bluuebunny/crossref_metadata_2025 huggingface dataset:
A cross sectional study to estimate prevalence of obesity and its risk factors in adolescent school children in Western Maharashtra, India
Authors: Shete Jagannath S. , Wagh Anjali V.
Published: August 2018

Background: There is an increase in prevalence of childhood obesity and its chronic health effects especially in developing countries like India in last 2-3 decades. This study is small effort to know prevalence and risk factors causing obesity. Aim of the study was to estimate prevalence of obesity and its risk factors in school students of age group 11 to 16 years.Methods: About 207 adolescent school children from selected school were enrolled in the study. Research tool comprised of questions about demographic characteristics, daily physical activity, frequency of having junk food intake etc. Height and weight were measured on calibrated scales. For statistical analysis MS Excel and SPSS 16 were used.Results: Among participants 58.9% were boys. 66.7% students were in the 13 to 14 years of age group. As per body mass index, 46.9% children were underweight and 8.7% were obese. 77.3% participants were eating junk food more than once in a week.Conclusions: Health education on dietary habits and physical activity is needed for adolescent children to prevent development of obesity and complications related to it.
A study of the association between hyperuricemia and knee osteoarthritis in the coastal Indian population
Authors: Jos Sujit , Anand Rajeev , Nazar Nawfal , Jose Renju
Published: August 2018

Background: Hyperuricemia and knee osteoarthritis are common problems that affect the aging population and they have an increasing prevalence with obesity and hypertension. Epidemiologic and immunological studies have shown a possible relation between the two conditions. Uric acid is a common factor found in association with the evaluation and treatment of osteoarthritis. There are serious therapeutic implications, particularly in using traditional gout medications, for use in osteoarthritis treatment is to be explored in detail. Our diet contains a good amount of purine containing food stuffs. The common items which increase our uric acid levels are red meat, all alcoholic beverages, seafood and shellfish. Previous studies have shown an association between serum uric acid and generalized osteoarthritis, but with the limited studies on the evidence of association between serum uric acid and knee joint osteoarthritis. This study aims to know the association between serum uric acid levels and osteoarthritis of knee joint.Methods: This is a Cross-sectional analytical study including eight hundred and thirty patients (461 males, 369 females) in a population screening during a patient education program on joint pains. Their serum uric acid level, total count, differential count, erythrocyte sedimentation rate (ESR), height, weight, blood pressure, BMI and standing radiographs of affected knees were obtained. The presence of radiographic osteoarthritis of the knee was analyzed using Kellgren-Lawrence system. The patients were divided into cohorts with hyperuricemia and osteoarthritis and compared with the subjects without either of the problems.Results: Isolated knee joint osteoarthritis is present in 183 subjects (22%), hyperuricemia was present in 154 subjects (18.55%). There is a significant positive association present between isolated knee joint osteoarthritis and the highest level of serum uric acid (adjusted odd’s ratio-2.24, 95% confidence interval-1.57-2.94). There is a significant positive association between high serum uric acid levels and progression of the knee joint osteoarthritis (highest level versus lowest level of serum uric acid odd’s ratio-1.38, 95% confidence interval-0.96-2.74).Conclusions: It is concluded that knee joint osteoarthritis and its progression are associated with hyperuricemia.
Effects of yoga in modifying blood pressure in patients of type 2 diabetes mellitus
Authors: Shrivastava Namita , Maheswari Basant Kumar , Rath Debapriya , Sarkar Debashree
Published: August 2018

Background: The incidence of diabetes mellitus is increasing with the increase in unhealthy dietary habits, physical inactivity and sedentary lifestyle. Hypertension complicated with diabetes further aggravates the problem. Yoga has been found to be helpful in delaying the progression and complications of the disease. The present study was undertaken with an aim to evaluate the effect of yoga in modifying blood pressure in patients of diabetes mellitus.Methods: Thirty patients of diabetes mellitus who were known case of hypertension were taken and their fasting and post-prandial blood glucose levels, systolic and diastolic blood pressure and waist circumference were analysed before and after ninety days of yoga in the department of physiology and biochemistry.Results: Systolic and diastolic blood pressure, waist circumference and fasting and post-prandial blood glucose level showed significant reduction (p value <0.05).Conclusions: This study emphasizes the importance of yoga in the control and management of type 2 diabetes mellitus and hypertension.
Serological and molecular approaches for leptospirosis at a tertiary care centre in northern India
Authors: Chaurasia Saurabh , Kalyan Raj Kumar , Gupta Prashant , Gupta Kamlesh K. , Kanta Chandra , Gupta Akanksha
Published: August 2018

Background: To determine prevalence rate of leptospirosis and recognition of common epidemiological situation and clinical manifestation of leptospirosis in patients with pyrexia of unknown origin at a tertiary care centre.Methods: This were a hospital based prospective observational study. The duration of study was from August 2015 to July 2016. Patients with clinical symptoms of pyrexia of unknown origin attending Gandhi Memorial and Associated Hospital, King George’s Medical University Lucknow during the study period were enrolled in this study. We performed the IgM ELISA and PCR for the leptospirosis at our centre and for the Micro Agglutination Test (MAT), we sent the serum samples to regional medical research centre Department of Health Research Ministry of Health and Family Welfare, Govt. of India Port Blair.Results: A Total of 104 symptomatic patients were recruited. Of total, IgM ELISA for leptospirosis were positive in 25 patients, PCR in 20 patients and MAT shows significant titres in 3 samples. The ROC curve analysis revealed significant diagnostic accuracy of IgM ELISA with 100.00% sensitivity and 78.22% specificity however showed less positive predictive value (12.0%) but high negative predictive value (100.0%). Most common presentation were fever, jaundice and rashes (40.4%) followed by fever and jaundice (29.8%).Conclusions: Leptospirosis IgM ELISA and PCR showed good detection accuracy. Age, sex, occupation is not significantly associated to the leptospirosis.
Study of prevalence of thyroid dysfunction in type 2 diabetes mellitus
Authors: Singh Raj K. , Mittal Mahim , Singh Amit , Kumar Ajay
Published: August 2018

