bluuebunny/crossref_metadata_2025 huggingface dataset:
Primary cesarean section in multigravidae: a case control study
Authors: S. Madhva Prasad , Chauhan Anahita R.
Published: June 2017

Background: Primary Cesarean Section (CS) is defined as CS in a patient who has not had a prior CS. While primigravidae contribute to the bulk of those undergoing primary CS, multigravidae (with only prior vaginal delivery) can also contribute. The purpose of this article is to examine the contribution of the group of multigravidae (with only prior vaginal delivery) and how they differ from primigravidae.Methods: A review of records was conducted for one year period. The confinements which were first or second para (which had undergone CS in either index pregnancy or previous pregnancy) were divided into primipara: primary CS and second para: primary CS. Various parameters were compared between the primipara undergoing primary CS and multipara undergoing primary CS.Results: Out of 1154 births, the number of CS was 401. Primary CS in primiparas was 266 (66.3%) and primary CS in multipara (with only prior vaginal deliveries) was 61(15.2%). Booking status, baby weights and NICU admission rates did not different significantly. Preterm deliveries, higher number of prior abortions; malpresentations, deep transverse arrest, antepartum hemorrhage was more common among the multipara group and the difference was statistically significant (p value < 0.05).Conclusions: Multipara (with prior vaginal delivery only) definitely contribute to primary CS rate and cannot be neglected. The profile of patients and the indications of CS in multipara appear to differ from those in primipara.
Comparing role of laparoscopy, ultrasound and clinical examination in pelvic pain
Authors: Bharwani Hema , Jain Meena
Published: June 2017

Background: Pelvic pain is a frequent and poorly understood complaint in women of reproductive age group, which is one of the most perplexing problems faced by the gynaecologist. This study was conducted to detect the cause of pelvic pain and to correlate clinical diagnosis, ultrasound, and laparoscopic di-agnosis and formulate treatment modalities.Methods: This study was conducted in the Department of Obstetrics and Gynecology, JLN Hospital and RC, Bhilai, Chattisgarh during the one year period from September 2014 to August 2015. 97 women belonging age 15 to 65 years with history of pelvic pain (acute / chronic) were admitted after excluding history of acute abdominal trauma, diagnosed gynaecological malignant disorder, severe cardiac/respiratory disease or signs of peritonitis. A detailed history was taken and clinical examination was done.Results: The age group in the present study was between 15 to 65 years. Among them, 36% cases belonged to 20-30 years age group. Clinically the most common sign was abdominal tenderness (59.89%). Clinically 47 cases (48.45%) had abnormal findings, on ultrasonography 61 cases (62.88%) had abnormal findings as compared to laparoscopy which could detect 75 cases (77.32%) showing abnormality. Most common pelvic pathology was adhesions (17.52%) followed by PID (14.43%). None of the cases of adhesions, fimbrial cyst, pelvic congestion syndrome and appendicitis were diagnosed clinically or ultrasonographically, all cases were diagnosed on laparoscopy. The sensitivity and specificity of clinical examination is 54% and 49% as compared to laparoscopy respectively. The PPV and NPV of clinical examination is 24% and 78% respectively. The sensitivity and specificity of ultrasonography is 59% and 69% as compared to laparoscopy respectively. The PPV and NPV of Ultrasonography is 36% and 85% respectively. Appropriate surgical intervention like salphingooopherectomy, adhesiolysis, myomectomy, hysterectomy was carried out laparoscopically.Conclusions: Laparoscopy eliminates the diagnostic error and corrects the wrong diagnosis. Laparoscopy is a more sensitive and superior method for evaluation of pelvic pain as compared to Ultrasonography. Laparoscope has definitive place in evaluating patients with pelvic pain and often a definitive procedure can be undertaken with the laparoscope without subjecting the patient to laparotomy.
Evaluation of feto-maternal outcome using AFI and SDVP for amniotic fluid assessment; Which is a better method?
Authors: Mukhopadhyay Biplab , Ahmad Syed Nawaz , Agarwal Shefali , Kabra Shashi Lata
Published: June 2017

ABSTRACTBackground: Abnormal amniotic fluid volume (AFV) may be the only or earliest sonographic sign of an obstetrical problem. There is no clear consensus on the best method to assess amniotic fluid adequacy. The AFI and the SDVP are the more commonly employed techniques for assessing adequacy of amniotic fluid. This study aimed to compare the maternal and foetal outcome when amniotic fluid was measured by these two methods.Methods: Hundred pregnant women at >28 weeks gestation scheduled for test of biophysical score due to various risk factors were enrolled and divided in two groups of 50 each. In each group, amniotic fluid volume was determined by either calculating the Amniotic Fluid Index (AFI) or measuring the Single Deepest Vertical Pocket (SDVP). Oligohydramnios was declared at cut off of <5 for the former and <2cm for the later method respectively. Maternal and foetal outcomes were compared between the two groups.Results: Diagnosis of oligohydramnios was 45/50 in group I and 23/50 in group II (p<0.0001). Induction of labour was done in 70.0% in group I and 18% in group II (p<0.0001). Non-reassuring foetal heart rate was seen in 36.0% in group I and 14.0% in group II (p=0.011). Rate of caesarean delivery was significantly higher in group I, 42.0% in comparison of 20.0% in group II (p=0.017). NICU admission were 32.0% in group I and 18.0% in group II (p=0.106).Conclusions: SDVP is a better choice for determining amniotic fluid to avoid unnecessary interventions without any significant improvement in peripartum outcome measures.
Clinical profile of cerebral venous thrombosis in pregnancy and puerperium in South India
Authors: Sasikala Ramasamy , Aishwarya Jagan , Dilshath Syed
Published: June 2017

