bluuebunny/crossref_metadata_2025 huggingface dataset:
A study of serum ferritin levels among voluntary blood donors
Authors: G. Deepa Devi , P. Arumugam , Hamsavardhini Swathandhran , S. T. Radhiga
Published: November 2017

Background: The frequent blood donations may lead on to iron deficiency and iron deficiency anaemia. Estimation of haemoglobin and hematocrit levels alone in voluntary blood donors may not be adequate. Hence this study was taken to estimate the serum ferritin level among voluntary blood donors with different frequency of donation and compare with hemoglobin levels.Methods: A Cross sectional study consisted of 314 voluntary blood donors, they were grouped into control groups donating blood for the first time and group donating blood once, twice and thrice in a year. The red cell parameters were measured by automatic cell count analyzer and estimation of serum ferritin by ELISA method.Results: There were 88.2% males and 11.8% females. The distribution of donors on the basis of the frequency of donation per year were 50% first time, 23.9% once a year, 19.7% twice a year and 6.4% thrice a year donation. A statistically significant correlation was seen between frequency of donation and total number of life time donations and serum ferritin levels. Distribution on the basis of number of donations per year and serum ferritin <15 ng/ml in male donors were 6.9 % in first time, 19.4 % in once a year, 26.7% in twice a year and 50% in thrice year donation. Among female donors 40.7% in first time, 50% in once a year, 50% in twice a year donation had serum ferritin levels <15 ng/ml.Conclusions: In this study, there was a definite correlation between dwindling of serum Ferritin level and the frequency of donation. As a part of donor haemovigilance program, our study suggests estimation of serum ferritin level, iron supplementation and donor health education on balanced nutritious diet for at least female donors and regular male donors to maintain adequate donor pool.
Glycosylated hemoglobin and left ventricular diastolic dysfunction in patients with type 2 diabetes mellitus
Authors: Yesankar Vishal S. , Humaney Nalini R.
Published: November 2017

Background: Diabetes mellitus is one of the most common diseases. Left ventricular diastolic dysfunction may represent the early stage of diabetic cardiomyopathy thus reinforcing the importance of the early examination of diastolic function in individuals with diabetes.Methods: This is a hospital based cross-sectional study done at a tertiary care hospital catering mainly to rural population. Patients having type 2 diabetes mellitus were scrutinized for doppler echocardiography and HbA1c levels. As per the previous studies and considering the prevalence of asymptomatic diastolic dysfunction in diabetics, the sample size was calculated. Statistical analysis was done by using descriptive and inferential statistics using chi square test.Results: In the present study 45 patients had HbA1C between 6.5- 8.0, out of which 9 had type I diastolic dysfunction, 1 had type II diastolic dysfunction and 35 had no diastolic dysfunction. 16 patients had HbA1C between 8.1- 9.5, out of which 7 had type I diastolic dysfunction, 8 had type II diastolic dysfunction and 1 had no diastolic dysfunction. 14 patients had HbA1C more than 9.5, out of which 4 had type I diastolic dysfunction, 5 had type II diastolic dysfunction, 4 had type III diastolic dysfunction and 1 patient did not had any diastolic dysfunction. The Chi-Square value is 55.51 and p value is 0.000 (Significant).Conclusions: Diastolic dysfunction correlates with the levels of glycosylated hemoglobin, duration of diabetes mellitus, presence of microvascular complications like diabetic retinopathy, neuropathy and nephropathy.
Handedness and learning styles: a study of its inter relationship
Authors: Vijayan Vineetha , Panchu Pallavi , Bahuleyan Biju
Published: November 2017

Background: The alleged link between handedness and learning is debatable. Studies unveil that handedness has a way of influencing learning and affects the academic performance of students. Despite the researchers pointing out that handedness influences the brain organization and function, teaching strategies have largely ignored this fact. The concept of using various sensory modalities as a part of learning has not been comprehended well. The aim of the study is to find out the prevalence of handedness among our medical students and to look onto the types of learning styles amongst them and to determine the correlation between handedness with learning styles.Methods: A cross sectional study was conducted among hundred medical students using handgrip dynamometer for handedness and VARK questionnaire (Visual, auditory, read/write, kinesthetic; a validated tool that helps one to identify the most preferred sensory modality for learning) for determining the learning preference. Data was analysed using univariate and bivariate analysis through cross tabulation and Pearson chi square test using SPSS version 20.Results: Right handers preferred VARK with dominancy for auditory learning styles, left handers preferred VARK with dominancy for auditory and kinesthetic learning styles while ambidextrous prefer visual learning styles.Conclusions: The awareness of the association of handedness with various learning styles and its implications on academic performance should be at the forefront of teaching strategies adopted by teachers. Hence, we conclude that to be an effective learner, the learning needs have to be understood and cater to by the trainers.
Observation of modes of brachial artery termination in south Indian cadavers
Authors: Jnanesh R. S.
Published: November 2017

