bluuebunny/crossref_metadata_2025 huggingface dataset:
EVALUATION OF PERFORMANCE OF TRAINEE AT 4 DAYS MOODLE BASED INTERNAL AUDITOR TRAINING AS PER ISO 15189:2012 AND NABL-112
Authors: Tailor Dr Piyush , Savaliya Dr. Niral , Patel Dr Chinka
Published: March 2020

Background: For medical testing laboratories accreditation, laboratory has follow ISO: 15189:2012 and NABL-112. For this,quality manager of the laboratory must have to go under 4 days internal auditor training as per ISO 15189:2012 and NABL-112. Moodle is Learning Management System (LMS) which helps in systemic evaluation of trainee during internal auditor training.

Objectives: The study was done to measure performance of trainee after completion of internal auditor training by comparing for each sub-clause of ISO 15189:2012 as well as for various categories of trainee.

Materials and Methods: Online Moodle based - internal auditor training as per ISO 15189:2012 and NABL-112 was arranged in GMC, Surat, Gujarat for 4 days, with total 28 trainee. MCQ test was taken on-line with Moodle. Relationship of score with ISO 15189:2012 clauses and trainee category were analysed.

Results: Participant’s average score in general, management and technical clause were 67% ,73.4% and 77.9% respectively. Teaching staff, Residents and Technicians scored 76.3 %, 77% and 70% respectively.

Conclusion: Training emphasis and effectiveness in ISO 15189:2012 management clause was comparable with technical clauses. Moreover, the study found that, Training was effective across all categories of trainee.

Keywords: ISO 15189:2012, NABL, Moodle
OCULAR MANIFESTATIONS IN SYSTEMIC LUPUS ERYTHAMATUSUS PATIENTS: A HOSPITAL BASED OBSERVATIONAL STUDY.
Authors: Kant Dev , Kumari Jyoti
Published: March 2020

Objectives: This study was to evaluate the incidence and ocular manifestation in systemic lupus erythematosus (SLE) patients.

Methods: A total of 50 cases with age group 15 to 50 years were enrolled. A detail history, clinical examinations and relevant investigations were performed to all cases. Patients who were diagnosed with systemic lupus erythamatusus (SLE) by using American Rheumatologic criteria with or without ocular features were included in this study.

Results: Data was analysed by using simple statistical methods with the help of MS-office software. All data was tabulated and percentage was calculated.

Conclusions: Females were commonly suffered with systemic lupus erythamatusus (SLE) and it was commonly seen in age 15-25 years. Episcleritis was the most common symptoms in SLE. Second most common symptoms were conjunctivitis and scleritis. Right eye was more affected than left eye. Most of the cases had ANA positive. Hence, ocular manifestation is the most common in SLE patients. Early diagnosis and prompt treatment may give light of hope for SLE patients. And more research is needed in order to determine which therapy will provide the best prevention and management in SLE patients.

Key words: Systemic lupus erythamatusus (SLE), ocular manifestation, age group, ANA-positive.
“PREVALENCE OF ISOLATED HYPERTENSION AMONG ELDERLY PATIENTS ATTENDING PERIPHERAL HEALTH CENTRE OF TERTIARY CARE HOSPITAL OF INDIA.”
Authors: Sharma Munish Kumar , Gour Neeraj , Choudhary Sanjay , Goel N K , Sharma Deepak , Chaudhary Meenakshi
Published: March 2020

Background: In this modern era, chronic non communicable diseases (NCDs) are a major global health challenge with numerous grave complications on the human body. Old age population tends to carry risk of almost all kind of diseases including non communicable diseases. Hypertension is one of biggest well known risk factor for many of non-communicable diseases usually found in the outdoor patients.

Method:  This cross sectional study was undertaken to provide the data on the Prevalence & Pattern of hypertension amongst patients who were aged 60 years & above and who attended the Out Patients Department of the Rural Health & Training Centre of tertiary care hospital of Chandigarh city of India.

Results: Majority of patients belonging to age group 60-69 years were found to be diastolic hypertensive (24.46%). Majority of male patients were found to be diastolic hypertensive (28.43%) (P< 0.05). More of less same trend was found among female patients.

Conclusion: Hypertension was found to be highly prevalent among the outdoor elderly patients of Rural Health & Training Centre of Chandigarh, India. This study warrants the need of an early detection of hypertension, which can be accomplished by a periodic screening of the people.

Keywords: Hypertension; Elderly; India.
EFFECT OF SLOW BREATHING EXERCISE PRACTICE ON ANTHROPOMETRIC PARAMETERS IN HEALTHY VOLUNTEERS
Authors: Tripathi Sonali , Tripathi Apoorva
Published: March 2020

Introduction: Regular practice of slow breathing technique shows improvement in the cardio respiratory functions.  it is well known to decrease the effect of stress which, in turn, improves the physical and mental health of an individual.

Objectives: To assess the effect of slow breathing exercise practice on anthropometric parameters in healthy volunteers.

Materials and Methods: A total of 60 young, healthy volunteers of both genders participated in this study. The subjects were allocated to the study group (n = 30) and control group (n = 30) based on simple random technique. Slow breathing exercise training was given to the study group for 20 minutes daily in two sessions for 12 weeks. Heights, weight, body mass index (BMI), were recorded at the start of the study and after 12 weeks in both the groups. Comparison between the study group and control group was done by Student’s unpaired t-test. P < 0.05 was considered as statistically significant.

Results: The average age of the study group and control group participants was 19.7 ± 1.7 years and 19.4 ± 1.9 years, respectively. BMI was significantly decreased in the study group from 21.72 ± 4.12 to 19.56 ± 3.92 (P < 0.05). There was a trend toward decrease in the waist–hip ratio from 0.78 ± 0.62 to 0.74 ± 0.58 (P > 0.05) which was not statistically significant.

