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Study and correlation of clinical, radiological, cytological, and histopathological findings in the diagnosis of thyroid swellings
Anuja Raniwala, DD Wagh, Ashwini Dixit-Shukla, Ninad Shrikhande, Mangesh Padmawar
April-June 2017, 12(2):138-142
Objectives: To study the clinical profile of patients with thyroid swellings. To study the radiological findings of these patients. To study the histopathological outcome. To correlate these factors in order to make diagnosis of malignant thyroid swellings in patients more accurate. Study Design: The present study: 'Study and correlation of clinical, radiological, cytological with histopathological findings in the diagnosis of thyroid swellings' was carried out in Jawaharlal Nehru Medical College and Acharya Vinoba Bhave Rural Hospital, Sawangi Wardha from July 2013 to October 2015 It was carried out as a cross sectional observational study involving OPD based patients requiring further management. The sample size was fixed at 60 patients. All the patients of any age and either gender having goitre requiring surgery were included. Every patient was evaluated in terms of detailed history, thorough examination and relevant investigations. Results: Out of 60 patients, 51 (85%) were female and 9 (15%) were males. Maximum i.e. 22 (36.67%) cases belonged to the age group 41-60 years. More than half i.e. 34 (56.67%) of the patients came with a swelling on one side of the neck. 11 (18.33%) patients came with complains of Solitary nodule of Thyroid. The main complaint was anterior neck and was of grade 3 as per WHO Grading in 28 patients (46.67%). The duration of swelling was between 1-7 years in 30 (50%) patients followed by < 1 year in 17 (28.33%) patients. On clinical examination, 53 (88%) were diagnosed as benign and remaining 7(22%) as malignant swellings. Later on FNAC (done under ultra sound guidance), 8 (13%) patients were diagnosed with malignant swellings. Malignancy was noted in 13 (21.67%) cases on histopathology. A correlation between the diagnosis made pre-operatively on clinical examination, USG and FNAC was made with the Gold Standard for diagnosis of malignant thyroid swellings i.e. Histopathology. Conclusion: Goitre was common in females of middle age and majority had single lobe enlargement. Most of them presented with large goitres which were present since many years. On clinical evaluation, the symptoms suggestive of malignancy were pressure symptoms and lymph node enlargement. Multinodular goitre and colloid cysts were the commonest findings on FNAC. FNAC is a reliable tool of investigation for thyroid nodule. Using a thorough clinical examination, ultrasound and FNAC, a surgeon can reliably diagnose malignancy in thyroid glands and choose appropriate surgery for the treatment of the same. Histopathology is gold standard for confirmation of the diagnosis of malignancy post operatively.
  1,734 113 -
Assessment of maternal and perinatal outcome in postdated pregnancy
Ritika Bhriegu, Manjusha Agrawal, C Hariharan
January-March 2017, 12(1):35-40
Objective: To study maternal and neonatal outcome in postdated pregnancies. Study Design: Prospective observational study. Results: Of 100 cases 79(79%) cases were under 20 to 25 years, majority cases were primigravida (62%), overall caesarean rate was 34%, Meconium stained liquor with fetal distress was the most common indication for LSCS 8(23.5 %) , fetal distress was the most common fetal complications, rate of NICU admission was 33.33% at 41 weeks 1 day to 42 weeks, rate of induced labour is 71.43% at 41 weeks 1 day to 42 weeks. Conclusion: In our study we concluded that prolonged pregnancy was associated with significant risk of perinatal complications like fetal distress, meconium aspiration syndrome and IUGR. There was significantly increased risk of obstetric complications like oligohydramnios, perineal tear, atonic pph and shoulder dystocia.
  1,599 208 -
A comparative study of cilostazol and pentoxifylline in intermittent claudication in peripheral arterial disease
Kshitij Gupta, Chandrashekhar Mahakalkar, Meghali Kaple, Swati Deshpande, Prateek Ladhha, Niket Jain
January-March 2017, 12(1):11-16
Aims: A comparative study of Cilostazole and Pentoxifylline on intermittent claudication in patients of peripheral arterial disease. Materials and Methods: A total of 70 patients clinically proven occlusive peripheral arterial disease admitted at wards of General Surgery at Acharya Vinoba Bhave Rural Hospital, Sawangi, Wardha. It was prospective study the patients were randomized in two groups in 1:1 ratio. The randomization was done using a random allocation sequence generated by computer program and sequential patient consenting to participate in the study was allocated in the respective treatment arms - Cilostazole and Pentoxyphylline per the allocation sequence. Group I Patients (n=35) were administered Tab. Pentoxifylline 400 mg thrice a day; Group II (n=35), Tab Cilostazol 100 mg twice a day. History, clinical examination, all routine investigation including lipid profile, color Doppler study of lower limb and Angiography of lower limb vessels was performed at the start of the trial. Patients were re-evaluated at the time of enrolment and at 24 weeks for Intermittent Claudication Distance (ICD), Absolute Claudication Distance (ACD), and Ankle Brachial Index (ABI). Results: The group II (Cilostazole Group) showed more rise in intermittent claudication distance and Acute Claudication Distance as compared to Pentoxifylline. There was also statically improvement in ankle brachial index of Group II (Cilostazole Group) as compared to Group I (Pentoxifylline). Conclusion: Thus, the comparative analysis revealed that the efficacy of Cilostazole is more than the Pentoxifylline in increasing the ICD and ACD in patients of occlusive peripheral arterial disease with stable intermittent claudication in patients of peripheral arterial disease.
