bluuebunny/crossref_metadata_2025 huggingface dataset:
Genetic study in congenital heart defects
Authors: Hussain Syed Abir , Wani Nasir U din , Muzaffar Tasneem , Dar Abdul Majeed , Bhat Mohammad Akbar , Rasool Roohi , Bhat Imtiyaz Ahmad , Singh Shyam
Published: April 2019

Background: Congenital heart diseases (CHD) are relatively common with a prevalence ranging from 3.7 to 17.5 per 1000 live births. Little is known about genetic link with respect to congenital heart disease. Iroquoise (Irx) homeobox genes have been widely studied and their expression in both developing and adult heart. Author tried to study the role of irx4 and irx5 genes in structural congenital heart disease, keeping the focus on study reported by Cheng Z et al.Methods: Author studied reported mutation site sequences in 25 various congenital heart disease patients and control healthy relatives of patients. It is a unique study and there has not been such a study reported in literature till date. Besides comparison with healthy related controls, author took cardiac tissue biopsy in patients while doing corrective cardiac surgery. However, blood samples were taken from controls due to ease of feasibility.Results: Although, there were no sequence variations in the studied exon regions, but author got a base pair sequence change at 6 bp intron region, which is near the exon splice site in irx4 gene. Besides two ASD patient’s male children (one child each) had ASD prompting us to believe some role of sex linkage. However later needs pedigree analysis and sex chromosome studies for further analysis.Conclusions: Gene sequence in the Kashmiri population is unique. There is possibility of role of irx genes in CHD. ASD might have sex linkage in some.
Climate change: what people living in Jammu city of India know?
Authors: Gupta Riya , Majeed Mudasir , Kumari Rashmi , Gupta Rajiv Kumar , Langer Bhavna , Singh Parveen
Published: April 2019

Background: Climate change has emerged as one of the greatest challenges of the present century. The current study explores the knowledge, attitudes and practices about climate change of the adults aged 18 years and above in Jammu city of North India.Methods: A cross-sectional study was conducted among attendants of the patients visiting medical OPD of a tertiary care teaching hospital. A pilot tested questionnaire eliciting information on knowledge, attitudes and practices about climate change was administered to those who were willing to participate.  The data collected was presented in proportions.Results: Majority (95%) of the respondents had heard of the term climate change, and 43.9% of them related it to changes in the weather pattern. Plastic use as a major cause of climate change was agreed upon by 95% of the respondents. About half of the respondents were very much concerned about climate change and 80% of them were very much interested in knowing more about climate change and its impact. Only 24.8% of the respondents read/watch stories on climate change.Conclusions: Knowledge levels of the respondents were found to be reasonably good but the same cannot be said about their attitude and practices. Role of NGOs, social communities and media is of utmost importance to make people aware of the harmful effects of climate change on both the environment as well as the health of the people.
A comparative study on efficacy of metoprolol and ivabradine in acute ST elevation myocardial infarction patients
Authors: Gurrala Rajashekar Reddy , Unni Vinod K. , Kadloor Parvaiz , Rayees T. K. Mohammed , Razvi Syed Azeemuddin , Uzma Syeda , Fatima Mehruq
Published: April 2019

Background: The ST-elevation myocardial infarction (STEMI), a fatal disease, is rapidly extending in patients, worldwide. Therefore, proper and timely diagnosis followed by appropriate management becomes necessary. The study aimed to compare the effectiveness of metoprolol and ivabradine in acute STEMI patients.Methods: This was an observational, comparative, in-hospital study carried out in patients admitted in the in-patient cardiac department, intensive cardiac care unit of a tertiary care centre in India. Total 60 patients diagnosed with acute ST-elevation MI were included in the study and were equally divided into two groups. Group 1 involved patients who were given metoprolol for treatment and group 2 involved patients who were given ivabradine. The patients were assessed in terms of heart rate, NYHA class, and ejection fraction. Follow-up of 30 days was taken in all patients.Results: Ivabradine reduced mean heart rate from 85.57 bpm at baseline to 78.23 bpm. Heart rate in the metoprolol group was reduced from 81.93 bpm to 76.47 bpm over the same time period. Metoprolol and ivabradine showed significant improvement in the ejection fraction volume during the in-hospitalization stay. Ivabradine showed a better improvement in ejection fraction when compared to metoprolol but the difference was not found to be statistically significant. Higher mortality was assessed in ivabradine group compared to metoprolol.Conclusions: The study gives the gold standard efficacy and mortality benefit of metoprolol, although ivabradine on the other hand gave better responses in heart rate reduction and improvements in ejection fraction.
Medical thoracoscopy in evaluation of undiagnosed pleural effusion
Authors: Dar Khurshid Ahmad , Sultan Sheikh Tariq , Jamil Ahmed Jamal , Mehfooz Nazia , Shah Naveed Nazir , Farooq Syed Suraiya , Datta Bikram Singh , Bhat Firdous Manzoor , Wani Lateef Ahmad , Bhat Khalid Feroz
Published: April 2019

