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Background: After completing graduation students has to prepare for post graduate entrance exam. The pursuit of higher medical education is expected to be stressful, which may be hazardous to physical and mental health status among these students. Objectives: To assess prevalence of psychological disorders (anxiety and depression) among post graduate aspirants and to determine if there is any gender difference. Materials and methods: General Health Questionnaire (GHQ-28), a self-administered instrument, rated on a four point Likert-type scale (0-1-2-3) giving a potential score of 0-84, participations with higher scores representing greater distress. Results: Among 300 students responded to questionnaire, 125 were females and 175 were males. 36.12 % (110) had psychological disorder among these 48% were females (60) and 28% were males (50). The gender difference was significant. Conclusion: In present study, there was high prevalence of psychological disorder among students preparing for post graduate entrance examination. Factors like exercise, sports and yoga should be encouraged to practice regularly for releasing stress and reducing depression.

1. Mosley TH Jr, Perrin SG, Neral SM, et al. Stress, coping and well-being among third year medical students. Acad Med 1994; 69: 765-7. 2. Wolf TM, Kissling GE. Changes in life-style characteristics, health and mood of freshman medical students. J Med Edu 1984; 59: 806-14. 3. Ko SM, Kua EH, Fones CSL. Stress and the Undergraduates. Singapore Med J 1999; 40(10): 627-30.4. Firth-Cozens J. Emotional Distress in junior house officers. British Medical Journal 1987; 295: 533-36.

Introduction: We report a case of severe malaria with HIV infection. The patient had parasitemia with Plasmodium falciparum and the patient was also reactive to HIV. Patient presented with multiorgan dysfunction including renal impairment, altered liver functions along with altered sensorium.

1. Chandra Mohan D, Greenwood BM l. “Is there an interaction between HIV and Plasmodium falciparum?” Int. J. Epidemiol. 1998 April; 27(2). 296-301. 2. Chirendra J, Siziya S, Tshimanga M. “Association of HIV infection with the development of severe and complicated malaria cases at a rural hospital in Zimbabwe. Central African of Journal Medicine 2000, 46(1): 5-9. 3. Kamya M, Gasasina A, Yeka A, Bakyaita S, Nsobya S, Francis D et al., “Effect of HIV infection on antimalarial treatment outcomes in Uganda: a population based study” J.infection Dis 2006, 193(1) 9-15. 4. Van Geertruyden J, Van Eijk E, Yosaatmadja F, Kasongow, Mulenga M, D’ Alessandro U, et al., “ The relationship of Plasmodium falciparum humoral immunity with HIV-1 immunosuppression and treatment efficacy in Zambia. Malaria Journal 2009, 8:258. 5. Cohen C, Karstaedt A, Frean J, Thomas J, Govender N, Prentice E et al., “ Increased prevalence of severe malaria in HIV infected adults in S.Africa.” Clinical infectious disease 2005 Dec 1; 41(11): 1631-7. 6. Chalwe V, Van Geertru yden JP, Mukwamataba D, Menten J, Kamabamba J, Mulenga M, D Alessandro U et al., “ Increased risk for severe malaria in HIV 1 infected adults,Zambia.” Emerging infectious diseases 2009 May: 15 (5):749. 7. Khasnis AA, Karnad D R. “HIV type 1 infection in patients with severe falciparum malaria in urban India.” J Post graduate, Med 2003. Apr-Jun; 49 (2):114-117. 8. Hoffman IF, Jere CS, Taylor TE, Munthali P, Dyer JR et al. “ The effect of P. falciparum malaria on HIV-1 RNA blood plasma concentration.” AIDS 1999 Mar 11; 13 (4): 487 – 94. 9. Quinn TC, Wawer MJ, Sewakambo N et al. “ Viral load and heterosexual transmission of HIV type I. Rakai project study group.” N England J Med 2000 Mar 30; 342 (13): 921-929.

Aims and objectives: 1) Morphology of pancreas in various grades of Acute pancreatitis 2) Complications of pancreatitis like pseudocyst, abscess, phlegmon formation and vascular complications (pseudoaneurysm and venous thrombosis) etc. 3) Grading the severity of disease using CTSI and Modified CT severity index (CTSI) Materials and Methods: This prospective study of 100 patients suspected of pancreatitis will be evaluated with two slice spiral CT scanner, somatom, Siemens (Germany) at Tertiary care centre, from August 2012 to October 2013.The series consists of patients of pancreatitis which were clinically diagnosed and sent directly for CT examination and the patients in whom abdominal ultrasound examination was suggestive of pancreatitis. Helical CT is an effective modality for imaging the pancreas with faster scanning time and no respiratory misregistration. Pancreas if scanned during the peak parenchymal enhancement phase, helps in better morphological characterization of pancreas and detection of pancreatic necrosis. Helical CT effectively detects the different non vascular and vascular complication of pancreatitis. Grading of acute pancreatitis according to the severity of the disease in the form of Modified CTSI which will predict the clinical outcome of the disease could be done effectively with helical CT.

