Asian Journal of Medical Research

PCNL in Staghorn Calculi: Our Experience

Mukesh Chandra Arya — 2019-08-24

Background: The treatment of STAG HORN calculi has varied from combination of percutaneous nephrolithotomy (PCNL) and shockwave lithotripsy (SWL) or sometimes open surgery. The goals of treatment of a STAG HORN stone are complete stone clearance with minimal morbidity. Although excellent stone-free rates are universally reported in the literature, complication rates vary widely, especially related to the need for blood transfusion.Subjects and Methods:From January 2015 to December 2018, 1400 patients underwent PCNL out of which 392 patients had stag horn stones. Our study included stag horn stones that were present in the renal pelvis and branched into two or more major calyces. All procedures were performed under general or spinal anesthesia by the same surgical team.Results:392 patients (144 women and 248 men) with mean age of 44.2 (range 8yr–72yr) years having partial/complete STAG HORN calculi were treated at our center S.P. Medical college, Bikaner from period of January 2015 to December 2018. 10 patients (10.2%) had pre existing renal insufficiency with a mean (range) serum creatinine of 3.0 (1.5-4.2) mg/dl.Conclusion: PCNL using multiple tracts is safe and effective and should be the first option for renal STAG HORN calculi. It must be done by experienced endourologists in a specialized centre with all the facilities for stone management and treatment of possible complications.

Retrospective Assessment of Postoperative Nausea and Vomiting after Unrestricted Clear Fluids before Day Surgery: An Observational Study

Prabodh Bansal — 2019-08-24

Background: Nausea and vomiting during and after the surgery are distressing for both the patient and his/her family. In addition, when vomiting occurs intraoperatively under regional anaesthesia, it offers significant challenge to the operating surgeon, potentially increasing the duration of the procedure and the risk of bleeding and inadvertent associated surgical trauma. Aim of the study: To assess postoperative nausea and vomiting after unrestricted clear fluids before day surgery.Subjects and Methods:The study was conducted in the Department of Surgery, Rama Medical College Hospital & Research Centre, Hapur, Uttar Pradesh, India. For the study, medical records of 200 patients who underwent surgical procedure at the hospital were selected for review. It was made sure that included patients were restricted from fluid intake for 12 hours before the surgery. We analysed records of randomly selected 200 patients who underwent surgical procedure at the hospital for the study period.Results:A total of 200 patient records randomly selected from the pool of records were analysed in the present study. We observed that mild nausea was experienced by 27 patients, moderate was experienced by 16 patients and severe nausea was experienced by 3 patients. We observed that 14 patients had vomiting only once, 8 patients had 2-3 times vomiting and 2 patients had vomiting more than 3 times. The results were compared and found to be statistically non-significant.Conclusion: From the results of the present study, this can be concluded that restriction of food and fluid intake before the day surgery is an efficacious method in avoiding nausea and vomiting in patients during post-operative time.

Role of Serum Bilirubin as a Marker of Acute and Complicated Appendicitis

Pankaj Garg — 2019-08-24

Background: Acute appendicitis is the most common surgical emergency and early surgical intervention is seen to improve outcomes. Jaundice has been associated with appendicitis and studies have shown hyperbilirubinemia to be a useful predictor of appendiceal perforation. Elevated serum bilirubin will help in early and accurate diagnosis of acute appendicitis. This study aims to evaluate the role of serum bilirubin as a marker in acute appendicitis.Subjects and Methods:This study was conducted in the department of surgery, Dayanand medical college and hospital, Ludhiana on patients of acute appendicitis. Routine investigations including bilirubin total and bilirubin direct were done and the mean value of bilirubin total and liver enzymes in cases of acute appendicitis was calculated. The p value <0.05 was considered significant.Results:The mean age of the patients was 27.29±16.4 years. There were a total of 59 patients with 47 males and 12 females. The total bilirubin levels in cases with acute appendicitis and complicated appendicitis were 0.71±0.29 and 1.46±0.66 respectively.Conclusion: Increase in serum bilirubin levels were seen in patients of complicated appendicitis and it can be added in the list of routine investigations at the time of admission in suspected cases of appendicitis.

Assessment of Various Techniques of Cholecystectomy: A Comparative Study

R. D. Sharma — 2019-09-16

Background: Gallbladder disease is one of the most common procedures done with more than 1.2 million cholecystectomies done annually. The technique of performing LC has undergone many changes and variations. Hence; the present study was undertaken for assessing efficacy of various techniques of Laparoscopic cholecystectomy. Subjects and Methods: A total of 90 patients were enrolled in the present study and were broadly divided into three study groups as follows: Group A: Patients who underwent single port LC, Group B: Patients who underwent three port LC, and Group C: Patients who underwent Four port LC. Preoperative work up included evaluation of a complete history and physical examination, and radiological examinations including abdominal ultrasound. All the patients underwent LC according to their respective groups under the hands of skilled and experienced surgeons. All the postoperative follow-up details of all the patients were recorded. Results: Significant results were obtained while comparing the mean duration of surgery among subjects of all the three study groups. No-significant results were obtained while comparing the mean duration of hospital stay and incidence of complications among subjects of the three study groups. Conclusion: All the three techniques can be used with equal efficacy among subjects of the three study groups. However; in terms of duration of surgery, three port techniques was better in comparison to other two techniques.

A Case-control Study of Prevalence of Cholelithiasis among Type 2 Diabetic Patients in Kashmir.

Shakeeb Nabi — 2019-10-13

Background: Type 2 Diabetes mellitus and gall bladder stones are both common and co-existent diseases in a significant population. Increasing age, female gender, overweight, fair skin , familial history of the disease and type 2 diabetes mellitus is all associated with an increased risk of gallstones. Several studies from around the world reported an increased prevalence of gall bladder stones in patients with diabetes mellitus. Aims and objectives: The aim of this study was to define the frequency of gall bladder stones among diabetics and to evaluate the possible associated risk factors in these patients.Subjects and Methods:A case control study was performed during 2018 at Government Medical College Baramulla. The study involved 161 randomly selected type-2 diabetic patients under regular follow up at the center, and 166 age and sex matched non-diabetic outpatients. Real-time abdominal ultrasound was performed by a radiologist to examine the abdomen after an overnight fast.Results:About 40% of the diabetic cohort had gall bladder stones as compared to 17.5% of non-diabetic patients. Females were significantly more affected than males. Patients with gall bladder stones were significantly older and had a significantly higher body mass index than those without stones.Conclusion: The prevalence of gallstones in diabetic patients is higher in Kashmir than the rates reported in other parts of the world. Kashmiri diabetic patients with gallstones tend to be older and more obese than those without gallstones. Duration of diabetes mellitus and type of treatment does not seem to influence the frequency of gall bladder stones among Kashmiri diabetics.

Jejunal Diverticulosis: Presenting As Peritonitis

Vikas Chalotra — 2019-10-19

Jejunal diverticular perforation is a rare complication of jejunal diverticular disease and few cases have been reported in the literature. Jejunal diverticula have a prevalence of approximately 1% in the general population. Pathophysiology of chronic symptoms is related to either intestinal dyskinesia or bacterial overgrowth from blind loop syndrome due to stasis in diverticular lumen. Patients may develop malabsorption, steatorrhea, and megaloblasticanaemia from vitamin B12 deficiency. Conventional enteroclysis and CT enteroclysis is beneficial for diagnosis of jejunal diverticular disease. Jejunal diverticular perforation is very rare. Clinically, the diagnosis is challenging and mimics with other causes of acute abdomen. Presentation varies widely from asymptomatic to non specific symptoms to acute abdomen with catastrophic consequences. Here, we present a rare case of jejunal diverticular perforation.

