bluuebunny/crossref_metadata_2025 huggingface dataset:
Intra-operative factors responsible for conversion of laparoscopic cholecystectomy to open cholecystectomy in a tertiary care center
Authors: Saeed Anam , Salim Mohammed , Kachhawa Devi Singh , Chaudhary Renuka
Published: April 2020

Background: Laparoscopic cholecystectomy is the gold standard treatment for symptomatic cholelithiasis and has multiple advantages over open approach. With increasing skills and techniques over the years, the contra-indications to laparoscopic cholecystectomy have reduced. Even after careful selection of appropriate candidates for laparoscopic cholecystectomy, it sometimes becomes necessary to convert into an open cholecystectomy to prevent complications. This study was undertaken so as to identify the intra-operative factors necessitating conversion of laparoscopic cholecystectomy to open cholecystectomy.Methods: In this study conducted at S. P. Medical College and P. B. M. Hospital, Bikaner, over a period of 1 year, 100 consecutive patients with symptomatic cholelithiasis, planned for laparoscopic cholecystectomy were included. Laparoscopic cholecystectomy was performed and cases which could not be completed laparoscopically were converted to open cholecystectomy via right subcostal incision. Intra-operative factors necessitating conversion were observed and analyzed.Results: The incidence of conversion was found to be 7%. The most common intra-operative factor for conversion was dense adhesions at the Calot’s triangle (71.43%) followed by obscure anatomy (42.86%). Uncontrolled bleeding and CBD stones also led to conversion. The identification and appearance of CBD and achievement of critical view of safety were significant factors for conversion to open cholecystectomy (p=0.0001).Conclusions: The rate of conversion to open cholecystectomy was 7% which is comparable to similar studies. Conversion is not a failure or complication but actually a safer alternative to ensure completion of the procedure without any real complications of laparoscopic cholecystectomy- biliary or visceral injury, haemorrhage, etc.
A comparative study of foot infections in diabetic and non-diabetic patients with reference to etiopathogenesis, clinical features and outcome
Authors: Reddy M. Venkata , Deep K. Varun , P. Inamdar
Published: April 2020

Background: Infections in the foot are more common with significant proportion of world’s population remaining bare foot, minor skin trauma is a frequent cause of local infection. The present study was conducted with an aim to study various foot infections and compare the findings in diabetic and non diabetic patients with reference to etiopathogenesis, clinical features, management, duration of hospital stay and outcome.Methods: The present study was conducted in Mamata General Hospital, Khammam, Telangana state from October 2016 to September 2018. A total of 50 cases were divided into 2 groups, Group A included 25 patients with diabetic foot infection and Group B included 25 patients with non diabetic foot infections.Results: In diabetics 6th decade and in non-diabetics 4th-6th decade was the most common age group presenting with foot infections. Cellulitis of the foot was the most common in both diabetics (40%) and non-diabetics (52%). Wagner’s grade 4 lesions were more common in diabetics (28%) than in non-diabetics (8%). The most common site of lesion in diabetics was dorsum (40%) and in non-diabetics was toes (40%). The incidence of neuropathy was significantly higher in diabetics (72%) than in non-diabetics (20%). Rate of amputation was high in diabetics (12%) compared to non-diabetics (8%). The average number days in a hospital stay in diabetics was 42.27 days and in non-diabetics it was 28.96 days.Conclusion: Diabetic patients have increased severity of infections, delayed healing process, need more active interventions. As compared to the non-diabetic patients, they do show high risk of amputations and prolonged hospital stay.
Management of pilonidal sinus disease with Limberg flap: our experience
Authors: Singh Mahavir , Dalal Saish , . Baleshwar , Raman Sethu
Published: April 2020

Background: Pilonidal sinus disease is a common disease of young adults. The management of the sacrococcygeal pilonidal sinus varies from conservative measures to various surgical procedures. The main concern for the treatment to the patient is the recurrence. Although several methods have been described all have been associated with high recurrence rates. This study was carried out to evaluate the advantages, results of rhomboid excision and limberg flap reconstruction in the management of pilonidal sinus disease.Methods: This prospective study was conducted in General Surgery department of a tertiary care centre of Haryana. It includes 29 patients who were treated for pilonidal sinus disease by Limberg flap surgery from January 2015 to January 2019.  Results: All patients were successfully treated with minimal postoperative discomfort. Only two patients developed seroma which was managed conservatively and in two patients there was slight flap tip necrosis which was also managed conservatively. Rest all other patients wound healed nicely with minimal scarring, with very less postoperative pain, with no recurrence so far.Conclusions:Limberg flap is very effective treatment for pilonidal disease. It has many advantages as it is easy to perform and design, and it flattens the natal cleft with large vascularized pedicle, sutured without tension. This in turn maintains good hygiene, reducing the friction, preventing maceration, and avoiding scar in the midline. The technique is easy to perform in quick time, useful in both primary and recurrent diseases, with very low complication and recurrence rate. Other advantages are quick healing time, short hospital stay, and early return to daily life.
Early debridement with physiotherapy for prevention of postburn contracture of neck: a case series
Authors: Bakhshi Girish D. , Marathe Aditya B. , Kamat Chirag , Hussain Khadeija
Published: April 2020

