World Wide Journals was founded in Ahmedabad (India) in 2011 by Dr. Khansa Memon. World Wide Journals is known as an innovative nursing, psychology, counseling, public health, social work, gerontology, and rehabilitation publisher. Dr. S. Menon is the CEO of World Wide Journals PVT LTD, which is privately held by Dr. Khansa Memon. The primary goal of this open access online journal is to publish original research papers in all the subjects. It intends to publish 12 issues a year and is currently accepting manuscripts. World Wide Journals will also keep all the traditional features of paper print such as a unique cover page for every issue, continuous volume, issue, and page numbers. All manuscripts including reviews will be subjected to peer review and published online every 1st Day of the Month after acceptance. The Journal is registered with National Institute of Science Communication and Information Resources, New Delhi having ISSN registration number 2249-555X.
STUDY OF HYPOTHYROIDISM COMPLICATING PREGNANCY AND ITS MATERNAL AND FETAL OUTCOME
AIMS AND OBJECTIVES: 1. To study occurrence of hypothyroidism in our hospital. 2. To study the maternal and fetal outcome in pregnant women diagnosed with hypothyroidism. MATERIALS AND METHODS: • It was a retrospective study from January 2018 to December 2018 conducted at Department of Obstetrics and Gynaecology in Mamata general hospital Khammam. The demographic data and other relevant data collected from past records and was analysed with a sample size of 50. • Apart from the routine obstetrical investigations, TSH was done as a screening test. Cut off values for TSH as per American Thyroid Association - 1st trimester: 0.1 -2.5 micro iu/L, 2nd trimester: 0.2-3.0 micro iu/L, 3rd trimester: 0.3 -3 micro iu/L. Those with the abnormal tests were categorized as Subclinical hypothyroid (Normal FT4 with high TSH), Overt hypothyroidism (Low FT4 with high TSH) RESULTS: In the present study, most common obstetric complication observed was preeclampsia (26%) followed by gestational diabetes (16%) and most common fetal complication was preterm delivery (37.5%). CONCLUSION: In view of the high prevalence of the thyroid dysfunctions and its association with different adverse pregnancy related complications, routine screening and adequate treatment is important to prevent adverse maternal and fetal outcomes.
Copyright (c) 2020 Indian Journal of Applied Research
SONOGRAPHIC EVALUATION OF RENAL SIZE, CORTICAL THICKNESS AND RENAL ECHOGENICITY IN PATIENTS WITH PRIMARY HYPERTENSION AND ITS CORRELATION WITH SERUM CREATININE LEVELS
Renal related complications are common among patients with hypertension. Sonography can assess kidney size, shape, cortical thickness and echogenicity. The present study was aimed at assessing the renal size, cortical thickness and renal echogenicity in patients with primary hypertension and to correlate it with their serum creatinine levels. Study was conducted at Bharati Hospital, Sangli using an ultrasound machine Affinity 50 and the patient selection was as per reference to Radiology department.
KNOWLEDGE AND AWARENESS AMONG SCHOOL TEACHERS REGARDING TYPE-I DIABETES IN RURAL AREA OF JAIPUR.
Backgrouns: Keeping in mind the increasing trend of diabetes among Indian population, it is highly important to know the awareness of diabetes among school teachers and to educate them about the risk factors associated with it. Aim:To study awareness and educate school teachers about risk factors associated with diabetes and its sign and symptoms so that awareness can be created at early age of life. Objective • To study knowledge of risk factors of diabetes among teachers • To educate teachers for factors responsible for development of diabetes • To educate teachers about sign & symptoms of type-I Diabetes Methodology:A cross sectional study was conducted among 237 teachers of 19 schools ofAchrol, Jaipur with a predesigned questionnaire and statistical analysis was done by Microsoft excel. Sampling technique A Total population Sampling was done Result:Among 19 schools 237 teachers took part in the study out of which 228/237(96%) were aware about Diabetes and out of 72/228(31%) were aware of both type-I and type-II diabetes and out of which 64/228(28%) were aware about risk factors, signs & symptoms of Diabetes. Conclusion :Teachers participated in the study have moderate knowledge regarding risk factors, sign & symptoms of Diabetes, so more awareness should be created.
A STUDY OF ONLAY MESH REPAIR IN INCISIONAL HERNIA
Incisional hernia is a quite common disease met in surgical outdoor as well as in surgical emergency. It remains a very frequent postoperative complication. The two most common technique performed worldwide are onlay and sublay mesh repair. This study aims at onlay mesh repair in incisional hernia and find the result in terms of time taken for surgery, wound infection and recurrence.
ROBOT-ASSISTED NAVIGATION SYSTEM FOR CT-GUIDED INTERVENTION PROCEDURES FOR PERCUTANEOUS LESIONS: OUR EXPERIENCE AT BIR, CHENNAI.
Objective of this study is to evaluate the Robot-assisted Navigation System for CT-guided Intervention procedures with the assessment of the accuracy of needle placement, radiation dose and performance level. All the procedures were done using MAXIO (Perfint healthcare Pvt Ltd.) machine using 16 slice CT scanners, under local anesthesia and aseptic precautions, under the supervision of trained radiologists. After marking the point of entry and target lesion, path of the needle is confirmed on the planning software and the system calculates, coordinates angle & depth and positions the biopsy arm. All procedures were successfully performed. Procedure duration, radiation dose precision of needle Diagnostic performance of the biopsy and rate of complications were evaluated. .This method is more patient friendly and ensures maximum safety. The average procedure time and radiation exposure is reduced by 70% as compared to the routine manual method. This clinical trial depicts the advantages of the automated CT guided planner in reducing the procedure time and radiation dose and ensuring patient safety with high diagnostic accuracy, thus making it acceptable for the routine clinical practice.
SOCIO-DEMOGRAPHIC PROFILE OF ELDERLY WHO COMMITTED SUICIDE IN A DISTRICT OF CENTRAL INDIA.
Background- The 21st Century is often called as the ―Age of Ageing. The elderly population has grown considerably due to increase in the life expectancy of people and decrease in fertility rates, achieved primarily because of medical interventions. But in the elderly population, the health problems are complicated to a greater extent by the social, economic and psychosocial interaction, as compared to the younger population. The lethality of method of suicide is very high among the elderly and it is more likely to be missed due to their indirect method of communication regarding the suicide intent. Methodology – A community based cross- sectional study was conducted in Wardha district of Central India from July 2015 to October 2017. The study participants were the survivors of suicide. Result- It was found in the study that out of the 71 elderly who committed suicide 56.3 % elderly were in the age group of 60-69 years, 38.0 % were educated up to primary level, while 29.6 % were illiterate and only 05.6 % had education of high school or above. Majority of the deceased were farmers (35.2 %) and labourer (33.8 %).
INFANT FEEDING PRACTICES AT URBAN SLUM OF AKOLA, MAHARASHTRA.
Background , Objectives: Infant feeding practices importanct for growth , development of children.Recent studies reported prevalence of wrong feeding practices in urban slums.So study conducted to assess infant feeding practices in urban slum , factors influencing it. Materials , Methods: Community based ,cross – sectional study at urban slum , Akola , January - December 2019. Variables included were the mother’s religion,occupation,education,antenatal clinic registration,breast feeding,weaning,knowledge , place and type of delivery, sex and age of baby. Fisher’s exact test used for statistical analysis. RESULT:Among 400 enrolled mothers,129(32.25%) started breast feeding within 1 hour after deliveries,colostrum given by 90(22.50% ),exclusive breast feeding for 6 months by 150(37.50%) mothers. Exclusive breast feeding more in literate and who were informed by the health personnel.This was statistically significant. CONCLUSION: Inappropriate feeding practices common at urban slum of Akola,Maharashtra.
