bluuebunny/crossref_metadata_2025 huggingface dataset:
A prospective randomized study: role of enalapril on oxidative stress in newly diagnosed type 2 diabetes mellitus and its correlation with glycaemic status
Authors: A. T. Sathiya Vinotha , R. Ranjani
Published: March 2017

Background: Oxidative stress is demonstrated the pathological conditions such as Atherosclerosis and diabetes mellitus. It has been suggested to be involved in the pathogenesis of both macro and microvascular complications. This study was designed to evaluate the effect of Enalapril on oxidative stress markers in type 2 diabetic patients.Methods: A Prospective Randomized controlled study was conducted in 75 participants in which 25 healthy volunteers and 50 newly diagnosed DM2 patients who were divided into three groups of 25 in each. In Group II DM2 patients were treated with Metformin alone, in group III DM2 patients were treated with Enalapril and Metformin and 25 healthy volunteers were included in Group I (controls). Oxidative stress parameters, FBS, HbA1c were measured at the time of diagnosis and at 4,8,12 weeks.Results: There was a significant decrease in free radical production (p<0.05) and significant increase in antioxidant enzymes (p<0.001) in both the patient Groups and positive correlation between oxidative stress markers and FBS and HbA1c (p<0.01).Conclusions: Oxidative stress measured as LPO is strictly influenced by glycaemic control. Enalapril and Metformin combination in diabetic patients has more significant effect on decreasing the oxidative stress than Metformin alone.
Pattern and pharmacotherapy of acute poisonings presenting to a tertiary care centre
Authors: V. Aravinda , Bedwal Ankita , Rajarathna Kavitha , M. Narayana Swamy
Published: March 2017

Background: Acute poisoning, a therapeutic emergency and one of the common causes of morbidity and mortality globally. The rate of mortality in developed countries range from 1-2%, but in India it varies between 15-30%. According to World Health Organization (WHO), globally more than three million acute poisoning cases with 2,20,000 deaths occur annually. Most of the fatalities are due to the victim not reaching the hospital in time. This study aims to evaluate the pattern of acute cases of poisoning in tertiary care hospital attached to BMCRI.Methods: Prospective, observational study based on hospital records at tertiary care hospital (twelve months). Data regarding demographic profile and treatment was collected. Data was analyzed using descriptive statistics and SPSS-24.Results: Out of a total of 810 poisoning cases, 608 were included (381 poisoning, 138 drug overdose and 89 snake bite). Organophosphorus compounds (OPC) (131/608) and Aluminium phosphide (43/608) were the commonest poisons consumed in the age group 21-30 years. Sedative-hypnotics, non-benzodiazepine antiepileptics (non BZD AEDs) and paracetamol were common drug overdose cases. Snake bite accounted for 14.6%.Conclusions: OP compounds were the most common among poisons, while sedatives-hypnotics were frequently consumed drugs, followed by Snake bite. Young adults from urban areas were the common victims with suicidal intention. This reflects the need for stringent rules regarding the availability and sale of drugs and poisonous substances.
To study the effect of various combinations of haart in CD4+ cell count in HIV patient at RIMS, Ranchi Art Centre
Authors: Mahato Sumit Kumar , Prasad Keshri Uma Shanker , Kumar Akhilesh , Protim Pholgu , Kumar Vineet
Published: March 2017

Background: India has the third largest HIV epidemic in the world. In 2013, HIV prevalence in India was an estimated 0.3%, an estimated 130,000 people died from AIDS-related illnesses. Overall, India’s HIV epidemic is slowing down, with a 19% decline in new HIV infections (130,000 in 2013), and a 38% decline in AIDS-related deaths between 2005 and 2013. Antiretroviral therapy (ART) for the treatment of HIV infection has improved steadily since the advent of potent combination therapy in 1996. ART has dramatically reduced HIV-associated morbidity and mortality. The aim of this study is to see the change in CD4+ count in patient taking various combination of HAART (Highly active anti-retroviral treatment).Methods: A total of 215 patients were included in this study that came to the rims art centre for regular follow up and there cd4+ count at 6 monthly interval upto 18 months was taken and analysed.Results: The patients were evaluated for their change in CD4+ cell count. Mean of CD4+ count at 6 monthly interval was taken in this study which showed that haart combination causes significant improvement in cd4+ count in each group (1) stavudine, lamivudine, nevirapine (2)stavudine, lamivudine, efavirenz (3) zidovudine, lamivudine, nevirapine (4) zidovudine, lamivudine, efavirenz, (5) tenofovir, lamivudine, efavirenz.Conclusions: SLN combination was found most effective in increasing the CD4+ Cell count in comparision to the other combination. Other drugs combinations in decreasing order are as follows- SLE, ZLE, TLE, ZLN.
Efficacy of hydroxychloroquine as a potential antidiabetic drug
Authors: Kumar D. Mithun , Kamath Laxminarayana , S. Narayana Reddy
Published: March 2017