  1,566 199 -
A clinical study of self-stigma among the patients of schizophrenia and alcohol dependence syndrome
Lipsy Modi, Imran Ali Shivji, Prakash B Behere, Kshirod K Mishra, Pradeep S Patil, Arvind Goyal
July-September 2017, 12(3):161-165
Background: Most patients with mental illness hesitate to use health services mainly because of two reasons. First, they do not want to be labeled as a “Mental Patient” and second to avoid the consequences associated with stigma. With this study, we intend to compare self-stigma between two illnesses and correlate it with sociodemographic and clinical variables. Materials and Methods: The study was conducted on consecutive male and female patients (50 with a diagnosis of schizophrenia and 50 with alcohol dependence syndrome as per International Classification of Diseases-10 diagnostic criteria), evaluated on sociodemographic pro forma and Internalized Stigma of Mental Illness Scale. Results: The total stigma scores were significantly different for all the three age groups, being more in the patients of age <30 years (2.78 ± 0.51) than the patients of other age groups. Furthermore, patients belonging to rural locality (2.77 ± 0.41) had higher scores than the patients from urban locality (1.92 ± 0.49). Patients with alcohol dependence syndrome (2.66 ± 0.54) had significantly higher total stigma scores than patients with schizophrenia (2.29 ± 0.59). However, patients with schizophrenia (2.55 ± 0.39) had higher scores on subscales of stigma resistance than of patients with alcohol dependence (2.34 ± 0.51). Conclusion: Patients with alcohol dependence experience higher level of self-stigma as compared to patients suffering from schizophrenia. Future research in stigma needs to be clinically driven and should help to develop standards of care because self-stigma acts as barrier which prevents people with mental illness to use health services consequently affecting the course and prognosis of their illness.
  1,522 165 -
Correlation between dermatoglyphic pattern of right thumb; learning methodologies; and academic performance of medical students
Satheesha B Nayak, Jeevan Velan, Ng Leong Shern, Loi Fuang Zoung, Abihirami Jeyarajan, Ashwini P Aithal
July-September 2017, 12(3):177-180
Background: Dermatoglyphics is developing its importance in everyday life and researchers are keen to unveil various unknown aspects of dermatoglyphics in biology, anthropology, genetics, and medicine. The present study was conducted to assess the relationship of thumbprint, learning methodologies, and academic performance of medical students. Methodology: A total of 143 medical students voluntarily participated in this study. Ethical committee clearance was obtained before the study. Validated questionnaires were distributed to the students, and their right-handed thumbprints were collected simultaneously. The data were analyzed using Microsoft Excel. Results: The most common dermatoglyphic pattern observed among the students was whorls. Malays, Malaysian Indians, and Chinese mostly had whorl pattern, while among the Sri Lankans the most common pattern was radial loop. A high percentage of students with ulnar loop scored distinction while students with other patterns mostly scored pass marks. Active learning strategies such as bringing reference books to class, revising previous chapters before class, taking notes in class, surfing internet for learning was seen mostly among the students with ulnar loop. Conclusion: Most of the students with whorl pattern were either in low or average scoring groups. Individuals with ulnar loop were significant for this study as they had higher scores and better learning methodologies compared to other students.
  1,510 150 -
Effect of music therapy in patients with moderate-to-severe traumatic brain injury
Bobba Ushasree Reddy, P Phanisree, M Priyanka, D Kavitha, S Indira, Prashant Bhandarkar, Veda Dhruthy Samudrala, Amit Agrawal
January-March 2017, 12(1):51-54
Introduction: Following traumatic brain injury (TBI), there are different innovative approaches to improve or enhance the recovery of brain. Musical therapy has shown promising results in better improvement of TBI patients. Such studies from our country are meager. The present study investigates the effect of musical therapy on TBI patients who have undergone brain surgery. Methodology: It is a prospective study conducted at Tertiary Hospital at Nellore. Moderate-to-severe brain injury patients who have undergone neurosurgery were selected. Three Indian classical ragas were selected and given as follows; Hindola in the morning, Todi in the afternoon, and Kalyani in the evening. The mp3 music was given over earphones at specific time for 30 min duration throughout a week. Vitals parameters such as heart rate, systolic blood pressure (SBP), respiratory rate, pupillary movement, and motor activity of patients were documented before and after music therapy. The SPSS version 20.0 software was used for statistical analysis. Results: Ten selected patients were undergone through predefined session for three times a day with consecutive 7 days. Mean age of the patients was 48.5 (23–71 years) and majority (90%) were male. Two hundred and ten responses of each, like this for ten patients, heart rate changes were observed in 77% with mean change of 0.92 units. On average, 5.20 units heart rate was decreased and 6.20 units increased after music therapy. Changes in SBP were observed in 63%with mean change of 1.36 units. About 9.10 units were lower and 10.95 units were higher after therapy. Nearly 64% responses of patients were changed for respiratory rate, with mean change of 0.13 units. On an average of 3.00 units, respiratory rate was decreased, and 4.22 units increased after musical therapy. Conclusion: The present study reports that musical therapy for TBI patients after neurosurgery has an important role in changing the vitals parameters such as respiratory rate, heart rate, and SBP. Detail prospective studies with larger number of patients are required to get in-depth knowledge on effect of musical therapy.
