Introduction: Abdominal pain is one of the most common reasons for an emergency department (ED) visit, accounting to about 5% to 10% of all ED visits. Aims and Objectives: To Study Correlation between Preoperative Provisional Diagnosis and Intra Operative Findings in the Patients with Non Traumatic Acute Abdominal Pain. Material and Methods: After approval form the Institutional ethical committee a records based, cross-sectional study was carried out in the Department of General Surgery at tertiary health care center during one-year period June 2014-June 2015. All details about clinical history, Clinical diagnosis, Ultrasongraphic findings, CT-Scan findings and Intraoperative findings was extracted from the case records. There were 100 patients were included into the study. 62 pt managed operatively and 38 patients managed conservatively. Result: The majority of the Patients were from the age group of 30-40 i.e. 33%. The majority of the patients were Males i.e. 56% and Females were 44% As per Preoperative Provisional Diagnosis the most common diagnosis found was Acute appendicitis in 44% followed by; Urolithiasis in 14%, Gastritis in 13%, Hollow viscus perforation in 12%, Intestinal obstruction in 06%, Acute cholecystitis in 6%, Acute Pancreatitis in 5%. As per Intraoperative findings in patients with preoperative provisional diagnosis of acute Appendicitis intra op finding was inflamed appendicitis in 63.46% followed by Perforated appendicitis in 20.46%, Gangrenous appendicitis in 13.64%, Normal appendicitis in 2.27%. For preoperative diagnosis in 12 patients as Hollow viscus perforation incidence of Duodenal perforation 58.4% followed by Gastric perforation in 33.3%, Ileal perforation in 8.3% . For total 6 patients as preoperative provisional diagnosis as intestinal obstruction the intraop finding were Postoperative adhesive band 50.1%, Sigmoid volvulus 16.7%, Superior mesenteric artery thrombus 16.7%, Obstructed hernia 16.7.The compatibility of intraoperative findings was highest with USG Diagnosis i.e. 89.00% followed by CT-Scan was 81% and of the Clinical diagnosis was 59%. Conclusion: As per Preoperative Provisional Diagnosis the most common diagnosis found was Acute appendicitis in followed by Urolithiasis, Gastritis, Hollow viscus perforation, Intestinal obstruction, Acute cholecystitis, Acute Pancreatitis etc . The compatibility of intraoperative findings was highest with USG Diagnosis i.e. 89.00% followed by CT-Scan was 81% and of the Clinical diagnosis was 59%.
1. Kamin RA, Nowicki TA, Courtney DS, Powers RD. Pearls and Pitfalls in the Emergency Department Evaluation of Abdominal Pain. Emerg Med Clin North Am 2003;21:61-72.
2. Agboola JO, Olatoke SA, Rahman GA. Pattern and Presentation of Acute Abdomen in a Nigerian Teaching Hospital. Niger Med J 2014;55:266-70.
3. Powers RD, Guertler AT. Abdominal Pain in the ED: Stability and Change over 20 Years. Am J Emerg Med 1995;13:301-3.
4. Gupta, K;. Bhandari, RK;. Chander, R. Comparative study of plain abdomen and ultrasound in non-traumatic acute abdomen Gastrointestin.radiol. 2005; 5(1) 109-115.
5. Smith, J .T ;.Mbchb, M;.and Parachemant, C .The role of imaging in the management of adults with nontraumatic acute abdominal pain .2009 ; vol. 21 : 1-19.
6. Walsh P.F, Crawford D and Crossling F.T . The value of immediate ultrasound in acute abdominal conditions: a critical appraisal. Clin Radiol 1990; 42:47–9.
7. Andrew B;.M;.Michael J. Lane;. Robert T. G.; .Harry A;.Claypool, S. K.;.Douglas, S. K. and Jonathan E. T.. Nontraumatic Acute Abdominal Pain: Unenhanced Helical CT Compared with Three View Acute Abdominal Series Radiol. 2005 ; 237:114-122.
8. Siewert B, Raptopoulos V, Mueller M. F, Rosen M. P and Steer M. Impact of CT on diagnosis and management of acute abdomen in patients initially treated without surgery. AJR Am J Roentgenol; 1997; 168:173–178.
9. Rosen MP, Sands D. Z, Longmaid HE, Reynolds K.F, Wagner M, and Raptopoulos V .Impact of abdominal CT on the management of patients presenting to the emergency department with acute abdominal pain. AJR Am J Roentgenol 2000; 174:1391–1396.
10. Bohner H,Yang Q and Franke, C. Simple data from history and physical examination help to include bowel obstruction and to avoid radiographic studies in patients with acute abdominal pain. Eur J Surg; 1998; 164:777–84.
11. Basim R. Gadban. Comparative study between ultrasound findings and intra-operative findings in non-traumatic Abdominal Pain. J Fac Med Baghdad. 2011; 53(4): 377-380.
12. Lakshay Chanana, Moses A. K. Jegaraj, Kimmin Kalyaniwala et al. linical profile of non-traumatic acute abdominal pain presenting to an adult emergency department . J Family Med Prim Care .2015 ; 4:422-5.
13. Raman, S.; Somasekar .; Winter R.K ;.Lewis M.H 2004 .Are we overusing ultrasound in non-traumatic acute abdominal pain? Postgrad Med J . 2004; 80:177-179.
14. Andrew B;.M;.Michael J. Lane;. Robert T. G.; .Harry A;.Claypool, S. K.;.Douglas, S. K. and Jonathan E. T. Nontraumatic Acute Abdominal Pain: Unenhanced Helical CT Compared with Three View Acute Abdominal Series Radiol. 2005 ; 237:114-122.
15. Malone AJ. Unenhanced CT in the evaluation of the acute abdomen: the community hospital experience.Semin Ultrasound CT MR; 1999; 20:68– 76.
16. Abdul Khair, Mahmond H, Mohammed M. Ultrasonography and liver abscesses. Am Surg 1981;193: 221-226.
Ipsilateral compound GR 2 femoral neck and shaft fracture in a 2 year old children- A case report
Introduction: Concomittant Ipsilateral Fractures of Neck And Shaft of femur are rare in children of age group 2 years. there are only 11 reported cases till now. These injuries occur in children due to high velocity trauma and there is no accepted method of treatment. Case Report: We had compound grade 2 mid shaft femur with bone loss and ipsilateral neck femur. After fixation it resulted in no limb length discrepancy and no varus deformity. we advocate operative stabilisation of femoral shaft fracture to reduce the risk of further displacement and simplify the fiation of femoral neck. The common complications we see have poor progonosis resulting in avascular necrosis, coxa vara and limb length discrepancy. But in our case report we had nothing of them despite of being compound grade 2 with bone loss. Conclusion: To Conclude, Case Of This Sort In Paediatric Age Group Are Rare, But If Managed Properly Gives A Satisfactory Outcome With Minimal Or Nil Complications.
Post-operative pain and analgesic requirements in breast surgery: Comparative study of combined general anaesthesia with paravertebral block versus general anaesthesia alone
Background:Patients undergoing breast cancer surgery frequently experience chronic postoperative pain. The primary objective of this randomized study was to determine if thoracic paravertebral block (TPVB) reduced the incidence of chronic pain after a modified radical mastectomy (MRM) when compared with general anesthesia (GA).This study was undertaken to compare analgesic efficacy and complications of combined general anaesthesia with paravertebral block versus general anaesthesia alone in breast surgery. Material and Methods: A total of 60 patients for elective breast surgery were grouped as Group A (General anaesthesia with paravertebral block) and Group B (General anaesthesia alone) and compared for analgesic efficacy and complications. Results: Duration of postoperative analgesia in group A was 17.63 ± 2.34 versus 5.47 ± 1.63 in group B. Patients in group A (PVB + GA) didn’t required any rescue analgesics as compared to group B (GA) where 28 patients received rescue analgesics. Incidence of PONV was significantly lower in group A as compared to group B. Conclusion: Para vertebral block when used with general anaesthesia induces excellent anaesthesia and greater postoperative pain relief and lower incidence of PONV and other complications.
1. Poleshuck EL, Katz J, Andrus CH, Hogan LA, Jung BF, Kulick DI, et al. Risk factors for chronic pain following breast cancer surgery: A prospective study. J Pain 2006;7:626-34.
2. Jaffe SM, Campbell P, Bellman M, Baildam A. Postoperative nausea and vomiting in women following breast surgery: An audit. Eur J Anaesthesiol 2000;17:261–4.
3. Gilbert J, Hultman J. Thoracic paravertebral block: A method of pain control. Acta Anaesthesiol Scand 1989;33:142–5.
4. Kairaluoma PM, Bachmann MS, Korpinen AK, Rosenberg PH, Pere PJ. Single-injection paravertebral block before general anesthesia enhances analgesia after breast cancer surgery with and without associated lymph node biopsy. Anesth Analg 2004;99:1837–43.
5. Breivik H, Borchgrevink PC, Allen SN, Rosseland LA, Romundstad L, Breivik HE, et al. Assessment of pain. Br J Anaesth 2008;101:17–24.
6. Patel LP, Sanghvi PR, Agarwal MB, Prajapati GC, Patel BM. Thoracic paravertebral block for analgesia after modified radical mastectomy. Ind J Pain 2014;28:160-5.
7. Barlacu CL, Frizelle HP, Moriaty DC, Buggy DJ. Fentanyl and clonidine as adjunctive analgesics with levobupivacaine in paravertebral analgesia for breast surgery. Anaesthesia 2006;61:932–93.
8. Klein SM, Bergh A, Steele SM, Georgiade GS, Greengrass RA. Thoracic paravertebral block for breast surgery. Anesth Analg 2000; 90:1402–5.
9. Coveney E, Weltz C, Greengrass A, Iglehart J, Leight G, Steele S, et al. Use of paravertebral block anaesthesia in the surgical management of breast cancer. Ann Surg 1998;(227):496–501.
10. Greengrass R, O’Brien F, Lyerly K, Hardman D, Gleason D, D’Ercole F, et al. Paravertebral block for breast cancer surgery. Can J Anaesth 1996;43(8):858–61.
11. Vila H, Liu J, Kavasmaneck D. Paravertebral block: new benefits from an old procedure. Curr Opin Anaesthesiol 2007;20(4):316–8.
Study of fine needle aspiration cytology in the diagnosis of ovarian masses
Background: Earlier the technique of aspirating ovarian masses was mostly unguided imaging technique. The ovarian masses were located by palpation and were approached transrectally, transvaginally and transcutaneously for fine needle aspiration cytology. The advancement of imaging technique has enabled many workers to undertake fine needle aspiration cytology of ovarian masses as it helped in correct localization and sampling from suspected area of cancerous and noncancerous lesions. Objectives: To study cytomorphological features of benign and malignant conditions of ovarian masses obtained at ultrasound guided fine needle aspiration cytology. To determine sensitivity and specificity at ultrasound guided fine needle aspiration cytology in diagnosis of ovarian masses. To draw value of comparison between cytodiagnosis and histomorphological diagnosis; rate of accuracy, false positive, false negative, positive predictive value and negative predictive value. Material and Methods: The present prospective study was carried out in the Department of Pathology, Jawaharlal Nehru Medical College, Sawangi (M), Wardha during two years duration from July 2009 to June 2011.FNAC was performed on cases with suspected ovarian masses with plan for surgical treatment. The material obtained at aspiration was wet fixed in 95 % ethyl alcohol and stained with papanicolaou stain while few were dry fixed and stained with May Grunwald Giemsa stain. Result: The false positive rate was 0 and false negative rate was 4.34%. The sensitivity and specificity of FNAC in diagnosis of ovarian masses was found to be 95.65% and 100% respectively. Negative predictive value was 96.77% and positive predictive value was 100% of FNAC in diagnosis of ovarian masses. Overall rate of accuracy of FNAC in diagnosis of ovarian masses was 98.11% in present study. Conclusion: FNAC over lesion of ovary carried out under USG guidance is a safe preoperative diagnostic modality. USG guided FNAC in the ovarian lumps has a definite ability to distinguish between a non neoplastic and neoplastic lesions of ovary with confidence.
1. Ramzy I, Delaney M, Rose P: Fine Needle Aspiration of Ovarian Masses II.Correlative Cytologic and Histologic Study of Nonneoplastic and Noncelomic Epithilial Neoplasms. Acta Cytologica 1979;23:185-193.
2. Ganjei,Mehrdad Nadji:Aspiration Cytology of Ovarian Neoplasm. Acta Cytologica 1984;28:329-332.
3. Kjellgren O, Angstrom T, Bergman F, D-E.Wiklund: Fine needle aspiration biopsy in diagnosis and classification of ovarian carcinoma. Cancer1971; 28:967-76.
4. Angstrom T, Kjellgren O, Bergman F: The Cytologic Diagnosis of Ovarian Tumors by Means of Aspiration Biopsy. Acta Cytologica 1972;26:336-40.
5. Ramzy I, Delaney M: Fine Needle Aspiration of Ovarian Masses I. Correlative Cytologic and Histologic Study of Celomic Epithilial Neoplasms. Acta Cytologica 1979;23:97-104.
6. Ellen Greenebaum: Aspirating Non Neoplastic Ovarian Cysts:Laboratory Medicine 1996;27:462-466.
7. Hemalata AL, Divya P, Mamatha R: Image –directed percutaneous FNAC of ovarian neoplasm.Indian J Pathol Microbiol 2005;48:305-309.
8. Marguerite M.Pinto,Ellen Greenebaum, Aylin Simsir,George M.Kleinman, Lewis M.Portnouy,Robin Garfinkel:CA-125 and Carcinoembryonic Antigen Assay vs. Cytodiagnostic experience in the Classification of Benign Ovarian Cysts. Acta Cytologica 1997;41:1456-1462.
9. Fabienne Allias, Jacques Chanoz, Gilles Blache, Francoise Thivolet-Bejui, SergeVancina:Value of Ultrasound-Guided Fine Needle Aspiration Cytology in the Management of Ovarian and Paraovarian Cyst.Diagnostic Cytopathology 2000;22:70-80.
10. Torben Larsen, Soren T.Torp-Pedersen, Marinne Ottesen, Erik Bostofte, Maxwell Sehested, Fritz E.Rank and Hans H. Holm:Abdominal ultrasound combined with histological and cytological fine needle biopsy of suspected ovarian tumors. EUROBS 1993;50:203-209.
11. Ghazala Mehdi,Veena Maheshwari,Sheerin Afzal, Hena A Ansari, Maryem Ansari: Image guided Fine Needle Aspiration cytology of ovarian tumors:An assestment of diagnostic efficacy.J Cytol 2010;27:91-95.
12. Nazoora Khan, Nishat Afroz, Barina Aqil, Tamkin Khan, IbneAhmad:Neoplastic and non neoplastic ovarian masses:Diagnosis on cytology.Journal of cytology 2009;26:129-133.
13. Ashim Kumar Lahiri, Manjula Jain, BS Baliga, KP Mittal: Evaluation of Adnexal Masses by Ultrasound and Fine Needle Aspiration Cytology. Indian J. Pathol.Microbiol 2002;45:255-259.
14. Ganjei P,Dickinson B,Harrison T,Nassiri M,Lu Y:Aspiration cytology of neoplastic and nonneoplastic ovarian cysts: is it accurate ?.Int J Gynecol Pathol 1996;15:94-101.
15. Nicholas J. Mulvany:Aspiration Cytology of Ovarian Cysts and Cystic Neoplasm. Acta Cytologica 1996;40:911-920.
16. Pranab Dey, Subhas C Saha, Kalian K Dhar: Fine Needle Aspiration Biopsy of Ovarian Neoplasm.Indian J. Pathol.Microbiol 2001;44:103-106.
17. T.Sood, U.Handa, H. Mohan,P. Goel :Evaluation of Aspiration Cytology of Ovarian cystic masses with Histopathological correlation. Cytopathology 2010;21:176-185.
18. Pauline Athanassiadou, Dimitra Grapsa: Fine Needle Aspiration of Borderline Ovarian Lesions. Acta Cytologica 2005;49:278-285.
19. Aysun Uguz, Canan Ersoz, FilizBolat, Ayse Gokdemir, M.Ali Vardar :Fine Needle Aspiration Cytology of Ovarian Lesions. Acta Cytologica 2005;49:144-148.
20. Robert V.Higgins,Jerry F.M atkins,Marie Clarie Marroum:Comparision of Fine Needle Aspiration Cytology of Ovarian Cyst with Ovarian histologic findings.Am j Obstet Gynecol 1999;180:550-3.
21. Carmen Alvarez Santin, Adela Sica, Silvia Melesi, Alicia Feijo, Griselle, Carmen Rodriguez Alvarez:Contribution of Intraoperative Cytology to thre Diagnosis of Ovarian Lesions. Acta Cytologica 2011;55:85-91.
22. Ganjei p: Fine Needle Aspiration Cytology of Ovary.Clin Lab Med 1995 ;15:705-26.
A study of prevalence and clinical profile of the patients having hypertensive disorders of pregnancy
Introduction: Hypertensive disorder in pregnancy is a condition in which the pregnant woman presents with an elevated blood pressure during pregnancy or puerperium as defined in 1986 by the American College of Obstetricians and Gynecologists and adopted by the World Health Organization (WHO). Hypertensive disorder of pregnancy is seen after 20weeks of pregnancy. It affects almost 6-10% of all pregnancies worldwide. Systolic blood pressure above 140 and diastolic blood pressure above 90mm of Hg with associated proteinuria. Eclampsia means patients with severe preeclampsia develop tonic-clonic convulsions. Material and Method: It was prospective hospital based observational study of patients of hypertensive disorders of pregnancy conducted at Bharti Hospital, Sangli in the department of Obstetrics and Gynecology. In this study patients with essential hypertension and chronic hypertension, patients with known renal disease prior to pregnancy were excluded. Results: The prevalence of Hypertension overall was 29.20 i.e. 125 out 428 ANC registered women. As per age wise in 10-16 years age group it was 29.26% in 17-19 years was 15.00 in 20-24 years. Conclusion: The overall prevalence of PIH in our study was Hypertension overall was 29.20. And associated factors were Obesity, H/o Hypertension, Family H/O of PIH, Diabetes, Primipara, H/O Exposure to Smoking
1. ACOG. ACOG technical bulletin. Hypertension in pregnancy. Number 219--January 1996 (replaces no. 91, February 1986). Committee on Technical Bulletins of the American College of Obstetricians and Gynecologists. Int J Gynaecol Obstet. 1996;53(2): 175-83.
2. Cunningham FG, Leveno KJ, Bloom SL, Hauth JC, Gilstrap III LC, Wenstrom KD. Williams Obstetrics. 22th ed. USA: McGraw-Hill Companies Inc; 2005. Chapter 34, Hypertensive disorders in pregnancy; p. 426-50.
3. McCaw Binns AM, MacGillivray I, Hawkins N, Golding J, Ashley DEC. International variation in the incidence of hypertension in pregnancy among primiparae: the Jamaican experience. West Indian Med J. 1997;46(Suppl 2):29.
4. Schroeder BM; American College of Obstetricians and Gynecologists. ACOG practice bulletin on diagnosing and managing preeclampsia and eclampsia. American College of Obstetricians and Gynecologists. Am Fam Physician. 2002;66(2):330-1.
5. Working Group on High Blood Pressure. Report of the National High Blood Pressure Education Program Working Group on High Blood Pressure in Pregnancy. Am J Obstet Gynecol. 2000;183(1):S1- S22.
6. Roberts CL, Algert CS, Morris JM, Ford JB, Henderson-Smart DJ. Hypertensive disorders in pregnancy: a population-based study. Med J Aust. 2005;182(7):332-5.
7. Golding J. A randomised trial of low dose aspirin for primiparae in pregnancy. The Jamaica Low Dose Aspirin Study Group. Br J ObstetGynaecol. 1998; 105(3):293-9.
8. Levine RJ, Hauth JC, Curet LB, Sibai BM, Catalano PM, Morris CD, et al. Trial of calcium to prevent preeclampsia. N Engl J Med. 1997;337(2):69-76.
9. Conde-Agudelo A, Belizán JM. Risk factors for preeclampsia in a large cohort of Latin American and Caribbean women. BJOG. 2000;107(1):75-83.
10. Trogstad LI, Eskild A, Magnus P, Samuelsen SO, Nesheim BI. Changing paternity and time since last pregnancy; the impact on pre-eclampsia risk. A study of 547 238 women with and without previous pre-eclampsia. Int J Epidemiol. 2001;30 (6):1317-22.
11. SheyWiysonge CU, Ngu Blackett K, Mbuagbaw JN. Risk factors and complications of hypertension in Yaounde, Cameroon. Cardiovasc J S Afr. 2004; 15(5):215-9.
12. Pridjian G, Puschett JB. Preeclampsia. Part 1: clinical and pathophysiologic considerations. ObstetGynecolSurv. 2002;57(9):598-618.
13. Leeners B, Rath W, Kuse S, Irawan C, Imthurn B, Neumaier-Wagner P. BMI: new aspects of a classical risk factor for hypertensive disorders in pregnancy. ClinSci (Lond). 2006;111(1):81-6.
14. Jun Zhang, Jonathan Zeisler, Maureen C. Hatch.Epidemiology of Pregnancy-induced Hypertension. Epidemiol Rev. 1997; 19 ( 2),218-232. Available at :http://epirev.oxfordjournals.org/content/19/2/218.full.pdf accessed last on Sep 2016.
15. Chesley LC. History and epidemiology of preeclampsia-eclampsia. ClinObstet Gynecol. 1984; 27(4):801-20.
16. Saftlas AF, Olson DR, Franks AL, Atrash HK, Pokras R. Epidemiology of preeclampsia and eclampsia in the United States, 1979-1986. Am J Obstet Gynecol. 1990;163(2):460-5
17. Nucci LB, Schmidt MI, Duncan BB, Fuchs SC, Fleck ET, Britto MMS. Nutrional status of pregnant women: prevalence and associated pregnancy outcomes. Rev SaúdePública. 2001;35:502-7.
18. Gaio DS, Schmidt MI, Ducan BB, Nucci LB, Matos MC, Branchtein L. Hypertensive disorders in pregnancy: frequency and associated factors in a cohort of Brazilian women. Hypertens Pregnancy. 2001;20:269-81
19. Assis TR, Viana FP, Rassi S. Study on the major maternal risk factors in hypertensive syndromes. Arq Bras Cardiol. 2008; 91:11-7.
