bluuebunny/crossref_metadata_2025 huggingface dataset:
Study of epidemiology, clinicopathological correlation, prognostic factors and management in squamous cell carcinoma of vulva
Authors: Parekh Chetana D. , Arora Ruchi S. , Patel Shilpa M. , Poddar Pabashi , Desai Ava D. , Mankad Meeta M.
Published: December 2018

Background: Carcinoma of the vulva is rare cancer, pruritus is the most common and long-lasting reported symptom. It is found to be associated with HPV and HIV infection. Currently, a more individualized and less radical treatment is suggested. In this study we evaluated epidemiology, clinicopathological prognostic factors, HPV distribution and risk factors for metastases to lymph nodes. We also reviewed multidisciplinary clinical management carried out at our institute.Methods: It is a prospective study of 25 biopsy proven cases of Squamous Cell Carcinoma of Vulva, treated at our center from September 2014 to September 2016. We collected the data regarding the clinical presentation, histological details, treatment given, survival and complications. HPV 16 and 18 testing were done using PCR method. Median follow up of the patients are for 24 months.Results: The mean age of patients was 54.6 years. Commonest presentation was perineal itching (36%). HPV 16/18 were positive in 25% of the patients. Radical vulvectomy with bilateral groin dissection was done in 14/25 (56%) patients. Among these 14 patients, 35.7 % (5/14) has lymph node metastases, disease free survival was 63.6% and overall survival was 81.1% for median follow up of 24 months. About one third of the patient presented with locally advanced disease.  Six (24%) patients received only chemo radiation as a treatment.Conclusions: HPV and HIV infection increase the risk of vulvar cancer. Individualization of treatment is necessary. The use of preoperative chemoradiation in locally advanced disease might have promising results in future.
Anaemia in term pregnancy: influence on maternal and perinatal outcome and role of demographic factors
Authors: Miglani Urvashi , Bhangadia Priya , Kadam V. K. , Laul Poonam
Published: December 2018

Background: The aim is to study maternal and perinatal outcome and various demographic factors in term pregnancy complicated with anaemia at DDU Hospital.Methods: Hospital based prospective observational analytical study. 200 pregnant women reporting to antenatal clinic or admitted to the Hospital in labour/not in labour after 36+6weeks of pregnancy were taken as study subjects. Study duration was one year between  July 2017 to June 2018.Results: The prevalence of mild, moderate and severe anaemia was 25%, 56% and 19% respectively. Education status, socioeconomic status, ANC visit, interpregnancy interval were significantly associated with anemia(p<0.05). Significant association was observed between occurrence of PPH and severity of anaemia(OR 12.77; CI 2.32 to 70.12). The incidence of LBW increased with severity of anaemia. (OR-6.25;CI 2.6 to 15). There was a statistically significant difference found in prevalence of IUGR babies. The risk of Apgar score <8 increased with severity of anaemia. Perinatal mortality was observed in 8% subjects with anaemia as compared to 3% in subjects without anaemia.Conclusions: Maternal anaemia is a major public health problem. Simple steps taken to correct anaemia in female contemplating pregnancy and pregnant women can definitely have far reaching influences on maternal and perinatal morbidity.
Study of cardiac disease and its outcome in pregnancy
Authors: Patel Tejal L. , Pandey Kritika S. , Ambaliya Arvind
Published: December 2018

Background: Pregnancy comes as a temporary complication in the disease process of a patient with a cardiac lesion. It is the 4th common cause of maternal mortality and one of the most important non-obstetrical causes of maternal death. Previously most women with diagnosed heart disease were advised to avoid pregnancy and labor and termination was advised. But in modern obstetrical practice, pregnancy in a patient with a heart disease is no longer an unacceptable hazard. The objective of this study is to find out incidence of cardiac diseases in pregnancy, to evaluate their management and to find out maternal and fetal outcome in pregnancy with cardiac disease.Methods: This study is a prospective cohort study in which an analysis of maternal and fetal outcome in 30 cases of cardiac diseases in pregnancy was carried out in the department of Obstetrics and Gynaecology in our institute at Civil hospital Ahmadabad from 01/01/2017 to 31/12/2017.The study included all known case of RHD, CHD, or newly diagnosed case or surgically corrected case with prosthetic heart valves during current pregnancy.Results: Majority of women having pregnancy with cardiac disease were in the age group of 20-30 years. Majority of them were primigravida and suffered from rheumatic heart diseases with grade 1 NYHA severity. Majority of women got delivered by normal vaginal delivery with healthy fetal outcome. Most of the babies born to cardiac mother had their baby weight ranging between 2.0-2.5kg.Conclusions: The results of present study indicate that heart disease forms a considerable proportion of medical illness complicating pregnancy. Cardiac disease presents problems both to the obstetrician and as well as to the physician, cardiologist and to the neonatologist. But the majority of pregnancies complicated by heart disease are uneventful with a favorably good outcome for both the mother and the fetus.
Incomplete pentalogy of Cantrell: a case report
Authors: Shenoy Heera T. , Venugopal Prasanna , S. Raghu , K. Remash
Published: December 2018