  1,373 164 -
Mentolabial sulcus: An esthetic-based classification
Dinesh Rokaya, Bishwa Prakash Bhattarai, Kanokwan Suttagul, Dashrath Kafle, Manoj Humagain
January-March 2018, 13(1):16-19
Objectives: The objectives of this study were to study the mentolabial sulcus in Nepalese, to compare the sulcus between male and female, and to classify the sulcus according to the angle. Materials and Methods: This study was conducted in 160 university students (65 males and 95 females) between April and September 2016. Photographs of all the students were taken using a digital camera. Mentolabial sulcus angles were measured from the lateral photographs using an angle instrument. The data were analyzed using SPSS 22. The comparison of sulcus between male and female was done using two-sample t-test at 95% confidence interval. Results: The mean mentolabial sulcus angle in Nepalese was 118.19° ±12.28° (male: 119.43° ± 9.99° and female: 117.61° ± 13.23°). There was no statistically significant difference of sulcus angle between males and females (P = 0.098). The sulcus was classified as deep, average, and shallow in males and females. In total students, the average was more predominant followed by deep and shallow. Conclusions: The mean mentolabial sulcus angle in Nepalese was 118.19° ± 12.28°, in male was 119.43° ± 9.99°, and in female was 117.61° ± 13.23°. The sulcus was classified as deep, average, and shallow. There was no statistically significant difference of sulcus angle between males and females. The average type of sulcus was more predominant in Nepalese.
  1,345 101 -
A comparative study of scalpel versus surgical diathermy skin incisions in clean and clean-contaminated effective abdominal surgeries in AVBRH, Wardha, Maharashtra, India
Noopur Priya, YR Lamture, Luv Luthra
January-March 2017, 12(1):21-25
Aim: To study the safety and efficacy of diathermy as a modality to give skin incisions. Study Design: Observational study conducted in department of surgery at AVBRH, over 2 years from 2013 to 2015. Material and Methods: 100 cases were studied. In 50 cases incision was given by scalpel and in 50 incisions was given by diathermy. Primary outcome variable was the incisional blood loss, calculated by measuring the weight of swabs used exclusively during incision until complete hemostasis was achieved. Secondary outcome variables were incision time, operative time, pain verbal rating scale (VRS), wound healing, and wound complications. Incision time was defined as the time from the beginning of skin incision until subcutaneous fat arrived, with complete haemostasis; it was expressed in s/cm2. Severity of pain was defined using VRS. Results: we reported shorter time for skin incision, lesser blood loss during surgery and lesser wound complication in cases of diathermy incision, and has more significant pain reduction as compared to scalpel group. Conclusion: The findings of the present study shows that diathermy seems to provide some benefit with respect to postoperative wound pain and has obvious safety advantages to the surgical team compared with scalpel.
  1,114 118 1
Comparative study of type I tympanoplasty with or without mastoidectomy in tubotympanic type of chronic suppurative otitis media patients
Disha Amar Methwani, Prasad T Deshmukh
April-June 2017, 12(2):85-88
Objectives: The aim is to compare the results of type I tympanoplasty alone and tympanoplasty with cortical mastoidectomy in safe chronic suppurative otitis media (CSOM) patients in terms of graft uptake, improvement in hearing and clinical improvement. Study Design: This was prospective study. Materials and Methods: Sixty cases of safe type of CSOM were included in the study. Type I tympanoplasty was done in thirty cases and tympanoplasty with cortical mastoidectomy was done in another thirty cases. Patients were followed up postoperatively at 3, 6, and 12 weeks for graft uptake and any complication. Pure-tone audiometry was done at 6th and 12th week postoperatively to note the hearing improvement. Results: Graft uptake was 76.67% in tympanoplasty alone group and 83.33% in tympanoplasty with cortical mastoidectomy group. In the present study, pre- and post-operative pure-tone average was compared and the statistical difference between tympanoplasty group and tympanoplasty combined with cortical mastoidectomy group was not statistically significant. Recurrence of discharge was seen in 6 cases of tympanoplasty alone group. Although tympanoplasty combined with cortical mastoidectomy is better in hearing yield, graft acceptance rate, and clinical benefit, but the difference in two groups is statistically insignificant. Conclusion: Hearing outcome, graft acceptance rate, and clinical benefit were statistically unequalled in two groups. Tympanoplasty combined with cortical mastoidectomy will not give an additional advantage in terms of hearing gain, disease clearance, and graft uptake.