Background: India is the world’s diabetic capital. Oral antidiabetic therapy is still incomplete. Prior studies have shown that hydroxychloroquine (HCQ), a commonly used antimalarial, anti-rheumatic drug reduces the risk of developing diabetes mellitus. It probably acts by decreasing insulin metabolism- a novel mechanism of action.Methods: A systematic search was done in MEDLINE database with key words ‘Type 2 Diabetes Mellitus’, ‘Hydroxychloroquine’. Articles assessing the antidiabetic efficacy of hydroxychloroquine were reviewed and their results summarized.Results: With extensive literature search, we found out three RCTs and four Cohort studies assessing the efficacy of HCQ on glycaemic markers in patients with type 2 diabetes mellitus. Two randomized controlled trials done by Gerstein H C et al, Pareek A et al, comparing hydroxychloroquine with established antidiabetic drugs showed that there is significant reduction in glycaemic parameters with comparable similarity in both the groups (HbA1c: -0.91%±0.4%). Solomon et al in their study on patients with RA concluded that HCQ improved insulin sensitivity. Two cohort studies by Chen Y M et al and Wasko MCM et al respectively showed reduced incidence of diabetes mellitus in Systemic lupus erythematosus (Hazard ratio=0.26) and rheumatologic disease (relative risk=0.23) patients who received hydroxychloroquine. In a cohort study by Rekedal LR et al, HCQ reduced HbA1c by 0.66% compared to baseline in patients with RA. These studies also showed that hydroxychloroquine has favourable effect on lipid profile and good tolerabilityConclusions: Hydroxychloroquine has a potential to enter antidiabetic armamentarium due to its efficacy and low toxicity profile. More studies are required to confirm this.
Knowledge, attitude and practice of research ethics among medical faculty in a teaching hospital
Authors: Munoli Swetha , G. Niveditha , R. Deepthi
Published: March 2017

Background: To assess the knowledge, attitudes and practice of medical faculty regarding research ethics and research ethics committees (RECs).Methods: A cross-sectional, questionnaire-based study was conducted in ESIC medical colleges in Bangalore among faculty using a validated questionnaire. Questions were designed to assess the knowledge, attitudes and practice of medical faculty regarding research ethics and research ethics committees. Statistical analysis was done using descriptive statistics and chi-square tests.Results: Majority (76%) of faculty had not undergone training in research ethics. Less than half of the participants answered correctly to a question on guidelines in research ethics, 60% responded correctly to question on research involving children. Majority responded correctly to question on role of a research ethics committee and confidentiality, informed consent and to question on composition of Institutional Ethics Committee. 68% taught that ethical review of research by an ethics committee would delay research. >90% were favourable towards research ethics training. Faculty held attitudes regarding certain research ethics practices that were not optimal, 96% believed that it is okay to fabricate data, 68% taught that if no surrogate is available to give informed consent for vulnerable groups, they could still be included.Conclusions: We conclude that among the medical faculties participating in our study, there is acceptance of RECs and training in research ethics, while there are knowledge gaps in research ethics guidelines, research involving children. There is need to train researchers and students to make them aware about various aspects of research.
A clinical study of cutaneous adverse drug reactions
Authors: Shah Riddhi , Agrawal Sakshi , Bhuptani Neela
Published: March 2017

Background: Adverse cutaneous drug reactions pose a diagnostic challenge due to a myriad of clinical manifestations and wide variety of causative agents. Present study aims to record various clinical patterns of adverse drug reactions, their causative agents and to study the pattern of morbidity and mortality in patients with severe cutaneous adverse drug reactions.Methods: 150 patients with adverse cutaneous drug reactions were included who came to Department of Dermatology, Venereology and Leprosy at PDU Govt. Medical College and Hospital, Rajkot, Gujarat from September 2009 to September 2011. Thorough history with all routine haematological and biochemical investigations, septic screening were done. HIV testing was done in severe reactions. Appropriate specific treatment was given with counselling regarding the offending drug.Results: The most common age group was 21-30 years (26.67%) with male to female ratio being 0.92:1. Morbilliform rash was the most common clinical type (42.67%) in both HIV reactive and non-reactive patients. Antimicrobials were the most common group (29.33%) and nevirapine was the most common offending drug (27.33%). Mortality rate was 2% (3 out of 150 cases) and all the patients were of toxic epidermal necrolysis.Conclusions: The pattern of cutaneous adverse drug reactions and the causative drugs are remarkably different in our study. Knowledge of the pattern and the causative agent helps in better management and reduced consequences in these patients particularly in severe adverse cutaneous drug reactions.
Efficacy and safety of panchgavya GHRIT along with flunarizine in prophylaxis for migraine patients: a comparitive study
Authors: Trivedi Mohit , Dixit Vishal , Mahmood Syed Esam , Mishra Sunil Kumar , Keshari S. S.
Published: March 2017

Background: Propranolol and flunarizine have proven to be useful tools in migraine prophylaxis. This trial aims the comparison of the efficacy of flunarizine, flunarizine and placebo and flunarizine and panchgavya ghrit in migraine prophylaxis.Methods: The present study was a prospective, randomized, open-label, blinded-endpoint trial. Patients with chronic migraine were randomized (1:1:1) to flunarizine and flunarizine and placebo and flunarizine and panchgavya ghrit in three treatment groups. The study was carried out in outdoor patients in the department of Psychiatry, T.S. Mishra Medical College and Hospital, Lucknow and K.G.M.U, Ayush Department, Lucknow after clearance from Institutional Ethical Committee. Data was analysed using SPSS software.Results: The prevalence of migraine was found to be higher in the age group greater than 30 years and females. Overall there was more reduction in CGI scores in flunarizine with panchgavya ghrit and the other two groups equally at the end of 4, 6 8 and 10 weeks. Decrease in MIDAS score was observed after the therapy. Clinical Global Impression rating scale employed revealed that to start with subjects scored 7 which stands for pathology interfering in many life functions which reduced drastically in Group C as compared to Group B and Group A in descending order. Pain scales namely VAS (visual analogue scale), NPRS (Numeric Pain Rating Scale), VRS (verbal rating scale) when employed denoted there was decreased migraine frequency, decreased perception of pain, less intake of abortive medication consumed by subjects implying there were reduction in number of migraine days and there was decrease in the abortive medications taken for the same. Group C scored better on pain scales followed by Group B and Group A. Lower proportion of individuals in group C had Behavioural Toxicity and Neurological Side effects as compared to Group A and B.Conclusions: Panch gavya ghrit when administered along with flunarizine was more efficacious and safe when compared with other two groups. However large multicentric RCTs of long duration and involving more number of subjects are required to ascertain these facts.
Knowledge and attitude towards emergency contraception among undergraduate medical students
Authors: Gajera Aditya N. , Barvaliya Manish J. , Shukla Apexa , Tripathi C. B.
Published: March 2017