Hypertrophic scars and contractures are well known sequelae after burns. They result in high morbidity in severely burned patients who are surviving. Present case study was done to establish the usefulness of early debridement and physiotherapy in preventing these sequelae. Present study was conducted on patients admitted in a tertiary care hospital on patients with alleged history of thermal burns to neck and upper chest over a period of 6 months. These patients were subjected to early debridement, daily dressings and early neck physiotherapy. They were assessed for neck mobility and development of neck contracture. Three patients were studied, two had a favourable outcome due to adherence to above measures while one developed contracture due to her late presentation and non-compliance to early physiotherapy. Post burn contractures are common sequelae of thermal burns involving the neck region. Early Debridement, daily dressing of the raw areas with starting of early neck physiotherapy are important and prove beneficial in preventing neck contractures with early return to normal daily activity.
Primary omental infarction: a report of a series of cases in an Indian tertiary care hospital
Authors: Ray Ruru , Sunny Ann , Ashwath Giridhar , Rozario Anthony Prakash , Sima Rahul
Published: April 2020

Primary omental infarction is a relatively rare and often presents as right sided abdominal pain. It is often diagnosed as appendicitis and is usually picked up intra-operatively, or - as often seen nowadays - on imaging. We describe a series of four cases of primary omental infarction that presented to us with varying clinical features. Three of them had a short history of right sided abdominal pain, whereas the fourth patient had a longer history of left sided abdominal pain. All 4 were managed operatively, with the fourth having presented with an intra-abdominal abscess that required laparotomy. Primary omental infarction is a diagnosis which must be considered in any case of acute abdomen. Cases diagnosed with certainty on imaging may be managed conservatively but must be followed up closely. Need for surgical intervention should be considered in select cases.
Pancake kidney with single draining ureter: a rare developmental anomaly
Authors: Ahmad Shabi , Mishra Vikas , Mishra Shirish
Published: April 2020

Pancake kidney is one of rare form of congenital developmental anomaly of kidney. Very rarely it is drained by a single ureter. We are reporting a case of pancake kidney with a single draining ureter. The diagnosis was made during the routine workup for abdominal pain and UTI in a 12 year old male child. Usually pancake kidney may be associated with other congenital malformation but in our case we did not find any. Pancake kidney is managed surgically as well as conservatively depending upon the presenting symptoms and problem. This case was managed conservatively for recurrent UTI.
Role of punctal plugs as a primarily treatment modality in moderate to severe dry eye
Authors: Kumar Sonali V.
Published: April 2020

Background: In dry eye syndrome tear film disrupts which lead to ocular discomfort. Treatment of dry eye is very challenging and time consuming. Multiple treatment options are available for treating dry eye and one of them is punctal plugs. It blocks the drainage of tear by occluding puncta which helps in the preservation of natural tears on the ocular surface and relieve dry eye symptoms. This study was conducted to assess the safety and efficacy of punctal plugs as a primary treatment modality in moderate to severe dry eye.

Methods: Fifty patients were included in this study and they were divided into two groups. In group A which included 25 patients punctal plugs were inserted and in group B (25 patients or 50 eyes) artificial tear drop was prescribed. The primary treatment outcome was the improvement in dry eye symptoms and secondary outcome was Schirmer test score, tear break up time and rose bengal staining score.

Results: There was drastic improvement in dry eye symptoms in group A (punctal plugs) compared to group B (artificial tear group). Schirmer test score, tear break up and rose bengal staining score also improved in punctal plug group.

Conclusions: This study has shown that punctal plug can be used as a primary treatment modality in moderate to severe dry eye as it improves greater symptomatic relief and also improves the condition of damaged ocular surface.
Community case management of chest indrawing pneumonia in children aged 2 to 59 months by community health workers: study protocol for a multi-country cluster randomized open label non-inferiority trial
Authors: Nisar Yasir Bin
Published: April 2020

Background: The World Health Organization (WHO) integrated management of childhood illness (IMCI) protocol recommends treatment of chest indrawing in 2-59 months old children with oral amoxicillin by trained health facility workers. Whereas, the WHO/UNICEF integrated community case management (iCCM) protocol recommends referral by community level health workers (CLHWs) to a health facility. This study aims to evaluate whether CLHWs can treat chest indrawing pneumonia effectively and safely.

Methods: This multi-centre cluster randomized controlled open label, non-inferiority trial will be conducted in Bangladesh, Ethiopia, India and Malawi. All sites will use a common protocol with the same study design, participants, intervention, control and outcomes. CLHWs will identify 2-59 months old children with chest indrawing. Study supervisors, trained in the iCCM protocol, will confirm CLHWs’ findings. Pulse oximetry will be used to identify hypoxaemic children. In the intervention group, enrolled children will be treated with oral amoxicillin for 5 days, and in the control group they will be referred to a health facility, after providing first dose of oral amoxicillin. An independent outcome assessor will visit each enrolled child on days 6 and 14 of enrolment, to assess study outcomes.

Conclusions: If CLHWs can effectively and safely treat chest indrawing pneumonia in 2-59 months old children, it will increase access to pneumonia treatment substantially, as in many settings, health facilities and trained health workers are not easily accessible. Moreover, this evidence will contribute towards the review of the current iCCM protocol and its harmonization with the IMCI protocol.