1. Haaga John R: The Pancreas; In Computed Tomography and Magnetic Resonance Imaging of the Whole Body (Vol.2); John R Haaga, Vikram S Dogra, Michael Forsting, Robert C Gilekeson; Fourth Edition 2003; Mosby ELSEVIER Pte. Ltd. Pg. 1395-1486. 2. Balthazar EJ: Acute Pancreatitis: Assessment of Severity with Clinical and CT Evaluation; Radiology 2002; 223:603-613.RSNA. 3. Ferrucci Joseph T, Jr, Wittenberg Jack, Black Edwaid B, Kirkpatrick Rob H, Hall Deborah A: Computed Body Tomography in Chronic Pancreatitis; Radiology 130: 175-182, January 1979. 4. Mendez Gaston, Jr., Isikoff Michael B, Hill Michael C: CT of Acute Pancreatitis: Interim Assessment; AJR 135:463-469, September 1980. 5. Seigelman Stanley S, Copeland Bruce E, Saba George P et al: CT of Fluid Collections Associated with Pancreatitis; AJR 134: 1121-1132, June 1980. 6. Federle Michael P, Brooke Jeffery R, Crass Richard A, Van Dalsem Volney: Computed Tomography of Pancreatic Abscess; AJR 136: 879-882, May 1981. 7. Silverstein William, Isikoff Michael B, Hill Michael C, Barkin Jamie: Diagnostic imaging of Acute Pancreatitis: Prospective Study Using CT and Sonognphy; AJR 137: 497-501, September 1981. 8. Brooke Jeffery R, Federle Michael P, Jeffery Brooke R, Cello John P: Early Computed Tomographic Scanning in Acute Severe Pancreatitis; Surgery, Gynecology and Obstetrics; February 1982, Volume 154. 9. Ranson JHC, Balthazar Emil J, Caccavale R and Cooper M: Computed Tomography and the Prediction of Pancreatic Abscess in Acute Pancreatitis: Ann Surg., May 1985, Vol. 391, No. 5. 10. Zeman RK, LV McVay, PM Silverman, EL Cattau, SB Benjamin, DF Fleischer, BS Garra and MH Jaffe: Pancreas divisum: thin- section CT; 1988 Radiology, Vol 169, 395-398 11. Vujic Ivan: Vascular Complications of Pancreatits; Radiological Clinics of North America-Vol.27, No. 1, January 1989. 12. Bradley EL III, Murphy F and Ferguson C: Prediction of Pancreatic Necrosis by Dynamic Pancreatography; Ann Surg. 1989; oct; 210(4):495-503; discussion503-4. 13. LR King, MJ Siegel and DM Balfe: Acute pancreatitis in children: CT findings of intra- and extrapancreatic fluid collections; Radiology, Vol 195, 196-200, 1995. 14. Paulson EK, Vitellas KM, Keogan MT et al: acute pancreatitis complicated by gland necrosis: spectrum of findings on CECT.AJR 1999; 172: 609-613. 15. Balthazar Emil J: Pancreatitis; In Textbook of gastrointestinal Radiology Vol.2, Gore Richard M, Levine Marc S, Laufer Igor; W B Saunders Company; 1994; Pg 2132-2134 16. Terrence C Demos, Harold V Posniak, Carla Harmath1, Mary C Olson1 and Gerard Aranha: Cystic Lesions of the Pancreas; AJR 2002; 179:1375-1388. 17. J. Darío Casas, Rocío Díaz, Gracia Valderas, Antonio Mariscal, Patricia Cuadras; Prognostic Value of CT in the Early Assessment of Patients with Acute Pancreatitis; AJR March 2004;182:569–574; 18. Raul SK. Acute necrotising pancreatits: Current Concepts. Indian J Surg 2005; 67:78-86. 19. Ishtiaq Ahmed Chishty, Vaqar Bari, Sajida Pasha, Dawar Burhan, Zishan Haider, Zafar Rafique; Role of Computed Tomography in Acute Pancreatitis and its Complications among Age Groups; J Pak Med Assoc2005; 55:431; 20. Nemes R, Georgescu I, Margaritescu D, Saftoiu A, Chiutu L, Georgescu E, Surlin V, Cartu D, Dumitrescu D : The pancreatic pseudocyst--late complication of the severe acute pancreatitis. Therapeutical options; 2006 May-Jun; 101 (3): 259-65. 21. Knoepfli AS, Kinkel K, Berney T, Morel P, Becker CD, Poletti PA: Prospective study of 310 patients: can early CT predict the severity of acute pancreatitis; aug2006 Aug 31 Pub MED. 22. Ekrem Kaya, Adem Dervişoğlu, Cafer Polat; Evaluation of diagnostic findings and scoring systems in outcome prediction in acute pancreatitis; World J Gastroenterol June 2007; 13(22): 3090-3094; 23. Jáuregui-Arrieta LAlvarez-López et al, Effectiveness of the modify tomographic severity index in patients with severe acute pancreatitis. Rev Gastroenterol Mex. 2008 Jul-Sep;73(3):144-8 24. Heiss P , Bruennler T, and Salzberger B et al , Severe acute pancreatitis requiring drainage therapy: findings on computed tomography as predictor of patient outcome. Pancreatology. 2010; 10(6):726-33. 25. Koenraad J. Mortele, Walter Wiesner, Lisa Intriere, Shridhar Shankar, Kelly H. Zou1, Babek N. Kalantari, Alex Perez, Eric vanSonnenberg, Pablo R. Ros, Peter A. Banks, Stuart G. Silverman: A Modified CT Severity Index for Evaluating Acute Pancreatitis: Improved Correlation with Patient Outcome: AJR November 2004:183: 1261-1265.

Aims and Objectives: To assess the cost benefit ratio in non-closure of the peritoneum at open appendectomy as compared to suture peritonization. Materials and Methods: The study population comprised of 100 in-patients who underwent open appendicectomy in Father Muller Medical College, Mangalore selected by purposive sampling method. To treat the patients with minimal pain and in the cheapest way. Results: Mean for VAS for closure was 8, 5 and 3 on day 0, 1 and 2 respectively. And that for non-closure was 5,3 and 2 on day 0, 1 and 2 respectively. Conclusion: Non-closure of peritoneum was better than closure of peritoneum in open appendicectomy because of short duration of the procedure, less postoperative pain, less analgesic requirement and less number of days of hospital stay. Also the cost was less in non-closure overall.