To Compare the Recurrence Rate of Suture Repair V/S Mesh Repair In Incisional Hernia: An Hospital Based Prospective Study.

Shankar Singh Gaur — 2019-10-31

Background: The technique of hernia repair is usually based on custom rather than evidence. The aim of this study to compare the recurrence rate of suture repair v/s mesh repair in incisional hernia. Subjects and Methods:A Prospective Clinical Hospital Based Study done on 30 patients in Department of Surgery, P.D.U. Medical College& Hospitals, Churu (Rajasthan) during one year period. Patients were randomly assigned to undergo suture repair or mesh repair. Follow-up of cases was done after 6 months after surgery on an outpatient basis for recurrence of hernia. Results:Our results showed that small (0-5cm) gap size 86.66% cases. Most common post-operative complication was 26.66% chest infection, followed by 20% wound infection in group A and fever was present 20% in group B. The recurrence of hernia was present in 26.66% cases in group A and 6.66% in group B. It was statistically significant (P=0.0488*).Conclusion: We concluded that in small defect incisional hernias, mesh repair provides better results than suture repair modalities.

A Prospective Study on Functional Outcome of Fracture Supracondylar and Inter Condylar Fracture of Femur Treated With Locking Plates

Gaurav Jain — 2019-09-16

Background: Distal femur fracture accounts for 3-6% of all femur fractures. Management is difficult as mostly fractures are unstable, communited with articular extension with extensive surrounding soft tissue injury. The introduction of distal femur LCP has brought a drastic difference in management of supracondylar and intercondylar fractures. Aim: To evaluate the functional outcome of distal femur fractures treated with distal femoral LCP. Subjects and Methods: The study was conducted at the Department of Orthopedics, Muzaffarnagar Medical College ,Muzaffarnagar during January 2018-2019 period .A total of 10 patients were included in the study. The method used for fixation was closed or open reduction and internal fixation with distal femoral LCP. All the patients were followed up for a period of one year and functional outcome was assessed according to Neer’s score system. Results: On evaluation according to Neer’s criteria our results were as follows-Out of 10 patients 3(30%) had excellent, 6(60%) had satisfactory and 1(10%) had unsatisfactory result. Conclusion: We conclude that locking plate provides the advantage of combining conventional screw capacity with fixed angle technology, that fixed angle screw provide stable fixation in small articular block, protecting against collapse and loss of alignment in osteoporotic patients.

Assessment of Cases of Anterior Cruciate Ligament Reconstruction Surgery- A Clinical Study

Shakti Condil Sharma — 2019-10-13

Background: The ACL is the primary restrain to anterior translation of the tibia on the femur. The present study was conducted to assess cases of anterior cruciate ligament reconstruction surgery in adult patients.Subjects and Methods:The present study was conducted on 72 patients who underwent anterior cruciate ligament reconstruction surgery. Risk factors were recorded. Results:Out of 72 patients, males were 48 and females were 24. Out of 72 patients, infection was present in 10 males and 4 females. Risk factors for ACL surgery was BPTB graft in 3, STG graft in 5 cases. Obesity was seen in 11, smoking in 6, and diabetes mellitus in 4. The difference was significant (P< 0.05).Conclusion: ACL injury is common among sports person. Risk factors reported were diabetes mellitus, smoking and obesity.

Prevalence of Diastolic Dysfunction in Asymptomatic Young and Middle Aged Individuals Attending a Tertiary Care Hospital

Rajiv Arora — 2019-08-24

Background: Heart problem is a common health issue encountered these days. Hence; the present study was planned for assessing the prevalence of Diastolic Dysfunction in Asymptomatic Young and Middle Aged Individuals Attending a Tertiary Care Hospital. Subjects and Methods: A total of 200 patients were included in the present study. The study group comprised of patients who reported to the department for routine medical checkup. Echocardiography using color Doppler was done in all the patients. Physical examination was done to look for any evidence of cardiac involvement in each and every patient.The diastolic dysfunction was graded as; Grade 1: An isolated early relaxation abnormality,Grade 2: Impaired relaxation, but with modestly elevated Left ventricular end-diastolic pressure, and Grade 3: Restrictive filling.All the results were recorded in Microsoft excel sheet. Results: Diastolic dysfunction was found to be present in 50 patients. Therefore; prevalence of diastolic dysfunction was found to be 25 percent. Significant increase in the prevalence of diastolic dysfunction was seen among elderly patients. However; no significant correlation was seen among patients with diastolic dysfunction divided on the basis of gender. Conclusion: Diastolic dysfunction is a major health issue affecting a significant patient population. Also, increase in severity of diastolic dysfunction is found to be positive correlated with increasing age.

A Correlation of Duration of Diabetes with Glycemic Indices in the Type 2 Diabetes Mellitus: A Prospective Study

Anil Kumar Gupta — 2019-08-24

Background: The development of chronic complications is related to the duration of Diabetes Mellitus, however it may not reflect the true duration of disease, rather it reflects the time since diagnosis. The aim of this study to correlation of glycemic indices with duration of diabetes. Subjects and Methods: An observational study has done on 100 patients with type 2 diabetes mellitus in department of medicine, MSY Medical College & Hospital, Lalpur, Meerut. Diabetes was diagnosed according to American Diabetes Association (ADA) revised criteria. Blood glucose level estimation was done by glucose oxidase method in venous blood. Glycosylated haemoglobin (HbA1C) was measured by ion-exchange chromatography method. Results: Our results showed that the 5-10 years of duration of diabetes was present in 42% cases and less than 5 years duration of diabetes was present in 40%. HbA1c was not significant correlate but >10 years duration of diabetes was higher mean value as compared to less than 5 year duration of diabetes. Conclusion: We concluded that on applying spearman correlation for microvascular complications, a positive association was observed for age of patients, duration of diabetes, HbA1C. Duration of diabetes was found to be a main culprit of micro vascular complication.

Liver Dysfunction in Dengue Fever: A Prospective Study

Gautam Chand Jingar — 2019-07-15

Background: Dengue has emerged as an important arbovirus disease with significant impact on the disease burden in population residing in tropical countries. The virus seems to have some hepatotoxic effects.The aim of this study to rule out extent of liver dysfunction in Dengue fever. Subjects and Methods: A total of ninety six (n=96) serologically confirmed patients who were hospitalised were included in the study. NS1 and IgM anti dengue antibodies using the IgM antibody capture – enzyme linked immunosorbent assay (MAC – ELISA) for diagnosis of dengue fever were done. Detailed clinical examination was performed on admission, blood sample were collected, and all haematological, coagulation profile and biochemical investigations for renal and hepatic function were studied. Results:The study group consisted of 96 patients with male to female ratio was 2.3:1 and age ranging from 12 to 75 years (27.68 years). Common clinical features were fever (100%), persistent vomiting (79.17%), rash (33.33%) and bleeding manifestation (10.42%) hypotension was observed in 2 patients (2.63%) without involving particular age group. Our study showed that the leucopenia (WBC <4000/μl) wasfound in 58.33% of cases followed by platelet count <1000/μlfound in 35.41% of cases. Among liver function tests hepatomegaly (nontender) was present in about 58.3% patients and 91% patients had raised transaminase level ,very high >25 times increase was found in 20.8% patients. S. Alkaline Phosphatase was normal in 70% and only 11% patients showed abnormal echotexture on ultrasound. Conclusion: The pattern of hepatic involvement of liver in dengue fever varies as per the severity of disease. In milder case of dengue fever liver function test was normal but there was hepatomegaly was present commonly but in severe form of disease pattern of hepatic involvement varies from tender hepatomegaly to significant increase in liver enzyme.

