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Background and aims: Post operative pain relief is important for decreased morbidity and mortality. It would be easy to compare analgesic efficacy of iv Paracetamol and iv Diclofenac postoperatively in two groups of patients undergoing similar surgeries Modified Radical Mastectomy experiencing similar pain. Methods: After Ethical committee approval, 70 patients undergoing modified radical mastectomy were randomly allocated to one of the two groups, each receiving IV Diclofenac and IV Paracetamol. Each group received the respective analgesic after axillary dissection, 30 minutes prior to reversal. IV Paracetamol 1 Gm. was administered as 100mL (10 mg/mL) proprietary solution over 20 minutes. IV Diclofenac 75 mg was administered in 100 mL saline as an infusion over 20 minutes.After surgery patients were shifted to Post-operative ICU. Analgesia was assessed postoperatively at the following intervals – immediate postop (time 0), 30 minutes, 1 hour, 2 hour from extubation and then at 2 hourly interval for first ten hours after surgery. Fentanyl was administered when the VAS scores crossed 4 and/ or the patient demanded the rescue analgesic. The time when the patient demanded the dosage of rescue analgesic was noted. Results: Pain scores changes during a 6 hour period between two groups were similar, 6 hours after surgery, pain scores were significantly higher with Paracetamol compared to Diclofenac (p<0.05),At 8hrs, 10hrs post extubation pain scores were significantly higher with Diclofenac. Group P patients received rescue analgesic 60-90 minutes prior to the group D (± minutes).The total number of patients demanding rescue analgesic in each of the groups was found to be statistically similar. Conclusion: Both Intravenous Paracetamol and Intravenous Diclofenac have equal efficacy for post operative analgesia following Modified radical mastectomy except duration of analgesia which is longer for Intravenous Diclofenac, as inferred from VAS scores and time of need for rescue analgesic. It appears from our study that IV Paracetamol is good alternative to IV diclofenac for post operative analgesia following Modified radical mastectomy.

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Philadelphia, Lippincott Williams & Wilkins, 2009; 476-480. 17. D. Hynes, M. MeCarroland O. Hiesse-Provost. Analgesic efficacy of parenteral paracetamol (pro pacetamol) and diclofenac in postoperative orthopaedic pain. Acta Anaesthesiologica 2005 Mar; 50(3):374-381. 18. Cengiz Kara, Berkan Resorlu, Izzet Cicekbilek, Ali Unsal. Analgesic efficacy and safety of nonsteroidal anti-inflamatory drugs after transurethral resection of prostate. International Braz J Urol Vol. 36 (1): 49-54, January - February, 2010 19. Tuzuner Oncul AM, Yazicioglu D, Alanoglu Z, Demiralp S, Ozturk A, Ucok C. Postoperative analgesia in imparted third molar surgery: the role of preoperative diclofenac sodium, paracetamol and hornonicam. Med Princ Pract 2011; 20(5):470-6. 20. Oncül AM, Cimen E, Küçükyavuz Z, Cambazoğlu M. Postoperative analgesia in orthognathic surgery patients: diclofenac sodium or paracetamol? Br J Maxillofac Surg 2011 Mar; 49(2): 138-41. 21. Moller PL, Sindet-Pedersen S, Petersen CT, Juhl GI, Dillenschneider A, Skoglund LA. Onset of acetaminophen analgesia: comparison of oral and intravenous routes after third molar surgery. Br J Anaesth 2005 Mar; 94(5):642-8. 22. Silvanto M, Munsterhjelm E, Savolainen S, Tiainen P, Niemi T, Ylikorkala O, Scheinin H, Olkkola KT. Effect of 3 Gm. of intravenous parcetamol on post-operative analgesia, platelet function and liver enzymes in patients undergoing tonsillectomy under local anesthesia. Acta Anaesthesiol Scand. 2007 Oct; 51(9):1147-54. 23. E. Khoshraftar, H.M. Anvari, H.K. Assadi, A.S. Abdulamir and F. Abu Bakar, 2011.Comparative Study on the Effectiveness of Acetaminophen and Diclofenac Pretreatment in the Relief of Acute Pain after Out-Patient Surgery. European Journal of Dentistry and Medicine, 3: 23-27. 24. Durak P, Yağar S, Uzuner A, Kılıç M, Dilber E, Ozgök A. [Postoperative pain therapy after laparoscopic cholecystectomy: paracetamol versus diclofenac]. Agri. 2010 Jul; 22(3):117-20. 25. E. D. McNicol,A. Tzortzopoulou, M. S. Cepeda, M. B. D. Francia, T. Farhat and R. Schumann. Single-dose intravenous paracetamol or propacetamol for prevention or treatment of postoperative pain: a systematic review and meta-analysis. British Journal ofAnaesthesia106(6): 764–75 (2011) 26. Macario, A. and Royal, M. A. (2011), A Literature Review of Randomized Clinical Trials of Intravenous Acetaminophen (Paracetamol) for Acute Postoperative Pain. Pain Practice, 11: 290–296. 27. Gorocs TS, Lambert M, Rinne T, Krekler M, Modell S. Efficacy and tolerability of ready-to-use intravenous paracetamol solution as monotherapy or as an adjunct analgesic therapy for postoperative pain in patients undergoing elective ambulatory surgery: open, prospective study. Int J Clin Pract. 2009 Jan; 63(1):112-20. 28. Sinatra RS, Jahr JS, Reynolds LW, Viscusi ER, Groudine SB, Payen-Champenois C. Efficacy and safety of single and repeated administration of 1gm IV acetaminophen (paracetamol) for pain management after major orthopaedic surgery. Anaesthesiology 2005 Apr; 102(4):822-31. 29. TW.Hahn, T. Mogeusen, C. Lund, et al. Analgesic effect of IV paracetamol: possible ceiling effect of paracetamol in postoperative pain.Acta Anaesthesiol Scard 2003; 47:138-145. 30. Salonen A, Silvola J, Kokki H. Does1 or 2 gm paracetamol added to ketoprofen enhance analgesia in adult tonsillectomy patients? Acta Anaesthesiol Scan 2009 Oct; 53(9):1200-6.

Aim: The aim of this study is to evaluate the analgesic activity of atorvastatin in tail clip model of rat. Methods and Material: Analgesic activity of atorvastatin 3mg/kg and 8mg/kg were assessed in in tail clip model of rat where they were compared with control and ibuprofen group. Results: In tail clip method of rats, Atorvastatin 8 mg/kg group showed significant analgesic activity as compared with control group on day 3 and 6. However, atorvastatin 3 mg/kg group did not show any analgesic effect. Analgesic activity of both group of atorvastatin showed improvement as the study progressed from day 3 to day 6. Conclusion: The result of this study if substantiated by further experimental and clinical research suggest that atorvastatin may play important role in treating painful condition like osteoarthritis and rheumatoid arthritis specially when there is coexisting hypercholesterolemia.

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Left ventricular hypertrophy has emerged as a powerful non invasive indicator of increased vulnerability to the occurrence of major Cardiovascular disease outcomes in hypertension. Electrocardiography and Echocardiography are the two very common modalities used to detect Left Ventricular Hypertrophy. The question is which among the two is better in terms of efficacy. So the present study was undertaken, because in the Indian population, due to lack of resources, expensive investigations like Echocardiography may not be within the common man’s reach. A total of 50 patients were included in this study between the age group of 31-65 years after satisfying the inclusion and the exclusion criteria. All these patients who had Echocardiographic evidence of Left Ventricular Hypertrophy were compared with the Electrocardiographic Criteria using the Romhilt-Estes scoring system and Sokolow-Lyon voltage criteria system. Our study confirms that Romhilt and Estes point score is specific but insensitive and showed that the sensitivity of both the Electrocardiographic criteria for diagnosing Left Ventricular Hypertrophy increased with increasing body mass index. Our findings suggest that Echocardiography is a better modality for the detection of Left Ventricular Hypertrophy when compared to Electrocardiography because of lack of sensitivity of the Electrocardiographic criteria, even though it is slightly more expensive. In view of its’ prognostic implication, routine use of Echocardiography for” the detection of Left Ventricular Hypertrophy could be justified. However, Electrocardiography should keep its place in the detection of Left Ventricular Hypertrophy as an initial modality because of its easy availability. Hence the two procedures be regarded as complementary to each other rather than mutually exclusive.

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Background: Caesarean Section is the second commonest surgery done on women in India after tubectomy and have great impact on maternal and neonatal health. Increasing Caesarean rates have raised the need to study its influencing factors. The overall Caesarean section rate in our set up is about 31.26%. of which 45.68% were primary sections. Objectives: To analyse the various clinical and non-clinical influencing factors of Caesarean Section. Materials and methods: We did a retrospective study consisting of 200 cases of caesarean sections conducted in Chigateri General Hospital, attached to JJMMC, Davangere during 2014. We analysed factors like age, Educational level, BMI, Parity, Co-morbidity, type of CS, Indications and fetal birth weight and Neonatal performance. Data was collected from the Hospital records. Results: In this study, 74.5% were unbooked, 74% were educated, 62.5% had more than normal BMI,16.5% were associated with hypertensive disorders, 58% were primary and 42% were repeat sections. There were 86.5% emergency and 13.5% were elective CS. The commonest indications were not willing for VBAC (70%), fetal distress (52%) and CPD (19%).Majority of the fetal weight among the study group were more than 2.5kg. Conclusions: According to our study, higher educational level, unbooked status and BMI more than normal were the significant factors determining CS. Nearly three-fifth of the patient underwent primary CS. Being a tertiary and referral Hospital we had a very high Caesarean rates.

1. F. Gary Cunningham, Normal F. Gant, Kenneth J. Leveno et al, “Caesarean delivery and postpartum hysterectomy”. Chapter -23, Textbook of Williams obstetrics, 21st Edn, Newyork; McGraw Hill, 2001;538-559pp 2. Tang S, Li X, Wu Z. Rising cesarean delivery rate in primiparous women in urban China: evidence from three nationwide household health surveys. Am J Obstet Gynecol 2006; 195: 1527-3214. 3. Betran et al., WHO statement on caesarean section rates: a commentary, BJOG 2016 4. Cesarean Section –A Brief History - U.S. National Library of Medicine-www.nlm.nih.gov/exhibition/cesarean 5. Emma L Barber, Lisbet S Lundsberg et al- Indications Contributing to the Increasing Caesarean Delivery Rate; American College of Obstetricians and Gynaecologists. Obstet Gynecol July 2011;118(1):29-37 6. Ranjit Akolekar, Suchitra Pandit, Sanjay B.Rao, ‘Indications for Cesarean Delivery’. Chapter-5, in textbook of The Cesarean Birth. A FOGSI publication. Mumbai; The National Book Depot 53-55pp 7. Farah Karim et al-Trends and Determinants of Caesarean Section; Journal of Surgery Pakistan(International) 16(1) January – March 2011 8. Sancheeta Ghosh, K S James; Levels and trends in caesarean births Economic and political weekly Jan 30, 2010; 45(5) Sancheetha Ghosh et al Levels and Trends in caesarean births: cause for concern?-Economic and Political Weekly January 30, 2010 VOL XLV No.5. 9. Fyfe et al-Risk of First-Stage and Second-Stage Caesarean Delivery by Maternal Body Mass Index Among Nulliparous Women in Labour at term; ACOG June 2011, 117(6) 10. Dutta D C “Text book of obstetrics” 8th Ed, Jaypee Brothers, New Delhi,2016, 669-679 Cesarean Delivery on Maternal Request. Committee Opinion Number 559; April 2013 Unnikrishna B, Rakshith Prasad B et al- Trends and indications for caesarean section in a tertiary care Obstetric Hospital in Coastal South India; Australasian Medical Journal AMJ 2010 3, 12, 821-825.