COMPARISON OF INTRA OPERATIVE EFFECTS AND POST OPERATIVE OUTCOME BETWEEN INTRATHECAL CHLOROPROCAINE AND CHLOROPROCAINE WITH FENTANYL FOR URETEROSCOPIC LITHOTRIPSY.
With the advent of Ambulatory surgery, the search for an ideal anaesthetic for outpatient spinal anaesthesia is ongoing.(1) An ideal anaesthetic is one that provides rapid onset of action, adequate potency, predictable duration with decreased side effects.(2) Among the various local anaesthetics available, Chloroprocaine – an amino ester – has been the forerunner in satisfying these criteria. It was first introduced in the year 1952 by Foldes and McNall and was found to be superior in efficacy and safety as compared to Procaine and Lidocaine.(3) However, due to reports of neurological deficits following intrathecal administration of chloroprocaine, in the early 1980s, its use drastically decreased and low dose Bupivacaine was preferred.(4) Extensive investigation revealed that a combination of low pH and sodium bisulfite, an antioxidant, could be the cause of neurotoxicity. Hence, an anti-oxidant and preservative free 2-choloroprocaine was developed and is now one of the preferred drugs for short duration spinal anaesthesia.(5)
ROLE OF DYNAMIC COMPRESSION PLATE (DCP) IN FEMORAL SHAFT FRACTURES
Although intramedullary fixation has standardized the management of femoral shaft fractures, Dynamic compression plating is a useful technique for specific indications where intramedullary nailing may be contra-indicated or technically not feasible. Our aim is to assess and study the Femoral shaft fractures presented to casualty and orthopaedic department at Viswabharathi Medical College & General Hospital, Kurnool from November 2016 to November 2019 and to evaluate the final outcome of patients treated with Dynamic compression plate. The procedure is safe with minimal morbidity, relatively few complications and helpful in early recovery after surgery.
SURGICAL MANAGEMENT OF DIAPHYSEAL FRACTURE OF HUMERUS BY INTRAMEDULLARY INTERLOCKING NAILING IN OUR GOVERNMENT GENERAL HOSPITAL
Background: Operative management of fracture shaft of the humerus can be with plate osteosynthesis or with intramedullary nailing. In this study, we have tried to analyze the outcome in terms of time for consolidation, union rates, functional results, and complications of humeral shaft fractures managed with closed antegrade interlocking nailing. The study was conducted in a government general hospital, Siddhartha medical college, Vijayawada. Methods: A series of 30 patients with acute fractures of the shaft of the humerus were treated with antegrade interlocking nailing during november 2017 to November 2019. There were 19 males and 11 females with an average age of 44.37 years (18-75 years). All the patients were followed up for an average period of 6.76 months, and results were analyzed. Results: 30 (100%) fractures united with an average consolidation time of 13.067 weeks (11-16 weeks. Functional results were excellent in 27(90%), moderate in 2(6.6%), and poor in 1(3.3%). Conclusion: Closed antegrade interlocking nailing offers a safe and reliable method of fixing fractures of the humeral shaft, with early fracture consolidation and higher union rates. It provides early rehabilitation and reduces the hospital stay.
CURRENT CLINICAL PROFILE OF RESPIRATORY DISEASES IN GERIATRIC POPULATION
Study of current clinical profile of respiratory diseases in geriatric population. We have taken 1234 patients for study in which males were773 females were 461. 394 patients required inpatient respiratory critical care with community acquired pneumonia, bronchogenic carcinoma, acute respiratory tract infections, acute exacerbation of COPD, bronchial asthma exacerbations and other pleural diseases. 890 patients belong to the age group 65-74yrs and 344 in 75+ yrs age group .studied demographic patient age, sex distribution above the age of 65yrs with more prevalence in males. Respiratory diagnosis in geriatric population upper respiratory tract infections percentage diagnosis is higher. Respiratory diagnosis of inpatient respiratory diseases highest is the acted exacerbation of the COPD. In pneumonia community acquired pneumonia high prevalence in age and sex distribution and highest isolated micro organisms is staphylococcus. For pulmonary TB males are higher with isolated new sputum positive cases.
RHEUMATOID ARTHRITIS & ITS HOMOEOPATHIC APPROACH
About 20% of the consultations in general practice related to locomotors system. Rheumatoid arthritis affects about 3% of the population. There has been a tremendous advance in this field. Rheumatoid arthritis is an inflammatory disease that exerts its greatest impact on those joints of the body that are lined with synovium a specialized tissue responsible for maintaining the nutrition & lubrication of the joints. The initial trigger for RA is unknown. There is evidence to suggest abnormalities in components of the immune system that lead to the body developing abnormal immune & inflammatory reactions, particularly in joints .These changes may precede the symptomatic onset of RA by many year.
A REVIEW ON HEPATOTOXICITY OF ANTITUBERCULOSIS THERAPY
The correlation between serum anti-tuberculosis (TB) drug levels and the drug-induced hepatotoxicity (DIH) remains unclear. The purpose of this study was to investigate whether anti-TB DIH is associated with basal serum drug levels. Serum peak levels of isoniazid (INH), rifampicin (RMP), pyrazinamide (PZA), and ethambutol (EMB) were analyzed in blood samples 2 hr after the administration of anti-TB medication. Anti-TB DIH and mild liver function test abnormality were diagnosed on the basis of laboratory and clinical criteria. Serum anti-TB drug levels and other clinical factors were compared between the hepatotoxicity and non-hepatotoxicity groups. A total of 195 TB patients were included in the study, and the data were analyzed retrospectively. Seventeen (8.7%) of the 195 patients showed hepatotoxicity, and the mean aspartate aminotransferase/alanine aminotransferase levels in the hepatotoxicity group were 249/249 IU/L, respectively. Among the 17 patients with hepatotoxicity,12 showed anti-TB DIH. Ten patients showed PZA-related hepatotoxicity and 2 showed INH- or RMP-related hepatotoxicity. However, intergroup differences in the serum levels of the 4 anti-TB drugs were not statistically significant. Basal serum drug concentration was not associated with the risk anti-TB DIH in patients being treated with the currently recommended doses of first-line anti-TB treatment drugs.
COMPARISON OF VARIOUS DESENSITIZING TOOTHPASTE – A CLINICAL STUDY
Background: Dentine hypersensitivity is a commonly encountered problem that is triggered by an external stimuli. Various treatment modalities have been proposed, amongst them desensitizing paste is used extensively. Objective: Main objective of the study was to compare the efficacy of three commercially available desensitizing tooth paste-Sequel F (R),Hiora k (RVantej(R). Materials and Methods: 30 subjects of dentin hypersensitivity were randomly selected and divided into 3 groups ,desensitizing pastes were prescribed. Baseline values were recorded by tactile method and air blast test using visual analogue scale rating from 0-10. Efficacy was compared on baseline, 10 days and after 30 days. Statistical analysis: Wilcoxon singed rank test and Kruskall Wallis test was done to compare the efficacy of sensitivity reduction between the three groups and during different time interval (P value was set at 0.05). Results: Comparison of all the three pastes showed positive results within 30 days but Vantej (R) showed statistically significant changes within 10 days indicating that it had rapid action. Conclusion: All the tooth paste have convincing evidence in reducing dentinal hypersensitivity. Long term studies to facilitate better understanding can be advocated in the future.
