Title: An Interesting Case of Abdominal Mass-Evans Tumour Arising From Greater Curvature of Stomach
Authors: Dr. N. Sivarajan, Dr. Sampathkumar Gorgya, Dr. R. Ganesan
We report here a case of Abdomen mass presented to our Outpatient Department, with clinical findings similar to that of Mesenteric cyst in a nineteen year old female, Laparotomy revealed mass arising from stomach with involvement of adjacent transverse colon, with a unique post operative Histopathological finding.
Key words: Abdomen lump, Low graded fibromyxoid sarcoma.
Title: A Review Based Study on Risk factors for Coronary Heart Disease
Authors: Keesari. Rohali, G. Likitha, A. Alekhya, Venkata Sravani Polamraju,Dr. P.Srinivas
Coronary heart disease (CHD) is a major cause of morbidity and mortality and has various risk factors. CHD has a multi-factorial etiology with many of the risk factors being influenced by the lifestyle. The cost of management of CHD is a significant economic burden and so prevention of coronary heart disease is very important step in the management. In recent years, attempts to combat this disease have extended beyond treatment and have centered mainly on prevention. The risk factors for CHD are classified into: Modifiable, Non Modifiable and Emerging risk factors. The modifiable risk factors are hypertension, diabetes mellitus (DM), dyslipidaemia, tobacco smoking, obesity, sedentary life style. The non-modifiable risk factors include advancing age, sex, family history of cardiovascular events. The emerging risk factors include elevated homocysteine, small dense lipoprotein (Lpa), plasminogen activator inhibitor, inflammatory markers such as C-reactive protein, infectious agents like chlamydia.The risk factors of CHD, if identified at an early stage can play a significant role in planning primary and secondary preventive strategies for CHD and its complications. This review focuses on the modifiable and non modifiable risk factors and also sheds light upon the emerging risk factors contributing to the development of coronary heart disease.
Keywords: Coronary Heart Disease, Modifiable risk factors, Non modifiable risk factors, Emerging risk factors, Prevention.
Title: Serum VEGF as a Marker of progression of Hepatitis C Virus Induced liver Disease in Egyptian Patients
Authors: Mohsen M. Maher, MD, Tarek Yossef, MD, Shereen A. Saleh, MD, Nesrine A Mohamed, MD, Ramy Awara
Background: Hepatitis C virus (HCV) results in inflammatory liver damage. Angiogenesis has been reported to play an important role in the liver damage. Vascular endothelial growth factor (VEGF) is an important proangiogenic factors which induces endothelial cell proliferation, migration and survival.
Aim of the work: is to evaluate VEGF as a marker of progression of HCV induced liver disease in Egyptian patients.
Methods: this study was conducted on 80 patients and 20 controls (Group5). The Patients were classified into 4 Groups: 20 with chronic hepatitis C infection with no evidence of cirrhosis by fibroscan (Group 1), 20 with Child A (Group 2), 20 with Child B (Group 3) and 20 with Child C liver cirrhosis (Group 4). Severity of liver disease was evaluated by the child Pugh score. Liver cirrhosis was diagnosed by ultrasound. Serum levels of VEGF was determined by ELISA. HCV RNA was analyzed by PCR.
Results: there was significant elevation of VEGF in HCV infected patients when compared to controls with p value < 0.001. There was statistically significant difference in median VEGF among the studied groups with p value < 0.001, and median of VEGF in Groups 1, 2, 3, 4 and 5: 544.4, 634.6, 1003, 1410 and 177 pg/ml respectively. Significant correlation was noted between VEGF and serum albumin and prothrombin time.
Conclusion: serum VEGF can serve as a marker of progression of HCV induced liver disease. VEGF also correlates with hepatic synthetic function as reflected by serum albumin and prothrombin time.
Keywords: Chronic hepatitis C, liver cirrhosis, angiogenesis, VEGF
Title: Case report – Lipoma Arboresences
Authors: Dr Abhay Agarwal, Dr Rohan Gala, Dr Siddhartha Yadav, Dr Prasad Chaudhari, Dr Sanjay Dhar
Lipoma arborescens is a rare intra-articular lesion, characterised by diffuse replacement of the subsynovial tissue by mature fat cells, producing prominent villous transformation of the synovium. The aetiology of this benign condition is unknown.
A 19yr old male patient presented to us with 3 years history of swelling and pain in both knee joint with terminal restriction of flexion , aggravated on standing for long and relief on rest. He has no history of trauma, underlying joint disorder. Patient has been taking NSAIDS for symptomatic relief for past 6 months.
Title: A Rare Case of Spontaneous Conception in Untreated Wilson’s Disease
Authors: Lavina Chaubey, Madhu Jain, Pooja Singh
Wilson’s disease is a rare, autosomal inherited disorder of abnormal ATP7B gene resulting in excessive accumulation of copper in the liver and brain. It is suspected primarily in patients with degrees of liver failure or neuropsychiatric manifestations of unknown etiology in persons below 40 years of age. Diagnosis may be strengthened by presence of Kayser-Fleischer rings, serum ceruloplasmin< 20 mg% or high 24 hours urinary copper. The gold standard is however liver biopsy. Wilson’s disease usually leads to infertility or repeated miscarriages in females. It occurs in approximately 1:30,000 individuals with a carrier frequency of about 1 in 90. Here we present a rare case of spontaneous, consecutively successful pregnancies in a female with untreated Wilson’s disease.
Title: The Relationship Between GBS and MG: A Systematic Review
Authors: Adnan Bashir Bhatti, MD, Shah Faisal Ahmad Tarfarosh
Aim: The aim of our review was to find the association between the two autoimmune conditions Guillain Barre Syndrome and Myasthenia Gravis, whether these have ever coexisted in any patient, possible mechanisms of co-occurrence, the related clinical features, laboratory diagnosis and the treatment modalities for co-occurrence.
Materials & Methods: We performed a literature search from PubMed database using the combinations of MeSH terms for Guillain Barre Syndrome and those for Myasthenia Gravis. We included only those papers which were original case reports, published in English language and had the publication dates ranging from 1980-2014. Relevant cross references were also reviewed.
Results: A detailed study of 13 case reports (14 cases) was carried out. The age for the concurrence of GBS and MG varied from 17-84 years with most cases in 40-60 year age group. There were 9 male and 5 female patients. Also, among these 14 cases, 6 were Chinese, 3 were Americans, 3 were from Israel, 1 was white and 1 belonged to France. 10 patients had a history of some precipitating factor. All of the 14 patients had areflexia as well as ptosis. Limb weakness, Respiratory failure, opthalmoplegia, dysphagia, dysarthria and facial palsy were other common clinical features.10 out of 14 patients had considerably elevated CSF protein. Nerve conduction and RNS test was abnormal in most cases. 3 patients clearly had evidence of a mediastinal mass. 12 patients were positive for AChR antibody while 4 patients for anti-GQ1b and/or anti-GM. Pyridostigmine, corticosteroids, IVIG, plasmapheresis, immunomodulators were used in various combinations. Although, 2 of them died, prognosis was good in 8 out of 11 recorded patients. Patients, who died, had received treatment either for only GBS or for only MG.
Conclusions: All the patients with coexistence syndrome of GBS and MG have areflexia and ptosis. Other clinical and laboratory features may vary in different patients. Treatment modalities used should belong to both the syndromes; otherwise we get a poor prognostic score. We suggest that the concurrence syndrome of GBS and MG occurs due to the antibodies against peripheral nerve (causing GBS) which also attack the neuromuscular junction leading to MG (and/or vice versa) based on enough evidence from literature. We propose that some part of the structure of Ach receptor or postsynaptic membrane at NMJ bears a close relationship to that of myelin sheath of the peripheral nerve and research work at molecular level in this context is suggested.
Keywords: Guillain-Barre Syndrome, Miller Fisher Syndrome, Myasthenia Gravis, Combined, Co-occurrence, Concurrent
Title: Negative Feed Back Regulation of Oestrogen & Vasodilatory Function of Progesterone Responsible for Preovulatory Gonadotropin Surge [LH Surge] - A Hypothesis
Authors: Dharwadkar Anand R, Dharwadkar Asha A, Chenmarathy Bindu B, Dharwadkar Archana A, Dharwadkar Kavitarati A
At present there are many universal observations related to GnRH pulse & Gonadotropins surge in female. The explanation regarding the possible cause of preovulatory LH surge is not clear. An effort is made to explain this, with help of multiple experimental & human study observations as follows
First peak of oestrogen occurring 24hrs prior to ovulation Þ Inhibition of GnRH at Hypothalamus. Þ ¯FSH +¯ LH [from gonadotropes of pituitary] Þ ¯ Oestrogen [from Theca interna cells] Þ Regain of GnRH secretory pulse after 15hrs. Þ 3½ times increased secretion of gonadotropins as preovulatory surge This surge has decreased ratio of LH : total gonadotropins
In conclusion “preovulatory gonadotropins’ surge” is better word used than “preovulatory LH surge”. There is one gonadotropin surge with one pulse of GnRH with LH content of 67% in follicular, 57% in preovulatory & 90% in luteal phases. Increase in LH content in luteal phase is due to vasodilatory effect of progesterone causing better hypothalamo – hypophyseal portal circulation, providing better nutrition supply of aminoacids [AA] favouring conversion of FSH to LH. The b subunit of FSH with addition of 3 AA. gets converted to LH i.e. 112 AA in FSH & 115 AA in LH.
Inspite of removal of inhibitory effect of 2nd peak of oestrogen on GnRH, Gonadotropins’ surge does not occur. This may be due to generalized vasoconstriction caused by sudden withdrawal of progesterone, resulting in poor nutrition of secretory cells of hypothalamus & pituitary.