CT has an important role in the workup and treatment of patients with small bowel obstruction. The diagnosis of small bowel obstruction on C.T is made when there is a discrepancy between the calibers of proximal and distal small bowel loops. If a distinct point of transition between the dilated proximal and collapsed distal bowel is detected, the diagnosis is more certain. Two secondary signs that has been reported to be helpful in confirming small bowel obstruction is the “small-bowel feces” sign and “string of beads” sign. This study was done to assess the role of these “small-bowel feces” sign and “string of beads sign” in the diagnosis of clinically suspected small-bowel obstruction. We assessed 62 patients in the study who were suspected to have intestinal obstruction and was referred for CT scan of the abdomen. Of the 62 patients 34 had small bowel obstructionand 28 had no obstruction.10 of them had small bowel feces sign and it was absent in the remaining 24.8 of them had string of beads sign and it was absent in the remaining 26. All those who had the above mentioned signs had small bowel obstruction on laparotomy suggesting a specificity of 100 %. However sensitivity was only 29% for small bowel feces sign and 23.5% for string of beads sign, indicating that these signs are not very sensitive for obstruction, but when present they are very specific.

1. Lazarus DE, Slywotsky C, Bennett GL, Megibow AJ, Macari M. Frequency and relevance of the "small-bowel feces" sign on CT in patients with small-bowel obstruction. AJR Am J Roentgenol. 2004 Nov;183(5):1361-6. 2. Singh J, Kumar R, Kalyanpur A. "Small bowel feces sign" - a ct sign in small bowel obstruction. Indian J Radiol Imaging 2006;16:71-4 3. Maglinte DD.T, Kelvin FM, Rowe MG, Bender GN, and Rouch DM. Small-Bowel Obstruction: Optimizing Radiologic Investigation and Nonsurgical Management. Radiology 2001 218:1, 39-46

Psoriatic arthropathy [PsA] is one of the common seronegative spondyloarthropathies. It was in the mid-19th century that an association between psoriasis and joint involvement first made when, apart from the clinical findings, diagnosis of PsA was based mainly on conventional radiography. In the recent times, imaging techniques like magnetic resonance imaging [MRI] and ultrasonography [USG] have been increasingly used in the diagnosis and management of PsA. . The interpretations provide additional clues to the pathogenesis of this progressive and sometimes mutilating disease. A positive radiological finding using X ray means an advanced disease, and hence the need for better imaging studies which can detect the pathology much earlier. As is well agreed upon, early detection of articular and peri-articular inflammation will help timely initiation of appropriate therapy to prevent further progression of the inflammation and thereby prevent joint destruction. USG ismore effective than X ray and less expensive than and having more or less equal diagnostic potential as MRI. USG is areliable investigatory tool freely available in many canters and should be made use of in the diagnosis and follow up of patients with PsA

1. Zochling J and Smith EU. Seronegative spondyloarthritis. Best Pract Res Clin Rheumatol. 2010; 24(6):747-56. 2. Mease PJ. Tumour necrosis factor (TNF) in psoriatic arthritis: pathophysiology and treatment with TNF inhibitors. Ann Rheum Dis. 2002; 61:298–304. 3. McQueen FM. MRI in Psoriatic Arthritis. Ann Reum Dis. 2007; 66(2):19. 4. Kumar A and Grover R. Management of psoriatic arthritis. J Indian Rheumatol Assoc 2002 : 10 : 64 – 68 5. Laura C, Richard H, Conaghan Philip G, Freeston Jane E. MRI and ultrasonography for diagnosis and monitoring of psoriatic arthritis. Best practice & research. Clinical rheumatology 2012; 26 (6): 805-22. 6. Sankowski AJ, Lebkowska UM, Cwikła J, Walecka I and Walecki1 J. The comparison of efficacy of different imaging techniques (conventional radiography, ultrasonography, magnetic resonance) in assessment of wrist joints and metacarpophalangeal joints in patients with psoriatic arthritis. Pol J Radiol. 2013; 78(1): 18–29. 7. Ross E Petty, Taunton R Southwood, Prudence Manners, John Baum, David N Glass, Jose Goldenberg, Xiaohu He et al. International League of Associations for Rheumatology Classification of Juvenile Idiopathic Arthritis: Second Revision, Edmonton, 2001. J Rheumatol. 2004; 31: 390-392. 8. Abby Van Voorhees, Steven R. Feldman, John Y. M. Koo,Mark G. Lebwohl, Alan Menter, Psoriasis andPsoriatic Arthritis Pocket Guide: Treatment Algorithms and Management Options.Third edition. Chapter 2 page 30-37. 9. Stoll ML, Zurakowski, D, Nigrovic, LE, Nichols DP, Sundel RP and Nigrovic, PA. Patients with juvenile psoriatic arthritis comprise two distinct populations. Arthritis & Rheumatism. 2006; 54: 3564–3572. 10. Gladman DD, Farewell VT. Progression in psoriatic arthritis: role of time varying clinical indicators.J Rheumatol. 1999;26(11):2409-13 11. Gladman D, Mease PJ, Choy E HS, et al. Analysis of risk factors for radiographic progression in psoriatic arthritis (PsA): subanalysis of ADEPT. Program and abstracts of the American College of Rheumatology (ACR) 71st Annual Meeting; November 6-11, 2007; Boston, Massachusetts. [Abstract #583] 12. Keat A. ABC of Rheumatology: Spondyloarthropathies. BMJ. 1995; 310:1321–24. 13. Lin Z, Wang Y, Mei Y, Zhao Y, Zhang Z. High-frequency ultrasound in the evaluation of psoriatic arthritis: a clinical study. 2016; Am J Med Sci 350:42–46 14. Frediani B, Falsetti P, Storri L, Allegri A, Bisogno S, Baldi F, Marcolongo R. Ultrasound and clinical evaluation of quadricipital tendon enthesitis in patients with psoriatic arthritis and rheumatoid arthritis. Clin Rheumatol. 2002; 21:294–298.] 15. Gutierrez M, Draghessi A, Bertolazzi C Erre GL, Saldarriaga-Rivera1 LM, López-Reyes1 A et al Ultrasound in psoriatic arthritis. Can it facilitate a best routine practice in the diagnosis and management of psoriatic arthritis? Clin Rheumatol published online 08/2016; DOI: 10.1007/s10067-015-3053-4. 16. Fiocco U, Sfriso P, Oliviero F, Roux-Lombard P, Scagliori E,Cozzi L, Lunardi F e al Synovial effusion and synovial fluid biomarkers in psoriatic arthritis to assess intra articular tumor necrosis factor-α blockade in the knee joint. Arthritis Res Ther. 2010; 12(4): R148. 17. Husic R, Ficjan A, and Duftner C, Dejaco C. Use of ultrasound for diagnosis and follow-up of psoriatic arthritis. EMJ Rheumatol. 2014; 1:65-72. 18. De Filippis LG, Caliri A, Lo Gullo R, Bartolone S, Miceli G, Cannavò SP, et al. Ultrasonography in the early diagnosis of psoriasis-associated enthesopathy. Int J Tissue React. 2005; 27(4):159-62. 19. Kane D. The role of ultrasound in the diagnosis and management of psoriatic arthritis. Curr Rheumatol Rep. 2005;7(4):319-24. 20. De simone C, Caldarola G, D'Agostino M, Carbone A, Guerriero C, Bonomo L et al. Usefulness of Ultrasound Imaging in Detecting Psoriatic Arthritis of Fingers and Toes in Patients with Psoriasis. Clinical and 21. Developmental Immunology. 2011, Article ID390726, 5 pages available at http://dx.doi.org/10.1155/2011/390726

Background and aims: Postoperativesore throat (POST) is a complication in patients undergoing endotracheal intubation for general anaesthesia Avoiding POST symptoms is a major priority for these patients. This study was done to primarily assess the incidence and severity of POST in the distilled water gargle group and compare it with Ketamine gargle group in patient undergoing elective surgical procedures performed under GA with tracheal intubation. Methods: Patients were randomly allocated in to two groups of 30 Patients each.GroupKFor30 patients, 50mg Ketamine diluted in 29 ml of distilled water was given. Group C-For 30 patients, 30 ml of distilled water was given. all Patients were made to gargle for 30 seconds, 5minutes before induction. In the postoperative period the incidence, duration and severity of sore throat was evaluated at 4, 8 and 24 hours. Results: Demographic characteristics such as age, height, sex, weight, duration of surgery were comparable, Incidence of postoperative sore throat was higher in control group at all the time compared to the Ketamine group. Most of the patients were complaining of mild sore throat in both the groups at 4hr, 8hr and 24 hr. But none had severe sore throat in Ketamine group where as in control group 23.3% at 4hr, 10% at 8hr and 3.3% at 24hr complained of severe sore throat. At 24th hour the incidence and severity of sore throat was significantly reduced in both the groups 4 (13.3) in group K and 14(46.7%) in group C. Conclusion: The incidence of POST in the patients undergoing GA with endotracheal intubation for routine surgical cases is quite common and this throat discomfort remains for next 24 hrs and Ketamine gargle significantly reduces the incidence and severity of POST.