Trial Registration: The trial is registered at AZNCTR International Trial Registry as ACTRN12617000857303.
Clinical features and risk factors for diabetic ketoacidosis in type 1 diabetes mellitus at tertiary care centre, Maharashtra, India
Authors: Gaikwad Vijaykumar , Deshmukh J. K. , Deshmukh Prachi , Takalkar Anant A.
Published: April 2020

Background: Diabetes Mellitus is increasing in incidence, prevalence and importance as a chronic disease throughout the world. The International Diabetes Federation projects that by 2030 there will be 438 million people with diabetes on a global scale. Three essential components of Diabetic Ketoacidosis are hyperglycemia, ketosis, and resultant metabolic acidosis.  4% of all patients with diabetes and 20% of those with Type 1 Diabetes are admitted to hospital with manifestations of ketoacidosis. Objectives was to study clinical profile of patients presenting as Diabetic Ketoacidosis.Methods: It is a descriptive observational study was conducted at Department of Medicine, Dr. Shankarrao Chavan Medical College and Hospital, Nanded. The study included 77 patients of diabetic ketoacidosis (DKA) from Male Medicine ward, Female Medicine ward, Medical Intensive Care Unit. The study was carried out during Jan 2012 to October 2013. The data was analyzed using SPSS 24.0 version.Results: Majority of the subjects were from 10-20 years age group i.e. 31(40.3%). 51.9% were males and 42.9% were females. 38(49.4%) have onset of Diabetes type 1 between 10- 20 years of age and mean±S.D.20.11±7.09yrs. Most common symptoms at the time of admission were abdominal pain in 54(70.1%), vomiting in 52(67.5%), nausea in 41(53.2%) and fatigue in 40(51.9%) patients. Most common risk factor for DKA was found to be infections in 36(46.8%) patients.Conclusions: Most common clinical features of Diabetic Ketoacidosis were abdominal pain, vomiting, nausea and fatigue. Most common risk factor for Diabetic Ketoacidosis was infection followed by omission of treatment or irregular treatment. The most common infections were due to urinary tract & respiratory tract infections.
Correlation between plasma myeloperoxidase and hs-troponin I, C-reactive protein and CKMB in acute coronary syndrome
Authors: M. Anusha A. , Rajan Sinju , T. Annamala P. , T. Govindanunni
Published: April 2020

Background: Acute coronary syndrome (ACS) is a group of clinical syndromes ranging from unstable angina pectoris to acute myocardial infarction (AMI) and death. Early prediction of ACS is frequently a challenging task. Myeloperoxidase is involved in oxidative stress and inflammation which plays an important role in the pathogenesis and course of ACS.Methods: The study was conducted in 30 male patients in the age group 20 - 80 years who were diagnosed as ACS and admitted to CCU. Twenty age matched normal subjects were taken as controls. Plasma MPO, hsTnI, hsCRP, CKMB, lipid parameters, urea, creatinine, glucose, AST and LDH were estimated in  patients and control subjects.Results: Plasma MPO level was found to be 155.5±19.5 ng/ml and 62.4±11.8 in ACS patients and normal controls respectively and that of hsTnI was 133.3±10.1 ng/L  and 20.7±1.8 ng/L, hsCRP to be 13.1±1.38 mg/L and 0.51±0.12 mg/L, CKMB to be 166.3±16.7  ng/dl and 12.8±1.51 ng/dl respectively. The values plasma of glucose, cholesterol, triglycerides, HDL-cholesterol, LDL-cholesterol, urea and creatinine were found to be slightly elevated in patients but, were not statistically significant when compared to controls. AST and LDH showed statistically significant increase in patients compared to controls. Direct linear correlation was observed between plasma MPO level and hsTnI, hsCRP and CKMB levels.Conclusions: Plasma MPO which is a predictor of early cardiovascular events and also severity of myocardial damage linearly correlates with the values of hsTnI, hsCRP and CKMB.
Correlation of fibrinogen level with lipid profile in type 2 diabetes mellitus
Authors: Desai Venkatesh Amalappa , . Chandrakala , Takalkar Anant A.
Published: April 2020

Background: Increasing evidence from epidemiological studies suggest that elevated plasma fibrinogen levels are associated with an increased risk of cardiovascular disorders especially in diabetic patients. Objective was to correlate fibrinogen levels in patients of type-2 diabetes mellitus with lipid profile.Methods: It is a descriptive observational study conducted among type-2 diabetes mellitus patients at Khaja Bandanawaz Institute of Medical Sciences, Gulbarga in year 2011. Newly detected type-2 diabetic patients with and without associated hypertension of more than 40 years of age belonging to both sexes were included.Results: Total 104 patients were involved in our study. Of which 75 were males and 29 females. There was a significant positive correlation between plasma cholesterol level and plasma fibrinogen level. The patients who had serum triglyceride level between 100-149 mg/dL had plasma fibrinogen level about 4.19±0.1 g/L and those with serum triglyceride level more than 400 mg/dL < had 9.01±0.83 g/L plasma fibrinogen level.  Significant positive correlation between serum triglyceride level and plasma fibrinogen level found. 36 patients with HDL level 35-39 mg/dL had plasma fibrinogen level of 5.9±1.50 g/L. So, there was a significant negative correlation between serum HDL and plasma fibrinogen level.Conclusions: The present study showed positive correlation between serum cholesterol level, LDL level and triglyceride level with plasma fibrinogen levels. There was inverse relation with HDL level.
Renal cell carcinoma at the time of presentation: a 5-year radiological survey at a tertiary care cancer hospital
Authors: Altaf Muhammad Omer , Riaz Asma , Shafqat Mehreen , Zahra Hamd , Iqbal Naila , Iftikhar Aamer
Published: April 2020

