bluuebunny/crossref_metadata_2025 huggingface dataset:
Beneficial role of Avocado oil orally used in Osteoarthritis: experience in a tertiary care hospital of Bihar, India
Authors: Chandra Akash , Kumar Anjani , Kumar Manish , Kumar Manish , Dikshit Harihar
Published: May 2019

Background: Osteoarthritis is the most common type of joint disease. It represents a heterogeneous group of conditions resulting in common histopathologic and radiologic changes. It is a degenerative disorder arising from biochemical breakdown of articular (hyaline) cartilage in the synovial joints.Methods: Total of 90 patients were randomly selected from outdoor and indoor of Orthopaedics department (IGIMS Patna). Study was done in Department of Pharmacology & Orthopaedics at IGIMS Patna. Three groups A, B and C were taken. Each group was consist of 30 patients of both sexes and age groups between 18 to 65 years. Group A was received Multivitamin with Exercise. Group B was received NSAIDS only. Group C was received Avocado oil orally along with Exercises as Muscle strengthening exercises of Quadriceps, Hamstrings, Abductor and Adductor muscles of thigh. We had compared pain thresholds among all these three groups with the help of Visual analogue scale and Oxford Knee score.Results: After 3 months of treatment the patients belonging to group C showed better response as compared to group A and B. When we compared pain threshold among group A, B and C on the basis of Oxford Knee score group C had occupied maximum score, which meant satisfactory joint functions and did not require any formal treatment. we also compared average visual analogue scale and average oxford knee score, Group C showed better response.Conclusions: Avocado oil is a food supplement and does not contain any side effects as compared to NSAIDS [Non-steroidal anti inflammatory drugs], glucosamine sulfate, chondroitin sulfate, sulfasalazine etc so avocado oil can be used for long duration in case of osteoarthritis.
Effects of peppermint, chewing gum on memory, cognition, alertness, reaction time, arithmetic skills and athletic performance during laboratory induced stress in undergraduate medical students
Authors: Gandhi Piyush Prashant , Siddiqui Riyaz Ahmed
Published: May 2019

Background: Many medical students are dealing with day to day stress in their lives and they need to be both physically and mentally active to counter and overcome their daily problems. In such scenario, a non-pharmacological adjunct could prove useful to counter all of it so that they can work more efficiently. Many universities do recommend the use of peppermints and chewing gums. This study is conducted to see if any of these items actually have an influence on cognitive and physical abilities.Methods: A non-randomized controlled trial was performed on the undergraduate medical students of  N.K.P. Salve Institute of Medical Sciences and Research Centre belonging to the age group of 18-21 years. They were given normal flavoured gum, mint flavoured gum and peppermint. A series of cognitive and physiological tests in both stressful and stress free environments were performed.Results: Consumption of peppermint in a stressful environment showed increase in attention span of the subjects and it increased the intelligence Wechsler Adult Intelligence Scale-R (WAIS-R) in both stress free and stressful environments. As compared to normal gum, peppermint and peppermint gum proved to be more effective. There was no significant change observed in alertness, reaction time, arithmetic ability, short term memory and fatigue index in any of the subjects.Conclusions: Peppermint has caused increase in the attention span and intelligence of medical students in a stressful work scenario. Peppermint gum was found to be more beneficial than normal gum.
Hypertensive disorder of pregnancy and its immediate outcome on neonates in a tertiary care hospital of Western Nepal
Authors: Gupta Badri Kumar , Shrivastava Amit Kumar , Shrestha Laxmi
Published: May 2019

Background: Hypertensive disorders in pregnancy remain a major cause of maternal and neonatal morbidity and mortality worldwide. This study prospectively examined the immediate neonatal outcome of women with maternal hypertensive disorder of pregnancy (HPD).Methods: This is a prospective study conducted at NICU in Universal College of Medical Sciences Hospital over a period from 2nd February 2018 to 1st February 2019. Fifty-two mothers and their newborn were selected. Mothers with gestational hypertension, preeclampsia, and preeclampsia superimposed on chronic hypertension and chronic hypertension were included.Results: Mean maternal age was 26.4 years. Mean gestational age was 34±4 weeks. 38 were male and 24 were female with male: female ratio 1.72:1. Thirty seven (71.2%) mothers needed lower uterine caesarian section, fourteen (26.9%) mothers delivered NVD and one (1.9%) forceps delivery. Low birth weight (<2.5kg) babies were 25 (48.1%%), very low birth weight (<1.5kg) were 9 (17.3%) and normal weight were 18 (34.3%). Intrauterine growth retardation (IUGR) were 18(30%). Perinatal asphyxia 10 (19.2%) were most common cause of admission, other cause of admission were sepsis and prematurity.Conclusions: Eclampsia is still a common and serious complication of pregnancy. Proper antenatal care, detection of preeclampsia with early management and timely referral of high risk patient, administered of MgSO4 in correct doses and properly timed caesarean section in selected cases would reduce the incidence of eclampsia associated maternal and perinatal morbidity and mortality in our facility.
Correlation between glycemic control and dyslipidemia in Type 2 Diabetes Mellitus patient
Authors: Yadav Neha , Singh Sujata , Gupta Smita , Mishra Saurabh , Singh Krishna
Published: May 2019