A STUDY OF PATTERN OF PERIPHERAL NEUROPATHY IN SYMPTOMATIC DIABETICS AND ITS CORRELATION WITH DIABETIC NEUROPATHY SYMPTOM SCORE
Background: Diabetic peripheral neuropathy is a usual disorder and presents as a diagnostic and therapeutic challenge to physicians . Early identification and screening of neuropathy is necessary to decrease morbidity due to diabetes mellitus Aims and objectives: -To determine the pattern of NCV in symptomatic diabetic study group -To determine the correlation of diabetic neuropathy symptom score(DNS) with NCV results Materials and methods The study was carried in Dr.PSIMS & RF , on 100 cases of symptomatic diabetics .Diabetic neuropathy symptom score was taken based on symptoms and Nerve conduction studies(NCS) and HbA1c were performed and data was analyzed . Results: The pattern of NCV among the study population were Axonal-SM (74%), Axonal-PS (16%), Demyelinating (9%), Axonal-PM (1% ).There is a significance in the correlation of DNS with various patterns of NCV. Conclusion:There is higher incidence of axonal sensory motor neuropathy in diabetes mellitus . DNS score is an acceptable tool to screen for peripheral neuropathy
EFFECT OF PRANAYAMA ON VISUAL REACTION TIME IN YOUNG ADULTS
Background: Pranayama is a breathing practice in which one controls his/her own breathing. This is a part of yoga practice and has multiple health benefits. Reaction time is the time between presentation of stimulus and appearance of appropriate voluntary response in a subject. Methodology: The study was conducted in 100 M.B.B.S. students in the age range of 18-23 years using reaction time software. Results: The visual reaction time value before Pranayama was 282.86 ± 16.20 ms and after Pranayama practice was 252.56 ± 18.12 ms. This is statistically significant with a p-value < 0.001. Conclusion: Regular practice of Pranayama results in reduced reaction time which indicates an improved attention span.
ANAEMIA AND HAEMOGLOBIN A1C: IN NON DIABETIC PATIENTS.
Background: Haemoglobin A1c (HbA1c) has been adopted by physicians as a surrogate for monitoring glycemic control. There exists concern that other factors beyond serum glucose concentration may affect glycation rates and by extrapolation HbA1c levels. Aims and Objective: The aim of this study was to determine the effect of IDA on the HbA1c levels in non diabetic patients, so as to consider IDA as an important factor which influenced the HbA1c levels, while monitoring the glycemic status of diabetics. Methods: The study group comprised 620 non diabetic aged > 20 years (290 patients with IDA and 330 patients without IDA) Results: The mean HbA1c (7.6 ± 0.9%) level in the patients with IDA was higher than that in the control group (5.5 ± 0.8%) (p < 0.05). Conclusion: The study emphasizes the need to exercise caution when Applying HbA1c reference ranges to anemic populations
AGE-BASED INTERPRETATION OF ANTI-MULLERIAN HORMONE (AMH) LEVELS IN FERTILE AND INFERTILE WOMEN
INTRODUCTION: Data related to AMH levels in fertile women are scarce, making interpretation for this population difficult. We aimed to characterize age-based AMH levels both in fertile and infertile women population to simplify interpretation of AMH results. This study represents the largest analysis to date of AMH levels in fertile women. Materials and Methods: This cross-sectional study analyzed serum AMH from 543 infertile women and 492 healthy controls, whose mean ages were 20-50 years. Sample collection was performed by random sampling and analyzed with SPSS version 16 software. AMH levels were abstracted from electronic medical records. AMH levels were measure by an independent laboratory RV Metro Polis by Chemiluminescence method. Results: There were significantly lower mean serum AMH levels among infertile women compared to the control group. The mean AMH serum levels from different ages of infertile and control group (fertile women) decreased with increasing age. Conclusion: We have observed decreased AMH levels with increasing age both in fertile and infertile women from 20 to 50 years of age. Assessments of AMH levels indifferent age group of female can help in predicting ovarian reserve in infertile women.
COMPARATIVE STUDY ON ROLE OF MAGNESIUM SULPHATE IN ATTENUATION OF SUCCINYLCHOLINE INDUCED FASCICULATIONS AND POSTOPERATIVE MYALGIA
BACKGROUND Succinylcholine, a depolarising muscle relaxant possesses a unique property of rapid onset and short duration of action, but is accompanied by side effects such as fasciculations and myalgia. A prospective randomised-controlled trial was designed to assess the effect of a combination of magnesium sulphate with propofol for induction of anaesthesia on succinylcholine-induced fasciculations and myalgia. MATERIALS AND METHODS 60 adult patients of ASA status I and II of both sexes for elective surgery under general anaesthesia were randomly allocated into two equal groups, group MG and group NS. The patients of MG group were pretreated with magnesium sulphate 40 mg/kg body weight in 10 mL volume, while patients of NS group were given isotonic saline 0.9% in the same volume (10 mL) intravenously slowly over a period of 10 mins. Anaesthesia was administered with pentazocine 0.6 mg/kg and propofol 2 mg/kg, followed by administration of succinylcholine 2 mg/kg intravenously. Muscle fasciculations were observed and graded as nil, mild, moderate or severe. Postoperative myalgia was assessed after 24 hrs. of surgery and graded as nil, mild, moderate or severe. Observations were made in double blind manner where the observer and the patient were blinded. RESULTS Demographic data and baseline parameters of both groups were comparable (P>0.05). Muscle fasciculations occurred in 66.7% patients of MG group versus 100% patients of NS group with a significant difference (P<0.001). After 24 hrs. of surgery, 12 patients of MG group and 28 patients of NS group had myalgia with a significant difference (P<0.001). Statistically significant difference was found in MAP and heart rate at various intervals between the two groups (P<0.001). CONCLUSION Magnesium sulphate 40 mg/kg intravenously maybe used with propofol for induction of anaesthesia to control succinylcholine-induced fasciculations and myalgia.
EVALUATION OF RESPIRATORY PARAMETERS DURING EMERGENCE IN NEUROSURGICAL PATIENTS: EVALUATION OF CONVENTIONAL AWAKE EXTUBATION VERSUS ENDOTRACHEAL TUBELARYNGEAL MASK AIRWAY EXCHANGE EXTUBATION
Background: Emergence from general anesthesia and tracheal extubation may be associated with tremendous physiological and metabolic stress in patients which could be major concern for the anesthesiologist in patients especially with neurosurgical patients. Methodology: A total of 60 patients of ASA physical status I and II between ages 18-60 years undergoing neurosurgery were evaluated for respiratory events like bucking, cough, desaturation, chin lift, jaw thrust and any complications that have occurred in two extubation methods. Results: In Group-A 86.67% patients have shown significant event of bucking and cough while desaturation events were comparable in two groups. Manipulation events i.e. Chin lift and jaw thrust had to perform in 66.67% and 21.67% respectively, in patients of Group-A compared to only 03.33% patients in Group-B (p<0.05). All the patients in Group-A have shown at least one complication while in Group-B only 33.33%. Conclusion: ETT/LMA exchange is the most effective technique for achieving the clinical endpoint of the study, i.e., prevention of emergence respiratory complication compared to awake extubation method.