Background: Renal cell carcinoma (RCC) is associated with highest mortality rates of all the genitourinary tumors with increased incidence in the past few decades. It is heterogenous tumor with several histological types. Main diagnostic approach is radiological imaging followed by histopathology.Methods: It is a retrospective study conducted at a tertiary care cancer hospital in Pakistan. We reviewed the record of all the RCC patients in terms of age, gender, radiological manifestation of tumor size, polarity, laterality, stage including nodal status, metastasis and histological type.Results: Our study included 149 patients of RCC. Mean age of presentation was 57 years with a male predominance. The most common stage of presentation was stage 3 seen in 41% patients followed by stage 1 in 37% patients. nodal metastasis was observed in around 13% patients and distant metastasis in 8% patients. Also, majority of the patient had histological subtype of clear cell CA (63%) followed by papillary CA (33%).Conclusions: Epidemiological features of renal cell CA are observed over a period of 5 years representing our population. The current trends show variation from those observed in developed countries depicting the struggle of healthcare awareness in developing countries.
Perceptions and opinion of the medical students about the National Medical Commission Act: a cross sectional study from a medical college in North Kerala
Authors: M. Madhusudan , Varghese Arun , V. Akhil Raj , A. Afreen , K. Mohammed Anees , Siddique Numan , Thomas Tessy
Published: April 2020

Background: The National Medical Commission (NMC) Act, 2019 has come into force from August 2019 with the aim of addressing the shortcomings in the process of regulating medical colleges in the country and also in the wake of allegations of corruption against the 63-year-old Medical Council of India. However, it has been criticized for various reasons viz., it is over-centralized, it would lead to increased profiteering, corruption etc. In this context the present study was undertaken to find out the perceptions and opinion of the medical students about the NMC act.Methods: This was a cross-sectional study done at a Medical College, Wayanad District, between August-January 2019. All the undergraduate medical students of the college were the study subjects. Data was collected using a predesigned and pretested self-administered questionnaire. The subjects were asked to give response to questions pertaining to NMC on a Likert scale of 1 to 5. Completed responses were obtained from a total 655 students.Results: The subjects strongly agreed with the 6 limitations of the NMC (median score 1) and agreed with 9 (median score 2) out of the total 15 limitations. The number of subjects agreeing (agree and strongly agree) was highest [574 (88.3%)] for “NMC is over-centralized”.Conclusions: The subjects agreed (strongly agree+agree) to all the limitations of the NMC. There was no disagreement to any of the limitations.
Coverage evaluation of the universal immunization program in Imphal-East district of Manipur: a cross-sectional study
Authors: Ingudam Dayananda , Singh Heisnam Kulabidhu , Devi Longjam Usharani
Published: April 2020

Background: For the state of Manipur, the evaluated coverage among children as per NFHS-2, NFHS-3 and NFHS-4 were 42.3%, 46.8% and 65.9% respectively. But with the introduction of Mission Indradhanush in December 2014 which aimed in achieving the full immunization coverage to all eligible children over the next five years through special catch-up drives might have helped in improving the coverage. Hence, some improvement is expected by now. To ascertain the current status, the study was taken up. The current study was conducted to evaluate the primary vaccination coverage among children aged 12-23 months. The study also aimed to determine any association between important background characteristics with the vaccination status.Methods: A cross-sectional study was conducted in Imphal East District, Manipur during May 2017 to April 2020 among mothers having 12-23 months old children. 1,309 eligible study-women were selected by using multi-stage sampling technique. Data on their background characteristics, immunization status of the children and vaccination-related details were collected by using a pre-tested interview schedule.Results: The full immunization rate among children was found to be 93%. There was significant association between the immunization status and important background characteristics like place of delivery, order of birth, family income and mother’s educational status.Conclusions: Present study indicated that the full immunization coverage of the district was higher than the national and regional coverage findings. Place of delivery, order of birth, family income and mothers’ low educational status were found to be significantly associated with full immunization coverage.
Prevalence and determinants of hypertension and diabetes mellitus in an urban area of Coimbatore
Authors: Jayaraj Naveen Prabhu , Shanmugam Jeevithan , Duraisamy Shanmugapriya , Padmavathy Loganathan
Published: April 2020

Background: Owing to change in behavior and lifestyle patterns, diabetes mellitus and hypertension are in increasing trend worldwide. They are associated with various complications resulting in high morbidity. Early detection of these would necessitate the prevention of complications associated with it and improves the quality of life of the people. The objective of the study was to assess the prevalence and determinants of diabetes mellitus and hypertension among urban population in the field practice area of a tertiary care hospital in Coimbatore.Methods: 299 individuals of both sexes belonging to six wards in the field practice area of a tertiary care hospital in Coimbatore were randomly selected and screened for diabetes mellitus and hypertension. Diagnosis was based on American Diabetic Association and JNC 7 guidelines for diabetes mellitus and hypertension respectively. Data on various factors associated was collected using pretested validated semi structured questionnaire.Results: Overall prevalence of diabetes mellitus and hypertension was found to be 32.44% and 38.8% respectively with newly diagnosed diabetes mellitus and hypertension of 4.02% and 7.37%. Overall adherence was found to be 80%. Factors such as elderly age, sedentary life style, non-vegetarian diet, obesity are found to be associated with both diabetes mellitus and hypertension.Conclusions: Almost one in every third person found to be having either diabetes mellitus/hypertension or both with 20% non-adherence to treatment. This high prevalence necessitates the need for adoption of various strategies to combat the risk factors and to promote healthy life style.
Exposure to electronic gadgets and its impact on developmental milestones among preschool children
Authors: V. Roopadevi , B. S. Shravanti , Karinagannanavar Aravind
Published: April 2020

