bluuebunny/crossref_metadata_2025 huggingface dataset:
Need of the hour: pharmacovigilance study of SGLT-2 inhibitors
Authors: Pradhan Sapna , A. Tejus , Koley Mrinalini , Mathur A. G.
Published: March 2019

Background: Diabetes mellitus represents a global pandemic. Various pharmacotherapy and non-pharmacotherapy measures are advocated for its control. The latest in the pharmacotherapy are Sodium Glucose Transporter -2 (SGLT-2) inhibitors, widely used. Many studies suggest adverse effects related to SGLT-2 inhibitors, evidence still not conclusive and few data from India. Hence this study was planned.Methods: Cross-sectional study over a period of 02 months, recorded demographic details and history of various adverse drug reactions reported with the use of SGLT-2 inhibitors.Results: Majority of the study participants were females (58%) and belonged to the age group of 40-70 yrs. Urinary tract infections (UTI) and genital infections was more seen in the users of dapagliflozin, followed by empagliflozin and canagliflozin.Conclusions: SGLT-2 Inhibitors offer a unique therapeutic approach to the management of Diabetes Mellitus. Further evaluation of the safety profile and the risk-benefit analysis is the need of the hour.
Acute bilirubin encephalopathy in term neonates: a hospital-based study
Authors: Iqbal Javaid , Sharma Sunil Dutt , Jamwal Ashu , Saini Ghanshyam
Published: March 2019

Background: Acute Bilirubin Encephalopathy and kernicterus is an important cause of cerebral palsy, developmental delay and hearing impairment in low-middle income countries. Interventions such as universal screening for neonatal jaundice, Rhesus immunoglobulins, intensive phototherapy and exchange transfusion have made kernicterus rare in high income countries, but in our set up such cases continue to be reported.  Methods: Retrospective observational study where case records of term neonates brought to the neonatal ICU with signs and symptoms of acute bilirubin encephalopathy during the years 2016 and 2017 were sought and analysed.Results: A total of ten term babies reported to the neonatal unit with severe hyperbilirubinemia along with signs and symptoms of bilirubin encephalopathy of which 60% were females. 90% had a birth weight of more than 2.5 kg and mean birth weight was 2.7±0.25 kgs. All the babies were out born. A 4 babies were born at home of which 3 pregnancies were completely unsupervised during the antenatal period. 90% of the babies were from the rural areas, 6 of the cases were from the districts Rajouri, Poonch and Reasi where the terrain is hilly, 2 from rural areas of Jammu and 1 from Kathua. Only 1 was from the Jammu city. The age at admission ranged from 3-9 days and serum bilirubin from 24 to 43.3 mg %. A 5 babies had ABO incompatibility, 1 Rh incompatibility, 1 sepsis, while no cause could be found in 3.Conclusions: Neonatal jaundice is often not easily appreciated by mothers and caregivers in the home setting until it becomes severe enough, at which point neurological damage may have already occurred. There is an urgent need to train the primary health care personnel in assessment and early identification of risk factors for severe neonatal hyperbilirubinemia. They can help the families to seek prompt treatment for this preventable cause of cerebral palsy and mental retardation.
Role of colonoscopy in haemorrhoids with other colorectal disorders
Authors: Mala Tariq Ahmed , Ahmad Syeed Rayees , Malla Shahid Amin
Published: March 2019

Background: Haemorrhoids are the enlargement or engorgement of the normal fibrovascular anal cushions. These fibrovascular cushions lose their attachment to the underlying rectal wall and lead to prolapse with repeated straining over time, thinning of rectal mucosa and subsequent bleeding. The objective of the present endeavour was to study the prevalence of associated colorectal lesions like colonic carcinoma, diverticular disease, inflammatory bowel disease which present the rectal bleeding and role of colonoscopy in these lesionsMethods: This study was conducted in hundred fifty patients presenting with bleeding and haemorrhoids were analyzed. All patients were examined locally and endoscopically. All significant endoscopic findings (diverticuli, polyps, cancer, angiodysplasia and varices or colitis) were recorded.Results: Majority of patients were males (102), accounting for (68 percent). The main symptom at the time of presentation was rectal bleeding (90 percent). The digital rectal examination was normal in 114 patients. The commonest finding on proctoscopy examination was haemorrhoids. Colonoscopy showed haemorrhoids in maximum patients (147 percent). The associate lesions with altered bowel habits were growth in 12, worm in 6, solitary rectal ulcer in 3, pancolitis in 3.Conclusions: It can be concluded that in the present study colonoscopy revealed a high proportion of colorectal pathologies with haemorrhoids presenting with bleeding per rectum.  Colonoscopy thus proved to be very useful procedure in patients with haemorrhoids especially in elderly.
Role of serum CA 19-9 as a tumor marker in TCC bladder
Authors: P. Rajeev T. , Das Nabajeet , Baruah S. J. , Barua S. K. , Bagchi P. K. , Sarma D. , Phukan M.
Published: March 2019