A STUDY TO ASSESS THE EFFECT OF MOBILE APP ON KNOWLEDGE REGARDING SELF DEFENCE FOR PHYSICAL ASSAULT AMONG NURSING STUDENTS AT SELECTED NURSING INSTITUTIONS OF BHOPAL
Background: India is one of the largest demographic countries in the world with the second largest population. Last ten years the economic growth of the nation is highly increasing than ever before. Health carries one of the fields growing along with the country “overall growth. In 2010, India will be world’s largest mass health care provider. To meet the demand, India produces largest number of nurses in the world. Violence in all its forms has increased dramatically worldwide in recent decades. Now concerns are wide spread over workplace violence against health workers. The problem of violence in health care is not new; it has probably always been a part of nursing (Paterson M, 1999). Violence has been defined as any aggressive behavior “aimed at inflicting harm or discomfort on its victims” (Felton, 1997). Physical and verbal assault from our patients and their friends and relatives is not only difficult to deal with at the time but can have a long and lasting negative impact on our wellbeing and mental health. Yet, incidents appear to be on the rise with 6,245 code blacks (incidents where the safety of hospital staff is threatened) in South Australian public hospitals by February 2017 for the year 2016-17, compared to 4,765 at the same point in 2015-16. Whilst the Australian Institute of Criminology ranked healthcare facilities as the most violent workplaces in the country as far back as 1999, the trend for aggression has continued to increase both at home, and in the rest of the world. In fact, worldwide you’re more likely to be attacked at work if you are a nurse than a police officer. The statistics make for alarming reading. According to the International Council of Nurses (ICN), A recently developed innovation for preventing attrition and promoting engagement in a variety of health promotion interventions is the use of mobile phones to increase contact with patients, provide reminders of patient behaviors in the health protocol, and send messages that encourage continued involvement. For example, researchers have recently tested the effectiveness of using mobile phones to increase HIV-positive patients' adherence to antiretroviral medication therapies (Villanueva, 2007) and to maintain smokers' involvement in smoking cessation programs (Lazev et al., 2004).
CONGENITALLY CORRECTED TRANSPOSITION OF GREAT ARTERIES A RARE CASE REPORT- GOVERNMENT GENERAL HOSPITAL, SIDDHARTHA MEDICAL COLLEGE, VIJAYAWADA.
Congenitally corrected transposition of great arteries (cc-TGA) is a rare condition that accounts for less than 1% of all congenital heart diseases (CHD). Patients with cc-TGA are usually diagnosed at the early stages of life due to associated anomalies, but they may even remain asymptomatic until later decades of their life. We report a case of a 45-year-old man who presented to the emergency department with unknown poison ingestion, in whom isolated cc-TGA was discovered incidentally. The patient was completely asymptomatic of cardiac features at presentation other than an abnormal ECG, which arouse the suspicion of cardiac abnormality and led us to do a thorough cardiac evaluation. Interestingly, the patient had congenitally corrected transposition of the great arteries (cc-TGA) with no associated anomalies but with conduction abnormalities, which is a rare CHD with late adulthood presentation.
ULTRASONOGRAPHIC DIAGNOSIS OF GALL BLADDER CANCER
Gall bladder cancer, despite being the most common malignant tumor of the biliary tract, is quite uncommon. The prognosis is most of the times poor because by the time it is detected it has already metastasised to distant organs. Signs and symptoms are mostly vague but may include abdominal pain, bloating, fever, jaundice, nausea and unintentional weight loss. Histologically, most of the gall bladder cancers are adenocarcinomas. We present to you a case study of a 60 year old woman who presented with right upper quadrant dull pain, anorexia and jaundice and thereon got detected with gall bladder cancer on ultrasonography with the findings of intraluminal calculus, multiple foci of irregular gall bladder thickening, porta hepatis lympadenopathy, ascites and liver and common bile duct metastasis. The objective of this case study is to discuss the ultrasonographic picture of gall bladder cancer, its prognosis, risk factors, histology and current treatment which can create more awareness and henceforth help in the improvement of overall prognosis of this disease.
COMPARISON OF TWO FRACTIONATION SCHEDULES IN TERMS OF LOCO REGIONAL CONTROL AND TOXICITY PROFILE IN POSTMASTECTOMY RADIOTHERAPY
In a general radiation oncology practice, breast cancer typically constitutes approximately 25% of total patient caseload. Radiation therapy (RT) plays an essential and critical role in the management of breast cancer. Locally advanced breast cancer is not clearly defined, though it commonly refers to stage III disease, which includes advanced primary or nodal disease without evidence of systemic metastases. Patients who present with locally advanced breast cancer require care from a multidisciplinary team.The purpose of this study was to compare two fractionation schedules(50Gy in 25 fractions vs 40Gy in 15 fractions) used in post mastectomy chest wall irradiation in Carcinoma Breast regarding loco-regional control and toxicity profile. Several studies have shown that two fractionation schedules are equivalent in loco-regional control and cosmetic outcome.The composition of this study is well matched regarding age, surgery and other histopathological findings.
ASSESSMENT OF THE ACCEPTABILITY OF CONTRACEPTIVE USE AMONG THE WOMEN OF RURAL AREAS OF KHAMMAM
Aim of the study was to document the prevalence of use of Contraceptives among the rural areas of Khammam. Specific objectives were to document different methods used for contraception, to assess the knowledge regarding contraception and to identify the reasons of use and non-use among rural areas. 200 females were recruited to assess the use of contraceptives from different rural areas of Khammam. Questionnaires were filled and data was analyzed. The significance for religious factor was checked. From the data obtained, the acceptability of contraceptive usage was high among women belonged to lower class (35%). Most of women belonged to 21-25 yrs (45%). Acceptability of contraceptive usage was high among literate women (67.5%) when compared to illiterate women. Most of women were housewives and belonged to Hindu religion. Women were mostly in favour of female sterilization (51%) and least with oral contraceptive pills.
STUDY TO ASSESS THE EFFECTIVENESS OF DIVERSION THERAPY ON PAIN AMONG INFANTS RECEIVING INTRAMUSCULAR INJECTIONS AT SELECTED HOSPITALS OF JABALPUR CITY
Injections are the painful procedures performed on infants. It is assumed that such procedures cause a certain degree of pain. Unlike the widely held belief of the past years, today it is accepted that small children and even newborns are able to feel pain and respond to painful stimuli. The infant undoubtedly has the neuronal apparatus to detect a painful stimulus and perhaps remember it.
POST-RENASCENCE ENVIRONMENTAL ADAPTATION OF SWINE-ORIGIN INFLUENZA VIRUS (S-OIV)
Background The three types of influenza viruses are A, B, and C. They belong to the Orthomyxoviridae family of single stranded RNA viruses. Method Retrospective study was conducted on 7515 sample results data which were collected from January 2014 to December 2018 in the Department of Microbiology, Government Medical College, Kota Results 16.58% samples were positive over the period of study. Prevalence in 2014 was 3.08% followed by the drastic change in the number of cases in 2015 with the prevalence of 18.57% with the similar trend in the successive years except in 2016 which might be due to change in humidity. Post-renascence the virus was able to infect even at higher relative humidity. Discussion The dominant flu strain in India in 2017 was A/ Michigan/7/2009 (H1N1) pdm09 virus, replacing A/California/7/ 2009 (H1N1) pdm09 seen during 2016. The new strain is capable of infecting at relatively higher temperature.
POSTOPERATIVE ANALGESIC EFFICACY OF INTRAPERITONEAL ROPIVACAINE VERSUS INTRAPERITONEAL ROPIVACAINE WITH DEXMEDETOMIDINE IN LAPAROSCOPIC CHOLECYSTECTOMIES.