Background: The wellbeing of the children including their physical, mental, psychological growth and development and their opportunity to achieve full potential as adults is very important. But there are several factors which affect the normal development of the children. TV, mobiles, video gaming, DVD’s and other forms of electronic gadgets have become pastimes among preschool children. Thus, this study is planned to know the exposure of electronic gadgets and its impact on the developmental milestones among preschool children.Methods: A cross sectional study was conducted at Gadag among 240 preschool children of age 2-5 years attending School. The data was collected from April 2018 to October 2018. Information was gathered from parents and teachers by using pretested semi-structured questionnaire. Frequencies, percentages and chi-square test were used in analysis.Results: In this study children using most common electronic gadgets were mobile and television for less than one hour followed by 1-2 hours usage. On an average each family had 5 members possessing 6 electronic gadgets and 3 mobiles. Majority of the children started using electronic gadget for the first time at 13-24 months. Authors found that there was significant association between electronic gadget usage and personal and social development.Conclusions: The most commonly used electronic gadgets were mobiles and television and, in this study, there is an association between total duration of electronic gadget usage and personal and social development.
Knowledge, attitude and practice of fathers about childhood immunization: a tertiary care hospital based cross sectional study
Authors: Jose Swetha E. , Joseph Navya C. , Sheela Soorya , Joshy Vidhu M.
Published: April 2020

Background: Immunization is globally recognized as one of the most powerful, safe, and cost-effective for the prevention/control of some childhood diseases. Father's involvement is essential for the successful immunization of the child, as man is the head of the family and he takes responsibility for all decision’s measures including health and financial issues. Fathers having good knowledge of RI are likely to encourage their children to assess immunization services. This study thus aimed at assessing the knowledge, attitude and practice of fathers, uptake of RI and its associated factors. To assess the knowledge, attitude and practice of fathers about childhood immunization.Methods: After obtaining institutional ethical clearance we interviewed 110 fathers who have children within the age group 9 months to 2 years who attended the pediatric OP and their knowledge, attitude and practice about immunization was analyzed.Results: Out of 110 fathers interviewed majority come from joint family (91.8%) and had secondary education only (42.7%). Majority were skilled workers (65.5%). Only 0.9% had child death in their family and only 2.7% had a history of vaccine preventable disease in their family. Only 10.9% had good knowledge, 99.09% had good attitude and only 32.7% had good practice.Conclusions: It was found that majority of fathers had poor knowledge and practice about childhood immunization. More awareness programs have to be done in order to improve the routine immunization.
Knowledge, attitude and practices regarding snakes and snake bite among students of industrial training institute in tribal area of Maharashtra
Authors: Chandrachood Mandar V. , Chavhan Snehal P.
Published: April 2020

Background: Snake bite is an important public health issue and an occupational hazard in India often faced by farmers and villagers. Most vulnerable are people in rural and tribal area but they are poorly informed about the snake bite. This study was undertaken with objective of assessing the knowledge, attitude and practices regarding snakes and snake bite among students of Industrial Training Institute (ITI) in tribal area.   Methods: A cross sectional study was conducted in all students of the institute to assess the knowledge, attitude and practices regarding snakes and snake bite. Data was collected in a predesigned and pretested proforma by oral questionnaire method and was analyzed by SPSS software using descriptive statistics and appropriate statistical tests of significance.Results: Knowledge about identification of snakes was low. Most correctly identified snake was spectacled cobra (92.3%). Snakes are fond of milk was the most prevailing myth (60%). There was inadequate knowledge about proper first aid and treatment measures of snake bite. Participants from urban area and having higher secondary education had significantly higher knowledge, (p=0.015, p=0.025 respectively).  Conclusions: Participants had inadequate knowledge about identification of snakes with various prevailing myths. Most of the participants were not aware of proper first aid measures but all knew that the patient should be taken to a hospital. There is a need to educate rural and tribal population about snakes and about first aid and treatment measures for snake bite.
Molecular analysis and prenatal diagnosis of β thalassemias in the Saurashtra region of Gujarat
Authors: Sorathiya Varsha P. , Colah Roshan B. , Vachhani Nishith A. , Nandani Sanjeev L. , Vekariya Daya J. , Kashiyani Heena N.
Published: April 2020