Background: Cerebral venous thrombosis (CVT) is any thrombosis occurring in intracranial veins and sinuses, which is a rare disorder affecting 5 persons per million per year with huge regional variation. Pregnancy and puerperium are the most prevalent prothrombotic states leading to cerebral venous thrombosis. The objective of this study was to analysis the clinical profile of CVT in pregnancy and puerperium.Methods: In this prospective study, we analysed 52 consecutive patients admitted with impairment of consciousness, seizures or focal neurological deficit at our hospital. The diagnosis of CVT was confirmed by neuroimaging. Detailed history, clinical examination and laboratory investigations were carried out in all the cases and analysed.Results: The incidence of CVT associated with pregnancy and puerperium at our Hospital was 3.9 per 1000 obstetric admissions. The age of the patients varied from 18-35 years with a maximum age incidence (77%) in the III decade (21-30 years). The maximum incidence was during the first two weeks of puerperium (61.8%). The most common presenting symptoms were focal or generalised seizures (88.4%) followed by headache (65.3%). In spite of the alarming clinical picture, recovery was rapid and remarkable. Total mortality was 15.5% (8 cases).Conclusions: CVT is more common during the puerperium than in the antenatal period. Obstetric CVT has a more acute onset with excellent recovery when promptly diagnosed and treated.
Comparative study to assess the maternal and paternal fetal attachment among the expectant mothers and fathers
Authors: Kaur Sarabjit , Mamta . , Sagar Nidhi
Published: June 2017

Background: Bonding during pregnancy refers to a process through which a pregnant women experiences feelings and emotions for her fetus, interacts with her fetus and develops a maternal identity during pregnancy. The mothers and fathers interact differently with the developing fetus, but evidences for these differences are contradictory. It is important to recognize the factors influencing maternal fetal attachment and paternal fetal attachment because of the effects on future health and development of the infant.Methods: A descriptive (comparative) research design was used to compare the maternal and paternal fetal attachment among 50 couples [Expectant mothers (50) and Expectant fathers (50) =100] selected by convenience sampling technique, who visited ANC OPD of DMC and Hospital, Ludhiana, Punjab. Modified Maternal Fetal Attachment Scale (Mecca S Cranley, 1979) and Modified Paternal Fetal Attachment Scale (Mecca S Cranley, 1979) were used to assess the maternal and paternal fetal attachment by self-report method.Results: Findings revealed that the maternal fetal attachment was higher than the paternal fetal attachment. There was significant difference between maternal and paternal fetal attachment scores (89.76±13.410 vs 80.62±15.494, p=0.002) respectively. The association of maternal fetal attachment was found to be statistically significant with gravida, parity, live babies, planned pregnancy, history of infertility, method of conception and marital relationship (p<0.05) whereas paternal fetal attachment was found to be statistically significant with duration of marriage, number of live children and method of conception (p<0.05).Conclusions: Thus, the study concluded that the maternal fetal attachment was higher than paternal fetal attachment.
Vaginismus treatment with libido increase and practice
Authors: Yalcin Bahat Pinar , Aslan Çetin Berna , Turan Gökçe
Published: June 2017

Vaginismus is an involuntary contraction of the vaginal muscles which makes sexual intercourse difficult or impossible. It is one of the more common female psychosexual problems. The cases illustrate that it is important to rule out the possibility of vaginismus among patients with infertility. The aim of the report was to share with readers the cases with common presentations and underlying psychological causes.
Massive hemoperitoneum in case of large subserosal fibroid- a rare case report
Authors: Jadeja Yuvrajsingh Digvijaysingh , Shukla Radha , Vaishnav Smruti , Patel Molina
Published: June 2017

Rupture of veins on the surface of uterine leiomyoma is an extremely uncommon gynaecological cause of haemoperitoneum. It is a life-threating emergency. In most cases, bleeding is a result of trauma or torsion. Here we report a case of massive intraperitoneal haemorrhage due to rupture of vessels on the surface of large sub-serous leiomyoma to stress on the fact that a differential diagnosis of rupture of surface vessels in a fibroid should be considered while dealing with a case of haemoperitoneum with pelvic masses
Recurrent hydatidiform mole transformed into invasive mole with co-morbid depression- a rare case report
Authors: Bhagat Nisha , Raj Rajnish
Published: June 2017

The gestational trophoblastic disease is a group of interrelated lesions that arise from abnormal proliferation of placental trophoblast. It comprises of hydatidiform mole (partial or complete), invasive mole, placental site trophoblastic tumor and choriocarcinoma. The occurrence of hydatidiform mole in more than two conceptions is known as recurrent hydatidiform mole. Although, its incidence is less than 2% but it may progress to invasive mole or choriocarcinoma. The case of 26-year old female is reported; she had five consecutive molar pregnancies and the sixth one developed into invasive mole with co-morbid depression that was managed by methotrexate chemotherapy, antidepressant and psychotherapy.
Small bowel enterocutaneous fistulae: is waiting worth?
Authors: Kumar Mukesh , Jauhari Abhinav
Published: June 2017

