The goal of therapy of patient with oral cavity malignancy is not only to cure the tumour, but also provide rehabilitation and try to preserve or restore some reasonable quality of life. Oral cavity reconstruction is not simply based on closure of the wound. Present study describes the various types of reconstructive procedures undertaken and its outcome in the patients at the tertiary care hospital in Miraj district of Maharashtra during the study period. Total of 52 cases were studied. The procedures done were Primary closure in 11 cases, Split Thickness Skin Graft in 2 cases, Local flaps in 11 cases, Myocutaneous flaps in 23 cases and free flaps in 5 cases. Recipient site morbidity in terms of infection was highest in Pectoralis Major Myocutaneous flaps (22%) followed by local flaps (18%) and free flaps (20%). Incidence of orocutaneous fistula was maximum in Pectoralis Major Myocutaneous flaps (13%) followed by free flap (13.3 %). Overall morbidity in terms of duration of operation, hospital stay, and return to operation theatre for evacuation of hematoma was more in free flaps. There was no peri-operative mortality. Post operative mortality was 5 % mainly due to cardiovascular and respiratory causes. Functional and aesthetic results were excellent in patients of free flap repair as compared to other procedures.
1. George RK, Krishnamurthy A. Microsurgical free flaps: Controversies in maxillofacial reconstruction. Ann Maxillofac Surg 2013;3:72-9
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3. Hidalgo DA, Rekow A (1995) A reviews of 60 consecutive fibula free flap mandible reconstructions. Plast Reconstr Surg 96:585–596, discussion 597–602
4. Rosenthal E, Carroll W, Dobbs M, Scott Magnuson J, Wax M, Peters G (2004) Simplifying head and neck microvascular reconstruction. Head Neck 26:930–936
5. Singh B, Cordeiro PG, Santamaria E, Shaha AR, Pfister DG, Shah JP (1999) Factors associated with complications in microvascular reconstruction of head and neck defects. Plast Reconstr Surg 103:403–411
6. Beausang ES, Ang EE, Lipa JE, Irish JC, Brown DH, Gullane PJ, Neligan PC (2003) Microvascular free tissue transfer in elderly patients: the Toronto experience. Head Neck 25:549–553
7. Haughey BH, Wilson E, Kluwe L, Piccirillo J, Fredrickson J, Sessions D, Spector G (2001) Free flap reconstruction of the head and neck: analysis of 241 cases. Otolaryngol Head Neck Surg 125:10–17
8. Suh JD, Sercarz JA, Abemayor E, Calcaterra TC, Rawnsley JD, Alam D, Blackwell KE (2004) Analysis of outcome and complications in 400 cases of microvascular head and neck reconstruction.Arch Otolaryngol Head Neck Surg 130:962–966
Study of various factors associated with septic abortion
Introduction: Unwanted pregnancy has been a problem of mankind from time immemorial. The WHO has estimated that on the Indian subcontinent 15-24 unsafe abortions take place in every 1000 women aged 15-49, even after 40 years of the implementation of medical termination of pregnancies in India Aims and objective: to study the incidence and various factors associated with septic abortion. Materials and method: The present study was conducted in department of obstetrics and gynecology at Government General Hospital and Sangameshwer Hospital. Gulbarga. All the cases of abortion reported were enrolled in the study. Cases of septic abortion were studied in detail. After stabilization of patients’ detailed history regarding name, age, parity, marital status and gestational period were inquired and record. Results: Out of the total 327 cases of abortion septic abortion was observed in 36 cases thus the incidence of septic abortion was 11.01%. Majority (61.11%) of the patients suffering from septic abortion were 21 to 30 years old. 27.78% were from Urban and 72.22% were from rural area and 72.22% were married. Septic abortion incidence was highest in less than 8 weeks of gestation (47.22%). Incidence of septic abortion was more common among multipara (30.56%), followed by Grand multiparas (27.78%) and nullipara (25%). Conclusion: The incidence of septic abortion in Government General Hospital Gulbarga was 11.01%. Septic abortion was common in younger married women residing in rural area and seen most commonly in first trimester and multi parous women.
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Background: Surgical resection is the mainstay of treatment of rectal cancer with curative intent. Laparoscopic surgery for rectal cancer is much more challenging than that for colon cancer because of the confined space within the pelvis. Further, because of the tumour's location in the pelvis, maintenance of resection margins is of greater concern. Aims and Objectives: To assess the feasibility of a laparoscopic resection for rectal carcinoma with emphasis on perioperative and short-term oncological outcomes. Materials and Methods: It was a hospital based nonrandomised prospective study. From July 2011 to November 2013, 37 patients underwent laparoscopic surgery for the rectal cancer. Results: Total 37 patients were operated for rectal carcinoma, 26 laparoscopic anterior resection and 11 laparoscopic abdominoperineal resection. There were 05 cases of conversion to open surgery and 02 procedures were abandoned. The average operative time was 237.5 minutes. The average hospital stay was 9.7 days. The most common postoperative complication was wound infection in 04 patients. The postoperative mortality was seen in 2 patients. The average number of lymph nodes harvested from specimen was 11. There was only one case of positive distal resection margin. The most common Astler Collar stage and tumour grade was stage B and grade 2. Conclusion: The laparoscopic surgery was safe and feasible for treatment of rectal cancer and associated with shorter hospital stay, less morbidity and reduced blood loss.
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9. Kuhry E, Schwenk W, Gaupset R, Romild U, Bonjer HJ. Longterm results of laparoscopic colorectal cancer resection. Cochrane Database of Systematic Reviews 2008, Issue 2. Art. No.: CD003432. Doi: 10.1002/14651858.
10. Schlachta CM, Mamazza J, Seshadri PA, Cadeddu M, Gregoire R, Poulin EC (2001) Defining a learning curve for laparoscopic resections. Dis Colon Rectum 44:217–222
11. Kurumboor Prakash, D. V. (2010). Lparoscopic colonic resectcion for rectosigmoid colonic tumours: A retrospective analysis and comparision with open resection. Indian J Surg, 318-322.
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13. Weida Day, P. Y. (2011). Clinical outcome of open and laparoscopic surgery in Dukes B and C rectal cancer: experience from a regional hospital in Hong Kong. Hong Kong Med J, 26-32.
14. Krumboor Prakash, N. P. (july- sept 2013). Does case selection and out come following laproscopic colo-rectal resection change after initial learning curve? Analysis of 235 consecutive elective laproscopic colorectal resection. journal of minimal access surgery, 99-103.
15. Kang SB, Park JW, Jeong SY et al, Open versus laparoscopic surgery for mid or low rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial):short term outcomes of an open label randomized controlled trial.Lancet Oncol.2010;11:637-45
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17. Braga M, Frasson M, Vignali A et al (2005) Laparoscopic vs. open colectomy in cancer patients: long term complications, quality of life, and survival. Dis Colon Rectum 48(12):2217–2223
18. Fleshman J, Sargent DJ, Green E et al (2007) Laparoscopic colectomy for cancer is not inferior to open surgery based on 5- year data from the COST study group trial. Ann Surg 246(4):655–662
19. Patankar SK, Larach SW, Ferrara A, Williamson PR, Gallagher JT, DeJesus S, Narayanan S. Prospective comparison of laparoscopic vs. open resections for colorectal adenocarcinoma over a ten-year period. Dis Colon Rectum 2003; 46: 601-611
20. Jayne DG, Thorpe HC, Copeland J, Quirke P, Brown JM, Guillou PJ. Five-year follow-up of the Medical Research Council CLASICC trial of laparoscopically assisted versus open surgery for colorectal cancer. Br J Surg. 2010; 97 (11): 1638-45.
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23. Jayne DG, Guillou PJ, Thorpe H et al (2007) Randomized trial of laparoscopic-assisted resection of colorectal carcinoma: 3-year results of the UK MRC CLASICC trial group. J Clin Oncol 25:3061–3068
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A comparative study of outcome of caesarean delivery in rural obstetric referrals with elective caesarean delivery
Objectives: To study the obstetric outcome of rural referrals who undergo emergency caesarean delivery versus elective caesarean delivery in a tertiary care hospital in rural scenario and to evaluate the risks and complications associated with it. Methodology: This comparative study was conducted at Rural Medical Hospital in Karnataka, India over a period of 18 months. Among the total of 100 patients who fulfilled the inclusion criteria 50 patients referred to us, who underwent caesarean delivery are emergency group and 50 patients admitted in our hospital who were posted for elective caesarean delivery were the other group in the study period. The various parameters, maternal morbidity, neonatal outcome, morbidity and mortality were compared in both groups using a semi structured Performa. The comparison was done by using Chi-square test and p-value< 0.05was considered statistically significant. Results: During our study period the referred cases constituted of 19.8%. Caesarean delivery rate among referred Cases was 40.7%. Statistically significant association was found between emergency CS and younger patients, low parity, irregular attendance at antenatal clinics, intra operative complications, postoperative morbidity and low Apgar score, NICU admission and also mortality as compared to elective caesarean section group. The commonest indication for caesarean delivery in emergency was obstructed labour (34 %), previous caesarean delivery (36%) being the commonest in elective group. Perinatal mortality was 12.5% Conclusions: The present study has shown that improper intranatal, an emergency care for a pregnant women being responsible for most of the referral cases undergoing caesarean section on emergency which caused increased maternal morbidity and perinatal deaths in our institution. It was concluded that every effort should be directed to effect-planned CS, as determined during the antenatal period, if possible, so as to reduce the various problems associated with emergency CS.
1. Akolekar R, Pandit S N, Rao. B.S., The cesarean Birth FOGSI publications, 1st Edn.,, National Book Depot, reprint 2010; p. 1-3.
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Comparative study of PFN and DHS in proximal femoral fractures
Introduction: The operative treatment of proximal femoral fractures has been a matter of discussion ever since internal fixation was advocated to prevent the complications of long-term confinement to bed for the elderly. Aims and objective: To compare the Dynamic Hip Screw and the Proximal Femoral Nail method of fixation in intertrochanteric fracture of femur. Materials and method: total 50 cases of intertrochanteric fracture of femur were enrolled in the study. 25 patients were treated by Proximal Femoral Nail method and 25 were treated by Dynamic Hip Screw method. All the patients were observed meticulously intra operatively and post operatively. Duration required for surgery, blood loss and complications were recored. Results: The mean age of the study patients was 64.25years. It was observed that 64% patients in the sturdy were male. In 68% patients cause of fracture was domestic fall. Mean duration of surgery was 58±12 min whereas in DHS group was91±8. Mean blood loss during surgery in PFN group was 100±16ml whereas in the DHS group was 250±50ml. Limb shortening was observed in 10 cases in PFN group whereas 24% in DHS. Nonunion was seen in one case of DHS group. In PFN group infection was seen in 6% patients and 14% in DHS group. Implant failure was seen in one case of PFN group whereas in two cases in DHS group. Death was observed in one cases of DHS group. Conclusion: thus we conclude that the Proximal Femoral Nail method for fixation in intertrochanteric fracture of femur is better as compared to the Dynamic Hip Screw.
1. R.K.J. Simmermacher, A.M. Bosch, Chr. Van der Werken. AO/ASIF–proximal femoral nail (PFN): a new device for the treatment of unstable proximal femoral fractures. Injury, 30 (1999), pp. 327–332
2. M. Saudan, A. Lubbeke, C. Sadowski, et al. Pertrochanteric fractures: is there an advantage to an intramedullary nail? A randomised, prospective study of 206 patients comparing the dynamic hip screw and proximal femoral nail. J Orthop Trauma, 16 (2002), pp. 386–393
3. L. Ahrengart, H. Tornkvist, P. Fornander, et al. A randomised study of the compression hip screw and Gamma nail in 426 fractures. Clin Orthop, 401 (2002), pp. 209–222
4. J.E. Madsen, L. Naess, A.K. Aune, et al. Dynamic hip screw with trochanteric stabilizing plate in the treatment of unstable proximal femoral fractures: a comparative study with the Gamma nail and compression hip screw. J Orthop Trauma, 12 (1998), pp. 241–248
5. G. Al Yassari, R.J. Langstaff, J.W. Jones, M. Al Lami. The AO/ASIF proximal femoral nail (PFN) for the treatment of unstable trochanteric femoral fracture. Injury, 33 (2002), pp. 395–399
6. H. Banan, A. Al Sabti, T. Jimulia, A.J. Hart. The treatment of unstable, extracapsular hip fractures with the AO/ASIF proximal femoral nail (PFN)–our first 60 cases. Injury, 33 (2002), pp. 401–405
7. W. Friedl, J. Clausen. Experimental examination for optimised stabilisation of trochanteric femur fractures, intra or extramedullary implant localisation and influence of femur neck component profile on cut-out risk. Chirurg, 71 (2001), pp. 1344–1352
8. PFNA. Leading the way to optimal stability: Synthes. Original instruments and implants of the Association for the Study of Internal Fixation. AO/ASIF. Stratec Medical 2004;1–44.
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Palynological studies of tertiary sediments of west coast of India to decipher provenance and environment of deposition
Tertiary sediments are deposited along the west coast in study area on basalt and covered by laterite. These sediments include carbonaceous shale, lignite and sandstone, which are rich in micro fossils and pollens. The Fungal remains, Pteridophyte spores and Angiosperm pollens are studied. The modern equivalents of these fossil pollen and spores are presently found in diversified ecologic habitats ranging from deltaic to fresh water swamps and low altitude ever green to open forests. Ecological distribution of the modern equivalents of these micro fossils indicates deltaic to swampy depositional environment. The source of pollen and lignite coal is in the Western Ghats and source rock is basalt for shale and sandstone.