Pentalogy of Cantrell (PC) is a rare congenital anomaly characterized by a defect in the lower sternum, anterior diaphragm, and anterior abdominal wall; ectopia cordis; and congenital heart disease. Authors report a case of male foetus terminated at 20 weeks of gestation with an Incomplete (class 3) pentalogy of Cantrell presenting with gastroschisis, ectopia cordis and absence of lower sterna. Prognosis of pentalogy of Cantrell depends on severity of intra and extra cardiac defects, pulmonary hypoplasia, extent of abdominal wall defect, cerebral anomalies and diaphragmatic herniation. Full pentalogy of Cantrell is a severe and rare syndrome, but incomplete forms with combination of two or three defects are reported frequently similar to present case report.  Early diagnosis through obstetric ultrasound would help in improved informed clinical decision making on the part of the obstetrician and family.
Bilateral absence of fallopian tube segments: an uncommon condition
Authors: Shrotri Tejashri , Ahuja Meenakshi
Published: December 2018

Congenital abnormalities of fallopian tube are rare among the abnormalities of female urogenital system. Bilateral absence of fallopian tube segments is an extremely uncommon condition. The authors report one such rare case diagnosed during diagnostic laparoscopy during evaluation of infertility. On one side, it was completely absent; while on the other side, it was partially absent simulating a formal tubal ligation. To the best of authors knowledge, this is an extremely unusual condition with very few reports available in literature.
Uterine sparing approaches in management of placenta accreta: a summarized review
Authors: Hussein Ali , Abdelaleem Ahmed A. , Abbas Ahmed M. , Salah Maher
Published: December 2018

Placenta accreta is a potentially life-threatening obstetric condition that required multidisciplinary approach to management. Placenta accreta occurs in complete absence of the decidua basalis. Women with previous cesarean section delivery or placenta previa are known to be at greater risk of placenta accreta. A previous study reported that 24%& 67% increase in the incidence of placenta accreta in women 1 versus 3 or more previous cesarean deliveries respectively. Antenatal diagnosis of placental invasion has the potential to improve maternal and fetal outcomes. In practice, incomplete non-separation of the placenta at delivery leads to massive obstetric hemorrhage resulting in maternal morbidities such as massive blood transfusion, DIC, injury to the bladder and intestines and the need for hysterectomy. Sonographic examination with gray scale and color doppler imaging is the recommended first line modality for diagnosis of morbidly adherent placenta. Techniques developed for conservative management are techniques developed to preserve uterus and future fertility which is crucially linked to societal status and self-esteem.
Obstetric hysterectomy: a receding trend
Authors: Tasneem Fasiha , Shanbhag Vijayalakshmi
Published: December 2018

Over 500,000 women die each year due to complications of pregnancy and childbirth, a number that has remained relatively unchanged since 1990, when the first global estimates of the burden of maternal mortality were developed. Hemorrhage due to uterine atony, adherent placenta and PPH are still the causes of maternal death in developing countries. Although advances have been made in the development of conservative medical and surgical treatment of obstetric haemorrhage like brace sutures, internal iliac artery ligation, selective arterial embolization etc emergency obstetric hysterectomy remains a lifesaving procedure in the management of intractable haemorrhage unresponsive to conservative management.
Stigma among doctors towards people with mental illness
Authors: Sharma Bishnu , Sampath Harshavardhan , Soohinda Geeta , Dutta Sanjiba
Published: December 2018

Background: Stigma towards adults with mental illness is a longstanding and widespread phenomenon. Stigmatizing attitudes are prevalent not only among the general population but also among doctors. Negative stereotyping of people with mental illness (PMI) leads to prejudice and discrimination, affecting all aspects of their medical care and well-being. The present study attempted to explore stigmatizing attitudes among doctors towards PMI.Methods: The research was observational and cross-sectional in design carried out on doctors in a medical college. Socio-demographic data including field of specialization, experience, and academic post were recorded. The community attitudes towards mental illness (CAMI) and social distance scale were administered. Social desirability bias was corrected for by using the Marlowe-Crowne social desirability scale.Results: Around 54 doctors from the specializations of medicine (n=24), surgery (n=19), and non-clinical fields (n=11) participated. We found no significant differences in attitudes towards mentally ill and social distance between medical specializations (p-values >0.05) even after adjusting for the effects of social desirability bias. Years of specialization experience (p=0.037) and having a family member or close friend with mental illness (p=0.012) were significantly associated with higher scores in the community mental health ideology sub-scale of CAMI. Higher social restrictiveness (p=0.014) and lower community mental health ideology (p=0.008) were associated with greater social distance from PMI.Conclusions: Doctors are not immune to biases and stigmatizing attitudes towards PMI. These attitudes are present across all fields of medical specialization and must be addressed by mental health professionals to ensure optimal care of this vulnerable population.
Histological evaluation of placenta in hypertensive pregnancies
Authors: Parmar Kantilal M. , Shah Gopal V. , Alamchandani Ravi R.
Published: December 2018