Background: Enterocutaneous fistula represents a group of complex intraperitoneal infectious processes. Even with recent advances in Para surgical management, critical care and nutritional support, enterocutaneous fistulas remain great challenges to the general surgeon. Mortality remains high largely due to frequent complications of sepsis and malnutrition. Most enterocutaneous fistulas occur following emergency abdominal surgeries and only 15-25% of spontaneous enterocutaneous fistulas are the result of underlying diseases such as Crohn’s diseases, radiation enteritis or diverticular disease. Expectant treatment consisting of octreotide, TPN, and antibiotics waiting for spontaneous closure is associated with high costs, high mortality and prolonged morbidity. In our country, there is need to abandon expectant lines of management for a more aggressive surgical approach once the fluid and electrolyte disturbance and sepsis have been corrected.Methods: The aim of the present study was to audit the result of an aggressive approach in patients with enterocutaneous fistulas and to identify the time of convalescence prior to restorative surgery thereby reducing the morbidity and mortality associated with them. The focus of this study was to determine whether, in patients with fistulae, early intervention resulted in low mortality and morbidity.Results: In the present study, 64 cases of small bowel enterocutaneous fistulas were taken, which were either operated in Patna medical college and hospital or outside in year 2011-13. Majority of patients were <60 years of age. Out of the total population (n=64), 50 patients were <60 years and 14 patients were ≥60 years, with mean age of 46 years (range 17-75 years). The percentage of male population was 56.2 and that of female was 43.8. Mortality was also higher in patients with sepsis, age>60 years and in patients with preoperative albumin below 3.0g/dl (p value>0.05). Early surgical intervention resulted in good patient outcomes as compared to conservative treatment (p value-0.0418). Mortality was higher in patients with foregut fistulae (p value-0.0178) and high output fistulae (p value-0.0309).Conclusions: This study shows that early surgery can result in good patient outcomes. Initial emphasis should be on the treatment of septic foci, aim to improve to patient’s condition. Rather than following a prolonged conservative line of management, surgical repair should be performed when the patient is stable.
A profile of 96 cases of penetrating injury of abdomen
Authors: Ramya Chatragadda , Jayasree Kasula
Published: June 2017

Background: Trauma is a major health problem. Among various modes of trauma, penetrating trauma necessitates for immediate surgical intervention in most of the cases. Most commonly penetrating injuries in civilian group involves younger healthy population, who most productive and are very much responsible for the progress of the society and the country.Methods: This is a prospective study of 96 cases of penetrating injury to abdomen admitted to Gandhi Hospital, Secunderabad during the period August 2011 to September 2013. All the patients with history of penetrating abdominal trauma requiring admission during the study period are included in this study. All cases were evaluated for abdominal organ injury due to penetrating trauma by clinical and radiological criteria all cases were evaluated for abdominal organ injury due to stab. All the patients with peritoneal, evisceration, signs of peritonitis, shock underwent laparotomy.Results: 81 cases (84.3%) had significant abdominal injury requiring laparotomy. The criteria for laparotomy were evisceration (20.8%), shock (8.3%) and peritonitis (50%). Mere peritoneal penetration (83%) is a poor indicator of emergency laparotomy in stab injury. Erect X-ray abdomen is an unreliable criterion for laparotomy in presence of other signs.Conclusions: Majority of the patients required operative intervention particularly those with hemodynamic instability, generalized peritonitis, evisceration of omentum and bowel, and continuing haemorrhage. Peritoneal penetration as such is a poor indication of significant organ injury; hence it requires direct organ specific evaluation, such as computed tomography or laparoscopy to identify patients who can be safely treated without operations.
Pseudo cholinesterase-diagnostic and prognostic value in organophosphorus poisoning
Authors: J. Lokesh A. , G Deepak U. , B. Venkatesh K. , K. Yuvaraj M.
Published: June 2017

Background: Organophosphorus compound poisoning is a common clinical situation encountered in emergency department. The estimation of pseudo cholinesterase levels in plasma help to identify OP poisoning. Aim of this study was the levels of pseudo cholinesterase in plasma as a diagnostic aid in patients with suspected organophosphorus poisoning and to predict the prognosis and mortality based on pseudo cholinesterase activity.Methods: 390 cases of suspected organophosphorus compound poisoning were selected above 18 years of age. Detailed history and clinical examination were done. The serum levels of enzyme pseudo cholinesterase were estimated on 1st and 3rd and 6th day.Results: 61% were males, 39% were females. Age range 18-55 years. Most of the patients were admitted within 4 hours of consumption. 50% cases were mild, 26% were moderate and 24% were severe cases, Commonest clinical features were vomiting, diarrhea and abdominal cramps. Common signs were miosis (46%), difficulty in breathing (42%), cold calmmy skin, bradycardia. Patients who survived had raising values of enzyme levels and in patients who expired did not show much increase in enzyme values.Conclusions: In initial stages of poisoning, determining pseudo cholinesterase activity forms a reliable test. In patients who survived had values above 4300 U/L and showed increasing levels on successive days indicating better prognosis. Low values of enzymes in initial stages of poisoning as well as decreasing values on the third day indicate increased mortality.
Impact of malnutrition on head size and development quotient
Authors: Tiwari Kavita , Goyal Suresh , Malvia Sunny , Sanadhya Anuradha , Suman Rameshwar L. , Jain Rupali
Published: June 2017

