Aim: “To Study the effect of tricep strengthening in lateral epicondylitis†Objectives: To study the effect of tricep srtenghthening on pain relief. To study the effect of tricep strenghthening in functional activities. To study the effect of conventional therapy on pain relief. To study the effect of conventional therapy on functional activities. To compare the effect of tricep strength thening and conventional therapy on pain and functional activities. Procedure: 30 Samples were collected according to inclusion and exclusion criteria. Then Consent was taken from the respective subjects to conduct the study. Respective protocol was followed for Group A and Group B; and treatment protocol was followed for 2 weeks. Pre and post values of subjects was assessed by numerical pain rating scale, strength of elbow flexors with 10 RM, isometric strength of triceps was reassessed by Jamar dynamometer, and pain and functional assessment with patient rated tennis elbow evaluation questionnaire. Data was collected and analyzed statistically. Results: t value for NPRS comparion between group A and B is 0.871. At p value 0.391: considered Significant at p≤ 0.05 with 95 % confidence interval. t value for 10RM in group A and B in pre and post treatment is -1.169. At p value 0.252: considered Significant at p≤ 0.05 with 95 % confidence interval. t value for isometric strength of right triceps with jamar dynamometer is-0.561. At p value 0.579: considered Significant at p≤ 0.05 with 95 % confidence interval. t value for isometric strength of left triceps with jamar dynamometer is 0.469. At p value 0.643: considered Significant at p≤ 0.05 with 95 % confidence interval. t value for comparison between PRTEEQ in group A and B is 0.871. At p value 0.391: considered Significant at p≤ 0.05 with 95 % confidence interval. Conclusion: This study concludes that triceps strengthening along with conventional physiotherapy program has shown better improvement on NPRS,10RM, (Triceps) Isometric strength with JAMAR DYNAMOMTERE score as compared to conventional physiotherapy alone over 2 week of training program.
Aim: “To Study the effect of tricep strengthening in lateral epicondylitis†Objectives: To study the effect of tricep srtenghthening on pain relief. To study the effect of tricep strenghthening in functional activities. To study the effect of conventional therapy on pain relief. To study the effect of conventional therapy on functional activities. To compare the effect of tricep strength thening and conventional therapy on pain and functional activities. Procedure: 30 Samples were collected according to inclusion and exclusion criteria. Then Consent was taken from the respective subjects to conduct the study. Respective protocol was followed for Group A and Group B; and treatment protocol was followed for 2 weeks. Pre and post values of subjects was assessed by numerical pain rating scale, strength of elbow flexors with 10 RM, isometric strength of triceps was reassessed by Jamar dynamometer, and pain and functional assessment with patient rated tennis elbow evaluation questionnaire. Data was collected and analyzed statistically. Results: t value for NPRS comparion between group A and B is 0.871. At p value 0.391: considered Significant at p≤ 0.05 with 95 % confidence interval. t value for 10RM in group A and B in pre and post treatment is -1.169. At p value 0.252: considered Significant at p≤ 0.05 with 95 % confidence interval. t value for isometric strength of right triceps with jamar dynamometer is-0.561. At p value 0.579: considered Significant at p≤ 0.05 with 95 % confidence interval. t value for isometric strength of left triceps with jamar dynamometer is 0.469. At p value 0.643: considered Significant at p≤ 0.05 with 95 % confidence interval. t value for comparison between PRTEEQ in group A and B is 0.871. At p value 0.391: considered Significant at p≤ 0.05 with 95 % confidence interval. Conclusion: This study concludes that triceps strengthening along with conventional physiotherapy program has shown better improvement on NPRS,10RM, (Triceps) Isometric strength with JAMAR DYNAMOMTERE score as compared to conventional physiotherapy alone over 2 week of training program.
A clinical study of effect of transcutaneous nerve stimulation (TENS) in labour analgesia
Bharati Rajani, Hemlata Chaudhary, Bhavna V Panchmatiya, Ravi Agrawal
Objective: Objectives are to observe the onset, effectiveness, extent of labour analgesia using TENS and cardiovascular and respiratory changes in mother. Effect of TENS on the progress of labour on fetal heart rate and adverse effect of TENS, if any.
1. Abouleish E. (1977) Pain control on /obstetrics, pop 365-382. Philadelphia. JB Lippincott.
2. Abouleish E. and Depp, R: (1975) Acupunture in obstetrics. Anaestheis and analgesia 54:83.
3. Beecher HK (1969): Anxiety and pain. J.A.M.A. 209, 1080.
4. Andersson, S.A. and Holmgen E. (1978): analgesic effect of peripheral conditioning stimulation III. Effect of high frequency stimulation, segmental mechanism interacting with pain. Acupunct. Electrother Res. 3:23.
5. Augustinsson L.E., Bohlin, P.H., Bundsen P., Carlsson, C.A. Feersmman L., et al (1977). Pain relief during delivery by transcutaneous electrical nerve stimulation. Pain 4; 59:1977.
6. Bajaj Pramilla, Artikelkar, Devendra Kumar (1996). TENS therapy for pain of different origin Indian Jr of Anaesthesia, 44: 309.
7. Bonica J.J. (1967) Principle and practice of obstetric Analgesia and Anesthesia. Philadelphia. F.A. Davis.
8. Bundsenn P. Peterson L.E. and Selstam G. (1981). Pain relief in labour by TENS. A prospective matched study. Acta Obstet. Gynecol. Scand. 60:459.
9. Burten C. and Maurer DD (1974): pain suppression by transcutaneous electronic stimulation. IEEE transcutaneous on Biomedicl Engineering BMe-21, 81.
10. BowsherD(1978). Pain and pain pathway mechanism Anaesthesia, 33,935.
11. Abubakirova AM, Koraeva LV, PoluianovaLA(1985). Comparative evaluation of drug free methods. Analgesion in labour. Anaestheziol. Reanimatel, May June, (3),(19-20)
12. Melzack R, Taenzer P Feldman P andKinch RA (1981). Labour is still painful after prepared childbirth training. Candian Medical Association Journal 125:357-363.
13. Melzack, M. and Wall, P.D. (1962). On the nature of cutaneous sensory mechanisms. Brain, 85,331-356.
14. Shealy CN, Maurer D (1976): Electropuncture and endogenous morphines. Lancet,2, 1085.
15. Peter Bundsen, KlasEvicson, Lars Erik Peterson and KlaraThritinger (1982). Pain relief in labour by TENS: ActaObstet. Gynecol. Scand 61.
16. Bonica J.J. (1979). Clinical study of nociceptive pathways from uterus. Pain, 7.
17. Argent PogesF(1921) SanidMilit Argent. 11, 351, Quoted by Wyllie and Churchill Davidson, 5th Ed. 888.
18. Chia YT, Arulkumaran S, Chua S, RatnamSS(1990). Effectivenss of transcutaneous electric nerve stimulator for pain relief in labour. Asia Oceania J. Obstet. Gynecol. Jun. 16(2):145-51.
19. Harrison RF, Woods T, Shore M, Mathews G, Unwin A(1986). Pain relief in labour using TENS. A TENS/TENS pacebo controlled study in two parity groups. Br. J. Obstet. Gynaeco:l Jul. 93(7), 739-46.
Development of indigenous innovative visual reinforcement system for hearing screening among young children
Visual reinforcement audiometry (VRA) is the gold standard hearing assessment procedure. It is a combination of both visual and auditory stimuli uses conventional toys and speakers to estimate hearing. The aim of the study is to develop digital animated VRA instrumentation and to test the feasibility of the tool in screening young children. The study was carried out in two phases, wherein the development of the age appropriate digital video animated clips and the VRA system as a part of phase I. Phase II focused on exploring the feasibility of the newly developed instrument with digital images. Two groups of 21 typically developing children underwent VRA hearing testing in a sound treated room. Children of three different age groups (7-12 month, 13-24 months, 25-36 months) were included in the study. Results indicates that older children (13 to 36 months) demonstrated greater interest and anticipation for the newly developed system of VRA. It is evident that the newly developed VRA system is a clinically plausible option for testing hearing in young children.
Visual reinforcement audiometry (VRA) is the gold standard hearing assessment procedure. It is a combination of both visual and auditory stimuli uses conventional toys and speakers to estimate hearing. The aim of the study is to develop digital animated VRA instrumentation and to test the feasibility of the tool in screening young children. The study was carried out in two phases, wherein the development of the age appropriate digital video animated clips and the VRA system as a part of phase I. Phase II focused on exploring the feasibility of the newly developed instrument with digital images. Two groups of 21 typically developing children underwent VRA hearing testing in a sound treated room. Children of three different age groups (7-12 month, 13-24 months, 25-36 months) were included in the study. Results indicates that older children (13 to 36 months) demonstrated greater interest and anticipation for the newly developed system of VRA. It is evident that the newly developed VRA system is a clinically plausible option for testing hearing in young children.
In-Vitro cultivation of mycobacterium leprae and confirmation by molecular method
Mycobacterium leprae was the first organism described as the causative agent of an infection. It was described by Dr. G. Armaner Hansen as the causative agent of leprosy in 1874. Thereafter, numerous agents/bacteria have been described as causative agents of disease like Mycobacterium tuberculosis, Vibrio cholera, etc. Almost all bacteria discovered till now have been grown in artificial culture in chemically defined media (in-vitro cultivation) in the laboratory. However, Mycobacterium leprae though first described as a causative agent still remains uncultivable in the laboratory in artificial culture media. Numerous attempts have been made by different workers to grow this organism in the laboratory but all attempts at cultivation have been unsuccessful till date. As it would be too extensive to list all the unsuccessful attempts at cultivating this organism on artificial culture media, only a few important references are cited here (see References 1-10 below).
Mycobacterium leprae was the first organism described as the causative agent of an infection. It was described by Dr. G. Armaner Hansen as the causative agent of leprosy in 1874. Thereafter, numerous agents/bacteria have been described as causative agents of disease like Mycobacterium tuberculosis, Vibrio cholera, etc. Almost all bacteria discovered till now have been grown in artificial culture in chemically defined media (in-vitro cultivation) in the laboratory. However, Mycobacterium leprae though first described as a causative agent still remains uncultivable in the laboratory in artificial culture media. Numerous attempts have been made by different workers to grow this organism in the laboratory but all attempts at cultivation have been unsuccessful till date. As it would be too extensive to list all the unsuccessful attempts at cultivating this organism on artificial culture media, only a few important references are cited here (see References 1-10 below).
Morbidity pattern among elderly population at tertiary care hospital: A retrospective study
In general, “elderly†age group is defined as persons aged 65 years and above. The two extremes of life child and elderly need special care. Elderly life is full of problems – physical, social and economic. While ageing of the population is essentially a simple phenomenon, its consequences are multiple and not always well recognized Methodology: A hospital based retrospective study was undertaken during the period of1 April 2014 to 31 March 2015 to know the morbidities in geriatric population admitted in Government Medical College Latur. Results: Mean age of geriatric patients was 72 years and maximum age of patient admitted was 106 years. common morbidity seen is cataract and diminished vision (62.92%), followed by Injury and various fractures(19.53), Diseases of circulatory system ;Diseases of blood and blood forming organs (4.52), Diseases of respiratory system (2.71), Infectious and parasitic diseases (2.44), Diseases of digestive system (2.26). Conclusion: There is a growing need for interventions to ensure the health of this vulnerable group and to create a policy to meet the care and needs of the disabled elderly. Further research, especially qualitative research, is needed to explore the depth of the problems of the elderly.
In general, “elderly†age group is defined as persons aged 65 years and above. The two extremes of life child and elderly need special care. Elderly life is full of problems – physical, social and economic. While ageing of the population is essentially a simple phenomenon, its consequences are multiple and not always well recognized Methodology: A hospital based retrospective study was undertaken during the period of1 April 2014 to 31 March 2015 to know the morbidities in geriatric population admitted in Government Medical College Latur. Results: Mean age of geriatric patients was 72 years and maximum age of patient admitted was 106 years. common morbidity seen is cataract and diminished vision (62.92%), followed by Injury and various fractures(19.53), Diseases of circulatory system ;Diseases of blood and blood forming organs (4.52), Diseases of respiratory system (2.71), Infectious and parasitic diseases (2.44), Diseases of digestive system (2.26). Conclusion: There is a growing need for interventions to ensure the health of this vulnerable group and to create a policy to meet the care and needs of the disabled elderly. Further research, especially qualitative research, is needed to explore the depth of the problems of the elderly.
Effect of rehablitation on muscle imbalance in upper cross syndrome
Aims and Objective: To assess the effect of exercise, stretching and postural correction on neck Imbalance and To assess the effect of exercise, stretching and postural correction on forward head posture Design: Experimental Study Setting: Dr.D.Y.Patil I.P.D. and O.P.D. Participants: Twenty four patients with the complain of neck pain in the age group of 20-40 years and history of working in same posture for 6 to 8 hours participated in the study. Intervention: All the patients were conveniently selected from the OPD of Physiotherapy clinic in our institution and after signing of consent form they were given 2 week rehabilitation protocol of stretching and strengthening (based on Sherrington law) and posture correction exercise. Craniovertebrtal angle, NDI and VAS were used to assess the pain discomfort and disability caused by neck pain. Outcome Measures: VAS (visual analogue scale), Neck Disability Index, CV angle. Result: 24 participants completed the study. Comparison of pre and post Neck disability index, Neck pain (VAS) and craniovertebral angle were found to be statistically significant (p<0.05) at the end of 2 week rehabilitation protocol of stretching, strengthening and posture correction Conclusion: This study concludes that the effect of exercise, stretching and postural correction was there on Pain, neck Imbalance and also on the forward head posture. There was significant decrease in pain and neck disability.
1. Griegel-Morris P, Larson K, Mueller-Klaus K, Oatis CA. Incidence of common postural abnormalities in the cervical, shoulder, and thoracic regions and their association with pain in two age groups of healthy subjects. Physical Therapy 1992; 72(6):425–31.
2. Moore, M.K., 2004. Upper crossed syndrome and its relationship to cervicogenic headache. Journal of Manipulative and Physiological Therapeutics, 27, 414–420
3. Watson DH, Trott PH. Cervical Headache:an investigation of natural head posture and upper cervical flexor muscle performance.Cephalgia 1993 Aug;13(4):272-284.
4. Fernandez-de-las-Penas, C., et al., 2005. Forward head posture and neck mobility in chronic tension type headache: A blinded, controlled study. Cephalalgia, 26, 314–319.
5. Panjabi MM. 1992. The stabilizing system of the spine. Part I. Function, dysfunction, adaptation, and enhancement. J Spinal Disord. 5(4):383-9
6. Janda v: Muscle strength in relation to muscle length: pain and muscle imbalance. In: Harms -Rindahl K,ed : muscle strength. New York, churchill Livingstone, 1993
7. Janda v: Muscles, central nervous motor regulation and back problems. In : korr I ed: The neurobiologic Mechanism in manupulative therapy, New York, Plenum press,1978:27-41
8. Darlene Hertling, Randolph M. Kessler et al :management of common musculoskeletal disorders, Physical therapyPrinciples and methods, 4th edition : 150
9. Janda V: Muscle function Testing. London,Butterworth,1983
10. Janda v: Muscles, central nervous motor regulation and back problems. In : korr I ed: The neurobiologic Mechanism in manipulative therapy, New York, Plenum press,1978:27-41
11. Janda v: Muscles as a pathogenic factor in back pain. In: The treatment of Patients, Proceedings of the 4th International Federation of Orthopedic Manipulative therapist, Christchruch,New Zealand,1980
12. Janda V : Muscle function Testing. London,Butterworth,1983
13. Janda v: Muscle and Cervicogenic pain syndrome In: Grant R ed: Physical therapy of cervical and thoracic spine, New York, churchill Livinstone,1988
14. Janda V: Muscle strength in relation to muscle length, Pain and muscle imbalance. In: Harms-Rindahl K, muscle strength New York, churchill Livinstone 1993: 83-105.
15. Janda V: Evaluation of Muscular imbalance In: LibensonC,ed : Rehabilitation of the spine. Philadelphia, Lippincott,Williams and Wilkins,1996:97-112
16. Watson DH. Cervical headache: an investigation of natural head posture and upper cervical flexor muscle performance. Grieve’s Modern Manual Therapy—The Vertebral Column. 2nd ed.; 1994: p. 349–60.
17. James Stoppani Encyclopedia of Muscle and Strength.ch:10 training cycles for gaining maximal strength.pg-199-207(2006)
18. Smith J, Padgett D, Kenton R, et al. Rhomboid muscle electromyography activity during 3 different manual muscle tests. Arch Phys Med Rehabil. 2004; 85:987–992.
19. Helen Hislop et..al:, Daniels and Worthingham's Muscle Testing: Techniques of Manual Examination and PerformanceTesting, 9th Edition
20. Jull G Trott P. A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache. Spine (Phila Pa 1976) 2002; 27(17):1835-43.
21. O Leary s, Falla D. Specific therapeutic exercise of the neck induces immediate local hypoalgesia. J Pain. 2007; 8(11):832-39.
22. Ting Yip CH, Wing Chiu TT. The relationship between head posture and severity and disability of patients with neck pain. Man Ther. 2008; 13(2):148-54.
23. Lindfors P. Work characteristics and upper extremity disorder in female dentists. J Occup Health. 2006; 48(3):192-97.
24. O Leary S. Specificity in Retraining Cranio cervical Flexor Muscle Performance. J Ortho Sports Phy Ther. 2007; 37(1): 3-9.
25. Rezasoltani et.al. The effect of a proprioceptive neuromuscular facilitation program to increase neck muscle strength in patients with chronic non-specific neck pain. World Journ of Sport Sci. 2010; 3 (1): 59-63.