Conclusion: Slow breathing exercise training improve the anthropometric parameters in the study group. This indicates that regular, long-term slow breathing exercise training helps in weight reduction among the obese population.

Keywords: Obesity, Anthropometry, Slow Breathing Exercises, body mass index, stress.
TO COMPARE EARLY ENTERAL FEED WITH EARLY PARENTERAL FEED IN PATIENTS OF ACUTE PANCREATITIS; A PROSPECTIVE RANDOMISED OBSERVATIONAL STUDY.
Authors: Tiwari Devesh Kumar , Somani Rajan B.
Published: March 2020

Acute pancreatitis has been recognised since antiquity but the importance of pancreas and the severity of its inflammatory disorders were realized only in the middle of the 19th century. In accordance with this wide variation in clinical presentation, the treatment of acute pancreatitis requires a multidisciplinary approach. But even today with technical advances in medical and surgical fields acute pancreatitis remains a major cause of morbidity and mortality. Increasing evidence suggests that enteral feeding maintains the intestinal barrier function and prevents or reduces bacterial translocation from the gut. Our aim is to compare the effects of early enteral feeding with early parenteral feeding in acute pancreatitis in terms of occurrence of infective & non infective complications in both types of feeding groups and to assess the average duration of hospital stay and cost in both groups. This prospective randomized clinical study was carried out on patients of 50 diagnosed cases of acute pancreatitis admitted in Sir T Hospital from October 2017 to August 2019. Patients included in study were randomly divided into two group A (Enteral feeding) and group B (Parenteral feeding). After initiation of respective nutrition patients were observed for infective and non infective complication incidence, duration of hospital stay and other morbidities. Enteral feeding decrease the incidence of infective and non pancreatic complications, decreases duration of hospital stay. Patients tolerating soft diet earlier in early enteral feeding group compared to early parenteral feeding group. Cost of treatment is also less in enteral feeding. So in acute pancreatitis early enteral feeding is superior to early parenteral feeding.

Keywords: Acute pancreatitis ,  Enteral , Parenteral, Feeding.
SOCIO-DEMOGRAPHIC AND CLINICAL PROFILE OF PEDIATRIC OCULAR TRAUMA: A HOSPITAL BASED PROSPECTIVE STUDY.
Authors: Kant Dev , Kumari Jyoti , Singh R. K.
Published: March 2020

Objectives: This present study was to evaluate the clinical and socio-demographical study in cases of paediatrics ocular injuries.

Methods: A detail assessment and relevant investigations were performed to all paediatrics OCT. And globe injuries were recorded according to the BETT. Occular injury was examined by using equipment model OCT 2000 by TOPCON at IGIMS, Patna. Treatment was given depending on type and severity of injuries. Patients were followed up on day 1, day 7, 1 month, and at 6 months. Initial best corrected visual acuity was evaluated on first day of follow up. And final best corrected visual acuity (BCVA) was evaluated on last day of follow up after 6 months.

Results: Data was analysed by using simple statistical methods with the help of MS-office software. All data was tabulated and percentage was calculated.

Conclusions: Age group 0-10 years and males were more prone to ocular trauma. Stick, stone RTA and fall were more causative risk for OCT.  School, home, Road traffic accident were the common places for ocular trauma. Open globe injury and close globe injury were commonly seen in ocular trauma cases. Close globe injury patients were shows the better BCVA with respect to OGI, lids and lacrimal apparatus injury and non-mechanical injury. Hence, we should aware the parents and family members about the common modes of trauma, the need of supervision of the objects of play. Self-protection should be taught to children to prevent possible ocular injuries. Houses, playgrounds and schools must be made safe and common items of trauma such as sharp objects, household lime, acids must be kept out of reach of children. Intensive campaign may be done before festival seasons about safety measures to increase public awareness. Ocular trauma is a frequent reason for emergency room visits. Evaluation of eye injuries should start with visual acuity and continue with prompt referral to an ophthalmologist as indicated.

Key words: Ocular trauma, clinical profile, open globe injury, close globe injury, BCVA
HOMOCYSTEINE LOWERING EFFECT OF DONEPEZIL AND VITAMIN B12 SUPPLEMENT IN ALZHEIMER’S DISEASE
Authors: Yeram Neelam , Dalvi Shubhangi , Patil Vinayak , Kale Vinayak , Jagiasi Kamlesh , Abichandani Leela
Published: March 2020

Background: Association of homocysteine (Hcy) metabolism with cognitive dysfunction in AD pathogenesis has been revealed by many studies. The aim of this study was to investigate serum levels of vitamin B12 (VB12) and Hcy with response to donepezil and VB12 supplement therapy in AD treatment.

Methods: Study comprised of 71 AD patients and 70 healthy controls above 60 years of age.  Blood serum samples were analyzed for VB12 and Hcy levels by the chemiluminescence method. AD patients were treated with donepezil (5mg/day) and nutritional supplement containing VB12 (1.5mg/day) and was observed at intervals of 3 and 6 months. Statistical evaluation was done by using IMB SPSS statistics version 25.

