premaxillary area and infratemporal fossa of the same side and into the nasopahrynx. Histopathology of biopsy revealed inflammatory polyp. The patient underwent a right medial maxillectomy with ethmoidectomy with excision of whole of the mass by lateral rhinotomy approach. A histological examination showed stellate cells in a chondromyxoid background with mitotic figures. It was provisionally diagnosed as Chondroblastic osteosarcoma. Immunohistochemistry confirmed the diagnosis of Chondromyxoid fibroma.

2-5

Authors: Shuba Srinivasan, Jyothi Lingegowda, Sneha Thomas, Ramkumar Kurpad R, Prakash Muddegowda.

Access to endoscopy in India, particularly in a rural setup, is limited by the cost, trained personnel and limited resources. Literature suggests inappropriate referrals to be high, thereby over stretching this limited procedure, resulting in over-servicing. The present study was carried out to evaluate adherence of primary care physicians to ASGE guidelines when referring patients for upper GI endoscopy in rural Indian population. An observational cross-sectional study on consecutive patients referred to Department of Medicine for upper GI endoscopy. Patients above the age of 40 years were included in the study. All dyspeptic patients above the age of 50 years or patients with alarm findings were considered as appropriate referrals. Descriptive statistics was done.315 patients were included in the study. Appropriate referrals were 57.14%. Majority of the referrals were for dyspepsia and pain abdomen. Among all patients, H pylori infection was positive by rapid urease test in 55.23% indicating inadequate eradication therapy. Important endoscopic findings among the patients were carcinoma stomach, gastric/ duodenal ulcer, varices and gastritis. Among patients with dyspepsia, malignancies were noted in 1.96% of patients. Even though appropriate indications were high, the percentage of positive findings among dyspeptic patients was very low. Adequate eradication therapy for H pylori and empirical acid suppression therapy to reduce symptoms of dyspepsia as well as following strict guidelines for appropriate referrals will improve patient selection for upper GI endoscopy. This can improve efforts aimed at enhancing positive pathology identification, improved quality and efficiency of care.

11-14

Authors: Vivek Harkare, Kanchan Dhote, Kunal Shrimal, Nitin Deosthale, Priti Dhoke, Sonali Khadakkar.

Chronic dacryocystitis which is an inflammation and infection of lacrimal sac is an important cause of epiphora leading to ocular morbidity in India. Out of many etiological factors of chronic dacryocystitis, poor hygiene and allergy have a major contribution to the disease development. The aim is to find out occurrence of dacryocystitis in patients belonging to various socioeconomic groups and to correlate dacryocystitis with socioeconomic status. The present study is cross sectional hospital based study from June 2016 to Aug 2016 in a tertiary health care centre of central India. The result shows the maximum number of patients belonging to the age groups of 61-70 years (47.32%). Females outnumbered males 69(61.61%) female patients. In this study of 112 patients who underwent surgery for Chronic Dacryocystitis, there were more patients belonging to class III, IV, V of modified B.G Prasad classification. To conclude with, we found that there were greater number of patients belonging to class III of modified B.G. Prasad classification 2014 and maximum patients fell into Class III, IV and V of socioeconomic status criteria indicating that there may be some co-relation between dacryocystitis and poor socioeconomic status.

19-21

Authors: Kalpana Date, Neena Nagdeo, Meenal Kulkarni.

In revised national tuberculosis control program (RNTCP), microscopic examination of sputum for AFB plays an important role in the initial diagnosis of tuberculosis. Decontamination and liquefaction with by 5% sodium hypochlorite increases sensitivity and safety for handling specimen. In this prospective hospital based cross sectional analytical study, patients of all ages and either sex coming to RNTCP centre were included according to RNTCP criteria. From each patient, two samples of sputum were collected one spot and one morning. One set of smears was prepared by RNTCP guidelines and remaining samples were concentrated by using 5% NaOCl, followed by centrifugation and staining with ZN stain. Both set of smears were observed by two observers to remove observer’s bias. A total of 882 patients were included in the study with 577 (65%) males and 305 (35%) females. A total of 172(19.5%) patients were positive by RNTCP method whereas 201(22.79%) patients were positive by concentration method diagnosing 29 additional patients. This constitutes a rise of 3.29%. This constitute 16.86% rise in case detection over RNTCP method. There is a rise in smear positive cases after concentration with 5% sodium hypochlorite solution. The bleach method has advantage over routine RNTCP method as it is simple, does not require any additional expertise, is safe, reagents are also affordable and easily available and could diagnose additional cases.

