bluuebunny/crossref_metadata_2025 huggingface dataset:
Study of cutaneous manifestations of polycystic ovarian syndrome
Authors: Kaur Sukhleen , Gupta Sunil K. , Juneja Sunil K. , Kaur Sukhjot , Rani Monika
Published: March 2020

Background: Polycystic ovarian syndrome (PCOS) is one of the most frequently encountered endocrine disorders that occurs in as many as 4 to 10% of women of reproductive age group. It presents with a series of skin changes including acne, hirsutism, seborrhea, androgenetic alopecia (AGA) and acanthosis nigricans. Aim of the study was to determine the prevalence and frequency of different cutaneous manifestations in PCOS patients and to correlate them with the degree of hormonal abnormalities.Methods: A total 100 patients with features of PCOS who presented to department of dermatology, gynecology (January 2018-December 2019) with cutaneous manifestations were recorded and diagnosis of PCOS was made using Rotterdam’s criteria. Pregnant women and diagnosed cases of any other endocrine disorder were excluded. Hirsutism was assessed using Ferriman-Gallwey score and AGA according to Ludwig’s classification. Serum hormonal profile including FSH, LH, prolactin, testosterone (free), DHEAS, TSH, FBS, fasting insulin were done. Insulin resistance was determined by calculating HOMA-IR score.Results: Among cutaneous manifestations of PCOS, hirsutism (85%) was the most common finding followed by acne (73%), seborrhea (50%), AGA (36%), acanthosis nigricans (29%) and acrochordons (9%). The most common hormonal abnormality was insulin resistance in 53% patients, followed by raised free testosterone in 19% and serum prolactin in 18% patients. A statistically significant association was present between AGA and insulin resistance, hirsutism and raised prolactin levels, seborrhea and raised body mass index (p < 0.05).Conclusions: Dermatological manifestations of PCOS play a significant role in making the diagnosis and constitute a substantial portion of the symptoms experienced by women with this syndrome.
Comparative study: normotensive and preeclampsia mother presenting with imminent symptoms of eclampsia in third trimester of pregnancy
Authors: C. Raji , S. Suba
Published: March 2020

Background: This prospective study compares the maternal and fetal outcome in normotensive and preeclampsia mother presenting with imminent symptoms of eclampsia in third trimester. This prospective study was conducted in the department of obstetrics and gynaecology, Government Theni Medical College, Tamil Nadu, India in 2019.Methods: A total 100 antenatal mothers were selected for the study. Group A - 50 known case of preeclampsia presented with imminent symptoms. Group B-50 previously normotensive patients present with imminent symptoms of eclampsia. Maternal and fetal outcome were analysed.Results: Incidence of eclampsia - 0.1%, HELLP syndrome - 0.04%, pulmonary edema - 0.06%, PRES - 0.07%, abruptio placenta - 0.14% and maternal death in Group A was 2% and in Group B was 8%. Maternal complications are more in normotensive women (46%) presented with imminent symptoms than in preeclampsia women (26%) with imminent symptoms. Incidence of IUGR in Group A was 46%, whereas in Group B 12%. Incidence of preterm babies in Group A was 18%, whereas in Group B was 42%. Perinatal death incidence was 2.2% in imminent eclampsia.Conclusions: Because known preeclampsia patients were aware of imminent symptoms and presented early to hospital. Early identification and treatment of this dreadful outcome at the imminent state itself can reduce the complications. In current status on preventive aspect of eclampsia, atypical presentation should also be considered for which new screening and diagnostic tools has to be developed.
Anesthetic management for emergency caesarean section and craniotomy together: an overview of the challenge
Authors: Pathak Nidhi , Katyal Misha
Published: March 2020

Traumatic brain injury in a pregnant woman is a challenge for anaesthesiologist, surgeon as well as paediatrician as it involves care and management of two lives together. We hereby discuss anaesthetic management of a 23 year old pregnant woman with extra axial bleed and brain contusion and skull fracture. Since the fetus was viable without signs of fetal distress, decision of doing caesarean section followed by craniotomy was taken and our patient was discharged a week later and the baby was handed over to attendant the next day.
Tubercular pyometra in a young unmarried female - dilemma and pitfalls in diagnosis: a rare case report with review of literature
Authors: Aggarwal Rasika , Malik Renuka , Singh Swati
Published: March 2020