Results: The serum levels of Hcy were significantly higher and VB12 were significantly low in AD patients as compared to baseline. The therapy did not show any improvement at 3 months interval but after 6 months the serum levels of VB12 increased and Hcy decreased as compared to 3 months. Hcy and VB12 show a negative correlation with each other in AD groups. (p < 0.01)

Conclusion: We conclude that the combination of donepezil and VB12 not only render symptomatic reliefs in AD patients, but also helps to revive from the metabolic consequences caused due to HHcy. It lowers the serum Hcy levels in AD, thereby reducing the progressive neurodegeneration and further vascular complications of AD. Research on efficacy of this combination therapy for a longer duration will help in better understanding of the disease pathogenesis and thus develop novel therapeutic target drugs.
PREPARATION, CHARACTERIZATION AND EVALUATION OF CELECOXIB LOADED NANOSPONGES FOR THE TREATMENT OF PSORIATIC ARTHRITIS
Authors: Ravi G. , Bose P. Subhash Chandra , Ravi Valluru , Sarita Damineni
Published: March 2020

Psoriatic arthritis is a chronic inflammatory joint disease which is one of the types of psoriasis. 25% of all psoriasis patients develop psoriatic arthritis. It is characterised with innate and adaptive immune responses. The main objective of the present work was to prepare characterization and evaluate the Celecoxib nanosponges for the treatment of Psoriatic Arthritis. It is a non-steroidal anti-inflammatory drug (NSAID) having low solubility and low bioavailability. In order to increase the solubility, this drug was incorporate in nanosponges by melting technique. The prepared formulation was evaluated for different parameters. SEM images confirm that the prepared formulation was spherical and porous in nature. Particle size analysis shows that as the cross-linker ratio increases, there is increase in the particle size of nanosponges. Particle size was in the size range of 201.69 nm. The in vitro studies were carried out for prepared nanosponges which showed drug release of 89.69% in 24 h.

Keywords: Nanosponges, Psoriatic arthritis, NSAID, Drug release
DYSLIPIDEMIA IN HYPOTHYROIDISM PATIENTS: A HOSPITAL BASED CASE AND CONTROL STUDY.
Authors: Jha Jyoti , Kant Nishi
Published: March 2020

Objectives: This present study was to evaluate the incidence and abnormalities in lipid profile in patients with hypothyroidism.

Methods: A detail history, clinical examinations and relevant investigations were performed to all subjects. Serum free T3 (fT3) and T4 (fT4) were measured by competitive enzyme-linked immunosorbent assay (ELISA) method. Serum TSH was measured by sand-witch ELISA method. Serum cholesterol was measured by cholesterol oxidase-peroxidase (CHODPAP) method. Serum triglyceride was measured by glycerol-3-phosphate oxidase (GPO) method. Serum VLDL (in mg/dl) was calculated by dividing the value of TG by 5. Serum LDL value was calculated by Fried-Wald equation. And serum HDL level was calculated by precipitation method.

Results: Data was analysed by using software SPSS 15.0. Independent t-test was applied. Mean and standard deviations were observed. P-value was taken equal to or less than 0.05 for significant differences (p≤0.05).

Conclusions: Hypothyroidism was commonly seen in elderly age group subjects. Females were more preponderance than males. Hypercholesterolemia, hyper triglyceridemia and increased LDL-cholestrol & VLDL-Cholestrol were extremely significant associated with hypothyroidism. Hence, hypothyroidism has an importantly associated with abnormal lipid profile. Therefore, biochemical screening for thyroid dysfunction should be perform in all dyslipidemic patients. Early diagnosis should be made for proper treatment of dyslipidemia in hypothyroidism patients.

Keywords: hypothyroidism, dyslipidemia, age, sex.
OSTEOMETRIC AND COMPARATIVE ANALYSIS OF SEXUAL DIMORPHISM IN THE FEMUR AMONG POPULATION OF DATIA REGION.
Authors: Jain Ruchi , Srivastava Amit
Published: March 2020

Background: Sexual identification from the skeletal parts has medico legal and anthropological importance. The femur the longest and strongest bone in the skeleton.

Objectives: to obtain values of maximum femoral length and to evaluate its possible usefulness in determining correct sexual identification.

Material and Methods: Study sample consisted of 190 dry, normal, adult, human femora (140 male & 50 female) from skeletal collections of Anatomy department, Government Medical College, Datia. Maximum length of femur was considered as maximum vertical distance between upper end of head of femur and the lowest point on femoral condyle, measured with the osteometric board.

Results: Mean Values obtained were, 450.81 and 416.48 for right male and female, and 443.35 and 419.44 for left male and female respectively. Higher value in male was statistically highly significant (P< 0.001) on both sides. Demarking point (D.P.) analysis of the data showed that right femora with maximum length more than 474.70 were male and less than 377.99 were female; while for left bones, femora with maximum length more than 484.49 were male and less than 385.73 were definitely female.

Conclusion: Maximum length identified 13.43% of right male femora, 4.35% of right female femora, 7.25% of left male femora and 8% of left female femora

Keywords: Maximum length, Sexual dimorphism, Femur, osteometry, femoral length.
CADAVERIC ANATOMY AND RELATIONSHIP OF PHRENIC NERVE AND SUBCLAVIAN VEIN
Authors: Madaan Dr. Sandeep , Mittal Dr. Lavlesh
Published: March 2020

INTRODUCTION: Deep knowledge of anatomy is an essential part of surgical practice. Students of medical sciences gain knowledge and theoretical data through actual visualization of anatomic structures of the cadavers also anatomic relations can be studied more efficiently by practicing on cadavers. As phrenic nerve may be damaged during subclavian vein catheterization the relationship between the phrenic nerve and the subclavian vein is of clinical interest. During the subclavian vein catheterization analogous variable relationships are helpful to explain and prevent damage to the phrenic nerve.

MATERIAL AND METHODS: Dissection was started from the root of the neck. No surgical scars, gross anatomical and morphological abnormalities was noted on the cadaver. Measurements were taken during the anatomical dissections.