Background: Medical thoracoscopy or pleuroscopy, in recent past has received lot of interest for diagnostic as well as therapeutic purposes. In the evaluation of undiagnosed pleural effusion, it has become a key diagnostic modality as it is a cost effective and safe procedure. The aim of present study was to assess the diagnostic yield of medical thoracoscopy in patients with undiagnosed exudative pleural effusion.Methods: This prospective study was conducted at government chest diseases hospital Srinagar between December 2016 to June 2018. One hundred and twenty-five (125) patients who fulfilled inclusion criteria were included in this study. Thoracoscopy was done using rigid thoracoscope under local anesthesia.  Thoracoscopic and histopathological data of enrolled patients was collected prospectively and analysed.Results: Patients enrolled in the study were in the age range of 17 to 82 years and consisted of 80 males and 45 females. Most common thoracoscopic finding was multiple variable sized nodules (53.6%) followed by sago grain infiltration (15.2%). Malignancy was the most common histopathological diagnosis (60.8%) with metastatic adenocarcinoma being the most common histopathological diagnosis (50%). The overall diagnostic yield of thoracoscopy was 90.4%.Conclusions: Medical thoracoscopy is a safe procedure with excellent diagnostic yield for evaluation of undiagnosed pleural effusion with minimal complication rates.
Glycaemic control and C- reactive protein levels in type 2 diabetes mellitus -how well they co-relate?: a prospective study
Authors: Petchiappan Velammal , Sivakrishna Nanubala , Manickam Santni , Menon Sujaya
Published: April 2019

Background: Poorly controlled diabetes mellitus as indicated by elevated glycated haemoglobin (HbA1c) levels is associated with increased cardiovascular risk. C–reactive protein (CRP), an important cardiovascular risk factor, is elevated in diabetics with poor glycaemic control than those with good control. The present study assessed the correlation between HbA1c and CRP levels.Methods: A prospective study was conducted in thirty type 2 diabetic patients irrespective of the disease duration and treatment; those with established target organ damage were excluded. HbA1c and hsCRP levels were measured at baseline; sugars were monitored monthly and medications optimised; at the end of six months HbA1c and hsCRP levels were measured.Results: Mean age of the study subjects was 58.7±8.6 years; At the baseline, all had poor glycaemic control (HbA1c >7%); 15 had hsCRP >3 mg/L. At the end of 6 months, 5 achieved good glycaemic control (HbA1c <7%); 10 had hsCRP >3 mg/L. Baseline median hsCRP was 3.33 mg/L (0.68, 15.9) and at the end of 6 months it was 2.08 mg/L (0.48, 9.12). Mean HbA1c at baseline and end line was 10.6±1.55% and 8.43±1.84% respectively. There was significant reduction in both the mean HbA1c and median hsCRP at the end of 6 months (p <0.001). Positive correlation was observed between HbA1c and CRP at baseline (r=0.32, p=0.10). However, this was not observed at the end of 6 months.Conclusions: There is positive correlation between the level of glycaemic control (HbA1c) and CRP levels; Better glycaemic control results in significant reduction in the hsCRP levels.
The role of laparoscopy in patients with abdominal trauma
Authors: Sharma Pranav K. , Gupta Gaurav
Published: April 2019

Background: Use of laparoscopy in penetrating trauma has been well established; however, its application in blunt trauma is gaining popularity as a useful diagnostic tool to avoid unnecessary laparotomies where there is diagnostic dilemma. Even though recent case reports seem to suggest that these patients can be managed using laparoscopy, the practice is not yet wildly adopted.Methods: All adult patients who presented with abdominal trauma laparoscopic surgery was considered in patients who were deemed fit for the same in the Department of General Surgery, MMIMSR, Mullana, Ambala during a period of 18 months starting from January 1st 2015 to June 30th 2016. Data was analysed using descriptive statistics.Results: A total of 53 patients with either blunt or penetrating abdominal trauma that required surgery were included in the study. Exploratory laparotomy was performed in 45 patients (84.91%) and laparoscopy was performed in 8 patients (15.09%). Overall mesenteric injury (45.28%) was the most common intra-abdominal injury noted. The most common organ involved in blunt trauma was the spleen (68.97%). The mean operating time of laparoscopy was lesser by 57 minutes as compared to exploratory laparotomy. The use of laparoscopy avoided negative and non-therapeutic laparotomy in 2 patients (25%). Therapeutic laparoscopy was performed in 3 patients with repair of bowel and mesenteric injuries. There was no documented procedure‑related morbidity and mortality.Conclusions: The positive outcomes from the study suggest that laparoscopy can be safe and feasible in both diagnostic and therapeutic interventions in carefully selected blunt abdominal trauma patients.
A study of comparison of liquid-based cytology versus conventional pap smear for evaluation of cervical cytology at a tertiary healthcare hospital
Authors: Singh Shruti , Gupta Amit , Nath D. , Shobha Hema J.
Published: April 2019

Background: Cervical cancer is the second highest cause of cancer-related mortality in women, and the only sign of this cancer in the early stages is the loss of abnormal cells. Clinical signs of the disease appear only after cancer has reached advanced stages. Conversely, this cancer in precancerous conditions is completely curable and screening with conventional Papanicolaou (CP) has reduced the mortality by 70% but it is also associated with a significant number of false-negative cases (20-50%). In 1996, liquid-based cytology (LBC) method was developed to overcome the disadvantages of the previous method expecting to have good features such as high sensitivity, faster sample preparation, and decreased the rate of inadequate smears.Methods: This descriptive-analytic study was conducted at the Department of Pathology and Department of Obstetrics and Gynaecology, government medical college, Datia for the period of 11 months from April 2018 to February 2019. The study includes total 80 subjects. Total No. of Pap smear examined (both LBC and CPS) are 160.Results: There were statistically significant differences of satisfactory/unsatisfactory rate, smear cellularity, background clarity and detection of endocervical cells, in between liquid based cytology and conventional Pap smear finding (p<0.05). Diagnostic efficacy i.e. sensitivity and specificity of LBC is greater than CPS for evaluation of cervical cytology.Conclusions: Results shows, that LBC may improve the sample's quality, reduce the number of unsatisfactory smear and increases the diagnostic efficacy.
Bilateral gluteal abscess caused by Kluyvera cryocrescens: a case report
Authors: Nautiyal Sulekha , Jauhari Shalabh , Pandey Kxitiza
Published: April 2019

