bluuebunny/crossref_metadata_2025 huggingface dataset:
Anemia in antenatal patients and its outcome: an experience in tertiary care centre
Authors: Ara Shabnam , Saldanha Cimona Lyn , Khan Insha
Published: July 2018

Background: Anemia is the most common hematological abnormality detected during the pregnancy and forms a major problem in affecting the females especially in the developing countries.Methods: All pregnant females with clinical evidence of anemia without any other co-morbidity attending the antenatal clinic were included in the study. Patients were studied in terms of the age, parity, inter-pregnancy spacing, type of pregnancy, post-partum outcome along with the biochemical tests like peripheral blood picture, hemoglobin estimation, and serum ferritin levels.Results: Total no. of patients was 500, age ≤20 years were 60 and ≥35 years were 107, mild anemia (10-10.9 gm%) 160, moderate anemia (7-10 gm%) 250, severe anemia (<7 gm%) 90. Normal vaginal delivery with medio-lateral episiotomy was done in 385 patients, normal vaginal delivery without medio-lateral episiotomy in 35 while lower-segment caesarean section in 80 patients. Pre-term delivery was done in 95 patients, post-term delivery in 20. 90 babies delivered were low-birth weight (<2500 gm), antepartum hemorrhage was seen in 10 patients while 20 patients had Post-partum hemorrhage.Conclusions: The present study concludes that anemia is still rampant in the society especially in pregnant women. The main cause of anemia-in-pregnancy is still the iron deficiency anemia. The peripheral blood picture, hemoglobin estimation, and serum ferritin levels form the basic pillars in the evaluation of the etiology and type of anemia. The multiple government sponsored facilities are to be made available to each pregnant female and that requires community, government as well as healthcare professional’s participation.
Role of chemotherapy in the management of locally advanced carcinoma cervix
Authors: Firdaus Huma , Husain Ayanat
Published: July 2018

Background: This study was undertaken to evaluate role of chemotherapy in the management of locally advanced carcinoma cervix in J.N. Medical College Hospital, A.M.U. Aligarh.Methods: A total of 50 cases were studied. 25 cases received radiotherapy alone or surgery followed by radiotherapy. In remaining 25 cases, 18 patients received neoadjuvant chemotherapy followed by surgery or radiotherapy where as seven patients out of 25 received concurrent chemo-radiation. SPSS software was used for data analysis.Results: Mean age of patient was 51.5 years. Majority of patients (60%) were in FIGO clinical stage IIB followed by stage IIIB (20%), stage IVA (12%) and stage IIA (8%). Out of 25 patients receiving chemotherapy, 68% showed CR whereas 20% showed PR, 4% showed minimal response and 8%showed PD while on chemotherapy. In radiotherapy group, CR was found in 56% and PR in 36% of cases.8% of patients showed PD while on radiotherapy. Patients with stage IIB disease showed best response with CR in 70% and PR in 16.66% cases. 6.66% of patients showed SD and 6.66% showed PD while on therapy. 55.55% of patients with SCC showed CR and 33.33% showed PR. In adenocarcinoma, CR was seen in 100% cases. In adenosquamous carcinoma, 66.66% showed CR whereas 33.33% showed PR. 61.9% of well differentiated carcinoma showed CR and 28.57% showed PR. 4.76% showed SD and 4.76% showed PD. 58.33% of moderately differentiated carcinoma showed CR, 37.5% showed PR and 4.17% showed SD. 20% of poorly differentiated carcinoma showed CR, 60% showed PR and PD was seen in 20%cases. Patients with bulkly tumours in present study, irrespective of their response to chemotherapy, appeared to have worse prognosis than patients with more advanced pelvic disease. These findings suggest that the biology of bulky stage lb, IIa & IIb disease may be more aggressive than that of more extensive locally advanced disease.Conclusions: Chemotherapy can be considered as an adjuvant to available modalities of treatment, like surgery or radiotherapy, to improve the overall survival of cancer cervix patients.
Impact of counselling on selecting a hormonal contraceptive method
Authors: Patel Darshna M. , Salat Vandita K. , Patel Mahesh M.
Published: July 2018

Background: Unmet need for family planning is an important indicator for assessing the demand for family planning services. As per NFHS-4, the contraceptive prevalence rate in women age 15-49 years was 53.5 % and the unmet need for family planning among married women was 12.9%. Counselling provides the Health care professionals (HCPs) an opportunity to understand the individual need of a contraceptive seeker.Methods: This was a cross-sectional, observational study conducted at GMERS hospital, Valsad during June 2017 to October 2017. Sexually active women of 18 to 40 years who consulted HCPs for contraception and who interested in starting hormonal contraceptive method or expressed interest in switching (changing) to hormonal methods were included in the study. Total 213 women were enrolled in the study.  Questionnaires with information on the women’s pre- and post-counseling contraceptive choice, her perceptions, and the reasons behind her post-counseling decision were filled both by the HCP and the participating women. The completed questionnaires were collected and analyzed.Results: During pre-counseling, most common hormonal contraceptive method selected by women was combined hormonal contraceptive pills followed by DMPA, LNG-IUS and POPs. In present study, structured contraception counseling helped most women (97.2 %) to choose a contraceptive method. There were statistically significant differences in choice of contraceptive methods during pre and post-counseling except COCs. Among hormonal contraceptive methods, maximum difference was observed for choice of the COCs after counseling as compared to pre-counseling. Counseling helped more than 90% of the women who were indecisive to choose any contraceptive method. More than three fourth of them opted for hormonal methods with a maximum selection of COCs. The most common reasons for selecting COCs was ease of use for COC, breast feeding for POP and the most common reasons for not choosing other available contraceptive methods was discussion with partner.Conclusions: The combined hormonal contraceptive pills were reported to be the most commonly used contraceptive method. There were statistically significant differences in choice of contraceptive methods during pre and post-counseling with maximum difference in COCs. Counseling helped most of the women who were indecisive to choose any contraceptive method.
I. V. Oxytocin versus oral Misoprostol for augmentation of labour, associated complications and effect on neonatal wellbeing
Authors: Wilson Swapnil , Das Subrata
Published: July 2018

