Vijay Kumar Srivastava
Introduction: Age-related macular degeneration (AMD) is the leading cause of blindness among people aged 55 years and older in the U.S and other Western countries. Aims and Objectives: To study Clinical profile and factors associated with Age related macular degeneration. Material and Methods: After approval from institutional Ethical committee a cross sectional study was carried out in patients with age related macular degeneration at Ophthalmology department of tertiary health care center during the year 2014. For the diagnosis of age related macular degeneration all the persons with age >45 with the signs and symptoms of AMD were Ophthalmoscopically examined and fundus examination was done by Ophthalmologist and confirmed by OCT or fluoresce in angiography or both. So, during the study period total 30 patients were diagnosed as AMD were included into study. All the data is presented in the tabular form and arranged in percentages. Result: The majority of the patients were in the age group of 75-85 and were 40.00%. The most common clinical features observed were Difficulty in recognizing the Faces i.e. in 73.33% followed by C/o Distorted images in center in 60%; Need brighter light than normal for reading in 56.66%; C/o Blurry Text in 53.33%; C/o Blind spot in the middle of visual field in 43.33%; Impaired depth perception in 33.33%; Difficulty in Reading and Driving in 30% of the patients respectively. The most common risk factor associated with Age related macular degeneration patients were H/o Hypertension in 70% followed by H/o Smoking in 63.33%; H/o Alcoholism in 56.66%; Female Sex in 53.33%;C/o Cataract in 43.33%; H/o Hyperopia in 33.33%; Atherosclerosis in 30%; Obesity (BMI >30)in 30 and Diabetes in 23.33 % of the patients respectively. Conclusion: It can be concluded from our study that the most common clinical features observed were Difficulty in recognizing the Faces, Distorted images in center, Need brighter light than normal for reading and the most common risk factors associated were H/o Hypertension followed by H/o Smoking, H/o Alcoholism. Female Sex, Cataract and H/o Hyperopia; Atherosclerosis; K/c/o Obesity (BMI >30) and K/c/o Diabetes etc.
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Vijay Kumar Srivastava, Leena Lawrence
A study of various complications and factors associated with primary trabeculectomy
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Pankaj Bohra, Eshan Sharma, Kamal Kumar Jain
Introduction: The time-related effect of treatment on survival and myocardial salvage in patients with acute myocardial infarction (MI) has been demonstrated in thrombolysis trials Aims and Objectives: To study Time interval between thrombolytic treatment and Outcome in Patients with Myocardial infraction. Methodology: This was a hospital based cross-sectional study of the Patients who were admitted to tertiary health care Centre with diagnosis of Myocardial Ischemia diagnosed by ST-Elevation Myocardial Infarction during the Period of One year from June 2014 to June 2021 at tertiary health care Centre. Total 120 patients were enrolled into the studyThe statistical analysis done by Chi-square test calculated by Graph Pad Prism software. Results: The majority of the Patients were from 40-50 -26.67% followed by 50-60- 25.00%, >60- 19.16%30-40- 19.16%, 20-30- 10%. Majority of the Patients were Male i.e. 58.33% and 41.67% were Female Majority of the Patients who recovered completely from the illness were the patients who received treatment <2 Hr. from onset of the Symptoms i.e. 66.67% as compared to 31.95% who received treatment >2Hr. This observed difference is statistically significant. (X2 = 13.99, df=1, P<0.0002.) Conclusion: In our study the Recovery among the MI patients were significantly higher if the treatment is started within 2 hrs. duration.
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Pankaj Bohra, Eshan Sharma, Kamal Kumar Jain
Introduction: In 2003, the prevalence of CHD in India was estimated to be 3-4 per cent in rural areas (two-fold higher compared with 40 year ago), and 8-10 per cent in urban areas (six fold higher compared with 40 year ago), with a total of 29.8 million affected Aims and Objectives: To study clinical profile of the patients with myocardial ischemia at tertiary health care Centre Methodology: This was a hospital based cross-sectional study of the Patients who were admitted to tertiary health care Centre with diagnosis of Myocardial Ischemia diagnosed by ST-Elevation Myocardial Infarction during the Period of One year from June 2014 to June 2021 at tertiary health care Centre. Total 110 patients were enrolled into the study. All the Socio-demographic information and Clinical information were recorded and the associated Risk factors have also studied. Result: The majority of the Patients were from 40-50- 25.45 % followed by 50-60- 23.63 %; 30-40- 20.90 %; >60- 19.09 %; 20-30- 10.90 % Majority of the Patients were Male i.e. 56.36% and 43.63% were Female Most common associated factors with MI patients were H/o Smoking - 52.72% followed by H/o- Hypertension -48.18%; Obesity (BMI >30) -39.09%; H/o Tobacco Chewing -34.45%; H/o Diabetes - 22.72%; Hyper-cholestremia -21.81%Out of the Total 110 Patients 82.72%- Recovered; 10.90%- Discharge Against medical Advise; 6.36%- Died.Conclusion: The most common age of presentation of Myocardial infarction observed in our study is 40-50 and was associated with risk factors like Smoking, Hypertension, Obesity, Tobacco Chewing, Diabetes, Hyper-cholestremia.
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Ravi Kumar Mathur, Vineet Choudhary, Brijesh Kumar Singh, Akhilesh Shekhawat
Background: Male breast carcinoma is a very rare disease. It accounts for less than 1% of malignancies in men. This study reviews the male breast carcinoma cases with regard to its incidence, presenting characteristics, risk factors, diagnosis, management and survival. Methods: We present a series of 5 consecutive cases seen at a single centre tertiary care teaching NIMS hospital over a period of from 2007 to 2013. We searched the paper charts of all male patients with a histologically confirmed diagnosis of breast cancer. A study of various epidemiological factors/clinical presentation and metastasis (local and distant) was done. Results: Mean age of diagnosis was significantly higher in males; mean survival after diagnosis was significantly lower in men because cancer was found at a more advanced stage in men at the time of diagnosis. Conclusion: Men have a delayed diagnosis, older age at diagnosis and shorter survival after the diagnosis of male breast cancer. There is a need for creating awareness of possibilities of breast cancer in men which would help in earlier diagnosis and potentially better outcome after treatment.
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Shivamurthy H M, Y Anusha Sunkara, N Spandana, Ashwini Konin, V Sridivya Choudary
Background: The incidence of twin pregnancies account is about 3% of all gestations. The second twin is generally considered at higher risk of severe morbidity and mortality because of obstetric complications. There is general consensus that vaginal delivery for twins is safe when both are in vertex presentation, whereas planned caesarean section is typically indicated for breech presentation of the first twin. Planned vaginal delivery has been associated with an increased risk of perinatal mortality and morbidity of the second twin compared with the first twin. The purpose of this study was to examine the association between mode of delivery and NICU admission, neonatal mortality in term and preterm twin pregnancies, particularly for second born twins. Objectives: To study the influence of various methods of delivery of the second of the twins on the neo natal outcome of the second twin. Material and Methods: We analyzed 50 cases of twin pregnancies delivered in hospitals attached to JJM Medical College, Davangere (from July 2013 to July 2014) where the first twin was vertex and delivered vaginally. Pregnancies with ante-partum complications were excluded. Three groups of twin pairs were selected and included in the study. Group A: Twin pairs with the second twin delivered by caesarean section. Group B: Vaginally delivered second twin. Group C: Version and breech extracted second twin. Twin pairs were excluded if the mother was assigned a diagnosis suggesting any ante-partum pathology: congenital malformations, immunization or hydrops, intrauterine growth restriction, chorioamnionitis, maternal infection or fever, ante-partum bleeding or placenta praevia, preeclampsia or eclampsia, diabetes, twin-to-twin transfusion syndrome, or intrauterine fetal death. Results: Total number of 50 cases were studied where the first twin was vertex and delivered vaginally. Out of 50 cases, 62% had a non-vertex second twin. 64% of babies delivered vaginally were admitted into NICU with 24% mortality. All cases of IPV and breech delivery were admitted into NICU with 50% mortality where as only 52.63% of babies delivered by caesarean sections were admitted into NICU with 15.78% mortality. The neonatal outcome in the three study groups were shown in Table 1 and 2. Second born twins in Group A (second twin delivered by caesarean section) was at lower risk of NICU admission (p=0.109) or neonatal death (p=0.232) compared to second born twins in group B (vaginally delivered second twin) and group C (version and breech extracted second twin). Conclusion: Neonatal mortality is lower for the second twin after caesarean delivery compared to Vaginal and IPV-breech but it is not statistically significant. The present results support that, caesarean delivery may be associated with a better chance of neonatal survival in otherwise uncomplicated twin pregnancies.