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3. Mittre, V., (1961) Contacts of Palynology. Bull. Nat. Inst. Sci. India No. 19 pp. 2 - 14.
4. Nair, P.K.K., (1960 a) Palynology in India - A Review Ibid 2: pp. 51 - 53.
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6. Phadtare, N.R. and Kulkarni, A.R., (1980) Palynological Investigation on Ratnagiri Lignite, Maharashtra. Geophytol. 10, pp. 158 - 170.
7. Phadtare, N.R. and Kulkarni, A.R., (1984) Affinity of the Genus Quilonipollenites with the Malasia Palm Eugeissona Griffith. Pollen at Spores, 26, pp. 217 - 226.
8. Potonie, R., (1960) Synopsis der Guttungen Sporae - Dispersae III, Beih. Geol. Jb., 39,pp. 1 – 189
9. Rao, K.P. and Ramanujam, C.G.K., (1976) A palynological Approach to the study of Quilon Beds of Kerala State in South India. Curr. Sci. 44, 730 - 732.
10. K.P. and Ramanujam, C.G.K., (1976) A palynological Approach to the study of Quilon Beds of Kerala State in South India. Curr. Sci. 44, 730 - 732.
11. Sah, S.C.D. and Kar, R.K.f (1969) Palynology of the Laki Sediments in Kutch - 3: Pollen from the Boreholes around Jhulrai, Barancla and Panandhro. Paleobotanist., 18, pp. 127 - 141.
12. Sahani, B., (1948) The Prospects of Palynology in India, Svensk. hot. Tidskr. V, 42, pp. 474 - 477.
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14. Suryawanshi R.A.(1995) Sedimentological and related studies of tertiary sediments exposed along the coast Dist. Ratnagiri Maharashtra Ph.D Thesis submitted to Shivaji University Kolhapur pp 207
15. Suryawanshi R.A.(2014) Use of microfossile to decipher the paleo-environment of tertiary sediments of Ratnagiri,Maharashtra,India
16. Venkatachala, B.S. and Kar, R.K., (1985) Palynology of the Tertiary Sediments of Kutch - 1: Spores and Pollen from Bore Hole No. 14, Palaeobotanist, 17, pp. 157 - 178.
17. Venkatachala, B.S. and Rawat. M.S., (1972) Palynology of the Tertiary Sediments in the Cauvery Basin - I Palaeocene - Eocene Palynoflora from the subsurface Proc.Sem. Palaeopalynol Indian Stratigr, Calcutta, pp. 292 – 335.
A study of Clinicopathological aspects of Pilonidal Sinus
Introduction: Pilonidal Sinus is a painful condition usually occurring in the intergluteal region, which consists of a Sinus or fistula, situated a short distance behind the anus and generally containing hair. Pilonidal Sinus has its peak incidence between 16-20 years of age and it decreases after age of 25 years it is rare after 45 years. Pilonidal Sinus occurs predominantly in men 80%. All races can develop the disease, but it seems more common in those with dark, stiff hair and hirsute individuals. However, Pilonidal Sinus can also occur in relatively hairless types. Aims and objective: to study the Clinicopathological aspects of Pilonidal Sinus. Materials and Method: In the present cross sectional study 30 patients of pilonidal sinus were enrolled. Detail history containing age, sex and occupation of the all the patients was noted in prestructured proforma. The main presenting symptoms were also noted. Routine general physical examination was done with special attention towards body hair distribution. On local examination site of the Pilonidal Sinus was confirmed, number of sinuses, presence of tenderness, discharge, any hair protruding from the sinuses and the condition of the surrounding area for indurations was examined. All patients also underwent digital rectal examination and proctoscopy. Results: 56.66% of patients were between 16-25 yrs of age. 70% were males. Labourers form the most common group constituting 40% of our patients followed by students. 24 (83.33%) of our patients were hairy individuals of which 18 were males and only 6 patients were hairy females. Discharge was the most common symptoms in the study being present in all patients. It was followed by pain (56.67%). Most common presentation being swelling and discharge from intergluteal region present in 20 (66.66%) of patients. Sinus was present in all patients (100%) and some form of discharge was seen in 86.7% patients. Conclusion: thus we conclude that pilonidal sinus is often very painful and associated with discharge and typically occurs in young hairy males.
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Comparison of surgically induced astigmatism (SIA) and postoperative astigmatism with superior, superotemporal and temporal incisions in phacoemulsification surgery
Introduction: Cataract is defined as any opacity of lens or capsule which is either developmental or acquired. Cataract surgery is the commonest procedure performed in ophthalmology. Astigmatism prevention and control is one of the biggest challenges for a surgeon after cataract surgery. Since postoperative astigmatism is the major determinant of visual outcome, a comparative study is essential to ascertain the difference in induced astigmatism, if any between different sites of incision in Phacoemulsification keeping the size of incision same. Aims and Objectives: To compare postoperative astigmatism and surgically induced astigmatism (SIA) with superior, superotemporal and temporal incisions in phacoemulsification surgery. Materials and Method: This prospective study comprised of 150 patients of cataract operated by using phacoemulsification using superior, superotemporal and temporal incisions. All the patients were divided in three groups containing 50 patients each depending upon the type of incision used. The outcome measures were post operative and surgically induced astigmatism (SIA) post operatively. Results: The pre-operative astigmatism in all three groups was measured it was in the range of 0 to 1.5D with no statistical significant difference. Majority of the patients were having post operative astigmatism between 0.75 to 1.25D. i.e. 44% in group A, 60% in group B and 58% in group C. Surgically induced astigmatism less than 0.75D in group A was seen in 78% patients whereas in group B was 92% and in group C was 90%. According to the Tukey’s multiple comparison test, post operative and surgically induced astigmatism was statically significant in group A and C. Whereas the difference in group A and B and group B and C was not significant. Conclusion: temporal and superotemporal incision leads to significantly less amount of mean post-operative astigmatism as well as Surgically Induced Astigmatism (SIA) as compared to superior incision.
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6. Kershner RM. Refractive cataract surgery. Curr Opin Ophthalmol. 1998 Feb; 9 (1):46-54.
7. http://www.insighteyeclinic.in/SIA_calculator.php ‘The SIA Calculator version 2.1’, a free software programme approved by All India Ophthalmological Society (AIOS).
8. Pakravan M, Nikkhah H, Yazdani S, Shahabi C, Sedigh-Rahimabadi M. Astigmatic Outcomes of Temporal versus Nasal Clear Corneal Phacoemulsification. J OphthalmicVis Res. 2009 Apr; 4(2):79-83.
9. Kohnen S, Neuber R, Kohnen T. Effect of temporal and nasal unsutured limbal tunnel incisions on induced astigmatism after phacoemulsification. J Cataract Refract Surg. 2002; 28:821–825.
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11. Iftikhar S, Bashir R, Naeem BA, Abrar R, Jaffri RH and Sarmad A. Comparison of surgically induced astigmatism in phacoemulsification with 5.5 mm superior vs. temporal incision. Al-Shifa Journal of Ophthalmology 2007; 3(1): 9-14.
12. SimÅŸek S, YaÅŸar T, Demirok A, Cinal A, Yilmaz OF. Effect of superior and temporal clear corneal incisions on astigmatism after sutureless phacoemulsification. J Cataract Refract Surg. 1998 Apr; 24(4):515-8.
Surgical and functional outcome of lateral canthal tarsorrhaphy in unilateral paralytic lagophthalmos
Ten patients having unilateral infranuclear 7th nerve palsy with lagophthalmos of different age group and different aetiology underwent lateral canthal tarsorrhaphy to prevent progression of and treatment of severe exposure keratitis in tertiary eye care centre at Govt. Medical College and Hospital, Nagpur. Patients were advised local lubricants, antibiotics. Nearly all pts showed improvement in lid closure, epiphora and keratitis. Lat. tarsorrhaphy supported the lower lid with not much cosmetic disfigurement of the eyeball. Only in a single case the ulcer perforated. Lateral tarsorrhaphy is a good option for poor patients having infranuclear Bell’s palsy with severe exposure keratitis who cannot afford to go for temporalis transplant.
1. Tan ST et al, Gold weight implantation andlateral tarsorrhaphy for upper eyelid paralysis. J. Craniomaxillofac. Surg. 2013; Apr. 41(3): e49 -53.
2. Panda A et al, Lateral Tarsorrhaphy – is it preferable to patching? Cornea 1999 May; 18(3): 299 – 301.
3. Rosenthal P Cotter JM et al, Treatment of persistent corneal epithelial defect with extended wear of a fluid ventilated gas permeable scleral contact lence. AMJ. Ophthalmol. 2000 Jul 130(1): 33 – 41.
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Comparative study of serum and aqueous humour electrolyte levels in cataract patients
Background and Objectives: There are about 50 million blind people in the world, a third of them being due to cataract. In India alone, cataract accounts for 80% of treatable blindness. Many factors such as ageing, altered blood electrolyte levels, nutrition and family history are involved in cataractogenesis. Aim: Comparative study of serum and aqueous humour levels in cataract patients. Objectives are to compare serum Na+, K+, Ca+2 and PO4 -3 levels with that of aqueous humour levels in patients with cataract and to establish a correlation between altered serum and aqueous humour electrolyte levels with the type of cataract. Methods: The study undertaken includes a total of one hundred cataract patients who visited VIMS and RC, White field, Bangalore between January 2012 and June 2013. It considered cataract patients of both sexes above the age of 40 years and excluded patients with any systemic disease, past ocular disease, or any drug intake known to cause electrolyte changes in the body. The patients were all routinely subjected to a detailed ocular examination including visual acuity, slit lamp examination to stage the type of cataract, fundoscopy, intraocular pressure recording. Serum and aqueous humour samples were collected intraoperatively in cataract patients and sent for Na+, K+, Ca+2 and PO4 -3 level measurement by Beckman Coulter Unicel DxC 600 and Synchron CX5PRO.The serum and aqueous humour electrolyte levels were compared with each other. Results: The aqueous humour, though a secretion of serum; shows a considerable difference in the electrolyte levels as compare to serum which is statistically significant (p<0.001). Conclusion: Aqueous sodium levels as compared to serum sodium levels were higher in patients with cataract. Aqueous potassium, calcium, phosphate levels were low compared to serum levels. Aqueous levels of potassium in cataract patients (50 % of cases) were raised when compared to normal aqueous levels.
1. Mirsamadi M, Nourmohammadi I, Imamiam M. “Comparative study of serum Na+ and K+ levels in senile cataract patients and normal individualsâ€. Int J Med sci 2004 1:165-169 pp.
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Uterus didelphys is one of the congenital uterine anomalies due to defective medial fusion of Mullerian ducts. Often remains asymptomatic and hence undetected. Women with congenital uterine alformation usually have higher incidence of complications during pregnancy and delivery. Although pregnancies can occur in patients with Mullerian duct anomalies, most of them have been linked to infertility, recurrent pregnancy loss, pre term deliveries, fetal mal-presentations and other obstetrics complications, making successful pregnancy outcome a rare situation in this condition. We report a case of successful pregnancy outcome in a case of uterus didelphys bicollis. A 25year old P2L2 with 2 previous LSCS, failed LS, with 2 months of amenorrhea, continued her pregnancy till term and underwent cesarean section with concurrent sterilization.
1. TeLinde’s operative Gynecology- 10th edition
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Study of incidence of ischemic stroke due to intracranial, extracranial and combined vascular lesions and associated risk factors
Introduction: Ischemic Cerebrovascular disease (ischaemic stroke) is a leading public health problem. Stroke is defined as an abrupt neurologic deficit that is attributable to focal vascular cause. Risk factors for stroke include hypertension, carotid stenosis, atrial myxomas, smoking, hyperlipidemia, diabetes, myocardial infarction and atrial fibrillation. Aims and objectives: To study the incidence of ischaemic stroke due to intracranial, extracranial and combined vascular lesions. Material and Method: in the present study 104 cases of ischemic stroke were included in the study. All these patients were studied clinically and radiologically to study the nature of lesion (intracranial or extracranial vascular lesion). Neuroimaging- MRI-Brain or CT-Brain was done in each patient to see site of infarct. Results: It was observed that out of 104 patients included in our study, 28.84% patients were having intracranial vascular lesion, 31.73% patients were having extracranial vascular lesion and 7.69% patients were having combined intracranial and extracranial vascular lesions. 31.73% patients were having normal angiographic study. Incidence of stroke increases with increasing age and has male preponderance. Hypertension was found in 76.92% of total patients. 41.35% of patients in our study were having diabetes mellitus. History of smoking was observed in 33.65% of patients. Conclusion: The incidence of stroke due to intracranial, extracranial and combined vascular lesion was 28.84%, 31.73% and 7.69% respectively. Increasing age, male sex, HTN, DM, IHD, past history of stroke and smoking were important risk factors for ischaemic strokes.
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8. Varadlaxmi EA, Kaul S, Murthy JMK, Ramamurthy A. Frequency, risk factor and distribution of intracranial large artey lesions in patients with ischaemic stroke. Annals of Indian Academy of Neurology 1999;2:37.
