bluuebunny/crossref_metadata_2025 huggingface dataset:
Safety and efficacy of methyldopa and labetalol in controlling blood pressure in hypertensive disorders of pregnancy
Authors: Pentareddy Mary Rohini , D. Shailendra , G. Prasuna , Y. Subbaratnam , D.T. V. Naresh , Katta Rajshekar
Published: March 2017

Background: Hypertensive disorders represent the most common medical complication of pregnancy, with a reported incidence of 6-10% and accounts for 15% of maternal mortality. Effective management of pregnancy induced hypertension is vital to improve maternal and foetal outcomes. As data are scarce on comparison of labetolol and methyldopa this study was undertaken. The objective of present study is compare the efficacy and safety of Labetalol versus Methyldopa in the management of Mild to Moderate pregnancy induced hypertension. To evaluate effect of both drugs on maternal and foetal outcomes.Methods: A comparative observational study is designed. 30 patients who received methyldopa and 30 patients who received labetalol were included in the study. Methyldopa was started at a dose of 250-500 mg thrice daily while labetalol was started at a dose of 100-400 mg twice daily. Patients were followed up during antenatal, intrapartum and postpartum period for efficacy, safety, maternal, and perinatal outcomes.Results: Methyldopa and Labetalol reduced mean systolic and mean diastolic blood pressures significantly. safety profile of both drugs was similar. Spontaneous vaginal deliveries were observed more with labetolol significantly.Conclusions: Labetalol is equally efficacious as methyldopa and well tolerated in the treatment of new onset hypertension during pregnancy.
Efficacy of vijaysar, aloevera alone and their combination in the treatment of newly diagnosed cases of type 2 diabetes mellitus: a randomized single blind prospective study
Authors: Maurya Arvind Kumar , Jain Atul , Pathak Asha , Chaudhary Pankaj , Rajdan Neeraj
Published: March 2017

Background: Diabetes mellitus is a disease was known since ancient time and all system of medicine over world were tried to cure this disease. Unfortunately the numbers of diabetes patients are increasing day by day due to many risk factors such as sedentary life, obesity etc.Methods: A total of 120 patients with newly diagnosed type 2 diabetes mellitus attending OPD of UPUMS, Saifai, Etawah, Uttar Pradesh, India, were included in the study. Patients were divided into 4 groups. Group-1, 2, 3 and 4 received Aloevera, Vijaysar, Aloevera + Vijaysar and Glimepiride respectively for thirteen weeks. Sample for fasting blood sugar and postprandial blood sugar were measured at baseline, 1st, 2nd, 3rd, 5th, 8th and at 13th week. HbA1c and Lipid profile were measured at baseline and at thirteen week.Results: Significant decrease in FPG, 2hPG, and HbA1c level were achieved in all groups but effects was maximum in Glimepiride group. Vijaysar had shown better glucose control than Aloevera as well as Aloevera + Vijaysar group. Synergism was shown by both herbal drugs for FPG control but not for 2hPG. The Effect of Vijaysar alone on 2hPG was similar to Glimepiride.Conclusions: Vijaysar could be a promising herbal drug for the treatment of mild uncomplicated cases of type-2 diabetes mellitus; however both drugs have shown synergism for FPG control. Both herbal drugs were safe during our study, only one patient of Vijaysar group had complaint of diarrhoea, which was subsided one week later.
Significance of prescription elements and determination of prescription errors in psychiatry outpatient department of a tertiary care hospital
Authors: R. Pradeep Kumar , Nandimath Meena K. , M. Aarpith Kamath
Published: March 2017

Background: Prescription is a paper or electronic document issued by licensed medical practitioner detailing the medicine or medicines to be dispensed for an individually named patient. Psychopharmacology is a rapidly growing field and psychiatrists are exposed to lots of newly introduced drugs. Therefore, this study was carried out to determine the Errors in elements of Prescription in Psychiatry Outpatient Department.Methods: A cross sectional descriptive, non-interventional study in OPD of Psychiatry Department for 12weeks, 300 prescriptions was analyzed.Results: Superscription transcription and subscription was included in almost all the prescriptions. In 244 (81.33%) signature was present. Registration number was written in 177 (59.0%) prescriptions. Only 56 (18.70%) prescriptions were written in generic name and 49 (16.34%) in capital letter. The dose was written in 241 (80.34%) of the total prescription. The frequency was written for all the drugs in 273 (91.0%) and some drugs in 46 (15.34%) and none of the drugs in 13 (4.33%) of the total prescriptions. Instructions for use was written for all the drugs in 216 (72.0%) and some drugs in 39 (13.0%) and none of the drugs in 45 (15.0%) of the total prescription. Total quantity to be dispensed was written for all the drugs in 284 (94.66%) and some drugs in 9 (3.0%) and none of the drugs in 7 (2.33%) of the total prescription. Polypharmacy was observed only in a quartile of the total prescriptions.Conclusions: The results of the present study show varied compliance to different elements of prescription writing. Low level of generic prescription observed in this study is a matter of concern. Increased generic prescribing will reduce the cost of medications and promote medication adherence.
Protective effect of Phyllanthus fraternus against cyclophosphamide-induced nephrotoxicity in rats
Authors: Moirangthem Rakesh Singh , Gunindro Ngangom , Takhellambam Dipdeba Singh , Khuraijam Sucheta Devi , Meena N. , Rita S.
Published: March 2017