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Bhumija, Girija Wagh
Objective: To report association between genital tuberculosis and infertility. Summary of Background Data: The incidence of genital tuberculosis varies widely with social status and environment of the patient. The incidence is around 1% amongst the gynaecological patients in developing countries. The incidence rises to 5-10% amongst patients with infertility.Tuberculosis specially affecting the female genital tract has been identified as the most difficult diagnostic challenge. Genital tuberculosis is a chronic disease with a low grade symptomology and a very few specific complaints. Methods: Prospective review of the patient’s lab reports and histo-pathological findings. Results: We reviewed records of 3 patients who presented to us with complaints of infertility. On basis of various investigation modalities and pathological studies, we found out that genital tuberculosis was the cause of infertility in these patients. Conclusion: We report that female genital tract tuberculosis poses a diagnostic challenge. The commonest clinical manifestation is infertility. Hence, a high degree of suspicion aided by intensive investigations is important in the diagnosis of the disease
1. Desai P, Hazra M (1993) Tubal infertility: reappraisal of etiology. J ObstetGynaecol India 43:76–78. 2. Parikh FR, Nadkarni SG, Kamat SA, Naik N, Soonawala SB, Parikh RM (1997) Genital tuberculosis—a major factor causing infertility in Indian women. FertilSteril 67:497–500. 3. Tripathy SN, Tripathy SN (2002) Infertility and pregnancy outcome in female genital tuberculosis. Int J GynecolObstet 76:159–163. 4. Schaefer G. Female genital tuberculosis. ClinObstetGynecol1976; 19:223. 5. Dam P, Shirazee HH, Goswami SK, Ghosh S, Ganesh A, Chaudhury K, Chakravarty B (2006) Role of latent genital tuberculosis in repeated IVF failure in the Indian clinical setting. GynecolObstet Invest 61:223–227. 6. Khan SM (1985) Incidence of genital tuberculosis in infertile women. J Pak Med Assoc 35:280–281. 7. Chattopadhyay SK, Sengupta BS, Edrees YB, Al-Meshari AA (1986) The pattern of female genital tuberculosis in Riyadh, Saudi Arabia. Br J ObstetGynaecol 93(4):367–371. 8. Oosthuizen AP, Wessels PH, Hefer JN (1990) Tuberculosis of the female genital tract in patients attending an infertility clinic. S Afr Med J 77:562–564. 9. De Vynck WE, Kruger TF, Joubert JJ, Scott F, Van der Merwe JP, Hulme VA, Swart Y (1990) Genital tuberculosis associated with female infertility in the western Cape. S Afr Med J 77:630–631. 10. Marana R, Muzii L, Lucisano A, Ardito F, Muscatello P, Bilancioni E, Maniccia, Dell’Acqua S (1991) Incidence of genital tuberculosis in infertile patients submitted to diagnostic laparoscopy: recent experience in an Italian University Hospital. Int J Fertil 36(2):104–107. 11. Haider P, Jafarey SN (1992) A histopathological study of endometrial tuberculosis in infertility. J Pak Med Assoc 42(11):269–270. 12. Margolis K, Wranz PAB, Kruger TF, Joubert JJ, Odendaal HJ (1992) Genital tuberculosis at Tygerberg Hospital—prevalence, clinical presentation and diagnosis. S Afr Med J 81:12–15. 13. Emembolu JO, Anyanwu DO, Ewa B (1993) Genital tuberculosis in infertile women in northern Nigeria. West Afr J Med 12:211–212. 14. Gupta N, Sharma JB, Mittal S, Singh N, Misra R, Kukreja M (2007) Genital tuberculosis in Indian infertility patients. Int J GynaecolObstet 97(2):135–138. 15. B NamavarJahromi,M.E Parsanezhad,et al. Female genital tuberculosis and infertility.International Journal of Gynecology & Obstetrics. Dec 2001 (3): 269–272. 16. Krishna VR, Sathe AV, Mehta H, Wagle S, Purandare VN. Tubal factors in sterility. J ObstetGynecol India 1979;29:663. 17. Nogales-Ortiz F, Tarancon I, Nogales FF. The pathology of female genital tuberculosis. ObstetGynecol 1979;53:422–8. 18. Klein TA, Richmond JA, Mishell DR. Pelvic tuberculosis. ObstetGynecol 1976;48:99–104.
Rajshekhar I Koujalgi
Background and Objectives: To study the Modes of presentation of MI along with Circadian, Circaseptan, Circannual pattern of onset in local population and the effect of time delay on mortality. Methods: Presentation of 316 patients (October 2006 to September 2009) of acute myocardial infarction (AMI) with typical chest pain and atypical symptoms were studied. The circadian, circaseptan and circannual rhythm of onset noted along with risk factors and delay in treatment and outcome. Results: 273 (86.39%) patients presented with chest pain, mean age (51.5) and 43(13.60%) with atypical symptoms, mean age (56.3) had proportionately more females. A larger (115 patients) morning peak (1st quarter) of onset of AMI and lesser (85patients) evening peak was noted. 12.97% mortality in patients presenting <6 hours and 24.75% in >6 hours. More onset of AMI on Friday and Sunday (circaseptan). 109 patients had onset of AMI in monsoon. Conclusion: 13.60% of individuals had atypical presentation of MI. Delay of arrival was associated with increased mortality rate and decreased thrombolysis there was significant morning peak in the onset of MI and seasonal peak onset in monsoon. But least onset in winter and no significant circaseptan pattern.
1. Gillum RF, Fortmann SP, Prineas RJ, Kottke TE. International diagnostic criteria for acute myocardial infarction and acute stroke. Am Heart J. 1984; 108:150-158. 2. Barron HV, Bowlby LJ, Breen T, et al. Use of reperfusion therapy for acute myocardial infarction in the United States. Circulation. 1998;97:1150-1156 3. PHILIP C. STRIKE,, AND ANDREW STEPTOE : New Insights into the Mechanisms of Temporal Variation in the Incidence of Acute Coronary Syndromes, Clin. Cardiol. 26, 495–499 (2003) 4. Emil Sigurdsson, Gudmundur Thorgeirsson, Helgi Sigvaldason and Nikulas Sigfusson. Unrecognized myocardial infarction Epidemiology, clinical characteristic, and the prognostic role of angina pectoris. (The Reykjavik study) Ann Intern Med.1995; 122:96-102 5. Canto JG, Shlipak MG, Rogers WJ, Malmgren JA, Frederick PD, Costas T, Lambrew, Ornato JP, Barron HV. Prevalence, clinical characteristics, and mortality among patients with myocardial infarction presenting without chest pain. JAMA.2000; 283: 3223-3229 6. K.N.Chowta, P. D. Prijith, M.N. Chowta : Modes of presentation of acute myocardial infarction, Indian J Crit Care Med; July-September 2005: vol 9 issue 3: 151-154 7. Kannel WB and Abbott RD. Incidence and prognosis of unrecognized myocardial infarction. An update on the Framingham study.N Engl Med.1984; 311:1144-1147. 8. Muller RT, Gould CA, Betzu R, Vachek T, Pradeep V. Painless myocardial infarction in the elderly. Am Heart J.1990; 119:202-203. 9. Margalis JR, Kannel WB, Feinlein M, Dawber TR, Mcnamara PM. Clinical features of unrecognized myocardial infarction silent and symptomatic.[The Framingham Study]Am J Cardiol.1973;32:1-7. 10. Katsuhiko Yano and Machean CJ. The incidence and prognosis of unrecognized myocardial infarction in the Honolulo, Hawai Heart Programe. Ann Intern Med.1989; 149:1528-1532 11. Kannel WB and Abbott RD. Incidence and prognosis of unrecognized myocardial infarction. An update on the Framingham study. N Engl Med.1984; 311:1144-1147. 12. Henry H. Ting, Elizabeth H. Bradley, Yongfei Wang, Brahmajee K. Nallamothu, MD, Bernard J. Gersh, Veronique L. Roger, et al. Delay in Presentation and Reperfusion Therapy in ST-Elevation Myocardial Infarction :Am J Med. 2008 April ; 121(4): 316–323.doi:10.1016/j.amjmed.2007.11.017. 13. Yarzebski J, Golberg RJ, Gare JM, Alpert JS. Temporal trends and factors associated with extent of delay to hospital arrival in patients with acute myocardial infarction: The Worchester heart attack study. Am Heart J.1994; 128(2):255-263. 14. Narris RM, Wong PS, Dixon G, Morris N, Penny WJ, Thomas A, Davies L, Boyle RM, Cooper S. Effect of time from onset to coming under care on fatality of patients with acute myocardial infarction effect of resuscitation and thrombolytic treatment. The United Kingdom heart attack study (UKHAS) collaborative group.Heart.1998; 80:114-120. 15. Mehta SR, Das S, Karloopia S, Mathur P, Dham SK, Ranganthan D. The circadian pattern of ischemic heart disease events in Indian population.JAPI.1998; 46:767-771. 16. C.P. Thakur, M.P. Ananda and M.P. Shahia Cold weather and myocardial infarction International Journal of Cardiology Volume 16, Issue 1, July 1987, Pages 19-25.
