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Papers by IOSR JDMS
Aim: Intraoperative frozen section analysis play an important role in modern day surgical practic... more Aim: Intraoperative frozen section analysis play an important role in modern day surgical practice. The quality assurance of this technique is vital as it is a major tool in guiding the patient surgical management. The present study was conducted to evaluate the diagnostic accuracy of frozen section results and to find out the common reasons of misdiagnosis. Method: This is a retrospective study done by retrieving the data from frozen section and routine histology registers over a period of two years. Total 163 cases were received for frozen section analysis in that period. Out of these 2 cases were deferred and analysis was done on 161 cases. Results: Out of 163 cases, results were deferred in 2 cases for routine histology leading to a deferral of 1.23%. The diagnostic accuracy was found to be 90.68% with a false positive diagnosis of malignancy in 4.97% and false negative benign diagnosis in 2.49% cases. The major causes of misdiagnosis were found to be interpretation error (73.33%), followed by sampling error (20%) and scanty tissue for analysis (6.67%). The interpretation error was mostly due to the freezing artefacts. Conclusion: A thorough clinical and radiological knowledge, proper sampling and processing as well as interpretation by experienced pathologists are the prerequisites for accurate diagnosis in frozen section study.
Introduction: The present study was conducted to compare the effects of prophylactic phenylephrin... more Introduction: The present study was conducted to compare the effects of prophylactic phenylephrine and ephedrine infusion on maternal haemodynamics in elective caesarean section under spinal anaesthesia. It was hypothesized that prophylactic phenylephrine infusion would maintain better maternal haemodynamics than ephedrine infusion. Methods: Seventy six patients were available for randomization into two equal groups to receive either prophylactic infusion phenylephrine 100µg/ml/min (Group P, n=38) or infusion ephedrine 8mg/ml/min (Group E, n=38) after induction of spinal anaesthesia with 10mg hyperbaric bupivacaine with 15µg fentanyl. The infusion was adjusted according to the patient's systolic blood pressure and was administered up to the time of umbilical cord clamping. The incidence of adverse events, if any, was recorded. Apgar scores of every neonate were assessed at 1and 5 minute after delivery. Results: Both the drugs were able to prevent the incidence of hypotension. The systolic blood pressure and bradycardia was higher in phenylephrine group whereas the incidence of tachycardia was the common problem with ephedrine. Also, in phenylephrine group, the maximum upper level of sensory anaesthesia was two segments lower than ephedrine group and there was same neonatal outcome in both the groups. Conclusion: The prophylactic infusion of phenylephrine can be an effective alternative to ephedrine in the prevention of maternal hypotension without imparting any significant neonatal adverse effect. Lesser rostral spread of spinal anaesthetic drug was observed in mother receiving infusion of phenylephrine. However, bradycardia is a common problem with the use of phenylephrine.
Acute pancreatitis is a common and potentially lethal inflammatory process with a highly variable... more Acute pancreatitis is a common and potentially lethal inflammatory process with a highly variable clinical course. Persistent organ failure develops in 10%–20% of patients, with mortality reaching 30% in this subgroup. Since the morbidity and mortality of acute pancreatitis differ markedly between mild and severe disease (mild < 5% vs severe 20–25%), the ability to identify patients at risk for persistent organ failure early in the disease course is very critical, both for triaging patients to the appropriate level of care and for designing mechanistic studies for targeted intervention. Our study aims toassess the severity of acute pancreatitis using APACHE II and HAPS (Harmless Acute Pancreatitis Score) scoring systems, to compare HAPS and APACHE scoring systems for assessment of prognosis of acute pancreatitis on admission and to assess the feasibility of HAPS scoring system over the complicated APACHE II scoring system.This prospective observational study was conducted on admitted patients clinically suspected to have acute pancreatitis in a tertiary teaching hospital between October 2015 to September 2017. A total of 80 patients were included in the study. Scoring was done on admission or at the time of diagnosis. The scores were compared with the clinical severity which were graded according to Atlanta criteria and also compared with the clinical outcome of the patient. Statistical analysis was done using independent t test. A " p " value of less than 0.05 was considered to be statistically significant.Of the 80 patients studied, 58 (72.5%) patients were positive for HAPS at the time of admission, while 57 (71.25%) patients had an APACHE II score of less than or equal to 8 within 24 hours of admission, signifying uncomplicated mild acute pancreatitis, while eventually 55 (68.8%) patients were found to have a mild course of the disease. As all the indices of statistical power were found to be the more or less the same for both HAPS and APACHE II scores, HAPS is as efficacious as APACHE II scoring system for identifying patients with mild course of the disease at the time of admission, while having the added advantages of being significantly less time-consuming, cumbersome and less invasive and at the same time accurately triaging patients as per disease severity. This indicates that HAPS is capable of identifying the patients who could be reliably triaged to receive less aggressive treatment, making it an ideal predictor for Indian patients at the community level.