Background: Type 2 diabetes mellitus (T2DM) is associated with increased incidence of thyroid dysfunction (TD). The coexistence of thyroid dysfunction in T2DM patient is an important barrier in achieving treatment goal. The study regarding prevalence of TD in T2DM has not been done in patients of Eastern Uttar Pradesh. The present study was aimed to know the prevalence of thyroid dysfunction in T2DM in patients of Eastern Uttar Pradesh.Methods: This is an observational cross sectional prevalence study of thyroid dysfunction in 250 diagnosed T2DM patients deleat diagnosed based on ADA criteria attending the department of medicine Baba Raghav Das Medical College, Gorakhpur, Uttar Pradesh, Study was India, done over a period of 1 year. Thyroid dysfunction was classified on the basis of ATA criteria. All subjects underwent a detailed history, clinical examination and relevant biochemical tests.Results: The prevalence of thyroid dysfunction in T2DM patients was found to be 20.4% in this study.Conclusions: The prevalence of thyroid dysfunction was found to be higher in type 2 diabetes mellitus patients in comparison to general population as mentioned in different literature.
Preliminary study of ratio of amylose and amylopectin as indicators of glycemic index and in vitro enzymatic hydrolysis of rice and wheat starches
Authors: Murugadass Gowri , Dipnaik Kavita
Published: August 2018

Background: Wheat and rice form the staple food of large majority of the population throughout the world. Starch is a carbohydrate which is a homopolymer consisting of a large number of D-glucose units joined by α- glycosidic bonds. Starch can be separated into two fractions-amylose and amylopectin. Amylose, Amylopectin ratio is an indicator of Glycemic Index. Starches with lower amylose content will have higher glycemic indexes. Invitro digestion of starch provides efficient means of analysing carbohydrate digestibility and hence glycemic properties of foods. Invitro digestion indicates how a given food item is likely to behave in vivo, in terms of rate and extent of sugar release from starch, by stimulating physiological processes occurring in the mouth, stomach and small intestine. The rate of starch hydrolysis which gives rise to sustained release of reducing sugars would be preferred by the diabetics.Methods: In our study, starches of wheat and rice were first isolated. Amylose and Amylopectin ratio was determined to predict the glycemic index of both. Wheat and rice having the same amylose and amylopectin ratio were selected for our study. These isolated starches were subjected to invitro enzymatic hydrolysis by salivary and pancreatic amylases. Reducing sugars released after hydrolysis and incubation of 0, 5, 10, 15, 20 and 30 minutes were estimated by Folin-Wu method. Statistical analysis was carried out in the form of unpaired student’s t-test to find significant difference between means of reducing sugars release by wheat and rice during enzymatic hydrolysis.Results: Having compared the starches of wheat and rice having the same amylose-amylopectin ratio, it was seen that the rice had low digestibility than the wheat starch. Rice starch releases less amount reducing sugars gradually while the wheat starch releases more reducing sugars rapidly in a short period of time. This can be due to amylopectin A which might be present in larger quantities in wheat starch than in rice starch which assists in rapid digestion of wheat starch.Conclusions: Our findings revealed that rice starch released less reducing sugars gradually over a period of time while wheat starch released more reducing sugars rapidly. So, rice is the best option for diabetics for consumption because of its comparatively low release of reducing sugars as compared to wheat.
Prevalence of metallo-beta-lactamases (MBLS) producing Pseudomonas aeruginosa in hospitalized patients in rural tertiary care hospital in Uttar Pradesh, India
Authors: Sinha Sarita , Singh Amit , Verma Rajesh Kumar , Singh Dharmendra Prasad , Kumari Sunita
Published: August 2018

Background: Pseudomonas aeruginosa is a leading cause of nosocomial infections due to MBLs production with limited therapeutic options, higher rate of colonization is encountered in hospitalized patient streated with broad spectrum antibiotics. This study was conducted with an aim to know the prevalence of Carbapenem resistant MBLs producing strains of Pseudomonas aeruginosa in hospitalized patients.Methods: A total of 14700 samples were obtained from various wards during Jan 2016 to June 2017, were screened for P. aeruginosa by conventional culture and biochemical tests. All confirmed P. aeruginosa isolates were further subjected to Modified Kirby- Bauer disc diffusion test as per CLSI guidelines. All IPM resistant isolates were screened for MBL production by DDST, CDST, MHT and E-test MBL.Results: Atotal of 1423were identified as P. aeruginosa. The isolation rate of P. aeruginosa at our hospital was 9.7%. Among these, 130(9.1%) isolates were IPM resistant. A total of 111 (85.4%) were MBL positive by CDST and E-test, 92 (70.5%) by DDST and 80 (61.5%) by MHT. The prevalence of MBL producing P. aeruginosa was 111/1423(7.8%) while among IPM resistant P. aeruginosa, its prevalence was 111/130 (85.4%).Conclusions: The study documents presence of nosocomial MBL producing P. aeruginosa strains in our Institute. E-test and CDST were superior to DDST and MHT for detection of MBLs.
A study on surgical management of undescended testis
Authors: M. Mallikarjuna , Dhotre Mahesh , S. Shanmukhappa
Published: August 2018