Background: Hemoglobinopathies pose a significant health burden in the Saurashtra region in western India. Identifying couples at- risk of having a child with a severe hemoglobin disorder prenatally can help in counseling with the option of prenatal diagnosis.Methods: All pregnant carriers of β thalassemia were advised to screen their husbands. If both were carriers, they were counselled to undergo prenatal diagnosis. Prenatal diagnosis was done in 174 couples. Chorionic villus sampling was done at 10 to 12 weeks gestation and the tissue sample was sent to the Genetic laboratory for DNA analysis along with blood samples of the parents. If the couple came after 14 weeks of pregnancy, amniocentesis was done and amniotic fluid was sent for DNA analysis. If the fetus was affected, the option of termination of the pregnancy was given.Results: In 50.5% of couples, the fetus was a carrier of β thalassemia, in 1.7% the fetus had hemoglobin E trait and in 23.0% the fetus was normal.  In 20.6% of couples, the fetus had β Thalassaemia major and after counseling, these couples opted for termination. 1.2% of couples had a fetus which was unaffected but remained in distinguished (normal/thalassemia carrier) while in 0.6% of cases the fetus had sickle-β thalassemia. In 1.2% of cases the result was inconclusive. In 1.2% of cases the results were not available for lack of follow up.Conclusions: Screening antenatal women for identifying carriers and referring couples at-risk for prenatal diagnosis helped in preventing the birth of 36 thalassemia major children.
Outbreak of kala azar: our experience in South Sudan
Authors: Pardal Maninder Pal Singh , . Rajiva , Orkeh Godwin O.
Published: April 2020

Background: Worldwide kala azar affects around 500,000 people every year with at least 50,000 deaths annually. Gedaref state in east Sudan is the epicentre of visceral leishmaniasis in east Africa. Objectives of this study were to describe the outbreak of kala azar in South Sudan, from August 2009 to July 2010, in terms of person and time distribution and to describe the outbreak of kala azar in South Sudan, from August 2009 to Jul 2010, in terms of frequency of various clinical features and outcomeMethods: A prospective cross-sectional descriptive study conducted at South Sudan with cases of kala azar affected during an outbreak in South Sudan from August 2009 to July 2010. Statistical analysis was percentage.Results: This outbreak indicates the emergence or re-emergence of kala azar in South Sudan. Within the restrictions on movement because of the civil war, further research is needed to investigate the extent of the transmission zone and whether other populations in South Sudan have been infected and have no access to treatment.Conclusions: There is lack of awareness regarding dog bite and its management among the rural population.
Functional outcome of tibial plateau fracture managed conservatively
Authors: Rijal Anubhav , Rajthala Aashish
Published: April 2020

Background: Tibial plateau fractures involve the articular surface of the proximal tibia. They account for approximately 1% of adult fractures. A number of articles have been published regarding tibial plateau fracture management. Interestingly excellent results have been published concluding not all fractures of the tibial plateau require surgery and not all displaced intra-articular fractures need to be reduced surgically. In this method we used conservative method to restore normal joint anatomy, joint stability, and functional motion and avoid complications.

Methods: This study design is prospective study including forty randomly selected cases of diagnosed tibial plateau fracture presented in Orthopaedic department of tertiary referral centre over 18 months period and treated with conservative method. The patients then were followed up and evaluation of outcome was analyzed as per modified Rasmussen clinical criteria and radiological criteria at six months.

Results: In this study, tibial plateau fracture was seen more in patients of age group 31-40 (35%). Mean age being 41.25 years. There were 28 (70%) male and 12 (30%) female. Road traffic accident comprises the majority of cases (75%). Regarding radiological outcome, 41.5% had excellent result, 34.3% had good result, 8.5% had fair result and 15.7% had poor result. 84% had acceptable outcome. The Rasmussen’s functional outcome at final follow up was 46% patients had excellent result, 30% had good result, 12% had fair result and 12% had poor result. 88% had acceptable clinical outcome.

Conclusions: Conservative management of tibial plateau is still a reliable, inexpensive and alternative treatment option with favourable functional outcome.
Dyskurs o wielokulturowości Lublina w lokalnej prasie
Authors: Szulich-Kałuża Justyna
Published: April 2020

Zasadniczym celem podjętym w artykule jest charakterystyka medialnego dyskursu o wielokulturowości w mediach lokalnych i pytanie, czy dyskurs przyczynia się do jakościowych, pozytywnych zmian w sferze społecznej, ekonomicznej, środowiskowej i budowania społeczeństw opartych na wartościach w pełni demokratycznych. W szczególności interesują mnie dwa zagadnienia: środki językowe w tworzeniu dyskursu o wielokulturowości oraz kategorie tematyczne i znaczeniowe definiujące wielokulturowość Lublina. Materiał badawczy tworzą artykuły prasowe lokalnych tytułów: internetowe wydania dzienników Kurier Lubelski i Dziennik Wschodni oraz bezpłatnych tygodników lubelskich: Nowy Tydzień i Nasze Miasto. W analizach własnych wykorzystane zostały: analiza zawartości i analiza pól semantycznych.
Bases de un sistema de gestión de calidad para un centro de técnicas de reproducción asistida
Authors: Saavedra-Saavedra Jaime
Published: April 2020

El propósito de este informe es revisar aquellos factores que se deberían considerar en la evaluación de calidad total de un centro de técnicas de reproducción asistida.Metodología: se revisan las definiciones de calidad, gestión de calidad y calidad en centros de reproducción. Se revisa la percepción del cliente sobre calidad en estos centros y se describen los indicadores aceptados por las entidades internacionales de la subespecialidad.Resultados: se hace una aproximación crítica a estos indicadores con la descripción de la acreditación de este centro como ejemplo del proceso a seguir, se brindan los indicadores de la entidad.
Evaluación nutricional en un grupo de adolescentes embarazadas en Cartagena, Colombia. Estudio de corte transversal
Authors: Rivas-Perdomo Edgar , Álvarez Ruth , Mejía Gloria
Published: April 2020