Background: The complications of prolonged labor are well recognized and the caesarean section has been used liberally. But even then, prolonged labor continues to be a problem. This could be due to weak uterine contractions or poor cervical dilatation. The problem can be overcome with the use of oxytocic drugs. The aim of the study was to compare the efficacy, adverse effects, safety, and feto-maternal outcome of the ARM and oral misoprostol with Artificial Rupture of Membrane (ARM) and oxytocin infusion for labor augmentation.Methods: This prospective study was conducted in the labor room of NRS Medical College and Hospital Kolkata and included 100 primigravidae women carrying singleton pregnancy at term with spontaneous onset of labor.Results: The result findings of the present study show that the prolonged labor was the major indication for LSCS in both the groups. There was a significantly higher subjects (P <0.05*) had fetal distress or fetal bradycardia, meconium staining of liquor, Tachysystole in the misoprostol group, compared to oxytocin group. No significant difference was observed among the groups with respect to neonatal wellbeing.Conclusions: Both the agents i.e. oral misoprostol and I.V. oxytocin shortens the duration of labor effectively and are effective for augmentation of labor. Apart from Tachysystole and meconium staining of liquor and fetal distress the incidence of any other complication was not significantly more in the oral misoprostol group when compared with oxytocin group. Status of the neonate was almost similar in both the groups.
Disappointment after hysterectomy: a stressful situation
Authors: Kanani Medha
Published: July 2018

Background: The overall incidence of hysterectomy in India is 7% which is lower as compared to other countries like U.S. which is around 9%. But recently, there is upsurge in the prevalence of hysterectomy. The reason for this may be due to reduced hospital stay and cost. Also, now a days hysterectomy by any modality is increasingly accepted by the professionals and the professional associations and gatherings like conferences as the sole treatment for any benign condition in compare to other modalities of treatment. An attempt was made here in this study to analyse the after-effects of hysterectomy. The overall aim of this study was to describe and investigate postoperative complications and the corrective surgeries being done for them.Methods: It is a retrospective statistical hospital-based study of relaparotomy done in post hysterectomised patients who came to Sir T General Hospital, Bhavnagar in the Department of Obstetrics and Gynecology. The study was done for the duration of 6 months from October 2016 to March 2017; during the time total of 55 patients were followed for this study that underwent resurgery for their problems.Results: The incidence of Laparotomy following hysterectomy was 42.5% and the incidence of corrective surgeries for urinary symptoms and vault prolapse was 57.5% including the highest incidence of Anterior colporrhaphy with Posterior colpoperineorrhaphy being 21.2%. The occurrence of problems was more in the patients who had undergone Abdominal hysterectomy (62.5%) in comparison to those who underwent Vaginal hysterectomy (32.5%).Conclusions: Oopherectomy should be encouraged with hysterectomy after menopause to reduce incidence of Laparotomy following hysterectomy.
Laparoscopic uterovaginal anastomosis in bicornuate uterus with cervical and vaginal aplasia
Authors: Munjal Rachita , Sundaram Meenakshi , Patel Juhul
Published: July 2018

The presence of Cervical and Vaginal Aplasia with bicornuate uterus is a very rare mullerian anomaly. Its true incidence is still unknown. The presence of functioning bicornuate uterus poses a great challenge for a gynecologist because a successful repair could restore normal menses and may preserve a patient's fertility. Hence, we report a case of 14-year-old unmarried female, known case of Bicornuate uterus with cervical and vaginal aplasia with history of a rudimentary horn excision. On clinical and radiological evaluation, she was diagnosed with complete cervical and vaginal aplasia with haematometra in right cornua of uterus. She underwent vaginoplasty along with laparoscopic uterovaginal anastomosis in an innovative way. On follow-up, hysteroscopy showed a patent anastomosis, vagina was completely healed, and she was menstruating normally.
A case report: spontaneous postpartum rupture of unscarred uterus
Authors: Singh Swati , Ahlawat Ravinder
Published: July 2018

Rupture of uterus is characterized by a breach in the wall of the uterus involving its full thickness. An unscarred uterus rupture is uncommon. It has non-specific symptoms and presentation differs according to site and time of rupture. Authors report an unusual case of spontaneous rupture of unscarred uterus. A 32-year-old, pregnant woman, developed postpartum bleeding with no history of prior uterine incision. She was diagnosed as a case of rupture of uterus and emergency laparotomy was done. Early diagnosis and immediate surgical intervention may significantly improve the prognosis. Differential diagnosis of uterine rupture should always be kept in mind in all patients with or without risk factors.
Alveolar Rhabdomyosarcomatous endometrial polyp in a 70-year-old woman
Authors: . Niranjanakesav , Bama Sathiya , . Radhakrishnan , Kumar Arbind
Published: July 2018