Intraperitoneal ropivacaine has postoperative analgesic effects in laparoscopic abdominal surgeries. Dexmedetomidine has been used as intraperitoneal instillation for postoperative analgesia. In this study our aim was to compare the postoperative analgesic efficacy of ropivacaine alone and ropivacaine with dexmeditomidine when used as an intraperitoneal instillation in laparoscopic cholecystectomies(LC). Methods: One hundred patients aged 20 to 60 years of ASA physical status I and II undergoing laparoscopic cholecystectomies were divided into 2 groups of 50 each. Group A patients received intraperitoneal instillation of 2 mg/kg ropivacaine along with 1 microgram /kg of dexmedetomidine in 50 ml and in Group B, patients received intraperitoneal instillation of 2 mg/kg ropivacaine in 50 ml normal saline( NS) before creation of a pneumoperitoneum. Postoperative pain abdomen, time to first rescue analgesia and total analgesic consumption was compared between the two groups. Results: VAS ( visual analogue scale for pain abdomen) was significantly lower in group A as compared to Group B(2.52 ± 0.73 in group A vs 3.53 ± 1.75 at 12 hours in group B, p<0.0001) . Time to first request of analgesia was found to be significantly lower in Group B ( 212.19min ± 14.42) when compared to group A (472.12 ± 23.65, P = 0.001). No of doses of rescue analgesia in 24 hours(1.42 ± 0.62 in group A vs 3.37 ± 0.56 in group B, p<0.0001) and total analgesic consumption(1285.0 gm ± 61.14 in group A vs 2340.0gm ± 86.12 in group B, p<0.0001) was significantly lower in group A when compared to group B. Conclusion: Intraperitoneal dexmeditomidine with ropivacaine is more efficacious than Intraperitoneal ropivacaine alone for postoperative pain management in laparoscopic abdominal surgeries.
COMPARISON OF POST OPERATIVE ANALGESIA WITH CAUDAL BUPIVACAINE VERSUS BUPIVACAINE + TRAMADOL IN PAEDIATRIC PATIENT UNDERGOING LOWER ABDOMINAL AND PERINEAL SURGERY
Pain is a common postoperative symptom impairing the quality of postoperative recovery, delaying discharge from Post-anaesthesia care unit (PACU) or surgical centre. It leads to an increase in the incidence of post-discharge readmissions. It increases overall morbidity and incurs higher costs. Ongoing acute postoperative pain may lead to chronic pain after surgery. Caudal block is a useful alternative/supplement to general anaesthesia and total I.V. anaesthesia as it provides effective post-operative analgesia.Considering the above facts, we have designed a randomised prospective intervention open labelled study using Bupivacaine alone and Bupivacaine plus Tramadol in caudal epidural block in order to assess duration of postoperative analgesia, haemodynamic changes, side effects and degree of sedation.
EVALUATION OF PRESCRIBING PATTERN AND SURVIVAL OF CHRONIC KIDNEY DISEASE PATIENTS ON HAEMODIALYSIS: A PERSPECTIVE FROM SUPERSPECIALITY TERTIARY CARE TEACHING HOSPITAL OF CENTRAL INDIA.
The incidence of CKD is increasing and there are very few studies of medication prescribing pattern in Haemodialysis patients in central India, hence the present study was planned to evaluate the medication prescribing pattern in CKD patients on haemodialysis. Methodology: An observational study with prospective design was conducted in the department of Nephrology in a superspeciality tertiary care teaching hospital from May 2011 to May 2012 and a total hundred and twenty (120) patients were enrolled after written informed consent of each patient. Results: Out of 120 patients of CKD undergoing hemodialysis, 95 were males and 25 were females with a mean age of 41.37 ± 13.25. Most common co-morbid condition associated with CKD was hypertension (92) followed by anemia (50). A total of 1926 drugs were prescribed off which only 285 drugs were prescribed by generic name. a total of 15 patients died out of 75 patients which were prescribed between 8-15 drugs about 12 patients died (9%).
A STUDY TO ASSESS THE LEVEL OF STRESS AMONG GRANDPARENTS RAISING THEIR GRANDCHILDREN OF WORKING PARENTS IN SELECTED URBAN AREA, KALYANPUR, KANPUR
Stress generally refers two things: the psychological perception of pressure, on the one hand, and body’s response to it, on the other, which involves multiple systems, from metabolism to muscle to memory. The stress that grandparents experience as repeat parents is quite different from the routine kinds of stress usually associated with raising children. Many of the grandchildren have substantial unmet physical, developmental and emotional needs and share an orientation toward and a history of family crisis that is different than the world of grandparents. The objectives of the study are assessing the level of stress among grandparents rearing their grandchildren of employed parents and to associate the level of stress with their selected demographic variables. In this research study, the research approach was quantitative research approach, research design was non experimental descriptive research design. The population was grandparents who are raising their grandchildren, selected by non probability convenient sampling technique. The sample size was 40. The study setting was Kalyanpur, Kanpur. The self-structured rating scale was used to collect data regarding level of stress among grandparents. The total mean of stress score 68.5. It was also proved that there was association found between level of stress and selected demographic variables like age of care givers, family income, type of residence, no. of grandchildren presently raising, previous occupation of caregivers and presence of any health issues for grandchildren.
SERUM MAGNESIUM LEVELS IN CRITICALLY ILL PATIENTS
INTRODUCTION- Magnesium being the fourth most populous cation in the human body, and the second most populous intracellular cation next to potassium; it plays an essential physiological role in many functions of the body. MATERIAL AND METHOD- A total of 96 critically ill medical patients, presenting to the Himalayan Hospital were recruited in the study. On admission, serum magnesium levels were recorded at entry. All cases were followed until discharge/death, to study correlation between serum magnesium levels and outcome of the patient. RESULT- 96 patients were enrolled in the study out of which 57.29 % patients were male and 42.7 % patients were female. Hypomagnesemia was observed in 12.5% patients and Hypermagnesemia in14.58 % patients. There was a significant association between hypomagnesemia and duration of ventilatory support, ICU stay and clinical outcome. CONCLUSION- Hypomagnesemia was significantly associated with duration of ICU stay, clinical outcome (mortality) and duration of ventilator support in critically ill patients. Thus hypomagnesemia is common in the critical care setting and should be looked for as it has an impact on the clinical outcome.
AN EXPLORATORY STUDY TO ASSESS THE PREVALANCE AND CAUSATIVE FACTORS ASSOCIATED WITH WORM INFESTATION AMONG PRESCHOOL CHILDREN (3-5 YEAR) IN SELECTED RURAL AREA OF JABALPUR, WITH A VIEW TO PROVIDE MASS HEALTH EDUCATION.
Worm infestations are amongst the most common infections worldwide.. These infections are regarded as serious public health problem, as they cause iron deficiency anemia, growth retardation in children and other physical and mental health problems. OBJECTIVES: Assess the prevalence and causative factors of worm infestation among preschool children (3-5year) in selected rural area of Jabalpur. METHODS: Quantitative research approach (Descriptive Exploratory research design) is used to conduct the present study. Convenient sampling technique is used to select the sample size of 100 preschool children. RESULT: 25% of preschool children are suffering from worm infestation. The mean score of causative factors of worm infestation is- Causative factor 1- Feces mean value is 2.92 with standard deviation 0.90. Causative factor 2- Food mean value is 3.28 with standard deviation 1.38. Causative factor 3-Flies mean value is 2.54 with standard deviation 1.4. Causative factor 4-Fomites mean value is 1.6with standard deviation 0.99. Causative factor 5-Fingers mean value is 4.51with standard deviation 1.89. Out of 25 positive samples the finger causative factor score highest (80%). There is significance variance between causative factors of worm infestation, between group df is 4 and within group 120,and the P value = 0.05 level = 3.92 and 0.01 level = 6.84 which is most significant and F – Ration = 23.61. CONCLUSION: Out of 100 samples 25 samples are worm infestation positive. It indicates that the wellness level of preschool children is not good and the researcher found that there is significant association between causative factors of worm infestation and demographic variables. It also shows that poor as well as average hygienic condition can cause the worm infestation among preschool children & mainly the finger causative factor is most responsible for worm infestation.
