bluuebunny/crossref_metadata_2025 huggingface dataset:
ANALISIS KELEMBAGAAN SUPPLY CHAIN AGROINDUSTRI BAWANG MERAH DI KABUPATEN SOLOK DENGAN MENGGUNAKAN METODE SUPPLY CHAIN OPERATION REFERENCE (SCOR) 10.0
Authors: Deperiky Dedet , Santosa Santosa , Hadiguna Rika Ampuh , Nofialdi Nofaldi
Published: March 2020

Penelitian ini dilakukan pada bulan Januari sampai Mei 2019. Penelitian ini bertujuan untuk mendeskripsikan struktur kelembagaan rantai pasok agroindustri bawang merah dan menganalisis kinerja rantai pasok bawang merah di Nagari Alahan Panjang Kabupaten Solok. Metode penelitian menggunakan Supply Chain Operation Reference (SCOR) 10.0. Metode pengambilan sampel secara purposive. Sampel yang diambil adalah sebanyak 50% dari populasi yaitu petani bawang merah (25 orang), ketua kelompok tani (2 orang), pedagang besar (3 orang), anak randai (3 orang) dan pedagang besar di Pekanbaru (2 orang).Hasil penelitian menunjukkan struktur kelembagaan rantai pasok agroindustri bawang merah meliputi petani – anak randai- kelompok tani - pedagang besar dan pedagang besar di Pekanbaru serta 3 aliran yang dikelola dalam rantai pasok bawang merah yakni barang, uang dan informasi. Untuk kinerja reliability yaitu 35,70, responsivness adalah 3,5 hari, nilai agility tidak dilakukan penghitungan disebabkan tidak adanya jumlah tambahan permintaan bawang merah sebesar 20% dari pelaku rantai pasok dan cost adalah 2,14 serta critical key performance indicator,s dari cost pada metrik level 1 di terjadi di tingkat petani yaitu 0,52.Saran yang diberikan adalah kelompok tani sebagai unit business harus mampu meningkatkan kinerja rantai pasok agroindustri bawang merah dengan cara semakin memperkuat kemitraan dengan pelaku rantai pasok dan pemerintah harus mensinergikan koordinasi dengan kelompok tani agar petani bisa mempunyai posisi tawar yang tinggi dalam menjual bawang merah.
PATTERN OF BIOCHEMICAL PARAMETERS IN OBESE AND NON-OBESE TYPE II DIABETIC PATIENTS ATTENDING MEDICINE OUTDOOR OF A TEACHING HOSPITAL IN KOLKATA: AN OBSERVATIONAL STUDY
Authors: Bhattacharyya Dr. Agnihotri , Kar Dr. Kaushik
Published: March 2020

Introduction: The diagnostic parameters of diabetes in obese and non obese individuals might not be always same because the physiological basis of developing diabetes in them is not similar.

Objectives: The present study has been done to assess any significant difference in the Clinical and Biochemical parameters of diabetes like Glycosylated Haemoglobin (HbA1C), Fasting and Post prandial Blood Sugar (FBS and PPBS) among obese and non obese Type II Diabetes patients.

Methodology: The present study was undertaken in the Medicine Outdoor of Calcutta National Medical College during June to August 2018 among 100 Type II Diabetes Mellitus patients of both sexes and aged 18 or above prior to an informed consent. Any significant difference in the Clinical and Biochemical parameters of diabetes among different groups of Diabetic patients as per BMI and waist circumference was assessed. Data was analyzed by standard statistical software like SPSS version 20 with proportion and percentage and using parametric and non-parametric tests like Chi-squares and ANNOVA.

Result: The study reveals that 30% of the study population has BMI 25-29.99 kg/m2, 9% has 30-34.99 kg/m2 and 3% have BMI between 35-39.99 kg/m2 and 83.67% of Males and 96.07% of females have increased Waist Circumference Complications like Diabetic Nephropathy, Retinopathy, Neuropathy and Foot ulcer etc was found in 61% of the study population. There is significant difference in mean values of Glycosylated Haemoglobin, fasting blood sugar and post prandial blood sugar in the different groups of BMI. 32.78% of patients with complications of Diabetes Mellitus have BMI>24.99 and this association is statistically significant.

Conclusion: The present study has found significant difference of the mean values of diagnostic parameters of diabetes in different groups according to Body Mass Index.  However the study was performed with the population who were already on treatment for some duration, so there can be a variation of findings in the present study from other studies done in different settings like primary care hospitals or with patients at onset of diabetes.

Key words: Diabetes, Glycosylated Haemoglobin, Fasting blood sugar, Post prandial blood sugar
SINGLE INCISION LAPAROSCOPIC ASSISTED APPENDECTOMY IN VEDANTA INSTITUTE OF MEDICAL SCIENCES, AN EXPERIENCE OF 50 CASES.
Authors: Shrivastava Dr. Rajesh Kumar P.
Published: March 2020

Introduction:  Laparoscopic appendectomy (LA) has advantage to diagnose and to also treat appendicitis at the same time also it has a less postoperative pain and a faster return to work and normal activity. In a classic LA, three to four incisions are required for trocars placement. Technique of Single Incision Laparoscopic Appendicectomy (SILA) has been developed to reduce abdominal trauma, improve cosmesis, reductions in postoperative pain and hospital stay. Aim of this prospective study was to test the feasibility, safety and potential advantages of SILA

Material and Methods: Patients over the age of 18 with a diagnosis of acute abdomen, later on confirmed to acute appendicitis based on clinical findings, imaging and laboratory tests were included in the study. Outcome of the patient was assessed in the form of operative time, length of hospital stay and postoperative complications. Prophylactic antibiotics were given pre-operatively to all the patients included in the study. Technique was evaluated for operative time, post-operative pain, post-operative length of stay and complication rate. Post-operative pain was evaluated at 12 hrs, day 1 and day 2 post-operatively by using a visual analogue scale (VAS) which ranged from 0 to 10. Patients were evaluated on the 7th and 14th postoperative day for analysis of recovery, any surgical site infection, abscess formation, abdominal tenderness and aesthetic satisfaction.