26. Ylinen J. Decreased Isometric Neck Strength in Women With Chronic Neck Pain and the Repeatability of Neck Strength Measurements. Arch Phys Med Rehabil. 2004; 85(8):1303-08.
27. Udoye C, Aguwa EN. Musculoskeletal symptoms: a survey amongst selected Nigerian dentists. Science; 5(1) The Internet Journal of Dental Science. 2007 Volume 5 Number 1
Manual small incision cataract surgery (MSICS) under topical anesthesia
Bhalchandra S Joshi, V H Karambelkar, Vikrant A Narwade
Introduction: Manual small incision cataract surgery under topical anesthesia with 0.5% proparacaine hydrochloride and 1% preservative free intracameral lignocaine is a reasonably well tolerated procedure and is absolutely safer alternative to surgery under peribulbar or retrobulbar anesthesia with excellent outcome. Aim: To evaluate the patient’s and surgeon’s experience in MSICS using topical anesthesia with 0.5% proparacaine hydrochloride eye drops andpreservative free intracameral 1% lignocaine in terms of pain, surgical complications and outcome.
1. Minasian DC, Mehera V. 3.8 Million blinded by cataract each year: projection of the first epidemiological study of incidence of cataract blindness in India. Br J Ophthalmol. 1990;74:31-3
2. Jose R. National programme for the control of blindness. Indian J Comm Health. 1997;3:5-9
3. Marseille E Cost-effectiveness of cataract surgery in public health eye care programme in Nepal. World Health Organ Bull OMS. 1996;74:319-24
4. Porter R. Global initiative: The economic case. Commen Eye Health. 1998;24:44-5
5. Parkar T, Gogate P, DeshpandeM, Adenwala A, Maske A, Verappa K, Comparison of subtenon anesthesia with peribulbar anesthesia for manual small incision cataract surgery. Indian J Ophthalmol.2005;53:255-9
6. Collins SL, Moore RA, McQuary HJ. The visual analogue pain intensity scale: What is moderate pain in millimetres? Pain.1990;72:95-7
7. Lee J, Stiell I, Hobden E, Wells G. Clinically meaningful value of the visual analogue scale of pain severity. AcadEmerg Med. 2007;7:550
8. Smith R. Cataract extraction without retrobulbar anesthetic injection. Br J Ophthlmol. 1990;74:205-7
9. Gupta SK, Kumar A, Kumar D, Agrawal S, Manual small incision cataract surgery under topical anesthesia with intracameral lignocaine: Study on pain evaluation and surgical outcome. Indian J Ophthalmology 2009;57:3-7
10. Fichman RA. Use of topical anesthesia alone in cataract surgery. J Cataract Refract Surg.1996:22:612-4
11. Gozum N, Altan-YayciogluR, Gucukoglu A, Arsian O. Does topical anesthesia increases patient’s serum cortisol level? Int J Ophthalmol Visual Sci. 2003;2:2
A study of gentamicin level in CSF of the pediatric patients with meningitis
Introduction: Paediatric clinical pharmacology is well established in western countries, but in our country. Bioavailability of a drug is altered in paediatric age group especially due to many variable factor, like, larger body surface in proportion to body-wt., changes in haematocrit values and phases of maturation of organs like kidney, liver etc. Hence clinical response, to a drug would depend on varieties of factors and, would decide the ultimate outcome in, especially, a sick child. Aims and Objectives: To Study Gentamicin level in CSF of the Pediatric Patients with Meningitis Methodology: This was prospective clinical trial at tertiary care hospitalthe children admitted in pediatric ward of a general hospital constituted the material for the present study. Only those children, for whom diagnostic L.P. was considered necessary on admission, were included in this study and hence no child was subjected to L.P. only for the purpose of this study. Out of the selected children, those who did not have any clinical and laboratory evidence of intracranial infections, constituted the group of normal children. Whereas those, who had clinical and Laboratory evidence of intracranial infections, constituted the another group under study. Both the group of children was subjected for similar work-up. Total 28 children were included into the study. Result: In Children Without Meningitis There are wide fluctuations is the serum concentration at 11/2 hrs. C.S.F. did not show any detectable concentration of drug. Fluctuation in serum concentration same as in group one. Most of the children show detectable concentration of drug in C.S.F. Serum levels after 5 doses have shown marked variation. None of them had any detectable level in C.S.F. Conclusion: Presence of detectable in c.s.f. is in marked variation. With absence of detectable levels in children without meningitis. This does show the effect of altered blood-brain barrier in meningitis
1. Jerome O. Klein: Gentamicin Am. J. Med.Sci; Vol.248; P 528, 1964.
2. Black, J. B. Williams: Phermacology of Gentamicin, Antimicrobiel agents and chemotherapy-1963, P.138-147; 964.
3. Anne-Marie Cyseilnck: Pharmacokinetics of Gentamicin J of inf.Dis.Vol.124 suppl; P.70; Dec.1971.
4. George R. Siber: Pharmacokinetics of Gentamicini in children and adults J. of inf. Dis; Vol.132 No.2; P.437; Dec.1975
5. John. W. Peisley; : Gentamicin in Newborn infants; Am. J. Dis. Child; vol.126: P.637; Oct.1973.
6. George H. Mc Cracken: Intravenous administration of Kananytin and Gentamicin in Newborn infants paed: Vol.60; No.4, No.4 Oct.1977; P.463.
7. Geroge H. Mc Cracken: Gentamincin in Neonetal period; Am. J.Dis. Children Vol.120; P.524; 1970.
8. George H. Mc Cracken: Pharmacological evaluation of Gentamicin in New born infants J. of inf.Dis.vol.124 Suppl; PS214; Dec.1971.
9. Newman R.L, : Intrathecal Gentamicin in treatment of ventriculitis in children, BMJ Vol. I; PS 39-542; 1967.
10. Arthrur W. Nunnery: Gentamicin, Pharmacological observations in Newborns and infants J. of inf. D; Vol.119 P 420; Apr.1969.
11. Clair E. Cox: Med.Clin.N. Amer.Vol.five 4; P.130five-15; 1970.
12. Harris D. Riley: J. of inf. D; Vol.124 P.S. 236; 1971. Clinical and Laboratory evaluation of Gentamicin in infants and children.
13. Robert L. Newman: Gentamicin in pediatrics; Report on inrathecal Gentamicin. J. of inf.Dis.; Vol.124, Dec.1971. P.S. 254.
14. Dr. Joseph Nawkins: Discussion J. of inf. Dis.Vol.124 PS. 260: Dec. 1971.
15. Donald Kaye: The unpredictability of serum concentrations of Gentamicin; J. of Inf. Dis.vol.130 No.2; P 150; Aug.1974.
16. Allen W. Methies: Gentamicin in the treatment of meningitis J. of inf. Dis; vol.124, Dec.1971; PS 249.
Synergistic effects of intrathecal magnesium sulphate to the combination of bupivacaine and fentanyl spinal anaesthesia in patients undergoing lower abdominal surgeries
Background: Local anesthetics are extremely useful drugs for anaesthesiologists. All modern local anesthetics are amides. Esters are unstable in its solution. Lignocaine, Prilocaine, Bupivacaine etc all shares a common basic structure termed aminoacylamide. The current study aims to evaluate the effects of intrathecal supplementation of magnesium sulphate to bupivacaine-fentanyl in patients undergoing lower abdominal surgeries. Methodology: The patients were randomly assigned into two groups of 40 patients each, to receive an intrathecal injection in sitting position of either 15mg of 0.5% hyperbaric bupivacaine + 20mcg i.e 0.4ml of fentanyl + 0.1mg (0.1ml) 50% of magnesium sulphate or 15mg of 0.5% hyperbaric bupivacaine + 20mcg i.e. 0.4ml of fentanyl + 0.1ml normal saline. Duration of motor blockade, time taken for two segments regression are noted. Results: Duration of motor blockade was higher in Group A compared to Group B (279.25+53.33 vs. 249.75+45.11, p<0.001). Regression of sensory block to S1 was significantly earlier in Group B compared to Group A (240.13±58.99 vs. 271.25±56.78, p<0.001). Conclusion: Longer time for two segment regression, longer duration of motor blockade,decrease incidence of adverse effects.
1. Bridenbaugh PO, Green NM and Brill SJ. Spinal (Subarachnoid) neural blockade, Neural blockade in Clinical Anaesthesia and Management of Pain. 3rd Edition, edited by Michael J Cousin, Phillip O. Bridenbaugh, Philadelphia, Lippincott-Raven, 1998;10:203-242.
2. Sirvinskas E, Laurinaitis R. Use of magnesium sulphate in anesthesiology. Medicina 2002;38:696.
3. Kehlet H. The stress response to surgery: Release mechanisms and the modifying effect of pain relief. ActaChirScandSuppl 1988;550:22.
4. Modig J, Borg T, Karlström G, Maripuu E, Sahlstedt B et al. Thromboembolism after total hip replacement: Role of epidural and general anaesthesia. AnesthAnalg 1983 Feb;62(2):174-80.
5. Thornburn J, Louden J, Vallance R. Spinal and general anaesthesia in total hip replacement: Frequency of deep vein thrombosis. Br J Anaesth 1980;52:1117.
6. Christopherson R, Beattie C, Frank SM, Norris EJ, Meinert CL, Gottlieb SO et al. Perioperative morbidity in patients randomized to epidural or general anaesthesia for lower extremity vascular surgery. Anesthesiology 1993 Sept;79(3):422-34.
7. Rosenfeld BA, Beattie C, Christopherson R, Norris EJ, Frank SM, Breslow MJ et al. The effects of different anaestheticregimens on fibrinolysis and the development of postoperative arterial thrombosis. Anesthesiology 1993 Sept; 79(3):435-43.
8. Yeager M, Glass D, Neff R, Brinck-Johnsen T. Epidural anaesthesia and analgesia in high-risk surgical patients. Anesthesiology 1987;66:729.
9. Moraca RJ, Sheldon DG, Thirlby RC. The role of epidural anaesthesia and analgesia in surgical practice. Ann Surg 2003;238:663.
10. Abouleish E, Rewal N, Show J, Lorenz T, Rashad MN. Intrathecal morphine 0.2mg versus epidural Bupivacaine 0.125% or their combination; effects on parturients. Anaesthesiology 1991;74:711-6.
11. Hunt CO, Naulty JS, Bader AM, Hauch MA, Vartikar JV, Datta S et al. Perioperative analgesia with subarachnoid fentanyl bupivacaine for caesarean delivery. Anaesthesiology 1989 Oct;71(4); 535-40.
12. Sing H, Yang J, Thortan K, Giesecks A H. Intrathecal fentanyl prolongs sensory bupivacaine spinal block. Can J Anesth 1995 Nov;42 (11):987-91.
13. Woolf CJ, Thompson SW. The induction and maintenance of central sensitization is dependent on N-methyl D-aspartic acid receptor activation: Implications for the treatment of post-injury pain and hypersensitivity states. Pain 1991;44:293-9.
14. Woolf CJ, Chong MS. Preemptive analgesia: Treating postoperative pain by preventing the establishment of central sensitization. AnaesthAnalg 1993;77: 362-79.
15. Ascher P, Nowak L. Electrophysiological studies of NMDA receptors. Trends Neurosci 1987;10:284-8.
16. Lysakowsi C, Dumont L, Czarnetzki C, Tramer MR. Magnesium as an adjuvant to postoperative analgesia: A systemic review of randomized trial. AnaesthAnalg 2007;104:1532-9.
17. Malleswaran S, Panda N, Mathew P, Bagga R. A randomized study of magnesium sulphate as an adjuvant to bupivacaine in patient with mild preeclampsia undergoing caesarean section, International J ObstetAnaesth 2010;19:161-166.
18. Bilir A, Gulec S, Erkan A, Ozcelik Aet al. Epidural magnesium reduces postoperative analgesic requirements, Br J Anaesth 2007;98:519-523.
19. Chanimov M, Cohen ML, Grinspun Y, Herbert M, Reif R, Kaufman I, et al: Neurotoxicity after spinal anaesthesia induced by serial intrathecal injections of magnesium sulphate. An experimental study in a rat model. Anaesthesia 1997;52:223-8.
20. David L Brown, spinal epidural and caudal anaesthesia, Miller’s anaesthesia, 7thed edited by Ronald D Miller, Lars L.Erikrson, Lee A. Fleisher, et al, New York, Churchill Elsevier 2005;51:1611-1638.
21. Christopher M Bernards: Epidural and spinal anaesthesia in Paul G.Barash Clinical anaesthesia 6thed, New York, Wolster Kluwer Lippincott Williams and Wilkins 2010;37:927-950.
22. William F. Ganong. Physiology of central nervous system, Review of Medical Physiology, 22nd edition, Lange Medical book. International edition 2005;15:556-574
Comparison of sample and re-sampling techniques in the estimation of third trimester obstetric parameters
Arumugam P, Keshav Singh, Rajendran A K, Kasthuri A
Background: Obstetricians interested in estimating the third trimester parameters, can find the outliers by estimating the crucial boundaries of these parameters. The estimation may be made by two approaches namely random sampling and re-sampling techniques (bootstrap sampling). AIM: Comparison between random sample and Bootstrap sample parameters Objectives: To calculate the statistics of the two procedures by means of averages. To estimate the population parameters by both methods. To interpret the difference statistically. Methodology: A random sample of 240 III trimester ante-natal mothers was selected as first 20 singleton pregnant mothers through the months of January to December 2014and among them 154 and 86 mothers were primi para and multi para respectively obtained from the records of a teaching hospital in Tamil Nadu. The Ultra Sona Graphed statistics like Head Circumference (HC), Abdominal Circumference (AC), and Placental Thickness (PT) were collected. The statistics and parameters of primi mothers (154) were computed by both techniques and the difference between the variance was inferred by variance ratio test with the help of IBM SPSS Version 20. Results: The following obstetric statistics viz. mean median SD and SE calculated by sample and Bootstrap methods are furnished. Discussion: The difference between the variances were not statistically significant (P>0.05). Hence the difference between Std. errors were also not statistically significant (P>0.05). And thus the parameters will also be not statistically significant (P>0.05). Conclusion: As the sample size of 154 was large, the estimated parameters of both techniques may not be significant. The Bootstrap sample parameter may be a more appropriate estimation in respect of small samples.
Mrutunjay M Mahindrekar, Sanjiv V Zangde, Vikas R Patel, Sanjay Muttyepod, Manish Meshram
1. Fishman’s Pulmonary Diseases and Disorders. Fourth Edition. Page No. 630.
2. Fishmans Pulmonary Diseases and Disorders,5thedition, Pg.3251.
3. H. Boot et al Obstructive Sleep Apnea- pathogenetic aspects and treatment, 2000-06-28
4. Hanish Sharma and S.K. Sharma Overview and implications of obstructive sleep apnea. Indian J Chest Dis Allied Sci 2008;50:137150.
5. Fishmans Pulmonary Diseases and Disorders ,5th edition, Pg.3261
6. JOAQUIN DURÃN et al Obstructive Sleep Apnea–Hypopnea and Related Clinical Features in a Population-based Sample of Subjects Aged 30 to 70 Yr , American Journal of Respiratory and Critical Care Medicine, Vol.163, No. 3 (2001), pp. 685-689.
7. Hader C, Schroeder A, Hinz M, Micklefield GH, Rasche K. Sleep Disordered Breathing in the elderly: comparison of men and women. J Physiol Pharmacol. 2005;56:85–91. [PubMed]
8. LOPEZ et al Prevalence of Sleep Apneain Morbidly Obese Patients Who Presented for Weight Loss Surgery Evaluation: More Evidence for Routine Screening for Obstructive Sleep Apneabefore Weight Loss Surgery, THE AMERICAN SURGEON Sepatientember 2008 Vol. 74 pp 834- 837.
9. Jamie C.M. Lam, S.K. Sharma* and Bing Lam review article on Obstructive sleep apnoea: Definitions, epidemiology and naturalhistory
10. Vagiakis E1, Kapsimalis F, Lagogianni I, Perraki H, Minaritzoglou A, Alexandropoulou K, Roussos CRoussos C, Kryger M study on Gender differences on Polysomnographic findings in Greek subjects with Obstructive Sleep Apnea syndrome.
11. O’Connor C, Thornley KS, Hanly PJ. Gender differences in the Polysomnographic features ofobstructive sleep apnea. Am J Respir Crit Care Med 2000;161:1465–1472. [PubMed: 10806140].
12. Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S. , The occurrence of sleep-disordered breathing among middle-aged adults.N Engl J Med. 1993 Apr 29;328(17):1230-5.
13. Lae Hyung Lee, Seung Ju Lee and Hyun Woo Kang study on Gender Differences in the Polysomnographic Findings among Obstructive Sleep ApneaPatients
14. Hassan A. Chami ,Carol M. Baldwin, Angela Silverman, Ying Zhang, David Rapoport, Naresh M. Punjabi, and Daniel J. Gottlieb study on Sleepiness, Quality of Life, and Sleep Maintenance in REM versus non-REM Sleep-disordered Breathing.
15. Naresh M. Punjabi The Epidemiology of Adult Obstructive Sleep ApneaProc Am Thorac Soc Vol, 2008, 5. pp 136–143.
16. Brian B. Koo retrospective study on The effects of gender and age on REM-related sleep-disordered breathing
The effect of circuit resistance training on upper limb muscle strength in volleyball attacker players
Aim: To find out effect of circuit resistance training on upper limb muscle strength in volleyball attacker players. Objectives: To study effect of circuit Resistance Training on strength of triceps, deltoid, shoulder internal rotator muscles and on workout volume in volleyball attacker players. Procedure: 30 Subjects were collected according to inclusion and exclusion criteria. Consent was taken from respective subjects to conduct the study. Respective protocol was followed for Group A (Controlled Group) and Group B (Experimental Group); over 5 weeks, with 3 sessions per week .Pre and post values of Subjects were assessed by using 10 RM and Push up test. The statistical tests used for analysis of result were: Paired t-test and unpaired t- test. Mean standard deviation and standard error was carried out for both groups. Result: After 5-weeks of training period, the B group showed more improvement in Strength of Triceps (P< 0.050) considered significant, Deltoid (p< 0.040) considered significant, Shoulder internal rotators(p<0.030) considered significant and Push up performance (p<0.000) Considered extremely significant. Conclusion: This study concludes that Circuit Resistance Training is more effective in improving the strength of shoulder internal rotators, deltoid and triceps Muscles as compare to regular Training in volleyball players.