Acetabular fractures are a major challenge for an orthopaedic surgeon. As with increasing inciden... more Acetabular fractures are a major challenge for an orthopaedic surgeon. As with increasing incidence of such injuries due to an increase in the frequency of road traffic accidents, it is a major concern in most of the hospitals. This study was done at Patna Medical College & Hospital, Patna between 2012 to 2016, on 20 aceta-bular fracture patients. All cases were operated according to standard operative techniques and surgical approaches and were followed up to 26 months on average. The midterm functional results were assessed by Har-ris Hip Score at 18 months. In our study, 70% of the cases had good to excellent results. It was concluded that early operative intervention according to principles of intra-articular fractures, resulted in good functional
Alveolar osteitis or dry socket is one of the most common complication after tooth extraction esp... more Alveolar osteitis or dry socket is one of the most common complication after tooth extraction especially in mandibular third molars.A lot of studies have been undertaken to investigate the etiology ,pathogenesis ,preventive methods and treatment of this condition but the results are inconclusive.The article aims to give an insight into the various facets of alveolar osteitis to help the dental practitioner in discerning and eliminating the risk factors as well as preventive and symptomatic management of this condition.
Esthetic outcomes have become key elements that are critical to defning success in implant restor... more Esthetic outcomes have become key elements that are critical to defning success in implant restorations. Long-term studies have demonstrated that single or multiple implants are highly predictable with high survival rates. However, in the anterior maxillary zone, the aesthetic success of implant therapy is, for many, as important as the implant survival rates. Several factors contribute to this " success " and can be objectively evaluated. These include the patient's healing capabilities, the level and condition of the existing soft and hard tissues, and the provisional and final restorations Esthetic outcomes have become key elements that are critical to defining success in implant restorations. In the anterior maxilla buccal cortical plate becomes thin after extraction of natural teeth, so implant placement has to be done off axis. Prosthetic management of this off axis placed implant becomes difficult with screw retained prosthesis.
Background: Uterine arteriovenous malformation (AVM) is an uncommon vascular disease, which can b... more Background: Uterine arteriovenous malformation (AVM) is an uncommon vascular disease, which can be a life-threatening condition. Treatment recommendations include embolization versus hysterectomy. Case: A 26 year-old gravida 6 para 2042 presented three months after an early pregnancy loss with persistent vaginal bleeding. Ultrasonography and angiography demonstrated a hypervascular intrauterine mass consistent with an AVM. Hysteroscopy demonstrated an intracavitary mass with increased vascularity which, upon resection and pathology evaluation, was confirmed to be retained products of conception (RPOC). Conclusion: AVMs are a rare condition in which angiography has classically been the gold standard modality to clinch the challenging diagnosis. Since there are several conditions which mimic the presentation of AVMs, hysteroscopy can be a useful tool in the diagnosis, which can influence treatment decisions.
