bluuebunny/crossref_metadata_2025 huggingface dataset:
Adverse drug reaction to antiparkinson agents in Idiopathic Parkinson Disease: a prospective observational study in a Movement Disorder outpatient clinic
Authors: Thaha Firoz , Gangadhar Reneega , Iype Thomas , Rajan Reeja
Published: March 2017

Background: Parkinson disease (PD) generally requires therapy for prolonged periods often with multiple drugs; drug-related adverse effects often add to the existing morbidity. Although, such ADRs are common, comprehensive information about their incidence, severity, and ultimate health effects are not available. The objective of the study was to analyze the pattern of occurrence of Adverse Drug Reactions (ADRs) in patients receiving anti-parkinson agents (APA) in a tertiary care hospital. We also aimed to assess the causality, severity and preventability of these ADRs.Methods: This prospective, observational study with 6 month follow up was conducted among consecutive PD patients receiving anti parkinson agents attending the Movement disorder clinic of Neurology department between April 1st 2011 and September 30th 2012. Tools used were ADR Reporting form of National Pharmacovigilance centre, WHO causality scale, Hartwig and Siegel scale to assess severity and Schumock and Thornton scale to assess preventability of ADRs. Descriptive statistics was used and the values were expressed in numbers and percentages.Results: ADRs were experienced in 87 patients (82.1%) out of 106 patients and most of these patients were on combination therapy (66%). No gender difference in distribution of ADRs was observed. The most common reactions were sedation, dizziness, dry mouth and fatigue. The drug usage was in the order of pramipexole (58.4%), levodopa+carbidopa (55.7%), trihexyphenidyl (28.3%), entacapone (5.7%) and amantadine (7.5%). Majority of the ADRs were mild level 1 (71.1%). ADR was maximum with entacapone. Majority of ADRs belonged to the causality possible ADR category. All the ADRs came under the definitely or probably preventable category.Conclusions: ADRs with antiparkinsonian drugs is common but mild and preventable.
Pharmacotherapeutic study of efficacy, safety and prognostic analysis of anti snake venom serum in snake bite patients
Authors: Inamdar Khalid , Parhate Sudhakar M. , Randad Rahul D.
Published: March 2017

Background: Snakebite is a common medical emergency especially in the rural areas. The effective measure to treat most of the manifestations of venomous snake bite is timely administration of anti-snake venom serum (ASVS). Problems associated with ASVS use are lack of evidence for optimal dose schedule and occurrence of hypersensitivity reactions.Methods: A retrospective review of snakebite cases was carried out from record section of a tertiary care teaching hospital from January 2011 to December 2011.Results: Out of total 202 snakebite patients admitted during the study period, age group of 21-30 years (mainly male victims) accounted for highest no. of snakebite cases (25.7%). The mean (±SD) dose of ASVS used was 124 (±112) mL. 11.8% patients had suffered from adverse drug reactions due to ASVS. 7.4% patients required mechanical ventilation. Overall mortality in our study was 9.4%. Mortality was higher (50%) where the time interval between the snakebite and initiation of treatment was >6 hours. Out of total 15 patients who required mechanical ventilation, n=10 (66.6%) patient died.Conclusions: In our study, mean dose of ASVS used was as per WHO guidelines. Less incidence of adverse drug reaction due to ASVS may be because of co-administration of corticosteroids and anti-histaminics. Delay in getting treatment with ASVS, neurotoxic envenomation and respiratory failure, were the risk factors associated with adverse prognosis due to snake bite in our set up.
Prescribing pattern of drugs in chronic kidney disease patients on hemodialysis at a tertiary care hospital
Authors: Murthy B. V. Narayana , V. Satyanarayana
Published: March 2017

Background: CKD (chronic kidney disease) is a general term for heterogeneous disorders affecting kidney structure and its function. It is defined as either kidney damage or a decreased glomerular filtration rate of less than 60 mL/min/1.73m2 for 3 or more months. Objective of present work is to study the drug utilization pattern in chronic kidney disease patients undergoing hemodialysis.Methods: After taking the clearance and approval from the institutional ethics committee, a cross sectional prospective observational study conducted on chronic kidney disease (CKD) patients undergoing hemodialysis, in the department of nephrology, of Rajarajeshwari Medical College and Hospital, Bangalore. The data was analyzed descriptively.Results: Study included 52 patients, among them 41 males, 11were females, with a mean age of 47.6yrs. In our study large number pt were suffering from hypertension (HTN) 88.46% (46), in them the calcium channel blocker (CCB) 08.48% (38) was most commonly prescribed anti hypertensive drug. Around 1/3 of pt suffering from diabetes mellitus (DM) 36.53% (19) most of these patients were treated with them treated with oral hypoglycemic agents (OHA), and less than half of pt treated with insulin01.56% (07). Other drugs like phosphate binders (calcium carbonate & acetate) used in 11.16% (50), aspirin in 08.70% (39), statins in 10.04% (45) pt were being most commonly prescribed drugs.  Totally 448 drugs were prescribed In 52 pts Ie about 8.61 drugs / prescription, showing poly pharmacy.Conclusions: Patients undergoing hemodialysis with CKD will be having multiple diseases associated, regular monitoring and counseling regarding these diseases and its complication may reduce the incidence of CKD and the mortality and morbidity associated. The poly pharmacy noted in the study found inevitable because of the multifactorial etiologiesinvolved and needful multi-interventional approach towards it.
Cost variation analysis study of oral anti-depressant drugs available in India
Authors: K. N. Chaithra , Kamath Laxminarayana
Published: March 2017