Evaluation of Thyroid Hormone Deficiency among Female Visited In Government Hospital: A Prospective Study

Gajendra Singh — 2019-08-24

Background: Among females, there is significant prevalence of diseases of the thyroid gland. Hence; the present study was undertaken for assessing thyroid hormone deficiency among females visiting government hospital. Subjects and Methods:A total of 255 patients were identified to be suffering from thyroid hormone deficiency. Among these 255 patients, 152 were females. A separate data sheet was made for recording the clinical profile of females. Complete demographic and medical details of all the female patients with thyroid hormone deficiency were obtained. All the results were recorded in Microsoft excel sheet and were analyzed by SPSS software. Results: 38.82 percent of the patients belonged to the age group of more than 50 years. 27.63 percent of the patients belonged to the age group of 41 to 50 years. 20.39 and 13.13 percent of the patients belonged to the age group of 30 to 40 years and less than 30 years. Feeling of tiredness was found to be present in 69.08 percent of the patients, while weakness and pain in muscles and joints was found to be present in 72.37 percent of the patients. Conclusion: Thyroid hormone deficiency is common among elderly females with feeling of tiredness and muscle and bone pain the prominent clinical manifestation encountered.

The Correlation between Rheumatological Manifestations and Diabetes Complications and Indices

Amandeep Singh — 2019-09-16

Background: Type 2 diabetes mellitus represents approximately 90% of all cases of diabetes. Nonvascular complications include gastrointestinal, genitourinary, dermatologic, infectious periodontal disease and rheumatological. Diabetic amyotrophy is characterized by muscle weakness and wasting, and by diffuse, proximal lower limb muscle pain, and asymmetrical loss of tendon jerks. There have been not much studies on diabetes and its association between rheumatological manifestations. Therefore, the present study was conducted with the aim to determine the correlation between rheumatological manifestations and diabetes complications and indices.Subjects and Methods:The present cross sectional study enrolled 100 subjects reporting to Department of Medicine, Rajindra Hospital/ Government Medical College, Patiala. Complete blood count, erythrocyte sedimentation rate, rheumatoid factor, serum uric acid were done. The rheumatoid factor upto 20 IU/dl and serum uric acid upto 7 mg/dl was taken as normal. X-rays of hand, shoulder, knee, spine and other involved joints wherever necessary were done. Examination of musculoskeletal system was performed. All the data thus obtained was arranged in a tabulated form and analyzed using SPSS software. Student t test was used for statistical analysis. Probability value of less than 0.05 was considered as significant.Results:Mean value of HbA1C of patients with rheumatological manifestations was 8.43 ±1.14 whereas Mean value of HbA1C of patients without rheumatological manifestations was 7.10±0.93. On statistical analysis significant association between rheumatological manifestations and HbA1c was found. On statistical analysis positive association between rheumatological manifestations and retinopathy was noted.Conclusion: Positive association of retinopathy and neuropathy was seen in our study with rheumatological manifestations in T2DM. So, screening of diabetic patients for the presence of rheumatic complications is needed, since early recognition of these lessens the chances of irreversible damage.

Cardiopulmonary Exercise Testing in Coronary Artery Disease Male Aviators Prior to Refighting: A Suggested Modality

Ashish Chauhan — 2019-10-13

Background: Exercise testing provides valuable diagnostic and prognostic information regarding patients with cardiovascular and pulmonary disease. The aim of this study is to assess maximum oxygen consumption (O2 Max), oxygen consumption at Lactate threshold and exercise ECG, heart rate, BP response in aviators with CAD who are being considered for refighting.Subjects and Methods:We included 7 males from age group 35 – 56 y who were CAD patients for medical evaluation at our center. A normogram was earlier obtained by subjecting 72 males between the age 18 – 60 year by random selection during medical for initial entry to Airforce and routine annual medical in serving personnel.Results:These males were subjected to cardiopulmonary stress test, after an echocardiogram was done to assess structural heart disease. The data obtained was compared with the normogram for age.Conclusion: In this study, we conclude that in our population a healthy aviator reaches an average of 80% of age predicted VO2 max (normogram for age 30 – 39 and 40 – 49 attached above). Aviator no, 2,3,4,5,7 were reflighted.

Study of Various Morphological Types of Anaemia in Patients With rheumatoid Arthritis and Comparison of Serum Ferritin with Bonemarrow Iron Stores in These Patients.

Dilip M Pancholi — 2019-10-13

Background: Anemia is a common extra-articular manifestation in rheumatoid arthritis patients. Its severity roughly parallels the activity of the disease1-2. Chronic disease and iron deficiency are considered to be the most significant causes of anemia 3-5. Anemia of chronic disease is usually confused with iron deficiency anemia due to the low level of iron in blood in both forms of anemia. Subjects and Methods:This study was conducted in Department Of Medicine, C. U. Shah Medical College, Gujarat, India. 68 total number of population were included in this study.The duration of study was over a period of six month. Results:In our study, 68 total numbers of cases were included. Among all cases 58.8 % were male & 41.2% were female. In the present study, 41.2% cases were belongs to 31-40 age group followed by 41-50(35.2%), <30 (11.7%) &>50 (11.7%) age group. This study suggested type of anemia which was found 76.5%Normocytic Normochromic followed by Microcytic Hypochromic 23.5%.Conclusion: Therefore, it can be concluded from the present study that normocytic normochromic anemia is the most common morphological type of anemia in patients with rheumatoid arthritis. And there is a positive correlation between serum ferritin and BMIS in RA patients presenting with anemia. The results of this study also revealed that serum ferritin is an useful index of iron stores in rheumatoid arthritis.

Clinical Profile of Patients Admitted in Hyperglycaemic Emergencies and Their Outcomes in Patients at a Tertiary Care Hospital in Southern India –a Retrospective Study

Dheeraj Jain — 2019-10-13

Background: To study the clinical profile of patients with diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) and their outcome in a tertiary care hospital in Puducherry.Subjects and Methods:This was a retrospective study of patients with DKA and HHS admitted in Indira Gandhi Medical College & Research Institute (IGMCRI), Puducherry over a period of two years. Data on precipitating factors, clinical features, serum electrolytes, duration of hospital stay and mortality were obtained.Results:100 patients were included in the study. 84 patients had DKA and 16 patients had HHS. Of the 84 patients with DKA 65 (77.4%) were diagnosed as Type 1 DM and 19 patients as Type 2 DM (22.4%). Commonest precipitating factor for DKA was missed treatment (61%) followed by Infection. Total number of deaths in DKA was 9. Out of 19 type 2 patients with DKA,5 expired which was much higher to those to with type l DM with DKA (4 out of 65). The commonest cause of death was infectious (sepsis related) cause, with UTI being the commonest (40%). In HHS patients the mean age of presentation was 68.3. HHS was associated with higher mortality compared to DKA. Coma, altered sensorium (6 out of 16), seizures (4 out of 16) was seen in significant number of patients with HHS. BU, creatinine, osmolality was significantly elevated in patients with HHS who expired compared to survivors. Most common cause of death in HHS was sepsis (infection) related with UTI (40%).Conclusion: DKA is common in patients with T2DM in our setup. Over 50% of the patients presenting with DKA or HHS have no previous diagnosis of DM. Infections and noncompliance are important precipitants of hyperglycaemic emergencies.