Background: Malnutrition is one of the most common global health problem. It produces notable morphological changes in the brains which damage the intellectual potential and leads to reduced brain size, inferred from measurements of head circumference(HC). Aim is to study the impact of malnutrition on head size and development quotient(DQ) in children suffering with malnutrition.Methods: It is a hospital based study on 120 children including 100 moderates to severely malnourished children and 20 healthy controls aged 6-60 months admitted in malnutrition treatment center. Statistical analysis of head circumference and development quotient was done with severity of malnutrition and with each other.Results: Out of 120 children, 80 were severely malnourished (SAM) and 20 were moderately malnourished (MAM) and 20 age and sex matched controls were taken. Mean age was 19.00±8.54 months. 36.25% of severely malnourished, 5% of moderately malnourished children and none in control had microcephaly (HC<-3SD). Mean DQ was 57.46±14.98, 78.35±6.60 and 94.45±3.96 in SAM, MAM and control children respectively. Statistically significant association was found for head circumference and development quotient with severity of malnutrition and with each other.Conclusions: SAM adversely affects the developing brain of children as evidenced in our study by reduced head size and low DQ scores in children suffering from malnutrition. As seen in this study, prevalence of microcephaly and lower DQ scores increases with severity of malnutrition. Therefore, the study emphasizes the importance of early and timely intervention in such children before the severity of malnutrition increases to an extent of irreversible effects on brain and development.
Assessment of surgical outcome in emergency gastrointestinal surgeries using P-POSSUM score
Authors: Hota Prasan Kumar , Yellapragada Harshita
Published: June 2017

Background: The physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM) and its modification, Portsmouth-POSSUM (P-POSSUM), are considered as methods of risk scoring. Application of this scoring system helps in assessing the quality of the health care provided and surgical outcome. Its utilization in our country where the level of healthcare and resources differ is limited. Hence, a prospective study to assess the outcome of emergency GI surgeries using P-POSSUM scoring system in a teaching hospital at district level was taken up.Methods: 80 cases which underwent emergency GI surgeries were studied. Using P-POSSUM equation, predicted mortality and morbidity rates were calculated and compared with the actual outcome. Statistical significance was calculated using chi square test.Results: An observed to expected ratio of 0.71 and 0.60 was obtained for mortality and morbidity respectively. No significant difference was noted between expected to observed mortality and morbidity rates with P=0.23 and P=0.09 for mortality and morbidity respectively, suggesting a reasonably good quality of outcome. P-POSSUM over predicted mortality and morbidity in low risk groups while it accurately predicted the outcome in high risk groups.Conclusions: The quality of surgical care provided and surgical outcome are comparable to other health care systems, with observed to expected mortality and morbidity ratio being nearly same. P-POSSUM can be used as a tool for outcome audits.
Clinical features, predisposing factors and radiological study of cerebral venous sinus thrombosis: experience from a tertiary care center in Southern India
Authors: T. Aneesh , Gururaj Hemamalini , J. S. Arpitha , Rao Anusha , Chakravarthy Vaishnavi , Shetty Abhiman
Published: June 2017

Background: Cerebral venous thrombosis (CVT) is a less common cause of stroke with a wide range of clinical presentations, predisposing factors, radiological features and outcomes. A high index of suspicion is absolutely essential to diagnose cerebral venous thrombosis. In this article, we have reviewed the clinical spectrum and radiological profile of patients with cerebral venous thrombosis and attempted to identify the specific predisposing factors for developing cerebral venous thrombosis particularly in this region of India.Methods: 116 patients hospitalized from January 2015 to March 2017 with a final diagnosis of Cerebral Venous Thrombosis which was confirmed by imaging (MRI/MRV or CT angiography) were included. Patients who were initially diagnosed as CVT but imaging were not suggestive of the same were excluded.Results: The mean age of the study population was 35.21 years, with most patients aged between 21-30 years. 18.1% of the study population were puerperal women, much lower than earlier series. 54.54% of the men had a significant history of alcohol consumption and 10.34% of the non-puerperal women revealed a history of consuming oral contraceptive pills. Among men, seizures were the most common presenting symptom followed by headache. Women presented with headache followed by vomiting. Superior sagittal sinus, transverse sinus, cortical veins and sigmoid sinus involvement were quite common in comparison to the other sinuses.Conclusions: Accurate and prompt diagnosis of CVT is crucial because timely and appropriate therapy can reverse the disease process and significantly reduce the risk of acute complications and long-term sequelae. In this article, we have reviewed the epidemiology, causative factors, clinical features and as well as radiological pattern of CVT from an Indian perspective. Over the last decade, a relatively high incidence of CVT in fairly young individuals warrants further evaluation towards genetic predisposition for pro-thrombotic states particularly in this region of India.
Transfusion effect of random donor platelet and single donor platelet in thrombocytopenic patients at tertiary care hospital of South Gujarat
Authors: Unagar Chirag A. , Patel Snehal G. , Patel Kamal A. , Pandya Amrish N. , Jarag Mayur A. , Patel, Jitendra N. , Wadhwani Sangita J.
Published: June 2017