Background: Depression is a disorder of major public health importance, in terms of its prevalence and the suffering, dysfunction, morbidity and economic burden. In India, the overall prevalence of depression is reported to be 15.9%. Antidepressant drugs are available in many different brands and costs of all brands are different. Patients of depression have to take the antidepressant drug for a long duration, so cost of the antidepressant drug influence the patient adherence to treatment and it is one of the important part of rational prescription.Methods: The cost of a particular drug being manufactured by different companies in the same strength and dosage forms was obtained from “Current Index of Medical Specialties” July-October, 2015, and “DrugsUpadate.com”. The cost ratio and percentage cost variation was calculated.Results: The prices of a total of 28 drugs (22 single and 6 combination preparations) available in 64 different formulations were analyzed. In single drug therapy, among Tri cyclic antidepressants (TCAs), Reboxetine (2 mg) showed the maximum price variation of 900%. In SSRIs, Dapoxetine (30 mg) showed the maximum price variation of 2360%. In SNRIs, Venlafaxine (75 mg) showed the maximum price variation of 109%. In Atypical antidepressants, Bupropion (150 mg) showed the maximum price variation of 515.38%. In RIMAs, Moclobemide (150 mg) showed the maximum price variation of 246.15% and in combination therapies, Amitriptyline with Chlordiazepoxide showed the maximum price variation of 129.35%.Conclusions: This study shows a wide variation in the prices of oral Anti-depressant drugs available in India. Psychiatrist/ Physician should consider the cost while prescribing antidepressant drugs. India being developing country most of the people belong to poor socioeconomic status, so prescribing same generic drug with low cost reduces economic burden and improves patient adherence to treatment which results in better outcome.
Imiquimod triggering varicella zoster reactivation in an immunocompetent patient
Authors: Stewart Thomas Jonathan , Tomizawa Andrea , Rosen Robert
Published: March 2017

Imiquimod is widely used for the treatment of superficial basal cell carcinoma as well as several other dermatologic conditions. While its local immunostimulatory action is well proven, its potential for systemic immunomodulation has been less well described. We report the first case (to our knowledge) of varicella zoster reactivation caused by Imiquimod in an immunocompetent patient.
A case report on methotrexate induced pancytopenia
Authors: Devulapallli Meghana , Durga Prasad T. S. , Narasimha Kumar G. V. , Avanthi B. , Shabana Banu S. K.
Published: March 2017

Systemic lupus erythematosus (SLE) is a non-specific systemic inflammatory disease that affects various organ systems in the body leading to a wide spectrum of clinical presentations. The management of SLE includes therapy with immunosuppressant agents who have a narrow safety range and a wide adverse effect profile. Methotrexate discussed in this case report is one of such drugs whose short term and long term usage has been associated with various adverse events that affect the individuals quality of life. So, it is always advisable to take prophylactic measures and to provide patient education to detect and prevent adverse events at the earliest.
Role of transvaginal ultrasound in assessment of endometrial pathology in patients with post-menopausal bleeding
Authors: Menon Sudha , R Sreekumari
Published: March 2017

Background: Post-menopausal bleeding (PMB) is the most distressing problem in females Endometrial thickness (EMT) as assessed by transvaginal ultrasound (TVS) aids in diagnosing endometrial pathology. This study analyses usefulness of TVS as a diagnostic tool in the evaluation of PMB.Methods: A prospective study was conducted in 100 patients. Correlation of EMT by TVS was compared with gold standard of histopathological examination (HPE) of the endometrium by fractional curettage (FC).Results: Mean age was 56.9±8.03 years and mean parity status was 2.83±1.45. Mean duration after menopause to presentation of bleeding per vaginum was 5.7±3.85 years. As per the receiver operating characteristic curve (ROC) analysis, an EMT of 10.8 mm had a high negative predictive value (99.1%) for malignancy with moderate specificity (62.79%) and high sensitivity (92.3%).Conclusions: TVS can be easily performed and is less expensive and a useful diagnostic tool in the evaluation of PMB with a cut off value of 10.8 mm EMT gives a high sensitivity (92.3%) and moderate specificity (62.79%).
Study of maternal and fetal outcomes in premature rupture of membrane in central rural India
Authors: Jaiswal Arpita A. , Hariharan C. , Dewani Deepika K. C.
Published: March 2017

Background: Premature rupture of membrane is linked to significant maternal prenatal mortalities and morbidity. The maternal and fetal outcomes in PROM is very important to decrease maternal and child mortality and for better management and prevention of complications. Thus, this study aimed to detect the maternal and fetal outcomes in patients with PLROM at tertiary care hospital in central rural India.Methods: This prospective study was conducted in Department of obstetrics & Gynecology, in a tertiary care institute located in central India, over a period of 18 months. 210 patients were diagnosed with PLROM and all of them were included in the study. The data of these women were collected using a checklist based on registration books.Results: The rate of maternal morbidity was 26%, commonest cause was clinical chorioamnionitis (11.9%) followed by febrile illness seen in 10.5%. No maternal mortality was seen in the study. Perinatal morbidity was seen in 30% of cases. Clinical early onset neonatal infection was the commonest cause for perinatal morbidity noticed in 23.8% of cases (50 out of 210). Perinatal mortality observed was 1.43% (3 out of 210). Birth asphyxia being the commonest cases of mortality.Conclusions: Major maternal morbidity is chorioamnionitis (11.9%). Major perinatal morbidity observed is early onset neonatal infection (24%).
Comparative evaluation of postpartum IUCD versus interval IUCD at a tertiary care centre in Allahabad, India
Authors: Singh Urvashi , Sonkar Shubhangi , Yadav Preeti , Dayal Meena , Gupta Veena , Saxena Somya
Published: March 2017