1. Ahmed A, Abbasi S, Ghafoor HB, Ishaq M. Postoperative sore throat after elective surgical procedures. J Ayub Med Coll Abbottabad 2007; 19: 12-4 2. Biro P, Seifert B, Pasch T. Complaints of sore throat after tracheal intubation: a prospective evaluation. Eur J Anaesthesiol 2005; 22: 307-11 3. Higgins PP, Chung F, Mezei G. Postoperative sore throat after ambulatory surgery. Br J Anaesth 2002; 88: 582-4 4. Kloub R: Sore throat following tracheal intubation. Middle East J Anesthesiol 2001;16:29-40 5. Kadri AK, Khanzada TW, Samad A, Memon W. Post-thyroidectomy sore throat. A common problem. Pak J Med Sci 2009;25:408-12 6. Marcario A, Weinger M, Truong P, Lee M. Which clinical anesthesia outcomes are both common and important to avoid ? The perspective of a panel of expert anesthesiologists. Anesth Analg 1999;88:1085 –91. 7. Sumathi PA, Shenoy T, Ambareesha M, Krishna HM. Controlled comparison between Betamethasone gel and Lidocaine jelly applied over tracheal tube to reduce postoperative sore throat, cough and hoarseness of voice. British Journal of Anaesthesia 2008; 100:215-18. 8. Elhakim M. Beclomethasone prevents postoperative sore throat. Acta Anaesthesiol Scand 1993;37:250-2. 9. Ogata J. Minami K, Horishita T,, Shiraishi M, Okamoto T, Terada T et al. Gargling with Sodium Azulene Sulfonate reduces the postoperative sore throat after intubation of the trachea. Anesth Analg2005;101:290-3. 10. Canbay O, Celebi N, Sahin A, Celiker V, Ozgen S, Aypar U. Ketamine gargle for attenuating postoperative sore throat. Br J Anaesth 2008;100: 490-3. 11. Agarwal A, Gupta D, Yadav G, Goyal P, Singh PK, Singh U. An evaluation of the efficacy of Licorice gargle for attenuating postoperative sore throat. A prospective randomized, single- blind study. Anesthesia Analgesia 2009;109: 77-81. 12. Agarwal A, Nath SS, Goswami D, Gupta D, Dhiraaj S, Singh PK. An evaluation of the efficacy of aspirin and benzydamine hydrochloride gargle for attenuating postoperative sore throat. A prospective, randomized, single-blind study. Anesth Analg 2006; 103:1001-3 13. Estebe JP, Delahaye S, Le Corre P, Dollo G, Le Naoures A, Chevanne F et al. Alkalinization of intra-cuff lidocaine and use of gel lubrication protect against tracheal tube-induced emergence phenomena. Br J Anaesth 2004 Mar;92:361-6. 14. Navarro LH, Lima RM, Aguiar AS, Braz JR, Carness JM, Modolo NS. The effect of Intracuff alkalinized 2% lidocaine on emergence coughing, sore throat and hoarseness in smokers. Rev Assos Bras 2012 Apr;58: 248-53. 15. Tanaka Y, Nakayama T, Nishimori M, Sato Y, Furuya H. Lidocaine for preventing postoperative sore throat. Cochrane Database Syst Rev. 2009 Jul 8;(3):CD004081.doi: 10.1002/14651858.CD004081.pub2. Review. 16. Soltani HA, Aghadavoudi O. The effect of different Lidocaine application methods on postoperative cough and sore throat. Journal of Clinical Anesthesia 2002;14:15-18. 17. Carlton SM, Coggeshall RE. Inflammation- induced changes in peripheral glutamet receptor populations. Brain Res 1999;820:63-70. 18. Carlton SM, Zhou S, Coggeshall RE. Evidence for the interaction of glutamet and NK1 receptors in the periphery. Brain Res. 1998;790:160-9. 19. Victor F B, Tremblay NAG. The complications of tracheal intubation: A new classification with a review of the literature. Anesthesia Analgesia 1974;53:202-13. 20. Keane WM, Denneny JC, Rowe LD, Atkins JP, Jr. Complications of intubation. Ann Otol Rhinol Laryngol 1982; 91: 584-7. 21. McHardy FE, Chung F: Postoperative sore throat: cause, prevention and treatment. Anaesthesia 1999; 54: 444-53. 22. Peppard SB, Dickens JH. Laryngeal injury following short-term intubation.Ann Otol Rhinol Laryngol 1983;92:327-30. 23. Alexopoulos C, Lindholm CE. Airway complaints and laryngeal pathology after intubation with an anatomically shaped endotracheal tube. Acta Anaesthesiol Scand 1983;27:339-44. 24. Loeser EA, Bennett GM, Orr DL, Stanley TH. Reduction of postoperative sore throat with new endotracheal tube cuffs. Anesthesiology 1980; 52:257-59. 25. Jensen PJ, Hommelgaard P, Sondergaard P, Eriksen S. Sore throat after operation: Influence of tracheal intubation, intracuff pressure and type of cuff. British Journal Of Anaesthesia 1982;54: 453-56. 26. Brimacombe J, Keller C, Giampalmo M, Sparr HJ, Berry A. Direct measurement of mucosal pressures exerted by cuff and non-cuff portions of tracheal tubes with different cuff volumes and head and neck positions. British Journal Of Anaesthesia 1999; 82: 708-11. 27. Suzuki N, Kooguchi K, Mizobe T, Hirose M, Takano Y, Tanaka Y. Postoperative hoarseness and sore throat after tracheal intubation: effect of a low intracuff pressure of endotracheal tube and the usefulness of cuff pressure indicator. Masui 1999; 48: 1091-5. 28. Joh S, Matsuura H, Kotani Y, Sugiyama K, Hirota Y. Kiyomitsu. Change in tracheal blood flow during endotracheal intubation. Acta Anaesthesiol Scand 1987;31:300-04. 29. Stout DM, Bishop MJ, Dwersteg JF, Cullen BF. Correlation of endotracheal tube size with sore throat and hoarseness following general anesthesia. Anesthesiology 1987; 67: 419-21. 30. Rudra A, Suchanda R, Chatterjee S, Ahmed A, Ghosh S. Gargling with ketamine attenuates the postoperative sore throat. Indian Journal Of Anaesthesia 2009;53: 40-3.

Problem statement: In this study initially an attempt has been taken to draw the demography of alcoholic and non-alcoholic liver disease. With the help of anthropometry and biochemical investigation, an attempt has been made to give an idea on nutritional status of the patients. Malnutrition refers to under nutrition, over nutrition and nutrient deficiency. The distribution of the malnutrition occurs in a society due to different public health outcomes and policy formulation. Body mass index (BMI) is the main indicator of malnutrition. Low social status and poor social relationship are strong determinants of poor health. Methods: It was performed on unselected patients(outdoor) with diagnosis of different kinds of liver disease, who were attending in this institution (M.G.M Medical College and L.S.K Hospital,)The adult patients (50) were included for this study. They were aged 18- 65 yrs. Results: Results are expressed; it has been observed that BMI decrease in ALD and Cirrhosis in Comparison to normal and in Malnutrition II in comparison to normal showed a depressed value. Biochemical parameters – LFT, MDA, GSH value were compared both case and control group and statistical analysis were calculated by the help of SPSS software. Conclusion: Malnutrition in the condition that develops when the body does not get the right amount of the vitamins, minerals and other nutrients in need to maintain healthy tissues and organ function. Malnutrition is a health problem with multiple facets. The ecological factors related to malnutrition are conditioning influences. Socioeconomic practices, food production, health services, mother education and type of family. Nutritional disorders can affect any system in the body and senses of sight, taste and smell. They also produced anxiety, changes in mood, abnormalities and organ malfunction followed by illness and death.

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Some new organic derivatives of heterocyclic β-diketone [4-chlorobenzoyl-3-methyl-1-phenyl-2-pyrazolin-5-one (CMPPOH)] of the type Ga(OPri)3-n (CMPPO)n (where n=1,2and 3) have been synthesized by the reactions of Ga(OPri)3 and heterocyclic β-diketone in different molar ratios. These derivatives were characterized by elemental analyses, mol. wt. measurements and their probable structures have been proposed on the basis of IR and 1H NMR spectral studies.

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Background: Q waves on a 12-lead ECG are markers of a prior myocardial infarction (MI). However, they may regress or even disappear over time, and there is no specific ECG sign of a non–Q-wave MI. Fragmented QRS complexes (fQRSs), which include various RSR’ patterns, without a typical bundle-branch block are markers of altered ventricular depolarization owing to a prior myocardial scar. We postulated that the presence of fQRS might be associated with a poorer outcome in patients of acute acute ST Elevation Myocardial Infarction (STEMI). Methods and Results: The study included 255 consecutive patients of acute ST Elevation Myocardial Infarction. After excluding 31 patients, the remaining 214 patients were divided into two groups, one consisting of patients who developed fragmented QRS during hospital stay (GROUP A with 139 patients) and the other group consisting of those who did not(GROUP B with 75 patients). In comparison Q wave appeared in 137 patients (64.01%). In 77 patients who did not develop a Q wave on ECG post MI, fragmented QRS developed in 57 of them (74 %), thus making it a valuable tool in identifying a non-Q wave MI. Significantly increased levels of cardiac biomarkers on presentation and increased rates of post MI angina, congestive heart failure, and major tachyarrhythmias were observed up to 30 days of follow up in patients of group A as compared to group B patients. Conclusion: This study of 255 patients highlighted the usefulness of fragmented QRS in identifying patients at higher cardiac risk with larger areas of ischemic jeopardized or necrotic myocardium, and it can provide very useful information in the risk stratification of acute STEMI patients. It also helps to identify the evidence of infarction in patients without a Q wave on surface ECG. These all features make fragmented QRS an area to explore in the field of electrocardiography in the near future in large randomized clinical trials.

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The scar is the signature of the surgeon. Apart from cosmetically good scars it is also necessary that the skin closure technique should be technically easy, acceptable, speedy and economical. The choice of wound closure after surgery has always been a matter of debate. Wound closure techniques have evolved from the earliest development of natural suturing materials through synthetic sutures (absorbable and non-absorbable), staplers, and tapes to the newest modality of adhesive compounds. This prospective randomized study compared time efficacy, post-operative pain, wound complication rate, cosmesis and cost-effectiveness between sutures, staplers and 2-octyl cyanoacrylate skin adhesive in closure of skin incisions of different sizes (1-10cm) in 150 patients who underwent clean elective surgery between January 2011 and January 2012 in our department.