1. Suresh B, Uday AS, Anilkumar G, Shailesh E, Lamani YP. Post operative Analgesic Requirement in Non-closure and Closure of Peritoneum during Open Appendectomy: A Randomized Controlled Study. JCDR. 2012 April; Vol-6(2): 264-66. 2. Kapur ML, Daneswar A, Chopra P. Evaluation of peritoneal closure at laparotomy. Am J Surg 1979;137:650-2. 3. Hugh TB, Nankivel C, Meagher AP, Li B. Is closure of the peritoneal layer necessary in the repair of midline surgical abdominal wounds? World J Surg1990;14:233-4. 4. Xiong Z,Dong W, Wang Z. Non-closure of the peritoneum and subcutaneous tissue at radical hysterectomy: A Randomized controlled trial. Front Med China 2010; 4: 112-6. 5. Hajsedvadi ES, Rasekh F. Post-caesarean pain in closure versus nonclosure of parietal peritoneum. The Journal of Qazvin Univ. of Med. Sci 2006;10:45-8. 6. Bamigboye AA, Hofmeyr GJ. Non-closure of peritoneal surfaces at caesarean section- a systematic review. South African Medical Journal 2005; 95:123-6.

Introduction: The incidence of Diabetes Mellitus is increasing rapidly. Patients of Type 2 Diabetes Mellitus can be managed with oral hypoglycaemic agents initially, however many require insulin therapy later in the course of the treatment due to secondary resistance to oral hypoglycaemic agents. Indian Diabetic patients tend to be wary about the use of insulin. This refusal to use insulin militates against achievement of ideal glycaemic control in conditions mandating insulin therapy. This study was aimed at determining the logistic and psychological factors contributing to the refusal or avoidance of insulin therapy and the initial barriers to the use of insulin as a treatment option for Diabetes management. Materials and Methods: This study was a Cross-Sectional Observational study involving 50 patients with Type 2 Diabetes Mellitus attending OPD and inpatients admitted to FMMCH. A Questionnaire was framed, prevalidated, piloted and the questionnaire was administered in the local language and the data collected was analysed. Results: From this study it was inferred that 88% diabetic patients were aware of insulin as a treatment modality for diabetes. It was found that 80% cases avoided insulin due to difficulty in administration and remembering dosage of insulin. It was found that 76% cases had inhibitions to initiate insulin injections in view of fear of pain and 60 % diabetic subjects were wary of insulin therapy fearing that once started, it would need to be continued lifelong. Conclusion: Exploring patient concerns and beliefs about insulin is crucial to assist physicians in counselling and motivating patients to take insulin.

1. Powers A C. Diabetes Mellitus. In: Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson JL, Loscalzo J (eds.) Harrison’s principles of internal medicine. 18th ed. USA: Mc Graw Hill Medical; 2012. p 2968. 2. Yadav R, Tiwari p, Dhanraj E. Risk factors and complications of type 2 diabetes in Asians. CRIPS 2008; 9(2):8-12. 3. Mohan V, Sandeep S, Deepa R. Indian scenario. Indian J Med Res 2007; 125:225-30. 4. Leslie CA, Satin-Rapaport W, Matheson D, Stone R, Enfield G: Psychological insulin resistance: a missed diagnosis? Diabetes Spectrum 1994; 7:52-57. 5. De Witt DE, Hirsch IB: Outpatient insulin therapy in type 1 and type 2 diabetes mellitus: a scientific review. JAMA 2003; 289:2254– 64. 6. Home PD, Boulton AJM, Jimenez J, Landgraf R, Osterbrink B, Christiansen JS: Issues relating to the early or earlier use of insulin in type 2 diabetes. Practical Diabetes Int 2003; 20:63-71. 7. Brown JB, Nichols GA, Perry A: The burden of treatment failure in type 2 diabetes. Diabetes Care 2004; 27:1535–40. 8. Dailey GE: Early insulin: an important therapeutic strategy. Diabetes Care 2005; 28:220–1. 9. Peyrot M, Rubin RR, Lauritzen T, Skovlund SE, Snoek FJ, Matthews DR, Landgraf R, Kleinebreil L; International DAWN Advisory Panel. Resistance to insulin therapy among patients and providers: results of the cross-national Diabetes Attitudes, Wishes, and Needs (DAWN) study. Diabetes Care 2005 ; 28: 2673-9. 10. Hunt LM, Valenzuela MA, Pugh JA. NIDDM patients' fears and hopes about insulin therapy. The basis of patient reluctance. Diabetes Care 1997; 20:292-8. 11. Polonsky WH, Jackson RA: What’s so tough about taking insulin? Addressing the problem of psychological insulin resistance in type 2 diabetes. Clinical Diabetes 2004; 22:147–50. 12. Zambanini A, Newson RB, Maisey M, Feher MD. Injection related anxiety in insulin-treated diabetes. Diabetes Res Clin Pract 1999; 46:239-46.

Introduction: Incisional hernia is a frequent complication of abdominal operations. The object of this study is to compare laparoscopic repair to open repair of incisional hernia regarding hospital stay and complications. Material and Methods: This study compares total 22 cases of incisional hernia repairs performed during December 2011 and May 2013, of which 10 were laparoscopic and 12 were open surgeries. Composite mesh (polypropylene, cellulose ORC) was used for laparoscopic intraperitoneal placement. Observations and Results: Both the groups were comparable regarding age. Mean operative time was 163.2 minutes for laparoscopic group (LG), 125.6 minutes for open group (OG). Mean hernia diameter was 6.1cm for laparoscopic group, 6.4cm for open group. Mean length of stay was 3.6 days for laparoscopic group, 7.33 days for open group. Mean follow up was 11.2 months for laparoscopic group, 12.1 months for open group. Complications occurred in 10% of laparoscopic and 41.66% open group. There was no recurrence and mortality in both groups. Conclusion: Results for laparoscopic incisional hernia repair seem to be superior to results for open repair in terms of shorter hospital stay, lower infection rate, earlier return to work and comparable recurrence rate and better cosmetic results.