Keywords- Estrogens, Gonadotropin –Releasing Hormone, Gonadotropins, LH surge, Ovulation, Progesterone
Title: Nutritional Problems of Elderly Population of Arar City KSA
Authors: Nagah Mohamed Aboel-Fetoh, Mohamed Mousa Abd El-Mawgod, Saima Ejaz, Abdelrahman Abukanna, Ahmed Hamad
Introduction: Demographic data show an increased life expectancy of the world population. Malnutrition is common in elderly persons living in the community. In many cases, this problem arises from interacting physiologic, economic, and psychosocial causes.
Aim of the study: The aim of this community based study is to estimate the prevalence of some nutritional problems among the elderly population of Arar city, KSA.
Subjects and methods: This community based cross sectional study was conducted in Arar city, the capital of Northern Borders Governorate. Personal interviews with the 100 sampled elderly and filling the questionnaire, which guided us to the socio-demographic data, nutritional problems due to physiological changes, digestive and dental health problems which affect feeding, consumption of drugs for treatment of chronic diseases and daily consumption of water and other drinks.
Results: characteristics of the sample showed that 42% of studied group were suffering from problems in food swallowing and salivation, impaired taste and smell was found in 20%. Appetite to food was normal in 38%, intermediate in 36%, weak in 20%. 22% feed themselves without difficulty or help from others. 58% needed help and 20% eat with difficulty, adding salt to food was found in 46% of the sample, 26% had regular times for eating, 26% mostly, 36%sometimes and 12.0% rarely eat in regular times. Ability to shopping was high in 24% but low in 68% of the sample. Feasibility of shopping was enough in 26% only, 38% of the sample sharing food with their families and 32% eat alone. Hyperacidity, distention, constipation and gases affect 72%, 66%, 54% and 68% of the studied population respectively. Dental caries was found in 72.0% and 22.0% had total loss of their teeth and were using dentures. 72% of the studied elderly populations consume daily drugs for treatment of chronic diseases. Who consume 1-3 cups of water and other drinks were 62.0% and 64.0% respectively and who consume 3-5 cups were 26.0% and 30.0%.
Key wards: nutritional problems, elderly, physiologic, social, economic, and psychosocial causes.
Title: Ratio of Follicle Stimulating and Luteinizing Hormone with Hormones of Implantation in Intracytoplasmic Sperm Injection
Objective: To assess relationship of ratio of follicle stimulating (FSH) and luteinizing hormone (LH) with hormones of implantation in females down-regulated for Intracytoplasmic sperm injection (ICSI).
Material & Methods: Retrospective study of 564 primary infertile females booked for ICSI from June 2012 till August 2014 was carried. They were 20-40-years old with infertility of more than two years and body mass index 18-35kg/m2. FSH and LH were assessed before and Estradiol (E2) and Progesterone (P) after down regulation of ovaries by enzyme linked Immunosorbent assay. Logistic regression was applied for clinical pregnancy (CP) with FSH, LH and its ratio. Median value of variables with best results after regression was used for stratification of groups. Hormones of implantation; E2, P and their ratios were compared in the derived groups.
Results: On the basis of highest Beta error, groups was stratified as;group I ≤ 1.26 and group II > 1.26 median value of FSH/LH ratio. The CP rate was 36% with higher number of pregnancies 158 /286 (55 %) in Group I as compared to 44/278 (16%) in group II. Group I females had high peak and mid luteal E2 and low P as compared to other group (p<0.001). Linear correlation of FSH/LH was observed with E2/P (r=-0.250, p<0.001).
Conclusion: High E2/P ratio required for CP in stimulated cycles was acquired by females with low FSH/LH ratio measured before down regulation of ovaries.
Key Words: Infertility, Intracytoplasmic sperm injection, follicle stimulating hormone, luteinizing hormone, FSH/LH ratio
Title: Screening of Aminoacidurias in Children
Authors: Helena Rajakumari J., Vasundhara Devi I., Sujatha C., Nirmal Alexander P.
Inborn errors of metabolism (IEM) are genetically determined biochemical disorders due to specific congenital defects in protein molecules. In infants and young children the inborn errors produce mental deficiency and serious ill health. Aminoacidurias being one of the common causes of preventable mental retardation, mass screening helps in early detection and early intervention to prevent disability and mortality. Thus the present study was undertaken to screen children below 5 yrs of age showing signs and symptoms of aminoacidurias. 604 children with such symptoms were screened by basic urine screening tests, of which three were found to be positive. The urine and plasma samples of these 3 children were subjected to thin layer chromatography (TLC) and confirmed by high performance liquid chromatography (HPLC). They were found to be suffering from phenylketonuria (PKU). Hence urine screening tests, TLC followed by HPLC are rapid and convenient methods for early diagnosis of aminoacidurias in children.
Keywords-Inborn errors of metabolism (IEM), Aminoacidurias, Thin layer chromatography (TLC), High performance liquid chromatography (HPLC) and Phenylketonuria (PKU).
Title: Study of Metabolic Syndrome and Thyroid Dysfunction
Authors: Dr. Nalini R Humaney, Dr. Saurabh Ashok Lande, Dr. Ramesh P Mundle
Metabolic Syndrome is a group of factors that predispose to cardiovascular diseases. The prevalence of metabolic syndrome is rising rapidly. Recently, a few studies have suggested that thyroid function in the reference range may be associated with metabolic syndrome, but the issue remains unsettled. We aimed to elucidate the relationship between thyroid function and components of metabolic syndrome.
Aims: 1. To find out the status of thyroid dysfunction in subjects with metabolic syndrome
Methodology: Study was conducted at the N.K.P.Salve Institute of Medical Sciences and Research. It was a hospital-based, cross-sectional study. Seventy patients (n=70) with metabolic syndrome, fulfilling National Cholesterol Education Program (NCEP) Adult Treatment Panel III were subjected to thyroid function tests (fT 3 , fT 4 and TSH) and were included in this study with their consent. A detailed history was taken and clinical examination done. Details like anthropometric measurement of height, weight, waist circumference and systolic and diastolic blood pressure were noted. Fasting blood glucose, triglycerides and HDL-C were estimated in all subjects. Relationship between thyroid function and metabolic syndrome was studied. Diagnosis of the metabolic syndrome was made when 3 or more of the risk determinants were present.
Statistical Analysis: Data was expressed as mean ± standard deviation and analyzed by using one-way ANOVA followed by Student's 't' test.
Results: ↑ waist circumference in 71.1%, hypertension in 59%, ↑ triglyceride levels in 62%, ↓ HDL-C in 60.8%, impaired fasting glucose in 58%, TSH > 6 mIU/ml in 37%. The metabolic syndrome was present in 54% of the patients. Increased wait circumference was the most common metabolic abnormality in both sexes.
Conclusion: Metabolic syndrome was present in 54%, with higher prevalence in females owing increased obesity. Most common abnormality seen was increased waist circumference followed by increased in triglycerides and decrease in HDL-C levels. Prevalence of hypertension was observed to be increasing with age. 37% of patients had increased in TSH levels.
Keywords: metabolic syndrome, TSH, fT3, fT4.
Title: Massive Synovial Cyst Arising Over the Acromio-Clavicular Joint
Authors: Dr. Namdev Gorgile, Dr. Yash Shah
Acromio clavicular joint synovial cyst is a rare condition and this is commonly associated with a rotator cuff tear. It generally presents as a painless slow growing swelling over the shoulder, hence this condition must not be taken lightly as in some rare cases it may be associated with a malignancy.
We report a case of a 65 year old male gentleman, with a painless gradually progressive swelling over the right shoulder joint. On examination, there was a 12 * 14 * 6 cm non-tender cystic swelling on the anterior aspect of the right shoulder extending medially to the coracoid process, superiorly to the acromio-clavicular joint and inferiorly in the delto-pectoral groove.
The patient was operated under general anaesthesia in the supine position with shoulder and arm resting on an arm support. An incision was made in the delto-pectoral groove proximally extending till the AC joint and distally to the level of deltoid insertion.
There was a synovial fluid with whitish flakes and there was a thickening of the synovium. The swelling was communicating with the AC joint. There were some degenerative changes at the AC joint.
We did not excise the lateral end of clavicle considering the old age of the patient.
Conclusions: A synovial cyst is a rare entity over the AC joint and it presents with a painless gradually enlarging swelling over the anterior aspect of the shoulder. It may be usually associated with a rotator cuff tear and arthritis of the AC joint. Whenever present excision of the cyst is to be done and the cuff tear is to be repaired and the lateral end of the clavicle may have to be excised. A histo-path examination is of prime importance to confirm the diagnosis. The entire wall of the capsule must be removed to avoid recurrence.
Keywords: Synovial cyst; shoulder cyst; swelling over shoulder
Title: Battered Child Syndrome –A Case Report
Authors: Pandey K.K., Maravi L.S.
In battered child Syndrome, the child is abused physically and he has fractures of multiple bones in different stages of fracture healing. We are reporting a child of 5 years age with multiple cigarette burn marks all over body which are rarely reported along with fractures of bones in various stages of healing.
Introduction: Battered child syndrome is a social problem. It is the responsibility of the physician beside medical treatment of the battered child to identify it and ensure action to prevent repetition of injury .All the necessary action should be taken to avoid disability of the child.
Keywords: Battered child, fractures, cigarette burn, syndrome, abuse.
Title: Oxidative Stress (MDA) Levels and Urinary Protein-Creatinine Ratio in Pre-Eclamptic Patients Attending in the Outpatient’s Clinic in A Tertiary Care Hospital
Authors: Dr. Prabhakar Singh Bais, Dr. Beenu, Dr. Priyanka Chauhan
Objective: To evaluate the serum levels of malondialdehyde as marker of lipid peroxidation and to estimate urinary protein-creatinine ratio to evaluate proteinuria.
Methods: This was a case-control study. The study was approved by the ethical committee of the institute. The consent was taken from each patient before enrolling in the study.
The cases comprised of pre-eclampsia patients. The control group consisted of age matched normal pregnant women. Both cases and control were interviewed to obtain the relevant data after taking informed consent. Based on inclusion and exclusion criteria, 30 cases were selected and 30 age matched normal pregnant women were taken as controls.