 RESULTS: Of the 36 cadavers dissected in 34 (94.44%) cases phrenic nerve was found posterior to the subclavian vein and in 2(5.56%) cases found anterior to the subclavian vein of which one case was male and the other was female. In the male case in which phrenic nerve was passing anterior to the subclavian vein, it was adherent to the anterior wall of the subclavian vein and was nor piercing the vein wall.

CONCLUSION: The cannulating needle may damage the phrenic nerve which is adherent to the subclavian vein. So, the puncture site should be more laterally at the outermost portion of the subclavian vein. Anatomical variants during invasive practical procedures should be always kept in mind.

KEYWORDS: phrenic nerve, subclavian vein, phrenic nerve palsy, catheterization.
SURGERIES OF LOWER LIMB UNDER COMBINED FEMORAL AND SCIATIC NERVE BLOCK
Authors: Agrawal Dr. Pawan Kumar , Gupta Dr. Anil Kumar
Published: March 2020

INTRODUCTION:  Peripheral nerve blocks (PNB) can provide surgical anesthesia with better cardiorespiratory stability and is the best option for life-saving procedures  where both general and central neuraxialanesthesia are risky, and no fasting, , or preoperative optimization is required. One of the most useful anesthetic technique is the combination of sciatic and femoral nerve block (3:1) for lower limb surgery. Peripheral nerve blocks are generally suitable for lower limb surgeries because of the peripheral location and the potential to block pain pathways at multiple levels. Also PNBs avoid hemodynamic instability and, facilitate postoperative pain management, and assure a timely discharge of the patient.

MATERIAL AND METHODS: In this prospective observational study 50 patients of 22 to 67 years age group of both sexes were included who were posted for lower limb surgeries. Patients were randomly divided into two groups of 25 each. In Group A: 20 ml of 0.5% ropivacaine for femoral nerve block and 20 ml of 0.5% ropivacaine for sciatic nerve block was given to the patients. In group B: 20 ml of 0.5% ropivacaine plus 25 µg fentanyl for femoral nerve block and 20 ml of 0.5% ropivacaine plus fentanyl 25 µg for sciatic nerve block was given. Visual analog scale (VAS) with 0 – 10 cm line was used to see the level of anesthesia in the postoperative period and interpreted as “0” means “no pain” and mark “10” means “severe pain.” Pain score was assessed every 30 min during surgery. If pain is experienced during surgery injection ketamine 0.5 mg/kg intravenously.

RESULTS: This study was carried out on 50 patients divided into two groups of 25 each of age group of 22 to 67 years posted for lower limb surgeries. In group A mean age of the patients was 43.78± 12.47and in group B it was 42.33± 13.29. Out of total 25 patients operated in group A 21 (84%) were male and 4 (16%) female, while in group B male and female were 22 (88%) and 3 (12%) respectively. Mean onset of sensory block (Minutes) in group A and Group B was 11.94 ± 3.54 and 12.19 ± 2.67 respectively. Mean onset of motor block in group A was 17.59 ±3.47 minutes and in group B was17.87± 2.78 minutes. Total duration of sensory block in group A was 13.96 ± 0.27 hours and in group B 13.05 ± 0.98 hours. Total duration of motor block in group A was11.58 ± 1.56 hours and in group B12.88 ± 0.96 hours. VAS score was 0 till 8 hours of the study period then it started increasing in both the groups. Patients demanded the first dose of rescue analgesia at 16th hour.

 CONCLUSION: Combined femoral-sciatic nerve block is one of the most useful anesthetic procedures and can be used without any major complications, it can also be used in critically ill patients.
EVALUATION OF USE OF NARROW DIAMETER IMPLANTS IN POSTERIOR REGION OF THE JAWS
Authors: Upasana Dr. Kumari , Choudhary Dr. Shivendra
Published: March 2020

The molars are one of the first teeth to be lost over lifetime; thus, their replacement is frequently needed. Implantation is generally the preferred choice to replace a missing single tooth avoiding vital teeth preparation and bridge fabrication. Placement of implant to replace a molar presents diagnostic, surgical, and prosthetic demands, such as an enlarged mesiodistal dimension and occlusal forces distribution.  Poor bone quality in the posterior regions, especially the maxilla, could jeopardize the short- and long-term implant success.  Anatomical considerations and adjacent vital structures (ie, maxillary sinus and mandibular canal), occlusal loads, and the occlusal table, which is frequently wider than the implant diameter, should also be of some concern.  Quality and density of the bone in the posterior regions can compromise initial implant stabilization and load transfer to the bone. The most frequent single molar to be replaced is the first mandibular molar, because this tooth is lost first. Implantation in the posterior area is a predictable procedure over time. The low rate of complications in addition to the high long-term success rate make implant restoration a reliable solution to treat posterior partial edentulism. Hence the present study was planned for evaluation for evaluation of use of narrow diameter implants in in posterior region of the jaws.

The present study was planned in Department of Impalantology, Manipal College of dental sciences Manipal. Total 20 cases were enrolled in the present study. Out of that 10 cases were scheduled for single unit prosthetic rehabilitation supported by implant in the posterior region of the jaws was evaluated in Group A. These cases were implemented with the Narrow Diameter Implant (NDI).  Remaining 10 cases were evaluated in the Group B as control cases. These control patients received the Regular Diameter Implant (RDI).

The data generated from the present study concludes that NDIs placed in posterior region of the jaws without sufficient bone thickness for placement of RDIs presented a high success and survival rate. In addition to that, NDIs presented marginal bone loss patterns similar to those for RDIs, both in the maxilla and mandible. Thus, it can be suggested that NDIs may be successfully used in the posterior regions of the jaws. More studies with longer follow-up intervals are, however, necessary to further evaluate single crowns supported by NDIs in the posterior region of the jaws.