Background: The use of Cu T in postpartum period can provide long term and effective contraception and this study compares PPIUCD versus interval IUCD.Methods: 300 women enrolled in the study were divided into two groups. Postpartum group-150; Postplacental or within 10 minutes/intracaesarean/within 48 hrs of delivery. Interval Group 150; after 6 weeks of delivery / postmenstrual. Cu T 380A was used in the study. Contraindication for PPIUCD were between 48 hrs and 6 wks postpartum, chorioaminionitis, PROM >18 hrs, unresolved PPH and puerperal sepsis. All were followed up for 6 months.Results: The continuation rate at 6 months was 81.81% in interval group and 88.23% in postpartum group. Complications occurred in 15.33% cases after PPIUCD and in 19.33% cases after interval IUCD. Expulsion rate was significantly higher in PPIUCD as compared to interval insertions (6.96% v/s 2.2%; p value <0.05). Removal rate of IUCD was almost similar in both the groups (4% in PPIUCD v/s 6.0% in interval).Conclusions: PPIUCD is an effective, safe, convenient, low cost and long term method of postpartum contraception irrespective of the mode of delivery.
Peri-partum cardiomayopathy-not a rare entity, clinical profile in a rural tertiary care center in Gujarat, India
Authors: Bhattacharjee Rumi , Raithata Nitin , Patel Molina , Vaishnav Smruti
Published: March 2017

Background: Peri-partum cardiomayopathy (PPCM) in pregnancy has a potential to adversely affect both mother and fetus. Severe cases can be associated with life threatening complications unless managed promptly by multidisciplinary team. The objective was to study maternal and fetal outcome of PPCM patients.Methods: An observational cohort over 4 years (2012 to 2015) was conducted in a Rural tertiary care center. Consecutive antenatal and postpartum women with PPCM were studied for medical and obstetric complications, deliveries, fetal outcome and maternal mortality.Results: The incidence of PPCM was 0.3% and Most patients presented with typical signs and symptoms of heart failure. 55.5% were in NYHA 3 and 4 and 50% had ejection fraction below 30%. 83.3% required ICU admissions of varying length and Maternal mortality was in 1 patient (5.56%). PPCM occurred in 55.5% of ante partum against 44.4% of postpartum patients. Obstetric complications like PPH occurred in 11.1% while poor fetal outcome like preterm deliveries occurred in 50% while still births in 16.67%.Conclusions: The low incidence and rarity of PPCM presents itself with diagnostic dilemma. Obstetrician should have high index of suspicion in patients with heart failure and high risk factors. Early diagnosis and prompt treatment can only improve the outcome.
A comparative study of the effect of body mass index on pregnancy outcomes in normal and overweight women
Authors: P. Seeniammal , K. Chellamma V. , N. Umadevi
Published: March 2017

Background: Maternal obesity has been reported as a risk factor for various antepartum, intrapartum, postpartum and neonatal complications. Increasing rates of overweight among pregnant women are a significant public health concern with various implications for prenatal care and supervision of delivery. Therefore, the present study is to determine the adverse materno-fetal outcome in primigravid overweight and obese women delivering singleton babies.Methods: A prospective comparative study was conducted for a year at IMCH, Medical College, Calicut. Primigravid women with a singleton uncomplicated pregnancy with cephalic presentation at ≥37 weeks of gestation with accurate information regarding height and weight recorded at the booking visit were included in the study. Comparisons were made between 100 women with BMI >25 and 200 women with BMI 18.5-24.9. Statistical analysis was done using SPSS version 16.0. Data was analysed by Pearson Chi square test and Fisher’s exact test.Results: Overweight mothers are at increased risk quoted as relative risk (RR) and 95% confidence intervals (CI) of adverse materno-fetal outcomes. Gestational hypertension RR 2.39 (CI 1.65-3.47), Gestational diabetes RR 2.67(CI 0.95-7.48), induction of labour RR 2.35 (CI 1.4-3.95), Cesarean section RR 5.73 (CI 3.76-8.73), macrosomia RR 14 (CI 1.75-112.23), NICU admissions RR 4.51(CI 2.61-7.84),perineal lacerations RR 4.72 (CI 1.15-20.4), wound infection RR 2.97 (CI 1.06-8.41), and prolonged hospital stay.Conclusions: It is clearly evident from the study that maternal overweight and obesity is associated with adverse materno-fetal outcome.
Analysis of maternal mortality: a retrospective study at tertiary care centre
Authors: Khandale Surekha N. , Kedar Kshama
Published: March 2017