TThis case report concerns a 70-year woman with a complaint of abnormal vaginal bleeding and foul smelling vaginal discharge of a short duration. Speculum examination revealed a huge polyp occupying the cervix and extending further downwards. On operation, it turned out to be an endometrial polyp arising from the fundus. Histologically the polyp showed classical features of alveolar rhabdomyosarcoma; confirmed immunochemically.
Steroid cell tumour of the ovary: a case report with review of literature
Authors: M. Fathima Seles , Revathy M. , Kanchana Madurai Padmanabhan
Published: July 2018

Virilising ovarian tumours account for less than 5% of all ovarian tumours. A steroid cell tumour (SCTs) of the ovary comes under the sex cord stromal tumours and accounts for only 0.1% of all ovarian tumours. Almost 75% are functioning tumors with production of androgenic hormones causing virilisation and cushingoid features. They are usually unilateral, benign with only 25-45% malignant cases. Here authors report the incidence of steroid cell tumour in our institution and discuss about a 37-year-old woman with steroid cell tumour, not otherwise specified who presented with oligomenorrhea followed by amenorrhea, secondary infertility and signs of virilisation.
Successful term pregnancy post laparoscopic management of thick perforate upper transverse vaginal septum
Authors: Anagani Manjula , Agrawal Prabha , Radhika B. , Ahuja Amodita
Published: July 2018

A 30-year-old woman presented with dyspareunia and infertility and was referred to after failure to visualize cervix during diagnostic laparoscopy by her primary consultant. Preoperative MRI was done which showed mild arcuate uterus with minimum fluid in vaginal cavity with vertical vaginal septum. This was managed successfully by a combined laparoscopic and vaginal approach. She conceived spontaneously and delivered a healthy term baby by caesarean section. Upper thick Transverse Vaginal Septum is a complex congenital malformation posing challenges for its correction, restoring normal healthy sex life and conception. The septum varies in thickness and may be located anywhere along the vagina reducing the functional length of the vagina.  Identifying and dissecting the anatomic structures is greatly aided by panoramic view of laparoscope allowing the surgeon to have an increased degree of freedom during surgery.
Study on epidemiology, risk factors and clinical characteristics of triple negative breast cancer in Bangladesh
Authors: Zohora Fatema Tuz , Rabbi Mohammad Fazle
Published: July 2018

Breast cancer is the second most common type of cancer in Bangladesh. Although significant improvement has been made in breast cancer treatment and management, Triple Negative Breast Cancer (TNBC) is still the least known breast cancer subtype in this country. TNBC is well known for its aggressive nature and limited therapeutic options when compared to other breast cancer subtypes. Several population-based studies indicated high prevalence of TNBC in African women in addition to few recent studies indicating a growing number of TNBC patients among Asian population. However, there is a lack of evidence on TNBC patients in Bangladesh due to limited knowledge and awareness. In this paper we review the epidemiology, general risk factors and clinical characteristics of TNBC to find out the correlation between TNBC and other conventional breast cancer subtypes in Bangladesh. Some diagnostic and therapeutic approaches as well as future novel solutions for TNBC are also discussed to understand the pathologic process and treatment strategies of TNBC. Literature review reveals that, there is a lack of TNBC studies in Bangladesh. Therefore, more investigations should be carried out to address the degree of vulnerability of TNBC in breast cancer patients of Bangladesh.
Effectiveness of allopurinol on triglyceride levels in hyperuricemic patients
Authors: Žiga Nermina , Bečić Fahir , Dedić Mirza
Published: July 2018

Background: In this clinical pharmacological research, we dealt with the action of allopurinol on triglyceride levels in hyperuricemic patients.Methods: The study included 40 hyperuricemic patients, of both genders and different age groups, that were sorted by comorbid diagnoses in several subgroups. All patients were clinically treated in the period of three years both at UCC Sarajevo, and P.I. General Hospital "Abdulah Nakaš" Sarajevo. All clinical measurements were carried out using standard IFCC methods with the appropriate analysers.Results: The study was based on mean triglyceride levels before and after three and six months of treatment with allopurinol. It was found out that the mean triglyceride levels were not significantly different from the reference values prior to treatment (p = 0.846) and after three months of therapy (p=0.153). In contrast, after six months of treatment, triglyceride levels significantly increased compared to the reference values. In patients with a diagnosis of gout and metabolic syndrome, triglycerides were statistically significantly increased during the six months of observation. A statin group of patients showed a statistically significant increase in triglyceride levels after three months of therapy (p = 0.032), while, after six months their levels had decreased (p = 0.029). In patients with diabetes mellitus type II, triglycerides rose after three months of treatment (p = 0.039) and retained the same level after six months of observation.Conclusions: The analysis shows that the use of allopurinol has an effect on triglyceride levels in hyperuricemic patients.
Factors related with length of stay (LOS) on digestive surgical patient in Dr. Wahidin Sudirohusodo hospital, Makassar, Indonesia
Authors: . Warsinggih , Kasim Nindy Agista , Harahap Hidayah , Prihantono Prihantono
Published: July 2018

