bluuebunny/crossref_metadata_2025 huggingface dataset:
Epidemiological and clinical profile of various plant poisons in a tertiary care center in South Tamilnadu, India
Authors: Kumari Meena , Latha Pattu Swarna , . Kalyanasundaram
Published: August 2019

Background: Plant poisoning is a common scenario in a toxicology unit . Some of the plants contain active components used as medicines. However, some of the plant constituents are poisonous with wide variety of clinical manifestations. Authors aimed to study the pattern of various types of plant poisons and clinical presentations and complications of various plant poisons admitted in our toxicological unit.Methods: A total of 87 patients admitted with history of plant poison ingestion, in toxicological unit of Tirunelveli medical college were studied . It was a retrospective observational study and was done over a period of one year.Results:  Out of 87 cases studied, 92%were due to consumption with suicidal intention. Plant poisoning ranks second only to pesticide poisoning . among the plant poisons encountered 66.6% were due to Oleander poison, followed by Datura (8%) and Glory lily(5.7%). Common parts of plant consumed by patients include seeds and plant oils . Vomiting and abdominal pain were the commonest presentations. Encephalopathy, dyselectrolytemia and arrhythmias were the notable complications in our study.Conclusions: Early admission and prompt first aid and monitoring at tertiary care center are key to the reduced mortality. The study throws light on various manifestations, toxic parts and complications of plant poisons.
Prevalence of anemia in type II diabetes mellitus patients
Authors: Reddy Sreenivas , Reddy Molugu Divya
Published: August 2019

Background: Anemia is a common haematological finding in diabetic patients. The prevalence of anemia in the patients with diabetes is two or three times higher than in patients with comparable renal impairment and iron stores in the general population. As India is foreseen a diabetic capital of the world, it becomes imperative to recognize co-morbidities such as anemia at the earliest. The aim of this study was to determine the prevalence of anemia among patients with type 2 diabetes. Author conducted a prospective analysis of 100 diabetic patients visiting the outpatient clinic in our institution. Duration of study is One Year (November 2016 - December 2017). Study perform at Om Sai Hospitals, Balapur, Hyderabad, Telangana, India. A 100 patients suffering from type 2 Diabetes Mellitus, attending Outpatient Department of General Medicine, were included in the study.Methods: All the patients were subjected to detailed history, through clinical examination and investigation. Patients’ blood samples were analyzed for Glycated hemoglobin (HbA1C) values and hemoglobin (Hb) levels. The prevalence of anemia was then determined defining anemia by an Hb level <13.0 g/dL for men and <12.0 g/dL for women.Results: The prevalence of anemia in this study population was found to be 43%. The prevalence of anemia is significantly greater in diabetic females than in diabetic males and in poorly controlled diabetics than those with glycemic status under control.Conclusions: We conclude that anemia is a prevalent finding in patients with type 2 diabetes mellitus and represents significant unrecognised burden.
Successful cerclage on cervix in the mid trimester: case report
Authors: Shaheed Saika , Haque Munima , Haider Rebeka
Published: August 2019

Cervical cerclage (CC) has been utilized for the cure of loss in second trimester pregnancy. The detection of cervical incompetency is problematic normally having repeated second trimester demise or early preterm delivery after cervical dilatation without pain having no bleeding, contractions, or other reasons for repeated loss in pregnancy. This study was performed at a tertiary care hospital in Dhaka, Bangladesh. These are 2 cases of patients undergoing emergency mid-trimester cerclage for advanced cervical dilatation with protruding membranes in 2016 and 2017. The 1st case patient was at 22 weeks of gestation and was admitted into hospital due to short history of lower abdominal pain and per vaginal bleeding. Vaginal inspection showed the cervix was dilated 1.5 cm. At 37 weeks of pregnancy she gave birth to a healthy female newborn by caesarean section and McDonald suture was removed. After delivery, mother and baby both were in good health. The 2nd case was of a patient of 26 years of age, second gravida, 24 weeks pregnant due to ovulation induction drug, who had a history of an abortion at 10 weeks. At her 24 weeks of pregnancy, she complained of profuse P/V whitish discharge and lower abdominal pain. It was found cervix was 2.5 cm dilated and bulging of membrane. Immediately McDonald suture was given. Patient was clinically improved, and USG showed OS is closed, length of the cervix is about 4.4 cm. At 32 weeks patient came with a complaint of rupture of membrane, then emergency caesarean section was done. A healthy premature female baby weighted 1.8 kg was delivered by vertex presentation. After operation, cerclage was removed. After delivery mother and baby both were in good health. Satisfactory neonatal result may be achieved in women having cervical deficiency in second-trimester pregnancy after emergency CC.
Blunt abdominal trauma in Sanglah Hospital Bali, Indonesia: a study of 65 cases
Authors: Partama Putu Gosen , Sueta Made Agus Dwianthara
Published: August 2019