Results: There was no significant (p>0.05) difference in age, height, weight and BMI between cases and controls. The lipid peroxidation product, MDA was significantly increased in the cases as compared to the controls (p=0.001). There was significant difference in the Protein-creatinine ratio between cases and controls. There was significant (p=0.001) difference in the Protein-creatinine ratio between non-severe and severe Pre-eclampsia.
Conclusion: The protein-creatinine ratio was found to be significant predictor of proteinuria with a reasonable sensitivity and specificity.
Key words: Pre-eclampsia, Proteinuria, Sensitivity, Specificity
Title: Risk Factors Associated with Asthmatic Children
Author: Dr Anwar T Elgasseir
Objectives: The aims of this study were to estimate hospital admission rates of asthma and to identify the risk factors associated with asthma in children, regarding family history of atopic diseases, environmental factors, and feeding practice in early infancy.
Patients and Methods: Descriptive study (Longitudinal hospital based study) in Paediatric Department, Misurata teaching hospital, extended for 22 month, from February 2012-Nov 2013. Children were recruited to the study if they were aged between 3 month and 14 year, had history of persistent wheeze or recurrent wheeze. Prospectively collected data on Asthmatic admitted cases include; history, clinical examination, investigations, and treatment, are recorded on a data collecting form. To know the pattern of wheeze, the patients were grouped to three groups; < 3 years, 3 ─ ≤ 6 years, > 6 years.
Results: In our hospital, 4.3% of children (82 children) who are admitted to the hospital suffer from acute exacerbation of asthma. The majority of asthmatic children admitted are below 3 years (71%) with mean age 14 months. About 86% of asthmatic children above 6 year are persistent asthmatic and just 14% of children older than 6 year are late onset asthmatic. Regarding family history of atopic disease 50% of persistent asthmatic had family history of atopic diseases. Paternal indoor smoking was reported in 67% of persistent asthmatic. Approximately 95% of infants associated with viral upper respiratory tract infection (URTI) compared to only 57% of children older than 6 years were associated with URTI.
Conclusion: Viral infection considered to be an important risk factor in exacerbation of asthma in young children. Other risk factors appear to predispose children to developing persistent asthma including atopy in the family and paternal smoking. Duration of breast feeding and the age for introduction of cow’s milk not differ markedly between different asthmatic groups.
Keywords: Asthma; Risk Factors; Atopic Patients; Indoor Smoking; Infant Feeding Practice.
Title: Prevalence of Obstructive Sleep Apnea (OSA) In Young Patients with Ischemic Stroke
Authors: Ansari T .A, Sharma .A, Gupta .R, Mittal .M
Objective: To prevalence of obstructive sleep apnea (OSA) in young patients with ischemic stroke
Method: 30 subjects were enrolled .we measured weight, height waist circumference and neck circumference and calculated body mass index, the risk of osa was assessed by using STOP –Bang Questionnaires
Results: In this study, OSA was diagnosed in 76.6% of stroke patients. The study shows that subjects with severe OSA were heavier, had higher body mass index and a larger neck circumference as compared to without OSA. In present study male predominance was seen in the OSA patients were (63.3%) and in female it was (13.3%). This finding has been supported by a number of earlier studies that had shown that OSA was more prevalent among males.
Conclusion: This study showed that OSA diagnosed on the STOP-Bang questionnaire. A STOP-Bang score of <3 will allow the healthcare team to rule out patients who do not have OSA. To prevent stroke in this general population of young due to OSA as it can reduce the risk of stroke and life style modification. Sleep apnea is a common disorder and if not recognized and treated due to stroke leads to significant morbidity and increased mortality. Particularly early recognition and treatment of OSA may improve cerebrovascular function. Treatment of OSA may represent a novel target to improve cerebrovascular health outcome.
Title: A Rare Case of Boerhaaves Syndrome Managed Conservatively
Authors: Dr. Vinaya Ambore, Dr. Vikram Wagh, Dr. Prashant Turkar, Dr. Kapil Patel, Dr. Aniket Deshmukh
The incidence of Boerhaave syndrome is relatively rare. A 1980 review by Kish cited 300 cases in the literature worldwide. A 1986 summary by Bladergroen et al described 127 cases. Of these, 114 were diagnosed antemortem; the others were diagnosed at autopsy. Its diagnosis is based mainly on exclusion of major causes of its presenting symptoms like chest pain and vomiting. We report one such rare case at our facility which was diagnosed late after investigation approx 5 days of admission. It was successfully managed by conservative methods without any operative intervention.
Keywords: Boerhaave syndrome, Conservative Boerhaave management, Rare case Boerhaave.
Title: Lobular Capillary Haemangioma of Oral Mucosa- A Case Report
Authors: Dr.B.Manovijay, Dr.N.Sayeeganesh, Dr.P.Arulmani, Dr.K.Priya, Dr.R.Saranyan, Dr.G.Balaji Babu
Background: Lobular capillary haemangioma is a rare histo pathological variant of pyogenic granuloma. It is a non-neoplastic tumor of the oral cavity. It is more common in females.
Case report: The present case report discusses one such lesion that was reported by a twenty-seven year old female during her third trimester of pregnancy. The lesion was surgically excised and examined histo pathologically to confirm lobular capillary haemangioma.
Conclusion: The association of pregnancy and pyogenic granuloma was analysed in the present report. Relapse of the lesion was prevented by removing the contributing local etiological factors.
Keywords: lobular capillary haemangioma, pyogenic granuloma, pregnancy, female-sex hormones, Excision biopsy.
Title: Oral Focal Mucinosis A Rare Clinico-Pathologic Condition: A Case Report
Authors: Dr.Shubhangi Mani, Dr.Ameet Mani, Dr.Prachi Shukla, Dr.Richa Patel, Dr.Tushar Bhople
Oral focal mucinosis (OFM) is a rare disease of unknown etiology, in which the connective tissue undergoes a focal myxoid degeneration. The aim of this case report is to describe the clinical and histological presentation as well as the management of OFM. In most of the focal gingival lesions, a preoperative diagnosis is not possible. This case report add to the differential diagnosis of myxoid lesions of the oral cavity.
Key Words: Myxoid lesions, Soft tissue lesions, Gingival lesions.
Title: Study of Speciality wise Profile of Patients attending Outpatient Department of SKIMS in General and Endocrinology in Particular
Authors: Muneer Bhat, Ashfaq Ul Hassan, Syed Amin, Reyaz Rangrez
Keeping in view the importance of referral system and centrality of outpatient department in a health care unit the present study at SKIMS will be undertaken to assess profile of patients attending outpatient department, their rationale for referral and thereby forming a policy of referral for health care institutions.
Key Words: SKIMS, out Patient, Clinic, Referral, Policy
Title: Prevalence of Pre-Menstrual Syndrome in Medical Student Population and Their Relief Measures - A Cross Sectional Study
Authors: Gantala Prameela Devi, Radhika Rani Kondugari, *Rama Mohan Pathapati
Background: The Premenstrual syndrome (PMS) is commonly seen in the younger age groups and, therefore it is demarcated as significant public health problem in young girls.
The aim of the study is to evaluate the prevalence, severity, factors of premenstrual syndrome (PMS) and its impact among the female medical students and relief measures adopted by teenage girls suffering from PMS.
Methods: This cross-sectional study was conducted on the female medical students attending SV Medical College Tirupathi, A.P, India. It included 150 medical students. They filled different pre structured questionnaires covering American College of Obstetrics and Gynecology (ACOG) criteria to diagnose PMS, socio- demographic factors, physical and psychological activities.
Results: PMS was diagnosed in 82% of cases .In our study in that severity is more in abdominal pain (76%), body ache (67.7%), backache (48.4%), irritation (22.6%), breast discomfort (66.72%), headache (15.3%), and acne (44.2%), abdominal bloating (0.5%).56 girls used medication to get relief from premenstrual symptoms.
Conclusion: PMS is a most common condition in young students with regular menstrual cycles. Severe PMS was associated with more impairment of daily works and psychological tensions. Older student age, rural residence, earlier age of menarche and positive family history are possible risk factors for PMS.
Key Words: Premenstrual Syndrome (PMS), Teenage girls, Psychological activities
Title: Clinical Profile of Dengue in a Tertiary Care Hospital of Rohelkhand of U.P.(Bareilly)
Authors: Amit Sachan, Nipun Agrawal, Amit Varshney, Pranesh Nigam, Nirmal Yadav
Dengue fever has emerged as one of the major health problems in North India in recent years. The 2011 epidemic and beyond had created concern about the efforts regarding the prevention and treatment of this disease at the country level. This study will highlight different clinical and laboratory features in patients with dengue fever in a tertiary care hospital which will go a long way in guiding primary care clinicians in diagnosing and managing such patients.
Material and methods- Seventy-two cases of dengue positive for dengue IgM and antibodies (ELISA) were included in this study. All relevant parameters were studied and analyzed with the help of STAT-A software version 2.0. The severity was classified as per WHO guidelines. They were submitted to detailed clinical history and laboratory investigation for hematocrit values, liver and renal function test.
Observations- Seventy-two cases of dengue were taken for this study of age varied from 8 to 69 years with mean ± SD= 32.6 ± 8.6 years and male to female ratio of 1.5:1. The most affected age group was 20 to 39 years (61.1%). Most of the cases were of dengue hemorrhagic fever (DHF=61.1%), Dengue fever(DF=35%) and dengue shock syndrome(DSS=4.17%). Common manifestations were fever, diminished/loss of appetite, headache, body ache in all patients. Bleeding manifestations (52.8%) were seen in the form of petechial rashes (52.8%), hematemesis (2.8%), malena (13.9%), conjunctival hemorrhag e (13.9%) with platelets< 50,000/cumm. Liver involvement was with hyperbilirubinemia and more than two fold increase of serum transaminases. Overall mortality was 8.4% with two cases out of 3 cases of Dengue Shock Syndrome. Recovery was fast with Dengue fever cases as compared to others.