20. Schmidt MI, Duncan BB, Reichelt AJ, Branchtein L, Matos MC, Costa e Forti A, et al. Gestational diabetes mellitus diagnosed with a 2-5h 75-g oral glucose tolerance test and adverse pregnancy outcomes. Diabetes Care. 2001;24:1151-5
21. Pipkin FB. Risk factors for preeclampsia. N Engl J Med. 2001;12:925-6
22. Sibai BM, Hauth J, Caritis S, Lindheimer MD, MacPherson C, Klebanoff M, et al. Hypertensive disorders in twin versus singleton gestations. Am J Obstet Gynecol. 2000;182:938-42.
23. Wen SW, Demissie K, Yang Q, Walker MC. Maternal morbidity and obstetric complications in triplet pregnancies and quadruplet and higher-order multiple pregnancies. Am J Obstet Gynecol. 2004;191:254-58.
Trends of poisoning in Vidarbh region of Maharashtra
Poisoning is mysterious, dangerous, and reliable method of dying. it is most common method of suicide and homicide since ancient time. Trends of poisoning are different in different parts of India. Present study was conducted at Kasturba Hospital of MGIMS Sevagram, Wardha. This hospital drains patients from the whole Vidarbh area. This study was conducted during period January 1997-December 1998. Durinng this period 364 cases of poisoning were reported at MGIMS Sevagram. Out of them 268 cases of poisoning were admitted for treatment and 49 died during treatment. 78 cases of poisoning directly brought for postmortem. Study showed male predominance in age group of 21-30 years. Organophasphorus poisoning was most common.
1. Aggrawal N.K., Aggrawal BBL (1998)- Death due to Aluminium phosphide poisoning, International Journal of Medical Toxicology and Legal Medicine, Volume No-1, July-December 1998, Page41-43.
2. Aggrawal N.K., Aggrawal BBL (1998-Trends poisoning in Delhi, Journal of Indian Academy of Forensic Medicine, Volume-20, page 32-36.
3. Aggrawal Praveen, Handa Rohini, Wali JP (1998)-Common poisoning in India, Journal of Forensic Medicine and Toxicology, Volume No1, January-June 1998, page73-79.
4. Alexander, Lawson AH, Ian Mitchel (1972)-Patients with acute poisoning seen in general medical unit( 1960-1971), British Medical journal, Volume-- 4,Page 911-915.
5. Dalal JS, Goria RK, 1998-Poisoning trends-a postmortem study, Journal of Indian Academy of Forensic Medicine, 1998, Volume No-20, No-2, page27-37.
6. Dogra TD, Bhoopendra Singh, 1996-Present status of poisoning in India, Indian Medical Gazette, November 1996, page No-364-368.
7. Hettiara Chchi, J Kodithu Wakku GCS 1991-Pattern of poisoning in rural Srilanka, International Journal of Epidemiology, Volume-18, No-2, page 418-422.
8. Horisberger B, Liao Z A, 1998-A comparison of poisoning deaths in medicolegal autopsies in Lausane city and three towns of China.-Journal of Forensic Medicine and Toxicology, Volume XV, No-1, January-June 1998, Page 33-36.
9. Naik R S, Khajuria BK, Tirpude BH-Hazzards of pesticide, their preventive measures and practical difficulties in adopting them. -Journal of Indian Academy of Forensic Medicine 1918, Volume 20, No 2, Page 42-45.
10. Nandi Apurba 1995-Principles of Forensic Medicine, 1 st Edition, 1995, NCBA, India.
11. Parikh C.K. 1990-Parikh’s Text Book of Medical Jurisprudence and Toxicology, 5th Edition 1990.
12. Pillay V V-Influence of fang structure and venum composition on the sympyomatology of snake bite, Journal of Forensic Medicine and Toxicology, Volume XII, No -3, Page-80-22.
13. Pohowala J N, Ghai O P, 1959-Common accidental poisoning in Indore, Indian Journal of Child Health, 1959, Volume -8, Page 524-530.
14. Samaria JK, Singh DP, 1990-Study of different poisoning in eastern UP and northen Bihar, Journal of Association of Physician India, Volume 38, No-1 Page-33
15. Sharma B.R. 1996-Trends of poison and drug abuse in Jammu, Journal of Forensic Medicine and Toxicology, Volume XIII, January-June 1996, No-1and2, Page 7-9.
16. Sharma S.K., 1998-Current scenario of poisoning in rural India, Journal of Forensic Medicine and Toxicology, Volume XV, No-1, January- June 1998, Page 89-93.
17. Siwach, S.B., Gupta A 1995-Profile of acute poisoning in Rohatak, Harayana, 1995. Journal of Association Physician India, 1995, Volume 43 Page 756-759.
18. Sondi Deepak, Sondhi M et al, 1990-A study of deaths due to poisoning in District –Lucknow, Uttar Pradesh, Indian Medical Gazzete, November, 1990, Page 349-352.
19. Tondon SK, Quershi GV 1998-Spectrum of childhood poisoning cases admitted in S.N. Medical college and Hospital Agra, Journal of Forensic Medicine and Toxicology, ISSN O971-1992, Volume XIII, No 1and2, January –June 1996, Page 10-12.
20. Wahal P.K., Lahiri B., Mathur K.S.1996--- Pattern of poisoning in Bombay, Poona and Karnataka, Journal of Association of Physician India, Volume-23 Page -103.
21. Zine K.V., Mohanty A.C., 1998-Pattern of acutepoisoning at Indira Gandhi Medical College and Hospital, Nagpur. Journal of Indian Academy of Forensic Medicine, 1998, Volume-20, No-2, Page 37-39.
A clinico-demographic study of reproductive tract infections at tertiary health care center
Birajdar Annasaheb Gulabrao, More N V, Suwarna Dahitankar
Introduction: the maximum cases of Bacterial vaginosis, Trichomonasvaginalis and Candidiasis were in the age group of 20-29 yrs. and least in the age group of ≤ 19 yrs. As parity increases, the no. of cases of each one become less and most of the cases were having parity 1 to 2. Aims and Objectives: To Study Clinico -Demographic profile of patients with Reproductive Tract Infections at tertiary Health care center. Methodology: Patients attending tertiary health care center with complaint of abnormal vaginal discharge of age group 15 to 40 years were selected for the study. This study was conducted at tertiary health care centre from January 2009 to September 2010. During the study period the total number of gynaec O.P.D attendees were 19,270. Presuming the equal distribution of cases on all days the no. of attendees (symptomatic and asymptomatic) with findings of RTI were 6,423. Data presented in tables and in percentages. Result: Vaginal discharge was the commonest complaint among the study group. Prevalence increased with increase in Parity. RTI was more among the Muslims. Prevalence was higher among non-working women. Prevalence of RTI cases was higher in Illiterate. The prevalence of RTI was highest in non-users of Contraceptives (41.26%) as compared to other groups; it was lowest in the women who were dependent on their spouse for the use of condom as a contraceptive. Out of 64 cases of Bacterial vaginosis, 43.75% complained of vaginal discharge, 37.5% complained of pain in abdomen, 15.62% patients complained of backache, 20.31% complained of itching at genital area, 23.43% complained of increased frequency of micturation and 10.93% complained of dyspareunia. Among 40 cases of Trichomonasvaginalis, vaginal discharge was present in 40% cases, pain in abdomen in 20%, backache in 22.5%, Itching in 45%, increased frequency of micturation in 27.5%, dyspareunia in 12.5% of cases. Among 36 cases of Candidiasis vaginal discharge was present in 59.45% cases, backache in 37.83%, pain in abdomen in 40.54%, itching at genital area in 51.35%, increased frequency of micturition in 29.72 % and dyspareunia in 24.32%. Conclusion: It can beconcluded from study that Majority of cases with suggestive symptoms of RTI were in the age group of 20-29 years, asymptomatic cases were highest in the parity group > 4. Prevalence of RTI cases was high among Muslims nonworking (housewife), in illiterate and in non-users of contraceptives.In the study population cases were having multiple symptoms of which in overall vaginal discharge was the most common complaint.
Introduction: The World Cancer Report issued by the International Agency for Research on Cancer (IARC), tells us that cancer rates are set to increase at an alarming rate globally. Aims and Objectives: To Study Different Treatment Modalities for Carcinoma of Breast at tertiary health care center. Material and Methods: After approval from Institutional ethical committee a cross-sectional study carried out in all Cases of Carcinoma of Breast that has undergone treatment from April 2012 to April 2014 at Department of General Surgery of CPR hospital attached to RCSM Government Medical College Kolhapur. All the patients were treated as per the protocol by Surgically, Radiology and Chemotherapy and Neo-adjuvant therapy as per necessary in one-year duration such a way 50 patients were selected. Result: 38 patients (76%) of the total 50 patients underwent modified radical mastectomy (MRM). Simple mastectomy (SM) was done in 4 patients (8%) post-operative complication was lymphedema in 10 patients (23.8%) out of 38 patients. post-operative complications were Flap necrosis 2(4.76%) and wound infection 1 patients (1.19%) out of 38 patients. In treatment of stage IV disease NACT+MRM+ post-operative adjuvant therapy required in 8 % and Adjuvant therapy only required in 67% and Simple Mastectomy and Post-operative adjuvant therapy required in 25 % individuals. Out of the total 50 patients neo-adjuvant CT(NACT) was given in 6 patients (12%), post-operative / adjuvant therapy 3 i.e. 6% patients. CT was given as CT only 20%, T+RT-30% CT+HT-16% CT+RT+HT-16 %. Of the total 47 patients of chemotherapy, CT was delayed in 10 patients (21%). CT was not stopped in any patients.46 patients (92%) remained disease free, two patients with previously diagnosed stage III disease developed metastasis to bone. One patients with stage IIIB disease developed local chest wall recurrence. One patients in stage IV died after 10 months of diagnosis. Conclusion: It can be concluded from our study that; mortality of the patients after adequate treatment in our study was found very less i.e. 2% so proper and adequate treatment of the patients as per the standard protocol should be given for increasing survival of the breast cancer patient.
1. Pal SK, Mittal B. Improving cancer care in India: Prospects and challenges. Asian Pac J Cancer Prev 2004; 5:226-8.
2. Dumitrescu RG, Cotarla I. Understanding breast cancer risk-where do we stand in 2005? J Cell Mol Med 2005; 9:208-21.
3. Chandra AB. Problems and prospects of cancer of the breast in India. J Indian Med Assoc 1979; 72:43-5.
4. Chopra R. The Indian Scene. Journal of Clinical Oncology 2001;19: S106-11.
5. Program NCR. Time trends in cancer incidence rates 1982-2005 bangaloreindia: Indian council of medical research 2009
6. httpa/tms.gov. in/cancerinfo/breast/breast.htm: Tata memorial center, 2013
7. Madigan M, Ziegler R, Benichon C et al. proportion of breast cancer cases in the united states explained by well established risk factors. jnatil cancer inst. 1995;87:1681.
8. Rockhill B, Weinberg CR, Newman B. population attributable fraction estimation for establish. Am j epidemiol. 1998; 147:826-33.
9. Rochill b,Spiegelman D, Byrne c, et al. Validation of gail et al model of breast cancer risk prediction and implication for chemoprevention.jnatl cancer inst. 2001;93:358-66.
10. Berry Da, ivarsenEs, Gudbjartsson DF, et al. BRCAPRO validation, sensitivity of genetic testing of BRCA 1/BRCA 2 and prevalence of other breast cancer susceptibility genes, j clinoncol. 2002; 20:2701-12.
11. Chlebowski RT, chen Z, Anderson GL. Ethnicity and breast cancer factors influencing differences in incidence and outcome. J Natl cancer inst. 2005; 97;439-448
12. hall IJ, Moorman PG, Millikan RC, Newman B. comparative analysis of breast cancer risk factors among African-american and white women. Am j Epidemiol. 2005; 161:40-51.
13. Wu GH, chen LS, chang KJ et al. Evolution of breast cancer screening in countries with intermediate and increasing incidence of breast cancer. J med screen. 2006; 13:23-7.
14. Zheng T, Holford TR, Mayne ST, et al Lactation and cancer risk: a case-control study in Connecticut. Br j cancer. 2001:84:1472-6.
15. Raina V, Bhutani M, Bedi R, Sharma A, Deo SV, Shukla NK, et al. clinical features and prognostic factors of early breast cancer at a major cancer center in north india. Indain J cancer 2005;42:36-41
16. Christobel M. saunders and michealbaum, the breast chapter 46 in : Bailey and love’s short practice of surgery, Ed. Russel R.C.G., et al. 26th Edition, London :Arnold publishers, 2013, 798-819.
An observational study to evaluate direct obstetric causes of maternal mortality at a tertiary care centre in Mumbai, Maharashtra
Niranjan N Chavan, Smurti Kamble, Neha Raj, Pradnya Changede
Background: To evaluate direct obstetric causes of maternal mortality at a tertiary care centre in Mumbai, Maharashtra
Methods: A total of 206 cases of maternal deaths due to direct obstetric causes from January 2011 to December2015 were analysed in a tertiary care centre. Information was extracted from the patients' case-notes from Medical Record Office, the labour ward registers, the antenatal and postnatal ward registers. Results: Majority of mortality occurred in age group of 21 -29, multiparous women belonging to urban Hindu community. Most of the cases were ANC registered as the study was carried out in a tertiary care centre, however 83 % of these were referred to our hospital. Most of the mortality occurred in postpartum period in ICU set up. Most common cause was found to be haemorrhage followed by eclampsia Conclusions: Multiple and frequent deliveries in already anaemic young women is the major underlying cause of maternal mortality. Antenatal care starting early in pregnancy, detection and managing pregnancy complications, detection and treatment of associated medical disorders, institutional deliveries, proper referral facility and emergency transport, timely intervention, access to contraceptives and safe abortion services can prevent most of the deaths.
1. World Health Organization. International Statistical Classification of Diseases and Related Health Problems, Tenth Revision. Geneva: World Health Organization. 1992
2. Juneja Y, Rai U. A five years review of maternal mortality. J Obstet Gynecol India 1993;43:944-9
3. Govt. of India (1962) Report of the Health survey and Planning Committee, Vol 1. Govt. of India, Ministry of health and Family Welfare (1984) Annual report 1983-84
4. Special Bulletin on Maternal Mortality in India 2007-09: Sample registration system, Office of Registrar General, India. 2011 Jun
5. Pathak D, Chakraborty B, Goswami S, Adhikari S. Changing Trends of Maternal Mortality: A Comparative Study. The Journal of Obstetrics and Gynecology of India March / April 2011 pg 161 -165
6. Smith JC, Hughes JM, Pekow PS, Rochat RW. An Assessment of the Incidence of Maternal Mortality in the United States. American Journal of Public Health. 1984, 74(8): Pg 780-78
7. Govt. of India Ministry of Health and Family Welfare Central Bureau of Health Intelligence, National Health Profile(2015)
8. Al-Farsi, Y. M., D. R. Brooks, et al. "Effect of high parity on occurrence of anemia in pregnancy: a cohort study." BMC Pregnancy Childbirth. 2011. 11: 7
9. United Nations Children’s Fund, United Nations University, WHO. Iron deficiency anaemia: assessment, prevention, and control. A guide for programme managers. www.who.int. http://whqlibdoc.who.int/hq/2001/WHO_NHD_01.3.pdf. Published 2001
10. Liang J,Dai L, Zhu J, Li X, Zeng W, Wang H et al. Preventable maternal mortality: Geographic/rural-urban differences and associated factors from the population-based maternal mortality surveillance system in China. BMC Public Health 2011, 11:243
The prediction of delivery date by ultrasonic measurement of fetal crown – Rump length in first trimester
Introduction: The establishment of pregnancy dates is important not only for the mother who wants to know when to expect the delivery, but it is also important to calculate the gestational age. Accurate dating decrease the number of labour inductions for postterm pregnancies, prevent iatrogenic prematurity Aims and Objectives: To study prediction of delivery date by ultrasonic measurement of fetal crown – rump length in first trimester. Material and Methods: This was a cross-sectional study at OBGY department of tertiary health care center during 12 months. Sample size was 200.EDD is calculated by Naegele’s rule Obstetric ultrasonography will be performed using Philips ultrasound scanner using a 3.5MHZ convex probe. Data was analyzed statically by chi square test, paired t test and other appropriate statistical tests using SPSS version. P value of <0.05 will be considered statistically significant. Result: The maximum cases studied were in age group of 20-24 years i.e., 124 cases (62%) . In EDD of USG, out of 200 cases 22(11%) delivered on predicted day, 61(30.5%) delivered 7 days before, 95(47.5%) delivered after 7 days, 1(0.5%) delivered 8-10 days before, 13(6.5%) delivered 8-10 days after, 0(0%) delivered 11-14 days before, 4(2.0%) delivered after 11-14 days, 1(0.5%) delivered before 15-21 days and 3(1.5%) delivered after 15-21 days in according with EDD calculated by CRL . In LMP-ED Dout of 200 cases, 88(44%) delivered before 5 days, 85(42.5%) delivered from 4 days before to 7 days after, 27(13.5%) delivered after days. Prediction of USG EDD is significantly differed from LMP EDD (Chi –Square =69.7, df =2, P Value =<0.0000001). Conclusion: 89% (178) women delivered within + or – 7 days EDD estimated from LMP 98%(196) women delivered within + or – 14 days of EDD estimated from CRL to conclude, ultrasonographic measurement of CRL (crown Rump Length) between 6-14 weeks of pregnancy is more accurate predictor of EDD as compared to LMP. We recommend the routine use of CRL estimate in the prediction of EDD even if the patient recalls her LMP certainly.
1. Mongelli M, wong YC venkat A, Chus TM, induction policy and missed post-term pregnancies: a mathematical model, Aust N Z J ObstetGynaecol 2001; 41:38-40
2. Geirsson RT, Busby-Earle RM, Certain dates may not provide a reliable estimated of gestational age, Br J obstetGynaecol 1991;98:108-9
3. Geirsson RT, Have G. comparison of actual and USG estimated second trimester gestational length in invitro fertilized pregnancies, actaobstetgynaecolscand 1993; 72:344-46.
4. Robinason HP. Sonar measurement of fetal crown-rump length as means of assessing maturity in first trimester of pregnancy, BMJ 1973;4:281
5. Drumm JE, Clinch J, Mackenzie G. the ultrasonic measurement of fetal crown-rump length as a method of assessing gestational age. Br J obstetGynaecol 1976;83:417-21
6. Hadlock FP, shah YP, kanon DJ et al, Fetal crown –rump length: reevaluation of relation to menstrual age (5-18 weeks) with high resolution real time. Us radiology 1992; 182:50-5.
7. Waldenstrom U, Axelsson O, Nilsson S: A comparison of the ability of a sonographically measured biparietal diameter and the last menstrual period to predict the spontaneous onset of labourobstetGynaecol 1990; 76:336-38
8. Campbell S, warsof SL, Little D, cooper DJ. Routine ultrasound screening for the prediction of gestational age.ObstetGynaecol 1985;65:613-20;
9. Lauret J salmon, Costanza pizza, Antonio Gasparrini, Jean pierre Bernard. Yves Vills. Prediction of the date of delivery based on first trimester ultrasound measurement: An independent method from estimated date of conception. Journal of maternal-Foetal and Neonatal Medicine 2010 jan; 23(1): 1-9
10. Mongelli M, Wilcox M, Gardosi J. Estimating the date of confinement: ultrasonographic biometry versus certain menstrual dates. Am J ObstetGynecol 1996; 174:278–81.
11. Waldenström U, Axelsson O, Nilsson S. A comparison of the ability of a sonographically measured biparietal diameter and last menstrual period to predict the spontaneous onset of labor.ObstetGynecol 1990; 76:336–8.
12. Kieler H, Axelsson O, Nilsson S, Waldenström U. Comparison of ultrasonic wseameasurement of biparietal diameter and last menstrual period as a predictor of day of delivery in women with regular 28 daycycles. ActaObstetGynecolScand 1993; 72:347–9.
13. Backe B, Nakling J. Term prediction in routine ultrasound practice. ActaObstetGynecolScand 1994; 73:113–8.
14. Taipale P, Hiilesmaa V. Predicting delivery date by ultrasound and last menstrual period in early gestation. ObstetGynecol 2001; 97:189–94.
15. Blondel B, Morin I, Platt RW, Kramer MS, Usher R, Breart G. Algorithms for combining menstrual and ultrasound estimates of gestational age: consequences for rates of preterm and postterm birth. BJOG 2002; 109:718–20.
16. Whitworth M, Bricker L, Neilson JP, Dowswell T. Ultrasound for fetal assessment in early pregnancy. Cochrane Database Syst Rev 2010; 4:CD007058
Clinicopathological study of splenomegaly in pediatric age group
The study is based on 100 cases in pediatric age group with splenomegaly carried out in the Government Medical College and Hospital, Aurangabad. The study group showed slight male predominance. Clinical grading of splenomegaly was done with conventional method. Majority of cases (87%) had either Grade I or II splenomegaly. Hackett’s method for grading of splenomegaly was also employed. Majority of cases (70%) had Grade I or II splenomegaly. The most common presenting complaint was fever followed by pallor. The other complaints were lump in abdomen, history of bleeding, pain in abdomen and symptoms of general ill health. The associated clinical findings were hepatomegaly (85%) and lymphadenopathy (33%). Hematological evaluation including bone marrow examination revealed diagnosis in the majority of cases (62%). These tests are safe, easy to perform and cost effective investigations. Other investigations like histopathology, biochemistry, serology, radiology proved helpful in the diagnosis in 16% cases. Anemia including hemolytic anemia and hematological malignancies were the common etiologies (28%) in the causation of splenomegaly. The Grade I and Grade II splenomegaly was the most common. Hemolytic anemia was the most common anemia (53.6%) followed by megaloblastic anemia (21.4%). The hematological malignancies also encountered frequently (28%). The most common malignancy was acute lymphoblastic leukemia (46.4%) followed by chronic myeloid leukemia (17.8%). The infectious etiologies included malaria, hepatitis, dengue fever, enteric fever etc. Malaria was the most common among them (46.1%). Infiltrative diseases mainly encountered in Grade III (conventional) and Grade 5 (Hackett’s method) splenomegaly.
1. Choudhari et al. Chronic splenomegaly in Bengal. J Indian Med Asso 1957;28(2):101-11
2. Nadir Ali, Masood Anwar, Mohammed Ayub et al. Hematological evaluation of splenomegaly. J Coll Physicians Surg Pak 2004;14(7):404-6.