Background: Variations in upper limb arteries have been frequently observed. Accurate knowledge of muscular and neurovascular variations is important for both surgeons and radiologists, which may prevent diagnostic errors.Methods: A study was done to note the variations in the termination of brachial artery in relation to the level of termination and the terminal branches. A total of 60 upper limbs (33 Right, 27 Left) were studied. The level of termination of brachial artery was identified based on the distance between the intercondylar line and the point of termination. The classic textbook description of brachial artery bifurcating into radial and ulnar arteries, 1 cm distal to elbow joint (ICL) was taken as normal.Results: A high origin of radial artery was noted in 11.67% of cases. Variations in the origin and relationship of median nerve to brachial artery, radial artery and ulnar artery was seen in 4 cases.Conclusions: Due to higher incidence of anatomical variations of arteries of the upper limb, prior anatomical knowledge of anomalies is of great clinical significance to vascular surgeons, orthopaedicians and radiologists performing angiographic studies.
Item and distracter analysis of multiple choice questions (MCQs) from a preliminary examination of undergraduate medical students
Authors: Sahoo Durgesh Prasad , Singh Rakesh
Published: November 2017

Background: Multiple choice questions (MCQs) or Items forms an important part to assess students in different educational streams. It is an objective mode of assessment which requires both the validity and reliability depending on the characteristics of its items i.e. difficulty index, discrimination index and distracter efficiency. To evaluate MCQs or items and build a bank of high-quality test items by assessing with difficulty index, discrimination index and distracter efficiency and also to revise/store or remove errant items based on obtained results.Methods: A preliminary examination of Third MBBS Part-1 was conducted by Department of Community Medicine undertaken for 100 students. Two separate papers with total 30 MCQs or items and 90 distractors each in both papers were analyzed and compared. Descriptive as well as inferential statistics were used to analyze the data.Results: The findings show that most of the items were falling in acceptable range of difficulty level however some items were rejected due to poor discrimination index. Overall paper I was found to be more difficult and more discriminatory, but its distractor efficiency was slightly low as compared to paper II.Conclusions: The analysis helped us in selection of quality MCQs having high discrimination and average difficulty with three functional distractors. This should be incorporated into future evaluations to improve the test score and properly discriminate among the students.
Presentation of pulmonary tuberculosis in diabetics and response to anti-tuberculosis therapy
Authors: Waseem Md Abdul , Zahera Misba , Gopalakrishnaiah V.
Published: November 2017

Background: Diabetes and Tuberculosis are known to be mutually affective. In high tuberculosis and Diabetes burden country like ours, it is essential that we understand all the aspects concerning both these diseases individually and in mutual coexistence, in order to improve the management of this unhealthy partnership.Methods: This is a prospective hospital based observational study, in which 100 patients with coexisting Diabetes and new sputum confirmed pulmonary tuberculosis with no other comorbidities were included. Detailed history, examination and appropriate investigations were done evaluating the clinical and radiological presentation and treatment response in terms of sputum conversion at follow up visits.Results: Predominant symptoms were anorexia, fever and cough with sputum, majority with duration of more than 4 weeks. About half of them had diabetes duration of less than 1 year, most being newly diagnosed. All cases had upper lobe involvement; two thirds of them had lower lung field and multiple lobe involvement. Confluent consolidation, cavitary lesions and fluffy infiltrates were common. 27 of the 100 cases had a delayed sputum conversion. Longer duration of diabetes, maintenance on oral hypoglycaemic drugs alone and uncontrolled diabetes had delayed sputum conversion.Conclusions: Presenting symptoms of tuberculosis in diabetics is more or less similar to that in non-diabetics. Atypical radiological presentation with lower lung field involvement and confluent consolidation mimicking pneumonia is common. Delay in sputum conversion is common in dual disease and is increased with increasing DM duration and poor glycemic control. Better results may be obtained with insulin therapy.
Coexistence of iron deficiency and thalassemia trait: a study in antenatal females
Authors: Arora Sheetal , Rana Deepshikha , Raychaudhuri Sujata , Dhupia J. S.
Published: November 2017

Background: Thalassemia is most common genetic disorder worldwide and about 7% of world population is carrier. The prevalence of Beta thalassemia trait (BTT) is 3.5–10% in India. The National Family Health Survey (NFHS-3) of 2011 reveals the prevalence of iron deficiency anemia (IDA) as 70–80% in children, 70% in pregnant women, and 24% in adult men. As both of them are close differential diagnosis and both can coexist together, this study aims to detect hemoglobinopathies in pregnant women and quantify the effect of iron deficiency on HbA2 levels in order to improve the detection of β thalassemia trait with and without iron deficiency.Methods: Hb, RBC indices, and peripheral smears of 90 pregnant females with microcytic hypochromic blood picture were studied. Serum ferritin and HPLC (High Performance Liquid Chromatography) was performed. The results were analysed statistically by using SPSS version 16.0.Results: 93.3% patients had HbA2 <2%, 4.44% had >4.0% which characterise BTT and remaining 2.22% had between 3.0%-4.0%. HbA2 <2.0% may be seen in IDA, ATT, HbH disease and Delta thalassemia. 91.11% had reduced serum ferritin and 2.22% had normal ferritin levels.Conclusions: This study reveals that there is frequent occurrence of iron deficiency anaemia in patients with thalassemia traits. This can substantially invalidate the diagnosis of the latter. Hence, iron deficiency should be identified and rectified in patients with suspicion of thalassemia trait.
Haematological profile of dengue fever
Authors: Tahlan Anita , Bhattacharya Amrita
Published: November 2017