Background: There is a dearth of reliable blood and urine markers for transitional cell carcinoma of urinary bladder. CA 19-9 is a well-known marker for gastrointestinal malignancies and is being investigated for other malignancies including carcinoma bladder. In this prospective study, we evaluated the role of serum CA 19-9 as a tumor marker and correlated its level with tumor grade and stage.Methods: One hundred and fifteen patients with transitional cell carcinoma of urinary bladder and 69 healthy volunteers, as controls were included in the study. Preoperative blood sample was analysed for level of CA 19-9 using ELISA kit (normal - 0 U/ml to 37U/ml) and were correlated with grade and TNM stage of tumor.Results: The range of the control group is 2-38U/ml (mean: 17.67±9.68U/ml); TCC group is 1-94U/ml (mean: 37.12±31.52U/ml) (p=0.304). When CA 19-9 level >37IU/ml was taken as cut-off for a positive test, sensitivity of detecting T3 disease, T4 disease, MIBC, presence of node and high grade tumour were 80%, 75%, 70.3%, 78% and 57.8% respectively. However, there was a statistically significant increase in levels of CA19-9 in relation to higher grade (<0.001), presence of muscle invasion (<0.001), T stage (<0.001) and N stage (<0.001).Conclusions: Serum CA19-9 is almost invariably raised in patients with high grade and invasive disease. Thus, it has a place as a prognostic marker rather than as a diagnostic tool due to its low sensitivity for TCC bladder.
Comparative evaluation of induction with propofol vs induction with sevoflurane for insertion of laryngeal mask airway in children
Authors: Bakshi Sandhya A. , Bule Sanjay S. , Shingade Ganesh U.
Published: March 2019

Background: There is increasing use of laryngeal mask airway in children because of ease of insertion and minimal disturbances in cardio respiratory system and lesser risk of airway injury during perioperative period as compared to endotracheal tube. It is also simple, well-tolerated, safe, reusable, cost effective method of airway management in paediatric patients. Intravenous propofol (1%) is a preferred induction agent for LMA insertion till date, while sevoflurane, a halogenated volatile inhalational, non-irritating anaesthetist agent with pleasant odour is also suitable for inhalational induction of children. This study was carried out to study and compare clinical efficacy of propofol and sevoflurane for laryngeal mask airway (LMA) insertion in children undergoing short surgical procedures.Methods: In this study, total 100 children of ASA grade I/II of either sex with age group 3-8 years, weighing between 10-20 kg were enrolled. They were induced with either sevoflurane (group S) or intravenous propofol (group P) 3 mg/kg. Then appropriate size LMA was inserted. Various parameters like jaw relaxation and ease of insertion attempts required hemodynamic changes were noted and compared in two groups.Results: In group P, 94% patients and groups S, 90% patients had full jaw relaxation. The LMA insertion was easy in 98% patients in groups P and 94% patients in groups S. In 98% patients of groups P and 96% patients in groups S, LMA was inserted successfully in first attempt. The mean time required for LMA insertion was 19.16±5.29 seconds in groups P and 20.8±6.39 seconds in groups S. Both the groups were comparable with respect to haemodynamic changes observed which were transient and clinically not significant though statically significant.Conclusions: Both the groups showed comparable and satisfactory LMA insertion conditions, hence both can be routinely used for induction of anaesthesia in children.
Association of non-alcoholic fatty liver disease with chronic kidney disease in type 2 diabetes mellitus
Authors: Rajender Akash , Bhargava Rajat , Choudhary Priyanka , N. Sheetal , Upadhyay Shalini , Singh Gopal , Nepalia Subhash , Rijhwani Puneet
Published: March 2019

Background: Non-alcoholic fatty liver disease (NAFLD) is closely associated with metabolic syndrome. NAFLD is considered a disease of no consequence. Data on the effect of NAFLD on renal dysfunction in T2DM is sparse. Author aimed to study the association of NAFLD with CKD in Indian T2DM subjects.Methods: In an observational cross-sectional study at Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India from February 2017 to March 2018. 197 out of 268 randomly selected type 2 diabetes mellitus (T2DM) subjects were selected for the study after considering the inclusion and exclusion criteria. CKD was defined as estimated GFR <60 ml/min per 1.73 m2 and/or albumin to creatinine ratio ≥30 mg/g. NAFLD was diagnosed using ultrasonography. The association between NAFLD and CKD was analyzed using SPSS (version 24.0).Results: On ultrasonography 133 (67.5%) T2DM subjects had NAFLD. Diabetic with NAFLD (133, 67.51%) had significantly more history of hypertension (p 0.006), higher systolic (p 0.03) and diastolic BP (p 0.009), higher BMI (p <0.001), waist circumference (p <0.001), fasting glucose (p 0.03), triglyceride (p<0.001) and higher urinary albumin-to-creatinine ratio (p <0.001). Diabetics with CKD (61, 30.96%), were older (p 0.03), hypertensive (p <0.001) and had higher fasting glucose (p 0.003). Subjects with CKD had a higher prevalence of underlying NAFLD (78.69% vs 62.5%, p 0.03) as compared with diabetics with no CKD. T2DM subjects with NAFLD had more than two times (OR 2.88 (1.1-6.78), p 0.03) the risk of developing CKD after multivariate analysis as compared to subjects without NAFLD.Conclusions: NAFLD is a risk factor for development of CKD in patients of type 2 diabetes mellitus. Screening and early preventive measures may go long way in reducing morbidity.
Clinicopathological study of testicular lesions
Authors: Dhawle Manjusha , Tangde Ashwini , Joshi Anil , Bindu Rajan
Published: March 2019