3. Timite KM, Kauame KJ, Konan A. et al. Etiology of splenomegaly in children in tropics. 178 cases reviewed at University Hospital Center of Abidjan Cocody (Ivory Coast). Ann Pediatr (Paris) 1992;39(2):136-41.
4. McIntyre OR, Ebaugh FG. Palpable spleens in college Freshmen. Ann Int Med 196766(2):301-06.
5. Muzumder DNG. Tropical splenomegaly syndrome vis-Ã -vis portal hypertension syndrome. Editorial J Indian Med Asso, Calcutta, Jan 1985.
6. Basu AK. Chronic splenomegaly and its relation to hepatic pathology. Br Med J 1958;947-50.
7. Klatt BC, Meyer PR. Pathology of the spleen in the acquired immunodeficiency syndrome. Arch Pathol Lab Med 1987;111: 1050-3.
8. Higgins PM. Splenomegaly in acute infections due to group A streptococci and viruses. Epidemiol Infect 1992;109:199-209.
9. Dacie JV. Nontropical idiopathic splenomegaly (Primary hypersplenism) : A review of 10 cases and their relationship to malignant lymphomas. Br J Hematol 1969;17:317.
10. Scamps RA, o'Neill BJ. Non-tropical idiopathic splenomegaly. Med J Aust 1971;2:1285-8.
11. Sen Gupta PC. Bengal Splenomegaly : A study of 50 cases with a discussion of etiology. Indian Med Gaz. 1943;Aug:371-5.
12. Ghosh K, Mukherjee GK, Surve RR et al. Splenomegaly in school children in a remote tribal area of Dhole district, Maharashtra. Indian J Malariol 2000;37(3-4):68-73.
13. Rajrajeshwari G and Viswanathan J. Leukemia in children a review of 100 cases with typical clinical manifestations. Indian Pediatr 1980;XVII(1):37.
Anatomical variations of the chorda tympani nerve observed during middle ear surgeries-an institutional study
Rahman Abdul Aman, Raja Premnath, Subramanian Kulasekaran
Objectives: The aim of this study is to describe observed variations in the middle ear anatomy of the chorda tympani nerve during middle ear surgeries in our institution. Study Design: A prospective study of 2 years covering 100 middle ear surgeries analyzing the course of the chorda tympani nerve in the middle ear. The surgeries were subdivided into myringoplasty (78 cases) and mastoidectomy with tympanoplasty (22 cases). Results: Chorda tympani nerve anatomy was observed based on its entry into the middle ear from the junction of the posterior and lateral walls of middle ear at the level of the tympanic sulcus. The variations observed were based on its entry at either three levels 1) Iter chordae posterius (35 cases) 2) Inferior toiter chordae posterious (63 cases) 3) Lateral to the tympanic sulcus (2 cases). Conclusion: Variations in the middle ear course of chorda tympani nerve were commonly seen in our case series. The most common variation being its entry into the middle ear inferior to the iter chordae posterious at the level of tympanic sulcus and the least common being its entry lateral to the tympanic sulcus.Understanding the middle ear anatomical variations in the course of chorda tympani nerve is surgically significant in preventing post-operative taste and salivary morbidity following middle ear surgeries. The present study highlights the varied course of the chorda tympani nerve in the middle ear and minor anatomical variations are not very rare.
1. Dragoslava R. Djeric. Anatomical variations of the Chorda tympani nerve. MJIRI. 1993; 7(1):7-8.
2. McManus, L.J., Dawes, P.J., Stringer, M.D. Clinical anatomy of the chorda tympani: a systematic review. J Laryngol Otol. 2011; 125(11):1101–1108.
3. Haynes, D.R. The relations of the facial nerve in the temporal bone. Ann Roy Col Surg England 1955; 16:175.
4. Durcan, D.J., Shea, J.J., Sleeckx, J.P. Bifurcation of the facial nerve. Arch Otolaryngol 1967; 86:619.
5. Hough, J.V.D. Malformations and anatomical variations seen in the middle ear during the operation for mobilization of the stapes. Laryngoscope 1958; 68:1337.
6. Gordon, B. Hughes., Myles, L. Pensak. Clinical otology. 3rd ed. New york: Thieme publishers; 2007. Section I, Basic science; p.14.
7. Natasha Pollak. Endoscopic ear surgery. California: Plural publishing; 2014. Chapter 1, Middle ear exploration and tympanoplasty; p.64.
8. Chilla, R., Nicklatsch, J., Arglebe, C. Late sequelae of iatrogenic damage to chorda tympani nerve. Acta Otolaryngol (Stockh) 1982; 94:461.
9. Michael, P., Raut, V. Chorda tympani injury: operative findings and postoperative symptoms. Otolaryngol Head Neck Surg. 2007; 136(6):978–981.
10. McManus, L.J., Stringer, M.D., Dawes, P.J. Iatrogenic injury of the chorda tympani: a systematic review. J Laryngol Otol. 2012; 126(1):8–14.
11. Nager, G.T., Proctor, B. Anatomical variations and anomalies involving the facial canal. Ann OtolRhinolLaryngol 1982; 91:45-61.
12. Durcan, D. Bifurcation of the facial nerve. Arch Otolaryngol 1967; 86: 619-31.
13. Kalcıoğlu, M.T., Köse, E., Bayındır, T., Duman, S. A rare anatomic variation of the chorda tympani. Kulak BurunBogazIhtisDerg. 2011 May-Jun; 21(3):171-172.
14. Sudhir, V. Bhise., Patil, N. P., Prashant, M. Hippergekar. A very rare anatomical variation of chorda tympani nerve. IOSR Journal of Dental and Medical Sciences. 2014 July; 13(7): 117-119.
Magnetic resonance imaging diagnosis of Mayer-Rokitansky-Kuster-Hauser syndrome
Mayer- Rokitansky-Kuster-Hauser (MRKH) syndrome is an uncommon variation in the prenatal development of the female genital tract. It is a congenital malformation of the female genital tract. Its features include partial or complete absence (agenesis) of the uterus with an absent or hypoplastic vagina normal fallopian tubes, ovaries, normal external genitalia and the typical 46, XX, female chromosome pattern. Breast development and growth of pubic hair are also normal. Associated renal and/or skeletal abnormalities are common. Mayer-Rokitansky-Kuster-Hauser syndrome is also known as Mullerian Agenesis. The incidence is one in 4000–5000 female births1,2. The normal external appearance of MRKH females makes it difficult to diagnose until puberty, typically diagnosed in mid-adolescence. The average age of diagnosis is between 15 and 18 years, although occasionally a girl may be diagnosed at birth or during childhood because of other health problems. A pelvic ultrasound may be used to see the presence or absence of the uterus and its condition.
1. Morcel K, Camborieux L. Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome. Orphanet J Rare Dis. 2007; 2:13.
2. Sultan C, Biason-Lauber A, Philibert P. Mayer-Rokitansky-Kuster-Hauser syndrome: recent clinical and genetic findings. GynecolEndocrinol. 2009; 25:8-11.
3. Sem KK, Kapoor A. Mayer-Rokitansky-Kuster-Hauser syndrome. Ind J RadiolImag. 2006; 16: 805-7
4. Gupta NP, Ansari MS. Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome—a review. Indian J Urol. 2002; 18:111-116.
5. Morcel K, Camborieux L. Programme de Recherchessur les AplasiesMulleriennes (PRAM), Daniel Guerrier, Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome. Orphanet J Rare Dis. 2007; 2:13.
6. Pittock ST, Babovic-Vuksanovic D, Lteif A. Mayer-Rokitansky-Kuster-Hauser anomaly and its associated malformations. Am J Med Genet A. 2005; 135: 314-316.
7. Siegel MJ. Pediatric applications. In: Lee JK, editor. Chapter 24 of computed body tomography with MRI correlation. 3rd ed. 1998. p. 1548.
8. Saleem SN. MR imaging diagnosis of utero vaginal anomalies: Current state of art. Radiographics.2003; 23:e13.
9. Chervenak FA, Stangel JJ, Nemec M, Amin HK. Mayer RokitanskyKuster Hauser syndrome. N Y State J Med. 1982; 82:23–6
10. Evans TN, Poland ML, Boving RL. Vaginal malformations. Am J ObstetGynaecol. 1961; 141:910–20.
11. Griffin JE, Edwards C, Madden JD, Harrod M, Wilson JD. Congenital absence of the vagina, the Mayer RokitanskyKuster Hauser syndrome. Ann Intern Med. 1976; 85:224–36.
12. Bryan A, Nigro J, Counseller VS. One hundred cases of congenital absence of the vagina. SurgGynecol Obstet. 1949; 88:79–86.
A study of clinical profile of respiratory distress syndrome(RDS) in preterm babies
Sambhaji S Wagh, Deepa S Phirke, Sudhakar Bantewad
Objective: Study of clinical profile of Respiratory Distress Syndrome in preterm babies. Design: Prospective observational study. Settings: Neonatal Intensive Care unit at tertiary care hospital. Outcome measures: To study role of antenatal steroid, surfactant and assisted ventilation in RDS and outcome in terms of morbidity and mortality in preterms with RDS. Results: 150 neonates with gestational age <37wk with diagnosed as RDS as per clinical investigational guidelines were included.97.3% babies received antenatal steroid while 2.7% did not. Out of the babies who received antenatal steroid 80% survived and 20% died. All (100%) who did not receive antenatal steroid died. Out of them 57.3% received surfactant and 42.7% did not receive. Out of babies who received surfactant 88% survived 12% died. Out of babies who did not receive surfactant 64% survived 36% died. All babies (100%) receiving only CPAP (SA score <4) survived. Out of babies receiving both CPAP and surfactant (SA score 4–7) 98.6% survived and 1.4% died. All babies receiving only assisted ventilation for >10 days died. Morbidity in RDS was sepsis 14.66%, PDA 14%, NEC 8.66% and pulmonary hemorrhage 5.33%. At the end of study 118 (78.66%) babies survived while 32(21.33%) died. Conclusion: We conclude that administration of antenatal steroids in pregnant women during preterm delivery significantly improves lung maturity. CPAP was safe and effective treatment modality. Early institution of CPAP reduced need of ventilation. Early use of surfactant improved the survival and shortened duration of assisted ventilation.
1. Kushal Y. Bhakta , Tests for pulmpnary surfactant In: Manual of
Neonatal Care Cloherty JP. 7th edition 2011: 406-407.
2. Singh M. Care of the Newborn 7th edition 2010; pp283
3. Nelson’s Textbook of Pediatrics 19th edition 2011; pp581
4. Miller HC, Futrakal P., Birthweight, gestational age and sex determining factor in incidence of respiratory distress syndrome of prematurely born infants. J Pediatrics 1968;72:628
5. Neil McIntosh, Ben Stenson; Forfar A. Textbook of Pediatrics. 7th edition 2008;pp245-248
6. Clements JA, Plodzker A, Tiemey DF et al. assessment of risk of RDS by rapid test for surfactant in amniotic fluid. N Engl J Med 1972;286;1077
7. Avery ME. Lung disorders in newborn infants. Saunders WB and Co., Philadelphia. 6th edition:2005;pp557-562
8. Urs S P, Khan F, Maiya P P. bubble CPAP – a primary respiratory support for respiratory distress syndrome in newborns.Indian Pediatrics, 2009 May (46):409-11
9. Jeya Balaji R.V, Rajiv P.K, Patel V.K, Kripal M. outcome of early CPAP in the management of RDS in premature babies with <32 weeks of gestation. Indian journal of neonatal medicine and research.2015 Apr,Vol-3(2): 1-6
10. Shrestha S, Dangol Singh S, Shrestha M, Shrestha RPB. Outcome of preterm babies and associated risk factors in a hospital. J Nepal med,2010 Oct-Nov (49):286-90.
11. Koti J, Murki S,Gaddam P, Reddy A, Reddy M D. (2010).to ascertain the immediate outcome of preterm infants with respiratory distress syndrome (RDS) on bubble CPAP and identify risk factors associated with its failure. Indian pediatrics, 47(2), 139-143
12. Sumiartini N M, Santoso H, Retayasa W, Kardana M. efficacy of dexamethasone for lung maturity in preterm delivery in association with lamellar bodies count. Pediatr Indones, 2007 May (3):115-19
13. Hossain M.M, Shirin M, Akter S, Hossain M, Hassan M.N, Zabin F,Afrin M. Surfactant replacement therapy for RDS-experience of a NICU of private set-up.DS (Child) H J 2010;26 (2): 76-81
14. Pradeep M, L. Rajam, P.Sudevan.perinatal mortality hospital based study.Indian Pediatric,1995 Oct (32):1091-1094
15. National Neonatal Perinatal Database. Report for the year 2002-03 http://www.newbornwhocc.org/pdf/nnpd_report_2002-03. PDF.
Study of serum uric acid and erythrocytic superoxide dismutase levels in gestational diabetes mellitus and normal pregnancy
Level of non-enzymatic antioxidant like serum uric acid and enzymatic antioxidant like superoxide dismutase is found to be deranged in patients of gestational diabetes mellitus. Serum uric acid and superoxide dismutase levels were estimated in sixty patients of gestational diabetes mellitus admitted in obstetrics and gynecology department of G.M.C., Nagpur and sixty normal healthy pregnant controls. The result of the study showed that serum uric acid levels were increased significantly in the gestational diabetes mellitus group compared to the normal pregnant group and serum superoxide dismutase levels were decreased significantly in the gestational diabetes mellitus group compared to the normal pregnant group. Furthermore when levels of serum uric acid and superoxide dismutase were correlated with the fasting and post meal blood glucose in gestational diabetes mellitus patients, significant positive and negative correlation was observed respectively.
1. Dornhost A, Paterson CM, Nicholls, JS et al. High prevalence of GDM in women from ethnic minority groups. Diabetic Med.1992; 9:820-2.
2. Bellamy L, Casas JP, Hingorani AD, Williams D. Type 2 diabetes mellitus after gestational diabetes: a systematic review and meta-analysis. Lancet. 2009 May 23; 373(9677):1773-9.
3. Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002 Feb 7; 346(6):393-403.
4. Knowler WC, Fowler SE, Hamman RF, Christophi CA, Hoffman HJ, Brenneman AT, et al. 10-year follow-up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study. Lancet. 2009 Nov 14; 374(9702):1677-86.
5. World Diabetes Foundation, Global Alliance for Women's Health. Diabetes, Women, and Development: meeting summary, expert recommendations for policy action, conclusions, and follow-up actions. International Journal of Gynecology and Obstetrics. 2009; 104(1):46-50.
6. Young IS, Woodside JV. Antioxidants in health and disease. J Clin Pathol. 2001; 54:176–186.
7. Waring WS, Webb DJ, Maxwell SR. Uric acid as a risk factor for cardiovascular disease. Q J Med. 2000; 93:707-13.
8. MartÃnez-Abundis E, González-Ortiz M, Grover-Páez F, Vera-Hernández A. Excretion of uric aid, sodium, and potassium in preeclampsia patients and its behavior in acute hyperglycemia-hyperinsulinemia. 1999Dec. Ginecol Obstet Mex; 67:590-4.28
9. Baynes JW, Dominiczak MH. Medical Biochemistry. 2nd edition. Elsevier Mosby. 2005: 497-501.
10. Dey P, Gupta P, Acharya NK, Rao SN, Ray S, Chakrabarty S et al. Antioxidants and lipid peroxidation in gestational diabetes- A preliminary study. Indian J Physiol Pharmacol. 2008; 52(2):149-56.
11. ADA. Standards of medical care in diabetes-2006. Diabetes Care. 2006; 29(suppl 1):S4-S42.
12. Glucose reagent set (Kit insert). Jalgaon (India): Nirmal Labortories; 2009.
13. Uric acid reagent set (Kit insert). Mumbai (India): Accurex Biomedical Pvt. Ltd.
14. SOD reagent set (kit insert). Crumlin (United Kingdom): RANDOX Laboratories Ltd.
15. Maitra S, Anitha M, Praveen S, Suresh SK, Vishwanath HL. A Study of Oxidative Stress In Gestational Diabetes Mellitus: An Observational Study at A Tertiary Centre. Asian J Med Res. 2012 Feb; 1(1):17-21.
16. Nagalaksmi CS, Devaki RN, Akila P, Suma KB, Prashant V, Suma MN et al. Exploration of the Clinico-Biochemical Parameters to Explain the Altered Renal Mechanisms in Gestational Diabetes Mellitus. J Clin Diagn Res. 2012; 6(3):369-71.
17. Kharb S. Uric Acid And Ascorbic Acid Levels In Pregnancy With Preeclampsia And Diabetes. Webmed Central Biochemistry. 2010; 1(10):WMC00718.
18. Laughon SK, Catovr J, Provins T, Roberts JM, Gandley RE. Elevated first trimester uric acid concentrations are associated with the development of gestational diabetes. Am J Obstet Gynecol. 2009 Oct; 201(4):402e1-e5.
19. Wolak T, Sergienko R, Wiznitzer A, Paran E, and Sheiner E. High Uric Acid Level During the First 20 Weeks of Pregnancy is Associated with Higher Risk for Gestational Diabetes Mellitus and Mild Preeclampsia2012. Hypertens Pregnancy. 2012;31(3):307-15.
20. Zhou J, Zhao X, Wang Z, Hu Y. Combinations of lipids and uric acid in mid-second trimester can be used to predict adverse pregnancy outcomes. J Matern Fetal Neonatal Med. 2012 Dec; 25(12):2633-8.97
21. Grissa O, Ategbo JM, Yessoufou A, Tabka Z, Miled A, Jerbi M et al. Antioxidant status and circulating lipids are altered in human gestational diabetes and macrosomia. Translational Res. 2007; 150:164-71.
22. Djordjevic A, Spasic S, Jovanovic-Galovic A, Djordjevic R, Grubor-Lajsic G. Oxidative stress in diabetic pregnancy: SOD, CAT and GSH-Px activity and lipid peroxidation products. J Matern Fetal Neonatal Med. 2004 Dec; 16(6):367-72.
23. Kharb S. Activity of Extracellular Superoxide Dismutase in Gestational Diabetes. Res J Obstet Gynecol. 2010; 3(1):1-4.
24. Biri A, Onan A, Devrim E, Babacan F, Kavutcu M, Durak I. Oxidant status in maternal and cord plasma and placental tissue in gestational diabetes.2006 Feb. Placenta; 27(2-3):327-32.
25. Peuchant E, Brun JL, Rigalleau V, Dubourg L, Thomas MJ, Daniel JY et al. Oxidative and antioxidative status in pregnant women with either gestational or type 1 diabetes. Clin Biochem. 2004 Apr; 37(4):293-8.
26. Pathak R,Pathak A. Study of lifestyle habits on risk of type 2 diabetes. 2012 jul-dec. Int J Appl Basic Med Res; 2(2):92-96.
Problem statement: Thalassemias are a group of inherited disorders of Hb synthesis characterised by a reduced rate of production of one or more globin chains of Hb resulting in an anaemic state. Blood transfusion which both elevates the anaemia and suppresses the compensatory mechanism is the basis of therapy. But the inevitable consequence of prolonged transfusion therapy is the hemosiderosis. This causes complications like endocrine abnormalities along with hepatic and myocardial siderosis. The group with regular blood transfusion has the more chance of iron excess. The patients with inadequate transfusion are not free from the danger of iron overload because in them the anaemia causes excessive iron absorption. The endocrine glands are not also free from the burnt of hemosiderosis The excess iron in the storage form of ferritin get deposited in endocrine organs like pituitary, pancreas, parathyroid, and thyroid. Methods: It was performed on selected patients with diagnosis of Thalassemia disease, who were attending in both institution (Malda Medical College and M.G.M Medical College and L.S.K Hospital,)The 30 patients were included in our study. In the present study maximum number of cases were in the age group of 5-15 years (68%) and 32% of patients were in the age group of 16-25 years. Results: Dysfunction of the thyroid gland is less frequent than other endocrinopathies in thalassemia patients. Results are Distribution of Cases in Different Types of Thalassemia: Growth Hormone Study, Gonadotrophins Study. In our study no patient had yet developed hypothyroidism but possibilities of hypothyroidism in future specially of the sub-clinical hypothyroid patients remain.
1. Whipple, G H and Bradford, W L (1932) racial or familial anaemia of children. Associated with fundamental disturbances of bone and pigment metabolism (Colley –Von Jaksch) Am J Dis Child 44, 336.
2. Chatterjee, J B (1959) Hemoglobinopathy in India. In: Abnormal Hemoglobins (eds J H O Jonxis and J F Delafresnaye) 322 Blackwell Scientific publications, Oxford.
3. Weatherall, D J 91980) Towards an understanding of the molecular biology of some common inhocited anemias : The story of thalassemia In : Blood pure and eloquent (ed M M Wintrobe) p 373, Mc Graw Hill, New York.
4. Diseases of the Blood, Development of the Hematopoitic system, Nelson’s Texbook of Pediatrics 15th edition p 1375-1378.
5. Benz, E J Forget, B G Hillman D G Cohen Solal M Pritchard J and Cavallesco C (1978) Variability in the amount of beta globin in RNA in beta thalassemia, cell 14, 299.
6. Weatherall, D J and Clegg, J B (1969) Disorders of globin synthesis in thalassemia. Ann N Y Acad Sci 165, 242.
7. Wainscoat J S Thein S L Weatherall D J : Thalassemia intermedia. Lood Rev. 1, 273, 1987.
8. Pintor C, Cella, S G Menso, P et al (1986) Impared G H response to G H releasing hormone in thalassemia major. J Clin Endocrinol Metab 62, 263.
9. Shehadeh, N, Hazani, A Rudolf, M C J Benderly, A and Hochberg, Z (1990) Neurosecretary dysfunction of growth hormone secretion in thalassemia major. Aeta Pediator Seand 79, 790.
10. Chatterjee R., Kate, M. Cox, T.F. and Porter J.B. (1993b) A prospective study of the hypothalamic pituitary axis in thalasemic patients who developed secondary amenorrhoea elin. Eudocrinol. 39, 287.
11. Vullo, C, DC. Sanctis, V., Katz, M. et al (1990) Endoerine abnormatlities in Jhalaremia. Aun N.Y. Acad. SCI 612,293.
12. Flynn, D.M., Fairney, A., Jackson, D. 4 clayton, B.E. (1976) Hormonal changes in Jhalasemia Major, Arch. Dis. Child. 51, 828.