Background: Maternal and fetal status are reflected in placenta. Toxemia of pregnancy exerts great impact on placenta and thereby fetal and maternal outcomes. Placenta reflects changes of toxemia and these changes are seen morphology as well as histology. Hence study of placenta gives information on the in-utero fetal condition.Methods: A total of 1000 placenta, 500 each from hypertensive and normotensive groups were included in this study conducted in Anatomy Department of SBKS Medical College and Research Centre, Vadodara. Histological evaluation of the samples taken was done under microscope.Results: Microscopic examination of the placenta revealed the presence of calcification, infarction, fibrinoid necrosis, villous hyalinization, syncytial knots and cytotrophoblastic cellular proliferation in both control and hypertension groups. In the present study, calcification was seen in 35.8% in the control group, while the same was seen in 53.8% patients in test group. Fibrinoid necrosis was seen in 48.8% patients in control group as against 69% patients in test group. Villous Hyalinization was seen in 7.40% and 21.4% patients in control and test groups respectively. On the other hand, syncytial knots were seen in 38% and 69% patients in control and test groups respectively. In test group, cytotrophoblastic cellular proliferation was seen in 69% patients while in control group, it was seen in 33.2% patients. Infarction was also seen in test (42.4%) and control (12.6%) groups.Conclusions: Hypertensive disorders of pregnancy have significant effect on the histology of placenta and also influences the fetal outcomes.
A cross sectional study on screening for depression among elderly in rural areas of Puducherry, India
Authors: Kavithai Pamagal , R. Anandaraj , S. Buvaneswary , M. Prakash
Published: December 2018

Background: Depression among elderly has been a neglected health issue. Various factors hinder its early diagnosis. The objectives of this study are to screen for depression among elderly using geriatric depression scale-15 and to determine its influencing factors.Methods: A community based cross sectional study on geriatric depression was done in villages catered by a primary health centre in Puducherry. Permanent residents of the study setting, aged ≥60 years consenting for the study were included. Line listing of elderly individuals in the study setting was done and subjects were selected by simple random sampling. A pretested structured questionnaire was used to collect socio-demographic and clinic-psychological variables. Hindi mental state examination scale was used to screen for cognitive impairment (score <23). Geriatric Depression Scale (GDS-15) was used to screen for depression (score >5) among geriatric individuals. Appropriate statistical tests of significance were done.Results: Among the 360 elderly individuals screened using GDS-15 tool, 41.4% of them were found to be at a higher risk of developing depression. Significant factors for risk of depression in univariate analysis include being female, illiterate, unemployed, widow/single, having sleep problems, dependency in activities of daily living and cognitive impairment. Predictors for risk of depression evident by multivariate analysis include presence of unemployment, sleep problems and cognitive impairment.Conclusions: A higher proportion of elderly was observed to be at risk of depression.  Primary care physicians may consider screening for depression in elderly with identified risk factors and act accordingly.
Prevalence of hepatitis A virus in patients attending a referral hospital in Bubanza Province, Northwest Burundi
Authors: Harabandi Rémy , Odari Eddy O. , Lihana Raphael W.
Published: December 2018

Background: Viral hepatitis is a public health problem wide world. Hepatitis A, transmitted by fecal-oral route, is an infectious viral disease caused by hepatitis A virus and mainly due to poor sanitation. This study aimed to determine the prevalence of hepatitis A virus and associated factors in patients attending Mpanda referral hospital in Northwest Burundi.Methods: A cross-sectional study was done from November 2017 to January 2018 on 385 participants aged 2 years and above. Participants were recruited using a systematic random sampling technique. Data were collected using questionnaire from consented/assented participants. Five millilitres of venous blood was collected and analyzed. Anti-hepatitis A virus antibodies were screened using Enzyme Immuno Assay. Data were analyzed using Statistical Package for the Social Sciences version 16.0 software. A descriptive analysis was followed by bivariate analysis using a Chi-square test for comparison of various sub-groups with 5% statistical significance level. Odds ratio and 95% Confidence Intervals were calculated and presented.Results: The median age of the participants was 23 years and the range 72 years. The overall prevalence of Hepatitis A virus was 60.3%. There was a significant association between age [OR=7.22 (4.04-12.93), P <0.001], lack of clean water [OR=10.07 (5.63-18.01), P <0.001], traditional latrines [OR=1.86 (1.02-3.40), P=0.04] and Hepatitis A Virus seroprevalence.Conclusions: Present study shows high prevalence of HAV infection in patients attending Mpanda Referral Hospital. Younger age, lack of clean water and traditional latrines play roles in increasing prevalence of HAV infection in both rural and urban areas.
Pattern of hepatobiliary involvement in HIV/AIDS patients: study in a tertiary care centre
Authors: Sharma Kamlesh , Sharma Vandana , Singh Aradhana , . Ketki
Published: December 2018

Background: Diseases of hepatobiliary system is a major problem in patients with HIV infection. It has been estimated that approximately one third of the death of patients with HIV infection are in some way related to liver disease. While this is predominantly a reflection of the problems encountered in the setting of co-infection Hepatitis B or C, it is also a reflection of the hepatic injury in the form of hepatic steatosis, that can be due to antiretroviral therapy. There had been little work done on liver function tests in HIV patients without pre-existing liver disease like viral hepatitis, or alcoholic hepatitis. So, this study was designed to assess the pattern of liver function test derangement in HIV patients. Aims and objective was to study the different pattern of hepatobiliary involvement in HIV positive patients, and to gauge the extent of liver damage.Methods: The study included 50 HIV positive patients coming to SMS hospital and Medical College, Jaipur, in medicine and HIV clinic of skin and VD department. Subjects having HIV test positive by ELISA, are included in this study. Other causes of liver function derangements were excluded from the study.Results: Maximum number of the patients were in the age group of 23-32 years. Out of 50 cases studied, 41 (82 %) cases had abnormal liver function tests, while 9 (18%) had normal liver function tests. Most of the cases had liver function abnormalities, and most common abnormality was raised SGOT/SGPT.Conclusions: Almost all types of liver function tests are found to be deranged in HIV patients. The pattern of hepatobiliary involvement varied from fatty liver, cholestasis to Toxic necrosis and granulomas.
Treatment of giant cell tumours of bone by radical curettage and bone cement
Authors: Medhi Mriganka , Badole C. M. , Mote Girish
Published: December 2018