Background: Cyclophosphamide is commonly used against malignancies, such as leukemia and solid organ cancers. It can induce nephrotoxicity in cancer patients thereby complicating the initiation of chemotherapy. The study is to evaluate the effect of Phylllanthus fraternus against cyclophosphamide induced nephrotoxicity in albino rats.Methods: In this study, a total of 20 albino rats were divided into four groups of five each. Group I (normal control) received i.p. injection of normal saline. While, group II, III and IV received single dose (200 mg/kg b/w) of cyclophosphamide i.p. on day 1. Group III and IV received 200 mg/kg and 400 mg/kg of aqueous extract of Phyllanthus fraternus respectively p.o. daily for 10 days. All the groups were fed with standard diet and water ad libitum. Serum levels of creatinine, urea and albumin were estimated. Histopathology of renal tissues was compared among the groups.Results: The renal parameters significantly improved in groups III and IV after 10 days of treatment with the extract. The histopathology study also supported the finding.Conclusions: The aqueous extract of Phyllanthus fraternus possesses protective effect against cyclophosphamide induced nephrotoxicity.
Case report on hydatid cyst of the liver progressed to the lungs
Authors: Nethi Sree Keerthi , Biradavolu Vyshnavi , T. S. Durga Prasad
Published: March 2017

Hydatid liver disease is commonly found in sheep farming areas. Hydatid cysts are confined to the liver and lungs in common. Many reports on hydatid cysts of liver and lungs were reported individually. Here, we report a case of hydatid cyst of the liver leading to the development of cysts in the lungs. The patient had previously underwent surgery for the removal of hydatid cysts in the liver but chemotherapy with albendazole was neither initiated immediately nor continued for 3 to 6 weeks after initiation. Later she presented with shortness of breath and cough along with fever and chills, for which she was diagnosed to have pleural effusion confirmed with pleural fluid analysis showing increase in ADA (Adenosine deaminase) and protein levels and USG (Ultrasonography) demonstrating loculations. Inspite of specific therapy, pleural effusion was not relieved and she was advised for CT chest which revealed multiple cysts in the lung. Suspecting for the liver cysts, USG abdomen was advised and it confirmed the presence of hydatid cysts in the liver. This helped to draw a conclusion that failure of earlier surgical intervention i.e excision of hydatid cyst of the liver lead to the development of cyst in the lungs that presented as pleural effusion. This case highlights the importance of chemotherapy along with surgical intervention before and after the surgery.
Isoniazid induced acute generalised exanthematous pustulosis
Authors: Ahire Niteen S. , Dudhagaonkar Sujata , Harle Krishna , Rakhunde Sharad
Published: March 2017

Tuberculosis (TB) poses major health problem in developing countries including India. According to WHO in 2010 survey, there were about 9.4 million active pulmonary TB Patients worldwide, out of that 2.3 million case were found in India. Isoniazid is known to be the least toxic among the first line antitubercular drugs.  Hypersensitivity reactions due to Isoniazid may present in the form of fever and skin rash. We hereby report a case of acute generalised exanthematous pustulosis due to isoniazid in a patient on anti-tubercular treatment. We also established the causality, severity, and preventability of the suspected adverse drug reactions (ADRs).
Rucaparib: a PARP inhibitor for the treatment of advanced ovarian cancer
Authors: Babu Merin , C. J. Josini
Published: March 2017

Ovarian cancers arise from the uncontrolled growth and replication of epithelial cells of the surface of ovary which constitutes 90% of cases. PARP (poly ADP-ribose polymerase) inhibitors are a novel type of therapy that prevents cancer cells from repairing their DNA which have been damaged by other chemotherapeutic agents. Rucaparib is a novel drug that was approved by the US FDA in 2016 for the treatment of patients with deleterious BRCA mutation associated advanced ovarian cancer. Inhibition of the PARP enzymes leads to the increased formation of PARP-DNA complexes which results in DNA damage, apoptosis and cell death. Nausea, fatigue including asthenia, vomiting, anemia, abdominal pain, constipation, decreased appetite, diarrhea, thrombocytopenia and dyspnea were the common adverse effects seen among rucaparib users. Even though, the drug may cause myleodysplastic syndrome/ acute myeloid leukemia (MDS/AML) it remains as novel therapeutic target for the treatment of advanced ovarian cancer involving BRCA mutation.
A comprehensive review of the factors predicting technical difficulty in laparoscopic cholecystectomy
Authors: Menon Aravind
Published: March 2017

Laparoscopic cholecystectomy is the most common laparoscopic procedure performed all over the world. It has now become the gold standard management for symptomatic gallstones. Aim of the study was to identify and highlight the predictive factors determining intra operative technical difficulty in laparoscopic cholecystectomy. A database search was done in Medline, Google scholar and Journal seek using keywords ‘Laparoscopic Cholecystectomy’, ‘difficult cholecystectomy’ and ‘predictive factors’. 54 abstracts were shortlisted out of which 15 were selected based on the time of publication (after 2005), size of study group, relevance to the title, level of evidence and the journal of publication. Results were compared and reviewed and the conclusion was reached. Fifteen papers were reviewed based on literature search and statistically significant variables predicting the technical difficulty in Laparoscopic cholecystectomy was found. These were age, sex, obesity, previous upper abdominal surgeries, comorbid diseases like Diabetes, acute cholecystitis, raised WBC counts, gall bladder wall thickness more than 3mm, presence of pericholecystitic collection, single impacted stone, multiple stones, contracted gall bladder, adhesions at Calot’s triangle, intrahepatic gall bladder, complications like gangrenous GB and fistulisation. The predictive risk factors reviewed here need to be kept in mind by the laparoscopic surgeon during a laparoscopic cholecystectomy. Though none of them is an absolute contraindication, presence of these factors demand modifications in technique for a safe laparoscopic surgery.
Recent trends in management of haemorrhoids
Authors: Ali S. Asif , Shoeb Mohammad Fazelul Rahman
Published: March 2017