Background: Cryptorchidism which is synonymous with Undescended testes. It is one of the most common congenital anomalies found in children. The aim is to study the surgical management of undescended testis in relation to age, position, side, symptoms, complications and management of undescended testis. This study will present an overview of the current understanding of this challenging problem, mainly concentrating on surgical management.Methods: About 30 cases of undescended testis were included in the study, which were diagnosed with regards to age of presentation, clinical features, inclusion and exclusion criteria and relevant investigations like ultrasonography, diagnostic laparoscopy, CT whereever required. Cases were managed accordingly in the course of study and sampling of cases was taken from Bapuji Hospital and C.G. Hospital, Davangere during the study period.Results: Undescended testis was found more common on right side and most of them presented with the age group of 1-15 years with absence of testis in the scrotum being the most common complaint and hernia was found to be most commonly associated with undescended testis. Most common position of undescended testis was found to be intra-canalicular with most of them being palpable. The only one case had torsion and few of the cases had post operative complications like, wound infection haematoma. Open and laparoscopic orchidopexy can be used as most common procedure in early age group.Conclusions: Undescended testes is eminently treatable in today’s practice with the surgical procedures, an early diagnosis, informed counselling of parents and optimal surgical management offer optimised opportunities for successful placement and function of the testes which lessen the burden of complications.
Clinico-pathological spectrum of testicular and paratesticular lesions: a retrospective study
Authors: Charak Annu , Ahmed Irfan , Sahaf Bushra Rashid , Qadir Rehana , Rather A. R.
Published: August 2018

Background: Both neoplastic and non neoplastic conditions affect the testis. Although non neoplastic testicular lesions are more common, still most of the studies were done on testicular neoplasms only. Hence the present study was undertaken to study histopathological spectrum of testicular and paratesticular lesions, their age distribution and clinical presentation.Methods: This is a retrospective study of 77 cases of orchidectomy specimens, testicular biopsies and paratesticular lesions received in the department from Jan 2015 to June 2018.Results: Non neoplastic testicular lesions were more common than neoplastic (90.1% Vs 9.8%) with majority in the second and third decade. Undescended testis comprised 46.1% of the total orchidectomy specimens followed by Torsion/Infarction testis (15.3%). None of the undescended testis showed tumour unlike western countries. Majority of patients presented with empty scrotum (31.16%) and testicular/scrotal swelling (18.11%). Only 5 cases of testicular neoplasm were diagnosed during the study period amounting to only 1.42 cases per year. All were germ cell tumours (4 classic seminoma and 1 yolk sac tumour).Conclusions: Non neoplastic testicular lesions were more common than neoplastic lesions. Complete neonatal examination for testicular descent should be mandatory to avoid late presentations and future malignancies. Germ cell tumours formed the bulk of testicular tumours.
Clinical and angiographic profile in patients of western Rajasthan undergoing percutaneous coronary interventions: a single centre experience
Authors: Sanghvi Sanjeev , Kumar Aditya , Mathur Rohit , Baroopal Anil
Published: August 2018

Background: This study was aimed to evaluate clinical and angiographic profile of patients undergoing percutaneous coronary intervention at the Department of Cardiology, Mathura Das Mathur (MDM) Hospital attached to Dr. Sampurnanand Medical College, Jodhpur.Methods: This study was hospital based prospective observational study conducted in the department of cardiology at MDM hospital. This study included 1166 patients who underwent percutaneous coronary intervention at cardiac cathlab of MDM hospital from January 2016 to April 2017. Procedural details noted included vascular access route, lesion characteristics, number of lesions intervened, stents used and periprocedural pharmacotherapy administered.Results: A total of 1166 patients (mean age- 56.3±10.4 years) with 76.5% male and 23.5% female were included in the study. Smoking and hypertension were the most common risk factors, present in 64% and 56% patients respectively. Diabetes mellitus and obesity were observed in 24.5% , 18.0% patients respectively. Anterior wall MI was the most common mode of presentation (36.2%). Single Vessel Disease (SVD) was the most common angiographic pattern observed in 62% patients; left anterior descending artery (LAD) was the most frequently involved vessel (65.9%); and type B lesions were most prevalent (48%). Most of the procedures were elective (61.4%) and femoral route was used in the majority (76%). Radial access was obtained in 24% of patients. Primary PCI was done in 6% of cases while pharmaco-invasive approach was adopted in 32.6% of patients. Drug eluting stents were deployed in 100% of the cases. The overall procedural success rate was 95.4%. Procedural mortality was nil and periprocedural complications occurred in 16.0% patients.Conclusions: This first PCI study from western Rajasthan provides an overview into the salient features of CAD among regional population and focus on the characteristics of PCIs performed with their outcomes.
Assessment of role of genetic polymorphisms in XRCC1, XRCC2 and XRCC3 genes in cervical cancer susceptibility from a rural population: a hospital based case-control study from Maharashtra, India
Authors: Datkhile Kailas D. , Patil Madhavi N. , Durgawale Pratik P. , Joshi Shreepad A. , Korabu Kalpita S. , Kakade Satish V.
Published: August 2018