Background: Studying the knowledge and attitude of medical students towards emergency contraception, as they are the future medical professionals and they will serve as the main channel for providing proper knowledge and making positive impression of it in general population. The objective of the study was to assess the knowledge and attitude of undergraduate medical students towards emergency contraception.Methods: Medical students were given pre-validated questionnaire and divided in two groups. Group A students did not learn about emergency contraception, whereas group B students learnt about it. Interview of both groups were conducted separately. For group A, 1 hour seminar was conducted and after 7 days, same questionnaire was provided again for data collection.Results: 154 students were included in group A whereas 162 students in group B. Average knowledge and attitude was significantly increased after seminar in group A [knowledge 41±16.88% vs. 59.32±14.46%; P<0.05; attitude 36.24±10.93 vs. 41.5±10.87; P<0.05]. Average knowledge of group B students was 64.73±12.15% whereas average attitude score was 42.9±9.79. Amongst all, 86.4%, 87% and 89.3% students were not able to describe about emergency contraception, different methods and advantages of intra-uterine device as emergency contraception, respectively. There are 82.1% students showed positive interest in learning more about emergency contraception and 70.1% agreed to recommend its use in future. Students having good knowledge showed more positive attitude towards emergency contraception [r= 0.41, P<0.05].Conclusions: Students have poor knowledge of special issues arises with emergency contraception. Proper attention should be given to these aspects during their teaching. Students have shown their positive interest to learn more about emergency contraception. Objective based seminar will be more helpful in improving knowledge and attitude.
Knowledge, attitude and practice towards pharmacovigilance among postgraduate medical students at a tertiary care hospital: a cross sectional questionnaire based study
Authors: K. Vishnu , K. R. Mamatha , C. R. Jayanthi
Published: March 2017

Background: Adverse drug reaction (ADR) is major global health problem affecting both children and adults. ADRs are among the leading cause of mortality and morbidity leading to prolonged hospitalization. Hence, spontaneous reporting of ADRs by healthcare professionals forms the backbone of pharmacovigilance. Therefore, there is an urgent need for sensitization about drug safety monitoring among healthcare professionals (HCPs).Methods: A cross sectional questionnaire based study was conducted among 200 postgraduate medical students between April 2016 and May 2016 using a pre-validated questionnaire. Descriptive statistics was used for analysis.Results: Among 200 questionnaires distributed, only 150 provided responses reflecting a response rate of 75%. The postgraduates who understood the definition of adverse drug reaction and pharmacovigilance were 90% and 64% respectively. The most encouraging finding was 97% of postgraduates thought that reporting an ADR was necessary which in turn increases the patient safety. 60% postgraduates were unaware that the nurses and pharmacists also had the responsibility of reporting ADR. The postgraduates who encountered ADRs during clinical practice were 79% whereas reporting was only 2%.Conclusions: This study suggests that even though majority of postgraduates have better knowledge and attitude towards pharmacovigilance and ADR, the practice of reporting ADRs is inadequate. Therefore, there is an urgent need for educational intervention in the form of training programmes and continued medical education (CME) periodically to encourage ADR reporting among the postgraduates.
Dapsone induced photosensitivity in Indian women: a rare case
Authors: Garg Yashika , Gore Rajeshwari , Jain Sourabh , Kumar Arun
Published: March 2017

Dapsone, a potent antileprotic anti-inflammatory drug is used in treatment and prophylaxis of many dermatological and non dermatological conditions. Cutaneous adverse reactions to dapsone are uncommon ranging from mild maculopapular rash to fatal toxic epidermal necrolysis. We report here a case of 40-year-old, housewife treated for leprosy with paucibacillary multi drug therapy who presented with red itchy skin lesions over exposed areas of skin which worsened on exposure to sunlight. The patient was diagnosed as a case of dapsone-induced photosensitive dermatitis which was confirmed by improvement of symptoms on withdrawal of dapsone and recurrence of similar lesions on rechallenge with dapsone in reduced dose. Photosensitivity as adverse drug reaction to dapsone is rare and very few reports are available in the literature.
Case report on tuberous sclerosis
Authors: S. Zeebaish , P. Hemalatha , Y. Anusha , N. Surendra Reddy , T. S. Durga Prasad
Published: March 2017

Tuberous sclerosis is a genetic multisystem disorder characterized by widespread hamartomas in several organs, including the brain, heart, skin, eyes, kidney, lung and liver.  The affected genes are TSC1 and TSC2, encoding hamartin and tuberin respectively.  Most features of tuberous sclerosis become evident only in childhood, limiting their usefulness for early diagnosis. We report a case of 3months old female child with seizures and hypo-pigmented skin lesions. The case is rare as it is documented in a family affected continuously in three generations involving four members.
Case report on laurence moon biedyl syndrome
Authors: P. Hemalatha , R. Chaitanya Deepthi , K. Udayalakshmi , G. Nirmala , P. Lakshmi
Published: March 2017