1. Benedict Tan. Manipulating resistance training program variables to optimize maximum strength in men: a review. Journal of strength and conditioning;1999, 13, (3):289- 304.
2. Robert U. Newton, William J. Kraemer. Developing explosive muscle power: implications for mixed method training strategy. National strength and conditioning association; 1994; 20- 35.
3. William J. Kraemer, Nicholas A. Ratamer. Progressive and resistance training. President council on physical fitness and sports, Washington;2005 ,6(3):1- 10.
4. Carolyn Kisner, Lynn Allen Colby.Therapeutic exercise: foundation and techniques. 5th edition.2007 ;chapter3, 58- 148.
5. Holyoke, Massachusetts (USA), William G Morgan, a YMCA physical education director ,(USA): 1985; 3-6
6. Cedric Dupuis, Claire Tourny-Chollet ,CETAPS, Increasing explosive power of shoulder in volleyball players :strength and conditioning journal, Volume 25, Number 6,December2003 page 7–11.
7. B D Chaurasia: Human Anatomy, vol 1 ,2004, pg:79.
8. A Kugler, M Krüger-Franke, S Reininger, H H Trouillier and B Rosemeyer Muscular imbalance and shoulder pain in volleyball attackers, Br. J.Sports Med 1996;30;256-259.
9. Hsing-Kuo Wang, Alison Macfarlane and Tom Cochran Isokinetic performance and shoulder mobility in elite volleyball athletes from the United Kingdom Br. J. Sports Med. 2000;34;39-43.
10. Humberto Miranda 1, Roberto Simão 2, Leonardo Marmo Moreira 1, Renato Aparecido de Souza. Effect of rest interval length on the volume completed during upper body resistance exercise :Journal of Sports Science and Medicine September 2009,8: 388-392.
11. Joseph M.Robibson, Michael H. Stone, Robert L.Johnson. Effect of different weight traning exercise/rest intervals on strength, power and intensity exercise endurance: Journal of strength and condition research, 1995, 9(4), 216-221.
12. Schafle MD, Requa RK, Patton WL, et al. Injuries in the 1987 national amateurVolleyball tournament. Am J Sports Med 1990;18(6):624-631.
13. Kraemer, James b.; Stone, Michael H.; O’Bryant, Harold S., et al. Effect of single versus multiple sets of weight training: impact of volume, intensity and variation. Journal of strength and conditioning research. 1997.
14. Bekir Yuktasir, Fehmi Tuncel; A comparison of two weight training methods on leg strength f high school boys. Athletes coaching.com.
15. Lee E. Brown. National strength and conditioning association.2007, chapter 2
16. Carrie A. Hall.Therapeutic exercise: Moving towards function.2005, 2nd edition, chapter 5, pg 81.
17. John Davidson. Getting stronger weight training for sport. 2005, 20th edition
18. Dave Smith and Stewart Bruce Low. Strength training and work of Arthur Jones. Journal of exercise physiology online.2004; vol 7 (6), pg 52 – 68.
19. James E. Graves, Barry A. Franklin. Resistance training for health and rehabilitation. 2001,chapter 7, pg- 105
20. Hass CJ, Garzarela L, De Hoyos , et al. Single versus multiple sets in long term recreational weight lifters. Med sci sports exercise.2000; 32; 235-242.
21. Andrew S. Rokito, Frank W. Jobe, and John Brault (2006) EMG Studies done on volleyball players.Journal of exercise physiology pg 11-13.
22. Aagaard H, Jorgensen U (1996) questionnaire survey in national volleyball players. Br. J. Sports Med. 2008;45;31-56
23. George A. Brooks.Exercise physiology- Human bioenergetics and its application.1996,chapter 20, pg 384-409
24. Robert U. Newton, William J. Kraemer. Developing explosive muscle power: implications for mixed method training strategy. National strength and conditioning association; 1994; 20-35.
25. William J.Kraemer, Nicholas A. Ratamer. Progressive and resistance Training. President council on physical fitness and sports, Washington; 2005, 6(3): 1-10.
26. William Dc Mc Cardle, Frank J. Katch. Exercise physiology: energy, and Nutrition human performance. 6th edition, chapter 22:509- 552.
Ileo -colic Intussusception in Adults due to Lipomatous Polyp: A rare case
Adult Intussusception is a rare but challenging condition. The condition is usually secondary to definitive lesion. The aetiology, clinical presentation and management of this condition are different in adults than in children. Preoperative diagnosis is usually missed or delayed because of non specific or sub acute symptoms. We present a case of ileo -colic intussuscepton in a 78 year old male patient.
1. Marinis A, Yiallourou A, Samanides L, Dafnios N, Anastasopoulos G, et al (2009) Intussusception of the bowel in adults: a review. World J Gasteroenterol 15: 407-411.
2. Ochiai H, Ohishi T, Seki S, Tokuyama J, Osumi K, et al. (2010) Prolapse of Intussusception through the anus as a result of sigmoid colon cancer. Case Rep Gasroenterol 4:346-350.
3. Warshauer DM, Lee JK. Adult intussusceptions detected at CT or MR imaging: clinical-imaging correlation. Radiology1999; 212:853-860.
4. Begos DG, Sandor A Modlin IM (1997) The diagnosis and management of adult intussusceptions. Am J Surg 173:88-94.
5. Azar T,Berger DL. Adult Intussusception. Ann surg 1997;226:134-8.
6. Agha FP. Intussusception in adults. AJR1986;146:527-31.
7. Chiang JM, Lin YS: Tumour spectrum of adult intussusceptions. J Surg Oncol 2008,989(6):444-47.
8. Sheth A,Jordan PA: Does small bowel intusssuception in adults always require surgery? Dig Dis Sci 2007,52(8):1764-66.
9. Johnstone J, Morson B : Inflammatory fibroid polyp of gastrointestinal tract. Histopathology 1978,2(5):34
10. Catalano O;Transint small bowel intussusceptions :CT findings in adults. BJR 1997 aug; 70(836):805-8.
Depression associated with cardiac surgery and the probable risk factors- A randomised observational clinical study
Davan K R, Bindu, Mallikarjuna, Sowmia Mammen, Sumaiya Sabreen
Introduction: Cardiovascular surgery can trigger depression; counselling and medications can easily beat it. The earlier we identify people who have depression, complicating their ability to get back to normal life, better is the chances of recovery. We conducted a prospective randomized observational study to assess incidence of depression in patients undergoing cardiac surgery and risk factors which can trigger depression. Materials and Methods: A prospective randomized double blind controlled Observational clinical study was conducted in 250 patients who underwent open heart surgery with and without assistance of cardio pulmonary bypass (CPB) from May 2013 to July 2014. All patients were screened for depression with Patient Health Questionnaire (PHQ-9) preoperatively (Q1), at hospital discharge (Q2), 3months (Q3) and 6months (Q4) postoperatively. At each interval patients were identified as ‘‘not depressed’’ (PHQ-9 score 0), minimally depressed (score 1-4), mild(score5-9), moderate (10-14), moderately severe(15-19), severe depression(20-27). Multiple regression analysis was used to identify variables associated with depression. Results: On regression analysis, preoperative depression for depression at discharge (OR 88.5, p<0.0001), depression at discharge for incidence of depression at three months (OR 4004, p<0.0001) and 6 months (OR 1194, p<0.0001) had significant Odds ratio (OR) with statistical significance. Patients who had depression at discharge were older, had lower preoperative ejection fraction (EF), prolonged waiting period, ICU stay, hospital stay. Other risk factors identified were higher NYHA class , history of prior CCF, abnormal lipid profile, pre-existing hypertension, diabetes mellitus, peripheral vascular disease and patients on beta blockers. Conclusion: Depression is common after cardiac surgery. Among all the risk factors, preoperative depression was associated with the highest risk for postoperative depression.
1. Judith H. Lichtmanetal. Depression and Coronary Heart Disease Recommendations for Screening, Referral, and Treatment.Circulation.2008;118:1768-1775.
2. Phillip J Tully1,2,3,4, Robert A Baker1. Depression, anxiety, and cardiac morbidity outcomes after coronary artery bypass surgery: a contemporary and practical review. J GeriatrCardiol2012; 9: 197−208.
3. David Horne, MD,etal Depression before and after cardiac surgery: Do all patients respond the same? .J ThoracCardiovascSurg 2013;145:1400-6.
4. Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16:606-13
5. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington, DC: American Psychiatric Association; 2000.
6. Connerney I, Shapiro PA, McLaughlin JS, et al. Relation between depression after coronary artery bypass surgery and 12-month outcome: a prospective study. Lancet 2001; 358:1766–1771.
7. Tully PJ, Baker RA, Winefield HR, et al. Depression, anxiety disorders and Type D personality as risk factors for delirium after cardiac surgery. Aust N Z J Psychiatry 2010; 44: 1005–1011.
8. Fraguas JR, Ramadan ZB, Pereira AN, et al. Depression with irritability in patients undergoing coronary artery bypass graft surgery: the cardiologist's role. Gen HospPsychiatry2000; 22:365–374.
9. Rafanelli C, Roncuzzi R, Milaneschi Y. Minor depression as a cardiac risk factor after coronary artery bypass surgeryPsychosomatics 2006; 47: 289–295.
10. Mitchell RH, Robertson E, Harvey PJ, et al. Sex differences in depression after coronary artery bypass graft surgery. AmHeart J 2005; 150: 1017–1025. ders. 4th ed. Washington, DC: American Psychiatric Association; 2000.
11. Jens-Holger A Krannichetal. Presence of depression and anxiety before and after coronaryartery bypass graft surgery and their relationship to age. BMC Psychiatry 2007, 7:47
12. McKann GM, Borowicz LM, Goldsborough MA, Enger C, Selnes OA. Depression and cognitive decline after coronary artery bypass grafting. Lancet. 1997; 349:1282-4.
13. Sansone RA, Sansone LA. Rumination: relationships with physical health. InnovClin Sci. 2012;9:29-34.
14. Van Melly etal. Beta-blockers and depression after myocardial infarction: a multicenter prospective study. J Am Coll Cardiol. 2006;48(11):2209-2214.
15. Myhren et al. Post traumatic stress , anxiety and depression symptoms in patients during the first year post intensive care unit discharge. Critical care 2010,14:R14.
16. Bruce Arroletal, Validation of PHQ-2 and PHQ-9 to Screen for Major Depression in the Primary Care Population.annals of family medicine ,www.annfammed.org vol. 8, no. 4 ,july/august 2010
17. Lee PH, Macfarlane DJ, Lam TH, Stewart SM. Validity of the International Physical Activity Questionnaire Short Form (IPAQ-SF): a systematic review. Int J NutrPhys Act. 2011;8:115.
18. Tanya m. goyal, phd, ellen l. idler, phd, tyrone j. krause, md, and richard j. contrada, phdQuality of Life Following Cardiac Surgery: Impact of the Severity and Courseof Depressive Symptoms PHD Psychosomatic Medicine 67:759 –765 (2005)
19. Pollock BG, Laghrissi-Thode F, Wagner WR. Evaluation of platelet activation in depressed patients with ischemic heart disease after paroxetine ornortriptyline treatment. J ClinPsychopharmacol. 2000;20: 137–140.
20. Serebruany VL, Glassman AH, Malinin AI, Sane DC, Finkel MS, Krishnan RR, Atar D, Lekht V, O’Connor CM. Enhanced platelet/endothelial activation in depressed patients with acute coronary syndromes: evidence from recent clinical trials. Blood Coagul Fibrinolysis. 2003;14: 563–56
21. Barger SD, Sydeman SJ. Does generalized anxiety disorder predict coronary heart disease risk factors independently of major depressive disorder? J Affect Disord2005; 88: 87–91.
22. Goodwin RD. Association between physical activity and mental disorders among adults in the United States. Prev Med 2003; 36: 698–70.
23. McAvay GJ, Van Ness PH, Bogardus ST Jr, et al. Depressive symptoms and the risk of incident delirium in older hospitalized adults. J Am Geriatr2007; 55: 684–691.
24. Davydow DS. Symptoms of depression and anxiety after delirium. Psychosomatics 2009; 50: 309–316.
25. Tully PJ, Baker RA, Knight JL, et al. Neuropsychological function five years after cardiac surgery and the effect of psychological distress. Arch ClinNeuropsychol2009; 24: 741–751.
26. Barger SD, Sydeman SJ. Does generalized anxiety disorder predict coronary heart disease risk factors independently of major depressive disorder? J Affect Disord2005; 88: 87–91.
27. Goodwin RD. Association between physical activity and mental disorders among adults in the United States. Prev Med 2003; 36: 698–703.
28. Carney RM, Freedland KE, Eisen SA, et al. Major depression and medication adherence in elderly patients with coronary artery disease. Health Psychol1995; 14: 88–90.
29. Kuhl EA, Fauerbach JA, Bush DE, et al. Relation of anxiety and adherence to risk-reducing recommendations following myocardial infarction. Am J Cardiol2009; 103: 1629–1634.
30. Frasure-Smith N, Lesperance F, Irwin MR, et al. Depression, C-reactive protein and two-year major adverse cardiac events in men after acute coronary syndromes. Biol Psychiatry 2007; 62: 302–308.
Comparative study of efficacy of per rectal misoprostol, intravenous methylergometrine and intramuscular carboprost in active management of third stage of labour
Introduction: Postpartum haemorrhage (PPH) during the third stage of labour is the most common cause of maternal deaths in developing countries. Active pharmacological management of this stage to prevent haemorrhage with an uterotonic drugs leads to a decrease in postpartum vaginal haemorrhage. The aim of this study was to assess and compare the effectiveness of rectal misoprostol compared with an intravenous oxytocin and intramuscular carboprost in active management of third stage of labour. Material and Methods: A total of 400 women in labour were randomized into four groups (100 women in each). Within 1 minute of delivery of the anterior shoulder participants in group A received 800ïg of rectal misoprostol; group B received 0.2mg of methylergometrine intravenously; group C received 125ïg of carboprost intramuscularly and group D served as control and had not received any prophylactic uterotonics. Results: All groups were compared regarding the need for excessive uterotonics, amount of blood loss, and hematocrit drop. Per rectal misoprostol was found to be equal or better to rest of the drugs in the study with lowest duration of third stage of labor (mean =8.69 mins), lowest amount of blood loss (mean=149.90 ml), haematocrit drop (0.51±0.32) and lowest incidence of PPH. There was no significant difference in the duration of third stage of labor amongst the four groups. Conclusions: Per rectal Misoprostol is equal or better as compared to injection methyl ergometrine or carboprost and can prove to be better alternative because of several advantages.
1. Abouzahr C (1998) maternal mortality overview In: Health dimensions of sex and reproduction. Murray CJ, lopez AD, eds. WHO, Geneva.111-64.
2. Donald I. Postpartum haemorrhage. M. Renu, Practical Obstetric Problems, 6th Edn. New Delhi, B.I Publications; 2007.604-24.
3. Mudaliar AL. Causation and stages of labour. Clinical Obstetrics 9th Edn. Madras Orient Longman;1994.85-96.
4. Cunningham FG, Leveno KJ, Bloom SL, Hauth JC, Rouse DJ, Spong CY. Williams Obstetrics. 23rd ed. New York: McGraw-Hill Medical; 2010. Normal Labor and delivery;374–409.
5. Justus Hofmeyr G, Sandra Ferreira V, Nikodem C, et al. Misoprostol for treating post partum haemorrhage: a randomized controlled trial [ISRCTN72263357] BMC Pregnancy childbirth. 2004;4:16.
6. Fraser DM, Cooper MA. Physiology and management of third stage of labour in Myles textbook of midwives. 14th edition China. 507-30.
7. Joshi V, Sapre S, Jaiswal N, Olyai R. Comparative study between per rectal misoprostol and im methrgin for prophylaxis of PPH. Obstet Gynecol Today 2006 March;XI(3):160-2.
8. Diab KM, Ramy AR, Yehia MA et al. The use of rectal misoprostol as active pharmacological management of the third stage of labour. J Obstet Gynaecol Res 1999 Oct;25(5):327-32.
9. Prata N, Hamze S, Gypson R, Nada K, Vahidnia F, Potts M. Misoprostol and active management of third stage of labour. Int J Gynaecol Obstet 2006;94:149-55.
10. Harriott J, Christie, Wynter, V DaCosta, H Fletcher, M Reid. A randomized comparison of rectal misoprostol with syntometrine on blood loss in third stage of labour. West Indian Med J. 2009. 58;3.
11. Nagaria Tripti, Sahu Balram et al. 400μg oral misoprostol versus 0.2 mg intravenous Methyl ergometrine for the active management of third stage of labour. J Obstet Gynecol India 2009:59:228-34.
12. Derman RJ, Kodkany BS, Goudar SS, Geller SE, Naik VA, Bellad MB et al. Oral misoprostol in preventing postpartum haemorrhage in resource-poor communities: a randomized controlled trial, Lancet 2006:368:1248-53.