Introduction: Cirrhosis is defined by the World Health Organization (WHO) as a diffuse process ch... more Introduction: Cirrhosis is defined by the World Health Organization (WHO) as a diffuse process characterized by fibrosis and the conversion of normal liver architecture into structurally abnormal nodules. 3,4 The progression of liver injury to cirrhosis may occur over weeks to years. Chronic liver diseases and cirrhosis result in 26,000-35,000 deaths each year in the United States (US). Cirrhosis is the 9th leading cause of death in the US and is responsible for 1.2% of all US deaths. 5 Materials and Methods: Three hundred consecutively diagnosed adult cirrhosis patients were prospectively studied at the Department of Gastroenterology, Kurnool Medical College and hospital, a tertiary care hospital of AP from June 2016-May 2017 for their clinical characteristics, prognosis and mortality at one month Results: Commonest age group was 35-54years, mean age 45.8+ 10.4 years; M: F ratio 7.5:1. Symptoms were ascites (74.3%), gastrointestinal bleeding (43.4%), jaundice (36.3%), low urine output (31%) and altered sensorium in 23%. 37.1% patients had severe malnutrition. Aetiology were alcohol related (72.2%), HBV (8.9%), HCV (3.2%), Autoimmune Hepatitis (0.9%), Cryptogenic cirrhosis (17.2%) and NASH (1%). Complications were ascites (78.6%), variceal bleeding (43.4%), hepatic encephalopathy (21.6%), Spontaneous bacterial peritonitis 4.2%, Hepatorenal syndrome (2.7%) and Hepatocellular carcinoma (1.3%). 50% had Child C disease, 83% had MELD between 10-29 and APRI (AST to Platelet ratio index) >2.5 in 38.5% patients. Mortality was 7.8% and highest among alcoholic cirrhosis (6.8%). Conclusion: Cirrhosis is common in the most productive age and the commonest cause was alcohol cirrhosis which is preventable through proper education and legislation. Proper awareness will lead to prevention of long term morbidity.
Introduction: Hepatitis B is a national and global public health problem. In 2013, viral hepatiti... more Introduction: Hepatitis B is a national and global public health problem. In 2013, viral hepatitis was a leading cause of death worldwide. 1 More than 90% of this burden is due to the sequelae of infections with the hepatitis B virus and hepatitis C virus.1 Prevention can reduce the rate of new infections. In the absence of additional efforts, 19 million hepatitis-related deaths are anticipated from 2015 to 2030. 1 Materials and Methods: We conducted a case control study among patients attending the Gastroenterology Department of Kurnool Medical College, Kurnool, AP. It is a tertiary care hospital and hence the patients from the peripheral areas of the state and neighbouring states are coming here. Data were collected after getting written consent from the respondents. Information collected includes background demographic, socioeconomic and health aspects. Results: The determinants of transmission of Hepatitis B was found statistically significant which included sex, religion, socioeconomic status, education, 'other related risk factors' which include earlier infection of HBV, diabetic and family history of hepatitis infection. Conclusion: There is a need to create awareness about determinants and transmission of Hepatitis B in this area. The vaccination against Hepatitis B should be strongly recommended for high risk groups like family history of infection. Majority of the respondents are not immunized. Since the disease is highly infective but preventable, awareness and prevention are factors of importance.
Endometrial polyps are localised hyperplastic overgrowths of endometrial glands and stroma around... more Endometrial polyps are localised hyperplastic overgrowths of endometrial glands and stroma around a vascular core that form a sessile or pedunculated projection from the surface of the endometrium. Incidence is unknown because many polpys are asymptomatic. Prevalence is reported to be between 7.8% to 34.9% and in women with postmenopausal bleeding, it is around 37.7%. Malignancy is uncommon and occurs in 0% to 12.9% of endometrial polyps. Out of 113 cases with postmenopausal bleeding, 14 patients were suspected to have endometrial polyps. Diagnosis was based on transvaginal USG. Out of 14 patients, 8 patients underwent hysterectomy, 2 underwent saline sonogram with hysteroscopy and 4 underwent hysteroscopy.This study was carried out to emphasize that hysteroscopic removal can be preferred to hysterectomy because of its less invasive nature, lower cost and reduced risk to patient. Removal of histologic assessment is appropriate in postmenopausal women with symptoms, but needs further follow up.