1. Galli SKD, Constantinides M (2011) Wound closure technique http://emedicine.medscape.com/article/1836438 Accessed 9 May 2011 2. Coover HN, Joyner FB, Sheerer NH (1959) Chemistry and performance of Cyanoacrylate adhesive: special technical papers. 5:413-417 3. Schwade ND (2008) Wound adhesives, 2-Octylcyanoacrylate 4. Dragu A, Unglaub F, Schwarz S, et al (2009) Foreign body reaction after usage of tissue adhesives for skin closure: a case report and review of the literature. Arch Orthop Trauma Surg 129:167–169 5. Terhune M (2009) Materials for wound closure 6. Borley N.R, Mortensen N.J. (2001) Topical adhesive as a wound dressing for elective abdominal surgery: Ann R CollSurg Engl. 80(4):285-286 7. Mertz PM, Davis SC, Cazzaniga AL, et al (2003) Barrier and antibacterial properties of 2-octyl cyanoacrylate derived wound treatment films: J Cutan Med Surg. 7(1):1-6 8. Quinn J, Wells G, Sutcliffe T, Jarmuske M, Maw J, Stiell I, Johns P (1998) Tissue adhesive versus suture wound repair at 1 year: randomized clinical trial correlating early, 3-month, and 1-year cosmetic outcome. Ann Emerg Med 32(6):645-649 9. Matin SF (2003) Prospective Randomized Trial of Skin Adhesive versus Sutures for closure of 217 laparoscopic port-site incisions. J Am CollSurg 196(6): 845-853 10. OngCCP , Jacobsen AS, Joseph VT (2002) Comparing wound closure using tissue glue versus subcuticular suture for pediatric surgical incisions: a prospective, randomised trial. PediatrSurgInt 18:553–555 11. Arunachalam P, King PA, Oxford J (2003) A Prospective comparison of tissue glue versus sutures for circumcision. PediatrSurgInt 19(1-2):18-19 12. Quinn J, Wells G, Sutcliffe T, Jarmuske M, Maw J, Stiell I, Johns P (1997) A Randomized trial comparing octyl cyanoacrylate tissue adhesive and sutures in the management of lacerations. J Am Med Assoc 277(19):1527-1530

Objectives: To study efficacy of honey, as a dressing agent, in lower limb ulcers. Methods: This was a prospective study comprises 53 patients of all the age groups with lower limb ulcer were admitted in the department of surgery and treated with local application of honey to the ulcer. Observations and Results: Observations noted in view of reduction in ulcer size, reduction in slough and discharge, culture results, and decrease in pain. In 42 patients duration of symptoms is less than 1 month, 18 patients were suffering from diabetes mellitus, 38 patients were having ulcer size less than 5cm, At the end of 14 days 100% wounds became free of slough and discharge. At the end of seven days only 6 patients were having pain at the ulcer site. On day 14 there was no associated pain. All the 53 ulcers became bacteria free within 14 days. On admission, 44 patients undergone debridement, 47 patients progressed to healthy granulation tissue in 1st week and 100% in two weeks. After 14 days ulcer of nine patients completely healed 50 patients had complete healing of the lower limb ulcer after 1 month evaluation. The mean healing time estimated was 19.98 days. Conclusion: Honey made the wounds bacteria free within 14 days, honey removes offensive smells and has a desloughing action, stimulates rapid granulation tissue formation, stops further infections and the moist environment very suitable for wound recovery. Honey reduces the need for amputations.

1. Bowler, P. (2002) Wound pathophysiology, infection and therapeutic options. Ann.Med. 34, 419–427. 2. Bose, B. (1983) Honey or sugar in the treatment of infected wounds. Lancet 1(8278),963. 3. Bayisaba, G., Bazira, L., Habonimana, E., and Muteganya, D. (1993) Clinical and bacteriological results in wounds treated with honey. J. Orthop. Surg. 7, 202–204. 4. Oladejo, O., Imosemi, I., Osuagwu, F., Oyedele, O., Oluwadara, O., Ekpo, O., Aiku, A., Adewoyin, O., and Akang, E. (2003) A comparative study of the wound healing properties of honey and Ageratum conyzoides. Afr. J. Med. Med. Sci. 32, 193–196. 5. Hejase, M., Bihrle, R., and Coogan, C. (1996) Genital Fournier's gangrene: experience with 38 patients. Urology 47,734–739. 6. Al-Waili, N. and Saloom, K. (1999) Effects of topical honey on post-operative wound infections due to gram positive and gram negative bacteria following caesarean sections and hysterectomies. Eur. J. Med. Res. 4, 126–130. 7. Yoo, S.K. and Huttenlocher, A. (2009) Innate immunity: wounds burst H2O2 signals to leukocytes. Curr. Biol. 19(14), R553–555. 8. Cho, M., Hunt, T.K., and Hussain, M.Z. (2001) Hydrogen peroxide stimulates macrophage vascular endothelial growth factor release. Am. J. Physiol. Heart Circ. Physiol. 280, H2357–H2363. 9. Chirife, J. and Scarmato, G. (1982) Scientific basis for use of granulated sugar in treatment of infected wounds. Lancet 1, 560–561. 10. Zeidek, Z. and Masek, K. (1998) Erratic behavior of nitric oxide within the immune system: illustrative review of conflicting data and their immunopharmcological aspects. Int. J. Immunopharmacol. 20, 319–343. 11. Yakar, I., Melamed, R., Shakhar, G., Shakhar, K., Rosenne, E., Abudarham, N., Page, G.G., and Ben-Eliyahu, S. (2003) Prostaglandin e(2) suppresses NK activity in vivo and promotes postoperative tumor metastasis in rats. Ann. Surg. Oncol. 10(4), 469–479. 12. Kozlov, V., Poveschenko, A., and Gromyhina, N. (1990) Some mechanism involved in the prostaglandin E2 immunosuppressive effect in F1 mice in vivo. Cell. Immunol. 128, 242–249. 13. Childress, B. and Stechmiller, K. (2002) Role of nitric oxide in wound healing. Biol. Res. Nurs. 4, 5–15. 14. Gethin G, Cowman S, Manuka Honey vs hyrdrogen – a prospective open label multiare randomized controlled trial to compare desloughing efficacy and healing outcome in venous ulcers. J Clin Nurs.2008;18:466-474. 15. Efem, S. (1988) Clinical observation of the wound healing properties of honey. Br. J. Surg. 75, 679–681. 16. Jull, A., Walker, N., Parag, V., Molan, P., and Rodgers, A. (2008) Honey as Adjuvant Leg Ulcer Therapy trial collaborators. Randomized clinical trial of honey-impregnated dressings for venous leg ulcers. Br. J. Surg. 95(2),175–182. 17. Kegles F (2011). Clinical evaluation of honey based products for lower extremity wounds in a home care setting. Wound UK 7(2):46-53. 18. Dunford, C.E. and Hanano, R. (2004) Acceptability to patients of a honey dressing for non-healing venous leg ulcers. J. Wound Care 13(5), 193–197. 19. Natarajan, S., Williamason, D., and Grey, J. (2001) Healing of an MRSA-colonized, hydroxyurea-induced leg ulcer with honey. J. Dermatolog. Treat. 12, 33–36.

Background: To compare the efficacy of rectal Diclofenac sodium suppository with orally administered Tramadol for relief of perineal pain following vaginal delivery. Objective: To determine the efficacy of Diclofenac rectal suppository and oral Tramadol tablets for perineal pain relief following vaginal delivery. Materials and Methods: In this randomized control cross sectional study, 300 subjects were divided in two groups. Group A (150 subjects) received rectal Diclofenac sodium suppositories and Group B (150 subjects) received oral Tramadol tablets. First suppository was inserted immediately after episiotomy suturing, and second offered 12-24 hours after first dose if the lady complained of pain still. Women in group B were given oral Tramadol tablets 0 and 8 hourly. Women were evaluated for pain relief using validated short form of McGill pain questionnaire, Wong-Baker facial pain rating scale and numeric pain rating scale. Results: There was statistically significant difference between the two groups for sensory, affective and total pain scores at rest or with movement after 24 hours of childbirth indicating rectal suppository was superior to oral tramadol tablets. Pain scores were significantly lower in Diclofenac sodium suppository group (p value ≤ .0001) when compared to Tramadol group. The difference was not sustained 48 hours after birth. Conclusion: The use of rectal Diclofenac sodium suppositories is simple, faster acting, effective and safe method of reducing the perineal pain experienced by women following normal vaginal delivery within 24 hours of normal vaginal delivery.

1. Dodd JM, Hedayati H, Pearce E, Hotham N, Crothew CA. Rectal analgesia for the relief of perineal pain after childbirth: a randomized controlled trial of diclofenac suppositories. BJOG 2004; 111: 1059-64. 2. Sikander R, Memon A, Sheikh F. Perineal pain after vaginal delivery. J Surg Pak 2003; 8: 23-25. 3. Habib L, Manzar S. Post operative analgesic effect of diclofenac suppository versus diclofenac i.m injection. Pak J Surg 2004; 20: 11-15. 4. Achariya U, Titapant, U. Relieving perineal pain after perineorraphy by diclofenac rectal suppositories: A randomized double-blinded placebo controlled trial. J Med Assoc Thai 2008; 91: 799-804. 5. Melzack R. The short form of McGill pain questionnaire. Pain 1987; 30: 191-97. 6. Sanders J, Campbell R, Peters TJ. Effectiveness and acceptability of lidocaine spray in reducing perineal pain during spontaneous vaginal delivery: a randomized controlled trial. BMJ 2006; 333: 117. 7. Facchinelti F, Casini ML, Costabile L, Malavasi B, Unfer V. Diclofenac pyrrolidene versus ketoprofen for relief of pain from episiotomy: a randomized controlled trial. Acta Obstet Gynaecol Scand 2005; 84: 951-55. 8. Searles J, Pring D. Effective analgesia following perineal injury during childbirth: a placebo controlled trial of prophylactic rectal diclofenac. British Journal of Obstetrics and Gynaecology 1998; 105:627–31. 9. Dr Joshi Vyankatesh S , Dr Vyavahare Ramesh D , Dr Khade Ganesh, Dr ShiledarVikram , Dr Jamadar N P. Comparative study of analgesic efficacy of rectal suppository of Tramadol versus diclofenac in suppressing postoperative pain after Cesarean section. International J. of Healthcare and Biomedical Research, Volume: 1, Issue: 2, January 2013, P: 32-37 10. Faiza Shafi, Shazia Syed, Naheed Bano, Rizwana Chaudhri: Journal of Rawalpindi Medical College (JRMC); 2011; 15(1):56-58.

Introduction: Caesarean section is one of the most common surgeries performed in modern obstetrics. At the beginning, the process was started for the interest of the mother but now it is frequently performed for fetal indications. Though, it was introduced in clinical practice as a life saving procedure for the mother and the child, as time elapsed, this procedure also developed some health care inequity in the world like other procedures of complexities. Under use in low income setting and adequate or even unnecessary use in middle and high income setting. Enhancing C- section Rate: In India the rate of caesarean delivery has increased from 3 per cent to 10 per cent between 1992-93 and 2005-06 (IIPS, 2007), are lower in comparison to some developing nations like Brazil and China. But, as India is the second most populous country in the world, a small percentage increase in rate affects huge number of population. In India, family members sometimes demand that the baby be born on an auspicious date and time by C-section for horoscopic/astrological preferences. Conclusion: Patients choice for the caesarian delivery is one of the major factors for rising trends in the C-section rate. Barring genuine indications, Obstetricians convenience and financial considerations are other major factors. With the prevailing situations patients must be informed about the later consequences like placenta previa, repeat C- section, postpartum hemorrhage and other morbidities.