A Clinical profile and Factors associated with Migraine in Pediatric patients
Introduction: The epidemiology of pediatric headache is described in numerous articles of international origin. Aims and Objectives: To Study Clinical profile and Factors associated with Migraine in Pediatric patients. Methodology: This was a cross-sectional study carried out at the Pediatric department of a tertiary health care center during one-year period from January 2015 to December 2015. All the Pediatric patients were screened except less than 3 yrs. as it was expected that children below this age might not be able to express their symptoms clearly. Prensky's criteria for migraine was used to diagnose the Patients the patients associated with other reasons of headache like sinusitis, refractive errors, hypertension, chronic renal illness, neurological disorders and neoplasms were excluded from the study. All detail clinical and associated or precipitating factors history was asked. Result: The majority of the Patients were from age group of 3-6 i.e. 10.25% followed by 7-10-35.89%; 11-12 -53.84%. The majority of the patients were females i.e. 58.97% followed by Males 41.03%. The most common symptoms were Pulsating or throbbing headache which shifts to a unilateral or to temporal location were 53.84% followed by bi-temporal/bi-frontal/Retro-orbital headache in 46.15% patients; Nausea /Vomiting in 41.02% of patients; Photophobia in 35.89% patients; Abdominal Pain in 30.76% patients and Sweating in 25.64% patients; Visual Disturbances in 25.64% of patients. Giddiness (Vertigo) in 23.07% patients. Tingling sensation in hands or Perioral area were present in 12.82% of patients. The most common associated or Precipitating factors were Sunlight -64.10%; Mental stress- 53.84%; Physical strain -48.71%; Family history -46.15%. Watching TV -43.58%; Exposure to unpleasant smell -33.33%. Hunger -28.20%; Winter season -23.07%. Conclusion: Migraine was having late childhood onset; the majority of the patients were females Most common clinical features were Pulsating or throbbing headache which shifts to a unilateral or to temporal location, The most common associated or Precipitating factors were Sunlight, Mental Stress Physical strain etc.
1. Gordon KE, Dooley JM, Wood EP. Self-reported headache frequency and features associated with frequent headaches in Canadian young adolescents. Headache. 2004;44:555–61.
2. Zwart JA, Dyb G, Holmen TL, Stovner LJ, Sand T. The prevalence of migraine and tension-type headaches among adolescents in Norway. The Nord-Trøndelag Health Study (Head-HUNT-Youth), a large population-based epidemiological study. Cephalalgia. 2004;24:373–9.
3. Ghandour RM, Overpeck MD, Huang ZJ, Kogan MD, Scheidt PC. Headache, stomachache, backache, and morning fatigue among adolescent girls in the United States: associations with behavioral, sociodemographic, and environmental factors. Arch PediatrAdolesc Med. 2004;158:797–803.
4. King S, Chambers CT, Huguet A, MacNevin RC, McGrath PJ, Parker L, et al. The epidemiology of chronic pain in children and adolescents revisited: a systematic review. Pain. 2011;152:2729–38.
5. Prensky AL. Migraine and migrainous variants in pediatric patients. PediatrClin North Am 1976, 23: 461-471. 1510 Migraine
6. Heinrich M, Morris L, Gassmann J, Kröner-Herwig B. Kopfschmerzhäufigkeit und KopfschmerztypenbeiKindern und Jugendlichen - ErgebnisseeinerepidemiologischenBefragung / Frequency and type of headache among children and adolescents - results of an epidemiological survey. Aktuel Neurol. 2007;34:457–63.
7. Kröner-Herwig B, Heinrich M, Vath N. The assessment of disability in children and adolescents with headache: adopting PedMIDAS in an epidemiological study. Eur J Pain. 2010;14:951–8.
8. Huguet A, Miró J. The severity of chronic pediatric pain: an epidemiological study. J Pain. 2008;9:226–36.
9. Kröner-Herwig B, Vath N. Menarche in girls and headache – a longitudinal analysis. Headache. 2009;49:860–7.
10. William C Robertson, William C Robertson, Jr. Amy Kao. Migraine in Children. http://emedicine.medscape.com/article/1179268-overview
11. N. Thilothammal Margaret Chellaraj K. BanuRatnam .Migraine in Children. Indian Pediatrics.Dec.1994; 31: 1503-10.
12. Raising Money for Migraine Research.https://migraineresearchfoundation.org/about-migraine/migraine-facts/
13. Gassmann J, Barke A, van Gessel H, Kröner-Herwig B. Sexspecific predictor analyses for the incidence of recurrent headaches in German schoolchildren. Psychosoc Med. 2012. doi:10.3205/ psm000081.
14. Bille, BO. Migraine in school children. ActaPediatr 1962, 51 (Suppl 136): 14- 151.
15. Vahlquist B. Migraine in children. Int Arch Allergy ApplImmunol 1955,7: 348- 355.
16. Rossi LN. Headache in childhood. Childs NervSyst 1989, 5: 129-134.
We know that large number of children in both wealthy and poverty stricken region suffer malnutrition. Optimal infant and young child feeding is an evidence based measure for improving child nutrition and child survival. According to the World Health Organization (WHO), Ninety nine per cent of all under-five deaths occur in developing countries. Most common causes of deaths are due to malnutrition, pneumonia, diarrhoea, malaria. So weaning at proper time and with proper food is very important for growth of child. Aim -To know weaning practices in rural area of latur .Objectives -1) To determine factors related to early and delayed weaning. 2) To study various factors regarding weaning and association of weaning with malnutrition. Materials and method- A cross sectional observational study was conducted in the Dept of Paediatrics MIMSR medical college Latur. A pretested questionnaire was introduced to mother and feedbacks were taken. Mothers having infant from 6months to 2yr old who attended Pediatrics outpatient department or ward were included in study. Statistical test-chi square test was used. Results and conclusion- In only 50% children, weaning was started at proper time. Factors affecting early weaning were feeling insufficient amount of milk, working mothers, family members forcing to start gutti at 2 months, television. Factors affecting delayed weaning were lack of knowledge to mother regarding weaning, family’s decision etc. Malnutrition was significantly associated with time of weaning. Weaning should be started at proper time to prevent malnutrition. Health education should be given to mothers regarding weaning.
1. Choudhari, S.G., A.B. Mudey, U.S. Joge et.al.2012. Weaning and supplementary practices - impressions from a rural community. Indian J. of Maternal and Child Health 14(1): 1-9.
2. Liaqat P, Rizvi MA, Qayyum A et.al. Maternal education and complementary feeding. Pak J Nutr. 2006; 5: 563–8.
3. Cameron M, Hofvander Y. 3rd ed. New York: Oxford University Press; 1983. Manual of Feeding Infants and Young Children; pp. 110–31.
4. Chuodhry R, Humayun N. Weaning practices and their determinants among mothers of infants. Biomedica. 2007; 23:120–4.
5. New Delhi: Department of Women and Child Development, Government of India; 2004. Ministry of Human Resource Development. National Guidelines for Infant and Young Child Feeding. Available from: http://www.wcd.nic.in/nationalguidelines.pdf.
6. Geneva: WHO; 2006. WHO. WHO Child Growth Standards: Length/Height for Age, Weight for Age, Weight for Length, Weight for Height and Body Mass Index for Age: Methods and Development. WHO Multicentric Growth Reference Study Group.
7. MushaphiLF,Mbhenyane XG, Khoza LB et.al. Infant-feeding practices of mothers and the nutritional status of infants in the Vhembe district of Limpopoprovince.SouthAfr J ClinNutr. 2008; 2: 36–41.
8. Katara PS, Patel SV, Mazumdar VS, Shringarpure K. A study on feeding practices among children aged 6 months to 2 years in urban slums of Vadodara. Indian J Matern Child Health. 2010; 12:1–9.
9. Bhanderi D, Choudhary S. A community based study of feeding and weaning practices in under five children in semi urban community of Gujarat. Natl J Community Med.2011; 2: 277–83.
10. Dandekar, R.H., M. Shafee and R. Kumar 2014. Breastfeeding and weaning practices among literate mothers: a community based study in rural area of Perambalurtaluk, Tamil Nadu. The Health Agenda 2(1):15-21.
11. ShailiVyas,S.D.Kandpal, VipulNautiyal. Trends in weaning practices among infants and toddlers in hilly terrain of newly formed state of India. International Journal of Preventive Medicine.2014.Jun;5(6):741-748.
A Study of Outcome of cranio-maxillofacial soft-tissue injuries at tertiary care health Centre
Introduction: Soft-tissue injuries of the cranio-maxillofacial region still remain one of the common disease encountered in the casualty department of every health-care facility. Aims and Objectives: To Study Outcome of Maxilo-facial soft-tissue injuries at tertiary care health Centre. Methodology: This was a Cross-sectional study carried out at the Department of Dentistry of Government Hospital of Tertiary Health care Centre during the period from June 2007 to June 2014 in 7 yrs. Period in all the patients Reported to Government Hospital for the injuries with the various reasons. The patients of Hard tissues except (Dento-alveolar) and head injury, were excluded from the study. Total 126 patients were reported during the time period. The outcome of these patients were noted. Result: In our study we have seen that The majority of the patients were form the age groups (Yrs.) of 30-40- were 45 (35.71%); followed by 20-30 were 35 (27.77%); 40-50 were 19 (15.07%); 50-60 were 15(11.90%); >60Yrs were- 12 (9.52%) respectively. The majority of the patients were Male- 95(75.30%) followed by Female-31 (24.70%)The most common cause was RTA- 62 (49.20%) followed by Assault 21 (16.66%); Fall -41(32.53%); Animal assault injuries -2 (1.58%). The most common pattern of injury was Soft tissue only was 55 (43.65%) followed by Soft tissue + Dentoalveolar was 38(30.15%); Soft tissue + Dentoalveolar + Tongue was 13 (10.31%); Soft tissue + Tongue only was 20 (15.87%). The majority of the patients were improved i.e. 120 (95.23%) followed by Referred to Higher Centre due to neurological problems were 6 (4.77%). Conclusion: The most common cause was RTA followed by Assault, Fall, Animal assault injury The most common pattern of injury was Soft tissue only was followed by,Soft tissue plus Dentoalveolar and in outcome the majority of the patients were improved and remaining referred to higher Centre for the neurological problems.
1. Fasola AO, Obiechina AE, Arotiba JT. Soft tissue injuries of the face: A 10 year review. Afr J Med Med Sci. 2000;29:59–62. [PubMed]
2. Okoje VN, Alonge TO, Oluteye OA, Denloye OO. Changing pattern of pediatric maxillofacial injuries at the Accident and Emergency Department of the University Teaching Hospital, Ibadan – A four-year experience. Prehosp Disaster Med. 2010;25:68–71. [PubMed]
3. Saddki N, Suhaimi AA, Daud R. Maxillofacial injuries associated with intimate partner violence in women. BMC Public Health. 2010;10:268. [PMC free article] [PubMed]
4. Ugboko VI, Olasoji HO, Ajike SO, Amole AO, Ogundipe OT. Facial injuries caused by animals in northern Nigeria. Br J Oral Maxillofac Surg. 2002;40:433–7. [PubMed]
5. Olasoji HO. Maxillofacial injuries due to assault in Maiduguri, Nigeria. Trop Doct. 1999;29:106–8.[PubMed]
6. McDade AM, McNicol RD, Ward-Booth P, Chesworth J, Moos KF. The aetiology of maxillo-facial injuries, with special reference to the abuse of alcohol. Int J Oral Surg. 1982;11:152–5. [PubMed]
7. Chrcanovic BR, Freire- Maia B, De souza LN, Araujo VO, De Abreu MHNG. Facial fractures: A 1- year retrospective study in a hospital in Belo Horizonte. Braz Oral Res 2004; 18: 322- 28.
8. Nwoku AL, Oluyadi BA. Retrospective analysis of 1206 maxillofacial fractures in an urban Saudi hospital: 8 year review. Pak Oral Dent J 2004; 24: 13- 16.
9. Ansari MH, Maxillofacial fractures in Hamedan province Iran: A retrospective study.JCraniomaxillofacSurg 2004; 32: 28-34.
10. Hogg NJV, Stewart TC, Armstrong JE, Girotti MJ. Epidemiology of maxillofacial injuries at trauma hospitals in Ontario, Canada between 1992 and 1997. J Trauma in 2000; 49: 425-32.
11. Kapoor P, Kalra N.A retrospective analysis of maxillofacial injuries in patients reporting to a tertiary care hospital in East Delhi. Int J CritIllnInj Sci. 2012; 1: 6–10.
12. Erol B, Tanrikulu R, Gorgun B. Maxillofacial fractures. Analysis of demographic distribution and treatment in 2901 patients (25-year experience). J CranioMaxillofacSurg 2004; 32: 308- 13.
13. AkinbamiBabatundeOlayemi, AkadiriOladimejiAdeniyi, Udeabor Samuel, and Obiechina Ambrose Emeka. Pattern, severity, and management of cranio-maxillofacial soft-tissue injuries in Port Harcourt, Nigeria J Emerg Trauma Shock. 2013 Oct-Dec; 6(4): 235–240.
Hypothyroidism as a sequelae following treatment of head and neck cancer
Background: Hypothyroidism is one of the late side effects seen after curative radiotherapy in the head and neck region encompassing part or whole of the thyroid gland. Still thyroid function tests are not a part of routine follow up of head – neck cancer patients treated with radiotherapy with or without surgery and / or chemotherapy. Aim of this study was to to find out the incidence of hypothyroidism in head – neck cancer patients treated with radiotherapy with or without chemotherapy and influence of concomitant chemotherapy. Materials and Methods: Of the 112 patients, 57 (50.8%) were planned to receive radiotherapy alone, 42 (37.5%) to receive neo-adjuvant chemotherapy with Cisplatin and 5-FU and the rest 13 (11.6%) patients to receive concurrent chemo-radiation. Thyroid function tests were done at the beginning of treatment, at six weeks after completion of radiotherapy and thereafter at six weeks’ interval for two years. Results: After 24 months follow up, overall incidence of clinical hypothyroidism of our reported patients was 31.03% and of sub-clinical hypothyroidism was 37.93%. Conclusion: As a significant number of patients develop hypothyroidism following radiotherapy to the neck, thyroid function tests should be included in the routine follow up protocol of such patients.
1. Carter Y, Sippel RS, Chen H. Hypothyroidism After a Cancer Diagnosis: Etiology, Diagnosis, Complications, and Management. The Oncologist. Jan 2014 vol. 19 no. 1 34-43.
2. Parkin DM, Pisani P, Ferlay J. Estimates of the worldwide incidence of 25 major cancers in 1990. Int J Cancer 1999;80:827-41.
3. Ahmadieh, H., and Salti, I. (2013). Tyrosine kinase inhibitors induced thyroid dysfunction: A review of its incidence, pathophysiology, clinical relevance, and treatment. BioMed Research International, 2013, 725410. http:// dx.doi.org/ 10.1155/2013/725410
4. Kari Hartmann, Pa-C. Thyroid Disorders in the Oncology Patient. J Adv Pract Oncol. Vol.6;2: 2015.
5. Turner SL, Tiver KW, Boyages SC. Thyroid dysfunction following radiotherapy for head and neck cancer. Int J Radiat Oncol Biol Phys 1995;31:279-83. 

6. Einhorn J, Wikholm G. Hypothyroidism after external irradiation to the thyroid region. Radiology 1967;88:326-8.
7. Palmer BB, Gaggar N, Shaw HJ. Thyroid function after radiotherapy and laryngectomy for carcinoma of the larynx. Head Neck Surg 1981;4:13-5.
8. Posner MR, Ervin TJ, Fabian RL, Weichselbaum RR, Miller D, Norris CM, et al. Incidence of hypothyroidism following multimodality treatment for advanced squamous cell cancer of the head and neck. Laryngoscope 1984;94:451-4.
9. Shafer RB, Nuttall FQ, Pollack K, Kuisk H. Thyroid function after radiation and surgery for head and neck cancer. Arch Intern Med 1975;135:843-6. 

10. dejong JMA, vanDaal WAJ, Elte JWF, Hordijk GJ, Frolich M. Primary hypothyroidism as a complication after treatment of tumors of the head and neck. Acta Radiol Oncol 1982;21:299-303.

11. Mercado G, Adelstein DJ, Saxton JP, Secic M, Larto MA, Lavertu P. Hypothyroidism: a frequent event after radiotherapy and after radiotherapy with chemotherapy for patients with head and neck carcinoma. Cancer 2001;92:2892-5. 

12. Tell R, Sjodin H, Lundell G, Lewin F, Lewensohn R. Hypothyroidism after external radiotherapy for head and neck cancer. Int J Radiat Oncol Biol Phys 1997;39:303-8.
Issue details
To study the effect of tricep strengthening in lateral epicondylitis
Meenakshi Vairagade, Pradeep N Borkar, Tanuja Chhotwani
Aim: “To Study the effect of tricep strengthening in lateral epicondylitis†Objectives: To study the effect of tricep srtenghthening on pain relief. To study the effect of tricep strenghthening in functional activities. To study the effect of conventional therapy on pain relief. To study the effect of conventional therapy on functional activities. To compare the effect of tricep strength thening and conventional therapy on pain and functional activities. Procedure: 30 Samples were collected according to inclusion and exclusion criteria. Then Consent was taken from the respective subjects to conduct the study. Respective protocol was followed for Group A and Group B; and treatment protocol was followed for 2 weeks. Pre and post values of subjects was assessed by numerical pain rating scale, strength of elbow flexors with 10 RM, isometric strength of triceps was reassessed by Jamar dynamometer, and pain and functional assessment with patient rated tennis elbow evaluation questionnaire. Data was collected and analyzed statistically. Results: t value for NPRS comparion between group A and B is 0.871. At p value 0.391: considered Significant at p≤ 0.05 with 95 % confidence interval. t value for 10RM in group A and B in pre and post treatment is -1.169. At p value 0.252: considered Significant at p≤ 0.05 with 95 % confidence interval. t value for isometric strength of right triceps with jamar dynamometer is-0.561. At p value 0.579: considered Significant at p≤ 0.05 with 95 % confidence interval. t value for isometric strength of left triceps with jamar dynamometer is 0.469. At p value 0.643: considered Significant at p≤ 0.05 with 95 % confidence interval. t value for comparison between PRTEEQ in group A and B is 0.871. At p value 0.391: considered Significant at p≤ 0.05 with 95 % confidence interval. Conclusion: This study concludes that triceps strengthening along with conventional physiotherapy program has shown better improvement on NPRS,10RM, (Triceps) Isometric strength with JAMAR DYNAMOMTERE score as compared to conventional physiotherapy alone over 2 week of training program.