Relationship of Microalbuminuria Levels among Patients with Type 2 Diabetes and its Complications in Western Uttar Pradesh

Abhishek — 2019-10-14

Background: To study the relation of levels of microalbuminuria among patients with type 2 diabetes and its complication in western UP.Subjects and Methods:The study included 110 patients with Type 2 diabetes mellitus visiting the diabetic clinic. Patients with complications, such as retinopathy and neuropathy were diagnosed on the basis of history, clinical examination and investigations. Microalbuminuria levels were compared in patients with complications (subjects) of Type 2 diabetes mellitus and patients without complications (control). Results:The study revealed that microalbumin levels in the urine are at significantly higher range in patients with complications (p<0.05) mainly with diabetic retinopathy, as compared to patients with other complications. Conclusion: The study supports that microalbuminuria is significant among patients with diabetic complications and strict glycemic control can prevent microalbuminuria and thereby prevent progress on to diabetic nephropathy in patients with Type 2 diabetes mellitus.

Assessment of Quality of Life among Post-Menopausal Women Visited in Tertiary Care Hospital in Barmer (Rajasthan)

Sawai Khatri — 2019-08-24

Background: Menopause is a universal event in a women’s life causing a variety of physical, vasomotor, psychological and sexual symptoms. Hence; the present study was planned for assessing Quality of Life (QOL) Among Post-Menopausal Women Visited in Tertiary Care Hospital in Barmer (Rajasthan).Subjects and Methods: A total of 50 postmenopausal women were reenrolled in the present study. Postmenopausal women with more than one history of amenorrhea were included in the present study. Detailed demographic and clinical data of all the subjects was obtained. Modification of a preexisting menopause-specific QOL (MENQOL) questionnaire was used in the present study. All the items of the questionnaire were graded as present of absent. Sum total of all the symptoms comprised of QOL of postmenopausal women. All the results were recorded in Microsoft excel sheet and were analyzed by SPSS software. Results: Night sweats were found to be present in 56 percent of the subjects. Dissatisfaction with personal life and nervous feeling was found to be present in 58 percent and 8 percent of the subjects. Depression and weight gain was found to be present in 66 percent and 70 percent of the patient population. Conclusion: Menopausal significantly affects the quality of life of women. Adequate awareness programs should be started for increasing the awareness among women regarding postmenopausal symptoms.

To Evaluate the Correlation between Symphysis Fundal Height and Abdominal Girth at Different Periods of Gestation and Birth Weight

Kheta Ram Soni — 2019-08-24

Background: SFH and abdominal girth measurement is a simple method of fetal growth assessment which could be utilized even by paramedical workers to screen for small for gestational age babies. In this study, we evaluated the correlation between symphysis fundal height and abdominal girth at different periods of gestation and birth weight. Subjects and Methods: This is a prospective observational study which was conducted in the Department of Obstetrics and Gynaecology, PBM Hospital, SP Medical College, Bikaner. 500 pregnant women attending antenatal clinic were enrolled after an informed consent. Symphysis fundal height and abdominal girth measured at monthly interval till 28 weeks, 15 days till 36 weeks than weekly till delivery. Results: In the present study, abdominal girth at different periods of gestation is a better indicator of birth weight. Fundal height also predicts birth weight but not as well as the fundal height. At term fundal height <30cm predicts birth weight <2kg. Conclusion: We concluded that abdominal girth at different periods of gestational is a better indicator of birth weight.

To Find Out the Incidence of Congenital Malformation in Pregnancies with Polyhydramnios: A Hospital Based Observational Study

Sunita Bishnoi — 2019-08-25

Background: Polyhydramnios is the term for abnormal increase in the amniotic fluid. The aim of this study to find out the incidence of congenital malformation in pregnancies with polyhydramnios..Subjects and Methods:This analytical study was conducted on 100 unselected pregnancies attending the antenatal clinic in Department of Obstetrics and Gynecology department of government Medical College and Bangur Hospital Pali, Rajasthan. Pregnancy outcome were recorded for the patients who were classified as having an excess amount of amniotic fluid. Those cases with gross congenital anomalies incompatible with life were advised termination of pregnancy after explaining the risk of procedure. Labor was induced by various methods. The fetal outcome was recorded.Results:In our study there were several confounding factors affecting the occurrence of polyhydramnios. Out of 100 cases 22 (22%) were placental abruption, body weight gain of >20 kg were present in 30 cases (30%). 28 cases (28%) were not associated with any confounding factors. Out of which 21% cases were of preterm labor, 6% were of acute abdominal pain, 7% were of PROM, 4% were of IUFD, 4% were of cord prolapsed, 5% were of PPH, 53% cases were not associated with any maternal complications.Conclusion: We concluded that amniotic fluid index is the guiding tool for early diagnosis of congenital anomalies and early obstetrics intervention. This further helps in reducing the rate of maternal complications of polyhydramnios.

To Determine the Vertical Transmission Rate of HIV in the PPTCT Programme since its Initiation in 2005 in Umaid Hospital, Jodhpur (Rajasthan)

Santosh Khokher — 2019-09-17

Background: As a part of the PPTCT program by NACO, the PPTCT program was started in our institute in April 2005. So this study is planned to note the vertical transmission rate of HIV in the PPTCT program as well as to have an evaluation of the PPTCT program in our institute since the initiation of this programme in 2005. Subjects and Methods: The present study was carried out in the department of Obsteterics and Gynaecology, Umaind Hospital attached to Dr. S. N. Medical College, Jodhpur. The data over this period were analyzed. As per the strategy and policy prescribed by NACO, tests (E/R/S) were performed on the serum samples. Those found HIV positive went for confidential post-test information and counseling regarding through intimation about the vertical transmission and importance of their institutional deliveries. Results: The present study shows that 29.82% of the seropositive women had anemia 26.31 had deranged LFT, 36.84% had genital infections. Mostly 99.18% new born were given Neviraoine. We found that 10 seropositive mothers had puerperial pyrexia, 8 had mastitis, 6 had UTI, 1 had episiotomy gap and another 1 had wound sepsis or gaping in LSCS wound. Conclusion: Prevention is the cure and antenatal clinic is the best opportunity to educate so simple intervention strategies under this PPTCT program will reduce the incidence of pediatric HIV infection in our scenario.

Comparative Study of Sublingual versus Vaginal Misoprostol for Induction of Labour

Naiya Devgan — 2019-10-13

Background: For majority of women labor starts spontaneously at or near term and result in vaginal delivery, however because of medical or obstetrics complications of pregnancy, labor induction is often required. Subjects and Methods: 72 pregnant women at term in department of Obstetrics and Gynecology, the subjects were randomly assigned into two groups sublingual versus vaginal misoprostol (50 mcg) given every 6 hrs.Results:The mean age of patients was 24.48±8.67 years in sublingual group and 25.02±8.97 years in the vaginal group. The mean period of gestation was 38.26±11.23 weeks in sublingual and 38.86±1.33 weeks in the vaginal group. The mean Bishop was 3.42±1.07 in sublingual group and 3.72±1.72 in the vaginal group. Conclusion: Induction of labor, vaginal misoprostol is preferable to sublingual misoprostol when used in equivalent dosage of 50 mcg.

Oral Labetalol Verses Oral Nifedipinein Hypertensive Disorders of Pregnancy- A Comparative Study

Shalini Bhushan — 2019-10-14

Background: Hypertensive disorders of pregnancy are the common medical disorders in pregnancy. The present study was conducted to compare oral labetalol and oral nifedipine in hypertensive disorders of pregnancy. Subjects and Methods: The present study was conducted on 60 pregnant women. Preterm or term pregnant women with severe preeclampsia/ eclampsia and BP ≥160/100 mm Hg were included in the study. Patients were divided into 2 groups of 30 each. Group I patients were given oral labetamol and group II were given oral 10 mg Nifedipine. Results: Primi was seen in 18 in group I and 17 in group II, G2 6 in group I and 5 in group II, G3 4 in group I and 5 in group II and G4 2 in group and 3 in group II. The difference was non- significant (P> 0.05). In group I, SBP was 174.2 mm Hg in group I and 166.4 mm Hg in group II, DBP was 112.6 mmHg in group I and 110.8 mm Hg in group II. The difference was significant (P< 0.05). Conclusion: The study concluded that oral Nifedipine better in terms of lowering blood pressure in pregnant ladies, although the difference was non- significant.