This rare case is the first case being reported as tubercular pyometra in a young unmarried woman. Diagnosis of genital tuberculosis which is a form of EPTB (extra pulmonary TB) can be baffling, compelling a high index of suspicion owing to paucibacillary load in the biological specimens. A negative smear for acid-fast bacilli, lack of granuloma on histopathology and failure to culture mycobacterium tuberculosis do not exclude the diagnosis of EPTB. A 25-year-old unmarried, government employee from Bihar presented to our OPD with secondary amenorrhea for two months carrying with her an USG, CT and MRI done in Bihar suggesting enlarged uterus with fluid collection. CT-also reported few enlarged lymph nodes. Her preoperative investigations revealed an elevated ESR and x-ray chest was normal. Dilatation was done under ultrasonic guidance in OT and 150 cc of thick caseous material was drained A gentle curettage was done on lateral wall near cornea and both the caseous material and endometrial tissue was sent for gram staining, TB-PCR (polymerase chain reaction), NAAT (nucleic acid amplification techniques) and culture. In the post-operative period gram staining for AFB, NAAT, TB-PCR all came negative and it was difficult to convince patient to take ATT. However, on day 10, HPE report came as granuloma suggestive of TB and patient was put on ATT. Culture too was reported negative later.  Paucibacillary female genital TB (FGTB) is difficult to diagnose because of varied presentation and limitations of diagnostic tests A raised ESR is presumptive but non-specific. Other tests are x-ray chest, HSG, endometrial tissue for TB PCR nucleic acid amplification techniques (NAAT, HPE and culture (conventional or Bactec). Patients with EPTB are, however, more likely to have negative sputum smear results and many EPTB cases do not have direct lung involvement.  Currently, there are no standard guidelines or algorithm for the diagnosis of FGTB. Female genital TB has varying presentation and diagnosis is difficult because of the paucibacillary nature.
Primary ovarian ectopic pregnancy: an unusual case study
Authors: Sharma Shikha , Moudgil Shelley , Kapoor Varun , Devi Anu
Published: March 2020

Ovarian pregnancy is rare variant of ectopic pregnancy. An accurate preoperative diagnosis is very challenging various advances in diagnostic modalities like Transvaginal ultrasonography has evolved in identifying an ovarian pregnancy. It results in significant maternal morbidity, fetal loss, repeat ectopic, impairment of subsequent fertility. The case report a 34-year female who presented with pain and severe anemia and explored keeping in view ruptured tubal ectopic but intraoperatively diagnosed as primary ovarian pregnancy and managed conservatively by ovarian wedge resection.
Three delay model: to find out the reason for maternal deaths
Authors: Agrawal Neha , Patel Seema , Badkur Mayank
Published: March 2020

Background: Each year in India, roughly 28 million women experience pregnancy and 26 million have a live birth. Of these, an estimated 67,000 maternal deaths and one million new-born deaths occur each year. A woman dies as a result of complication arising during pregnancy and childbirth every 90 seconds in the world, and every 7 minutes in India. The three delay model can be used to find the causes of delays in relation to maternal deaths.Methods: A retrospective study was carried out in a tertiary care centre. All cases of maternal mortality between July 2010 to June 2016 were included in the study. Then data analysis was done.Results: Out of the total 382 maternal deaths, Majority of maternal deaths 43% were due to type 1 delay. 150 patients had delay in seeking help, 9 patients refused treatment and 5 patients refused admission to health care centre. 13% maternal deaths were due to type 3 delay which include delay in receiving adequate treatment, Delay in diagnosis and intervention, Lack of facilities etc.Conclusions: Type-1 delay was major contributors of maternal deaths in the study region. Therefore, to prevent the preventable maternal deaths effective action should be taken.
A study of effect of medications on patients with non complicated acute bronchitis
Authors: Shukla Rohit S. , Sharma Anshuman
Published: March 2020

Background: Authors define acute bronchitis as a self-limiting infection of large airways, which is characterized by cough without pneumonia. NSAIDS (Non-steroidal anti-inflammatory drugs) are prescribed in patients with Lower Respiratory Tract Infections (LRTI). In cough, fever and chest pain it is common practice to prescribe NSAIDS or antibiotics. Authors have conducted assessment of effect of medications in the resolution of cough of patients with uncomplicated acute bronchitis.Methods: It was a single blinded randomized clinical trial conducted in patients admitted to pulmonary medicine department of government medical college Shivpuri. Patients were from age group 18 to 70 years presenting with respiratory tract infection of less than one week’s duration, with cough as the predominant symptom and diagnosed with non-complicated acute bronchitis. Patients were randomized into two groups, group A and B according to medications.Results: Among 120 participants were randomized (60 to ibuprofen and 60 to antibiotic). The median number of days with frequent cough was slightly lower among patients of group A (12 days) compared with those receiving amoxicillin-clavulanic acid (14 days). No significant difference was found. Adverse effect was seen in 24 patients, which was most common in group B (15.25%) than group A (9.15%). p<0.05).Conclusions: No significant differences were observed in the number of days with cough between patients with uncomplicated acute bronchitis treated with ibuprofen or amoxicillin-clavulanic acid.
Comparison of urodynamic parameters with respect to neurological levels in post-traumatic spinal cord injury patients
Authors: Gaikar Rohit Ramesh , Gaur Anil Kumar , More Sumedh Narayan , Lokhande Vaibhav Shivram , Khade Amol Babanrao
Published: March 2020