Aim: “To Study the effect of tricep strengthening in lateral epicondylitis†Objectives: To study the effect of tricep srtenghthening on pain relief. To study the effect of tricep strenghthening in functional activities. To study the effect of conventional therapy on pain relief. To study the effect of conventional therapy on functional activities. To compare the effect of tricep strength thening and conventional therapy on pain and functional activities. Procedure: 30 Samples were collected according to inclusion and exclusion criteria. Then Consent was taken from the respective subjects to conduct the study. Respective protocol was followed for Group A and Group B; and treatment protocol was followed for 2 weeks. Pre and post values of subjects was assessed by numerical pain rating scale, strength of elbow flexors with 10 RM, isometric strength of triceps was reassessed by Jamar dynamometer, and pain and functional assessment with patient rated tennis elbow evaluation questionnaire. Data was collected and analyzed statistically. Results: t value for NPRS comparion between group A and B is 0.871. At p value 0.391: considered Significant at p≤ 0.05 with 95 % confidence interval. t value for 10RM in group A and B in pre and post treatment is -1.169. At p value 0.252: considered Significant at p≤ 0.05 with 95 % confidence interval. t value for isometric strength of right triceps with jamar dynamometer is-0.561. At p value 0.579: considered Significant at p≤ 0.05 with 95 % confidence interval. t value for isometric strength of left triceps with jamar dynamometer is 0.469. At p value 0.643: considered Significant at p≤ 0.05 with 95 % confidence interval. t value for comparison between PRTEEQ in group A and B is 0.871. At p value 0.391: considered Significant at p≤ 0.05 with 95 % confidence interval. Conclusion: This study concludes that triceps strengthening along with conventional physiotherapy program has shown better improvement on NPRS,10RM, (Triceps) Isometric strength with JAMAR DYNAMOMTERE score as compared to conventional physiotherapy alone over 2 week of training program.
A clinical study of effect of transcutaneous nerve stimulation (TENS) in labour analgesia
Bharati Rajani, Hemlata Chaudhary, Bhavna V Panchmatiya, Ravi Agrawal
Objective: Objectives are to observe the onset, effectiveness, extent of labour analgesia using TENS and cardiovascular and respiratory changes in mother. Effect of TENS on the progress of labour on fetal heart rate and adverse effect of TENS, if any.
1. Abouleish E. (1977) Pain control on /obstetrics, pop 365-382. Philadelphia. JB Lippincott. 2. Abouleish E. and Depp, R: (1975) Acupunture in obstetrics. Anaestheis and analgesia 54:83. 3. Beecher HK (1969): Anxiety and pain. J.A.M.A. 209, 1080. 4. Andersson, S.A. and Holmgen E. (1978): analgesic effect of peripheral conditioning stimulation III. Effect of high frequency stimulation, segmental mechanism interacting with pain. Acupunct. Electrother Res. 3:23. 5. Augustinsson L.E., Bohlin, P.H., Bundsen P., Carlsson, C.A. Feersmman L., et al (1977). Pain relief during delivery by transcutaneous electrical nerve stimulation. Pain 4; 59:1977. 6. Bajaj Pramilla, Artikelkar, Devendra Kumar (1996). TENS therapy for pain of different origin Indian Jr of Anaesthesia, 44: 309. 7. Bonica J.J. (1967) Principle and practice of obstetric Analgesia and Anesthesia. Philadelphia. F.A. Davis. 8. Bundsenn P. Peterson L.E. and Selstam G. (1981). Pain relief in labour by TENS. A prospective matched study. Acta Obstet. Gynecol. Scand. 60:459. 9. Burten C. and Maurer DD (1974): pain suppression by transcutaneous electronic stimulation. IEEE transcutaneous on Biomedicl Engineering BMe-21, 81. 10. BowsherD(1978). Pain and pain pathway mechanism Anaesthesia, 33,935. 11. Abubakirova AM, Koraeva LV, PoluianovaLA(1985). Comparative evaluation of drug free methods. Analgesion in labour. Anaestheziol. Reanimatel, May June, (3),(19-20) 12. Melzack R, Taenzer P Feldman P andKinch RA (1981). Labour is still painful after prepared childbirth training. Candian Medical Association Journal 125:357-363. 13. Melzack, M. and Wall, P.D. (1962). On the nature of cutaneous sensory mechanisms. Brain, 85,331-356. 14. Shealy CN, Maurer D (1976): Electropuncture and endogenous morphines. Lancet,2, 1085. 15. Peter Bundsen, KlasEvicson, Lars Erik Peterson and KlaraThritinger (1982). Pain relief in labour by TENS: ActaObstet. Gynecol. Scand 61. 16. Bonica J.J. (1979). Clinical study of nociceptive pathways from uterus. Pain, 7. 17. Argent PogesF(1921) SanidMilit Argent. 11, 351, Quoted by Wyllie and Churchill Davidson, 5th Ed. 888. 18. Chia YT, Arulkumaran S, Chua S, RatnamSS(1990). Effectivenss of transcutaneous electric nerve stimulator for pain relief in labour. Asia Oceania J. Obstet. Gynecol. Jun. 16(2):145-51. 19. Harrison RF, Woods T, Shore M, Mathews G, Unwin A(1986). Pain relief in labour using TENS. A TENS/TENS pacebo controlled study in two parity groups. Br. J. Obstet. Gynaeco:l Jul. 93(7), 739-46.
Development of indigenous innovative visual reinforcement system for hearing screening among young children
Shradha S, Daisy E, Gladys Prathiba D, Krithika K
Visual reinforcement audiometry (VRA) is the gold standard hearing assessment procedure. It is a combination of both visual and auditory stimuli uses conventional toys and speakers to estimate hearing. The aim of the study is to develop digital animated VRA instrumentation and to test the feasibility of the tool in screening young children. The study was carried out in two phases, wherein the development of the age appropriate digital video animated clips and the VRA system as a part of phase I. Phase II focused on exploring the feasibility of the newly developed instrument with digital images. Two groups of 21 typically developing children underwent VRA hearing testing in a sound treated room. Children of three different age groups (7-12 month, 13-24 months, 25-36 months) were included in the study. Results indicates that older children (13 to 36 months) demonstrated greater interest and anticipation for the newly developed system of VRA. It is evident that the newly developed VRA system is a clinically plausible option for testing hearing in young children.
Visual reinforcement audiometry (VRA) is the gold standard hearing assessment procedure. It is a combination of both visual and auditory stimuli uses conventional toys and speakers to estimate hearing. The aim of the study is to develop digital animated VRA instrumentation and to test the feasibility of the tool in screening young children. The study was carried out in two phases, wherein the development of the age appropriate digital video animated clips and the VRA system as a part of phase I. Phase II focused on exploring the feasibility of the newly developed instrument with digital images. Two groups of 21 typically developing children underwent VRA hearing testing in a sound treated room. Children of three different age groups (7-12 month, 13-24 months, 25-36 months) were included in the study. Results indicates that older children (13 to 36 months) demonstrated greater interest and anticipation for the newly developed system of VRA. It is evident that the newly developed VRA system is a clinically plausible option for testing hearing in young children.
In-Vitro cultivation of mycobacterium leprae and confirmation by molecular method
D Pal, K Ghosh
Mycobacterium leprae was the first organism described as the causative agent of an infection. It was described by Dr. G. Armaner Hansen as the causative agent of leprosy in 1874. Thereafter, numerous agents/bacteria have been described as causative agents of disease like Mycobacterium tuberculosis, Vibrio cholera, etc. Almost all bacteria discovered till now have been grown in artificial culture in chemically defined media (in-vitro cultivation) in the laboratory. However, Mycobacterium leprae though first described as a causative agent still remains uncultivable in the laboratory in artificial culture media. Numerous attempts have been made by different workers to grow this organism in the laboratory but all attempts at cultivation have been unsuccessful till date. As it would be too extensive to list all the unsuccessful attempts at cultivating this organism on artificial culture media, only a few important references are cited here (see References 1-10 below).
Mycobacterium leprae was the first organism described as the causative agent of an infection. It was described by Dr. G. Armaner Hansen as the causative agent of leprosy in 1874. Thereafter, numerous agents/bacteria have been described as causative agents of disease like Mycobacterium tuberculosis, Vibrio cholera, etc. Almost all bacteria discovered till now have been grown in artificial culture in chemically defined media (in-vitro cultivation) in the laboratory. However, Mycobacterium leprae though first described as a causative agent still remains uncultivable in the laboratory in artificial culture media. Numerous attempts have been made by different workers to grow this organism in the laboratory but all attempts at cultivation have been unsuccessful till date. As it would be too extensive to list all the unsuccessful attempts at cultivating this organism on artificial culture media, only a few important references are cited here (see References 1-10 below).
Morbidity pattern among elderly population at tertiary care hospital: A retrospective study
Chinte L T, Andurkar S P, Kendre V V, Dixit J V
In general, “elderly†age group is defined as persons aged 65 years and above. The two extremes of life child and elderly need special care. Elderly life is full of problems – physical, social and economic. While ageing of the population is essentially a simple phenomenon, its consequences are multiple and not always well recognized Methodology: A hospital based retrospective study was undertaken during the period of1 April 2014 to 31 March 2015 to know the morbidities in geriatric population admitted in Government Medical College Latur. Results: Mean age of geriatric patients was 72 years and maximum age of patient admitted was 106 years. common morbidity seen is cataract and diminished vision (62.92%), followed by Injury and various fractures(19.53), Diseases of circulatory system ;Diseases of blood and blood forming organs (4.52), Diseases of respiratory system (2.71), Infectious and parasitic diseases (2.44), Diseases of digestive system (2.26). Conclusion: There is a growing need for interventions to ensure the health of this vulnerable group and to create a policy to meet the care and needs of the disabled elderly. Further research, especially qualitative research, is needed to explore the depth of the problems of the elderly.
In general, “elderly†age group is defined as persons aged 65 years and above. The two extremes of life child and elderly need special care. Elderly life is full of problems – physical, social and economic. While ageing of the population is essentially a simple phenomenon, its consequences are multiple and not always well recognized Methodology: A hospital based retrospective study was undertaken during the period of1 April 2014 to 31 March 2015 to know the morbidities in geriatric population admitted in Government Medical College Latur. Results: Mean age of geriatric patients was 72 years and maximum age of patient admitted was 106 years. common morbidity seen is cataract and diminished vision (62.92%), followed by Injury and various fractures(19.53), Diseases of circulatory system ;Diseases of blood and blood forming organs (4.52), Diseases of respiratory system (2.71), Infectious and parasitic diseases (2.44), Diseases of digestive system (2.26). Conclusion: There is a growing need for interventions to ensure the health of this vulnerable group and to create a policy to meet the care and needs of the disabled elderly. Further research, especially qualitative research, is needed to explore the depth of the problems of the elderly.
Effect of rehablitation on muscle imbalance in upper cross syndrome
Chhotwani Tanuja, Vairagade Meenakshi, Borkar Pradeep
Aims and Objective: To assess the effect of exercise, stretching and postural correction on neck Imbalance and To assess the effect of exercise, stretching and postural correction on forward head posture Design: Experimental Study Setting: Dr.D.Y.Patil I.P.D. and O.P.D. Participants: Twenty four patients with the complain of neck pain in the age group of 20-40 years and history of working in same posture for 6 to 8 hours participated in the study. Intervention: All the patients were conveniently selected from the OPD of Physiotherapy clinic in our institution and after signing of consent form they were given 2 week rehabilitation protocol of stretching and strengthening (based on Sherrington law) and posture correction exercise. Craniovertebrtal angle, NDI and VAS were used to assess the pain discomfort and disability caused by neck pain. Outcome Measures: VAS (visual analogue scale), Neck Disability Index, CV angle. Result: 24 participants completed the study. Comparison of pre and post Neck disability index, Neck pain (VAS) and craniovertebral angle were found to be statistically significant (p<0.05) at the end of 2 week rehabilitation protocol of stretching, strengthening and posture correction Conclusion: This study concludes that the effect of exercise, stretching and postural correction was there on Pain, neck Imbalance and also on the forward head posture. There was significant decrease in pain and neck disability.
1. Griegel-Morris P, Larson K, Mueller-Klaus K, Oatis CA. Incidence of common postural abnormalities in the cervical, shoulder, and thoracic regions and their association with pain in two age groups of healthy subjects. Physical Therapy 1992; 72(6):425–31. 2. Moore, M.K., 2004. Upper crossed syndrome and its relationship to cervicogenic headache. Journal of Manipulative and Physiological Therapeutics, 27, 414–420 3. Watson DH, Trott PH. Cervical Headache:an investigation of natural head posture and upper cervical flexor muscle performance.Cephalgia 1993 Aug;13(4):272-284. 4. Fernandez-de-las-Penas, C., et al., 2005. Forward head posture and neck mobility in chronic tension type headache: A blinded, controlled study. Cephalalgia, 26, 314–319. 5. Panjabi MM. 1992. The stabilizing system of the spine. Part I. Function, dysfunction, adaptation, and enhancement. J Spinal Disord. 5(4):383-9 6. Janda v: Muscle strength in relation to muscle length: pain and muscle imbalance. In: Harms -Rindahl K,ed : muscle strength. New York, churchill Livingstone, 1993 7. Janda v: Muscles, central nervous motor regulation and back problems. In : korr I ed: The neurobiologic Mechanism in manupulative therapy, New York, Plenum press,1978:27-41 8. Darlene Hertling, Randolph M. Kessler et al :management of common musculoskeletal disorders, Physical therapyPrinciples and methods, 4th edition : 150 9. Janda V: Muscle function Testing. London,Butterworth,1983 10. Janda v: Muscles, central nervous motor regulation and back problems. In : korr I ed: The neurobiologic Mechanism in manipulative therapy, New York, Plenum press,1978:27-41 11. Janda v: Muscles as a pathogenic factor in back pain. In: The treatment of Patients, Proceedings of the 4th International Federation of Orthopedic Manipulative therapist, Christchruch,New Zealand,1980 12. Janda V : Muscle function Testing. London,Butterworth,1983 13. Janda v: Muscle and Cervicogenic pain syndrome In: Grant R ed: Physical therapy of cervical and thoracic spine, New York, churchill Livinstone,1988 14. Janda V: Muscle strength in relation to muscle length, Pain and muscle imbalance. In: Harms-Rindahl K, muscle strength New York, churchill Livinstone 1993: 83-105. 15. Janda V: Evaluation of Muscular imbalance In: LibensonC,ed : Rehabilitation of the spine. Philadelphia, Lippincott,Williams and Wilkins,1996:97-112 16. Watson DH. Cervical headache: an investigation of natural head posture and upper cervical flexor muscle performance. Grieve’s Modern Manual Therapy—The Vertebral Column. 2nd ed.; 1994: p. 349–60. 17. James Stoppani Encyclopedia of Muscle and Strength.ch:10 training cycles for gaining maximal strength.pg-199-207(2006) 18. Smith J, Padgett D, Kenton R, et al. Rhomboid muscle electromyography activity during 3 different manual muscle tests. Arch Phys Med Rehabil. 2004; 85:987–992. 19. Helen Hislop et..al:, Daniels and Worthingham's Muscle Testing: Techniques of Manual Examination and PerformanceTesting, 9th Edition 20. Jull G Trott P. A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache. Spine (Phila Pa 1976) 2002; 27(17):1835-43. 21. O Leary s, Falla D. Specific therapeutic exercise of the neck induces immediate local hypoalgesia. J Pain. 2007; 8(11):832-39. 22. Ting Yip CH, Wing Chiu TT. The relationship between head posture and severity and disability of patients with neck pain. Man Ther. 2008; 13(2):148-54. 23. Lindfors P. Work characteristics and upper extremity disorder in female dentists. J Occup Health. 2006; 48(3):192-97. 24. O Leary S. Specificity in Retraining Cranio cervical Flexor Muscle Performance. J Ortho Sports Phy Ther. 2007; 37(1): 3-9. 25. Rezasoltani et.al. The effect of a proprioceptive neuromuscular facilitation program to increase neck muscle strength in patients with chronic non-specific neck pain. World Journ of Sport Sci. 2010; 3 (1): 59-63. 26. Ylinen J. Decreased Isometric Neck Strength in Women With Chronic Neck Pain and the Repeatability of Neck Strength Measurements. Arch Phys Med Rehabil. 2004; 85(8):1303-08. 27. Udoye C, Aguwa EN. Musculoskeletal symptoms: a survey amongst selected Nigerian dentists. Science; 5(1) The Internet Journal of Dental Science. 2007 Volume 5 Number 1
Manual small incision cataract surgery (MSICS) under topical anesthesia
Bhalchandra S Joshi, V H Karambelkar, Vikrant A Narwade
Introduction: Manual small incision cataract surgery under topical anesthesia with 0.5% proparacaine hydrochloride and 1% preservative free intracameral lignocaine is a reasonably well tolerated procedure and is absolutely safer alternative to surgery under peribulbar or retrobulbar anesthesia with excellent outcome. Aim: To evaluate the patient’s and surgeon’s experience in MSICS using topical anesthesia with 0.5% proparacaine hydrochloride eye drops andpreservative free intracameral 1% lignocaine in terms of pain, surgical complications and outcome.