Background: India is one of the countries with highest number of diabetes patients. Patients of type 2 diabetes mellitus are usually dyslipidemic. The objective of the research was to study the pattern of dyslipidemia and to study the correlation of glycemic control with dyslipidemia in type 2 diabetes mellitus patients.Methods: A cross sectional observational study was performed on patients of type 2 diabetes mellitus over 6 months period. The study included 200 patients and the variables recorded were demographic profile, FBS, PPBS, HbA1C and lipid profile parameters. The patients were divided into 3 groups according to HbA1C level i.e. Group I (Good glycemic control HbA1C 6-7 gm%), group II (Fair glycemic control HbA1C 7.1-8.2 gm%) and group III (poor glycemic control, HbA1C >8.2 gm%).Results: The data showed that TG level was maximum in group III and was minimum in group I. Comparison between the group shows a significant difference between all the groups (P <0.001). A significant positive correlation (Correlation coefficient 0.67, P <0.001) was also observed between level of TG and HbA1C. Similarly, LDL level was also highest in group III with a significant difference with other two groups (P <0.05). Also, a positive correlation (Correlation coefficient 0.64, P <0.05) was observed between LDL and HbA1C. On the other hand, HDL was lowest in group III as compared to groups I and II (P <0.001) and a negative correlation (Correlation coefficient -0.716, P <0.001) was seen between HDL and HbA1C.Conclusions: Dyslipidemia is less prevalent in diabetics who have better glycemic control.
A randomized controlled study on expectant management of incomplete abortions caused by self medication
Authors: Kushwah Beenu , Kushwah Devendra Singh
Published: May 2019

Background: Medical method of termination of pregnancy is a very effective method when used as per recommended regimen and under proper supervision. Self-administration of these drugs has become a very common practice these days, resulting in incomplete abortion because of improper use. Traditionally surgical curettage has been the preferred mode of treatment for these cases but is associated with very high complication rates. Expectant management of incomplete abortion has been recently adopted as a better method of management of incomplete abortions worldwide. Present study compares expectant management with surgical curettage in cases of incomplete abortions caused by self medication.Methods: It was one-year prospective randomized controlled study. Total of 220 patients were recruited for the study out of which 103 were randomized to undergo expectant management while 117 to undergo surgical curettage. Results were compared using chi square test..Results: Success rate of expectant and surgical management was found to be 82% and 95% respectively. Complication rate was found to be comparable in both the group while acceptability of expectant management was found to be much higher in expectant group. However, significantly more unplanned admissions and unplanned surgical curettage occurred after expectant management than surgical management.Conclusions: Expectant management is a safe and efficacious option in carefully selected cases. If used properly it can avoid complications associated with surgical management and therefore should be utilized whenever suitable.
Study of drug prescription pattern and adverse drug reaction monitoring in patients with hypertension and diabetes visiting outpatient department in a government tertiary care hospital in Maharashtra, India
Authors: Shinde Rucha M. , Kale Anand S. , Sawant Mahadeo P.
Published: May 2019

Background: Drug utilization study is an important tool to study the clinical use of drugs and its impact on healthcare system. DUS in patients with HTN and DM is essential to observe the changing prescribing attitude of physicians with the aim to promote rational use of drugs and to minimize the adverse drug reactions.Methods: A cross sectional observational study was conducted on randomly selected patients attending medicine outpatient department in a tertiary care hospital. Drug prescription sheets of 600 patients were studied for 18 months from January 2016 to June 2017 and the prescribing pattern was analysed using the World Health Organization basic drug indicators.Results: Total 2029 drugs were prescribed to 600 patients that belonged to various classes. The average number of drugs prescribed per encounter was 3.4. Majority (61.5%) drugs were prescribed using generic names. Percentage encounters with the antibiotics and injections were 6.3 and 11.5 per cent respectively. 38% drugs were prescribed from the 20th edition of WHO Model List of Essential Medicines. PDD in the current study was found to be significantly less than WHO DDD in all drugs. All of the prescriptions in the present study conformed to WHO guidelines and majority of them with JNC VIII guidelines.Conclusions: The findings of this study are comparable to those of other studies. However, there is a scope of improvement in areas such as overdosing, prescribing more by generic names instead of brand names and from WHO Model List of Essential Medicines.
Prescription pattern of medicines in a tertiary care hospital: a cross-sectional study
Authors: . Roshi , Tandon Vishal R. , Gupta Brij Mohan , Gupta Sanjeev
Published: May 2019

Background: Prescribing drugs for any disease is not complete until it is rationally done. Irrational prescriptions often lead to treatment failure, toxicity or drug interactions which may prove detrimental to the patient. Antibiotics are very much prescribed in day to day practice but their rational use prevents treatment failure, resistance.Methods: A cross sectional study was conducted in a tertiary care hospital to see the antibiotic prescribing pattern. Prescriptions were screened one time from different OPDs with prior permission from the doctor attending the respective OPD.Results: A total of 200 prescriptions were assessed out of which 121 had monotherapies prescribed, 79 had FDCs. Antibiotics were the most commonly prescribed drugs. Prescriptions having drug combinations were assessed and pantoprazole domperidone was the most commonly prescribed (32.91%).Conclusions: Drugs should be prescribed rationally for proper therapeutic benefit. It encourages the patient to properly use the medicine and properly comply to it.
A case report on incidental finding of thymoma as anterior mediastinal mass
Authors: T. Nithin K. , Kumar Vikas , Prasanth P.
Published: May 2019