Background: Testis is affected by both neoplastic and non neoplastic conditions. Non neoplastic lesions of the testis include epididymo-orchitis, testicular atrophy, undescended testis, testicular abscess etc. Testicular tumors are relatively rare. They constitute the 4th most common cause of death from neoplasia in the young males. This study was undertaken to study the histopathological spectrum, age wise distribution and clinical symptoms of testicular lesions.Methods: This is a retrospective study of three years conducted in the department of pathology, Aurangabad from June 2015 to May 2018. It included all the orchidectomy specimens received from the department of surgery and excluded the orchidectomy specimens sent for infertility and prostatic carcinoma. A detail clinical history was taken. Histopathological examination was done after routine processing and staining with H and E. The data collected was tabulated, analysed and compared to other similar studies.Results: We studied 70 cases. Non neoplastic testicular lesions were 57 and 13 were neoplastic. Non neoplastic testicular lesions were more common than the neoplastic ones. Non neoplastic testicular lesions presented most commonly in the 2nd decade. Most common non neoplastic lesion was epididymo-orchitis followed by torsion, atrophy and testicular abscess. Most common neoplasm was malignant mixed germ cell tumor. Most of the patients of neoplasms presented in the 3rd decade. The most common complaint was testicular swelling and pain.Conclusions: Majority of testicular lesions are non neoplastic. Neoplastic lesions are rare. Non neoplastic lesions mimic neoplastic ones clinically, as testicular swelling is the most common complaint. So histopathological diagnosis is necessary for an accurate diagnosis of testicular lesions.
Cephalometry to determine the head index of children younger than 6 years in kindergartens at the Ministry of higher education in Kabul, Afghanistan
Authors: Hasan Alipanah , Mahdi Mohaqiq , Najibullah Amarkhel
Published: March 2019

Background: A part of the anthropometry that measures and studies the dimensions of the head and the faces is called cephalometric, the results of which are used in various medical branches. The standard of this measurement is different in each country because different racial factors and geographic impact on it, so the values obtained by researchers in other countries cannot be a criterion for determining the normal growth of head in other countries. The aim of this study was to determine the head standard index and the prevalence of head anatomic types in children younger than 6 years old in Kabul ministry of higher education Kindergartens in order to determine the head standard index in 2018.Methods: This descriptive study was conducted for all male and female children less than 6 years old at the ministry of higher education in Kabul, which had no specific physical and mental problems in 2018. The measurements of the length and width of the head were measured by the Martin Calliper Cephalometry, and according to the protocol, the head index and the prevalence of different phenotypes was determined.Results: Based on the present study, it was found that most of the male and female head are in the form of brachicephalic with a total percentage of 56.82%, as well as 31.81% of the heads hyper brachicephalic and 9.09% of the mesosafalic head and the lowest number of heads the were dolgossific species with a total percentage of 2.28%. Also, the study of the head index based on age showed that in less than one-year olds, the heads were most the type of hyper brachicephalic and in other age groups, the head index was lower and the brachicephalic.Conclusions: The results of this study indicate that the dominant phenotypes in children under the age of six years in kindergartens at the ministry of higher education in Kabul are of brachicephalic in both males and females.
Effectiveness of clinical teaching practices of preceptors in three referral hospitals at Stung Treng Region, Cambodia
Authors: Yung Narem , Johns Joyce
Published: March 2019

Background: Students are not mere followers of teacher instructions, but fully aware and very observant of what differentiates a good clinical preceptor from a poor clinical preceptor and have expectations of how preceptors and clinical teachers should act. This study describes students’ perceptions on the effectiveness of clinical teaching practices of preceptors.Methods: A cross-sectional survey was conducted by using the Clinical Teaching Evaluation (CTE) Questionnaire to determine the level of effective clinical teaching by preceptors in the following areas: nursing expertise, teaching competence, and interpersonal relationship skills, and to identify characteristics (gender, age, program, and year level) associated with effective clinical teaching. The sample was composed of 158 randomly chosen students, Associate Degree Nurses and Associate Degree Midwives years 2 and 3, with clinical experience under preceptors at the 3 Referral Hospitals (Stung Treng, Kratie, and Ratanakiri) in Stung Treng region of Cambodia. Evaluations were ranked on a five-point scale with one being strongly disagree up to five being strongly agree.Results: The mean scores for all items were 0.739. Mean rating scores for effective clinical teaching of preceptors was 3.63, with nursing expertise at 3.72, teaching competence at 3.51, and interpersonal relationship skills at 3.65.Conclusions: The clinical teaching quality of preceptors can be improved by training with appropriate teaching methods with emphasis on effective clinical teaching practices to assist students in clinical competency.
Pellagra induced psychosis: a rare presentation
Authors: Parikh Disha , Panse Smita
Published: March 2019

Pellagra is a nutritional deficiency disease associated with low levels of niacin (vitamin B3). Neuropsychiatric symptoms are rare and are difficult to be diagnosed by clinicians in a timely manner. A 35 years old male was brought with complaints of generalized weakness, decreased appetite and work impairment since past 4 years. Scaly and itching skin rashes have also been present since 3 months followed by hearing voices, suspiciousness and agitated behaviour since one month. On examination, he had pruritic skin rashes over hands which extended over face and neck. His diet comprised mainly of jowar and maize and had history of occasional alcohol use. With an initial diagnosis of psychosis, the patient was started on oral olanzapine. Laboratory and imaging investigations were within normal limits. Dermatology referral confirmed pellagra clinically. The patient was started on injectable multivitamins for 14 days and later shifted to oral multivitamins. Patient showed significant improvement in his skin and neuropsychiatric symptoms. Present case suggests that physicians need to remain vigilant because it is easy to overlook such patients. Pellagra has an insidious onset and psychiatric symptoms appear rare and late in the course when disease is allowed to progress.
Open quadricepsplasty in hyperextension deformity of knee in children with arthrogryposis
Authors: Sananta Panji , Dradjad Respati Suryanto , Nurandani Fiki
Published: March 2019