Results: Mean age in years was 27±10.48 tears. There were 22 (44%) male and 28(56%) female. Mean duration of SILA procedure was 38±3.8 minutes. Hospital stay in days was 1.8±1.1. Patient returned back to work in 9±2.4 days. Post-operative pain was evaluated at 12 hrs, day 1 and day 2 post-operatively by using a visual analogue scale (VAS) which ranged from 0 to 10. After 12 hours score was 6.5, at day 1 4.0 and at day 2 it was 1.5.

Conclusion: Single incision appendicectomy operative time is less, pain is less and hospital stay is reduced thereby increasing the patient satisfaction and this technique is effective in terms of pain and hospital stay.

Keywords: LA, SILA, VAS
CLINICAL ASSESSMENT OF OCCURRENCE OF ORAL SUBMUCOUS FIBROSIS IN PATIENTS FROM PATNA DENTAL COLLEGE & HOSPITAL
Authors: Kumar Dr. Tanoj , Rai Anurag , Kumari Dr. Minti , Rai Dr. Shweta , Kumar Dr. Avanindra , Kumar Dr. Kunal
Published: March 2020

Oral submucous fibrosis is a chronic progressive scarring disease of oral cavity and oropharynx characterized by epithelial atrophy and juxta epithelial inflammatory reaction with progressive fibrosis of the lamina propria and deeper connective tissue. The resulting stiffness of the oral mucosa then causes a progressive decrease in mouth opening. Hence based on above findings the present study was planned for Clinical Assessment of Occurrence of Oral Submucous Fibrosis in Patients from Patna Medical College & Hospital.

The present study was planned in Department of Oral Pathology, Patna Dental College & Hospital, Patna. Total 50 cases of the patient diagnosed with the Oral Sub mucous Fibrosis (OSMF) were evaluated in the present study. History, examination and investigation of patients were done in detail as per predesigned proforma. Histopathological examination of biopsy tissue from oral mucosa was done in patients who had taken pre-therapy and post-therapy (if and when required). X-ray of temporomandibular joint was requested (whenever needed).

OSMF is a commonly occurring and widely spread premalignant condition increasingly affecting the youth. The occurrence of OSMF in gutkha chewers is far faster and more severe as compared in other forms of areca nut products chewers. The easy availability and promotions of these areca nut products especially gutkha and pan masala outside the schools colleges and social places has impacted younger population in India which has led to the increased occurrence of OSMF.

Keywords: Oral Submucous Fibrosis, OSFM, gutkha, pan masala, etc.
PREVALENCE OF SICK EUTHYROID SYNDROME IN NON-THYROIDAL ILLNESS
Authors: Hambhire Dr. Dattatray
Published: March 2020

INTRODUCTION: Sick euthyroid syndrome is also known as low triiodothyronine (T3) syndrome or non-thyroidal illness syndrome which is characterized by alterations in the levels of thyroid hormones in the absence of any disorder related to thyroid gland or hypothalamic-hypophysial axis. Abnormal findings on thyroid functions tests which occur in the setting of a non thyroidal illness (NTI) without preexisting hypothalamic-pituitary and thyroid gland dysfunction. In the 1970s initially described low T3 (triiodothyronine) syndrome, known as the euthyroid sick syndrome or the nonthyroidal illness syndrome (NTIS). This can be representing especially in in critically ill patients, particularly those admitted to intensive care units. Although by definition these abnormalities are not related to intrinsic diseases of hypothalamus-pituitary-thyroid axis though rather represent imbalances in thyroid hormone production, metabolism, and action. As there is progress in illness gradual development of a more complex syndrome associated with low levels of T3 and thyroxine (T4). AIM: The main objective of this study is to study clinical profile sick euthyroid syndrome in Non-thyroidal Illness. MATERIAL AND METHODS: Total 60 patients were included in this study with the diagnosis of euthyroid syndrome with suggestive of Non-thyroidal Illness. From all the patients detail history were recorded as data as well as all the necessary lab investigations were recorded as hemogram, renal function test, liver function test, ECG, Chest roentgenogram, and thyroid function status and serum cholrine esterase. RESULT: Total 60 patients were including in this study within the period of study with different age group. Patients with age group 20-30 years age group shows majority followed by age group 30-40 years age group as 33.3% and 30% respectively. Among the 60 patients only 15 patients were observed as sick Euthyroid. Out of 15 patients with sick Euthyroid 60% showed Low T3 alone and 40% shows changes in T3, T4 & TSH Levels. CONCLUSION: Non-thyroidal illness syndrome is common among male in comparisons to female with the middle ages. Since the mechanism of sick euthyroid syndrome is similar to sick euthyroid syndrome in other critical care illnesses. Therefore more and more studies should be done for the better evaluation of the prognostic value of NTIS in critically ill.  Thyroid functions should be assessed routinely in patients for prevent of Non-thyroidal illness syndrome.