Keywords: Narrow Diameter Implants, Posterior Region of the Jaws, Regular Diameter Implant, NDI, RDI, etc.
A LATERAL CEPHALOGRAPHIC EVALUATION OF ASSOCIATION OF CLEFT LIP AND PALATE WITH CERVICAL VERTEBRAL ANOMALIES
Authors: Khatoon Shazia , Jain Samir
Published: March 2020

Generally, orthodontic treatment and intervention are timed to take place before or during the peak growth velocity or pubertal growth spurt to achieve favorable effects in correcting sagittal, transverse, and vertical plane disharmonies. Skeletal maturity and growth spurts have been assessed by several methods in the literature, including chronological age, dental development, and sexual maturation characteristics. All of these methods have limitations, such as poor correlation with growth spurt. Hence based on above findings the present study was planned for A Lateral Cephalographic Evaluation of Association of Cleft Lip and Palate with Cervical Vertebral Anomalies.

The present study was planned in Department of Dentistry, Anugrah Narayan Magadh Medical College and Hospital, Gaya, Bihar, India. In the present study 20 cases of the age from 5 to 20 years suffered from the cleft lip and Palate were enrolled and evaluated with the different parameters. The radiographs were traced for cervical spine from C1- C4 on an acetate paper with 3H pencil under optimal illumination. Cervical vertebral anomalies were recorded and categorized into posterior arch deficiencies and fusion or both.

The data generated from the present study concludes that the association between cleft lip and palate and cervical vertebral anomalies indicates that cervical vertebral anomalies may be implicated as the etiology of cleft lip and palate. As oral and maxillofacial radiologists, lateral cephalographs are easily available in records of dental patients and can be used to identify cervical vertebral anomalies. Cervical vertebral anomalies can predispose to further disorders and identification of such anomalies mandates referral to the concerned specialist for appropriate management.

Keywords: Cleft Lip and Palate; Cervical Vertebral Anomalies; Dehiscence; Fusion; Lateral Cephalographs, etc.
TO STUDY EPIDEMIOLOGICAL ASPECTS OF ACUTE HEAD TRAUMA AT TERTIARY CARE CENTER BIKANER RAJASTHAN
Authors: Pareek Kapil , Sodhi Dinesh
Published: March 2020

Background: Worldwide, traumatic brain injury (TBI) is the single largest cause of death and disability following injury. Most TBI’s are due to road side accidents. According to WHO data, by the year 2020, head trauma will be third largest killer in the developing world.

Methods: The present study was conducted in Department of Neurosurgery, Trauma center of S. P. Medical College and A.G. of Hospitals, Bikaner. The study group consisted of a total of 100 head injury patients presenting to the Trauma center and admitted in neurosurgery ward.

Results: The incidence of injury with respect to the time of occurrence in a day has shown a maximum number of incidents occur between 6.00 pm and 12.00 midnight (40.00%), followed by 12 noon to 6 pm having (28.00%).

Conclusion: The lack of awareness among the pedestrians and disregard for traffic rules by the motorists were important reasons for most of the accidents.

Keywords: Neurosurgery, Trauma, Injury
CONTEMPORARY TREATMENT OF ALK POSITIVE NON SMALL CELL LUNG CANCER PATIENT WITH BRAIN METASTASES: OUR EXPERIENCE
Authors: Crvenkova S , M Popova
Published: March 2020

Purpose: The aim of this study is to show alectinib efficacy and safety, with focus on alectinib intracranial efficacy.

Case presentation: We report on a 46-year-old woman diagnosed as non small cell lung cancer harboring echinoderm microtubule-associated protein-like 4-anaplastic lymphoma kinase fusion gene. She has intracranial metastases and poor performance status of 3. We treated this patients with alectinib after whole brain irradiation and discontinuation of chemotherapy after two 2 cycles due to progressive brain and liver metastases. Good response was obtained with improving of her performance status without adverse events.  

Conclusions: We recommend alectinib as a treatment approach for ALK+ NSCLC patients, especially those with CNS metastases at the time of the diagnosis and poor PS.

Key words: CNS metastasis, ALK+ NSCLC patients, alectinib
HEMATOLOGICAL PROFILE IN PRIMARY HYPOTHYROIDISM
Authors: Fatima Qadir , Dotasara Priyanka , Gauri Liyakat Ali
Published: March 2020

Introduction: Thyroid function disorders are among the most common endocrine diseases. Females are affected more than males, especially during the reproductive age. Hypothyroidism is the most prevalent type with a reported frequency of 2–5% worldwide. Thyroid hormones are essential for virtually all body tissues. So deficiency may affect hematopoiesis in bone marrow and eventually hematopoietic cells. Hematological abnormalities have frequently been reported in thyroid disorders. Anemia is frequently observed in patients with primary hypothyroidism.

Objectives: To study the hematological changes and pattern of anemia in primary hypothyroid patients.

Materials & Methods: This is a cross sectional study conducted on newly diagnosed 100 patients with primary hypothyroidism, between 18 –60 years. They were categorized as 35 patients of subclinical and 65 patients of overt hypothyroidism based on TSH level. Patients’ who fulfills the inclusion exclusion criteria were evaluated for thyroid function tests (T3, T4 and TSH) and hematological parameters (CBC and PBF).

Results: Our analysis revealed an overall prevalence rate of anemia was 56% in patients with hypothyroidism which is higher than the WHO reported data of prevalence of anemia throughout the world. Our results showed that prevalence of normocytic normochromic anemia was significantly higher, microcytic anemia had the second rank, while macrocytic anemia had the lowest prevalence rate. On subgroup analysis, there was no statistical difference between subclinical hypothyroid and overt hypothyroid, in term of hematological parameters and type of anemia.