Kluyvera is a relatively new genus, belonging to family Enterobacteriaceae. This organism colonizes mainly respiratory and gastrointestinal tract. It has also been reported from various environmental sources. Due to a rise in immune-compromised states and ease of identification using automated methods rare organisms are now being reported with their role as potential opportunistic pathogens. Meticulous detailed identification and reporting of pathogens like Klyuvera to differentiate it from other members of Enterobacteriaceae can lead to solving the pathogenic importance of such organisms. We report a case of bilateral gluteal abscess due to Kluyvera cryocrescens in an obese diabetic adult male.
Impact of active smoking on nasal functions in patients with allergic rhinitis
Authors: Chamarajanagara Bhaskara Pratibha , Ross Anita , Gupta Neha
Published: April 2019

Background: Allergic rhinitis is an important health problem in view of its prevalence and its impact on patients’ social life, school performance and work productivity. Smoking is known to affect the asthmatic airway inflammation. The additional effect of smoking in impairment of nasal functions in patients with allergic rhinitis is a subject of interest. The aim and objective of this study was to study the effect of active tobacco smoke on mucociliary clearance and olfactory thresholds in allergic rhinitis.

Methods: A descriptive observational pilot study was carried out on 40 patients of allergic rhinitis. Nasal mucociliary clearance was measured by saccharine transit time and olfactory threshold test was measured by butanol threshold test score.  

Results: The saccharine transit time was significantly prolonged in smokers as compared to nonsmokers. Amongst the subgroups of allergic rhinitis mucociliary clearance was found to be more prolonged with the severity of allergic rhinitis. Butanol threshold test scores were significantly lower in smokers when compared to non- smokers. Amongst the subgroups of allergic rhinitis olfactory threshold was found to be lower with the severity of allergic rhinitis.

Conclusions: In the current study we found that nasal functions were significantly impaired in smokers with allergic rhinitis. This indicates that smoking leads to worsening of symptoms in allergic rhinitis.
Retrospective analysis of total laryngectomy with post-operative radiotherapy for CA larynx in a tertiary care centre: a case series
Authors: Siddique S. Mohamed , Selvarajan G.
Published: April 2019

Background: Squamous cell carcinoma is the most common malignancy of the larynx. Various treatment modalities are available. Recently, total laryngectomy is a viable option as primary treatment or salvage surgery after radiotherapy than organ preservation surgeries. The aim was to analyse the results of the patients with advanced laryngeal cancers treated with total laryngectomy and postoperative radiotherapy.

Methods: It is a retrospective study from January 2015 to June 2018 with 16 patients with squamous cell carcinoma of larynx. Detailed history, examination, radiological, endoscopic evaluation of tumour, tissue biopsy proof and staging was done.  

Results: Of the 16 patients (15 male and 1 female), 12 patients (75%) were primary cases and 4 patients (25%) were radiorecurrent. 14 patients (87%) had pre-operative tracheostomy done and 2 patients (13%) had undergone direct laryngectomy. All the 16 patients had transglottic growth. All the patients had undergone total laryngectomy with post-operative radiotherapy. No pharyngocutaneous fistula reported. One patient (6%) had neck edema. One patient (6%) had nodal recurrence.

Conclusions: Total laryngectomy with post-operative radiotherapy affords a longer period of survival compared to radiotherapy alone. Minimal complications in our study are attributed to thorough pre-operative evaluation, meticulous surgical technique and post-operative care.

 
Evaluation of middle ear pressure and post-operative adenoid size in adenotonsillectomy: comparison between curettage and endoscopic assisted coblation technique
Authors: Bhat Sweekritha N. , Dutta Angshuman
Published: April 2019

Background: The aim of the study is to evaluate the effect on middle ear pressure and study the residual adenoid size post adenotonsillectomy after adenotonsillectomy by curettage and endoscopic assisted coblation among pediatric age group.

Methods: The present study was designed as a prospective observational study among patients undergoing adenotonsillectomy in a tertiary care hospital among pediatric age group (7-13 years) by measuring middle ear pressure (by tympanometry) and residual adenoids post adenoidectomy by diagnostic nasal endoscopy in 60 patients. The patients were included by simple random sampling, 30 patients for each group one undergoing cold steel the other endoscopic coblation adenotonsillectomy.  

Results: Greater reduction was observed in the post-operative adenoid size with endoscopic assisted coblation as compared to curettage. The difference in the middle ear pressure at pre operatively, day 1, day 7 and at 3 months between the study groups was not statistically significant.