Background: Dengue is a viral illness that is increasingly becoming endemic in India. This study aimed to study the haematological profile of patients diagnosed with dengue infection in a tertiary care hospital.Methods: 89 patients suspected of having dengue illness were followed. Out of which those confirmed by positive serology were followed and studied in detail (n=46).Results: Common clinical symptoms were fever, vomiting, and abdominal pain. Common haematological abnormalities were thrombocytopenia and leucopoenia. All patients improved clinically with improvement of biochemical and hematological parameters. None of the patients died in this series.Conclusions: Dengue Fever continues to be a significant health problem especially in Northern region of India. A sharp vigilance is required by concerned authorities to prevent and minimize any future outbreak. It is extremely important to implement and maintain an effective, sustainable and community based disease prevention program.
Fresh frozen plasma utilization pattern in tertiary care hospital of North Western India
Authors: Prinja Nippun , Sharma Sarita , Narain Rachna
Published: November 2017

Background: Fresh Frozen Plasma (FFP) is mainly used in treatment of coagulation derangements; trauma emergencies. It is the most inappropriately used blood component. Since the guidelines for FFP use in a clinical setting are not well defined, this study aims at defining the appropriateness of use of FFP in the light of its risks and adverse effect. Audit of institute FFP usage with specific aim of assessing appropriate use, based on clinical indications and laboratory parameters in requisition form.Methods: Retrospective analysis of 10,753 FFP supplied in 3072 patients from June 2016 to December 2016 in SMS Hospital, Jaipur, Rajasthan, India was done in Department of Immunohaematology and Transfusion Medicine, SMS Hospital, Jaipur, Rajasthan, India. Detailed analysis of clinical indication, INR value, specialty, age, gender of patient was done.Results: 10,753 FFP was supplied to 3072 Patients. 6990 FFP was supplied to 1995 males. 3763 FFP was supplied to 1077 females. Clinical use of FFP for medical and surgical conditions was highest seen in Blood Cancers (13%) and Cardiosurgery (22.3%). 15.2% was available from Emergency Department. 1.9% of FFP was returned back. Patients with Deranged Coagulation Profile (DCP) require maximum transfusion (49.3), Bleeding patients (37.6%), DIC (3.3%). FFP used for plasmapheresis (2.6%). No information available about diagnosis (7.2%) was available from Emergency Department.Conclusions: FFP is most inappropriately used blood component (39.57%) and should be used judiciously. Regular audit of blood components serves as tool for accomplishment of quality tools and to understand clinical transfusion practices.
Assessment of epidemiological factors and clinical profiles of cerebral infarction cases in tertiary health center in southern Maharashtra and hence evaluating computed tomography as its diagnostic modality: a prospective study
Authors: Jadhav Nitin , Rode Vikram
Published: November 2017

Background: Cerebrovascular accidents are one of the leading causes of death in developed countries. The advent of CT in early 1970s greatly facilitated the diagnosis and management of stroke. The present study aims at assessing epidemiological factors and clinical presentation of cerebral infarction cases and hence to evaluate computed tomography as a diagnostic tool for cerebral infarction.Methods: A prospective study was carried out among cases of Cerebral infarction. Every patient was interviewed personally, and detailed history was taken followed by clinical, systemic and neurological examination. Results were analysed comparing clinical diagnosis, sites of lesions, nature of lesions and CT scan findings.Results: Cases showed male predominance with 69% cases and 31% were females. 19% cases presented with headache, 17% with convulsions and 9% with vomiting. Upon eliciting past history of cases, we found that 48% were known cases of hypertension, 23% were having past history of cerebrovascular episodes, 20% cases were smokers and tobacco chewers whereas 15% were known cases of diabetes mellitus.Conclusions: Currently India is facing double burden of communicable and non-communicable diseases, and now a day’s cases of non-communicable diseases have started increasing, following iceberg phenomenon. So, diagnosing these conditions in its initial stage and halting the disease progress will be the priority. The present study recommends a comprehensive model for non-communicable disease prevention and control based on current healthcare needs and disease scenario.
Immunologic glomerulopathies-diagnostic role of immunofluorescence study of renal biopsies
Authors: Pandey Kaushlendra K. , Tiwari Anjali , Agarwal Asha
Published: November 2017

Background: The kidney is a structurally complex organ that has evolved to subserve a number of important functions: excretion of the waste products of metabolism, regulation of body water and salt, maintenance of appropriate acid balance, and secretion of a variety of hormones and autacoids. Some clinical disorders affect more than one structure. In addition, the anatomic interdependence of structures in the kidney implies that damage to one almost always secondarily affects the others. Thus, severe glomerular damage impairs the flow through the peritubular vascular system, conversely, tubular destruction, by increasing interglomerular pressure, may induce glomerular atrophy. Thus, whatever the origin, there is a tendency for all forms of chronic renal disease ultimately to destroy all four components of the kidney, culminating in chronic renal failure and what has been called end-stage contracted kidneys. The functional reserve of the kidney is large, and much damage may occur before functional impairment is evident. The circulating immune complexes play a very major role in various types of glomerular nephropathies.Methods: The present study was conducted on renal biopsies referred to Pathology Department of G.S.V.M. Medical College, Kanpur and Regency Hospital Ltd., Kanpur. Frozen section of renal biopsy was taken for IF studies. Renal biopsy tissue was received in IF fluid containing Ammonium sulphate, N-ethyl malcimide, Magnesium sulphate.Results: The lgG class of immunoglobulins was found to be most fatal to the G13M, the 1gM and IgA were also found to cause glomerular damage. This mechanism was seen responsible for most cases of ICGN. In the present study, fluorescent study of renal biopsy tissue was also done using Hollande’s fixative and it was observed that a better diagnosis could be done when used with routine H & E and immunofluorescent studies.Conclusions: The immunofluorescence microscopy proved to be very useful and essential, for proper diagnosis and therapy of a renal disease. IFM comes out to be a very good indicator of the deposition site and class of immunoglobulin involved in the Immune-complex deposit.
Pseudophakic cystoid macular edema after uneventful small incision cataract surgery
Authors: Ghelani Abhishek , Sheikh Khushnood , Shastri Manisha , Patel Abhishek
Published: November 2017