1. Luz Gibbons et al. The Global Numbers and costs of Additionally Needed and Unnecessary Caesarean Sections Performed Per Year: Overuse as a Barrier to Universal Coverage. World Health Report (2010) 2. Sur S, Mackenzie IZ. Does discussion of possible scar influence preferred mode of delivery after cesarean section? J ObstetGynecol2005; 25:338-41. 3. Zelop C, Heffner LJ. The downside of cesarean delivery: short and long term complications. ClinObstetGynecol 2004; 47:386-93. 4. Center for Disease Control and Prevention. C-sections rise, so do premature births. Hindustan Times. New Delhi. 2005; 23 Nov. 5. Khawaja M, Kabakian. Khasholian T, Jurdi R. Determinants of cesarean section in Egypt. Evidence from demographic and healthsurvey. Health Policy 2004; 69:273-81. 6. Jurdi R, Khawaja M. Cesarean section rates in Arab region: a cross national study. Health Policy Plan 2004;19:101-10. 7. Wagner M. Choosing cesarean section. Lancet 2000; 356:1677-80. 8. Caesarean sections. Postnote No. 184. London: Parliamentary Office of Science and Technology; 2002. Available from: http://www.parliament.uk/post/pn184.pdf. 9. World Health Organization. Appropriatetechnology for birth. Lancet 1985; 2(8452):436-7. 10. C Black, JA Kaye, H Jick. Caesarean delivery in the United Kingdom: time trends in the general practice research database ObstetGynecol2005; 106:151-5. 11. Laws, PJ, Sullivan EA. Australia’s mothers andbabies 2002. Perinatal Statistics Series No. 15.Sydney: National Perinatal Statistics Unit; 2004 12. AL Tranquilli, SR Giannubilo.Cesarean delivery on maternal request in Italy.Int J GynaecolObstet 2004; 84: 169-70. 13. R Dobson. Caesarean section rate in England and Wales hits 21%. BMJ 2001; 323:951 14. IIPS and Macro International (2007): National Family Health Survey (NFHS-3),2005- 06, India, Vol. I andVol. II, International Institute for Population Sciences, Mumbai 15. Mishra, U.S., Ramanathan M. (2002): “Delivery-related complications and determinants of caesarean section rates in India”. Health Policy and Planning, 17(1):90-98 16. Biswas A. B., Das D. K., Misra R., Roy R. N., Ghosh D., Mitra K. (2005): “Availablity and Use of Emergency Obstetric Care Services in Four Districts of West Bengal, India”, J Health PopulNutr, 23(3): 266-274. 17. Pahari K., Ghosh A. (1997): “Study of Pregnancy Outcome over a Period of Five Years in a Postgraduate Institute of West Bengal”, J Indian Med Assoc, 95(6): 172- 174. 18. Kambo I., Bedi N., Dhillon B. S., Saxena N. C. (2002): “A Critical Appraisal of Caesarean Section Rates at Teaching Hospitals in India”, Int J Gynecol and Obstet, 79(2): 151-158. 19. Padmadas, S. S., Kumar S. S., Nair S. B., Kumari A. K. R. (2000): “Caesarean section delivery in Kerala, India: evidence from a National Health Survey”. Social Science and Medicine, 51:511-521. 20. FIGO Committee for the Ethial Aspects of Human Reproduction and women’s Health. Ethical aspects regarding cesarean delivery for non-medical reasons.Int J ObstetGynecol 1999; 64:217-21. 21. Thomas J, Parenajothy S. Royal College of Obstetricians and Gynecologists Clinical Effectiveness Support Unit. The NationalSentinel Cesarean Section Audit Report. London. RCOG Press. 2001 22. Editorial. Cesarean section on the rise. Lancet 2000;356;1697 23. Mackenzie IZ, Cooke I, Annan B. Indications for cesarean section in a consultant unit over the decades. J ObstetGynecol 2003; 23:233-8. 24. Harper MA, Byington RP, Espeland MA et al. Pregnancy related death and health care services. Am J ObstetGynecol 2003; 102:273-8. 25. Confidential Enquiries into Maternal Deaths in UK. London. RCOG Press. 2001 26. Van Ham M, van Dongen P, Mulder J. Maternal consequences of cesarean section: a retrospective study of intraoperative and postoperative maternal complications of cesarean section during a 10 year period. Eur J ObstetGynecolReprodBiol 1997; 74:1-6. 27. Kaemar J, Bhimani L, Boyd M et al. Route of delivery as a risk factor for emergent peripartum hysterectomy: a case-control study. ObstetGynecol 2003; 102:141-5. 28. Smith JF, Hernandez C, Wax JR. Fetal laceration injury at cesarean delivery. ObstetGynecol 1997; 90:344-6. 29. Wagner M. Pursuing the birth machine: the search for appropriate birth technology. Syndey.ACE Graphics. 1994. 30. Zelop C, Heffner LJ. The downside of cesarean delivery: short and long term complications. ClinObstetGynecol 2004; 47:386-93. 31. Lydon-Rochelle M, Holt VL, Easterling TR et al. First-birth cesarean and placental abruption or previa at second birth. ObstetGynecol2001; 97:765-9. 32. Gilliam M, Rosenberg D, Davis F. The likelihood of placenta previawith greater number of cesarean deliveries and higher parity.ObstetGynecol 2002; 99:976-80. 33. Miller DA, Choller JA, Goodwin TM. Clinical risk factors for placenta previaaccreta. Am J ObstetGynecol 1997; 177:210-4. 34. Zaki Z, Bahar AM, Ali ME et al. Risk factors and morbidity in patients with placenta previaaccreta compared to placenta previanon-accreta. ActaObstetGynecolScand 1998; 77:391-4. 35. Catanzarite VA, Lorrain MS, Schrimmer DR et al. Managing placenta previaaccreta. ContempObstetGynecol 1996; 41:66-95. 36. Chung CL, Cheng PJ, Liang CC et al. Obstetrical hysterectomy and placenta previa / accreta. Three bladder injury case reports. ChangeGung Med J 1997; 20:44-51.

Introduction: Blunt trauma to abdominal is one of the leading causes of morbidity and mortality among all age groups. Identification of serious intra abdominal pathology is often challenging. Intestinal disruptions can be due to a variety of types of blunt trauma, with automobile being the most common etiologic agent. Aims and objective: To study the incidence and pattern of various organ injury due to blunt trauma to Abdomen and its Management. Materials and Method: Total 40 cases of blunt abdominal trauma were enrolled in the present study. Diagnostic laproscopic was performed in all the patients using standard guidelines. Hemodynamic parameters were watched meticulously during the procedure. Postoperatively, the patients were observed for vital parameters, hemoglobin level and return of bowel functions and wound complications. The patients who underwent spleenectomy were given vaccination against meaningful, pneumococcal, and H. influenza type B infections. The patients were discharged after return of normal bowel functions, drain removal and ruling out complications if any. The collected data was analyzed and presented with appropriate table and graphs. Results: Majority of the patients (75%) in the present study were less than 40 years of age. Majority of the patients were male (80%). The most common mode of injury was road traffic injury (60%) followed by fall (15%) and assault (20%). The incidence of liver trauma was 70% followed by spleen injury (35%). The incidence of small bowel injury was 20% whereas kidney and colon injury was 10% each. 75% patients were managed successively by conservative management. Explorative laprotomy was required in 25% patients. Conclusion: Thus we conclude that the highest incidence of blunt abdominal trauma was seen in males in 2nd and 3rd decade of life and was most commonly due to RTA. The liver, spleen and small bowel were the most commonly injured organs. By using diagnostic laproscopy majority of the patients were managed efficiently by conservative management.

1. Shuck JM, Lowe RJ. Intestinal disruption due to blunt abdominal trauma. Am J Surg 1978 Dec; 136(6):668-673. 2. Munns J, Richardson M, Hewett P.A review of intestinal injury from blunt abdominal trauma. Aust N Z J Surg 1995 Dec; 65(12):857-860. 3. Salomone JA, Salomone JP. Abdominal Trauma, Blunt. Available at e medicine at Web MD, Accessed on 2nd Oct 2014. 4. Zheng YX, Chen L, Tao SF, Song P, Xu SM. Diagnosis and management of colonic injuries following blunt trauma. World J Gastroenterol 2007 Jan; 13(4):633-636. 5. Fraga GP, Silva FH, Almeida NA, Curi JC, Mantovani M. Blunt abdominal trauma with small bowel injury: are isolated lesions riskier than associated lesions? Acta Cir Bras 2008 Mar-Apr; 23(2):192-197. 6. Fakhry SM, Watts DD, Luchette FA; EAST Multi-Institutional Hollow Viscus Injury Research Group. Current diagnostic approaches lack sensitivity in the diagnosis of perforated blunt small bowel injury: analysis from 275,557 trauma admissions from the EAST multi-institutional HVI trial. J Trauma 2003 Feb; 54(2):295-306. 7. Nagy KK, Roberts RR, Joseph KT, Smith RF, An GC, Bokhari F, et al. Experience with over 2500 diagnostic peritoneal lavages. Injury 2000 Sep; 31(7):479-482. 8. Shanmuganatahn K, Mirvis SE, Chiu WC, KL, Hogan GJF and Scalea Tm (2004): Penetrating torso trauma: triple-contrast helical CT in peritoneal violation and organ injury – a prospective study in 200 patients. Radiology; 231; 775-84. 9. Timothy C, Fabian, et al: A prospective analysis of laparoscopy in trauma. Annals of surgery 217(5):557-65. 10. Chol YB and Lim KS (2003): Therapeutic laparoscopy for abdominal trauma. Surg Endosc ; 17:421-7. 11. Jason Smith, et al. Laparoscopy in pediatric Blunt Trauma Abdomen. A case report, surg.l endosc 2002; 16:358-63. 12. Townsend MC, Flancbaum L, Choban PS, Cloutier CT. Diagnostic laparoscopy as an adjunct to selective conservative management of solid organ injuries after blunt abdominal trauma. J Trauma 1993;35:647-51 13. Meyer Richard A, crass Robert C, lim Jr R, Brooke Jeffrey Michael P, Federle Donald D, trunkey. New concepts in abdominal trauma. Arch surg 1985; 120(5): 550-54. 14. Pascal Fabiani, et al j. of lap endosc and adv surge tech oct 2002;13(5): 309-12 15. Sarmiento, et al. feasibility of laparoscopy in stable blunt trauma j Trauma 2003; 57:887-89.