9. Liu HM, Yong KT, Yip PK et al. Evaluation of intracranial and extracranial carotid steno-occlusive diseases in Taiwan, Chinese patients with MR angio. Stroke 1996; 27:650-653.
10. Farhad Iranmanesh, Farahmand H, Gadari F et al. Doppler sonography of extracranial and intracranial vessels in patients with throbotic stroke; Journal of Research in Med sciences, 2006: vol.11.
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13. Yip PK, Jend JS, Lee TK, Chang YK, Huang ZS et al. subtypes of ischaemic strokes: A hospital based stroke registry in Taiwan. Stroke Dec 1997; 25(12):2507-12.
14. Srivastava A, Padma MV, Jain S, Maheshwari MC. Risk factor analysis and genetic influences of stroke: A case control study; Annal Ind Ac Neurol, vol2: suppl1:123.
15. Berne JD, Renauld KS, Villareal DH, Mc Govern TM, Roue SA, Norwood SH et al. Sixteen slice multi-detector computed tomographic angiography improves accuracy of screening for blunt CVA. J Trauma 2006; 60:1204-9, discussion 1209-10.
16. Rincon F. Incidence and risk factors of intracranial atherosclerotic stroke: The Northern Manhatten study. Cerebrovasc Dis. Jan 2009; 28(1) 65-71.
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Computed tomographic prevalence of intracranial calcification of pineal gland in apparently normal individuals
Introduction: This study was undertaken to know the prevalence of pineal calcification in normal individuals of south central Maharashtra with the objective to study the age related variation, the sexual variations in the prevalence of normal pineal gland calcification. It increased from 2.22% in the first decade to 57.5% in seventh decade with statistically significant rise from 13.33% to 26.66% from second to third decade. Considering the process of calcification, endocrine activity of pineal gland and the significant rise in the prevalence of calcification after second decade, it was concluded that secretions of pineal gland may influence sexual hormone and the gland is more active in second and third decade of life.
1. Daghighi MH, Rezaei V, Zarrintan S, Pourfathi H. Intracranial physiological calcifications in adults on computed tomography in Tabriz, Iran. Folia Morphol 2007;66:115–119
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A study of etiological factors in ascities - a cross sectional study
Introduction: Ascites is a known complication in cirrhosis of liver and ascites can develop in many other conditions in adults like cardiac, infectious, autoimmune, renal, malnutrition and many others clinical conditions. Ascites along with abdominal distension presents with other salient features depending on the etiology. This study was focused on evaluating variuos aetiological facors involved in ascites. Methods and Materials: It was a cross sectional study done among 60 patients with ascites in K M C Hospital Mangalore from September 2006 to September 2008. Patients were clinically assessed and subjected to various biochemical tests of blood and ascitic fluid. Results: Among the 60 patients of ascites majority of the patients are males85% probably related to alcohol, and cirrhosis of liver was the leading cause for ascites66.7% followed by HBV infection10% and tubercular peritonitis8.3% and nearly33.3% were of the age group between 40 to 50years. In our study anorexia and pain abdomen were common presenting symptom along with distension of abdomen and pedal oedema was seen in 88.3% of patient’s pallor and spleenomegaly are the other common signs. Conclusions: Cirrhosis was the common aetiology for ascites when compared to other causes probably seen in chronic alcoholics as it is shown in our study that males in mid age group are more affected.
1. Runyon B.A., "Approach to the patient with ascites", Chapter in Text book of gastroenterology, Newyork J.P. Lippincott. Third Ed. 1999; 966-991.
2. Runyon B.A, 1994: Care of patients with ascites. N. Engi. J. Med. 330; 337-341.
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7. Schenker S., Montalvo R. 1997: "Alcoholic liver disease"; Current Opinion in Gastroenterology. 13: 235-247.
8. Bhusnurmath S.R. 1994: "Budd-Chiari syndrome: Current concepts". Indian J. Gastroenterology. 13(1): 9-12.
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10. Jain A.P., Sharat Chandra; Gupta S. et al.1999. "Spontaneous bacterial peritonitis in liver cirrhosis with ascites". JAPI, Vol. 47, No.6, 619-620.
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Study of awareness about diabetes mellitus among undergraduate medical students
Rashmi Amans Flora Nazareth, Arunachalam R, Sudeep K
Introduction: Diabetes mellitus (DM) causes significant morbidity and mortality. The importance of proper diagnosis and management of this non communicable disease is being increasingly recognized. This study was conducted to assess the knowledge about DM among medical students who are the future health care providers. Materials and Methods: The data was collected from a questionnaire filled by medical students studying in Final year MBBS and internship in Father Muller Medical College Hospital, Mangalore. Results: From this study it was found that 81.25% of the interns and 78.75% of the final year students were aware of the classical symptoms of DM. The interns (65.4%) were more knowledgeable than the final year students (48.3%) about the biochemical parameters. The awareness about diabetic ketoacidosis (DKA) and its management was poor. Conclusion: There were gaps in knowledge of both the final year students and interns. Education programs teaching in detail about diabetes mellitus, its complications and management are needed to be incorporated more effectively in the medical curriculum.
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. Shaw JE, Sicree RA, Zimmet PZ. Global estimates of the prevalence of diabetes for 2010 and 2030. Diabetes Res Clin Pract 2010 ; 87: 4-14.
3. Singh H, Thangaraju P, Kumar S, Aravindan U, Balasubramanian H, Selvan T. Knowledge and Awareness of Diabetes and Diabetic Ketoacidosis (DKA) Among Medical Students in a Tertiary Teaching Hospital: An Observational Study. J Clin Diagn Res 2014; 8 : 4-6.
4. Wadaani, FA Al. "The knowledge attitude and practice regarding diabetes and diabetic retinopathy among the final year medical students of King Faisal University Medical College of Al Hasa region of Saudi Arabia: A cross sectional survey." Nigerian journal of clinical practice 2013; 16: 164-8.
5. Derr R L, Sivanandy M S, Bronich L, Rodriguez A. Insulin-Related Knowledge Among Health Care Professionals in Internal Medicine. Diabetes Spectrum July 2007; 20: 177-85.
6. Lansang M C, Harell H. Knowledge on inpatient Diabetes among Fourth-year medical Students May 2007; 30: 1088-91.
Metabolic syndrome in an adult population of rural Karnataka
Vanitha Gowda M N, Krishnamurthy U, Shalini C N, Pruthvish S, Shalini P, Dinesh R6, Murthy N S
Background: Metabolic syndrome is a group of abnormalities that confers an increased risk of developing atherosclerotic cardiovascular diseases and type 2 diabetes mellitus. Aim: To determine the prevalence of metabolic syndrome in adults aged ≥18 years in a rural population, to find the prevalence of various risk factors of metabolic syndrome and to determine the factors significantly contributing to metabolic syndrome in the same population. Materials and Methods: A cross-sectional study was undertaken in Jangamsheegehally village of Chintamani taluk in Karnataka. A detailed personal and clinical history, blood pressure, anthropometric measurements were recorded and a fasting blood sample was drawn from each of the 188 subjects. The serum samples were analyzed for Fasting Blood Sugar and lipid profile. Results: the prevalence of metabolic syndrome in adults aged ≥18 years, using the updated AHA/NHLBI statement criteria was 42 (22.3%). At least one metabolic abnormality was seen in 87.23% subjects (90% of females and 84% of the males). The commonest abnormality in females was low HDL (79%), Central obesity (29%) and hyperglycemia (12%). In males, low HDL (67%) was also the most common abnormality followed by high triglycerides (40.9%) and hyperglycemia (18.1%). The most significant independent risk factors for developing metabolic syndrome were found to be Hypertriglyceridemia (OR 21.07, CI 8.48-52.35, p<0.001), Low HDL levels (OR 20.71, CI 1.78- 101.0, p= 0.001) and Central obesity (OR 15.75, CI 7.40-38.69, p<0.001). Conclusion: The prevalence of metabolic syndrome was highest in the age group of 31-40 years with low HDL levels, hypertriglyceridemia and central obesity being independent risk factors. Efforts should be aimed at educating the rural masses regarding lifestyle modifications including suggestions on improving eating habits, the importance of a regular exercise regimen, social support and stress management strategies in order to alleviate the metabolic abnormalities that could increase the risk of Metabolic syndrome.
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6. Grundy SM, Cleeman JI, Daniels SR, Donato KA, Eckel RH, Franklin BA, Gordon DJ, Krauss RM, Savage PJ,Smith SC Jr, Spertus JA, Costa F; American Heart Association; National Heart, Lung, and Blood Institute. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung and Blood Institute Scientific Statement. Circulation 2005; 112: 2735-2752
7. International Diabetes Federation. Worldwide definition of the metabolic syndrome Available at: http://www.idf.org/webdata/docs/IDF_ Metasyndrome_ definition.pdf. Accessed June 11, 2011
8. Alberti KG, Eckel RH, Grundy SM, Zimmet PZ, Cleeman JI, Donato KA, Fruchart JC, James WP, Loria CM, Smith SC Jr; International Diabetes Federation Task Force on Epidemiology and Prevention; Hational Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; International Association for the Study of Obesity. Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation. 2009 Oct 20; 120(16):1640-1645.
9. Misra A, Wasir JS, Pandey RM. An Evaluation of candidate definitions of the Metabolic syndrome in adult Asian Indians. Diabetes Care, 2005; 28:398–403.
10. Kanjilal S, Shanker J, Rao VS, Khadrinarasimhaih NB, Mukherjee M, Iyengar SS, Kakkar VV. Prevalence and component analysis of metabolic syndrome: An Indian atherosclerosis research study perspective. Vascular Health and Risk Management 2008:4(1) 189–197.
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Effect of diet and exercise on improvement of anthropometric variables and BSL in prediabetic study subjects of urban slum area
Chandrashekhar M Gedam, Pravin N Yerpude, P B Sawant, Keerti S Jogdand
Introduction: Subjects with IGT and IFG have an increased risk of type-2 diabetes therefore form an important target group for interventions aimed at preventing diabetes. Approximately one third of the individuals with either IFG or IGT and two third of individuals with both will develop diabetes within six years. Present study was planned to focus attention on prediabetes and to see the effect of the intervention measures such as diet change and increasing level of physical activity to control the blood sugar level in prediabetics. Materials and Methods: The present hospital based interventional study was conducted in urban slum area. The outpatient department attendees of the Urban Health Centre, comprises the study population for the present study. If blood sugar levels fits in the definition of pre-diabetes (either IFG or IGT or both) then subjects were assigned to the groups, either in the intervention group or control group by randomization. Subjects in the intervention group were advised regarding diet change and exercise. All the subjects in both the groups were followed-up for 9 months. Results: Total 288 study subjects undergo investigation for pre-diabetes, out of which 104 (36.11%) found to have pre-diabetes. So prevalence of pre-diabetes was 36.11%. Majority of the participants i.e. 34 were in the age group of 40 to 49 yrs. Majority of the participants had completed their education up to graduation (39 %) and post-graduation (17 %). Anthropometric variables like BMI and waist hip ratio were not found significant before intervention but after intervention there is significant variation in anthropometric variables between control and intervention groups. Similarly fasting and post prandial blood sugar level among control and intervention groups were found to be significant after intervention. Conclusion: The study shows that intervention measures like diet change and exercise are effective to decrease and maintain the blood sugar levels among prediabetics by decreasing and maintaining their bodyweight.
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Lineament Fabric of South Baluchistan (Iran) and its Impact on Geomorphic Landforms
U D Kulkarni, Yousefi Hamidoddin, Ravindra G Jaybhaye
Lineament analysis of South Baluchistan region in Iran using sensors of Landsat 8 (Landsat Data Continuity Mission, LDCM)) suggests orgoenic uplift of the region brought about deformation of mesoscopic structures. The lineament fabric showed prominent lineament directions along E-W and NW-SE. The study also revealed that the Alpine Himalayan orogenic uplift has been responsible for the structural fabric of the south Baluchistan. This deformation is documented in the form of reverse and normal faults.
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3. Al Rawashdeh, S., Bassam, S., Hamzah, M., (2006),The use of Remote Sensing Technology in geological Investigation and mineral detection in El Azraq-Jordan. European Journal of Geography, Systemes, Modelisation, Geostatistiques 2856, PP. 203–219.
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17. ShahidNaseem,, Salma Hamza, Erum Bashir, Syed NayyerAhsan, Shamim Ahmed Sheikh, (2012), Petrography, Geochemistry and Tectonic Setting of Mafic Rocks of Southern Bela Ophiolite, Balochistan, New York Science Journal,5(7), PP.35-38.
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Do spontaneous separation of placenta reduce blood loss during caesarean delivery?