COMPARISON BETWEEN CLONIDINE AND EPINEPHRINE AS ADJUVANT TO BUPIVACAINE IN RESPECT TO ONSET AND POST OPERATIVE DURATION OF ANALGESIA IN SUPRA CLAVICULAR APPROACH BRACHIAL PLEXUS BLOCK IN UPPER LIMB SURGERY.
Introduction: Supraclavicular brachial plexus block is a popular and widely employed regional nerve block technique for intra-operative anaesthesia and post-operative analgesia for surgery of upper extremity. Local anaesthetics alone for supraclavicular brachial plexus block provide good operative condition but have shorter duration of postoperative analgesia. Alpha-2 agonists are mixed with local anaesthetic agents to extend the duration of spinal, extradural and peripheral nerve blocks. Materials and Methods: Seventy patients patients, scheduled for elective upper limb surgeries under supraclavicular brachial plexus block were divided into two equal groups in a randomized, double-blinded fashion. Group C received clonidine 150 μg, group E received epinephrine 200 microgram added to 0.5 ml/kg body weight of 0.5% bupivacaine. Onset time and duration of sensory and motor block, duration of analgesia and cardiorespiratory variables were studied in the two groups. Results: The onset time, duration of complete sensory and motor block was statistically highly significant between two groups. Time to rescue analgesic was longer in group C than group E. Conclusion: Small dose of clonidine produces early sensory and motor onset along with enhancement of the quality of the peripheral nerve block from local anesthetics and limits its two side effects to bradycardia and hypotension.
MICROALBUMINURIA AND LOW HEMOGLOBIN AS RISK FACTORS FOR THE OCCURRENCE AND INCREASING SEVERITY OF DIABETIC RETINOPATHY.
Aim: To assess the influence of urinary microalbuminuria and hemoglobin concentration on the occurrence and severity of diabetic retinopathy (DR). Materials and Methods: In this prospective cross-sectional study carried out over a period of 1 year, type 2 diabetic patients seeking ocular evaluation for DR were assessed for presence and severity of DR. Results: out of 100 patients were included in the study. DR of any grade was seen in 43 patients, Duration of diabetes (P < 0.001), microalbuminuria (P < 0.001) and low hemoglobin (P = 0.001)were found to be highly significant risk factors for the development and increasing severity of DR. Conclusion: Microalbuminuria and low hemoglobin are strong predictors for DR, in type 2 diabetics., Although not directly involved in the pathogenesis, microalbuminuria can help in identifying patients at risk for more severe diabetic eye disease. Microalbuminuria warrants intensive monitoring of both retinal and renal status. The hemoglobin levels should be monitored regularly in diabetic patients to detect and treat anaemia so that we reduce one risk factor for DR.
COMPARATIVE EVALUATION OF FUNCTIONAL OUTCOME OF USE OF PROXIMAL FEMORAL NAIL VERSUS DYNAMIC HIP SCREW IN THE MANAGEMENT OF PERTROCHANTERIC FRACTURE.
Introduction Pertrochanteric fractures are becoming increasingly common as our population ages. These fractures typically occur in elderly patients and often result in the end of the patient's functional independence .Conservative methods of treatment for pertrochanteric fractures have shown higher morbidity and complications rates . Rigid internal fixation and early mobilisation has become standard method of treatment for such fracture . A variety of treatment options have evolved like extra medullary implants (Fixed angle plates or D.H.S.) and intramedullary implants (P.F.N) for pertrochanteric fractures .There are numerous literature advocating for both the procedure citing their advantage of one over another. The present study was done with comparative evaluation of functional outcome of use of proximal femoral nail versus dynamic hip screw in the management of pertrochanteric fracture to determine whether there is advantage advantage of one method over other or not. Material and Method This prospective study was conducted in Netaji Subhas Chandra Bose Subharti Medical College from June 2017 to September 2019. Total 60 patients were included in this study in which 30 were included in PFN group “P” and 30 in DHS group “D”. Intra-operative parameters like duration of surgery, length of incision, c-arm exposure , blood loss were evaluated and post-operatively patient was followed for minimum of 6 months and evaluation was done by Harris hip score. Results PFN group had less blood loss, less length of incision, long duration of surgery, early union and fewer complication as compare to DHS group . Follow up of patients showed that Harris hip score at 24th week in PFN group was better than DHS group. Conclusion The present study demonstrates PFN group had better function outcome as compare to DHS group.
PARENTAL PERCEPTIONS AND PRACTICES REGARDING EYE HEALTH OF CHILDREN: A STUDY FROM A TEACHING HOSPITAL OF COASTAL KARNATAKA.
Aims: To assess the perceptions and practices followed by parents regarding eye health of their children. Setting & Design: A questionnaire based study done in a teaching hospital of coastal Karnataka. Material & Method: A cross-sectional study amongst 96 parents attending tertiary health care centre and camps conducted by the same centre, through a self designed validated questionnaire. Results: Age of the respondents ranged from 23 to 55 years. Majority (79.16%) were females. 69.79% and 90.62% of the parents knew that cataract and strabismus can occur in children respectively. Amblyopia as a complication of untreated refractive error was not known to 56.25% of the participants. Participants got the information about ocular conditions mainly from newspaper 70.83%. Overall knowledge regarding the use of different mode of treatments for the ocular conditions was good except patching. Parents (66.66%) preferred to take their children to an Ophthalmologist .The reason for not consulting a doctor for ocular conditions was found to be time and financial constraints. Conclusion: Parents were aware of common eye problems in children. Information about ocular health among parents was largely acquired through the newspaper which can be used as a tool to spread awareness. Increased awareness about these is required to positively affect the eye-care seeking behavior of parents for their children, thereby reducing visual impairment in this population.
TOTAL THYROIDECTOMY- COMPLICATIONS AND MANAGEMENT-AN INSTITUTIONAL AUDIT
Thyroid disorders are one of the most common endocrine diseases known worldwide for which patients require medical or surgical intervention. There had been tremendous increase in the incidence and prevalence of various benign and neoplastic pathologies of the gland in the recent past and hence their respective surgical interventions too have increased proportionately. Thyroid pathology is extremely common in the sub Himalayan terrain and considering the geographical location of North Bengal Medical College, we had been performing a significant number of thyroid surgeries since a long time. Our present study is a descriptive retrospective cohort study which deals with the complications after total or completion thyroidectomy with or without neck dissection.(CND with/without MRND). A detailed review of the complications along with the management and its respective literature review are also presented herewith.
COST VARIATION ANALYSIS OF SECOND GENERATION ANTIHISTAMINIC DRUGS (SGAS): A STUDY
Allergic rhinitis (AR) is the most common form of non-infectious rhinitis most commonly affecting adults. AR affects 10% and 30% of all adults and 40% of children. Epidemiologic studies by WHO show that the prevalence of AR continues to increase worldwide and is estimated as 400 million.[1] AR can impair quality of life and through loss of work and school attendance, is responsible for as much as $2 to $4 billion in lost productivity annually.