Conclusion- The appropriate investigation, strict monitoring and prompt supportive management can reduce the mortality. This study indicates that dengue hemorrhagic fever is a common manifestation and dengue should be considered as a differential diagnosis in patients with clinical bleeding manifestation in association with raised liver enzymes.
Key words- Dengue fever (DF), Dengue hemorrhagic fever(DHF) and Dengue Shock(DSS) Dengue rashes and Bleeding.
Title: Cortical Evoked Potentials in Children with Learning Disorder
Authors: Mr. Shivraj Bhimte, Mr. R Rangasayee
The purpose of the study was to investigate MLR and LLR response from children with LD. Auditory cortical potential were recorded in 30 subjects with LD (experimental group) and 30 age-gender matched children (control group) aged 10 -14 years with means age 11.2years. The responses were recorded using the click stimulus. MLR (Pa, Na) & P1, N1, P2, N2 latency and amplitude were analyzed. Result of study indicates that both the group had statistically significant difference in latency. Pa, Na , P1 and N1 amplitude had significant different between two test group. The present study finding reports that click evoked auditory late latency response is traceable in all children with LD and typically developing children. However, children with LD exhibited prolonged latency with reduced amplitude with inconstant wave morphology responses in the present study, inferred that the abnormalities in processing from the thalamus, auditory cortical area results in altered auditory cortical recording. Further, research is required to use MLR, Long latency response as a tool that clinically differentiates between individuals with and without LD.
Key Words: Evoked potential, LLR, MLR, Normal Hearing, Learning disorder.
Title: Current Status and Risk Factors of Coronary Heart Diseases in Urban and Rural Population of District Hapur and Bulandshahr
Authors: Sunil Kumar Goel, Anil Kumar Ken
Coronary heart disease (CHD) is an emerging public health problem characterized by premature onset and high mortality. The aim of the present study was to highlight the major risk factors responsible for CHD. Present study reveals a striking prevalence and risk factors in the population of district Hapur and Bulandshahr. Hypertension (χ2=9.81, d.f.=1, P=0.0024), dyslipidemia (χ2=8.58, d.f.=1, P=0.0034), diabetes mellitus (χ2=14.12, d.f.=1, P=0.0002) and tobacco smoking (χ2=12.91, d.f.=2, P=0.0016) were the most important risk factors responsible for the premature development of CHD. Low fruits-vegetables intake, physical inactivity are next important risk factors. These risk factors are highly prevalent in this region. Prevention and control of premature CHD needs urgent control of these factors. Improving lifestyle with tobacco cessation, diet with more fruits-vegetables and low fat intake, appropriate physical activity are important to decrease the risk of CHD. Target oriented good control of hypertension, dyslipidemia and hyperglycemia in addition to educating the general population about the dangers and preventive measures of the diseases are required.
Key words: Heart, CHD, CAD, Risk factors,
Title: Simultaneous Determination of Lamivudine and Tenofovir Disproxil Fumarate by UV Spectrophotometric Method
Authors: Ashwini S.Mali, P.A.Salunke, S.D.Barhate, M.M.Bari
A simple and rapid UV spectrophotometric method has been developed for simultaneous estimation of Lamivudine (LAM) and Tenofovir disoproxil fumarate (TDF). The absorption maxima of both drugs were found at 268nm and 258nm and obeyed Beer’s law in the range of 2-10μg/ml (y = 0.059x-0.02; r2 = 0.998) and 2-10μg/ml (y = 0.0565x-0.017; r2 = 0.997) respectively for LAM and TDF in water: water (50:50) solvent system. Accuracy and reproducibility of the proposed method was statistically validated by recovery studies. This method is found to be precise and accurate and can easily be employed in the laboratory for the routine estimation of drugs.
Key words: Tenofovir disoproxil fumarate, Lamivudine, Simultaneous equation, UV spectrophotometry
Title: Effects of Noise Level and Azimuth on Speech Perception Ability of Children with Hearing Impairment Using Cochlear Implant and Hearing AIDS
Authors: Mr. Shivraj L. Bhimte, Mr. R. Rangasayee
Speech perception is a specialized aspect of a general human ability, the ability to seek and organize speech sound to central auditory system. Speech perception ability plays significant role for classroom learning special for children with hearing impairment. Daily classroom activities and background noises in schools create unfavorable context for children with HI in speech perception. Teachers in regular classroom act as moving sound source for children with hearing loss. Therefore current study aimed to evaluates the effect of noise level and direction (azimuth) on speech perception ability of children with HI using HA and CI. 50 subjects (25 HA users 25 CI users age and gender matched) were enrolled in the study with mean age range of CI subjects was 8.13 and HI subjects was 7.65. Test was performed in an acoustically sound treated two room setup. Better ear/implanted side speaker was set for giving speech input at a constant level of 60 dB whereas other side speaker used for delivering broadband noise (BBN) at different SNR(i.e. 15dB,10dB,5dB,0dB). Further to check effect of direction 0, 45, 90, 180 azimuth PB word (speech) delivered and corresponding speech perception score were recorded. Results indicate that both the group shown effect of noise on speech perception ability, increasing SNR better speech perception. Whereas higher speech perception scores seen when speech delivered at 0 azimuth and least score obtained at 180 azimuths. Statistical‘t’ tail test results showed significant difference between groups and higher score obtained by CI group. Research study suggests that both the groups adversely effected by noise on speech perception score. Therefore conclusion of study that currently used HA & CI electro-acoustic technologies are not efficient to overcome effect of noise on speech perception ability, therefore the strong need felt in the advancement of speech processing technology in HA and CI.
Key Words: Speech Perception, Cochlear Implant Users, Hearing aid users, Noise, Azimuth
Title: Maternal and Perinatal Outcome of Preterm Premature Rupture of Membrane
Authors: Fatheia Elrishi, Ibrahim Larbah, Ziead Altaei, Suliman Elderrja
Background: preterm premature rupture of membrane is associated with significant risks of maternal and perinatal morbidity and mortality, therefore the suitable decision play an important role in the management of this complication aiming to decrease maternal and fetal risks.
Objective: to evaluate the prevalence and outcome of pregnancies complicated by preterm premature rupture of membrane in terms of maternal morbidity, perinatal morbidity and mortality.
Methodology; during the study period 78 patients who had prolonged preterm premature rupture of membrane more than 24 hours at 24 to 36 weeks of gestation and received medical care at Misurata Teaching Hospital.
Results: the prevalence was 1.2% and the mean gestational age at the onset of membrane rupture and delivery was 33.2 ± 2.9 weeks and 34.9 ± 2.7 weeks, respectively. Maternal morbidity included placental abruption, chorioamnionitis, and postpartum hemorrhage. The majority of the mothers were delivered vaginally while 25.6% delivered by Cesarean section, 21.4% of the neonates had neonatal sepsis.
Conclusion: expectant management is a favorable to achieve fetal maturity and improve perinatal outcome of preterm premature rupture of membrane as survival rate is significantly increased with gestational age at time of diagnosis and birth weight with.
Key wards: preterm premature rupture of membrane, latency period, maternal and fetal morbidity and mortality.
Title: Carotid Artery Disease in Patients with Chronic Kidney Disease
Authors: Satish Reddy N, Praveen Kumar K, Mastan Valli B, Mahaboob V Shaik
Objective: 1. To study the prevalence of carotid artery disease in patients with chronic kidney disease using carotid artery intima media thickness as a surrogate marker, measured by B mode ultrasonography.
2. To study the co relation of carotid intima media thickness with glomerular filtration rate and other cardiovascular risk factors
Background: The present study is aimed at studying the prevalence of atherosclerosis in patients with CKD using carotid intima media thickness (CIMT) as a surrogate marker of atherosclerosis and co relating the various CVD risk factors and declining renal function in the causation of atherosclerosis.
Materials And Methods: Seventy patients with CKD, defined by NKF/KDOQI guidelines, attending nephrology OPD were studied for demographic data and CIMT values and comparing with thirty age and sex matched controls. CIMT was derived via B-mode ultrasonography and CKD was evaluated by the estimated glomerular filtration rate (eGFR) using the Modification of Diet in Renal Disease Study equation.
Results: Mean CIMT in CKD patients was 0.86± 0.21 mm and that in healthy age and sex matched controls was 0.63±0.17mm which was statistically significant (P = 0.001). Univariate correlation analysis has revealed a strong correlation between CIMT and age (r = 0.605 P < 0.000), BMI (r = 0.377, P = 0.002), Serum Cholesterol (r = 0.236. P= 0.018) and Serum Triglyceride levels (r = 0.387, P = < 0.001) and eGFR (r= -0.02, p <0.001).
Conclusions: Patients with CKD are associated with greater risk of atherosclerosis as compared to the general population. CIMT, used as a surrogate marker of atherosclerosis is significantly higher in CKD patients when compared to healthy controls. The exact pathogenesis of accelerated atherosclerosis in CKD patients is unclear but probably involves interplay of traditional and uremia related risk factors.
Keywords: carotid intima media thickness, Chronic kidney disease, glomerular filtration, rate atherosclerosis.
Title: Papillary Carcinoma of Thyroid Presenting As Lateral Neck Cyst - A Diagnostic Dilemma
Authors: Jyotsna V. Wader, Rekha Matta, S.S. Kumbhar, Dhiraj Kumar B. Shukla, Hardik Thakkar, Atul B. Hulwan
Brachial cyst has been referred to be the main cause of cystic mass in the lateral aspect of neck in a young adult. However occult papillary carcinoma of thyroid can present as solitary cystic mass as the initial manifestation of the disease. A 32 years old male presented with lateral neck swelling since 2 years which on radiological investigations was suspected as vascular malformation. Excisional biopsy of the cystic mass revealed the papillary carcinoma of thyroid with metastasis to the adjacent lymph node. Tumor cells expressed TTF1. Radioisotope scan showed patchy tracer uptake. Total thyroidectomy with histopathological examination for the presence of papillary carcinoma in thyroid tissue is indicated in such cases. The case is being presented for its rarity and the diagnostic dilemma.