Pankaj B Palange, R B Kulkarni, R K Shrawasti, Nikhil A Kharat, Atul Jankar
This study was done on 68 patients of dengue fever who were admitted in Bharati Hospital, Sangli during the period Jan. 2012 to Dec. 2013. All the patients require hospitalization due to one or the other complications of dengue fever like bleeding manifestations, shock, organ dysfunction etc. 57 patients recovered completely without any complications. While 11 patients expired due to severe dengue in spite of intensive management. These patients suffered from dengue haemorrhagic fever and dengue shock syndrome. It was observed that mortality was mainly due to plasma leak leading to shock, severe haemmorhage and multiorgan failure. Platelet count was not found to be a predictor of severity of disease or outcome. Effective fluid resuscitation by colloids, crystalloids and blood
1. Singhi S, Kissoon N, Bansal A. Dengue and dengue hemorrhagic fever: management issues in an intensive care unit. J Pediatr (Rio J.) 2007; 83 (2 suppl): S22-35. 2. Nathan MB, Dayal Drager R, Guzman. Epidemiology, burden of disease and transmission. Dengue: Guidelines for diagnosis, treatment, prevention and control-New Edition .Geneva: WHO; 2009. pgs 3-11. 3. Guidelines for Clinical Management of Dengue Fever, Dengue Hemorrhagic Fever and Dengue Shock Syndrome. Government of India. Directorate of National Vector Borne Disease Control Program. Directorate General of Health Services, Ministry of Health and Family Welfare. 2008. 4. Cattand P et al. Tropical diseases lacking adequate control measure: dengue, leis African trypanosomiasis. Disease Control Priorities in developing countries, 2nd Ed. New York, NY, Oxford University Press, 2006. 5. Harris E, Hombach J, Lazdins - Held J. New avenues. Dengue: Guidelines for diagnosis, treatment, prevention and control - New Edition. Geneva: WHO; 2009. 6. Guha - Sapir D, Shimmer B. Dengue fever: new paradigms for a changing epidemiology. The Emerging Themes in Epidemiology 2005,2:1. 7. Premratna Ranjan, Lyanaarachchi E, Weerasinghe M, de Silva H.J. Should colloid boluses be prioritized over crystalloid boluses for the management of dengue shock syndrome in the presence of ascites and pleural effusions? BMC Infectious Diseases 2011; 11:52. 8. Wills BA, Nguyen MD, Ha TL, Dong TH, et al. Comparison of three fluid solutions for resuscitation in dengue shock syndrome. N Engl J Med. 2005; 353:877-89. 9. Dengue Guidelines for diagnosis, treatment, prevention and control – New edition . WHO 2009 : 25. 10. Deen J, Lum L, Martinez E, Tan LH. Clinical management and delivery of clinical services. Dengue: Guidelines for diagnosis, treatment, prevention and control - New Edition. Geneva: WHO; 2009. 11. Lei HY, Huang KJ, Lin YS, Yeh TM, Liu HS , Liu CC. Immunopathogenesis of dengue hemorrhagic fever. American Journal of Infectious Diseases 2008; 4(1): 1-9 12. Muto RSA. Dengue Fever/ Dengue Hemorrhagic Fever and its control - status in WHO's Western Pacific region by 1999. WHO Internal Report Manila, WHO Western Pacific regional office; 2000:4. 13. Lye D.C, Lee V.J , Yan Sun, Leo Y.S. Lack of Efficacy of Prophylactic Platelet Transfusion for severe thrombocytopenia in adults with acute uncomplicated dengue infection. Clinical Infectious Diseases 2009; 48:1262-5. 14. Lum L.C.S, Goh A.Y.T, et al. Risk factors for hemorrhage in severe dengue infections. The Journal of Pediatrics May 2002; vol 140 (5):629-31 15. Guidelines on Management of Dengue Fever and Dengue Hemorrhagic Fever in Adults. Ministry of Health- Sri Lanka. National Guidelines. December 2010. 16. Ahluwalia G, Sharma S.K. Dengue: Current Trends and Challenges - An Indian Perspective. J API Jul 2004; vol 52: pg 561-563. 17. From Site www.NBVCP.in State wise incidence of dengue in 2011-12. 18. Siririavin S, et al. Vertical dengue infection: case reports and reviews. Pediatr Infect Dis J 2004; 23:1042 -1047 19. Chye JK et al. vertical transmission of dengue. Clin Infect Dis 1997; 25:1374- 1377. 20. Guidelines on Management of Dengue Fever and Dengue Hemorrhagic Fever in Adults. Ministry of Health- Sri Lanka. National Guidelines. December 2010.
Uma Deshmukh, Meenal Vardhan
Objectives: To assess the incidence, clinical features, investigations and management of secondary postpartum Haemorrhage (PPH). Methods: A retrospective analysis of 50 cases who presented at BRIMS, Bidar with secondary PPH was carried out. Results: The incidence of secondary PPH was 0.71%. Eight of these women also had primary PPH due to atonic uterus. In 0.14% of cases secondary PPH occurred during the second postpartum week. Sonography findings were suggestive of retained products of conception in 10 cases. Eighty-six percent of women responded to conservative line of management and 14% required surgical evacuation. Only in 50% of cases, the ultrasound diagnosis of retained products was confirmed by histology. Conclusion: Complete blood count should be done for all secondary PPH patients. Midwifery training for third stage of labour is must. Per speculum examination is must in developing country like INDIA. Role of ultrasound is debatable. Unnecessary operative procedures on the puerperal uterus should be avoided. Curettage material should be sent for histopathology.
1. Dewhurst DJ. Secondary post – partum Haemorrhage. J Obstet Gynecol Br Commonw 1966;73:53-8. 2. Rome RM. Secondary post – partum Haemorrhage. Br J Obstet Gynecol 1975;82:289-92. 3. Hoveyda F, Mackenzie IZ. Secondary post – partum Haemorrhage : incidence, morbidity and current management. Br J Obstet Gynecol 2001;108:927-30. 4. King PA, Duthie SJ, Dong ZG et al. Secondary post – partum Haemorrhage. Aust NZ J Obstet Gynecol 1989;29:394-8 5. Malvern J, Campbell S, May P. Ultrasonic scanning of the puerperal uterus following secondary postpartum Haemorrhage. J Obstet Gynecol Br Commonw1973;80:320-4. 6. Nanda S, Singhal S, Sharma D et al. Nonunion of uterine incision: A rare cause of Secondary post – partum Haemorrhage: A report of 2 cases. Aust NZ J Obstet Gynecol 1997;37:475-6.
Rajshekhar I Koujalgi
Background and Objective: This study was done to evaluate circadian, circaseptan, and circannual rhythms in onset of stroke subtypes along with influence of risk factors, in local population. Subjects and Methods: 294 stroke patients, subtyped as Ischemic Stroke (IS), Intracerebral hemorrhage (ICH) and Subarachnoid hemorrhage (SAH) with Circadian (time in a day), circaseptan (day in a week) and circannual (season in a year) onset and risk factors were studied between January 2009 and December 2010 Results: 229 (77.89%) had IS, 63(21.42%) ICH and 2(0.68%) SAH. Bimodal peak of stroke onset noted, with bigger (51.7% patients) morning peak (4:01 am to 8:00 am), smaller (19.38% patients) evening peak (4:01 pm to 8:00 pm).Stroke subtypes and risk factors had similar pattern except diabetics (34 patients), had bigger peak in evening than morning. Stroke onset (circaseptan) was, on Wednesday (24.01%), Monday (21.83%), least on Sunday (14.87%) and similar in stroke subtypes. Seasonal (circannual) onset of stroke was highest in monsoon (34.01%), summer (33.67%), post monsoon (17%) and least in winter (15.30%) for all subtypes of stroke. Conclusion: Stroke onset has bimodal circadian peak (morning and evening), and attenuation of morning peak in diabetics and Circannual (seasonal) onset in monsoon and summer in local population.