STUDY OF AWARENESS AND UTILITY OF CARTRIDGE BASED NUCLEIC ACID AMPLIFICATION TEST (CBNAAT) AMONGST DOCTORS
Introduction: CBNAAT is one of the most useful investigations in detecting tuberculosis and drug resistance. It is now included in new RNTCP guidelines. Majority of patients with tuberculosis receive care from a primary care physician such as general practitioners and the rest obtain treatment from specialists including respiratory physicians. This study aims to explore the awareness and utility of CBNAAT amongst general practitioners and specialists other than respiratory physicians. Aim: To obtain data regarding awareness and utility of the CBNAAT amongst the doctors. Methodology: A survey was carried out amongst the general practitioners including AYUSH doctors and specialists other than Respiratory physicians in the vicinity of our hospital regarding the awareness and utility of CBNAAT. Results: The awareness amongst surveyed population showed partial awareness regarding the CBNAAT and its utility is thus inadequate. Conclusion: It was concluded that many aspects of CBNAAT is not known to general practitioners.
A STUDY TO ASSESS THE KNOWLEDGE OF BREAST SELFEXAMINATION (BSE) AMONG WOMEN OF SELECTED RURAL COMMUNITY OF MAHARASHTRA.
Introduction – Breast disorders are a significant health concern for women. Whether benign or malignant, intense feelings of shock, fear, and denial often accompany the initial discovery of a lump or change in the breast. These feelings can be associated both with the fear of death and with the possible loss of a breast. Throughout history, female breast has been regarded as symbol of beauty, femininity, sexuality and motherhood. A number of screening tests have been employed including clinical and self-breast, mammography, genetic screening, ultrasound, and magnetic resonance imaging. BSE is the recommended method in developing countries because it is easy, convenient, safe and requires no specific equipment. Objectives:- To assess knowledge of breast self examination among rural women. Population: Women above the age group of 30 years. Methods:- A cross-sectional descriptive study with Convenience sampling technique was used to collect data from 50 samples. The research variables were Breast Self-Examination, knowledge. Based on the objectives a semi-structured questionnaire was prepared to identify sociodemographic variables along with knowledge on Breast Self-Examination. Data was analysed using simple statistical tests. Results:- Majority of the subjects are found to possess poor knowledge (62%) and 38% of the sample had average knowledge of Breast Self-Examination. Conclusion- The finding of the study revealed that the samples does not acquire adequate knowledge about Breast Self-Examination.
ASSOCIATED FACTORS AND OUTCOME OF UTERINE RUPTURE AT A TERTIARY CARE CENTRE
Objective: To find risk factors and causes of uterine rupture, treatment modalities and maternal and foetal outcome of uterine rupture in a tertiary care centre. Method: A 2-year retrospective study of 24 cases of uterine rupture was done. These cases were analysed for demographic profile, risk factors, management and maternal and foetal outcome. Results: Our study shows that most cases of uterine rupture found in women of low socioeconomic status (79.1%), 91.6% cases were unbooked and 95.7% were multiparous. 50% cases were due to obstructed labour and 41.6% were due to rupture of scarred uterus. Repair was done in 12.5% cases while hysterectomy was done in 87.5% cases maternal mortality was only 8.3% but neonatal mortality was very high (100%). Conclusion: Uterine rupture is a major cause of maternal morbidity and neonatal mortality. Obstructed labour, prior caesarean section and grand multipara were the major contributing factors. Identification of these highrisk women, early referral and optimal management needs to reduce maternal morbidity and perinatal mortality.
COMPARATIVE STUDY USING PAPANICOLAOU STAIN AND AGNOR STAIN IN CERVICAL SMEARS IN A TERTIARY CARE HOSPITAL
In India Cervical cancer is the second most common cancer among women. The AgNOR dots are quite useful in tumour detection. Aim: A comparative study using Papanicolaou and AgNOR stain in cervical smears. Material and Methods :present study was prospective analytical study,carried out in pathology department in tertiary care hospital.100 patients from Gynaec OPD were selected .Two cervical smears were prepared . One stain with conventional Papanicolaou stain and other with AgNOR stain . Cytopathological findings were compared with number of AgNOR dots of corresponding slide. Observations:The AgNOR dots increases ( NILM1.62 , Chronic cervicitis -2.01, LSIL-2.75and HSIL-4.06)severity of lesion increases. Conclusion: AgNOR dots tend to increase as the severity of lesion of cervix increase and also indicates AgNOR counts in cervical dysplasia has potential diagnostic importance.
BACTERIOLOGICAL STUDY OF DRINKING WATER : A STUDY FROM RURAL NORTH INDIA.
Background: The routine monitoring and assessment of the microbiological quality of water is the key priority for both water suppliers and surveillance agencies. Microbiological quality is of principal concern because of the acute risk to health posed by viruses, bacteria and helminths in drinking-water. Therefore, monitoring and assessment of drinking-water is primarily a health-based activity which emphasises the protection of public health through ensuring that the water supplied is of a good quality. Aim: The aim of this study is to analyze the bacteriological quality of the available drinking water collected directly from various sources, namely, water source supply outlets, as well as drinking water sources from different areas of Kangra district received in the Department of Microbiology of Dr.Rajendra Prasad Government Medical Collage & Hospital Kangra at Tanda. Methods: A total of 274 water samples from different sources received from april 2016 - may 2019. The bacteriological analysis of water was done by the multiple tube technique. Results were interpreted after 48 hours of incubation of the water sample in MacConkey bile broth medium in accordance with Mc Crady probability table. Results: Out of a total of 274 water samples were received in the Microbiology laboratory 5 (1.85%) sample were rejected due to improper transport, 112(41.63%) were unsatisfactory, 13(4.8%) suspicious, 117(44%) were satisfactory and 27( 10 %) were excellent. Nearly 5.5% samples from water tanks, 16.7% from public taps were unsatisfactory but water samples from all the aqua guards were excellent. Escherichia coli (71%) was the commonest isolate followed by, Citrobacter fruendii(24%), Klebsiella pneumaoniae spp.(3.6%) and Pseudomonas aeruginosa (1.4%). Conclusions: Bacteriological assessment of drinking water is essential and should be carried out on regular basis so as to prevent outbreaks of water borne diseases.
A CRITICAL REVIEW OF DEEPAN DRAVYA IN THE MANAGEMENT OF AGNIMANDHYA
Ayurveda is the science, which emphasize on health as well as cure of diseases. In Ayurved, Ahara, Nindra and Brahamcharya are mentioned as Tryopasthambha. Among Tryopasthambha, Ahara is described first which shows its importance. Ahara (Food) plays an important role in Dehanirmana. It is also important for growth and energy for our routine works but all the qualities of Ahara is worst if it is not digested properly. Acharya Charak clearly said that Ahara Matra is depends upon strength of Agnibala. Agni converts food in the form of energy, which is responsible for all the vital functions of our body. Mandagni is the state of Agni which cannot digest even little quantity of food in the scheduled time. In Ayurvedic classics Mandagni is described as the root cause of many diseases. Mandagni produces ama which is able to activate autoimmune system. Mandagni leads to several severe diseases like Obesity, which is major key factor to heart diseases, hypertension, diabetes etc. So, for the management of Mandagni, Deepan Dravyas described in Ayurvedic classics are very useful.
AFFERENT LOOP SYNDROME IN A PATIENT WITH PAST HISTORY OF BILLROTH II PROCEDURE FOR ANTROPYLORIC GROWTH STOMACH.
Afferent loop syndrome in a patient with past history of billroth II procedure for antropyloric growth stomach.