1. Mudge M, Hughes LE. Incisional hernia: A 10 year prospective study of incidence and attitudes. Br JSurg. 1985;72:70–1. 2. Bucknall TE, Cox PJ, Ellis H. Burst abdomen and incisional hernia: a prospective study of 1129 major laparotomies. BMJ.1982;284:931–933. 3. Stoppa RE. The treatment of complicated groin and incisional hernias. World J Surg. 1989;13:545–54. 4. Le Blanc KA, Booth WV. Laparoscopic repair of incisional abdominal hernias using expanded polytetrafluoroethylene: Preliminary findings. Surg Laparosc Endosc. 1993;3:39–41. 5. Flum DR, Horvath K, Koepsell T. Have outcome of incisional hernia repair improved with time? A population-based analysis. Ann Surg. 2003;237:129 –135. 6. Luijendijk RW, Hop WCJ, van den Tol P, et al. A comparison of suture repair with mesh repair for incisional hernia. N Engl J Med. 2000;343:392–398. 7. Heniford BT, Park A, Ramshaw BJ, Voeller G. Laparoscopic ventral and incisional hernia repair in 407 patients. J Am Coll Surg. 2000;190:645– 650. 8. Rosen M, Brody F, Ponsky J, et al. Recurrence after laparoscopic ventral hernia repair. A five year experience. Surg Endosc.2003;17:123–128. 9. Holzman et al , laparoscopic ventral and incisional hernioplasty. Surg endosc1997;11:32-35. 10. Park A, Birch DW, Lovrics P. Laparoscopic and open incisional hernia repair: acomparison study. Surgery. 1998 Oct;124(4):816-21; discussion 821-2. 11. Carbajo MA, Martpdel, Olmo JC, Blanco JL. Laparoscopic approach to incisional hernia . Surg Endoscopy 2003; 17(1): 118-22 12. Ramshaw BJ, Esartia P, et al: Comparison of laparoscopic and open ventral herniorrhaphy. Am Surg 65:827, 1999. 13. Kirhstein B, Lantsberg L, Avinoach E, Bayme M, Mizrahi S. Laparoscopic repair of large incisional hernia. Surg Endosc. 2002;16:1717–1719. 14. Berger D, Bientzle M, Muller A. Postoperative complications after laparoscopic incisional hernia repair. Incidence and treatment. Surg Endosc. 2002;16:1720 –1723.

Swine flu was pandamic in 1918 and 1989-90 in the year 2009 the disease was wide spread throughout the world. All the governments are worried that they have to safe guard the population. there was travel restriction in the air and train-rail routes etc. at the airport and railway stations all the travellers were screened for symptoms of H1N1 by the specially trainne medical personnel. H1N1 was the cause of loss of many lives. During the 2009 epidemic the author has screened about 450 cases out of this 395 were positive for H1N1. he treated all the positive cases with the drug tamiflu and broad spectrum antibiotic when needed. He shares his experience for future guidance.

1. Merck veterinary manual swine flu 2008. Retrieved on April 2009. 2. The Canadian food inspection agency. an Alberta swine herd investigated for h1n virus 2009. 3. New York times the names of swine flu a curious matter 2009. 4. Centre for disease outbreak of swine orgin infection (H1N1) virus ---mexico2009. Http/www/edc/govt/preview. 5. Lynch.jp. Walsh. e influenzaevolving strategies in treatment and prevention. Semin. respir. cretical care medicine—2009. 6. U.S. Pork group urge hog farmer to reduce flu risk2009

Introduction: Diabetic Nephropathy affects up to 30% of the population with ACE-I and ARB as mainstay of treatment but associated with side effect of hyperkalemia. Allopurinol has been studied to reduce the proteinuria in randomized double blind prospective trial for 1 month. Allopurinol has significantly reduced serum uric acid (P = 0.002) and urine protein (P = 0.0003) in study group as compare to control group.

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Background: Acute Lower Respiratory Infections (ALRI) is the most common cause of global child mortality, with the incidence almost 10 times higher in developing countries in under-5 children. Many in vitro studies have shown the role of vitamin D in promoting and regulating immune response via binding to vitamin D receptor (VDR). In this study, we aimed to find the association between vitamin D receptor polymorphism and ALRI. Methods: Three vitamin D receptor (VDR) polymorphisms (FokI, TaqI, ApaI) were studied by the method of PCR-RFLP in 78 hospitalised cases of acute lower respiratory infections (ALRI) and were compared with 75 age and sex matched apparently healthy children below five years of age. Serum vitamin D levels were also measured. Results: TaqI tt genotype and independent t allele were found to confer a significant protection against ALRI. FokI and ApaI genotypes had no significant association with the risk of ALRI in our study population. Vitamin D levels were found to be significantly low in children suffering from ALRI. No statistically significant difference in vitamin D levels was found among the three genotypes in FokI, TaqI and ApaI polymorphisms. Conclusions: The present study demonstrates that presence of tt genotype confers a significant protection against ALRI of bacterial origin.