Background: Giant cell tumour of bone remains a difficult and challenging management problems because there are no absolute clinical radiographic or histologic parameters that accurately predict the tendency of any single lesion to recur or metastasize.Methods: We performed surgery on 12 patients of GCT with radical curettage and bone cement over a period of 5.8 years. Results were evaluated using the musculoskeletal skeletal grading system.Results: The present series consists of 12 case of GCT age ranging from 16-45 years. Painful swelling was the commonest presentation, limitation of motion was seen in 9 cases and pathological fracture was seen in 1 case. 9 of the tumour occurred around knee joint. Rare involvement of talus was seen in 1 case. Overall 9 patients had a perfect functional score of 30 points and 1 patient scored less than 20 points.Conclusions: Acrylic cement reconstruction is safe and effective procedure that provides local adjuvant therapy, the cement field defect is mechanically stable. Patient can bear weight immediately and rehabilitate quickly.
Evaluation of the learning environment and the perceived weakness of the curriculum: student perspective
Authors: Ahmed Yasar , Taha Mohamed H. , Alneel Salma , Gaffar Abdelrahim M.
Published: December 2018

Background: Educational environment has been shown to have influence on learning outcome and affects student achievement, satisfaction, and success. The study was conducted to assess medical students’ perception of their learning environment and to explore areas of weakness within the educational environment.Methods: A mixed method of study, was performed using non-probability sampling at the Faculty of Medicine, Gezira University (FMUG), Sudan. An updated Arabic Dundee Ready Education Environment Measure (DREEM) was developed and administered to 854 students during the academic year 2016-2017.Results: Seventy five percent of students completed the inventory (638/854) and Sixty four percent (546/854) responded to the open-ended question providing comments and suggestions. The overall reliability coefficient alpha in this study was 0.914. The global score for this study was found positive (122/200). Students were most satisfied with the learning aspects, academic environment, and academic self-perception. However, they were unsatisfied with their teaching and social atmosphere (inadequate social support for stressed students, substandard teaching, overemphasised factual learning, unpleasant accommodation). The qualitative content analysis was performed and emerged with four themes: the physical environment, a number of students, pedagogical approaches and faculty-student communication.Conclusions: The study suggested the overall students’ perceptions of the educational environment in the FMUG were on the positive side. However, certain specific elements of the learning environment and educational programme need to be critically investigated and remedied. The updated Arabic DREAM can be used reliably in the context of medical education in Arabic speaking countries.
Analysis of multiple choice questions from a formative assessment of medical students of a medical college in Delhi, India
Authors: Garg Richa , Kumar Vikas , Maria Jyoti
Published: December 2018

Background: Assessment is a dominant motivator to direct and drive students learning. Different methods of assessment are used to assess medical knowledge in undergraduate medical education. Multiple choice questions (MCQs) are being used increasingly due to their higher reliability, validity, and ease of scoring. Item analysis enables identifying good MCQs based on difficulty index (DIF I), discrimination index (DI), and distracter efficiency (DE).Methods: Students of second year MBBS appeared in a formative assessment test, that was comprised of 50 “One best response type” MCQs of 50 marks without negative marking. All MCQs were having single stem with four options including, one being correct answer and other three incorrect alternatives (distracter). Three question paper sets were prepared by disorganizing sequence of questions. One of the three paper sets was given to each student to avoid copying from neighboring students. Total 50 MCQs and 150 distracters were analyzed and indices like DIF I, DI, and DE were calculated.Results: Total Score of 87 students ranged from 17 to 48 (out of total 50). Mean for difficulty index (DIF I) (%) was 71.6+19.4. 28% MCQs were average and “recommended” (DIF I 30-70%). Mean for discrimination index (DI) was 0.3+0.17. 16% MCQs were “good” and 50% MCQs were in “excellent” criteria, while rests of the MCQs were “discard/poor” according to DI criteria. Mean for distracter efficiency (DE) (%) was 63.4+33.3. 90% of the items were having DE from 100 to 33%. It was found that MCQs with lower difficulty index (<70) were having higher distracter efficiency (93.8% vs. 6.2%, p=0.004).Conclusions: Item analysis provided necessary data for improvement in question formulation and helped in revising and improving the quality of items and test also. Questions having lower difficulty index (<70) were significantly associated with higher discrimination index (>0.15) and higher distractor efficiency.
Hemoglobin status in pregnant women for diagnosis of anemia, assessment of severity and its socio-demographic determinants in rural area of Kanpur district, Uttar Pradesh, India
Authors: Gautam Praveen Kumar , Prajapati Beenu , Arya Manju Lata
Published: December 2018