Conclusions: In our study endoscopic coblation technique was found to be more superior to curettage in terms of greater reduction in adenoid mass. The effects on transient middle ear pressure between both study groups showed no difference. 
Clinical significance of paranasal sinuses and its anatomical variations using 3D cone beam computed tomography: a retrospective study
Authors: Gopal Saraswathi , Preetha Madhu
Published: April 2019

Background: Paranasal sinuses are a group of four paired air filled spaces surrounding the nasal cavity. During the developmental process, anatomical variations can occur in consequence of intra and extramural migration of the ethmoidal air cells, over pneumatization or hypoplasia of the sinuses and bulging of the neurovascular structures to the sinuses, thereby affecting the drainage pathways, causing chronic infections and complications during functional endoscopic sinus surgery (FESS). The aim of the study was to study the clinical significance of paranasal sinuses and it’s anatomical variations using CBCT.

Methods: A retrospective study was carried out at Meenakshi Ammal Dental College, Chennai, from June 2018 to November 2018 using 100 CBCT images of 50 males and 50 females, with their age group ranging from18-60 years. Radiographic assessment of paranasal sinuses and it’s variations were accurately characterized using customized Planmeca Romexis software and the data was analysed statistically.  

Results: It is found that agar nasi cells were found to be higher 79% followed by Kuhn cells 45%, onodi cells 23% and haller cells 12%. Concha bullosa was found in 39%. Nasal septum was deviated to right in 31% and to the left in 36%. Maxillary sinus septa in 21%, sphenoid sinus pneumatization in 23%,maxillary sinus pneumatization in 2%, and crista galli pneumatization in 7% of the study population. And the results based on gender, the p value is found to be highly significant.

Conclusions: CBCT is the best tool for imaging the paranasal sinuses including osteo meatal complex, due to its high quality bone definition, thin slicing, multi planar cross-sectioning and low patient dosage.
Benign lesions of the sinonasal tract: clinical study
Authors: S. Sridhara , K. S. Gangadhara , Shetty Hamsa
Published: April 2019

Background: Benign nasal mass lesions may remain asymptomatic for a long time. Bothersome symptoms like nasal obstruction, bleeding from nose, headache prompts the patient to visit the hospital. Although these are not life threatening, but yet timely intervention not only relieves patient symptoms but also prevents its further progress which may necessitate a more extensive surgical approach. The aim of the study was to determine the incidence of various benign nasal mass lesions presenting to the ENT outpatient department, by reviewing the histopathological report postoperatively.

Methods: It’s a retrospective study over a period of 4 years and 1 month (from November 2012 to November 2016). Both males and females in the age group 1 yr to 70 yrs, who underwent surgery for nasal mass and histopathologically proved as benign mass, were included in the study. Patient data was collected from medical record section, operation theatre surgical records and histopathology register from the department of pathology.

Results: Histopathology review of 146 cases was done. Majority of the patients (139/146) had non neoplastic lesions and only 7 patients had benign neoplastic lesion. Majority were males and in the age group of 20 to 60 yrs.

Conclusions: Though the majority of nasal mass lesions studied are benign non neoplastic, yet these cause bothersome symptoms to the patients thereby requiring surgical intervention. 
Type 1 tympanoplasty: does the status of contralateral ear affect the outcome?
Authors: Das Arindam , Mitra Sandipta , Ghosh Debasish , Sengupta Arunabha
Published: April 2019

Background: The objective of the study was to investigate the effect of contralateral ear status on the success rate (anatomical closure) of type 1 tympanoplasty.

Methods: The study is a prospective observational study comprising of 60 patients diagnosed with chronic otitis media, who underwent type 1 tympanoplasty during 2016-2018 in a tertiary care hospital.  

Results: In our study, contralateral ear was normal in 40 (66.7%) cases & diseased in 20 (33.3%) cases. Success rate of type 1 tympanoplasty in patients with normal contralateral ear was 90% (n=36) but success rate was only 60% (n=12) in diseased contralateral ear. This was statistically significant (p=0.006).

Conclusions: Our study revealed that the status of the opposite ear is an individual prognostic factor for type 1 tympanoplasty. In other words, graft-healing rates are poorer in individuals whose opposite ears are atelectatic or perforated because of chronic otitis media.
Clinicopathological study of asymptomatic thyroid swelling and its correlation with thyroid function tests
Authors: Bhargava Anuja , Faiz Syed M. , Shakeel M. , Singh Nafas J. , Singh Saloni
Published: April 2019

Background: Thyroid swelling without symptomatic manifestation is common occurrence and could affect 5 to 20% patients in endemic areas. Majority of them are non neoplastic and may not require surgery. Less than 5% of thyroid nodules are malignant.

Methods: Present study was conducted to correlate clinical findings, HRUSG findings, thyroid profile and FNAC findings in patients of asymptomatic thyroid swelling.  

Results: Proportion of euthyroid patients was higher compared to hyperthyroid and hypothyroid diagnosed as colloid goiter on FNAC findings (82.4% vs. 0.0% and 12.9%). Proportion of hypothyroid was higher compared to euthyroid and hyperthyroid diagnosed as Follicular adenoma (3.2% vs. 0.0% and 1.2%) and colloid goiter with cystic changes (48.4% vs. 0.0% and 10.6%). Proportion of hyperthyroid compared to hypothyroid and euthyroid patients were higher diagnosed as thyroiditis (75.0% vs. 32.3% and 5.9%) and papillary/medullary CA (25.0% vs. 3.2 and 0.0%). A statistically significant association of FNAC diagnosis and thyroid profile of patients with asymptomatic thyroid swelling was found.