Background: To study the clinical profile of patient undergone small incision cataract surgery. To measure the incidence of CME after manual SICS and phacoemulsification method of cataract extraction.Methods: It`s a hospital based prospective study carried in ophthalmology dept. patients with normal clinical profile with no history of hypertension, diabetes mellitus, or any ocular trauma or infection/inflammation are randomly selected for cataract surgery either phacoemulsification or manual SICS and were regularly followed till sixth week after cataract surgery. During follow up complete examination including visual acuity, anterior segment examination fundoscopy and FFA done.Results: Out of 115 patients, 59 were operated by phacoemulsification and 56 were operated by manual SICS. 59were operated by phaco, 9 patients lost in follow up. Out of these, 2 patients developed CME. One was operated by phaco and the other by SICS (P value = 1.000) BCVA 6/9 or more after second follow up was seen in 42.45% of phaco patients and 40.56% of SICS patients which is statistically insignificant (P value = 0.343607).Conclusions: With advent of modern cataract surgery, rapid visual rehabilitation and unaided best corrected visual acuity is achieved with negligible early and late postoperative complications and thereby cystoid macular edema.
Abnormal ossified structures around the hip joint and its clinical implications
Authors: Kalyan Chakravarthi Kosuri , K. S. Siddaraju , Venumadhav Nelluri , Atamaram Bali Sangeeta
Published: November 2017

Background: The hip joint is the body’s second largest weight-bearing joint forms a connection from the lower limb to the pelvic girdle. It is formed by an articulation between the pelvic acetabulum and the head of the femur. Ankylosis or fusion of the joint, ossification of the adjacent ligaments and calcific tendinitis of adjacent muscles can decrease the mobility of the joint. The study was undertaken to evaluate the incidence of abnormal ossified structures around the hip joint.Methods: This study was carried out on 228 dry human hip bones (right- 114 and left-114) and 228 dry human femur bones (right- 114 and left-114) irrespective of age and sex at Varun Arjun medical college-Banthra, UP, KMCT Medical College, Manassery-Calicut and Melaka Manipal Medical College-Manipal. All the hip and femur bones were macroscopically inspected for the abnormal ossified structures around the pelvic acetabulum and upper end of the femur. Photographs of the abnormal ossified structures were taken for proper documentation.Results: Very rare and unusual unilateral ossified and complete fused left hip joint was noted (0.43%). Unilateral ossified acetabular labrum with ossified transverse acetabular ligament was noted in seven right hip bones (3.07%). Unusual ossified fibrous capsule on the posterior aspect of neck of femur was noted in 4 left sided femur bones (1.75%). Unusual unilateral ossified deposits near the greater trochanter and intertrochanteric line of femur was noted in nine left sided femur bones (3.94%).Conclusions: Anatomical knowledge of ankylosis of hip joint, ossification of the ligaments and muscles tendons around the hip joint as found in the present study made this study unique such abnormal ossifications may be helpful for clinicians, radiologists and surgeons for differential diagnosis and can be implicated in the development of innovative treatments of hip joint and hip pains.
Perception of medical teachers towards undergraduate medical theoretical assessment system in a medical college of West Bengal
Authors: Adhikari Anjan , Bhattacharya Sangita , Indu Rania , Ray Moumita , Waghmare Lalit
Published: November 2017

Background: With change of disease pattern and complexities of therapy globally, medical education become challenging. Problem based learning and self-directed learning became more relevant and occupied its space in medical education. Assessment is very crucial with the change in curriculum for appropriate feedback and learning in the system. Present study evaluated the perception of medical teachers on this issue of theory examination. Assessment or evaluation plays a pivotal role in effectivity of the system. Assessors always guide any system to achieve its objectives.Methods: This is an observational study, done with a questionnaire. It was done by interviewing the faculties of R.G. Kar Medical College, Kolkata, West Bengal who were examiners at University level.Results: Present study comprised faculty of fifteen undergraduate Departments of R. G. Kar Medical College, Kolkata 29.68% faculty supported semester system. 70.32% faculty participated as the study population. 48.4% agreed and 35.93% strongly agreed on the concept of model answers. A majority of the faculties (31.25%) strongly agreed on the issue that answers should be checked by two or more examiners. Regarding the threshold of pass marks, 48.4% strongly agreed and 43.75% agreed that students need to get 50% marks separately in theory examination to get through the examination.Conclusions: Present study evaluated importance of theory assessment system in medical education. It also necessitates further research to improve the objectivity of theory assessment system in medical curriculum at University level, in India.
Clinical profile and outcome of the children with diabetic ketoacidosis (DKA) in hilly Himalayan state of north India
Authors: Bhardwaj Parveen , Yadav Vijay , Sharma Minoo
Published: November 2017