13. Pratico., G., Di, Gregor io, F., Cattabiano, L, Palano, G.M. and Caruso Nicoletti, M. (1998) Calcium phosphate metabolism in Thalassemia. Pediatr. Med. Chir. 20,265.
14. Hussain, M.A. M., Green, N. Flynn. D.M. Hussain, S and Hoffbrand, A.V. (1976) Subcutaneous infusion and intramascular injection of desferrioxamine in patients with transfusional iron overload. Lancet ii, 1278.
Hodgkins lymphoma presenting as a solitary bone tumor: A case report
Manimaran Karthikeya Pandian, Varaprasad Sagiraj, Indhumathy K
Abstract: Primary lymphoma of the bone is the bone involvement by malignant lymphoid infiltrate without the involvement of lymph nodes or other tissues. Differential diagnoses for the primary bone lymphomas include chronic osteomyelitis, primary bone sarcoma, Ewing’s sarcoma, metastatic sarcomas, leukemic infiltrate and carcinoma. Lymphomas of the bone are commonly misdiagnosed as Ewing’s sarcoma. We report a case of 16 years old male, who presented with pain in the Right hip and difficulty in walking that had persisted for 2 months with no history of trauma. The patient was initially diagnosed as a case of PLB of the right acetabulum confirmed by open biopsy but the FDG-PET-CT examination was done which showed an abnormally high uptake of F-FDG in the cervical, mediastinal, retroperitoneal, iliac lymphnodal groups, skeletal system, liver and spleen and Immunohistochemistry favoured the diagnosis of Classical Hodgkins lymphoma, mixed cellularity type. He was classified as stage IV B Cell lymphoma and referred to oncology department for favour of chemotherapy and radiotherapy.
1. Singh T, Satheesh CT, Lakshmaiah KC, Suresh TM, Babu GK, Lokanatha D, Jacob LA, Halkud R. Primary bone lymphoma: a report of two cases and review of the literature. J Cancer Res Ther. 2010; 6:296–298. [PubMed]
2. Oberling C. The reticulosarcomas and the reticulotheliomas of Ewing’s osterosarcoma. Bull AssocFr Etude Cancer (Paris) 1928; 17:259–296. (In French)
3. Heyning FH, Hogendoorn PC, Kramer MH, Hermans J, Kluin-Nelemans JC, Noordijk EM, Kluin PM. Primary non-Hodgkin’s lymphoma of bone: a clinicopathological investigation of 60 cases. Leukemia.1999; 13:2094–2098. [PubMed]
4. Lewis VO, Primus G, Anastasi J, Doherty D, Montag AG, Peabody TD, Simon MA. Oncologic outcomes of primary lymphoma of bone in adults.ClinOrthopRelat Res. 2003; 415:90–97. [PubMed]
5. Jawad MU, Schneiderbauer MM, Min ES, Cheung MC, Koniaris LG, Scully SP. Primary lymphoma of bone in adult patients. Cancer. 2010; 116:871–879. [PubMed]
6. Mulligan ME, McRae GA, Murphey MD. Imaging features of primary lymphoma of bone. AJR Am J Roentgenol. 1999; 173:1691–1697. [PubMed]
7. Ramadan KM, Shenkier T, Sehn LH, Gascoyne RD, Connors JM. A clinicopathological retrospective study of 131 patients with primary bone lymphoma: a population-based study of successively treated cohorts from the British Columbia Cancer Agency. Ann Oncol. 2007; 18(1):129–135. [PubMed]
8. O’Connor AR, Birchall JD, O’Connor SR, Bessell E. The value of 99mTc-MDP bone scintigraphy in staging primary lymphoma of bone. Nucl Med Commun. 2007; 28:529–531. [PubMed]
9. Park YH, Choi SJ, Ryoo BY, Kim HT. PET imaging with F-18 fluorodeoxyglucose for primary lymphoma of bone. ClinNucl Med. 2005; 30:131–134. [PubMed]
10. Park YH, Kim S, Choi SJ, Ryoo BY, Yang SH, Cheon GJ, Choi CW, Lim SM, Yoo JY, Lee SS. Clinical impact of whole-body FDG-PET for evaluation of response and therapeutic decision-making of primary lymphoma of bone. Ann Oncol. 2005; 16:1401–1402. [PubMed]
Comparison of phenotypic methods for the detection of extended spectrum beta lactamase production among enterobacteriaceae
Introduction: Extended-spectrum β-lactamases (ESBLs) are enzymes which hydrolyse extended-spectrum Cephalosporins and are more common in recent times. Aim: We aimed to compare Chrome agar, double disk synergy test (DDST) and potentiated combined disk diffusion test (PCDDT) with ESBL E test for their sensitivity in ESBL detection. Materials and Methods: The study was a cross-sectional prospective analytical study involving 100 isolates of Enterobacteriaceae family between May 2014 and December 2014. All the isolates were subjected to ESBL detection by Chrome agar, double disk synergy test (DDST), Phenotypic confirmatory disk diffusion test (PCDDT) and ESBL Estrip method. Results: Among the 100 isolates tested, 61 isolates were resistant to one of the third generation Cephalosporins. Among them potentiated disk diffusion test (PCDDT) detected 30/61 isolates (49.18%), DDST detected26 (42.62%) and E strip detected detected35 (57.37%) isolates. Chrome agar showed growth on 42 samples. Conclusions: In resource poor settings, Chrome agar along with Phenotypic confirmatory disk diffusion test (PCDDT) can be taken as an effective screening method for ESBL detection.
1. Singh RM, Singh LH. Comparative evaluation of six phenotypic methods for detecting extended-spectrum beta-lactamase-producing Enterobacteriaceae. J Infect DevCtries2014; 8(4):408-15.
2. Bradford PA. Extended-spectrum â-lactamases in the 21st century: characterization, epidemiology, and detection of this important resistance threat. ClinMicrobiol Rev 2001; 14:933-51.
3. Garrec H, Rouzet LD, Golmard JL, Jarlier V, Robert J. Comparison of Nine Phenotypic Methods for Detection of Extended-Spectrum β-Lactamase Production by Enterobacteriaceae. J ClinMicrobiol 2011; 49(3):1048-57.
4. Phenotypic detection of extended-spectrum β -lactamase production in Enterobacteriaceae: review and bench guide. ClinMicrobiol Infect 2008; 14( 1): 90–103.
5. Gazin M, Paasch F, Goossen H, Kumar SM. Current Trends in Culture-Based and Molecular Detection of Extended-Spectrum-β-Lactamase-Harboring and Carbapenem-Resistant Enterobacteriaceae. J ClinMicrobiol 2012; 50(4): 1140-6.
6. Dalela G. Prevalence of Extended Spectrum Beta Lactamase (ESBL) Producers among Gram Negative Bacilli from Various Clinical Isolates in a Tertiary Care Hospital at Jhalawar, Rajasthan, India. J ClinDiag Res 2012; 6(2): 182-7.
7. Tsering DC, Das S, Adhiakari L, Pal R, Singh TSK.Extended Spectrum Beta-lactamase Detection in Gram-negative Bacilli of Nosocomial Origin. J Glob Infect Dis. 2009 Jul-Dec; 1(2): 87–92.
8. Singhal S, Mathur T, Khan S, Upadhyay DJ, Chug S, Govind R, et al. Evaluation of methods for Amp C β lactamases in Gram Negative clinical isolates from Tertiary care hospitals. Ind J ClinMicrobiol. 2005; 23:120–4.
9. Mathur P, Kapil A, Das B, Dhawan B. Prevalence of Extended Spectrum β Lactamase producing GNB in a tertiary care hospital. Indian J Med Res. 2000; 15:153–7.
10. Khan MKR, Thukral SS, Gaind R. Evaluation of a Modified Double-Disc Synergy Test for Detection of Extended Spectrum Î’-Lactamases in Ampc Î’-Lactamase-Producing Proteus mirabilis. IndJ MedMicrobiol 2008; 26(1): 58-61.
11. Harwalkar, A, Sataraddi, J, Gupta, S, Yoganand R,Rao A, Srinivasa H. The detection of ESBL-producing Escherichia coli in patients with symptomatic urinary tract infections using different diffusion methods in a rural setting. Journal of infection and public health. 2013;6(2):108-14
12. Sridhar Rao P N, Basavarajappa K G, Krishna G L. Detection of extended spectrum beta-lactamase from clinical isolates in Davangere. Indian J PatholMicrobiol 2008;51:497-9.
13. Nandagopal B, Sankar S, Sagadevan K, Arumugam H, Jesudason M V, Aswathaman K, Nair A. Frequency of extended spectrum β-lactamase producing urinary isolates of Gram-negative bacilli among patients seen in a multispecialty hospital in Vellore district, India. Indian J Med Microbiol 2015; 33:282-5.
Study of serum CRP and malondialdehyde levels in gestational diabetes mellitus and normal pregnancy
Introduction: Markers of inflammation and oxidative stress like C Reactive Protein and Malondialdehyde may provide information about risk of developing Type II DM, cardiovascular disease and hypertension in future in patients of Gestational diabetes mellitus. Serum C Reactive Protein and serum MDA level were estimated in sixty patients of gestational diabetes mellitus admitted in obstetrics and gynecology department of G.M.C., Nagpur and sixty normal healthy pregnant controls. The result of the study showed that serum C Reactive Protein and Malondialdehyde levels were increased significantly in the gestational diabetes mellitus group compared to the normal pregnant group. Furthermore when levels of serum C Reactive Protein and Malondialdehyde were correlated with the fasting and post meal blood glucose in gestational diabetes mellitus patients, significant positive correlation was observed.
Introduction: Markers of inflammation and oxidative stress like C Reactive Protein and Malondialdehyde may provide information about risk of developing Type II DM, cardiovascular disease and hypertension in future in patients of Gestational diabetes mellitus. Serum C Reactive Protein and serum MDA level were estimated in sixty patients of gestational diabetes mellitus admitted in obstetrics and gynecology department of G.M.C., Nagpur and sixty normal healthy pregnant controls. The result of the study showed that serum C Reactive Protein and Malondialdehyde levels were increased significantly in the gestational diabetes mellitus group compared to the normal pregnant group. Furthermore when levels of serum C Reactive Protein and Malondialdehyde were correlated with the fasting and post meal blood glucose in gestational diabetes mellitus patients, significant positive correlation was observed.
A retrospective study of prescription pattern and cost analysis of selected drugs used in coronary artery disease and angioplasty patients
Coronary Artery Disease (CAD) is a condition wherever the vascular supply to the heart is obstructed by fatty tissue, occlusion or spasm of coronary arteries. There is increasing importance of prescription pattern monitoring studies (PPMS) due to a lift in promoting of latest medicine, variations in pattern of prescribing and consumption of medication, growing concern regarding drug interactions, price of medication and pattern of prescription. The present study was planned to assess the prescription pattern and cost of selected drugs used in Coronary Artery Disease and Angioplasty patients. The drug prescription pattern was noted from cardiology department of multi specialty tertiary care hospital and cost analysis was performed for the selected drugs. The data was collected by using structured data collection form. A total of 107 prescriptions were analysed from 240 patient records. Most of the patients diagnosed with coronary artery disease were in the age group of 61-70 years (41.12 %). The cost difference between Atenolol and Metoprolol were statistically significant (P<0.01). The most common classes of drugs prescribed were antihypertensives, antiplatelets, antianginals and antihyperlipidemics. The study results showed that the inappropriate use of drugs in CAD increases the cost of treatment and in long term this may even contribute to drug related problems. Interventions are necessary to improve rational drug use of drugs.
1. Roger Walker, Clive Edwards, Coronary Artery Disease In: Clinical Pharmacy and Therapeutics, 3rd ed., Elsevier Publication: 2003; 279-280.
2. Indrayan A, Forecasting cardiovascular disease cases and associated mortality in India. National Commission for Macroeconomics and Health, Government of India, International journal of scientific and research publication, 2004; 3(1):1-5.
3. Kamath A, Shanbhag T, Shenoy S, Ramesh S, A retrospective study of the drug prescribing pattern in acute myocardial infarction. Indian Journal of Pharmacology, 2008, 4 (1): 60 -61.
4. Strom BL, Stephan EK, Pharmacoepidemiology, 5th ed., 2012; 285-286.
5. Subash Philip, KG Revikumar, A study on the prices of some branded drugs of eight therapeutic categories. Hygela journal for drug and medicines, 2012; 4(2) : 78-86.
6. Veintramuthu, Sankar; Kandasamy, Ruckmani; Kanniyappan, Velayutham; Munusamy, Nithyananth, A study on prescription pattern and cost analysis of antiretroviral drugs. International Journal of Pharma and Bioscience, 2010; 1 (2): 2-7.
7. Kumar Raj, Kohli Kamlesh, Kajal H L. A study of drug prescribing pattern and cost analysis among diabetic patients in a tertiary care teaching institute in north India, Journal of Drug Deliver and Therapeutics; 2013; 3(2) : 56-61.
8. Jamuna Rani, Sambasiva Reddy, Prescribing pattern of antidiabetic drugs in urban population of Hyderabad. Natl J Physiol Pharm Pharmacol. 2015; 5(1): 5-9
9. Shruthi Dawalji, Venkateshwarlu K, Sridhar Thota, Praveen Kumar Venisetty, Raj Kumar Venisetty, Prescribing Pattern in Coronary Artery Disease: A Prospective Study. IJPRR, 2014; 3(3) : 24-33.
10. Tamilselvan T, Veerapandiyan A K, Karthik N, Study on drug utilization pattern of chronic renal failure patients in a tertiary care hospital. Int J Pharm Pharm Sci, 2014; 6(9), 482-484
11. Kiran P. Vakade, Vandana M. Thorat, Chitra C. Khanwelkar, Sujata A. Jadhav, Vijayprasad M. Sanghishetti A study of prescribing pattern of drugs in patients of emergencies in tertiary care hospital of Western Maharashtra. Int J Res Med Sci. 2016; 4(2): 556-561.
12. Md. Abdul Muhit, Md. Obaidur Rahman, Sheikh Zahir Raihan, Muhammad, Asaduzzaman, Mohammad Ahasanul Akbar, Nahid Sharmin and A. B. M. Faroque, Cardiovascular disease prevalence and prescription pattern at tertiary care hospital in Bangladesh, Journal of Applied Pharmaceutical Science, 2012; 2 (3) : 80-84.
13. Shabnam Narayanan, K Bhaskaran, Amritha P Vinod, A prospective study of prescription pattern in patients with coronary artery disease in a tertiary care center, International journal of recent trends in Science and technology,2016; 19( 2) : 272-277.
14. G. Divya,, A Rekha Devi, P Lakshmi, Sastha Ram V Kishore, T S Durga Prasad, D Ranganayakulu, Prescribing pattern of antihypertensive drugs in cardiology department, Inventi Rapid: Pharmacy Practice, 2014; 3 (1) : 976-384.
Study the association of midtrimester insulin resistance with development of pre-eclampsia among primi gravidae
Soft tissue tumors are a highly heterogenous group of tumors that are classified on a histogenetic basis. Benign tumors far outnumber the malignant ones which form less than 1 % of all cancers. The most common sites are extremities, chest wall, mediastinum and retroperitoneum and as in the case of other malignancies, occur mainly in the older age group except rhabdomyo sarcoma. These tumors present a varied histomorphological pattern. Our study has included the different patterns, with specific site, gender and age distribution.
1. Coindre JM, Terrier P, Guillon L, Le Doussal V, Collin F, Ranchere D, et al. Predictive value of grade metastasis development in the main histological types of adult soft tissue sarcomas: A study of 1240 patients from the French Federation of Cancer Centres Sarcoma Group. Cancer 2001, 91:1914-1926.
2. Cooper JE, Allen PW, Low grade sarcomas. Pathol Ann 1990; 25(part 2):1–18.
3. Rosai J. Ackerman's surgical pathology. 10th edition Vol II - soft tissues.
4. Gerrand, C.H., Bell, R.S., Wunder, J.S. et al, The influence of anatomic location on outcome in patients with soft tissue sarcoma of the extremity. Cancer. 2003, 97:385–492.
5. Stojadinovic A, Leung DH, Hoos A, Jaques DP, Lewis JJ, Brennan MF. Analysis of the prognostic significance of microscopic margins in localized primary adult soft tissue sarcomas. Ann Surg. 2002, 235; 424–434.
6. Mariani L, Micceli R, Kattan MW, et al: Validation and adaptation of a nomogram for predicting the survival of patients with extremity soft tissue sarcoma using a three-grade system. Cancer 2005; 103:402.
7. Behranwala KA, A’Hern R, Omar AM, Thomas JM. Prognosis of lymph node metastasis in soft tissue sarcoma. Annals of Surgical Oncology. 2004;11:714
8. Enzinger and Weiss's Soft Tissue Tumors, Sharon W. Weiss,John R. Goldblum 6th Edition
9. Singer S, Demetri GD, Baldini EH, et al: Management of soft-tissue sarcomas: An overview and update. Lancet Oncol 2000, 1:75–85.
10. Hashimoto H, Daimaru Y, Takeshita S, et al. Prognostic significance of histologic parameters of soft tissue sarcomas. Cancer 1992, 70: 2816–2822.
Issue details
A study of correlation between preoperative provisional diagnosis and intra operative findings in the patients with non traumatic acute abdominal pain
Anil Shriram Mundhe, Tushar S. Agrawal
Introduction: Abdominal pain is one of the most common reasons for an emergency department (ED) visit, accounting to about 5% to 10% of all ED visits. Aims and Objectives: To Study Correlation between Preoperative Provisional Diagnosis and Intra Operative Findings in the Patients with Non Traumatic Acute Abdominal Pain. Material and Methods: After approval form the Institutional ethical committee a records based, cross-sectional study was carried out in the Department of General Surgery at tertiary health care center during one-year period June 2014-June 2015. All details about clinical history, Clinical diagnosis, Ultrasongraphic findings, CT-Scan findings and Intraoperative findings was extracted from the case records. There were 100 patients were included into the study. 62 pt managed operatively and 38 patients managed conservatively. Result: The majority of the Patients were from the age group of 30-40 i.e. 33%. The majority of the patients were Males i.e. 56% and Females were 44% As per Preoperative Provisional Diagnosis the most common diagnosis found was Acute appendicitis in 44% followed by; Urolithiasis in 14%, Gastritis in 13%, Hollow viscus perforation in 12%, Intestinal obstruction in 06%, Acute cholecystitis in 6%, Acute Pancreatitis in 5%. As per Intraoperative findings in patients with preoperative provisional diagnosis of acute Appendicitis intra op finding was inflamed appendicitis in 63.46% followed by Perforated appendicitis in 20.46%, Gangrenous appendicitis in 13.64%, Normal appendicitis in 2.27%. For preoperative diagnosis in 12 patients as Hollow viscus perforation incidence of Duodenal perforation 58.4% followed by Gastric perforation in 33.3%, Ileal perforation in 8.3% . For total 6 patients as preoperative provisional diagnosis as intestinal obstruction the intraop finding were Postoperative adhesive band 50.1%, Sigmoid volvulus 16.7%, Superior mesenteric artery thrombus 16.7%, Obstructed hernia 16.7.The compatibility of intraoperative findings was highest with USG Diagnosis i.e. 89.00% followed by CT-Scan was 81% and of the Clinical diagnosis was 59%. Conclusion: As per Preoperative Provisional Diagnosis the most common diagnosis found was Acute appendicitis in followed by Urolithiasis, Gastritis, Hollow viscus perforation, Intestinal obstruction, Acute cholecystitis, Acute Pancreatitis etc . The compatibility of intraoperative findings was highest with USG Diagnosis i.e. 89.00% followed by CT-Scan was 81% and of the Clinical diagnosis was 59%.
1. Kamin RA, Nowicki TA, Courtney DS, Powers RD. Pearls and Pitfalls in the Emergency Department Evaluation of Abdominal Pain. Emerg Med Clin North Am 2003;21:61-72. 2. Agboola JO, Olatoke SA, Rahman GA. Pattern and Presentation of Acute Abdomen in a Nigerian Teaching Hospital. Niger Med J 2014;55:266-70. 3. Powers RD, Guertler AT. Abdominal Pain in the ED: Stability and Change over 20 Years. Am J Emerg Med 1995;13:301-3. 4. Gupta, K;. Bhandari, RK;. Chander, R. Comparative study of plain abdomen and ultrasound in non-traumatic acute abdomen Gastrointestin.radiol. 2005; 5(1) 109-115. 5. Smith, J .T ;.Mbchb, M;.and Parachemant, C .The role of imaging in the management of adults with nontraumatic acute abdominal pain .2009 ; vol. 21 : 1-19. 6. Walsh P.F, Crawford D and Crossling F.T . The value of immediate ultrasound in acute abdominal conditions: a critical appraisal. Clin Radiol 1990; 42:47–9. 7. Andrew B;.M;.Michael J. Lane;. Robert T. G.; .Harry A;.Claypool, S. K.;.Douglas, S. K. and Jonathan E. T.. Nontraumatic Acute Abdominal Pain: Unenhanced Helical CT Compared with Three View Acute Abdominal Series Radiol. 2005 ; 237:114-122. 8. Siewert B, Raptopoulos V, Mueller M. F, Rosen M. P and Steer M. Impact of CT on diagnosis and management of acute abdomen in patients initially treated without surgery. AJR Am J Roentgenol; 1997; 168:173–178. 9. Rosen MP, Sands D. Z, Longmaid HE, Reynolds K.F, Wagner M, and Raptopoulos V .Impact of abdominal CT on the management of patients presenting to the emergency department with acute abdominal pain. AJR Am J Roentgenol 2000; 174:1391–1396. 10. Bohner H,Yang Q and Franke, C. Simple data from history and physical examination help to include bowel obstruction and to avoid radiographic studies in patients with acute abdominal pain. Eur J Surg; 1998; 164:777–84. 11. Basim R. Gadban. Comparative study between ultrasound findings and intra-operative findings in non-traumatic Abdominal Pain. J Fac Med Baghdad. 2011; 53(4): 377-380. 12. Lakshay Chanana, Moses A. K. Jegaraj, Kimmin Kalyaniwala et al. linical profile of non-traumatic acute abdominal pain presenting to an adult emergency department . J Family Med Prim Care .2015 ; 4:422-5. 13. Raman, S.; Somasekar .; Winter R.K ;.Lewis M.H 2004 .Are we overusing ultrasound in non-traumatic acute abdominal pain? Postgrad Med J . 2004; 80:177-179. 14. Andrew B;.M;.Michael J. Lane;. Robert T. G.; .Harry A;.Claypool, S. K.;.Douglas, S. K. and Jonathan E. T. Nontraumatic Acute Abdominal Pain: Unenhanced Helical CT Compared with Three View Acute Abdominal Series Radiol. 2005 ; 237:114-122. 15. Malone AJ. Unenhanced CT in the evaluation of the acute abdomen: the community hospital experience.Semin Ultrasound CT MR; 1999; 20:68– 76. 16. Abdul Khair, Mahmond H, Mohammed M. Ultrasonography and liver abscesses. Am Surg 1981;193: 221-226.