Background: Platelet transfusion plays a key role in therapy for the patients with thrombocytopenia. Superiority of Single donor platelet (SDP) over Random donor platelet (RDP) transfusions is largely assumed, but unproven. Platelet Rich Plasma-Platelet concentrate (PRP-PC) and Apheresis-PC were prepared and their therapeutic efficacy were assessed in thrombocytopenic patients.Methods: This study included 60 transfusion episodes consisting of 30 SDP and 30 RDP (147units of RDP). The post transfusion efficacy of transfused platelets was assessed at 1 hour and 24 hours by corrected count increment (CCI) and percentage recovery (PR). Paired ‘t’-test was used for statistical analysis and a probability of p<0.05 was used to reject null hypothesis.Results: The mean platelet dose of SDP (n=30) and RDP (n=30) was 2.86±1.05 x 1011 and 2.36±0.54 x 1011 respectively. The mean platelet increments of SDP at 1 hour and 24 hours were 38±18.1 x 103/μl and 37.3±20.7x 103/μl. The mean platelet increments of RDP at 1 hour and 24 hours were 28.5±11.4 x 103/μl and 26 ±11.6 x 103/μl. The mean CCI of SDP at 1hour and 24 hours were 21.4 ±7.3 x 103/μl and 20.8±7.4 x 103/μl respectively. The mean CCI of RDP at 1hour and 24 hours were 18.5±6.3x 103/μl and 17.4±7.6 x 103/μl respectively.Conclusions: Post-transfusion increments were significantly higher in patients who received SDP as compared to RDP, but the CCI and PR were comparable in both groups of patients.
A study on prevalence and co-morbidity of bipolar and anxiety disorders in chronic headache patients
Authors: M. Sivaji , J. Manickavasagam , Sundaramurthi Indumathi , S. Gopinathan
Published: June 2017

Background: Co morbidity between headache and psychiatric disorders is more prevalent in chronic headache patients. The bipolar disorders and anxiety disorders are predominant in migraine and TTH respectively. This co morbidities have a poor reflection and impact on quality and outcome of chronic headache patients and results in worst prognosis and poor response to medical treatment.Methods: The chronic headache patients especially migraine and tension type of headache were analyzed with following materials such as the structured psychiatric clinical interview with ICD-10 mental and behavioural disorder, DSM-5 criteria. HAM-A, HAM-D, BDI-2, BPRS, young mania rating scale, Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and panic disorder scale.Results: Various subsets of bipolar disorder and anxiety disorder were found as follows: 74% of migraineurs are associated with psychiatric disorders in which bipolar affective disorder 6%, depressive episode 48%, dysthymia 30%, GAD 10% and Panic disorder 6%. 52% of TTH are associated with psychiatric disorders as follows: major depressive episode 52%, GAD 30%, separation anxiety disorder 6%, PTSD 7%, OCD 3% and panic disorder 2%.Conclusions: From previous and future studies the headache can be identified according to subsets of headache with psychiatric disorders make easier to provide appropriate pharmacological and psychological treatment which may reduce the chronicity and intractability of headache.
Stability of visual acuity after cessation of occlusion therapy in patients of amblyopia
Authors: Nazir Arjumand , Wani Fayaz A. , Shah Sumaya , Dar Saleema
Published: June 2017

Background: It is generally recognized that most children with amblyopia have an improvement of visual acuity (VA) with treatment, little is known about the course of vision once treatment is decreased or stopped in a child. The treatment of amblyopia in children is frequently discussed in the literature; however, there is a lack of research into which method of treatment cessation is the most appropriate once therapy has been completed. We undertook this specifically designed prospective study to directly compare the potential relationship between the method of therapy cessation and the short-term (12-weeks) recurrence of amblyopia.Methods: Fifty children of 5-14 years of age group with different types of amblyopia fulfilling the inclusion criteria were included in the study. Once BCVA was achieved, the subjects were randomized into one of two groups; abrupt cessation group or therapy tapering group. In subjects of tapered group occlusion was reduced from full-time occlusion to 50% of waking hours at BCVA and then additional by 50% at the 4-week’s study visit with occlusion being discontinued completely at the 8-week’s visit. All subjects in the abrupt cessation group stopped their full-time occlusion completely at the Best corrected visual acuity (BCVA). All subjects were followed for 3 consecutive 4-weeks intervals, for a total of 12 weeks, to assess the short-term recurrence rate of amblyopia.Results: The overall results show that at 12-weeks study outcome visit, 9 of the 50 subjects developed recurrence. Out of the total of 9 recurrences, 5 (20%) occurred in abrupt cessation group and 4 (16%) occurred in gradual cessation group. Comparing the time of occurrence of recurrence of amblyopia between the 2 studied groups, the recurrence of amblyopia was more during first 4 weeks of study 60% in abrupt group, whereas in gradual group all the recurrences occurred between 8 and 12 weeks visits. The pre-treatment VA and BCVA had a significant impact on the recurrence of amblyopia.Conclusions: In present study, the results demonstrate that the overall risk of amblyopia recurrence is 18% and the difference in the risk of amblyopia recurrence between the abrupt cessation group and the gradual cessation group (20% vs. 16%) is not statistically significant.
Prevalence of constitutive and inducible clindamycin resistance among clinical isolates of Staphylococcus aureus in a tertiary care institute in North India
Authors: Shetty Jeevan , Afroz Zarrin
Published: June 2017