Thymomas are rare tumors in the anterior mediastinum, representing 50% of anterior mediastinal masses and about 20-30% of all mediastinal tumors. They are of unknown etiology; about 50% of patients with thymomas are diagnosed incidentally with chest radiography. Thymoma is classified into different stages, which determine the prognosis and type of management, the standard primary treatment for these tumors is Thymectomy. We present a case of 55-year female presented with shortness of breath, cough with expectoration and fever for past ten days. Chest x-ray revealed mediastinal widening. CECT chest showed a well-circumscribed heterogeneous solid enhancing mass lesion. FNAC was planned that showed features in favour of thymoma. Biopsy was done that confirmed lymphocyte rich type B thymoma.
LRINEC: an economical diagnostic tool for prognosis in patients with necrotizing soft tissue infections in a tertiary care centre
Authors: Prasad Ballapalli Hari , Chengalrayan Narendra Minchala , Hameed Shaik Nurul
Published: May 2019

Background: The objective of the study was to evaluate the efficacy of LRINEC score in the management and prognosis of patients with soft tissue necrotizing infections.Methods: This is a prospective study conducted in Sri Padmavathi Medical College (W), Tirupati, Andhra Pradesh, India from May 2018 to January 2019. It included 50 patients who were diagnosed with severe soft tissue infection of lower limbs who needed surgical intervention. The effectiveness of LRINEC score was determined from the outcome.Results: Age group varied from 40 to 60 years. Out of 50 patients 40 were men and 10 were women. The male to female ratio was 4:1. All the patients were investigated at the time of admission in the emergency department using the LRINEC score. Hospital stay varied from 15-45 days.Conclusions: This study concludes that LRINEC score is an economical and accurate investigating tool in necrotizing soft tissue infections to determine the prognosis and outcomes.
A study of clinical profile and etiology ring enhancing lesion in CT scan brain at a tertiary care center
Authors: G. Rahul Gandhi , Khalid Taha Mahboob Ali
Published: May 2019

Background: Confusion lies over the diagnosis when the patients show ring enhancing lesions of the brain on CT scan. Some consider it as tuberculoma while some consider it as cysticercosis. More studies are required to give clear picture of ring enhancing lesions of the brain. The objective was to study clinical profile and etiology ring enhancing lesion in CT scan brain at a tertiary care center.Methods: This study was conducted in the Department of General Medicine, SVS Medical College, Mahabubnagar district which is a tertiary care referral hospital in the state of Telangana. This study was done during the period from July 2006 to October 2008. A total of 50 cases were taken up for this study. After selecting the patients for the study, already prepared protocol was followed strictly for each patient. The protocol contained identification data, detailed history and examination of central nervous system and peripheral signs for tuberculosis and cysticercosis.Results: The males were more than the females and 14-24 years age group was most affected. The most common presentation of ring enhancing lesions was seizures alone in 72% of the cases. Out of these cases the most common presentation was generalized tonic-clonic seizure in 40% of the cases. Majority i.e. 45 had single ring enhancing lesion on CT scan of the brain. The most common etiology of the ring enhancing lesion was found out to be neurocysticercosis in 54% of the cases of ring enhancing lesions.Conclusions: Ring enhancing lesions should be considered in differential diagnosis of those who present with seizures in endemic areas like India.
Evaluation of echocardiographic variables in patients of chronic renal failure: pre and post hemodialysis-a single center prospective study
Authors: Garg Gaurav , Vohra Devinder K. , Kumar Sharvan , Singh Ganesh , Srivastava Alka
Published: May 2019

Background: Cardiovascular disease is the leading cause of morbidity and mortality at each stage of Chronic Kidney Disease (CKD) around 30%-45% of patients of stage 5 CKD have advanced cardiovascular complications. Congestive Heart Failure is responsible for approximately 15% death in hemodialysis patients. Hence this study was done with the aim to evaluate the effects of Hemodialysis on various Cardiac parameters detected by 2D Echocardiography in patients with Chronic Kidney Disease.Methods: In this prospective cohort study, 54 patients with Stage 4 and 5 CKD were evaluated for various cardiac parameters by 2D Echocardiography before and after Hemodialysis and detailed characteristics of the patients were analyzed using SPSS version 16 and paired student t-test.Results: Among 54 patients with CKD, 9% (5/54) patients had stage 4 CKD while 91% (49/54) had stage 5 CKD. Hypertension was present in 81.48% (44/54) of patients and Left ventricular hypertrophy was present in 77.77% (42/54). 6 (11%) patients had associated pericardial effusion. Mean Pre and Post Hemodialysis Left ventricular end diastolic diameter (LVIDed) and Left ventricular end systolic diameter (LVIDes) was 50.38±4.16mm and 48.91±4.14mm; 33.54±3.29 mm and 32.58±2.80 mm respectively which was statistically significant (p <0.001). Pre-HD Left atrial diameter was 34.20±3.81mm and it became 33.19±3.30mm Post-HD (p <0.001). Left ventricular mass index (LVMI) was 136.70±35.91 g/m2 pre-HD and 125.54±29.35 g/m2 post-HD which is significant. Left Ventricular Ejection Fraction was 47.34±5.72% before HD and it became 48.82±4.56% after 6 session of Hemodialysis over 3 weeks which is statistically significant (p<0.038).Conclusions: The present findings suggest patients with Stage 4 and 5 CKD who were on hemodialysis there was significant improvement in various cardiac parameters apart from increase in left ventricular ejection fraction, which may lead to decrease morbidity and mortality in these patients.
Evaluating diagnostic value of clinical symptoms and signs for chronic sinusitis by CT-scan in patients admitted to Ardabil city hospital, Iran
Authors: Fouladvand Tirzad , Pirzadeh Akbar , Isazadehfar Khatereh , Alipour Alireza
Published: May 2019