Conclusions: The present study showed that thyroid dysfunction could play a significant role in determining the underlying pathology behind thyroid swelling and must be evaluated at the earliest using thyroid function tests as the first line of diagnostic tool. In case of suspected thyroid profile; USG neck and FNAC should be done. In view of lack of studies correlating thyroid and clinicopathological profiles of thyroid swellings, further studies to potentiate the present study findings are recommended.
Transoral transvsetibular thyroidectomy: an initial approach and experience
Authors: Mehta Raghav , Jain Sanchit , Soni Ravindra
Published: April 2019

Background: The objective of the study was to record our intial experience of transoral transvestibular thyroidectomy and to ascertain the problems faced, their possible solutions and further suggestions.

Methods: Inclusion criteria were unilateral thyroid swelling, patients who had a neck ultrasound (US) with a estimated thyroid diameter not larger than 8 cm; (b), USG estimated gland volume ≤40 ml, nodule size ≤50 mm, A benign tumor, such as a thyroid cyst, single-nodular goitre, or multinodular goitre. The procedure is carried out through a three-port technique placed at the oral vestibule, one 10-mm port for 30° endoscope and two 5-mm ports for dissecting and coagulating instruments. CO2 insufflation pressure is set at 6 mmHg. An anterior cervical subplatysmal space is created from the oral vestibule down to the sternal notch, laterally to the sternocleidomastoid muscle. Thyroidectomy is done fully endoscopically using conventional endoscopic instruments and Harmonic.  

Results: All transoral transvestibular thyroidectomy procedures were performed successfully with no conversions. The mean operative time was 112.5 (90-180) min. We observed one case of transient postoperative hypocalcemia. There was no recurrent laryngeal nerve palsy. The cosmetic result was excellent in all patients.

Conclusions: Transoral transvestibular thyroidectomy may provide a method for ideal cosmetic results. It also provides a wide and enhanced endoscopic view. Though more study and further instrumental development is required to fully embrace this procedure a preliminary experience show encouraging results.
Evaluating the role of otoendoscope in cholesteatoma surgery
Authors: Gupta Nitika , Lal Mohinder , Gupta Rohan
Published: April 2019

Background: Endoscope assisted ear surgery (EAES) reduces the chances of residual cholesteatomas as compared to the conventional microscopic technique, primarily because of the direct visualization of sites where residual cholesteatoma is common, which is often missed out during the traditional microscopic surgical procedure. The aim of the study was to evaluate the hidden areas of middle ear using endoscopes during the conventional microscopic cholesteatoma surgery.

Methods: The present prospective study was carried out in the Dept. of Otorhinolaryngology and Head & Neck Surgery, Shri Mata Vaishno Devi Narayana Superspeciality Hospital, Katra, Jammu for a period of one year during which a total of 20 patients of acquired cholesteatoma who underwent conventional microscopic surgery were followed by oto-endoscope assisted examination were enrolled.  

Results: Otoendoscope was used in all the surgeries to look for residual cholesteatoma in the hidden areas like protympanum, sinus tympani and anterior attic. An overall incidence of cholesteatoma observed and removed from hidden areas using otoendoscope was recorded to be 30% in the present study.

Conclusions: Microscopic ear surgery assisted with oto-endoscope allows a better visualization of the extent of cholesteatoma and thus improved eradication of residual/recurrent disease from the hidden areas of middle ear such as facial recess, sinus tympani, anterior epitympanic space, protympanum and hypotympanum.
Atypical presentation of tracheoesophageal fistula: immediate failure of ventilation via tracheostomy tube
Authors: Bong Qi Yi , Yong Doh Jeing , Tan Heng Yao
Published: April 2019

Tracheoesophageal fistula (TOF) is a rare complication of prolonged endotracheal intubation. Undiagnosed TOF during tracheostomy poses a risk of improper placement of tracheostomy tube and can lead to a potentially life-threatening situation. We report a case of an undiagnosed tracheoesophageal fistula during tracheostomy in a lady in which we encountered difficulty in placement of tracheostomy tube and were eventually able to cannulate the trachea with the help of a fibre optic bronchoscope.
Bilateral peritonsillar abscess: a case series
Authors: Tau Ng Chun , Afandi Ahmad Nordin
Published: April 2019

Peritonsillar abscess (PTA) is one of the most common deep neck abscesses. Unlike unilateral peritonsillar abscess, bilateral peritonsillar abscess is rather rare. We report 3 cases of bilateral peritonsillar abscess which were proven by either computerized tomography imaging or needle aspiration. One of the patients was treated with intravenous antibiotics and corticosteroid. The other 2 patients underwent needle aspiration for confirmation of diagnosis and subsequent incision and drainage. All patients were treated successfully with complete resolution. Bilateral PTA should always be considered when there is presence of bilateral peritonsillar swelling with non-deviated uvula and trismus. Despite surgical drainage being the most common management, the option of medical therapy alone may be sufficient. To the best of our knowledge, this is the first case of bilateral PTA reported being treated successfully with medical therapy.
Novel surgical technique for management of tongue schwannoma: case report
Authors: Jain Neha , Shishodia Shama , Dham Ruchima , Roy Suparna , Goel Sachin
Published: April 2019

Schwannomas are rare, solitary, slow growing, smooth surfaced and well encapsulated tumors. Schwannomas of head and neck region account for 25-40% of all the cases. Approximately 1%–12% of schwannomas occur intraorally, the tongue being the most common site. Complete surgical excision is the treatment of choice.  In this article, we describe a case of tongue schwannoma in a child, along with diagnostic and treatment options of tongue lesions. The tongue mass was completely excised via trans-oral approach using coblation method. The patient followed up for 1 year; he had an uneventful recovery and no recurrence.
Functional outcome of total hip replacement using a short stem implant
Authors: Kapila Rajiv , Lal Mukand , Kapila Preeti Takkar
Published: April 2019

Background: Conventional cementless THA is associated with stress shielding of the proximal femur and thigh pain. Short femoral stem can conserve bone, reduce stress shielding in the femur and reduce thigh pain. The present study aims to describe the functional outcomes associated with short stem metaphyseal implant in THA in our department.