Background: Cervical cancer is a major concern of health risk, moreover the leading cause of cancer causing deaths in women of rural parts of India. This study was aimed to assess the risk of cervical cancer development in association with polymorphisms in X-Ray Cross Complementing Group (XRCC1, XRCC2 and XRCC3) genes in the rural population of south-western Maharashtra. We focused to determine the frequency of polymorphisms in DNA repair genes including XRCC1 at codon (cd) 194, cd 280, cd 399, XRCC2 at cd 188 and XRCC3 at cd 241 and their plausible role in cervical cancer risk from rural parts of India.Methods: This study included 350 proven cases with cervical cancer and 400 age and sex matched controls. We used polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) to analyze the association XRCC1, XRCC2 and XRCC3 gene polymorphisms with cervical cancer development in women of South-Western Maharashtra.Results: The result from our study showed that allele frequencies of selected genes were not statistically different between the groups for XRCC1 Trp194, XRCC2 His188 and XRCC3 Met241. XRCC1 His280 (OR= 4.36; 95% CI= (3.20-5.95); p= <0.0001) and XRCC1 Gln399 (OR= 2.99; 95% CI= (1.60-5.56); p= <0.0001) genotypes significantly increased the risk of cervical cancer.Conclusions: This study indicates that polymorphisms in cd 280 of exon 9 and cd 399 of exon 10 of XRCC1 gene could play a role in modifying genetic susceptibility of individuals towards cervical cancer among women from rural Maharashtra. This case-control study suggest that selected DNA repair genes represent genetic determinants in cervical carcinogenesis along with other risk factors in the rural Indian population.
Correlation of BMI and serum albumin with c-reactive protein in male patients with stable chronic obstructive pulmonary disease
Authors: Mandal Pranab , Sit Niranjan , Agarwala Abinash , Ghoshal Aloke Gopal , Bandyopadhyay Debasmita
Published: August 2018

Background: There is growing consensus that chronic obstructive pulmonary disease (COPD), a chronic inflammatory disease of the airways and lung parenchyma is associated with low grade systemic inflammation even in stable COPD, which increases during acute exacerbation. It is still debated whether the inflammation is a spill-over from the lung or the lung bears the share of systemic inflammation in COPD. There is systemic manifestation in COPD which is responsible for its severity in individual cases, but it is not clearly known whether the systemic inflammation give rise to systemic manifestations.Methods: In this background we measured serum C-reactive protein (CRP) level in 53 stable COPD patients and 32 age/sex matched control without known ischemic heart disease (IHD)/ diabetes mellitus (DM)/ peripheral arterial disease and normal chest X-ray and tried to find out any correlation of serum CRP level (marker of systemic inflammation) with BMI and serum albumin (marker of nutritional abnormality).Results: The study found that serum CRP level was significantly higher in stable COPD patient in comparison to healthy control. (6.226±3.9 vs 1.31±0.53).Though serum CRP level did not significantly increase with increasing severity of the disease, but serum CRP level was significantly increased in COPD patients with low BMI and low serum albumin (9.10±3.14 vs 4.01±2.90 p value <0.001 and 8.51±3.5 vs 3.59±2.5 with p value <0.001 respectively for BMI and serum albumin).Conclusions: So, the study concluded that stable COPD is associated with increased systemic inflammatory markers than normal control, correlates significantly with nutritional parameters in COPD like BMI and serum albumin level and may be an indicator of malnutrition regardless of lung function impairment.
Screening for retinopathy, risk factors, adherence to treatment and complications among diabetic and hypertensive individuals attending a primary care centre in Puducherry, India
Authors: Hansdak Amod , V. Saravanan , . Manikandan , . Navin , Bazroy Joy , . Velavan , Purty Anil J.
Published: August 2018

Background: The increasing prevalence and incidence of diabetes and hypertension with increasing age and adult age group are at high risk of developing diabetic and hypertensive retinopathies.Methods: The study was conducted in a rural area of Puducherry, data collection was carried over a period of six months. Self-reported patients of diabetes and hypertension were included in the study and predesigned questionnaire was used to collect the information about socio-demographic details, risk factors, physical activity, history related to DM/HTN and history of fundus examination.Results: Majority of patients screened for diabetes 56% and hypertension 47% was by government hospital. The proportion of diabetics and hypertensives who had undergone fundus examination to rule out diabetic and hypertensive retinopathy was found to be 29.3% (12) and 14.5% (10). Complications such as neuropathy and retinopathy were given by 36.5% (15) and 2.4% (1) of diabetic patients Two third of the patients 64.1% had sedentary life style.Conclusions: Health care providers need to plan for larger coverage of fundus examination among diabetic and hypertensive patients.
Association between serum magnesium and obesity in postmenopausal women
Authors: Yadav Alka , Gupta Madhuri , Gupta R. C.
Published: August 2018