Background: Clindamycin is an important drug used in the treatment of Methicillin Sensitive Staphylococcus aureus (MSSA) as well as in Methicillin-resistant Staphylococcus aureus (MRSA) infections. This drug is widely used in the treatment of skin and soft tissue infections caused by them. Therapeutic failure caused by macrolide-lincosamine-streptogramin B constitutive and inducible clindamycin resistance (MLSBc and MLSBi) is being more commonly reported.Methods: The present study was conducted over a period of six months from October 2016 to March 2017 to know the incidence of MLSBc and MLSBi in Staphylococcus aureus (S. aureus) isolates obtained in our hospital by D-test as per CLSI guidelines. A total of 130 isolates of S.aureus were obtained from different clinical specimens which included pus/ wound swab (n=266), urine (n=577), sputum (n=225), blood (n=221), throat swab (n=71), ear/eye discharge (n=21), high vaginal swab (n=20) and body fluids (n=50). All the isolates were subjected to antibiotic sensitivity testing by Kirby Bauer’s disc diffusion method. Amoxyclav, Erythromycin, Clindamycin, Co-trimoxazole, Tetracycline, Ofloxacin, Gentamicin, Linezolid and Vancomycin were the antibiotics used.Results: Out of 130 (8.9%) isolates of S. aureus obtained from 1451 clinical samples, 82 (63.1%) were found to be MSSA and 48 (36.9%) were MRSA. Among S. aureus, 43 (33.1%) isolates showed MLSBc resistance, 22 (16.9%) isolates showed MLSBi resistance and 20 (15.4%) isolates showed MS phenotype. The remaining 45 (34.6%) isolates remained sensitive to Erythromycin. Among MSSA, MLSBc were observed in 18 (22%) isolates and MLSBi in 9 (11%) while in MRSA, MLSBc were observed in 25 (52.1%) isolates and MLSBi in 13 (27.1%) isolates. Almost all clinical isolates showed 100% sensitivity to Vancomycin and Linezolid in routine antibiotic susceptibility testing. Both MLSBc and MLSBi resistance was significantly higher (p<0.05) in MRSA than in MSSA.Conclusions: The study emphasizes the importance of conducting D test along with routine antibiotic susceptibility testing for better utilization of clindamycin in S. aureus infections.
Comparison of microwave decalcification with conventional decalcification method by using different decalcifying agents
Authors: Rehan Ahmad Danish , Saigal Sonal , Bhargava Ankur , Kumar Uddipan , Thakur Pragya , Kausar Tasnim
Published: June 2017

Background: In routine histopathology, decalcification of teeth is an essential and important step during tissue processing. The present study was attempted to decalcify teeth using microwave method and to compare it with conventional decalcification method. The aim of the study was to compare microwave decalcification with conventional decalcification method with respect to the speed of decalcification, preservation of tissue structure, and efficacy of staining.Methods: In our study, the total sample size used for both routine and microwave decalcification was 30 premolar teeth. The three solutions were diluting nitric acid (5%), formic acid (5%), and EDTA (14%).Results: The results in the present study confirmed the fact that the microwave method using nitric acid was indeed the fastest decalcifying method needing just about 4 days for premolars, compared with routine decalcification. The results also showed that the overall structural details and good staining characteristics were better in teeth decalcified by 5% nitric acid in comparison to EDTA and formic acid in both the methods used. But nitric acid showed good staining details in microwave method in comparison to conventional method.Conclusions: 5% nitric acid by microwave method proved to be the best decalcifying agent as it was fast and gave good structural details and staining characteristics.
Percutaneous transcatheter intervention in a cyanotic congenital heart disease at tertiary care hospital in Western Rajasthan: a single centre experience
Authors: Mathur Rohit , Gupta Deepak , Kumar Goutam , Sanghvi Sanjeev , Baroopal Anil
Published: June 2017

Background: Treatment of congenital heart disease (CHD) is either surgical or interventional. Medical management is mainly symptomatic or palliative. Although surgery is the main mode of treatment but in the recent past non-surgical interventional method is replacing it because of its multiple advantages over surgical procedures. In this article, we report the success rate of the percutaneous transcatheter device closure procedures in our tertiary care hospital.Methods: The aim of this study is to review the short-term outcome of the non-surgical interventional treatment of congenital heart diseases. We included percutaneous transcatheter device closure of atrial septal defect (ASD), ventricular septal defect (VSD), patent ductus arteriosus (PDA) and ruptured sinus of valsalva aneurysm (SVA) performed at our hospital between September 2014 and November 2016.Results: We performed total 28 cases of ASD device, 3 cases of VSD device, 12 cases of PDA device, 2 cases of ruptured SVA device closures. Almost all our intervention procedures were successful except two cases of failure of ASD closure. There was no mortality and major complication related to procedures. All patients of successful interventional treatment are enjoying new life without any morbidity.Conclusions: Percutaneous transcatheter device closure for suitably selected cases of a cyanotic CHDs including ASD, VSD, PDA and ruptured SVA may be an alternative, lucrative, safe and effective option with least morbidity and mortality.
Sexually transmitted infections among men who have sex with men: a retrospective study in a tertiary care hospital
Authors: P. Prabahar , T. Ranganathan , C. Vijayabhaskar , Kalaivani S. , L. Balamurugan , P. Sivasankri
Published: June 2017