Background: Urodynamic evaluation is mandatory in order to correctly assess and classify bladder dysfunction in spinal cord injury (SCI) patients. Study investigated patterns of neurogenic bladder dysfunction in patients with post traumatic spinal cord injury and assessed the relationship of detrusor leak point pressure with compliance, post void residual urine volume and maximum cystometric capacity.Methods: Eighty six patients with neurogenic bladder secondary to traumatic spinal cord injury (SCI) underwent cystometry with electromyography (EMG). T-test was used to compare detrusor leak point pressure (LPP) between complete and incomplete injury groups. Pearson correlation test was used to seek correlation between detrusor LPP and compliance, post void residual volume (PRV) and maximum cystometric capacity (MCC).Results: Mean detrusor LPP in suprasacral complete injury group, suprasacral incomplete injury group and sacral complete injury was 52±21 cm of H2O, 53±18 cm of H2O and 16±9 cm of H2O respectively. No significant difference in detrusor LPP was found between suprasacral complete and incomplete group on t-Test (p= 0.571068). Significant difference in detrusor LPP was found between suprasacral and sacral group (p= 5.71891E-12). Mean compliance in sacral injury group was 24±16 and in suprasacral complete injury group was 5±6. Mean compliance in suprasacral incomplete injury group was 4±2. Pearson correlation showed negative correlation (r = -0.6918934) between detrusor leak point pressure and compliance (p= 1.2744E-13). Negative correlation (r = -0.311409922) was observed between detrusor leak point pressure and post leak/ void residual urine volume (p= 0.003335033) and between detrusor LPP and maximum cystometric capacity (r = -0.31354), (p= 0.003115).Conclusions: Significant difference in urodynamic parameters exists between sacral and suprasacral injury patients. However there is no significant difference in urodynamic parameters between complete and incomplete injury at suprasacral level.
Study of correlation between adequacy of dialysis and glycemic control in patients of type 2 diabetes mellitus with chronic kidney disease stage 5
Authors: Mitra Samrat , Barui Sanghita
Published: March 2020

Background: The adequacy of haemodialysis in patients of type 2 diabetes mellitus with chronic kidney disease stage 5 depends on several clinical as well as laboratory parameters. Previous studies from Western literature have identified several clinical and laboratory markers for predicting adequacy of dialysis. There is a dearth of literature regarding the same in Indian patient populace. Authors aimed to find correlation, if any, between glycemic control and adequacy of dialysis in this cohort of patients.Methods: A set of 200 patients of type 2 diabetes mellitus who have undergone hemodialysis at a tertiary care hospital were included in the study. Random blood sugar (RBS), Glycated hemoglobin (HbA1c) were measured at admission. After 4 hours of dialysis, the urea reduction ratio (URR) and Kt/V was measured for each patient. The correlation coefficient as well as linear equation of the association between these variables were calculated. Standard statistical method and software were used in the process.Results: The study revealed a linear negative correlation between the variables RBS, HbA1c and URR as well as Kt/V. This suggests the importance of pre dialysis glycemic control in patients undergoing hemodialysis.Conclusions: Authors formulate the hypothesis that glycated hemoglobin and random blood sugar at admission correlate well with the outcome and adequacy of dialysis in patients of stage 5 chronic kidney disease undergoing haemodialysis.  Good glycemic control (HbA1c <6.5 % and RBS <120 mg/dL) have shown to be important predictive markers of adequate dialysis. The hypothesis needs to be tested with a larger study.
Comparative study of retinal nerve fibre layer thickness in normal and glaucomatous human eyes as measured by optical coherence tomography
Authors: Jain Ritu , Choudhary Nupur
Published: March 2020

Background: Glaucoma is a disease primarily associated with damage to the Retinal Ganglion Cell (RGC) bodies and axons, which causes characteristic patterns of Visual Field (VF) and changes in the appearance of the Optic Nerve Head (ONH). This Study Compares Nerve Fibre layer thickness in normal and Glaucomatous Human Eye.Methods: It is a case control observational study carried out in 100 patients in a tertiary eye care hospital in the department of ophthalmology in the period from 1st January 2019 to 30th June 2019.Results: The diagnostic ability for distinguishing between normal and glaucoma patients were same when authors consider average RNFL thickness and average GCC thickness. Diagnostic accuracy increases when authors consider both RNFL and GCC thickness. There was a significant difference in both RNFL and GCC thickness between normal and glaucoma patient (p<0.001). The mean deviation shows a significant correlation with all the parameters in eyes with glaucoma (<0.001).Conclusions: RNFL thickness as measured by OCT showed statistically significant correlation with glaucoma. RNFL seems to have higher sensitivity and specificity for the detection of early glaucoma. Diagnostic accuracy increases when we include other parameters like RNFL and visual fields.
Characteristic of risk factor of thyroid cancer related metastatic bone disease at Sanglah General Hospital Denpasar between January 2013 to March 2019
Authors: Nugraha Gede Ketut Alit Satria , Wiratnaya I. Gede Eka , Andika Gde Dedy , Sunaria Made
Published: March 2020

Background: Metastatic bone disease (MBD) causes a massive morbidity, pain, and disability for the sufferers. Thyroid carcinoma, which is the most common endocrine cancer worldwide, also contributes to the increased rate of MBD, as 60% of patients with thyroid carcinoma experience bone metastasis. An urgency to further analyze the risk factors of bone metastasis in thyroid cancer is necessary in order to prevent and treat this unwanted occurrence earlier and better.Methods: A descriptive retrospective study was conducted using patients’s medical record data obtained from Sanglah General Hospital between January 2013 until March 2019. The variables obtained were sex, age, diagnosis, management, and fracture site.Results: There were 15 patients involved in this study, presenting with pathological fracture due to MBD from thyroid cancer. Ten patients were female (66.7%)  and 5 were male (33.3%). According to the age group, 2 patients (13.3%) were <40 years old, 5 patients (33.3%) were >60 years old, while the majority of 8 patients (53.4%) were 40-60 years old. From the pathological result, 9 patients had follicular neoplasm (60%) and 5 patients had papillary neoplasm (33%). The most common site of metastasis was humerus in 7 patients (47%), while the other sites were femur, pelvic, and tibia.Conclusions: According to this series, there are several risk factors related to MBD from thyroid carcinoma, including female gender, the age of 40-60 years old, and follicular type neoplasm. A further study with bigger amount of sample is needed to improve the result.
Retinopathy of prematurity in preterm babies in a local medical college and hospital
Authors: Mishra Shantisena , Saji Anjali , Behera Saiprasanna , Mohanty Sridhar
Published: March 2020