Methods: This prospective study was conducted in the Department of Orthopaedic Surgery, Indira Gandhi Medical College, Shimla among patients who needed THA for painful disabling hip. Modified Harris hip scores (HHS) were assessed for all patients pre-operatively and at their final follow up.

Results: During the study period, a total of 20 patients were included in the study, 20% of them were females. The most common indication for THA was avascular necrosis head of femur with secondary osteomyelitis (n=14), of which 12 cases had excellent Hip Harris Score while two were in good category. Modified Harris hip score was excellent in patients where early partial and full weight bearing was started. Per-operatively, there was only one complication of fracture greater trochanter which was fixed with cerclage wire. In early post-operative period, two cases of superficial infection were noted and one case of varus malposition was present. In late post operative period, there were three cases of varus malposition and one case of deep infection as sinus.

Conclusions: Total hip replacement with short anatomical metaphyseal loading stem improved the modified Harris Hip score significantly, with very few complications. Future multicentric studies are needed to evaluate the efficacy of short stem implants over a long follow up period.
Cemented versus uncemented hemiarthroplasty for femoral neck fractures in elderly patients
Authors: Paramesh Nikil Sanaba , Taufiq Usman
Published: April 2019

Background: Controversy still exists regarding using cemented or uncemented hemiarthroplasty for femoral neck fractures in elderly patients. The aim of this study is to compare the effectiveness and safety of the two surgical techniques in femoral neck fracture patients over 60 years old.

Methods: We searched PUBMED from inception to December 2012 for relevant randomized controlled trials (RCTs). Outcomes of interest include postoperative hip function, residue pain, complication rates, mortality, reoperation rate, operation time and intraoperative blood loss. Odds ratios (OR) and weighted mean differences (WMD) from each trial were pooled using random-effects model or fixed-effects model given on the heterogeneity of the included studies.

Results: Our control trial involved 132 patients (132 hips) who were eligible for the study. Our results demonstrate that cemented hemiarthroplasty is associated with better postoperative hip function (OR = 0.48, 95% CI, 0.31–0.76; p = 0.002), lower residual pain (OR = 0.43, 95%CI, 0.29–0.64; p<0.0001), less implant-related complications (OR = 0.15, 95%CI, 0.09–0.26; p<0.00001) and longer operation time (WMD = 7.43 min, 95% CI, 5.37–9.49 min; p<0.00001). No significant difference was observed between the two groups in mortality, cardiovascular and cerebrovascular complications, local complications, general complications, reoperation rate and intraoperative blood loss.

Conclusions: Compared with uncemented hemiarthroplasty, the existing evidence indicates that cemented hemiarthroplasty can achieve better hip function, lower residual pain and less implant-related complications with no increased risk of mortality, cardiovascular and cerebrovascular complications, general complications, local complications and reoperation rate in treating elderly patients with femoral neck fractures.
Management of closed shaft of humerus fractures in non admitted adult patients in a tertiary care hospital
Authors: Arfee Sakib , Rashid Mudasir , Bhat Imran Yousouf , Verma Sandeep , Tahir Syed Rouf
Published: April 2019

Background: Fracture shaft humerus is among the most common of fractures. Proximal fractures are more common in elderly and are commonly attributed to low-energy falls, they make up to 5% of all fractures and 25% of humerus fractures, middle fractures about 60% and distal fractures contribute to the remaining fractures. Fractures shaft of humerus account for approximately 3% of all fractures encountered by the orthopedic surgeons.

Methods: From November 2017 to October 2018 sixty-two fractures of humeral shaft presented at Emergency Orthopedic Department in Government Medical College Jammu, 30 fractures considered suitable for the study. All these patients were treated conservatively by using the Coaptation ‘U’ shaped slab discharged the next day and evaluation done both clinically and radiologically every two weeks.

Results: This study showed that the angulation deformities were considerably reduced by the use of U slab and the POP cast. Smoking appeared to have negative effect on the rate of union.

Conclusions: Conservative treatment is one of the most effective methods of treatment. Operative treatment should be limited as much as possible to specific indications given below.
Radiographic evaluation of posterior tibial slope in ACL deficient Indian patients
Authors: Kumar Ravi , Kunal Kishore
Published: April 2019

Background: There are several studies which have investigated various osseous morphologic characteristics as they relate to ACL injury. Tibial slope, notch width, and notch width index are some. However, there does not appear to be consensus across studies. The aim of this study was to validate association between posterior tibial slope (PTS) and ACL injury in an ACL deficient knee of Indian patients.