Arthrogryposis includes heterogeneous disorders, characterized by congenital contractures of multiple joints. Knee involvement is very common (38–90 % of patients with amyoplasia) ranging from soft-tissue contractures (in flexion or hyperextension) to subluxation and dislocation. Children who present late will require surgery involving quadricepsplasty or lengthening of the contracted quadriceps muscle. Curtis and Fisher describe an open V-Y lengthening of the quadriceps femoris with post-operative immobilization in 30-45 ° of flexion. The main issue of this technique was limited degree of flexion that can be achieved, and the fibrous replacement of the quadriceps muscle. This is a neglected case of hyperextension deformity and congenital dislocation of knee in children with arthrogryposis resistant to conservative management and successfully treated by open quadricepsplasty.
Patient safety issues in rehabilitation for person with locomotor disabilities: a review
Authors: Deka Kuldeep , Gogoi Pranjal
Published: March 2019

Since the publication of the Institute of medicine report, To Err Is Human: Building a safer health system, notes that errors in health care are a significant cause of death and injury and the emphasis on patient safety has steadily increased. The rehabilitation professionals engaged for the management of patient with locomotor disabilities should incorporate elements of patient safety into their practices and also to stimulate research associated with prevalence of analysis of error/harm which occurs during the rehabilitation phase and also to develop and validate certain specific measuring tools and instruments for patient safety issues.
Subcutaneous negative pressure versus simple closure of skin incision following an emergency laparotomy: a randomized control study
Authors: Kagita Rakesh , Mulla Sameer Ahmed , Srinivas Pai B. , Desai Mallikarjun
Published: March 2019

Background: Surgical site infection (SSI) is a major problem associated with open abdominal surgery and is related to increased morbidity, mortality and healthcare costs. A subcutaneous negative pressure drain reduces dead space in subcutaneous tissue by preventing accumulation of fluid. The aim of present study was to establish the efficacy of a subcutaneous negative pressure for preventing SSI following exploratory laparotomy.Methods: A total of eligible 76 patients who underwent emergency abdominal surgical procedure, between October 2016 to March 2018, were randomized into subcutaneous drainage (DG) and no drainage group (NDG). Antibiotic prophylaxis was applied to each patient. The diagnosis of superficial SSI was made and was graded according to Southampton Grading System.Results: 5 patients in drain group (40) and 25 patients in no drain group (36) had incisional SSI with statistical difference (p<0.05). No statistical difference between groups was observed for age, sex, hospital stay (p>0.05).Conclusions: Subcutaneous negative pressure prevents post-operative surgical site infection significantly. Subcutaneous negative pressure drainage reduces hospital stay in a patient undergone emergency laparotomy, compared to patients in whom negative pressure drain was not placed.
Evaluation of axillary lymph node metastasis in relation to size and metastatic status of sentinel lymph node in carcinoma breast
Authors: Pandey Vineet Kumar , Ghuliani Deepak , Neogi Sushanto , Khurana Nita , Jindal R. K.
Published: March 2019

Background: Sentinel lymph node (SLN) is the first node in the nodal basis of a tumor and the most likely site for earliest lymph node metastasis. Modified radical mastectomy with axillary lymph node dissection (ALND) has been the standard of care for carcinoma breast. The SLN is the only involved node in majority (40-70%) of the patients undergoing ALND for a positive SLN biopsy. ALND is associated with significant morbidities like seroma, infection, lymphedema and nerve injury. The purpose of this study was to evaluate the axillary node metastasis with respect to the size and tumoral load of positive SLN.Methods: Thirty patients of biopsy proven early breast carcinoma underwent SLN biopsy with methylene blue dye followed by modified radical mastectomy (MRM). After measuring the size of the SLN with Vernier caliper, SLN and MRM specimen were sent for histopathological examination. Status of non-sentinel ALNs was compared with the size and tumoral load of SLN.Results: Among 30 patients, 5 patients had positive SLN. Patients with positive SLNs were younger (mean 36 vs. 52 years), had larger diameter (10.8 vs. 7.4 mm, p<0.03) with higher number of non-sentinel ALN metastasis (35% vs. 4.86%). Macrometastasis in positive SLN was associated with higher risk of metastasis to non-sentinel ALNs.Conclusions: A SLN size of more than 7.5mm has higher risk of harboring metastasis. A SLN size higher than 10mm and macrometastasis is associated higher risk of metastasis to non-sentinel ALNs.
Reamputation rates, morbidity and rehabilitation after lower limb amputations
Authors: Vishwakarma Nishish , Rehmani Babar , Agarwal Atul , Ray Jitendra Prasad
Published: March 2019