KEYWORDS:  sick euthyroid syndrome, Non-thyroidal Illness, Thyroid
A CLINICAL COMPARATIVE STUDY BETWEEN MISOPROSTOL (PGE1) AND DINOPROSTONE (PGE2) FOR INDUCTION OF LABOUR AT TERM - A PROSPECTIVE RANDOMISED CONTROLLED TRIAL
Authors: B Dr Beena. , S Dr Shyla. , Devi Dr P.K. Syamala
Published: March 2020

Background: Comparative study beween misoprostol and dinoprostone for induction of labour at term has been done at various centres which showed misoprostol to be more effective. This study was done, 18 years back in 2001, when the most common method of induction was dinoprostone. Since then both the drugs has been used equally for induction of labour at term. But in recent past, PGE1 is not being used widely because of fear of untoward effect.  Hence, the importance this article which shows misoprostol to  be more effective with less side effects, easy for storage and low cost. This study is to compare the effectiveness between the two molecules of prostaglandins PGE1 and PGE2 for induction of labour in term. The complication can be reduced by proper selection, 1 to 1 and continuous fetal monitoring.

Methods: It was a prospective RCT. 200 Women at term in whom induction of labour was indicated with no contraindications for the use of prostaglandin attending labor room in a tertiary care centre (SAT Hospital Government Medical College Trivandrum) for a period of five months, from September 1St 2000 to January 31st 2001 was chosen to compare the effectiveness of Misoprostol and Dinoprostone for induction of labour at term. Both the groups were comparable in age, parity and bishop score.

Results: Among 200, 123(61%) were primigravida and 146 (73%) were in the age group of 21 – 30 yrs. Median induction delivery interval was about 9 hrs shorter in PGE1 group. Only14.14% required oxytocin augmentation in PGE1 Group compared to 50.54% in PGE2 group. There was 8 failures in PGE2 and there was one case of hyper stimulation in PGEI group for which LSCS was done. PGE2 costs 10 times more than PGE1.

Conclusion: Misoprostol is faster acting with low induction delivery interval and requirement for oxytoccin augmentation. Misoprostol is low cost drug, affordable to most of our patient from low socio economic status.

Keywords: Term pregnancy, Tab Misoprostol, PGE1, Dinoprostone gel, PGE2, Induction of labour.
CLINICAL ASSESSMENT OF SUPRACONDYLAR FEMUR FRACTURE WITH RETROGRADE NAILING IN PATIENTS FROM BIHAR REGION
Authors: Kumar Dr. Arun
Published: March 2020

A distal femoral fracture is one of the challenging injuries to orthopaedic surgeons. Operative treatment has been the mainstay to obtain early mobilization of patients. Traditionally, stabilization has been achieved with open reduction using several kinds of plates. However, this conventional technique is not a biologic method; it requires large exposure, with its related risk of soft tissue damage, promoting devascularization of bone fragments and compromising fracture healing. [15] Based on above findings the present study was planned to study patient with distal femur fracture including both supracondylar fracture operated with retrograde femoral nail to evaluate the pre and post-surgical outcomes.

The present study was planned in Department of Orthopaedic, Sri Krishna Medical College and Hospital (SKMCH), Muzaffarpur, Bihar, from jan 2018 to December 2018. Total 650 bone injuries were reported in the hospital. From that 15 cases of the supracondylar Fracture Femur were evaluated in the present study.

The data generated from the present study concludes that retrograde intramedullary supracondylar nail is a good fixation system for the distal third femoral fractures, particularly the extra-articular type. The operative time is lessened with decrease in blood loss. Distal screw related local symptoms is a common problem, and is related to the implant and technique. Early surgery, closed reduction, at least two screws in each fragment, and early post-operative knee mobilisation are essential for good union, and good knee range of motion.

Keywords: supracondylar, distal femur, retrograde nailing, biological fixation, femur fracture, etc.
ROLE OF R.E.N.A.L NEPHROMETRY IN PREDICTING TUMOR HISTOLOGY AND GRADE OF RENAL MASS.
Authors: Gupta Dr. Manu
Published: March 2020

Background: The R.E.N.A.L.(radius, exophytic/endophytic properties, nearness of tumor to the collecting systemor sinus in mm, anterior/posterior location relative to polar lines) nephrometry scoring system was recently introduced as an objective reproducible means to describe salient renal tumor anatomy. Objective of this study is to evaluate the role of R.E.N.A.L. Nephrometry score in predicting tumor histology and grade.

 Methods: It is a prospective study carried out in Lilawati Hospital and Research Centre, a tertiary care centre consisting of 40 patients including male and female who had T1 renal mass.  Preoperative R.E.N.A.L. Nephrometry scoring  done for every patient and after treatment (Open Partial Nephrectomy, Laproscopic partial Nephrectomy, Radical Nephrectomy)  tumor sent for histopathology to predict tumor histology and grade for solid renal mass.

Results: Clear cell histology also increased with R.E.N.A.L score, from 2/6 (33.3%) in patients with low R.E.N.A.L scores ( 4–6) up to 15/17 (88.24%) for patients with high R.E.N.A.L scores( 10–12) . Conversely, the probability of the potentially more indolent papillary RCC decreased with increasing lesion complexity (from 66.67% in low score to 11.76% in moderate score).The Fuhrman grade is an important prognostic indicator for RCCs. In our study Fuhrman grade 1 tumours represented 4/40 (66.7%) low and 2(13%)high- complexity lesions . Conversely, there is no grade 3 lesion in low score (0.0%) compared with 5/40 (33.3%%) moderate complexity lesions, respectively showing more the nephrometry score higher will be Fuhrman grade.