www.iosrjournals.org 45 | Page NATURE OF LESION-subglottis and trachea being slightly ovoid struc... more www.iosrjournals.org 45 | Page NATURE OF LESION-subglottis and trachea being slightly ovoid structures stenotic segments were mostly circumferential , very few were partial and also pinhole type of stenoses Glottis lesions were in the form of anterior web. Supraglottis was distorted due to multiple adhesions to surrounding structures.
Breast cancer is the second most common cause of death from cancer in women. The aim of this stud... more Breast cancer is the second most common cause of death from cancer in women. The aim of this study was to determine which is more accurate imaging test among mammography ,ultrasound and color doppler ultrasound for diagnosis of breast cancer based on the women's age and breast density. We examined 81 patients with breast symptoms, by clinical breast examination which is cofirmed by mammography ,ultrasound and color doppler. A total of 81 breast lesions were compared with final histopathology of the lesion taking it as the gold standard. Sensitivity varied significantly with age and breast density. Adding color Doppler with ultrasound provides a better diagnostic accuracy.
Background: Nephrotic Syndrome is one of the most common renal disorders in pediatric age group, ... more Background: Nephrotic Syndrome is one of the most common renal disorders in pediatric age group, which predisposes to various systemic infections. Of all the infections urinary tract infections remains the most important cause for most of the relapses. The present study was conducted to find out the prevalence of urinary tract infections and their microbiological profile in children with Nephrotic Syndrome. Methods: A cross sectional descriptive study which included all children less than 12 years of age admitted with Nephrotic Syndrome between August 2017 and July 2018. All the data regarding history, clinical findings and investigations were recorded in a pre-designed Performa. A clean catch mid-stream urine sample was collected from all the children at the time of admission for culture and sensitivity pattern. Results: Among the 32 children with Nephrotic Syndrome, urinary tract infection was detected in 8 children (25%). The most common microorganism isolated was Escherichia coli (62.5%), followed by Klebsiella (25%) and Proteus (12.5%).Conclusion: About 25% of children with Nephrotic Syndrome have urinary tract infection at the time of admission. Gram negative enteric bacilli remain the most common agent. As urinary tract infection is found in a considerable rate among children with Nephrotic Syndrome, routine urine culture should be carried out in all children with Nephrotic Syndrome.
Thyroid gland is located anteriorly in the neck at the level of 5,6,7cervical &1thoracic vertebra... more Thyroid gland is located anteriorly in the neck at the level of 5,6,7cervical &1thoracic vertebrae. It lies deep to sterno thyroid& sterno hyoid .The morphological variations are usually diagnosed incidentally during examination for other thyroid diseases. This study was done to observe the gross anatomical features of the thyroid in 30 cadavers [21male 9female] 20 from anatomy&10 from forensic medicine at Rajiv Gandhi institute of medical sciences ongole, Andhra Pradesh. In our study we observed lobes of thyroid, absence of isthmus, pyramidal lobe, levator glandulae thyroidea, accessory thyroid tissue. This study highlights the various developmental anomalies of the thyroid gland which is an useful information in the treatment and for safe and effective surgeries to clinicians.