Background: Mother is the pillar of the family and maternal deaths during pregnancy and delivery are great loss to baby, family, society and country too. Epidemiological data pertaining to maternal mortality is valuable in each set-up to design interventional programs to reduce the ratio favourably. This study was design to evaluate the mortality rate in our hospital, to assess the epidemiological aspects and causes of maternal mortality, types of delay, and to suggest recommendations for improvement. Aim of the study was to analyse the causes of maternal death at tertiary care centre. Objective of the study was to analyse causes of maternal death and type of delay, and to suggest measures to reduce it.Methods: A retrospective study done at a tertiary level care centre from January 2011 to June15. Demographic data and other data were collected from maternal death review forms and case records. Data studied and analysed.Results: Most maternal deaths were due to obstetric causes like eclampsia (16.66%), preeclampsia (11.53%), anaemia (14.10%)and haemorrhage (10.25%). Associated co-morbid medical conditions hepatitis (6.41%) and heart disease (5.12%) were in the top list. Majority women were from rural area (69.23%), belonged to below poverty line (76.92%), had less than three visits (64.09%), received care at periphery below the level of specialist sub-district hospital. 94.87%were referred, and travelled more than 4 hours to reach hospital (88.44%). In majority cases Type 1 delay was most common (85.89%) comparatively to Type 2 and 3 delay.Conclusions: High risk cases should be identified. Early referral, easy transport, continued skill based training, monitoring of health services can reduce maternal mortality. Special training should be conducted for ASHA workers and ANM who generally works at grass root level in our country. Continued medical training is required for medical officers who are working at PHC and sub district hospital for early recognition of high risk women and their referral in time to higher centers to avoid maternal near miss or death.
Acute intraabdominal hemorrhage from an aneurysm on uterine artery
Authors: Nakagawa Tomoko , Kyukawa Yutaka , Nakaoka Yukiharu , Ninoi Teruhisa , Nakamura Kenji , Tsujita Yujiro , Honda Ken-ichi , Kurihara Yasushi , Terada Hiroyuki , Ando Tetsuji , Yasui Tomoyo , Sumi Toshiyuki , Koyama Masayasu
Published: March 2017

A 36-year-old woman was underwent emergency laparotomy for acute intraabdominal hemorrhage, but bleeding points were not found. Abdominal pains continued after the laparotomy, and rupture of aneurysm on uterine artery was found in angiography. An transcatheter arterial embolization was done for the uterine artery, and the aneurysm was found to disappear in 4-day-after the angiography. Rupture of an aneurysm on uterine artery should be considered for the causes of acute intraabdominal hemorrhage.
Effectiveness of negative pressure wound therapy in the management of chronic diabetic ulcers: a prospective study
Authors: Sharma Dhruv , Singh Biplav , Jaswal K. S. , Thakur Vishal , Nanda Vibhor , Nabh Rishi
Published: March 2017

Background: Chronic ulcers in patients with diabetes are complex and treatment is often difficult. At the moment, negative pressure wound therapy (NPWT) is widely used for the treatment of several types of wounds. Nevertheless, the clinical evidence to support the application of this dressing in chronic diabetic ulcers is scarce. The aim of this study was to evaluate the efficacy of NPWT to treat chronic diabetic ulcers.Methods: Prospective time bound comparative study. Diabetic patients aged 18 years or older with an ulcer were assigned to treatment with NPWT. Primary efficacy end point was time in reaching complete ulcer closure. A size of sample of 15 patients was used. NPWT was prepared with a polyurethane foam dressing, a Silicone catheter, a transparent adhesive drape and continuous negative pressure of 125 mm Hg. The wound was treated for cycles of 5 days and evaluated at every dressing change. Descriptive and analytical statistics were used.Results: There were 15 patients, with a mean age of 54.4 years (73.3% men). The average time to complete ulcer closure was (41.2 [8.5] days).Conclusions: NPWT is an effective modality of treatment of chronic diabetic ulcers with early appearance of granulation tissue and faster rates of overall complete wound closure.
Indications of ventriculoperitoneal shunt: a prospective study
Authors: Jaykar Ritvik D. , Patil Shrikant P.
Published: March 2017

Background: Shunts have been used to drain the Cerebrospinal fluid into practically every body cavity, organ system and tissue spaces. Scraff has critically reviewed the efficacy of various shunts.  These are of historical interest.  Ventriculo peritoneal and ventriculo cardiac shunts continue to remain the chief surgical techniques in the management of hydrocephalus.Methods: This study included sixty cases where VP shunt insertion surgery was indicated. Chhabra’s medium pressure VP shunt was used in all 60 cases.  32 out of 60 cases were below 2 years (53.3%) .70% of the patients were male and 30% were female. Male to female ratio was 2.3:1. Out of 24 cases of congenital hydrocephalus 16 were due to aqueductal stenosis i.e. 66.6 % of cases. Dandy Walker malformation was found in 2 cases. And in 2 more cases, Arnold Chiari malformation was found. In acquired group 22 cases had tuberculous meningitis, 4 cases were of post meningitis aetiology and 10 cases were of communicating hydrocephalus with history of trauma.Results: In congenital group of patients, most common clinical feature was ‘enlargement of head’ bulging of fontanelle.  In acquired group of patients the common clinical features were headache, vomiting, fever and convulsions. USG cranium and CT scan proved to be highly informative investigations and were done wherever necessary. Out of 36 cases of acquired group the percentage of tuberculous meningitis was 61.6% and communicating hydrocephalus with trauma was about 27%. USG cranium was also used in follow up congenital hydrocephalus to assess the position and functioning of shunt.  Even CT scan was used in adult age group to assess the position of shunt and condition of the brain. All patients of with VP shunt surgery were treated with higher antibiotics preoperatively and postoperatively.Conclusions: Common complications included, shunt infections, shunt obstruction, shunt malposition. Rare complications included shunt migration through anus and shunt ascites. Four patients died after VP shunt surgery, two were operated case of encephalocele with associated congenital anomalies with uremia and other two were with dreaded shunt infection with septicaemia. Ten (16.6%) patients required revision of VP shunt surgery in present study.
A prospective study to compare the effectiveness of saline dressing versus povidone iodine dressing in chronic diabetic wound healing: study from a tertiary hospital in south India
Authors: Gopi Ellikunnel Vithon , Basava Amrut H. , Matad Siddharth
Published: March 2017