Methods: This retrospective cum prospective study was done at a tertiary hospital from June 2017 to May 2018. 40 patients were included. Inclusion criteria were documented evidence of ACL tear to the affected knee; no history of osteoarthritis; no history of rheumatoid arthritis; patients voluntarily consented for the use of their radiographs for the study. The assessment was completed with a true lateral view of the knee with full length leg and ankle. The functional tibial slope as described by Julliard et al was used to determine the PTS. The mean and standard deviation (SD) for medial PTS were measured. Demographic data like age, sex were collected and entered into a database.

Results: 95% of patients were male. Mean age was 29.25. The mean PTS was 13.037 which is reasonably high as compared to normal while the standard deviation was 4.487 reflecting large amount of variation.

Conclusions: Increased posterior tibial slope can be concluded as a significant risk factor in ACL injury which corroborates the findings of various previously published studies. The findings presented may help identify patients who are at greater risk of ACL injury. 
Comparative study of early functional outcome between cruciate retaining knee and 3D knee: who is more satisfied?
Authors: Saraf Hrushikesh Ramesh , Munot Shreepal
Published: April 2019

Background: With growing demand on quality of life, there is drastic increase in total knee arthroplasty (TKA) surgeries and accordingly there is increase in research on TKA design to get the best possible outcome. Commonly known TKA designs are PCL substituting or retaining, fixed bearing or mobile bearing. Now the scientific research shifted to center of rotation of angulation (CORA) of knee i.e. medial or lateral pivot. 3D knee is based on lateral pivot system and designed to match the natural knee. The purpose of this study is to compare 3D knee with cruciate retaining (CR) knee functionally and also to assess the patient’s level of satisfaction.

Methods: 20 patients each included in 3D knee and CR knee group from June 2016 to June 2018 who satisfied the inclusion and exclusion criteria. Patients were followed up for 1 year. Their functional outcome assessed using knee society score (KSS) part 1 and 2. Also patient’s knee range of motion documented separately.

Results: Postoperatively there is improvement in knee society score in both the groups. 3D knee showed significant better KSS score than CR knee groups in first 3 months but as the patients followed up for 1 year both groups reached similar KSS score and also similar knee range of motion.

Conclusions: 3D knee showed satisfactory outcome when compared with CR knee and definitely provides a step ahead in search of natural knee.
A comparative study of efficacy and safety of platelet rich plasma versus fractional co2 laser in the treatment of post acne scars
Authors: Murali Babu Amita , Shetty Vinma H. , Goel Saumya , Eram Hafsa
Published: April 2019

Background: Facial scars prompt restorative issues and have mental impacts, for example, humiliation, poor confidence, and social isolation. This study intends to assess efficacy and safety of platelet rich plasma (PRP) versus CO2 laser in post acne scar treatment.

Methods: It is an outpatient based comparative study.  All patients enlisted in this study were separated into two groups, ten in each treatment group. In group A, patients received PRP month to month for 3 sittings and followed up eight weeks after the third sitting. In group B, patients received fractional CO2 laser month to month for 3 sittings and followed up eight weeks after the third sitting. Improvement of acne scars was assessed utilizing digital photographs with identical camera settings and Goodman and Baron’s qualitative grading system at beginning, after each sitting and followed up eight weeks after the third sitting. Patients subjectively evaluated clinical improvement eight weeks after the last sitting. Software (SPSS, version 16.0 statistical packages) was used.

Results: Assessment using qualitative acne scars grading system prior to and after treatment as well as patient’s subjective assessment 2 months after the third treatment session showed significant improvement in both groups. The baseline scores before treatment for group A and B were similar (p=0.7678) and final scores of both treatment groups showed no significant difference (p=0.8011) after treatment.

Conclusions: This study shows that PRP as well as fractional CO2 laser result in significant clinical change in the quality of post acne scars.
Study of the clinical pattern of contact dermatitis over the face and its correlation with patch testing
Authors: Goel Saumya , Shetty Vinma H. , Eram Hafsa , Babu Amita Murali
Published: April 2019

Background: Contact dermatitis (CD) is an altered state of reactivity; occur due to direct contact with noxious agents in our environment. Face is a very common site for CD.

Methods: Prospective hospital based study was conducted at A. J. Institute of Medical Sciences, Mangalore from June 2018 to November 2018. Fifty cases aged above 18 years with suspected allergic contact dermatitis (ACD) over face who gave written informed consent were enrolled. A complete history was taken and detailed clinical examination was done. Patch testing was done over the back in all patients which was removed after 48 hours and positive result was recorded based on the recommendation of the international Contact Dermatitis Research Group (ICDRG).

Results: The most common clinical pattern observed was pigmented contact dermatitis(PCD) (70%), followed by irritation (6%), acneiform eruptions (5%) and contact urticaria (2%). Out of 50 patients, 20 patients developed CD to fragrances and perfumes. 14 patients developed to soaps and shampoos. On patch testing, most common allergen in fragrances/perfumes was fragrance mix (52.9%). In soaps and shampoos it was triclosan (68.4%), parabens (31.5%). Sesquiterpene lactone in parthenium plant (4%), Paraphenylenediamine in hair dye (8%). In face creams were gallate mix and cetrimide among metals, nickel and chromium (6%). In case of kumkum it was paraphenylenediamine (4%).