Background: This study attempted to document the indications for lower limb amputation (LLA) and its outcomes especially the wound healing problems, reamputations and subsequent use of prosthesis for mobilization in Indian population.Methods: This observational study included 92 patients over a period of 18 months. Indications, level of LLA, morbidity and reamputation rates after LLA were recorded. Stump status, wound healing and other morbidity was followed over period of one month. The use of prosthesis and level of mobility were assessing in follow-up over a period of six months.Results: There were total 109 LLA in 92 patients as some of these patients had to undergo revision of amputation stump at a higher level. Atherosclerosis (29.3%) was the main cause for LLA. Age group 35-55 years and male patients were most commonly needed LLA. Total 64.13% patients developed post-operative wound infection and 18.4% patients underwent reamputation. E. coli and Staphylococcus were the most common organism cultured from the infected surgical site. Conversion of below knee amputation (BKA) to above knee amputation (AKA) was the most frequent reamputation and atherosclerosis was the leading cause. According to final level LLA, 54 had major amputations (above ankle joint), only 37% were using a prosthesis whereas majority of patients were dependent on crutches/walker.Conclusions: Patients of atherosclerosis and trauma had a higher frequency of reamputations. Only 37% of major LLA opted for prosthesis whereas majority of patients mobilize by other means like crutches or walker.
Laparoscopic management of pancreatic pseudocyst: a prospective study
Authors: Bhingare Pravin D. , Dakhore Sanjay D. , Wankhade Sunil B. , Lihitkar Saurabh
Published: March 2019

Background: Pancreatic pseudocysts can be defined as localized fluid collections that have a nonepithelialized wall consisting of fibrous and granulation tissue. These pseudocysts usually appear several weeks after the onset of pancreatitis. Advancement in the management of pseudocyst with laparoscopic drainage provides a good alternative or supplement to the surgical treatment of pancreatic pseudocyst. The purpose of this study is to evaluate the feasibility, effectiveness and outcome of Laparoscopic drainage.Methods: It was a prospective interventional hospital based study carried out among 32 indoor cases of pancreatic pseudocysts operated using laparoscopic procedures admitted under department of general surgery in a tertiary healthcare teaching institute during study period. Cases of pancreatic pseudocysts were evaluated with detailed history, clinical signs and symptoms, the duration and investigations. Details of laparoscopic, its indications, peculiarities, complications rates, recurrence rate and outcome was analyzed.Results: Single and multiple pancreatic pseudocysts were found in 26 (81.25%) and 6 (18.75%) patients and the most common site was found to be body of pancreas (59.37%). Obstructive jaundice (18.50%) and gastric outlet obstruction (15.63%) were the most common complications seen. The common procedures undertaken in the studied cases were laparoscopic cystogastrostomy (65.62%) followed by laparoscopic cystojejunostomy (12.50%) and laparoscopic external drainage (12.50%). Common complications in studied cases were found to be pain (15.65%), fever (12.5%) and external fistula (6.25%).Conclusions: Laparoscopic technique for treatment of pancreatic pseudocysts is safe, efficacious, feasible and is associated with fast recovery. These techniques should be preferred over open surgical drainage.
Study of contents of inguinal hernia in girls
Authors: Mankar Kishor , Shinde Nandkishor , Moinuddin Mohammed , Ahmed Ashfaq
Published: March 2019

Background: Inguinal hernia in females is relatively uncommon as compared to males. In female patients, the hernial sac contains one ovary in approximately 15–20% of cases, and some also contain a fallopian tube. This study was done to know the contents in inguinal hernia in girls.Methods: A prospective study on eight girls with inguinal hernia presenting between January 2016 to December 2018, presented with swelling in inguinal region. Physical examination in all girls was done followed by ultrasonogram to know the content of inguinal hernia. All patients underwent surgical exploration.Results: Among 8 girls with inguinal hernia, 2 (25%) girls had bilateral inguinal hernia, 4(50%) girls had right and 2 (25%) girls had left sided inguinal hernia. Ultrasonogram showed 2 girls with bilateral inguinal hernia had intestines as content on both sides. 3 girls had intestines, one (10%) girl had omentum and 2 (20%) girls had ovary as content of hernia sac. On surgical exploration one girl had omentum, one had ovary, two had intestine as hernial sac content. Two girls with irreducible hernia had omentum and ovary respectively as hernial content. In all girls after reduction of content, herniotomy was done.Conclusions: Surgical repair should be done at diagnosis in all girls presenting with inguinal hernia in view of high incidence of incarceration of ovary and tubes. Sac must be opened and its contents examined before it is tied off and excised.
Effectiveness of fibrin glue in comparision to polypropylene suture for mesh fixation in lichtenstein inguinal hernia repair
Authors: Parameshwar Narayanakar Rajkumar , Talagavara Radhakrishna Kushal Kumar , Naik Madhuri G.
Published: March 2019

Background: Hernia is one of the oldest maladies known and suffered by humans. It has been known since ages and will be known for centuries to come as long as human beings prompt to stand and walk. Lichtenstein hernia repair is the most common procedure followed surgery but with some devastating complications such as chronic groin pain (CGP). The search for the most appropriate method to fix mesh and to reduce complications is still on and this study aims for the same.Methods: A comparative prospective study conducted in Department of General Surgery, Bangalore medical college & Research institute from November-2016 to May-2018. 100 patients falling into inclusion criteria were taken to study with randomization, 50 in each group (prolene vs Fibrin-glue). Postoperatively patient was assessed for complications, recovery time and Data collected was statistically analyzed using appropriate statistical test and p<0.05 was taken significant.Results: Most common age group presenting with hernia was from 41-50 years (29%) with M: F ration 5.6:1. Laterality being right: left: bilateral:: 58%: 36% :6% respectively. Type of hernia being Indirect: Direct:: 66%: 34% respectively. Duration of surgery, recovery to ADL and postoperative complications like seroma, chronic groin pain, foreign-body sensation was significantly less with fibrin glue compared to prolene group. Postoperative Haematoma, local numbness and recurrence were comparable and the difference in the result was statistically insignificant.Conclusions: Through our study from the above-mentioned benefits, it can be concluded that use of fibrin Glue in mesh fixation is a safe and acceptable method and can be used as a better alternative for prolene suture for mesh fixation in Liechtenstein’s hernioplasty.
A study on the antimicrobial usage pattern for the prevention of surgical site infections in a teaching hospital
Authors: K. Rajkumar
Published: March 2019