Background: Chronic rhinosinusitis (CRS) refers to inflammatory nasal and para nasal sinuses which last at least 12 weeks. Despite its high prevalence, it is not easy to diagnose, and clinical criteria and simple radiographs are not so sensitive. The aim of this study was to investigate the diagnostic value of clinical symptoms and signs for chronic sinusitis by Ct-scan in patients admitted to Ardabil city hospital, Iran.Methods: This descriptive cross-sectional study has been done on 83 patients with CRS symptoms who referred to ENT of Ardabil city hospital. The necessary checklist included information such as age, gender, clinical symptoms and CT scan findings were completed and analyzed by statistical methods in SPSS version 21.Results: Of all 83 patients, 55.4% were female and most of patients were in age group 30-39 years with 30.1%. Of all patients, 29 (35%) had positive findings in CT scan of which 72.4% were female. The highest rate of sinus involvement was in the ethmoid sinus. The highest positive predicted value was for nose congestion with OR=2.26 and the lowest was for facial pain and toothache each with OR=0.1.Conclusions: In general, clinical symptoms have a small predictive value in the diagnosis of sinusitis and should be evaluated with CT scan findings (15.7%).
Assessment of liver involvement in type 2 diabetes mellitus using fibroscan® and correlation with risk factors
Authors: . Alagesan , Kumar Sairam
Published: May 2019

Background: Non‐alcoholic fatty liver disease (NAFLD) is one of the most common causes of chronic liver injury. The most important predictor of mortality in NAFLD is the extent of liver fibrosis. Advanced liver fibrosis is associated with overall and liver related mortality. The upcoming non-invasive imaging modality for the evaluation of liver fibrosis is transient elastography (TE) (Fibro scan®). The aim of this study is to assess hepatopathy among diabetics using TE and to correlate the degree of hepatopathy with the associated risk factors.Methods: Type 2 diabetes mellitus patients were assessed for liver stiffness using TE. Liver stiffness was correlated with the associated risk factors. Authors recruited 100 patients from diabetic clinic in tertiary care teaching hospital.Results: About 55% of males and 39% of females had increased liver stiffness. 14% of males and 11% of females had severe fibrosis(F3-F4). Body mass index, waist circumference, fasting blood sugar levels, and liver enzymes, had significant positive correlation with liver stiffness whereas triglyceride levels, high-density lipoprotein levels, and duration of diabetes mellitus did not correlate with liver stiffness.Conclusions: Diabetic patients have high prevalence of NAFLD and advanced fibrosis. Those with obesity and dyslipidaemia are at particularly high risk. Type 2 diabetes mellitus patients with hepatopathy can be easily identified using TE scan eliminating the need for liver biopsy. The establishment of a national program for the recognition of NAFLD is essential to reduce the risk of liver disease progression.
Management of late hemorrhagic radiation cystitis in patients of carcinoma cervix with special reference to 1% alum irrigation and its safety: a clinical study in a tertiary care centre
Authors: Barua Sasanka Kumar , Das Nabajeet , Baruah S. J. , P. Rajeev T. , Bagchi Puskal Kumar , Sarma Debanga , Phukan Mandeep
Published: May 2019

Background: Radiation cystitis is a well-known complication arising from radiation therapy in pelvic malignancies. Haematuria is usually the main presenting symptom of radiation cystitis, which can range from mild to severe refractory and life-threatening forms. There are various forms of treatment ranging from intravesical instillations like alum, formalin, prostaglandins and pentosan sulphate; hyperbaric oxygen therapy to surgical treatment like cystoscopic fulguration, arterial ligation and cystectomy.Here authors aimed to find the efficacy of 1% alum irrigation in controlling haematuria due to radiation cystitis and to correlate its use with change in clinical status and biochemical parameters.Methods: This   retrospective study was done for a period from July 2010 to July 2017 which included all female cervical cancer patients with intractable haematuria due to radiation cystitis. Only patients with normal renal function were included. Irrigation with 0.9% NS, hem coagulase and subsequently 1% alum irrigation were given. Failed cases underwent cystoscopic fulguration.Results: Average age of presentation was 59.79 years. Of the 34 patients 20 (64.51%) patients showed complete response, 4 (12.9%) patients showed partial response and 7 (22.58%) patients had no response to alum irrigation and cystoscopic fulguration were done in these cases. There was no significant change in vital parameters and biochemical parameters except increased prothrombin time (<0.001).Conclusions: No standard of care therapy is presently available for patients with hematuria following radiation cystitis although there is big armamentarium of therapies. Authors found that 1% alum irrigation is safe and efficacious for these patients although normal renal function is a prerequisite.
Clinical and biochemical profile of patients hospitalized with jaundice: Experience from a teaching hospital in north India
Authors: Chauhan Suneel , Rana Baldev S. , Sharma Rajesh , Barwal Vijay K. , Sood Nikhil , Rana Naveen , Minhas Shailender , Chaudhary Ankit
Published: May 2019