Background: Length of stay (LOS) is to show how many days a patient is admitted to the hospital during one treatment period. The best length of daycare is 6-9 days. Some factors affect the length of stay of the patient. This study aims to determine the factors associated with the duration of treatment on digestive surgical patients in Dr. Wahidin Sudirohusodo Hospital, Makassar, Indonesia.Methods: This research was analytical, descriptive research method using cross-sectional study design, and sampling used is total sampling technique with 419 patients. Data analysis was obtained to see the relationship between independent variables (sex, age, secondary diagnosis, surgery setting, surgery risk, and outcome) and the dependent variable (length of stay).Results: The study found that there were four factors related to the duration of treatment of digestive surgical patients that are secondary diagnosis (p = 0.000), surgery setting (p = 0.000), surgery risk (p = 0.000), and out patient condition (p = 0.000). While no significant relation the age with p value = 0.140, and sex p value = 0.917 with length of stay.Conclusions: There were four factors have a significant relationship with the length of stay (LOS) on a digestive surgical patient in dr. Wahidin Sudirohusodo Hospital such as secondary diagnosis, surgery setting, the risk of surgery and outpatient condition.
Prevalence of anaemia in obstetric fistula patients in Abakaliki
Authors: Adegoke Adedokun I.
Published: July 2018

Background: Obstetric fistula remains a devastating condition among economically marginalised members of the society. Anaemia can result from inadequate intake of nutrients due to poverty. The study aims to assess the prevalence of anemia in obstetric fistula patients.Methods: A retrospective study was carried out at the National Obstetric Fistula Centre, Abakaliki, Nigeria to determine the prevalence of anaemia among obstetric fistula patients. Data were retrieved from the case record of patients and analysis was done using SPSS version 20.Result: Out of the 136 patients studied, 87 (63.9%) were petty traders and farmers. Eighty-nine (65.4%) were anaemic while 19 (13.9%) had packed cell volume of 30% and below.Conclusion: Two-thirds of the patients were anaemic based on WHO's cut off and this is higher than global and local prevalence of anaemia in non-pregnant women. Therefore, it is reasonable to suspect anaemia in obstetric fistula patients and correction of same should start as early as possible in order to minimize the complications of anaemia in this group of patients.
Role of serum Cystatin C as a marker of early nephropathy in metabolic syndrome: a case control study
Authors: Goel Hemant , Aggarwal Onam , Kumar Anuj , Lali Pramod , Chandra Lal
Published: July 2018

Background: The metabolic syndrome (MS) has become a significant public health problem and patients with MS are at higher risk for developing renal diseases. Serum Cystatin C suggested as a sensitive endogenous marker than creatinine for slight changes in GFR could be useful marker in MS.Methods: A total of 200 subjects were included. New International Diabetes Federation (IDF) definition of MS was used as inclusion criteria. Patients excluded were those with hypo/hyperthyroidism, on glucocorticoids, statins and fibrate, malignancy, cirrhosis, active liver disease and conditions affecting abdominal girth. Serum Cystatin C, insulin, creatinine, triglycerides, high density lipoproteins-cholesterol (HDL-C), fasting glucose, Urinary microalbumin and Urinary creatinine were estimated by standard method.eGFR and HOMA-IR (homeostasis model assessment of insulin resistance) were calculated. The primary outcome assessed was the occurrence of early nephropathy in MS and the secondary outcome included evaluation of early nephropathy by serum Cystatin C and eGFR. Appropriate statistical test was applied by using SPSS Version 21 software.Results: Fasting insulin levels and insulin resistance were significantly raised in MS cases. eGFR (MDRD) was lower in the MS cases (72.59±8.79mL/min/1.73m2) vs non-MS (130.34±40.75 mL/min/1.73m). Urinary microalbumin levels and serum cystatin C were significantly increased in MS and the cystatin c levels showed significant positive correlation with urinary microalbumin and negative correlation with eGFR.eGFR was found to be lower in the microalbuminuric than normoalbuminuric groups.Conclusions: Serum Cystatin C levels are higher in MS and can be useful, practical, non-invasive biomarker for evaluation of early renal involvement in MS.
Comparison of the efficacy and safety of rosuvastatin versus atorvastatin in reduction of low density lipoprotein cholesterol in patients of type 2 diabetes mellitus with dyslipidemia
Authors: Kashyapa Hrishikesh , Jadhav Rupali Bajrang , Deshkar Anuradha
Published: July 2018

Background: Approximately 80% of deaths in diabetic patients are attributable to cardiovascular disease (CVD), which in turn is highly correlated with diabetic dyslipidemia. Statins are drug of choice for raised LDL-C in treating dyslipidemia. The present study compares the efficacy and safety of rosuvastatin against commonly used atorvastatin in patients of type 2 diabetes mellitus with dyslipidemia, so as to guide the present treatment strategies in the management of the same in Indian population.Methods: The study was a single blinded study conducted in a district level tertiary care hospital attached to a medical teaching institute. Patients fulfilling the inclusion criteria were randomized in two groups. Group I received atorvastatin (10mg) and group II received rosuvastatin (5mg) at bedtime orally daily. Serum TC, serum LDL-C, serum HDL-C and serum TG were assessed on week 0, week 6 and week 12.Results: At the end of 12 weeks, the percentage reduction of LDL-C levels in atorvastatin group was 33.58% whereas in rosuvastatin group, it was 43.12%. The percentage reduction in total cholesterol (TC) in atorvastatin group was 24.85% while in rosuvastatin group, it was 30.8%. Rise in HDL-C levels in atorvastatin group was 7.1% whereas in rosuvastatin group, it was 11.16%. All these differences were statistically significant. There was no significant difference in reduction of TG levels between the two groups.Conclusions: Rosuvastatin 5mg causes greater reduction in LDL-C and TC, comparable reduction of TG and greater rise in HDL-C when compared with atorvastatin 10mg therapy.
Care of unfortunate mothers with perinatal loss
Authors: Pancholi Nidhi , Rami Bijal
Published: July 2018