  1,036 158 -
An epidemiological study of acute malnutrition in children of age 6 months to 5 years in an Urban Slum of Mumbai, Maharashtra
Durgesh Prasad Sahoo, Armaity Dehmubed, Mahesh B Jajulwar
July-September 2017, 12(3):181-186
Introduction: Malnutrition continues to be one of the major causes of morbidity and mortality among under-five children in developing countries. There are numerous factors that directly or indirectly affect the nutritional status of the children. Aim: This study aims to study the prevalence and associated risk factors of acute malnutrition in children 6 months to 5 years of age in an urban slum. Subjects and Methods: This community-based cross-sectional study was carried out in an urban slum in Mumbai. A total of 270 children of age 6 months to 5 years were enrolled in the study. Samples were selected by simple random sampling from various sectors. All mothers/informant were interviewed, and anthropometric measurements were recorded. Data were analyzed using SPSS version 20.0 and Chi-square test was used to find out the association between two qualitative variables. Results: The prevalence of underweight, stunting, and wasting were 52.2%, 42.2%, and 50.4%, respectively. The factors associated with acute malnutrition were age of the child, mother's educational status, occupation of mother, type of family, socioeconomic status, age at marriage below 18 years, children who were given prelacteal feeds, were not exclusively breastfed and were partially immunized. Conclusions: The findings of the present study revealed that higher prevalence of acute malnutrition was found in the children of urban slum in Mumbai. Socioeconomic development along with counseling on breast-feeding practices and nutrition education among the urban slum masses needs to be ensured which is an important factor to combat malnutrition.
  1,060 125 -
Evaluation of knowledge and awareness about the ebola virus disease among the medical undergraduate students: A cross-sectional study
P Abhinitha, Camelia Putri Binti Yusof, Shaktesh Shanmugam Muthusamy Sinniah, Naveen Kumar
April-June 2017, 12(2):89-92
Introduction: Ebola virus disease (EVD), also known as Ebola hemorrhagic fever, is a fatal illness and it can be transmitted to people from wild animals and spreads in the human population by human-to-human transmission. Proper awareness of viral infection is necessary for both general population and medical professionals in minimizing the rate of mortality of the infected individual. The current cross-sectional study has been undertaken to evaluate the level of awareness about EVD in medical undergraduate students at their early academic curriculum. Materials and Methods: A total of 282 MBBS students of Malaysian origin studying in India were included in the study. Faculty-validated close-ended questionnaire was designed which comprised the questions related to general and medical-related aspects of Ebola virus. Results: Overall knowledge on EVD was moderate (score 2) with a majority of students (59%) followed by 35% of students having a low level (score 1) of awareness and only minimal number (6%) of students having an adequate level of awareness (score of 3). Conclusion: Overall knowledge about EVD among the medical undergraduate students at their preliminary curricular stages was in a satisfactory range with a score of 2. Nevertheless, their awareness of medical perspectives of EVD is comparatively more than that of general aspects.
  997 136 -
Comparative evaluation of effectiveness of surgical blade, electrosurgery, free gingival graft, and diode laser for the management of gingival hyperpigmentation
Pooja P Suryavanshi, Prasad V Dhadse, ML Bhongade
April-June 2017, 12(2):133-137
Aim and Objectives: To compare effectiveness of surgical blade, electrosurgery, free gingival graft (FGG), and diode laser for the management of gingival hyperpigmentation. Materials and Methods: Forty patients who were concern for the unesthetic anterior gingival due to melanin hyperpigmentation were treated in this study. Of 40 patients, 10 patients were treated using surgical blade, 10 by electrosurgery, 10 using FGG, and 10 patients using diode laser. The gingival hyperpigmentation was recorded preoperatively and 3 months postsurgery by measuring area of hyperpigmentation in square millimeters and severity of hyperpigmentation using Dummet's oral pigmentation index. Results: Healing was uneventful and required no supportive therapy. No patients experienced severe pain during or postsurgically. Mild discomfort was more common in FGG during the 1st week. At 3 months localized area of repigmentation was seen in group treated by surgical blade and electrosurgery. However, no repigmentation was noticed at 3 months in diode laser group and free gingival group. Conclusion: Depigmentation of gingival hyperpigmentation using diode laser and FGG were found to be effective procedures. However, diode laser yields esthetically acceptable results along with patient satisfaction.