Background: Retinopathy of prematurity is a multifactorial vasoproliferative retinal disease that increases in incidence with decreasing gestational age and is one of the leading causes of preventable childhood blindness in India. Advances in neonatology have led to dramatic increase in survival of preterm neonates and in turn, to the risk of developing ROP. Since most of the risk factors associated with ROP mentioned above arise in the neonatal intensive care unit (NICU) itself and most of them are avoidable, cautious monitoring of the risk factors, early screening, follow up and surgical intervention have been shown to reduce the incidence and improve the outcome of ROP.Methods: This was a prospective observational study conducted for a period of 2 years. A total of 151 infants admitted in NICU /SNCU who satisfied the inclusion criteria were enrolled in this study. Initial and follow up screening was conducted in three phases the results were documented in proforma after ethical clearance.Results: Comparison of risk factors between eyes with and without ROP was done using Chi-square test. A p-value of<0.05 was considered to be statistically significant. Incidence of ROP in centre is found to be 33.8%. Among maternal risk factors, multiple gestation and PROM/PPROM is found to be significant in the development of ROP from this study. However, mode of delivery and gestational hypertension, were found to be not significant in ROP. Among neonatal risk factors, low birth weight, lower gestational age, prolonged oxygen exposure, blood transfusion, mechanical ventilation, sepsis, phototherapy was found to be significant in this study.Conclusions: ROP, being an emerging cause for potentially blinding visual disability, needs to be diagnosed early. Due to the advancements in neonatology and better survival of preterm babies, timely screening, regular follow up, early detection and intervention is mandatory. A multidisciplinary approach is required in diagnosis and treatment of the disease. Proper counselling and motivation for parents of preterm and low birth weight babies for regular follow up is also essential.
Bird flu in Nepal
Authors: Thapa Kajol , Mishra Ved Prakash , Twanabasu Suraj , Kusma Susan
Published: March 2020

Avian flu also known as bird flu is caused by deadly virus H5N1 which initially was found in birds and wild animals, however, later it was found in human beings causing severe respiratory related problems. This review article was performed to understand the epidemiology of outbreaks of H5N1 in different districts of Nepal. First outbreak of strain H5N1 was reported in 2009. Consequently, highest number of outbreaks i.e. 201 was noted in the year 2013. Till date only one human case was identified by NPHL which was later confirmed by genetic laboratory in Japan in collaborating with WHO.
Persistent genital arousal disorder it’s etiology, treatment guideline and management strategy
Authors: Singh Preksha T. , Singhvi Shreyans D.
Published: March 2020

Persistent genital arousal disorder is a recently recognized disorder. Its first case was reported in 2001, since then many cases have been diagnosed and treated with various methods, yet no FDA approved treatment guidelines have been proposed. Although it is a cause of not only sexual, but also psychological impairment to the patients of the disorder, Persistent genital arousal disorder is not well recognized currently due to the social stigma attached to it  This study is important for the physicians treating a case of PGAD, as it has all the published data about the disorder.The review of literature was done by using all the research articles and case reports of PGAD using keywords like ‘persistent’, ‘genital’, ‘arousal’, ‘disorder’ on platforms like google scholar and pubmed. Various research articles and case reports were reviewed and grouped into different levels of intervention; at the female genital system, at the spinal cord and the brain. This study has evaluated all the possible etiologies and suggested the possible treatments and management strategies for the disorder. This study has thrown striking limelight on all the potential causes leading to PGAD, its potential line of treatment, and the management strategy. This study is based on the case reports found till date, but there is still a paucity in data, the number of reported cases is less due to a possible social stigma associated with the disease. The present investigation demands extensive research in the topic as this is a cause of social concern leading to psychological, emotional and nervous breakdown.
The role of diagnostic laparoscopy in abdominal masses
Authors: El Zanati Hisham I. , Aboelwafaa Waleed A. , Hamza Yasser M.
Published: March 2020