Shivamurthy H M, Durgadas Asaranna, Giridhar S A, Ashwini Konin, Jyotsna R Himgire
Background: Blood loss during a caesarean section is of great concern for the surgeon, especially in an anaemic patient and where facilities are not available for blood transfusion especially at the peripheral hospitals. Also majority of our pregnant women (nearly 80%) are anaemic. Again there is a lot of demand for blood transfusion due to non-comparable conditions like APH, PPH etc which may further lessen the availability of blood for transfusion. Such being the situation the technique of bloodless caesarean proves to be a boon in our setup .So also blood transfusion has its own complications. Objectives: To compare the blood loss after spontaneous separation of placenta with the blood loss associated with manual removal of placenta during caesarean section deliveries. Materials and Methods: In this study, estimation of blood loss in the placental delivery ,was done on 100 consecutive women undergoing caesarean section due to various indications excluding those who are likely to bleed by the virtue of their pathology like APH .Of the 100 cases 50 cases were managed by waiting for placental separation ,and alternative cases were managed by manual removal placenta without waiting for spontaneous separation .The blood loss was assessed by using preweighed cotton mops and weighing them again after the use to mop the blood loss. Care was taken to not allow the mixing of amniotic fluid and all the clots were weighed and computed for the loss of blood (by multiplying the weight of the clot by1.05) Results: Shapiro wilks test showed that the data was normally distributed, thus parametric test was employed. There was a statistical significance between the study and control groups for placental delivery interval, blood loss and drop in Hb levels at p < 0.05. There was no difference in the morbidity levels in study and control groups as shown by the Chi square test p (< 0.05) Conclusion: The spontaneous placental separation and delivery during caesarean section is associated with less blood loss than that of manual removal of placenta.
1. Gahlot Ajay and Suman A; Spontaneous delivery or manual removal of placenta during caesarean section: A randomised trial; the journal of Obstetrics and Gynaecology of India, 2009; 59:127-130.
2. Vincenzo Berghella, Baxter J K, Chauhan S P; Evidence based surgery for caesarean delivery; Am J Obstet Gynecol;2005;193;1607-1617.
3. S.Dehbashi, M honarvar, F H fardi; Manual removal or Spontaneous placental and postcesarean endometritis and bleeding;Int J Gynecol obstet;2004;86;12-15.
4. Michal Morales, Gilles Ceysens, Nicole Jastrow, Caroline Viradot, Gilles Faron, Yvan Vial, Christine Kirkpatrick et al; Spontaneous delivery or manual removal of placenta during caesarean section: A randomised controlled trial; 2004; 111; 908-912.
5. Samir Haider, Taha M Jennane, Sassi Bouguizane, Latifa Lassoued,Mohamed Bibi, Hedi Khairi; The effect of placental removal method at caesarean delivery on peri operative haemorrhage; a randomised clinical trial; Eur J Obstet Gynecol and Reprod Biol;2004;117;179-182.
6. H. Ramadani ; caesarean section intraoperative blood loss and mode of placental saperation; Int J Gynecol obstet;2004;87;114-118.
Issue details
Comparative study of various types of reconstructive procedures in facial and oral malignancies at tertiary care hospital: an observational study
Abdul Rafe Abdul Qadeer, Sharad S Sawant, Vikas Gosavi, P D Gurav
The goal of therapy of patient with oral cavity malignancy is not only to cure the tumour, but also provide rehabilitation and try to preserve or restore some reasonable quality of life. Oral cavity reconstruction is not simply based on closure of the wound. Present study describes the various types of reconstructive procedures undertaken and its outcome in the patients at the tertiary care hospital in Miraj district of Maharashtra during the study period. Total of 52 cases were studied. The procedures done were Primary closure in 11 cases, Split Thickness Skin Graft in 2 cases, Local flaps in 11 cases, Myocutaneous flaps in 23 cases and free flaps in 5 cases. Recipient site morbidity in terms of infection was highest in Pectoralis Major Myocutaneous flaps (22%) followed by local flaps (18%) and free flaps (20%). Incidence of orocutaneous fistula was maximum in Pectoralis Major Myocutaneous flaps (13%) followed by free flap (13.3 %). Overall morbidity in terms of duration of operation, hospital stay, and return to operation theatre for evacuation of hematoma was more in free flaps. There was no peri-operative mortality. Post operative mortality was 5 % mainly due to cardiovascular and respiratory causes. Functional and aesthetic results were excellent in patients of free flap repair as compared to other procedures.
1. George RK, Krishnamurthy A. Microsurgical free flaps: Controversies in maxillofacial reconstruction. Ann Maxillofac Surg 2013;3:72-9 2. Jewer DD, Boyd JB, Manktelow RT, Zuker RM, Rosen IB, Gul-lane PJ, Rotstein LE, Freeman JE (1989) Orofacial and mandibular reconstruction with the iliac crest free flap: a review of 60 cases and a new method of classification. Plast Reconstr Surg 84:391– 403, discussion 404–395 3. Hidalgo DA, Rekow A (1995) A reviews of 60 consecutive fibula free flap mandible reconstructions. Plast Reconstr Surg 96:585–596, discussion 597–602 4. Rosenthal E, Carroll W, Dobbs M, Scott Magnuson J, Wax M, Peters G (2004) Simplifying head and neck microvascular reconstruction. Head Neck 26:930–936 5. Singh B, Cordeiro PG, Santamaria E, Shaha AR, Pfister DG, Shah JP (1999) Factors associated with complications in microvascular reconstruction of head and neck defects. Plast Reconstr Surg 103:403–411 6. Beausang ES, Ang EE, Lipa JE, Irish JC, Brown DH, Gullane PJ, Neligan PC (2003) Microvascular free tissue transfer in elderly patients: the Toronto experience. Head Neck 25:549–553 7. Haughey BH, Wilson E, Kluwe L, Piccirillo J, Fredrickson J, Sessions D, Spector G (2001) Free flap reconstruction of the head and neck: analysis of 241 cases. Otolaryngol Head Neck Surg 125:10–17 8. Suh JD, Sercarz JA, Abemayor E, Calcaterra TC, Rawnsley JD, Alam D, Blackwell KE (2004) Analysis of outcome and complications in 400 cases of microvascular head and neck reconstruction.Arch Otolaryngol Head Neck Surg 130:962–966
Study of various factors associated with septic abortion
Asha Hanamshetty, Sarita M Hattarki
Introduction: Unwanted pregnancy has been a problem of mankind from time immemorial. The WHO has estimated that on the Indian subcontinent 15-24 unsafe abortions take place in every 1000 women aged 15-49, even after 40 years of the implementation of medical termination of pregnancies in India Aims and objective: to study the incidence and various factors associated with septic abortion. Materials and method: The present study was conducted in department of obstetrics and gynecology at Government General Hospital and Sangameshwer Hospital. Gulbarga. All the cases of abortion reported were enrolled in the study. Cases of septic abortion were studied in detail. After stabilization of patients’ detailed history regarding name, age, parity, marital status and gestational period were inquired and record. Results: Out of the total 327 cases of abortion septic abortion was observed in 36 cases thus the incidence of septic abortion was 11.01%. Majority (61.11%) of the patients suffering from septic abortion were 21 to 30 years old. 27.78% were from Urban and 72.22% were from rural area and 72.22% were married. Septic abortion incidence was highest in less than 8 weeks of gestation (47.22%). Incidence of septic abortion was more common among multipara (30.56%), followed by Grand multiparas (27.78%) and nullipara (25%). Conclusion: The incidence of septic abortion in Government General Hospital Gulbarga was 11.01%. Septic abortion was common in younger married women residing in rural area and seen most commonly in first trimester and multi parous women.
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Laparoscopic management of rectal carcinoma
Mitra A S, Memane S S, Chandak U, Ghuge D B
Background: Surgical resection is the mainstay of treatment of rectal cancer with curative intent. Laparoscopic surgery for rectal cancer is much more challenging than that for colon cancer because of the confined space within the pelvis. Further, because of the tumour's location in the pelvis, maintenance of resection margins is of greater concern. Aims and Objectives: To assess the feasibility of a laparoscopic resection for rectal carcinoma with emphasis on perioperative and short-term oncological outcomes. Materials and Methods: It was a hospital based nonrandomised prospective study. From July 2011 to November 2013, 37 patients underwent laparoscopic surgery for the rectal cancer. Results: Total 37 patients were operated for rectal carcinoma, 26 laparoscopic anterior resection and 11 laparoscopic abdominoperineal resection. There were 05 cases of conversion to open surgery and 02 procedures were abandoned. The average operative time was 237.5 minutes. The average hospital stay was 9.7 days. The most common postoperative complication was wound infection in 04 patients. The postoperative mortality was seen in 2 patients. The average number of lymph nodes harvested from specimen was 11. There was only one case of positive distal resection margin. The most common Astler Collar stage and tumour grade was stage B and grade 2. Conclusion: The laparoscopic surgery was safe and feasible for treatment of rectal cancer and associated with shorter hospital stay, less morbidity and reduced blood loss.
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Veldkamp R, Kuhry E, Hop WC, Jeekel J, Kazemier G, Bonjer HJ, Haglind E, Pahlman L, Cuesta MA, Msika S, Morino M, Lacy AM (2005) Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol 6:477–484 8. Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AM, Heath RM, Brown JM (2005) Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet 365:1718–1726 9. Kuhry E, Schwenk W, Gaupset R, Romild U, Bonjer HJ. Longterm results of laparoscopic colorectal cancer resection. Cochrane Database of Systematic Reviews 2008, Issue 2. Art. No.: CD003432. Doi: 10.1002/14651858. 10. Schlachta CM, Mamazza J, Seshadri PA, Cadeddu M, Gregoire R, Poulin EC (2001) Defining a learning curve for laparoscopic resections. Dis Colon Rectum 44:217–222 11. Kurumboor Prakash, D. V. (2010). Lparoscopic colonic resectcion for rectosigmoid colonic tumours: A retrospective analysis and comparision with open resection. Indian J Surg, 318-322. 12. Martijn H G Mvan der Pas, E. H. (2013). Laparoscopic versus open surgery for rectal cancer (COLOR II): short term outcomes of a randomised, phase 3 trial. Lancet oncology, 1-9. 13. Weida Day, P. Y. (2011). Clinical outcome of open and laparoscopic surgery in Dukes B and C rectal cancer: experience from a regional hospital in Hong Kong. Hong Kong Med J, 26-32. 14. Krumboor Prakash, N. P. (july- sept 2013). Does case selection and out come following laproscopic colo-rectal resection change after initial learning curve? Analysis of 235 consecutive elective laproscopic colorectal resection. journal of minimal access surgery, 99-103. 15. Kang SB, Park JW, Jeong SY et al, Open versus laparoscopic surgery for mid or low rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial):short term outcomes of an open label randomized controlled trial.Lancet Oncol.2010;11:637-45 16. Katrine Kanstrup Aslak, O. b. (2012). The implementation of a standardized approach to laproscopic rectal surgery. journal of the society of laproendoscopic surgeons, 264-270. 17. Braga M, Frasson M, Vignali A et al (2005) Laparoscopic vs. open colectomy in cancer patients: long term complications, quality of life, and survival. Dis Colon Rectum 48(12):2217–2223 18. Fleshman J, Sargent DJ, Green E et al (2007) Laparoscopic colectomy for cancer is not inferior to open surgery based on 5- year data from the COST study group trial. Ann Surg 246(4):655–662 19. Patankar SK, Larach SW, Ferrara A, Williamson PR, Gallagher JT, DeJesus S, Narayanan S. Prospective comparison of laparoscopic vs. open resections for colorectal adenocarcinoma over a ten-year period. Dis Colon Rectum 2003; 46: 601-611 20. Jayne DG, Thorpe HC, Copeland J, Quirke P, Brown JM, Guillou PJ. Five-year follow-up of the Medical Research Council CLASICC trial of laparoscopically assisted versus open surgery for colorectal cancer. Br J Surg. 2010; 97 (11): 1638-45. 21. Sonoda T, Pandey S, Trencheva K, Lee S, Milsom J. Longterm complications of hand-assisted versus laparoscopic colectomy. J Am Coll Surg 2009; 208: 62-66 22. COST Study Group (2004) A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 350:2050–2059 23. Jayne DG, Guillou PJ, Thorpe H et al (2007) Randomized trial of laparoscopic-assisted resection of colorectal carcinoma: 3-year results of the UK MRC CLASICC trial group. J Clin Oncol 25:3061–3068 24. 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A comparative study of outcome of caesarean delivery in rural obstetric referrals with elective caesarean delivery
Sowmya M1*, Indranil Dutta2, Vijayalakshmi S
Objectives: To study the obstetric outcome of rural referrals who undergo emergency caesarean delivery versus elective caesarean delivery in a tertiary care hospital in rural scenario and to evaluate the risks and complications associated with it. Methodology: This comparative study was conducted at Rural Medical Hospital in Karnataka, India over a period of 18 months. Among the total of 100 patients who fulfilled the inclusion criteria 50 patients referred to us, who underwent caesarean delivery are emergency group and 50 patients admitted in our hospital who were posted for elective caesarean delivery were the other group in the study period. The various parameters, maternal morbidity, neonatal outcome, morbidity and mortality were compared in both groups using a semi structured Performa. The comparison was done by using Chi-square test and p-value< 0.05was considered statistically significant. Results: During our study period the referred cases constituted of 19.8%. Caesarean delivery rate among referred Cases was 40.7%. Statistically significant association was found between emergency CS and younger patients, low parity, irregular attendance at antenatal clinics, intra operative complications, postoperative morbidity and low Apgar score, NICU admission and also mortality as compared to elective caesarean section group. The commonest indication for caesarean delivery in emergency was obstructed labour (34 %), previous caesarean delivery (36%) being the commonest in elective group. Perinatal mortality was 12.5% Conclusions: The present study has shown that improper intranatal, an emergency care for a pregnant women being responsible for most of the referral cases undergoing caesarean section on emergency which caused increased maternal morbidity and perinatal deaths in our institution. It was concluded that every effort should be directed to effect-planned CS, as determined during the antenatal period, if possible, so as to reduce the various problems associated with emergency CS.