Background: Context: DKA is an important complication of undiagnosed or poorly controlled diabetes mellitus. Proper management of DKA can prevent morbidity and mortality attributable to diabetes mellitus. The aim of the research was to study the clinical profile and outcome of the children admitted with Diabetic Ketoacidosis (DKA).Methods: A descriptive retrospective study was conducted in pediatric ICU of tertiary level care hospital over three years between January 2013 and December 2015. 29 patients were diagnosed with DKA during the three-year period, the data was collected by reviewing the medical record of the patient and information with respect to personal details, clinical features, laboratory parameters, management and outcome was recorded.Results: 29 patients were diagnosed with DKA, of these 17 were males and 12 females. M:F was 1.4:1 and mean age at presentation was 11.4±4.4 yrs. DKA was the presenting manifestation of Diabetes in 48.2% patients and 51.8% were already known cases of Diabetes. Abdominal pain (62%), polyuria (58.6%), fast breathing (58.6%), vomiting (55.1%), and altered sensorium (44.8%) were common presenting symptoms of DKA. Severe ketoacidosis was noted in 48.2% and severe dehydration in 31%. Shock was observed in 27.5% patients and 20.9% had cerebral edema. Metabolic abnormalities like hponatremia, hypernatremia, hyperkalemia, hypokalemia were seen in 44.8%, 13.7%, 24.1%, 17.2% respectively. We had 1 (3.4%) mortality.Conclusions: Diabetic Ketoacidosis (DKA) is an important cause of hospital admissions and 48.2% of newly diagnosed cases presented with DKA. Infections and omission of the insulin were the most common precipitating factors. For the long- term management strategy it is important to educate of the patients and their parents regarding regular blood sugar monitoring and insulin dosing.
Pattern of lipid profile in type 2 diabetes mellitus-a study from north Bihar
Authors: Das Bhagwan , Kumar Durgesh , Kumar Munish
Published: November 2017

Background: Diabetes mellitus refers to a group of common metabolic disorders that share the phenotype of hyperglycemia. Type 2 Diabetes Mellitus (DM) is a heterogeneous group of disorders characterized by variable degree of insulin resistance, impaired insulin secretion, and increased glucose production.Methods: To study of pattern of lipid profile in type 2 diabetes mellitus, 100 cases of type 2 Diabetes Mellitus attending the tertiary care centre were selected. The result was compared with 25 healthy, non-obese, non- diabetic and non-hypertensive subjects.Results: Triglyceride (TG) and very low-density lipoprotein (VLDL) were significantly higher whereas high density lipoprotein (HDL) levels lower in diabetics than healthy controls. Total cholesterol (TC) and low-density lipoprotein (LDL) were other fractions which were slightly above optimal levels in diabetics.Conclusions: From our study, it was concluded that diabetes mellitus has a real impact on lipid metabolism.
Evaluating the effect of dexmedetomidine premedication on the quality of subarachnoid block, haemodynamics and sedation in patients undergoing lower limb surgeries: a prospective randomized controlled trial
Authors: Sharma Sandeep , Somani Mahesh , Chandramohan Madhan , Raiger Lalit Kumar
Published: November 2017

Background: Present study was designed to evaluate the effect of intravenous dexmedetomidine on haemodynamics, sedation and quality of spinal anaesthesia with 0.5% hyperbaric bupivacaine.Methods: Sixty ASA grade 1 and 2, 18-60 years aged patients scheduled for elective lower limb surgeries were randomly divided into two groups: Group C (Control) and Group D (Study), received intravenous normal saline 10ml and intravenous dexmedetomidine 1μg/kg in dilution of 10ml respectively over 10minutes duration, 10minutes before subarachnoid block with 2.5ml of 0.5% hyperbaric bupivacaine. The heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), quality of sensory and motor block and level of sedation were monitored intraoperatively and postoperatively.Results: The heart rate was statistically significantly decreased in group D both intraoperatively and postoperatively. Intraoperative and postoperative SBP and DBP were lower in dexmedetomidine group but clinically that was insignificant. Intraoperative Ramsay sedation scores were significantly higher in dexmedetomidine group (3.49±0.240) as compared to control group (2.51±0.249) (p<0.001) but the patients were easily arousable. The duration of sensory blockade (208.83±9.53 min vs 162.83±9.62 min), duration for 2 dermatomal regression of sensory blockade (146.5±10.013min vs 98±8.57min) and the duration for motor block regression to Modified Bromage scale 0 (167.33±10.5min vs 137.83±11.94min) were significantly prolonged in dexmedetomidine group as compared to control group. The highest level of sensory blockade was also significantly higher in dexmedetomidine group (T6.90±0.759 vs T7.60±0.621). There was no difference in the time for attaining highest level of sensory blockade, time taken for motor blockade to reach Modified Bromage Scale 3 between both the groups. Average 24hr mean VAS score was significantly lower in dexmedetomidine group (1.37±0.15 vs1.72±0.17, p<0.001). Time to first request for rescue analgesic was also significantly longer in dexmedetomidine group (mean 174.33min vs 143.5min). Average 24hour consumption of tramadol analgesic was significantly higher in control group as compared to dexmedetomidine group (391.86±111.62mg vs 279.86±80.55mg, p<0.001).Conclusions: Intravenous dexmedetomidine significantly prolongs the duration of sensory and motor block of bupivacaine spinal anaesthesia. It provides excellent sedation and analgesia. Dexmedetomidine induced decrease in heart rate, systolic/diastolic blood pressure are not clinically significant.
Study of urinary uric acid and creatinine ratio as a marker of neonatal asphyxia for babies born in a tertiary care hospital
Authors: Krishnana Elango , Ponnusamy Venmugil , Sekar Sathiya Priya
Published: November 2017