1. Manfredini R, Boari B, Smolensky MH, Salmi R, la Cecilia O, Maria Malagoni A, Haus E, Manfredini FCircadian variation in stroke onset: identical temporal pattern in ischemic and hemorrhagic events. Chronobiol Int. 2005;22 (3) :417-53 2. Hatano S. Experience from a multicentre stroke register: a preliminary report Bull World Health Organ. 1976;54:541-553 3. Mulcahy D: Circadian variations in cardiovascular diseases and implication for therapy. J cardiovasc pharmacol 1999,suppl 2 : s3-8 4. Chasen C, Muller JE: Cardiovascular triggers and morning events. Blood Press Monit 1998; 3:35-42. 5. Gottlieb SO : circadian pattern of myocardial ischaemia: Pathophysiologic and therapeutic considerations.J cardiovasc pharmacol 1988,12 suppl 7:s 18-21 6. Deedwania P C: Hemodynamic changes as triggers of cardiovascular events.Cardiol Clin 1996; 14:229-238. 7. Feng DL, Tofler GH: Diurnal physiologic process and circadian variation of acute myocardial infarction.J cardiovasc Risk 1995; 2:494-498. 8. Muller JE,Mangel B : Circadian variation and triggers of cardiovascular diseases. CARDIOLOGY 1994;85 suppl 2:3. 9. Muller JE,Tofler GH, Willich SN et al: Circadian variation and triggers of cardiovascular diseases and sympathetic activity. J Cardiovasc pharmacol 1987; 10 (suppl 2): s104-109. 10. Becker RC,Corrao JM : Circadian variation in cardiovascular diseases. Cleve Clin J Med 1989;56: 676-680. 11. Mulcahy D: Circadian variations in cardiovascular diseases. Press Monit 1998; 3:29-34 12. Bhalla A, Singh R, Sachdev A, D’Cruz S, Duseja A. Circadian pattern in cerebrovascular disorders. Neurology India 2002; 50:526-7. 13. William J. Elliott: Circadian Variation in the Timing of Stroke Onset: A Meta-analysis. Stroke 1998;29;992-996 14. Margaret Kelly-Hayes, Philip A. Wolf, Carlos S. Kase, Frederick N. Brand, Jacqueline 14) M. McGuirk, and Ralph B. D'Agostino: Temporal Patterns of Stroke Onset: The Framingham Study. Stroke, Aug 1995; 26: 1343 - 1347. 15. Ann L. Oberg, 1–3 Jeffery A. Ferguson, 4,5 Lauren M. McIntyre,2,6–8 and Ronnie D. Horner2,6,9Incidence of Stroke and Season of the Year: Evidence of an Association Am J Epidemiol 2000;152:558–64. 16. Hyun-Seok Park, M.D.1Myong-Jin Kang, M.D.2Jae-Taeck Huh, M.D.1 Recent Epidemiological Trends of Stroke J Korean Neurosurg Soc 43 : 16-20, 2008 17. Berginer VM, Goldsmith J, Batz U, Vardi H, Shapiro Y : Cluster in of stroke in association with meteorologic factors in the Negev Desert of Israel : Stroke 20 : 65-69, 1989. 18. Stephen Fava, Joseph Azzopardi, Hugo Agius Muscat, Frederick F Fenech Absence of circadian variation in the onset of acute myocardial infarction in diabetic subjects Br HeartJ7 1995;74:370-372
Smitha Surendran, Jyotsna R Himgire
Objective: To assess the value of uterine volume estimated by ultrasound sonography in decision making for route and technique of hysterectomy. Methods: Uterine volume was measured by ultrasound sonography in 50 cases posted for hysterectomy. Intra operative difficulties, accessibility and ease of surgery were noted. Also, uterine weight postoperatively was compared with the volume. Results: Vaginal hysterectomy was done without difficulty up to 300cm³. With uterine volume more than 300cm³, debulking was more frequently required. In patients with uterine volume greater than 500cm³, i.e., approximately more than 16 weeks pregnant uterus size the surgeons preferred abdominal rather than vaginal route. Uterine volume correlated well with the uterine weight measured post operatively. Conclusion: Uterine volume measured by ultrasound sonography was found to correlate with uterine weight measured post operatively. It played an important role in assessing the feasibility of vaginal hysterectomy.
1. Nieboer TE, Johnson N, Lethaby A, Tavender E, Curr E, Garry R, et al. Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Database Syst Rev 2009;(3):CD003677.doi: 10.1002/14651858.CD003677.pub4. 2. Kovac SR. Clinical opinion: guidelines for hysterectomy. Am J Obstet Gynecol 2004;191:635-40. 3. Shanthini NF, Poomalar GK, Jayasree M, Bupathy A. Evaluation of complications of abdominal and vaginal hysterectomy. Int J Reprod Contracept Obstet Gynecol 2012;1:7-11. 4. Sheth SS, Shah NM. Preoperative sonographic estimation of uterine volume: An aid to determine the route of Hysterectomy. Journal of Gynecological surgery 2002; 18(1): 13-22. 5. Benassi L, Rossi T, Kaihura CT, Ricci L, Bedocchi L, Galanti B, Vadora E. Abdominal or Vaginal Hysterectomy for enlarged Uteri: Randomized clinical trial. Am J Obstet Gynecol. 2002 Dec;187(6):1561-5. 6. Daraï E, Soriano D, Kimata P, Laplace C, Lecuru F. Vaginal hysterectomy for enlarged uteri, with or without laparoscopic assistance: randomized study. Obstet Gynecol. 2001 May;97(5 Pt 1):712-6. 7. Unger J.B. Vaginal hysterectomy for the woman with a moderately enlarged uterus weighing 200 to 700 grams. Am J Obstet Gynecol. 1999 Jun;180(6 Pt 1):1337-44.
Inayath Ali Badusha
Diagnosis of bronchial asthma in children poses great difficulty up to five years. The moment the pediatrician makes a diagnosis of bronchial asthma there is a lot of stress, anxiety and worry in the minds of parents. There are many causes of wheeze in children other than bronchial asthma. So it is difficult for the physician to make a concrete diagnosis of childhood asthma .so the author has taken a decision to review the topic in detail.
1. British guidline 2009 p4 2. Martinez fd genes, environment (2007) and asthma areppraisal-europian respiratory journal 29(1)179-84.dor:10.1183/09031936.00087906 3. Gina 2011p71,p2-5 4. Editor, andrew harver, harry kotses, (2011) asthma health and society public health perspective. New York spring p315 isbn978-0-387-78285-0. 5. Miller, R. I; March (2008) environmental epigenetics and asthma current concepts. http//www.nebi.gov/pmc/artic les/pmc 2267336american journal of respiratory and critical care medicine 6. Nhlbi guideline p213 7. Cats, CJ; Cates, J(april 18,20012) Cates, Christopher Jed regular treatment with salmetrol for chronic asthma serious adverse events cochrane database of systemic reviews4:cd006923 8. Cats, CJ, Cats. J. (july 16-2008) Cates Christopher 9. British guideline 2009 p43 10. Scott JP, peter-golden M. (september2013) antileukotrienes agents for treatment of lung disease am. J., respire. Crit. Care med.188(5):538-544doi:10.1164 11. Zyflo (Zileuton tablet)(http.www.accessdata.fda.gov/drugs .united state food and drug administraton 12. Noppen M (auguest20012) magnesium treatment for asthma. Hest 122(2)101-16 http:www.nebi,nlm,nih,gov/pubmed/20435668.
Shivamurthy H M, Durgadas Asaranna, Giridhar S A, Aparna Madhavan, Ashwini Konin, V Sridivya Chowdary
Background: Management of labour is an art and science and many a times achallenge in the present scenario with the advent of many modifications in labour science and the increasing demand of the clients for a safe and not so painful experience. “Programmed labour is an indigenously developed protocol for labour management developed with dual objective of providing pain relief during labour and reaching the goals of safe motherhood by optimizing obstetric outcome”1. I this direction the current study was undertaken to examine the effectiveness of analgesics used in the management of Programmed labour. Objectives: To study the efficacy of Obstetric analgesics in programmed labour. Materials and Methods: This prospective study includes two hundred women in active phase of labour who underwent management of labour by programmed labour protocol assessed for effectiveness of labour analgesia. Two patients went for caesarean section in the beginning itself due to non-reassring Foetal status. Labour pain scoring was done when the patient was set into active labour in three distinct groups. Then the analgesic medication was administered as per the protocol in programmed labour. The postmedication pain relief scoring was done. Efficacy of the analgesic in relation to the cervical dilatation and duration of labour was examined and analysed statistically. Results: Of the 198, parturients 2 patients had bearable pain (pain score 1), 177 had severe pain (score 2) and 21 had unbearable pain (score3).Of the group with unbearable pain (score 3) 12 (57.2%) had complete pain relief. Out of 135 patient who had cervical dilatation of 3-4 cms, 75% had substantial relief of pain. Those who had 1-2 hrs of active labour, 73% had substantial pain relief after medication. Conclusions: Programmed labour protocol proved to be efficient in pain relief, shorter duration of labour, reduction in incidence of dystocia, reduction in instrumental deliveries and caesarean sections with a good maternal and neonatal outcome in both primi and multigravidae.