Background: Perinatal loss is one of the most traumatic life events. It is indeed a great psychological and emotional shock to not only the mother and father but the entire family and society as a whole. The study aims to take physical and psychological care of mother and father, to help in bereavement process, to know the incidence and prevalence and etiological factors of perinatal loss and to study the outcome of psychological support to mother.Methods: It was a prospective analytical study. All patients with IUFD and early neonatal loss were studied. Postpartum both mother and father were counselled. Emotional reaction of both mother and father were recorded. A new ritual of giving the mother her baby (dead) was done to those who were willing for that.Results: The results showed that the incidence of IUFD was 3.7% and early neonatal death was 10.8% per total admissions. The perinatal mortality rate was 63.62 per 1000 live births. There were varied reactions of grief which could be handled by effective counselling. Seeing and holding the baby was associated with fewer anxiety and depressive symptoms than not doing so.Conclusions: Psychological counselling is very important. The patients are helped to cross over the crisis in their life and made them well prepared for next pregnancy. Counselling and communication skills should be routinely included in all residency programmes. Hospitals should have a separate place for mothers with perinatal loss which would help them to overcome their grief.
Role of Tc-99m MDP bone scan in evaluation of osteoid osteoma at varied locations
Authors: Pawar Shwetal U. , Dharmalingam Anitha , Bhatt Bhairavi M. , Shetye Suruchi S. , Ghorpade Mangala K.
Published: July 2018

Background: Osteoid osteoma is a benign bone tumor; diagnosed using x-ray and Computer Tomography (CT). It shows a nidus and cortical thickening. When the nidus is not well visualised especially in uncommon locations; Bone Scan (BS) can be performed for evaluation of osteoid osteoma.Methods: A retrospective observational study was done where 21 subjects presenting with suspicion of osteoid osteoma underwent BS using 10-20mCi (370 to 740MBq) of Technetium-99m Pertechnetate with perfusion, delayed cortical and Single Photon Emission Tomography/Computer Tomography (SPECT/CT). Increased perfusion and delayed focal cortical uptake was assessed on BS to locate osteoid osteoma. Response evaluation to Radiofrequency ablation (RFA) was also performed using BS.Results: Osteoid osteoma was detected in femur (8), spine (3), forearm bones (2), humerus (2), tibia (2), fibula in one and iliac bone in one patient using BS. BS detected more lesions (18) than CT scan where nidus as confirmatory sign was seen in 13 lesions. The McNemar test showed no significant difference (p=0.22) in the detection of osteoid osteoma using CT and BS in common location of femur. However there was significant difference noted between BS and CT in uncommon site (p=0.023). 3/8 patients showed persistent increased cortical activity after RFA ablation on BS.Conclusions: BS was more useful for confirmation of diagnosis of Osteoid osteoma for lesions in uncommon sites. BS also helped to assess response to RFA ablation therapy. SPECT/CT improved interpretation of BS to locate the osteoid osteoma.
Study of thyroid function in patients admitted in intensive care unit in a tertiary care centre
Authors: Sasi Sekhar T. V. D. , Appalaneni Ramya , Jada Avinash , Pinnamaneni Shalima
Published: July 2018

Background: Thyroid hormones play a key role in the maintenance of body growth by modulating metabolism and the immune system. These alterations in thyroid hormone levels are referred to as “euthyroid sick syndrome” or “non thyroidal illness syndrome” (NTIS), which is characterized by low serum levels of free and total triiodothyronine (T3) and high levels of reverse T3 (rT3) accompanied by normal or low levels of thyroxine (T4) and thyroid-stimulating hormone (TSH). During critical illness, changes in circulating hormone levels are a common phenomenon. These alterations are correlated with the severity of morbidity and the outcomes of patients in ICU.Methods: This study was carried out at a tertiary care hospital. 100 patients of age above 18yrs, both sexes, admitted to intensive care units with following diseases Septicemia, ARF, Respiratory failure, CCF, DKA, Stroke were taken into the cross-sectional study. Relevant hematological and radiological examination are done. Fasting venous blood samples were collected immediately on admission to ICU from all patients and were subjected for hormone analyses. Samples were tested for total T3, total T4, and TSH. The hormone estimation was done by chemiluminescence assay.Results: Patients (59%) had low T3 level, 41(41%) patients had normal T3, 31 patients (31%) had low T4, 69 patients (69%) had normal T4 level and TSH was low in 11 patients (11%), 76 patients (76%) had normal TSH and 14 patients (14%) slightly high. Our study showed low T3 (59%) is the commonest abnormality in ICU admitted patients. There is a significant relation present between T3 and mortality (p value-0.0001) and need for ventilation (p value 0.004).Conclusions: Our study suggests that low T3 is an important marker of mortality in ICU admitted patients. We suggest that in ICU patients T3 levels should be done and used as a prognostic marker for mortality and need for ventilation.
Clinical profile and outcome of pediatric bacterial meningitis: a prospective study from tertiary institute in Northern India
Authors: Garg Ashok , Sharma Ashish , Kumari Sandhya , Shandil Ambuj
Published: July 2018