Objetivo: evaluar el estado nutricional de un grupo de adolescentes embarazadas en la ciudad de Cartagena, Colombia.Materiales y Métodos: estudio de cor te transversal. Se escogieron 25 adolescentes embarazadas de una población de 40 que reciben apoyo de una fundación en Cartagena, Colombia. Se midieron variables antropométricas y bioquímicas.Resultados: se encontró un predominio de bajo peso preconcepcional con promedios por debajo del percentil 5 para la edad, reflejados en el índice de masa corporal. Se reportaron valores de hemoglobina y hematocrito tan bajos como de 7 g/dl y 20% respectivamente. También se encontró déficit de linfocitos en 50% de las mismas. Al aplicar el nomograma de Rosso-Mardones sólo el 24% de las pacientes fue normal.Conclusiones: se identificó una deficiencia nutricional en las adolescentes embarazadas. Hay una inadecuada ingesta calórica con valores entre 594-2150 Kcal./día.
Cirugía de abdomen abierto en gineco obstetricia: indicaciones, técnica y manejo
Authors: Forero Juan Carlos , Rodríguez Jorge Augusto
Published: April 2020

La cirugía de abdomen abierto para el manejo de algunas patologías severas en obstetricia ha aumentado y actualmente es común en muchas de nuestras pacientes. Los beneficios incluyen la prevención y tratamiento del Síndrome de Hipertensión Intraabdominal (HIA), de las infecciones de la cavidad peritoneal y el del Síndrome Compartimental Abdominal (SCA) secundario a enfermedades potencialmente catastróficas como la preeclampsia severa y Síndrome de HELLP. La presente revisión explora los mecanismos de infección, las consecuencias fisio-patológicas del SCA y las nuevas técnicas quirúrgicas de la cirugía de abdomen abierto para el manejo adecuado de estas entidades.
Síndrome de congestión pélvica: utilidad del tratamiento laparoscópico
Authors: Navarro Hernando , Escobar María Fernanda , Fonseca Javier
Published: April 2020

Objetivo: determinar la utilidad de la ligadura de la vena ovárica dilatada por vía laparoscópica en el tratamiento del síndrome de congestión pélvica.Tipo de estudio: ensayo clínico controlado no aleatorizado.Institución: Clínica Los Andes, Cali - Colombia.Pacientes: 70 pacientes con diagnóstico confirmado por laparoscopia de síndrome de congestión pélvica.Intervenciones: ligadura de la vena ovárica en 28 pacientes (grupo experimental) y manejo médico en 42 pacientes (grupo control).Resultados: en el grupo experimental se observó una mejoría del dolor del síndrome de congestión pélvica a los 6 meses en 26 de los 28 pacientes versus 11 de 42 pacientes en el grupo control (RR 3,41 IC95% 2,02-5,76).Comentarios: las pacientes sometidas a varicocelectomía laparoscópica tienen una mayor probabilidad de curación del dolor en el síndrome de congestión pélvica.
Tamizaje para cáncer de cuello uterino: cómo, desde y hasta cuándo
Authors: Amaya Jairo , Restrepo Sonia
Published: April 2020

Objetivo: evaluar la evidencia disponible en cuanto a tamizaje de cáncer de cuello uterino en tópicos tales como pruebas disponibles, cuándo iniciarlo, a qué intervalos, cuándo suspenderlo e indicaciones en mujeres sometidas a histerectomía por patología benigna.Metodología: se revisó la literatura publicada entre enero de 1999 y diciembre de 2003 en MEDLINE, PROQUEST y revistas que usualmente publican artículos referentes al tema, como el British Medical Journal, The Lancet y JAMA.Resultados: en programas de tamizaje organizados, las campañas educativas y las invitaciones por carta son las estrategias que dan mejores resultados; pese a las limitaciones de la citología convencional, no hay suficiente evidencia para recomendar de rutina el uso de nuevas tecnologías como la citología en base líquida, pruebas de virus de papiloma humano (VPH) o la inspección visual del cuello uterino con ácido acético (IVAA). Lo importante es lograr con ésta, una cobertura del 80% y un adecuado seguimiento. El tamizaje debe iniciarse en los primeros tres años posteriores al inicio de las relaciones sexuales, con un intervalo de un año en el caso de mujeres de alto riesgo, mientras que en las de bajo riesgo se puede hacer cada 2 ó 3 años. En quienes han tenido tamizaje regular y tres o mas citologías negativas en los últimos diez años es posible suspenderlo después de los 65 ó 70 años. En mujeres que han sido sometidas a histerectomía por patologías benignas se debe individualizar el manejo y practicar evaluación citológica periódica de la cúpula vaginal en mujeres con factores de riesgo.Conclusiones: la citología cervicouterina continúa siendo el pilar en los programas de tamizaje de cáncer de cuello uterino.
Efecto del hábito de fumar sobre los resultados de laboratorio de la fertilización in vitro
Authors: Arent Adriana , Badalotti Mariangela , Machado Julia , Petracco Rafaella , Petracco Alvaro
Published: April 2020