1. Minasian DC, Mehera V. 3.8 Million blinded by cataract each year: projection of the first epidemiological study of incidence of cataract blindness in India. Br J Ophthalmol. 1990;74:31-3 2. Jose R. National programme for the control of blindness. Indian J Comm Health. 1997;3:5-9 3. Marseille E Cost-effectiveness of cataract surgery in public health eye care programme in Nepal. World Health Organ Bull OMS. 1996;74:319-24 4. Porter R. Global initiative: The economic case. Commen Eye Health. 1998;24:44-5 5. Parkar T, Gogate P, DeshpandeM, Adenwala A, Maske A, Verappa K, Comparison of subtenon anesthesia with peribulbar anesthesia for manual small incision cataract surgery. Indian J Ophthalmol.2005;53:255-9 6. Collins SL, Moore RA, McQuary HJ. The visual analogue pain intensity scale: What is moderate pain in millimetres? Pain.1990;72:95-7 7. Lee J, Stiell I, Hobden E, Wells G. Clinically meaningful value of the visual analogue scale of pain severity. AcadEmerg Med. 2007;7:550 8. Smith R. Cataract extraction without retrobulbar anesthetic injection. Br J Ophthlmol. 1990;74:205-7 9. Gupta SK, Kumar A, Kumar D, Agrawal S, Manual small incision cataract surgery under topical anesthesia with intracameral lignocaine: Study on pain evaluation and surgical outcome. Indian J Ophthalmology 2009;57:3-7 10. Fichman RA. Use of topical anesthesia alone in cataract surgery. J Cataract Refract Surg.1996:22:612-4 11. Gozum N, Altan-YayciogluR, Gucukoglu A, Arsian O. Does topical anesthesia increases patient’s serum cortisol level? Int J Ophthalmol Visual Sci. 2003;2:2
A study of gentamicin level in CSF of the pediatric patients with meningitis
Sham D Kulkarni
Introduction: Paediatric clinical pharmacology is well established in western countries, but in our country. Bioavailability of a drug is altered in paediatric age group especially due to many variable factor, like, larger body surface in proportion to body-wt., changes in haematocrit values and phases of maturation of organs like kidney, liver etc. Hence clinical response, to a drug would depend on varieties of factors and, would decide the ultimate outcome in, especially, a sick child. Aims and Objectives: To Study Gentamicin level in CSF of the Pediatric Patients with Meningitis Methodology: This was prospective clinical trial at tertiary care hospitalthe children admitted in pediatric ward of a general hospital constituted the material for the present study. Only those children, for whom diagnostic L.P. was considered necessary on admission, were included in this study and hence no child was subjected to L.P. only for the purpose of this study. Out of the selected children, those who did not have any clinical and laboratory evidence of intracranial infections, constituted the group of normal children. Whereas those, who had clinical and Laboratory evidence of intracranial infections, constituted the another group under study. Both the group of children was subjected for similar work-up. Total 28 children were included into the study. Result: In Children Without Meningitis There are wide fluctuations is the serum concentration at 11/2 hrs. C.S.F. did not show any detectable concentration of drug. Fluctuation in serum concentration same as in group one. Most of the children show detectable concentration of drug in C.S.F. Serum levels after 5 doses have shown marked variation. None of them had any detectable level in C.S.F. Conclusion: Presence of detectable in c.s.f. is in marked variation. With absence of detectable levels in children without meningitis. This does show the effect of altered blood-brain barrier in meningitis
1. Jerome O. Klein: Gentamicin Am. J. Med.Sci; Vol.248; P 528, 1964. 2. Black, J. B. Williams: Phermacology of Gentamicin, Antimicrobiel agents and chemotherapy-1963, P.138-147; 964. 3. Anne-Marie Cyseilnck: Pharmacokinetics of Gentamicin J of inf.Dis.Vol.124 suppl; P.70; Dec.1971. 4. George R. Siber: Pharmacokinetics of Gentamicini in children and adults J. of inf. Dis; Vol.132 No.2; P.437; Dec.1975 5. John. W. Peisley; : Gentamicin in Newborn infants; Am. J. Dis. Child; vol.126: P.637; Oct.1973. 6. George H. Mc Cracken: Intravenous administration of Kananytin and Gentamicin in Newborn infants paed: Vol.60; No.4, No.4 Oct.1977; P.463. 7. Geroge H. Mc Cracken: Gentamincin in Neonetal period; Am. J.Dis. Children Vol.120; P.524; 1970. 8. George H. Mc Cracken: Pharmacological evaluation of Gentamicin in New born infants J. of inf.Dis.vol.124 Suppl; PS214; Dec.1971. 9. Newman R.L, : Intrathecal Gentamicin in treatment of ventriculitis in children, BMJ Vol. I; PS 39-542; 1967. 10. Arthrur W. Nunnery: Gentamicin, Pharmacological observations in Newborns and infants J. of inf. D; Vol.119 P 420; Apr.1969. 11. Clair E. Cox: Med.Clin.N. Amer.Vol.five 4; P.130five-15; 1970. 12. Harris D. Riley: J. of inf. D; Vol.124 P.S. 236; 1971. Clinical and Laboratory evaluation of Gentamicin in infants and children. 13. Robert L. Newman: Gentamicin in pediatrics; Report on inrathecal Gentamicin. J. of inf.Dis.; Vol.124, Dec.1971. P.S. 254. 14. Dr. Joseph Nawkins: Discussion J. of inf. Dis.Vol.124 PS. 260: Dec. 1971. 15. Donald Kaye: The unpredictability of serum concentrations of Gentamicin; J. of Inf. Dis.vol.130 No.2; P 150; Aug.1974. 16. Allen W. Methies: Gentamicin in the treatment of meningitis J. of inf. Dis; vol.124, Dec.1971; PS 249.
Synergistic effects of intrathecal magnesium sulphate to the combination of bupivacaine and fentanyl spinal anaesthesia in patients undergoing lower abdominal surgeries
Mallikarjuna
Background: Local anesthetics are extremely useful drugs for anaesthesiologists. All modern local anesthetics are amides. Esters are unstable in its solution. Lignocaine, Prilocaine, Bupivacaine etc all shares a common basic structure termed aminoacylamide. The current study aims to evaluate the effects of intrathecal supplementation of magnesium sulphate to bupivacaine-fentanyl in patients undergoing lower abdominal surgeries. Methodology: The patients were randomly assigned into two groups of 40 patients each, to receive an intrathecal injection in sitting position of either 15mg of 0.5% hyperbaric bupivacaine + 20mcg i.e 0.4ml of fentanyl + 0.1mg (0.1ml) 50% of magnesium sulphate or 15mg of 0.5% hyperbaric bupivacaine + 20mcg i.e. 0.4ml of fentanyl + 0.1ml normal saline. Duration of motor blockade, time taken for two segments regression are noted. Results: Duration of motor blockade was higher in Group A compared to Group B (279.25+53.33 vs. 249.75+45.11, p<0.001). Regression of sensory block to S1 was significantly earlier in Group B compared to Group A (240.13±58.99 vs. 271.25±56.78, p<0.001). Conclusion: Longer time for two segment regression, longer duration of motor blockade,decrease incidence of adverse effects.
1. Bridenbaugh PO, Green NM and Brill SJ. Spinal (Subarachnoid) neural blockade, Neural blockade in Clinical Anaesthesia and Management of Pain. 3rd Edition, edited by Michael J Cousin, Phillip O. Bridenbaugh, Philadelphia, Lippincott-Raven, 1998;10:203-242. 2. Sirvinskas E, Laurinaitis R. Use of magnesium sulphate in anesthesiology. Medicina 2002;38:696. 3. Kehlet H. The stress response to surgery: Release mechanisms and the modifying effect of pain relief. ActaChirScandSuppl 1988;550:22. 4. Modig J, Borg T, Karlström G, Maripuu E, Sahlstedt B et al. Thromboembolism after total hip replacement: Role of epidural and general anaesthesia. AnesthAnalg 1983 Feb;62(2):174-80. 5. Thornburn J, Louden J, Vallance R. Spinal and general anaesthesia in total hip replacement: Frequency of deep vein thrombosis. Br J Anaesth 1980;52:1117. 6. Christopherson R, Beattie C, Frank SM, Norris EJ, Meinert CL, Gottlieb SO et al. Perioperative morbidity in patients randomized to epidural or general anaesthesia for lower extremity vascular surgery. Anesthesiology 1993 Sept;79(3):422-34. 7. Rosenfeld BA, Beattie C, Christopherson R, Norris EJ, Frank SM, Breslow MJ et al. The effects of different anaestheticregimens on fibrinolysis and the development of postoperative arterial thrombosis. Anesthesiology 1993 Sept; 79(3):435-43. 8. Yeager M, Glass D, Neff R, Brinck-Johnsen T. Epidural anaesthesia and analgesia in high-risk surgical patients. Anesthesiology 1987;66:729. 9. Moraca RJ, Sheldon DG, Thirlby RC. The role of epidural anaesthesia and analgesia in surgical practice. Ann Surg 2003;238:663. 10. Abouleish E, Rewal N, Show J, Lorenz T, Rashad MN. Intrathecal morphine 0.2mg versus epidural Bupivacaine 0.125% or their combination; effects on parturients. Anaesthesiology 1991;74:711-6. 11. Hunt CO, Naulty JS, Bader AM, Hauch MA, Vartikar JV, Datta S et al. Perioperative analgesia with subarachnoid fentanyl bupivacaine for caesarean delivery. Anaesthesiology 1989 Oct;71(4); 535-40. 12. Sing H, Yang J, Thortan K, Giesecks A H. Intrathecal fentanyl prolongs sensory bupivacaine spinal block. Can J Anesth 1995 Nov;42 (11):987-91. 13. Woolf CJ, Thompson SW. The induction and maintenance of central sensitization is dependent on N-methyl D-aspartic acid receptor activation: Implications for the treatment of post-injury pain and hypersensitivity states. Pain 1991;44:293-9. 14. Woolf CJ, Chong MS. Preemptive analgesia: Treating postoperative pain by preventing the establishment of central sensitization. AnaesthAnalg 1993;77: 362-79. 15. Ascher P, Nowak L. Electrophysiological studies of NMDA receptors. Trends Neurosci 1987;10:284-8. 16. Lysakowsi C, Dumont L, Czarnetzki C, Tramer MR. Magnesium as an adjuvant to postoperative analgesia: A systemic review of randomized trial. AnaesthAnalg 2007;104:1532-9. 17. Malleswaran S, Panda N, Mathew P, Bagga R. A randomized study of magnesium sulphate as an adjuvant to bupivacaine in patient with mild preeclampsia undergoing caesarean section, International J ObstetAnaesth 2010;19:161-166. 18. Bilir A, Gulec S, Erkan A, Ozcelik Aet al. Epidural magnesium reduces postoperative analgesic requirements, Br J Anaesth 2007;98:519-523. 19. Chanimov M, Cohen ML, Grinspun Y, Herbert M, Reif R, Kaufman I, et al: Neurotoxicity after spinal anaesthesia induced by serial intrathecal injections of magnesium sulphate. An experimental study in a rat model. Anaesthesia 1997;52:223-8. 20. David L Brown, spinal epidural and caudal anaesthesia, Miller’s anaesthesia, 7thed edited by Ronald D Miller, Lars L.Erikrson, Lee A. Fleisher, et al, New York, Churchill Elsevier 2005;51:1611-1638. 21. Christopher M Bernards: Epidural and spinal anaesthesia in Paul G.Barash Clinical anaesthesia 6thed, New York, Wolster Kluwer Lippincott Williams and Wilkins 2010;37:927-950. 22. William F. Ganong. Physiology of central nervous system, Review of Medical Physiology, 22nd edition, Lange Medical book. International edition 2005;15:556-574
Comparison of sample and re-sampling techniques in the estimation of third trimester obstetric parameters
Arumugam P, Keshav Singh, Rajendran A K, Kasthuri A
Background: Obstetricians interested in estimating the third trimester parameters, can find the outliers by estimating the crucial boundaries of these parameters. The estimation may be made by two approaches namely random sampling and re-sampling techniques (bootstrap sampling). AIM: Comparison between random sample and Bootstrap sample parameters Objectives: To calculate the statistics of the two procedures by means of averages. To estimate the population parameters by both methods. To interpret the difference statistically. Methodology: A random sample of 240 III trimester ante-natal mothers was selected as first 20 singleton pregnant mothers through the months of January to December 2014and among them 154 and 86 mothers were primi para and multi para respectively obtained from the records of a teaching hospital in Tamil Nadu. The Ultra Sona Graphed statistics like Head Circumference (HC), Abdominal Circumference (AC), and Placental Thickness (PT) were collected. The statistics and parameters of primi mothers (154) were computed by both techniques and the difference between the variance was inferred by variance ratio test with the help of IBM SPSS Version 20. Results: The following obstetric statistics viz. mean median SD and SE calculated by sample and Bootstrap methods are furnished. Discussion: The difference between the variances were not statistically significant (P>0.05). Hence the difference between Std. errors were also not statistically significant (P>0.05). And thus the parameters will also be not statistically significant (P>0.05). Conclusion: As the sample size of 154 was large, the estimated parameters of both techniques may not be significant. The Bootstrap sample parameter may be a more appropriate estimation in respect of small samples.
1. Educational Research, Fundamentals for the Consumer; II Ed. JAMES H. MCMILLAN. Virginia Commonwealth University, Chapter-4 Page- 87. 2. Muthusamy, R. Uthiramerur Inscriptions on Chola Kudavolai Election System. Internet- www. File///C:/ Documents. 3. Face book logo: Internet- www. File///C:/ Documents. 4. Jelke Bethlehem, The rise of survey sampling, Discussion Paper Statistics Netherlands. The Hague/Heerlen, 2009. Pages:6, 5. Ibid (4)- page-6. 6. Ibid (4)- page-6 7. Ibid (4)- page-7 8. Ibid (4)- page-8 9. Ibid (4)- page-10 10. Ibid (4)- page-12 11. Ibid (4)- page-14 12. Ibid (4)- page-16 13. Ibid (4)- page-16 14. Ibid (4)- page-19 15. Kesar Singh and Minge Xie, Bootstrap: A Statistical Method, Rutgers University. 16. Mooney & Duval, Bootstrapping, A nonparametric Approach to Statistical Inference. Series on Quantitative Applications in the Social Sciences, Sage University Papers Seminar, General Statistics, 25 October 2012. 17. Wikipedia. Why the Name Bootstrapping? 18. Bootstrap Methods AND Permutation Tests. W. H. Freeman and Company New York- Chapter -18.2: Page-7. 19. Saravanan Iyer, Uthiramerur Sri Sundara Varadhar: Hind Pedia. 20. Ibid (1) Page-90. 21. Ibid (3) 22. Ibid (4) - page-8. 23. Frerichs, R.R. Rapid Surveys (unpublished), © 2008, Chapter-3. Simple Random Sampling, Page: 12.
Study of gender differences in polysomnographic profile of obstructive sleep apnea patients
Mrutunjay M Mahindrekar, Sanjiv V Zangde, Vikas R Patel, Sanjay Muttyepod, Manish Meshram
Mrutunjay M Mahindrekar, Sanjiv V Zangde, Vikas R Patel, Sanjay Muttyepod, Manish Meshram
1. Fishman’s Pulmonary Diseases and Disorders. Fourth Edition. Page No. 630. 2. Fishmans Pulmonary Diseases and Disorders,5thedition, Pg.3251. 3. H. Boot et al Obstructive Sleep Apnea- pathogenetic aspects and treatment, 2000-06-28 4. Hanish Sharma and S.K. Sharma Overview and implications of obstructive sleep apnea. Indian J Chest Dis Allied Sci 2008;50:137150. 5. Fishmans Pulmonary Diseases and Disorders ,5th edition, Pg.3261 6. JOAQUIN DURÃN et al Obstructive Sleep Apnea–Hypopnea and Related Clinical Features in a Population-based Sample of Subjects Aged 30 to 70 Yr , American Journal of Respiratory and Critical Care Medicine, Vol.163, No. 3 (2001), pp. 685-689. 7. Hader C, Schroeder A, Hinz M, Micklefield GH, Rasche K. Sleep Disordered Breathing in the elderly: comparison of men and women. J Physiol Pharmacol. 2005;56:85–91. [PubMed] 8. LOPEZ et al Prevalence of Sleep Apneain Morbidly Obese Patients Who Presented for Weight Loss Surgery Evaluation: More Evidence for Routine Screening for Obstructive Sleep Apneabefore Weight Loss Surgery, THE AMERICAN SURGEON Sepatientember 2008 Vol. 74 pp 834- 837. 9. Jamie C.M. Lam, S.K. Sharma* and Bing Lam review article on Obstructive sleep apnoea: Definitions, epidemiology and naturalhistory 10. Vagiakis E1, Kapsimalis F, Lagogianni I, Perraki H, Minaritzoglou A, Alexandropoulou K, Roussos CRoussos C, Kryger M study on Gender differences on Polysomnographic findings in Greek subjects with Obstructive Sleep Apnea syndrome. 11. O’Connor C, Thornley KS, Hanly PJ. Gender differences in the Polysomnographic features ofobstructive sleep apnea. Am J Respir Crit Care Med 2000;161:1465–1472. [PubMed: 10806140]. 12. Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S. , The occurrence of sleep-disordered breathing among middle-aged adults.N Engl J Med. 1993 Apr 29;328(17):1230-5. 13. Lae Hyung Lee, Seung Ju Lee and Hyun Woo Kang study on Gender Differences in the Polysomnographic Findings among Obstructive Sleep ApneaPatients 14. Hassan A. Chami ,Carol M. Baldwin, Angela Silverman, Ying Zhang, David Rapoport, Naresh M. Punjabi, and Daniel J. Gottlieb study on Sleepiness, Quality of Life, and Sleep Maintenance in REM versus non-REM Sleep-disordered Breathing. 15. Naresh M. Punjabi The Epidemiology of Adult Obstructive Sleep ApneaProc Am Thorac Soc Vol, 2008, 5. pp 136–143. 16. Brian B. Koo retrospective study on The effects of gender and age on REM-related sleep-disordered breathing
The effect of circuit resistance training on upper limb muscle strength in volleyball attacker players
Pradeep Borkar, Bhavika Keswani, Meenakshi Vairagade
Aim: To find out effect of circuit resistance training on upper limb muscle strength in volleyball attacker players. Objectives: To study effect of circuit Resistance Training on strength of triceps, deltoid, shoulder internal rotator muscles and on workout volume in volleyball attacker players. Procedure: 30 Subjects were collected according to inclusion and exclusion criteria. Consent was taken from respective subjects to conduct the study. Respective protocol was followed for Group A (Controlled Group) and Group B (Experimental Group); over 5 weeks, with 3 sessions per week .Pre and post values of Subjects were assessed by using 10 RM and Push up test. The statistical tests used for analysis of result were: Paired t-test and unpaired t- test. Mean standard deviation and standard error was carried out for both groups. Result: After 5-weeks of training period, the B group showed more improvement in Strength of Triceps (P< 0.050) considered significant, Deltoid (p< 0.040) considered significant, Shoulder internal rotators(p<0.030) considered significant and Push up performance (p<0.000) Considered extremely significant. Conclusion: This study concludes that Circuit Resistance Training is more effective in improving the strength of shoulder internal rotators, deltoid and triceps Muscles as compare to regular Training in volleyball players.