Keywords: Ectopic thyroid, Neck cyst, Papillary carcinoma, Metastasis
Title: Role of Micronutrients -“Selenium & Zinc” in Preeclampsia
Authors: Prof. Dr.Kaliki Hymavathi Reddy, Dr.Surekha.T, Dr.Pavithra.D, Dr.Vamsi Krishna Suman Dasari
Background: Micronutrients are vitamins and minerals required in minute amounts for normal functioning, growth and development. Adequate maternal micronutrient status is especially vital during pregnancy and lactation. Micronutrient deficiencies are exacerbated in pregnancy, leading to potential adverse effects not only on the mother but also on fetus. Therefore, micronutrient status plays an important role in pregnancy and birth outcomes. Deficiencies of specific antioxidant activities associated with the micronutrients like Selenium and Zinc can result in poor pregnancy outcomes, including fetal growth restriction, preeclampsia and the associated increased risk of diseases in adulthood, including cardiovascular disease and type 2Diabetes.
Aim: To asses the status of Selenium & Zinc in preeclamptic women.
Objective: To prove Selenium & Zinc deficiencies as contributory factors for the onset of preeclampsia..
Data Sources: This is a prospective study done in the Department of Obstetrics and Gynaecology, Narayana Medical College & Hospital, Nellore for a period of 2yrs (October 2012 –October 2014).100 preeclamptic women, are recruited into the study (Study group). A similar number (100) of healthy pregnant women were taken as controls (Control group).
Methodology: Serum and tissue (Placenta) samples for SE and Zn are measured by atomic absorption spectrophotometry. The Statistical software namely SPSS 20.0 were used for the analysis.
Results: The mean serum & tissue SE and Zn levels are found to be significantly reduced in preeclamptic cases compared to controls.
Conclusions: Selenium and zinc supplementation either alone or in combination with a general multi-nutrient supplement may have a significant effect not only on the incidence of preeclampsia, but may also delay the onset and severity of the disease, ameliorating placental oxidative stress and buying valuable time for fetal development prior to delivery.
Key Words: Selenium-Zinc-Serum &Tissue Levels-Preeclampsia
Title: Lasers in the Treatment of Dentin Hypersensitivity: A Review
Authors: Dr.Ameet Mani, Dr.Raju Anarthe, Dr.Tushar Bhople, Dr.K.S.Bhople, Dr.Richa Patel
Dentin hypersensitivity (DH) is a relatively common painful condition among dental problems for which several treatment options have been tested. Although many studies have been performed regarding the diagnosis and treatment of DH, dental professionals are still confused about the definite diagnosis and treatment. The use of lasers as a treatment for dentin hypersensitivity was first introduced in 1985. Laser has been investigated as one of the possible therapies to minimize pain by either obliterating dentinal tubules or promoting dental analgesia. Laser treatment in dentin hypersensitivity is an interesting and controversial issue and many investigations have been done on its mechanism of action, advantages, and disadvantages. The purpose of this overview is to summarise our current knowledge regarding laser applications for the treatment of dentine hypersensitivity.
Keywords-dentine hypersensitivity; laser therapies; review; dentinal tubules ; desensitizing.
Title: Blood Sugar & Vitamin B12 Level in Psoriasis Patients in Relation to Diabetes Mellitus and Hyper Tension
Authors: Payasvi Baweja,B.K.Agrawal,V.K.Sharma, Anna Alex, S.K.Mishra
Background: Psoriasis is a chronic disfiguring inflammatory and proliferative condition of the skin in which both genetic and environmental influences have a critical role. Several reports have shown an increased risk for the metabolic syndrome (a combination of central obesity, DM Type 2 or insulin resistance, Hyper Tension and combined hyperlipidemia) in patients with psoriasis, but there are few Indian studies on the association between psoriasis with diabetes and hypertension together.
Objective: To study blood sugar and serum B12 level at the beginning of study and after 8 weeks in 2 groups of Psoriasis patients.
Method:A cross-sectional study was performed in 300 clinically diagnosed Psoriasis patients (Group II) which were further grouped as 200 plain psoriasis (Group IIA) and 100 psoriasis cases with DM or DM and HT both (Group IIB) and 200 age and gender matched healthy subjects as the controls(Group I). Blood sugar and serum Vit. B12 level were measured at the beginning of study and after 8 weeks in both the groups.
Result:Patient presented no significant change in the blood glucose level in Group IIA psoriasis patients at the beginning of study and after 8 weeks as compared to controls but in Group IIB psoriasis there is significant increase (P<0.01) at the beginning but after 8 weeks its value is increased highly significantly (P<0.001) as compared to controls.
Serum B12 level is decreased and increased significantly (P<0.01) in Group IIA psoriasis patients at the beginning and after 8 weeks respectively. But in Group IIB psoriasis patients its value is decreased and increased highly significantly (P<0.001)at the beginning of study and after 8 weeks which shows that B12 level is lower in psoriatic skin than in non-psoriatic skin and active lesions had lower level than healed lesions.
Conclusion:Data suggests that psoriatic patients must be considered as a group at high risk for becoming diabetic due to high Blood sugar level and more prone for cardiovascular disease due to low serum B12 level in psoriatic skin than in non-psoriatic skin.
Keywords- Psoriasis, blood glucose, Vit. B12, diabetes, cardiovascular disease.
Title: Blood Pressure and Cardiac Responses to Isotonic Exercise and Its Modification by Beta Adrenoreceptor Blockade in Human Subjects
Authors: Dr V. Malleswaramma, Dr G. Durgadevi
Introduction: The role of physical activity in cardio vascular health has received increasing attention in recent years. Exercise has dramatically occupied an unique projection as a recreational activity for the past two decades. Paffernbarger have shown that vigorous exercise is associated with lower incidence of hypertension. The terms aerobic, isotonic and dynamic are used interchangeably to refer to activity that is predominantly fueled by oxidative phospharylation (aerobic), is performed against a constant load that is isotonic and involves the rhythmic contraction of flexor and extensor muscle groups (dynamic). Use of isotonic exercise as non pharmacological therapeutic agent in rehabilitative medicine has become increasingly prevalent and progressively ever gaining prominence.
The risk of sudden cardiac death is more common during the exercise than at rest, greater in sedentary subjects, in elderly and in the initial period of programme. In such case, Beta blocking drugs introduced into clinical practice during the past 2 decades. Drugs which block cardiac adrenergic transmission or cardiac beta adrenoreceptors are most effective in attenuating the pressor and tachycardiac response to dynamic exercise.
Materials and Methods: Male volunteers of 20-30 years were only chosen for this study. They are moderate built with a mean weight of 58 kgs. Blood pressure, heart rate, and the resting respiratory rate also has been recorded. The subject who is sitting upright is instructed to pedal fast the bicycle. The blood pressure, Heart rate, Respiratory rate are continuously recorded at the end of the one minute interval during the exercise and at the end of 5 minutes on cessation of pedaling.
After ensuring complete recovery from stress, in the first propranolol group 80mg of the drug was administered. After 2 hours of administration, all the 4 parameters are recorded and the subject is again subjected to dynamic exercise as above and the same recording done.
After ensuring complete recovery from stress, in the second Atenolol group 50mg of the drug was administered. After 2 hours of administration, all the 4 parameters are recorded and the subject is again subjected to dynamic exercise as above and the same recording done.
Results: Before the administration of drugs to the individuals the resting parameters are recorded.
In case of propronolol, the fall in systolic blood pressure at rest is 12.36%, Diaslostic blood pressure at rest is 14.031% . After administration of Atenolol, the fall in systolic pressure at rest is 10.69% and fall in diastolic pressure at rest is 11.60%. After 1mt isotonic exercise the % of all is 17.14%, in case of Propronolol 13.13 and in case of Atenolol 11.60.
The percentage of fall in pulse rate after propronolol is 16.49 at rest and 16.59% after 1mt exercise. In case of Atenolol the pulse rate at rest is 15.08% and after 1mt exercise 12.73%. In relation to propronolol the values are maintained but the effect of Atenolol shows the percentage of all is less which is observed.
The percentage of fall in respiratory rate is less in case of propronolol than Atenolol. In case of propronolol the fall at rest is 9.77% and after 1mt exercise 6.67%. In case of Atenolol the fall at rest is 9.1 and after 1mt exercise it will be 13.81.
Key words: isotonic exercise, propronolol, atenlol, blood pressure, heart rate, resting respiratory rate
Title: A Prospective Clinical Study of Congenital Heart Disease in Children with Consanguineous Marriages
Authors: Dr. M. S. Raju, Dr. M. Murali Krishna
Objectives: 1. To study the incidence of Congenital Heart Disease in children born to consanguineously married parents.
2. To study the spectrum of Congenital Heart Disease in children born to consanguineously married parents.
Material and Methods:The study was conducted on 305 consanguineously married parents’ children in Dept. of Paediatrics. Govt. General Hospital, Kakinada. from October.’2010 to September.’2011. Age Group selected for this study are 0-5 Years children 2nd Degree, 3rd Degree and 4th Degree consanguineous marriages are included in this study. Maternal gestational diabetes, maternal exposure to teratogenic drugs; Radiations etc. are excluded from the study.
Results: Out of 305 children born to consanguineously married parents, 36 had congenital anomalies 11.8% of which 16 cases found Congenital Heart Diseases (5.2%) and 20 cases found other Congenital Diseases like Gastroschisis, Club Foot, Cleft lip, Polydactyly, etc (6.55%). The frequency of Acyanotic Heart Diseases are 13 (81.3%) and Cyanotic Congenital Heart Diseases are 3 (18.7%) in 16 cases of Congenital Heart Diseases. Spectrum of Heart Diseases diagnosed are VSD, Dextrocardia, TOF, Complex CHD, ASD, PDA, MR and DORV.