Background: Diagnostic laparoscopy is an added tool that has become widely available for the assessment of abdominal masses in addition to conventional imaging. It is the best real time imaging technique due to the magnification and intense illumination provided. The aim of this work is the assessment of the impact of performing diagnostic laparoscopy at the start of operations intended for resection of an abdominal mass.Methods: This prospective study included 40 patients admitted for surgical resection of an abdominal mass. All Patients were subjected to thorough conventional investigations followed by diagnostic laparoscopy performed prior to the start of the definitive operation. We assessed the extra time needed, complications encountered, effect on decision making and the overall benefit of laparoscopy in this context.Results: Overall 21 patients (52.5%) did benefit from diagnostic laparoscopy somehow between upgrading the staging, affecting the laparotomy incision site and confirming feasibility of laparoscopic resection. Of the patients who proceeded to a laparotomy (n=30), diagnostic laparoscopy missed local invasion in 7 patients, which precluded the resection of the tumor in 5 of them. Only 1 complication related to diagnostic laparoscopy was encountered in the form of a port-site hematoma (2.5%).Conclusions: While diagnostic laparoscopy doesn't carry significant added morbidity, it might save the patient an unnecessary laparotomy by altering the preoperative staging and improving the accuracy of anatomical and pathological diagnoses. Laparoscopy has its limitations mainly in the assessment of the retroperitoneal space as well as direct tumor invasion to adjacent organs and vessels.
Profile of congenital digital anomalies in children seen in two tertiary health facilities in Southern Nigeria
Authors: Ekemenye Okoro Philemon , Ikechukwu Otene Cletus
Published: March 2020

Background: Anomalies of the digits are among the common congenital limb anomalies seen worldwide. Whereas the majority of these digital malformations are relatively minor and require simple treatment, some of them are complex and often associated with other anomalies and systemic disorders. Reports on the occurrence of these anomalies and their treatment are scanty in our region. The study sought to evaluate the burden of these digital anomalies among paediatric patients seen in our centres and outcome of treatment.Methods: Study was carried out as a prospective study in two tertiary health facilities in Southern Nigeria between June 2014 and May 2019. Data obtained and analyzed were the patients’ gender, age, family history, type of digital anomaly, the limb/s involved, other limb anomalies, systemic disorders, treatment given, outcome, and duration of follow up.Results: A total of 113 children with anomalies of the fingers and or toes were seen during the study period, but 104 were analyzed. They comprised, 63 (60.6%) were males and 41 (39.4%) females giving a male female ratio of 1.5:1. Polydactyly was by far the commonest digital anomaly and the upper limbs were mostly affected. Associated anomalies contributed significantly to morbidity and mortality in those cases.Conclusions: Digital anomalies are fairly common surgical problems in our region. Though majority of cases are mild and are easily treated, the more complex ones still pose a challenge to treatment in our practice. There is need for more interest and training among surgeons in our region to improve the surgical care and outcome of treatment of these digital anomalies in our region.
Transhiatal oesophagectomy: a single unit study
Authors: Mulla Sameer Ahmed , Pai Srinivas
Published: March 2020

Background: Oesophageal cancer is a common gastrointestinal malignancy in our country and transhiatal oesopahgectomy is popular choice of surgery for lower oesophageal cancers. This study aims at identifying the feasibility and effectiveness of this surgery in our setting.Methods: This prospective study was performed in Department of Surgery, SDM College of Medical Sciences and Hospital, Dharwad, India. It included a total of 10 cases operated during the study period. Various pre-operative, intra-operative and post-operative parameters were observed and results tabulated.Results: In our study dysphagia (90%) was the most common presenting complaint and tobacco, either smoked (40%) or chewed (40%) formed a common risk factor. Lower oesophageal growths (80%) were more common than mid oesophageal (20%). The preferred incision was midline (80%) and average duration of surgery was 351min and average blood loss was estimated to be 521 ml. There was one mortality and a R0 resection in 90% of the cases with 10% positive for local lymphnodal malignant spread.Conclusions: Our statistics are not very different to the studies compared, and we believe they will only improve. We propose transhiatal oesophagectomy to be a practical and affective tool in a surgeon’s armamentarium, which certainly can be a formidable treatment modality in sub-carinal oesophageal cancer.
C reactive protein as a prognostic indicator of severity in patients with acute pancreatitis
Authors: Ganesh Bharath Nayak , Setty Srinivas Nanjangud Masana
Published: March 2020

Background: Acute pancreatitis ranges from a mild illness to a severe disease with high morbidity and mortality. Severity affects the treatment and outcome. The existing scoring systems for assessment of its severity require are time consuming and expensive. This study was an attempt to evaluate the effectiveness of C-reactive protein (CRP) as a prognostic indicator and a marker of severity of acute pancreatitis.Methods: This was a prospective observational study conducted between among 50 patients diagnosed with acute pancreatitis. The Ranson’s score and CTSI was calculated for these patients. CRP levels were measured 48 hours after the onset of symptoms. They were observed for the development of local and systemic complications, and outcome. These were compared with the CRP values. Pearson coefficient was used to study the correlation between the variables. A p value of less than 0.05 was considered to be statistically significant.Results: 30 of the 50 patients had no local complications. 14 patients (28%) had peripancreatic collection and 6 (12%) had pancreatic necrosis. 24 of the 50 patients had systemic complications (48%). 25 patients had mild disease and 25 had severe disease as evidenced by the Ranson’s score. These 25 patients with severe disease also had raised CRP (p<0.05). There was no statistically significant correlation between the CTSI and CRP values. 4 patients with CRP values more than 400 succumbed to the illness.Conclusions: CRP can serve as an inexpensive alternative to the conventional severity assessment methods for the prediction of severity and outcome of patients with acute pancreatitis.
The risk factors of laparoscopic and open repair surgery of inguinal hernia in a tertiary care center
Authors: Goenka Ashish , Ijjapawar Mahesh
Published: March 2020