Background: Haemorrhoids are common clinical conditions. Their treatment is one of the most challenging situations in the field of general surgery. In this study, we compared and evaluated the results and postoperative complications of Lords dilatation procedure and haemorrhoidectomy.Methods: The study evaluates comparative results of Lords dilatation procedure and haemorrhoidectomy. This study was conducted over a period of 1 year from January 1984 to December 1984. It includes 40 patients with haemorrhoids who attended surgical OPD of Krishnarajendra Hospital, Mysore. These 40 patients were selected randomly and divided into two groups of 20 patients each (Lords dilatation group and haemorrhoidectomy group). All parameters including clinical, physical and baseline investigations for all patients were recorded and finally analysed.Results: The age of the patients ranged from 20-70 years. Male preponderance was observed (7:1). The commonest symptoms were mass per rectum (90% and 85%) and bleeding P/R (85%), pain during defecation (85% and 70%) in Lords dilatation and haemorrhoidectomy groups respectively. Protoscopic examination revealed the presence of grade II haemorrhoids in most of the patients in both the groups, 45% and 65% respectively. Postoperative complications including pain, sphincter incontinence, bleeding and urinary retention is high in haemorrhoidectomy group as compared to Lords dilatation group. Recurrence of haemorrhoids (5%) and fecal incontinence (5%) was observed in Lords dilatation group after 6 months of treatment.Conclusions: Haemorrhoidectomy for treatment of hemorrhoids offers the best immediate and long term results compared to Lords dilatation.
Hyperbilirubinemia as a predictor of the severity of acute appendicitis - an observational study
Authors: Cheekuri Sadhan Kumar , Mohanty Alok , Ganesh T. , Kannan R. , Smile Robinson
Published: March 2017

Background: Appendicitis is the most common acute abdominal condition requiring emergency surgery, with a lifetime risk of 6%. Appendectomy continues to be one of the commonest procedures in general surgery, accounts for approximately 1% of all surgical operation. Despite the increased use of ultrasonography, computed tomography scanning and laparoscopy, the rate of misdiagnosis of appendicitis has remained constant (15.3%). The aim of this study was to whether Serum Bilirubin can be considered as a new laboratory marker to aid in the diagnosis of acute appendicitis and if so, does it have the predictive capacity to warn us about complicated appendicitis.Methods: This was prospective observational study done in Mahatma Gandhi Medical College and Research Institute, Pondicherry between November 2014 and August 2016. About 110 patients of acute appendicitis who had undergone appendicectomy were studied. Data was collected and analyzed critically.Results: Males 66 (60%) outnumbered females 44 (40%) and overall mean age was 26.61±12.37 years. Of the 110 patients, 9% were normal appendix, 59.09% were confirmed as acute appendicitis while 31.81% were diagnosed with complicated appendicitis on biopsy. The Sensitivity and Specificity of serum bilirubin as a marker in predicting Acute appendicitis and complicated appendicitis was 47.6% and 90.9% respectively. Similarly, the Positive predicative value and Negative predicative value for the same was 88.5% and 61.5% respectively with odds ratio 12.4 with significant p value <0.0001.Conclusions: Serum bilirubin is easily available test and cheap and can be estimated from the sample of blood drawn for routine blood investigations. Patients with clinical signs and symptoms of appendicitis and with hyperbilirubinemia should be identified as having a higher probability of complicated appendicitis. Hence, serum bilirubin levels have a predictive potential for the diagnosis of severity of acute appendicitis and need for early appendicectomy. If total serum bilirubin is added to already existing laboratory tests, then the diagnosis of complicated appendicitis in clinically suspected cases can be made with fair degree of accuracy, the need for CECT and MRI can be reduced and unnecessary delay in appendicectomy can be avoided.
Splenic flexure cancer optimum level of vessel ligation
Authors: Rao T. Uma Maheswara , Reddy Boddu Sankar , Chilukoti Supriya
Published: March 2017

Background: Incidence of splenic flexure carcinoma is very low in colorectal cancer but often time presented in an advanced stage with high risk of obstruction, contributing poor prognosis. Aim of the study was to investigate the adequacy of vessel ligation in SFC in term of overall survival.Methods: 35 patients diagnosed with splenic flexure carcinoma enrolled and analyzed, patients categorized based on the level of vessel ligation as group-A, left branch of middle colic (LMA) and left colic artery division (LCA) compared, group-B, LCA and marginal of middle colic artery (MMC).Results: CEA marker was not significantly changed post-operatively, as it was within normal range preoperatively at an average of 9-12 µg/ml. There is no significance in staging of tumors in all stages, and recurrence of tumor is present in 5 in group A. Radical margins both proximal and distal ends are not significant. Tumor clearance achieved successfully in both arms in term of proximal margin achieved at 7.9±3.5cm in groups B and 8.3±4.1 cm in group A, p = 0.312. Distal margin reported at 8.7±4.1 cm and 8.9±3.98cm, p = 0.58, respectively. Lymph nodes are positive in group-A and group-B without any significance. Tumor size or diameter ranging from 5.1±3.1 in group-A and 4.76±3.8 in group-B. According to the cell differentiation, majority of the tumor grade turned out to be moderately differentiated cancer, rated at 14 patients (40.1%) in group A and 13 patients (37.1%) in group B. one patients found to be well or poorly differentiated cell tumors in group-A. Overall p-values were insignificant in regards tumor cell differentiation in both groups, p = 0.213. Incidence of lympho-vascular invasion reached only 3 (8.5%) vs. 4 patients (11.2%), p = 0.562, in A and B group.Conclusions: Higher level of vessel ligation has no added significance in overall outcome, but has role to lower the risk of recurrence rate in Splenic flexure carcinoma patients.
A study of surgical profile of patients undergoing appendectomy
Authors: Dhruv Kamlesh , Meshram Sunita , Agrawal Sujan Narayan
Published: March 2017