Abdominal trauma is a challenge for every surgeon, whether related to diagnosis or treatment. In developing countries, the number of traumatic events associated with death makes it necessary for a study to be carried out to see the patterns and damage caused by abdominal trauma and the organs involved. Material and Method is all patients with blunt trauma of the abdomen who came to emergency unit Sanglah Hospital Bali, from January 2017 up to May 2018 that undergo laparotomy exploration were enrolled, the data were collected retrospectively using patient medical records. Results is 65 patients with blunt abdominal trauma came to the emergency department and undergoes laparotomy exploration, range of age was 4-74 year old and 75.3% of them were men. The most common injured organs were spleen and liver, both are 26 and 15 cases (40 and 23%). Another intraoperative finding are Ileum Perforation (10 cases) Left Zone II Retroperitoneal Haematoma (7 cases), and Mesenterium Rupture (5 cases). Splenectomy was the most performed procedure (26 cases). The most common cause of blunt abdominal trauma was motor vehicle accident. Hypovolemic shock was the most common clinical presentation (48 patient). The Conclusions are according to this study, men consisted 75.3% cases of blunt abdominal trauma and the range age of patients was 4-74 year old. The most common cause was motor vehicle accident. Among patients with intra-abdominal organ damage, spleen and liver were most commonly involved. About 84.6% of all patients with blunt abdominal trauma were discharged without complication and morbidity.
Sporadic ovarian sex cord-stromal tumor with annular tubules: a rare case report
Authors: Patel Krutika , Painter Devang , Bhagat Vashudha M. , Shah Pinkal
Published: August 2019

Ovarian sex cord stromal tumor with annular tubules (SCTAT) is a distinctive, rare subtype of sex cord stromal tumor of the ovary, predominant component of which has morphological features intermediate between that of granulosa cell and sertoli cell. The majority of ovarian SCTAT are benign. So far, malignant behavior in SCTAT has been reported only in sporadic cases. We have presented a case of SCTAT in a 40 year old lady with no association of Peutz-Jegher (P-J) syndrome. The patient’s chief complaints were post-menopausal bleeding for 1 year on and off along with menorrhagia. MRI abdomen was suggestive of intensely enhancing solid tissue mass lesion in the right  adnexa, features suggestive of ovarian mass. Panhysterectomy was done. Grossly uterus and left adnexa appeared to be normal. Right ovary showed mass measuring 17x11x9cm3 in size, on cut section, solid, homogenous lobulated, yellowish areas identified. Microscopic and Immunohistochemistry findings confirmed the diagnosis of sex cord stromal tumor with annular tubules of granulosa cell type. PAS stain supported the diagnosis.
Dissesiminated cysticercosis with neurocysticercosis – A rare presentation diagnosed by fine needle aspiration cytology
Authors: Singhal Shipra , Shushmita Shweta , Sharma Preeti
Published: August 2019

Disseminated cysticercosis is a rare presentation of human T. Solium infection in which the parasite disseminates via the blood stream throughout the human body. The various clinical manifestations depend upon the location of the parasitic cyst inside the body. Neurocysticercosis is the most common parasite disease of the central nervous system. Disseminated cysticercosis with neurocysticercosis is a very rare presentation of human cysticercus infection. Here we present such a rare case in which a young man presented with multiple swellings all over the body and a history of seizures. Fine needle aspiration cytology was done and the diagnosis was established.
Laser versus dermabrasion and split thickness skin graft for management of post burn leucoderma
Authors: Gad Shawki S. , Kishk Tarek F. , Taalab Ahmed A. , Gerza Ahmed I. El
Published: August 2019

Background: The aim of the study is to compare between dermabrasion and split thickness skin grafting and fractional CO2 laser in management of post burn leucoderma. Deep burn can have serious aesthetic consequences as it often result in scar tissue and pigmentary changes in the skin. It is understood that skin pigmentation involves melanin. Leucoderma results from melanin loss at the basal layer of the epidermis. Fibrosis ultimately inhibits melanocyte migration and subsequent production of melanin in the injured area. Management of post burn leucoderma was either non-surgical or surgical treatment. Non-surgical therapies are make-up, tattooing and fractional CO2 laser. The surgical treatments include dermabrasion with thin split thickness skin grafting, non-cultured keratinocyte-melanocyte suspensions, mini grafting, cultured epithelium, blister epidermal grafting, chip skin grafting and epidermal cell suspension spray.Methods: A prospective study of 30 patients with post burn leucoderma between May 2018 and May 2019, at Ahmed Maher Teaching Hospital. Dermabrasion and split thickness skin grafting in 15 patients (group 1). Fractional CO2 laser in another 15 patients (group 2).Results: Group one: 13% of patients showed excellent colour match, 33% good colour match and 53% poor colour match. Group two: 27% of patients showed excellent colour match, 47% good colour match and 26% poor colour match (p value=0.311).Conclusions: Fractional CO2 laser is better than dermabrasion and STSG for management of post burn leucoderma.
Modified Limberg flap versus modified Karydakis flap in pilonidal sinus disease: single surgeon experience
Authors: Turan Umit
Published: August 2019