Assessment Of Class II Caries MOD Visited In Hospital: A Three Months Retrospective Analysis.

Ankita Agrawal — 2019-09-17

Background: Dental caries is a multifactorial oral disease which affects humans of any age, sex, race and socioeconomic status. The present study was retrospectively conducted to assess the prevalence of class II MOD caries patients visited in a department over the period of 3 months. Subjects and Methods: The present study was conducted retrospectively in which record of 250 patients were examined to check the prevalence of Class II MOD cavities. Patients were selected from the out-patient department of Conservative Dentistry. Before commencement of the study permission was taken from ethical committee of the institution.In this study we recorded only class II MOD caries. Results: In our study we examined 250 patients for Class II MOD caries. In 250 patients 76 (30.4%) patients had Class II MOD caries. The class II MOD caries was prevalent in age group 31-40 years (36.84%). Conclusion: Our study concluded that class II MOD was more prevalent than any other carious lesion. The class II MOD caries was prevalent in age group 31-40 years.

Qualitative and Quantitative Analysis of Changes in Saliva and Subjective Oral Dryness in Patients with Thyroid Disorders

Zhahid Hassan — 2019-10-13

Background: The association of salivary function with numerous systemic illnesses has been stated by various researches. There is a strong relationship of salivary function with common illnesses like diabetes, oral submucous fibrosis, and asthma. Thyroid dysfunction are one of the most common endocrine disorders worldwide. Aims and objective: To determine the qualitative and quantitative changes in the salivary function in patients with thyroid dysfunction.Subjects and Methods:A cross-sectional study was carried out on 40 subjects, including 20 thyroid disorders patients and 20 control subjects. Unstimulated and stimulated salivary flow rates, pH, and buffering capacity of the whole saliva were determined as well as subjective oral dryness in the study subjects.Results:In the present study, a statistically significant decrease in salivary parameters such as buffering capacity and flow rates was seen. Subjective oral dryness was observed in affected patients.Conclusion: In the present study, a correlation between thyroid dysfunction and salivary gland function was observed in patients with thyroid disorders.

A Cross-Sectional Study of the Histopathological correlation with serum Level of Carbohydrate Antigen-125 in Different Forms of Ovarian Cancer

Roquiya Begum — 2019-10-13

Background: Ovarian cancer is a common malignancy of the female reproductive system. Tumor markers serve as tools in the diagnosis of the disease. The aim of the present study was to determine the diagnostic value of sera levels of carbohydrate antigen-125 (CA-125)and correlate its level with the histopathological findings of the ovarian mass specimen. Subjects and Methods:The sera were measured using an electrochemoluminescence technique on 200 individuals (100 patients with ovarian cancer, and 100 patients as control). Results:The results showed that levels of CA‑125 in the sera of the malignant ovarian neoplasm were significantly higher than those of the control groups. In the malignant epithelial cancers, the highest rise was seen in serous Cyst adenocarcinoma, metastatic carcinoma and then mucinous cyst adenocarcinoma, respectively.Conclusion: In conclusion, the results showed that the serum level of CA-125 is important indicators in the diagnosis of ovarian cancer despite its limited sensitivity in early stage of disease and its inadequate specificity for malignancy.

Study of Electrolyte Profile Levels in Hypoglycemic Diabetic Mellitus in Tertiary Care Hospital

Prabha Verma — 2019-10-13

Background: Diabetes mellitus (DM) is usually referred as diabetes. It is a group of metabolic disorders in which there are high blood sugar levels over a long period. The main symptoms of high blood sugar are frequent urination, increased thirst, and increased hunger. Subjects and Methods:This cases control study was conducted in the Department of biochemistry in a medical college.This case control study had two groups. Each group contains 30 populations.The duration of study was over a period of six month. Results:In our study 60 total number populations were included. Total populations were divided in two group one in study group and another one control group. In the study group male were dominant followed by female.Conclusion: This study concludes that, the prevalence of Type II diabetes mellitus is increasing day by day and is associated with a very high mortality rate, reduced quality of life and high costs of treatment, despite intensive insulin treatment.HbA1c can be used as early detector of diabetic complications and hypoglycemia in addition to glycemic control. Electrolyte profile and magnesium level estimation will allow the identification of patients with diabetic complications at very early course of the disease.

Correlation between Iron Profile of Pregnant Women and Their Newborns: A Cross Sectional Study

Gorav Kumar — 2019-08-24

Background: Maternal anemia leads to many adverse effects on the fetuses fetal complications. The mechanisms leading to increased morbidity include a decreased oxygen delivery capacity and the dysfunction of enzymes. The aim of this study to relationship between iron status of pregnant mothers and their newborns using a combination of several hematological parameters. Subjects and Methods: A hospital based descriptive type of observational study done on 50 singleton primi pregnant women at term gestation (37-42 weeks) admitted to labour room in government Medical College and general Hospital, Dungarpur (Raj.). General physical examination was done meticulously to assess maternal conditions regarding anemia such as nutritional status, pallor, edema and glossitis. Results: Our study showed that the male to female ratio was 1.28:1. Normal birth weight in baby was seen in 80% of cases. The spearman correlation of hemoglobin concentration was statistical significant in the newborns of mothers with hemoglobin concentration (

Acute Phase Complications of Older Children with Kawasaki Disease

Toshimasa Nakada — 2019-10-23

Background: Older children with Kawasaki disease (KD) have a risk for acute phase complications including coronary artery lesions (CALs).Objective: To clarify the frequency and outcomes of acute phase complications in older children who received an initial single intravenous immunoglobulin (IVIG) therapywith delayed use of aspirin. Subjects and Methods: This retrospective study included data from 216 consecutive patients who underwent initial single IVIG therapy at 2 g/kg with DUA. The data were divided into a group for cases aged 5 years or older (older group, n = 34) and another group for cases aged <5 years (younger group, n = 182). Statistical analyses were performed using Chi-square, Fisher’s exact, and Mann–Whitney U tests as appropriate. Results: Six of 34 (17.6%) older group patients were associated with complications (2 with CAL and 4 with non-cardiac complications required treatment). The non-cardiac complications included arthritis, transient blindness, and atlantoaxial rotatory fixation. All of these non-cardiac complications were recovered after treatment. The rate of CAL in older group patients was similar to that in younger group patients (5.9% vs. 1.6%, P = 0.177). However, the rate of non-cardiac complications in the former was significantly higher than that of the latter (11.8% vs. 0.0%, P < 0.001). Conclusion: Whereas the older children who underwent initial single IVIG therapy at 2 g/kg with DUA have the higher risk for non-cardiac complications compared to the younger patients, the rate of CAL was similar between the older and younger children.

To Evaluate the Endometrial Histopathological Etiology of Abnormal Uterine Bleeding: A Hospital Based Observational Study

Namrata Sharma — 2019-08-24

Background: The study of endometrial microscopy in women with AUB is helpful to distinguish anovulatory from ovulatory AUB and to diagnose hyperplasia and carcinoma of endometrium. The aim of this study to find out the endometrial histopathological causes of abnormal uterine bleeding. Subjects and Methods: A hospital based descriptive type of observational study done on all abnormal uterine bleeding cases of age above menarche attending the outdoor of Government hospital & Government Medical College, Bharatpur (raj.). The study material consisted of endometrial curettings from 100 patients attending Gynecology OPD. These patients were having a clinical diagnosis of Abnormal uterine bleeding. Endometrial curettage samples were fixed in 10% formalin and histopathological slides were prepared sand Hematoxyline and Eosin staining was done. Results: In the present Study, high incidence of AUB was noted in 31-40 years (42%). The incidence of AUB in the reproductive age group was 57%. Conclusion: We concluded that dilatation and curettage is useful for diagnosis, to assess therapeutic response and to know the pathological incidence of organic lesions in cases of abnormal uterine bleeding prior to surgery.