Conclusions: Proportion with  clear cell histology also increases with R.E.N.A.L score and the probability of the potentially more indolent papillary RCC decreased with increasing lesion complexity. The Fuhrman grade also increases with increase in nephrometry score

Keywords:  R.E.N.A.L  Nephrometry score, Fuhrman grade, Tumor histology
RENAL DYSFUNCTION AND ELECTROLYTE IMBALANCE IN CHILDREN WITH BETA-THALASSEMIA MAJOR.
Authors: Goyal Gourav Kumar , Jagrwal Sameer , Gupta Kalika , Tak SK
Published: March 2020

Background: Beta-thalassemia major (β-TM), is a type of chronic, microcytic anaemia that is characterized by impaired biosynthesis of the β-globin chain leading to accumulation of unpaired α-globin chain. Due to the severe anaemia caused in Thallassemia, patient must undergo repeated blood transfusions for survival. Repeated blood transfusions lead to built-up of iron overload which is responsible for tissue deposition of excess iron, ultimately resulting in iron toxicity. There are evidences of aminoaciduria, hypercalciuria, phosphaturia, magnesiuria, hyperuricosuria, low urine osmolality, and excess urinary secretion of markers of tubular damage such as N-acetyl-D-glucosaminidase in patients with beta-thalassemia major. In the present study, authors tried to investigate the proportion of patients diagnosed with β-Thalassemia Major manifesting renal dysfunction and electrolyte imbalance.

Material and Methods: It was a hospital based case-control study involving 100 patients coming to Department of Pediatric Medicine, and belonging to the age group 1 to 18 years. Equal number of healthy age and sex matched children were taken as controls.

Results:  When cases and controls were compared with respect to albuminuria, blood pH, serum bicarbonate, phosphorus and blood urea, higher number of cases had deranged values as compared to the healthy controls [p<0.05].

Conclusion:  Renal damage and tubular dysfunctions leading to eletrolyte imbalances exist in children with β-thalassemia major.

Keywords: kidney, Thalassemia, Electrolytes, children.
ECHOCARDIOGRAPHIC STUDY OF RIGHT VENTRICLE CHANGES IN CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) PATIENTS OF DIFFERENT SEVERITY
Authors: Sharma Abhishek , Tripathi Yogesh , Yadav Berendra , Garg Rinku
Published: March 2020

Chronic obstructive pulmonary disease (COPD) characterized by interminable air flow limitation that is not fully reversible COPD includes chronic bronchitis, emphysema, and chronic asthmatic bronchitis.  Chronic obstructive pulmonary disease as a complex disease with various systemic manifestations and one of the co-morbidity linked with COPD is cardiovascular disease.  Hypoxic vasoconstriction and alterations in pulmonary microvasculature, which are both observed in COPD patients, leads to an increase in pulmonary vascular resistance. As a result, this increase in right ventricular (RV) after load causes right ventricular remodeling, including chamber dilatation and wall hypertrophy and ultimately to functional deterioration.  The aim of this study to evaluate the right ventricular changes that develop secondary to COPD using GOLD guidelines and echocardiographic findings .This cross-sectional study involved 134 patients who presented to the pulmonary disease outpatient clinic with COPD. We assessed the right ventricular changes in COPD patients of different severity using echocardiography .COPD patients shown change in the right ventricular dimensions as the severity of COPD increases and right ventricular function as well.  It is also observed that frequency of pulmonary hypertension also increased as the severity of COPD increases. The study shows high prevalence of cardiac co-morbidities such as RV dysfunction and pulmonary hypertension in COPD patients. The severity of complications increases with severity of COPD and makes a linear relation.

Keywords: Echocardiography, ECG, COPD
PREVENTING EXCESSIVE POSTNATAL WEIGHT LOSS IN HEALTHY NEW-BORNS. WILL CONTINUOUS TEMPERATURE MONITORING HELP?
Authors: Sreekumar Dr. Kavita , Nachinolkar Miss Pallavi , Silveira Dr. M.P.
Published: March 2020

Objective: To study if continuous temperature monitoring helps to prevent excessive postnatal weight loss in healthy newborns during hospital stay.

Design: Prospective randomised controlled trial

Setting: Postnatal ward of a tertiary level hospital in south-west India, between July 2018 and October 2018.

Participants: 515 healthy newborns born in the hospital during the study.

Intervention: Mothers were given the BEMPU device within 24 hours of delivery and  taught to recognize alarms and take measures to treat hypothermia when the device alarmed till the baby was discharged from the hospital. All healthy newborns born in the hospital were included in the study and random allocation was done to either the intervention or control group.  Babies who were sick and admitted in NICU and babies with congenital anomalies were excluded. 

IEC approval was obtained prior to the study. 

Outcome measures: postnatal weight loss.

Results:  515 babies were included in the analysis.  For vaginal deliveries; 163 babies were in the intervention group and 168 were in the control group. The mean lowest weight was higher and the mean weight loss was lower for the intervention group. For caesarean deliveries, 91 babies were in the intervention and 93 were in the control groups. The mean lowest weight was higher and the mean weight loss was lower for the intervention group for cesarean deliveries as well.

Conclusions: Continuous monitoring of the temperature helps to prevent excessive postnatal weight loss in healthy babies born by spontaneous vaginal deliveries.

Keywords: Hypothermia, Newborn, Temperature, Weight loss
PULMONARY HYPERTENSION IN END STAGE KIDNEY DISEASE (ESKD) PATIENTS ON MAINTENANCE HEMODIALYSIS (MHD) VIA SURGICALLY CREATED ARTERIOVENOUS FISTULA.
Authors: Jeelani Hamad , Sharma Manjuri , Parry Manzoor A. , Doley Prodip.K. , Pegu Gayatri
Published: March 2020

Background Pulmonary hypertension is a disorder which worsens systemic diseases. One of the important underlying pathology is end stage chronic kidney disease The aim of this study was to assess the incidence of unexplained PHT, and to relate this to the cardiovascular status and arteriovenous fistula characteristics in ESKD patients on maintenance hemodialysis

Methods: 159 patients with end stage kidney disease on maintenance hemodialysis were evaluated, 103 were excluded. Clinical, laboratory parameters were recorded. Systolic Pulmonary artery pressure and cardiac functions were evaluated by echocardiography. Flow across arteriovenous fistula was assessed by Doppler sonography. Patients were divided between the group with and without pulmonary hypertension. It was a cross sectional study.