Background: Saline dressings and povidone iodine dressings have been traditionally used for the management of chronic diabetic wounds Methods: Subjects attending diabetic wound clinic and surgery outpatient department/ casualty of Government Medical College and Hospital, Kozhikode, Kerala, India were divided into two groups by consecutive sampling i.e., Povidone iodine and Saline dressing group. Regular occlusive dressing was done for 6 weeks of follow-up period.Results: 3 out of 20 subjects in Saline treated group achieved complete healing by 6 weeks as compared to 1 out of 20 subjects in Povidone iodine treated group. There was a significant decrease in the wound surface area at 6th week in Saline dressing group in comparison to the povidone iodine group at P = 0.03 (<0.05) level of significance.Conclusions: Saline dressing is more effective in achieving healing in chronic diabetic wounds as compared to Povidone iodine dressing.
Knowledge and attitude of dentists on bisphosphonates use in the UAE: a descriptive cross-sectional study
Authors: Gaballah Kamis , Hassan Mawada
Published: March 2017

Background: The aim of this study was to assess the level of awareness and attitude of dentists practicing in the UAE about bisphosphonate intake and its dental implications.Methods: A descriptive cross-sectional study using a 15 close-ended and fixed choice questions was performed on a representative sample of 502 dentists practicing in the UAE.Results: The majority of the practitioners did not report treating patients on a bisphosphonate. Most of the participants were not familiar with the route of administration of the drug or the spectrum of side effects except for BRONJ which was regarded as the most common adverse effect. Furthermore, only a minority were aware of the standard treatment for patients on Bps.Conclusions:The responses received not only highlight the lack of knowledge among practicing dentists regarding dental management of such cases but also urges the need for dissemination of guidelines for best practice in this field.
A rare case of squamous cell carcinoma with xanthogranulomatous pyelonephritis in a patient with chronic obstructive renal calculi
Authors: Gautam P. Varun , Litake Manjusha M.
Published: March 2017

Squamous cell carcinoma (SCC) of the kidney is a rare entity. Often it is confused with Xanthogranulomatous Pyelonephritis (XGP), which is a chronic inflammatory disorder of the kidney, associated with the destruction of the renal parenchyma usually in the setting of an infectious process.  A 76 year old male presented with right flank pain and vomiting. On examination, was found to have tenderness with localized guarding in the right flank. Investigations revealed a mass arising from the lower pole of the right kidney which was hydronephrotic and had features suggestive of stage III xanthogranulomatous pyelonephritis (XGP) with pyonephrosis and the presence of multiple calculi. Patient initially underwent a drainage of the pyonephrosis and subsequent nephrectomy.  Histopathology revealed the presence of both XGP and SCC in the resected kidney specimen. Chronic nephrolithiasis is a predisposing factor for both XGP and SCC. XGP shares many characteristics with SCC in terms of both its radiographic appearance and its ability to involve the adjacent structures. Chronic nephrolithiasis is a predisposing factor for both XGP and SCC. XGP shares many characteristics with SCC in terms of both its radiographic appearance and its ability to involve the adjacent structures.
Meatal ulcer: very rare complication of Foley catheterization
Authors: Yagnik Vipul D.
Published: March 2017

A 65 year old gentleman was admitted with the diagnosis of exophytic tumor arising from the stomach wall. His vitals were normal. Patient was poorly built and poorly nourished with BMI of blood chemistry, ECG, and ECHO was normal. His past medical and surgical history was not significant. Urethral catheterization was performed pre-operative with strict aseptic technique. Patient underwent   laparotomy with subtotal gastrectomy and gastrojejunostomy. Catheter care was done regularly by trained staff. Catheter was removed on third post operative day. After removal of catheter, Patient had a difficulty in passing   urine. On examination, single meatal ulcer was noted (Figure 1). Post –operative course was unremarkable. Patient is in follow up since last six month without any problem.
Vestibular migraine- a dilemma no more
Authors: Rajguru Renu , Singh Inderdeep , Gupta Abhishek
Published: March 2017

Background: Vestibular migraine (VM) is an increasingly recognized cause of episodic vertigo. However, the pathophysiology of VM is still a matter of speculation and it is not known to what extent the dysfunction is located in the central or peripheral vestibular system. Though in its earlier version International Headache Society recognized only adult onset VM in the setting of basilar migraine, but in its latest 3rd edition beta version in consensus with Barany Society (2013), VM is included in the International Headache Society classification of migraine in appendix 1. It does not figure in the main list because it is yet to be validated by scientific research.

Methods: The purpose of this study is to record and describe the spectrum of clinical findings of VM patients, to study the vestibular system and find out the site of vestibular dysfunction. In this study we studied 20 patients with acute VM in the symptomatic and asymptomatic phase.  

Results: Abnormal findings in the vestibular work up were present in all 20 VM patients (100%). Central pathology in the vestibular system was seen in 10 patients (50%), 6 patients had peripheral vestibular pathology (30%), and in 4 patients (20%) the site of vestibular dysfunction was indeterminate as they had features of both central and peripheral dysfunction and the exact site of dysfunction could not be determined with certainty.

Conclusions: Acute VM should be considered in the differential diagnosis of vertigo. It can present both as a central and a peripheral vestibular disorder. However there are no definitive signs to pin-point the diagnosis. A careful clinical history combined with clinical findings and exclusion of other causes of vertigo, is fundamental for assessing the profile of patients with vestibular migraine.
Montelukast: a better alternative than antihistaminics in allergic rhinitis
Authors: Kaur Gurpreet , Dhingra Rachna , Singh Manjinder , Kaur Manpreet
Published: March 2017

Background: Allergic rhinitis is associated with sleep disturbances, daytime somnolence, and fatigue. Hence, present study was undertaken to evaluate and compare the nocturnal symptoms such difficulty in going to sleep, night time awakening and nasal congestion/obstruction on awakening among allergic rhinitis patients after administration of montelukast, chlorpheniramine meleate, levocetrizine, desloratidine and fexofenadine and to find out anti-allergic drug with maximum improvement in total symptom complex score.