Laurence moon Biedyl syndrome is a rare autosomal recessive condition with a wide spectrum of clinical features. The accepted major criteria for diagnosis include retinal dystrophy, obesity, Polydactyly, male hypogonadism, mental retardation and renal dysfunction. We have presented a 36 year old male patient exhibiting characteristic features of Laurence moon Biedyl syndrome and then the literature is reviewed.
Unusual case of acute coronary syndrome: inferior wall myocardial infarction 19 years young male presented with fever and right ankle cellulites treated with tissue plasminogen activator and its out come
Authors: Patel Dipesh Sureshbhai , Das V. K. , Desai Keyur
Published: March 2017

Unusual case of acute coronary syndrome: inferior wall myocardial infarction in 19yrs young male patient presented with fever and right ankle cellulites with fungal infection, thrombolysis was done with injection tenectaplase a newer tissue plasminogen activator with Troponin-T positive. Tenectaplase drug showed ECG changes within 30 minutes of thrombolysis with normal coronary during the angiography and preserved the left ventricular ejection function making it a successful thrombolysis by the tissue plasminogen activator (TPA) in young patient with myocardial infarction.
Recurrent pain in right lower quadrant- chronic appendicitis versus stone in urinary tract
Authors: Srivastava Vijai Prakash , Agarwal Ajai , Agarwal Shwetank
Published: March 2017

Background: At times, patient undergoing treatment for stone (4mm-6mm) in urinary tract beyond 6-8 weeks keeps on complaining mild, intermittent pain in RLQ, Central abdomen with nausea without urinary symptoms. In these cases, appendicectomy was performed. Post-operative relief and histopathology revealing inflammatory changes in appendix validated the procedure.Methods: This study was conducted in department of surgery of Rajshree Medical and Research Institute of Bareilly, Uttar Pradesh, India. India. 35 patients of ages between 14-65 years, mean being (39.5 years). Male female ratio being (2.5:1) who were suffering from recurrent pain in RLQ and being treated for stone in urinary tract (4-6 mm) were selected for the study. These patients were already received treatment for Urolithiasis for 6-8 weeks but proved to be of no avail. They were considered for appendicectomy. Macroscopic and microscopic results were analysed of the specimen rendered from 35 patients. Follow up results observed for complete one year.Results: On the firm belief that symptomatically these patients are more in favour of chronic appendicitis appendicectomy was performed. Post-operative relief of pain with no added morbidity or mortality provided rationale of the procedure. Histopathology of the remove specimen showed all changes pertaining to the chronic appendicitis.Conclusions: Obvious/oblivious, when patient is having both at the same time it really becomes perplexing to take the decision. Only experienced clinical skill decision taken yields positive results. Appendicectomy done in presence of small stones in urinary tract and relief patient received in present study proved the point.
Intraoperative transit time flow measurement to predict clinical outcomes in patient undergoing on pump coronary artery bypass graft
Authors: Suwannachod Chollada , Boonme Nakorn
Published: March 2017

Background: Transit time flow measurement (TTFM) is used for intraoperative graft measurement to estimate graft failure. PI≤3 was suggested because it shows lower incidence of early graft failure. Objective of the study was to compare myocardial function and clinical outcomes of patients who underwent coronary artery bypass graft (CABG) surgery, between PI≤3 in all grafts (optimal group) and PI >3 in one or more grafts (suboptimal group) by Transit time flow measurement (TTFM).Methods: 90 patients who underwent CABG since June 2012 to December 2014 were included. Patients were classified into 2 groups: Optimal group (n=32) and Suboptimal group (n=58). CABG with intraoperative TTFM was performed as standard. Postoperative outcomes of both groups were compared.Results: Patients whose postoperative EF was increased were found in optimal group more than suboptimal group (62.1% vs 25%, p<0.001). The patients whose postoperative EF increased equal or more than 5% was found in optimal group more than suboptimal group (73.2% vs 25%, p=0.002). Suboptimal group found one patient with myocardial infarction but optimal group found none (3.13% and 0%). Postoperative atrial fibrillation and prolong ventilator more than 48 hours were found in suboptimal group more than optimal group (43.75% vs 37.93%, 62.50% vs 37.93%). In midterm, postoperative follow-up, all-cause mortality in suboptimal group was higher than optimal group (3.13% vs 1.72).Conclusions: Optimal group had patients whose postoperative EF significantly increased more than suboptimal group. Tendency of finding postoperative complications in suboptimal group was more than in optimal group.
Evaluation of prognostic value of Fernandez scoring system on the management of ectopic pregnancy in the emergency room at Suez Canal University Hospitals, Egypt
Authors: Essa Ahmed A. , Madny Elham H. , Zayed Osama M. , Elshaboury Islam M. , Mahmoud Bassma M.
Published: March 2017