Result: Out of 159 patients, 56 patients who fulfilled inclusion criteria were evaluated, 36% had systolic pulmonary artery pressure of 35 mm Hg, mean age was 52.42 ± 9.12 years, 71.4% were males, and mean duration of end stage kidney disease was 33.66 ±11.56 months. Pulmonary hypertension patients were exposed to longer duration of hemodialysis therapy (p=0.0001) as compared to the patients with no pulmonary hypertension group, they also had a longer duration of functional Arterio venous fistula (p=0.0001), and flow across Arterio venous fistula was significantly more in pulmonary hypertension group (p=0.022), and these also had higher cardiac output (p=0.0001).  Patients with Pulmonary hypertension were significantly more anemic, had more hypoalbuminemia and more interdialytic weight gain.

Conclusions:  Pulmonary hypertension is frequent in end-stage kidney disease patients on maintenance hemodialysis. It appears to be a late complication of hemodialysis with surgically created AVF with implications on cardiovascular status.

Keywords: Arterio venous fistula (AVF), End-stage kidney disease (ESKD), Maintenance hemodialysis (MHD), pulmonary hypertension (PHT).Systolic pulmonary artery pressure (sPAP)
PREVALENCE OF DEPRESSION AND ITS ASSOCIATED FACTORS AMONG PATIENTS OF CHRONIC KIDNEY DISEASE IN A TERTIARY CARE HOSPITAL FROM ASSAM: A CROSS-SECTIONAL STUDY.
Authors: Jeelani Hamad , Parry Manzoor A. , Dange Shruti
Published: March 2020

Background: Chronic kidney disease (CKD) patients are at high risk of depressive disorders because of considerable psychological stress due to physical and social changes brought on by disease. The aim of this study is to assess the prevalence of depression in patients with CKD and the factors affecting it at a public tertiary care hospital.

Methods: This cross-sectional study was carried out at the renal clinic of a tertiary care hospital. Data on 629 patients diagnosed with CKD from September 2014 to April 2016 was obtained. Nine-item Patient Health Questionnaire from PRIME-MD was used to assess the depression.

Results: Of all the patients, 44.7% had depression. Mild depression was found to affect 28.9% of the patients followed by moderate depression and severe depression (15.4% and 0.4%, respectively). According to multiple logistic regression, the occurrence of depression was significantly higher with age below 60 years [odds ratio (OR) 1.5, 0.9–2.7; P<0.05], male gender (OR 1.4, 1.0–3.1; P<0.05), no treatment funding (OR 2.7, 1.3–4.6; P<0.05), education less than grade 12 (OR 1.3, 1.3–3.2; P<0.05), monthly income ≤INR 20,000 (OR 1.6, 1.1–3.6; P<0.05), CKD stage V (OR 1.4 1.0– 2.9; P <0.05), Patients on hemodialysis (HD) (OR 2.5, 1.2–4.5; P<0.05), comorbidities ≥3 (OR 1.6, 1.3–3.0; P<0.05), overweight (OR 2.4, 1.3–2.9; P<0.05), and duration of CKD >2 (OR 2.4, 1.4–4.4; P<0.05).

Conclusion: About 44.7% of the patients were found to have depression. Patients’ age, gender, body mass index, treatment funding, education status, income, CKD duration and stage, HD status, and comorbidities were found to be significant factors affecting depression.
IN VITRO EVALUATION OF FRACTURE RESISTANCE OF ENDODONTICALLY TREATED TEETH WITH THE USE OF DIFFERENT ROOT CANAL SEALERS
Authors: Shreya Dr Shivangi
Published: March 2020

After endodontic treatment, teeth are structurally different from untreated vital teeth, so these teeth require specialized treatment. The toughness of an endodontically treated tooth is associated to the tooth structure left. In vertical root fracture, resection of the affected root or extraction of the tooth is mandatory. Hence, this is a serious concern as there is an unfavorable prognosis leading to endodontic failure. One major cause for tooth fracture is found to be endodontic treatment in many in vivo studies. Vital teeth are less prone to fracture than nonvital teeth. It is a well-known fact that loss of structural integrity associated with the access preparation results in increased cuspal deflection during function leading to a higher occurrence of fractures. It is difficult to establish whether the occurrence of fractures depends on change in dentin structure or missing tooth structure. If endodontically treated teeth are not restored immediately, there is bacterial contamination and coronal microleakage, and this can lead to retreatment or endodontic failure. Hence, bonded restorations must be used to avoid microleakage. Based on above findings the present study was planned to evaluate the In Vitro Evaluation of Fracture Resistance of Endodontically Treated Teeth with the Use of Different Root Canal Sealers.

The present study was planned in Department of Conservative Dentistry and Endodontics, Buddha Institute of Dental Science and Hospital, Patna, Bihar, India. For the in vitro study, 30 extracted maxillary central incisors from patients in the age group 30-55 years were obtained. After extraction, soft tissue and calculus were mechanically removed and teeth were stored in 5% sodium hypochlorite solution for 24 h to remove any remaining soft tissue. Certain teeth that had fracture lines, calcifications, surface irregularities were discarded, and a total of 20 teeth samples were obtained for the study. Although the sample size was small, it was sufficient to achieve a statistical difference. The teeth were sectioned at the cementoenamel junction using a diamond disc and water spray The sectioned teeth were taken, and a working length for each root was then established 1 mm short of the apical foramen using a No. 20 K-file. Further, the roots were divided randomly into four groups.