Background: Perinatal asphyxia is a common neonatal problem and there is significant contribution to neonatal morbidity and mortality. It is regarded as an important and common cause of preventable cerebral injury. The prediction of perinatal asphyxial outcome is important but formidable. There is only a limited role for the Apgar score for predicting the immediate outcome, such as HIE and the long-term neurological sequelae observational error can happen in APGAR. But biochemical parameters can be truly relied upon. This study was to evaluate the utility of urinary uric acid to creatinine ratio (UA/CR ratio) as non-invasive, easy, cheap and at the same time early biochemical means of asphyxia diagnosis.Methods: In this prospective case control study conducted in KAPV Government medical college between Feb 2017 to Sept 2017, 100 asphyxiated and 100 non-asphyxiated newborns were included. Detailed history and assessment were for all the enrolled newborns. Spot urine samples were sent for uric acid and creatinine estimation. Results were recorded, and statistical analysis was done.Results: The mean Uric acid/Creatinine ratio in the cases and controls groups were 2.58±1.09 and 0.86±0.17 respectively. The ratio also correlated well with the stage of HIE.Conclusions: The ratio of UA/Cr enables early and rapid recognition of asphyxial injury and also the assessment of its severity and the potential for short term morbidity or death.
Role of leukocyte free platelet rich plasma in planter fasciitis: a prospective study
Authors: Shekhar Chandre , Jhan Alamgir , Singh Ganesh , Singh Pankaj , S. Bhandhari Shailendre
Published: November 2017

Background: Planter fasciitis, is by definition, inflammation of planter fascia. Most of the cases are well treated conservatively and a few responds to surgery only. Objectives of present study were evaluating the efficacy of a single injection of leukocyte free platelet rich plasma in plantar fasciitis and to derive a correlation between the clinical and radiological outcome.Methods: The present study consisted of 120 patients of bilateral (PF), (240 feet). These patients were divided into two groups PRP group of 60 patients and Placebo group of 60 patients. The study was conducted on patients attending Orthopaedics outpatient department Post Graduate Institute of Medial Education and Research (PGIMER) from July 2011 to June 2012. A primary efficacy criterion was changes from baseline in pain using (VAS). Functional results, level of satisfaction and outcome were measured by – AOFAS Foot Scale. Correlation of clinical with radiological outcome were performed.Results: There was a significant decrease in the visual analogue scale (pain score) in the PRP. Group while in placebo group it was increased significantly at the end of 6 month. Functional outcome scores were improved significantly from their baseline values in PRP group while in placebo group the mean functional score were deteriorated at 6 months follow up. There was no improvement seen in functional status with normal saline injection. In PRP group the mean heal pad thickness was reduced significantly at 6 months follow up while in placebo group was not changed significantly at 6 months follow up. Correlation between radiological parameters and VAS was found to be positive while it was found negative with other functional outcome scores like AOFAS.Conclusions: Platelet-rich plasma (PRP), which is a natural concentrate of autologous growth factors,plays a role in the regeneration process in treatment of (PF).
A numerical misinterpretation in the computer screen during middle of the image free navigation assisted knee replacement-a dilemma of what to do next?
Authors: Selvanayagam Rajkumar , Pfluger Gerald
Published: November 2017

Misinterpretation can occur during any step of navigation system. It is not only a dilemma for the orthopaedic surgeons on how to proceed further in such instances, but also a challenging situation to take a right call. We report here an unusual error encountered in image free Orthopilot navigation system during knee replacement surgery. A gross numerical measurement error occurred in the computer screen while femoral planning step in the tibia first technique, following which a dilemma persisted on how to proceed further. The system was reverted backwards, and the procedure was initiated again right from the beginning of the registration of bony landmarks, followed by completion of all other consecutive steps with the help of navigation system. The end result of the surgery was achieved at an accurate neutral mechanical axis with 5 degrees of maximum possible extension.
Metastatic germ cell tumor with complete response-7 years follow up
Authors: Jakovljevic Branislava Golub , Đokanović Dejan , Miličević Snježana , Škobić Anđa , Ćazić Dejan , Krivokuća Vladimir
Published: November 2017

Cancer of the testis is a relatively uncommon disease, accounting for approximately 1-1.5% of all cancers in males.  5% of the malignant germ cell tumors are made of extragonadal origin. Germ cell tumors occur in men younger, usually between 20 and 35 years old. We report a case of a patient with metastatic extragonadal germ cell tumor with multiple sites of metastases, and very high initial values of tumor marker human chorionic gonadotrophin (HCG)- 1351308. At the time of diagnosis, the patient was in a very poor general condition. After the applied chemotherapy, there was a complete response and 7 years later the patient is without any symptoms of disease.
Bolus ileus-an occasional cause of small bowel obstruction-case report
Authors: Janež Jurij
Published: November 2017