Conclusion:The study suggests that children born to consanguineous parents are more likely to have congenital heart disease and other anomalies involving various systems. Congenital Heart Diseases found to be more common in children born to 2nd Degree congenital couple.
Keywords:Consanguineous marriage, Congenital Heart Disease, Gene Copy
Title: Clinical Evaluation of Intrathecal Dexmedetomidine as an Adjuvant to Bupivacaine in Patients of Abdominal Hysterectomy Under Spinal Anaesthesia
Authors: Dr. Rajesh V Nagmothe, Dr. Sanjay S Bule, Dr. Sandhya A Bakshi, Dr. A V Sangawar, Dr. Naresh G Tirpude
This was a prospective randomized double blind study was conducted to evaluate Dexmedetomidine as an adjuvant with Bupivacaine (Bupivacaine 0.5% - Heavy for spinal anesthesia) intrathecally in patient undergoing abdominal hysterectomy surgery.
Aim and Objectives:
1. To evaluate the efficacy of Inj. Dexmedetomidine as an adjuvant to Inj. Bupivacaine (Heavy 0.5%) for Spinal anaesthesia.
2. To know the onset, duration & quality of sensory & motor block of spinal anaesthesia.
3. To know the hemodynamic stability & side effects of the drug under study.
Methods: A total of 60 female patients’ age between 35-70 years classified as ASA grade I and II were randomly divided into two equal groups scheduled for abdominal hysterectomy under spinal anesthesia. The dose of spinal anesthesia drug in Group I was 3.5 ml Bupivacaine with 0.05 ml (5μg) Dexmedetomidine and in Group II was 3.5 ml Bupivacaine with 0.05 ml Normal Saline. The onset of sensory and motor block, duration of sensory and motor block, haemodynamic stability, quality of surgical anesthesia, intraoperative complications, postoperative analgesia and side effects were recorded.
Results: In Group I, early onset of sensory and motor block was noted as compared to Group II. The duration of sensory and motor block was significantly longer in Group I than Group II. The hemodynamic stability was observed in Group I. The quality of anesthesia was excellent in group I. The requirement of intraoperative sedation was significantly less in Group I when compared with Group II. The postoperative analgesia duration was significantly longer in Group I than Group II with minimal postoperative side effects.
Conclusions: Inj. Dexmedetomidine 5 μg seems to be an excellent alternative adjuvant with spinal Bupivacaine (Heavy 0.5%) to increase duration of postoperative analgesia of spinal anesthesia in surgical procedure like abdominal hysterectomy.
Keywords: Dexmedetomidine (As adjuvant), Bupivacaine (Heavy), Abdominal hysterectomy, Sensory & motor blockade, Spinal anaesthesia.
Title: The Study of Various Endometrial Pattern in Patients with Dysfunctional Uterine Bleeding
Authors: Dr. Deepthi H.R, Dr. Syeda Ayesha Siddiqua, Dr. Savitha. H.C, Dr. Lalitha Shivanna
Aim: To determine the various bleeding and endometrial patterns in patients with Dysfunctional Uterine Bleeding
Objective: To correlate these three methods of estimation of fetal weight with the actual birth weight of the baby after delivery.
Materials And Methods: This was a retrospective study that was conducted at Mandya Institute of Medical Sciences, Mandya from July 2013 to December 2013 on 100 patients attending gynaecology out-patient department with clinical diagnosis of Dysfunctional Uterine Bleeding. A detailed history of the patient was taken and examination done, Ultrasound (abdominal-pelvic) and other required investigations were carried out to exclude any organic pathology, pregnancy, bleeding disorder or thyroid dysfunction. The age, parity, pattern of bleeding, associated symptoms, contraceptive method, any medical history such as diabetes or hypertension were recorded. Dilatation and curettage (D & C) was done on the patients who fulfilled the inclusion criteria after the procedure was explained and consent taken. The histopathology reports were obtained from the pathology department. Data was entered in excel sheets and analysed using proportions and percentages.
Results: Out of the100 patients, in age group of 40-45 years, 42 cases (42%) were seen., in the age group of 45-50 years, 38 cases (38%) were seen, where as in the age group of 50-55 years, 12 cases (12%) were seen and minimum incidence was in the age group of 35-40 (8%). Most common clinical presentation was menorrhagia (66%) followed by metrorrhagia (20%). Histopathologically the most common endometrial pattern was proliferative type at 55%. 70 (70%) had symptoms since 6 months, 22 (22%) had symptoms between 6 –12 months and only 8 (8%) of them presented in their very first abnormal cycle
Conclusion: Dysfunctional uterine bleeding affect 9%-30% of women in all age group and accounts for 12% of the gynaecological consultation. Although different bleeding patterns are associated with DUB, most common symptom is heavy bleeding rendering the women anaemic. As the risk of genital tract malignancy increases in perimenopaucal age group, all cases of DUB especially in women of perimenopausal age need further evaluation.
Key Words: Dilatation and Curettage, Dysfunctional Uterine Bleeding, Endometrial patterns, Menorrhagia, Metrorrhagia, Oligomenorrhea, Polymenorrhagia
Title: Health and Nutritional Status of HIV Women Attending Tertiary Care Center in South India - A Cross Sectional Study
Authors: Mamuduru P Srikrishna, Bhaskar Singamsetty
Background: The majority of the HIV infected people live in resource poor countries of Africa and Asia where food insecurity is widespread and the diagnosis of HIV is often made only in the advanced stage. Malnutrition has been shown to be an important co-morbid condition, as these populations are vulnerable to high prevalence of food insecurity. There are only a few studies available on nutritional deficiencies in symptomatic and asymptomatic HIV infected Adults in the Indian scenario. The objective of the study was to assess the nutritional status of women patients suffering for HIV and who were attending ART centre in a Tertiary care hospital.
Methods: This cross-sectional study was conducted during the period October 2008 to April 2009. One hundred and ten HIV positive female patients age group of 18-45 years attending antiretroviral therapy centre (ART) in a Tertiary care hospital, south India. We measured Weight, height, general examination, urine routine and blood investigations like hemoglobin and CD4/CD8 count. In the History we have enquired about appetite, sleep, duration of illness and treatment and follow up. The data were classified and tabulated. The results were expressed in terms of ranges percentages, means, median and standard deviation.
Results: The mean age of the study population was 29.5±5.5 years and more than half 61/110 (55.4%) of the subjects were below secondary level of education. 70/110 (63.4%) were working women, among them 26/110 (23.6%) were either widow or separated. The mean number of children and adults in the family were 2.32± 1.05 and 1.31±1.37 respectively. In 15 (13.6%) opportunistic infection was tuberculosis. The other cause includes chronic dermatitis 27(24.5%) and oral candidiasis 48 (43.6%). These patients are taking (58.52% of RDA) in proteins, (63.6% of RDA) carbohydrates, (96.2% of RDA) fats a rough estimate by 24 hr recall method.
Conclusion: Majority of women suffering with anemia and malnutrion with lower social economic background. Therefore nutritional counseling, education, family support will play a major role in management of malnutrition and HIV disease progression.
Keywords: HIV infection, AIDS, Anemia, Malnutrition
Title: Effect of the Pyridoxine Supplements on the Minimum Inhibitory Concentration of the Co-Ampicillin-Cloxacillin against Staphylococcus Aureus: In Vitro Study
Author: Batool Hazim Al-Daherie
Background: Pyridoxine or vitamin B6is a water-soluble vitamin that is naturally present in many foods, added to others, and available as a dietary supplement. Microorganisms synthesized pyridoxine and played a role in their virulence.
Objectives: This study aims to evaluate the effect of synthetic (exogenous) pyridoxine against Co-ampiclox susceptible and resistant Staphylococcus aureus.
Materials and Methods: This study was done in the Department of Microbiology, College of Medicine, Al-Mustansiriya University in Baghdad, Iraq from November 2014 to January 2015. A total number of thirty Staphylococcus aureus isolated from infected wounds were obtained from the Laboratories of Al-Yarmouk Teaching Hospital. The antibacterial effect of Co-ampiclox (25µg/ml), pyridoxine (at serial concentrations 1-64µg/ml) or a combination were examined in vitro using broth dilution technique.
Results: Four out of thirty isolates were resistant to 25 µg/ml ampiclox. Pyridoxine per se at low concentration (1µg/ml) inhibits the growth of the susceptible isolates by 18.7% while at higher concentrations failed to exert any antimicrobial effect and it reduced the antimicrobial effects of Co-ampiclox against the susceptible Staphylococcus aureus. Pyridoxine at low concentration (1µg/ml) inhibits the growth of the resistant isolates by 13%. while its combination with Co-ampiclox at concentration 4µg/ml inhibit the mean growth of bacteria by 18.3%.
Conclusions: Exogenous pyridoxine exerts antibacterial effect as demonstrated in this study while the endogenous pyridoxine that synthesized by the bacteria is necessary for their resistance and this indicated that pyridoxine exerts dual effect against the growth of the microorganisms.
Keywords: Pyridoxine, ampiclox, antimicrobial, Staphylococcus aureus.
Title: Tobacco Smoke: Break the Chain with Nicotine Replacement Therapy
Authors: Dr. Gauri Motiwale, Dr. Shradha Jaiswal, Dr. Ashok Vikey, Dr. Tejas Motiwale
Today’s world is facing the epidemic of smoking tobacco. It is one of the greatest threats to global health. Smoking is a major preventable cause of premature death and is an important cause of several general diseases ranging from oral ulcers, xerostomia to lung cancers. Tobacco has been consumed from historical times & has got long history. Many varieties of smoked and smokeless form of tobacco products are available, to which people get addicted even though they contain many carcinogens. But these forms are making people to get addicted. To fight this global agent of death, Government & different organizations are coming up with strict policies. This paper reviews tobacco, its constituents & various treatment modalities available for cessation of the habit.