1. Akolekar R, Pandit S N, Rao. B.S., The cesarean Birth FOGSI publications, 1st Edn.,, National Book Depot, reprint 2010; p. 1-3. 2. Cunningham F G, Leveno K J, Bloom S L, Hauth J C,Rouse D J, Spong C Y. Cesarean delivery and peripartum hysterectomy. Williams Obstetrics. 23rd edition. Mc Graw Hill 2010; 544-555. 3. Kambo I, Bedi N, Dhillon B S, Saxena N C. A Critical Apprriasal of Cesarean section rates at teaching hospital in India. International Journal Gynecol and obstet 2002; 79: 151-158. 4. Nuiam L A, Soltan M H, Khashoggi T, Addar M, Chowdhury N, Adelusi B A. Outcome in elective and emergency cesarean sections: A comparative study. Annals of Saudi medicine 1996; 16 (6): 645-649. 5. Limaye H R, Ghadialli M V. Maternal and fetal outcome in obstetric emergency cases referred from rural area and recommendations to improve it. Journal of obstet and gynec of India 1982; 32: 520-529. 6. Gasparovic VE, Pulanic TK, Peter B. Maternal and fetal outcome in elective v/s emergency cesarean section in a developing country, coll. Antropol ; 30 (2006) 1 : 113-118. 7. Cebeku L, Buchmann EJ. Complications associated with cesarean section in second stage of labor. Int J Obstet Gynecol; 2006: 95: 110-114. 8. Neilson TF, Hokegard KH. Post operative cesarean section morbidity. A prospective study. Am J Obstet Gynecol vol 146, no 8 ; 1983 : 911-915. 9. Onkapa B, Ekele B. Fetal outcome following cesarean section in a university teaching hospital. J of National Medical Association, vol 101(6) ; 1999: 10. Sahoo R, Chakladar BK. A Profile of maternity cases admitted in rural maternity and child welfare centres. J Obstet Gynecol India; 1992; 42(1) : 132-138. 11. Gaddi SS, Seetharam S. Study of PMR in Head quarters hospital bellary. J Obstet Gynecol India; 2001 vol 51 (6): 101-103.
Comparative study of PFN and DHS in proximal femoral fractures
Gourishankar D
Introduction: The operative treatment of proximal femoral fractures has been a matter of discussion ever since internal fixation was advocated to prevent the complications of long-term confinement to bed for the elderly. Aims and objective: To compare the Dynamic Hip Screw and the Proximal Femoral Nail method of fixation in intertrochanteric fracture of femur. Materials and method: total 50 cases of intertrochanteric fracture of femur were enrolled in the study. 25 patients were treated by Proximal Femoral Nail method and 25 were treated by Dynamic Hip Screw method. All the patients were observed meticulously intra operatively and post operatively. Duration required for surgery, blood loss and complications were recored. Results: The mean age of the study patients was 64.25years. It was observed that 64% patients in the sturdy were male. In 68% patients cause of fracture was domestic fall. Mean duration of surgery was 58±12 min whereas in DHS group was91±8. Mean blood loss during surgery in PFN group was 100±16ml whereas in the DHS group was 250±50ml. Limb shortening was observed in 10 cases in PFN group whereas 24% in DHS. Nonunion was seen in one case of DHS group. In PFN group infection was seen in 6% patients and 14% in DHS group. Implant failure was seen in one case of PFN group whereas in two cases in DHS group. Death was observed in one cases of DHS group. Conclusion: thus we conclude that the Proximal Femoral Nail method for fixation in intertrochanteric fracture of femur is better as compared to the Dynamic Hip Screw.
1. R.K.J. Simmermacher, A.M. Bosch, Chr. Van der Werken. AO/ASIF–proximal femoral nail (PFN): a new device for the treatment of unstable proximal femoral fractures. Injury, 30 (1999), pp. 327–332 2. M. Saudan, A. Lubbeke, C. Sadowski, et al. Pertrochanteric fractures: is there an advantage to an intramedullary nail? A randomised, prospective study of 206 patients comparing the dynamic hip screw and proximal femoral nail. J Orthop Trauma, 16 (2002), pp. 386–393 3. L. Ahrengart, H. Tornkvist, P. Fornander, et al. A randomised study of the compression hip screw and Gamma nail in 426 fractures. Clin Orthop, 401 (2002), pp. 209–222 4. J.E. Madsen, L. Naess, A.K. Aune, et al. Dynamic hip screw with trochanteric stabilizing plate in the treatment of unstable proximal femoral fractures: a comparative study with the Gamma nail and compression hip screw. J Orthop Trauma, 12 (1998), pp. 241–248 5. G. Al Yassari, R.J. Langstaff, J.W. Jones, M. Al Lami. The AO/ASIF proximal femoral nail (PFN) for the treatment of unstable trochanteric femoral fracture. Injury, 33 (2002), pp. 395–399 6. H. Banan, A. Al Sabti, T. Jimulia, A.J. Hart. The treatment of unstable, extracapsular hip fractures with the AO/ASIF proximal femoral nail (PFN)–our first 60 cases. Injury, 33 (2002), pp. 401–405 7. W. Friedl, J. Clausen. Experimental examination for optimised stabilisation of trochanteric femur fractures, intra or extramedullary implant localisation and influence of femur neck component profile on cut-out risk. Chirurg, 71 (2001), pp. 1344–1352 8. PFNA. Leading the way to optimal stability: Synthes. Original instruments and implants of the Association for the Study of Internal Fixation. AO/ASIF. Stratec Medical 2004;1–44. 9. Kyle RF, Wright TM, Burstein AH. Biomechanical analysis of the sliding characteristics of compression hip screws. J Bone Joint Surg Am. 1980;62:1308e1314. 10. Hardy D, Descamps P, Krallis P, et al. Use of an intramedullary hip screw compared with a compression hip screw with a plate for intertrochanteric femoral fractures. A prospective randomized study of one hundred patients. J Bone Joint Surg Am. 1998;80:618e630. 11. Boyd HB, Griffin LL. Classification & treatment of intertrochanteric fractures. Arch Surg. 1949;58:853e866. 12. Jensen JS, Michaelsen M. Trochanteric fractures treated with McLaughlin plate. Acta Ortho Scand. 1975;46:795e803.
Palynological studies of tertiary sediments of west coast of India to decipher provenance and environment of deposition
R A Suryawanshi
Tertiary sediments are deposited along the west coast in study area on basalt and covered by laterite. These sediments include carbonaceous shale, lignite and sandstone, which are rich in micro fossils and pollens. The Fungal remains, Pteridophyte spores and Angiosperm pollens are studied. The modern equivalents of these fossil pollen and spores are presently found in diversified ecologic habitats ranging from deltaic to fresh water swamps and low altitude ever green to open forests. Ecological distribution of the modern equivalents of these micro fossils indicates deltaic to swampy depositional environment. The source of pollen and lignite coal is in the Western Ghats and source rock is basalt for shale and sandstone.
1. Couper R.A. (1953) Upper Mesozoic and Cainozoic Spores and Pollen Grains from New Zealand. New Zeal. Geol. Surv. Palaeontol. Bull 22: pp. 1 - 77. 2. Dilcher D.L., (1965) Epiphyllous Fungi from Eocene Deposits in Western Tennessee, U.S.A. Palaeontographica 116 B: pp. 1-54. 3. Mittre, V., (1961) Contacts of Palynology. Bull. Nat. Inst. Sci. India No. 19 pp. 2 - 14. 4. Nair, P.K.K., (1960 a) Palynology in India - A Review Ibid 2: pp. 51 - 53. 5. Phadtare, N.R., (1982) Floristic Studies on the Lignitic Beds of Ratnagiri District, Ph.D. Thesis, Univ. of Bombay, p. 275. 6. Phadtare, N.R. and Kulkarni, A.R., (1980) Palynological Investigation on Ratnagiri Lignite, Maharashtra. Geophytol. 10, pp. 158 - 170. 7. Phadtare, N.R. and Kulkarni, A.R., (1984) Affinity of the Genus Quilonipollenites with the Malasia Palm Eugeissona Griffith. Pollen at Spores, 26, pp. 217 - 226. 8. Potonie, R., (1960) Synopsis der Guttungen Sporae - Dispersae III, Beih. Geol. Jb., 39,pp. 1 – 189 9. Rao, K.P. and Ramanujam, C.G.K., (1976) A palynological Approach to the study of Quilon Beds of Kerala State in South India. Curr. Sci. 44, 730 - 732. 10. K.P. and Ramanujam, C.G.K., (1976) A palynological Approach to the study of Quilon Beds of Kerala State in South India. Curr. Sci. 44, 730 - 732. 11. Sah, S.C.D. and Kar, R.K.f (1969) Palynology of the Laki Sediments in Kutch - 3: Pollen from the Boreholes around Jhulrai, Barancla and Panandhro. Paleobotanist., 18, pp. 127 - 141. 12. Sahani, B., (1948) The Prospects of Palynology in India, Svensk. hot. Tidskr. V, 42, pp. 474 - 477. 13. Srivastavan, S.K., (1962) Palynology A Gift of Flowers, Sci. Cult. V. 28, pp. 265 - 269. 14. Suryawanshi R.A.(1995) Sedimentological and related studies of tertiary sediments exposed along the coast Dist. Ratnagiri Maharashtra Ph.D Thesis submitted to Shivaji University Kolhapur pp 207 15. Suryawanshi R.A.(2014) Use of microfossile to decipher the paleo-environment of tertiary sediments of Ratnagiri,Maharashtra,India 16. Venkatachala, B.S. and Kar, R.K., (1985) Palynology of the Tertiary Sediments of Kutch - 1: Spores and Pollen from Bore Hole No. 14, Palaeobotanist, 17, pp. 157 - 178. 17. Venkatachala, B.S. and Rawat. M.S., (1972) Palynology of the Tertiary Sediments in the Cauvery Basin - I Palaeocene - Eocene Palynoflora from the subsurface Proc.Sem. Palaeopalynol Indian Stratigr, Calcutta, pp. 292 – 335.
A study of Clinicopathological aspects of Pilonidal Sinus
Anilkumar M Talwade, Sanjay Baswaraj Chanda
Introduction: Pilonidal Sinus is a painful condition usually occurring in the intergluteal region, which consists of a Sinus or fistula, situated a short distance behind the anus and generally containing hair. Pilonidal Sinus has its peak incidence between 16-20 years of age and it decreases after age of 25 years it is rare after 45 years. Pilonidal Sinus occurs predominantly in men 80%. All races can develop the disease, but it seems more common in those with dark, stiff hair and hirsute individuals. However, Pilonidal Sinus can also occur in relatively hairless types. Aims and objective: to study the Clinicopathological aspects of Pilonidal Sinus. Materials and Method: In the present cross sectional study 30 patients of pilonidal sinus were enrolled. Detail history containing age, sex and occupation of the all the patients was noted in prestructured proforma. The main presenting symptoms were also noted. Routine general physical examination was done with special attention towards body hair distribution. On local examination site of the Pilonidal Sinus was confirmed, number of sinuses, presence of tenderness, discharge, any hair protruding from the sinuses and the condition of the surrounding area for indurations was examined. All patients also underwent digital rectal examination and proctoscopy. Results: 56.66% of patients were between 16-25 yrs of age. 70% were males. Labourers form the most common group constituting 40% of our patients followed by students. 24 (83.33%) of our patients were hairy individuals of which 18 were males and only 6 patients were hairy females. Discharge was the most common symptoms in the study being present in all patients. It was followed by pain (56.67%). Most common presentation being swelling and discharge from intergluteal region present in 20 (66.66%) of patients. Sinus was present in all patients (100%) and some form of discharge was seen in 86.7% patients. Conclusion: thus we conclude that pilonidal sinus is often very painful and associated with discharge and typically occurs in young hairy males.
1. Keighley MRB. Pilonidal sinus In: Keighley MRB, Williams N, and editors. Surgery of the anus rectum and colon. 2nd edition. London: W B Saunders: 1999; P.539-63. 2. Guyuron B, Dinner MI, Dowden RV. Excision and grafting in treatment of recurrent pilonidal deisease. Surg. Gynecol Obstet 1983; 156: 201-4. 3. Sondenaa K, Andersen E, Nesvik I, et al. Patient characteristics and symptoms in chronic pilonidal sinus disease. Int J Colorectal Dis 1995; 10: 39-42. 4. Patel MR, Bassini L, Nashad R, et al. Barber’s interdigital pilonidal sinus of the hand: a foreign body hair granuloma. J Hand Surg. 1990; 15A: 652-5. 5. Templeton HJ. Foreign body granuloma or interdigital cysts with hair formation. Arch Dermatol Syph 1942, 46: 157-8. 6. Matherson AD. Interdigital pilonidal sinus caused by wool. Aust N.Z.J Surg 1951; 21: 76-7. 7. Philips PJ. Web space sinus in a shearer. Med J Awist 1966; 2: 1152-3. 8. Meneghini CL. Gianotti F. Granulomatosis fistulosa interdigitalis of milkers hands Dermatologia 1964, 128; 38-50. 9. Mohanna PN. Al-Sam SZ, Flemming AFS Subungual Pilonidal Sinus of the hand of a dog groomers Br J Plas Surg 2001; 54: 176-8. 10. Allegaert WJ. Pilonidal sinus of the umbilicus. Br J Clin Pract 1967; 21: 201. 11. Sagger RP Pilonidal disease of the chestwall J Ir Med Assoc. 1967; 60: 125-7. 12. Wilson E. Failes DG, Killingback M. Pilonidal sinus of the anal canal: report of a case Dis Colon Rectum 1971; 14: 468-70. 13. Woodward WW. A pilonidal sinus of the ear. Aust N Z J Surg 1965; 35: 72-3. 14. Moyer DG Pilonida cyst of the scalp. Arch Demnatol 1972; 105: 578-9. 15. Akinici OF, Coskum A, Uzunkoy A. Simple and effective surgical treatment of pilonidal sinus: asymmetric excision and primary closure using suction drain and subcuticular skin closure. Dis Colon Rectumd 2000; 43: 701-7. 16. Kooistra HP. Pilonidal sinusesl review of the literature and report of three hundred and fifty cases. AM J Surg 1942; 55: 3.