A food bolus can be an occasional cause of small bowel obstruction. Especially older and senile patients are at higher risk for developing a bolus ileus. Certain pathological conditions are associated with a higher risk for developing a bolus ileus, such as duodenal and small bowel diverticula. In this paper is presented a case of a 68-year-old female patient with food bolus, that caused a mehanical small bowel obstruction. The abdominal computed tomography scan before surgery did not show the precise cause of intestinal obstruction. During surgery we found a big grape in the distal ileum, which was removed through enterotomy. Further postoperative course was uneventful.
Septated concha bullosa in an antrochoanal polyp patient
Authors: Ertugrul Suha
Published: November 2017

The term of septated concha bullosa has been described recently and it is an uncommon pneumatization anomaly of the middle turbinate. Solitary, benign soft tissue masses originating at the maxillary sinus and extending to the nasopharynx are called antrochoanal polyps. Antrochoanal polyp may be accompanied by concha bullosa. However, combination of septated concha bullosa and antrochoanal polyp has never been reported to the best of our knowledge. This paper presents a 45-year-old male patient who has a combination of septated concha bullosa and antrochoanal polyp.
Staphylococcal scalded skin syndrome caused by methicillin-resistant Staphylococcus aureus with superadded fungal infection in a neonate
Authors: Gogoi Mayuri , Borah Nilakshi , Sharma Ajanta
Published: November 2017

Staphylococcal scalded skin syndrome (SSSS) or acute staphylococcal epidermolysis is an exfoliative skin disease and a toxin mediated staphylococcal infection affecting mostly neonates and adolescents. We describe here a case of 10-day old full term, vaginally delivered baby weighing 1530gms presenting with erythematous lesions first developing on the face and later spreading to the entire body for the last 6 days. The mucosal areas were spared. Blood culture of the patient revealed growth of Methicllin Resistant Staphylococcus aureus (MRSA). Culture from the skin lesions also revealed growth of MRSA with similar antibiotic sensitivity pattern. Fungal culture from the skin lesions revealed growth of Candida tropicalis. The diagnosis of SSSS was based on clinical criteria and microbiological findings.
Compartment syndrome of the forearm following moderately displaced fracture of the radial head in a 10-year-old child
Authors: Jan Wazir Fahad , Jahan Alamgir , Yahya Dar Mohd , Mushtaq Khan Umar
Published: November 2017

Compartment syndrome of the forearm is a rare complication of radial head fractures. We report the unsual case of a 10-year-old child who developed acute volar compartment syndrome of the forearm following a moderately displaced fracture of the radial head. The patient underwent volar fasciotomy of the forearm and open reduction of the radial head fracture with Krishner wire. Due to timely intervention the patient had a good postoperative outcome and is expected to have a good functional recovery.
Isolated pulmonary cavitary mucormycosis in uncontrolled diabetic, diagnosed by fiber-optic bronchoscopy and completely managed medically
Authors: Waseem MD. Abdul , Zahera Misba , V. Gopalakrishnaiah
Published: November 2017

Pulmonary mucormycosis is rare life‐threatening infection affecting mostly immunocompromised individuals such as diabetes mellitus, hematological malignancies, chronic renal failure, post transplantation etc. Based on the anatomic site involved, mucormycosis can be one of several forms, such as rhinocerebral, pulmonary, cutaneous, gastrointestinal, disseminated, and uncommon presentations that include endocarditis, osteomyelitis, peritonitis, and renal infection. Pulmonary infection is the most common form of mucormycosis recognized in patients with hematological malignancy and remains the second most common presentation after rhinocerebral infection in diabetic patients. Its presentation in the lungs may mimic cavitary diseases like tuberculosis, mass lesions as in malignancies and non-resolving pneumonias. Here we report a case of isolated pulmonary mucormycosis in an uncontrolled diabetic male patient with a cavitary lesion. Diagnosis was made with a bronchoscopic biopsy and treatment was completely medical with liposomal amphotericin B.
Head neck neuroblastoma in early childhood: a rare case report
Authors: Das Amit Kumar , Sengupta Prashant , Singh Richa , Kihemba Kas
Published: November 2017

Neuroendocrine tumors (NETs) comprise a heterogeneous group of malignancies from cells derived from the neural crest with neuroendocrine differentiation. Neuroblastoma is an embryonal malignancy of the sympathetic nervous system arising from neuroblasts (pluripotent sympathetic cells). It can be sporadic or nonfamilial in origin. Despite the differences in the site of origin, nomenclature, biological behaviour, and functional status, NETs share certain immunohistochemical and ultrastructural features. NETs are relatively rare tumors with an annual incidence of 6 new cases per 100000 inhabitants. It is primarily a tumor of abdominal origin from where it metastasizes to lymph nodes, liver, orbital sites, and central nervous system.  Head and neck NETs are uncommon. We report a rare case of neuroblastoma in a 3-year-old child presenting with an unusual large fungating mass in left parotid region.
Giant prostatic hyperplasia: surgical treatment a rare case
Authors: S. Gadhvi Ashwin , I. Gadhvi Udit , B. Thakkar Nimesh , D. Shah Nidhi , V. Patel Nirav
Published: November 2017

We report a rare case of giant prostatic hyperplasia in an 80-year-old male patient. MRI revealed a markedly enlarged prostate measuring 814gm.We have performed suprapubic open prostatectomy (Transvesical). The adenoma was completely enucleated in one piece which was 11cm×16cm in size and weighed 504gm.
Bilateral ruptured tubal pregnancy: a case report
Authors: Kour Gagandeep , Dhar Tapasya , Jaiswal Shristi , Sobti Vijeta , Isaacs Roma
Published: November 2017