The data generated from present study concludes that increased the fracture toughness of the instrumented roots after obturation. Therefore the ability of these materials i.e., Resilon and Epiphany sealer, Gutta-percha and AH plus sealer, guttapercha and Endomethasone sealer to reinforce the Endodontically treated teeth looks very promising but further long-term clinical studies are necessary to collect evidence based data thus to be able to support the confident use of these materials in day to day practice.

Keywords: Fracture resistance, root canal sealers, Resilon, Epiphany, AH Plus Sealer, Endomethasone sealer, etc.
COMPARATIVE ANALYSIS OF VARIOUS RISK ASSESSMENT SCORES FOR LOW RISK ACUTE CORONARY SYNDROME IN AN INDIAN SCENARIO – AN ED BASED OBSERVATIONAL STUDY.
Authors: Shaikh Zahid , Shinde V. S. , Tripathi Sumalya , Jadhav Dhiraj , Lamba Ishan , Gangurde Alok , K. Sweta
Published: March 2020

Chest pain is one of the most common presentation to emergency department (ED). The misdiagnosis or over-diagnosis of patients with acute chest pain can be associated with serious clinical events or is time-consuming and this places a heavy burden on overcrowded and resource constraint ED. To help overcome this issue various scores are formed to rule out acute coronary syndrome (ACS) in these patients. Those who do not meet the criteria of high risk ACS like raised cardiac biomarkers, ECG changes, etc are labeled as low risk ACS. These patients form the majority of patients. A multitude of risk score have been formulated to predict the outcome and risk stratify patients with chest pain. Our objective was to evaluate the utility of these score in Indian setting in low risk ACS patients.

We studied the various risk prediction score of 100 patients presenting to the ED of tertiary care teaching institute in an urban industrial area with low risk ACS. The scores that were calculated included HEART, TIMI, ADAPT, GRACE, NACPR and EDACS.

Of all the scores only the HEART score correlated well with identifying those who required further testing. Taking a score of less than 3 as a marker of low risk ACS we get a sensitivity of 95.83% (95CI - 89.67% to 98.85%) and specificity of 100%. The PPV is 100% and accuracy of 96%. All other scores were either not specific enough or had limited utility.

Keywords: Low risk ACS, ACS, HEART, TIMI, ADAPT, GRACE, NACPR, EDACS
CASE OF DU PERFORATION WITH SECONDARY OMENTAL NECROSIS- A RARE CASE REPORT
Authors: K Dr. Radha Krishna , Khan Dr. Bushra , Samee Dr. Atif Abdul , Ibrahim Dr. Syed Mujtaba
Published: March 2020

Introduction: The Omentum is rich in blood supply. Omental Infarction can be classified as primary or secondary depending on the pathogenesis.

Aims and Objectives: To report a case of DU perforation with secondary Omental Infarction.

Case Details: A 21 year old male patient came with complaints of generalized dull aching abdominal pain, associated with persistent vomiting and high grade fever since 3 days. On examination, he was drowsy, BP was not recordable and peripheral pulses were not palpable. Abdominal examination revealed guarding and rigidity. X-ray erect abdomen showed gas under the right dome of the diaphragm (pneumoperitoneum).

The patient was taken up for an exploratory laparotomy. Intraoperatively, findings included: 1) A 0.5*0.5cm in size perforation over the anterior first part of the duodenum, 2) approximately 3L of haemorrhagic peritoneal fluid 3) necrosed omentum and 4) petechial patches over the parietal wall of peritoneum. Primary repair of the DU perforation with omental plug (modified graham’s repair) with omentectomy of the necrosed part of omentum was done.

The HPE report of excised specimen of omentum was suggestive of intense congestion and necro-inflammatory reaction of the omentum with necrosis and netrophilic infiltrate.

Conclusion: A rare case of DU perforation with secondary omental necrosis is being reported.

Keywords: DU Perforation; Omental Necrosis; Omental Infarction; Modified Graham’s patch

Abbreviations: OI- Omental Infarction, DU- Duodenum.
CLINICAL SIGNIFICANCE OF THE LEVELS OF THE GINGIVAL CREVICULAR FLUID VOLUME AND LEPTIN DURING ORTHODONTIC TOOTH MOVEMENT
Authors: Upasana Dr. Kumari , Choudhary Dr. Shivendra
Published: March 2020

It is assumed that leptin has a role in protecting gingival tissues, leptin stimulates the immune system and enhances bone formation by acting directly on osteoblasts. As periodontal disease progresses, the protective role of leptin on the gingiva is lost owing to a decrease in the leptin level. During orthodontic tooth movement, the early response of periodontal tissues to mechanical stress is an acute infammatory reaction. Study of leptin therefore is a useful guide to determine its relationship with tooth movement in both tension and pressure sites and the role of this cytokine in controlling the local infammation around the tooth. Detection of the leptin level in GCF at sites under orthodontic movement had been tested and it was found that the concentration of leptin in GCF is decreased by orthodontic tooth movement.

The present study was planned in Department of Periodontology, Manipal College of Dental Sciences Manipal. Total 20 cases were evaluated in the present study. The 10 cases were enrolled in Group A as study cases and 10 cases were enrolled in control cases. The selected 10 patients were bonded with fixed appliance 0.022" PEA bracket slot, MBT prescription. The maxillary right canines (control tooth, CT) were not bonded with the bracket. The initial wire will be 0.016" NiTi wire. The distalisation force were applied on the left canine (test tooth, TT) using 0.010 SS lace backs.

Significantly decreased levels of leptin concentration might result from the presence of inflammation adjacent to the teeth undergoing movement. It has been shown previously that orthodontic tooth movement may therefore show local traits of a damage/ repair process with inflammation-like reactions: high vascular activity, many leukocytes and macrophages, and involvement of the immune system.