  979 120 -
Morphometric measurement of fetal femur length for the prediction of gestational age in the IInd and IIIrd trimester of pregnancy by ultrasonography
Monalisa Roy, Ujwal L Gajbe, Brij Raj Singh, Priti Thute
July-September 2017, 12(3):187-190
Introduction: Femur length (FL) is a fetal biometric parameter used for estimation of gestational age. Gestational age determination by ultrasonography (USG) is very essential as it gives an accurate estimation. Aim and Objectives: This study is an attempt to measure FL of the fetus for the prediction of gestational age in the IInd and IIIrd trimester of pregnancy by USG. Materials and Methods: Five hundred pregnant women in the IInd and IIIrd trimester with the single live fetus and having no other complications either in mother or fetus, were selected for the study. Fetal FL was measured, and results were analyzed for accuracy in estimation of gestational age and were compared with findings of other workers. Observation and Results: Gestational age estimated from FL in 500 cases between 20 and 36 weeks of gestation showed that in the mean FL in each week of gestation the maximum difference of ±0.7 mm was found in the IInd trimester and ±2 mm was in the IIIrd trimester. The accuracy of the correctly diagnosed cases and P value decreases as pregnancy advance. Conclusion: Sonographic examination was found to be effective to assess the accurate FL parameter for different weeks of gestation. FL was found to be more appropriate in predicting gestational age in the IInd trimester and its reliability decreases in the IIIrd trimester.
  1,028 71 -
Clinical profile and management of primary open-angle glaucoma patients above 40 years: A rural hospital-based study
Praveen Tidake, Surabhi Sharma
January-March 2017, 12(1):1-6
Aim: The aim was to do appropriate screening of the patients of primary open angle glaucoma (POAG) visiting ophthalmology OPD in AVBRH, Sawangi(Meghe) and to compare Visual Acuity(VA), Intraocular Pressure(IOP) retinal nerve fiber layer (RNFL) thickness measurements using optical coherence tomography (OCT) and visual field defects(VFD) with age and sex. Materials and Methods: In this cross-sectional, observational, clinical study ,100 eyes of 50 patients with POAG above 40 years of age were examined. They underwent investigations like visual acuity, intra ocular pressure, fundus examination, gonioscopy, optical coherence tomography (OCT) of optic disc examination and perimetry. Only patients who had intraocular pressure (IOP) greater than 21 mmHg were enrolled into the study. Results: A total of 100 eyes of 50 patients were examined. Mean age of 50 patients was 54.22±13.28 (25-82 yrs), out of which, were 54% were females and 46% were males. At presentation,34% had blurring of vision and 16% had eye pain or photophobia. The mean IOP was 27.49±5.50 mmHg, and the mean CDR was 0.65±0.1. Conclusion: Visual Acuity(VA),Intraocular Pressure(IOP) retinal nerve fiber layer (RNFL) thickness measurements using optical coherence tomography (OCT) and visual field defects(VFD) are correlated to each other and show a correlation with age but not with gender.
  974 105 -
Birth preparedness and complication readiness among rural pregnant women: A cross-sectional study in Udupi, Southern India
Jayata Gurung, Varalakshmi Chandrasekaran, Sameer Phadnis, VS Binu
January-March 2017, 12(1):70-74
Introduction: As per the WHO estimates in 2013, about 289,000 women died of complications related to pregnancy or childbirth. The present study aimed at assessing the status of birth preparedness (BP) and complication readiness (CR) among rural pregnant women and its correlates in coastal Karnataka in Southern India. Methods: This cross-sectional study was conducted in Udupi taluk. In all, 305 pregnant women in the second and third trimesters of pregnancy were interviewed. Two-stage cluster sampling was used to select 320 women. To achieve this sample size, of 16 clusters using simple random sampling, 20 pregnant women in the second and third trimesters were selected from each village with the help of lay health workers in the community. Results: Among 305 pregnant women, 157 pregnant women (51.47%) were prepared to face birth. The factors associated with preparedness were awareness about expected date of delivery (odds ratio [OR] = 2.48, 95% confidence interval [CI]: 1.15–5.35) and at least one danger sign during delivery (OR = 2.88, 95% CI: 1.28–6.51). The identification of skilled birth attendant and arrangement for transportation were high at 99% and 100%. However, only about 42.3% of the respondents had identified a health facility for an emergency. Conclusion: The low preparedness level may be due to inadequate maternal knowledge on BP/CR practices as a result of inadequate information being provided to pregnant women. This study places emphasis on the need to plan and implement training programs for the health-care providers (ASHA, auxiliary nurse midwife's, staff nurse) on the components of BP/CR.