Analysis of Abnormal Uterine Bleeding in Endometrium of Perimenopausal Women: AnHistopathological Study

Madhuri Agrawal — 2019-09-16

Background: Abnormal uterine bleeding is one of the most common health problem encountered by women of perimenpausal age group. Hence; the present study was undertaken for assessing abnormal uterine bleeding in endometrium of perimenopausal women. Subjects and Methods: A total of 72 subjects were enrolled. Subjects with menstrual cycles of 21 to 35 days were enrolled. Subjects with duration of flow of 2 to 6 days were excluded from the present study, as they were considered as normal. Complete demographic details of all the subjects were obtained. Collection of the specimen was done for histopathologic assessment. Results: Abnormal uterine bleeding was clinical diagnosis in 30 patients, while it was pathologic diagnosis on 21 patients. Fibroid formation was clinical diagnosis in 20 patients, whereas on histopathologic examination, fibroid formation was found to be present in 15 patients. Proliferative phase was found to be present in 41.6 percent of the patients. Secretory phase was found to be preset in 20.8 percent of the patients. Hyperplasia was found to be present in 26.4 percent of the patients. Conclusion: The most common cause of abnormal uterine bleeding in perimenopausal women are benign lesions of endometrium and myometrium.

Study of Haematological Parameters in Malaria

Supriya Bandil — 2019-10-19

Background: Malaria causing plasmodia are parasites of blood and hence induce haematological alterations. The haematological changes that have been reported to accompany malaria include anemia, thrombocytopenia and leucocytosis, leukopenia, mild to moderate atypical lymphocytosis, monocytosis, eosinophilia and neutrophilia. Subjects and Methods: Total hundred smear positive malaria cases were taken and various hematological parameters and biochemical parameters were studied. Results: Out of 100 smear positive cases, P. vivaxwas positive in 55 cases while P. falciparum was positive in 45 cases. It was seen in 86.67% of falciparum Malaria patients and in 72.72% of vivaxMalaria patients. Severe anemia was seen in 9% of patients. Normocytic normochromic blood picture was the most common type in anaemic patients (51.89%). Thrombocytopenia was seen in 71% of the patients. Mild thrombocytopenia was more common and present in 52% of patients while Severe thrombocytopenia was seen in 19% of cases. In falciparum malaria thrombocytopenia was present in 66.66% of the patients while it was present in 74.54% of the patients in vivaxmalaria. Total Leucocyte Count was normal in 72% of the patients. Conclusion: Various haematological findings can help in early diagnosis of malaria which is essential for timely and appropriate treatment which can limit the morbidity and prevent further complications.

The Utility of Transbronchial Needle Aspiration and Conventional Diagnostic Procedures in the Diagnosis of Bronchogenic Carcinoma

Mahesh Kumar Mahich — 2019-09-16

Background: Lung tumours often present as masses or nodules situated beyond the range of even new-generation fibreoptic bronchoscopes. The aim of this study to compare diagnostic yield of TBNA with CDP for diagnosis of Bronchogenic carcinoma. Subjects and Methods: The study was carried out and data were gathered in a prospective fashion and all the data were reviewed retrospectively. All the suspected patients were diagnosed on the basis of clinical, radiological and video bronchoscopic examination (CDP+TBNA); and further diagnosis was confirmed on the basis of histological and / or cytological examination. Results: In the present study, after TBNA & CDP, the overall diagnostic yield for carcinoma was 93% (28/30). CDP was diagnostic in 100% cases of EML and only 70% in SPD. TBNA provided an additional diagnostic yield of 30% in Cases of SPD where CDP was not possible for taking samples, which is seen to be statistically significant (p = 0.02). Conclusion: We conclude that TBNA is a safe procedure that should be routinely used to increase diagnostic yield in patients with EML or SPD.

Study On Microbiological Profile of Endotracheal Secretionsin Patients on Mechanic Ventilators

Priyadarshi Sharma — 2019-10-13

Background: Respiratory infections in critically ill patients are associated with high morbidity and mortality. Rapid diagnosis and initiation of appropriate antibiotic therapy is essential for better outcomes. Patients who are intubated and mechanically ventilated are further at risk of acquiring respiratory infections due to complex interplay between the endotracheal tube, host immunity and virulence of invading bacteria, which may lead to Ventilator Associated Pneumonia (VAP). Subjects and Methods:307 total numbers of cases were included. Among all 209 cases did not develop respiratory infection & 98 cases developed respiratory infection. This study conducted in the Department of TB & Chest in Geetanjali Medical College, Udaipur, Rajasthan, India. The duration of study was over a period of six month. Results:In this study 307 total numbers of cases were included. Among all 209 cases did not develop respiratory infection & 98 cases developed respiratory infection. Out of 98 cases 47.9% were male & 52.1% were female who developed respiratory infection. In this study we suggested that 50% gram negative bacteria followed by 43.8% gram positive bacteria were found & 6.2% fungus isolate from the 98 cases.Conclusion: This study concludes that, Culture of ET aspirate is an easy, cost-effective procedure which helps in identifying the organism. If there are any delays in antibiotic treatment, it may lead to poor outcomes.

A Study on Effects of Dexmedetomidine Used as an Adjuvant in Epidural Post-Operative Analgesia

Bhaidas Onkar Patil — 2019-08-24

Background: Epidural anaesthesia with adjuvant is normally used for postoperative pain management in infra umbilical surgeries but search for ideal adjuvant without any side effect goes on. Aim: This study was done to assess the onset and duration of sensory and motor block and side effects of dexmedetomidine, when used as an adjuvant in epidural anaesthesia in infra umbilical surgeries. Subjects and Methods: 60 patients of ASA status I and II, posted for infra umbilical surgeries were randomly allocated into two groups of 30 each. Group L patients received epidural 0.5% levobupivacaine. Group LD patients received epidural 0.5% levobupivacaine and 1μg/kg dexmedetomidine. Preoperative and postoperative block characteristics as well as hemodynamic parameters and side effects were monitored. Results: Dexmedetomidine as an adjuvant had an earlier onset and longer duration of sensory and motor block compared to levobupivacaine alone. Sedation scores were statistically significant with dexmedetomidine group in comparison to levobupivacaine alone group. Conclusion: Dexmedetomidine, as an adjuvant to epidural levobupivacaine provided prolonged analgesia in infraumbilical surgeries.

Comparison of ProSeal Laryngeal Mask Airway & Supreme Laryngeal Mask Airway as Ventilatory Devices

Keshav Dev Jagar — 2019-10-14

Background: The present study was conducted to compare Proseal-Laryngeal Mask Airway and Supreme laryngeal mask airway (SLMA) in patients.Subjects and Methods:The present study was conducted on 40 patients of both genders. Patients were divided into 2 groups of 20 each. Group I patients were given supreme laryngeal mask airway and group II were given ProSeal laryngeal mask airway. All the devices were checked, prepared, inserted and secured.Results:The number of attempt in group I and II was 1, insertion time was 16.4 seconds in group I and 21.5 seconds in group II. Duration of anesthesia in group I was 61.8 minutes and in group II was 61.2 minutes, duration of pneumoperitoneum in group I was 62.4 minutes and 62. 8 minutes in group II. Insertion time NG tube in group I was 10.2 minutes and in group II was 8.4. The difference was significant (P< 0.05).in group I (cm H2O), OLP1 was 29.2 and in group II was 34.8, OLP2 in group I was 27.9 and in group II was 33.2, OLP3 in group I was 28.5 and in group II was 34.9. The difference was significant (P< 0.05).Conclusion: ProSeal laryngeal mask airway better as compared to supreme laryngeal mask airway.