Background: Jaundice is a common problem in both medical and surgical practice. For best line of management, it is very essential to differentiate all types of jaundice. The cause can often be correctly anticipated clinically but usually biochemical and radiological imaging investigations are required for confirmation. Here we present a study on clinical and biochemical profile of jaundice patients admitted in a tertiary care hospital.Methods: It was an observational study and all patients admitted with jaundice in the department of medicine meeting inclusion/exclusion criteria were enrolled. Data was collected on a self-designed, pretested and structured format.Results: Out of 100 patients, 77 were males, and median age of 47.5 years. Apart from jaundice, anorexia was the most common presenting complaint (90%), while ascites was the most common finding. Cirrhosis (60%) was the most common cause of jaundice. The mean total bilirubin was 7.9 mg%. Mean Hemoglobin in patients with cirrhosis was 9.7gm/dL. 78% patients of cirrhosis revealed esophageal varices. Majority (80%) showed hypoproteinemia.  PT was prolonged >3sec in 87% of cases. On USG shrunken liver was noted in all patients with cirrhosis, enlarged liver was found in two patients of liver abscess while altered echotexture was seen in 66% cases. 90 patients improved, 9 died and only one was referred.Conclusions: Alcoholic liver disease was the leading cause of cirrhosis (92%). Jaundice in general and alcoholic cirrhosis in particular affects mostly the productive age group of the male population and has a high economic burden on our society.
Assessment of seven year long results of kidney biopsy
Authors: Subramanyam Nambakam Tanuja , Vakrani Girish P.
Published: May 2019

Background: Kidney biopsy is a standard kidney biopsy tissue analysis to look at histopathological diagnosis of various kidney diseases. Previous studies have shown kidney biopsy findings mostly in pediatric population, and there is no much data on impact of various sized biopsy guns on biopsy outcome. This study includes all age group and describes impact of usage of various sized biopsy guns on biopsy outcome.Methods: A retrospective study was done on all patients who underwent kidney biopsy over 7 years.Results: Among total number of 386 patients, 55.2% were males. The commonest indication for biopsy was nephrotic syndrome. The commonest histopathological pattern was Lupus nephritis. Renal failure (RF) was found in 157 (40.7%) of which it improved in 78 (20.2%). Amongst RF patients, the commonest was IgA nephropathy. Change of needle size from 18G to 16G showed increased morbidity in the form of complications but also increased diagnostic yield. Biopsy related complications were noted in 0.8%-1.8%.Conclusions: The commonest indication for kidney biopsy was nephrotic syndrome. The commonest histopathological pattern was Lupus nephritis. Amongst RF patients, the commonest entity was IgA nephropathy. Change of needle size from thinner to thicker showed increased complications but also increased diagnostic yield too.
Evaluation of efficacy of intravenous magnesium sulphate versus dexamethasone for prevention of postoperative sore throat in patients undergoing lumbar spine surgery in prone position: a prospective randomized double blind placebo controlled study
Authors: Sheikh Shahnaz Ahmad , Mir Aabid Hussain , Yousuf Abida , Naqash Imtiaz Ahmad
Published: May 2019

Background: Endotracheal intubation is associated with postoperative sore throat. The aim was to evaluate the efficacy of intravenous magnesium sulphate versus dexamethasone for prevention of postoperative sore throat in patients undergoing lumbar surgery in prone position.Methods: 150 patients of ASA physical status I and II in the age group of 18 to 70 years were divided into three groups of 50 each. group I (magnesium sulphate) received intravenous magnesium sulphate 30 mg. kg-1 in a total of 50 ml of normal saline for 10 minutes after intubation, group II (dexamethasone group) received intravenous dexamethasone 8 mg in 50 mL normal saline for 10 minutes after intubation and group III (placebo group) received 50 ml of normal saline for 10 minutes after intubation. The incidence and severity of postoperative sore throat and hoarseness was assessed by an anesthesiologist unaware of the group allocation, on arrival in the post anesthesia care unit at 0 h, and at 1 h, 6 h, 12 h, and 24 h thereafter.Results: Both incidence and severity of sore throat and incidence of hoarseness was more in placebo group than magnesium sulphate group and dexamethasone group and was statistically significant (p<0.05) and was comparable between magnesium sulphate and dexamethasone groups.Conclusions: Endotracheal intubation is associated with sore throat and hoarseness of voice. Magnesium sulphate and dexamethasone given intravenously reduce the incidence and severity of sore throat and hoarseness associated with endotracheal intubation.
Vitamin B12 deficiency in patients with type 2 diabetes
Authors: Sekhri Tarun , Aggarwal Rashmi , Chugh Pradeep , Belagavi Shreeshail , Aggarwal Hemant
Published: May 2019