Background: Wrong antimicrobial selection and usage increase the incidence of drug resistance, drug toxicity and superinfections, thus decreasing the quality of healthcare delivery. Various approaches for rationalizing the antimicrobial usage have been recommended. Understanding the existing antimicrobial usage pattern is suggested as the first step in this approach, which would help to understand the current issues and to find the solution. The aim of the study was to evaluate the usage pattern of antimicrobial prophylaxis in surgical patients, to identify any inappropriateness of the usage.Methods: A retrospective evaluation of the randomly selected 258 medical records of general surgical cases for eight months in a tertiary care teaching hospital were verified for the appropriateness of the antimicrobial prophylaxis. The collected data was studied, and conclusions were drawn with the help of appropriate statistics.Results: All the 262 (100%) patients received a third generation cephalosporin through the intravenous route as a prophylactic dose. Also, 92 (35%) patients received nitroimidazole or aminoglycosides in addition to the cephalosporins. The antimicrobials were administered half an hour to one hour before the surgery. No intraoperative redosing was given.Conclusions: The timing of administration of the preoperative dose was at par with international guidelines and well allotted to the nursing staff. The intraoperative dose was appropriately omitted in the short term surgeries. The main concern was the increasing use of the third generation cephalosporins and the long duration of the postoperative prophylaxis, which required to be addressed.
Breast cancer: correlation of receptor status with clinical presentation, stage of disease, histopathological grade and short term outcome
Authors: Kumar Kanav , Akhtar Murtaza , Rangwala Murtuza
Published: March 2019

Background: Breast cancer is the commonest female cancer representing a quarter of all cancers worldwide. An important development in breast cancer management was the realization of role of hormone receptors in disease. Thus, the present study was carried out to evaluate the receptor status and its correlation with clinical presentation, stage, grade and short term outcome.Methods: All female patients with lump in breast confirmed as breast cancer were included and their receptor status was evaluated using immunohistochemistry.Results: A total of 147 patients with a mean age of 50.16±12.08 years were enrolled. Almost half of the patients (48.3%) of the patients were found to have locally advanced breast cancer. Of the 147 patients, 91.49% tumours were either Nottingham grade 2 or 3. Triple negative breast cancer (TNBC) was the commonest subtype seen in 43.54% patients. On correlating the results with receptor status, it was found that TNBC patients were younger than HER2neu positive and ER PR positive patients. Also, TNBC patients had a longer duration of lump and the lump was of larger size at presentation. On correlating receptor status with tumour biology it was seen that more than half (54.69%) of the patients who were triple negative had a grade 3 tumour and poorer disease free survival and overall survival.Conclusions: In conclusion it is seen that TNBC forms a majority of the cases in the central Indian population with more aggressive presentations and outcomes. Absence of any targeted therapies against them leads to a worse DFS and overall survival.
A multi centric study of diabetic foot ulcer: causes and complications
Authors: Prasad Pilla Earnest Daniel , Desai Rajendra , Kokiwar Prashant Ramdas
Published: March 2019

Background: Diabetes mellitus is a metabolic disorder and has become an epidemic. 73 million people in India have diabetes mellitus. Presently India has ranked the second highest country with diabetics in the world. Diabetic foot ulcer is a result of one or both of the complications of diabetes such as neuropathy and ischemia. The objective of the study was to study the causes for the ulcer formation on the toes.Methods: A prospective study was carried out from January 2016 to August 2018 from multiple diabetic clinics in Hyderabad, India. All the patients had undergone the following tests. 1) X-ray foot, 2) ABI (ankle brachial index) test, 3) Neuropathy test by VPT (vibration perception test) and monofilament.Results: The age of the patients mostly ranged from 50 to 70 years. 61% of the patients had neuropathic ulcer, 20% had ischemic ulcer, 19% had neuro-ischemic ulcer. 69% of these patients had osteomyelitis. 52% had ulcer on the right foot and 48% on the left. 15% had dry gangrene with ulcer where as 85% had infected ulcers. 60% of the ulcers were only on the plantar aspect and 24% had ulcers all around the toe. ABI (ankle brachial index) was normal 0.9 to 1.2 in 80% of patients whereas 20% had abnormal (<0.9). 60% of patients had ulcers involving the 1st and 2nd toes and both feet were almost equally affected.Conclusions: Neuropathy is the leading cause for ulcers on the toes followed by ischemia and then infection. Treating the neuropathic ulcer early can bring down the amputation rate of the toes by 50%.
Comparison between lateral sphincterometry and Lord’s operation in treatment of anal fissure
Authors: Velani Yogesh V. , Velani Attman P.
Published: March 2019