  923 143 -
Laparoscopic approach to adnexal mass in adolescents: A retrospective analysis
Kavitha D Yogini, Devi Balasubramaniam, Chinnusamy Palanivelu, Amrutha Kakollu
January-March 2017, 12(1):55-60
Background: Adnexal masses result from benign or malignant lesions of ovarian, tubal and paratubal origin as well as pregnancy related causes such as mullerian anomalies, infectious causes and ectopic pregnancy. The current study aimed to evaluate the preoperative diagnosis, surgical procedure and histopathological findings of adolescent girls who underwent laparoscopic surgery for adnexal mass in our hospital. Materials and Methods: A retrospective chart review of patients with adnexal mass was conducted over a period of one year from Jan 2014-2015. Overall 96 patients were included in the study after reviewing clinical records. In all the patients' malignancy was excluded by preoperative imaging with sonography, CT or MRI and tumor marker study. Results: Laparoscopy was the operative approach for all 96 patients. None resulted in malignant histology. Majority of the adnexal masses were simple cyst (28%), 11.4% were dermoid cyst, 2% were endometriotic cyst. One patient had tubal ectopic, 3 patients had Koch's abdomen and pelvis. Among them one 13 year old girl underwent rudimentary horn excision who presented as a para tubal mass with acute abdomen. Almost half of the patients (68.7%) presented with acute abdomen of which 41.6% were adnexal torsion. All adnexal masses were resected laparoscopically and the outcome was uneventful in all the patients. Conclusion: Laparoscopy is regarded as an appropriate surgical method for benign adnexal masses which was safe and effective even for giant ovarian cyst in well selected cases as most of the pelvic adnexal masses seen in adolescents and young girls are of benign nature.
  941 122 -
A comparison between intrathecal dexmedetomidine with hyperbaric bupivacaine and intrathecal fentanyl with hyperbaric bupivacaine in lower abdominal surgeries: A prospective double-blinded study
Lyba Ann Varghese, Karuna Taksande
April-June 2017, 12(2):99-109
Background: The aim of this study is to compare the efficacy and safety of injection dexmedetomidine 5 μg and injection fentanyl when given intrathecally as adjuvant to injection bupivacaine in patients undergoing total abdominal hysterectomy in terms of the following parameters: (1) Characteristics of onset of sensory and motor block. (2) Characteristics of regression of sensory and motor block. (3) Level of sedation (4) Hemodynamic stability as assessed by pulse rate, systolic, and diastolic blood pressure (BP) and requirements of vasopressors. (5) Quality of postoperative analgesia as assessed by visual analog scale. (6) Evaluation of complications associated with injection dexmedetomidine and injection fentanyl when used as an adjuvant to injection bupivacaine. Materials and Methods: Ninety patients of the American Society of Anesthesiologists Class I and II posted for lower abdominal surgeries were allocated randomly into three groups of thirty patients each. C group: (n = 30) received 0.5 mL normal saline with hyperbaric bupivacaine 17.5 mg in 3.5 mL to make 4 mL. D group: (n = 30) received dexmedetomidine 5 μg with hyperbaric bupivacaine 17.5 mg in 3.5 mL diluted with 0.4 mL normal saline to make it 4 mL. F group: (n = 30) received fentanyl 25 μg with hyperbaric bupivacaine 17.5 mg in 3.5 mL to make 4 mL. Results and Conclusion: We observed that the groups were comparable with respect to demographic data (age, weight, height and duration of surgery) and onset time of sensory and motor blockade. The onset of sensory and motor block was slightly delayed in both groups. Two segment regression time of sensory blockade and time to reach Bromage scale 0 was greatly significant in dexmedetomidine and fentanyl. However, in comparison of the two, dexmedetomidine was clearly superior. The groups were comparable in terms of hemodynamic parameters, oxygen saturation, and respiratory rate, though there had been a statistically significant fall in BP and heart rate when compared to baseline. Sedation scores were found to be statistically significantly higher in group dexmedetomidine as compared to Fentanyl. The results showed statistically significant increase in the duration of postoperative analgesia in group using dexmedetomidine as compared to group fentanyl. The requirement of first rescue analgesic was greatly significant. The group using fentanyl had an postoperative pain free period of unto 4 h and dexmedetomidine had analgesia period unto 7 h. We found some adverse effects such as hypotension, bradycardia, nausea and vomiting with dexmedetomidine and fentanyl; however, the results were statistically insignificant. To conclude, the addition of dexmedetomidine prolonged the sensory and motor block significantly when used with hyperbaric bupivacaine intrathecally, to a much greater extent to the addition of fentanyl without increasing the incidence of significant adverse effects.