Ipsilateral compound GR 2 femoral neck and shaft fracture in a 2 year old children- A case report
Karan Chopra, Suman Dhar, Mangesh Panat, Pratik Israni
Introduction: Concomittant Ipsilateral Fractures of Neck And Shaft of femur are rare in children of age group 2 years. there are only 11 reported cases till now. These injuries occur in children due to high velocity trauma and there is no accepted method of treatment. Case Report: We had compound grade 2 mid shaft femur with bone loss and ipsilateral neck femur. After fixation it resulted in no limb length discrepancy and no varus deformity. we advocate operative stabilisation of femoral shaft fracture to reduce the risk of further displacement and simplify the fiation of femoral neck. The common complications we see have poor progonosis resulting in avascular necrosis, coxa vara and limb length discrepancy. But in our case report we had nothing of them despite of being compound grade 2 with bone loss. Conclusion: To Conclude, Case Of This Sort In Paediatric Age Group Are Rare, But If Managed Properly Gives A Satisfactory Outcome With Minimal Or Nil Complications.
1. Agarwal A, Agarwal R, Meena DS. Ipsilateral femoral neck and shaft fracture in children. J Trauma.2008;64(4):E47–E53. doi: 10.1097/01.ta.0000196696.87716.8c. 2. McDougall A. Fracture of the neck of femur in childhood. J Bone Jt Surg Am. 1967;49:16–29. 3. Fardon DF. Fracture of neck and shaft of the same femur. Report of a case in a child. J Bone Jt Surg Am.1970;52:797–799. 4. Hoeksema HD, Olsen C, Rudy R. Fracture of femoral neck and shaft and repeated neck fracutre in a child. Case report. J Bone Jt Surg Am. 1975;57:271–272. 5. Swiontkowski MF, Hansen ST, Kellam J. Ipsilateral fracture of the femoral neck and shaft. J Bone Jt Surg Am. 1984;66:260–268. 6. Canale ST. Hip fractures in children. Curr Orthop. 2000;14:108–113. doi: 10.1054/cuor.2000.0091. 7. Bennett FS, Zinar DM, Kilgus DJ. Ipsilateral hip and femoral shaft fracture. Clin Orthop Related Res.1993;296:168–177. 8. Hoekstra HJ, Binnendijk B. Fracture of the neck and shaft of same femur in children. A report of two cases. Arch Orthop Trauma Surg. 1982;100(3):197–198. 9. Akahane T, Fujioka F, Shiozawa R. A transepiphyseal fracture of the proximal femur combined with a fracture of the mid-shaft of ipsilateral femur in a child: a case report and literature review. Arch Orthop Trauma Surg. 2006;126(5):330–334. 10. Cannon SR, Pool CJF. Trauamtic separation of proximal femoral epiphysis and fracture of the mid-shaft of the ipsilateral femur in a child: a case report and review of the literature. Injury. 1983;15:156. 11. Schwarz N, MoosmÜller W. Simultaneous fracture of the femur shaft and femur neck in the children and adolescents. Unfallchirurg. 1986;89(6):268–271.Colonna PC. Fracture of the neck of the femur in children. Am J Surg. 1929;6:793–797. 12. Marsh JL, Slongo TF, Agel J, Broderick JS, Creevey W, DeCoster TA, Prokuski L, Sirkin MS, Ziran B, Henley B, Audigé L (2007) Fracture and dislocation classification compendium—2007: Orthopaedic Trauma Association Classification, Database and Outcomes Committee. J Orthop Trauma 21 (Suppl 10):S1–S163 13. Ratliff AH. Fractures of the neck of the femur in children. J Bone Jt Surg Br. 1962;44:528–542. 14. Morrissy RT. Hip fractures in children. Clin Orthop Relat Res. 1980;152:202–210. 15. Flynn JM, Wong KL, Yeh GL, Meyer JS, Davison RS. Displaced fractures of the hip in children. Management by early operation and immobilisation in a hip spica cast. J Bone Jt Surg Br. 2002;84:108–112. 16. Canale ST. Fractures of the hip in children and adolescents. Orthop Clin North Am. 1990;21:341–352. 17. Forlin E, Guille JT, Kumar SJ, Rhee KJ. Complications associated with fracture of the neck of the femur in children. J Pediatr Orthop. 1992;12:503–509. doi: 10.1097/01241398-199207000-00017. 18. Heiser JM, Oppenheim WL. Fractures of the hip in children: a review of forty cases. Clin Orthop Relat Res. 1980;149:177–184. 19. Leung PC, Lam SF. Long-term follow-up of children with femoral neck fractures. J Bone Jt Surg Br.1986;68:537–540. 20. Hughes LO, Beatty JH (1994) Current concepts review: fracture of the head and neck of the femur in children. J Bone Jt Surg Am 76:283–292. 21. Swiontkowski MF, Winquist RA. Displaced hip fractures in children and adolescents. J Trauma.1986;26:384–388. doi: 10.1097/00005373-198604000-00013. 22. Morsy HA. Complications of fractures of the neck of the femur in children. A long-term follow-up study. Injury. 2001;32:45–51. doi: 10.1016/S0020-1383(00)00109-1. 23. Moon ES, Mehlman CT. Risk factors for avascular necrosis after femoral neck fractures in children: 25 Cincinnati cases and meta-analysis of 360 cases. J Orthop Trauma. 2006;20:323–329. 24. Togrul B, Bayram H, Gulsen M, Kalaci A, Ozbarlas S. Fractures of the femoral neck in children: long-term follow-up in 62 hip fractures. Injury. 2005;36:123–130.
Post-operative pain and analgesic requirements in breast surgery: Comparative study of combined general anaesthesia with paravertebral block versus general anaesthesia alone
Nilambari S Adke, Pravin C Jadhav
Background:Patients undergoing breast cancer surgery frequently experience chronic postoperative pain. The primary objective of this randomized study was to determine if thoracic paravertebral block (TPVB) reduced the incidence of chronic pain after a modified radical mastectomy (MRM) when compared with general anesthesia (GA).This study was undertaken to compare analgesic efficacy and complications of combined general anaesthesia with paravertebral block versus general anaesthesia alone in breast surgery. Material and Methods: A total of 60 patients for elective breast surgery were grouped as Group A (General anaesthesia with paravertebral block) and Group B (General anaesthesia alone) and compared for analgesic efficacy and complications. Results: Duration of postoperative analgesia in group A was 17.63 ± 2.34 versus 5.47 ± 1.63 in group B. Patients in group A (PVB + GA) didn’t required any rescue analgesics as compared to group B (GA) where 28 patients received rescue analgesics. Incidence of PONV was significantly lower in group A as compared to group B. Conclusion: Para vertebral block when used with general anaesthesia induces excellent anaesthesia and greater postoperative pain relief and lower incidence of PONV and other complications.
1. Poleshuck EL, Katz J, Andrus CH, Hogan LA, Jung BF, Kulick DI, et al. Risk factors for chronic pain following breast cancer surgery: A prospective study. J Pain 2006;7:626-34. 2. Jaffe SM, Campbell P, Bellman M, Baildam A. Postoperative nausea and vomiting in women following breast surgery: An audit. Eur J Anaesthesiol 2000;17:261–4. 3. Gilbert J, Hultman J. Thoracic paravertebral block: A method of pain control. Acta Anaesthesiol Scand 1989;33:142–5. 4. Kairaluoma PM, Bachmann MS, Korpinen AK, Rosenberg PH, Pere PJ. Single-injection paravertebral block before general anesthesia enhances analgesia after breast cancer surgery with and without associated lymph node biopsy. Anesth Analg 2004;99:1837–43. 5. Breivik H, Borchgrevink PC, Allen SN, Rosseland LA, Romundstad L, Breivik HE, et al. Assessment of pain. Br J Anaesth 2008;101:17–24. 6. Patel LP, Sanghvi PR, Agarwal MB, Prajapati GC, Patel BM. Thoracic paravertebral block for analgesia after modified radical mastectomy. Ind J Pain 2014;28:160-5. 7. Barlacu CL, Frizelle HP, Moriaty DC, Buggy DJ. Fentanyl and clonidine as adjunctive analgesics with levobupivacaine in paravertebral analgesia for breast surgery. Anaesthesia 2006;61:932–93. 8. Klein SM, Bergh A, Steele SM, Georgiade GS, Greengrass RA. Thoracic paravertebral block for breast surgery. Anesth Analg 2000; 90:1402–5. 9. Coveney E, Weltz C, Greengrass A, Iglehart J, Leight G, Steele S, et al. Use of paravertebral block anaesthesia in the surgical management of breast cancer. Ann Surg 1998;(227):496–501. 10. Greengrass R, O’Brien F, Lyerly K, Hardman D, Gleason D, D’Ercole F, et al. Paravertebral block for breast cancer surgery. Can J Anaesth 1996;43(8):858–61. 11. Vila H, Liu J, Kavasmaneck D. Paravertebral block: new benefits from an old procedure. Curr Opin Anaesthesiol 2007;20(4):316–8.
Study of fine needle aspiration cytology in the diagnosis of ovarian masses
Delux V Godghate, Arvind Bhake
Background: Earlier the technique of aspirating ovarian masses was mostly unguided imaging technique. The ovarian masses were located by palpation and were approached transrectally, transvaginally and transcutaneously for fine needle aspiration cytology. The advancement of imaging technique has enabled many workers to undertake fine needle aspiration cytology of ovarian masses as it helped in correct localization and sampling from suspected area of cancerous and noncancerous lesions. Objectives: To study cytomorphological features of benign and malignant conditions of ovarian masses obtained at ultrasound guided fine needle aspiration cytology. To determine sensitivity and specificity at ultrasound guided fine needle aspiration cytology in diagnosis of ovarian masses. To draw value of comparison between cytodiagnosis and histomorphological diagnosis; rate of accuracy, false positive, false negative, positive predictive value and negative predictive value. Material and Methods: The present prospective study was carried out in the Department of Pathology, Jawaharlal Nehru Medical College, Sawangi (M), Wardha during two years duration from July 2009 to June 2011.FNAC was performed on cases with suspected ovarian masses with plan for surgical treatment. The material obtained at aspiration was wet fixed in 95 % ethyl alcohol and stained with papanicolaou stain while few were dry fixed and stained with May Grunwald Giemsa stain. Result: The false positive rate was 0 and false negative rate was 4.34%. The sensitivity and specificity of FNAC in diagnosis of ovarian masses was found to be 95.65% and 100% respectively. Negative predictive value was 96.77% and positive predictive value was 100% of FNAC in diagnosis of ovarian masses. Overall rate of accuracy of FNAC in diagnosis of ovarian masses was 98.11% in present study. Conclusion: FNAC over lesion of ovary carried out under USG guidance is a safe preoperative diagnostic modality. USG guided FNAC in the ovarian lumps has a definite ability to distinguish between a non neoplastic and neoplastic lesions of ovary with confidence.
1. Ramzy I, Delaney M, Rose P: Fine Needle Aspiration of Ovarian Masses II.Correlative Cytologic and Histologic Study of Nonneoplastic and Noncelomic Epithilial Neoplasms. Acta Cytologica 1979;23:185-193. 2. Ganjei,Mehrdad Nadji:Aspiration Cytology of Ovarian Neoplasm. Acta Cytologica 1984;28:329-332. 3. Kjellgren O, Angstrom T, Bergman F, D-E.Wiklund: Fine needle aspiration biopsy in diagnosis and classification of ovarian carcinoma. Cancer1971; 28:967-76. 4. Angstrom T, Kjellgren O, Bergman F: The Cytologic Diagnosis of Ovarian Tumors by Means of Aspiration Biopsy. Acta Cytologica 1972;26:336-40. 5. Ramzy I, Delaney M: Fine Needle Aspiration of Ovarian Masses I. Correlative Cytologic and Histologic Study of Celomic Epithilial Neoplasms. Acta Cytologica 1979;23:97-104. 6. Ellen Greenebaum: Aspirating Non Neoplastic Ovarian Cysts:Laboratory Medicine 1996;27:462-466. 7. Hemalata AL, Divya P, Mamatha R: Image –directed percutaneous FNAC of ovarian neoplasm.Indian J Pathol Microbiol 2005;48:305-309. 8. Marguerite M.Pinto,Ellen Greenebaum, Aylin Simsir,George M.Kleinman, Lewis M.Portnouy,Robin Garfinkel:CA-125 and Carcinoembryonic Antigen Assay vs. Cytodiagnostic experience in the Classification of Benign Ovarian Cysts. Acta Cytologica 1997;41:1456-1462. 9. Fabienne Allias, Jacques Chanoz, Gilles Blache, Francoise Thivolet-Bejui, SergeVancina:Value of Ultrasound-Guided Fine Needle Aspiration Cytology in the Management of Ovarian and Paraovarian Cyst.Diagnostic Cytopathology 2000;22:70-80. 10. Torben Larsen, Soren T.Torp-Pedersen, Marinne Ottesen, Erik Bostofte, Maxwell Sehested, Fritz E.Rank and Hans H. Holm:Abdominal ultrasound combined with histological and cytological fine needle biopsy of suspected ovarian tumors. EUROBS 1993;50:203-209. 11. Ghazala Mehdi,Veena Maheshwari,Sheerin Afzal, Hena A Ansari, Maryem Ansari: Image guided Fine Needle Aspiration cytology of ovarian tumors:An assestment of diagnostic efficacy.J Cytol 2010;27:91-95. 12. Nazoora Khan, Nishat Afroz, Barina Aqil, Tamkin Khan, IbneAhmad:Neoplastic and non neoplastic ovarian masses:Diagnosis on cytology.Journal of cytology 2009;26:129-133. 13. Ashim Kumar Lahiri, Manjula Jain, BS Baliga, KP Mittal: Evaluation of Adnexal Masses by Ultrasound and Fine Needle Aspiration Cytology. Indian J. Pathol.Microbiol 2002;45:255-259. 14. Ganjei P,Dickinson B,Harrison T,Nassiri M,Lu Y:Aspiration cytology of neoplastic and nonneoplastic ovarian cysts: is it accurate ?.Int J Gynecol Pathol 1996;15:94-101. 15. Nicholas J. Mulvany:Aspiration Cytology of Ovarian Cysts and Cystic Neoplasm. Acta Cytologica 1996;40:911-920. 16. Pranab Dey, Subhas C Saha, Kalian K Dhar: Fine Needle Aspiration Biopsy of Ovarian Neoplasm.Indian J. Pathol.Microbiol 2001;44:103-106. 17. T.Sood, U.Handa, H. Mohan,P. Goel :Evaluation of Aspiration Cytology of Ovarian cystic masses with Histopathological correlation. Cytopathology 2010;21:176-185. 18. Pauline Athanassiadou, Dimitra Grapsa: Fine Needle Aspiration of Borderline Ovarian Lesions. Acta Cytologica 2005;49:278-285. 19. Aysun Uguz, Canan Ersoz, FilizBolat, Ayse Gokdemir, M.Ali Vardar :Fine Needle Aspiration Cytology of Ovarian Lesions. Acta Cytologica 2005;49:144-148. 20. Robert V.Higgins,Jerry F.M atkins,Marie Clarie Marroum:Comparision of Fine Needle Aspiration Cytology of Ovarian Cyst with Ovarian histologic findings.Am j Obstet Gynecol 1999;180:550-3. 21. Carmen Alvarez Santin, Adela Sica, Silvia Melesi, Alicia Feijo, Griselle, Carmen Rodriguez Alvarez:Contribution of Intraoperative Cytology to thre Diagnosis of Ovarian Lesions. Acta Cytologica 2011;55:85-91. 22. Ganjei p: Fine Needle Aspiration Cytology of Ovary.Clin Lab Med 1995 ;15:705-26.
A study of prevalence and clinical profile of the patients having hypertensive disorders of pregnancy
Vidya Jadhav, Supriya Waydande
Introduction: Hypertensive disorder in pregnancy is a condition in which the pregnant woman presents with an elevated blood pressure during pregnancy or puerperium as defined in 1986 by the American College of Obstetricians and Gynecologists and adopted by the World Health Organization (WHO). Hypertensive disorder of pregnancy is seen after 20weeks of pregnancy. It affects almost 6-10% of all pregnancies worldwide. Systolic blood pressure above 140 and diastolic blood pressure above 90mm of Hg with associated proteinuria. Eclampsia means patients with severe preeclampsia develop tonic-clonic convulsions. Material and Method: It was prospective hospital based observational study of patients of hypertensive disorders of pregnancy conducted at Bharti Hospital, Sangli in the department of Obstetrics and Gynecology. In this study patients with essential hypertension and chronic hypertension, patients with known renal disease prior to pregnancy were excluded. Results: The prevalence of Hypertension overall was 29.20 i.e. 125 out 428 ANC registered women. As per age wise in 10-16 years age group it was 29.26% in 17-19 years was 15.00 in 20-24 years. Conclusion: The overall prevalence of PIH in our study was Hypertension overall was 29.20. And associated factors were Obesity, H/o Hypertension, Family H/O of PIH, Diabetes, Primipara, H/O Exposure to Smoking
1. ACOG. ACOG technical bulletin. Hypertension in pregnancy. Number 219--January 1996 (replaces no. 91, February 1986). Committee on Technical Bulletins of the American College of Obstetricians and Gynecologists. Int J Gynaecol Obstet. 1996;53(2): 175-83. 2. Cunningham FG, Leveno KJ, Bloom SL, Hauth JC, Gilstrap III LC, Wenstrom KD. Williams Obstetrics. 22th ed. USA: McGraw-Hill Companies Inc; 2005. Chapter 34, Hypertensive disorders in pregnancy; p. 426-50. 3. McCaw Binns AM, MacGillivray I, Hawkins N, Golding J, Ashley DEC. International variation in the incidence of hypertension in pregnancy among primiparae: the Jamaican experience. West Indian Med J. 1997;46(Suppl 2):29. 4. Schroeder BM; American College of Obstetricians and Gynecologists. ACOG practice bulletin on diagnosing and managing preeclampsia and eclampsia. American College of Obstetricians and Gynecologists. Am Fam Physician. 2002;66(2):330-1. 5. Working Group on High Blood Pressure. Report of the National High Blood Pressure Education Program Working Group on High Blood Pressure in Pregnancy. Am J Obstet Gynecol. 2000;183(1):S1- S22. 6. Roberts CL, Algert CS, Morris JM, Ford JB, Henderson-Smart DJ. Hypertensive disorders in pregnancy: a population-based study. Med J Aust. 2005;182(7):332-5. 7. Golding J. A randomised trial of low dose aspirin for primiparae in pregnancy. The Jamaica Low Dose Aspirin Study Group. Br J ObstetGynaecol. 1998; 105(3):293-9. 8. Levine RJ, Hauth JC, Curet LB, Sibai BM, Catalano PM, Morris CD, et al. Trial of calcium to prevent preeclampsia. N Engl J Med. 1997;337(2):69-76. 9. Conde-Agudelo A, Belizán JM. Risk factors for preeclampsia in a large cohort of Latin American and Caribbean women. BJOG. 2000;107(1):75-83. 10. Trogstad LI, Eskild A, Magnus P, Samuelsen SO, Nesheim BI. Changing paternity and time since last pregnancy; the impact on pre-eclampsia risk. A study of 547 238 women with and without previous pre-eclampsia. Int J Epidemiol. 2001;30 (6):1317-22. 11. SheyWiysonge CU, Ngu Blackett K, Mbuagbaw JN. Risk factors and complications of hypertension in Yaounde, Cameroon. Cardiovasc J S Afr. 2004; 15(5):215-9. 12. Pridjian G, Puschett JB. Preeclampsia. Part 1: clinical and pathophysiologic considerations. ObstetGynecolSurv. 2002;57(9):598-618. 13. Leeners B, Rath W, Kuse S, Irawan C, Imthurn B, Neumaier-Wagner P. BMI: new aspects of a classical risk factor for hypertensive disorders in pregnancy. ClinSci (Lond). 2006;111(1):81-6. 14. Jun Zhang, Jonathan Zeisler, Maureen C. Hatch.Epidemiology of Pregnancy-induced Hypertension. Epidemiol Rev. 1997; 19 ( 2),218-232. Available at :http://epirev.oxfordjournals.org/content/19/2/218.full.pdf accessed last on Sep 2016. 15. Chesley LC. History and epidemiology of preeclampsia-eclampsia. ClinObstet Gynecol. 1984; 27(4):801-20. 16. Saftlas AF, Olson DR, Franks AL, Atrash HK, Pokras R. Epidemiology of preeclampsia and eclampsia in the United States, 1979-1986. Am J Obstet Gynecol. 1990;163(2):460-5 17. Nucci LB, Schmidt MI, Duncan BB, Fuchs SC, Fleck ET, Britto MMS. Nutrional status of pregnant women: prevalence and associated pregnancy outcomes. Rev SaúdePública. 2001;35:502-7. 18. Gaio DS, Schmidt MI, Ducan BB, Nucci LB, Matos MC, Branchtein L. Hypertensive disorders in pregnancy: frequency and associated factors in a cohort of Brazilian women. Hypertens Pregnancy. 2001;20:269-81 19. Assis TR, Viana FP, Rassi S. Study on the major maternal risk factors in hypertensive syndromes. Arq Bras Cardiol. 2008; 91:11-7. 20. Schmidt MI, Duncan BB, Reichelt AJ, Branchtein L, Matos MC, Costa e Forti A, et al. Gestational diabetes mellitus diagnosed with a 2-5h 75-g oral glucose tolerance test and adverse pregnancy outcomes. Diabetes Care. 2001;24:1151-5 21. Pipkin FB. Risk factors for preeclampsia. N Engl J Med. 2001;12:925-6 22. Sibai BM, Hauth J, Caritis S, Lindheimer MD, MacPherson C, Klebanoff M, et al. Hypertensive disorders in twin versus singleton gestations. Am J Obstet Gynecol. 2000;182:938-42. 23. Wen SW, Demissie K, Yang Q, Walker MC. Maternal morbidity and obstetric complications in triplet pregnancies and quadruplet and higher-order multiple pregnancies. Am J Obstet Gynecol. 2004;191:254-58.