Background: Vitamin B12 deficiency may occur consequent to long-term treatment with metformin but very few studies in India have assessed this risk. Metformin is considered the drug of first choice not only for the management of type 2 diabetes but also for prediabetes and polycystic ovary disease. The aims and objective of study was carried out to assess the serum levels of vitamin B12 in Indian patients with type 2 diabetes mellitus who were treated with metformin for a minimum duration of five years.Methods: Serum vitamin B12 level was estimated in 39 patients with type 2 diabetes mellitus, who were on metformin for more than five years. vitamin B12 deficiency was defined as serum concentration less than 200 pg/dl. apart from vitamin B12, fasting blood sugar, post prandial sugar and glycosylated hemoglobin were also estimated.Results: 39 subjects in age group of 40-65 years, suffering from type 2 diabetes mellitus, for more than five years were recruited for the study. The mean serum level of vitamin B12 was 153.27±46.01. Vitamin B12 deficiency was found in 35.89%subjects.Conclusions: Patients suffering from long standing type 2 diabetes mellitus and taking large doses of metformin should be screened for Vitamin B 12 deficiency.
Ephedrine versus phenylephrine: effects on fetal acid-base status during spinal anesthesia for elective cesarean delivery
Authors: Kumari Pradeep , Tahir Sifna , Mir Altaf Ahmad , Kumari Haveena
Published: May 2019

Background: During elective caesarean sections, post-spinal hypotension is a common problem. Prevention of this complication by sympathomimetic agents is of potential clinical significance. The objective of this study was to compare and evaluate the effects of ephedrine and phenylephrine on the fetal outcome when used in the treatment of maternal hypotension during spinal block in elective caesarean section.Methods: After fulfilling the inclusion criteria, hundred patients were enrolled in this study and were randomly allocated into two groups of fifty each. According to their group, patients received either ephedrine 6 mg (group E) or phenylephrine 75µg (group P) as vasopressor. For spinal anaesthesia lumber puncture was done in sitting position and 12.5mg, 0.5% hyperbaric bupivacaine was given intra-thecally to every patient. Throughout surgery, maternal and neonatal complications were controlled and recorded. During the study, Apgar scores on the 1st and 5th minutes, and blood gases of the umbilical cord blood were evaluated.Results: Ephedrine and phenylephrine were used in the mean doses of 6.72±1.97mg and 91.5±31.38µg respectively. There was no significant difference observed in total number of boluses used in treating post-spinal hypotension. The difference in the first- and fifth-minute Apgar scores was statistically insignificant between the group E and group P. There was a statistically significant difference observed in SaO2 and base excess in arterial gas sample between two studied groups. Similarly, a significant difference was observed in PCO2 of umbilical venous sample between two studied groups. However, none of the neonates had the true fetal acidosis.Conclusions: Intravenous phenylephrine 75µg and ephedrine 6 mg offer a comparable hypotensive control without any significant complication for mother or her fetus in elective caesarean section.
Knowledge attitude and practice towards human papilloma virus vaccination among medical and paramedical students in a tertiary care teaching hospital in south Karnataka, India
Authors: B. Shruthi , Mallam Srikanth Goud , K. Manojkumar B. , A. Dhanalakshmi T.
Published: May 2019

Background: Human papilloma virus infection is responsible for 75-80% of the cervical cancers worldwide. Human papilloma virus infection is a preventable disease, but precaution depends on the cognitive aspects of young women. Authors conducted a study to assess the knowledge, attitude and practices regarding human papilloma virus vaccination and to determine acceptance rate of human papilloma virus vaccination among medical and paramedical students.Methods: Human papilloma virus infection is responsible for 75-80% of the cervical cancers worldwide. Human papilloma virus infection is a preventable disease, but precaution depends on the cognitive aspects of young women. Authors conducted a study to assess the knowledge, attitude and practices regarding human papilloma virus vaccination and to determine acceptance rate of human papilloma virus vaccination among medical and paramedical students.Results: Out of 322 students, 114 medicals (35.4%), 106 pharmacy (32.9%) and 102 nursing students (31.7%) were included in this study. Ninety-one (79.8%) medical students, 64 (60.37%) pharmacy students, 43 (42.1%) nursing students were aware that human papilloma virus can cause cervical cancer. Seventy-three (64.03%) medical students, 64(60.37%) pharmacy students, 40(40.1%) nursing students were aware that there is vaccination for human papilloma virus infection, and it can prevent cervical cancer. Most of the students,78(68.4%) medical students, 57 (53.77%) pharmacy students and 46(45.09%) nursing students believe that more awareness required regarding risk factors of human papilloma virus infection and prevention of cervical cancer. Furthermore, around 66 (57.89%) medical students, 44 (41.05%) pharmacy students, 37(36.27%) nursing students were willing to accept the vaccine for themselves.Conclusions: Majority of the students are lacking knowledge regarding HPV vaccination and cervical cancer prevention with least knowledge among paramedical students. More awareness programmes are required to increase the awareness and acceptability of HPV vaccination.
Practices for diabetes mellitus in doctors
Authors: Jeergal Vasanti A. , Upadhye Jayshree J.
Published: May 2019

Background: Doctors know everything about cause, diagnosis, treatment and care to be taken for diabetes mellitus. This study was carried out to evaluate awareness, attitude and practices of diabetes in doctors.Methods: A cross sectional study was conducted among 100 male and 100 female doctors of various subjects who attended a conference at Mangaluru 25th to 27th October 2018.Results: Prevalence of diabetes mellitus was 12% in male doctors while it was 8% in female doctors. 11 (91.66%) male doctors and 8 (100%) female doctors were taking medicines for diabetes regularly, 8 (66.66%) male doctors and 7 (87.5%) female doctors were doing blood sugar regularly, 7 (58.33%) male doctors and 5 (62.5%) female doctors were doing diet control, 7 (58.33%) male doctors and 5 (62.5%) female doctors were doing exercise regularly, 9 (75%) male doctors and 8 (100%) female doctors were using footwear while 6 (50%) male doctors and 4 (50%) female doctors were taking proper dental care.Conclusions: In present study, doctors were aware of causes, diagnosis, treatment & care to be taken in diabetes. Still, routine check-up was not seen in 100%. After diagnosis, doctors were taking medicines quite regularly but regular follow up for diabetes & cardiovascular risk was seen in less numbers.
A clinical and microbiological profile of urinary tract infection in patients with chronic kidney diseases
Authors: Pugalendhi Siddharth , Dutta Tarun Kumar , R. Hemachandar , S. Lokesh
Published: May 2019