1. Daftary SN. Optimizing labour protocol – An Indigenously developed protocol of labour management. Int J Gynecol Obstet India Jan-Feb 2003; 6(1):47-49. 2. Corssen G. Ketamine in obstetric anaesthesia Clin Obstet Gynacol 1974 June; 17(2):249-258. 3. Cohill DJ, Boylan PC, O’Herhily C. Dens oxytocin augmentation increase perinatal risk in primigravid labor ? Am J Obstet Gynecol 1992; 166:847-56. 4. Akamatsu TJ, Bonica JJ. Experiences with the use of ketamine for parturition; primary anaesthetic for vaginal delivery. Anesth Amalg 1974; 53:284-287. 5. Sarkar P, Sahu SP. Ketamine hydroxhloride for painless labour. Indian J Anaesth 1992; 40:120. 6. Leena G, Rahman H. Obstetric analgesia with intra venous low dose ketamine. J Obstet Gynecol India 1994 Dec.; 894-900. 7. Traser WD, Turcot L, Kraws I. Amniotomy for shortening spontaneous labour. Cochrane Database Sys Rev 2000; 2:CD000015. 8. Satin AJ, Leveno KJ, Sherman ML. High versus low dose oxytocin for labor stimulation. 9. Anju K, Indu B, Krishna D, Krishna S. A comparative study of efficacy of valathamate bromide with drotaverine in normal labour. J Obstet Gynec India 2003; 53(6):568-576. 10. Trigoletto FD, Lieberman E, Lang JM. A clinical trial of active management of labour. N Engl J Med 1995; 333:745-50.
R R Shinde, B S Nagaonkar, R D Anerao
Background: It was proposed to study the scope of PPP as a strategic management policy to improve standards of health services in hospital to IPHS (Indian Public Health Standards) level. Objectives: The objective of this study is to assess the scope and feasibility of specific managerial inputs to promote Public Private Partnership of National Rural Health Mission in emphasizing qualitative aspect of services by identifying components where Public Private Partnership can be evolved for hospital services development and probable modalities for the sustainability of the same. To study and compare outcome of select indicators in study and control groups, implementing Public Private Partnership strategies in the domains of “Outsourcing’’ of Clinical services, Nonclinical services, Paramedical services, Civil works, Hospital accreditation under Janani Suraksha Yojna. To review public-private partnership practices in Public Health Department and to recommend strategies of Public Private Partnership in implementing quality health services in hospitals based on study findings. Material and Methods: The present study adopts an experimental epidemiological study design involving study and control group, in which study group of 6 hospitals receives an intervention package and control group of 14 hospitals does not receive an intervention package. Results and Impact: In Present study output indicators are found statistically different at 90% C.I. level, while outcome indicators are not found statistically different at 90% C.I.level. So it is needed to institutionalize outcome quality indicators. All these Outcome quality indicators are included in grading criteria of empanelled Public and Private hospitals under Rajeev Gandhi Jeevandayee Yojna of state which is a Health insurance scheme.
1. Cost containment is driving hospital reforms in most counties. P. Eriksson, V. Diwan, and I Karlberg, eds.nization, 2001); Accessed on 10.02.09. 2. Bihar State Infrastructure Development Enabling Act, 2006industries.bih.nic.in/ Acts/AD-01-19-12-2006.pdf Accessed on 11.04.09. 3. Role of Branding in health care www.ncbi.nlm.nih.gov/pubmed/10185773 Accessed on 11.09.09 4. National Conference on PPP in Health by CEHAT 25 September 2009, Regulation of PPP Initiatives. Accessed on 25.09.09. 5. National Conference on PPP in Health by CEHAT 26 September 2009 Issues And Challenges in Regulation of Private Sector Dr RituKhatri and Padma Deosthali CEHAT Accessed on 26.09.09. 6. Private Partnership (PPP) in District Hospitals of Bihar. Project Description. State Health Society shsbihar.org/tenders/tender_52.pdf Accessed on 27.02.10. 7. Ethical guidelines and regulations grants.nih.gov/grants/policy/hs/ethical_guidelines.htm Accessed on 10.09.09 8. Public-private partnerships for providing healthcare servicesthe public-private partnership is an initiative to improve efficiency. Ministry of health and family welfare. National Rural Health Mission (2005-2012) www.issuesinmedicalethics.org/154co174.html - 14k Accessed on 10.02.10. 9. National Health Systems Resorce Center Ministry of Health and Family Welfare Government of India Approaches to capacity BuidingAccessed on 22.12.09. 10. Guidelines – Incentives for health professionals Page 14 - www.who.int /workforcealliance /.../Incentives_Guidelines%20EN.pdfaccessed on 27.02.10. 11. Monitoring PPP Health care infrastructure Design construction - www.ukas.gov.my/.../10157/33dc9b9d-1f6c-4150-a811-53e241c75634 Accessed on 20.02.10. 12. Community Based monitoring Maharashtrawww.maha-arogya.gov.in / Community% 20 based %20 NRHM/ CBM_Repo.
Shreyaa Sriram, U T Bhosale, Ramchandra Shriwastav
Introduction: Abdominal and vaginal hysterectomies are the two prominent operative modalities for various uterine conditions. However the indications for selecting a particular procedure in any setting may not be optimally defined. This study was undertaken to evaluate the appropriate route of hysterectomy in a hospital population for women with benign disease by comparing peri operative and post operative complications. Method: This experimental study was undertaken at the department of OBGY Bharati Hospital, Sangli, from Jan 2014 to June 2014. 50 subjects were equally divided into vaginal and abdominal hysterectomy groups by convenience sampling. The primary outcome measures were operative time, primary haemorrhage, wound infection, post operative analgesia, febrile morbidity, hospital stay and secondary haemorrhage and secondary outcome measures were estimated
1. Sheth SS. Vaginal hysterectomy.In: PuriR, Malhotra N. eds. Operative Obstetrics and Gynaecology. New Delhi. Jaypeebrother’s medical publishers.2009:499-510. 2. Sheth SS, Paghdiwalla K P. In: Saraiya UB, Rao A K, ChateerjeeA.eds .Principles and Practice of obstetrics and Gynaecology.2ndedition. New Delhi. Jaypeebrothers medical publishers.2003.374-30. 3. Goel N, Rajaram S, GhummanS.eds .Step by Step Non-Descent vaginal hysterectomy.New Delhi. Jaypeebrothers medical publishers. 4. Dewan R, Agarwal S, Minocha B, Sen SK. Non-descent Vaginal Hysterectomy –An Experience. J ObstetGynecolInd .2004; 54(4):376- 8. 5. Ikram M, Saeed Z, Saeed R, Saeed M. Abdominal versus vaginal hysterectomy. Professional Med J 2008; 15:486-91. 6. Iftikhar R. Vaginal hysterectomy is superior than abdominal hysterectomy. J Surg Pak 2008; 13:55–8. 7. Akingba DH, Deniseiko-Sanses TV, Melick CF, Ellerkmann RM, Matsuo K. Outcomes of hysterectomies performed by supervised residentsvs those performed by attendings alone. Am J Obstet Gynecol 2008; 199:673.e1-6. 8. Oláh KS, Khalil M. Changing the route of hysterectomy: the results of a policy of attempting the vaginal approach in all cases of dysfunctional uterine bleeding. Eur J Obstet Gynecol Reprod Biol 2006; 125:243–7. 9. Kovac SR. Guidelines to determine the route of hysterectomy. Obstet Gynecol 1995; 85(1):18–23. 10. Cardosi. J.Richard. Determining the best route for hysterectomy .The journal of family practice .July 2002; 14(7):. 11. Dicker RC, Greenspan JR, Strauss LT etal. Complications of vaginal and abdominal hysterectomy among women of reproductive age in the United States. Am J Obstet G ynecol.982; 144; 841-8. 12. Geoff. McCracken, Guylaine G. Lefebvre. Vaginal hysterectomy: Dispelling the myths. JOGC 2007; 424-7. 13. Chakraborty S, Goswami S, Mukherjee P, Sau M. Hysterectomy... which route. Journal of Obstet and Gynecol of India. 2012; 61(5): 554- 7. 14. Royal KK,Goyal MM ,Singh S, Malhotran N, Kumar S. Archives of Gynaecology 2011; 284(4);907-12.