Background: Meningitis is one of the fatal infections occurring in infants and older children. In acute bacterial meningitis (ABM), inflammation of the leptomeninges is triggered by bacteria present in the subarachnoid space. ABM is associated with a high rate of acute complications and long-term morbidity. Aim of our study was to determine the incidence, etiological profile and complications of acute bacterial meningitis amongst children belonging to one month to five years of age.Methods: The present study was conducted over a period of one year and diagnosis of meningitis was made on basis of history, examination and laboratory investigations. Clinical features were recorded on case sheet. Lumbar puncture was done, and CSF was sent for biochemical analysis, cell counts, staining, culture and latex agglutination test (LAT).Results: Out of total 1560 admitted cases (1 month to 5years age group), 160 cases were suspected with meningitis while 57 cases were confirmed to have ABM. Most (59.6%) cases belonged to 3 months to 1-year age group and males outnumbered the females by a ratio of 2:1. Group B Streptococcus (45.6%) was most common pathogen in 45.6% cases followed by Streptococcus pneumoniae (21%) and Hemophilus influenzae (10.52%). Seizures (45%) and increased ICP (28%) were main acute complications observed during hospitalization while hemiparesis 9.6%, monoparesis 4.8%, seizures 38%, vision and hearing deficits were the sequelae observed on follow up examination. These complications were predominantly contributed by S. pneumoniae and H. Influenzae.Conclusions: The incidence of ABM is still high and Group B streptococcus is main pathogen even in post neonatal period. The complications of ABM are markedly higher in cases of S. pneumoniae, H. Influenzae meningitis in comparison to Group B streptococcus meningitis. Formulating standard protocols for management of ABM and rational antibiotic use to prevent resistance is the need of hour.
Immediate and delayed effect of dry needling in musculoskeletal disorders: a quasi experimental study
Authors: K. B. Riyas Basheer , N. M. Jazeel , Krishna Harish S. , K. S. Veena , P. Madhuripu , P. K. Sreejisha , Varghese Dainy
Published: July 2018

Background: The roles of physiotherapists in managing the chronic and acute pain in musculoskeletal (Msk) conditions are inevitable now days. Physiotherapists work across the time period aiding patients with their pain in medical care settings with the aim of decreasing pain, rising quality of life wherever attainable and preventing acute and sub-acute painful conditions developing into chronic pain. Dry needling, an invasive technique in the hand of Physios is a new trend in managing acute and chronic pain. Purpose of the study is to identify the immediate and delayed response of pain and presence of soreness after the dry needling in common Msk conditions which can be managed in association with other conventional physical therapy techniques. Objective was to find out the immediate and delayed effects of dry needling over pain in musculoskeletal disorders.Methods: This study was carried out in the department of physiotherapy, Malabar medical college hospital and research centre. Patient was prepared and identified the extreme tender point over the muscle affected and needle removed after 3-5 twitch response elicited. Sterility of the treatment area and needle was well maintained. Prior to the treatment again confirmed with the NPRS score and procedure was done. After few seconds of insertion of needle subjects NPRS score assessed. After removal of needling pain score was assessed after 5 mins, 30 mins, 1 hour and after one day.Results: Study showed a marked reduction in pain after dry needling at each intervals and this suggesting promoting dry needling as an adjunct to pain relief technique in physiotherapy.Conclusions: Dry needling is effective over pain in musculoskeletal disorders.
Clinicopathological study of benign ovarian tumuors
Authors: Vohra Nikita V. , Jokhi Cyrus Dara , Kanetkar Sujata R.
Published: July 2018

Background: The incidence of ovarian tumor amongst gynecological admissions have been reported to vary from 1-3 %. About 75% of these tumors have been found to be benign. Ovarian malignancies represent the greatest clinical challenge of all the gynecological malignancies. During the reproductive years most of the ovarian tumors encountered are benign. About 2/3 of the ovarian tumors are encountered in this group only. The chance that an ovarian tumor is malignant in a patient younger than 45 years is 1 in 15. The differentiation of the benign from malignant tumors can go wrong even with imaging modalities.CA125 along with ultrasound are useful in differentiating benign from malignant tumors. Histopathological examination is gold standard for diagnosis of ovarian neoplasm.Methods: The present study includes consecutive cases of histopathologically proven ovarian tumors of 3 years from June 2010 to May 2013 reported by the Department of Pathology of our tertiary care center. It includes total 150 cases. After careful study of gross findings, appropriate bits were taken from received ovarian specimen, followed by routine paraffin processing to make H and E stained slides. Special stains were used wherever needed.Results: Majority of the cases 91 (60.67%) were benign, 53 (35.33%) were malignant and 6 (4.0%) were borderline. Surface epithelial tumours were the most common type (68.13%) of ovarian neoplasm in this study. Most of tumours in our study occurred in the age group of 21-40 years. Mucinous cystadenomas were most common benign surface epithelial tumour and most common benign tumors overall. There were 22 cases of benign germ cell tumor, all were mature teratoma. All the sex-cord stromal tumours were diagnosed in women older than 40 years. Most common benign lesion in our study is surface epithelial tumour and in age group of 21-40 years. 84% patients studied had symptoms at presentation, out of which 26% of patient presented with dull/dragging pain. Pan hysterectomy was the most common procedure for surgical management.Conclusions: Most of ovarian neoplasm are benign with mucinous cystadenoma being commonest entity. Commonest age group is 21-40 years. Commonest benign germ cell tumor is Mature cystic teratoma. Commonest clinical symptom is dull/dragging pain. Pan hysterectomy was the most common procedure for surgical management.
Prescription analysis of drug prescribed in post-operative period in a teaching hospital in Bhilai, Chhattisgarh, India
Authors: Ingole Nishikant , Keche Yogendra , Wankhade Archana , Chandraker Sunita
Published: July 2018