Comparative Evaluation of I Gel and Cuffed ET Tube for Anesthesia in Abdominal Surgery

Anirudh Prasad Mandal — 2019-10-19

Background: This study aims to test and compare Endo tracheal tube and i-gel in terms of their: Efficacy: Difference in the leak fraction between two airway devices before and after pneumoperitoneum with different tidal volumes andcomparison of oropharyngeal leak pressure. Ease of insertion: Number of attempts required for optimal positioning. Subjects and Methods: Sixty patients, ASA I–II, were randomly selected to the study. Standard anaesthetic technique was used for all patients. The i-gel was then inserted. The lungs were ventilated at three different tidal volumes (6, 8 and 10 ml kg l) using volume controlled ventilation (VCV). The leak volume was calculated as the difference between the inspired and expired tidal volumes. The leak fraction was also calculated as the leak volume divided by the inspired tidal volume. These observations were recorded with every tidal volume before and after pneumoperitoneum with the i-gel and the conventional tracheal tube. Results: We found oropharyngeal leak pressure for i gel as 26cm of H2O and there was no leak in endotracheal tube group even at 40 cm of H2O peak air way pressure. Before and after pneumoperitoneum there was no statistically significant difference in leak fraction or leak volume between i-gel and tracheal tube at tidal volume 6ml kg−1. At 8 and 10 ml kg−1 there was statistically significant difference between i-gel and tracheal tube both before and after pneumoperitoneum. Conclusion: In our study we found that i-gel airway can be used safely and effectively during volume controlled ventilation with low and moderate tidal volumes.

To Find Out Prevalence of Various Ocular Manifestations and to Assess the Possible Aetiological Factors Including Psycho-Social and Hereditary Factors in Mentally Retarded Children

Vandana Misra — 2019-08-24

Background: Children with disabilities are at a higher risk of visual impairment as compared to normal population. The present study was conducted to find out the prevalence of various ocular manifestations and to assess the possible aetiological factors including psycho-social and hereditary factors. Subjects and Methods: The present study was undertaken in the department of ophthalomology and paediatrics, S.N. Medical College, Agra. Two hundred and forty mentally retarded children between the ages of 3 months to 15 years of either sex were scrutinized to find out the prevalence of ocular manifestations in cases of mental retardation. A complete case history was taken. Results: In the present study, in 50% cases, the cause of mental retardation could not be identified clinically. Causes of mental retardation which could be identified in our study were developmental cranial anomalies -12.5%, down’s syndrome (7.5%), post inflectional (6.7%), congenital cerebral palsy (5.8%) , epilepsy (3.3%), endocrine disorders, others 11.6%. Out of these 66.7% were males and 33.3% cases were females. Ocular examination of the mentally retarded children revealed that 60% cases were having one or other form of ocular abnormalities. Strabismus (30.5%) was the commonest ocular anomaly followed by refractive errors (27.8%). Other ocular manifestations in order of frequency were congenital cataract (12.5%), optic nerve disorders (7.5%), lid and orbital abnormalities (5.5%), nystagmus (2.7%) and retinal disorders (1.4%). Colour vision defects were found to be present in 13.2% mentally retarded children. Conclusion: The children with disabilities should undergo annual ophthalmic evaluation. We concluded from our study that visual function of the children should be assessed as soon as the child is admitted to the school. Earlier assessment and correction of the visual problems will have greater chance of achieving potential and will prevent unnecessary visual impairment.

A Study on Intraocular Pressure Elevation after Intravitreal 4mg Triamcinolone Acetonide Injection in Treatment of Macular Edema among North India Population

Shipra Tripathi — 2019-10-19

Background: Macular edema is one of the leading causes for impaired vision in some retinal vascular disorders. Recent clinical studies suggest that intravitreal injection of triamcinolone acetonide (IVTA) may be a therapeutic option for the treatment of macular edema. In 1995, Penfold et al reported a pilot study of intravitreal injection of 4mg of triamcinolone acetonide (IVTA) to treat exudative age-related macular degeneration with encouraging results. Subjects and Methods: A prospective, non-comparative study was performed with 100 patients (100 eyes) who received 4mg/0.1mL (40g/L) IVTA injection for macular edema and who were followed-up for a minimum of 3 months at the Department of Ophthalmology. Patients using steroid eye drops or systemic steroid, those previously treated with subconjunctival or subtenon steroid injection, and those with a history of glaucoma were excluded from the study. Results: Of the 100 eyes, 50 were from women and 50 were from men; the mean age was 56.3±11.4 years. Reason for the IVTA was progressive declining of visual acuity due to macular edema associated with retinal vein occlusion (60 eyes), or diabetic retinopathy (40 eyes). IOP increased significantly (p<0.001) from 14.95±2.83 mmHg preoperatively to a mean maximum of 19.01±5.92 mmHg postoperatively. Conclusion: According to our results, intravitreal injection of 4mg of triamcinolone acetonide can lead to significant IOP elevation in approximately one-third of patients, occurring at a mean of 4 weeks after injection. The findings of our study suggest that the IVTA in a dosage of 4 mg could lead to a secondary ocular hypertension.

KAP Study towards Organ and Whole Body Donation in Medical, Dental & Nursing Students: A Randomised Institutional Based Survey

Simmi Mehra — 2019-08-24

Background: In our country more than 500,000 people suffer from non-availability of organ and waiting for a transplant. About 150,000 patients wait for kidneys, 50,000 for hearts and 50,000 for liver transplants approximately. Nearly 10, 00,000 people suffering from blindness need donors. In a country such as ours with a population of 1.3 billion, the donor rate is comparatively low i.e. just 0.4 per million population when compared to the USA where it accounts to around 25 per million. This data shows a huge variation between demand and availability.Subjects and Methods:A total of 175 students were involved in our study analysis. A total of 109 MBBS, 52 BDS and 14 nursing students were involved in the study analysis. The study was conducted using an objective type questionnaire.Results:Awareness regarding organ donation during life was analysed and students of MBBS were able to give most correct answers. Awareness regarding organ donation after life was also analysed and students of MBBS yet again had the most correct answers.Conclusion: It can be understood that an aware population of the medical personnel will help to promote the concept of organ/ whole body donation in the public and motivate them.

Morphometric Study of the Acromion Process and its Clinical Relevance

Gursharan Singh Dhindsa — 2019-09-16

Background: The acromion process along with the coracoid process and the coracoacromial ligament form the coracoacromial arch which acts as a secondary socket for the shoulder joint. The subacromial space gives passage to the tendons of muscles forming the rotator cuff. Any abnormality, acquired or congenital, which leads to the reduction in the subacromial space can cause impingement syndrome. Morphology of the acromion thus plays an important role in impingement syndrome and the pathogenesis of rotator cuff diseases. Subjects and Methods: A total of 70 Indian unpaired dry human scapulae (Right-35, Left-35) of unknown sex were studied. Various parameters related to acromion process- a) Maximum length of acromion b) Maximum breadth of acromion c) Acromio-Glenoid distance and e) Acromio-Coracoid distance were measured with the help of a sliding digital vernier caliper and recorded in millimeters. Results: The mean values of each measurement were: maximum length of acromion: 43.10mm; maximum breadth acromion: 24.46mm; acromio- glenoid distance: 30.15 mm and acromio-coracoid distance: 37.05 mm. Conclusion: Knowledge of the morphometeric values of acromian process is important to the orthopaedicians in the differential diagnosis and surgical treatment of shoulder joint ailments, to the forensic experts in specimen identification from skeleton remains and to the anthropologists in their racial and population studies.