Background: Obesity is a complex, multifactorial condition in which excess body weight may put a female at risk of serious health problems such as hypertension, dyslipidemia, diabetes mellitus and cardiovascular diseases. Magnesium deficiency is reported to be associated with obesity in children and adolescents. An inverse relationship has been reported between serum magnesium and estrogen levels in women. It is not known whether magnesium deficiency may have a role in genesis of obesity in women after menopause. Therefore, the present study was planned to compare serum magnesium levels in obese and non-obese postmenopausal women and to find out the relationship, if any, between serum magnesium levels and obesity.Methods: This cross-sectional study was conducted in the department of Biochemistry at National Institute of Medical Sciences and Research, Jaipur, Rajasthan on fifty subjects over a period of six months. Twenty-five obese postmenopausal women (BMI ≥ 30) having their final menstrual period at least one year prior to the study were taken as the study group and twenty-five non-obese (BMI ≤ 22.9) post-menopausal women were taken as control group. All subjects were asked to give detailed dietary history using Food Frequency Questionnaire (FFQ). Venous blood samples were collected after an overnight fast for estimation of serum total magnesium in all subjects.Results: Obese postmenopausal women had significantly higher weight (78.36±0.064kg) and BMI (32.68±1.7kg/mt2) compared to non-obese postmenopausal women (wt. 54.72±4.80kg and BMI 21.75±1.68kg/mt2). The mean±SD serum magnesium concentration found in the obese postmenopausal women was 1.40±0.45mg/dl as compared to 2.03±0.49 mg/dl in the non-obese group. Pearson’s correlation analysis showed a significant (r = -0.9) negative correlation between BMI and serum magnesium in postmenopausal women.Conclusions: Serum magnesium was lower in obese postmenopausal women as compared to that in non-obese postmenopausal women. Serum magnesium was negatively correlated with BMI. Magnesium supplementation may be useful in prevention of obesity after menopause.
Incidence of ventilator associated pneumonia and drug-resistant bacterial preponderance: a fact to ponder
Authors: Asir Johny G. , Jayasekaran Vidya , Shanmugam Vadivu , Elan Sujitha , Kanungo Reba
Published: August 2018

Background: Management of ventilator-associated pneumonia (VAP) in critically ill patients is a challenge to intensivists. This study aimed at identifying microbial factors and infection control practices that influenced incidence of VAP in a tertiary care hospital.Methods: Incidence of VAP among patients admitted to the intensive care units (ICU) from January to December 2016 was estimated. A one year period of study was divided into 3 segments of January to April, May to August, and September to December. Isolation rates of Gram Negative Bacteria (GNB) from respiratory samples and their extensively drug resistance (XDR) pattern were also analyzed.Results: A total of 14 patients had developed VAP. Incidence of VAP in the 1st, 2nd and 3rd segments of the year was 25.3, 15.2 and 4.1/1000 ventilator days respectively. Acinetobacter baumannii was the causative agent in all patients (100%). Among all GNB isolated the rate of Acinetobacter baumannii was 83%, 64%, 59% during the 3 segments of the year. XDR strains were 76%, 62% and 55%. Interventional factors like improvement in infection control practices which included hand hygiene, cohorting of MDR/XDR infected patients and environmental surveillance was noted.Conclusions: The VAP incidence declined in the later part of the year than the earlier (25.3 Vs 4.1/1000 ventilator days), with a notable decrease in the isolation of Acinetobacter baumannii (p value-0.005) and XDR organisms (p value-0.01). Directly proportionate association of VAP incidence with microbial factors were noted. Infection control measures to curtail MDR organisms should be an important component in the management of patients on ventilators.
Multicystic nephroma: a rare benign renal tumor with diagnostic predicament
Authors: Venkatesh Kusuma , Ravindra Savithri , Agarwal Ankita , Malhotra Ankit
Published: August 2018

Multi cystic Nephroma is a rare benign tumor of kidney occurring in adults which has clinical, radiological and morphological features causing diagnostic dilemma as it mimicks other cystic renal lesions. Distinguishing it from a cystic renal carcinoma is very important. Multicystic nephroma is usually unilateral, more common in females, presenting as a well capsulated mass lesion with multiple non communicating cysts lined by hobnailing epithelium. A similar lesion occurring in children represents a well differentiated nephroblastoma. The case presented here was a female patient complaining of pain in the left flank and had a mass lesion which was diagnosed as cystic renal cell carcinoma radiologically. The nephrectomy specimen showed a multilocular cystic mass well delineated from adjacent renal parenchyma. Histopathologically the cysts were lined by hobnail type of epithelium and separated by fibrocollagenous stroma. The stroma had hyalinised areas, chronic inflammatory cell infiltration and foci of mature adipose tissue. No atypia or mitoses were seen in the epithelium or stromal cells. Based on the histological criteria a diagnosis of multicystic nephroma was made. It is important to make a diagnosis of multicystic nephroma based on histomorpholgical criteria as it relieves the patient from the burden of a malignant lesion.
A rare case presentation of hydatid cyst in ilio-psoas muscle
Authors: Galani Kamlesh , Trivedi Bhargav , Vaghela Jaivik
Published: August 2018

We report a rare case of hydatid cyst in iliopsoas muscle in 35-year-old male patient. Where, patient presented with pain and swelling in right groin and fixed flexion deformity of right lower limb with constitutional symptoms. CECT abdomen revealed hydatis cyst with daughter cyst. We performed excision by retroperitoneal approach through lumber incision. Cyst was completely removed with daughter cysts.
Suprasellar epidermoid cyst: a rare cause of painless progressive bilateral vision loss-case report with clinico-radiological correlation
Authors: Chauhan Gaurav , Singh Vivek , Phadke R. V. , Yadav Sapna
Published: August 2018

Intracranial epidermoid cysts are relatively rare lesions. They result from inclusion of ectodermal elements during time of neural tube closure. This lesion could rarely be acquired due to post-surgical or post traumatic implantation of the ectodermal components. They typically present in middle age group patients with evidence of loco-regional mass effect on adjacent structures. We present a clinico-radiological case report of the 27-year-old female patient who presented with painless progressive bilateral vision loss for last 4 months.
Intestinal obstruction in cystic fibrosis: a surgeon’s perspective
Authors: Odofin Ayodeji
Published: August 2018