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Association of vitamin D receptor genotypes with the susceptibility to pulmonary tuberculosis in female patients & resistance in female contacts. Indian J Med Res 2000; 111:172-179. 42. Kang TJ, Jin SH, Yeum CE, Lee SB, Kim CH, Lee SH et al. Vitamin D Receptor Gene TaqI, BsmI and FokI Polymorphisms in Korean Patients with Tuberculosis. Immune Netw 2011; 11(5):253-257. 43. Alexandra SG, Georgiana DC, Nicoleta C, Daniela PM, Traian S, Stoian V. Apa 1 and Taq 1 polymorphisms of VDR (Vitamin D receptor) gene in association with susceptibility to tuberculosis in the Romanian population. Biotechnological letters. 2013; 18 (1): 7956-62. 44. Liu PT, Stenger S, Li H, et al. Toll-like receptor triggering of a vitamin D-mediated human antimicrobial response. Science. 2006;311:1770-1773. 45. 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J Clin Endocrinol Metab 2000; 85(12):4639-4643. 50. Chen RH, Chang CT, Chen HY, Chen WC, Tsai CH, Tsai FJ. Association between vitamin-D receptor gene FokI polymorphism and Graves' disease among Taiwanese Chinese. J Clin Lab Anal 2007; 21(3):173-177. 51. Uitterlinden AG, Fang Y, van Meurs JBJ et al. Vitamin D receptor gene polymorphisms in relation to Vitamin D related disease states. J Steroid Biochem Mol Biol.2004;89-90:187-193.

Background: Adnexal masses are the fourth most common gynaecological causes for hospitalization with differential diagnosis varying from benign masses to malignant tumors. As amount of tumor left after the primary cytoreductive surgery is one of the most important prognostic factors in ovarian cancers, preoperative determination of whether a mass is benign or malignant is very important for timely referral to a gynaecologic oncologist. Objectives: The aim of this study was to evaluate the ability of four malignancy risk indices (RMI 1, RMI 2, RMI 3 and RMI 4), incorporating menopausal status, serum CA125 levels, and ultrasound findings, to discriminate a benign from a malignant pelvic mass. Materials and Methods: This is a descriptive correlative study of 100 women admitted to Department of Obstetrics and Gynaecology, Father Muller Medical College, Mangalore, Karnataka, India from September 2012 to August 2013 for surgical exploration of pelvic masses. The sensitivity, specificity, and positive predictive value of serum CA 125 levels, ultrasound findings, and menopausal status were taken separately and combined into the RMI 1, RMI 2, RMI 3 and RMI 4 to diagnose ovarian cancer. The histopathological diagnosis was considered as the gold standard for defining the outcomes. Data was analysed using the Statistical Package for the Social Sciences, and Pearson’s Chi square test was used to compare the individual RMI scores between the benign and malignant cases. Results: In this study we found that there is no statistically significant difference in the performance of the four different RMIs in discriminating malignancy. Individual variables that were analysed showed significant differences in ultrasound score of ≥2 and mean serum CA-125 level (p <0.001and p = 0.001, respectively) between the benign and malignant cases. Conclusions: We concluded that the risk of malignancy index is able to identify malignant and benign pelvic masses efficiently to optimize therapy and any of the four malignancy risk indices described can be used for selection of cases for optimal therapy. These methods are simple techniques that can be used even in less-specialized gynaecology clinics to facilitate the selection of cases for referral to an oncological unit.

1. Grimes DA, Hughes JM. Use of multiphasic oral contraceptives and hospitalizations of women with functional ovarian cysts in the United States. Obstet Gynecol. 1989; 73: 1037-9. 2. Gillis CR, Hole DJ, Still RM, Davis J, Kaye SB. Medical audit, cancer registration, and survival in ovarian cancer. Lancet 1991; 337:611-2. 3. Earle CC, Schrag D, Neville BA, Yabroff KR, Topor M, Fahey A, et al. Effect of surgeon specialty on processes of care and outcomes for ovarian cancer patients. J Natl Cancer Inst. 2006; 98:172-80. 4. Jacobs I, Oram D, Fairbanks J, Turner J, Frost C, Grudzinskas JG. A risk of malignancy index incorporating CA 125, ultrasound and menopausal status for the accurate preoperative diagnosis of ovarian cancer. Br J Obstet Gynecol. 1990; 97:922–9. 5. Tingulstad S, Hagen B, Skjeldestad FE, Onsrud M, Kiserud T, Halvorsen T, et al. Evaluation of risk of malignancy index based on serum CA 125, ultrasound findings and menopausal status in the preoperative diagnosis of pelvic masses. Br J Obstet Gynecol. 1996; 103:826–31. 6. Tingulstad S, Hagen B, Skjeldestad FE, Halvorsen T, Nustad K, Onsrud M. The risk of malignancy index to evaluate potential ovarian cancers in local hospitals.Obstet Gynecol. 1999; 93:448-52. 7. Davis AP, Jacobs I, Woolas R, Fish A, Oram D. The adnexal mass: Benign or Malignant? Evaluation of a risk of malignancy index. Br J Obstet Gynecol. 1993; 100:927–31. 8. Morgante G, la Marca A, Ditto A, De Leo V. Comparison of two malignancy indices based on serum CA 125, ultrasound score and menopausal status in the diagnosis of ovarian masses. Br J ObstetGynaecol. 1999; 106:524-7. 9. Yamamoto Y, Yamada R, Oguri H, Maeda N, Fukaya T. Comparison of four malignancy risk indices in the preoperative evaluation of patients with pelvic masses. Eur J ObstetGynaecolReprod Biol. 2009; 144:163-7. 10. Manjunath AP, Pratapkumar, Sujatha K, Vani R. Comparison of three risks of malignancy indices in evaluation of pelvic masses. GynecolOncol. 2001; 81:225-9. 11. Ong C, Biswas A, Choolani M, Low JJ. Comparison of risk of malignancy indices in evaluating ovarian masses in a Southeast Asian population. Singapore Med J. 2013; 54: 136-9. 12. Akturk E, Karaca RE, Alanbay I, Dede M, Karasahin E, Yenen MC, et al. Comparison of four malignancy risk indices in the detection of malignant ovarian masses. J GynecolOncol. 2011; 22(3):177-182