Background: Men who have sex with Men (MSM) have a higher prevalence of HIV and other sexually transmitted infections (STI) than the heterosexual men. In India, NACP recommendations to reduce HIV prevalence among MSM include early detection of HIV and other STI by screening and treatment. We conducted a study of STIs among MSM attending our OPD. The aim of the study was to assess the prevalence of STIs in MSM attending our OPD.Methods: 1215 MSM among 9008 patients who attended our OPD between June 2015 and May 2016 were included in the study. Detailed history was taken and clinical examination carried out. Urethral discharge and urine samples were tested for Gonococcal infection. Smears from ulcers were tested for Syphilis, Chancroid, Herpes and Donovanosis. Serum samples were tested for HIV and other STIs like Syphilis and Herpes.Results: Among 1215 MSMs, 55 (4.5%) tested positive for VDRL and TPHA and 33 (2.7%) tested positive for HIV. 24 (2%) had urethritis (10 GU and 14 NGU), 15 (1.25%) had Balanophosthitis, 12 (1%) had genital herpes, 9 (0.75%) had genital scabies, 6 (0.5%) had Genital Wart and 2 (0.16%) had Molluscum contagiosum. Prevalence of these STIs were far higher in MSMs than in heterosexual men.Conclusions: This study highlights the higher prevalence of STIs among MSMs and the need for early intervention and treatment in this high-risk population.
Antifungal activity of various plant oils against yeast isolates from ICU patients
Authors: Suman Akansha , Chauhan Sapna , Lata Suman , Sharma Rajeev K.
Published: June 2017

Background: To evaluate the in-vitro antifungal activity of various essential plant oils against yeast species.Methods: The present study was a prospective study conducted in Department of Microbiology along with Department of Pharmacology at Tertiary care teaching hospital. Various clinical samples from ICU patients were inoculated on Sabourauds Dextrose Agar (SDA) in accordance with the standard methods. Yeast isolates were recovered and identified as per standard recommended procedure. The antifungal activity of plant oils against these isolated yeasts was determined using disc diffusion method. The results were interpreted as <9mm-inactive, 9-12mm-partially active, 13-18mm-very active. Fluconazole and Itraconazole were taken as control drugs.Results: The various yeast isolated were C. albicans, C. tropicals, C. krusei, C. glabrata, C. gulliermondi, C. keyfr, Cryptococcus and Tricosporon. Among essential plant oils, Cinnamon oil and clove oil showed high activity against all isolated yeast species. Olive oil showed least antifungal activity. Fluconazole was resistant in all yeast isolates, while Itraconazole was sensitive to all yeast isolates. Sensitivity of cinnamon and clove oil was statistically significant than Itraconazole.Conclusions: To conclude present study shows the potential of essential plant oils as newer therapeutic alternatives to antifungal drugs. These may be used in combination with antifungal agents to overcome drug resistance, adverse effects and in shortening the long-term treatment with antifungal drugs. Thus, these essential plant oils can be used in future as antifungal agents in azoles resistant strains.
Isolated tuberculous epididymo-orchitis masquerading as testicular tumor: a diagnostic dilemma
Authors: Rana Shweta , Kalhan Shivani , Satarkar Rahul N. , Garg Shilpa , Sangwaiya Ashok
Published: June 2017

Isolated tuberculous epididymo-orchitis is rare and may present with clinical and radiological features similar to those of testicular tumor. It is thus a diagnostic and therapeutic challenge. A 40 yrs old male presented with left sided mass in scrotum for past 6 months, which was clinically and radiologically diagnosed as testicular tumor with hydrocele. FNAC was attempted twice but was inconclusive. Left sided orchiectomy was done. However, the histopathological findings of testicular mass revealed features consistent with tuberculous epididymo- orchitis (TEO). This case emphasizes that patient may present with isolated TEO, which is considered an unusual presentation of tuberculosis and can masquerade as testicular tumor clinically and radiologically. But in countries where prevalence of tuberculosis is high, tuberculous orchitis must be considered in the differential diagnosis of testicular swellings.
Current trends of adenotonsillar hypertrophy presentation in a developing country, Nigeria
Authors: Adegbiji Waheed A. , Aremu Shuaib Kayode , Nwawolo Clement C. , Asoegwu Chinyere N.
Published: June 2017

Background: Adenotonsillar hypertrophy is a common paediatric disorder in Otorhinolaryngological practice worldwide. The prevalence, clinical manifestations and predisposing factors are well documented in developed countries. However, available data shows differences between the various studies. There is paucity of data from developing countries. Thus, this study is aimed at assessing the age group distribution, predisposing factors, clinical manifestation and complications of adenotonsillar hypertrophy in a developing country.

Methods: It is a prospective study of children under 10 years over a period of 24 months. Interviewer assisted questionnaire was administered. Data obtained were statistically analysed using SPSS version 18.  

Results: Two hundred and fifty three, 253 subjects were enrolled into the study. Adenotonsillar hypertrophy affected all age groups studied. A high incidence was noted among the under 2 year olds. The Male: Female ratio was 2:1. Chronic cases constituted 55.7% of our study population. Common predisposing factors were atopy (73.9%), familial history (67.3%) and recurrent upper respiratory tract infection (58.2%). The Commonest clinical features were snoring, noisy breathing, tonsillar enlargement and narrowing of postnasal space air column. Failure to thrive, otitis media and rhinosinusitis were the commonly associated complications observed. No death was recorded.

Conclusions: Adenotonsillar hypertrophy is common in our environment. It is important for all primary health care physicians, paediatricians and otorhinolaryngologists to have a clear knowledge on this ailment. Prevention or reduction in incidence is possible.
Solitary nodule thyroid: diagnosis and management
Authors: Deepthi M. , Sukthankar P. S. , Narsimloo K.
Published: June 2017

Background: Solitary nodule can be a true solitary nodule or a dominant nodule of multinodular goitre or ectopic thyroid or unilateral agenesis. Solitary nodule can be benign or malignant. Purpose of evaluation is to differentiate between the two.

Methods: A prospective study of solitary nodule thyroid (STN) patients presenting to ENT outpatient department, for a period of 3 years from September 2012 to 2015.  