Background: The most common cause of acute abdomen in surgical is appendicitis. Among the surgeries of abdomen performed all over the world, appendectomy is the most common operation performed. Many studies have shown variations of age, gender in acute appendicitis as well as the seasonal variations in the occurrence of acute appendicitis, although the cause is not found yet. Objective was to study the surgical profile of patients undergoing appendectomy.Methods: A total of 302 patients who have undergone appendectomy were included in the present study which was hospital based cross sectional study. The study was carried out for two years at Osmania General Hospital, Hyderabad, India. Permission from Institutional Ethics Committee permission was obtained. From each and every patient included in the study, initially Informed individual consent was taken.Results: The incidence of appendicitis is much more in females i.e. 60% compared to only 40% in males. Appendicitis was most common in younger age groups of below 30 years of age. As the age increased the incidence of appendicitis decreased. From 83.2% at 30 or less than 30 of age it drastically dropped down to 15.9% in the age group of 30-49 years and in the age group of 50 and above, the incidence of appendicitis came down to less than one percentage. Only three cases were recorded above the age of 50 years.Conclusions: Present study revealed more rates in females. The disease was more common in younger age groups. The most common presenting symptom was abdominal pain. Presence of abdominal mass was absent in the present study.
Sutureless versus conventional thyroidectomy
Authors: Mohamed Wael Barakaat Ahmed , Ahmed Ahmed Eisa
Published: March 2017

Background: The thyroid gland is a highly-vascularized organ, prompt and effective hemostasis is a crucial part of the procedure. Nowadays with the major advent of energy devices such as ultrasonic coagulation (Harmonic Scalpel, Ethicon) and bipolar energy (LigaSure, Valleylab) for cutting and hemostasis introducing new methods of vessel ligation and division without increasing the risk of postoperative complications. The aim of this study was to compare the outcome of the use of the Harmonic® FOCUS and conventional suture ligation technique in a prospective comparative study of open total thyroidectomy.Methods: This was prospective comparative study at Sohag University Hospital, Sohag, Egypt. Patients were divided into two groups, the first group included patients who had the Harmonic® FOCUS thyroidectomy group or Sutureless thyroidectomy (S group), and the second group included patients who received Conventional thyroidectomy group (C group).Results: Between September 2014 and September 2016, 69 patients, with thyroid disease were enrolled in this study. 34 patients (49.3%) had a Sutureless total thyroidectomy and 35 patients (50.7%) had a conventional total thyroidectomy, the mean age for Sutureless thyroidectomy was39.85±8.47 years and for conventional group was 43.17±9.69 years. the operative time, intraoperative blood loss, postoperative, drainage volume, transient hypocalcaemia, overall postoperative complications and hospital stay were significantly lower in Sutureless thyroidectomy group. no significant difference between both group as regard recurrent laryngeal nerve function.Conclusions: Sutureless thyroidectomy is the procedure of choice for treatment of thyroid diseases as it had shorter operative time, reduction of overall complications rate and good function results.
Possible mechanisms of development of carcinoma of breast in patients with early-onset cataract
Authors: Singh Kaushal Deep , Faridi Shahbaz Habib , Lodhi Mehershree
Published: March 2017

Background: A nation-wide population based retrospective cohort study from Taiwan in 2014 suggested a propensity of developing breast cancer in young females with early-onset cataract. One such patient presented to us who was a young non-obese female with a large lump in the right breast with skin nodules and bilateral painless progressive diminution of vision. Patient was diagnosed as locally advanced carcinoma of right breast with axillary metastasis (stage IIIB) and bilateral early-onset nuclear cataract. Mechanism of this possible association has never been described.Methods: A comprehensive online English literature search was done using various electronic search databases. Different search terms related to pathogenesis of carcinoma breast and cataract, and their possible association, were used. An advanced search was further conducted by combining all the search fields in abstracts, keywords, and titles.Results: We summarized the data from the searched articles and found that there are certain biochemical pathways and genetic associations that link cancer to cataract. We identified four specific links between carcinoma breast and cataract (in some cases even early-onset cataract). The four mechanisms which explained this possible association included metabolic syndrome, action of reactive oxygen species, genetic polymorphisms and environmental factors.Conclusions: The evidence linking early-onset cataract with cancer is relatively new so possible mechanisms of development of breast cancer in patients with early-onset cataract needs to be elucidated. These plausible connections can further help to take up large scale molecular, biochemical, epidemiological and clinical studies to investigate this association in terms of cause-effect relationship. The impact this association can have, on understanding cataract and cancer pathogenesis; and its potential in reducing cancer incidence in patients with EOC, can be profound.
Perineal lipoma mimicking an accessory penis with scrotum
Authors: Jabbal Harmandeep S. , Wagh Dhirendra D.
Published: March 2017