Background: Anaemia is one of the most common nutritional deficiency disorders affecting the pregnant women in the developing countries. In India anaemia in pregnancy is a major health issue with adverse maternal and foetal outcome. Nutritional anaemia in pregnant women continues to be a cause of concern despite the fact that this problem is largely preventable and easily treatable. Objectives was to determine the prevalence and severity of anaemia in the pregnant women.Methods: Around 350 pregnant women in different trimesters of pregnancy were enrolled coming for the 1st time in outpatient department of Obstetrics and Gynaecology, in Rama Medical College Hospital and Research Centre, Kanpur from Janurary 2016 to December 2016. Information regarding age, age at marriage, age at 1st pregnancy, parity, Interval between previous and index pregnancy, no of abortions, educational status, dietary habits, Type of family, Socioeconomic status was collected in pre-designed structured schedule after taking written consent from pregnant women attending out-patient department. Haemoglobin estimation was done by auto analyser and anaemia was graded according to WHO criterion. Statistical analysis was done by percentages and proportions.Results: A high prevalence of anaemia, (87.71%) was observed in pregnant women. The current study shows (24.7%) cases of mild anaemia, (54.5%) cases of moderate anaemia, and (7.9%) of severe anaemia.Conclusions: A very high prevalence of anaemia in pregnancy needs awareness about late marriage, birth spacing, one or two child norm, antenatal care, green leafy vegetable in diet, mandatory regular supply of iron folic acid (IFA) tablets to adolescent and pregnant women along with correction of other nutritional deficiencies.
Clinical, biochemical and haematological changes in leptospirosis
Authors: Modi Rahul A. , Patel Ankita K. , Patel Mubin I. , Padsala Suresh G.
Published: December 2018

Background: Leptospirosis is a globally important zoonotic disease caused by pathogenic leptospira. Leptospira species are spirochetes belonging to the order spirochetes and the family leptospiraceae. Present study is done to find out the incidence of thrombocytopenia in leptospirosis and to correlate it with other parameters like renal dysfunction, hepatic dysfunction and bleeding manifestation.Methods: Study includes 51 clinically suspected and diagnosed cases of leptospirosis, in Government hospital, South Gujarat, during a period from January 2017 to December 2017. Clinical signs and symptoms and complications, biochemical profile like bilirubin and creatinine, haematological profile like Hb, WBC count and platelet count were recorded. Thrombocytopenia was defined as a platelet count below 1,50,000/cmm.Results: The present study includes 51 cases of Leptospirosis. Age ranged from 16 years to 61 years (male-39 and Females-12) There were 38 (74.5%) cases with thrombocytopenia and 13 (25.4%) cases with normal platelet count. Out of 38 thrombocytopenic cases, 32 (84.2%) cases had renal dysfunction, 26 (68.4%) cases had hepatic dysfunction and 16 (42.1%) cases had pulmonary haemorrhage. Among 13 cases with normal platelet count, 8 (61.5%) cases had hepatic dysfunction and 7 (53.8%) cases had renal dysfunction and 3 (23%) cases had pulmonary haemorrhage.Conclusions: Thrombocytopenia is a frequent complication (present in more than half of the patient) in leptospirosis and associated with more frequent and more severe complications. Therefore, early recognition of thrombocytopenia is recommended to prevent complications and mortality in leptospirosis.
Urinary tract infection in elderly: clinical profile and outcome study done at Kempegowda Institute of Medical Science and Hospital, Bengaluru, India
Authors: Swamy Sumedha , Ramaswamy Manjunath , Pakale Ashootosh M.
Published: December 2018

Background: Urinary tract infection (UTI) being the most common bacterial infection with considerable morbidity and mortality. In hospitalized geriatric patients, the risk is more attributable to differing characteristics such as anatomical and hormonal changes, presence of comorbidities such as neurological and urological abnormalities, diabetes mellitus and prolonged indwelling catheter use in hospitals and long-term care facilities.Methods: A retrospective study of patients admitted to medicine wards of age above 60 years with symptoms of urinary tract infection and positive urine culture spanning over a year were included. Demographic profile, clinical features, predisposing factors, laboratory features, urine culture reports, antimicrobial susceptibility patterns and outcome were noted and analysed.Results: Of the 120 patients included in our study, 58.2% were males and 41.8% were females. Dysuria was the most common major symptom (77.5%). Diabetes mellitus was the most common Predisposing factor observed in (63.3%) of the patients. Gram negative organism were responsible for (68.27%) of the uropathogen profile; Escherichia coli was the commonest isolate (31.66%) seen. Mortality rate was 29.16%. Significantly higher mortality was seen in patients with diabetes mellitus (p<0.001), complicated UTI (p<0.001), serum creatinine >1.4mg/dl (p<0.001) and increasing number of predisposing factors. Mortality was also associated with higher leucocyte count in the study population.Conclusions: Urinary tract infection in elderly increases the population mortality and morbidity; and the co morbid factors associated play a key role in the severity of the infection. Early management and appropriate antibiotic therapy will help in preventing antibiotic resistance and also in decreasing the overall geriatric population fatality.
Retrospective study of clinical profile and management of patients with swine flu at tertiary care hospital
Authors: Jethani Varuna , Khanduri Rakhee , Khanduri Sushant , Taneja Neha , Aggarwal Ankit
Published: December 2018