Background: Distal intestinal obstruction syndrome(DIOS) is one of the commonestgastrointestinal manifestation of Cystic Fibrosis. It occurs as a result ofimpaction of mucofeculent material in the ileocaecum and ascending colon. Themedical management is effective in the chronic presentation, but the optimummanagement in the acute presentation is still a grey area.The aim of this study is to retrospectively follow up patients presenting withfeatures of DIOS who had surgical resection of the ileocaecum to assess thelong-term outcome in terms of recurrence of symptoms.Methods: Case notes of eight patients presenting with features of acute DIOS between 2000 and 2006 were retrieved from the Cystic fibrosis unit of a tertiary teaching hospital and analysed.Results: Eight patients were included in this study, male: female ratio of 5:3age range: 18-24. Acute presentation: 6, elective presentation:2. The mainpresenting features were abdominal pain, constipation, vomiting and RIF mass.Six patients had ileocaecectomy; one had a small bowel resection and one anextended right hemicolectomy.Six patients had no further symptoms of DIOS four years post-surgery, two hadfurther symptoms with one requiring further surgery.Conclusions: Ileocaecal resection in patients presenting with acute DIOS is aviable and effective option in management.
Risk factors for loco-regional recurrence after breast conserving surgery: impact of young age and surgical margin status in breast cancer patients
Authors: Vasigh Mahtab , Rahmani Soodeh , Omranipour Ramesh , Haghighat Shahpar , Olfatbakhsh Ensiie , Kenari Adel Yazdankha
Published: August 2018

Background: Breast cancer is a common malignant tumor and treatment predominantly consists of surgery.  Modern society has increased the demands of women to have higher requirements for breast appearance and quality of life. Therefore, exploring effective measures to control or reduce the rate of loco-regional recurrence (LRR) after breast conserving surgery (BCS) is the main focus of this study.Methods: This cohort included 743 consecutive patients with invasive breast cancer, treated with BCS in 2 centers in Tehran, Iran between 2005 and 2010. The primary endpoint was the rate of loco-regional recurrence in a 5-year follow- up period. Authors also investigated the factors that could predict LRR after BCS.Results: The prevalence of LRR after BCS was 7.6% in a median follow-up of 56.9 months. The Median time to local recurrence was 20.45 months.  A correlation between follow-up outcome and age; histologic sub-type; surgical margin; number of positive nodes; complete pathologic response to neo-adjuvant chemotherapy; chemotherapy and hormone therapy was recognized. Surgical margin status, hormone therapy, histologic sub-type, age and Ki67 were shown to be significant risk factors for LRR in univariate analysis whereas surgical margin status emerged as an independent risk factor in multivariate analysis.Conclusions: Increased LRR was observed among those with higher ki67, aged under35, not receiving hormone therapy and with a surgical margin less than 2mm. These factors appeared to be risk factors for LRR after BCS, while, histologic grade, axillary nodal status, tumor size and biologic sub-type did not predict LRR after BCS.
Surgery after neoadjuvant chemotherapy for muscle invasive bladder cancer: clinicopathological and surgical outcomes
Authors: Denewer Adel , Atallah Khalid , Wahab Khaled Abdel , Hamed Emad , Refky Basel , Abouzid Amr , Emarah Ziad , Zaky Mona , Elashry Mohamed Saad , Mohamed Mie , Aziz Mahmoud Abdel , Elmetwally Mohamed , Roshdy Sameh
Published: August 2018

Background: Neoadjuvant chemotherapy (NAC) before radical cystectomy (RC) is the standard of care for muscle-invasive bladder cancer (MIBC) owing to the survival advantage, which has correlated with down-staging of the cancer to pT0. This approach is underused because it may be associated with increased perioperative morbidity and mortality rates. This study was designed to evaluate NAC plus RC regarding pathological response, perioperative morbidity and mortality outcomes. Methods: This is a prospective study that was carried out from August 2015 till July 2017 for patients with bladder carcinoma. We enrolled all cases with ≥ T2 bladder receiving NAC. Patients with metastatic disease, poor performance were excluded from this study.Results: pathological response rate and Complications occurred within 30 and 90 d after surgery. Heterologous blood transfusions, length of stay, readmission, and perioperative morbidity, and mortality were compared.Conclusions: Our results suggest that non-urothelial tumor showed no response to Platinum based combination chemotherapeutic regimens. NAC followed by RC gives no more perioperative complications.
Role of feeding jejunostomy in patients undergoing pancreatoduodenectomy: a single center experience
Authors: Giriyappa Venugopal Hunasanahalli , Casaba Shilpa Mariappa , Nanjegowda Vinay Boppasamudra
Published: August 2018