Background: Two widely performed surgeries include Lord’s anal dilatation (LAD) and lateral internal sphincterotomy (LIS). LAD is one of the ancient and simple surgical techniques, but with high incidence of recurrence and incontinences. LIS is the preferred surgical technique these days, but again with high incidence of incontinence. Aim of this study was done to compare LAD with LIS in the treatment of anal fissure with regard to symptoms, post-operative complications and recurrence.Methods: In the present study the age of patient was to be between 18–50 years, having CAF, all the patients having CAF not responded to the medical management for more than 6 weeks. The patients were randomly assigned to either group. Pre and post-operative pain was accessed using Wong-baker faces pain rating scale. Constipation was accessed by modified Longo score. Incontinence was accessed by scoring system reported by Wexner.Results: When the Wong Bakers faces pain score was done there were 69% of patients with grade IV score and 31% had grade V pain score. The second most presenting complaint was of bleeding per rectum, it was found in 80% of the patients. For constipation the preoperative modified Longo score was 14. On examination sentinel tag was present in all the cases out of which 93% was posterior, 5% anterior and multiple in 2% cases.Conclusions: A total of 200 patients were studied during the study. In this study, females were commonly affected than males. Constipation was the major predisposing factor among all cases 85%. Most of the fissures were located in the posterior midline 89%. Anterior fissures were slightly more common in females. It is our view that the role of pharmacological agents is likely to assume greater prominence in the future and that more effective agents and modes of delivery will be developed.
Primary and secondary abdominal cocoon- diagnostic and management challenges: retrospective study
Authors: Koil Devabalan Titus , Nadarajan Abinaya R. , Roopavathana Beulah , Chase Suchita , Nayak Sukria , Eapen Anu
Published: March 2019

Background: Abdominal cocoon is a rare cause of intestinal obstruction characterized by fibro collagenous membrane encapsulating the abdominal contents to varying degrees. The most commonly identified etiology remains to be ‘idiopathic’ and hence it is also known as idiopathic sclerosing encapsulating peritonitis.. Few case reports of abdominal cocoon secondary to gastrointestinal malignancy and tuberculosis have also been reported. The objective of the study was to study the spectrum of clinical presentation, identify the various aetio pathogenesis described and their impact on outcome of surgically managed patients with abdominal cocoon.Methods: The clinical data of twelve different cases of abdominal cocoon presented to a general surgery unit from January 2012 to December 2017 with minimum of 1 year follow up were analyzed.Results: In our series we had 12 patients with cocoon who underwent surgical intervention out of which 8 were primary and 4 were secondary to TB. In primary type one out of eight patients had acute presentation, but in secondary three out of four had acute presentation. In primary 6 out of 7 patient’s pre-operative CT showed cocoon, but in secondary only 1 out of 3 showed cocoon. In patients with primary cocoon 3 out of 8 patients had bowel resection and only one had post-operative morbidity. In patients with secondary cocoon three patients had bowel resection, stoma creation and reoperations with stormy post operative period. All 4 had post-operative morbidity, however all of them received ATT and definitive surgery was performed 1-2 years later with minimal resection and serial images also showed resolution of cocoon formation with ATT. Primary group up to 5 years follow up, there was no recurrence of symptoms. Both groups did not have any mortality.Conclusions: Abdominal cocoon is a rare disorder and the cause may be primary or secondary. In our series tuberculosis is the aetiology for secondary cocoon. Primary cocoon is easier to diagnose, manage and associated with less post operative complications compare to secondary cocoon. Damage control first surgery, nutritional build up and treatment with anti tubercular drugs are needed for management of cocoon secondary to TB for a better outcome in acute presentations. Definitive surgery can be performed once the nutritional status improves with less morbidity.
Lyell’s syndrome: a rare case report
Authors: Rao Venkata Mahipathy Surya Rao , Durairaj Alagar Raja , Sundaramurthy Narayanamurthy , Ramachandran Manimaran , Natarajan Praveen Ganesh
Published: March 2019

Lyell's syndrome or toxic epidermal necrolysis (TEN) is an epidermal detachment of more than 30% of total body surface area, most commonly due an idiosyncratic immune-allergic reaction to a drug. It causes an acute necrosis of the epidermis, with a clinical picture resembling extensive burns. There is also associated mucosal damage and can occasionally develop into a multiorgan having a poor prognosis. Here we report a case of toxic epidermal necrolysis, due to allopurinol intake and its management as in a large burns and stressing the importance of early treatment in an intensive care unit, with high vigil on fluid and electrolyte balance, prevention and treatment of infection with appropriate antibiotics and regular dressings.
Gradation trajectories as an analog of gradation curves in the metric CIE Lab space: discrete approach
Authors:   Ural Federal University, Tarasov D.A. , Milder O.B. ,   Ural Federal University
Published: March 2019

In the work, an approach that uses three-dimensional gradation trajectories in the CIE Lab metric space as analogs of traditional gradational curves is developed. It is shown that the mathematical apparatus of differential geometry of spatial curves describing gradation trajectories can be supplemented by a simpler discrete approach. The possibilities of applying the discrete method for calculating gradation trajectories to the problems of linearization of digital printing systems are demonstrated.
Avalanche instability of the orbital angular momentum higher order optical vortices
Authors:   Physics and Technology Institute (Academic Unit) of V.I. Vernadsky Crimean Federal University, Volyar A.V. , Bretsko M.V. ,   Physics and Technology Institute (Academic Unit) of V.I. Vernadsky Crimean Federal University, Akimova Ya.E. ,   Physics and Technology Institute (Academic Unit) of V.I. Vernadsky Crimean Federal University, Egorov Yu.A. ,   Physics and Technology Institute (Academic Unit) of V.I. Vernadsky Crimean Federal University
Published: March 2019