Background: The aim of this study was to analyze and compare the results of the modified Limberg flap (MLF) and modified Karydakis flap (MKF) techniques which were performed for the treatment of pilonidal sinus disease (PSD).Methods: The patients who were operated for PSD by the same surgeon between November 2010 and July 2013 in Konya Seydisehir Hospital were retrospectively analyzed. A total of 106 patients were evaluated in this study regarding age, gender, operation time, length of hospital stay, and postoperative complications.Results: There were 14 female and 92 male patients (MLF; 5/52 and MKF; 9/40). MLF was performed in 57 (53.8%) patients and MKF was performed in 49 (46.2%) patients. Length of Hospital stay and drain removal time were less in MKF group but it was not significantly different between two groups (p>0.05). Operation time was shorter in MKF group than MLF group (p<0.05). The complication rates of the MLF and MKF groups were 10.5% and 12.2% respectively. The recurrence was seen in 1 patient in MLF group and 2 in MKF group.Conclusions: MKF has shorter operation time than MLF, however both techniques have a similar complication and recurrence rate. In conclusion MLF and MKF procedures can be safely used as a surgical treatment of PSD.
Peritonitis secondary to non-traumatic small and large bowel perforation
Authors: Ilyas Syed O. , Sheikh Saeed A. , Muneeb Muhammad D. , Makhdoomi Mahmood A. , Naz Erum , Bano Sajila , Elsyed Ashraf A.
Published: August 2019

Background: The objective of the study was to determine the outcome of secondary peritonitis in non-traumatic small and large bowel perforation in a secondary care hospital in the region of Ha’il, Kingdom of Saudi Arabia (KSA).Methods: This prospective study was conducted in a surgical unit of King Khalid Hospital, Ha’il Kingdom of Saudi Arabia, from 01 October 2013 to 30th June 2014. 30 patients were admitted through emergency room (ER). Every patient was enquired a detailed history about abdominal distension, abdominal pain, fever, constipation, vomiting, and gut motility. Clinical examination of the patient was done. Baseline investigations along with chest radiograph posterio-anterior (PA) view, abdominal radiograph with erect and supine views and ultrasound whole abdomen were included. All patients landed in the ER with peritonitis due to gastrointestinal perforation, regardless of their sex and age, were included. Peritonitis of primary cause or due to trauma, corrosive ingestion and anastomosis leak were excluded. Follow up of all the patients was done. Data was analyzed through SPSS software 16.Results: Out of 30 patients, 23 (76.66%) were male and 7 (23.33%) were female. Mean age 36.28±2.3 years. 80% presented with abdominal pain. Pneumoperitoneum on chest X-Ray was found in 21 (70%) patients. Duodenal perforation was the most common reason of peritonitis in 14 patients (46.66%). Surgical site wound infection is the commonest complication in 16 patients (53.33%).Conclusions: In conclusion, the outcome of secondary peritonitis in our Eastern population is perforation of the upper gastrointestinal tract and small bowel as the documented common cause, and wound infection as the commonest complication.
Axillary dissection versus non dissection in negative sentinel node biopsy patients
Authors: Elkasem Hossam Abd Ellatif Abo , Aldardeer Ahmed Abdel Kahaar
Published: August 2019

Background: The goal of this series was to compare performing axillary clearance versus none performing in patients with node biopsy negative.Methods: This study included 114 patients had breast cancer , presented with breast mass no enlarged axillary node either clinically or radiologically and all patients had negative sentinel lymph node intraoperatively those patients presented to Sohag Cancer Center and General Surgery Department Sohag, Egypt during the period of May 2018 to May 2019. Analysis of the clinical presentation, grade of breast cancer and radiological findings was done. All patients with above mentioned criteria were fitted for the study.Results: A total of 114 patients, all of them had sentinel lymph node negative, axillary dissection done in 55 patients of them while 59 patients had no dissection. We divided the patients in our series into group A (with axillary dissection) and group B with non-dissection; in group A 27 (49.1%) patients had lymphoedema on post-operative follow up while in group B none of patients complained from lymphoedema. Numbness was found in 11 (20%) patients among group A patients, while in group B none of patients complained from numbness. On follow up of seroma we discovered that in group A all the patients had seroma while in group B only 9 (15.3%) patients had seroma. None of our 114 patients either with or without dissection had recurrence on follow up period.Conclusions: Clearance of the axilla in sentinel node negative patients has no significant difference in overall survival but also increased rates of lymphoedema, seroma and haematoma.
The use of screening computed tomography prior to renal transplantation should be limited to high-risk patients with advanced age, coronary artery disease and diabetes mellitus
Authors: Patel Parth M. , Patel Parth Y. , Alhana Farouk Abu , Jaara Eyad , Safadi Zayd G. , Parsell Connor D. , Mitro Graham , Rees Michael , Ortiz Jorge
Published: August 2019

Background: Computed tomography (CT) scans’ predictive value is not well established for screening prior to renal transplantation. The purpose of this study is to measure the extent to which CT findings during transplant evaluation alter candidacy.Methods: Data for 639 renal transplant candidates who underwent CT screening were obtained. Of these, 454 patients had sufficient data and met criterium of having undergone screening CT within six months of official renal transplant evaluation. Transplant status before and after CT imaging was assessed.Results: Those who had screening CTs prior to renal transplantation who were older (p=0.01), had coronary artery disease (p=0.006), or had diabetes mellitus (p=0.042) had significant waitlist status changes. Candidates whose CT findings included vascular calcification or pulmonary nodules were more likely to be permanently excluded from the waitlist (p<0.05). Thirty-two, or 7.0%, had a permanent waitlist status change due to pathologic CT findings that precluded transplantation.Conclusions: Focusing on older patients with coronay artery disease, atherosclerosis, or diabetes would reduce the number of CTs obtained during workup. Candidates with systemic vascular calcification or pulmonary nodules found on subsequent imaging are at the greatest risk for permanent exclusion from renal transplantation.
Comparative analysis of immediate and delayed insertion of flexible cystoscope after application of topical anaesthetic lubricant on patient comfort
Authors: Bhat Zubair , Wani Mudassir
Published: August 2019