1. Benedict Tan. Manipulating resistance training program variables to optimize maximum strength in men: a review. Journal of strength and conditioning;1999, 13, (3):289- 304. 2. Robert U. Newton, William J. Kraemer. Developing explosive muscle power: implications for mixed method training strategy. National strength and conditioning association; 1994; 20- 35. 3. William J. Kraemer, Nicholas A. Ratamer. Progressive and resistance training. President council on physical fitness and sports, Washington;2005 ,6(3):1- 10. 4. Carolyn Kisner, Lynn Allen Colby.Therapeutic exercise: foundation and techniques. 5th edition.2007 ;chapter3, 58- 148. 5. Holyoke, Massachusetts (USA), William G Morgan, a YMCA physical education director ,(USA): 1985; 3-6 6. Cedric Dupuis, Claire Tourny-Chollet ,CETAPS, Increasing explosive power of shoulder in volleyball players :strength and conditioning journal, Volume 25, Number 6,December2003 page 7–11. 7. B D Chaurasia: Human Anatomy, vol 1 ,2004, pg:79. 8. A Kugler, M Krüger-Franke, S Reininger, H H Trouillier and B Rosemeyer Muscular imbalance and shoulder pain in volleyball attackers, Br. J.Sports Med 1996;30;256-259. 9. Hsing-Kuo Wang, Alison Macfarlane and Tom Cochran Isokinetic performance and shoulder mobility in elite volleyball athletes from the United Kingdom Br. J. Sports Med. 2000;34;39-43. 10. Humberto Miranda 1, Roberto Simão 2, Leonardo Marmo Moreira 1, Renato Aparecido de Souza. Effect of rest interval length on the volume completed during upper body resistance exercise :Journal of Sports Science and Medicine September 2009,8: 388-392. 11. Joseph M.Robibson, Michael H. Stone, Robert L.Johnson. Effect of different weight traning exercise/rest intervals on strength, power and intensity exercise endurance: Journal of strength and condition research, 1995, 9(4), 216-221. 12. Schafle MD, Requa RK, Patton WL, et al. Injuries in the 1987 national amateurVolleyball tournament. Am J Sports Med 1990;18(6):624-631. 13. Kraemer, James b.; Stone, Michael H.; O’Bryant, Harold S., et al. Effect of single versus multiple sets of weight training: impact of volume, intensity and variation. Journal of strength and conditioning research. 1997. 14. Bekir Yuktasir, Fehmi Tuncel; A comparison of two weight training methods on leg strength f high school boys. Athletes coaching.com. 15. Lee E. Brown. National strength and conditioning association.2007, chapter 2 16. Carrie A. Hall.Therapeutic exercise: Moving towards function.2005, 2nd edition, chapter 5, pg 81. 17. John Davidson. Getting stronger weight training for sport. 2005, 20th edition 18. Dave Smith and Stewart Bruce Low. Strength training and work of Arthur Jones. Journal of exercise physiology online.2004; vol 7 (6), pg 52 – 68. 19. James E. Graves, Barry A. Franklin. Resistance training for health and rehabilitation. 2001,chapter 7, pg- 105 20. Hass CJ, Garzarela L, De Hoyos , et al. Single versus multiple sets in long term recreational weight lifters. Med sci sports exercise.2000; 32; 235-242. 21. Andrew S. Rokito, Frank W. Jobe, and John Brault (2006) EMG Studies done on volleyball players.Journal of exercise physiology pg 11-13. 22. Aagaard H, Jorgensen U (1996) questionnaire survey in national volleyball players. Br. J. Sports Med. 2008;45;31-56 23. George A. Brooks.Exercise physiology- Human bioenergetics and its application.1996,chapter 20, pg 384-409 24. Robert U. Newton, William J. Kraemer. Developing explosive muscle power: implications for mixed method training strategy. National strength and conditioning association; 1994; 20-35. 25. William J.Kraemer, Nicholas A. Ratamer. Progressive and resistance Training. President council on physical fitness and sports, Washington; 2005, 6(3): 1-10. 26. William Dc Mc Cardle, Frank J. Katch. Exercise physiology: energy, and Nutrition human performance. 6th edition, chapter 22:509- 552.
Ileo -colic Intussusception in Adults due to Lipomatous Polyp: A rare case
Harpreet Singh, D G Mote
Adult Intussusception is a rare but challenging condition. The condition is usually secondary to definitive lesion. The aetiology, clinical presentation and management of this condition are different in adults than in children. Preoperative diagnosis is usually missed or delayed because of non specific or sub acute symptoms. We present a case of ileo -colic intussuscepton in a 78 year old male patient.
1. Marinis A, Yiallourou A, Samanides L, Dafnios N, Anastasopoulos G, et al (2009) Intussusception of the bowel in adults: a review. World J Gasteroenterol 15: 407-411. 2. Ochiai H, Ohishi T, Seki S, Tokuyama J, Osumi K, et al. (2010) Prolapse of Intussusception through the anus as a result of sigmoid colon cancer. Case Rep Gasroenterol 4:346-350. 3. Warshauer DM, Lee JK. Adult intussusceptions detected at CT or MR imaging: clinical-imaging correlation. Radiology1999; 212:853-860. 4. Begos DG, Sandor A Modlin IM (1997) The diagnosis and management of adult intussusceptions. Am J Surg 173:88-94. 5. Azar T,Berger DL. Adult Intussusception. Ann surg 1997;226:134-8. 6. Agha FP. Intussusception in adults. AJR1986;146:527-31. 7. Chiang JM, Lin YS: Tumour spectrum of adult intussusceptions. J Surg Oncol 2008,989(6):444-47. 8. Sheth A,Jordan PA: Does small bowel intusssuception in adults always require surgery? Dig Dis Sci 2007,52(8):1764-66. 9. Johnstone J, Morson B : Inflammatory fibroid polyp of gastrointestinal tract. Histopathology 1978,2(5):34 10. Catalano O;Transint small bowel intussusceptions :CT findings in adults. BJR 1997 aug; 70(836):805-8.
Depression associated with cardiac surgery and the probable risk factors- A randomised observational clinical study
Davan K R, Bindu, Mallikarjuna, Sowmia Mammen, Sumaiya Sabreen
Introduction: Cardiovascular surgery can trigger depression; counselling and medications can easily beat it. The earlier we identify people who have depression, complicating their ability to get back to normal life, better is the chances of recovery. We conducted a prospective randomized observational study to assess incidence of depression in patients undergoing cardiac surgery and risk factors which can trigger depression. Materials and Methods: A prospective randomized double blind controlled Observational clinical study was conducted in 250 patients who underwent open heart surgery with and without assistance of cardio pulmonary bypass (CPB) from May 2013 to July 2014. All patients were screened for depression with Patient Health Questionnaire (PHQ-9) preoperatively (Q1), at hospital discharge (Q2), 3months (Q3) and 6months (Q4) postoperatively. At each interval patients were identified as ‘‘not depressed’’ (PHQ-9 score 0), minimally depressed (score 1-4), mild(score5-9), moderate (10-14), moderately severe(15-19), severe depression(20-27). Multiple regression analysis was used to identify variables associated with depression. Results: On regression analysis, preoperative depression for depression at discharge (OR 88.5, p<0.0001), depression at discharge for incidence of depression at three months (OR 4004, p<0.0001) and 6 months (OR 1194, p<0.0001) had significant Odds ratio (OR) with statistical significance. Patients who had depression at discharge were older, had lower preoperative ejection fraction (EF), prolonged waiting period, ICU stay, hospital stay. Other risk factors identified were higher NYHA class , history of prior CCF, abnormal lipid profile, pre-existing hypertension, diabetes mellitus, peripheral vascular disease and patients on beta blockers. Conclusion: Depression is common after cardiac surgery. Among all the risk factors, preoperative depression was associated with the highest risk for postoperative depression.
1. Judith H. Lichtmanetal. Depression and Coronary Heart Disease Recommendations for Screening, Referral, and Treatment.Circulation.2008;118:1768-1775. 2. Phillip J Tully1,2,3,4, Robert A Baker1. Depression, anxiety, and cardiac morbidity outcomes after coronary artery bypass surgery: a contemporary and practical review. J GeriatrCardiol2012; 9: 197−208. 3. David Horne, MD,etal Depression before and after cardiac surgery: Do all patients respond the same? .J ThoracCardiovascSurg 2013;145:1400-6. 4. Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16:606-13 5. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington, DC: American Psychiatric Association; 2000. 6. Connerney I, Shapiro PA, McLaughlin JS, et al. Relation between depression after coronary artery bypass surgery and 12-month outcome: a prospective study. Lancet 2001; 358:1766–1771. 7. Tully PJ, Baker RA, Winefield HR, et al. Depression, anxiety disorders and Type D personality as risk factors for delirium after cardiac surgery. Aust N Z J Psychiatry 2010; 44: 1005–1011. 8. Fraguas JR, Ramadan ZB, Pereira AN, et al. Depression with irritability in patients undergoing coronary artery bypass graft surgery: the cardiologist's role. Gen HospPsychiatry2000; 22:365–374. 9. Rafanelli C, Roncuzzi R, Milaneschi Y. Minor depression as a cardiac risk factor after coronary artery bypass surgeryPsychosomatics 2006; 47: 289–295. 10. Mitchell RH, Robertson E, Harvey PJ, et al. Sex differences in depression after coronary artery bypass graft surgery. AmHeart J 2005; 150: 1017–1025. ders. 4th ed. Washington, DC: American Psychiatric Association; 2000. 11. Jens-Holger A Krannichetal. Presence of depression and anxiety before and after coronaryartery bypass graft surgery and their relationship to age. BMC Psychiatry 2007, 7:47 12. McKann GM, Borowicz LM, Goldsborough MA, Enger C, Selnes OA. Depression and cognitive decline after coronary artery bypass grafting. Lancet. 1997; 349:1282-4. 13. Sansone RA, Sansone LA. Rumination: relationships with physical health. InnovClin Sci. 2012;9:29-34. 14. Van Melly etal. Beta-blockers and depression after myocardial infarction: a multicenter prospective study. J Am Coll Cardiol. 2006;48(11):2209-2214. 15. Myhren et al. Post traumatic stress , anxiety and depression symptoms in patients during the first year post intensive care unit discharge. Critical care 2010,14:R14. 16. Bruce Arroletal, Validation of PHQ-2 and PHQ-9 to Screen for Major Depression in the Primary Care Population.annals of family medicine ,www.annfammed.org vol. 8, no. 4 ,july/august 2010 17. Lee PH, Macfarlane DJ, Lam TH, Stewart SM. Validity of the International Physical Activity Questionnaire Short Form (IPAQ-SF): a systematic review. Int J NutrPhys Act. 2011;8:115. 18. Tanya m. goyal, phd, ellen l. idler, phd, tyrone j. krause, md, and richard j. contrada, phdQuality of Life Following Cardiac Surgery: Impact of the Severity and Courseof Depressive Symptoms PHD Psychosomatic Medicine 67:759 –765 (2005) 19. Pollock BG, Laghrissi-Thode F, Wagner WR. Evaluation of platelet activation in depressed patients with ischemic heart disease after paroxetine ornortriptyline treatment. J ClinPsychopharmacol. 2000;20: 137–140. 20. Serebruany VL, Glassman AH, Malinin AI, Sane DC, Finkel MS, Krishnan RR, Atar D, Lekht V, O’Connor CM. Enhanced platelet/endothelial activation in depressed patients with acute coronary syndromes: evidence from recent clinical trials. Blood Coagul Fibrinolysis. 2003;14: 563–56 21. Barger SD, Sydeman SJ. Does generalized anxiety disorder predict coronary heart disease risk factors independently of major depressive disorder? J Affect Disord2005; 88: 87–91. 22. Goodwin RD. Association between physical activity and mental disorders among adults in the United States. Prev Med 2003; 36: 698–70. 23. McAvay GJ, Van Ness PH, Bogardus ST Jr, et al. Depressive symptoms and the risk of incident delirium in older hospitalized adults. J Am Geriatr2007; 55: 684–691. 24. Davydow DS. Symptoms of depression and anxiety after delirium. Psychosomatics 2009; 50: 309–316. 25. Tully PJ, Baker RA, Knight JL, et al. Neuropsychological function five years after cardiac surgery and the effect of psychological distress. Arch ClinNeuropsychol2009; 24: 741–751. 26. Barger SD, Sydeman SJ. Does generalized anxiety disorder predict coronary heart disease risk factors independently of major depressive disorder? J Affect Disord2005; 88: 87–91. 27. Goodwin RD. Association between physical activity and mental disorders among adults in the United States. Prev Med 2003; 36: 698–703. 28. Carney RM, Freedland KE, Eisen SA, et al. Major depression and medication adherence in elderly patients with coronary artery disease. Health Psychol1995; 14: 88–90. 29. Kuhl EA, Fauerbach JA, Bush DE, et al. Relation of anxiety and adherence to risk-reducing recommendations following myocardial infarction. Am J Cardiol2009; 103: 1629–1634. 30. Frasure-Smith N, Lesperance F, Irwin MR, et al. Depression, C-reactive protein and two-year major adverse cardiac events in men after acute coronary syndromes. Biol Psychiatry 2007; 62: 302–308.
Comparative study of efficacy of per rectal misoprostol, intravenous methylergometrine and intramuscular carboprost in active management of third stage of labour
Sonal Agrawal, Vimal Kumar Agarwal
Introduction: Postpartum haemorrhage (PPH) during the third stage of labour is the most common cause of maternal deaths in developing countries. Active pharmacological management of this stage to prevent haemorrhage with an uterotonic drugs leads to a decrease in postpartum vaginal haemorrhage. The aim of this study was to assess and compare the effectiveness of rectal misoprostol compared with an intravenous oxytocin and intramuscular carboprost in active management of third stage of labour. Material and Methods: A total of 400 women in labour were randomized into four groups (100 women in each). Within 1 minute of delivery of the anterior shoulder participants in group A received 800ïg of rectal misoprostol; group B received 0.2mg of methylergometrine intravenously; group C received 125ïg of carboprost intramuscularly and group D served as control and had not received any prophylactic uterotonics. Results: All groups were compared regarding the need for excessive uterotonics, amount of blood loss, and hematocrit drop. Per rectal misoprostol was found to be equal or better to rest of the drugs in the study with lowest duration of third stage of labor (mean =8.69 mins), lowest amount of blood loss (mean=149.90 ml), haematocrit drop (0.51±0.32) and lowest incidence of PPH. There was no significant difference in the duration of third stage of labor amongst the four groups. Conclusions: Per rectal Misoprostol is equal or better as compared to injection methyl ergometrine or carboprost and can prove to be better alternative because of several advantages.
1. Abouzahr C (1998) maternal mortality overview In: Health dimensions of sex and reproduction. Murray CJ, lopez AD, eds. WHO, Geneva.111-64. 2. Donald I. Postpartum haemorrhage. M. Renu, Practical Obstetric Problems, 6th Edn. New Delhi, B.I Publications; 2007.604-24. 3. Mudaliar AL. Causation and stages of labour. Clinical Obstetrics 9th Edn. Madras Orient Longman;1994.85-96. 4. Cunningham FG, Leveno KJ, Bloom SL, Hauth JC, Rouse DJ, Spong CY. Williams Obstetrics. 23rd ed. New York: McGraw-Hill Medical; 2010. Normal Labor and delivery;374–409. 5. Justus Hofmeyr G, Sandra Ferreira V, Nikodem C, et al. Misoprostol for treating post partum haemorrhage: a randomized controlled trial [ISRCTN72263357] BMC Pregnancy childbirth. 2004;4:16. 6. Fraser DM, Cooper MA. Physiology and management of third stage of labour in Myles textbook of midwives. 14th edition China. 507-30. 7. Joshi V, Sapre S, Jaiswal N, Olyai R. Comparative study between per rectal misoprostol and im methrgin for prophylaxis of PPH. Obstet Gynecol Today 2006 March;XI(3):160-2. 8. Diab KM, Ramy AR, Yehia MA et al. The use of rectal misoprostol as active pharmacological management of the third stage of labour. J Obstet Gynaecol Res 1999 Oct;25(5):327-32. 9. Prata N, Hamze S, Gypson R, Nada K, Vahidnia F, Potts M. Misoprostol and active management of third stage of labour. Int J Gynaecol Obstet 2006;94:149-55. 10. Harriott J, Christie, Wynter, V DaCosta, H Fletcher, M Reid. A randomized comparison of rectal misoprostol with syntometrine on blood loss in third stage of labour. West Indian Med J. 2009. 58;3. 11. Nagaria Tripti, Sahu Balram et al. 400μg oral misoprostol versus 0.2 mg intravenous Methyl ergometrine for the active management of third stage of labour. J Obstet Gynecol India 2009:59:228-34. 12. Derman RJ, Kodkany BS, Goudar SS, Geller SE, Naik VA, Bellad MB et al. Oral misoprostol in preventing postpartum haemorrhage in resource-poor communities: a randomized controlled trial, Lancet 2006:368:1248-53.