Conclusion: Without proper diagnosis and effective treatment of the underlying thyroid disease, it is often difficult to achieve a complete correction of the anemia. The high prevalence of anemia in patients with hypothyroidism suggests screening for hypothyroidism during the differential diagnosis of cases presenting with anemia.

Keywords: Hypothyroidism, subclinical, overt, anemia, hematological, thyroid, blood.
ASSOCIATION OF HYPERTENSION AND DIABETES WITH OBESITY
Authors: Savani Samir , Moulick Nivedita D.
Published: March 2020

Introduction: Hypertension, diabetes and obesity are one of the top risk factors for cardiovascular complications in the world. Indians have high burden of obesity compared to western population. Hypertension and type 2 diabetes mellitus are major non communicable diseases and it is important to examine modifiable risk factors such as obesity, physical inactivity , tobacco use and alcohol consumption. Metabolic syndrome (MS) is defines as presence of type 2 diabetes or impaired glucose tolerance with any two of the following characteristics: obesity, low levels of high-density lipoprotein, high levels of triglycerides and hypertension by World Health Organization (WHO).

Materials and Methods: 1485 samples were selected from the patients attending OPD of General Medicine Department of D.Y. Patil University School of Medicine, Mumbai. They were assessed for height, weight and body mass index (BMI) measurement. Hypertension was defined according to the guidelines given in Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure. Abdominal obesity is defined as an abdominal circumference > 102cm in males and >88cm in females for NCEP criteria and > 90cm in males and > 80cm in females for IDF criteria for South Asians. Blood glucose concentration was measured, the diagnosis of diabetes was defines by either casual plasma glucose ≥ 200mg/dl associated with symptoms of diabetes and on fasting samples- plasma glucose ≥ 126mg/dl.

Results: Among all 1485 patients, 764(51.44%) were males and 721(48.56%) were females. It was observed that 32(21.6%) cases were obese, hypertension was observed in 289(19.5%) cases and diabetes in 168(11.3%). Among 289 hypertensive subjects, 214(74%) were obese and 75(36%) were non-obese. Out of 168 diabetic cases 96(57.1%) cases were obese and 72(42.9%) were non-obese. A statistically significant association was observed between diabetes, hypertension and obesity. Conclusion: There is significant association between obesity, hypertension and diabetes. BMI can provide useful information to classify the presence of hypertension and diabetes in population.

Keywords: Obesity, Hypertension, Diabetes, BMI.
A RARE CASE OF RAPUNZEL SYNDROME - A SMALL BOWEL TRICHOBEZOAR
Authors: Tailor Harin , Dekhaiya Firdaus A , Mehta Smit , Shah Samir M , Panchal Dhawal
Published: March 2020

Bezoars are concretions of foreign material in the gastrointestinal tract, mainly the stomach. In humans, the most common type of bezoar is the trichobezoar, is more often found in children and teenage girls. . The most frequent type of bezoar in adults is phytobezoar. A rare manifestation of trichobezoar is Rapunzel syndrome (RS) which occurs when the bezoar extends into the small intestine. An 11 years old girl from low socio economic social status presented to emergency department. . She had a complain of abdominal pain and vomiting before 3 month which was relieved itself after vomiting which contains hair, threads and cloths. Abdominal examination revealed a generalised abdominal distension. Ultrasonography (USG) of abdomen was done. . Trichobezoar was removed by open surgery with longitudinal enterotomy.  The mass was occupying 30cm part of terminal ileum up to iliocecal junction with a putrid smell which was removed from enterotomy. Trichobezoars are a bizarre medical problem, and Rapunzel syndrome is an extremely uncommon variety of trichobezoar which occurs when the bezoar extends into the small intestine.  The diagnosis of trichobezoar is possible on imaging in a proper clinical setting.

Keywords: Trichobezoar, Rapunzel Syndrome, Enterotomy.
PROSTATIC STROMAL SARCOMA: RARE CASE REPORT
Authors: Dalal Niti , Singh Sunita , Goel Vartika , Sharma Pooja , Narayanan Arsha , Sen Rajeev
Published: March 2020

Prostatic stromal sarcoma is rare and aggressive malignant mesenchymal tumor accounting for 0.1- 0.2% of all prostate malignancy. Here we report a case of middle aged male with lower urinary tract symptoms and normal PSA levels. Ultrasonography findings showed grade 3 prostatomegaly. An open prostatectomy specimen was sent and a diagnosis of Prostatic Stromal Sarcoma was made based on histopathological and immunohistochemical findings.

Keywords: Prostate, Stromal sarcoma, mesenchymal
FOLLOW UP STUDY OVER A PERIOD OF SIX MONTHS WITH RESPECT TO REHABILITATION AND RECURRENCE AFTER BURN SURGICAL PROCEDURES.
Authors: Ramole Yashpal , Patel Badri , Songara M. C. , Chaurasia Ishant
Published: March 2020

The study was conducted in the Department of General Surgery, Gandhi Medical College, Bhopal over the period of one & half year. Evaluation started with History and clinical examination including range of movement of joints. Scar was scored as per Clinical Assessment Score. Range of movement was measured using goniometer.

Although most patients came for follow up and were compliant with the rehabilitation protocol, their compliance needs to be re-evaluated at every follow up and they should be encouraged to follow the advices strictly. Also they must be counseled that contracture may not be corrected to the full extent despite best of treatment and compliance with rehabilitation protocol but a good level of improvement can be achieved.