Background: The objective of the study was to compare the difference in pain scores during flexible cystoscopy between patients undergoing the procedure with insertion of the flexible cystoscope either immediately after topical lubrication with lignocaine gel or after a 3-minute delay.Methods: A total of 127 male patients with various indications for flexible cystoscopy were enrolled in this prospective study. Patients were randomized in two groups, immediate group and the delayed group depending on the retention time (immediate or after 3-minute delay) of the topical lignocaine gel. Pain scores were recorded immediately after the procedure using a visual analogue scale. The statistical analyses were performed using students “t” test.Results: Both the groups (immediate group and the delayed group) were comparable for variables including age, level of operating endoscopic surgeon and indication for the procedures. The most common indication for flexible cystoscopy was visible hematuria. There was no statistically significant difference in the mean pain scores between the two groups (p=0.98). However a small subset of patients (age less than 50 years), having flexible cystoscopy for the first time had less pain scores in the delayed group (p=0.003) but the sample size was very small.Conclusions: The study revealed that there appears to be no benefit in longer retention times of local anaesthetic during the outpatient flexible cystoscopy. However, there might be a possible advantage in men younger than 50 years of age who are having flexible cystoscopy for the first time.
Co-relation between pre-operative imaging findings and per-operative findings in acute abdomen
Authors: Deherkar Juthika Abhijit
Published: August 2019

Background: The term acute abdomen refers to a sudden, severe abdominal pain that is less than 24 hours in duration. It is in many cases an emergent condition requiring urgent and specific diagnosis and/or surgical interventions. Abdominal pain can be just one of the symptoms. Most frequently its cause is benign and/or self-limited, but more serious causes may require urgent intervention. Many new diagnostic and management aids have been introduced into the surgical decision-making process over the past decade or so to improve clinical performance. Correct pre-operative diagnosis of acute abdomen remains challenging despite good history taking and clinical examination, and improvement in new imaging techniques including computer-aided diagnosis, ultrasound imaging, computed tomography and laparoscopy. These imaging techniques need sophisticated equipment and specialist expertise round the clock which is not feasible always. Hence, we have tried studying the accuracy of clinical correlation between these newer modalities of diagnosis and intraoperative diagnosis.Methods: Patients were clinically diagnosed, and then a pre-operative diagnosis was made based on radiological investigations and was then compared with the intra-operative findings for its accuracy.Results: The newer modalities of radiological diagnostic techniques proved to be more accurate in diagnosing the cases of acute abdomen.Conclusions: There was a huge range of correlation between newer diagnostic modalities and our clinical and pre- and post-operative findings.
A prospective randomized controlled trial to study the effect of preoperative and intraoperative magnesium over postoperative ileus and postoperative pain in major non–laparoscopic abdominal surgeries
Authors: Bathina A. R. Vishal Varma , Peetani Rama Krishna , Vaitla Viswa Teja
Published: August 2019

Background: The objective of the study were postoperative pain on 1st postoperative hour and 2, 4, 12, 24th postoperative hour as per numeric rating scale (NRS); total dose of postoperative analgesic consumption; postoperatively time of first appearance of bowed sounds; postoperatively time of first passage of flatus.Methods: A randomized controlled study will be performed. Patients of ASA 1 and 2, scheduled for major abdominal (GI) surgery, were divided into magnesium group and control group. Serum magnesium levels are estimated in both groups. Magnesium group receives 40 mg/kg of magnesium sulfate in 100 cc NS 30 minutes before the induction* as Intravenous drip, followed by 10 mg/kg/hr during the intraoperative hours. Control group receives the same volume of isotonic saline solution. Intra-operative hemodynamic parameters are evaluated constantly by recording pulse rate, blood pressure and Spo2. Further, post- operative analgesic will be ensured by epidural top-up using bupivacaine and tramadol when patients complaints of pain or when monitored with numeric rating scale (NRS). Postoperative patient pain is going to be evaluated in post-anesthetic care unit (PACU)/ SICU by numeral rating scale (NRS) during 1st hour, 2nd hour, 4th hour, 12th hour and 1 day, total dose of post-operative analgesic consumption will be recorded.Results: Of the 60 patients studied, 30 belong to magnesium group for which pre-operative and intraoperative intravenous magnesium (cases). Remaining 30 were given equal amounts of preoperative and intraoperative normal saline given (controls).Conclusions: The results of present study suggests that pre and intra operative. Magnesium as an adjunct to epidural analgesia reduces postoperative pain pre-operative and intra operative IV mg reduces post-operative ileus duration.
Nigam’s inverted curtain hernioplasty: a modified lichtenstein tension free hernioplasty for inguinal hernia
Authors: Nigam Vinod Kumar , Nigam Siddharth
Published: August 2019