Background: The first isolation of a swine influenza virus from a human occurred in 1974. There are no unique clinical features that distinguish swine influenza in humans from typical influenza. Thus, clinical course and management were recorded as per a planned pro forma and analysed. This type of study has not been done previously in Himalayan region.Methods: Retrospective observational study done in a group of patients diagnosed with swine flu admitted in department of pulmonary medicine at the tertiary care hospital from November 2016 to July 2017.Results: Out of 30 patients, 53.3% were male, mean age was 48.8±17.7, history of travel or contact to infected person was only 13.3%. Most common symptom recorded was fever (83.3%), followed by dyspnoea, cough, throat pain. Most common co-morbidity was diabetes and presence were significantly associated with admission in an ICU (P<0.05). Bilateral lung infiltrate seen in 53.3% on chest X-ray. Organ involved other than respiratory were renal followed by liver involvement. 40% of patients received corticosteroid for an average of 6days, mostly given in patients with sepsis, septic shock, multi organ involvement. Out of 40%, 16.6% patient expired, 6.6% left against medical advice and 16.6% were discharged, corticosteroid doesn’t help in reducing mortality.Conclusions: A multivariate model to identify independent predictors associated with mortality in swine flu were the use of vasopressor, respiratory failure, requirement of mechanical ventilation and number of organ failure. Use of corticosteroid is controversial.
Retrospective study of pattern of treatment in free health camps from 2005 to 2017 in East Singhbhum, Jharkhand, India
Authors: Kumar Ratan , Rao Jakka Srinivas , Biswas Chandan
Published: December 2018

Background: Free health camp is a common objective of non-governmental organization (NGO). Government health department alone or jointly with NGO use to organize free medical camp for some specific health program. This retrospective study of occurrence and proportion of diseases and their pattern of treatment was done for period from 2005 to 2017 with an NGO has been working in East Singhbhum district of Jharkhand.Methods: The data of patients over the age of 05 years attended the free health camp from 2005 to 2017 and consent were provided by NGO concerned in this study. The year wise, block wise number of patient, male/female ratio and list of drugs used in different time were tabulated for analysis.Results: The result of this study has been noted in four different tables which elaborates the total number of patients year wise, block wise, percentage wise, male/female ratio during thirteen years. Another table showed occurrence of diseases/ailments in different period with changing percentage of use the drugs in their treatment.Conclusions: This retrospective study provides a conception about some changes in occurrence of diseases in free medical camp in the rural areas of Jharkhand in thirteen years. These health camps have tried to provide and follow the treatment according to need of the patients with safer, efficacious, economical drugs and with periodical inclusion of new generation drugs.
Threats of sedimentation to agricultural land due to land use and degradation of watershed physical environmental
Authors: . Ramlan , Basir-Cyio Muhammad , . Mahfudz , Rahman Abdul , . Faisal , Sutrisno Muhammad , Pratama Muhammad Fardhal
Published: December 2018

Background: The Lake Lindu sub-watershed has experienced environmental damage, mainly as a result of various activities of the surrounding community who are less aware of the principles of environmental sustainability. This study aims to determine the effect of land use area and environmental physical conditions on sedimentation and water debit in the Lake Lindu sub-watershed.

Methods: This research was carried out by implementing survey and non-experimental method at 3 rivers: Langko (P1), Wongkodono (P2), and Kati (P3). The dependent variable in this study is the area of land use (area of farm, shrub, paddy field, forest, and settlement) and the physical condition of the environment (the width of the catchment area and annual average rainfall). Then, the independent variables are sedimentation and water debit. Statistical analysis used is a multiple regression model.  

Results: The results of this study are that the wider shrub (X2) reduces the sedimentation (Y1) and increases the water debit (Y2). Each addition of one shrub unit will reduce the sediment by 0.208 mg/L and affect the water debit of 0.258 m3/ s-1. The regression equation is Y1=185.903 - 0.208X2-587.269X8 and Y2=6.854+0.258 X2 - 71.708 X8. As for the coefficient of the shape of the river (X8). The bigger the shape of the river, the smaller the average of the water debit. Thus, each reduction of one coefficient unit of the river shape will affect the water debit of 71,708 m3 /s-1.

Conclusions: The significant predictor factors for sedimentation and river water debit are the shrubs and the coefficient of the river shape.

 
Speech evoked auditory brainstem responses in children with learning disability
Authors: . Sachin , Munjal Sanjay , Kohli Adarsh , Panda Naresh , Arya Shantanu
Published: December 2018

Background: Learning disabilities are characterized by significant impairments in acquisition of reading, spelling or arithmetic skills. A growing number of studies have used speech sounds to assess auditory processing to linguistic elements in children with learning disability. The present study seeks to report whether speech evoked Auditory Brainstem Responses can be used as a biological marker of deficient sound encoding in children with learning disability. The study aims to establish relationship between click evoked auditory brainstem responses (ABR) and speech evoked ABR in children with learning disability; to report whether speech evoked auditory brainstem responses can be used as a biological marker of deficient sound encoding in children with learning disability.

Methods: Pure tone audiometry, immitance audiometery, click and speech evoked brainstem responses were obtained in 25 children diagnosed with learning disability and the data was compared with the responses in the control group.  