Laparoscopic Cholecystectomy (LC) has lot of proven advantages over open cholecystectomy but some of its complications are always to be kept in mind for better results. This study was undertaken to study the complications of laparoscopic cholecystectomy and analyze them with regard to, conversion rate, intra-operative complications, post-operative complications, mortality and their management. This prospective study was conducted in the Department of Surgery, Government Medical College of Miraj, Maharashtra. The study included 50 patients who underwent elective laparoscopic cholecystectomy. Patients with age > 80 years, pregnant females, portal hypertension, and severe cardiac or pulmonary disease and pancreatic malignancies were excluded from the study. The complications which were noted include conversion to open cholecystectomy (12%), hematoma (16%), hemorrhage (6%), bile duct injury (2%), vascular injury (2%), visceral injury (2%), wound infection and wound pain (32%), pancreatitis (16%), retained stones (4%), subhepatic collection (2%), Port site and incisional hernia (16%).Guidelines for prevention for operative injury are similar to those of any open procedure namely, adequate training and experience, accurate identification of anatomy and identification of risk factors preoperatively leading to conversion of laporoscopic cholecystectomy to laparatomy.

1. David Fletcher et al. Complications of cholecystectomy: Riska of the laparoscopic approach and protective effects of operative cholangiography. Annals of surgery Vol 229, No4: 449-457 2. Pierre-Alain Clavien et al. Proposed Classification of complications of Surgery with examples of utility in cholecystectomy. 3. Norman Oneil Machado et al; Biliary complications past Laparoscopic Cholecystectomy: Mechanism, preventive measures and Approac to management review. 4. Melloul E et al, Percutaneous drainage versus emergency cholecystectomy, for the treatment of acute cholecystitis in critically ill patients: does it matter? World J Surg 2011; 35:826-833. 5. Shaikh IA e al, Are we performing enough emergency laparoscopic cholecystectomies? An experience from a distric general hospital. Int J Surg 2009; 7:482-484. 6. Change TC, et al. Evaluation of early versus delayed laparoscopic Cholecystectomy in the treatment of acute cholecystitis Hepatogastroenlerology 2009; 56:26-28. 7. L.H. Blumgarth, T. Fong: Surgery of the Liver and Biliary Tract; Third Edition, Volume one Page no. 735-74 8. Lee SW, et al. Impact of the Tokyo guidelines on the management of patients with acute calcully cholecystitis J Gastroentero Hepatol 2009; 24:1857-1861. 9. Steel e et al. Choledocholithiasis. Endoscopic Sphincterotomy or common bile duct exploiration. Ann Surg. 213:677-34, 1991. 10. Williams et al. Comparison of laparoscopic Chilecystectomy with open cholecystectomy in a single centre. Am J. Surg. 165; 459-65.1993. 11. Suuronen et al. Bleeding Complications in cholecystectomyL a register study of over 22000 cholecystectomyies in Finlad, BMC Surgery (2016) 15197. 12. Steel e et al. Choledocholithiasis. Endoscopic Sphincterotomy or common bile duct exploiration. Ann Surg. 213:677-34, 1991. 13. B. Krishna Rau Management of post operative complications after Laparoscopy Cholecystectomy. Bakken K, self harm in male patients with substance dependence syndrome. Addiction 2013; 108:433–40.

In this paper we study outcome of sutureless and glue free conjunctival autograft in pterygium surgery. To study pattern of astigmatism induced due to primary pterygium. To study the different complications after sutureless and glue free conjunctival autograft in pterygium surgery. To study change in astigmatism after pterygium surgery by sutureless and glue free conjunctival autograft.

1. Mitra S et al. Autoblood as Tissue Adhe- sive for Conjunctival Autograft Fixation in Pterygium Surgery. Poster presented at the Annual Meeting of the American Academy of Ophthalmology; Oct. 22 and 23, 2011; Orlando, Fla. 2. Wit D, Athanasiadis I, Sharma A, Moore J (2010). Sutureless and glue free conjunctival autograft in pterygium surgery: a case series. Eye 24: 1474-77. 3. Kenyon KR, Wagoner MD, Hettinger ME. Conjunctival autograft transplantation for advanced and recurrent pterygium. Ophthalmology 1985; 92: 1461 4. Tan D. Conjunctival grafting for ocular surface disease. Curr Opin Ophthalmol 1999; 10: 277–281 5. Pan HW et al. Ophthalmology. 2011;118(6): 1049-1054. 6. Hirst LW. Extensive Incision and Conjunc- tival Transplantation for Pterygium: Results of 1,000 Surgeries. Presented at World Cor- nea Congress; April 7-9, 2010; Boston.

: To investigate the role of postoperative topical 0.05% cyclosporine A (CsA) eye drops in the prevention of recurrence among patients with primary pterygium treated with bare-sclera technique. Methods: In this prospective randomized controlled study, 36 eyes (34 patients) with primary pterygium were randomized into two groups: Group I comprised 40 eyes (40 patients), and Group II comprised 40 eyes (39 patients). Bare sclera technique was performed in both groups. In Group I, 0.05% CsA was administered postoperatively at 6-hour intervals for 6 months, and Group II did not receive any cyclosporine treatment. The patients were assessed for recurrence, side effects, and complications at postoperative 1 and 7 days as well as each month during the following year. Conjunctival advances which showed a limbus higher than 1 mm were recognized as recurrence.

1. Coroneo MT, Girolamo N, Wakefield D. The pathogenesis of pterygia. Curr Opin Ophthalmol. 1999;10:282–288. 2. Hill JC, Maske R. Pathogenesis of pterygium. Eye. 1989;3:218–226. 3. Cameron ME. Histology of pterygium: an electron microscopic study. Br J Ophtalmol. 1983;67:604–608. 4. Chan CM, Liu YP, Tan DT. Ocular surface changes in pterygium. Cornea. 2002;21:38–42. 5. Wang IJ, Lai WT, Liou SW. Impression cytology of pterygium. J Ocular Pharmacol Therap. 2000;16:519–528. 6. Di Giriloma N, Chui J, Coreneo MT, Wakefield D. Pathogenesis of pterygia: role of cytokines, growth factors, and matrix metalloproteinases. Prog Retin Eye Res. 2004;23(2):195–289. 7. Girolama ND, Kumar RK, Cornea MT, Wakefield D. UVB. Mediated indication of interleukin-6 and 8 in pterigia and cultured human pterigium epithelial cells. Inves Opthalmol Vis Sci. 2002;143(119):3430–3437. 8. Dushku N, Reid TW. P53 expression in altered limbal basal cells of pingueculae, pterygia, and limbal tumors. Curr Eye Res. 1997;16(12): 1179–1192. 9. Tan DT, Tang WY, Liu YP, Goh HS, Smith DR. Apoptosis and apoptosis related gene expression in normal conjunctiva and pterygium. Br J Ophthalmol. 2000;84(2):212–216. 10. Weinstein O, Rosenthal G, Zirkin H, Monos T, Lifshitz T, Argov S. Overexpression of p53 tumor suppressor gene in pterygia. Eye. 2002; 16(5):619–621. 11. Lee DH, Cho HJ, Kim JT, Choi JS, Joo CK. Expression of vascular endothelial growth factor and inducible nitric oxide synthase in pterygia. Cornea. 2001;20(7):738–742. 12. Marcovich AL, Morad Y, Sandbank J, et al. Angiogenesis in pterygium: morphometric and immunohistochemical study. Curr Eye Res. 2002; 25(1):17–22. 13. Van Setten G, Aspiotis M, Blalock TD, Grotendorst G, Schultz G. Connective tissue growth factor in pterygium: simultaneous presence with vascular endothelial growth factor – possible contributing factor to conjunctival scarring. Grafes Arch Clin Exp Ophthalmol. 2003;241(2):135–139. 14. Yosihada S, Ono M, Shono T, et al. Involvement of interleukin-8, vascular endothelial growth factor, and basic fibroblast growth factor in tumor necrosis factor alpha-dependent angiogenesis. Mol Cell Biol. 1997;17(7):4015–4023. 15. Pucci N, Novembre E, Ciaferoni A, et al. Efficacy and safety of cyclosporine eyedrops in vernal keratoconjunctivitis. Ann Allergy Asthma Immunol. 2002;89(3):298–303. 16. Strong B, Farley W, Stern ME, Pflugfelder SC. Topical cyclosporine inhibits conjunctival epithelial apoptosis in experimental murine keratoconjunctivitis sicca. Cornea. 2005;24(1):80–85. 17. Al Fayez MF. Limbal versus conjunctival autograft transplantation for advanced and recurrent pterygium. Ophthalmology. 2002;109(9): 1752–1755. 18. Mutlu FM, Sobaci G, Tatar T, Yildirim E. A comparative study of recurrent pterygium surgery: limbal conjunctival autograft transplantation versus mitomycin C with conjunctival flap. Ophthalmology. 1999;106(4):817–821. 19. Nakamura M, Nishida T. Differential effects of epidermal growth factor and interleukin 6 on corneal epithelial cells and vascular endothelial cells. Cornea. 1999;18(4):452–458. 20. Solomon AS. Immunologic basis for the pathogenesis of pterygium. Am J Optalmol. 1985;99:216–217. 21. Nussenblatt RB, Palestine AG. Cyclosporine: immunology, pharmacology and therapeutic uses. Surv Opthalmol. 1986;31:159–169. 22. Okudaira H, Sakurai Y, Terado K, et al. Cyclosporin A-induced suppression of ongoing IgE antibody formation in the mouse. Int Arch Allergy Appl Immunol. 1986;79:164–181. 23. Hercules LA, Viveiros MM, Schellini SA, Cadeias J, Padovani CR. Exposure of Tenon’s capsule fibroblasts of pterygium to cyclosporine 0.05%. Arg Bras Oftalmol. 2006;(69):831–834. 24. Wu H, Chen G. Cyclosporine A and thiotepa in prevention of postoperative recurrence of pterygium. Yan Ke Xue Bao. 1999;15(2):91–92. 25. Yalcin Tok O, Burcu Nurozler A, Ergun G, Akbas Kocaoglu F, Duman S.Topical cyclosporine A in the prevention of pterygium recurrence. Ophthalmologica.2008;222(6):391–396. 26. Aydin A, Karadayi K, Aykan U, Can G, Colakoglu K, Bilge AH. Effectiveness of topical ciclosporin A treatment after excision of primary pterygium and limbal conjunctival autograft. J Fr Ophtalmol. 2008;31(7):699–704. 27. Ibáñez M, Eugarrios MF, Calderón DI. Topical cyclosporin A and mitomycin C injection as adjunctive therapy for prevention of primary pterygium recurrence. Ophthalmic Surg Lasers Imaging. 2009;40(3): 239–244.