A case of accessory penis with scrotum in a 4 months old boy is reported because of its rarity. The infant presented with a tumour mimicking an accessory penis with scrotum between the normal sited scrotum and anus. Both testes had descended into the scrotum. After complete evaluation, there was no other urological anomaly. The tumour was excised and the histo-pathological findings of the tumor indicated a perineal lipoma. An overview of normal development of male external genitalia has been provided and the deranged mechanism resulting in this anomaly has been reviewed with hypothesis regarding etiology of accessory scrotum.
A rare case of adult hepatoblastoma mimicking hepatocellular carcinoma- case report and review of literature
Authors: Sharma Digvijoy , Bheerappa Nagari , Thumma Venu Madhav , Varma Suryaramchandra , Navakishore Kunduru , Reddy Jagan Mohan
Published: March 2017

Hepatoblastoma (HB) is a rare malignant primary tumour of the liver and occurs mostly in the pediatric group within the first 3 years of life. It is extremely unusual to find hepatoblastoma in adults and is a very rare cause of primary malignant liver tumour in adults and due to this patient may be diagnosed at late stages of the disease at leading to poor prognosis in this group. Reported here a case of a 20-year-old boy with a large liver mass with abdominal pain. Triphasic CT revealed the presence of a large heterogenous tumor in the right lobe of liver suggestive of hepatocellular carcinoma. Patient underwent a right hepatectomy. Final histopathology was reported as Epithelial type hepatoblastoma. The patient had an uneventful post-operative recovery. We present this case for its rarity and ability to masquerade other primary liver tumors in the adult age as seen in our patient.
Intra-testicular epidermoid cyst: a rare case report with clinico-radiological dilemma
Authors: Rawal Gireesha , Sharma Preeti , Goyal Surbhi , Yadav Amit Kumar , Mandal Ashish Kumar
Published: March 2017

Intra-testicular epidermoid cyst of testis is a benign tumour and accounts for 1-2% of all testicular neoplasms. It is a benign lesion, and should be distinguished from dermoid cyst or teratoma, which have a considerable malignant potential. We describe a rare case of testicular epidermoid cyst in an elderly male presenting with gradually increasing testicular mass since 8 months. Local examination revealed a non-tender, irregular, hard mass in the right testis. All routine laboratory investigations along with tumour markers were within normal limits. Ultrasound showed features of a testicular neoplasm following which orchidectomy was performed. Grossly, cut surface of testis showed a cyst measuring 4x2x1cm and microscopic examination revealed features of an epidermoid cyst. Extesive sampling excluded the possibility of a teratomatous focus. This case is described owing to the rarity of this neoplasm and the unusual clinico-radiological presentation. The pre-operative diagnosis of this tumour can be made if characteristic sonographic and MRI findings are obtained in the absence of which these masquerade neoplastic lesions. Histopathological examination thus is vital for a decisive diagnosis.
Pleomorphic giant cell adeno-carcinoma gall bladder: a histological rarity and a surgical dilemma
Authors: Ray M. S. , Deepak B. S. , Jassar Aneeta , Pathania Kunjan
Published: March 2017

Undifferentiated pleomorphic giant cell adeno-carcinoma of the gall bladder (GB) is an extremely rare condition and is usually an incidental diagnosis. Here, we describe a rare case of gall bladder carcinoma in a 50 year old lady who presented with upper abdominal pain and palpable lump in the right hypochondrium. Computed tomography and Ultrasonography of the abdomen showed an ill-defined giant heterogeneous soft tissue mass involving gall bladder and adjacent liver parenchyma with obvious regional adenopathy. Metastatic work-up was abnormal and the patient underwent radical cholecystectomy. Histopathology and immunohistochemistry (IHC) study revealed Undifferentiated carcinoma or pleomorphic giant cell adenocarcinoma of gall bladder involving the adjacent hepatic parenchyma. Patient received post-op adjuvant chemotherapy and is under monthly follow-up. The present case emphasizes the need for better detection, evaluation and analysis of such rare entities, to identify their natural course and effective treatment modalities.
Acromegaly with negative immunostaining for growth hormone on the contrary to silent somatotroph tumor
Authors: Ozisik Hatice , Yurekli Banu Sarer , Kutbay Nilufer Ozdemir , Altun Ilker , Ertan Yesim , Saygılı Fusun
Published: March 2017

Silent somatotropinomas are not rare. On the contrary to that, the absence of GH immunostaining in acromegaly has not been well defined. So, we would like to to draw the clinician’s attention to such an entity through a case of acromegaly with negative GH staining.
Idiopathic low flow priapism: a rare presentation
Authors: Yagnik Vipul D.
Published: March 2017

A young male adult was presented with persistent penile erection since last 3-4 days.There was no history of predisposing conditions like sickle cell disease, malignancy, drug ingestion, trauma etc. On Examination penis was erect, rigid and tender on palpation
Prospective analysis of type I thyroplasty using gore-tex implant
Authors: Mohanty Sanjeev , . Sreenivas , T. Vinay Raj , . Devipriya , M. Vinoth
Published: March 2017

Background: Vocal cord paralysis is a clinical sign caused by paralysis of intrinsic muscles of larynx due to dysfunction of recurrent laryngeal nerve. There are several methods available surgically for the medialisation of the abducted vocal cord. One of the common effective modality is the Gore-Tex medialisation thyroplasty. The results depend on a number of factors including the surgical expertise and extrusion of the Gore –Tex implant. This study is aimed at analysis of all Gore-Tex medialisation thyroplasty done at our centre. Prospectively asses and analyze the vocal outcomes and quality of life of patients in type 1 medialisation thyroplasty using Gore-Tex implant.