Background: Urinary tract infections (UTIs) are a major public health problem in terms of morbidity and financial cost in CKD patients in India. The resistance pattern of community acquired uropathogens in CKD patients has not been extensively studied. Thus, knowledge of local antimicrobial susceptibility patterns of common uropathogens is essential for prudent empiric therapy of community acquired UTIs.Methods: It is a cross sectional study conducted in a tertiary care hospital involving 65 chronic kidney disease patients with UTI who attended general medicine OPD and those admitted in wards after fulfilling the inclusion and exclusion criteria, after obtaining written informed consent. Blood sample and urine samples were collected from these patients and sent for blood analysis, urine analysis and urine culture and sensitivity.Results: Among 65 CKD participants with UTI who were studied, E. coli (47.7%) and K. pneumoniae (15.4%) were the most common isolates which were sensitive in order of colistin, polymyxin B, meropenem (carbapenem) and less sensitive to other commonly used antibiotics.Conclusions: The main purpose of this study was to find the various common local uropathogens in CKD patients and their antibiotic profile which will help in formulating antibiotic therapies. As previously stated, there are very few studies regarding profile and management of UTI in CKD patients. Hence this study can throw some light into this area.
A prevalence study of vaginal candidiasis among pregnant women
Authors: Sutaria Pooja , Cholera Meera , Donga Shilpa B.
Published: May 2019

Background: Pregnancy is associated with specific anatomical, physiological and immunological changes that can predispose to infection and also alter the response to the disease process. Infections in pregnancy demands prompt adequate and careful management. The disease process as well as the treatment protocol may have profound effects on the outcome of pregnancy. Pregnant women frequently develop vaginal discharge which can lead to complications during pregnancy like abortions, premature birth, low birth weight and other morbidities. Some of the infections may be serious and life threatening for the mother while others may seriously jeopardize the fetus or neonate leaving the mother asymptomatic. The aim and objective of this study was based on the present study was aimed to study the prevalence of vaginal candidiasis among pregnant patients who were visited in outdoor patient’s department of Prasutitantra and Streeroga.Methods: About 135 high vaginal swabs were collected from the women who carrying 2nd and 3rd trimester of pregnancy with symptoms of vaginal infection. These samples were tested under microscopic examination and culture on Mac Conkey agar, blood agar and Sabouraud dextrose agar respectively. Colonial morphology, wet/K.O.H. preparation, gram staining, germ tube test, were carried out for identification of the isolated organisms.Results: Out of 135 samples collected, 61 (45.18%) patients were shown positive fungal infection of candidial species. The age group showing the highest number of positive candidiasis was of 20 to 25 years. Multigravida (60%) were more commonly affected than primigravida (40%) and commonly seen in third trimester (67.41%).Conclusions: Vaginal Candidiasis was common in pregnant women with more common in young adults.
Generalized eczematous rash in a patient with shoe contact dermatitis: a case report
Authors: Alotaibi Moteb K.
Published: May 2019

The id reaction, which is also known as autoeczematisation or autosensitisation dermatitis, refers to the acute development of dermatitis at a site distant from the site of the primary inflammatory cutaneous reaction. Many stimuli have been reported as causes of id reactions, including allergic contact dermatitis. The exact prevalence of id reaction is unknown, however, id reactions have been found to occur in 4%-5% of cases of dermatophyte infections and in up to 37% of patients with stasis dermatitis. This condition has no known predilection for any race, sex or age groups. Shoe dermatitis is a type of contact dermatitis developed following the contact of the foot’s skin with shoe’s parts that contain different chemical substance that harbor the potentiality to be an immune trigger. Among the potential allergens, rubber is found to be the most common shoe-related allergen reported in the literature. Other known allergens include: cements, dichromats used in tanning, dyes, anti-mildew agents, formaldehyde, and nickel eyelets or nickel arch supports. The pathogenesis of allergic contact dermatitis is a type IV, delayed-type immune response that provoked by cutaneous contacts with different material that have the ability to stimulate antigen-specific T-helper 1 (TH1) in a sensitized individual. The clinical presentation of id reaction includes acute onset of pruritic erythematous eruption with symmetrical distribution that follows the primary dermatitis by one to two weeks. Authors report a 27-year-old male who presented with generalized, symmetric pruritic and eczematous eruption following localized shoe dermatitis.
A rare case of duodenal carcinoid presenting as ectopic Cushing’s syndrome
Authors: Pugalendhi Siddharth , Dutta Tarun Kumar , . Dhivya , Yadav Kiran
Published: May 2019