Introduction: Most caesarean sections are performed under epidural or spinal block and women undergoing caesarean section often experience anxiety in anticipation of the event to which one may be unfamiliar, uncomfortable or have undesirable results. Methods: This randomized controlled clinical trial was conducted for a period of one year. 100 pregnant with American Society of Anesthesiologists (ASA) physical status I–II scheduled to undergo cesarean section surgery under spinal anaesthesia were taken up for the study and were randomly divided into two equal groups. The objective of the study was to evaluate the effect of music on self-reported anxiety and hemodynamic parameters in the intraoperative phase in patients who underwent caesarean section under spinal anaesthesia. Patients of study group were subjected to listen preoperatively self chosen music with the help of headphone with the volume label as acceptable by the patient. Music listening started on completion of successful spinal anaesthetic procedure and lasted till the end of the surgery. The Visual Analogue Scale (VAS) was explained in detail to the patients and was used to measure the preoperative & postoperative anxiety, and maternal satisfaction score (MSS), and haemodynamic parameters was recorded. Results: There was no statistically significant change in the SpO2 (P=.782), systolic (P=.405) and diastolic blood pressure (P=.513) but there was significant change in the respiratory rate (P=.004) and pulse rate (P=.017) on completion of the surgery in the music group. A statistically significant difference was also recorded in the VAS for anxiety score (VASA), P=.000 and MSS (P=.000) in the postoperative period in the music group. Conclusion: Music therapy is an example of a non-pharmacological aid that can be used on patients undergoing surgical under spinal anaesthesia, empowering the patient to develop own ability to gain control over negative effects of the surgical stress.
1. Mok E, Wong KY: Effects of music on patient anxiety: AORN Journal. 2003 Feb; 77(2):396-7, 401-6, 409-10. 2. Minkoff H, Chervenak FA: Elective primary cesarean delivery: New England Journal of Medicine 2003 March; 348(10): 946–50. 3. Voss JoA, Good M, Yates B, et al: Sedative music reducesanxiety and pain during chair rest after open-heart surgery: Pain 2004;112:197–203. 4. Nilsson U, Rawal N, Unestahl LE, et al: Improved recovery after music and therapeutic suggestions during general anaesthesia:A double-blind randomized controlled trial: ActaAnaesthesiol Scand. 2001;45:812–817. 5. Chang E. F., Bao S., Imaizumi K., Schreiner C. E., Merzenich M. (2005). Development of spectral and temporal response selectivity in the auditory cortex. Proc. Natl. Acad. Sci. U.S.A. 102, 16460–16465 10.1073/pnas.0508239102 6. Tse MM, Chan MF, Benzie IF: The effect of music therapy on postoperative pain, heart rate, systolic blood pressures and analgesic use following nasal surgery: J Pain Palliat Care Pharmacother. 2005;19:21–29. 7. Locsin R: The effect of music on the pain of selected postoperative patients: J AdvNurs. 1981;6:19–25. 8. Nilsson U, Rawal N, Enqvist B, Unosson M: Analgesia following music and therapeutic suggestions in the PACU in ambulatory surgery: A randomized controlled trial: ActaAnaesthesiol Scand. 2003; 47:278–283. 9. Colt HG, Powers A, Shanks TG: Effect of music on state anxiety scores in patients undergoing fiberoptic bronchoscopy: Chest 1999; 116:819–824. 10. Ebneshahidi A, Mohseni M: The Effect of Patient-Selected Music on Early Postoperative Pain, Anxiety, and Hemodynamic Profile in Cesarean Section Surgery: The Journal Of Alternative And Complementary Medicine. 2008; 14(7): 827–831. 11. Allen K, Golden LH, Izzo JL Jr: Listening to music during ambulatory ophthalmic surgery reduced blood pressure, heart rate, and perceived stress: Evid Based Nurs. 2002; 5(1):16-17. 12. Augustin P, Hains AA: Effects of music on ambulatory surgery patients’ preoperative anxiety: AORN J. 1996; 63(4):750, 753-758. 13. Miluk-Kolasa BM, Matejek M, Stupnicki R: The effects of music listening on changes in selected physiological parameters in adult pre-surgical patients: J Music Ther. Fall. 1996; 33:208-218. 14. Updike PA, Charles DM: Music Rx: physiological and emotional responses to taped music programs of preoperative patients awaiting plastic surgery: Ann Plast Surg. 1987; 19(1):29-33. 15. Yung PMB, Chui-Kam S, French P, Chan TMF: A controlled trial of music and pre-operative anxiety in Chinese men undergoing transurethral resection of the prostate: J Adv Nurs.2002; 39(4):352-359. 16. Steelman VM: Intraoperative music therapy: effects on anxiety, blood pressure: AORN J. 1990; 52(5):1026-1034. 17. Clark M, Isaacks-Downton G, Wells N, et al: Use of preferred music to reduce emotional distress and symptom activityduring radiation therapy: J Music Ther. 2006; 43:247–265. 18. Allen K, Golden LH, Izzo JL Jr, et al: Normalization of hypertensive responses during ambulatory surgical stress by perioperative music: Psychosom Med. 2001; 63:487–492. 19. Mitchell LA, MacDonald RA: An experimental investigation of the effects of preferred and relaxing music listening on pain perception: J Music Ther. 2006; 43:295–316. 20. Koch M, Kain ZN, Ayoub C, Rosenbaum SH: The sedativeand analgesic sparing effect of music: Anesthesiology. 1998; 89:300–306. 21. Siedliecki SL, Good M: Effect of music on power, pain, depression and disability: J AdvNurs 2006; 54:553–562. 22. Broscious SK: Music: An intervention for pain during chest tube removal after open heart surgery: Am J Crit Care. 1999; 8:410–415. 23. McCaffrey R, Locsin RC: Music listening as a nursing intervention: A symphony of practice: Holist NursPract. 2002; 16:70–77. 24. Dunn K: Music and the reduction of post-operative pain: Nurs Stand. 2004; 18:33–39.
Anil Joshi, Rajani Joshi
Rhinoliths are mineralised foreign bodies in the nasal cavity and may be discovered during routine radiographic exam. The incidence of adult rhinolith is very low. Rhinoliths are generally single, exogenous or endogenous, unilateral, and asymptomatic. They can cause nasal obstruction, fetid odour and purulent discharge. Though infrequently observed, rhinoliths can be the source of bad smell from the nose and therefore a social concern for the patient. The CT Scan of paranasal sinuses is the radiological investigation of choice in this condition. We report four patients with rhinoliths presenting with diverse clinical findings.
1. Varley EWB (1964) Rhinolith: an incidental finding. Br J Oral Surg2: 40-43. 2. Carder HM, Hiel JJ (1966) Asymptomaticrhinolith: a brief review of the literature and case report. Laryngoscope 76:524-530. 3. Orhan K, Kocyigit D, Kisnisci R. Rhinolithiasis: An uncommon entity of the nasal cavity. Oral Surg Oral Med Oral Pathol Oral RadiolEndod 2006; 101:e28-32. 4. Sumbullu M, Tozoglu U, Yoruk O, Yilmaz A, Ucuncu H. Rhinolithiasis: the importance of flat panel detector-based cone beam computed tomography in diagnosis and treatment. Oral Surg Oral Med Oral Pathol Oral RadiolEndod 2009;107:e65-67 5. Langlaris RP, Langland OE, Nortje CJ. Diagnostic imaging of the jaws. Chapter 19 “Soft tissue radioopacities, Williams and Wilkins, Baltimore, 1995; 6.30-31. 6. Hsiao JC, Tai CF, Lee KWl. Giant rhinolith: A case report. Kaohsiung J Med Sci 2005; 21:582-5. 7. K. Orhan, D. Kocyigit, R. Kisnisci, et al “Rhinolithiasis: an uncommon entity of the nasal cavity,” Oral Surgery, oral Medicine, Oral Pathology, Oral Radiology and Endodontology, 2006;vol. 101, no. 2: E28–E32 8. Pinto LSS, Campagnoli EB, Azevedo, RS, Lopes, MA. Rhinoliths causing palatal perforation: case report and literature review. Oral Surg Oral Med Oral Pathol Oral RadiolEndod 2007;104: e42-46 9. Keck T, Liener K, Strater J, Rozsasi A. Rhinolith of the nasal septum. Int. J Pediatrhinolaryngol 2000;53;225-228 10. Royal SA, Gardner RE. Rhinolithiasis: An unusual pediatric nasal mass. PediatrRediol 1998; 28:54-55
Maya Rose Jose, SanjanaVinod
Hospital admission, anesthesia and surgery are stressful experiences for children which may lead to psychological trauma and personality changes. The increasing use of day care surgery, the avoidance of parental separation and the use of sedative premedication may reduce the stress of hospitalization in children and the risk of adverse psychological sequel. Search for an ideal premedicant drug for children is still on. Aims and objectives: To compare and evaluate the efficacy of midazolam and triclofos when given orally as premedicants in children. Materials and methods: In the present study 50 children were selected and were divided in two groups (midazolam group and triclofos group). Preoperative assessment was performed one day before the surgery by an observer.Evaluation of post-premedication sedation (thirty minutes post-premedication in the Midazolam group and sixty minutes post-premedication in the Triclofos group) was recorded. Level of sedation at the post premedication and level of sedation at the time of separation from parents was recorded. Behavior at the time of separation from parents and behavior during mask acceptance was recorded and analyzed. Results: On Post Premedicant it was observed that in midazolam group majority children (22) had sedation score of two whereas in triclofos group majority of the children (21) had sedation score four. Evaluation of the level of sedation at the time of separation from parents showed that majority of the children (22) in the Midazolam group had a sedation score of two whereas in triclofos group majority of the children (20) were having score four. The comparison of sedation scores between the two groups was done using the Fisher’s exact probability test. The difference between the two groups was very highly significant statistically. While studying behavior at the time of separation from parents, it was observed that majority of the children in midazolam and triclofos were having score four (21 and 23 children respectively). In the Midazolam group, 14 children had a mask acceptance score of four and in the triclofos group, 20 children had a mask acceptance score of four. Conclusion: Even though the children are less sedated with oral midazolam as compared to triclofos, if produces an equally satisfactory separation from parents and satisfactory mask acceptance.