Theoretical and experimental studies of spectra of optical vortices and orbital angular momentum (OAM) carried by combined singular beams are presented. The combined beams are composed of superposition of Laguerre-Gauss or Bessel-Gauss modes with "resonant" amplitudes depending on a real parameter. If the parameter is an integer, then the OAM of the singular beam is equal to this number. If the real parameter is fractional, then the OAM can be either substantially larger or much smaller than the integer closest to the parameter value. For a non-integer value of the beam parameter, a large number of beams from superposition with integer topological charges contribute to its amplitude. For an integer beam parameter, the contribution to the amplitude is made by only one mode with a topological charge equal to the value of the beam parameter. In the experiment, singular beams with fractional OAMs were shaped using a binary amplitude diffraction grating consistent with the phase function of the singular beam. The measured correlation degree between the initial beam and the beam reconstructed from the vortex spectrum was no less than 90%.
FaceDetectNet: face detection via fully-convolutional network
Authors:   State Research Institute of Aviation Systems, Gorbatsevich V.S. ,   Moscow Institute of Physics and Technology, Moiseenko A.S. ,   State Research Institute of Aviation Systems,   Moscow Institute of Physics and Technology, Vizilter Y.V. ,   State Research Institute of Aviation Systems,   Moscow Institute of Physics and Technology
Published: March 2019

Face detection is one of the most popular computer vision tasks. There are a lot of face detection approaches proposed including different CNN-based techniques, but the problem of optimal balancing between detection quality and computational speed is still relevant. In this paper we propose new CNN-based solution for face detection called FaceDetectNet. Our CNN architecture is based on ideas of YOLO/DetectNet and GoogleNet architecture supported with some new tools and implementation details created especially for our face detection application. We propose: original iterative proposal clustering (IPC) algorithm for aggregation of output face proposals formed by CNN and the 2-level “weak pyramid” providing better detection quality on the testing sets containing both small and huge images. Our face detection approach is close to previously proposed SSD-based face detection, but the principal difference is that we use the deep features of top hidden CNN layer for forming the face proposals of any size. Thus we utilize the global semantic and context information for improving the detection quality for small faces. Our FaceDetectNet is trained and tested on the most challenging WIDER FACE detection benchmark. Our algorithm achieves the average precision (AP) 0.69 on the WIDER FACE hard level, and thus outperforms all competitive detectors on the Hard level besides the HR state-of-the-art solution. Note that HR solution is based on essentially deeper and slower CNN, while our FaceDetectNet can work in real-time on the NVIDIA GeForce 1080 GPU. On the other hand, SSD-based face detector with comparable CNN parameters provides AP 0.625 only on the WIDER FACE hard level. So, our approach provides the best quality with reasonable computational speed.
A framework of reading timestamps for surveillance video
Authors:   Computer School, Hubei Polytechnic University, Cheng J. ,   School of Economics and Management, Hubei Polytechnic University, Dai W. ,   Computer School, Hubei Polytechnic University,   School of Economics and Management, Hubei Polytechnic University
Published: March 2019

This paper presents a framework to automatically read timestamps for surveillance video. Reading timestamps from surveillance video is difficult due to the challenges such as color variety, font diversity, noise, and low resolution. The proposed algorithm overcomes these challenges by using the deep learning framework. The framework has included: training of both timestamp localization and recognition in a single end-to-end pass, the structure of the recognition CNN and the geometry of its input layer that preserves the aspect of the timestamps and adapts its resolution to the data. The proposed method achieves state-of-the-art accuracy in the end-to-end timestamps recognition on our datasets, whilst being an order of magnitude faster than competing methods. The framework can be improved the market competitiveness of panoramic video surveillance products.
The Development of a Core Syllabus for Teaching Anatomy of the Respiratory System to Medical Student
Authors: Munawaroh S , Mulianingsih D E , Wiyono N , Hastami Y , Kartikasari M N D , Hermasari B K
Published: March 2019

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The Agreement Level of Tuberculin Skin Test (TST) and T-SPOT.TB Examinations in Detecting Latent Tuberculosis Infection in Illicit Drug Users
Authors: Maulana Eka Hamdani S , . Reviono , Gusti Bagus Indro Nugroho I
Published: March 2019

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Influence of Heat Treatment After Arc Discharge Route on Structure and Loading Capacity of SBA-15 Encapsulated By Iron Particles
Authors: Ulfa M , Saraswati T E , Mulyani B
Published: March 2019

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The Correlation Between Knowledge About Occupational Accidents and Safe Work Behaviors Among Employees at the Production Division of PT X Indonesia
Authors: Dita M , Atmojo T B , Sari Y , Susilawati T N
Published: March 2019

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The Increase of nontuberculous mycobacteria Infection: Emphasis on Epidemiology, Risk Factors and Diagnostic Tools
Authors: Suryawati B , Sari Y , Saptawati L
Published: March 2019

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The Effect of Quran Recitation to Pain and Comfort Feeling on Patients with Reduced Consciousness in UNS Hospital
Authors: Hanafi M , Muhammad F , Wulandari D
Published: March 2019

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Wasting Prevention in under Five-Years-Old Children with Exclusive Breastfeeding
Authors: Wijiwinarsih A , Nugraha Susilawati T , Murti B
Published: March 2019

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