Keywords: nicotine replacement therapy, carcinogens
Title: Evaluation of Isokientic Activities of Shoulder Muscles Post Mastectomy in Different Age Groups
Authors: Raafat Ezz El-Deen Abd Elhameed, Dr, Zizi Mohammed Ibrahim, Prof. Dr. Adel Abdelhameed Nosier
Background: Shoulder movement impairment is a commonly reported consequence of surgery for breast cancer.
Purpose: The purpose of this study to investigate the differences in the isokinetic muscle forces of shoulder flexors, extensors, abductors, and adductors between affected and non-affected sides in patients with post unilateral mastectomy.
Subjects: One-hundred and fifty female's patient with unilateral post mastectomy assigned into three equal groups. Group (A) consisted of 50 patients with age ranging from (35-45), Group (B) consisted of 50 patients with age ranging from (46-55), and Group (C) consisted of 50 patients with age ranging from (56-65).
Procedure: isokinetic peak torque of shoulder flexors, extensors, abductors, and adductors were measured at angular velocity 90 degree/sec for all patients at different age groups.
The Results: Mixed design MANOVA revealed that there was a significant reduction of isokinetic peak torque of shoulder flexors, extensors, abductors, and adductors at affected side compared to non affected side for group A and B (P<0.05). While there was significant reduction of isokinetic peak torque of shoulder abductors and adductors at affected side compared to non affected side for group C and there was no significant difference of isokinetic peak torque of shoulder flexors, extensors between affected and non affected at group C.
Conclusion: It could be concluded that, there was reduction of isokinetic peak torque of shoulder flexors, extensors, abductors, and adductors at affected side compared to non affected side in patients with post unilateral mastectomy at age from 35-55 years.
Key words: Mastectomy, Isokinetic, Shoulder muscles, Breast cancer.
Title: Comparison of Pelvic and Lumbar Wedges in Prevention of Hypotension in Patients Undergoing Caesarean Section Under Subarachnoid Block
Authors: Ashok Kulasekhar, Anand Subramaniam
A major cause of maternal hypotension during caesarean section is aorto caval compression.A randomised controlled trial was done to compare the effectiveness of tilt using wedges in the pelvic and lumbar regions for preventing hypotension following spinal anaesthesia for caesarean section. 60 parturients undergoing caesarean section were randomly assigned to 2 different wedged positions. After completion of the subarachnoid injecton, patient was placed with either a wedge under the right lumbar region [group 1, lumbar wedge], or under the right pelvis[group 2,pelvic wedge]. Systolic,diastolic and mean blood pressures and heart rate were recorded every 2 minutes after the subarachnoid block for the first 20 mts,thereafter15 mts till the end of surgery. Fall of Systolic blood pressure < 90 mm hg was treated with inj ephedrine 6 mg i.v. The obtained values were tested statistically using the students t test and chi square test. The incidence of hypotension was significantly higher in the pelvic group [25/30] than the lumbar group[6/30].Heart rate did not change significantly in either group.A lumbar wedge is more effective than a pelvic wedge in preventing hypotension following spinal anaesthesia for caesarean section.
Title: Anaesthetic Management for Emergency Caesarean Section of Patient with Unrepaired Tetralogy of Fallot with Absent Pulmonary Valve (Severe Annular Stenosis) - A Case Report
Authors: Dr. Sanjay S Bule, Dr Rajesh V Nagmothe, Dr Shruti Khatkhedkar, Dr A V Sangawar4, Dr N G Tirpude
As tetralogy of fallot (TOF) is one of the most common congenital cyanotic cardiac disease with combinations of abnormalities like ventricular septal defect (VSD), Pulmonary stenosis, overriding of aorta and right ventricular hypertrophy(RVH)(1). Uncorrected TOF results in increase incidence of complications and morbidity. Management of such cases are always challenging.
We are presenting a case report of emergency caesarean section in a patient of TOF with absent pulmonary valve due to severe annular stenosis and not on regular medication. She was diagnosed case of TOF since birth.
Keywords- tetralogy of fallot (TOF), LSCS, General anaesthesia, severe pulmonary stenosis
Title: Oral Allopurinol for Preventing Mortality and Morbidity in Neonates with Moderate Hypoxic Ischemic Encephalopathy
Authors: Dina Abd El Razek Midan, MD, Sameh Abdallah Abd El Naby MD
Background: Despite progress in neonatal care, the mortality and the incidence of neuromotor disabilities after perinatal asphyxia have failed to show substantial improvement. Delayed neuronal death following a perinatal hypoxic insult is partially due to xanthine oxidase-mediated production of cytotoxic free radicals. Evidence exists that allopurinol, a xanthine oxidase inhibitor,reduces delayed cell death in experimental models of perinatal asphyxia.
Objectives: To determine the effect of oral allopurinol on mortality and mobidity in newborn infants with hyoxic ischemic encephalopathy.
Methods/Design: Term newborns(gestional age≥ 36 weeks and birth weight ≥1800g) with precocious metabolic, clinical and electroencephalographic signs of moderate hypoxic ischemic encephalopathy will be recruited from the neonatal intensive care unit of menoufyia university hospital and will be randomised to receive allopurinol added to standard treatment of asphyxia. Allopurinol will be administered orally within the first 4 hours after birth through a nasogastric tube in total daily dose of 40 mg/kg of birth weight and continued for three days after birth. To evaluate the efficacy of allopurinol, the neurologic outcome of enrolled cases will be evaluated by serial neurologic and neuroradiologic examinations at 1 week after birth, at 3 months and at 12 months of age.
Results: Our results showed a significant decrease in morbidities in neonates who received allopurinol as an adjunctive to ordinary therapy ,as the incidence of seizures beyond the neonatal period, continued nasogastric tube feeding, epilepsy and its control with drugs and also the incidence of epilepsy were all less in those who received allopurinol. Also the results of neuroimaging were in favour of those neonates.
Discussion: This study will explore the possible theraputic role of allopurinol. Any favourable results of this research might open new perspectives about the reduction of cerebral insults following hyoxic ischemic encephalopathy.
Conclusion: Allopurinol is a simple and inexpensive intervention that serves as a beneficial adjunctive treatment for newborns suffering from hypoxic ischemic encephalopathy
Keywords: Hypoxic ischemic encephalopathy, allopurinol, xanthine oxidase inhibitor, morbidity, mortality.
Title: A Prevalence of Hypertension in Children – School Based Study
Authors: Dr. M. S. Raju, Dr. S.Narmadha
Objectives: To study the prevalence and aetiology of Hypertension in school children aged 10-15 Years.
Methods:In this study 975 students from 3 Govt. Schools and 975 Students from 4 Pvt. Schools of age group of 10 – 15 Years were selected based on random table method with help of their role numbers.
Anthropometric data, Blood Pressure measurement and family history of Hypertension, Diabetes, Ischemic Heart Disease and Obesity were collected for all 1950 Children. For children with High Blood Pressure readings or positive family history, repeated Blood Pressure measurements were taken on three different occasions with one-week interval.
Subsequently, in children with increased Blood Pressure on three separate occasions, detailed history was taken, children were thoroughly examined and necessary investigations were done.
Results:The present study includes 1950 children of which the prevalence of Hypertension is 2.4% (47/1950) and Pre Hypertension is 8.15% (159/1950) with p value - 0.0001 which is statistically significant.
Prevalence of Hypertension is 3.69% (36/975) in Private School Children while it is 1.2% (11/975) in children from Govt. School. Prevalence of Pre Hypertension is 14.25% (139/975) in Private School while it is 2.05% (20/1950) in Govt. Schools.
Pre Hypertension is found to be more prevalent in 13 – 15 Years (10.09%) age group then 10 – 12 Years age group (5.79%) with p value of 0.0006 which is statistically significant.
Prevalence of Pre Hypertension and Hypertension is more in children with family history of Hypertension, Diabetes Mellitus, Obesity and Ischemic Heart Disease. In overweight children Pre Hypertension in more and in obese children, Hypertension is more.
Secondary Hypertension is seen in 4 Cases out of which 2 cases are diagnosed with Hyperthyroidism and 2 cases has history of acute Glomerulonephritis.
Conclusion: Hypertension and Pre Hypertension are more common in older children (13-15 Years). Prevalence of Pre Hypertension and Hypertension is more in boys then is girls. Corporate Schools then in Govt. School, High – Socioeconomic group then low Socio-Economic group, with family history of Hypertension, Diabetes Mellitus, Obesity and Ischemic Heart Disease, Obesity Children and Overweight Children without any physical activity.
Keywords: Pre Hypertension, Hypertension, Secondary Hypertension, Glomerulonephritis.
Title: Study of Electoro Encephelography (EEG) and Magnetic Resonance Imaging (MRI) in full term Newborns with Hypoxic Ischemic Encephalopathy (HIE) in Comparison to full Term Normal Newborns
Authors: Dr. M. S. Raju, Dr. V.Raja Rajeswari Sathi
Objectives: To know the abnormalities in Electroencephalogram in full term newborns with hypoxic ischemic encephalopathy in comparison to full term normal newborns.
To know he abnormalities in MRI of brain in full term newborns with hypoxic ischemic encephalopathy in comparison to full term normal newborns.
Material & Methods: The Study population comprised of 100 term asphyxiated full term neonates and 100 fullterm normal neonates who were admited to the neonatal unit in Govt. General Hospital, Kakinada from Oct.2012 to Apr.’2014.
The encephalopathy in term neonates was graded clinically into three stages based on Sarnat & Sarnat, Levene grading system EEG and MRI of brain were done in all new borns who were enrolled in the study.
Results: In present study ot of 100 neonates HIE I-15, HIE II-80, HIE III-5 Cases EEG was normal in 94% and abnormal in 6% of HIE group abnormal EEG suggestive of burst suppreession pattern. In HIE Group MRI Brain was normal in 44% abnormal in 56% of cases, where as in controle group MRI Brain was normal 97% and abnormal in 3% neonates. In present study sensitivity and specificity of MRI Brain were found to be 94.91% and 74.04% respectively. MRI Brain is more sensitive and specific than EEG in detection of abnormalities in HIE.