Background: Recent evidence supports an association between vitamin D deficiency and hypertension, peripheral vascular disease, diabetes mellitus, metabolic syndrome, coronary artery disease, and heart failure. Materials and Methods: 100 consecutive cases of acute myocardial infarction and angina pectoris were included in this study. Another 100 otherwise age and sex matched healthy individuals formed the control group. The study was a prospective observational study. Observations: There was not much difference between the two groups as per the age and sex. 56 patients were obese while 38 were in the control group. Physical activity was slightly more in control group as 12 in patient group and 24 in control group were optimally active. 74% cases were smokers as against 46% in the asymptomatic group. There was no difference in alcohol consumption amongst the groups. Diabetes mellitus was more prevalent in study group (48 vs 22). 75% of patient group did record low Vitamin D levels, while 45% of the control individuals showed lower than 30 ng/ml. Without adjustment, the chance of being affected by coronary artery disease in individuals with vitamin D deficiency is 4.12 (1.64-8.04) times in comparison with those with normal vitamin D and after adjustment with risk factors, i.e., blood pressure, diabetes, smoking, obesity, physical activity and high blood cholesterol, this chance becomes 6.08 times (1.76-18.83). Discussion: The results of our study demonstrate that vitamin D deficiency increases the chance of coronary artery disease due to ischemic heart disease and the association between ischemic heart disease and vitamin D deficiency remains significant even after adjustment for cardiovascular risk factors such as diabetes, smoking, obesity, physical activity, high blood cholesterol.

1. Stamler J, Vaccaro O, Neaton JD, Wentworth D. Diabetes, other risk factors, and 12-yr cardiovascular mortality for men screened in the Multiple Risk Factor Intervention Trial. Diabetes Care 1993; 16(2): 434-44. 2. Krause R, Buhring M, Hopfenmuller W, Holick MF, Sharma AM. Ultraviolet B and blood pressure. Lancet.1998; 352:709–10. [PubMed] 3. Chiu KC, Chu A, Go VL, Saad MF. Hypovitaminosis D is associated with insulin resistance and beta cell dysfunction. Am J Clin Nutr. 2004; 79:820–5. [PubMed] 4. Cigolini M, Iagulli MP, Miconi V, Galiotto M, Lombardi S, Targher G. Serum 25-hydroxyvitamin D3 concentrations and prevalence of cardiovascular disease among type 2 diabetic patients. Diabetes Care.2006; 29:722–4. [PubMed] 5. Targher G, Bertolini L, Padovani R, Zenari L, Scala L, Cigolini M, et al. Serum 25-hydroxyvitamin D3 concentrations and carotid artery intima-media thickness among type 2 diabetic patients. Clin Endocrinol.2006; 65:593–7. [PubMed] 6. Wang TJ, Pencina MJ, Booth SL, Jacques PF, Ingelsson E, Lanier K, et al. Vitamin D deficiency and risk of cardiovascular disease. Circulation.2008; 117: 503–11. [PMC free article] [PubMed] 7. Judd S, Tangpricha V. Vitamin D deficiency and risk for cardiovascular disease. Circulation. 2008;117:503–11.[PMC free article] [PubMed] 8. Holick MF. Vitamin D deficiency. N Engl J Med 2007; 357(3): 266 – 81 9. Judd S, Tangpricha V. Vitamin D deficiency and risk for cardiovascular disease. Circulation. 2008;117:503–11.[PMC free article] [PubMed] 10. Douglas AS, Dunnigan MG, Allan TM, Rawles JM. Seasonal variation in coronary heart disease in Scotland. J Epidemiol Community Health. 1995;49:575–82.[PMC free article] [PubMed] 11. Kendricka J, Targherb G, Smitsa G, Chonchola M. 25-Hydroxyvitamin D deficiency is independently associated with cardiovascular disease in the Third National Health and Nutrition Examination Survey. Atherosclerosis.2009; 205: 255–60. [PubMed] 12. Scragg R, Sowers M, Bell C. Serum 25-hydroxyvitamin D, ethnicity, and blood pressure in the Third National Health and Nutrition Examination Survey. Am J Hypertens 2007; 20(7): 713-9. 13. Siadat ZD, Shariat AS, Sadeghi M, Kiani K, Farajzadegan Z, Kheirmand M. Vitamin D deficiency and coronary artery disease. J Res Med Sci 2012; 17(Spec 2): S190-S193. 14. Vacek JL, Vanga SR, Good M, Lai SM, Lakkireddy D, Howard PA. Vitamin d deficiency and supplementation and relation to cardiovascular health. Am J Cardiol.2012; 109:359–63. [PubMed] 15. Motiwala SR, Wang TJ. Vitamin D and cardiovascular risk. Curr Hypertens Rep. 2012; 14:209–18. [PubMed]

Dietary habits play a major role in the healthy wellbeing of and individual and may be the key intervention for treatment of overweight and obesity and the chronic disorders along with it. The study to know the incidents of obesity in medical students and its correlation with dietary habits is of great significance as students in general are highly inclined to irregular and unhealthy dietary habits. On the other hand medical students, with irregular and prolonged study schedules tend to be further inclined to such dietary habits. Obesity is well known disorder of the 21st century which is constantly on the rise, carrying with it the vast Variety of health related factors. The study included 200 medical students of the ages 18-24. The students were examined thoroughly, so as to exclude those suffering from major diseases, psychological problems and those on medication. Obesity was determined by calculating the BMI according to the American journal of clinical nutrition. And the grading of obesity into various grades between 18.5 to 24.9 kg/m, was done according to WHO. Dietary habits was determined by a self admitted questionnaire on dietary and exercise habits, (extracted from) “A Survey of Dietary and Exercise Habits and Perceived Barriers to Following a Healthy Lifestyle in a College Population by Kathryn Silliman, Kathleen Rodas-Fortier, Michelle Neyman California State University, Chico2. After appropriate statistical analysis and assessment it was observed that 47 (23.5%) students belonged to the overweight category with BMI ranging from 30.0 to 39.9.Maximum number of students i.e. 89 (44.5%) were found to be inclined to snacking while studying Majority of the students 85 (42.5%) snacked on food items such as chips, crackers and nuts. While 42 (21%) students snacked on ice cream, candy and cookies. There is significant concern about the regularity of consumption of fruits and vegetables, as Maximum number 80 (40%) of students consumed vegetables a mere 2-6 times a week, while only 33 (16.5%) students consumed vegetables daily. Fruits were consumed by majority of students 123 (63%) only once a week or less. while only 11 (5.50%) students consumed fruits on a daily basis.

1. William H, Mary C. American journal of clinical nutrition.1999; 70: 123-25. 2. Silliman K. A survey of dietary and exercise habits and perceived banners to following a healthy Lifestyle in college population. California journal of health promotion 2004; 2(2): 10-12. 3. Theresea N, Tom B, Karen W and Gerald B. Eating patterns, dietary quality and obesity. Journal of the American college of nutrition 2001; 20(6): 599-608. 4. Babar T Shaikh et al. Education for health 2004; 17(3): 346-53. 5. Masaaki Tanaka et al, relationship between dietary habits and the prevalence of fatigue in medical students. Nutrition 2008; 24(10): 985-89. 6. Gopalkrishna S, Ganeshkumar P, Prakash M V, Christopher, Amlraj V, Prevalence of overweight/obesity among medical students, Malaysia Med J Malaysia 2012; 67(4): 442-4. 7. Ruka S, Kenji T, Rie A, Chuan-Jun L, Naotaka S. Nutritional knowledge, food habits and health attitude of Chinese university students. Nutritional journal 2005; 4(4) 8. Delia Smith West et al. Self-reported sugar-sweetened beverage intake among college students, obesity 2006; 14(10): 1825-31. 9. Gopalkrishna S, Ganeshkumar P, Prakash M V, Christopher, Amlraj V, Prevalence of overweight/obesity among medical students, Malaysia, Med J Malaysia aug 2012, 442-4. 10. Ekpanyaskul C, Sithisarankul P, Wattansirichaigoon S, Overweight/obesity and related factors among Thai medical students. Asia Pac J public health. 2013: 25(2): 170-80. 11. Mervin Israel, UshaPatil, V.M. Ruikar. A study to know the incidence of obesity in medical students and its correlation with physical fitness. IJRTSAT 2016; 14(3): 549-53.

Endoveinous laser ablation (EVLA) of the great saphenous vein (GSV) is thought to minimize postoperative morbidity and reduce work loss compared with high ligation and stripping (HL/S). Patients with varicose veins due to GSV insufficiency were randomized to either EVLA (980 nm) or HL/S in tumescent anesthesia. In our clinics, 50 varicose patients were treated between August 2013 and September 2016. EVLA was applied in 25 cases and HL/S was applied in 25cases. Clinical features and demographic characteristics of the patients were summarized. EVLA procedure was done by 980 nm diode laser (Ceralas D 980, Biolitec) at continues mode with 15 W energy. Patient visits were done at post-operative 10th day, 6th month, 1st year and 2nd year. Routine physical examination and Doppler USG assessments were performed at these visits. EVLA and HL/S procedures were done in complete success in all cases at both groups. All cases were invited for control visits. When complications developed after procedures were evaluated; no infection, hematoma or paresthesis were observed in EVLA group. However in HL/S group; infections, hematomas and paresthesis were observed in 6, 4 and 2 cases respectively. In terms of treatment success, there was no recurrence in EVLA procedure while recurrence rate after conventional surgery found in 3 cases. In terms of post-op complication, EVLA method was associated with significantly less paresthesis, hematoma and pain. EVLA method is a method as effective and safe as standard treatment. However, when a long term result of this method is shown completely, its effectiveness will be cleared and its clinical utility will be established.