The infrequency with which Bilateral Tubal Pregnancy (BTP) occurs makes it a rare entity with an estimated incidence of 1 in 2,00,000 of all pregnancies and about 0.1 percent of all ectopic pregnancies. In the last few decades enhancement in the rate of occurrence has been reported in literature which has been attributed to Assisted Reproductive Technology (ART), Intra-Uterine Devices (IUD) and Pelvic Inflammatory Diseases (PID). We report a case of ruptured BTP where rupture of one tube preceded the rupture of contralateral side by approximately 3 weeks. 30 years old G4P2L1A1 presented with complaints of nausea and vomiting, vaginal bleeding and pain lower abdomen. There was no history of ART, IUCD or PID. A presumptive diagnosis of ruptured tubal pregnancy was made on the basis of clinical examination and ultrasound findings and patient was taken up for laparotomy. There was a right tubo-ovarian mass with bleeding from ruptured tube. Right salpingo-oophrectomy was done. Left tube on examination revealed a mass with a bleeding rent. Left salpingectomy was done because of extensive damage. Bilateral ruptured tubal ectopic pregnancy was confirmed on histopathological examination. BTP is likely to be missed even during USG as was in this case. This emphasizes the need to thoroughly examine pelvis for any other ectopic gestation during laparotomy.
Dengue fever presenting as acute pancreatitis
Authors: Kumar Surendra , Lakhiwal Rajkumar , Bhandiwad Chandrashekhar , Chhimpa Atmaram , Gupta Akhil
Published: November 2017

A 32-year-old non-alcoholic female was admitted with complaints of severe abdominal pain and was diagnosed with acute pancreatitis after blood investigations and USG of the abdomen. She had fever on the initial two days of admission, and serology tested positive for dengue. Treatment for dengue was instituted, leading to a good response and complete resolution of pancreatitis. The patient has been doing well and has had no recurrence of pancreatitis.
Catheter directed thrombolysis in management of early acute thrombotic ischemia: early experience
Authors: Ismail Osama Abdou , Al-Islam Abdelfattah Ahmed Saif
Published: November 2017

Background: To assess the effectiveness of catheter directed thrombolysis in management of early acute thrombotic ischemia.Methods: A prospective study was carried out on 18 patients (13 males, 5 females) with a mean age of 49 years (ranged from 45 - 69 years) suffered from acute thrombotic lower limb ischemia (Rutherford II- a) and submitted to catheter directed thrombolysis (CDT) using tissue plasminogen activator (TPA) between August 2015 to March 2017. The commonest thrombosed artery was superficial femoral artery (SFA). Major risk factors were diabetes and smoking (66% and 56%) respectively. The infusion method was lacing technique followed by continuous infusion.Results: Technical success was obtained in 15 patients (83%). Complementary revascularization was performed in 5/15 patients (33.3 %) by balloon angioplasty. Limb salvage rate at 6 months was (77.7%). Failure of thrombolysis occurred in 3 limbs (16.6%); one patient treated by femoro-popliteal bypass while the other two limbs ended by amputation. Regarding complications, bleeding (local groin hematoma or minimal retroperitoneal hematoma) occurred in 3 patients (16.6 %). No major bleeding was recorded. Amputation had performed in 2 cases (11%) while mortality rate within 6 months was 16.6 %.Conclusions: With proper patient selection, CDT should be considered the first-line treatment for patients with (Rutherford II- a) acute thrombotic limb ischemia.
Neurological outcome and postoperative stability after anterior cervical spine fixation by the use of cervical spine locking plate
Authors: Manzoor Ch Ali , Irshad Muhammad , Aamir Muhammad
Published: November 2017

Background: The fractures of cervical spine are divided into upper cervical spine (C1-C2) and lower cervical spine (C3-C7) also called sub axial cervical spine. Sub axial cervical injuries are common, ranging in severity from minor ligamentous strain or spinous process fracture to complete fracture dislocation with bone and ligament disruption, resulting in severe spinal cord injury. The objective of this study was to determine the neurological outcome and postoperative stability after anterior cervical spine fixation by the use of cervical spine locking plate (CSLP) attached with cancellous screws.Methods: This descriptive study was carried out in the Department of Neurosurgery, Nishtar Hospital, Multan, Pakistan. One hundred and fifteen patients fulfilled the inclusion criteria were selected. Patient of either gender more than 15 years of age and less than 60 years of age having unstable lower cervical spine injuries from C-3 to C 7 on X-ray underwent anterior cervical fixation.Results: Age range from 15 to 60 years with mean 32.34±standard deviation (SD) =12.06. The mean Frankel grading of the patients was 3.26±standard deviation (SD) =1.33. There were 97 (84.3%) male patients and 18 (15.7%) female patients. The neurological outcome was good in 107(89.6%) patients and poor in 12 (10.4%). The postoperative stability was YES in 109 (94.8%) patients and NO in 06 (5.2%). In the mode of injury there were 65 (56.5%) patients having road traffic accident, 41 (35.7%) patients having fall from tree/roof/stairs, 6 (65.2%) patients having fall of brick on the patient, 1 (0.9%) patient having Buffalo hit/animal contact, 2 (1.7%) patient having contact of head at floor of swimming pool after jumped in.Conclusions: It is concluded from this study that good results were achieved with the use of the CSLP. The use of anterior approach in treatment of the injured lower spine is safe and effective.