Keywords: Burn, Surgery, Rehabilitation & Recurrence.
SPECTRUM AND OUTCOME OF BLUNT ABDOMINAL TRAUMA
Authors: Sharma Mahesh Kumar , Bhargava Dr. Arun
Published: March 2020

Background: Blunt abdominal trauma is a leading cause of morbidity and mortality among all age groups. So we evaluate the spectrum and outcome of blunt trauma.

Methods: Hospital based prospective study conducted on 100 patients at department of general surgery.

Results: Distribution according to type of injury consisted of maximum cases, 84 (84%) of road traffic accidents, 11% cases were of fall from height.

Conclusions: Males were pre-dominantly affected. Road traffic accident was the most common cause of injury. Though conservative management is successful in carefully selected patients, operative management remains the main stay of treatment.

Keywords: Blunt abdominal trauma, Liver injury, Perforation, Splenic injury
TO STUDY THE PATTERN OF DYSLIPIDEMIA IN HYPOTHYROID PATIENTS
Authors: Tarik Mohammed , Chandra Subhash
Published: March 2020

Background: Thyroid hormones play an important role in regulating lipid metabolism and thyroid dysfunctions can result in lipid abnormalities which increase the risk of endothelial dysfunction, hypertension and cardiovascular disease.

Methods: A cross-sectional study was conducted on 100 patients selected as a sample of convenience in this cross sectional study from out-patient department of Medicine. Meticulous history taking and thorough clinical examinations were done. Report of lipid profile and thyroid function tests were recorded from patients file. All the information's were recorded in a pre-desigaed structured questionnaire. Collected data were classified, edited, coded and entered into the computer for statistical analysis by using Epi-info software.

Results: The serum TC, TG and LDL levels in hypothyroid individuals were significantly higher than euthyroid subjects.

Conclusion: We conclude that hypothyroid subjects had dyslipidemia. The present study indicated that hypothyroidism was associated with an abnormal lipid profile, especially with respect to the levels of TC, LDL and TG.

Keywords: Total cholesterol, Triglycerides and LDL
A COMPARATIVE STUDY OF CD 56+ NK (NATURAL KILLER) CELLS IN ENDOMETRIAL TISSUE OF NORMAL AND INFERTILE PATIENTS
Authors: Parveen Sultana , Singh O.Okendrajit , Pukhrambam Gayatri Devi , Devi R.K Praneshwari , Devi Ph. Madhubala
Published: March 2020

Introduction: The endometrium is the special epithelial lining of the uterine cavity which plays important roles in different phases of menstrual cycle as well as in implantation process. The natural killer (NK) cells are a type of lymphocytes circulating in peripheral blood, named because of their effector functions in killing target cells. Immune cells that share similar phenotypic characteristic but are poor killers which populate the uterine lining at implantation and during early pregnancy when the placenta is established and are identified by the surface marker CD56+.

Aims and Objectives: The aim of the study is to evaluate the mean cell count of CD56+ uterine natural killer (uNK) cells in endometrial tissue specimens and determine the association of the histopathological findings with CD56+ mean cell count.

Materials and Methods: In this cross sectional study, 50 endometrial tissue samples (biopsy and dilatation and curettage specimen) received in the department of Pathology, Regional Institute of Medical Sciences (RIMS), Imphal during the period between September, 2016 and August, 2018 were selected and included in the study. Twenty-nine cases with history of primary and secondary infertility were included in the test group and 21 cases with no history of abortions and miscarriages constituted the control group. CD56+ cells were stained using mouse monoclonal CD56+ antibody and counted manually under ten high power fields  (40X) and mean cell count was calculated and statistically analysed.

Results: The age of the study group ranged from 18 to 45 years (Mean ± SE; 35.88 ± 1.13). The mean number of CD56+ NK cells was higher in control groups 56.62 ± 5.683 (Mean ± SEM; N=21) as compared to the mean number of CD 56+ NK cells in the test group 38.20 ±3.958 (Mean ± SEM; N=29). The difference was statistically significant (difference of 1.195 with 95% confidence interval of 0.536 to 3.294, p = 0.008).

Conclusion: Mean number of CD 56+ uNK cells, show significant correlation with primary infertility and repeated miscarriages (p=0.022). CD56+ NK cells may have a role in the maintenance of normal pregnancy. It might be a useful marker for predicting risk of miscarriages and infertility.

 Keywords:  CD 56+, Natural killer (NK) cells, Endometrial tissue, Primary and secondary infertility.
FUNCTIONAL OUTCOME OF FRACTURE SHAFT OF FEMUR IN PEDIATRIC AGE GROUP TREATED WITH TITANIUM ELASTIC NAILING SYSTEM
Authors: Mishra Vishal Kumar , Kumar Arvind , Kumar Gutha Sethu , Sarang Siddhartha
Published: March 2020

Femoral shaft fractures are common fractures in paediatric age group. In children, fractures of the femoral shaft have been traditionally treated mostly by conservatively immobilization in a Spica cast, either immediately or after a period of traction. But this safe form of treatment has major drawbacks. The management of paediatric femoral shaft fractures gradually has evolved towards a more operative approach in the past decade. Elastic stable intramedullary nailing (ESIN) or Titanium elastic nailing system (TENS) is a recent technique which allows stable reduction, maintenance of reduction and early mobilization. . Aim of study is to assess the functional outcome of fracture shaft of femur in pediatric age group treated with titanium elastic nailing system. It is a prospective study which was conducted in the all children between 5-14 years of age with diaphyseal fractures of femur. Outcome of  fracture  shaft  of  femur  in  pediatric  age  group  treated  with titanium elastic nailing system was studied studied by observing following, Type of reduction among children with diaphyseal fractures of femur, .Duration for union after surgery , Range of motion after surger, weeks of  Weight Bearing started , Limb length discrepancy, Malalignment . From present study we conclude that femur diaphyseal fracture in children between 5-14 years of age can be effectively managed with titanium elastic nails. TENS offers a biological, minimally invasive method of treatment for fracture shaft of femur in children with advantages of sufficient axial stability, early mobilization and more rapid return to function. this technique yields higher rate of excellent functional outcome.