Methods: The present study comprised of 125 patients suffering from allergic rhinitis on the basis of characteristic history, corroborative physical findings and blood eosinophilia. Night times symptoms including difficulty in going to sleep, night time awakenings and nasal congestion on awakening were evaluated after patients were given oral treatment with chlorpheniramine maleate, levocetrizine, fexofenadine, desloratadine and montelukast for a period of 6 weeks in different 5 groups and the result interpreted on the basis of symptoms relieved. Symptoms were recorded on day 1, 2 weeks, 4 weeks and 6 weeks of treatment and analysed. All the patients were randomly divided into five groups of 25 each. The results were tabulated and analyzed by chi-square, Kruskal-Wallis test.  

Results: The present study found that levocetirizine provided immediate effect at 2 weeks which is significantly better than other drugs. But at 6 weeks, montelukast is best among the drugs which were compared; followed by levocetrizine, fexofenadine, and desloratadine and chlorpheniramine maleate.  Montelukast was found to be a better drug as it has no significant side effects. Desloratadine group had dryness of mouth. Chlorpheniramine maleate has maximum side effects. 6 patients who took chlorpheniramine maleate complained of sedation, 1 patient complain of psychomotor disturbance.

Conclusions: The present study concludes that in terms of clinical efficacy, safety/tolerability and improvement in night time symptom scores at six weeks therapy in allergic rhinitis, montelukast is the better drug.
Efficacy of single dose preoperative intravenous dexamethasone for postoperative pain relief in tonsillectomy patients
Authors: M. S. Lakhan , Ramlan Sharwak , Somayaji Gangadhara
Published: March 2017

Background: Tonsillectomy is one of the most commonly performed surgical procedures in otolaryngology. For managing post tonsillectomy pain, different modalities like use of intravenous opioids, NSAIDS, local anaesthetics, nerve blocks and steroids are available. The aim of this study is to determine the efficacy of single dose preoperative intravenous dexamethasone for postoperative pain relief in patients undergoing tonsillectomy.

Methods: This study was conducted with 120 patients who underwent tonsillectomy. Patients were divided into two groups of 60, where one group received preoperative dexamethasone. Postoperative pains of both groups were assessed.  

Results: There is significant difference in pain in both the groups in 6th and 12th postoperative hours, but in 2nd hour there is no significant difference.

Conclusions: A single dose of preoperative intravenous dexamethasone significantly decreased the postoperative pain in tonsillectomy patients.

 
Audiometric evaluation of type 1 tympanoplasty for hearing results
Authors: Tegnoor Mallikarjun S. , Ali Kazim , Mithun Sutrave
Published: March 2017

Background: To evaluate the graft uptake rate of the type1 tympanoplasty performed by underlay technique using autologous temporalis fascia graft for the last two years and to assess the hearing improvement in the successfully operated cases with respect to age, sex, size and location of perforation.

Methods: This prospective Study included 50 patients, who underwent type1tympanoplasty.All operations are performed using an underlay technique and by postural approach. In all the cases, temporalis fascia is used for the reconstruction of TM. The data of all the patients regarding preoperative disease, perforation size and location, surgical approach, graft material, pre and postoperative clinical and functional (hearing evaluation by pure-tone audiogram) results are analyzed.  

Results: Successful closure rate of the TM perforation is 88% and the graft failure rate is 12%. In this study, lowest and highest age of patients at presentation is 13 and 55 years respectively with a mean age of 26.6 years. Most common approaches is post aural. The mean pre and post-operative air conduction threshold in the successful cases are 33.34 dB and 20.20 dB respectively with a mean audiological improvement of around 13 dB. The improvement in the hearing is achieved in only 88% (44 out of 50) among the successful operated type 1 tympanoplasty.

Conclusions: Type 1 tympanoplasty is a safe and effective technique to improve the quality of life of patients. The most common approach is postural. The graft uptake rate is better at three months. The improvement in hearing is noted irrespective of age, sex, size and location of perforation.
A study of clinical and audiometric profile in patients presenting with sudden sensorineural hearing loss
Authors: K. Vinod M. , Kaur Amanjot , Singh Jagdeepak , Singh Jatinder , Sandhu Kulwinder Singh , Singh Priyanka , Chabra Shiffali
Published: March 2017

Background: To assess the clinical and audiometric profile in patients presenting with sudden sensorineural hearing loss (SSNHL).The study also aimed to find out any possible etiology of SSNHL, prognostic factors and effectiveness of treatment. Prospective, open label, randomized study conducted in department of ENT at the Ram Lal eye and ENT hospital attached to Government medical college, Amritsar, Punjab, India.

Methods: 50 patients of either sex aged between 18 to 50 years suffering from unilateral or bilateral onset SSNHL included in the study on the basis of predetermined clinical criteria. The hearing assessments of patients were done before and after the treatment with tuning fork tests, pure-tone and impedance audiometry.  

Results: Most of the patients of SSNHL presented with unknown etiology. Steroid treatment gave a statistically significant improvement in pure tone averages.  Maximum improvement is observed in patients who started treatment within one month of developing SSNHL. Post-treatment outcomes were not influenced by age of the patient and type of the pure tone audiometry graph. The presence of vertigo and diabetes are bad prognostic factors for hearing outcome in SSNHL.