Neonatal sepsis remains a significant cause of morbidity and mortality in newborns, more so in developing countries like India due to delivery and post natal care taking place in an unclean environment having more chances of contamination with infective organisms. For the effective treatment of sepsis it is essential to have periodic review regarding the causative organisms and its susceptibility to available antibiotics. Present study was undertaken to describe the bacteriological profile and antibiotic susceptibility pattern of culture isolates from Neonatal sepsis patients at a tertiary care centre in Sangli district of Maharashtra, India. Study was carried over a period of one year at the Department of Paediatrics of PVPGH Sangli and Govt Medical College, Miraj. One hundred and five neonates (0 to 28 days) with clinical diagnosis of sepsis were included in the study. Patients who underwent surgery and those who were older than 28 days were excluded. Blood culture reports were studied in 105 cases of clinically suspected septicaemia in neonates using the standard technique of Mackie and McCartney. The antibiotic sensitivity was performed by Kirby-Bauer's disc diffusion method. Blood culture was positive in 19 cases (18.09%). Klebsiella pneumoniae and staphylococcus aureus were the most common isolated organisms. Resistance to antibiotics was very common in isolated organisms. Gram positive organisms isolated were found to be sensitive to ciprofloxacin, amikacin, chloramphenicol and gram negative organisms were found to be sensitive to vancomycin.

Neonatal sepsis remains a significant cause of morbidity and mortality in newborns, more so in developing countries like India due to delivery and post natal care taking place in an unclean environment having more chances of contamination with infective organisms. For the effective treatment of sepsis it is essential to have periodic review regarding the causative organisms and its susceptibility to available antibiotics. Present study was undertaken to describe the bacteriological profile and antibiotic susceptibility pattern of culture isolates from Neonatal sepsis patients at a tertiary care centre in Sangli district of Maharashtra, India. Study was carried over a period of one year at the Department of Paediatrics of PVPGH Sangli and Govt Medical College, Miraj. One hundred and five neonates (0 to 28 days) with clinical diagnosis of sepsis were included in the study. Patients who underwent surgery and those who were older than 28 days were excluded. Blood culture reports were studied in 105 cases of clinically suspected septicaemia in neonates using the standard technique of Mackie and McCartney. The antibiotic sensitivity was performed by Kirby-Bauer's disc diffusion method. Blood culture was positive in 19 cases (18.09%). Klebsiella pneumoniae and staphylococcus aureus were the most common isolated organisms. Resistance to antibiotics was very common in isolated organisms. Gram positive organisms isolated were found to be sensitive to ciprofloxacin, amikacin, chloramphenicol and gram negative organisms were found to be sensitive to vancomycin.

Background and objectives: Diabetes mellitus is a long term disease with variable clinical manifestation and progression. The prevalence of diabetes mellitus in India was found to be 2.4 % in rural and 4 - 11.6 % in urban. It leads to number of complications like cardiovascular, renal, neurological, ocular and others such as intercurrent infections. Therefore understanding the pathophysiology of hypertension and diabetes is important.Hence this study is taken up to estimate Serum Nitrate levels in Type II Diabetic Patients with Hypertension compared with healthy individuals. Methodology: The present study was conducted in the Department of Physiology, Al-Ameen Medical College, Bijapur and District Hospital, Bijapur. Thirty five Type II Diabetic Patients with Hypertension (35) between 35 to 65 yrs age and Thirty nine (39) healthy individuals, controls between 38 yrs to 65 yrs age visiting Al-Ameen Medical College Hospital, Bijapur and District Hospital Bijapur were selected. Serum Nitrate was estimated by GRIESS METHOD. Statistical analysis was done by ANOVA and unpaired t test. Results: Statistically significant variations were found in parameters like age, Ht, Wt, BSA, BMI, PR, SBP, DBP, Serum Nitrate levels in controls and Primary Hypertension patients. Interpretation and conclusion: In the present study the mean ± SEM of Serum Nitrate in controls was found to be 49.93 ± 1.01 μ mol / lt, and Type II Diabetic patients with Hypertension was 29.36 ± 1.29 μ mol / lt. It was found Serum Nitrate levels of Type II Diabetic patients with Hypertension was lower when compared with the controls, these difference were found to be statistically significant (t =15.324, p= 0.0000). Mechanism which can reduce NO levels in Diabetic patients with Hypertension are decreased eNOS activity and thus reduces the bioavailability of NO and also increased oxidative stress. ADMA is an endogenous inhibitor of eNOS thus elevated ADMA will further decrease the bioavailability of NO. Elevated CRP has been reported to decrease the stability of mRNA for eNOS, thus further reducing the synthesis of NO.