1. Saarnivaara L, Lindragen L, Klemola UM. Comparison of chloral hydrate and midazolam by mouth as premedicants in children undergoing otolaryngological surgery. Br JAnaeshta. 1988;61:390-96 2. Feld LH, Negus JB, White PF. Oral midazolam preanesthtic medication in Pediatric outpatients. Anesthesiology. 1990; 73:831-34. 3. McMillan CO, Spahr-Schopfer IA, Sikich N, Hartley E. Leman J. Premedication of children with oral midazolam. Can J anaesth. 1992; 39:6:545-50. 4. Parnis SJ, Foate JA, Van Daer Walt JH, Short T, Crowe CE. Oral midazolam is an effective premedication for children having day stay anesthesia. Anaesth intensive Care 1992; 20:91-4. 5. Suresh C, Kulshrestha S, Jain A, Kohli P. Oral premedication for pediatric anaesthesia – Comparison of midazolam and ketamine. Indian J Anaesth 2000;44:41-6. 6. Brosius KK, Bannister CF. Midazolam premedication in children: A comparison of two oral dosage formulations on sedation score and plasma midazolam levels. AnesthAnalg 2003;96:392-5, 7. Kazak Z, Sezer GB, Yilmaz AA, Ates Y. Premedication with oral midazolam with or without parental presence. Eur J Anaesthesiol 2010;27:347-52. 8. Harvey CS. Hypnotics and sedatives. In: Gliman AG, Goodman LS, Glimon A editors. Pharmacological basis of therapeutics. 6thed. New York; MacMillan Publishing Compay; 1980.p. 350-63. 9. Jackson EA, Rabbette PS, Dezateux C, Hatch DJ, Stocks J. The effect of triclofos sodium sedation on respiratory rate, oxygen saturation, and heart rate in infants and young children. PediatrPulmonol 1991;10:40-5. 10. Kaplan RF, Yaster M, Stafford MA, Cote CJ. Pediatric sedation for diagnostic and Therapeutic Procedures outside the Operating Room. In: Cote CJ, Ryan Js, Todres ID, Goudsouzian NG editors. Anestheisa for infants and children. 3rd ed. Philadelphia: WB Saunders Compnay; 1994,p. 598-600. 11. Mitchell V, Grange C, Black A, Train J.A Comparison of Midazolam with trimeprazine as an oral permedicant for children. Anaesthesia 1997;52: 416-21.
Anita Jagdish Kandi, Venkat Arjunrao Gite, Anagha S Varudkar
Introduction: Phimosis or inability to retract the foreskin in the majority of neonates is because of natural adhesions exist between the prepuce and the glans. Circumcision is often regarded as a minor surgical procedure but there is probably more complication associated with this operation. In cases of pathologic phimosis, surgical correction is the standard treatment. However, in recent years, the topical application of steroids provides an alternative to the management of this disease. Aims and objectives: To evaluate the efficacy of topical steroid betamethasone (0.05%) in management phimosis. Materials and methods: 50 pediatric patients of phimosis attending the surgery outpatient department and patients referred from pediatric outpatient department as well as Indoor ward were included in the study. The phimosis was graded by using Kikiros grading system. All patients underwent treatment with application of topical steroid betamethasone 0.05% thrice daily after washing or bathing for 4 weeks to the foreskin. After the foreskin become retractable, patients / parents were asked to retract the foreskin gently without causing any pain. When the phimosis didn’t resolve then patients were offered another course of two weeks. A final assessment of the grading was done at completion of 6 weeks course. All patients were followed up at 8, 10, and 12 weeks respectively after completion of treatment. Results: The mean age of children in the study was 6.3 ± 0.43 years. Majority of the children were having grade V phimosis (86%) and it was followed by grade IV (14%). Response rate of topical steroid betarnethasone 0.05% at 4th week was 80%. Out of 8 patients who did not respond at 4th week were given additional 2 week treatment and 6 patients responded. First follow up was done at 8th week and the treatment response rate was maintained (92%). The response rate was maintained at 92% till the follow-up was done at 12th week. Conclusion: Thus in the end we conclude that topical treatment of phimosis with corticosteroids is simple and efficient treatment modality.
1. Hodges FM. Phimosis in antiquity. World J Urol 1999;17(3):133-6. 2. Babu R, Harrison SK, Hutton KA. Ballooning of the foreskin and physiological phimosis: is there any objective evidence of obstructed voiding? BJU Int 2004. 3. Gairdner D (1949) The fate of the foreskin. Br Med J 2: 1433-1437 4. Jorgensen ET, Svensson A. The treatment of phimosis in boys, with a potent topical steroid (clobetasol propionate 0.05%) cream. Acta Dermato-Venereok:|f7ica. 1993;73(1):55-56. 5. Deibert G.A. The separation of the prepuce in the human penis. Anat Rec 1933, 57:387-389. 6. Kikiros CS, Beasley S W, Woodward AA, The response of phimosis to local steroid application. Ped sury mt 1993; 8:329-32. 7. Wai-Tat Ng, Ning Fan et al ... Julio Cesar Morales Concepci6n, Emilio Cordie s Jackson et al Phimosis, where there was discomfod, pain or other problems, it is true that there was 138 boys who were prescribed 0.05% betamethasone ointment (Diprocel) during 1 August 2001-31July 2004. 8. Webster TM, leonard MP "Topical steroidtherapy for Phimosis. "J. Urol. 2002 Apr, 9(2):1492-5. 9. Kuehhas FE, Miernik A, Sevcenco S, Tosev G, Weibl P, Schoenthaler M, et al. Predictive power of objectivation of phimosis grade on outcomes of topical 0.1% betamethasone treatment of phimosis. Urology 2012;80:412-6. 10. BK Rai Department of General Practice & Emergency Medicine Nepal is an effective alternative to circumcision for the treatment of infant and childhood phimosis.Health Renaissance, September-December 2010;Vol 8 (No.3); 176-180. 11. Orsola A, Caffaratti J, Garat JM. Department of Pediatric Urology 2000 Aug 1;56(2):7-1.0. Conservative treatment of phimosis in children using topical steroid. 12. Elmore JM, Baker LA. Snodgrass WT. "Topical steroid therapy as an Alternative to circumcision for Phimosis in boys younger than 3 years. J.Urol. 2002 pct, 168(4):1746-5. 13. Lee KS, Koizmi T, Nakatsuji H; el. at.Treatment of Phimosis with Betamethascn ointment 0.10% in children" 2001 Sep.9, 2(6):619-23 14. Flavio de Oliveira Pileggi. m moisturizing cream (placebo) for the treatment of phimosis. Children aged Journal of Pediatric Surgery (2007) 42, 1749-1752 15. Peter D. Metcalfe, Remon Elyas. Foreskin management. Can Fam Physician 2010;56:e290-5 16. Bloom D.A., Wan J. and Key D. (1992) Disorders of the male external genitalia and inguinal canal. In: Kelalis P.P., King L.R. and Belman A.B. (Eds.)Clinical Pediatric Urology. Philadelphia: WB Saunders. 17. Cuckow P.M., Rix G. and Mouriquand P.D. Preputial plasty: a good alternative to circumcision. J Pediatr Surg 1994, 29:561-563. 18. Jorgensen E.T. and Svensson A. The treatment of phimosis in boys, with a potent topical steroid (clobetasol propionate 0.05%) cream. Acta Derm Venereol1993, 73:55-56. 19. Australasian Association of Paediatric Surgeons: Guidelines for Circumcision. Hersion, Queensland, Australia, Australasian Association of Paediatric Surgeons, April 1996.