Comparison of surgically induced astigmatism (SIA) and postoperative astigmatism with superior, superotemporal and temporal incisions in phacoemulsification surgery
Snehal P Gade, Bhaskar S Khaire
Introduction: Cataract is defined as any opacity of lens or capsule which is either developmental or acquired. Cataract surgery is the commonest procedure performed in ophthalmology. Astigmatism prevention and control is one of the biggest challenges for a surgeon after cataract surgery. Since postoperative astigmatism is the major determinant of visual outcome, a comparative study is essential to ascertain the difference in induced astigmatism, if any between different sites of incision in Phacoemulsification keeping the size of incision same. Aims and Objectives: To compare postoperative astigmatism and surgically induced astigmatism (SIA) with superior, superotemporal and temporal incisions in phacoemulsification surgery. Materials and Method: This prospective study comprised of 150 patients of cataract operated by using phacoemulsification using superior, superotemporal and temporal incisions. All the patients were divided in three groups containing 50 patients each depending upon the type of incision used. The outcome measures were post operative and surgically induced astigmatism (SIA) post operatively. Results: The pre-operative astigmatism in all three groups was measured it was in the range of 0 to 1.5D with no statistical significant difference. Majority of the patients were having post operative astigmatism between 0.75 to 1.25D. i.e. 44% in group A, 60% in group B and 58% in group C. Surgically induced astigmatism less than 0.75D in group A was seen in 78% patients whereas in group B was 92% and in group C was 90%. According to the Tukey’s multiple comparison test, post operative and surgically induced astigmatism was statically significant in group A and C. Whereas the difference in group A and B and group B and C was not significant. Conclusion: temporal and superotemporal incision leads to significantly less amount of mean post-operative astigmatism as well as Surgically Induced Astigmatism (SIA) as compared to superior incision.
1. Stedman’s Concise Medical Dictionary illuatrated, 2nd edition. Philadelphia. Wiliams and Wilkins. 1994 2. Revised by Sihota R, Tandon R. Parson’s Diseases of the Eye, 19th edition. New Delhi. Butterworth-Heinemann. An Imprint of Elsevier; 2003 3. Gogate P.Comparison of various techniques for cataract surgery, their efficacy, safety, and cost.Oman J Ophthalmol 2010; 3:105-6. 4. Albert Jakobeics : principle and practice of Ophthalmology ; Vol 2 ;2nd edition WB Saunders company:1500-1550 5. Jaffe NS, Jaffe MS, Jaffe GF. Cataract surgery and its complications. Sixth edition. St. Louis, Missouri: Mosby-Year Book; 1997. 6. Kershner RM. Refractive cataract surgery. Curr Opin Ophthalmol. 1998 Feb; 9 (1):46-54. 7. http://www.insighteyeclinic.in/SIA_calculator.php ‘The SIA Calculator version 2.1’, a free software programme approved by All India Ophthalmological Society (AIOS). 8. Pakravan M, Nikkhah H, Yazdani S, Shahabi C, Sedigh-Rahimabadi M. Astigmatic Outcomes of Temporal versus Nasal Clear Corneal Phacoemulsification. J OphthalmicVis Res. 2009 Apr; 4(2):79-83. 9. Kohnen S, Neuber R, Kohnen T. Effect of temporal and nasal unsutured limbal tunnel incisions on induced astigmatism after phacoemulsification. J Cataract Refract Surg. 2002; 28:821–825. 10. Marek R, Kluś A, Pawlik R. Comparison of surgically induced astigmatism oftemporal versus superior clear corneal incisions. Klin Oczna.2006; 108(10-12):392-6. 11. Iftikhar S, Bashir R, Naeem BA, Abrar R, Jaffri RH and Sarmad A. Comparison of surgically induced astigmatism in phacoemulsification with 5.5 mm superior vs. temporal incision. Al-Shifa Journal of Ophthalmology 2007; 3(1): 9-14. 12. Simşek S, Yaşar T, Demirok A, Cinal A, Yilmaz OF. Effect of superior and temporal clear corneal incisions on astigmatism after sutureless phacoemulsification. J Cataract Refract Surg. 1998 Apr; 24(4):515-8.
Surgical and functional outcome of lateral canthal tarsorrhaphy in unilateral paralytic lagophthalmos
Kavita A Dhabarde, A H Madan
Ten patients having unilateral infranuclear 7th nerve palsy with lagophthalmos of different age group and different aetiology underwent lateral canthal tarsorrhaphy to prevent progression of and treatment of severe exposure keratitis in tertiary eye care centre at Govt. Medical College and Hospital, Nagpur. Patients were advised local lubricants, antibiotics. Nearly all pts showed improvement in lid closure, epiphora and keratitis. Lat. tarsorrhaphy supported the lower lid with not much cosmetic disfigurement of the eyeball. Only in a single case the ulcer perforated. Lateral tarsorrhaphy is a good option for poor patients having infranuclear Bell’s palsy with severe exposure keratitis who cannot afford to go for temporalis transplant.
1. Tan ST et al, Gold weight implantation andlateral tarsorrhaphy for upper eyelid paralysis. J. Craniomaxillofac. Surg. 2013; Apr. 41(3): e49 -53. 2. Panda A et al, Lateral Tarsorrhaphy – is it preferable to patching? Cornea 1999 May; 18(3): 299 – 301. 3. Rosenthal P Cotter JM et al, Treatment of persistent corneal epithelial defect with extended wear of a fluid ventilated gas permeable scleral contact lence. AMJ. Ophthalmol. 2000 Jul 130(1): 33 – 41. 4. Cosar CB et al, Tarsorrhaphy clinical experience from a cornea practice. Cornea 2001 Nov; 20(8) 787 – 91. 5. Pushker N Dada et al, Neurotrophic Keratopathy. CLAO J 2001 April; 27(2); 100 – 7. 6. De Silve DJ et al, Surgical technique: modified lateral tarsorrhaphy. Ophthal plast. Reconstr. Surg. 2001 May – June 27 (3) 216 – 8. 7. Gire et al, PROSE treat for lagoph. And expo. Keratopathy ophth. Plast reconst. Surg. 2013 Mar – Apr: 29(2).
Comparative study of serum and aqueous humour electrolyte levels in cataract patients
Tasneem A F, Shwetha B A, Mamata N
Background and Objectives: There are about 50 million blind people in the world, a third of them being due to cataract. In India alone, cataract accounts for 80% of treatable blindness. Many factors such as ageing, altered blood electrolyte levels, nutrition and family history are involved in cataractogenesis. Aim: Comparative study of serum and aqueous humour levels in cataract patients. Objectives are to compare serum Na+, K+, Ca+2 and PO4 -3 levels with that of aqueous humour levels in patients with cataract and to establish a correlation between altered serum and aqueous humour electrolyte levels with the type of cataract. Methods: The study undertaken includes a total of one hundred cataract patients who visited VIMS and RC, White field, Bangalore between January 2012 and June 2013. It considered cataract patients of both sexes above the age of 40 years and excluded patients with any systemic disease, past ocular disease, or any drug intake known to cause electrolyte changes in the body. The patients were all routinely subjected to a detailed ocular examination including visual acuity, slit lamp examination to stage the type of cataract, fundoscopy, intraocular pressure recording. Serum and aqueous humour samples were collected intraoperatively in cataract patients and sent for Na+, K+, Ca+2 and PO4 -3 level measurement by Beckman Coulter Unicel DxC 600 and Synchron CX5PRO.The serum and aqueous humour electrolyte levels were compared with each other. Results: The aqueous humour, though a secretion of serum; shows a considerable difference in the electrolyte levels as compare to serum which is statistically significant (p<0.001). Conclusion: Aqueous sodium levels as compared to serum sodium levels were higher in patients with cataract. Aqueous potassium, calcium, phosphate levels were low compared to serum levels. Aqueous levels of potassium in cataract patients (50 % of cases) were raised when compared to normal aqueous levels.
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A rare case of uterine didelphys
Sudha R, Sunanda N, Babitha M C
Uterus didelphys is one of the congenital uterine anomalies due to defective medial fusion of Mullerian ducts. Often remains asymptomatic and hence undetected. Women with congenital uterine alformation usually have higher incidence of complications during pregnancy and delivery. Although pregnancies can occur in patients with Mullerian duct anomalies, most of them have been linked to infertility, recurrent pregnancy loss, pre term deliveries, fetal mal-presentations and other obstetrics complications, making successful pregnancy outcome a rare situation in this condition. We report a case of successful pregnancy outcome in a case of uterus didelphys bicollis. A 25year old P2L2 with 2 previous LSCS, failed LS, with 2 months of amenorrhea, continued her pregnancy till term and underwent cesarean section with concurrent sterilization.
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Study of incidence of ischemic stroke due to intracranial, extracranial and combined vascular lesions and associated risk factors
Anjali Deshmukh, Sanjiv Zangde
Introduction: Ischemic Cerebrovascular disease (ischaemic stroke) is a leading public health problem. Stroke is defined as an abrupt neurologic deficit that is attributable to focal vascular cause. Risk factors for stroke include hypertension, carotid stenosis, atrial myxomas, smoking, hyperlipidemia, diabetes, myocardial infarction and atrial fibrillation. Aims and objectives: To study the incidence of ischaemic stroke due to intracranial, extracranial and combined vascular lesions. Material and Method: in the present study 104 cases of ischemic stroke were included in the study. All these patients were studied clinically and radiologically to study the nature of lesion (intracranial or extracranial vascular lesion). Neuroimaging- MRI-Brain or CT-Brain was done in each patient to see site of infarct. Results: It was observed that out of 104 patients included in our study, 28.84% patients were having intracranial vascular lesion, 31.73% patients were having extracranial vascular lesion and 7.69% patients were having combined intracranial and extracranial vascular lesions. 31.73% patients were having normal angiographic study. Incidence of stroke increases with increasing age and has male preponderance. Hypertension was found in 76.92% of total patients. 41.35% of patients in our study were having diabetes mellitus. History of smoking was observed in 33.65% of patients. Conclusion: The incidence of stroke due to intracranial, extracranial and combined vascular lesion was 28.84%, 31.73% and 7.69% respectively. Increasing age, male sex, HTN, DM, IHD, past history of stroke and smoking were important risk factors for ischaemic strokes.
1. Harold P Adams, John W Norris. Ischemic cerebrovascular disease, CNS Series 2003; 1-46. 2. Feigin VL, Wiebers DO, Nikitin YP, O’Fallon WM, Whisnant JP. Risk factors for ischemic stroke in a Russian community: a population based case control Study. Stroke 1998; 29: 34-39. 3. P.M. Dalal. Cerebrovascular Disorders, API Textbook of Medicine, 7th Edition, Association of Physician of India, 2003; 796-798. 4. Charles Warlow. Stroke, transient ischaemic attack and intracranial venous thrombosis: Brain’s Disease of the nervous system.11th edition, Oxford University Press, 2001; 776-830. 5. Wade S Smith, S. Claiborn Johnston, J. Donald Easton. Cerebrovascular Disease, Harrison’s Principles of Internal Medicine 16th Edition, McGraw Hill Medical Publications, 2005; 2372-2387. 6. Brown RD, Whishant JP, Sicks RD, O’fallom WM, Weibers DO, Stroke incidence, prevalence and surviv al: secular trends in Rochester, Minnesota. Stroke 1996; 27: 373-380. 7. Wolf PA, D’Agostino RB, O’Neal MA, Sytkowski P, Kase CS, Belanger AJ et al, secular trends in stroke incidence and mortality: The Framingham study. Stroke.1992; 23:1551-1555. 8. Varadlaxmi EA, Kaul S, Murthy JMK, Ramamurthy A. Frequency, risk factor and distribution of intracranial large artey lesions in patients with ischaemic stroke. Annals of Indian Academy of Neurology 1999;2:37. 9. Liu HM, Yong KT, Yip PK et al. Evaluation of intracranial and extracranial carotid steno-occlusive diseases in Taiwan, Chinese patients with MR angio. Stroke 1996; 27:650-653. 10. Farhad Iranmanesh, Farahmand H, Gadari F et al. Doppler sonography of extracranial and intracranial vessels in patients with throbotic stroke; Journal of Research in Med sciences, 2006: vol.11. 11. Uddin MJ et al. Association of lipid profile with ischaemic stroke; Mymensingh Med J; Jul 2009; 18(2): 131-5. 12. Ralph LS, Benjamin EJ, Broderick JP, Easton JD, Goldstein LB, Gorelick PB et al. Public health burden of stroke; Stroke 1997; 28:1507-1517. 13. Yip PK, Jend JS, Lee TK, Chang YK, Huang ZS et al. subtypes of ischaemic strokes: A hospital based stroke registry in Taiwan. Stroke Dec 1997; 25(12):2507-12. 14. Srivastava A, Padma MV, Jain S, Maheshwari MC. Risk factor analysis and genetic influences of stroke: A case control study; Annal Ind Ac Neurol, vol2: suppl1:123. 15. Berne JD, Renauld KS, Villareal DH, Mc Govern TM, Roue SA, Norwood SH et al. Sixteen slice multi-detector computed tomographic angiography improves accuracy of screening for blunt CVA. J Trauma 2006; 60:1204-9, discussion 1209-10. 16. Rincon F. Incidence and risk factors of intracranial atherosclerotic stroke: The Northern Manhatten study. Cerebrovasc Dis. Jan 2009; 28(1) 65-71. 17. Wolf PA, Abott RD, Kannel WB et al IHD- an independent risk factor for stoke: Th Framingham study. Stroke 1991; 22:983-988. 18. Katzan L Iron. Antiplatelet agents in secondary stroke prevention; cleavland clinic centre for continuing education.(updated on 20 Feb 2012). 19. Burn J, Dennis M, Banford J, Sandercock P, Wade D et al. Long term risk of recurrent stroke after a firs ever stroke: The Oxfordshire community stroke project; Stroke 1994 Feb; 25(2):333-7. 20. Shinton R, Beevers G. Meta-analysis of relation between cigarette smoking and stroke. BMJ 1989; 298: 789-794. 21. Sacco RL, Kargman D, Gu Q, Zamanillo MC; Race-ethnicity and determinants of intracranial atherosclerotic cerebral infarction: the Northern Manhattan Stroke Study; Stroke 1995: 26( 1):14–20. 22. Caplan LR, Gorelick PB, Hier DB. Race, sex and occlusive cerebrovascular disease: a review; Stroke 1986: 17(4): 648–655.