Objetivo: evaluar la influencia del tabaquismo femenino, activo y pasivo, sobre los resultados de la fertilización in vitro (FIV) de mujeres fumadoras.Diseño: estudio de cohorte.Materiales y métodos: ciento diecinueve (119) parejas fueron sometidas a FIV, en primerintento, cuya indicación fue el factor tubario, fueron divididos en 3 grupos: mujeres no fumadoras (n=81), mujeres fumadoras pasivas (n=15) y mujeres fumadoras verdaderas (n=23). Los resultados de laboratorio de la FIV fueron analizados en separado.Resultados: las mujeres fumadoras tuvieron un bajo índice de fertilización (40,7%) y mala calidad embrionaria (70,6%) en comparación con las no fumadoras (59,1% y 82,5%) y las fumadoras pasivas (67,4% y 87,9%) (p<0,05). No se ha encontrado diferencia en el numero de oocitos obtenidos y de embriones clivados entre los grupos.Conclusiones: los resultados indican que el éxito de la FIV puede estar afectado negativamente en las fumadoras, donde el índice de fertilización es menor y la calidad embrionaria peor.
Importancia de la respuesta a la inducción de ovulación y la edad en el resultado de las técnicas de reproducción asistida
Authors: Madero José Ignacio , López Claudia , León María Fernanda , Ruiz Jair , Gutiérrez Carlos , Guerra Óscar , Avila Mábel , Escobar Magally , Ruiz Jesús A.
Published: April 2020

Objetivo: este estudio pretendió analizar la eficacia de las técnicas de reproducción asistida en un grupo de pacientes con una respuesta disminuida a la estimulación ovárica (tres folículos o menos al finalizar la estimulación ovárica) y correlacionarla con la edad.Materiales y métodos: se describen 966 casos de pacientes sometidas a fertilización in vitro o inyección intracitoplasmática de espermatozoides, de las cuales 100 tuvieron una respuesta pobre.Resultados: el grupo de las «pobres respondedoras » en un 80% de los casos correspondió a mujeres mayores de 35 años, siendo el 46% mayor de 40. El promedio de embriones transferidos fue 1,59 para el grupo de estudio y 3,47 para el grupo control, con una tasa de implantación de 11,34 y 12,34% respectivamente. La tasa de embarazo fue menor en el grupo de las «pobres respondedoras» (16,39%) comparado con el grupo control (29,62%).Conclusiones: los resultados sugieren que las pacientes con una respuesta pobre a la inducción de ovulación (tres folículos o menos) tienen mayor riesgo de un resultado adverso al someterse a técnicas de reproducción asistida por la poca producción de ovocitos, lo cual limita la posibilidad de seleccionar los mejores embriones para transferir y aumenta la probabilidad de obtener embriones con anomalías cromosómicas.
Esteroides antenatales para maduración pulmonar. ¿Curso único o cursos múltiples? una pregunta aún vigente
Authors: Vélez Gladis Adriana
Published: April 2020

Se hace una revisión de la administración antenatal de esteroides para acelerar la maduración pulmonar fetal, su origen, bases fisiológicas y utilización en la práctica clínica a través del tiempo haciendo énfasis en el examen de los posibles beneficios y riesgos de la administración de cursos repetidos. Al sopesar la evidencia e incertidumbre alrededor de los riesgos de los cursos repetidos, no se recomienda su uso de rutina en la práctica clínica.
Isoflavonas en ginecología, terapia no convencional
Authors: Bonilla Carlos Alberto
Published: April 2020

La soya y sus componentes las isoflavonas como la genisteína, daidzeína e ipriflavona son comercializados hoy en día por quienes ejercen la medicina alternativa con fines de promoción y prevención de enfermedades neoplásicas, osteoporosis, asociadas al climaterio y cardiovasculares. Diferentes publicaciones médicas presentan estudios realizados con el fin de confirmar sus beneficios farmacológicos a la luz del método científico. Aunque hay clara evidencia de sus efectos al interactuar con receptores esteroideos en el organismo humano, reconocidos por entidades como la Food and Drugs Administration de Estados Unidos, aún faltan estudios controlados para determinar su real impacto terapéutico; se deben mejorar los sesgos en las poblaciones analizadas y realizar más estudios dedicados a cada uno de los componentes de las isoflavonas por separado con el propósito de valorar su propio espectro terapéutico.
El síndrome de la plaqueta pegajosa: serie de casos en gestantes en el hospital militar central y revisión de literatura
Authors: Velásquez Alvinzy II , Carmona Vicente , Ramos Gloria
Published: April 2020

El síndrome de la plaqueta pegajosa es un desorden plaquetario autosómico dominante asociado con eventos tromboembólicos arteriales y venosos. Se caracteriza por hiperagregabilidad plaquetaria en plasma rico en adenosindifosfato y epinefrina. Clínicamente las pacientes pueden presentar angina de pecho, infarto agudo del miocardio, accidentes isquémicos transitorios, accidentes cerebrovasculares, trombosis retiniana, trombosis de arterias periféricas y trombosis venosas, frecuentemente recurrente bajo tratamiento anticoagulante oral. Se presentan cuatro casos de gestantes diagnosticadas y tratadas en la Unidad de Alto Riesgo Obstétrico del Hospital Militar Central, con pruebas diagnósticas para otros eventos hipercoagulables normales que sólo presentaban hiperagregación plaquetaria. Posteriormente se hace una revisión de la literatura.