Injury and deaths due to road traffic accidents are a major but neglected public health problem in developing countries. This ever expanding epidemic targeting the young and productive generation is likely to take heavy burden on quality of life and economy of the nation. The present studywas conducted in Rajiv Gandhi Institute of Medical Sciences, Adilabad to study epidemiology and injury pattern of Road Traffic Accident (RTA) cases. The present study wasaretrospectiverecordbasedstudyanddata wascollectedusingquestionnairemethod. A total of 504 RTA cases were studied from thecaserecordsofthe medicalrecordssectionof Rajiv Gandhi Institute of Medical Sciences, Adilabad during the period of October 2010 toSeptember2011. The results revealed that (i) out of total 504 RTA cases, 395 (77.3%) of the victims were males and the rest 109 (22.7%) were females. (ii) Thehighestnumberofvictims186(36.90%) werefrom21-30yearsofagegroup.(iii) The highestnumberof Accidents took place in February (11.71%) and on Sunday (18.06%) during 6 p.m. to 9 p.m. (27.58 %) (iv) Head, neck and face was involved in 219 (32.93%) cases while out of total 161cases of fractures, the commonest site of fracture was lower limb in 75 (46.58%) cases.
1. ParkK(2009)Park’sTextbookofPreventiveandSocialMedicine,(20thed.),BanarsiDas Bhanot, Jabalpur,353 2. United Nations,Economic and Social Commission for Asia and the Pacific, Status of Road Safety in Asia.Regional Expert Group Meeting on Implementation of Decade of Action for Road Safety, 2011-2020, 21-23 September 2010 Bangkok 3. Peden M, Scurfield R, Sleet D, Mohan D,HyderAA,JarawanEet al(2004)WorldReportonRoadTrafficInjuryPrevention. World Health Organization, Geneva. 4. World health statistics 2008. World Health Organization, Geneva. 5. World’s first road death. Road peace, (2003) London. 6. World Health Organization. Global Status Report on Road Safety: Time for action. WHO, Geneva 2009. 7. Nantulya and Reich. The neglected epidemic: road traffic injuries in developing countries. BMJ VOLUME 324 11 MAY 2002: 1139-1141 8. Report of National Crime Records Bureau (2010). 9. Feasibility study for injury surveillance at Dr. Ram ManoharLohia Hospital, New Delhi GOI- WHO collaborative program 2006-2007 By Dr. S.K Sharma Nodal Officer 10. JhaN,SrinivasaDK,RoyG,JagdishS(2004)Epidemiologicalstudyofroadtrafficaccidentcases:astudyfrom SouthIndia.Indian Journal of Community Medicine, 29 (1): 20-24. 11. Deepak Sharma, Uday Shankar Singh, Sidhyartha Mukherjee. A study on road traffic accidents in Anand-Gujarat. Healthline, Volume 2Issue 2 July-December 2011: 12-15 12. SupriyaPatil, R V Kakade, P M Durgawale, S V Kakade. Pattern of Road Traffic Injuries: A Study from Western Maharashtra. Indian Journal of Community Medicine, 33(1). Jan-March 2008:56-57 13. VirenKaul, D DBant, N D Bendigeri, GeetaBhatija. A brief medico-social-demographic profile of non fatal Road Traffic Accident cases admitted to Karnataka Institute of Medical Sciences. Scholar’s Research Journal, Vol 1,Issue1,Jan-June 2010:32-36 14. Abhishek Singh, AnuBhardwaj, RambhaPathak, SK Ahluwalia. An epidemiological study of road traffic accident cases at a tertiary care hospital in rural Haryana. Indian Journal of Community Health. Vol 23 no. 2. July-Dec 2011: 15. Badrinarayan Mishra, N D Sinha, S K Shukla, A K Sinha. Epidemiological Study of Road Traffic Accident Cases from Western Nepal.IndianJournalof Community Medicine vol 35 issue 1Jan-March 2010: 115-121 16. Mehta SP. An epidemiological study of road traffic accident cases admitted in Safdarjang Hospital, New Delhi, Indian Journal of Medical Research, 1968;56(4):456-466. 17. Ganveer GB, Tiwari RR. Injury pattern among non-fatal road traffic accident cases: A cross-sectional study in Central India. Indian Journal of Medical Sciences 2005;59:9-12 18. NilambariJha, D K Srinivasa, Goutam Roy, S Jagdish. Injury Pattern among road traffic accident cases a study from South India. IndianJournalof Community Medicine vol 28 issue 2, April-june 2003: 85-90.
Agarwal Vimal K, Agrawal Sonal
A 23 year old woman presented in outpatient Department in obst. and gynecology her 3rd pregnancy at 32 weeks of gestation age in labour with an unusual bulge of her lower abdomen. Abdominal bulge was her gravid uterus herniating through anterior abdominal wall. Incisional hernia is though not rare, but potentially serious condition due to its antecedent complications. Initially these hernias may be reducible, but delay in recognition can lead to incarceration and subsequent strangulation of gravid uterus. In this case Caeserean section and bilateral tubal ligation were done with repair of incisional hernia with nonabsorbable suture with uneventful post operative recovery. Even for emergency operations like caesarean section surgical principles must be followed.
1. Sahu L, Bupathy A. Evisceration of pregnant uterus through incisional hernia site. J Obstet Gynaecol Res. 2006;32:338-340. 2. Malhotra M, Sharma JB, Wadhwa L, Arora R. Successful pregnancy outcome of cesarean section in a case of gravid uterus growing in incisional hernia of anterior abdominal wall. Indian J Med Science 2003; 57:501-503. 3. O Dwyer PJ, Courtney CA. Factors involved in abdominal wall closure and subsequent incisional hernia. Surgeon.2003;1:17-22. 4. Rao Radha S, Shankaregowda HS. A case of herniated gravid uterus through a laparotomy scar. Indian J Med Sci.2006;60:154-157. 5. Adesunkami AR, Faleyinmu B. Incidence and aetiological factor of incisional hernia in a post caesarian operation in a Nigerian hospital. J Obstet Gynaecol.2003;23:258-260. 6. Saha PK, Rohilla M, Dahiwal LK, Gupta I. Herniation of gravid uterus: Report of 2 cases and Review Literature. Medscape General Medicine 2006;8:14. 7. Banerjee N, Deka D, Sinha A, Prasad R, Takkar D. Gravid uterus in incisional hernia. J Obstet Gynacol Res 2001;27:77-79. 8. Nagpal M, Kaur S. Herniated pregnant uterus with bleeding from previous abdominal scar. J Obstet Gynaecol India 2003;53:283. 9. Dare O, Lawal OO. Experience with 29 case of female ventral incisional hernia in Ile Ife, Nigeria Int J Gynaecol Obstet. 1991;36:29-32. 10. Fullman PM. An incisional hernia containing an incarcerated twin pregnant uterus. Am J Obstet Gyecol. 1971;111:308-309. 11. Dare FO, Makinde OO, Lawal OO. Gravid uterus in an anterior abdominal wall hernia of a Nigerian woman. Int J Gynaecol Obstet. 1990;32:377-379. 12. Duncan JL, Rogers K. Umblical and Epigastric Hernia Surgery. 1991;97:2326-2329.
Rahul Dagwar, NileshGaddewar, Ashok Madan
Context: Many students of various government schools, having eye problems are referred to tertiary eye care hospital underSarwaShikshaAbhiyan (Education for all).Aim: To study the causes of blindness and functional vision improvement in visually impaired students (BCVA<6/60) by providing optical low vision aids (LVAs).Setting and design: Students of various government schools of Nagpur district are referred to government medical college, Nagpur for various eye problems under SarwaShikshaAbhiyan (education for all). Prospective series was conducted among the students who are advised visual handicap certificate (BCVA<6/60) after complete evaluation. Materials and Methods: Ocular evaluation of these students was done using World Health Organization's eye examination protocol by slit lamp examination, ophthalmoscopy, retinoscopy and visual acuity estimation with the log MAR chart at a distance of 4 m and reduced Snellen's acuity charts. LVAs were prescribed.Results: Study includes two hundred and thirty students who were advised handicap certificate (BCVA <6/60). ; Their mean age was 12.6 years (S.D. 3.3 years, range 5-20 years) and 123 (53.5%) were males. Two hundred and seven (90%) were visually handicap since birth. The students were handicap due to microphthalmos, anophthalmos and coloboma 121 (52.60%), diseases of cornea 30 (13%), lens 39 (16.9%), uvea 5%, retina 21 (9.13%) including retinopathy of prematurity (ROP) and optic nerve lesions 6%. LVA for distance was prescribed to 30 students (13%) who improved >1 line and for near was prescribed to 72 students (31.3%) of whom 68 attained N6-N12 acuity. Conclusion: LVA prescription improved visual acuity of visually handicap students and allowed them to learn and read print.
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