Conclusion: MRI brain is more sensitive and specific in detection of abnormalities of HIE in neonates. Clinical staging of HIE reliability correlates with abnormal changes in MRI Brain than in EEG as structural abnormalities are seen in MRI Brain and functional intigrity known by EEG. MRI is better tool for early detection of the abnormalities of brain compared to EEG in HIE Cases.
Key Words: HIE (Hypoxic Ischemic Encephalopathy), EEG (Electro Encephalography), MRI (Magnetic Resonance Imaging),
Title: Pterygoid Hamulus Bursitis: A Rare Case Report
Authors: Dr. Tejas Motiwale, Dr. Gauri Motiwale, Dr. Satish Motiwale
Craniofacial pain disorders are frustrating to the doctor and the patient. Diagnosis is often difficult because the anatomy of the head and neck region is complex, grossly and neurologically. Frequently, several pain syndromes exhibit similar symptoms. One such disorder is bursitis of the pterygoid hamulus. This type of bursitis may produce symptoms of soft palatal, ear, and throat pain, maxillary pain, and difficulty and pain on swallowing. This disorder is often misdiagnosed as otitis media. Treatment may be conservative or surgical. This article discusses the anatomy, symptoms, diagnosis, and treatment of bursitis of the hamular process along with a case report.
Key words: Bursitis, pterygoid hamulus, referred pain, temporomandibular disorders.
Title: Carcinoma Cervix with Cutaneous Metastasis: A Case Report
Authors: Dipti Rani Samanta, Chaitali Bose, Saumyaranjan Mishra, Sulagna Mohanty, Surendra Nath Senapati
Cutaneous metastasis is an uncommon entity in gynecologic cancer. Though carcinoma cervix is the commonest female malignancy in the developing countries, cutaneous involvement of cervical cancer is particularly unusual, even in the terminal stage of the disease. The incidence of cutaneous metastasis in carcinoma cervix ranges from 0.1% to 2%. Here we present a case of cutaneous metastasis to anterior abdominal wall from carcinoma cervix after 18 months of completion of treatment with chemoradiation. She was treated with six cycles of chemotherapy with paclitaxel and carboplatin, followed by external beam radiotherapy to cutaneous presentation area. This case is reported due to its rarity and for documentation.
KEY WORDS- Carcinoma cervix, cutaneous metastasis, squmous cell carcinoma.
Title: Using Muscle Architecture to Predict Maximum Strength and Its Relation to Activity Levels in Cerebral Palsy Patients
Authors: Prof. Dr. Emam Hassan El Negamy, Prof. Dr. HodaAbd El AzimEl Talawy, Dr. Eman Hassan AbdAlsalam, Taher Salah El Din Taha
Background:To provide insight into the relationship between muscle architecture, muscle strength and activity level in CP.
Subjects and Methods:This study was conducted on forty subjects divided into two groups of equal number, group A (normally development) and group B (cerebral palsy patients). All participated subjects examined for their rectus femoris and vastus lateralis muscle thickness by sonography, quadriceps muscle isometric peak torque measured by isokinetic dynamometer, activity level for group B only evaluated by pediatric outcome data collection instrument (parent report and self-report). Group A evaluated for one time and group B evaluated two times at starting and after six months of physical therapy program.
Results: showed direct relationship between muscle thickness measured by sonography and both muscle strength and activity level.
Conclusion:muscle thickness measured by sonography can be used to evaluate muscle strength and activity level in cerebral palsy patient.
Key words:Muscle architecture, muscle strength, activity level, cerebral palsy.
Title: Evaluation of Medication Adherence in Diabetes Mellitus Patients by Using 8- Item Morisky Scale
Authors: D.Sunanda, K.Sindhuja, A.Roopa Sri, G.Likitha, A.Alekhya, K.Rohali
Background: Medication adherence is the extent to which a patient’s medication taking behavior coincides with intention of the physician. The aim of the study was to evaluate self reported medication adherence and to identify factors related to poor adherence in type-2 Diabetes mellitus and make them adherence to the medication to prevent complications.
Methods: A 6 months Cross sectional study was conducted at Narayana Hrudayalaya-MallaReddy Hospital (tertiary care ) with 150 Diabetic patients to assess the adherence to medication. Adherence was measured by using 8-item Morisky Medication Adherence Questionnaire consisting of 8questions. Other data such as patient demographics, family history, duration of DM, smoking & alcoholic, BMI, comorbidities and treatment were also collected from patient medical records.
Results: A total of 150 patients were recruited in the study and they were assessed for their adherence rate in three reviews. Approximately 60% of patients in the study were non-adherent in first review and 10% of patients in the study were non-adherent in second review and 6.66% of patients in the study were non-adherent in third review. Age from 40-49years(30.66%) were more nonadherent and duration <6months(33.33%) were more and Whereas 37.33% of obese patients and 33.33% over weight patients were observed and comorbidities were 48.66%
Conclusion: Adherence to medication in T2DM patients in the tertiary care hospital was found to be poor. This is a cause of concern, because nonadherence could lead to a worsening of disease.Improving medication knowledge by paying particular attention to different age groups and patients with comorbities could help to improve adherence.
Keywords: Type 2 diabetes mellitus, adherence, teritary care
Title: Intramedullary Interlocking Nail Fixation for Fracture Shaft Humerus - A Prospective Study
Authors: Suresh Reddy.S, Obulapathy.D.
Humerus is the longest and strongest bone of upper extremity and serves as the pivot for functional activities of the upper limb. It is prone for frequent fractures with overall incidence of 3% in all fractures. Most of the fractures of shaft humerus can be managed conservatively but remains controversial particularly when associated with polytrauma. To minimise the risk of complications of conservative treatment the surgical management by open or close reduction and internal fixation by intramedullary nailing or plate osteosynthesis are preferred. The aim of the present study was to evaluate the functional outcome of the fracture shaft humerus treated with closed or open reduction and internal fixation by antegrade intramedullary interlocking nail as this is a better implant biomechanically and provides a good degree of axial, angulatory and rotational stability. 25 Patients with fracture shaft of humerus, admitted in the Orthopaedics department of S.V.R.R.G.G.Hospital and Sri Venkateswara Medical College, Tirupati were included in the study. Neer’s critena was used to evaluate the results, which was, excellent in 18(72%), good in 5(20%) and poor in 2(8%) patients. Average time for fracture union was around 14 weeks. Only 2(8%) patients had complications, one with non-union and the other with restricted shoulder movement. Hence intramedullary interlocking nailing for fracture shaft of humerus appears to be a safe and reliable method. It allows micro movement at the fracture site, enhancing early fracture consolidation and early mobilization thereby improving functional out come.
Keywords- fracture shaft of humerus, internal fixation, interlocking, intramedullary nailing.
Title: Occular Prosthesis – Case Series
Authors: Dr. Nihar Ranjan Naik, Dr. B.K.Motwani, Dr. Shailendra Kumar Sahu, Dr. Sanjeev Singh, Dr. Anurag Dani, Dr. Shuchi Kulkarni
Eyes are generally first features of the face to be noticed and most vital organ of the body. loss of eye due to any reason affect the psychology and appearance of the patient. Occular prosthesis is an artificial replacement of the eye. After enucleation, evisceration and exenteration of the eye, the goal is to replace the missing tissues with an artificial prosthesis and restore the facial symmetry and normal appearance of the anophthalmic patient.
This is a case report presenting simplified approach of the fabrication of occular prosthesis in a cost effective manner with a unique impression technique.
Keywords: Occular Prosthesis, custom made Occular impression, Maxillofacial prosthesis
Title: A Comparative Study of Dexmedetomidine Versus Midazolam-Pentazocine for Tympanoplasty Under Monitored Anaesthesia Care
Authors: Dr. Nazima Memon, Dr. Ramesh G.Pathak
Background: Monitored Anaesthesia Care (MAC)is a planned procedure during which the patient undergoes local anaesthesia with sedation and analgesia. MAC is chosen for 10-30% of all surgical procedures. Tympanoplasty is one of the procedure done under MAC. The present study was designed to compare newly introduced alpha-2 agonist drug, Dexmedetomidine with intravenous midazolam and pentazocine given routinely in our set up.
Objectives: To compare intravenous dexmedetomidine with intravenous midazolam-pentazocine combinationwith respect to (i) Analgesic effect (ii) Sedation score (iii) Bloodless field during surgery (iv)Hemodynamic stability (v) Quality of anaesthesia. (vi) Postoperative analgesic requirement in 24 hours.
Material and Methods: Sixty patients, ASA physical status I and II, posted for tympanoplasty under local anaesthesia with sedation were included in the study. The patients were randomly divided into two groups- Group D: 30 patients received intravenous dexmedetomidine 1 mcg/kg over 10 min. followed by infusion 0.5 mcg/kg/hr till end of surgery. Group MP: 30 patients received intravenous midazolam 0.05mg/kg and intravenous pentazocine 0.5mg/kg followed by saline infusion at rate of 0.5ml/kg/hr. Vital parameters, sedation score (Ramsay Sedation score), Bleeding, requirement of rescue analgesic (IV Midazolam 0.01mg/kg and IV Ketamine 20 mg as and when required) and quality of anaesthesia noted.
Results: The analgesic effect was better in Group D than Group MP. Only 1 patient in Group D required rescue analgesic whereas 17 patients in Group MP required rescue analgesic. There was fall in heart rate and fall in blood pressure in Group D. No such changes in hemodynamics seen in Group MP. Quality of anaesthesia was better in Group D than Group MP. The mean postoperative requirement of analgesic was 1.6 ± 0.49 in Group D and 2.86 ± 0.34 in Group MP.
Conclusion: Intravenous Dexmedetomidine is an excellent drug for surgeries like Tympanoplasty done under monitored anaesthesia care. It not only improves intraoperative anaesthesia but also postoperative analgesia and thereby, improving the outcome of surgery.
Keywords: Tympanoplasty, Dexmedetomidine, Midazolam, Pentazocine, Monitored Anaesthesia Care.