Background: The lifetime prevalence of substance use disorders is at least 40% in bipolar I patie... more Background: The lifetime prevalence of substance use disorders is at least 40% in bipolar I patients. Although high smoking rates have been reported among bipolar patients, only a few studies examined the prevalence of smoking in bipolar disorder, and their findings are inconsistent Aims and Objectives: To study the prevalence and clinical correlates of nicotine dependence among patients with Bipolar Disorder. The objectives of this study are to study the prevalence of Nicotine dependence among Bipolar Disorders, socio-demographic variables of the Bipolar patients with Nicotine dependence and to determine the clinical correlates of Bipolar patients with Nicotine dependence. Materials and Methods: A cross sectional study was conducted at Psychiatric Department, at Maharajah's Institute of Medical Sciences, Vizayanagaram, for a period of 2 years on a sample of 92 patients who were diagnosed as having Bipolar Affective Disorder. The tools used were self structured socio-demographic schedule and Fagerstrom Test for Nicotine Dependence which is a widely used measure of severity of Nicotine Dependence. Results: The total sample size was 92 bipolar patients. The mean age of the sample was 33.62±10.573, out of 92 patients, 28 (30.4%) were from 18 to 27 age group; 31 (33.7%) from 28 to 37 age group, and 15 (16.3%) were from 38 to 47 age group. 15 (16.3%) from 48 to 57 age group and 3 (3.3%) from 58 to 67 years age group. In our study 39 (42.4%) were compliant and 53 (57.6%) non compliant. Among the 56 dependents 18(32.1%) patients were compliant, 38(67.9%) were non compliant. Conclusion: that the prevalence of Nicotine dependence was high among the BPAD patients and significantly varied with age, marital status, family history of Alcohol abuse, Total number of episodes and Drug compliance.
Problem of unanticipated difficult intubation is worldwide and search continues for tests that ar... more Problem of unanticipated difficult intubation is worldwide and search continues for tests that are reliable, accurate & rapid to predict difficult intubation. Our aim was to compare the ability to predict difficult intubation from six preoperative airway tests-Upper lip bite test, Modified Mallampati, Interincisor gap, Head & Neck movements, Thyromental distance, Ratio of height to Thyromental distance, compared individually & to confirm the same with Cormack Lehane score for difficult intubation. Airway was assessed in preanesthetic checkup using these six tests by the principle investigator & anesthesiologist assessing glottic exposure was blinded from the preoperative test results. Sensitivity, specificity, positive & negative predictive values & accuracy of each tests was calculated. Statistical significance was compared using Kappa statistics & p value <0.05 was considered significant. All the tests were significant, of which Modified Mallampati showed maximum agreement with gold standard Cormack Lehane score. However, a combination of tests in parallel is more sensitive and has higher predictivity than single tests alone.
La Thrombophilie constitutionnelle est une maladie rare, de mécanismes assez complexes. Plusieurs... more La Thrombophilie constitutionnelle est une maladie rare, de mécanismes assez complexes. Plusieurs facteurs sont incriminés, notamment les facteurs environnementaux mais surtout les facteurs génétiques impliquant parfois plusieurs anomalies. Devant la survenue des manifestations thrombotiques à un âge jeune ou en cas d'antécédents familiaux de celles-ci, l'origine constitutionnelle de la thrombophilie est fortement suspectée et impose la recherche de l'anomalie génétique causale. A travers nos deux observations et une revue de littérature de cette pathologie, nous rappelons les mécanismes physiopathologiques, tout en mettant le point sur les différentes étiologies de la thrombophilie constitutionnelle. Mots clés : thrombophilie, constitutionnelle, physiopathologie, étiologie. Abstract : Constitutional thrombophilia is a rare disease, with rather complex mechanisms. Several factors are incriminated, including environmental factors but especially genetic factors sometimes involving several anomalies. Faced with the occurrence of thrombotic manifestations at a young age or with a family history of these, the constitutional origin of thrombophilia is strongly suspected and requires the search for the causal genetic anomaly. Through our two observations and a literature review of this pathology, we recall the physiopathological mechanisms, while highlighting the different etiologies of constitutional thrombophilia.
Various bio-compatible materials can be used to restore the function and esthetics of any congeni... more Various bio-compatible materials can be used to restore the function and esthetics of any congenital or acquired defects. Proper assessment, examination, planning and rehabilitation of the distorted body parts has been the target of clinical maxillofacial prosthodontics. The aim of this article is to present a case report of fabrication of silicone prosthesis for a patient with a congenital bilateral auricular defect.