Background: Concomitant placement of Feeding Jejunostomy (FJ) tubes is common after pancreaticoduodenectomy for optimizing postoperative nutrition. The aim of this study is to determine the role FJ tube placement for postoperative nutrition following pancreaticoduodenectomy.Methods: All patients undergoing concomitant FJ following pancreaticoduodenectomy (Whipples procedure) from July 2014 to July 2016 were reviewed retrospectively. FJ feeds were routinely started on POD 2. Jejunostomy feeds were discontinued once patient is able to take adequate oral feeds. Data were represented by frequency and mean.Results: A total of 28 patients underwent pancreaticoduodenectomy in the study period and concomitant FJ was performed in all those patients. A total of 18 (64.3%) were men and mean age was 47.1 years. Majority (25, 89.3%) of these patients had malignancy as an indication for surgery. Only 6 out of 28 (21.4%) patients required nutrition supplementation through FJ on POD 7. Only 2 out of 28 (7.1%) patients required FJ feeds on POD 30. None of these patients had tube related complications in 30-day postoperative period. There was no FJ related mortality in 30-day postoperative period. The patients who required prolonged FJ feeds had grade C pancreatic leak, gastrojejunal anastamotic leak and GJ anastamotic stricture.Conclusions: Concomitant FJ can be used as a routine in patients undergoing pancreaticoduodenectomy. It is especially beneficial among patients requiring prolonged postoperative nutritional supplementation due to grade c pancreatic leak and gastrojejunal anastamotic leak. Literature review suggested that one third of the nasojejunostomy tubes dislodge and TPN doubles the risk of infection, hence FJ is considered safe and effective adjunct for patients undergoing pancreaticoduodenectomy.
A retrospective comparative study between laparoscopic and open appendectomy in teaching hospital of India
Authors: Singh Lal Mani , Wadiwa Yogendra Singh
Published: August 2018

Background: This study was aimed to compare laparoscopic with open appendicectomy and ascertain the therapeutic benefit, in the overall management of appendicitis. Laparoscopic appendicectomy though widely practiced has not gained universal approval. Laparoscopic appendicectomy in India is relatively new and the literature is exiguous.Methods: The study group consisted of 100 patients suffering from appendicitis. 40 patients underwent laparoscopic appendicectomy (LA) and 60 patients underwent open appendecectomy (OA). Comparison was based on length of hospital stay, operating time, postoperative morbidity, postoperative complications, duration of convalescence and operative cost in terms of their medians.Results: The rate of infections and overall complications (LA: 5%, OA: 11.66% were significantly lower in patients undergoing LA. The median length of stay was significantly shorter after LA (45% discharged 2nd day) than after OA (36% discharged on 4th day). VAS WAS 0-2 IN 60% cases LA and9-10 in 00% cases as compared to OA VAS Was 0-2 in15% and 9-10 in 3.33% cases.Conclusions: LA is associated with increased clinical comfort in terms of fewer wound infections, faster recovery, earlier return to work and improved cosmesis. Hospital stay for LA is significantly shorter and the one-time operative charges appear to be almost the same.
Indications and outcome of patients undergoing cutaneous ureterostomy as a mode of urinary diversion after radical cystectomy: an experience from a tertiary care center
Authors: Agarwal Shikhar , Sarpal Rajeev , Dang Shivam , Kalra Yogesh , Biswas Manoj
Published: August 2018

Background: Radical cystectomy is associated with high morbidity, especially in elderly patients. Most of the associated complications are related to the urinary diversion. Cutaneous ureterostomy (CU) is usually an uncommon form of urinary diversion and is avoided because of the frequent complication of stomal stenosis.Methods: In this study the authors retrospectively analyzed 84 patients who underwent radical cystectomy. 17 Patients who underwent single stoma CU were included in the study who required lifelong monthly stent changes. Varied indication and outcome of these patients were analyzed.Results: Patients in which CU was used as a mode of urinary diversion had less blood loss, less operative time and discharged without ICU stay.Conclusions:  It seems that single stoma CU is a viable option in elderly, high risk patients and in post radiotherapy patients who require radical cystectomy. Although the patient requires lifelong stent changes, postoperative complications are reduced.
A primary splenic epithelial cyst: rare case report
Authors: Chandak Unmed , Mitra Arti , Kamble Archana
Published: August 2018

Splenic cysts are rare, most of them being hydatid cysts. Our case is about a primary (true) splenic epithelial cyst. A 21-year-old female patient presented to casualty with pain in the upper left abdomen. On being investigated with by sonography she was found to have a solitary cystic lesion in the spleen. Her contrast enhanced computed tomography of the abdomen and pelvis revealed a 10.9 × 11.4 × 12.0 cm cystic lesion of the spleen, probably a hydatid or primary splenic epithelial cyst. Due to the large size of the cyst, an open surgical approach was planned. On exploratory laparotomy via a left subcostal incision, a solitary cyst involving >75% of the splenic parenchyma was discovered. Total splenectomy was done as splenic parenchyma could not be functionally salvaged. Histopathological investigation showed a primary epithelial splenic cyst. The patient recovered uneventfully.
Early versus late dressing removal in clean and contaminated midline laparotomy wounds: a non-randomized pilot study
Authors: C. Vijayakumar , R. Prabhu , V. Muthukrishnan , R. Kalaiarasi , T. Swetha
Published: August 2018

Background: This study was carried out to evaluate the efficacy of early versus late dressing removal in clean and contaminated midline laparotomy wounds.Methods: Fifty patients aged ≥18 years who were admitted and operated for surgical procedures (both emergency and elective) were included in the study. All laparotomy wounds had fulfilled the CDC criteria.  Twenty-five patients each were included in early dressing removal group and the late removal group. In early removal group, the laparotomy wound dressing was removed within 48 hours and in late removal group, was removed after 48 hours of surgery. The incidences of superficial and deep surgical site infection (SSI) in both groups were analysed. Other secondary parameters like incidence of wound dehiscence and secondary suturing were also analysed.Results: Twenty-five patients each, in early removal group and in late removal group were included for final analysis. The incidence of superficial SSI (%) was significantly less in early removal group (65.50 versus 89.50; p= <0.001). The duration (days) required for complete wound healing (8.52 versus 10.65; p=0.734) was significantly less in the early removal group. The length of postoperative hospital stay (days) was significantly less in early removal group (10.30 versus 14.90; p= <0.001).Conclusions: Early removal of dressing significantly reduces the incidence of superficial SSI in midline clean and contaminated laparotomy wounds. It also significantly reduces the duration required for complete wound healing and facilitates early discharge of the patient compared to late dressing removal.
Study of post-operative pulmonary complications in patients of emergency abdominal surgeries
Authors: Verma Siddhartha , Bhardwaj Ankur , Patil Sagar Manohar
Published: August 2018