Trends of poisoning in Vidarbh region of Maharashtra
Shankar Dakhankar, Bipin Tirpude
Poisoning is mysterious, dangerous, and reliable method of dying. it is most common method of suicide and homicide since ancient time. Trends of poisoning are different in different parts of India. Present study was conducted at Kasturba Hospital of MGIMS Sevagram, Wardha. This hospital drains patients from the whole Vidarbh area. This study was conducted during period January 1997-December 1998. Durinng this period 364 cases of poisoning were reported at MGIMS Sevagram. Out of them 268 cases of poisoning were admitted for treatment and 49 died during treatment. 78 cases of poisoning directly brought for postmortem. Study showed male predominance in age group of 21-30 years. Organophasphorus poisoning was most common.
1. Aggrawal N.K., Aggrawal BBL (1998)- Death due to Aluminium phosphide poisoning, International Journal of Medical Toxicology and Legal Medicine, Volume No-1, July-December 1998, Page41-43. 2. Aggrawal N.K., Aggrawal BBL (1998-Trends poisoning in Delhi, Journal of Indian Academy of Forensic Medicine, Volume-20, page 32-36. 3. Aggrawal Praveen, Handa Rohini, Wali JP (1998)-Common poisoning in India, Journal of Forensic Medicine and Toxicology, Volume No1, January-June 1998, page73-79. 4. Alexander, Lawson AH, Ian Mitchel (1972)-Patients with acute poisoning seen in general medical unit( 1960-1971), British Medical journal, Volume-- 4,Page 911-915. 5. Dalal JS, Goria RK, 1998-Poisoning trends-a postmortem study, Journal of Indian Academy of Forensic Medicine, 1998, Volume No-20, No-2, page27-37. 6. Dogra TD, Bhoopendra Singh, 1996-Present status of poisoning in India, Indian Medical Gazette, November 1996, page No-364-368. 7. Hettiara Chchi, J Kodithu Wakku GCS 1991-Pattern of poisoning in rural Srilanka, International Journal of Epidemiology, Volume-18, No-2, page 418-422. 8. Horisberger B, Liao Z A, 1998-A comparison of poisoning deaths in medicolegal autopsies in Lausane city and three towns of China.-Journal of Forensic Medicine and Toxicology, Volume XV, No-1, January-June 1998, Page 33-36. 9. Naik R S, Khajuria BK, Tirpude BH-Hazzards of pesticide, their preventive measures and practical difficulties in adopting them. -Journal of Indian Academy of Forensic Medicine 1918, Volume 20, No 2, Page 42-45. 10. Nandi Apurba 1995-Principles of Forensic Medicine, 1 st Edition, 1995, NCBA, India. 11. Parikh C.K. 1990-Parikh’s Text Book of Medical Jurisprudence and Toxicology, 5th Edition 1990. 12. Pillay V V-Influence of fang structure and venum composition on the sympyomatology of snake bite, Journal of Forensic Medicine and Toxicology, Volume XII, No -3, Page-80-22. 13. Pohowala J N, Ghai O P, 1959-Common accidental poisoning in Indore, Indian Journal of Child Health, 1959, Volume -8, Page 524-530. 14. Samaria JK, Singh DP, 1990-Study of different poisoning in eastern UP and northen Bihar, Journal of Association of Physician India, Volume 38, No-1 Page-33 15. Sharma B.R. 1996-Trends of poison and drug abuse in Jammu, Journal of Forensic Medicine and Toxicology, Volume XIII, January-June 1996, No-1and2, Page 7-9. 16. Sharma S.K., 1998-Current scenario of poisoning in rural India, Journal of Forensic Medicine and Toxicology, Volume XV, No-1, January- June 1998, Page 89-93. 17. Siwach, S.B., Gupta A 1995-Profile of acute poisoning in Rohatak, Harayana, 1995. Journal of Association Physician India, 1995, Volume 43 Page 756-759. 18. Sondi Deepak, Sondhi M et al, 1990-A study of deaths due to poisoning in District –Lucknow, Uttar Pradesh, Indian Medical Gazzete, November, 1990, Page 349-352. 19. Tondon SK, Quershi GV 1998-Spectrum of childhood poisoning cases admitted in S.N. Medical college and Hospital Agra, Journal of Forensic Medicine and Toxicology, ISSN O971-1992, Volume XIII, No 1and2, January –June 1996, Page 10-12. 20. Wahal P.K., Lahiri B., Mathur K.S.1996--- Pattern of poisoning in Bombay, Poona and Karnataka, Journal of Association of Physician India, Volume-23 Page -103. 21. Zine K.V., Mohanty A.C., 1998-Pattern of acutepoisoning at Indira Gandhi Medical College and Hospital, Nagpur. Journal of Indian Academy of Forensic Medicine, 1998, Volume-20, No-2, Page 37-39.
A clinico-demographic study of reproductive tract infections at tertiary health care center
Birajdar Annasaheb Gulabrao, More N V, Suwarna Dahitankar
Introduction: the maximum cases of Bacterial vaginosis, Trichomonasvaginalis and Candidiasis were in the age group of 20-29 yrs. and least in the age group of ≤ 19 yrs. As parity increases, the no. of cases of each one become less and most of the cases were having parity 1 to 2. Aims and Objectives: To Study Clinico -Demographic profile of patients with Reproductive Tract Infections at tertiary Health care center. Methodology: Patients attending tertiary health care center with complaint of abnormal vaginal discharge of age group 15 to 40 years were selected for the study. This study was conducted at tertiary health care centre from January 2009 to September 2010. During the study period the total number of gynaec O.P.D attendees were 19,270. Presuming the equal distribution of cases on all days the no. of attendees (symptomatic and asymptomatic) with findings of RTI were 6,423. Data presented in tables and in percentages. Result: Vaginal discharge was the commonest complaint among the study group. Prevalence increased with increase in Parity. RTI was more among the Muslims. Prevalence was higher among non-working women. Prevalence of RTI cases was higher in Illiterate. The prevalence of RTI was highest in non-users of Contraceptives (41.26%) as compared to other groups; it was lowest in the women who were dependent on their spouse for the use of condom as a contraceptive. Out of 64 cases of Bacterial vaginosis, 43.75% complained of vaginal discharge, 37.5% complained of pain in abdomen, 15.62% patients complained of backache, 20.31% complained of itching at genital area, 23.43% complained of increased frequency of micturation and 10.93% complained of dyspareunia. Among 40 cases of Trichomonasvaginalis, vaginal discharge was present in 40% cases, pain in abdomen in 20%, backache in 22.5%, Itching in 45%, increased frequency of micturation in 27.5%, dyspareunia in 12.5% of cases. Among 36 cases of Candidiasis vaginal discharge was present in 59.45% cases, backache in 37.83%, pain in abdomen in 40.54%, itching at genital area in 51.35%, increased frequency of micturition in 29.72 % and dyspareunia in 24.32%. Conclusion: It can beconcluded from study that Majority of cases with suggestive symptoms of RTI were in the age group of 20-29 years, asymptomatic cases were highest in the parity group > 4. Prevalence of RTI cases was high among Muslims nonworking (housewife), in illiterate and in non-users of contraceptives.In the study population cases were having multiple symptoms of which in overall vaginal discharge was the most common complaint.
1. Kantida Chaijareenont, Korakot Sirimai, Dittakarn, Boriboonhirunsarn, Orawan Kiriwat. Accuracy of Nugent’s Score and Each Amsel’s Criteria in the Diagnosis of Bacterial Vaginosis.J Med Assoc Thai 2004; 87(11): 1270-4. 2. Aggarwal D. Reproductive tract infections – challenges and responses. Health for the Millions. 2001; 3:21–3. 3. Meheus AZ. Women's health and reproductive tract infections: The challenges posed by pelvic inflammatory disease, infertility, ectopic pregnancy and cervical cancer. In: Germain A, Holmes KK, Piot P, Wasserheit JN, editors. Reproductive Tract Infections: Global impact and priorities for Women's Reproductive Health. New York: Plennum Press; 1992. pp. 61–91 4. National Guidelines on Prevention, Management and Control of Reproductive tract- Infections including Sexually Transmitted Infections. National AIDS Control Organization, MOHFW, Govt. of India; 2006. Nov. 5. Bansal KM, Singh K, Bhatangar S.Prevalence of lower RTI among married females in the reproductive age group (15-45). Health PopulPerspect Issues 2001; 24:157-63. 6. S C Panda, Lsarangi, D Bebartta, S Parida, O P Panigrahi. Prevalenc of RTI/STI among women of Reproductive Age in District Sundergarh (Orissa). Indian Journal for the Practising ;Vol.4,No.1(2007-03-2007-04) 7. Bhawna Pant, JV Singh, M Bhatnagar, SK Garg, H Chopra, SK Bajpai.Social Correlates in Reproductive Tract Infections among Married Women in Rural Area of Meerut. Indian J Community Med. 2008 January; 33(1): 52–53. 8. Deoki Nandan, S.K. Misra, AnitaSharma, Manish Jain. Estimation of Prevalenc of RTI/STD’s among women of Reproductive Age Group in District Agra. Indian Journal of Community Medicine; Vol.27, No.3 (2002-07-2002-09). 9. Aggarwal AK, Kaur M, Kumar R. Community based study of reproductive tract infection among women of reproductive age in rural area of Haryana.J Common Dis 1993;31:223-8 10. Daniel V landers, Harold C Wiesenfeid, R Phillip Heine, Marijane A Krohn, Sharon L Hiller. Predictive value of the clinical diagnosis of lower genital tract infection in women. American Journal of Obstetrics and Gynecology vol 190, Issue 4, April 2004, Pages 1004-1008. 11. Ray A, Gulati AK, Pandey LK, Pandey S.Prevalence of common infective agents of vaginitis. J Commun Dis 1989 Sep; 21(3):241-4. 12. Linda French, Jennifer Horton, Michelle Matousek. Abnormal Vaginal discharge: Using office diagnostic testing more effectively. The Journal of Family Practice: October 2004. Vol 53, No. 10 13. Oladele TeslimOjoromi, Wellington Aghoghovwia Oyibo, Adetokunbo OlufelaTayo, Comfort AeejokeIbidapo, Adetayo Foluscho Fagbenro-Beyioku, Oladipo Olarinre Oladosu, I.Isiaka Olaniyi Ola-Gbadamosi, Eromese Ruth Okposugbo, and Abiola Oluwatoyin Balogun. Reliance on microscopy in T. Vaginalis diagnosis & its prevalence in females presenting with vaginal discharge in lagos, Nigeria. J infect Developing Countries 2007; 1 (2): 210-213 14. B BLô, M Philippon, P Cunin, D Meynard, M Tandia- iagina. The microbial etiology of genital discharges in Nouakchott, Mauritania.Bulletin de la Société de pathologieexotique (1990): Volume: 90 ISSN: 0037-9085 ISO Abbreviation: Bull SocPatholExot Publication Date: 1997. 15. Dasgupta Aprajita, Sarkar Madhutandra. A study on reproductive tract infections among married women in the reproductive age group (15-45 yrs) in a slum of Kolkata. J ObstetGynecol India November/December 2008; Vol.58, No.6: pg 518-522. 16. Kantida Chaijareenont, Korakot Sirimai, Dittakarn, Boriboonhirunsarn, Orawan Kiriwat. Accuracy of Nugent’s Score and Each Amsel’s Criteria in the Diagnosis of Bacterial Vaginosis.J Med Assoc Thai 2004; 87(11): 1270-4.
A study of different treatment modalities for carcinoma of breast at tertiary health care center
Koustubh Mench, T Phira
Introduction: The World Cancer Report issued by the International Agency for Research on Cancer (IARC), tells us that cancer rates are set to increase at an alarming rate globally. Aims and Objectives: To Study Different Treatment Modalities for Carcinoma of Breast at tertiary health care center. Material and Methods: After approval from Institutional ethical committee a cross-sectional study carried out in all Cases of Carcinoma of Breast that has undergone treatment from April 2012 to April 2014 at Department of General Surgery of CPR hospital attached to RCSM Government Medical College Kolhapur. All the patients were treated as per the protocol by Surgically, Radiology and Chemotherapy and Neo-adjuvant therapy as per necessary in one-year duration such a way 50 patients were selected. Result: 38 patients (76%) of the total 50 patients underwent modified radical mastectomy (MRM). Simple mastectomy (SM) was done in 4 patients (8%) post-operative complication was lymphedema in 10 patients (23.8%) out of 38 patients. post-operative complications were Flap necrosis 2(4.76%) and wound infection 1 patients (1.19%) out of 38 patients. In treatment of stage IV disease NACT+MRM+ post-operative adjuvant therapy required in 8 % and Adjuvant therapy only required in 67% and Simple Mastectomy and Post-operative adjuvant therapy required in 25 % individuals. Out of the total 50 patients neo-adjuvant CT(NACT) was given in 6 patients (12%), post-operative / adjuvant therapy 3 i.e. 6% patients. CT was given as CT only 20%, T+RT-30% CT+HT-16% CT+RT+HT-16 %. Of the total 47 patients of chemotherapy, CT was delayed in 10 patients (21%). CT was not stopped in any patients.46 patients (92%) remained disease free, two patients with previously diagnosed stage III disease developed metastasis to bone. One patients with stage IIIB disease developed local chest wall recurrence. One patients in stage IV died after 10 months of diagnosis. Conclusion: It can be concluded from our study that; mortality of the patients after adequate treatment in our study was found very less i.e. 2% so proper and adequate treatment of the patients as per the standard protocol should be given for increasing survival of the breast cancer patient.
1. Pal SK, Mittal B. Improving cancer care in India: Prospects and challenges. Asian Pac J Cancer Prev 2004; 5:226-8. 2. Dumitrescu RG, Cotarla I. Understanding breast cancer risk-where do we stand in 2005? J Cell Mol Med 2005; 9:208-21. 3. Chandra AB. Problems and prospects of cancer of the breast in India. J Indian Med Assoc 1979; 72:43-5. 4. Chopra R. The Indian Scene. Journal of Clinical Oncology 2001;19: S106-11. 5. Program NCR. Time trends in cancer incidence rates 1982-2005 bangaloreindia: Indian council of medical research 2009 6. httpa/tms.gov. in/cancerinfo/breast/breast.htm: Tata memorial center, 2013 7. Madigan M, Ziegler R, Benichon C et al. proportion of breast cancer cases in the united states explained by well established risk factors. jnatil cancer inst. 1995;87:1681. 8. Rockhill B, Weinberg CR, Newman B. population attributable fraction estimation for establish. Am j epidemiol. 1998; 147:826-33. 9. Rochill b,Spiegelman D, Byrne c, et al. Validation of gail et al model of breast cancer risk prediction and implication for chemoprevention.jnatl cancer inst. 2001;93:358-66. 10. Berry Da, ivarsenEs, Gudbjartsson DF, et al. BRCAPRO validation, sensitivity of genetic testing of BRCA 1/BRCA 2 and prevalence of other breast cancer susceptibility genes, j clinoncol. 2002; 20:2701-12. 11. Chlebowski RT, chen Z, Anderson GL. Ethnicity and breast cancer factors influencing differences in incidence and outcome. J Natl cancer inst. 2005; 97;439-448 12. hall IJ, Moorman PG, Millikan RC, Newman B. comparative analysis of breast cancer risk factors among African-american and white women. Am j Epidemiol. 2005; 161:40-51. 13. Wu GH, chen LS, chang KJ et al. Evolution of breast cancer screening in countries with intermediate and increasing incidence of breast cancer. J med screen. 2006; 13:23-7. 14. Zheng T, Holford TR, Mayne ST, et al Lactation and cancer risk: a case-control study in Connecticut. Br j cancer. 2001:84:1472-6. 15. Raina V, Bhutani M, Bedi R, Sharma A, Deo SV, Shukla NK, et al. clinical features and prognostic factors of early breast cancer at a major cancer center in north india. Indain J cancer 2005;42:36-41 16. Christobel M. saunders and michealbaum, the breast chapter 46 in : Bailey and love’s short practice of surgery, Ed. Russel R.C.G., et al. 26th Edition, London :Arnold publishers, 2013, 798-819.
An observational study to evaluate direct obstetric causes of maternal mortality at a tertiary care centre in Mumbai, Maharashtra
Niranjan N Chavan, Smurti Kamble, Neha Raj, Pradnya Changede
Background: To evaluate direct obstetric causes of maternal mortality at a tertiary care centre in Mumbai, Maharashtra Methods: A total of 206 cases of maternal deaths due to direct obstetric causes from January 2011 to December2015 were analysed in a tertiary care centre. Information was extracted from the patients' case-notes from Medical Record Office, the labour ward registers, the antenatal and postnatal ward registers. Results: Majority of mortality occurred in age group of 21 -29, multiparous women belonging to urban Hindu community. Most of the cases were ANC registered as the study was carried out in a tertiary care centre, however 83 % of these were referred to our hospital. Most of the mortality occurred in postpartum period in ICU set up. Most common cause was found to be haemorrhage followed by eclampsia Conclusions: Multiple and frequent deliveries in already anaemic young women is the major underlying cause of maternal mortality. Antenatal care starting early in pregnancy, detection and managing pregnancy complications, detection and treatment of associated medical disorders, institutional deliveries, proper referral facility and emergency transport, timely intervention, access to contraceptives and safe abortion services can prevent most of the deaths.
1. World Health Organization. International Statistical Classification of Diseases and Related Health Problems, Tenth Revision. Geneva: World Health Organization. 1992 2. Juneja Y, Rai U. A five years review of maternal mortality. J Obstet Gynecol India 1993;43:944-9 3. Govt. of India (1962) Report of the Health survey and Planning Committee, Vol 1. Govt. of India, Ministry of health and Family Welfare (1984) Annual report 1983-84 4. Special Bulletin on Maternal Mortality in India 2007-09: Sample registration system, Office of Registrar General, India. 2011 Jun 5. Pathak D, Chakraborty B, Goswami S, Adhikari S. Changing Trends of Maternal Mortality: A Comparative Study. The Journal of Obstetrics and Gynecology of India March / April 2011 pg 161 -165 6. Smith JC, Hughes JM, Pekow PS, Rochat RW. An Assessment of the Incidence of Maternal Mortality in the United States. American Journal of Public Health. 1984, 74(8): Pg 780-78 7. Govt. of India Ministry of Health and Family Welfare Central Bureau of Health Intelligence, National Health Profile(2015) 8. Al-Farsi, Y. M., D. R. Brooks, et al. "Effect of high parity on occurrence of anemia in pregnancy: a cohort study." BMC Pregnancy Childbirth. 2011. 11: 7 9. United Nations Children’s Fund, United Nations University, WHO. Iron deficiency anaemia: assessment, prevention, and control. A guide for programme managers. www.who.int. http://whqlibdoc.who.int/hq/2001/WHO_NHD_01.3.pdf. Published 2001 10. Liang J,Dai L, Zhu J, Li X, Zeng W, Wang H et al. Preventable maternal mortality: Geographic/rural-urban differences and associated factors from the population-based maternal mortality surveillance system in China. BMC Public Health 2011, 11:243
The prediction of delivery date by ultrasonic measurement of fetal crown – Rump length in first trimester
Arati Mane, L L Pujari
Introduction: The establishment of pregnancy dates is important not only for the mother who wants to know when to expect the delivery, but it is also important to calculate the gestational age. Accurate dating decrease the number of labour inductions for postterm pregnancies, prevent iatrogenic prematurity Aims and Objectives: To study prediction of delivery date by ultrasonic measurement of fetal crown – rump length in first trimester. Material and Methods: This was a cross-sectional study at OBGY department of tertiary health care center during 12 months. Sample size was 200.EDD is calculated by Naegele’s rule Obstetric ultrasonography will be performed using Philips ultrasound scanner using a 3.5MHZ convex probe. Data was analyzed statically by chi square test, paired t test and other appropriate statistical tests using SPSS version. P value of <0.05 will be considered statistically significant. Result: The maximum cases studied were in age group of 20-24 years i.e., 124 cases (62%) . In EDD of USG, out of 200 cases 22(11%) delivered on predicted day, 61(30.5%) delivered 7 days before, 95(47.5%) delivered after 7 days, 1(0.5%) delivered 8-10 days before, 13(6.5%) delivered 8-10 days after, 0(0%) delivered 11-14 days before, 4(2.0%) delivered after 11-14 days, 1(0.5%) delivered before 15-21 days and 3(1.5%) delivered after 15-21 days in according with EDD calculated by CRL . In LMP-ED Dout of 200 cases, 88(44%) delivered before 5 days, 85(42.5%) delivered from 4 days before to 7 days after, 27(13.5%) delivered after days. Prediction of USG EDD is significantly differed from LMP EDD (Chi –Square =69.7, df =2, P Value =<0.0000001). Conclusion: 89% (178) women delivered within + or – 7 days EDD estimated from LMP 98%(196) women delivered within + or – 14 days of EDD estimated from CRL to conclude, ultrasonographic measurement of CRL (crown Rump Length) between 6-14 weeks of pregnancy is more accurate predictor of EDD as compared to LMP. We recommend the routine use of CRL estimate in the prediction of EDD even if the patient recalls her LMP certainly.