  935 114 -
Immunohistochemical analysis of tumor-associated stroma in oral squamous cell carcinoma with and without preexisting oral submucous fibrosis
Hande Harish Alka, Zade Rangrao Prajakta, Chaudhary S Minal, Gawande N Madhuri, Patil Swati, Agarwal Aakruti
July-September 2017, 12(3):170-176
Context: It has been proposed that oral squamous cell carcinoma (OSCC) arising in preexisting oral submucous fibrosis (OSMF) constitutes a clinicopathologically distinct disease than the OSCC arising without OSMF. Expression of myofibroblasts is an early event in tumorogenesis, and its expression in malignant lesions has been suggested to represent an important participant in invasion. Aim: To evaluate the expression of myofibroblasts in OSCC arising in OSMF and OSCC without OSMF. Settings and Design: Thirty each histopathologically proven cases of OSMF, OSCC with OSMF, and OSCC without OSMF were included in the study. The tissue sections were studied for histopathological evaluation and alpha-smooth muscle actin (α-SMA) expression. Statistical Analysis Used: Descriptive and inferential statistics using Kruskal–Wallis test, Mann–Whitney test, and Chi-square test. Results: The expression of α-SMA was found to be high in OSCC with OSMF and OSCC without OSMF group as compared to OSMF group. However, the difference between α-SMA expression in OSCC with OSMF and OSCC without OSMF group was found statistically nonsignificant. Comparison of α-SMA score with histopathological grading and tumor, node, metastasis staging in OSCC with OSMF and OSCC without OSMF groups showed statistically nonsignificant difference, whereas comparison of α-SMA score with lymph node metastasis was statistically significant. Conclusion: The altered extracellular matrix in OSCC with OSMF could be responsible for modified epithelial–mesenchymal transition, which is further proven by reduced intensity and distinct pattern of α-SMA staining in OSCC with OSMF.
  939 107 -
Ultra-fast-tracking in cardiac anesthesia “Our Experience” in a rural setup
Manisha Taware, Manish Sonkusale, Rashmi Deshpande
April-June 2017, 12(2):110-114
Background: Fast-track cardiac anesthesia refers to extubation within 6 h of the end of surgery, whereas ultra-fast-track anesthesia (UFTA) refers to extubation within 2 h of the end of surgery. Objectives: We have tested a protocol for early extubation to see safety, efficacy of ultra-fast tracking, and its cost containment in the present study of forty patients in cardiac surgery department in a tertiary care rural center. Materials and Methods: We have observed in our study the outcome of UFTA on a set of forty patients posted for cardiac surgery, using a protocolized approach and have prospectively noted the duration of mechanical ventilation, extubation time, length of Intensive Care Unit (ICU) stay, rate of re intubation, and other complication. Results: Extubation could be achieved within 30 min in 29 patients (72.5%). Mean length of ICU stay could be cut to 1.6 days (39 h). 55% patients could be mobilized on postoperative day 1, With approximate cost savings of 5000 rupees/patient/day. No cases of reintubation or serious complications noted. Conclusion: Ultra-fast-tracking is found to be feasible in our cardiac surgical setup. It is safe in all age groups, with proper selection of cases and rational utilization of available resources, besides it is found to be cost-effective.
  934 87 -
Study of motor nerve conduction velocity in patients of thyroid dysfunction in central India
Avinash Baliramji Taksande, Arunita Tushar Jagzape, VK Deshpande
October-December 2017, 12(4):229-233
Background: Hypothyroidism is a clinical disorder due to the deficiency of thyroid hormone. This hormone is a key regulator of cellular metabolism in our body. Hypothyroid state is usually asymptomatic, symptoms in the early phase while associated with a number of symptoms later affecting skin, heart, endocrine, brain, and nerves. Hyperthyroidism is less commonly associated with neuromuscular disorders and polyneuropathy. Objective: The objective of the study was to assess motor nerve functions in thyroid dysfunction patients. Study Design: This study design was a comparative study. Population: The study population was clinically diagnosed thyroid dysfunction patients and healthy individuals. Sample Size: The sample size was 82 (41 each in cases and control group). Materials and Methods: Neuro Perfect 2 – Channel EMG NCV EP, Medicaid, instrument was used. Parameters such as distal motor latency (DML), compound motor action potential CMAP amplitude, conduction velocity (CV) for motor nerve, and F-wave minimum latency of motor nerve were recorded and analyzed. Results: The median motor nerve CV (MNCV) and F-minimum latency were significantly reduced in cases as compared to controls on the right side (P < 0.05). The MNCV, DML, and F-minimum latency were significantly reduced in cases as compared to controls on the left side (P < 0.05). Conclusion: The findings suggest that polyneuropathy is associated with hypothyroidism. Further nerve conduction study might be useful to evaluate and to diagnose peripheral neuropathy in hypothyroid patients.
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The partial pressure of oxygen in arterial blood: A relation with different fraction of inspired oxygen and atmospheric pressures
NK Agarwal, Sumit Trivedi
October-December 2017, 12(4):280-283
As an anesthesiologist and critical care intensivist, it is mandatory to have thorough knowledge of variable partial pressure of oxygen, at different fraction of inspired oxygen (FiO2), and effect of various atmospheric pressures in alveoli, diffusion, and transport of oxygen to tissue. The partial pressure of oxygen in arterial blood gas shall always be expressed with respect to the atmospheric pressure and FiO2; unless these conditions are mentioned, one may not be able to assess the exact respiratory status of patient.