Background: Surgical site infections are associated with prolonged hospital stays and increased cost of therapy. Prophylactic use of antimicrobials is to prevent the incidence of postoperative wound infection. To generate data on postoperative use of antimicrobials this study was planned.Methods: The information was collected in semi-structured questionnaire format from the patient’s case paper. Information regarding the antimicrobials prescribed by surgeon, including drug combinations, duration of therapy, frequency of drug administration, and diagnosis for the surgery was collected. Surgical wounds were classified based on National Research Council (NRC) criteria.Results: Mean duration of antibiotic use was 3.71 days for clean surgeries (70%) and ranging from 2.67 days to 6 days for clean contaminated, contaminated and dirty types of surgeries. average number of antimicrobials prescribed for surgical antimicrobial prophylaxis was 3 per patients. Ceftriaxone, cefixime, ofloxacin, levofloxacin, amikacin, amoxycillin + clavulanic acid, ampicillin, metronidazole were used for postoperative prophylaxis.Conclusions: As per guidelines, the usage of antibiotics was found to be inappropriate in some conditions. Third generation cephalosporin was the preferred or most prescribed choice of drug for postoperative prophylaxis. The average number of antimicrobials prescribed for postoperative prophylaxis was 3 per patients.
Effective dose of propofol for smooth induction in midazolam premedicated and in unpremedicated children
Authors: Shukla Veena , Kaur Harpreet
Published: July 2018

Background: Propofol, an intravenous (IV) anaesthetic agent, is widely used in paediatric day care surgeries. Present study was conducted to determine clinically effective dose of Propofol for smooth induction in children.Methods: This randomized controlled study was conducted in 100 children of American Society of Anaesthesia (ASA) grade I and II, posted for short genitourinary surgeries. Group P patients received premedication with injection glycopyrrolate and midazolam IV. Group U patients were unpremedicated. Both groups were split in five subgroups with ten patients in each as per propofol dose of 2.0, 2.5, 3.0, 3.5, and 4.0mgkg-1 respectively. Following observations were made-pain on injection site, facemask tolerance, repeat dose and total dose of Propofol required for smooth induction, time of recovery and complications like post-operative nausea and vomiting (PONV). All data was analyzed by using chi square test and student t test.Results: Demographic profile showed no significant difference. Mean dose of Propofol in group P was 3.29±0.51 mg kg-1 while for group U was 3.70±0.57mg kg-1. Facemask tolerance was maximum in group P5 (100%) followed by (80%) in U5. Mean dose of Propofol required for younger children 1-3 years (group P 3.46±0.43 mgkg-1 v/s group U 3.94±0.48 mgkg-1) was much higher than dose required for 7-10 years (group P 3.13±0.52 mgkg-1 and group U 3.18±0.59 mgkg-1) for both groups. Recovery time after anaesthesia was delayed in group P and complications were more in group U.Conclusions: Propofol is the drug of choice for paeditric ambulatory surgery. Midazolam premedication enhances the benefits.
Depression, anxiety, stress and its correlates among urban school going adolescents in Tamilnadu, India
Authors: Daya A. Praveena , G. Karthikeyan
Published: July 2018

Background: Undetected and untreated mental disorders can impair a person’s ability to perform at school or work place, cope with daily activities of life and can lead to severe psychiatric disorders and consequences later in their life. Study objective was to determine the prevalence and patterns of depression, anxiety and stress among 400 school going adolescents belonging to classes 10th to 12th of Tirunelveli district, Tamilnadu, India.Methods: Burden of Depression, anxiety and stress was assessed using DASS21 questionnaire. Chi-square test was done using SPSS software version 21 to test for statistical significance.Results: Overall prevalence of depression, anxiety and stress was 73.6%, 86.5% and 24.7% respectively. Depression (p value=0.01), Anxiety (p value = 0.005) and stress (p value = 0.007) were significantly observed more among 10th class students when compared with other classes.Conclusions: The present study has identified a higher prevalence of depression, anxiety and stress among students. This warrants immediate action of creating awareness among teachers and parents in early identification and treatment to prevent serious consequences in later life.
A prospective study of serum electrolyte disorders and their clinical manifestation in HIV patients
Authors: Damor Ajesh Kumar , Honta Praful Bala
Published: July 2018