Keywords: Leptin levels, periodontal disease activity, orthodontic tooth movement, ininflammatory  markers
ANATOMY OF TULP’S VALVE
Authors: K Khan , Mohammad Fateh , MT Alam , Nawaz Mohd , Mohsin Azmi , MS Ansari
Published: March 2020

Introduction: Tulp’s valve is also known as ileocaecal valve which is situated at ileocaecal junction. Tulp’s valve is a diverse anatomical valve where the ileum makes an access into the caecum. Earlier researchers have observed that there is occurrence of high densities of neurons in the Tulp’s valve, though meticulous anatomical depiction about constitution of the myenteric plexus in and around the Tulp’s valve has thus far to be obtained in humans. In array to add contribution to this vicinity of explore, the present work was performed to appreciate the anatomical composition of myenteric plexus in and around the Tulp’s valve in human foetuses.

Materials and Methods: The research was performed on ileocaecal sections obtained from human foetuses (n=17) of various gestational ages after obtaining ethical authorization from the ethical clearance committee of Hind Institute of Medical Sciences, Sitapur. Cresyl Violet staining and NADPH- diaphorase enzyme histochemistry was performed over the obtained ileocaecal sections. Study Group-1(G-1) included foetuses of 9 to 14 week of gestational age group while Group-2(G-2) comprised of foetuses of 15 to 33 week of gestational age group. The Neuronal cell profiles (area, perimeter, ferret diameter) and Neuronal cell density were assessed in and around the Tulp’s valve in human foetuses.      

Results: In Cresyl violet stained sections, the difference in the neuronal cell profile area between G-1 (50.10±2.26 µm2 )and G-2 (61.25±4.07 µm2 ) was found to be statistically significant (p=0.0028).The perimeter of myenteric neuronal cells in G-1 (26.32±0.51 µm ) was significantly (p=0.0028) lower than G-2 (29.17±0.85 µm). The differences in Feret diameter of neuronal cells between G-1 (9.49±0.27 µm) and G-2 (10.53±0.21 µm) was statistically significant (p=0.0028). The neuronal cell density in Myenteric Ganglia (MG) in G-1 and G-2 was 60.01±9.77 and 52.27±6.54 respectively, which was statistically insignificant (p=0.1367) difference. The difference in the nitrergic neuronal cell area between G-1 (66.35±8.43 µm2) and G-2 (74.93±0.53 µm2) was statistically significant (p=0.0038). The mean perimeter of nitrergic neuronal cells in G-1 (32.01±2.57µm) was insignificantly (p=0.2001) lower than G-2 (33.83±0.73 µm). The mean Feret diameter of G-1 (11.97±1.26) was also insignificantly (p=0.2624) lower than G-2 (12.91±0.75). The nitrergic neuronal cell density in Myenteric Ganglia in G-1 was 22.41±4.13 and in G-2 it was 18.61±2.09, which was statistically insignificant (p=0.0983). acquaintance of the innervations of the Tulp’s valve in human foetuses may help in restoration of it for improved movement of ileum inside into the caecum, as well as to check retrospective run of caecal inside into the ileum.

Keywords: Tulp’s Valve, Cresyl Violet, NADPH- diaphorase, Nitrergic Neurons
ROLE OF VITAMIN C IN TYPE 2 DIABETES MELLITUS CASES, A STUDY IN VEDANTA INSTITUTE OF MEDICAL SCIENCES
Authors: Teltumbadr Dr. Umesh
Published: March 2020

INTRODUCTION:  Diabetes is one of the largest emerging global health problem with 415 million people between the ages of 20 and 70 worldwide estimated as having diabetes in 2015 and Type 2 DM (T2DM) accounts for at least 90% of all cases of diabetes. Vitamin C is naturally present in fruit and vegetables, is often added as a preservative to foods/beverages, and is also used as a dietary supplement. As vitamin C is water-soluble, it has a relatively short half-life in the body due to rapid renal clearance and a regular and adequate intake is required to prevent deficiency. In T2DM patients Vitamin C levels are usually low as blood glucose may compete with vitamin C for uptake into cells due to its structural similarity to the oxidised form, and increased oxidative stress may deplete antioxidant stores. MATERIAL AND METHODS:  A total of 206 T2DM patients were included in the study and were divided randomly in to 2 groups of 103 each. Participant’s demographic and physical activity was noted. Anthropometric data including the body mass index (BMI) and waist and hip circumference were collected. Glycated haemoglobin (HbA1c) was determined in EDTA blood by standard methods. Fasting glucose was measured in blood collected in fluoride oxalate tubes. The vitamin C concentration of the processed samples was determined. Drug (Vitamin C and Placebo) was issued to patients for duration of thirty days at a time all patients were maintained on their usual dietary pattern while limiting their consumption of vitamin C-rich foods throughout the study. RESULTS: Mean age in Vitamin C group was 46.87 ± 6.77while in placebo group it was 42.11 ± 6.46. There were 56 male and 44 female in Vitamin C group. In Placebo group male and female were 60 and 40 respectively. No statistical significance was observed in both the group.At 12 weeks fasting blood sugar levels were decreased by -23.74± 2.74 in patients receiving Vitamin C while in placebo group reduction was -5.44± 3.77. Post meal blood sugar was reduced by -21.72± 2.45in vitamin C group while in placebo it was -8.11± 2.45.CONCLUSION:Supplementation of Vitamin C in T2DM patients can significantly reduce the blood glucose levels and HbA1C levels.
MORPHOLOGY AND MORPHOMETRY OF SCAPULAE IN TERTIARY CARE HOSPITAL IN K.M. MEDICAL COLLEGE AND HOSPITAL, MATHURA (UP).
Authors: Mittal Dr. Lavlesh , Madaan Dr. Sandeep
Published: March 2020

Introduction:  The shoulder joint is the most important joint in the body and limitation of this joint movements affects the quality of life. Severe shoulder injury and glenohumeral arthritis causes shoulder dysfunction with devasting results, and to restore normal functions orthopaedic surgeon can perform total shoulder arthroplasty, or reverse shoulder prosthesis, or hemiarthroplasty.Lateral angle of the scapula becomes truncated and broadened and bears the glenoid cavity which articulates with the humerus in the shoulder joint. Shoulder joint is formed when the glenoid cavity is connected with the head of the humerus. This study was carried out to study the morphology and morphometry of the glenoid cavity as dimensions of the glenoid cavity are important in designing and fitting of glenoid components for total shoulder arthroplasty.