Conclusions: Most of the cases of sudden sensorineural hearing loss have unknown etiology. Patients with associated DM and vertigo are having poor recovery of hearing. Early starting of treatment gives maximum improvement of hearing. 
Oral cancer profile in a tertiary care center
Authors: Arora Nitin , Davessar Jai Lal , Singh Jyoti
Published: March 2017

Background: Head and neck cancers constitute around 5-50% of all cancers worldwide.  Head and Neck Cancers constitute about 30% of all cancers that are found in India. It is the 8th most common cancer in the world. Oral cancer forms a major public health issue in India due to its rising incidence, especially in women and in younger age group.  The purpose of our study was to evaluate, the epidemiologic profile of patients with oral cancer, its incidence according to age and sex, site distribution, risk factors involved and clinical stage at presentation.

Methods: It is a prospective study done from January 2014 to November 2014, in a total of 100 patients in age group 21 to 70 years, irrespective of gender, with a proven malignancy confined to the oral cavity. Patients were observed for the age and sex distribution, tumour staging, location and metastasis, commonly associated risk factor and most common site.  

Results: Oral cavity cancers were more common in males, than females. It is most prevalent in age group of 51-60 years. Oral tongue is the most common site. Betel nut chewing is the most significant risk factor associated with oral cavity cancer.T1 and T2 is the most the most common primary T stage. Neck metastasis occurs most commonly at N2 stage. Most common neck node level involved is level 2.

Conclusions: Oral cancers presents at advanced stage and age. It has also been seen in younger generations, which is due to increasing use of tobacco, its related products and alcohol. We see patient’s reports at advanced age and stage, which is increasing the morbidity and mortality related to oral cancers. Hence, today there is great need to create awareness about oral cancers. Preventive strategies must be designed in order to lessen the burden of Oral cancers. 
Merits and demerits of endoscopic tympanoplasty
Authors: Ambani Kirti P. , M. Bhavya B. , Vakharia Sanket D. , Khanna Ankur , Katarkar Ashish U.
Published: March 2017

Background: Aim of the study was to evaluate the merits and demerits of endoscopic tympanoplasty compared to conventional microscopic tympanoplasty.

Methods: This prospective comparative study was carried out between October 2015 to September 2016 in our otolaryngology department, for a period of 12 months. Total of 40 patients who fit into inclusion criteria, underwent endoscopic tympanoplasty under local anaesthesia with sedation. All laboratory preoperative testing was done; hearing evaluation was done with audiometry. Postoperative follow up was done at 2nd and 3rd  month’s period, graft status and hearing evaluation with PTA for all four frequencies 500, 1000, 2000 and 4000 Hz with air conduction and bone conduction thresholds were recorded.  

Results: Out of 40 patients, 16 (40%) were males, and 24 (60%) were females, there were 21 (52.5%) cases had moderate perforation, 15 (37.5%) cases had large perforation and 4 (10%) cases had subtotal perforation. Average time taken was of around 1hour and 30minutes, range was (70-140min.). All patients were evaluated for graft status, hearing gain and cosmetic results. Out of 40 patients, 35 (87.5%) patients had successful graft uptake, 2 (5%) patients had graft infection and 3 (7.5%) patients had residual perforation seen postoperatively.

Conclusions: Use of endoscope not only serves as a great teaching tool, but also helps to visualize the middle ear anatomy and pathology intraoperatively with minimal soft tissue manipulation better cosmesis and reduced postoperative morbidity. In our study, we found that endoscopic tympanoplasty had better graft uptake rate.
Cavernous hemangioma of the nasal cavity: mimicking as the inverted papilloma
Authors: Panbude Sushil Natthuji , Guha Amrita Harish , Mahajan Abhishek , Sable Nilesh Pandurang , Arya Supreeta
Published: March 2017

Cavernous hemangioma of the nasal cavity is extremely rare with only case reports in the literature highlighting the imaging findings on CT and MRI. Haemangioma are benign vascular tumours, which originate in the skin, mucosa and deep structures such as bones, muscles and glands. Exact etiopathogenesis of the haemangioma is not known, although they are divided into two types depending on the dominant vessel size at microscopy, capillary and cavernous. When these neoplasms arise in the nasal cavity, they are predominantly capillary and are found to arise from the nasal septum and are more common in the children. On the other hand, Cavernous haemangiomas are more likely to be found on the lateral wall of the nasal cavity and are more commonly seen in elderly. Also, inverted pappiloma also more commonly arise from the lateral wall of the nasal cavity, from the middle turbinate and also has the same demographics as the cavernous hemangioma. So, the distinction between the two should be carefully made based on the imaging findings so as to give the appropriate treatment to the patient. We have presented a rare case cavernous haemangioma arising from the mucosa of the middle nasal meatus, in a 37-year-old male which is mimicking as an inverted pappiloma based on the imaging features; however on histopathology proved to be cavernous hemangioma and also on the multimodal imaging that helps in early diagnosis and advocating appropriate and timely treatment.
The role of neoadjuvant chemotherapy in the surgical management of women with breast cancer in a middle-income country
Authors: Yip Cheng-Har , Yusof Mastura , Abdullah Matin Mellor , Foo Yoke-Ching , Yap Beng-Khiong , Ng Yi-Siang , Pathmanathan Rajadurai
Published: March 2017