An Association between Anti-Phospholipid Antibodies and Connective Tissue Diseases

Ketha Ravindra Reddy — 2019-10-23

Background: Anti-phospholipid antibodies (APLA) are mostly directed against phospholipids and also with their binding proteins. They are frequently associated with connective tissue disorders. Systemic Lupus Erythematosus (SLE) associated with APLA might cause diagnostic dilemma due to several manifestations mainly neurological, serositis proteinuria, thrombocytopenia, haemolytic anemia, ulceration of legs, which occur in both the conditions. So, we had conducted a study to determine the association between anti-phospholipid antibodies and connective tissue diseases and also compared clinical and laboratory parameters between anti-phospholipid antibody positive and anti-phospholipid antibody negative groups. Subjects and Methods: The present study was conducted among two hundred and four patients who were diagnosed with connective tissue diseases. APLA testing was done at baseline and the patients who were found to be positive for the test, a repeat of the test was performed after 12 weeks. Results: Among the patients with connective tissue diseases (14 p.c) had a positive test result for anti-phoshpolipid antibodies. In the SLE group positive anti-phospholipid antibody was detected among 73.3 p.c of patients, mixed connective tissue disease (MCTD) was present among 13.3 p.c of the patients and systemic sclerosis was present among 13.3 p.c of the patients. Conclusion: Always an anti-phospholipid antibody test should be conducted among all the patients with connective tissue disease for early diagnosis and prevention of life-threatening complications.

A Prospective Study to the Morphological Variation on Radiological Examination (In Form of Appearance of Ossification Centers in Carpal Bones) in Boys and Girls of Age Group 5 to 12 Years of the Western Rajasthan (Jodhpur) Region

Ramratan Bishnoi — 2019-08-24

Background: The Determination of age of an individual by radiological observation of the time of appearance and fusion of ossification centers is a matter of great medicolegal and academic interest.In the present study estimation of age in the individual of age varying between 5 year to 12 years will, be conducted using the appearance of ossification of carpal bones in boys and girls of the western Rajasthan (Jodhpur) region.Subjects and Methods:A radiological prospective study done on appearances of ossification centers in the carpal bones inboys and girls of age group 5 years to 12 years in western Rajasthan jodhpur region.Results:There were 50% males and 50% females in the study with male to female ration of 1:1. Precaution was taken to select equal proportion of cases from each half year interval of age among both sexes.Conclusion: We concluded that trapezium, trapezoid and scaphoid carpals appeared between the age of 5 to 9 years.Their appearance was slightly earlier in females than in males.

A Study on Neck Injuries in Deaths Due to Hanging on Basis of Epidemiological Factors

Ashok Singh Dangus — 2019-08-24

Background: Most of the hanging cases are consider as suicidal until the homicidal and accidental are prove, because both homicidal and accidental hanging are rare. In these cases a watchful forensic examination plays an important role to determine the ante mortem character of the lesion and to exclude causes of hanging other than suicidal hanging. Aim: This study done to know the internal and external assessment findings among hanging cases. Subjects and Methods:Hanging deaths with external neck injuries along with ligature mark were included in this study. In this study a total of 60 cases of deaths due to hanging, was subjected to medico legal autopsy. Results:Most of the cases were observed in the age group of 21-40 years i.e., 41 (69.4%) out of 59 hanging deaths. Out of 59 deaths, 32 (54.2%) were females and 27 (45.7%) were males. Among neck structure injuries, majority of hanging cases had rupture / contusion of sternocleidomastoid and other strap muscles of neck, it was 57.6%. 33.8% cases had carotid intimal tear, 5% cases showed hyoid bone fracture and 3.3% thyroid cartilage. No fractures noted in Cricoid cartilage and cervical vertebra. Conclusion: Social awareness, problem solving and family support of most common age group is extremely necessary.

Mastoidale, Asterion and Porion (MAP) Triangle – The Determinant of Sexual Dimorphism

Pinki Kumari — 2019-10-14

Background: Sex determination isutmost importantfor forensic experts and Anthropological studies.Aim: The aim of this study is to compare cranial morphology between male and female skull using MAP Triangle.Subjects and Methods:A total of 100 adult dry skull (50male and 50 female) were used for study using a digitalVerniercalliper. Results:The male parameters were significantly higher then female parameters with no significance difference in Right and Left side of male and female.Conclusion: The skull is most commonly site for sexual dimorphisms in human Skeleton and MAP Triangle can be additive value gender differentiation.

Evaluation of Sexual Dimorphism of Foramen Magnum: A Morphometric Study

Pinki Kumari — 2019-10-14

Background: Sex determination from skull morphology is important in medico-legal cases. The foramen magnum is an important structure of the skull base and is of particular interest for forensic experts. Aim: In this study the foramen magnum was analyzed for sex differences using standard osteometric techniques for the North Indian Population. Subjects and Methods: This study included 100 completely ossified dry human skull (M=F) in good condition with a record of sex. The cranial base was visually assessed for foramen magnum shape. Morphometry was determined using vernier caliper and the differences amongst gender were ascertained. Results: Oval shape was the most common followed by round, tetragonal and pentagonal in both sex. The results demonstrated that sexual dimorphism is present in the foramen magnum. APD and TD were higher in male skulls than females. Conclusion: In incomplete skeletons, metric analysis of the foramen magnum may provide a statistically useful indication as to sex of the unknown skull.

Assessment of Heart Rate Variability in Hypertensive Patients

Archana — 2019-10-13

Background: Heart rate variability (HRV) has emerged as a practical, noninvasive tool to quantitatively investigate cardiac autonomic dysregulation in hypertension. The present study was conducted to assess heart rate variability in hypertensive patients.Subjects and Methods:The present study was conducted on 45 hypertensive patients of both genders. Spectral indices of HRV such as total power (TP), normalized low frequency power (LFnu), normalized high frequency power (HFnu), ratio of low frequency power to high frequency power (LF-HF ratio), standard deviation of normal-to-normal RR intervals (SDNN), root mean square successive difference (rMSSD) and the proportion of NN50 to the total number of NN intervals (pNN50) were assessed.Results:Group I had 25 males and 20 females while group II had 23 males and 22 females. SDNN (ms) in group I was 157.2 and in group II was 146.3, rMSSD (ms) in group I was 44.5 and in group II was 38.5, pNN50 in group I was 15.4 and in group II was 10.8. LFnu in group I was 76.2 and in group II was 89.1, HFnu in group I was 57.4 and in group II was 37.6, LF/HF ratio in group I was 2.87 and in group II was 4.85.Conclusion: HRV can be used as a routine screening test to predict the future risk of hypertension at an earlier stage. There is an increased sympathetic activity and a decreased vagal tone associated with hypertension.

A Case of Diagnostic Dilemma - LCH

Jyoti Arora — 2019-10-13

LCH in the skin, bones, lymph nodes or pituitary gland usually gets better with treatment and is called low-risk. Some patients have involvement in the spleen, liver, bone marrow, lung and skeleton. This is called high-risk disease and may be more difficult to treat. This study was conducted in the Department of Physiology, SGT Medical College, Gurugram (Haryana). The result of this study revealed that Hepatitis along with above findings suggestive of langerhans cell histiocytosis. So this diagnosis was made in advanced stage of disease. This case had all the typical findings (symptoms & signs), but even then it took considerable time to come to the correct diagnosis of advanced stage of langerhans cell histiocytosis. Though presenting rarely, this case was interesting enough to discuss.