Le léiomyosarcome du col utérin (LMS) représente une entité histologique particulièrement rare et... more Le léiomyosarcome du col utérin (LMS) représente une entité histologique particulièrement rare et agressive. Nous rapportant les observations de cinq patientes traitées à l'institut national tunisien de cancérologie Salah Azaïez entre 1998 et 2014 pour un LMS du col confirmé histologiquement dont deux cas survenant après une hystérectomie subtotale pour des pathologies bénignes. L'âge moyen de nos patientes était de 48.6 ans. Une patiente était classée au stade IV de FIGO 2009, trois patientes étaient au stade Ib2 et une autre patiente était au stade IIb. Nous avions réalisé une colpo-hystérectomie totale avec lymphadénectomie pelvienne bilatérale (CHL) chez trois patientes, une cervicectomie associée à une colpectomie et annexectomie bilatérale chez la patiente au stade IV, une cervicectomie associée à une colpectomie et un prélèvement sous-veineux iliaque bilatéral chez la 5ème patiente ayant déjà eu une hystérectomie subtotale d'hémostase. La radiothérapie externe (RTE) adjuvante était indiquée dans trois cas et la chimiothérapie(CT) était administrée dans un but palliatif chez une patiente. Deux patientes sont actuellement en rémission complète, deux patientes avaient présenté une récidive sarcomateuse dont l'une était traitée par une exentération antérieure suivie d'une RTE avec rémission et la 5ème patiente d'emblée métastatique était décédée après progression sous CT. Devant la rareté de cette entité, aucun standard thérapeutique n'était établi et chirurgie représente la base du traitement.
Aim: Intraoperative frozen section analysis play an important role in modern day surgical practic... more Aim: Intraoperative frozen section analysis play an important role in modern day surgical practice. The quality assurance of this technique is vital as it is a major tool in guiding the patient surgical management. The present study was conducted to evaluate the diagnostic accuracy of frozen section results and to find out the common reasons of misdiagnosis. Method: This is a retrospective study done by retrieving the data from frozen section and routine histology registers over a period of two years. Total 163 cases were received for frozen section analysis in that period. Out of these 2 cases were deferred and analysis was done on 161 cases. Results: Out of 163 cases, results were deferred in 2 cases for routine histology leading to a deferral of 1.23%. The diagnostic accuracy was found to be 90.68% with a false positive diagnosis of malignancy in 4.97% and false negative benign diagnosis in 2.49% cases. The major causes of misdiagnosis were found to be interpretation error (73.33%), followed by sampling error (20%) and scanty tissue for analysis (6.67%). The interpretation error was mostly due to the freezing artefacts. Conclusion: A thorough clinical and radiological knowledge, proper sampling and processing as well as interpretation by experienced pathologists are the prerequisites for accurate diagnosis in frozen section study.
Introduction: The present study was conducted to compare the effects of prophylactic phenylephrin... more Introduction: The present study was conducted to compare the effects of prophylactic phenylephrine and ephedrine infusion on maternal haemodynamics in elective caesarean section under spinal anaesthesia. It was hypothesized that prophylactic phenylephrine infusion would maintain better maternal haemodynamics than ephedrine infusion. Methods: Seventy six patients were available for randomization into two equal groups to receive either prophylactic infusion phenylephrine 100µg/ml/min (Group P, n=38) or infusion ephedrine 8mg/ml/min (Group E, n=38) after induction of spinal anaesthesia with 10mg hyperbaric bupivacaine with 15µg fentanyl. The infusion was adjusted according to the patient's systolic blood pressure and was administered up to the time of umbilical cord clamping. The incidence of adverse events, if any, was recorded. Apgar scores of every neonate were assessed at 1and 5 minute after delivery. Results: Both the drugs were able to prevent the incidence of hypotension. The systolic blood pressure and bradycardia was higher in phenylephrine group whereas the incidence of tachycardia was the common problem with ephedrine. Also, in phenylephrine group, the maximum upper level of sensory anaesthesia was two segments lower than ephedrine group and there was same neonatal outcome in both the groups. Conclusion: The prophylactic infusion of phenylephrine can be an effective alternative to ephedrine in the prevention of maternal hypotension without imparting any significant neonatal adverse effect. Lesser rostral spread of spinal anaesthetic drug was observed in mother receiving infusion of phenylephrine. However, bradycardia is a common problem with the use of phenylephrine.