1. Mandrup Poulsen T. Recent advances: Diabetes. BMJ. 1998: 316: 1221 - 1225. 2. K. Park. Park’s text book of preventive and social medicine. 20th Edn. India: M/s Banarsidas Bhanot Publishers; 2009. 325-343. 3. Tabit CE, Chung WB, Hamburg NM, Vita JA. Endothelial dysfunction in diabetes mellitus: molecular mechanisms and clinical implications. Reviews in endocrine & metabolic disorders. 2010;11(1):61-74. 4. Ding H, Triggle CR. Endothelial cell dysfunction and the vascular complications associated with type 2 diabetes: assessing the health of the endothelium. Vascular health and risk management. 2005;1(1):55. 5. Drew B, Leeuwenburgh C. Aging and the role of reactive nitrogen species. Annals of the New York Academy of Sciences. 2002;959(1):66-81. 6. Champe P C, Harvey R A, Ferrier D R. Lippincotts Illustrated Reviews: Biochemistry .3 rd Edition. J.P Brothers Medical Publishers.2005: 148 - 149. 7. Wilkinson IB, Qasem A, McEniery CM, Webb DJ, Avolio AP, Cockcroft JR. Nitric oxide regulates local arterial distensibility in vivo. Circulation. 2002;105(2):213-7. 8. Kelm M, Preik-Steinhoff H, Preik M, Strauer BE. Serum nitrite sensitively reflects endothelial NO formation in human forearm vasculature: evidence for biochemical assessment of the endothelial l-arginine–NO pathway. Cardiovascular research. 1999;41(3):765-72. 9. Ghosh A, Sherpa M, Bhutia Y, Pal R, Dahal S. Serum nitric oxide status in patients with type 2 diabetes mellitus in Sikkim. International Journal of Applied and Basic Medical Research. 2011;1(1):31. 10. Tessari P, Cecchet D, Cosma A, Vettore M, Coracina A, Millioni R, et al. Nitric oxide synthesis is reduced in subjects with Type 2 Diabetes and nephropathy. Diabetes. 2010;59(9):2152-9. 11. Vanhoutte P. Endothelial dysfunction and atherosclerosis. European heart journal. 1997;18(suppl E):19. 12. Murray RK, Gurner D, Rodwell V W. Harper's Illustrated Biochemistry: 27 th Edition .LANGE medical Book, International Edition .2006 : 580 - 581. 13. Shiekh GA, Ayub T, Khan SN, Dar R, Andrabi KI. Reduced nitrate level in individuals with hypertension and diabetes. Journal of Cardiovascular Disease Research. 2011;2(3):172. 14. Arora S, Das N, Srivastava K. Nitric Oxide and eNOS Gene in Essential Hypertension. International Journal of Collaborative Research on Internal Medicine and Public Health (IJCRIMPH). 2009;1(2):56-71. 15. Han Moshage, Bart KoK, Johannes R, Huizenga, and Peter L. M. Jansen. Nitrite and Nitrate determinations in plasma: a critical evaluation. Clin chem. 1995: 892 - 896. 16. Ghasemi A, Hedayati M, Biabani H. Protein precipitation methods evaluated for determination of serum nitric oxide end products by the Griess assay. Journal of Medical Sciences Research. 2007;2(0):29-32. 17. Shahid SM, Mahboob T. Diabetes and hypertension: Correlation between glycosylated hemoglobin (HbA1c) and serum nitric oxide (NO). Aust J Basic Appl Sci. 2009;3(2):1323-7. 18. Ghosh A, Sherpa M, Bhutia Y, Pal R, Dahal S. Serum nitric oxide status in patients with type 2 diabetes mellitus in Sikkim. International Journal of Applied and Basic Medical Research. 2011;1(1):31. 19. Kawakatsu M, Ishihara T, Kani K, Nakagawa A, Hiura M, Hazui H, et al. Plasma nitrite/nitrate concentration in healthy population and patients with diabetes mellitus relationship with gender, aging and diabetic complications. Bull Osaka Med Coll. 2002;48(1/2):1-6. 20. Prasad S, Sinha AK. Free radical activity in hypertensive type 2 diabetic patients. International Journal of Diabetes Mellitus. 2010. 21. Ding H, Triggle CR. Endothelial cell dysfunction and the vascular complications associated with type 2 diabetes: assessing the health of the endothelium. Vascular health and risk management. 2005;1(1):55.

Objectives: To find out the short term morbidity of non-closure of the visceral and parietal peritonium during caesarean section compared to suturing of visceral and parietal peritonium. Method: A prospective study of two hundred women undergoing caesarean section was done. Perioperative, intraoperative and postoperative details were observed. Results: Operating time, anaesthesia time and time of ambulation were significantly shorter in non-closure group. There was less postoperative pain, analgesic requirement and febrile requirement in non-closure group. However, it was not statistically significant. Conclusion:Non-closing the visceral and parietal peritonium at caesarean is associated with lesser operating time, decreased febrial morbitity and lesser need for postoperative analgesic. Hence, routine closure of peritoneum at caesarean can be avoided.

1. Iron O, Luzuy F, Beguin F. Nonclosure of the visceral and parietal peritoneum at cesarean section: a randomized controlled trial. Br J Obstet Gynaecol 1996; 103:690-4. 2. Bamigboye AA, Hofmeyr GJ. Non-closure of peritoneal surfaces at cesarean section-a systematic review. S Afr Med J 2005; 95:123-6. 3. Weerawetwat W, Buranawanich S, Kanawong M: Closure vs non-closure of visceral and parietal peritoneum at cesarean delivery: 16 years study. J Med Assoc Thai 2004; 87:1007-11. 4. Kucuk M, Okman TK. Non-closure of visceral peritoneum at abdominal hysterectomy. Int J Gynaecol Obstet 2001; 75:317-9. 5. Hull DB, Varner MW. A randomized study of closure of the peritoneum at cesarean delivery. Obstet Gynecol 1991; 77:818-21. 6. Grundsell HS, Rizk DE, Kumar RM. Randomized study of non-closure of peritoneum in lower segment caesarean section. Acta Obstet Gynecol Scand 1998; 77:110-5. 7. Pietrantoni M, Parsons MJ, O’Brien WF et al. Peritoneal closure or non-closure at cesarean. Obstet Gynecol 1991; 77:293-6. 8. Nagele F, Karas H, Spitzer D et al. Closure or non-closure of the visceral peritoneum at cesarean delivery. Am J Obstet Gynecol 1996; 174:1366-70. 9. Hojberg KE, Aagaard J, Laursen H et al. Closure versus non-closure of peritoneum at caesarean section – evaluation of pain. Acta Obstet Gynecol Scand 1998; 77:741-5. 10. Saha SK, De KC, Bhattacharya PK et al. Closure versus non-closure of the visceral peritoneum in Gynaec and Obstetric major operations. J Obstet Gynaecol India 2001; 51:34-6. 11. Cheong YC, Bajekal N, Li TC. Peritoneal closure-to close or not to close. Hum Reprod 2001; 16:1548-52.