Results: Statistical differences were seen in speech recognition threshold, speech discrimination scores, latencies and amplitude of speech evoked auditory brainstem responses between control and study group. This poor representation of significant components of speech sounds in children with learning disability could be due to synaptic efficacy distortion and poor synaptic transmission. Other reasons may be activation of fewer auditory nerve fibres in the auditory brainstem in response to speech stimulus.

Conclusions: The speech evoked auditory brainstem responses can serve as an efficient tool in identifying underlying auditory processing difficulties in children with learning disability and can help in early intervention.

 
Unilateral maxillary swelling: a varied spectrum
Authors: Satish Deepthi , Pratibha C. B. , Balasubramanya A. M. , Philip Sumy
Published: December 2018

Background: Diverse disease entities may present with mass in the maxilla and include benign conditions and malignant tumours. A detailed evaluation including preoperative imaging is essential to plan approach to management of isolated maxillary sinus lesions optimally.

Methods: We did a retrospective chart review of 14 patients with isolated maxillary swelling and involvement of maxillary sinus who presented to the Department of ENT in a tertiary care hospital over a period of 4 years. A detailed history and examination were done and investigations including contrast enhanced CT scan of the nose and paranasal sinuses was done in all patients.  

Results: A total of 14 patients were included in this study. 7 were male and 7 were female. The mean age of the patients was 52.6, the age group of patients varied from 6 to 77 years. In our series we had patients with benign lesions like dentigerous cyst, fibro-osseous lesions, mucocele, radicular cyst, aspergilloma, and mucormycosis. Malignant cases included Adenoid cystic carcinoma, Low grade myofibroblastic sarcoma, Diffuse B cell lymphoma and undifferentiated carcinoma. All patients were treated surgically, they underwent a combined endoscopic and Caldwell Luc approach.

Conclusions: In patients with unilateral maxillary swelling, a systematic approach to diagnosis with preoperative contrast enhanced CT scan is essential with a high index of suspicion. Trans nasal endoscopic approach with sinus surgery is the preferred approach for these lesions, however, in cases of jaw cysts and odontogenic cysts extending laterally it can be combined with a Caldwel-Luc approach.
Assessment of eustachian tube dysfunction in middle ear pathologies
Authors: Singh T. Dinesh , Sudheer C. P.
Published: December 2018

Background: Auditory tube dysfunction is suspected as primary cause of chronic otitis media and leads to surgical related complications in otitis media with tympanic membrane perforation. The diagnosis of eustachian tube malfunction is essential to know the pathogenesis of chronic otitis media.

Methods: A total 150 cases and 75 age, sex matched control subjects between age group 20-50 years were selected. Pre and post-surgical history was noted and detailed ear examination, tympanometry was done. Auditory tube function was evaluated through Valsalva test, nasopharyngoscopy, pneumatic otoscopy. Intact tympanic membrane was assessed by Williams test, perforated tympanic membrane by Toynbee’s test.  

Results: Postoperative assessment of eustachian tube function by Toynbee’s test for 19 cases with failed tympanoplasty showed normal ET function in 5 cases, 8 cases had partial and 6 cases had gross ET dysfunction. Postoperative assessment ET function by William’s test showed 4 cases among 19 cases had partial ET dysfunction and 01 cases had gross ET dysfunction.

Conclusions: Efficient surgical outcome of middle ear complications always depends on eustachian tube function. Most of the cases with residual CP showed partial or gross ET dysfunction. Patients with tubal dysfunction should be evaluated for underlying cause and treatable causes should addressed before proceeding for surgery as it increases the success rate of tympanoplasty.
A comparative study of diagnostic nasal endoscopy and computerized tomography of paranasal sinus in diagnosing sino nasal disease
Authors: Belure Gowda P. R. , Vinay Kumar M. V.
Published: December 2018

Background: Paranasal sinus diseases are one of the commonest causes of patients visit to an otolaryngologist. The symptoms are multiple and vague, while examination is often limited as sinuses cannot be examined directly. The objective of the study was to compare the diagnostic nasal endoscopy and computerized tomography findings of paranasal sinus in diagnosing sino nasal disease.

Methods: A comparative study was conducted at Hassan Institute of Medical Sciences, Hassan for duration of one year from June 2017 to June 2018. All the patients attending the ENT OPD with sin nasal disease and who meets the inclusion criteria during the study periods were included in the study. A total of 100 Patients were included in the study and analyzed.  

Results: The most common diagnosis leading for diagnostic evaluation was chronic sinusitis. The septal deviation was best diagnosed using CT scan. CT scan was also found to effective and better than DNE in identifying the haziness in the sinus and checking the patency of sinus. DNE was found to better in identifying the secretion in the middle meatus.

Conclusions: Sino nasal disease in the adults needs to evaluate using DNE and CT scan before planning for the sino nasal surgeries. Both the diagnostic techniques have merits over the other, but CT scan can give better view and reports of the sinonasal diseases.
Study on incidence of fungal aetiology in cases of chronic rhinosinusitis: a teaching hospital based study
Authors: Singh Kamalpreet , Goyal Sunil , Gupta Arun
Published: December 2018

Background: To study the presence of fungus and their types in nasal swabs taken from osteomeatal complex and in cases of nasal polyp from the nearest point of osteomeatal complex under endoscopic vision from the patients of chronic rhinosinusitis, using fungal culture and smear as the diagnostic method and to ascertain radiological, endoscopic and clinicopathological correlation.