Background: Ectopic pregnancy is a major cause of morbidity and mortality in reproductive-aged women, accounting for 9% of pregnancy-related deaths in the first trimester. Clinical prediction tools have been developed to aid management decision making. Fernandez et al “1991” developed a score based on gestational age, β-hCG level, progesterone level, abdominal pain, hemo-peritoneum volume, and hematosalpinx diameter. A score of less than 12 predicts more than 80% success with expectant or nonsurgical management. Aim of the study was to improve the outcome of patients with ectopic pregnancy attending the emergency room at Suez Canal University hospitals, Egypt.Methods: This is a descriptive (cross-sectional) study conducted on 62 patients diagnosed to have ectopic pregnancy in the emergency department in Suez Canal University Hospital. The patients were subjected to full assessment including full history, examination, investigation and Fernandez score. These data were collected in a questionnaire, interpretted using SPSS program and the score was calculated.Results: The study revealed that 48.8% of the patients were in the age group between 31-40 years. It was found that in 61 patients (98%) the decision matched using Fernandez score and experts’s opinion while only one patient was given a different decision. Using Fernandez score, 40 patients had results less than 12 which guided to conservative management and 22 patients had a score more than 12 which guided to operative management.Conclusions: It was found that Fernandez score has 100% sensitivity and 95.2% specificity.
A case series of standard surgical management of bulbo-membranous stricture
Authors: Selukar Dhananjay , Pothare Amit Narayan , Meshram Kunal , Rahangdale Vinay , Jibhkate Nikhilesh , Hedaoo Jagdish , Helgeri Samir
Published: March 2017

Background: Urethral stricture is an acquired permanent narrowing of the urethra impeding the flow of urine during micturition. It is one of the oldest urological diseases, and its treatment remains a challenge for urologists. Urethral stricture disease affects about 300 per 100,000 men. Most common causes are trauma and infections in developing countries and idiopathic in developed countries. Treatment options for short bulbar urethral strictures include dilatation, direct visual internal urethrotomy and anastomotic urethroplasty. Excision and end to end anastomosis (anastomotic urethroplasty) for short bulbo-membranous urethral strictures and buccal mucosal graft gives excellent long term results with reduced recurrence rate.Methods: Sixty-three patients who had undergone anastomotic urethroplasty from 2013 to 2016 at Government Medical College and Superspeciality Hospital, Nagpur, Maharashtra, India Department of Urology were included in the study. For strictures less than 2cm, excision of stricture and anastomosis done, while for stricture more than 2cm buccal mucosal grafting done over 16 F Foleys catheter. Postoperative follow up done up to 1 year.Results: The total number of patients included is 63 and study conducted between January 2013 to December 2016. End to end urethroplasty was done in 41 patients and had mean duration of surgery of about 120 minutes, while buccal mucosal grafting was done in 22 patients. Age ranges from 14 to 78 years with highest incidence of stricture was seen after 5th decade of life, mainly due to iatrogenic causes of previous instrumentation and post TURP surgery. Strictures in younger adults are mainly as a result of trauma by fall astride injury and pelvic fractures and seen during 3rd and 4th decade of life. Most common length of stricture observed was 1-2cm in about 65.07% and mainly occurred due to post urethral procedures. Long strictures more than 2cm were mainly because of trauma in about 35%. Seven patients had recurrence in follow up, out of which 2 managed conservatively by repeated dilatation and 5 patients needed reoperation.Conclusions: The present results suggest that in patients with strictures too long to be excised and re-anastomosed a tension-free buccal mucosal graft provides better results. However, in patients with short strictures, in whom a completely tension-free anastomosis can be achieved, direct end-to-end anastomosis remains good option.
Aetiopathological and demographic profile of diabetic foot: a prospective cross sectional study from a tertiary hospital in South India
Authors: Valappil Ragesh Kalikottu , Krishnan Sheena , Matad Siddharth , Vayalipath Shameej Kinakool
Published: March 2017

Background: Diabetes mellitus is a chronic disorder affecting large segment of population and is a major public health problem.Methods: A prospective cross sectional study of 150 patients conducted in the Department of Surgery at Government Medical College, Kozhikode, Kerala, IndiaResults: Maximum numbers of patients were in the age group of 60-69. Male to female ratio is 3.04:1.50% had duration of diabetes <10 years and 50% had duration ≥10. years. 81 (54%) patients had neuropathy, 53 (35.3%) had PVD, 41 (27.3%) had history of prior foot ulcer, 70 (46.7%) had poor glycemic control (RBS >200 mg/dl) at the time of admission and 44 (29.3%) had history of smoking.Conclusions: Most important risk factors for diabetic foot ulcers were neuropathy (54%), poor glycemic control (46.7%) and PVD (35.3%), diabetic foot requires a comprehensive management.
Laparoscopic cholecystectomy in wall echo complex gall stone disease: a study
Authors: Arora Bhavinder K. , Arora Rachit , Arora Akshit
Published: March 2017

Background: There are so many subtitles for difficult laproscopic cholecystectomy. Stone in the neck of gall bladder constitutes one of the entities. Wall echo complex is an ultrasound terminology used for cholelithiasis. It has three layers, first the pericholecystic fat between gallbladder and liver. Second layer consists of gall bladder wall. The third layer consists of echogenic stone itself. Wall echo complex is one of the entities which constitute difficult laproscopic cholecystectomy. Wall echo complex in the neck of the gall bladder is particularly difficult gall bladder where the conversion rates are high.Methods: The study was conducted in Department of Surgery. Standard four port cholecystectomy was done in 50 patients. Wall echo complex in all these patients was reported by ultrasonologist. Difficulties in operating wall echo complex cholelithiasis consisted of dissection of neck of gall bladder due to adhesions and a sleeve of fat covering the calot’s triangle. The difficulty of wall echo cholelithiasis was managed by opening the neck of gall bladder and evacuating the stones into a separate latex bag. By this procedure the difficult wall echo cholelithiasis was managed in all cases. Ligaclips were used for ligation of cystic duct, cystic artery and pericholecystic veins.Results: The evacuation of stones from the neck of gall bladder led to an easy cholecystectomy in 46 patients while the four patients had conversion to open cholecystectomy.Conclusions: Wall echo complex although an ultrasonologists entity but is a difficult gall bladder for laproscopic cholecystectomy.
Patient preference matters: cholecystectomy for uncomplicated gallbladder diseases should be performed by single port laparoscopy
Authors: Romero-Marcos Juan M. , Carbonell-Aliaga M. Pau , Muñoz-Pérez José M. , Tejada-Gavela Silvia , Sanchis-Cortés Pilar , Cifuentes-Ródenas J. Andrés
Published: March 2017