CLEAR CELL SARCOMA OF KIDNEY – A RARE CASE REPORT
Clear cell sarcoma of the kidney is a rare malignant tumor mostly seen in children less than five years of age with a slight male preponderance. Patients usually present with a palpable abdominal lump, abdominal distention, pain and gross hematuria. It is an aggressive tumor with about 17-40% of patients presenting with bone metastasis. It is one of the renal tumor in children which is most frequently misdiagnosed as it is rare, has varied histomorphology and lack of specific diagnostic markers. However, BCOR gene have emerged as a recent molecular marker. Management includes total nephrectomy followed by postoperative chemotherapy and radiotherapy. We describe a case of clear cell sarcoma of kidney diagnosed on histopathology in a 2.5 year old male child.
DEXAMETHASONE (8MG) AS AN ADJUVANT WITH BUPIVACAINE (0.5%) IN EPIDURAL ANAESTHESIA FOR LOWER LIMB SURGERY - A COMPARATIVE STUDY OF 60 CASES
Introduction: Surgical Anaesthesia and perioperative Analgesia delivered through an indwelling epidural catheter is a safe and effective method for management of Perioperative pain. We planned to evaluate addition of dexamethasone 8 mg (2cc) to bupivacaine 0.5% plain(16cc) in epidural block in patients undergoing lower limb surgery to study sensory and motor blockade characteristics, postoperative analgesia and side effect profile. Method & Material: All patients were divided into two groups-group BD(n=30), inj.Bupivacaine (0.5%) plain 16 ml with 2 ml Dexamethasone (8mg) via epidural catheter and Group B(n=30) Inj. Bupivacaine (0.5%) plain 16 ml with 2 ml normal saline via epidural catheter. Assessment of peri-operative pain was evaluated by using visual analogue scale . Result: Intraoperative pulse rate, systolic blood pressure, diastolic blood pressure and mean blood pressure changes in both Groups show no significant difference. The onset of sensory and motor block was earlier, duration of sensory and motor block was longer, duration of analgesia was longer in Group BD than Group B. There was statistical difference between onset and duration of sensory and motor block between two groups. None of the patients in both the groups required epidural top up dose or show any complications. Conclusion: Addition of dexamethasone (8mg) to Bupivacaine 0.5% plain (16ml) when given epidurally influence the sensory and motor block by shortening the onset time, early peak effect and prolonging the duration of surgical anaesthesia and prolonged analgesia without affecting the other parameters and no complications perioperatively.
A STUDY ON DERMATOLOGICAL OUTCOME IN DENGUE FEVER
Background: Around the world dengue incidence has dramatically grown witha large number of asymptomatic cases. Worldwide about 390 million dengue infections were occurring per year, among them 96 million people were developing clinical manifestations with varied severity. About 3.9 billion people residing in 128 countries, were at-risk of dengue virus infection.Dengue fever (DF) is one of the common causes of acute febrile illness. In half the patients with dengue fever skin involvement occurs. Aim& Objectives: To study the socio-demographic parameters, clinical features and laboratory parameters among the patients with and without skin rash in dengue infection. Also determine outcome among the patients with dengue fever and its association with skin rash. Material and Methods: A hospital-based, analytical prospective study was conducted in the Department of General Medicine, Kamineni Institute of Medical Sciences, Narketpally, Nalgonda (Dist), Telangana. Patients older than 16 years of age with clinical features and laboratory reports suggestive of dengue infection were included. The study was conducted for a period of 6months from 1st August 2018 to 31st January 2019. These patients were further divided based on the skin rash presence and absence. The data obtained was entered in Microsoft Excel and analyzed in SPSS version-22 trial. Analysis was done using unpaired students t-test, ANOVA. Results: In total 97 patients with dengue fever were enrolled into the study. About 14.4 p.c (14) patients were with skin rash. The patients with skin rash were found to have lower platelet levels during the disease course. Patientswith skin rash had higher percentage of platelet transfusion which was statistically significant. Conclusion: A cutaneous involvement may facilitate clinical diagnosis but it may not be present among all the patients.
CYTOPATHOLOGICAL EVALUATION OF THYROID LESIONS WITH IMPLEMENTATION OF BETHESDA SYSTEM: A 6.5 YEARS STUDY
Thyroid nodules are commonly encountered in clinical practice. Fine needle aspiration (FNA) of these nodules is widely accepted, cost-effective and simple method for diagnosis. This study aims at determining the distribution of diagnostic categories according to The Bethesda system for reporting thyroid cytopathology (TBSRTC), to analyze cytological features and correlate them with histopathology. We report retrospective and prospective analysis of 869 FNA of thyroid nodules using the Bethesda system. FNA were performed in prospective cases (554), whereas in retrospective cases (315) all smears were reviewed. All cases were categorized into six Bethesda categories. The sensitivity, specificity, positive predictive value, negative predictive value was calculated. The distribution of 869 evaluated thyroid nodules was as follows: 3.68% Nondiagnostic / unsatisfactory, 86.77% benign, 1.73% atypia of undetermined significance, 3.2% follicular neoplasm, 2.53% suspicious for malignancy and 2.07% malignant. In 141 cases, histopathological correlation was available and of these cytohistological concordance was found in 94% cases. The sensitivity, specificity, positive predictive value, negative predictive value and overall accuracy were 76%, 96%, 84%, 95% and 93% respectively. The risk of malignancy in categories II, III, IV, V and VI was 1.8%, 25%, 29%, 70%, & 100% respectively. Use of TBSRTC in well-defined and consistent manner especially in grey zone areas of thyroid cytopathology, allow appropriate evaluation of thyroid lesions cytologically.
ALKAPTONURIA-- A CASE REPORT OF RARE DISEASE
Alkaptonuria also known as Black Bone Disease or Black urine disease is a rare autosomal recessive disorder. It was first described by Archibald Garrod as an inborn error of metabolism in 1902 in London.(4 ).The problem is in tyrosine metabolism in the liver due to deficiency of homogentisinate 1,2 dioxygenase (HGD).Which results in accumulation of homogentisic acid (HGA) in the cells and body fluids. The oxidized polymers bind to collagen, leading to progressive deposition of grey to bluish black pigment resulting in degenerative changes in cartilage, intervertebral disc and other connective tissues leading to arthritis This is the main disabling effect seen in later life. The diagnosis can be made in neonates and infancy when blackish stain is noticed in an unchanged diaper. The classical triad is that of that of homogentisic aciduria, arthritis and ochronosis. Treatment of Alkaptonuria is mainly symptomatic. Ascorbic acid (Vit C) and dietary restriction of foods containing phenylalanine and tyrosine is recommended. Surgical intervention may be required at a later date in advanced stages. The disease is very common in Dominion Republic and Slovakia.
Osteopetrosis is a very uncommon genetic disorder with characteristic features of increased bone density due to impaired bone resorption by osteoclasts. This leads to increased bone density. It is classified into three forms: Infantile malignant autosomal recessive (AR) Osteopetrosis, intermediate (AR) Osteopetrosis and autosomal dominant (AD) Osteopetrosis. Incidence of infantile malignant AR is 1/2, 00,000 and if untreated has a fatal outcome. The condition is commonly diagnosed in infancy with symptoms of significant hematological abnormalities and bone marrow failure, hepatosplenomegaly, macrocephaly with frontal bossing and bone fractures. As malignant infantile form of Osteopetrosis is very rare, we are reporting a case of Malignant Infantile Osteopetrosis who presented to us with convulsions and a bulging fontanel , anemia and melaena at eight months of age.