28-30

Authors: Madhura Wasnik, Sushil Mankar.

Osteoporosis is a systemic skeletal disease characterized by low bone mass and micro-architectural deterioration of bone tissue which results in consequent increase in bone fragility and susceptibility to fracture and more common in post-menopausal women and elderly people. Fractures in osteoporotic bones can be prevented by simple methods like early detection by certain investigative methods like DEXA and its treatment. A questionnaire was devised to assess knowledge of osteoporosis, its risk factors, risk reducing factors, complications and required treatment along with investigations. It was completed by 97 patients who attended the orthopedic outpatient department. Overall knowledge about osteoporosis was poor. 57.73% patients were aware about osteoporosis, 50.01% were aware about its preventive measures, regarding risk factors (for alcohol only 33.33% could identify it as a risk factors, similarly for smoking scored 29.62%, malnutrition had 16.66%, lack of exercise had 3.7%, gender scored 11.11% and drugs scored 5.55%). Merely 29.89% and 7.21% were aware about the complications and investigations respectively. Knowledge about osteoporosis amongst patients was found low. There is a need for public to be made more aware about osteoporosis and its causes. With the help of social media and national campaigns, people can be well educated about this disorder.

35-39

Authors: Payal Katre, Vivek Harkare.

Chronic suppurative otitis media (CSOM) is one of the most common illnesses encountered in early childhood as well as in adult life hampering the quality of life. The incidence of CSOM has increased in recent years. The present study was carried out with the aim of studying the epidemiological factors contributing to causation of chronic suppurative otitis media in paediatric age group and also to suggest corrective measures for the same. A cross-sectional study was carried out in the department of ENT in a tertiary care hospital in rural area. Total 200 patients suffering from CSOM visiting ENT, Paediatrics and Medicine outpatient departments were selected. High incidence of CSOM in children in rural population was observed in the families having more number of children, illiteracy of the parents, low socioeconomic status, prone to various kinds of allergies. We concluded that the incidence can be controlled or prevented by implementing special measures like health education, awareness and providing proper medical aid at primary level.

48-50

Authors: Vivek Kumar, Nimish Gupta.

Although, anecdotal case reports are being published describing complicated opioid withdrawal e.g. seizure and delirium, various international classification system and standard textbooks do not mention about the complicated withdrawal like with alcohol. Interestingly, these complications reported from specific form of the opioid and specific geographical region. The case in this report presented with complicated opioid withdrawal like picture which later found to be due to medical condition. Hence, we report this case here to discuss various possibilities to be explored while dealing with the case of complicated opioid withdrawal.

53-55

Authors: Vaishali Walke, S. Kawathalkar, R. Rane, M. Goel, WK Raut.

Perivascular epithelioid cell (PEC) neoplasms are an unusual group of mesenchymal tumors which arise from the perivascular epithelioid Cell that characteristically expresses melanocytic and muscle markers. These neoplasms show a wide range of morphologic spectrum and have been described in multiple anatomical locations which includes uterus. We report a 46-year-old patient diagnosed as uterine fibroid on ultrasonography in whom the hysterectomy specimen unveiled characteristic features of intramural PEComa consisting of small nests and sheets of clear epithelioid cells particularly present around the blood vessels in a background of loose oedematous stroma along with the foci of mature adipose tissue which exhibits myometrial infiltration. The correct diagnosis is crucial as there is an emerging role of mTOR inhibitors which can provide a ray of hope to the patients of PEComa.