Background: Laparoscopic cholecystectomy for uncomplicated gallbladder diseases (UGD) is a low-complexity procedure with little morbidity. Single port approach (SPA) benefits are unclear. Our aim is to identify any advantages by evaluating both the clinical outcomes of this approach and also patient opinion, following a year of implementation in our institution.Methods: Data from patients operated on during 2015 for UGD by SPA or conventional laparoscopic approach (CLA) were collected. Patients were asked to answer a telephone questionnaire 4-6 months after the operation.Results: 47 patients were operated on by SPA (SP group) and 117 by CLA (CL group). No differences were found between preoperative variables, surgical time, morbidity, length of stay or wound complications. More SP group patients reported no pain at discharge (72.3 vs 54.7%, p=0.037). 138 patients answered the questionnaire. No significant differences were found when comparing overall satisfaction. Wound aspect satisfaction was higher in the SP group (100 vs 80.9%, p=0.001). A higher proportion of CL group patients felt that had they had fewer scars, they would be more satisfied (46.8 vs 9.1%, p <0.001), and 35.1% of them opined that their satisfaction would be greater had they been operated on by SPA. In the multivariate analysis, the only variable associated with maximum overall satisfaction was wound aspect satisfaction.Conclusions: SPA is a valid alternative to CLA for UGD. It should be chosen when available, since it provides equal clinical outcomes, diminishes postoperative pain and is preferred by patients.
Prediction of difficulties during laparoscopic cholecystectomy by preoperative clinical examination and ultrasonography
Authors: Kumar Arun , Singh Kunwar Vishal , Shakya Jugendra Pal Singh , Sahu Sangita , Dhiman Soniya , Agrawal Neelabh
Published: March 2017

Background: Cholelithiasis (gall stone disease) is a well-known disease worldwide. Ultrasonography is the most common screening test for cholecystitis and cholelithiasis. Laparoscopic Cholecystectomy is considered the treatment of choice for symptomatic gall stone disease. It is important to know the different clinical, radiological parameter and specific predictor that give some prediction of difficult LC. The aim of this study was to predict the difficulty of LC and the possibility of conversion to OC before surgery using the clinical and ultrasonographic criteria in our set up.Methods: The present study was carried out in the Department of surgery, Sarojini Naidu Medical College Agra, from November 2014 to October 2016.  A total of 210 patients were enrolled for the laparoscopic cholecystectomy. All patients who were included in the study were undergone detailed history and clinical examination. A number of clinical and ultrasonographical parameters were noted.Results: Amongst the 210 patients admitted for laparoscopic cholecystectomy, 21 (10%) were male and 189 (90%) female, with age ranging from 12–60 years.  The conversion rate in our study was 4.5% (9 of 210). In our study significant pre-operative factors which increased the conversion rate to open cholecystectomy includes male gender, obesity, abdominal scar of previous surgery, contracted and thickened gall bladder and patients having stone impacted at the neck of gall bladder.Conclusions: From this study, we conclude that preoperative ultrasonography is a good predictor of difficult laparoscopic cholecystectomy in the majority of cases and should be used as a screening procedure.
hsCRP levels as predictor of difficult laparoscopic cholecystectomy- current status evaluation experience in a teaching institution
Authors: Arora Balvinder Singh , Sen Poornima , Singh Raj Kumar , Biswal Indu , Paruthy Shivani B.
Published: March 2017