Methods: 100 patients with CRS attending ENT OPD at tertiary care hospital to know the presence of fungus and their types and correlate clinico-pathological findings among patients of CRS with positive fungal culture and staining with those without positive fungal culture and staining.  

Results: Positive fungal cultures and smear in all cases including those who underwent endoscopic sinus surgery tissue samples were submitted for fungal elements, eosinophilia and fungal culture. Evidence of fungal infection was obtained in 32% (n=32) cases. Amongst the total patients, in 68 (68%) patients fungal culture and smear were negative (Table 1). Correlation between CT score (Lund-Mackay) and endoscopic findings score (Lund- Mackay) among patients of CRS with positive fungal etiology and CRS without positive fungal etiology showed highly significant p value.

Conclusions: The fungal infection is frequent in patients with chronic rhinosinusitis (32%), though on the lower side when compared to various other studies which have shown much more incidence of fungus in cases of CRS using advanced diagnostic tools and better methods of sample collection. Based on our results, Aspergillus (71.875%) was the most frequent isolated fungus in CRS patients followed by Mucormycosis and Candida.
A case report of subglottic haemangioma
Authors: Karunakaran Vignesh , Swamirao Rajaganesh Kutuva , Natarajan Dhinakaran
Published: December 2018

We report a case of 18 year old female who presented with hoarseness of voice and hemoptysis for 6 months eventually diagnosed as subglottic haemangioma through video laryngoscopy, CT imaging and histopathological examination of excision biopsy. The tumor excision was done by endolaryngeal surgery with tracheostomy under general anesthesia. The diagnosis of subglottic haemangioma, its management and prognosis were discussed.

 
A panoramic view of type 4 Kuhn cells, only one of its kind
Authors: Prasad K. C. , Mohiyuddin Azeem , Swapanthi M. B. , Harshita T. R. , Gopinath Induvarsha , Koneru Pratyusha , Nallencherry Mansheer
Published: December 2018

There are different type of pneumatizing air cells in the frontoethmoidal region, as described by Kuhn el all, in this type IV Kuhn cell is that kind of cell which is completely isolated within the frontal sinus, or as Wormald described it as, fronto-ethmoidal cells extending more than 50% of its vertical height of the frontal sinus. In this study we would like to show a macroscopic or panoramic view of type IV Kuhn cell, which was a glorious view while performing an external approach, as there is no literature on type IV Kuhn cell with a panoramic view. Possibly this could be the first of its kind in medical literature. And therefore, this image can be incorporated in various studies for further references.

 
Assessment of peripheral arterial disease in diabetic adults with foot ulcers in an African population
Authors: Ede Osita , Enweani Ugochukwu N. , Ogbonnaya Iheuko S. , Madu Kenechi A. , Anyaehie Udo E. , Ikpegbu Tochukwu , Basil-Nwachukwu Chinonso
Published: December 2018

Background: Peripheral arterial disease (PAD) is a recognized risk factor for diabetic foot ulceration. It was thought that PAD is not common in Sub-Saharan Africa. Studies show otherwise. It becomes necessary to assess the prevalence of PAD among diabetic adults with foot ulcers in Nigeria. The objective of the study was to assess the prevalence of PAD in diabetic subjects with foot ulcers in Nigeria.

Methods: Diagnosis of PAD was made with the ankle-brachial index (ABI). Edinburgh claudication questionnaire was administered to the patients. An ABI of <0.9 is diagnostic of PAD. Risk factors for PAD were assessed. A control group of non-diabetic adults was used.

Results: Sixty-seven per cent (67%) of the test group has PAD as compared to 18% of the control group. Smoking, duration of diabetes and systemic hypertension were strongly associated with PAD.

Conclusions: Diabetic adults with foot ulcers in Nigeria have a high prevalence of PAD.
Comparison of functional outcome at three month follow up using knee society score in patients undergoing total knee replacement by ERP and non ERP
Authors: Pawar Sawan Kumar , Soni Susheel , Archik Shreedhar
Published: December 2018

Background: Comparison of functional outcome at three month follow up using knee society score in patients undergoing total knee replacement by ERP and Non ERP.

Methods: In this prospective study of 29 patients in group (II) who underwent total knee arthroplasty using Enhanced recovery protocol and compared with 29 patients in control group (I) whose data was obtained from hospital database in Lilavati Hospital & Research Centre, Mumbai.

Results: The majority of the patients were from the age group of 61-70 years in both group I & II. There was female predominance in our study. The mean length of stay for group I was 5.69 days and for group II 3.28 days. The average knee clinical score in group I was pre op 33.52 which improved to an average post-op score of 82.62 at 3 months and for group II it improved from 34.21 to 84.66 at 3 months. The average pre-op knee functional score was 43.28 which improved to an average post-op score of 85.00 at 3 months in study group II. The average pre-op Knee Society Score was 77.14 which improved to an average post-op score of 169.66 at 3 months follow up for group II.

Conclusions: The results of the present study showed that patients who underwent TKA using ERP protocol has reduced length of stay in hospital, significantly improved KSS proving TKA as an effective procedure that is associated with substantial functional improvement.