Acute pancreatitis is a common and potentially lethal inflammatory process with a highly variable... more Acute pancreatitis is a common and potentially lethal inflammatory process with a highly variable clinical course. Persistent organ failure develops in 10%–20% of patients, with mortality reaching 30% in this subgroup. Since the morbidity and mortality of acute pancreatitis differ markedly between mild and severe disease (mild < 5% vs severe 20–25%), the ability to identify patients at risk for persistent organ failure early in the disease course is very critical, both for triaging patients to the appropriate level of care and for designing mechanistic studies for targeted intervention. Our study aims toassess the severity of acute pancreatitis using APACHE II and HAPS (Harmless Acute Pancreatitis Score) scoring systems, to compare HAPS and APACHE scoring systems for assessment of prognosis of acute pancreatitis on admission and to assess the feasibility of HAPS scoring system over the complicated APACHE II scoring system.This prospective observational study was conducted on admitted patients clinically suspected to have acute pancreatitis in a tertiary teaching hospital between October 2015 to September 2017. A total of 80 patients were included in the study. Scoring was done on admission or at the time of diagnosis. The scores were compared with the clinical severity which were graded according to Atlanta criteria and also compared with the clinical outcome of the patient. Statistical analysis was done using independent t test. A " p " value of less than 0.05 was considered to be statistically significant.Of the 80 patients studied, 58 (72.5%) patients were positive for HAPS at the time of admission, while 57 (71.25%) patients had an APACHE II score of less than or equal to 8 within 24 hours of admission, signifying uncomplicated mild acute pancreatitis, while eventually 55 (68.8%) patients were found to have a mild course of the disease. As all the indices of statistical power were found to be the more or less the same for both HAPS and APACHE II scores, HAPS is as efficacious as APACHE II scoring system for identifying patients with mild course of the disease at the time of admission, while having the added advantages of being significantly less time-consuming, cumbersome and less invasive and at the same time accurately triaging patients as per disease severity. This indicates that HAPS is capable of identifying the patients who could be reliably triaged to receive less aggressive treatment, making it an ideal predictor for Indian patients at the community level.
Acetabular fractures are a major challenge for an orthopaedic surgeon. As with increasing inciden... more Acetabular fractures are a major challenge for an orthopaedic surgeon. As with increasing incidence of such injuries due to an increase in the frequency of road traffic accidents, it is a major concern in most of the hospitals. This study was done at Patna Medical College & Hospital, Patna between 2012 to 2016, on 20 aceta-bular fracture patients. All cases were operated according to standard operative techniques and surgical approaches and were followed up to 26 months on average. The midterm functional results were assessed by Har-ris Hip Score at 18 months. In our study, 70% of the cases had good to excellent results. It was concluded that early operative intervention according to principles of intra-articular fractures, resulted in good functional
Alveolar osteitis or dry socket is one of the most common complication after tooth extraction esp... more Alveolar osteitis or dry socket is one of the most common complication after tooth extraction especially in mandibular third molars.A lot of studies have been undertaken to investigate the etiology ,pathogenesis ,preventive methods and treatment of this condition but the results are inconclusive.The article aims to give an insight into the various facets of alveolar osteitis to help the dental practitioner in discerning and eliminating the risk factors as well as preventive and symptomatic management of this condition.