Aim: To study visual field changes in patients with raised intraocular pressure and optic disc changes suspicious of glaucoma. Methodology: This was a cross sectional studies of 100 patients with disc changes suspicious of glaucoma or IOP≥21 mm Hg were included. Patients of both sexes and all age groups were included. Anterior chamber angle was examined with Goldmann 3 mirror gonioscopic lens. IOP was measured with applanation tonometer. Fundus examination was performed to document the degree of optic disc cupping. Results: The prevalence of visual field defects in the present study was 36%. 36 patients showed glaucomatous field defects. Mean age of patients with field defect was 48 years ± 10.6. Majority of patients with field defects were above 50 years of age, only 20% of patients had a positive family history of POAG .The mean IOP of 51 eyes with visual field defects was found to be 28.02 ± 7.65 mm Hg.50% of patients with asymmetrical C:D ratio ≥ 0.2 had visual field defects. Conclusions: Glaucoma suspects patients with F/H/O glaucoma, IOP ≥ 21 mm Hg, C:D> 0.5 & a symmetrical cupping are more prone for glaucoma& also constitute an important group that would benefit from energetic screening for glaucoma by Visual field analysis.

1. A K Khurana, Comprehensive Ophthalmology,5th edition, 2012; 9:222-256. 2. M Bruce Shields, Shields textbook of Glaucoma, 6th edition, 2011; 168. 3. Anderson DR, Patella VM: Automated static perimetry. 2nd edn. Mosby; 1999. 4. Ramakrishnan R, Nirmalan PK, Krishnadas R, Thulasiraj RD, Tielsch JM, Katz J, Friedman DS, Robin AL. Glaucoma in a rural population of southern India: the Aravind comprehensive eye survey. Ophthalmology. 2003 Aug; 110(8):1484-90. 5. Wilson’s-Jungner’s Criterias for appraising the validity of a Screening Programme, WHO 1998. 6. Jack J Kanski, Clinical Ophthalmology,5th edition,2005;9:193-222. 7. Roland Gross, Clinical Glaucoma Management, 2001; 81-167. 8. Becker-Shaffers, Diagnosis and Therapy of Glaucoma,8th edition, 2010;3-4. 9. Wensor MD, Mc Carty CA, Stanislavsky YL, Livingston PM, Taylor HR. The prevalence of glaucoma in the Melbourne visual impairment project. Ophthalmology 1998; 105:733. 10. Mason RP, Kosoko O, Wilson MR, Martone JF, Cowan CL Jr, Gear JC, et al. National survey of the prevalence and risk factors of glaucoma in St.Lucia, West Indies, I:Prevalnce findings. Ophthalmology 1989; 96:1363. 11. Hollows FC, Graham PA. Intraocular Pressure, glaucoma and glaucoma suspects in a defined population. Br J Ophthalmol 1996; 50:570. 12. Tielsch JM, Sommer A, Katz J, Royall RM, Quigley HA, Javitt J. Racial variation in the prevalence of primary open angle glaucoma. The Baltimore eye survey. JAMA 1991; 266:369. 13. Klein BEK, Klein R, Sponsel WE, Franke T, Cantor LB, Martone J et al. Prevalence of glaucoma. The Beaver Dam Eye study. Ophthalmology 1992; 99:1499. 14. Rosenthal AR, Perkins ES. Family studies in glaucoma. Br J ophthalmol 1985; 69:664. 15. Nemsure B, Leske MC, He Q, Mendell N. Analyses of reported family history of glaucoma: a preliminary investigation. The Barbados eye study group. Ophthalmic Epidemiol 1996; 3:135. 16. Wolfs RC, Klaver CC, Ramrattan RS, Van Duijn CM, Hofman A, M. de Jong PT. Genetic risk of primary open angle glaucoma: population based familial aggregation study. Arch ophthalmol 1998; 116:1640. 17. M Bruce Shields, Shields textbook of Glaucoma, 6th edition, 2011; 61-100. 18. L.C.Dutta, Modern Ophthalmology,3rd edition, Volume 1,2005;473-522. 19. Jack J Kanski, Clinical Ophthalmology,7th edition,2011;10:311-399.

Introduction: Thyroid cancers are fairly uncommon neoplasms, the annual incidence of which ranges from 0.5 to 10 cases per 1,000,000 population. The commonest thyroid malignant tumours are those of papillary carcinoma and follicular carcinoma followed by medullary, malignant and undifferentiated carcinoma. Aims/ Objectives: To determine the most common malignancy encountered and to identify the most common associated benign lesion. Materials and Methods: Fifty histopathologically diagnosed cases of thyroid malignancies were analysed retrospectively for the associated benign condition. A statistical analysis was done to determine the common association and the common malignancy encountered. Observation/ Results: of the fifty cases studied, 45 cases were papillary carcinoma, 4 cases follicular carcinoma and one case of medullary carcinoma. Among the 45 cases of papillary carcinoma 12 of them were papillary microcarcinoma. While thirty five cases of papillary carcinoma were associated with multi-nodulargoiter, 9 cases were associated with Hashimoto’s thyroiditis and in one case the rest of the thyroid was normal. Among the 4 cases of follicular carcinoma 3 were associated with multi-nodular goitre and one with Hashimoto’s thyroiditis. Medullary carcinoma was associated with Hashimoto’s thyroiditis. Conclusion: Since most of the thyroid malignancies in our study were associated with multi-nodulargoiter and, as a significant number of cases were papillary microcarcinomas a vigilant sectioning of the specimen is to be done to identify the presence of neoplastic foci grossly. The findings of the study also warrants for a follow up of the patients who have under gone hemithyroidectomy for nodular goiter, as most of thyroid malignancies have indolent clinical course.

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