Background: It is an open tension-free hernioplasty for primary inguinal hernias using minimal dissection and only 3 sutures to fix the mesh.Methods: A description of operative technique and patient’s demographics are presented.Results: 362 repairs were done with this technique over a period 18 years (March 2000 to March 2018). All were primary uncomplicated inguinal hernias.Conclusions: NICH tackles the both known aetiological factors for recurrence i.e., weakness in inguinal floor and tension at the suture line. It involves minimal tissue dissection and least number of sutures. Two sutures are used to fix the mesh with inguinal ligament. Third suture is used to make an artificial deep inguinal ring in the mesh as well as used to narrow the natural deep inguinal ring to further avoid recurrence. No suture is applied in main body of mesh which remains free like an inverted curtain covering the whole hernia susceptible region of groin. Prolene mesh is used which completely covers the potentially weak area on the floor of inguinal region irrespective of the size of the area in small or big frame persons. Semi double breasting of external oblique aponeurosis avoids displacement of mesh. NICH is associated with least recurrence, less post-operative pain, less post-operative complications and short learning curve.
Modified Hasson technique versus Veress technique: a comparative study
Authors: George Robinson , Mathew Mebin , Radhakrishna Veerabhadra , Rahman Ashna , Thenamangalath Aswini
Published: August 2019

Background: There are two techniques of port placement for laparoscopy, Veress and Hasson. Both have their own advantages of disadvantages. Plenty of new modifications of these techniques have been tried to reduce the risks. We modified Hasson’s technique and evaluated whether the technique is better than the standard Veress technique.Methods: A retrospective analysis was carried out in the Department of General Surgery, Al Azhar Medical College Hospital, India from January 2013 to December 2018.Results: There were 156 patients in group A who underwent laparoscopy by Modified Hasson technique. The Veress technique was used in 149 patients who belonged to group B. There was no difference between the two groups in terms of age and indications for the surgery. The entry time (the time to place the first port) for group A was significantly lesser than that of group B (2.08±0.65 min vs. 4.59±0.53 min; p=0.000). There were a total of two complications in group A which was significantly lesser than that of group B (14; p=0.002). There was no significant difference between the two groups in terms of extraperitoneal port placement, intraperitoneal injury, failure to enter the abdomen, port site seroma, port site infection, port site hematoma, and mortality. But, port site hematoma was significantly lesser in group A compared to group B (0 vs. 5; p=0.027).Conclusions: Modified Hasson’s entry was found to be much better than Veress needle entry due to its simplicity for beginners in laparoscopy, lesser time of achieving pneumoperitoneum and lesser duration of surgery in our study.
A study on predictive factors for anastomotic leakage in enteropancreatic anastomosis in a tertiary centre in Andhra Pradesh
Authors: Desu Bharath Kumar , Kunnuru Supreeth Kumar Reddy , Gurjar Mayank Kumar , Palanati Varun , Salavakam Muni Krishna , R. Rakesh , Varty Gurudutt P. , Challapalli Praneeth Reddy , S. Thirunavukkarasu
Published: August 2019

Background: This study aimed to identify various factors influencing occurrence of post-operative pancreatic fistula.Methods: Only those patients who underwent standard pancreatojejunostomy anastomosis in duct to mucosa technique using vicryl 4-0 sutures (double layer- interrupted fashion) were included in the study. Patients who had duct size ≤3 mm underwent papillary like main pancreatic duct invaginated technique of pancreaticojejunostomy (fish mouth type).Results: In 40 patients, 10 patients (25%) developed postoperative pancreatic fistula. 5 (12.5%) patients had grade A pancreatic fistula and 5 patients had CR–POPF [grade B–3(7.5%), grade C–2(5%)]. Pancreatic fistula in relation with duct size has attained statistical significance. When all the four factors were put together and given fistula risk score, it correlated well with the occurrence of fistula. Fistula risk score has high negative predictive value. Of 40 patients, 13 patients fall into low risk zone, out of which 1 patient developed grade A fistula. 26 patients fall into moderate risk zone, out of which 4 patients developed grade A, 3 patients developed grade B and 1 patient developed grade C fistula. One patient fall into high risk zone and developed grade C fistula.Conclusions: We found in our study that, post-operative pancreatic fistulae could be modestly predicted using fistula risk score. However, the latter had high negative predictive value and thus could be used to prognosticate risk of non-development of fistula than predicting its severity.
Impact of the modified bleomycin, etoposide and cisplatinum chemotherapy regimen on the outcome of testicular germ cell tumor: a tertiary care institute experience
Authors: Madan Renu , Thakur Niketa , Rana Sakshi , Kumar Narendra , Yadav Budhi Singh , Khosla Divya , Kapoor Rakesh
Published: August 2019

Background: Bleomycin, cisplatin and etoposide (BEP) based combination chemotherapy is established as standard treatment for testicular germ cell tumors. As these tumors are highly curable, so management is crucial in terms of long-term toxicity particularly lung toxicity. With standard BEP there is increased toxicity which leads to poor compliance. So, we at a tertiary care center assessed modified BEP regimen in such patients and evaluated its effectiveness in terms of response and toxicity as compared to standard BEP.Methods: Forty-nine patients of testicular germ cell tumors were enrolled in this study from January 2012 to December 2016. The modified BEP regimen consisted of bleomycin 30 IU day 1, cisplatin 20 mg/m2 day 1-5 and etoposide 100 mg/m2 day 1 to 5, given every three weeks. The planned drug intensities were 33.3 mg/m2/week for cisplatin, 166.7 mg/m2 week for etoposide and 10 IU/body/week for bleomycin. The schedule for chemotherapy was as follows: four courses of modified BEP for stage I patients and six courses of modified BEP for stage I S, II and III patients.Results: Overall response rate in our study was seen to be 81.2% which was comparable with the available evidence. Five (10.4%) patients developed febrile neutropenia. Two (4.1%) patients showed clinically evident bleomycin induced pulmonary toxicity. Lower toxicity seen in these patients led to better overall compliance.Conclusions: Modified BEP protocol is a good alternative to standard BEP with comparable efficacy and reduced toxicity.
Gall stone pancreatitis in a syringomyelia patient: case report and historical review
Authors: Mathew Abel Chundankuzhiyil , Poothankandi Athira , Khader Rahana , Shajahan Amina , Panakkal Linu Mohan
Published: August 2019