Neoadjuvant chemotherapy (NAC) in women with large breast tumours can downsize tumours to allow for breast conservation surgery (BCS). The aim of this study is to compare the BCS rate between those who had NAC versus those who underwent surgery first and to determine the factors affecting response rate. 1,183 patients, who had surgery for breast cancer in a single institution from December 2012 to December 2015, were included in this study. 80 (6.8%) patients had NAC. Patient and tumours characteristics, and type of surgery were compared between those who had surgery first or surgery after NAC. Variables affecting the response rate were analyzed. The BCS rate between the surgery first and the NAC group were similar (34.2% versus 35%). The pathological complete response (PCR) rate, partial response rate and stable disease rate was 22.5%, 65% and 12.5%, respectively. PCR rate was not significantly affected by subtype of breast cancer, although there was a tendency for PCR to be higher in ER-negative (32.4%), PR-negative (26.1%) HER2-positive (28.6%), HER2 overexpressing (37.5%) and TNBC (22.7%) tumours. NAC is able to downsize tumour to achieve BCS rate that is similar to those without NAC.
Measurement of Indoor Terrestrial Gamma Radiation Dose and Evaluation of Annual Effective Dose at AECD Campus, Dhaka, Bangladesh
Authors: Md. Ashraful Islam, Dr. M. Habibul Ahsa Shahadat Hossain Dr. Mohammad Sohelur Rahman
Published: March 2017

Background: In this study, indoor terrestrial gamma radiation dose rates were measured at the Atomic Energy Centre Dhaka (AECD) Campus within Dhaka University area in Shahbag Thana of Dhaka, Bangladesh. Aim of the study: This kind of study is required to detect the presence of natural and artificial radionuclides (if any) releasing from nuclear facilities in the country or from neighbouring countries. Materials and Methods: The measurement was performed using a portable High Purity Germanium (HPGe) detector (Model No. GEM25P4-83). The portable HPGe detector was placed at 1 meter above the ground facing downward and data acquisition time for each monitoring point (MP) was 10,000 sec. Total 21 monitoring points (MP) were selected for collection of gamma-ray spectrum in the indoor environment at the AECD Campus. The MPs were marked-out using Global Positioning System (GPS) navigation. The GPS reading of the sampling locations were varied from E: 90o23'42'' — 90o23'47.4'' and N: 23o43'49.8'' — 23o43'53.4''. Results: The measured dose rates due to natural radionuclides were ranged from 0.373 µGy.h-1 to 0.646 µGy.h-1 with an average of 0.494 ± 0.0682 µGy.h-1. The annual effective dose to the population from indoor terrestrial gamma radiation was varied from 1.83 to 3.17 mSv. Conclusion: The range of dose rate and annual effective dose due to indoor terrestrial gamma radiation is lower than some European Countries like Italy, Sweden and Czech Republic and higher than India, Iran and Azerbaijan. It was observed that ground floor dose rate is slightly higher than first floor dose rate because accumulation from radon gas near ground surface contributes to the higher gamma absorbed dose rate..
Rozwój odnawialnych źródeł energii w Polsce w świetle unijnego pakietu klimatyczno-energetycznego oraz ustawy o odnawialnych źródłach energii
Authors: Ciepielewska Magdalena
Published: March 2017

W artykule została podjęta próba oceny polskiego prawodawstwa związanego z wykorzystaniem energii ze źródeł odnawialnych, zwłaszcza tego, jak odnosi się ono do rozwoju OZE w świetle dokumentów narzuconych Polsce przez UE. Warto zauważyć, że Polska ma bardzo duży potencjał związany z rozwojem odnawialnych źródeł energii, jest on jednak w niewielkim stopniu wykorzystywany. Prognozy przeprowadzone przez liczne instytucje badawcze wskazują, że największy potencjał mają energia pochodząca z biomasy i biogazu, a także energetyka wiatrowa. Warto zauważyć, że Polska zobowiązała się wobec Unii Europejskiej do zwiększenia produkcji energii z OZE do 2020 roku, poprzez podpisanie pakietu ,,3x20%”. Zobowiązaliśmy się także do zmniejszenia szkodliwych emisji zanieczyszczeń i współpracy na rzecz ochrony środowiska. Wspierać owe działania ma ustawa o OZE, która weszła w życie w 2015 roku. Niestety dokument ten okazał się mało przyjazny dla inwestorów. Nakłada on wiele obowiązków, zaś ewentualne korzyści związane z produkcją energii z odnawialnych źródeł są niedoprecyzowane i opisane w zawiły sposób. Zapewnienie 15% udziału OZE w końcowym zużyciu energii brutto w 2020 roku jest możliwe, lecz pod warunkiem że rząd polski będzie wspierać przedsiębiorców i zapewni im wszystkie niezbędne instrumenty do tego, by mogli bezpiecznie inwestować i rozwijać swoją działalność gospodarczą.
Crédito e conservação ambiental no extrativismo da carnaúba (Copernicia prunifera (Mill.) H. E. Moore) no nordeste brasileiro no período de 2007 a 2012
Authors: Costa Vera Lúcia dos Santos , Gomes Jaíra Maria Alcobaça
Published: March 2017

A carnaúba (Copernicia prunifera (Mill.) H. E. Moore) tem prestado importante contribuição à economia nordestina, além de desempenhar funções ambientais para o equilíbrio ecológico. Este trabalho faz um panorama do crédito ofertado pelo Banco do Nordeste do Brasil (BNB) e pelo Banco do Brasil (BB) para o setor da carnaúba no Nordeste, analisando o montante de recursos e de contratações no período de 2007 a 2012 e a aplicação deles em cumprimento às determinações da Lei n. 7827 de 27 de setembro de 1989 e do Protocolo Verde.