Methods: Prospective study of 48 months on 30 patients with unilateral vocal cord paralysis.  Surgical procedure for the patients was standardized by using Gore-Tex implant to medialize the cord. Video-Laryngoscopy at end of 1st month and stroboscopy & voice analysis at end of 3rd month post treatment, the parameters used for the pre and post treatment objective analysis are a) stroboscopic analysis, b) psychoacoustic evaluation, c) maximum phonation time, d) patient’s self-assessment.  

Results: In our study of 30 patients with a follow up period of 48 months, we can conclude as follows – a)unilateral vocal cord paralysis does not have age or gender specificity, b)statistically significant vocal cord palsy affects the left side more by 70%, c)post op Gore-tex medialisation thyroplasty showed a statistically highly significant improvement in psychoacoustic, mean phonation time, d)post op Gore-Tex medialisation thyroplasty showed a statistically significant improvement in videostroboscopic analysis.

Conclusions: Psycho acoustic, mean phonation time analysis would complement each other in the assessment of the medialisation thyroplasty thus obviating videostroboscopy.
Effects of adenoidectomy and adenotonsillectomy on the components of Waldeyer ring
Authors: Bhat Vikram K. , Shetty Deekshith , Nagaiah Preetham H.
Published: March 2017

Background: The consolidated effects of adenoidectomy alone and adenotonsillectomy on the Waldeyer ring need to be studied in children.

Methods: This was a clinical trial with a sample size of 100 in each of the two arms [Group A: adenoidectomy alone, Group B: adenotonsillectomy].  

Results: It was found that the association between adenoid recurrence (Risk 3 times) and palatine tonsil hypertrophy (Risk 11 times) in Group A patients at 3 and 6 months was extremely significant. Whereas lingual tonsil hypertrophy was found to be highly associated with Group B.

Conclusions: If adenoidectomy alone is performed, there are high chances of hypertrophy of palatine tonsils, lateral pharyngeal bands and a high risk of adenoid recurrence. If adenoidectomy and tonsillectomy are performed together there is some chance of lingual tonsil hypertrophy. Hence it would be prudent to perform both the surgeries simultaneously in most children for better control of chronic infections and obstructive sleep apnoea symptoms.
Role of usage of antibiotics in pharyngitis: a prospective study
Authors: Deepthi M. , Narsimloo K.
Published: March 2017

Background: Antibiotic resistance is emerging as a global public health problem and is growing day by day in both developed and developing countries. This study aims at scientific investigation into the need for the use of antibiotics in cases of pharyngitis.

Methods: A prospective study of 2000 patients complaining of sore throat, randomly selected from outpatient department during 1 year period from August 2015 – 2016 .They were studied clinically and investigated for infectious etiology and the role of usage of antibiotics was analysed.  

Results: Among 2000 patients, 1840 patients were relieved of sorethroat with only symptomatic treatment. Antibiotics were given only in 160 patients (8%) as throat swab demonstrated bacterial growth. Most common organisms were Group A beta haemolytic Streptococci and E coli. Allergic pharyngitis and laryngo pharyngeal reflux disease constituted the important causes of sore throat among middle age groups (20-40 years) and elderly age groups (50-60 years) respectively.

Conclusions: Antibiotics should not be given to patients unless there is documentary evidence of bacterial infection. Most of the patients (92%) did not require antibiotic prescription, the illness was self-limiting in acute cases and patients who demonstrated allergic and laryngo-pharyngeal reflux etiology required symptomatic medication. Inadvertent use of antibiotics will lead to spread of resistance in the community; this will limit the usage of higher antibiotics for complicated cases and ICU patients. This highlights opportunity to enhance physician‘s awareness for reducing inadvertent use of antibiotics among adult pharyngitis patients and optimizing Antibiotic therapy usage.
A retrospective study of noise induced hearing loss in a tertiary care hospital of Jharkhand - an alarming but ignorant truth
Authors: Singh Pradeep Kumar , Kumar Nishant , Kumar Dheeraj , Shrivastava Nisha , Kumar Abhishek
Published: March 2017

Background: Noise induced hearing loss (NIHL) is hearing impairment resulting from exposure to loud sound. People may have a loss of perception of a narrow range of frequencies, impaired cognitive perception of sound, or other impairment, including sensitivity to sound or ringing in the ears. NIHL is 2nd most common cause of hearing loss, next to presbycusis. Most of the population of developing countries is ignorant of the hazards of excessive noise exposure. 1) To describe the socio-demograpic profile of patients in the young age group (18-35 years) with noise induced hearing loss in Rajendra Institute of Medical Sciences (RIMS), Ranchi during June 2015- November 2016. 2) To study the major presenting complaints. 3) To categorize the patients on the basis of degree of hearing loss.

Methods: Data for study was collected from RIMS Out Patient Department (OPD) register during period June 2015 – November 2016 (18 months).Total sample size for this period was 50. Templates were generated in MS excel sheet and data analysis was done using SPSS software (version 20).  