Syringomyelia is a rare neurological disorder generally regarded as chronic, characterized by slowly progressing fluid-filled cyst (syrinx) forms within the spinal cord. Here we describe the historical review of a patient suffering from syringomyelia for the past 16 years and present gastric condition- gall stone induced pancreatitis. A quadriparetic female patient who had previously undergone surgical treatment for syringomyelia with the early signs including muscle weakness and wasting (atrophy), loss of reflexes, loss of sensitivity to pain and temperature and also stiffness in back, shoulders, spinal curvature (scoliosis) presenting complains of multiple episodes of hematemesis and severe constipation since 5 days. Ultrasonography imaging and laboratory investigations revealed gallbladder stone induced acute pancreatitis also associated. The patient underwent multiple surgical interventions for syrinx removal and associated surgical complications were managed adequately. Currently, the pancreatitis was managed by laparoscopic corrections. Postoperatively, there was a prompt resolution of pancreatitis and associated gastric symptoms. In conclusion, early diagnosis of syringomyelia with magnetic resonance imaging is critical in the prophylaxis of spinal cord compression and potential neurologic injury. Surgical interventions are recommended in symptomatic cases. This case report describes clinical manifestations and management of acute pancreatitis in a chronic sufferer of syringomyelia.
Phosphaturic mesenchymal tumor
Authors: Cheereth Robin George , Augustine Rogers P. , Nazar Highness Tholakkara
Published: August 2019

Phosphaturic mesenchymal tumors (PMTs) are very unusual tumors, commonly associated with tumor induced osteomalacia (TIO). The tumor cells produce a peptide hormone-like substance known as fibroblast growth factor 23 (FGF23), which regulates phosphate levels. When FGF23 is over expressed by the tumor cells it leads to phosphaturia, which inturn causes mobilization of calcium and phosphate from bones, and decreased osteoblastic activity, which finally leads to severe osteomalacia. Usual presentation of PMT will be gradual muscular weakness and diffuse bone pain from pathologic fractures. The majority of PMTs are benign, malignant PMTs are extremely rare, but exist. However, very rarely PMT present without phosphaturia and TIO i.e., the nonphosphaturic variant. The challenge in diagnosis of PMT is due to the vague nature of the symptoms and lack of clinical suspicion. The diagnosis is often missed due to the rarity of PMTs. The usual location for PMT involves the extremities followed by head and neck sites. We report a case of a 37 year old male who presented to the outpatient department with a swelling in the left parotid region. He had no associated symptoms. CT scan showed a well-defined heterogeneous mass measuring 2.3 × 2.0 cm with calcification and soft tissue density seen superficially in the left pre auricular region. Per operatively the tumor was found to be intramuscular, embedded in the left masseter muscle. The final histopathology report was confirmative of phosphaturic mesenchymal tumor.
Peptic perforation in paediatric case of dengue: rare presentation
Authors: Pillai Mahalaxmi , Rao Gyaneshwar
Published: August 2019

Dengue fever is a common disease in tropical and subtropical regions and is characterized by fever, headache, and joint and muscle pain. Occasionally, patients develop abdominal and gastrointestinal symptoms. Gastrointestinal manifestations are increasingly being identified in severe dengue infection. Gastric perforation is very rare manifestation in dengue infection. Here we report a case of a 12 year old female who was diagnosed with dengue fever with perforative peritonitis due to prepyloric perforation with no prior symptoms of gastric ulcer.
An uncommon presentation of cryptorchidism
Authors: Mishra Ipseet , Mollah Washim , Dutta Arup Kumar , Kumar Rohan
Published: August 2019

Cryptorchidism as a cause of bowel obstruction is very unsuspecting. Bowel obstructions in cases of cryptorchidism, though reported were mostly as a complication of malignant transformation. Only two case reports of cryptorchidism document a non-malignant aetiology for bowel obstruction. This case is of a 16 year old boy referred for pain abdomen and obstipation for last 3 days. He had signs of peritonitis on examination and so, urgent exploratory laparotomy was planned. A loop of jejunum of approx. 30 cm length at a distance of 35 cm from duodeno-jejunal junction was found gangrenous with gubernacular bands around the loop emerging from a left cryptorchid testis. Resection– anastomosis was done along with left orchidectomy. Histopathology revealed an atrophied testis with no malignant changes. This is the first case report of a non-malignant cryptorchid testis as a cause of strangulated intestinal obstruction in literature.
Post traumatic hepatic artery pseudoaneurysm: a tertiary care centre experience
Authors: Gopal Prasanna , Subbarayan Shankar , Mohan Karthikeyan , Anbalagan Amudhan , S. Kalpana , Shanmugasundaram Rajendran , Moorthy Naganath Babu Obla Lakshmana
Published: August 2019