Material and Methods: A total of 100 unpaired dry scapula were isolated from the department of Anatomy. Two groups were made according to the side of the scapula and were equally divided into 50 right and 50 left scapula each. Bones were segregated and inspected individually.To classifying shape of the glenoid fossa, presence or absence of a glenoid notch was used and were classified into 3 types, pear shaped or inverted comma shape in presence of a glenoid notch & oval in absence of notch. The pear shaped shows indistinct glenoid notch and the inverted comma shaped shows a distinct notch.

Results: On the basis of presence or absence of the glenoid notch. 56%, 28% & 16% glenoid cavities of right side were pear shaped, inverted comma shaped and oval shaped respectively. On the left side 60%, 30% & 10%were pear shaped, inverted comma shaped and oval shaped respectively. In total 58% glenoid cavities were pear shaped, 29% were inverted comma shaped and 13% were oval shaped.Average length and breadth of scapulae included in this study was 134.07±13.87 mm and 98.43 ±9.58 mm respectively.Mean glenoid cavity index of right side was 48.12 to 86.87 %, while in left side it was 44.21 – 84.78%.

Conclusion: The most common glenoid cavity was pear shaped followed by inverted comma shaped and the oval glenoid cavity. Mean glenoid cavity index of right side was 48.12 to 86.87 %, while in left side it was 44.21 – 84.78%.
EVALUATION OF TYPES OF GALL STONES AND FACTORS AFFECTING IT.
Authors: Khatri Ashok Premchand
Published: March 2020

Introduction:  Gallstone (GS) is an important cause of morbidity all over the world. Gallstones are becoming increasingly common and are seen in all age groups. When there is an imbalance in the chemical constituents of bile that result in precipitation of one or more of the components gall stones are formed. In majority of the cases they do not cause symptoms, and about 10% to 20% will eventually become symptomatic within 5 years and 20 years of diagnosis. Gallstones contain mainly cholesterol, bilirubin, and calcium salts, with some amounts of protein and other materials. Pure cholesterol crystals are generally soft, and protein contributes to the strength of cholesterol stones. Pigment stones account for 30 % of gallstones and are divided into black pigment and calcium bilirubinate stones.

Material and Methods: Demographic characteristics of the patients participating in the study such as age, sex, occupation, lifestyle habits such as alcohol consumption , smoking, sports activity , medication if any used, any diseases, Body mass index (BMI), milk consumption, liver diseases and dietary habits was obtained. Patients were divided into two groups depending upon the type of gall stone either cholesterol or pigment stone.

Results: A total of 76 patients were included in the present study who underwent cholecystectomy surgery. Age group of more than 51 years showed maximum number of stones in both the groups. Maximum numbers of stones were seen in patients having family history of stones. Patients who were overweight and obsess were having higher incidence of gall stone as compared to normal weight and slim population. Formation of stones in female was more as compared to males.

Conclusion: Various factors can be considered for the formation of gall stones of which gender, increasing age, genetic factors, dilatory habits, and sedentary lifestyle can be considered as the contributing factors for formation of gall stones and most of them can be prevented by proper education.

Keywoerds: GS, BMI, liver disease, smoking, alcohol consumption.
STUDY BASED ON DIAGNOSIS AND EVALUATION OF PATIENTS AFFECTED BY ORAL SUBMUCOUS FIBROSIS (OSMF) FROM BIHAR REGIONS
Authors: Manish Kumar , Raman Nikita , Gautam Abhishek , Jain Samir , Jha Prakash Chandra , Kumar Amar
Published: March 2020

OSMF (Oral Submucous Fibrosis) is a widely recognized precancerous condition which is also looked upon as a potentially malignant disorder of and is characterized by a reduction in mouth opening, having  palpable circumoral fibrous bands either on one side or bilaterally along with the sensation of “burning mouth”. The condition is defined as “an insidious, chronic disease affecting any part of the oral cavity and sometimes the pharynx. Although occasionally preceded by and/or associated with vesicle formation, it is always associated with juxta-epithelial inflammatory reaction followed by fibroelastic change of the lamina propria, with epithelial atrophy leading to stiffness of the oral mucosa causing trismus and inability to eat”. The increased consumption of commercially prepared arecanut preparations (Gutkha, Pan masala) specially in the younger generation has led to such high incidence of this diseasein certain areas of India. Based on above reported findings the present study was planned for Study of Cases of Oral Submucous Fibrosis (OSMF) from Bihar Region.

All the patients were informed consents. The aim and the objective of the present study were conveyed to them. Approval of the institutional ethical committee was taken prior to conduct of this study. Total 30 cases of the patients suffering from oral submucous fibrosis were enrolled in the present study.

In conclusion, the result of present study provides information on the prevalence of oral mucosal lesion in our population. It is important that preventive efforts be carried out by the concerned authorities and public health professionals in establishing tobacco cessation clinics and tobacco education in such masses (especially the young generation) along with a long standing and a close knit motivation program that enables our future generations to come to avoid the menace of tobacco and its subsequent health effects.

Keywords: Oral Submucous Fibrosis, OSMF, Oral Cancer, Bihar region, etc.