Background: The purpose of the present study to investigate the incidence of inguinal hernia and risk factors of laparoscopic and open repair surgery.Methods: The present study contained 3 bilateral,17 right-sided and 7 left-sided hernia in the laparoscopic group and 2 bilateral, 19 right-sided and 6 left-sided hernia in open repair group. A total of 54 patients had an inguinal hernia, 27 underwent open repair and 27 underwent laparoscopic to open repair.Results: The age group of patients of open repair is 51-60 years, whereas 41-50 years in laparoscopic repair. The mean age was 47 years in open repair against 43 years in the laparoscopic repair.Conclusions: Among them, eight patients from open repair (1-COPD, 3-asthma,1-hypertension, 3-smoking) and five patients with the laparoscopic repair (2- COPD, 2-asthma, 1-hypertension) had one of the above-mentioned risk factors.
Outcome of early laparoscopic cholecystectomy versus delayed laparoscopic cholecystectomy for patients with acute cholecystitis
Authors: Rather Zahid Mohd , Majid Nighat Ara , Islam Mohd Nazrull , Mohd Raja Waseem
Published: March 2020

Background: This prospective randomized study was undertaken to to assess the outcomes of early versus delayed cholecystectomy for patient’s acute cholecystitis.Methods: 70 patients with acute cholecystitis were prospectively randomized to either an early laparoscopic cholecystectomy (n=35) or a delayed laparoscopic cholecystectomy group (n=35). The mean operative time, conversion rate, total hospital stay, intra-operative and post-operative complications, average hospital cost were evaluated between the two groups.Results: A total of 70 patients were enrolled, 35 patients in each group. There was no significant difference in the conversion rates (early, 8.57% vs delayed, 5.71%) and postoperative complications (early, 25% vs delayed, 20%). At the cost of an increased operating time (early, 81 minutes vs delayed, 78 minutes) and blood loss (early, 180.33ml vs delayed, 108.00 ml), early laparoscopic cholecytectomy significantly shortened the total hospital stay (early, 1.5 days vs. delayed, 7.95 days) and  average hospital cost (early 9240 INR vs delayed, 12251 INR).Conclusions: The safety and efficacy of early and delayed laparoscopic cholecystectomy for acute cholecystitis were comparable in terms of morality, morbidity and conversion rate. However early laparoscopic cholecystectomy allows significantly shorter  total hospital stay and reduction in days away from work at the cost of  longer operating time and blood loss and offers definitive treatment at initial admission. Moreover it avoids repeated admissions for recurrent symptoms has both medical as well as socioeconomic benefits and should be the preferred approach for patients managed by surgeons with adequate experience in laparoscopic cholecystectomy.
A study of prognostic score for predicting the outcome in cases of traumatic brain injury
Authors: Singh Pal Sudhir , Rathore Ashay
Published: March 2020

Background: Glasgow coma scale (GCS) and the Glasgow outcome scale help us with confident predictions after 24 h following the injury, but not on admission. The IMPACT and CRASH studies provided new methods for performing prognostic studies of traumatic brain injury. And this prognostic scoring system has been studied in our study.Methods: This is an observational prospective cohort study performed at the department of surgery, Gandhi medical college and Hamidia hospital, Bhopal on 87 patients during a period of 2 years. A preformed pro-forma was filled for each patient after 6 hours of resuscitation which included all the details of the patients like name, age, sex, CR no., and GCS after resuscitation, mode of injury, the clinical evaluation score used by IMPACT trial and neurological finding, management details, CT scan was done as soon as possible for all patients and findings were included in the pro-forma. The final outcome was recorded at the time of discharge.Results: Among Patients with mean total prognostic score of 0-4, 97% patients discharged without deficit, 3% discharged with deficit with no mortality. Among score of 15-20, only 7 % can be discharged without deficit and 7% could be discharged without deficit, while 86 % patient died.Conclusions: The mean total prognostic score of discharged groups was significantly lower than the patients in discharged group. We concluded that this prognostic model helps us to individually identify patients who will succumb to death and early need for surgical intervention.
Ultrasound abdomen as a tool to predict difficult cholecystectomy
Authors: Mulla Sameer Ahmed , Pai Srinivas , Shetty Dishita
Published: March 2020

Background: Laparoscopic cholecystectomy is a commonly performed procedure in general surgical practise, which can sometimes be tedious and can have high morbidity. Ultrasound abdomen is a routinely performed radiological investigation for every case of cholecystectomy. This study intends to find correlation between the ultrasound findings and the perceived difficulty during surgery.Methods: This is a prospective study of 100 patients who underwent cholecystectomy after a preoperative ultrasound. Difficult cholecystectomies were defined and sonographic findings and intraoperative difficulties recorded and tabulated.Results: Fifty one cholecystectomies were classified as difficult cholecystectomy (20 converted to open procedure and 31 took more than 90 min to complete laparoscopically). The commonest ultrasound finding that was encountered was multiple calculi (62%) followed by gallbladder (GB) wall thickness of >4 mm (33%), stone size >1 cm (22%), contracted GB (17%), intrahepatic biliary radicals (IHBR) dilatation (15%) and the least common finding was empyema of the gallbladder seen in 7% of the cases.Conclusions: This study is a reflection of surgeries performed by a single team over 3 years which included 100 cases. It was started with an idea to identify the findings on a preoperative ultrasound that predicted a difficult cholecystectomy (laparoscopic or open). In our experience we found that empyema GB, pericholecystic fluid, IHBR dilatation and wall thickness of GB are excellent predictors of a difficult cholecystectomy.
Primary ileal volvulus: a rare cause of small intestinal obstruction
Authors: Faizan Syed , Jain Amit Kumar C. , Thimmappa Durganna
Published: March 2020