Background: Present study was conducted to evaluate the serum electrolyte disorders and their clinical manifestation in HIV positive patients.Methods: Total 100 patients who were known to be HIV positive or those who were found to be HIV positive were taken. HIV infection was diagnosed by one ELISA and two E/R/S test. All clinical diagnosis medication and routine chemical profiles were recorded along with detailed history and physical examination. Fluid depletion was inferred from the findings like decreased skin turgor, dry mucus membrane; fluid overload was ascertained by presence of jugular venous distension and dependent pulmonary rales. Hyponatremia was defined as a serum sodium concentration less than 135mmol/L and hypokalemia was defined as potassium concentration less than 3.5mmol/L.Results: Eighty percent patients had disorders of electrolyte imbalance. Most common electrolyte was hyponatremia (58%) and hypokalemia (28%). The mean serum sodium concentration was 133.48±7.06 and potassium concentration was 3.87±0.63. Neuromuscular manifestation and neuropsychiatric manifestation were present in 58% and 49% respectively.Conclusions: Patients with HIV infection may develop a bewildering variety of electrolyte and acid-base disturbances. Hyponatremia and hypokalemia from many causes is common and associated with an increased mortality.
Surgical management of enchondroma with joint transfer: a case report
Authors: Banegas-Ruiz Rodrigo , R. Baca-Domínguez C. , G. Campos-Angulo , I. Ríos de la Torre K. , Granados-Romero Juan J. , Valderrama-Treviño Alan I. , Mendoza-Barrera German E. , Barrera-Mera Baltazar
Published: July 2018

The enchondromas are the most common benign bone tumor in the hands, mainly in young patients and its treatment is surgical in most cases due to its possible complications avoided through different procedures such as joint transfer, which allows to maintain a good quality of life for the patient. We present the case of a 42-year-old woman who came to the clinic for blunt trauma in the right hand where she was incidentally diagnosed with enchondroma on the third finger of the proximal interphalangeal joint of the right hand. Articular transfer of the proximal interphalangeal joint was performed. Second toe on the right, at 6 weeks corroborates correct evolution with bone consolidation of the articular transfer grade III and donor zone grade II, without infection complications, the correct recovery of the extensor movement range of this joint improving so their state of life should be the main objective of these procedures.
A case of dengue fever in a health worker in university of Port-Harcourt teaching hospital
Authors: Egboh Stella-Maris C. , Otike-Odibi Bolaji I. , Altraide Dasetima D. , Awopeju Abimbola T. O.
Published: July 2018

Dengue fever is a mosquito borne disease which can easily be missed or misdiagnosed in early stages as a result of poor surveillance, similarity with other febrile illness and unavailability of PCR necessary for its diagnosis. We hereby report a 44year old female nurse living around a bushy and swampy environment, who presented to university of Port-Harcourt teaching hospital (UPTH) with high grade fever of 1week duration, also developed joint pains, passage of coke colored urine, sensor neural deafness, hyperglycemia and petechial hemorrhage while on admission. Patient continued to have persistent fever despite having completed her anti-malaria and antibiotics, viral studies were subsequently done for her and she was found to have dengue virus. Patient was conservatively managed and discharged for follow-up in medical outpatient and Ear nose and throat clinic.
Medial patellofemoral ligament reconstruction with gracilis autograft for recurrent patellar instability: a case report
Authors: Mahendra Laksana Komang , Wien Aryana I. G. N.
Published: July 2018

The medial patellofemoral ligament (MPFL) is the primary passive restraint in pathologic lateral translation of the patella. Recurrent patellar instability is com­mon, and multiple procedures have been described for its treatment. Chronic instability of the patellofemoral joint and recurrent dislocation may lead to progres­sive cartilage damage and severe arthritis if not treated adequately. A 17-years-old female presented with a one-year history of knee pain in his left knee. The apprehension test is positive; there is pain and muscle defensive contraction of lateral patellar dislocation with 20°-30° of knee flexion. MRI revealed flattened trochlear joint surface proximally and the concavity is less pronounced distally. The inclination angle is less than 11 degrees and trochlear facet asymmetry can be seen on axial view. Patient undergone medial patellofemoral ligament reconstruction with gracilis autograft and six months postoperatively, the patient was followed up using WOMAC score and showed good result. WOMAC score was 96.2% indicating no significant pain, joint stiffness, or any difficulty on physical activity. After the operation, the patient is able to perform regular daily activities without any complaints. This study has shown that treatment of recurrent patellar instability with medial patellofemoral ligament reconstruction using gracilis autograft resulted in satisfactory functional outcome based on WOMAC score.
Neuropathic pruritus: an early indicator of neuromyelitis optica spectrum disorders
Authors: Bansal Pradeep Kumar , Nawal C. L. , Singh Aradhana , Chejara Radheyshyam , Marker Sebastian , Mangal Pankaj
Published: July 2018

Neuromyelitis optica is a relapsing, inflammatory astrocytopathic disorder, affecting predominantly the optic nerves and spinal cord. It is associated with antiaquaporin-4 immunoglobulin G (AQP4-IgG) in up to 70% of patients. Spinal cord involvement typically presents as a longitudinally-extensive transverse myelitis, with associated sensorimotor and sphincter dysfunction. Sensory symptoms such as numbness, dysaesthesia, pain and tonic spasms are common. Here, we present a case of a 25years old female who came to the medicine OPD, with the chief complaints of intense itching over face and forehead, which was later on progressed to quadriparesis after 3 weeks. This case highlights neuropathic pruritus as an under-recognised early feature of neuromyelitis optica.