In blunt trauma abdomen, liver is the most commonly injured organ after spleen. Management of blunt hepatic injury has shifted from operative to non-operative management NOM in hemodynamically stable patients. Main cause of failure of NOM is hemodynamic instability due to re-bleeding or secondary hemorrhage due to rupture of capsular hematoma. Post traumatic hepatic artery pseudoaneurysm HAP as a cause of failure of NOM is rare, reported in about 1.2%. HAP requires early intervention by angiographic embolisation or surgery to prevent catastrophic event. Here, we report our experience with four cases of HAP managed in our centre in past three years. Three patients were managed by selective angioembolisation and one patient was treated by surgery. All patients had uneventful recovery and are asymptomatic on follow-up. HAP is a rare life threatening complication which can present even after successful NOM as a delayed presentation. All symptomatic pseudoaneurysm has to be managed by angioembolisation or surgery depending on hemodynamic stability.
Obstructed lumbar hernia: an unusual encounter
Authors: Meher Dibyasingh , Jena Suvendu Sekhar , Chopra Vishal , Baburam Argal Narottamsingh
Published: August 2019

Spontaneous lumbar hernia is one of the few rarely encountered clinical entities. Only few hundred cases had been reported since it was first described by Barbette in 1672. Obstruction of lumbar hernia is even rarest among reported cases. 60 year female presented with features of obstructed lumbar hernia through inferior triangle of Petit. Onlay meshplasty was done after repair of the small defect. Though obstruction of lumbar hernia is rare, but can be presented as surgical emergency if not address early.
Treatment and outcomes of multinodular hepatocellular carcinoma: a systematic review and meta-analysis
Authors: Adhikari Rajeev , Wen Tianfu , Karn Hare Ram , Shrestha Parvani
Published: August 2019

Hepatocellular carcinoma (HCC) is the third leading cause of cancer-related death worldwide. Recent advances in surgical techniques and perioperative management have been suggested to have improved survival. However, full agreement about the overall survival ofpatient with multinodular HCC is still not reached yet. The aim of this meta-analysis is to evaluate the survival of patients with multinodular HCC undergoing recent treatment modalities.Weperformed the systematic computerized search for eligible articles fromfour databases (PubMed, Embase, Google Scholar and Web of Science) published before February 2018. Summary effect size (ES) and 95% confidence interval (CI) were calculated with the random-effects model and fixed-effects model. A total of 25 studies with 18954 multinodular hepatocellular carcinoma patients were included. Overall survival was shorter inpatient having multinodular carcinoma undergoing different treatment modalities (ES 1.12, 95 % CI 1.02 to 1.21; p=0.000) which was statistically significant. Those undergoing hepatectomy was shorter (ES 1.49, 95% CI 1.33 to 1.64; p=0.304) which was not statistically significantand patients undergoing RFA was shorter (ES 1.61, 95% CI 1.28 to 1.94; p=0.020) which was statistically significant. Begg’s funnel plot showed no publication bias exists.Our meta-analysis result showed that the overall survival of patients with multinodular carcinoma is shorter.
Prevalence of peripheral neuropathy and peripheral artery disease in diabetic patients attending a tertiary care hospital
Authors: Meena Sangeetha , C. Manikandan R.
Published: August 2019

Background: Foot complications are one of the most devastating complications among diabetes all over the world. Both Diabetic Peripheral Neuropathy (DPN) and Peripheral Artery Disease (PAD) are responsible for diabetic foot complications. Aim of this study is to screen diabetic patients for both DPN and PAD.Methods: This is a cross-sectional study covering 200 diabetic patients attending a Teaching Hospital. Prevalence of DPN was assessed using Biothesiometer and PAD by measuring the Ankle Brachial Index using handheld Doppler.Results: 49.5% had DPN and 19.5% had PAD. 13% had both PAD and DPN. Most of the subjects were in 51-60 years age group constituting 36.5 %. 61.5% were females. 69.5% had diabetes for more than 10 years. 88% had their HbA1C of more than 6.5%.Conclusions: The prevalence of PVD is multi-fold higher in patients with diabetes with smoking, hyperglycemia, hypertension, dyslipidemia, as major risk factors. Ankle, brachial pressure index, is useful in identifying PVD and it needs further evaluation by an arterial color Doppler and digital subtraction angiography.
Intestinal lymphangiectasia: case report
Authors: Aljohnei Reham Mohmmad , Abdullah Alani Hawazen Yousef
Published: August 2019