Computed tomographic prevalence of intracranial calcification of pineal gland in apparently normal individuals
M S Ugale, P R Kulkarni, R G Surwase, G M Ugale
Introduction: This study was undertaken to know the prevalence of pineal calcification in normal individuals of south central Maharashtra with the objective to study the age related variation, the sexual variations in the prevalence of normal pineal gland calcification. It increased from 2.22% in the first decade to 57.5% in seventh decade with statistically significant rise from 13.33% to 26.66% from second to third decade. Considering the process of calcification, endocrine activity of pineal gland and the significant rise in the prevalence of calcification after second decade, it was concluded that secretions of pineal gland may influence sexual hormone and the gland is more active in second and third decade of life.
1. Daghighi MH, Rezaei V, Zarrintan S, Pourfathi H. Intracranial physiological calcifications in adults on computed tomography in Tabriz, Iran. Folia Morphol 2007;66:115–119 2. Sutton D “textbook and Radiology and imaging†in “the normal skullâ€, 4th edition, Churchill Livingstone, London, pp-1452(1975). 3. Sculler A, “Roentgen diagnosis of diseases of head†C. V. Mosby Co. St Louis. P. 156 4. Adeloye A. and Felson B: Incidence of normal pineal gland calcification in skull roentgenograms of black and white Americans, American journal of Roentgenology Radiography, 1974; 122:503. 5. Schey WL: Intracranial calcification in childhood frequency of occurrence and significance, American journal of Roentgenology Radiotherapy, 1974; 122:495. 6. Lukaszyk A, Reiter R J: Histophysiological evidence for the secretion of polypeptides by the pineal gland, American Journal of Anatomy, 1975; 143:451-464. 7. Haga JR, Alfidi RJ: Computed tomography of whole body†in normal axial anatomy of the brain –CT correlation,2 nd edition vol 1, C.V. Mosy co. St. Louis, pp43-44(1988). 8. Kolhi N, Rastogi H, Bhadury S, Tandon V: Computed tomographic evaluation of pineal calcification, Indian journal of medical research (B), 1992; 96: 139-142. 9. Srivastava VK, Prusty GK: Physiological calcification in skull, Indian Journal of radiology and Imaging, 1986; 40: 273-275. 10. Zimmerman RA, Biknuik LT: Age related incidence of pineal calcification detected by computed tomography, Radiology, 1982; 142: 659-662. 11. Hard wood –Nash D C, “Neuroradiology in infants and childrens†Vol. -2,C.V. Mosby Co.St Louis,PP484-486(1976)
A study of etiological factors in ascities - a cross sectional study
Bindu C B, Uday B Nayak, Sydney D Souza
Introduction: Ascites is a known complication in cirrhosis of liver and ascites can develop in many other conditions in adults like cardiac, infectious, autoimmune, renal, malnutrition and many others clinical conditions. Ascites along with abdominal distension presents with other salient features depending on the etiology. This study was focused on evaluating variuos aetiological facors involved in ascites. Methods and Materials: It was a cross sectional study done among 60 patients with ascites in K M C Hospital Mangalore from September 2006 to September 2008. Patients were clinically assessed and subjected to various biochemical tests of blood and ascitic fluid. Results: Among the 60 patients of ascites majority of the patients are males85% probably related to alcohol, and cirrhosis of liver was the leading cause for ascites66.7% followed by HBV infection10% and tubercular peritonitis8.3% and nearly33.3% were of the age group between 40 to 50years. In our study anorexia and pain abdomen were common presenting symptom along with distension of abdomen and pedal oedema was seen in 88.3% of patient’s pallor and spleenomegaly are the other common signs. Conclusions: Cirrhosis was the common aetiology for ascites when compared to other causes probably seen in chronic alcoholics as it is shown in our study that males in mid age group are more affected.
1. Runyon B.A., "Approach to the patient with ascites", Chapter in Text book of gastroenterology, Newyork J.P. Lippincott. Third Ed. 1999; 966-991. 2. Runyon B.A, 1994: Care of patients with ascites. N. Engi. J. Med. 330; 337-341. 3. Ayroyo V, Gene's P et al. "Pathogenesis, diagnosis and treatment of ascites in cirrhosis". A chapter in Oxford text book of clinical hepatology. New York, Oxford Medical Publications Second Ed. 1999; 697-728. 4. Runyon B.A. "Ascites and spontaneous bacterial peritonitis, Sleizenger/ Fortran gastrointestinal disease", W.B. Saunders, 5th Edition, 1977-99. 5. G.ines P. Quintero E., Arroyo V. et al. 1987: "Compensated cirrhosis: Natural history and prognostic factors". Hepatology. 7: 122-8. 6. Sherlock S., James Dooly. "Hepatic cirrhosis" Chapter in disease of liver and biliary system. London. Blackwell scientific publications. 910 edition, pp. 371-382. 7. Schenker S., Montalvo R. 1997: "Alcoholic liver disease"; Current Opinion in Gastroenterology. 13: 235-247. 8. Bhusnurmath S.R. 1994: "Budd-Chiari syndrome: Current concepts". Indian J. Gastroenterology. 13(1): 9-12. 9. Press O.W. Press N.O. 1992: "Evaluation and management of chylous ascites". Ann. of Internal Medicine. 96: 358-364. 10. Jain A.P., Sharat Chandra; Gupta S. et al.1999. "Spontaneous bacterial peritonitis in liver cirrhosis with ascites". JAPI, Vol. 47, No.6, 619-620. 11. Rector, W.G., and Reynolds, T.B. 1984:"Superiority of serum-ascites albumin difference over the ascites total protein concentration in separation of "Transudative" and "Exudative" ascite". Am. J. Med. 77: 83. 12. Saunders J.B., Walters J.R., Davices J. 1981 "A 20-years prospective study of cirrhosis". BMJ. 282: 263-266
Study of awareness about diabetes mellitus among undergraduate medical students
Rashmi Amans Flora Nazareth, Arunachalam R, Sudeep K
Introduction: Diabetes mellitus (DM) causes significant morbidity and mortality. The importance of proper diagnosis and management of this non communicable disease is being increasingly recognized. This study was conducted to assess the knowledge about DM among medical students who are the future health care providers. Materials and Methods: The data was collected from a questionnaire filled by medical students studying in Final year MBBS and internship in Father Muller Medical College Hospital, Mangalore. Results: From this study it was found that 81.25% of the interns and 78.75% of the final year students were aware of the classical symptoms of DM. The interns (65.4%) were more knowledgeable than the final year students (48.3%) about the biochemical parameters. The awareness about diabetic ketoacidosis (DKA) and its management was poor. Conclusion: There were gaps in knowledge of both the final year students and interns. Education programs teaching in detail about diabetes mellitus, its complications and management are needed to be incorporated more effectively in the medical curriculum.
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. Shaw JE, Sicree RA, Zimmet PZ. Global estimates of the prevalence of diabetes for 2010 and 2030. Diabetes Res Clin Pract 2010 ; 87: 4-14. 3. Singh H, Thangaraju P, Kumar S, Aravindan U, Balasubramanian H, Selvan T. Knowledge and Awareness of Diabetes and Diabetic Ketoacidosis (DKA) Among Medical Students in a Tertiary Teaching Hospital: An Observational Study. J Clin Diagn Res 2014; 8 : 4-6. 4. Wadaani, FA Al. "The knowledge attitude and practice regarding diabetes and diabetic retinopathy among the final year medical students of King Faisal University Medical College of Al Hasa region of Saudi Arabia: A cross sectional survey." Nigerian journal of clinical practice 2013; 16: 164-8. 5. Derr R L, Sivanandy M S, Bronich L, Rodriguez A. Insulin-Related Knowledge Among Health Care Professionals in Internal Medicine. Diabetes Spectrum July 2007; 20: 177-85. 6. Lansang M C, Harell H. Knowledge on inpatient Diabetes among Fourth-year medical Students May 2007; 30: 1088-91.
Metabolic syndrome in an adult population of rural Karnataka
Vanitha Gowda M N, Krishnamurthy U, Shalini C N, Pruthvish S, Shalini P, Dinesh R6, Murthy N S
Background: Metabolic syndrome is a group of abnormalities that confers an increased risk of developing atherosclerotic cardiovascular diseases and type 2 diabetes mellitus. Aim: To determine the prevalence of metabolic syndrome in adults aged ≥18 years in a rural population, to find the prevalence of various risk factors of metabolic syndrome and to determine the factors significantly contributing to metabolic syndrome in the same population. Materials and Methods: A cross-sectional study was undertaken in Jangamsheegehally village of Chintamani taluk in Karnataka. A detailed personal and clinical history, blood pressure, anthropometric measurements were recorded and a fasting blood sample was drawn from each of the 188 subjects. The serum samples were analyzed for Fasting Blood Sugar and lipid profile. Results: the prevalence of metabolic syndrome in adults aged ≥18 years, using the updated AHA/NHLBI statement criteria was 42 (22.3%). At least one metabolic abnormality was seen in 87.23% subjects (90% of females and 84% of the males). The commonest abnormality in females was low HDL (79%), Central obesity (29%) and hyperglycemia (12%). In males, low HDL (67%) was also the most common abnormality followed by high triglycerides (40.9%) and hyperglycemia (18.1%). The most significant independent risk factors for developing metabolic syndrome were found to be Hypertriglyceridemia (OR 21.07, CI 8.48-52.35, p<0.001), Low HDL levels (OR 20.71, CI 1.78- 101.0, p= 0.001) and Central obesity (OR 15.75, CI 7.40-38.69, p<0.001). Conclusion: The prevalence of metabolic syndrome was highest in the age group of 31-40 years with low HDL levels, hypertriglyceridemia and central obesity being independent risk factors. Efforts should be aimed at educating the rural masses regarding lifestyle modifications including suggestions on improving eating habits, the importance of a regular exercise regimen, social support and stress management strategies in order to alleviate the metabolic abnormalities that could increase the risk of Metabolic syndrome.