Conclusions: Amongst the various patterns of contact dermatitis, PCD to cosmetics, fragrances and daily care products was most common pattern observed and the main allergens were triclosan, fragrance mix and balsum of Peru.
Prevalence of HIV in syphilis in a tertiary care centre
Authors: Sundararaj Sumithra , Sendurpandian Devaprabha , Rajakumari Suganthy R.
Published: April 2019

Background: Aim of this study was to determine the prevalence of HIV in syphilis in patients attending the STD clinic in a tertiary care center.

Methods: Study was conducted in all new patients attending the STD clinic during the study period of 6 months from June 2012 to November 2012. Clinically suspected cases of syphilis were diagnosed serologically and all the patients were tested for HIV after proper counselling and consent.

Results: In a total of 200 new patients attended the STD clinic 47 (23.5%) were diagnosed as syphilis. Majority of the cases (43) were latent syphilis in our study. A total of 77 (38.5%) cases were reactive to HIV. Among the 47 (23.5%) syphilis cases 24 (51%) were reactive to HIV. In the age group of 21-30 years most of the syphilis male (5/6) patients showed HIV reactivity.

Conclusions: Seroprevalence of syphilis among other STI was found to be significant. Rising trend in latent syphilis was noted may be due to antenatal checkup, purpose of foreign job and strict blood screening protocols. The prevalence of HIV in syphilis individual was 51% and it was high in the age group of 31-50 when compared to other age group. In the age group of 21-30 most of the males, diagnosed as syphilis were serologically positive for HIV. Hence these sexually active groups were to be targeted for their safe sexual practice to prevent the transmission of HIV.
Renal cyst occurring in a case of Darier’s disease
Authors: Thomas Vipul Paul , Sivaramakrishnan Sangiah , Thomas Jayakar
Published: April 2019

Darier’s disease is a rare genodermatosis inherited in an autosomal dominant pattern. The disease is characterised by chronic persistent hyperkeratotic papular eruptions over the seborrheic regions. 
Photodistributed granuloma annulare responsive to topical corticosteroids
Authors: Bhatia Shibani S. , Nayak Sudhir U. K. , Shenoi Shrutakirthi D. , Pai Kanthilatha
Published: April 2019

Granuloma annulare is a benign granulomatous disorder which is usually of unknown etiology. It is usually known to be associated with diabetes mellitus. It presents in various forms like localized, generalized, subcutaneous and perforating. We report a 52 year old female who presented with annular lesions exclusively over sun-exposed areas and was diagnosed with granuloma annulare. Photodistributed pattern of granuloma annulare has rarely been mentioned in the literature.
Managing the challenging cases of pemphigus vulgaris with modified pulse therapy: case series
Authors: P. Saraswathy , N. S. Jayanthi , Y. Venkatesh
Published: April 2019

In pemphigus vulgaris, pulse therapy is a promising modality to achieve better therapeutic response and to minimize the side effects of daily steroids. Here we report 5 different challenging situations where we successfully managed with modification of pulse therapy. Our first case had multiple comorbidities with persistent skin infections managed with dexamethasone and cyclophosphamide pulse (DCP) and interval pulse. The second case was unmarried hypertensive male with poor DLQI managed with Azathioprine pulse therapy. The third case was uncontrolled diabetic patient with pulmonary tuberculosis managed with rituximab. The fourth case was diabetic and hypertensive was managed with one day dexamethasone cyclophosphamide pulse therapy (DCP). The fifth case was not completed family with cushingoid features managed with dexamethasone azathioprine pulse therapy (DAP). Pulse therapy is effective in controlling disease activity in pemphigus. But it can be modified in some situations according to the patient needs.
Metabolismo bioquímico de plântulas de mamoeiros sob estresse salino
Authors: Silva Júnior Eugênio Gonçalves da , Silva Anselmo Ferreira da , Lima Jucelino De Sousa , Maia Josemir Moura , Souza Dhayane Dos Santos , Diniz José Paulo Costa
Published: April 2019

Objetivou-se com presente trabalho, avaliar o metabolismo bioquímico de plântulas de mamoeiro submetidas a diferentes níveis de salinidade, e cultivados e três tipos de substratos, a fim de determinar qual substrato promoveu um melhor ajustamento osmótico ao estres salino. Para produção das mudas da cultivar Havaí foram utilizados tubetes com capacidade 300 cm3. Empregou-se o delineamento inteiramente casualizado, no esquema fatorial 3x4. Os tratamentos foram compostos por três tipos de substratos: S1= vermiculita+húmus de minhoca (1/1); S2= vermiculita+húmus+esterco caprino (1/1/1); S3= vermiculita+esterco (1/1) e quatro níveis de condutividade elétrica na água de irrigação: C1= 0,0; C2= 2,5; C3= 5,0 e C4= 7,5 dS m-1 com cinco repetições. A solução salina para a irrigação foi obtida com a adição NaCl e monitorada com auxílio de um condutivimetro. Após a emergência das plântulas iniciou-se os tratamentos salinos até o 15º dia após a emergência. Analisou-se o conteúdo de açúcares solúveis totais, aminoácidos livres totais e teor de prolina em parte aérea e raiz. Com base na análise dos dados, observou-se que plântulas de mamoeiro cultivadas em substrato S1 incrementaram os teores de açúcares solúveis totais e aminoácidos solúveis totais em raiz e parte aérea, proporcional ao aumento dos níveis de salinidade. Concluindo, portanto, que o substrato vermiculita+húmus de minhoca (1/1) promoveu um possível ajustamento osmótico às plântulas em condições de estresse salino, através do aumento de compostos nitrogenados.