1. Mongelli M, wong YC venkat A, Chus TM, induction policy and missed post-term pregnancies: a mathematical model, Aust N Z J ObstetGynaecol 2001; 41:38-40 2. Geirsson RT, Busby-Earle RM, Certain dates may not provide a reliable estimated of gestational age, Br J obstetGynaecol 1991;98:108-9 3. Geirsson RT, Have G. comparison of actual and USG estimated second trimester gestational length in invitro fertilized pregnancies, actaobstetgynaecolscand 1993; 72:344-46. 4. Robinason HP. Sonar measurement of fetal crown-rump length as means of assessing maturity in first trimester of pregnancy, BMJ 1973;4:281 5. Drumm JE, Clinch J, Mackenzie G. the ultrasonic measurement of fetal crown-rump length as a method of assessing gestational age. Br J obstetGynaecol 1976;83:417-21 6. Hadlock FP, shah YP, kanon DJ et al, Fetal crown –rump length: reevaluation of relation to menstrual age (5-18 weeks) with high resolution real time. Us radiology 1992; 182:50-5. 7. Waldenstrom U, Axelsson O, Nilsson S: A comparison of the ability of a sonographically measured biparietal diameter and the last menstrual period to predict the spontaneous onset of labourobstetGynaecol 1990; 76:336-38 8. Campbell S, warsof SL, Little D, cooper DJ. Routine ultrasound screening for the prediction of gestational age.ObstetGynaecol 1985;65:613-20; 9. Lauret J salmon, Costanza pizza, Antonio Gasparrini, Jean pierre Bernard. Yves Vills. Prediction of the date of delivery based on first trimester ultrasound measurement: An independent method from estimated date of conception. Journal of maternal-Foetal and Neonatal Medicine 2010 jan; 23(1): 1-9 10. Mongelli M, Wilcox M, Gardosi J. Estimating the date of confinement: ultrasonographic biometry versus certain menstrual dates. Am J ObstetGynecol 1996; 174:278–81. 11. Waldenström U, Axelsson O, Nilsson S. A comparison of the ability of a sonographically measured biparietal diameter and last menstrual period to predict the spontaneous onset of labor.ObstetGynecol 1990; 76:336–8. 12. Kieler H, Axelsson O, Nilsson S, Waldenström U. Comparison of ultrasonic wseameasurement of biparietal diameter and last menstrual period as a predictor of day of delivery in women with regular 28 daycycles. ActaObstetGynecolScand 1993; 72:347–9. 13. Backe B, Nakling J. Term prediction in routine ultrasound practice. ActaObstetGynecolScand 1994; 73:113–8. 14. Taipale P, Hiilesmaa V. Predicting delivery date by ultrasound and last menstrual period in early gestation. ObstetGynecol 2001; 97:189–94. 15. Blondel B, Morin I, Platt RW, Kramer MS, Usher R, Breart G. Algorithms for combining menstrual and ultrasound estimates of gestational age: consequences for rates of preterm and postterm birth. BJOG 2002; 109:718–20. 16. Whitworth M, Bricker L, Neilson JP, Dowswell T. Ultrasound for fetal assessment in early pregnancy. Cochrane Database Syst Rev 2010; 4:CD007058
Clinicopathological study of splenomegaly in pediatric age group
Pore Shubhajyoti N, Patil Sunita P, Bindu Rajan S
The study is based on 100 cases in pediatric age group with splenomegaly carried out in the Government Medical College and Hospital, Aurangabad. The study group showed slight male predominance. Clinical grading of splenomegaly was done with conventional method. Majority of cases (87%) had either Grade I or II splenomegaly. Hackett’s method for grading of splenomegaly was also employed. Majority of cases (70%) had Grade I or II splenomegaly. The most common presenting complaint was fever followed by pallor. The other complaints were lump in abdomen, history of bleeding, pain in abdomen and symptoms of general ill health. The associated clinical findings were hepatomegaly (85%) and lymphadenopathy (33%). Hematological evaluation including bone marrow examination revealed diagnosis in the majority of cases (62%). These tests are safe, easy to perform and cost effective investigations. Other investigations like histopathology, biochemistry, serology, radiology proved helpful in the diagnosis in 16% cases. Anemia including hemolytic anemia and hematological malignancies were the common etiologies (28%) in the causation of splenomegaly. The Grade I and Grade II splenomegaly was the most common. Hemolytic anemia was the most common anemia (53.6%) followed by megaloblastic anemia (21.4%). The hematological malignancies also encountered frequently (28%). The most common malignancy was acute lymphoblastic leukemia (46.4%) followed by chronic myeloid leukemia (17.8%). The infectious etiologies included malaria, hepatitis, dengue fever, enteric fever etc. Malaria was the most common among them (46.1%). Infiltrative diseases mainly encountered in Grade III (conventional) and Grade 5 (Hackett’s method) splenomegaly.
1. Choudhari et al. Chronic splenomegaly in Bengal. J Indian Med Asso 1957;28(2):101-11 2. Nadir Ali, Masood Anwar, Mohammed Ayub et al. Hematological evaluation of splenomegaly. J Coll Physicians Surg Pak 2004;14(7):404-6. 3. Timite KM, Kauame KJ, Konan A. et al. Etiology of splenomegaly in children in tropics. 178 cases reviewed at University Hospital Center of Abidjan Cocody (Ivory Coast). Ann Pediatr (Paris) 1992;39(2):136-41. 4. McIntyre OR, Ebaugh FG. Palpable spleens in college Freshmen. Ann Int Med 196766(2):301-06. 5. Muzumder DNG. Tropical splenomegaly syndrome vis-Ã -vis portal hypertension syndrome. Editorial J Indian Med Asso, Calcutta, Jan 1985. 6. Basu AK. Chronic splenomegaly and its relation to hepatic pathology. Br Med J 1958;947-50. 7. Klatt BC, Meyer PR. Pathology of the spleen in the acquired immunodeficiency syndrome. Arch Pathol Lab Med 1987;111: 1050-3. 8. Higgins PM. Splenomegaly in acute infections due to group A streptococci and viruses. Epidemiol Infect 1992;109:199-209. 9. Dacie JV. Nontropical idiopathic splenomegaly (Primary hypersplenism) : A review of 10 cases and their relationship to malignant lymphomas. Br J Hematol 1969;17:317. 10. Scamps RA, o'Neill BJ. Non-tropical idiopathic splenomegaly. Med J Aust 1971;2:1285-8. 11. Sen Gupta PC. Bengal Splenomegaly : A study of 50 cases with a discussion of etiology. Indian Med Gaz. 1943;Aug:371-5. 12. Ghosh K, Mukherjee GK, Surve RR et al. Splenomegaly in school children in a remote tribal area of Dhole district, Maharashtra. Indian J Malariol 2000;37(3-4):68-73. 13. Rajrajeshwari G and Viswanathan J. Leukemia in children a review of 100 cases with typical clinical manifestations. Indian Pediatr 1980;XVII(1):37.
Anatomical variations of the chorda tympani nerve observed during middle ear surgeries-an institutional study
Rahman Abdul Aman, Raja Premnath, Subramanian Kulasekaran
Objectives: The aim of this study is to describe observed variations in the middle ear anatomy of the chorda tympani nerve during middle ear surgeries in our institution. Study Design: A prospective study of 2 years covering 100 middle ear surgeries analyzing the course of the chorda tympani nerve in the middle ear. The surgeries were subdivided into myringoplasty (78 cases) and mastoidectomy with tympanoplasty (22 cases). Results: Chorda tympani nerve anatomy was observed based on its entry into the middle ear from the junction of the posterior and lateral walls of middle ear at the level of the tympanic sulcus. The variations observed were based on its entry at either three levels 1) Iter chordae posterius (35 cases) 2) Inferior toiter chordae posterious (63 cases) 3) Lateral to the tympanic sulcus (2 cases). Conclusion: Variations in the middle ear course of chorda tympani nerve were commonly seen in our case series. The most common variation being its entry into the middle ear inferior to the iter chordae posterious at the level of tympanic sulcus and the least common being its entry lateral to the tympanic sulcus.Understanding the middle ear anatomical variations in the course of chorda tympani nerve is surgically significant in preventing post-operative taste and salivary morbidity following middle ear surgeries. The present study highlights the varied course of the chorda tympani nerve in the middle ear and minor anatomical variations are not very rare.
1. Dragoslava R. Djeric. Anatomical variations of the Chorda tympani nerve. MJIRI. 1993; 7(1):7-8. 2. McManus, L.J., Dawes, P.J., Stringer, M.D. Clinical anatomy of the chorda tympani: a systematic review. J Laryngol Otol. 2011; 125(11):1101–1108. 3. Haynes, D.R. The relations of the facial nerve in the temporal bone. Ann Roy Col Surg England 1955; 16:175. 4. Durcan, D.J., Shea, J.J., Sleeckx, J.P. Bifurcation of the facial nerve. Arch Otolaryngol 1967; 86:619. 5. Hough, J.V.D. Malformations and anatomical variations seen in the middle ear during the operation for mobilization of the stapes. Laryngoscope 1958; 68:1337. 6. Gordon, B. Hughes., Myles, L. Pensak. Clinical otology. 3rd ed. New york: Thieme publishers; 2007. Section I, Basic science; p.14. 7. Natasha Pollak. Endoscopic ear surgery. California: Plural publishing; 2014. Chapter 1, Middle ear exploration and tympanoplasty; p.64. 8. Chilla, R., Nicklatsch, J., Arglebe, C. Late sequelae of iatrogenic damage to chorda tympani nerve. Acta Otolaryngol (Stockh) 1982; 94:461. 9. Michael, P., Raut, V. Chorda tympani injury: operative findings and postoperative symptoms. Otolaryngol Head Neck Surg. 2007; 136(6):978–981. 10. McManus, L.J., Stringer, M.D., Dawes, P.J. Iatrogenic injury of the chorda tympani: a systematic review. J Laryngol Otol. 2012; 126(1):8–14. 11. Nager, G.T., Proctor, B. Anatomical variations and anomalies involving the facial canal. Ann OtolRhinolLaryngol 1982; 91:45-61. 12. Durcan, D. Bifurcation of the facial nerve. Arch Otolaryngol 1967; 86: 619-31. 13. Kalcıoğlu, M.T., Köse, E., Bayındır, T., Duman, S. A rare anatomic variation of the chorda tympani. Kulak BurunBogazIhtisDerg. 2011 May-Jun; 21(3):171-172. 14. Sudhir, V. Bhise., Patil, N. P., Prashant, M. Hippergekar. A very rare anatomical variation of chorda tympani nerve. IOSR Journal of Dental and Medical Sciences. 2014 July; 13(7): 117-119.
Magnetic resonance imaging diagnosis of Mayer-Rokitansky-Kuster-Hauser syndrome
Shaurya Thakran, Hemant Mishra, Sunilagrawal, Ravindrakumar
Mayer- Rokitansky-Kuster-Hauser (MRKH) syndrome is an uncommon variation in the prenatal development of the female genital tract. It is a congenital malformation of the female genital tract. Its features include partial or complete absence (agenesis) of the uterus with an absent or hypoplastic vagina normal fallopian tubes, ovaries, normal external genitalia and the typical 46, XX, female chromosome pattern. Breast development and growth of pubic hair are also normal. Associated renal and/or skeletal abnormalities are common. Mayer-Rokitansky-Kuster-Hauser syndrome is also known as Mullerian Agenesis. The incidence is one in 4000–5000 female births1,2. The normal external appearance of MRKH females makes it difficult to diagnose until puberty, typically diagnosed in mid-adolescence. The average age of diagnosis is between 15 and 18 years, although occasionally a girl may be diagnosed at birth or during childhood because of other health problems. A pelvic ultrasound may be used to see the presence or absence of the uterus and its condition.
1. Morcel K, Camborieux L. Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome. Orphanet J Rare Dis. 2007; 2:13. 2. Sultan C, Biason-Lauber A, Philibert P. Mayer-Rokitansky-Kuster-Hauser syndrome: recent clinical and genetic findings. GynecolEndocrinol. 2009; 25:8-11. 3. Sem KK, Kapoor A. Mayer-Rokitansky-Kuster-Hauser syndrome. Ind J RadiolImag. 2006; 16: 805-7 4. Gupta NP, Ansari MS. Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome—a review. Indian J Urol. 2002; 18:111-116. 5. Morcel K, Camborieux L. Programme de Recherchessur les AplasiesMulleriennes (PRAM), Daniel Guerrier, Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome. Orphanet J Rare Dis. 2007; 2:13. 6. Pittock ST, Babovic-Vuksanovic D, Lteif A. Mayer-Rokitansky-Kuster-Hauser anomaly and its associated malformations. Am J Med Genet A. 2005; 135: 314-316. 7. Siegel MJ. Pediatric applications. In: Lee JK, editor. Chapter 24 of computed body tomography with MRI correlation. 3rd ed. 1998. p. 1548. 8. Saleem SN. MR imaging diagnosis of utero vaginal anomalies: Current state of art. Radiographics.2003; 23:e13. 9. Chervenak FA, Stangel JJ, Nemec M, Amin HK. Mayer RokitanskyKuster Hauser syndrome. N Y State J Med. 1982; 82:23–6 10. Evans TN, Poland ML, Boving RL. Vaginal malformations. Am J ObstetGynaecol. 1961; 141:910–20. 11. Griffin JE, Edwards C, Madden JD, Harrod M, Wilson JD. Congenital absence of the vagina, the Mayer RokitanskyKuster Hauser syndrome. Ann Intern Med. 1976; 85:224–36. 12. Bryan A, Nigro J, Counseller VS. One hundred cases of congenital absence of the vagina. SurgGynecol Obstet. 1949; 88:79–86.
A study of clinical profile of respiratory distress syndrome(RDS) in preterm babies
Sambhaji S Wagh, Deepa S Phirke, Sudhakar Bantewad
Objective: Study of clinical profile of Respiratory Distress Syndrome in preterm babies. Design: Prospective observational study. Settings: Neonatal Intensive Care unit at tertiary care hospital. Outcome measures: To study role of antenatal steroid, surfactant and assisted ventilation in RDS and outcome in terms of morbidity and mortality in preterms with RDS. Results: 150 neonates with gestational age <37wk with diagnosed as RDS as per clinical investigational guidelines were included.97.3% babies received antenatal steroid while 2.7% did not. Out of the babies who received antenatal steroid 80% survived and 20% died. All (100%) who did not receive antenatal steroid died. Out of them 57.3% received surfactant and 42.7% did not receive. Out of babies who received surfactant 88% survived 12% died. Out of babies who did not receive surfactant 64% survived 36% died. All babies (100%) receiving only CPAP (SA score <4) survived. Out of babies receiving both CPAP and surfactant (SA score 4–7) 98.6% survived and 1.4% died. All babies receiving only assisted ventilation for >10 days died. Morbidity in RDS was sepsis 14.66%, PDA 14%, NEC 8.66% and pulmonary hemorrhage 5.33%. At the end of study 118 (78.66%) babies survived while 32(21.33%) died. Conclusion: We conclude that administration of antenatal steroids in pregnant women during preterm delivery significantly improves lung maturity. CPAP was safe and effective treatment modality. Early institution of CPAP reduced need of ventilation. Early use of surfactant improved the survival and shortened duration of assisted ventilation.
1. Kushal Y. Bhakta , Tests for pulmpnary surfactant In: Manual of Neonatal Care Cloherty JP. 7th edition 2011: 406-407. 2. Singh M. Care of the Newborn 7th edition 2010; pp283 3. Nelson’s Textbook of Pediatrics 19th edition 2011; pp581 4. Miller HC, Futrakal P., Birthweight, gestational age and sex determining factor in incidence of respiratory distress syndrome of prematurely born infants. J Pediatrics 1968;72:628 5. Neil McIntosh, Ben Stenson; Forfar A. Textbook of Pediatrics. 7th edition 2008;pp245-248 6. Clements JA, Plodzker A, Tiemey DF et al. assessment of risk of RDS by rapid test for surfactant in amniotic fluid. N Engl J Med 1972;286;1077 7. Avery ME. Lung disorders in newborn infants. Saunders WB and Co., Philadelphia. 6th edition:2005;pp557-562 8. Urs S P, Khan F, Maiya P P. bubble CPAP – a primary respiratory support for respiratory distress syndrome in newborns.Indian Pediatrics, 2009 May (46):409-11 9. Jeya Balaji R.V, Rajiv P.K, Patel V.K, Kripal M. outcome of early CPAP in the management of RDS in premature babies with <32 weeks of gestation. Indian journal of neonatal medicine and research.2015 Apr,Vol-3(2): 1-6 10. Shrestha S, Dangol Singh S, Shrestha M, Shrestha RPB. Outcome of preterm babies and associated risk factors in a hospital. J Nepal med,2010 Oct-Nov (49):286-90. 11. Koti J, Murki S,Gaddam P, Reddy A, Reddy M D. (2010).to ascertain the immediate outcome of preterm infants with respiratory distress syndrome (RDS) on bubble CPAP and identify risk factors associated with its failure. Indian pediatrics, 47(2), 139-143 12. Sumiartini N M, Santoso H, Retayasa W, Kardana M. efficacy of dexamethasone for lung maturity in preterm delivery in association with lamellar bodies count. Pediatr Indones, 2007 May (3):115-19 13. Hossain M.M, Shirin M, Akter S, Hossain M, Hassan M.N, Zabin F,Afrin M. Surfactant replacement therapy for RDS-experience of a NICU of private set-up.DS (Child) H J 2010;26 (2): 76-81 14. Pradeep M, L. Rajam, P.Sudevan.perinatal mortality hospital based study.Indian Pediatric,1995 Oct (32):1091-1094 15. National Neonatal Perinatal Database. Report for the year 2002-03 http://www.newbornwhocc.org/pdf/nnpd_report_2002-03. PDF.
Study of serum uric acid and erythrocytic superoxide dismutase levels in gestational diabetes mellitus and normal pregnancy
Amol D Shinde, Archana Dhotre, Suresh Ghangle, Mangesh Tekade, Sucheta Ghule
Level of non-enzymatic antioxidant like serum uric acid and enzymatic antioxidant like superoxide dismutase is found to be deranged in patients of gestational diabetes mellitus. Serum uric acid and superoxide dismutase levels were estimated in sixty patients of gestational diabetes mellitus admitted in obstetrics and gynecology department of G.M.C., Nagpur and sixty normal healthy pregnant controls. The result of the study showed that serum uric acid levels were increased significantly in the gestational diabetes mellitus group compared to the normal pregnant group and serum superoxide dismutase levels were decreased significantly in the gestational diabetes mellitus group compared to the normal pregnant group. Furthermore when levels of serum uric acid and superoxide dismutase were correlated with the fasting and post meal blood glucose in gestational diabetes mellitus patients, significant positive and negative correlation was observed respectively.
1. Dornhost A, Paterson CM, Nicholls, JS et al. High prevalence of GDM in women from ethnic minority groups. Diabetic Med.1992; 9:820-2. 2. Bellamy L, Casas JP, Hingorani AD, Williams D. Type 2 diabetes mellitus after gestational diabetes: a systematic review and meta-analysis. Lancet. 2009 May 23; 373(9677):1773-9. 3. Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002 Feb 7; 346(6):393-403. 4. Knowler WC, Fowler SE, Hamman RF, Christophi CA, Hoffman HJ, Brenneman AT, et al. 10-year follow-up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study. Lancet. 2009 Nov 14; 374(9702):1677-86. 5. World Diabetes Foundation, Global Alliance for Women's Health. Diabetes, Women, and Development: meeting summary, expert recommendations for policy action, conclusions, and follow-up actions. International Journal of Gynecology and Obstetrics. 2009; 104(1):46-50. 6. Young IS, Woodside JV. Antioxidants in health and disease. J Clin Pathol. 2001; 54:176–186. 7. Waring WS, Webb DJ, Maxwell SR. Uric acid as a risk factor for cardiovascular disease. Q J Med. 2000; 93:707-13. 8. MartÃnez-Abundis E, González-Ortiz M, Grover-Páez F, Vera-Hernández A. Excretion of uric aid, sodium, and potassium in preeclampsia patients and its behavior in acute hyperglycemia-hyperinsulinemia. 1999Dec. Ginecol Obstet Mex; 67:590-4.28 9. Baynes JW, Dominiczak MH. Medical Biochemistry. 2nd edition. Elsevier Mosby. 2005: 497-501. 10. Dey P, Gupta P, Acharya NK, Rao SN, Ray S, Chakrabarty S et al. Antioxidants and lipid peroxidation in gestational diabetes- A preliminary study. Indian J Physiol Pharmacol. 2008; 52(2):149-56. 11. ADA. Standards of medical care in diabetes-2006. Diabetes Care. 2006; 29(suppl 1):S4-S42. 12. Glucose reagent set (Kit insert). Jalgaon (India): Nirmal Labortories; 2009. 13. Uric acid reagent set (Kit insert). Mumbai (India): Accurex Biomedical Pvt. Ltd. 14. SOD reagent set (kit insert). Crumlin (United Kingdom): RANDOX Laboratories Ltd. 15. Maitra S, Anitha M, Praveen S, Suresh SK, Vishwanath HL. A Study of Oxidative Stress In Gestational Diabetes Mellitus: An Observational Study at A Tertiary Centre. Asian J Med Res. 2012 Feb; 1(1):17-21. 16. Nagalaksmi CS, Devaki RN, Akila P, Suma KB, Prashant V, Suma MN et al. Exploration of the Clinico-Biochemical Parameters to Explain the Altered Renal Mechanisms in Gestational Diabetes Mellitus. J Clin Diagn Res. 2012; 6(3):369-71. 17. Kharb S. Uric Acid And Ascorbic Acid Levels In Pregnancy With Preeclampsia And Diabetes. Webmed Central Biochemistry. 2010; 1(10):WMC00718. 18. Laughon SK, Catovr J, Provins T, Roberts JM, Gandley RE. Elevated first trimester uric acid concentrations are associated with the development of gestational diabetes. Am J Obstet Gynecol. 2009 Oct; 201(4):402e1-e5. 19. Wolak T, Sergienko R, Wiznitzer A, Paran E, and Sheiner E. High Uric Acid Level During the First 20 Weeks of Pregnancy is Associated with Higher Risk for Gestational Diabetes Mellitus and Mild Preeclampsia2012. Hypertens Pregnancy. 2012;31(3):307-15. 20. Zhou J, Zhao X, Wang Z, Hu Y. Combinations of lipids and uric acid in mid-second trimester can be used to predict adverse pregnancy outcomes. J Matern Fetal Neonatal Med. 2012 Dec; 25(12):2633-8.97 21. Grissa O, Ategbo JM, Yessoufou A, Tabka Z, Miled A, Jerbi M et al. Antioxidant status and circulating lipids are altered in human gestational diabetes and macrosomia. Translational Res. 2007; 150:164-71. 22. Djordjevic A, Spasic S, Jovanovic-Galovic A, Djordjevic R, Grubor-Lajsic G. Oxidative stress in diabetic pregnancy: SOD, CAT and GSH-Px activity and lipid peroxidation products. J Matern Fetal Neonatal Med. 2004 Dec; 16(6):367-72. 23. Kharb S. Activity of Extracellular Superoxide Dismutase in Gestational Diabetes. Res J Obstet Gynecol. 2010; 3(1):1-4. 24. Biri A, Onan A, Devrim E, Babacan F, Kavutcu M, Durak I. Oxidant status in maternal and cord plasma and placental tissue in gestational diabetes.2006 Feb. Placenta; 27(2-3):327-32. 25. Peuchant E, Brun JL, Rigalleau V, Dubourg L, Thomas MJ, Daniel JY et al. Oxidative and antioxidative status in pregnant women with either gestational or type 1 diabetes. Clin Biochem. 2004 Apr; 37(4):293-8. 26. Pathak R,Pathak A. Study of lifestyle habits on risk of type 2 diabetes. 2012 jul-dec. Int J Appl Basic Med Res; 2(2):92-96.