Keywords: Femur, Diaphyseal Fracture,  Children, TENS
USE OF MIFEPRISTONE AND MISOPROSTOL COMBINATION FOR FIRST TRIMESTER MTP UP TO 9 WEEKS
Authors: Vaghani Dhara N. , Parikh Rajni M.
Published: March 2020

In India about 6.7 million abortions takes place every year of which 4 million are induced and 2 millions are spontaneous. WHO estimates that unsafe abortion kills about 70,000 women annually, many more suffer serious injuries and permanent disability. In spite of legalization of medical termination of pregnancy in India, the incidence of illegal abortion is at time more common than legal abortion. Unsafe abortion is major cause of mortality among women in India accounting for 12% of all maternal death. One way of reducing mortality and morbidity associated with unsafe abortion is early decision by women for termination of pregnancy by use of combination of mifepristone and misoprostol for termination of pregnancy up to 9 weeks. So the present study aims to study the efficacy of mifepristone and misoprostol  for medical termination of pregnancy up to 9 weeks of pregnancy. This is a prospective randomized study undertaken in 100 patients seeking MTP, in the reproductive age group with a history of less than or equal to 9 weeks gestation, attending Obstretic and Gynace OPD of Sir Takhsinhji Hospital attached to Govt. Medical College, Bhavnagar from March 2018 to August 2019. They were administered 200 mg of mifepristone followed by oral misoprostol 400 ug after 48 hours and another 400ug misoprostol after 24 hours. Results show Overall success rate of 92% abortion failure rate of 8% were achieved. This treatment regimen was more effective in earlier gestational age group.

Keywords: Abortion, MTP, Mifepristone ,  Misoprostol
STUDY TO CORRELATE CLINICAL AND HISTOPATHOLOGICAL FINDINGS OF ABNORMAL UTERINE BLEEDING ACCORDING TO FIGO’S PALM-COEIN CLASSIFICATION
Authors: Patel Disha , Nakum Kanaklata D , Vithal Aditi
Published: March 2020

Abnormal uterine bleeding (AUB) is a common and debilitating condition with high direct and indirect costs. AUB frequently co-exists with fibroids, but the relationship between the two remains incompletely understood and in many women the identification of fibroids may be incidental to a menstrual bleeding complaint.  Abnormal uterine bleeding (AUB) is one of the common presenting complaints encountered by a Gynaecologist. The International Federation of Gynaecology and Obstetrics working group on menstrual disorders has recently developed a classification system (PALM–COEIN) for causes of the AUB in non-gravid women. The present study was conducted with the aim to study and analyse the structural (PALM) and the functional (COEIN) component of the PALM–COEIN system of AUB in perimenopausal age group. A total of 200 perimenopausal women (aged 40 years and above till 1 year beyond menopause) who were admitted with complaints of abnormal uterine bleeding comprised the study population. Clinical diagnosis and allocation to PALM–COEIN was done. Endometrial biopsy and hysterectomy specimens (wherever applicable) were obtained and sent for histopathology. As per the histopathological ﬁndings, possible underlying causes were categorized. Clinical diagnosis was then correlated with histopathology-based ﬁnal diagnosis. PALM and COEIN components contributed almost equally for AUB when assessed clinically. The histological examination revealed signiﬁcantly more cases of PALM (structural or anatomical) component of AUB. The PALM COEIN classification system helps us in understanding various etiological causes of AUB and can be used by clinicians and researchers for international comparisons.

Keywords: Abnormal uterine bleeding (AUB) , PALM–COEIN . Perimenopause
STUDY THE EFFECT OF SURGICAL STRESS ON SERUM POTASSIUM AND SERUM CALCIUM LEVEL
Authors: N Farukh Kha , Gothwal Sudarshan , Om Prabha
Published: March 2020

Background: This study was randomized clinical trial carried out in 100 patients to study the effect of surgical stress on serum potassium and calcium and to relate these changes to age of the patient and duration of surgical stress.

Materials and Methods: The study was done in the Department of General Surgery SMS Medical College, Jaipur from June 2015 to June 2017. Patients equally distributed in two groups A and B on the basis of timing of collection of sample.

Blood was taken from the patients who were operated under spinal anaesthesia only, so that the chemical effect of anesthetic was as minimal as possible. For comparison few cases were investigated who were operated under general anaesthesia. In all the patients operated under spinal or general anaesthesia same drug and techniques were used to overcome bias.

Observations and Results: In the study we observed that variation in serum electrolyte seen in period of stress. Range of hypokalemia and hypocalcemia were 2.8 to 3.7 meq/lt and 7.6 to 8.4 mg% respectively in group A and hypokalemia and hypocalcemia were 3.0 to 3.4 meq/lt and 7.6 to 8.4 mg% respectively in group B. Maximum incidence of hypokalemia and hypocalcemia seen during 30-60 minutes duration of operation.

Conclusion: Surgical stress is main cause of fluctuation in blood calcium, and blood potassium levels in surgical ward. The variation consists of increase or decrease of both electrolytes because of activation of the pituitary adrenocortical systems and maximally seen in immediate post operative period.

Keywords: Calcium (Ca+2), Potassium (k+), Serum electrolytes, Surgical stress