ACTH-dependent Cushing syndrome (CS) due to an ectopic source is responsible for approximately 10-15% cases of Cushing’s syndrome. It is associated with various tumors such as small cell lung cancer and well-differentiated bronchial or gastrointestinal neuroendocrine tumors. Many a times ectopic ACTH production is difficult to manage, and identification of the source may take many years.  Hormonal diagnostics include assessments in basic conditions as well as dynamic tests, such as the high-dose dexamethasone suppression test and corticotrophin releasing hormone (CRH) stimulation test. Treatment selection depends on the type of tumor and its extent. In the case of neuroendocrine tumors, the main treatments are surgery and administration of somatostatin analogues or bilateral adrenalectomy in refractory cases and if the source remains unidentified. Here, we report a case who presented with features of Cushing’s syndrome which eventually through workup led us to a diagnosis of duodenal carcinoid producing ectopic ACTH which is extremely rare and was successfully treated.
Actinomycotic lacrimal canaliculitis: a rare case report
Authors: Bashir Humaira , Nazir Asifa
Published: May 2019

Actinomyces israelii is a gram-positive anaerobic organism commonly associated with canaliculitis in adults. Actinomyces are normal commensal bacteria in humans and primarily cause opportunistic infections during immunosuppressive state or when loss of continuity of epithelial lining in mucosa occurs. Lacrimal canaliculitis is a relatively rare condition and is undiagnosed for long periods of time. Being a relatively rare condition, it is commonly overlooked and undiagnosed for long periods of time. Primary chronic canaliculitis is an uncommon problem and Actinomycosis may form in up to 2% of all lacrimal disease. Here present study reports a case of lacrimal canaliculitis caused by Actinomyces israelii.
The vanishing phantoms
Authors: Patil Aniket , Jain Siddhant , Acharya Sourya , Gagneja Sakshi
Published: May 2019

A50-year-old known diabetic female presented to us with gradually progressive dyspnea and swelling over both lower limbs since 15 days. She was a known case of ischemic heart disease since 3 years on medical management. On examination she was afebrile, heart rate was 128 beats/min, BP-98/52mm of Hg, JVP was raised at 11 cm of water. The respiratory rate was 30/min. Oxygen saturation was 92% while breathing in ambient air. Air entry was decreased on right inter and infra scapular areas with bi basal late inspiratory crepitations.
Broken needle in gluteal region following an intramuscular injection: a case report
Authors: Singh Jagdeep , Kalia Anoop , Banga Ravinder Kumar , Dahuja Anshul
Published: May 2019

Incidence of broken hypodermic needle in patients has been decreased because of superior manufacturing techniques. Breaking of hypodermic needle after intramuscular injection has been rarely reported. We report a case of broken needle in the gluteal region in a 36 years old woman following an intramuscular injection. Patient arrived in the emergency after 2 days of the episode. Patient was taken for surgery for removal of the needle. Initially attempts for removal of needle were made without use of image intensifier under local anaesthesia, but it failed as it was very difficult to locate the needle. Patient was taken up for surgery under spinal anaesthesia with the use of image intensifier. Broken needle was located and removed. The following case describes the management of broken hypodermic needle and suggests valuable guidelines for minimising the chances of undue complications arising due to needle migration.
Autologous serum skin test in 250 patients of chronic spontaneous urticaria at tertiary care hospital in Gujarat
Authors: Patel Sonal Gaurang , Joshi Rima Rakesh , Patel Raksha Maganlal
Published: May 2019

Background: Chronic urticaria (CU) is defined as urticaria persisting daily as or almost daily for more than 6 weeks and affecting 0.1% of the population. In chronic autoimmune urticaria, immunoglobulin G (lgG) auto antibodies react to the alpha subunit of the high-affinity lgE receptor (FceR1) on dermal mast cells and basophils, leading to chronic stimulation of these cells. This results in the release of histamine and other inflammatory mediators which cause urticaria and angioedema. More than half of the patients have autoimmune urticaria. ASST is the only in vivo test to detect autoimmune urticaria. The aim was to study the frequency of ASST positivity among patients with chronic spontaneous urticaria and to identify the clinical and laboratory parameters associated with positive ASST.

Methods: The present study is prospective observational study of chronic spontaneous urticaria. ASST was performed in 250 patients fulfilling exclusion and inclusion criteria. Baseline investigations (CBC, ESR, urine, stool, RBS and CRP) were done for all the patients whereas specific investigations (ANA, Thyroid Profile, IgE, Anti H.Pylori IgG and skin biopsy) were done in selected cases.

Results: Out of 250 patients examined, 60% had positive autologous serum skin test suggestive of autoimmune urticaria. H. pylori antibodies were significantly higher (29%) in ASST positive patients. While antinuclear antibody (ANA) was positive in 4% and thyroid antibodies were present in 7% of patients with positive ASST. Serum IgE was elevated in 32% ASST positive patients.

Conclusions: ASST is an easy, simple and cost effective screening test for chronic autoimmune urticaria.
NATURE AND BASIC PROBLEMS OF NON-CONVICTION-BASED CONFISCATION IN THE UNITED STATES
Authors: Cassella Stefan D.
Published: May 2019

This report discusses the goals that asset forfeiture is intended to serve in the federal criminal justice system, the types of property that are subject to forfeiture, and the procedures that are used to initiate, litigate, and conclude asset forfeiture cases.  With respect to procedure, its focus is on non-conviction-based (NCB) forfeiture, and especially on the safeguards that protect the property interests and due process rights of property owners.