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Circulation. 2002; 106:3143–3421. 5. Kahn R, Buse J, Ferrannini E, Stern M. The Metabolic Syndrome: Time for a Critical Appraisal Joint statement from the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care 2005; 28:2289-304. 6. Grundy SM, Cleeman JI, Daniels SR, Donato KA, Eckel RH, Franklin BA, Gordon DJ, Krauss RM, Savage PJ,Smith SC Jr, Spertus JA, Costa F; American Heart Association; National Heart, Lung, and Blood Institute. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung and Blood Institute Scientific Statement. Circulation 2005; 112: 2735-2752 7. International Diabetes Federation. Worldwide definition of the metabolic syndrome Available at: http://www.idf.org/webdata/docs/IDF_ Metasyndrome_ definition.pdf. Accessed June 11, 2011 8. Alberti KG, Eckel RH, Grundy SM, Zimmet PZ, Cleeman JI, Donato KA, Fruchart JC, James WP, Loria CM, Smith SC Jr; International Diabetes Federation Task Force on Epidemiology and Prevention; Hational Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; International Association for the Study of Obesity. Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation. 2009 Oct 20; 120(16):1640-1645. 9. Misra A, Wasir JS, Pandey RM. An Evaluation of candidate definitions of the Metabolic syndrome in adult Asian Indians. Diabetes Care, 2005; 28:398–403. 10. Kanjilal S, Shanker J, Rao VS, Khadrinarasimhaih NB, Mukherjee M, Iyengar SS, Kakkar VV. Prevalence and component analysis of metabolic syndrome: An Indian atherosclerosis research study perspective. Vascular Health and Risk Management 2008:4(1) 189–197. 11. Sawant A, Mankeshwar R, Shah S, Raghavan R, Dhongde G, Raje H et al. Prevalence of Metabolic Syndrome in Urban India. Cholesterol. 2011; 2011: 920983, 7 pages. 12. Prasad DS, Kabir Z, Dash AK, Das BC. Prevalence and risk factors for metabolic syndrome in Asian Indians: A community study from urban Eastern India. J Cardiovasc Dis Res. 2012 Jul;3(3):204-211. 13. Beigh SH, Jain S. Prevalence of metabolic syndrome and gender differences. 2012; Bioinformation 8(13): 613-616. 14. WHO Monica Project http://www.ktl.fi/publications/monica/manual/index.htm Monica Manual Section 2, Part III. {internet},1998.Available:URL:http://www.thl.fi/publications/monica/monograph_cd/docs/manual/part3/iii-2.htm#s3 (Accessed Feb 13, 2014). 15. Shah B, Mathur P. Surveillance of cardiovascular disease risk factors in India: The need and scope. Indian J Med Res 132, November 2010, 634-642 16. P Malhotra, Savita Kumari, S Singh, S Varma. Isolated Lipid Abnormalities in Rural and Urban Normotensive and Hypertensive North-West Indians. Journal of Association of Physicians of India 2003; 51, 459-63. 17. Tietz Textbook of Clinical Chemistry. Carl A Burtis, Edward R Ashwood. W B Saunders Company, 3rd ed., 1999. Philadelphia. 18. Alberti KG, Zimmet P, Shaw J, IDF Epidemiology Task Force Consensus Group. The metabolic syndrome--a new worldwide definition. Lancet. 2005 Sep 24-30; 366(9491):1059-1062. 19. Sarkar S, Das M, Mukhopadhyay B, Chakrabarti CS, Majumder PP. High prevalence of metabolic syndrome and its correlates in two tribal populations of India and the impact of urbanization. Indian J Med Res. 2006; 123, May: 679-686. 20. Chow CK, Naidu S, Raju K, Raju R, Joshi R, Sullivan D, Celermajer DS, Neal BC. Significant lipid, adiposity and metabolic abnormalities amongst 4535 Indians from a developing region of rural Andhra Pradesh. Atherosclerosis. 2008. 196:943–952. 21. Kamble P, Deshmukh PR, Garg N. Metabolic syndrome in adult population of rural Wardha, central India. Indian J Med Res. 2010. December 132; 701-705 22. Mammi MV, Pavithran K, Abdu Rahiman P, Pisharody R, Sugathan K. Acute myocardial infarction in north Kerala--a 20 year hospital based study. Indian Heart J. 1991 Mar-Apr; 43(2):93-6. 23. Hughes LO, Raval U, Raftery EB. First myocardial infarctions in Asian and white men. BMJ. 1989 May 20; 298(6684):1345-50. 24. Enas EA, Dhawan J, Petkar S. Coronary artery disease in Asian Indians: lessons learnt and the role of lipoprotein (a). Indian Heart J. 1997 Jan-Feb; 49(1):25-34. 25. Joshi SR, Anjana RM, Deepa M, Pradeepa R, Bhansali A, Dhandania VK, Joshi PP, Unnikrishnan R, Nirmal E, Subashini R, Madhu SV, Rao PV, Das AK, Kaur T, Shukla DK, Mohan V; ICMR– INDIAB Collaborative Study Group. Prevalence of Dyslipidemia in Urban and Rural India: The ICMR-INDIAB Study. PLoS One. 2014 May 9; 9(5): e96808. doi:10.1371/journal.pone.0096808 26. Zahid N, Claussen B, Hussain A. High prevalence of obesity, dyslipidemia and metabolic syndrome in a rural area in Pakistan. Diabetes and Metabolic Syndrome: Clinical Research and Reviews. 2008; 2: 13–19. 27. Lewington S, Whitlock G, Clarke R, Sherliker P, Emberson J, Halsey J, Qizilbash N, Peto R, Collins R. Blood cholesterol and vascular mortality by age, sex, and blood pressure: a meta-analysis of individual data from 61 prospective studies with 55,000 vascular deaths. Lancet 2007, 370:1829-1839. 28. Ali KM, Wonnerth A, Huber K, Wojta J. Cardiovascular disease risk reduction by raising HDL cholesterol - Current therapies and future opportunities. British Journal of Pharmacology. 2012; 167(6):1177-1194. 29. Tai ES, Emmanuel SC, Chew SK, Tan BY, Tan CE. Isolated low HDL cholesterol: an insulin-resistant state only in the presence of fasting hypertriglyceridemia. Diabetes. 1999 May; 48(5):1088-92. 30. Dodani S, Henkhaus R, Wick J, Vacek J, Gupta K, Dong L, Butler MG. Metabolic syndrome in South Asian immigrants: more than low HDL requiring aggressive management. Lipids Health Dis. 2011 Mar 16; 10:45. doi: 10.1186/1476-511X-10-45. 31. Henkhaus RS, Dodani S, Manzardo AM, Butler MG. APOA1 gene polymorphisms in the South Asian immi-grant population in the United States. Indian J Hum Genet 2011; 17: 194-200. 32. Skeggs JW, Morton RE. LDL and HDL enriched in triglyceride promote abnormal cholesterol transport. J Lipid Res. 2002; 43: 1264–1274. 33. Ip S, Lichtenstein AH, Chung M, Lau J, Balk EM. Systematic review: association of low-density lipoprotein subfractions with cardiovascular outcomes. Ann Intern Med. 2009; 150: 474–484. 34. Miller M, Stone NJ, Ballantyne C, Bittner V, Criqui MH, Ginsberg HN, Goldberg AC, Howard WJ, Jacobson MS, Kris-Etherton PM, Lennie TA, Levi M, Mazzone T, Pennathur S; American Heart Association Clinical Lipidology, Thrombosis, and Prevention Committee of the Council on Nutrition, Physical Activity, and Metabolism; Council on Arteriosclerosis, Thrombosis and Vascular Biology; Council on Cardiovascular Nursing; Council on the Kidney in Cardiovascular Disease. Triglycerides and cardiovascular disease: a scientific statement from the American Heart Association.Circulation. 2011 May 24; 123(20):2292-333. 35. Dunn FL. Hyperlipidemia in diabetes mellitus. Diabetes Metab Rev. 1990; 6: 47–61. 36. Bodicoat DH, Gray LJ, Henson J, Webb D, Guru A, Misra A, Gupta R, Vikram N, Sattar N, Davies MJ, Khunti K. Body mass index and waist circumference cut-points in multi-ethnic populations from the UK and India: the ADDITION-Leicester, Jaipur heart watch and New Delhi cross-sectional studies. PloS One. 2014 Mar 5; 9(3):e90813. doi: 10.1371/journal.pone.0090813. eCollection 2014. 37. Misra A, Chowbey P, Makkar BM, Vikram NK, Wasir JS, Chadha D, et al. Consensus Statement for Diagnosis of Obesity, Abdominal Obesity and the Metabolic Syndrome for Asian Indians and Recommendations for Physical Activity, Medical and Surgical Management. Journal of Associations of Physicians of India. 2009; 57:163- 170.
Effect of diet and exercise on improvement of anthropometric variables and BSL in prediabetic study subjects of urban slum area
Chandrashekhar M Gedam, Pravin N Yerpude, P B Sawant, Keerti S Jogdand
Introduction: Subjects with IGT and IFG have an increased risk of type-2 diabetes therefore form an important target group for interventions aimed at preventing diabetes. Approximately one third of the individuals with either IFG or IGT and two third of individuals with both will develop diabetes within six years. Present study was planned to focus attention on prediabetes and to see the effect of the intervention measures such as diet change and increasing level of physical activity to control the blood sugar level in prediabetics. Materials and Methods: The present hospital based interventional study was conducted in urban slum area. The outpatient department attendees of the Urban Health Centre, comprises the study population for the present study. If blood sugar levels fits in the definition of pre-diabetes (either IFG or IGT or both) then subjects were assigned to the groups, either in the intervention group or control group by randomization. Subjects in the intervention group were advised regarding diet change and exercise. All the subjects in both the groups were followed-up for 9 months. Results: Total 288 study subjects undergo investigation for pre-diabetes, out of which 104 (36.11%) found to have pre-diabetes. So prevalence of pre-diabetes was 36.11%. Majority of the participants i.e. 34 were in the age group of 40 to 49 yrs. Majority of the participants had completed their education up to graduation (39 %) and post-graduation (17 %). Anthropometric variables like BMI and waist hip ratio were not found significant before intervention but after intervention there is significant variation in anthropometric variables between control and intervention groups. Similarly fasting and post prandial blood sugar level among control and intervention groups were found to be significant after intervention. Conclusion: The study shows that intervention measures like diet change and exercise are effective to decrease and maintain the blood sugar levels among prediabetics by decreasing and maintaining their bodyweight.
1. David M, Nathan N.Impaired Fasting Glucose and Impaired Glucose Tolerance. Diabetes care 2007; 30(3):110-115. 2. Powers AC .Diabetes Mellitus. Harrison`s principle of internal medicine, 16th ed.page no.2152- 2155 3. Wild S. Global prevalence of diabetes: Estimates for the year 2000 and projections for 2030.Diabetes Care 2004; 27: 1047-53. 4. Sicree R. Diabetes and impaired glucose tolerance. Diabetes Atlas. International Diabetes Federation. 3rd ed. Belgium: International Diabetes Federation; 2006 p. 15-103. 5. Tuomilehto J. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. NEJM; 344:1343-50; 2001 6. Ramachandran A. High prevalence of Diabetes and IGT in India: National Urban Diabetes Survey: Diabetologia 2001; 44; 1094-1101. 7. Mohan V. Secular trends in the prevalence of diabetes and glucose tolerance in urban South India - the Chennai Urban Rural Epidemiology Study (CURES-17). Diabetologia 2006; 49: 1175-78. 8. Menon VU, Kumar KV, Gilchrist A. Prevalence of known and undetected diabetes and associated risk factors in Central Kerala-ADEPS. Diabetes Res Clin Pract 2006; 74: 289-94. 9. Chow CK. The prevalence and management of Diabetes in Rural India. Diabetes Care 2006; 29: 1717-8. 10. Flegal KM, Carroll MD .Diabetes Prevention Programme Research Group: reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. NEJM 2002;346:110-117 11. Gregory A, Nichols D. Progression from Newly Acquired Impaired Fasting Glucose to Type 2 Diabetes. Diabetes Care 2007; 30:228–233. 12. Wilfred Y, Fujimoto A. Body Size and Shape Changes and the Risk of Diabetes in the Diabetes Prevention Program. Diabetes 2007;56:59-66 13. Jaakko T. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. NEJM 2001; 344:1343-50.
Lineament Fabric of South Baluchistan (Iran) and its Impact on Geomorphic Landforms
U D Kulkarni, Yousefi Hamidoddin, Ravindra G Jaybhaye
Lineament analysis of South Baluchistan region in Iran using sensors of Landsat 8 (Landsat Data Continuity Mission, LDCM)) suggests orgoenic uplift of the region brought about deformation of mesoscopic structures. The lineament fabric showed prominent lineament directions along E-W and NW-SE. The study also revealed that the Alpine Himalayan orogenic uplift has been responsible for the structural fabric of the south Baluchistan. This deformation is documented in the form of reverse and normal faults.
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Do spontaneous separation of placenta reduce blood loss during caesarean delivery?
Shivamurthy H M, Durgadas Asaranna, Giridhar S A, Ashwini Konin, Jyotsna R Himgire
Background: Blood loss during a caesarean section is of great concern for the surgeon, especially in an anaemic patient and where facilities are not available for blood transfusion especially at the peripheral hospitals. Also majority of our pregnant women (nearly 80%) are anaemic. Again there is a lot of demand for blood transfusion due to non-comparable conditions like APH, PPH etc which may further lessen the availability of blood for transfusion. Such being the situation the technique of bloodless caesarean proves to be a boon in our setup .So also blood transfusion has its own complications. Objectives: To compare the blood loss after spontaneous separation of placenta with the blood loss associated with manual removal of placenta during caesarean section deliveries. Materials and Methods: In this study, estimation of blood loss in the placental delivery ,was done on 100 consecutive women undergoing caesarean section due to various indications excluding those who are likely to bleed by the virtue of their pathology like APH .Of the 100 cases 50 cases were managed by waiting for placental separation ,and alternative cases were managed by manual removal placenta without waiting for spontaneous separation .The blood loss was assessed by using preweighed cotton mops and weighing them again after the use to mop the blood loss. Care was taken to not allow the mixing of amniotic fluid and all the clots were weighed and computed for the loss of blood (by multiplying the weight of the clot by1.05) Results: Shapiro wilks test showed that the data was normally distributed, thus parametric test was employed. There was a statistical significance between the study and control groups for placental delivery interval, blood loss and drop in Hb levels at p < 0.05. There was no difference in the morbidity levels in study and control groups as shown by the Chi square test p (< 0.05) Conclusion: The spontaneous placental separation and delivery during caesarean section is associated with less blood loss than that of manual removal of placenta.
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