Results: Out of 67 patients enrolled into study, 53 patients had benign true STN, 9 patients had multinodular goiter (MNG) presenting as solitary nodule and 5 had malignant nodule (7.46%). Among the benign nodules, 25 patients had small solitary nodule (<4 cm size). They were treated medically and followed-up for a period of 1 year. 28 patients with large benign solitary nodules (>4 cm size) were taken up for surgery directly. Hemithyroidectomy was done in benign STN patients (39 patients) and total thyroidectomy was done in malignant nodule and MNG patients and followed-up by lifelong L-T4 therapy.

Conclusions: Small benign solitary nodules regress with medical therapy alone. In large solitary nodules, and in those nodules not regressing with medical therapy, hemithyroidectomy is adequate. In MNG and malignant nodules, total thyroidectomy is advocated. Hemithyroidectomy and total thyroidectomy patients were followed - up with suppression and supplementation therapy respectively.This area being fluorotic belt, there is an increased prevalence of goiter. This study gives a concise guideline in evaluation and management of STN for goiter endemic areas.

 
Clinical profile of cases of dysphagia presenting in ENT department: a study from rural tertiary care center
Authors: Datta Ginni , Gupta Manish , Rao Naiya
Published: June 2017

Background: Swallowing is a complex motor reflex requiring coordination among the neurologic system and muscles of the oropharynx and oesophagus. Disorders both benign and malignant may interfere with the process and cause dysphagia. We hereby undertake a study in a rural tertiary care centre to study the clinical profile of cases of dysphagia and to find the relative incidence of various etiologies of dysphagia.

Methods: A prospective study was conducted upon both out and indoor patients coming to Department of Otorhinolaryngology from January 2016 to January 2017 with predominant symptom of difficulty in swallowing for both solids, liquids or either. Detailed history & examination was done. Further endoscopy, barium swallow, fine needle aspiration cytology (FNAC) & biopsies were done as required. A total of 140 cases were taken into consideration.  

Results: The mean age was 52.5 years with 60% patients males and 40% females. The commonest etiology of dysphagia was Gastroesophageal reflux disease (GERD) occupying 28.57%of cases. Among them 65% werefemales majority in the age group of 45-55 years. The 2nd common cause of dysphagia was growth pharynx 18.5% of cases. Among them 19 cases were diagnosed as growth oropharynx and 7 cases as growth supraglottis extending to hypopharynx. 88.46% were males and all were smokers. The 3rd common etiology of dysphagia was obstructive oesophageal causes which included oesophageal malignancies, oesophageal webs, strictures and diverticula in the frequency of 16%, 3%, 3% and 6% respectively. Oesophageal malignancies were mainly adenocarcinoma, all males who were chronic smokers.

Conclusions: Dysphagia is a commonly encountered clinical problem & limited studies exist regarding the prevalence of dysphagia etiologies. It is an alarm symptom, malignancy should be ruled out, and warrants early intervention. 
Study of benign oral lesions and serum vitamin levels in tobacco consumers
Authors: Chavan Reshma P. , Ingole Shivraj M. , Dalvi Shubhangi M.
Published: June 2017

Background: Oral mucosal lesions are seen commonly in tobacco consumers and some of them are precancerous. Study of various benign oral mucosal lesions has done in tobacco consumers. Comparison of serum Vitamin levels was done in patients with benign oral lesions in tobacco consumers and non- tobacco consumers.

Methods: Retrospective study of 100 patients with benign oral lesion with tobacco addiction was done. Control group includes tobacco non-addicts. Detail history regarding tobacco consumption was noted. Tobacco consumption pattern was studied in patients with benign oral lesion. Ear, nose, throat examination was done in detail. Oral lesion was noted. Comparison between serum levels of vitamin A, C and vitamin E in benign oral lesion of patients with tobacco addiction and tobacco non-addicts were included in the study. The results were analysed statistically by student t-test.  

Results: Patient with tobacco consumption with lime application was more prone to develop benign oral lesions. Gingivitis was most common lesion seen in study population followed by leukoplakia. Serum vitamin A, C and E were significantly decreased in tobacco consumers with benign oral lesions as compared to tobacco non-consumers. Decreased in serum vitamin levels were seen in all benign oral lesions irrespective of its malignant potential.

Conclusions: Gingivitis was most common lesion seen in study population followed by leukoplakia. Serum level of non-enzymatic antioxidant vitamin such as vitamin A, C and E gets decreased significantly in all benign oral lesions irrespective of its malignant potential. Serum levels of the antioxidant vitamins indicate need of increased oral intake of these vitamins to protect from damage in all benign oral lesions.
Giant cell tumor of the frontal sinus: case report
Authors: Alzarei Ali , Assiri Majed , N. B. Rabab , Aljoraebi Wael , Sumaily Ibrahim
Published: June 2017

Giant cell tumor (GCT) is an uncommon aggressive primary bone tumor usually affects long bones. It is rarely involving skull bones, and to less extent the frontal bone. Up to date only 3 adult cases reported of the frontal bone, only one of them was occupying the frontal sinus. Here, we present a 49 year old male presented with slowly growing left supraorbital swelling for 3 years. This swelling was a firm mass with destruction of anterior table of frontal bone. Diagnostic radiological work-up showed a mass in left frontal sinus, mass excised with external approach. Reporting this case with its clinical, radiological and histopathological images should add significant material to the literature for further studies of GCT of paranasal sinuses.