A 50-year-old lady presented to us in the emergency department with history of acute abdominal pain and vomiting since the past 24 hours. Abdominal examination showed tenderness and guarding in the hypogastrium, lumbar and right iliac fossa region. Initial diagnosis of ruptured appendicitis was considered but exploratory laparotomy gave us an intra-operative surprise. Small bowel volvulus is extremely rare in clinical practice and their symptoms are usually nonspecific. The diagnosis is typically confirmed at surgery most of the time just like in this case. No etiology of this volvulus was found in this patient. Ileal volvulus carries a significant risk of mortality. Awareness of this condition among surgeons will help to reduce the morbidity and mortality associated with this unusual form of intestinal obstruction.
Therapeutic approach to epidermoid cyst
Authors: Vagholkar Ketan , Vagholkar Suvarna
Published: March 2020

Epidermoid cyst is one of the commonest cutaneous swelling treated by a general surgeon. It is usually misnamed as a sebaceous cyst. Understanding the anatomical origin and pathogenesis of the cyst is pivotal for diagnosis and successful treatment. The etiopathogenesis, clinical features and surgical approach is presented in this paper.
A retrospective study on benign paraoxysmal positional vertigo in a tertiary health care facility of North India
Authors: Munjal Manish , Bhatti Harsimran , Kaur Japneet , Rishi Porshia , Munjal Shubam
Published: March 2020

Background: Benign paraoxysmal positional vertigo (BPPV) has been attributed to be one of the commonest causes of vertigo presenting to the clinician. However, this often remains undiagnosed and undertreated, epidemiology remaining an underexplored territory for this disorder.

Methods: A study was carried out at outpatient clinic, Ear Nose Throat, Head and Neck services, Dayanand Medical College and Hospital, Punjab over a period of one year from 1st January to 31st December 2018. Based upon history, detailed otological examination, and Dix-Hallpike testing, 374 patients were evaluated for benign paroxysmal positional vertigo presenting with complaint of vertigo and dizziness in the vertigo clinic and were treated with Epley’s maneuver.  

Results: Out of 374 patients evaluated, 79 patients were diagnosed as BPPV and underwent office management in the form of Epley’s maneuver.

Conclusions: This study helps in effective team approach among practitioners and clinicians in the hospital for referring vertigo cases to ENT OPD for effective management of vertigo.

 
Management of acute otitis externa in India: a questionnaire based survey of ENT specialists across the country
Authors: Singh Kritarth Naman , Patil Saiprasad , Barkate Hanmant
Published: March 2020

Background: A questionnaire-based survey was conducted across ENT specialists in India to know current perception and practice of acute otitis externa (AOE) management.

Methods: The survey was conducted between January-June 2019 using a 23-item questionnaire. Questions were pertaining to epidemiology, clinical as well as microbiological features, diagnostic and management approaches. An ENT specialist who has postgraduate diploma or masters in ENT with an active practice from at least 5 years was considered eligible. 100 ENT specialists were randomly approached across India to take this survey.  

Results: 68 doctors filled survey-questionnaires completely. 60 (88.23%) specialists were males, with mean age of 48.46±9.98 years. Majority agreed that AOE is polymicrobial (62,91.17%), with bacteria being either a primary pathogen or superimposed on fungal infections (otomycosis) (64,94.11%). Almost 90% respondents (61, 89.7%) agreed that empirical cover for both bacterial and fungal pathogens should be provided in AOE cases. 75% respondents (51/68) agreed that topical ear drop containing antimicrobial agents with steroid is the desirable option to manage AOE. Majority respondents (54, 79.41%) agreed that pain-relieving local anaesthetic eardrops should not be recommended in AOE as their usage can mask the symptoms. 63 respondents (92.64%) agreed that neomycin and clotrimazole have broad spectrum action and are safe in AOE.   

Conclusions: Majority ENT specialists opined that AOE cases have mixed bacterial and fungal etiology, and topical eardrop containing both antibacterial and antifungal agent with steroid is the desirable empirical option to manage AOE. Local anaesthetic eardrop should not be used as it may mask the symptoms and affect patient compliance. This publication has collated viewpoints of ENT specialists in India pertaining to AOE. It can aid practitioners in getting information about the current practice in the country related to AOE.  
Study of effect of chronic suppurative otitis media on auditory brainstem response latency
Authors: Muniyappa Hanumanth Prasad , Dudda Ravi , Kalegowda Balaji Nagavara , Basvaraj Vandana
Published: March 2020

Background: Chronic suppurative otitis media (CSOM) emerging as common hearing problems in the recent years with high prevalence requiring immediate attention. Hence, our study includes assessment of adult patients with CSOM using electrophysiological test, auditory brainstem response (ABR) and analysing the latency of ABR peaks in order to find the effect of CSOM on ABR latency with respect to shift in latency.