Background: Post-operative Pulmonary Complications (PPCs) form a significant chunk of post-operative morbidity. Their incidence varies from 2.7-23% in multiple studies. Pre-disposing factors can be divided as: pt. related: >60yrs, ASA class≥2 and COPD; procedure related: long surgeries (≥3hrs), emergency surgeries. Till now, most of the studies have focused on elective surgeries. In this study, I have studied morbidity and risk factors of PPCs in emergency abdominal surgeries.Methods: It is a retrospective case control study, carried out in 50 patients in M.B. Government Hospital, Udaipur over 1 year. Cases comprised of those patients who underwent emergency laparotomy and developed PPCs. Controls were selected from group who didn’t develop PPC.Results: Incidence of PPCs in emergency abdominal surgeries was found to be 2.9%. Elderly patients had more chances of developing PPCs. Smoking was found to be twice as common in case group. Those who quit smoking ≥1 year before surgery benefitted the most. Pre-OP chest x-ray abnormalities were 3 times more common in case group. Upper abdomen surgeries were 20% more common in Case group. Surgeries lasting for ≥ 3 hours had increased chances of PPCs. Total hospital stay was 21.7 days in cases (12.5 in control), total ICU stay was 8.5 days (1.4). 28% of the PPCs patients could not be saved.Conclusions: Pre-operative chest examination, cheat x-ray and regular SpO2 monitoring helps in diagnosing PPCs earlier. Early mobilization and deep breathing exercises should be encouraged.
A clinical study of etiology and management of acute intestinal obstruction
Authors: C.R Shivakumar , Shoeb Mohammad Fazelul Rahman , Reddy Anil P. , Patil Sharangouda
Published: August 2018

Background: Acute intestinal obstruction is one of common abdominal emergency and is associated with significant morbidity and mortality. Early diagnosis of obstruction, skilful operative management, proper technique during surgery and intensive postoperative treatment carries better results. The aim of this study was to identify the etiology, clinical presentation, management and outcomes of patients with acute intestinal obstruction presenting in GIMS, Gulbarga.Methods: This is a prospective study carried out in the department of general surgery A unit at Gulbarga Institute of Medical Sciences, Gulbarga, from May 2014 to January 2018.  50 patients with acute intestinal obstruction coming to the OPD and emergency department were included in study and data was analysed.Results: A total of 50 patients, presented with acute intestinal obstruction during the period of the study. Mean patient age was 46.5 years with peak incidence in 50-59 years. Small intestinal obstruction was seen more commonly than large intestinal obstruction. Most common etiology of intestinal obstruction was due to adhesion and bands (40%).Conclusions: Present study concluded that Intestinal obstruction is seen more commonly in middle age group. Males were affected twice as common as females. Abdominal pain was the most common symptom, while tenderness was the most common sign. Post-operative adhesion caused most cases of   small bowel obstruction while large bowel obstruction was caused most commonly by malignancy. Earlier the presentation better will be the outcome.
Correlation of epidermal growth factor receptor score with prognostic variables in transitional cell carcinoma of urinary bladder among north-eastern Indian population
Authors: Barua Sasanka Kumar , Das Nabajeet , Baruah Saumar Jyoti , P. Rajeev T. , Bagchi Puskal Kumar , Sarma Debanga , Phukan Mandeep
Published: August 2018

Background: Epidermal growth factor receptor (EGFR) has demonstrated over expression in bladder tumours and correlation with stage and grade of tumours. The aim of present study was to find the relation between score of the EGFR in Transitional Cell Carcinoma (TCC) of bladder and its various prognostic variables.Methods: This is a retrospective study conducted in Dept of Urology, Gauhati Medical College Hospital between Dec 2016 and July 2017. Forty cases of TCC bladder that were operated either by TURBT or radical cystectomy have been taken. However, patients with CKD, pre-existing systemic disease and UTI were excluded from the study. Presence of EGFR and its score were analysed. The rating was done as 0 (non-immunoreactive), 1+ (weak), 2+ (moderate) and 3+ (strong). The correlation between EGFR score and the various factors like age, sex, stage, size of tumour, presence of CIS, tumour grade, muscle invasion, number of tumours and type of stalk were evaluated statistically using chi square tests.Results: Average age is 59.825 years and male to female ratio is 5.6:1. EGFR score is not significantly related with age, sex, stage of disease, muscle invasiveness or number of tumours whereas size of tumour, presence of CIS changes, grade of TCC and type of tumour stalk bears statistically significant relation with EGFR score.Conclusions: Studies have shown EGFR positivity to be associated with high tumour stage, tumour progression, and poor clinical outcome. Authors have found size >3cm, CIS changes, high grade tumours and broad-based stalks to be significantly associated with higher EGFR scores among patients with TCC of bladder.