Background: CRP, an acute phase reactant, is known to increase up to 1000 folds following inflammation and/or infection, but it’s utility as a significant predictor of difficult LC or need for conversion to OC still remains controversial. Limited studies on levels of hsCRP and its association with difficult cholecystectomy are available in literature, especially in Indian context. It is hypothesized that levels of hsCRP pre-operatively for a given population or an individual patient if high would help a surgeon anticipate better a difficult LC, avoid excessive intra-operative manipulations, go for conversion early, reduce time of surgery and hence also minimise post-operative complications.Methods: The present included 30 clinically diagnosed ‘cholecystitis with cholelithiasis’ patients, and 30 healthy individuals. For accurate comparison of hsCRP levels, a fasting and post-operative, 6 and 12 hours, blood samples were analyzed by ELISA test. Pre-and post-operative hsCRP values were recorded and analyzed using multi-user licensed SPSS- Version 21.0.Results: The mean value of hsCRP in controls was 1.43mg/L. In study group, in pre-operative serum samples, the concentration was 20.46 mg/l. At 6 and 12 hours post-operative periods, the mean values observed were 24.4mg/L and 23.7 mg/L respectively. Compared with controls, the mean values are fairly high and statistically also significant (p-values <0.0001). For the study group comparison of hsCRP value pre-operative and post-operatively 6 hours, using Wilcoxon Signed Rank Test has given the p-value <0.001 indicating that the increased hsCRP concentration in patients’ circulation is highly significant as a predictor of difficult laparoscopic cholecystectomy. Similarly, Comparison of hsCRP value pre-operative and post-operative 12 hours, using Wilcoxon Signed Rank Test revealed the p-value <0.007 showing it as highly significant and a predictor of difficult LC requiring conversion. The preoperative value of 20.46% is significant for an individual planned for LC who may require conversion.Conclusions: The preoperative hsCRP value of 20.64mg/L, as per our study results, can be relied upon as predictors of difficult LC and/or need for conversion not only in the study group in the given population but also in individual cases. Such a value of 20.64mg/L is definitely important for an individual case management. Knowing the preoperative values beforehand and if found high, it places a surgeon on a cautious note to avoid too much of LC manipulations intra-operatively, take an early decision to go for conversion, reduce the time of surgery, minimise post-operative complications and hence also morbidity.
Is it time to write obituary for open choledocholithotomy in the present era of endoscopic management? Outcome of surgery for failed endoscopic extraction, retrospective study
Authors: Sharma Rajkumar , Kumar Vipan , Gupta Niraj , Rana Kirti , Dogra Amit , Nanda Anupam
Published: March 2017

Background: Between 05 to 20 percent of patients undergoing cholecystectomy for gallstones, have choledocholithiasis. Treatment of the common bile duct (CBD) stones can be conducted as open cholecystectomy and open CBD exploration or laparoscopic cholecystectomy plus laparoscopic CBD exploration (LC + LCBDE) versus pre- or post-cholecystectomy endoscopic retrograde cholangiopancreatography (ERCP) in two stages, usually combined with either sphincterotomy or sphincteroplasty (papillary dilatation) for CBD clearance. The merits and demerits of individual techniques are yet to be settled.Methods: We reviewed the outcome of patients operated at our centre after failed endoscopic clearance of CBD stones. Over a period of 03 years, total 2145 laparoscopic/open cholecystectomies were performed at our institute. In the same time period, 14 patients (06 males and 08 females) presented with choledocholithiasis after failed ERCP extraction (median age 59 years, range 29-62 years). All the patients had undergone ERCP and ± sphincterotomy/sphincteroplasty with failed clearance. None of the patient had undergone a cholecystectomy previously.Results: We performed open choledocholithotomy with T-tube drainage plus cholecystectomy in all the patients. There were no deaths and only one major complication. Surgery resulted in complete duct clearance in 93% of patients.Conclusions: Open surgery can be performed safely and effectively in patients with retained bile duct stones and surgery can be offered as primary modality of treatment over combined endoscopic management after appropriated patient selection.
Clinical study on cystic swellings of the scrotum in adults in a tertiary care hospital
Authors: Kemparaj Thammegowda , Mathew Joseph
Published: March 2017

Background: Cystic swellings of the scrotum are common clinical entities that surgeons encounter in daily practice. Males of all ages are affected. Today, considerable heterogeneity exists in their treatment. This study sought to identify the prevalence and patterns of presentation of these swellings in adults and evaluate the different modalities of surgical management.Methods: A cross-sectional study was undertaken from January 2013 to December 2016. A total of 186 patients fulfilling the inclusion criteria were included. Data was collected using a proforma. All patients were managed surgically.Results: Majority of cases (28%) were observed between 41-50 years (mean age 43.9 years). In 71%, mode of presentation was a painless, gradually progressive swelling. Mean duration of symptoms was 17.3 months. Primary vaginal hydrocele was the commonest swelling encountered (in 73.1%). Jaboulay’s procedure was undertaken in 75.2% of patients. Lord’s plication was associated with a comparatively shorter operative time, lesser postoperative scrotal edema and a shorter hospital stay. Epididymal cysts accounted for 19.4% and were managed by excision. The most common complication observed irrespective of surgery performed was scrotal edema (in 36%). Hematoma and infection were less frequently observed. Patients were followed-up for a mean period of 1.8 months. No recurrences were detected during this period.Conclusions: Cystic swellings of the scrotum are conditions predominantly affecting middle-aged males. Among these, primary hydrocele is the commonest. Although Lord's plication is simpler and gives good results with fewer complications, Jaboulay’s procedure remains the gold standard for surgical management of hydrocele.
Non-traumatic intestinal perforation in the regional hospital Borgou of Benin: epidemiological and therapeutic characteristics
Authors: Allode Alexandre S. , Dossou Francis M. , Hodonou Adrien M. , Séto Morel , Gbessi Gaspard D. , Sambo Bio Tamou , Olory-Togbé Jean-Léon T.
Published: March 2017