Methods: The study followed cross sectional study design where data collected from March to September 2019 were used. A total of 50 subjects with unilateral CSOM were analysed. Descriptive statistics and paired t-test was used for statistical analysis of the data.  

Results: The data was divided into 3 groups based on degree of hearing loss (mild, moderate and moderately severe). The Mean ABR peak latency was analysed and subjects showed a significant latency shift. Also, it was found that the magnitude of latency shift increased with increase in degree of hearing loss.

Conclusions: Hence the study concludes that as the amount of conductive component increases the pure tone threshold deteriorates and ABR latency gets affected. Also, the morphology of ABR peaks on comparison to the normal hearing ear gets affected due to constant conductive pathology in the pathological ear.

 
Clinical, pathological and radiological correlation of thyroid swellings
Authors: Chauhan Hetal H. , Aiyer R. G. , Shah Purva C.
Published: March 2020

Background: The cause and type of thyroid swellings vary across geographical areas, lifestyles, and socioeconomic status of people. The incidence of palpable thyroid swellings is 4-7% out of which only 1% are malignant. Out of all thyroidectomy cases, histologically confirmed thyroid malignancy constitutes only 20%. Hence, we attempt to evaluate thyroid swellings based on clinical examination, ultrasonography (USG), Fine needle aspiration cytology (FNAC), and histopathological evidence to aide in arriving at proper diagnosis and treatment at an early stage.

Methods: This was a prospective observational study conducted at the SSG Hospital, Vadodara from December, 2016 to September 2017 and included 30 patients. Following preliminary examination, we performed thyroid function tests, FNAC, and USG pre-operatively. Histopathological examination of excised tissue was performed within 4-5 hours after thyroid surgery, and later, post-op complications were noted. Results were derived after appropriate statistical tests.  

Results: 65% patients belonged to 2nd and 3rd decade with male to female ratio of 1:5 and all patients presented with an anterior neck swelling. Clinical examination was found to be 50% sensitive and 100% specific. The sensitivity and specificity of FNAC was 50% and 96% respectively while that of USG was 67% and 100% respectively. Out of 16% malignant cases, all were of papillary type. Most common post-op complication was related to wound care (3-5%).

Conclusions: Correlation between clinical findings, ultrasonography findings, cytology, serum investigations and histopathological examinations are to be carried out for appropriate management of thyroid swelling.

 
Hoarseness of voice-prospective study: etiology, evaluation and treatment
Authors: Upadhya Ila B. , Patel Dhaval C. , Rao Kartika R.
Published: March 2020

Background: Despite advances in medical technologies and improvement in diagnostic armamentarium in laryngology about 20% of cases remain undiagnosed until suspension laryngoscopy. The study was undertaken to identify etiological factors, type of lesions, age and sex distribution, sites of involvement, efficacy of different diagnostic and treatment modalities.

Methods: A prospective study of 45 cases of benign vocal cords lesions was carried out. Patients with hoarseness of voice for >3 weeks were investigated and treated with conservative management and surgery.  

Results: Hoarseness of voice presented within 6 months after onset of symptom. The common age of presentation was between 21 to 40 years, with male:female ratio of 1.25:1. Vocal abuse, laryngopharyngeal reflux disease (LPRD) and smoking, were the most common etiological factors. Housewives were most common group. Wide angled 700 telelaryngoscopy showed 80% accuracy rate. Suspension laryngoscopy showed 100% accuracy rate. Involvements of both the vocal cords were more common, vocal cord nodule being the commonest. 70% responded very well to conservative management.

Conclusions: Dysphonia is the most common presenting symptom having vocal cord lesion, non-professional voice user young females are most common sufferers with delay of 6 months in presenting to a laryngologist. Vocal abuse and LPRD are most common aetiologies. Telelaryngoscopy can diagnose up to 80% of them which is cost effective Outpatient Department procedure. 70% of them respond well to medical therapy and voice training. Identification of causative factor and management of them is mandatory for treatment and prevention of recurrence.
Nasal hemangioma as a cause of epistaxis: a case report
Authors: John Nikhil Mathew , A. Vivekanand , Varghese Tija Susan
Published: March 2020

Hemangioma is a benign, rapidly growing solitary lesion that usually occurs in the skin and mucous membrane. The exact etiology of such a lesion is unknown, but thought to be due to trauma and hormonal factors. Sinonasal hemangiomas are rare. Bleeding and nasal obstruction with mass sometimes filling the nasal cavity are the usual clinical presentation of such a lesion. We report a case of 42-year-old female with right nasal hemangioma presented with on and off epistaxis and progressive right-sided nasal obstruction. Examination of nasal cavity physically combined with endoscopy revealed a polypoid, reddish colored mass in the nasal cavity on the right side arising from septum. Endoscopic subperichondrfial excision was done under local anaesthesia. The histopathology showed vascular proliferative lesion, consistent with hemangioma. Endoscopic excision is preferred as it helps in better visualization. Subperichondrial excision helps to reduce bleeding also, prevent the recurrence. Although rare, the diagnosis of hemangioma must always be kept in mind while discussing the differential diagnosis of a bleeding mass in the nasal cavity.