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Prevelance of tobacco use among school children reporting to dental hospital for treatment
Utkarsha Basakhetre, Ashish Jaiswal, Shravani Deolia, Sourav Sen, Malsawm Dawngliani, Arpan Jaiswal
October-December 2017, 12(4):242-245
Objective: The objectives of this study are to study the pattern of tobacco use in Indian school children aged 10–15 years in Wardha district and to study the role of psychosocial factors in initiation and prevention. Materials and Methods: A descriptive questionnaire cross-sectional study to evaluate the patterns of tobacco use in India among school children aged 10–15 in Wardha district. Results: Of the total of 1000 children selected, 5.9% were tobacco users and out of these 3.7% claimed to be addicted to it. Among the habitués, the mean age of initiation of tobacco use was 11.65 ± 2.62. The possible causes being peer pressure (35.08%), tension (49.12%), to achieve the aim (5.26%) and influence from parents (10.52%). Among the habitués, a mean number of 2.71 ± 2.03 children were using tobacco regularly with the range of 1–5 times per day. Conclusion: The peer group influence was the reason for initiating this habit in majority of the users. It is better to prevent the initiation of the habit than trying to stop the habit. The present study suggests the need for school-based tobacco prevention programs. Joint efforts from family, school, and social welfare groups are needed to address these factors for effective prevention, in addition to raising awareness against tobacco use among the school students.
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A comparative study to evaluate the efficacy of butorphanol as an adjuvant to epidural analgesia for rib fractures
Virendrakumar Belekar
July-September 2017, 12(3):166-169
Background: Pain management through epidural catheters has emerged as optimal method of pain control in patients with rib fractures. This study was done to evaluate the efficacy of butorphanol in this subset of patients. Materials and Methods: Sixty patients were randomly allocated in two Groups R and B. Group R patients received 0.2% ropivacaine epidurally (10 mL) while Group B patients who received 0.2% ropivacaine and 1 mg butorphanol epidurally (10 mL). Baseline respiratory rate, oxygen saturation, partial pressure of oxygen, visual analog score (VAS), and peak inspiratory flow rate were noted in both the groups. Results: There was a significant increase in duration of analgesia and nonsignificant reduction in VAS score in Group B and nonsignificant decrease in invasive ventilation cases and significant reduction in length of Intensive Care Unit (ICU) stay in Group B. There were no significant adverse effects in both the groups except for nausea in Group B. Conclusion: Butorphanol as an adjuvant to epidural analgesia leads to better oxygenation, decreased length of ICU stay, and duration of mechanical ventilation without increase in significant side effects.
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A case of phenytoin induced multiple toxicities
Khalid I Khan, PD Jalgaonkar, Sachin Agrawal
April-June 2017, 12(2):157-158
Phenytoin (PNT) is a commonly used sedative antiepileptic medication in many countries. It is used in generalized tonic-clonic (grand mal) and complex partial (psychomotor, temporal lobe) seizures and prevention and treatment of seizures occurring during or following neurosurgery. Adverse effects of PNT may occur even at therapeutic doses and may involve any system.
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Heterogeneous group discussion to improve reliability and validity of data tool: A global mental health assessment tool – Primary care version study
Vaishali D Tendolkar, Prakasha Behere, Zahir Quazi, Abhai Gaidhane
January-March 2017, 12(1):45-50
Background: Mental illness constructs are not universal and are likely to be burdened with ethnocentric conceptualization. Different terminology is used to refer to the same aspects of the translation process, making it harder to achieve clarity. Heterogenous focus group discussion is particularly suited for obtaining several perspectives about the same topic. The benefits of heterogenous focus group discussion include gaining insights into people's shared understandings of a concept and the ways in which individuals are influenced by others in a group situation. Objectives: 1) To find out reliability of GMHAT/PC Marathi. 2. To assess the validity of the GMHAT/PC Marathi for the diagnosis of psychiatric illness. Research Design: cross sectional study Sample: Persons aged 15 yrs and above, reporting to psychiatry units. Sample size: 500. Material: Global Mental Health Assessment Tool – Primary care Marathi. Result: The Cronbach's alpha coefficient estimated to 0.854 with the reliability coefficient of r=0.921. The 'k' value is 0.744 which indicates that the tool has good diagnostic accuracy. The overall sensitivity of the tool was found to be 96.51% (CI = 94.21% to 98.08%) (Assumed sensitivity = 90%). The estimated specificity of the tool is 74.75% (CI =65.02% to 82.94%). Conclusion: GMHAT/PC -Marathi is a valid, quick and comprehensive assessment and diagnoses of mental disorders for Marathi speaking people. GMHAT/PC- Marathi in psychiatric settings appears to have very good sensitivity and specificity. The mean duration of the interview was around 13.4 minutes which makes it feasible for routine use in the outpatient departments.
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