1. Callam M.J. Epidemiology of varicose veins Br J Surg 1994; 81: 167-173. 2. Slagsvold CE, Stranden E, Rosales A. Venous insufficiency in the lower limbs Tidsskr Nor Laegeforen. 2009 Nov 5; 129: 2256-2259. 3. Evans CJ, Fowkes FG, Ruckley CV, et al. Prevalence of varicose veins and chronic venous insufficiency in men and women in the general population: Edinburgh Vein Study. J Epidemiol Community Health 1999; 53: 149-153. 4. Carpentier PH, Maricq HR, Biro C, et al. Prevalence, risk factors, and clinical patterns of chronic venous disorders of lower limbs: a population-based study in France J Vasc Surg 2004; 40: 650-659. 5. Jawien A. The influence of environmental factors in chronic venous insufficiency. Angiology 2003; 54 1: 19-31. 6. National Institute for Clinical Excellence-NICE. Interventional procedures overview of endovenous laser treatment of the long saphenous vein 2003. 7. Min RJ, Khilnani N, Zimmet SE. Endovenous laser treatment of saphenous vein reflux: long-term results. J VascIntervRadiol 2003; 14: 991-996. 8. Teruya TH, Ballard JL. New approaches for the treatment of varicose veins. Surg Clin North Am 2004; 84: 1397-417. 9. Tessari L, Cavezzi A, Frullini A. Preliminary experience with a new sclerosing foam in the treatment of varicose veins. Dermatol Surg 2001; 27: 58-60. 10. Lurie F, Creton D, Eklof B, et al. Prospective randomized study of endovenous radiofrequency obliteration (closure procedure) versus ligation and stripping in a selected patient population 2003; 38: 207-214. 11. Lurie F, Creton D, Eklof B, et al. Prospective randomised study of endovenous radiofrequency obliteration (closure) versus ligation and vein stripping (EVOLVeS): two-year follow-up. Eur J Vasc Endovasc Surg 2005; 29: 67-73. 12. Hinchliffe RJ, Ubhi J, Beech A, et al. Braithwaite BDA prospective randomised controlled trial of VNUS closure versus surgery for the treatment of recurrent long saphenous varicose veins. Eur J VascEndovascSurg 2006; 31: 212-218. 13. De Medeiros CAF, Luccas GC. Comparison of endovenous treatment with an 810 nm laser versus conventional stripping of the GSV in patients with primary varicose veins. DermatolSurg 2005; 31: 1685-1694. 14. Wright D, Gobin JP, Bradbury AW, et al. Varisolve polidocanolmicrofoam compared with surgery or sclerotherapy in the management of varicose veins in the presence of trunk vein incompetence: European randomized controlled trial. Phlebology 2006; 21:190. 15. Hartmann K, Klo de J, Pfister R, et al. Recurrent varicose veins: sonography-based re-examination of 210 patients 14 years after ligation and saphenous vein stripping. Vasa 2006; 35: 21-26. 16. Uncu H. Should complete stripping operation to the ankle be avoided in the treatment of primary varicose veins due to greater saphenous vein insufficiency? Acta Cir Bras 2009; 24: 411-415. 17. Rasmussen LH, Bjoern L, Lawaetz M, et al. Randomized trial comparing endovenous laser ablation of the great saphenous vein with high ligation and stripping in patients with varicose veins: short-term results. J VascSurg 2007; 46: 308-315. 18. Proebstle T, Gul D, Lehr H, et al. Infrequent early recanalization of greater saphenous vein after endovenous laser treatment. Journal of Vascular 2003; 38: 511-516. 19. Al Samaraee A, McCallum IJ, Mudawi A. Endovenous therapy of varicose veins: A better outcome than standard surgery? Surgeon 2009; 3:186. 20. Theivacumar NS, Della grammaticas D, Beale RJ, et al. Fate and clinical significance of saphenofemoral junction tributaries following endovenous laser ablation of great saphenous vein. Br J Surg 2007; 94: 722-725. 21. Demirkili9 U. Endovenoz Lazer Tedavisinde Son Geli§meler Turkiye Klinikleri J Cardiovasc Surg- Special Topics 2009; 2: 36-38. 22. Prince EA, Ahn SH, Dubel GJ, et al. An investigation of the relationship between energy density and endovenous laser ablation success: does energy density matter?J Vasc Interv Radiol 2008; 19: 1449¬1453.

Survival analysis encompasses investigation of time to event data in clinical research. In survival analysis, it is common to have truncated data due to limited time span of the study or drop out of the subject for various reasons. The estimation of survivor function under left truncation was first discussed by Kaplan Meier by extending the well known product limit estimator of the survivor function. Later several parametric models are used for modelling survival data. The focus of this paper is to compare the models and their application in the study on increased access to emergency contraception by Raymond, E. et al. (2006) and their adverse impact on risk of sexual transmitted infections. Various models are computed using SAS (Statistical Analysis System) program. The findings are presented and discussed.

1. D.R.Cox and D.Oakes, Analysis of Survival Data, Chapman and Hall London (1984). 2. Elandt-Johnson, R. C. and N.L. Johnson Survival Models and Data Analysis, John Wiley and Sons New York (1980). 3. D.Collett, Modeling Survival Data in Medical Research, Chapman and Hall London (1994). 4. J R. D W Hosmer, S.Lemeshow Applied Survival Analysis; Regression Modeling of Time to Event Data. John Wiley and Sons New York 1999. 5. D G Kleinbaum , Survival Analysis: A self-Learning Text. Springer-Verlag New York 1996. 6. P. D Allison, Survival Analysis Using the SAS System: A Practical Guide, SAS Institute, Cary, NC, SAS Institute, Inc., 1995.

Meconium peritonitis is an aseptic chemical peritonitis that follows perforation of intestines in fetal life. Bowel wall calcification in such cases is rare. It should be emphasized that correct diagnosis can be made on basis of characteristic roentgenographic findings.

1. BMJ Case Reports 2014;doi;10.1136/bcr-2014-203536 2. Rickham PP. Intraluminal intestinal calcification in the newborn.Arch.Dis.Child.1957;32(161):31-4.doi;10.1136/adc.32.161.31 3. Payne RM, Nielsen AM. Meconium Peritonitis. AmSurg 1983; 28; 224-231. 4. Valladares E, Rodriguez D, Vela A, et al. Meconium pseudocyst secondary to ileum volvulus perforation without peritoneal calcification 5. HillcoatBL. Calcification of the meconium within the bowel of the newborn.Arch.Dis.Child.1962; 37:86-9. 6. Selke AC, Cowley CE. Calcified intraluminal meconium in a female infant with imperforate anus.AJR Am J Roentgenol.1978; 130(4):786-8.

Intestinal Malrotation is a congenital anatomical anomaly which results from an abnormal rotation of the gut as it returns to the abdominal cavity during embryogenesis.

1. Fischer JE, Bland KI. Mastery of surgery. Lippincott Williams & Wilkins. (2007) ISBN: 078177165X. 2. CT and MRI of the whole body by John R. Hagga Volume 2 Fourth edition Page No. 2071. 3. Textbook of radiology and imaging by David Sutton Volume 1 Seventh Edition. 4. Zerin JM, DiPietro MA: Mesenteric Vascular anatomy at CT: Normal And abnormal Appearances, Radiology 179:739-742,1991.

Background: Hypothyroidism is the most frequently encountered health problem in India, especially among women population. Aims and Objectives: To study the occurrence of hypothyroidism in adults with male to female ratio, its age of onset, to see for drug induced hypothyroidism. To see for co-morbid conditions associated with hypothyroidism. Material and Methods: Total 100 patients were included in this study. All adults attending medicine OPD/IPD who fulfill the criteria for suspect hypothyroidism were included in the study. Results: A female preponderance with an alarming ratio of 24:5 (female: male) was observed. Average age of onset of hypothyroidism was 33 years. Subclinical hypothyroidism was observed in 37% cases. Hypertension was present as a comorbid state in 70 % cases. Hypertension and Diabetes mellitus coexistedin 17 % of the cases.

1 Boelaert K, Franklyn JA; Thyroid hormone in health and disease. J Endocrinol. 2005 Oct; 187(1):1-15. 2 Cooper DS. Subclinical hypothyroidism. N Engl J Med. 2001;345(4):260-265 [PubMed] 3 Roberts CG, Ladenson PW. Hypothyroidism. Lancet 2004;363:793-803 4 Davidson's Principles and Practice of Medicine By Brian R. Walker, Nicki R Colledge-22nd edition 5 Harrison's Principles of Internal Medicine, 19eDennis Kasper, Anthony Fauci, Stephen Hauser, Dan Longo, J. Larry Jameson, Joseph Loscalzo

Introduction: Subtrochanteric femur fractures have demanded special consideration in orthopaedic traumatology, given the high rate of complications associated with their management. 10%–34% of all hip fractures occur in the subtrochanteric region. Purpose of the study: To compare the clinical outcome of Seinsheimer type IIB and type IIIA subtrochanteric fractures treated with PFN versus LCP – PF. Materials and Method: A prospective study of 40 patients with Seinsheimer type IIB and type IIIA subtrochanteric fracture among which 20 were treated with Proximal Femoral Nail and 20 with Proximal Femoral-Locking Compression Plate at two Hospitals attached to J.J.M Medical College Davangere, Karnataka, India between June 2014 to October 2016.. At final follow up results were assessed with Modified Harris Hip score. Result: In the PFN group, 9 patients (45%) showed excellent outcome, 9 patients (45%) showed good outcome and 2 patients (10%) showed fair outcome. Among the PF-LCP group, 12 patients (60%) showed good outcome, 4 patients (20%) showed fair outcome and 04 patients with poor outcome. Conclusion: Proximal Femoral Nail for subtrochanteric fractures has better results compared to Locking Compression Plate-proximal femur with less failure rates and restoring better hip biomechanics.

1. La Velle DG, Canale ST and Beaty JH, Campbell's Operative Orthopaedics. Vol 3,11th ed. Philadelphia: Mosby; 2008. p. 3237-8, 62. (vol3). 2. Kwok-sui Leung Subtrochanteric fracture Chapter 46, Rockwood and green's fractures in adults; 6th edition pg 1827-1844. 3. Harkess J.W., Crockarell J.R. “Arthroplasty of hip”. Chapt 7 in Campbell’s Operative Orthopaedics. Volume 1, 11thed, Canale S.T. and Beaty J.H. (edts), Philadelphia; Mosby; 2008:312-482. 4. Pavelka T, Kortus J, Linhart M. Osteosyntehsis of proximal femoral fractures using short proximal femoral nails. ActaChirOrhtopTraumatolCech 2003; 70 (1):31-8. 5. Alho A, Ekeland A, Grogaard B, Dokke JR. A locked hip screw-intramedullary nail (cephalomedullary nail) for the treatment of fractures of the proximal part of the femur combined with fractures of the femoral shaft. J Trauma 1996; 40:10-16. 6. McLaurin, Toni M. M.D.; Lawler, Ericka A. M.D. Treatment Modalities for Subtrochanteric Fractures in the Elderly JBJS Septr 2004 Vol 19(3), pp 197-213. 7. Yoo MC, Cho YJ, Kim KI, Khairuddin M, Chun YS. Treatment of unstable peritrochanteric femoral fractures using a 95degrees angled blade plate. J Orthop Trauma 2005; 19:687–92. 8. Crist BD, Khalafi AK, Hazelwood SJ, Lee MA.A biomechanical comparison of locked plate fixation with percutaneous insertion capability versus the angled blade plate in a subtrochanteric fracture gap model. J Orthop Trauma 2009; 23:622–7. 9. Setiobudi T, Ng YH, Lim CT, Liang S, Lee K, Das De S. Clinical outcome following treatment of stable and unstable intertrochanteric fractures with dynamic hip screw. Ann Acad Med Singapore 2011; 40:482–7