Results: Study showed NIHL was more common in urban (82%) and male (72%) population. More than half (54%) patients presented with hearing loss and 24% with tinnitus. Most of the patients had bilateral mild hearing loss (70%).

Conclusions: NIHL is more common in urban males, mostly in age group (26-35 years). More than 2/3rd (68% ) of patients had history of exposure to loud noise. 
A comparative study on effects of diabetes on auditory functions as measured by BERA and DPOAE
Authors: Joshi K. D. , Galagali J. R. , Kanzhuly Manoj Kumar , Singh I. D.
Published: March 2017

Background: Diabetes is prevalent endocrine disorder associated with many complications. However, the link between auditory dysfunctions and diabetes is still vague.  The current study aims to correlate auditory dysfunction caused by DM, measured by distortion product otoacoustic emission (DPOAE) & brainstem evoked otoacoustic emissions (BERA).

Methods: This is a descriptive (comparative) study in which auditory functions of 100 diabetics and 100 matched non-diabetics were assessed by distortion product otoacoustic emission (DPOAE) & brainstem evoked otoacoustic emissions (BERA). The data for diabetic and non- diabetic group was compared and analysed. Effects of age of individual on auditory functions were also analysed separately using suitable statistical tests. The data collected was analysed with suitable statistical tests were performed with a significance level of ɑ=0.1 using SPSS 2.0 software.  

Results: The demographical variable was comparable in both the groups. The results showed decline in free field hearing, which are further adversely affected by duration of diabetes and patient’s age. The pure tone thresholds were not significantly higher in diabetics; however the thresholds were significantly higher in diabetics in older age groups. The hearing loss appear at early age in diabetics but gradually become indistinguishable from age related hearing loss.

Conclusions: Although the auditory dysfunction can be linked to diabetes, but are usually not detectable at earliest stages with routine clinical and audiological tests. The DPOAE and BERA have role to play in monitoring of the auditory dysfunction.
Hearing loss following temporal bone fractures- a study on classification of fractures and the prognosis
Authors: Maradi Nagaraj , M. Somanath B.
Published: March 2017

Background: Temporal bone fractures are traditionally classified as transverse, longitudinal or mixed fractures depending on their relationship to the petrous pyramid. However recent studies show that classifying temporal bone fractures as otic capsule sparing (OCS) and otic capsule violating (OCV) types has more relevance with the prognosis of hearing loss and other associated complications. To assess the predictive value of two different types of temporal bone fracture classification systems with respect to hearing loss and its type.

Methods: This prospective study was done on patients attending a tertiary care hospital in the study period of one year. Temporal bone fracture patients satisfying inclusion and exclusion criteria were clinically and audiologically evaluated. All patients with temporal bone fractures were categorized into two groups - Longitudinal/ Transverse (old) and OCS / OCV (new). Hearing loss was evaluated audiologically on multiple intervals- initially following the injury once the patient is stable, later after a gap of 1 month and 3 months following the injury.

Results: During the study period, 45 patients presenting with temporal bone fractures who satisfied the selection criteria were evaluated. The correlation was statistically significant for new classification system (P- 0.000) with respect to severity and prognosis of hearing loss which was not the case with the old system (P- 0.450).

Conclusions: We found that classifying temporal bone fractures into OCV and OCS correlates well with the severity of the hearing loss, the prognosis of the patient and the residual hearing disability when compared to the traditional system.
A clinical study of inhalant allergens in patients with allergic rhinitis
Authors: Choudhari Suhas Y. , Sangavi Aravind B.
Published: March 2017

Background: The basis of diagnosis of allergy requires a good history and examination, however, the diagnosis cannot be confirmed on the basis of symptoms alone, because both allergic and non-allergic conditions can present with similar symptoms. Hence, allergy testing in the form of specific IgE (sIgE) measurement is an important aid in demonstrating both the presence and severity of such an allergy. The present study was undertaken to find out the common environmental allergens prevailing in Raichur causing allergic rhinitis, using carbohydrate cross reactive determinants (CCD), an in vitro test with high degree of sensitivity.

Methods: The present prospective study was conducted among 30 patients with allergic rhinitis. A detailed general andENT examination were done, X-ray ofPNS, CT scan ofPNS, diagnostic nasal endoscopy and nasal smear examination for eosinophils, absolute eosinophil count and serum IgE levels using  Euroimmun system of in vitro assay of specific IgE antibodies.  

Results: Allergy to dust mite, D. faranie, corn, carnation flower, sunflower, sheep wool and straw dust were the most frequent allergens causing allergic symptoms among patients in Raichur area.  Total serum IgE was elevated in all the patients, 60% were allergic to dust mite as found by anti CCD specific IgE.

Conclusions: Antibodies to dust mite D. faranie, rye, T. mothy grass was the commonest finding. Identification of inhalant allergens is an important factor in prevention and treatment of allergic rhinitis. 
Parapharyngeal space schwannomas: our experience and review of literature
Authors: Singh Inderdeep , Gupta Vikas , Goyal Sunil , Kumar Manoj , Singh Anubhav
Published: March 2017

Background: Tumors of the parapharyngeal space are a rare group of head & neck tumors. Due to their indolent nature they present late with either cranial nerve palsy or lateral neck swelling. The aim of the study was i) to determine the incidence of parapharyngeal space schwannoma among defence personnel’s and their dependents presenting to ENT OPD and ii) to study the clinical presentation, management and outcomes of such lesion.