Clinico biochemical abnormalities in Thalassemia
Suman Ghosh, Sheereen Tarannum, Monidipa Ghosh
Problem statement: Thalassemias are a group of inherited disorders of Hb synthesis characterised by a reduced rate of production of one or more globin chains of Hb resulting in an anaemic state. Blood transfusion which both elevates the anaemia and suppresses the compensatory mechanism is the basis of therapy. But the inevitable consequence of prolonged transfusion therapy is the hemosiderosis. This causes complications like endocrine abnormalities along with hepatic and myocardial siderosis. The group with regular blood transfusion has the more chance of iron excess. The patients with inadequate transfusion are not free from the danger of iron overload because in them the anaemia causes excessive iron absorption. The endocrine glands are not also free from the burnt of hemosiderosis The excess iron in the storage form of ferritin get deposited in endocrine organs like pituitary, pancreas, parathyroid, and thyroid. Methods: It was performed on selected patients with diagnosis of Thalassemia disease, who were attending in both institution (Malda Medical College and M.G.M Medical College and L.S.K Hospital,)The 30 patients were included in our study. In the present study maximum number of cases were in the age group of 5-15 years (68%) and 32% of patients were in the age group of 16-25 years. Results: Dysfunction of the thyroid gland is less frequent than other endocrinopathies in thalassemia patients. Results are Distribution of Cases in Different Types of Thalassemia: Growth Hormone Study, Gonadotrophins Study. In our study no patient had yet developed hypothyroidism but possibilities of hypothyroidism in future specially of the sub-clinical hypothyroid patients remain.
1. Whipple, G H and Bradford, W L (1932) racial or familial anaemia of children. Associated with fundamental disturbances of bone and pigment metabolism (Colley –Von Jaksch) Am J Dis Child 44, 336. 2. Chatterjee, J B (1959) Hemoglobinopathy in India. In: Abnormal Hemoglobins (eds J H O Jonxis and J F Delafresnaye) 322 Blackwell Scientific publications, Oxford. 3. Weatherall, D J 91980) Towards an understanding of the molecular biology of some common inhocited anemias : The story of thalassemia In : Blood pure and eloquent (ed M M Wintrobe) p 373, Mc Graw Hill, New York. 4. Diseases of the Blood, Development of the Hematopoitic system, Nelson’s Texbook of Pediatrics 15th edition p 1375-1378. 5. Benz, E J Forget, B G Hillman D G Cohen Solal M Pritchard J and Cavallesco C (1978) Variability in the amount of beta globin in RNA in beta thalassemia, cell 14, 299. 6. Weatherall, D J and Clegg, J B (1969) Disorders of globin synthesis in thalassemia. Ann N Y Acad Sci 165, 242. 7. Wainscoat J S Thein S L Weatherall D J : Thalassemia intermedia. Lood Rev. 1, 273, 1987. 8. Pintor C, Cella, S G Menso, P et al (1986) Impared G H response to G H releasing hormone in thalassemia major. J Clin Endocrinol Metab 62, 263. 9. Shehadeh, N, Hazani, A Rudolf, M C J Benderly, A and Hochberg, Z (1990) Neurosecretary dysfunction of growth hormone secretion in thalassemia major. Aeta Pediator Seand 79, 790. 10. Chatterjee R., Kate, M. Cox, T.F. and Porter J.B. (1993b) A prospective study of the hypothalamic pituitary axis in thalasemic patients who developed secondary amenorrhoea elin. Eudocrinol. 39, 287. 11. Vullo, C, DC. Sanctis, V., Katz, M. et al (1990) Endoerine abnormatlities in Jhalaremia. Aun N.Y. Acad. SCI 612,293. 12. Flynn, D.M., Fairney, A., Jackson, D. 4 clayton, B.E. (1976) Hormonal changes in Jhalasemia Major, Arch. Dis. Child. 51, 828. 13. Pratico., G., Di, Gregor io, F., Cattabiano, L, Palano, G.M. and Caruso Nicoletti, M. (1998) Calcium phosphate metabolism in Thalassemia. Pediatr. Med. Chir. 20,265. 14. Hussain, M.A. M., Green, N. Flynn. D.M. Hussain, S and Hoffbrand, A.V. (1976) Subcutaneous infusion and intramascular injection of desferrioxamine in patients with transfusional iron overload. Lancet ii, 1278.
Hodgkins lymphoma presenting as a solitary bone tumor: A case report
Manimaran Karthikeya Pandian, Varaprasad Sagiraj, Indhumathy K
Abstract: Primary lymphoma of the bone is the bone involvement by malignant lymphoid infiltrate without the involvement of lymph nodes or other tissues. Differential diagnoses for the primary bone lymphomas include chronic osteomyelitis, primary bone sarcoma, Ewing’s sarcoma, metastatic sarcomas, leukemic infiltrate and carcinoma. Lymphomas of the bone are commonly misdiagnosed as Ewing’s sarcoma. We report a case of 16 years old male, who presented with pain in the Right hip and difficulty in walking that had persisted for 2 months with no history of trauma. The patient was initially diagnosed as a case of PLB of the right acetabulum confirmed by open biopsy but the FDG-PET-CT examination was done which showed an abnormally high uptake of F-FDG in the cervical, mediastinal, retroperitoneal, iliac lymphnodal groups, skeletal system, liver and spleen and Immunohistochemistry favoured the diagnosis of Classical Hodgkins lymphoma, mixed cellularity type. He was classified as stage IV B Cell lymphoma and referred to oncology department for favour of chemotherapy and radiotherapy.
1. Singh T, Satheesh CT, Lakshmaiah KC, Suresh TM, Babu GK, Lokanatha D, Jacob LA, Halkud R. Primary bone lymphoma: a report of two cases and review of the literature. J Cancer Res Ther. 2010; 6:296–298. [PubMed] 2. Oberling C. The reticulosarcomas and the reticulotheliomas of Ewing’s osterosarcoma. Bull AssocFr Etude Cancer (Paris) 1928; 17:259–296. (In French) 3. Heyning FH, Hogendoorn PC, Kramer MH, Hermans J, Kluin-Nelemans JC, Noordijk EM, Kluin PM. Primary non-Hodgkin’s lymphoma of bone: a clinicopathological investigation of 60 cases. Leukemia.1999; 13:2094–2098. [PubMed] 4. Lewis VO, Primus G, Anastasi J, Doherty D, Montag AG, Peabody TD, Simon MA. Oncologic outcomes of primary lymphoma of bone in adults.ClinOrthopRelat Res. 2003; 415:90–97. [PubMed] 5. Jawad MU, Schneiderbauer MM, Min ES, Cheung MC, Koniaris LG, Scully SP. Primary lymphoma of bone in adult patients. Cancer. 2010; 116:871–879. [PubMed] 6. Mulligan ME, McRae GA, Murphey MD. Imaging features of primary lymphoma of bone. AJR Am J Roentgenol. 1999; 173:1691–1697. [PubMed] 7. Ramadan KM, Shenkier T, Sehn LH, Gascoyne RD, Connors JM. A clinicopathological retrospective study of 131 patients with primary bone lymphoma: a population-based study of successively treated cohorts from the British Columbia Cancer Agency. Ann Oncol. 2007; 18(1):129–135. [PubMed] 8. O’Connor AR, Birchall JD, O’Connor SR, Bessell E. The value of 99mTc-MDP bone scintigraphy in staging primary lymphoma of bone. Nucl Med Commun. 2007; 28:529–531. [PubMed] 9. Park YH, Choi SJ, Ryoo BY, Kim HT. PET imaging with F-18 fluorodeoxyglucose for primary lymphoma of bone. ClinNucl Med. 2005; 30:131–134. [PubMed] 10. Park YH, Kim S, Choi SJ, Ryoo BY, Yang SH, Cheon GJ, Choi CW, Lim SM, Yoo JY, Lee SS. Clinical impact of whole-body FDG-PET for evaluation of response and therapeutic decision-making of primary lymphoma of bone. Ann Oncol. 2005; 16:1401–1402. [PubMed]
Comparison of phenotypic methods for the detection of extended spectrum beta lactamase production among enterobacteriaceae
M Anitha Raj, V Abarna, E Arthi
Introduction: Extended-spectrum β-lactamases (ESBLs) are enzymes which hydrolyse extended-spectrum Cephalosporins and are more common in recent times. Aim: We aimed to compare Chrome agar, double disk synergy test (DDST) and potentiated combined disk diffusion test (PCDDT) with ESBL E test for their sensitivity in ESBL detection. Materials and Methods: The study was a cross-sectional prospective analytical study involving 100 isolates of Enterobacteriaceae family between May 2014 and December 2014. All the isolates were subjected to ESBL detection by Chrome agar, double disk synergy test (DDST), Phenotypic confirmatory disk diffusion test (PCDDT) and ESBL Estrip method. Results: Among the 100 isolates tested, 61 isolates were resistant to one of the third generation Cephalosporins. Among them potentiated disk diffusion test (PCDDT) detected 30/61 isolates (49.18%), DDST detected26 (42.62%) and E strip detected detected35 (57.37%) isolates. Chrome agar showed growth on 42 samples. Conclusions: In resource poor settings, Chrome agar along with Phenotypic confirmatory disk diffusion test (PCDDT) can be taken as an effective screening method for ESBL detection.
1. Singh RM, Singh LH. Comparative evaluation of six phenotypic methods for detecting extended-spectrum beta-lactamase-producing Enterobacteriaceae. J Infect DevCtries2014; 8(4):408-15. 2. Bradford PA. Extended-spectrum â-lactamases in the 21st century: characterization, epidemiology, and detection of this important resistance threat. ClinMicrobiol Rev 2001; 14:933-51. 3. Garrec H, Rouzet LD, Golmard JL, Jarlier V, Robert J. Comparison of Nine Phenotypic Methods for Detection of Extended-Spectrum β-Lactamase Production by Enterobacteriaceae. J ClinMicrobiol 2011; 49(3):1048-57. 4. Phenotypic detection of extended-spectrum β -lactamase production in Enterobacteriaceae: review and bench guide. ClinMicrobiol Infect 2008; 14( 1): 90–103. 5. Gazin M, Paasch F, Goossen H, Kumar SM. Current Trends in Culture-Based and Molecular Detection of Extended-Spectrum-β-Lactamase-Harboring and Carbapenem-Resistant Enterobacteriaceae. J ClinMicrobiol 2012; 50(4): 1140-6. 6. Dalela G. Prevalence of Extended Spectrum Beta Lactamase (ESBL) Producers among Gram Negative Bacilli from Various Clinical Isolates in a Tertiary Care Hospital at Jhalawar, Rajasthan, India. J ClinDiag Res 2012; 6(2): 182-7. 7. Tsering DC, Das S, Adhiakari L, Pal R, Singh TSK.Extended Spectrum Beta-lactamase Detection in Gram-negative Bacilli of Nosocomial Origin. J Glob Infect Dis. 2009 Jul-Dec; 1(2): 87–92. 8. Singhal S, Mathur T, Khan S, Upadhyay DJ, Chug S, Govind R, et al. Evaluation of methods for Amp C β lactamases in Gram Negative clinical isolates from Tertiary care hospitals. Ind J ClinMicrobiol. 2005; 23:120–4. 9. Mathur P, Kapil A, Das B, Dhawan B. Prevalence of Extended Spectrum β Lactamase producing GNB in a tertiary care hospital. Indian J Med Res. 2000; 15:153–7. 10. Khan MKR, Thukral SS, Gaind R. Evaluation of a Modified Double-Disc Synergy Test for Detection of Extended Spectrum Β-Lactamases in Ampc Β-Lactamase-Producing Proteus mirabilis. IndJ MedMicrobiol 2008; 26(1): 58-61. 11. Harwalkar, A, Sataraddi, J, Gupta, S, Yoganand R,Rao A, Srinivasa H. The detection of ESBL-producing Escherichia coli in patients with symptomatic urinary tract infections using different diffusion methods in a rural setting. Journal of infection and public health. 2013;6(2):108-14 12. Sridhar Rao P N, Basavarajappa K G, Krishna G L. Detection of extended spectrum beta-lactamase from clinical isolates in Davangere. Indian J PatholMicrobiol 2008;51:497-9. 13. Nandagopal B, Sankar S, Sagadevan K, Arumugam H, Jesudason M V, Aswathaman K, Nair A. Frequency of extended spectrum β-lactamase producing urinary isolates of Gram-negative bacilli among patients seen in a multispecialty hospital in Vellore district, India. Indian J Med Microbiol 2015; 33:282-5.
Study of serum CRP and malondialdehyde levels in gestational diabetes mellitus and normal pregnancy
Amol D Shinde, Archana Dhotre, Suresh Ghangle, Mangesh Tekade, Sucheta Ghule
Introduction: Markers of inflammation and oxidative stress like C Reactive Protein and Malondialdehyde may provide information about risk of developing Type II DM, cardiovascular disease and hypertension in future in patients of Gestational diabetes mellitus. Serum C Reactive Protein and serum MDA level were estimated in sixty patients of gestational diabetes mellitus admitted in obstetrics and gynecology department of G.M.C., Nagpur and sixty normal healthy pregnant controls. The result of the study showed that serum C Reactive Protein and Malondialdehyde levels were increased significantly in the gestational diabetes mellitus group compared to the normal pregnant group. Furthermore when levels of serum C Reactive Protein and Malondialdehyde were correlated with the fasting and post meal blood glucose in gestational diabetes mellitus patients, significant positive correlation was observed.
Introduction: Markers of inflammation and oxidative stress like C Reactive Protein and Malondialdehyde may provide information about risk of developing Type II DM, cardiovascular disease and hypertension in future in patients of Gestational diabetes mellitus. Serum C Reactive Protein and serum MDA level were estimated in sixty patients of gestational diabetes mellitus admitted in obstetrics and gynecology department of G.M.C., Nagpur and sixty normal healthy pregnant controls. The result of the study showed that serum C Reactive Protein and Malondialdehyde levels were increased significantly in the gestational diabetes mellitus group compared to the normal pregnant group. Furthermore when levels of serum C Reactive Protein and Malondialdehyde were correlated with the fasting and post meal blood glucose in gestational diabetes mellitus patients, significant positive correlation was observed.
A retrospective study of prescription pattern and cost analysis of selected drugs used in coronary artery disease and angioplasty patients
Tamilselvan T, Hesly Rajan, Sabith T, Anand Kumar S, Kumutha T
Coronary Artery Disease (CAD) is a condition wherever the vascular supply to the heart is obstructed by fatty tissue, occlusion or spasm of coronary arteries. There is increasing importance of prescription pattern monitoring studies (PPMS) due to a lift in promoting of latest medicine, variations in pattern of prescribing and consumption of medication, growing concern regarding drug interactions, price of medication and pattern of prescription. The present study was planned to assess the prescription pattern and cost of selected drugs used in Coronary Artery Disease and Angioplasty patients. The drug prescription pattern was noted from cardiology department of multi specialty tertiary care hospital and cost analysis was performed for the selected drugs. The data was collected by using structured data collection form. A total of 107 prescriptions were analysed from 240 patient records. Most of the patients diagnosed with coronary artery disease were in the age group of 61-70 years (41.12 %). The cost difference between Atenolol and Metoprolol were statistically significant (P<0.01). The most common classes of drugs prescribed were antihypertensives, antiplatelets, antianginals and antihyperlipidemics. The study results showed that the inappropriate use of drugs in CAD increases the cost of treatment and in long term this may even contribute to drug related problems. Interventions are necessary to improve rational drug use of drugs.
1. Roger Walker, Clive Edwards, Coronary Artery Disease In: Clinical Pharmacy and Therapeutics, 3rd ed., Elsevier Publication: 2003; 279-280. 2. Indrayan A, Forecasting cardiovascular disease cases and associated mortality in India. National Commission for Macroeconomics and Health, Government of India, International journal of scientific and research publication, 2004; 3(1):1-5. 3. Kamath A, Shanbhag T, Shenoy S, Ramesh S, A retrospective study of the drug prescribing pattern in acute myocardial infarction. Indian Journal of Pharmacology, 2008, 4 (1): 60 -61. 4. Strom BL, Stephan EK, Pharmacoepidemiology, 5th ed., 2012; 285-286. 5. Subash Philip, KG Revikumar, A study on the prices of some branded drugs of eight therapeutic categories. Hygela journal for drug and medicines, 2012; 4(2) : 78-86. 6. Veintramuthu, Sankar; Kandasamy, Ruckmani; Kanniyappan, Velayutham; Munusamy, Nithyananth, A study on prescription pattern and cost analysis of antiretroviral drugs. International Journal of Pharma and Bioscience, 2010; 1 (2): 2-7. 7. Kumar Raj, Kohli Kamlesh, Kajal H L. A study of drug prescribing pattern and cost analysis among diabetic patients in a tertiary care teaching institute in north India, Journal of Drug Deliver and Therapeutics; 2013; 3(2) : 56-61. 8. Jamuna Rani, Sambasiva Reddy, Prescribing pattern of antidiabetic drugs in urban population of Hyderabad. Natl J Physiol Pharm Pharmacol. 2015; 5(1): 5-9 9. Shruthi Dawalji, Venkateshwarlu K, Sridhar Thota, Praveen Kumar Venisetty, Raj Kumar Venisetty, Prescribing Pattern in Coronary Artery Disease: A Prospective Study. IJPRR, 2014; 3(3) : 24-33. 10. Tamilselvan T, Veerapandiyan A K, Karthik N, Study on drug utilization pattern of chronic renal failure patients in a tertiary care hospital. Int J Pharm Pharm Sci, 2014; 6(9), 482-484 11. Kiran P. Vakade, Vandana M. Thorat, Chitra C. Khanwelkar, Sujata A. Jadhav, Vijayprasad M. Sanghishetti A study of prescribing pattern of drugs in patients of emergencies in tertiary care hospital of Western Maharashtra. Int J Res Med Sci. 2016; 4(2): 556-561. 12. Md. Abdul Muhit, Md. Obaidur Rahman, Sheikh Zahir Raihan, Muhammad, Asaduzzaman, Mohammad Ahasanul Akbar, Nahid Sharmin and A. B. M. Faroque, Cardiovascular disease prevalence and prescription pattern at tertiary care hospital in Bangladesh, Journal of Applied Pharmaceutical Science, 2012; 2 (3) : 80-84. 13. Shabnam Narayanan, K Bhaskaran, Amritha P Vinod, A prospective study of prescription pattern in patients with coronary artery disease in a tertiary care center, International journal of recent trends in Science and technology,2016; 19( 2) : 272-277. 14. G. Divya,, A Rekha Devi, P Lakshmi, Sastha Ram V Kishore, T S Durga Prasad, D Ranganayakulu, Prescribing pattern of antihypertensive drugs in cardiology department, Inventi Rapid: Pharmacy Practice, 2014; 3 (1) : 976-384.
Study the association of midtrimester insulin resistance with development of pre-eclampsia among primi gravidae
05-08
Study the association of midtrimester insulin resistance with development of pre-eclampsia among primi gravidae
Study the association of midtrimester insulin resistance with development of pre-eclampsia among primi gravidae
Diversity in the spectrum of malignant soft tissue tumors
Naseem Noorunnisa, Prema Saldanha, Syed Ahmed Hussain, Senthil N. Ganesh
Soft tissue tumors are a highly heterogenous group of tumors that are classified on a histogenetic basis. Benign tumors far outnumber the malignant ones which form less than 1 % of all cancers. The most common sites are extremities, chest wall, mediastinum and retroperitoneum and as in the case of other malignancies, occur mainly in the older age group except rhabdomyo sarcoma. These tumors present a varied histomorphological pattern. Our study has included the different patterns, with specific site, gender and age distribution.
1. Coindre JM, Terrier P, Guillon L, Le Doussal V, Collin F, Ranchere D, et al. Predictive value of grade metastasis development in the main histological types of adult soft tissue sarcomas: A study of 1240 patients from the French Federation of Cancer Centres Sarcoma Group. Cancer 2001, 91:1914-1926. 2. Cooper JE, Allen PW, Low grade sarcomas. Pathol Ann 1990; 25(part 2):1–18. 3. Rosai J. Ackerman's surgical pathology. 10th edition Vol II - soft tissues. 4. Gerrand, C.H., Bell, R.S., Wunder, J.S. et al, The influence of anatomic location on outcome in patients with soft tissue sarcoma of the extremity. Cancer. 2003, 97:385–492. 5. Stojadinovic A, Leung DH, Hoos A, Jaques DP, Lewis JJ, Brennan MF. Analysis of the prognostic significance of microscopic margins in localized primary adult soft tissue sarcomas. Ann Surg. 2002, 235; 424–434. 6. Mariani L, Micceli R, Kattan MW, et al: Validation and adaptation of a nomogram for predicting the survival of patients with extremity soft tissue sarcoma using a three-grade system. Cancer 2005; 103:402. 7. Behranwala KA, A’Hern R, Omar AM, Thomas JM. Prognosis of lymph node metastasis in soft tissue sarcoma. Annals of Surgical Oncology. 2004;11:714 8. Enzinger and Weiss's Soft Tissue Tumors, Sharon W. Weiss,John R. Goldblum 6th Edition 9. Singer S, Demetri GD, Baldini EH, et al: Management of soft-tissue sarcomas: An overview and update. Lancet Oncol 2000, 1:75–85. 10. Hashimoto H, Daimaru Y, Takeshita S, et al. Prognostic significance of histologic parameters of soft tissue sarcomas. Cancer 1992, 70: 2816–2822.