A Clinical profile and Factors associated with Migraine in Pediatric patients
Shivakumar R
Introduction: The epidemiology of pediatric headache is described in numerous articles of international origin. Aims and Objectives: To Study Clinical profile and Factors associated with Migraine in Pediatric patients. Methodology: This was a cross-sectional study carried out at the Pediatric department of a tertiary health care center during one-year period from January 2015 to December 2015. All the Pediatric patients were screened except less than 3 yrs. as it was expected that children below this age might not be able to express their symptoms clearly. Prensky's criteria for migraine was used to diagnose the Patients the patients associated with other reasons of headache like sinusitis, refractive errors, hypertension, chronic renal illness, neurological disorders and neoplasms were excluded from the study. All detail clinical and associated or precipitating factors history was asked. Result: The majority of the Patients were from age group of 3-6 i.e. 10.25% followed by 7-10-35.89%; 11-12 -53.84%. The majority of the patients were females i.e. 58.97% followed by Males 41.03%. The most common symptoms were Pulsating or throbbing headache which shifts to a unilateral or to temporal location were 53.84% followed by bi-temporal/bi-frontal/Retro-orbital headache in 46.15% patients; Nausea /Vomiting in 41.02% of patients; Photophobia in 35.89% patients; Abdominal Pain in 30.76% patients and Sweating in 25.64% patients; Visual Disturbances in 25.64% of patients. Giddiness (Vertigo) in 23.07% patients. Tingling sensation in hands or Perioral area were present in 12.82% of patients. The most common associated or Precipitating factors were Sunlight -64.10%; Mental stress- 53.84%; Physical strain -48.71%; Family history -46.15%. Watching TV -43.58%; Exposure to unpleasant smell -33.33%. Hunger -28.20%; Winter season -23.07%. Conclusion: Migraine was having late childhood onset; the majority of the patients were females Most common clinical features were Pulsating or throbbing headache which shifts to a unilateral or to temporal location, The most common associated or Precipitating factors were Sunlight, Mental Stress Physical strain etc.
1. Gordon KE, Dooley JM, Wood EP. Self-reported headache frequency and features associated with frequent headaches in Canadian young adolescents. Headache. 2004;44:555–61. 2. Zwart JA, Dyb G, Holmen TL, Stovner LJ, Sand T. The prevalence of migraine and tension-type headaches among adolescents in Norway. The Nord-Trøndelag Health Study (Head-HUNT-Youth), a large population-based epidemiological study. Cephalalgia. 2004;24:373–9. 3. Ghandour RM, Overpeck MD, Huang ZJ, Kogan MD, Scheidt PC. Headache, stomachache, backache, and morning fatigue among adolescent girls in the United States: associations with behavioral, sociodemographic, and environmental factors. Arch PediatrAdolesc Med. 2004;158:797–803. 4. King S, Chambers CT, Huguet A, MacNevin RC, McGrath PJ, Parker L, et al. The epidemiology of chronic pain in children and adolescents revisited: a systematic review. Pain. 2011;152:2729–38. 5. Prensky AL. Migraine and migrainous variants in pediatric patients. PediatrClin North Am 1976, 23: 461-471. 1510 Migraine 6. Heinrich M, Morris L, Gassmann J, Kröner-Herwig B. Kopfschmerzhäufigkeit und KopfschmerztypenbeiKindern und Jugendlichen - ErgebnisseeinerepidemiologischenBefragung / Frequency and type of headache among children and adolescents - results of an epidemiological survey. Aktuel Neurol. 2007;34:457–63. 7. Kröner-Herwig B, Heinrich M, Vath N. The assessment of disability in children and adolescents with headache: adopting PedMIDAS in an epidemiological study. Eur J Pain. 2010;14:951–8. 8. Huguet A, Miró J. The severity of chronic pediatric pain: an epidemiological study. J Pain. 2008;9:226–36. 9. Kröner-Herwig B, Vath N. Menarche in girls and headache – a longitudinal analysis. Headache. 2009;49:860–7. 10. William C Robertson, William C Robertson, Jr. Amy Kao. Migraine in Children. http://emedicine.medscape.com/article/1179268-overview 11. N. Thilothammal Margaret Chellaraj K. BanuRatnam .Migraine in Children. Indian Pediatrics.Dec.1994; 31: 1503-10. 12. Raising Money for Migraine Research.https://migraineresearchfoundation.org/about-migraine/migraine-facts/ 13. Gassmann J, Barke A, van Gessel H, Kröner-Herwig B. Sexspecific predictor analyses for the incidence of recurrent headaches in German schoolchildren. Psychosoc Med. 2012. doi:10.3205/ psm000081. 14. Bille, BO. Migraine in school children. ActaPediatr 1962, 51 (Suppl 136): 14- 151. 15. Vahlquist B. Migraine in children. Int Arch Allergy ApplImmunol 1955,7: 348- 355. 16. Rossi LN. Headache in childhood. Childs NervSyst 1989, 5: 129-134.
Study of weaning practices in rural area of Latur
Vidyadevi D Kendre, Varsharani Kendre
We know that large number of children in both wealthy and poverty stricken region suffer malnutrition. Optimal infant and young child feeding is an evidence based measure for improving child nutrition and child survival. According to the World Health Organization (WHO), Ninety nine per cent of all under-five deaths occur in developing countries. Most common causes of deaths are due to malnutrition, pneumonia, diarrhoea, malaria. So weaning at proper time and with proper food is very important for growth of child. Aim -To know weaning practices in rural area of latur .Objectives -1) To determine factors related to early and delayed weaning. 2) To study various factors regarding weaning and association of weaning with malnutrition. Materials and method- A cross sectional observational study was conducted in the Dept of Paediatrics MIMSR medical college Latur. A pretested questionnaire was introduced to mother and feedbacks were taken. Mothers having infant from 6months to 2yr old who attended Pediatrics outpatient department or ward were included in study. Statistical test-chi square test was used. Results and conclusion- In only 50% children, weaning was started at proper time. Factors affecting early weaning were feeling insufficient amount of milk, working mothers, family members forcing to start gutti at 2 months, television. Factors affecting delayed weaning were lack of knowledge to mother regarding weaning, family’s decision etc. Malnutrition was significantly associated with time of weaning. Weaning should be started at proper time to prevent malnutrition. Health education should be given to mothers regarding weaning.
1. Choudhari, S.G., A.B. Mudey, U.S. Joge et.al.2012. Weaning and supplementary practices - impressions from a rural community. Indian J. of Maternal and Child Health 14(1): 1-9. 2. Liaqat P, Rizvi MA, Qayyum A et.al. Maternal education and complementary feeding. Pak J Nutr. 2006; 5: 563–8. 3. Cameron M, Hofvander Y. 3rd ed. New York: Oxford University Press; 1983. Manual of Feeding Infants and Young Children; pp. 110–31. 4. Chuodhry R, Humayun N. Weaning practices and their determinants among mothers of infants. Biomedica. 2007; 23:120–4. 5. New Delhi: Department of Women and Child Development, Government of India; 2004. Ministry of Human Resource Development. National Guidelines for Infant and Young Child Feeding. Available from: http://www.wcd.nic.in/nationalguidelines.pdf. 6. Geneva: WHO; 2006. WHO. WHO Child Growth Standards: Length/Height for Age, Weight for Age, Weight for Length, Weight for Height and Body Mass Index for Age: Methods and Development. WHO Multicentric Growth Reference Study Group. 7. MushaphiLF,Mbhenyane XG, Khoza LB et.al. Infant-feeding practices of mothers and the nutritional status of infants in the Vhembe district of Limpopoprovince.SouthAfr J ClinNutr. 2008; 2: 36–41. 8. Katara PS, Patel SV, Mazumdar VS, Shringarpure K. A study on feeding practices among children aged 6 months to 2 years in urban slums of Vadodara. Indian J Matern Child Health. 2010; 12:1–9. 9. Bhanderi D, Choudhary S. A community based study of feeding and weaning practices in under five children in semi urban community of Gujarat. Natl J Community Med.2011; 2: 277–83. 10. Dandekar, R.H., M. Shafee and R. Kumar 2014. Breastfeeding and weaning practices among literate mothers: a community based study in rural area of Perambalurtaluk, Tamil Nadu. The Health Agenda 2(1):15-21. 11. ShailiVyas,S.D.Kandpal, VipulNautiyal. Trends in weaning practices among infants and toddlers in hilly terrain of newly formed state of India. International Journal of Preventive Medicine.2014.Jun;5(6):741-748.
A Study of Outcome of cranio-maxillofacial soft-tissue injuries at tertiary care health Centre
Priyesh Patil, Vaibhav Mirajkar
Introduction: Soft-tissue injuries of the cranio-maxillofacial region still remain one of the common disease encountered in the casualty department of every health-care facility. Aims and Objectives: To Study Outcome of Maxilo-facial soft-tissue injuries at tertiary care health Centre. Methodology: This was a Cross-sectional study carried out at the Department of Dentistry of Government Hospital of Tertiary Health care Centre during the period from June 2007 to June 2014 in 7 yrs. Period in all the patients Reported to Government Hospital for the injuries with the various reasons. The patients of Hard tissues except (Dento-alveolar) and head injury, were excluded from the study. Total 126 patients were reported during the time period. The outcome of these patients were noted. Result: In our study we have seen that The majority of the patients were form the age groups (Yrs.) of 30-40- were 45 (35.71%); followed by 20-30 were 35 (27.77%); 40-50 were 19 (15.07%); 50-60 were 15(11.90%); >60Yrs were- 12 (9.52%) respectively. The majority of the patients were Male- 95(75.30%) followed by Female-31 (24.70%)The most common cause was RTA- 62 (49.20%) followed by Assault 21 (16.66%); Fall -41(32.53%); Animal assault injuries -2 (1.58%). The most common pattern of injury was Soft tissue only was 55 (43.65%) followed by Soft tissue + Dentoalveolar was 38(30.15%); Soft tissue + Dentoalveolar + Tongue was 13 (10.31%); Soft tissue + Tongue only was 20 (15.87%). The majority of the patients were improved i.e. 120 (95.23%) followed by Referred to Higher Centre due to neurological problems were 6 (4.77%). Conclusion: The most common cause was RTA followed by Assault, Fall, Animal assault injury The most common pattern of injury was Soft tissue only was followed by,Soft tissue plus Dentoalveolar and in outcome the majority of the patients were improved and remaining referred to higher Centre for the neurological problems.
1. Fasola AO, Obiechina AE, Arotiba JT. Soft tissue injuries of the face: A 10 year review. Afr J Med Med Sci. 2000;29:59–62. [PubMed] 2. Okoje VN, Alonge TO, Oluteye OA, Denloye OO. Changing pattern of pediatric maxillofacial injuries at the Accident and Emergency Department of the University Teaching Hospital, Ibadan – A four-year experience. Prehosp Disaster Med. 2010;25:68–71. [PubMed] 3. Saddki N, Suhaimi AA, Daud R. Maxillofacial injuries associated with intimate partner violence in women. BMC Public Health. 2010;10:268. [PMC free article] [PubMed] 4. Ugboko VI, Olasoji HO, Ajike SO, Amole AO, Ogundipe OT. Facial injuries caused by animals in northern Nigeria. Br J Oral Maxillofac Surg. 2002;40:433–7. [PubMed] 5. Olasoji HO. Maxillofacial injuries due to assault in Maiduguri, Nigeria. Trop Doct. 1999;29:106–8.[PubMed] 6. McDade AM, McNicol RD, Ward-Booth P, Chesworth J, Moos KF. The aetiology of maxillo-facial injuries, with special reference to the abuse of alcohol. Int J Oral Surg. 1982;11:152–5. [PubMed] 7. Chrcanovic BR, Freire- Maia B, De souza LN, Araujo VO, De Abreu MHNG. Facial fractures: A 1- year retrospective study in a hospital in Belo Horizonte. Braz Oral Res 2004; 18: 322- 28. 8. Nwoku AL, Oluyadi BA. Retrospective analysis of 1206 maxillofacial fractures in an urban Saudi hospital: 8 year review. Pak Oral Dent J 2004; 24: 13- 16. 9. Ansari MH, Maxillofacial fractures in Hamedan province Iran: A retrospective study.JCraniomaxillofacSurg 2004; 32: 28-34. 10. Hogg NJV, Stewart TC, Armstrong JE, Girotti MJ. Epidemiology of maxillofacial injuries at trauma hospitals in Ontario, Canada between 1992 and 1997. J Trauma in 2000; 49: 425-32. 11. Kapoor P, Kalra N.A retrospective analysis of maxillofacial injuries in patients reporting to a tertiary care hospital in East Delhi. Int J CritIllnInj Sci. 2012; 1: 6–10. 12. Erol B, Tanrikulu R, Gorgun B. Maxillofacial fractures. Analysis of demographic distribution and treatment in 2901 patients (25-year experience). J CranioMaxillofacSurg 2004; 32: 308- 13. 13. AkinbamiBabatundeOlayemi, AkadiriOladimejiAdeniyi, Udeabor Samuel, and Obiechina Ambrose Emeka. Pattern, severity, and management of cranio-maxillofacial soft-tissue injuries in Port Harcourt, Nigeria J Emerg Trauma Shock. 2013 Oct-Dec; 6(4): 235–240.
Hypothyroidism as a sequelae following treatment of head and neck cancer
S Suresh
Background: Hypothyroidism is one of the late side effects seen after curative radiotherapy in the head and neck region encompassing part or whole of the thyroid gland. Still thyroid function tests are not a part of routine follow up of head – neck cancer patients treated with radiotherapy with or without surgery and / or chemotherapy. Aim of this study was to to find out the incidence of hypothyroidism in head – neck cancer patients treated with radiotherapy with or without chemotherapy and influence of concomitant chemotherapy. Materials and Methods: Of the 112 patients, 57 (50.8%) were planned to receive radiotherapy alone, 42 (37.5%) to receive neo-adjuvant chemotherapy with Cisplatin and 5-FU and the rest 13 (11.6%) patients to receive concurrent chemo-radiation. Thyroid function tests were done at the beginning of treatment, at six weeks after completion of radiotherapy and thereafter at six weeks’ interval for two years. Results: After 24 months follow up, overall incidence of clinical hypothyroidism of our reported patients was 31.03% and of sub-clinical hypothyroidism was 37.93%. Conclusion: As a significant number of patients develop hypothyroidism following radiotherapy to the neck, thyroid function tests should be included in the routine follow up protocol of such patients.
1. Carter Y, Sippel RS, Chen H. Hypothyroidism After a Cancer Diagnosis: Etiology, Diagnosis, Complications, and Management. The Oncologist. Jan 2014 vol. 19 no. 1 34-43. 2. Parkin DM, Pisani P, Ferlay J. Estimates of the worldwide incidence of 25 major cancers in 1990. Int J Cancer 1999;80:827-41. 3. Ahmadieh, H., and Salti, I. (2013). Tyrosine kinase inhibitors induced thyroid dysfunction: A review of its incidence, pathophysiology, clinical relevance, and treatment. BioMed Research International, 2013, 725410. http:// dx.doi.org/ 10.1155/2013/725410 4. Kari Hartmann, Pa-C. Thyroid Disorders in the Oncology Patient. J Adv Pract Oncol. Vol.6;2: 2015. 5. Turner SL, Tiver KW, Boyages SC. Thyroid dysfunction following radiotherapy for head and neck cancer. Int J Radiat Oncol Biol Phys 1995;31:279-83. 
 6. Einhorn J, Wikholm G. Hypothyroidism after external irradiation to the thyroid region. Radiology 1967;88:326-8. 7. Palmer BB, Gaggar N, Shaw HJ. Thyroid function after radiotherapy and laryngectomy for carcinoma of the larynx. Head Neck Surg 1981;4:13-5. 8. Posner MR, Ervin TJ, Fabian RL, Weichselbaum RR, Miller D, Norris CM, et al. Incidence of hypothyroidism following multimodality treatment for advanced squamous cell cancer of the head and neck. Laryngoscope 1984;94:451-4. 9. Shafer RB, Nuttall FQ, Pollack K, Kuisk H. Thyroid function after radiation and surgery for head and neck cancer. Arch Intern Med 1975;135:843-6. 
 10. dejong JMA, vanDaal WAJ, Elte JWF, Hordijk GJ, Frolich M. Primary hypothyroidism as a complication after treatment of tumors of the head and neck. Acta Radiol Oncol 1982;21:299-303.
 11. Mercado G, Adelstein DJ, Saxton JP, Secic M, Larto MA, Lavertu P. Hypothyroidism: a frequent event after radiotherapy and after radiotherapy with chemotherapy for patients with head and neck carcinoma. Cancer 2001;92:2892-5. 
 12. Tell R, Sjodin H, Lundell G, Lewin F, Lewensohn R. Hypothyroidism after external radiotherapy for head and neck cancer. Int J Radiat Oncol Biol Phys 1997;39:303-8.