Methods: The study is a retrospective observational study. All new patients referred to ENT OPD at our center were included in the study. Data was collected from our OPD records over two years between Jan 2015 and Dec 2016.  

Results: It was found that the incidence rate of parapharyngeal space schwannoma was 0.034% out of all fresh cases reporting to ENT OPD and 0.47% out of all fresh diagnosed cases of head and neck tumours at our centre. Out of the total 5 cases of parapharyngeal space schwannomas, 2 patients had vagal schwannomas and one each had hypoglossal nerve schwannoma, spinal accessory nerve schwannoma and sympathetic chain schwannoma.

Conclusions: Schwannomas of the parapharyngeal region can be very extensive and may require to be removed in a staged procedure involving the head & neck and neurosurgeons.It is important to distinguish these tumors from other head and neck malignancies by detail clinical and radiological examinations. Despite the benign nature of the disease, the surgery can be morbid with cranial nerve palsies in extensive tumors. 
The efficacy of fat myringoplasty in small central perforation of pars tensa
Authors: Gangwani Rachana W , Ambani Kirti P. , Vakharia Sanket D , M. Bhavya B. , Katarkar Ashish U.
Published: March 2017

Background: In the present study, an attempt was made to study the effectiveness of fat graft material and the improvement in hearing following fat myringoplasty in small central perforations of pars tensa.

Methods: This prospective study was carried out in our tertiary centre between October 2014 to October 2015 in 38 patients selected randomly who attended our ENT OPD. Patients with tubotympanic type of chronic suppurative otitis media CSOM (TT), with dry small central perforation involving less than 25% of tympanic membrane (TM) were included. Patients with ossicular fixation or disruption with air bone gap (ABG) >40dB were excluded. All procedures were performed under local anesthesia (LA). Fat graft was harvested from ear lobule and was placed through endomeatal microscopic approach after freshening perforation margin. All patients were followed up to 5months postoperative period and graft status and audiological assessment was made.  

Results: In 86.8% cases (33 patients) graft was taken up while in 13.2% cases (5 patients) graft was not taken up. Mean pre-operative air conduction in right/left ear was 28.5±7.6/27.1±8.5 and post-operative was 24.9±5.3/23.4±6.9 dB respectively. Similarly, it was seen that mean pre-operative air bone gap in right/left ear was 17.6±7.2/17.0±7.4 and post-operative was 14.0±5.3/13.2±6 dB respectively.
Conclusions: It is a very safe, simpler procedure and in this we don’t disturb the annulus so the chance of lateralization or medialization of graft is nil. During fat myringoplasty the angle of tympanic membrane and anterior recess is maintained in natural position and we don’t disturb acoustics, so fat myringoplasty is an excellent option especially for small perforation.
Hidradenocarcinoma of scalp: a case report and review of literature
Authors: Gandla Sowjanya , Chatterjee Satakshi , Patil Ashuthosh , Rao Vishal
Published: March 2017

Hidradenocarcinoma of the scalp is a rare skin adnexal tumour accounting for less than 0.001% of all tumors. In this study, we describe a rare presentation of the hidradenocarcinoma of the scalp in a 64 years old man. Patient presented with a right side scalp lesion in the occipital area, for which biopsy was done which showed hidradenocarcinoma. Patient underwent wide local excision of the posterior scalp lesion and posterolateral neck dissection and the patient was advised to receive adjuvant chemotherapy and radiotherapy, but the patient refused to undergo adjuvant therapy. Six months postsurgery patient had local recurrence in the posterior margin resection area and lung metastasis, which could have been prevented by adjuvant therapy. Malignant hidradenocarcinoma is a rare aggressive malignant tumour. Patients with this tumour should undergo surgical excision followed by adjuvant therapy.
Bezold’s abscess: a rare complication of chronic suppurative otitis media in a 13 year old female child
Authors: G. Shankar , Kurle Geeta , Puneeth Puneeth
Published: March 2017

Suppurative otitis media is one of the most common ear diseases in developing countries. The advent of antibiotics has decreased the otogenic complications of this disease. Benzold’s abscess is one such rare complication of chronic suppurative otitis media. The study was done with the objective to report a case of a patient presenting with Bezold’s abscess as a complication of chronic suppurative otitis media. The case report included a 13 year old female presented with a complaint of foul smelling and scanty discharge in left ear for the past 2 years. She developed fever & a painful swelling in left side of neck extending from the tip of mastoid to the angle of mandible which was of 1 week duration. Clinical examinations and investigations revealed as left sided chronic suppurative otitis media (active squamosal type) with severe conductive hearing loss with a rare extracranial complication of Bezold’s abscess. Chronic suppurative otitis media can lead to a rare complication of Bezold’s abscess.
Facial palsy: a rare manifestation in Fanconi anaemia
Authors: Sangavi ArvindKumar B. , Banu Nasima , P. Shashikala
Published: March 2017

Fanconi anemia (FA) is an autosomal recessive genetic disorder characterized by progressive pancytopenia, multiple congenital anomalies, increased susceptibility to acute myelogenous leukemia and epithelial cancers especially in head and neck and GUT. The otologic manifestations in patients with Fanconi anemia is only about 10%. The present case report highlights the rare manifestation of Facial palsy/otologicand other associated anomalies in a 5 year old boy with Fanconi anemia.