Primary intestinal lymphangiectasia (PIL) was first described by Waldmann et al, in 1961. PIL is a rare disease with several hundred reported cases. It is rarely reported in adults because it is presumably a congenital disorder and when present in adults it typically produces a long duration of manifestation such as diarrhea, abdominal distention from ascites, and peripheral edema. This disorder is characterized by markedly dilated intestinal lymphatics, hypoproteinemia, generalized edema, lymphocytopenia hypogammaglobinemia, and immunologic anomalies. The loss of protein into the from dilated intestinal lymphatics leads to the development of hypoproteinemia in these patients and its demonstration is important in the diagnosis of intestinal lymphangiectasia. The disease can be secondary to congenital, secondary or idiopathic defects in the formation of the lymphatic ducts. In the present report, we describe a case of 15 years old female presented to our hospital with history of generalized edema, bilateral hand spasm, and diarrhea. Endoscopy of the patient revealed White spots (dilated lacteals), white nodules, and submucosal elevations were observed. Changes suggestive of the disease includes White villi and/or spots (dilated lacteals), white nodules, and submucosal elevations are observed. Xanthomata’s plaques are often visualized, there are no specific treatments for patients with PIL. treatment of patients with primary intestinal lymphangiectasia involves control of symptoms with the use of dietary, pharmaceutical, and behavioral modifications.
Quality of life on caregiver of schizophrenia client in outpatient installation of Tampan psychiatric hospital
Authors: Patricia Helena , Abdullah Khatijah Lim , Erwina Ira
Published: August 2019

Background: The process of caring for a schizophrenic client creates a stressful situation; caregiver's unpreparedness in dealing with this problem has an impact on the deterioration of the quality of life. The decline in quality of life of caregiver is influenced by several factors such as caregiver’s burden and characteristic of caregiver include age, gender, sex, marital status, education, income, and relationship with client. This study aimed to determine the relationship of burden and characteristic with the quality of life on the caregiver.Methods: The design of this study was descriptive analytic with cross sectional study approach on 186 caregiver with convenient technique sampling. Data were collected by the Zarit Burden Interview questionnaire and the World Health Organization Quality of Life (WHOQOL-BREF).Results: The results showed 99 (53.2%) caregivers had a low quality of life, 92 (49.5%) caregivers felt heavy burden. Chi-square statistical test proved a significant relationship between burden (0.001) and all characteristics caregiver include age (0.033), gender (0.033), sex (0.000) marital status (0.001), education (0.001), income (0.002), and relationship with client (0.000) with quality of life.Conclusions: The result showed that test proved a significant relationship between burden and characteristics caregiver with quality of life of multivariate analysis showed that marital status was the most correlated with quality of life of caregiver. Suggestions for Tampan Psychiatric Hospital Pekanbaru are to improve mental nursing service comprehensively to client and family like health education program about how to improve quality of life.
Prevalence of hypertension and its significant correlates among Bangladeshi adults: a quantitative analysis from City Corporation Rangpur, Bangladesh
Authors: Das Sukanta , Chakravorti B. K. , Islam Sahebul
Published: August 2019

Background: Hypertension (HTN) is a common medical problem and the premier risk factor for cardiovascular disease. Hypertension is growing at a faster rate among all aged population. Therefore, this study aimed to investigate the prevalence of hypertension and to identify the significant risk factors of hypertension among the respondents.Methods: The sample of 1302 randomly selected respondents of various government offices at Rangpur City Corporation, Bangladesh are taken for this study. Hypertension was defined by the systolic blood pressure reading above 140 or the diastolic reading above 90 mmHg. Pre-hypertension was defined by the systolic blood pressure reading 120-139 or the diastolic reading 80-89 mmHg. Prevalence and risk factors of hypertension are presented as percentages. The significant association between the categorical variables is measured using Chi-square test.Results: It is found that the prevalence of hypertension and pre-hypertension (stage-1 HTN) among the respondents are 25% and 54%, respectively. Most of the respondents are in the pre-HTN stage, and at any time they may fall under hypertension. Respondent’s age, gender, residence, smoking habit, and physical activity are found as significant factors of hypertension.Conclusions: Reliable information about the prevalence of hypertension and its associated risk factors is very essential for growing awareness, treatment, and control of hypertension. Prevalence of hypertension is high among the study subjects. The male respondents who are at the higher age group, residing in the urban area, not taking regular physical exercise, and having smoking habit are found more prevalent cases of hypertension than the other counterparts.
The effect of mindfulness therapy on the pregnant women’s anxiety level in facing childbirth
Authors: Wulandari Apri N. , Susanti Brigitta A. D.
Published: August 2019

Background: The health improvement for pregnant women in antenatal phase is not only focused on maintaining physical health, but also the psychological health. One of the factors of maternal psychological health is anxiety. Anxiety is common in pregnant women caused by maternal concerns about complications that accompany the mother and her fetus. The increasing anxiety in pregnant women can have an impact on pregnancy complications. Therefore an intervention is needed to overcome anxiety in pregnant women. The purpose of this study was to determine the effect of mindfulness therapy on the anxiety level of pregnant women in labor.Methods: This study uses a quasi-experimental design with a pre-test and post-test with control group. Implemented in the Public Health Center working area like Sleman in August-September 2018. There were 26 participants selected using purposive sampling, with 13 assigned in experiment and control groups. The questionnaire used is Pregnancy Related Anxiety Questionnaire-Revised 2. Independent sample t-test used for data analysis.Results: There was a significant difference in the mean of anxiety score after the intervention in the experimental group compared to the control group with a value of p=0.017 (p<0.05). The mean of anxiety score after intervention in the control group was 32.00, while the average of anxiety score after intervention in the experimental group was 24.54.Conclusions: Giving mindfulness therapy to pregnant women is able to reduce maternal anxiety levels significantly in facing labor.