Background: Non-traumatic small bowel perforation is common condition in our income countries. This study aims to determine the pattern of non-traumatic intestinal perforation in our environment.Methods: The demographics, clinical features, relevant investigations, surgery performed and outcome of all the patients confirmed at surgery with intestinal perforation were collected for five years and the data analyzed using version 3.5.1 of Epi Info.Results: Out of the 69 cases involved in this study, there were 46 (66.7%) males and 23 (33.3%) females with a male/female ratio of 2; their mean age was 22.5±13.7 years (range 2 - 68 years). Young people in school constituted 23 (33,34%) of the cases and typhoid intestinal perforation was responsible for 64 (92.8%) cases while ischemic perforation as a result of postoperative flange, strangulated hernia and acute intussusception was responsible in 5 (7.2%) cases. The average duration before presentation in the hospital was 3 days while the average duration between presentation at the hospital and surgery was 2 days.  The surgery offered was simple closure after freshening the edges in 35 (50.7%) cases, resection and anastomosis in 28 (40.5%) cases and resection with ileostomy in 6 (8.8 %) cases. The immediate postoperative course was uneventful in 64 (92.8%) case while the mortality was 10 (14.5%). The cause of death was not identified in 3 cases. The average hospital stay was 14.5±12.8 days with extremes of 7 and 55 days.Conclusions: NTIP is relatively common among the causes of widespread acute peritonitis in sub-Saharan Africa and its management remains difficult with high mortality.
The role of Pim-2 in apoptotic signal transduction pathway of hepatocellular carcinoma
Authors: Chen Jiahai , Yang Xiaoli
Published: March 2017

Background: Hepatocellular carcinoma (HCC) is one of the most frequent malignant tumors. The objective was to investigate the role of serine/threonine kinase Pim-2 in apoptosis signal transduction pathway, because there is little study about its contribution to apoptosis in hepatocellular carcinoma.Methods: The Pim-2 gene and protein expression were examined by qRT-PCR, Western blot and immunohistochemical stain in HCC tissues and normal liver tissues. The plasmid pCI-neo-Pim2 was transfected into human hepatoma cell line SMMC7721 by lipofectamine. Total RNAs were extracted from SMMC7721 cell in logarithm growth phase. The mRNA expression of Pim-2, Akt-1 (protein kinase B), 4E-BP1 (translation repressor of mammalian target of rapamycln), SOCS-1 (repressor of cytokine), Bad（Bcl-xL/Bcl-2 associated death promoter, Bim（Bc1-2 interacting mediator of cell death）and Puma (p53 upregulated modulator of apoptosis) were identified by qRT-PCR. The cell cycle of post-transfected SMMC7721 cells was assessed by flow cytometry.Results: Pim-2 expression was enhanced in HCC. In post-transfected SMMC7721 cells, Pim-2 mRNA expression was up-regulated, level of Bad mRNA was attenuated, furthermore, the transcription level of Akt-1, SOCS-1, 4E-BP1, Bim and Puma gene wasn’t variety. Up-graulated Pim-2 can’t cause distinct change of cell cycle or apoptosis in hepatoma cell.Conclusions: The serine/threonine kinase Pim-2 plays an import role in the development of HCC, Pim-2 dependent maintenance of cell size and survival correlated with its ability to maintain down-regulated expression of the BH3 protein Bad. Pim-2 is not a trigger in cell-autonomous survival or inhibiting apoptosis in hepatocellular carcinoma. Pim-2 is a redundancy pathway of survival signaling.
A comparative analysis of the efficacy of topical phenytoin with conventional wound dressing in healing of diabetic foot ulcers
Authors: Prasad Sanjay , Prakash Advait , Patel Shailendra , Lunawat Ajay , Mahore Devendra
Published: March 2017

Background: Foot ulcers secondary to diabetes mellitus are very difficult to treat. Various agents have been used with varying success for their treatment. Recently phenytoin has been used in the treatment of these stubborn ulcers. Therefore this study was conducted and compared for the efficacy of topical phenytoin with conventional wound dressings in healing of diabetic foot ulcers.Methods: This is a prospective study comprising of 50 patients which were divided into two groups. In group I patients conventional betadine dressing was applied. In group II patients phenytoin was used for the dressing. Both the groups were compared on various parameters like time required for healing, complications, grafting and the results were statically evaluated.Results: Increased rate of granulation tissue formation was seen in topical phenytoin group when compared to conventional group. Better graft take up was seen in topical phenytoin group when compared to conventional group. On contrasting the number of days required for healing, effect on bacterial load and side effects of topical phenytoin dressing with conventional betadine dressing, the former yielded better results in all respects.Conclusions: Topical phenytoin dressing is an effective, inexpensive and widely available therapeutic agent in wound healing in chronic diabetic ulcers.
Pre-operative hypoalbuminemia is a major risk factor for anastomotic leak in emergency gastrointestinal resection and anastomosis
Authors: Anandan Prem Kumar , Hassan Mir Mohammed Noorul , Mathew Mebin
Published: March 2017

Background: The serum albumin level is one of several clinical parameters of the status of general health. Hypoalbuminemia is known to be associated with delayed wound healing. The hypoalbuminemic state interferes with the normal functioning of the gastrointestinal tract. This study evaluates the relation of pre-operative albumin level and the risk for anastomotic leak in emergency gastrointestinal resection and anastomosis.Methods: A total of 112cases that meet the inclusion and exclusion criteria are included from Bangalore Medical College and Research Institute, Karnataka, India for a duration of 18 months November 2014 to October 2016.51 cases belonged to the stapled group and 61 cases belonged to the sutured group. Anastomosis using the two techniques, stapled and hand sewn anastomosis are evaluated separately.Results: The relation of pre-operative serum albumin and anastomotic leak is analysed in each study group separately and found that a pre-operative albumin of <3.5gm/dl is significantly associated with post-operative anastomotic leak, with a p-value of 0.0418 (p<0.05) in stapled anastomosis group and a p-value of 0.0357 (p<0.05) in hand sewn anastomosis group.Conclusions: Pre-operative albumin of <3.5gm/dl is significantly associated with post-operative anastomotic leak in both the groups, irrespective of the technique adopted.