Esthetic outcomes have become key elements that are critical to defning success in implant restor... more Esthetic outcomes have become key elements that are critical to defning success in implant restorations. Long-term studies have demonstrated that single or multiple implants are highly predictable with high survival rates. However, in the anterior maxillary zone, the aesthetic success of implant therapy is, for many, as important as the implant survival rates. Several factors contribute to this " success " and can be objectively evaluated. These include the patient's healing capabilities, the level and condition of the existing soft and hard tissues, and the provisional and final restorations Esthetic outcomes have become key elements that are critical to defining success in implant restorations. In the anterior maxilla buccal cortical plate becomes thin after extraction of natural teeth, so implant placement has to be done off axis. Prosthetic management of this off axis placed implant becomes difficult with screw retained prosthesis.
Background: Uterine arteriovenous malformation (AVM) is an uncommon vascular disease, which can b... more Background: Uterine arteriovenous malformation (AVM) is an uncommon vascular disease, which can be a life-threatening condition. Treatment recommendations include embolization versus hysterectomy. Case: A 26 year-old gravida 6 para 2042 presented three months after an early pregnancy loss with persistent vaginal bleeding. Ultrasonography and angiography demonstrated a hypervascular intrauterine mass consistent with an AVM. Hysteroscopy demonstrated an intracavitary mass with increased vascularity which, upon resection and pathology evaluation, was confirmed to be retained products of conception (RPOC). Conclusion: AVMs are a rare condition in which angiography has classically been the gold standard modality to clinch the challenging diagnosis. Since there are several conditions which mimic the presentation of AVMs, hysteroscopy can be a useful tool in the diagnosis, which can influence treatment decisions.
Introduction: Cirrhosis is defined by the World Health Organization (WHO) as a diffuse process ch... more Introduction: Cirrhosis is defined by the World Health Organization (WHO) as a diffuse process characterized by fibrosis and the conversion of normal liver architecture into structurally abnormal nodules. 3,4 The progression of liver injury to cirrhosis may occur over weeks to years. Chronic liver diseases and cirrhosis result in 26,000-35,000 deaths each year in the United States (US). Cirrhosis is the 9th leading cause of death in the US and is responsible for 1.2% of all US deaths. 5 Materials and Methods: Three hundred consecutively diagnosed adult cirrhosis patients were prospectively studied at the Department of Gastroenterology, Kurnool Medical College and hospital, a tertiary care hospital of AP from June 2016-May 2017 for their clinical characteristics, prognosis and mortality at one month Results: Commonest age group was 35-54years, mean age 45.8+ 10.4 years; M: F ratio 7.5:1. Symptoms were ascites (74.3%), gastrointestinal bleeding (43.4%), jaundice (36.3%), low urine output (31%) and altered sensorium in 23%. 37.1% patients had severe malnutrition. Aetiology were alcohol related (72.2%), HBV (8.9%), HCV (3.2%), Autoimmune Hepatitis (0.9%), Cryptogenic cirrhosis (17.2%) and NASH (1%). Complications were ascites (78.6%), variceal bleeding (43.4%), hepatic encephalopathy (21.6%), Spontaneous bacterial peritonitis 4.2%, Hepatorenal syndrome (2.7%) and Hepatocellular carcinoma (1.3%). 50% had Child C disease, 83% had MELD between 10-29 and APRI (AST to Platelet ratio index) >2.5 in 38.5% patients. Mortality was 7.8% and highest among alcoholic cirrhosis (6.8%). Conclusion: Cirrhosis is common in the most productive age and the commonest cause was alcohol cirrhosis which is preventable through proper education and legislation. Proper awareness will lead to prevention of long term morbidity.
Introduction: Hepatitis B is a national and global public health problem. In 2013, viral hepatiti... more Introduction: Hepatitis B is a national and global public health problem. In 2013, viral hepatitis was a leading cause of death worldwide. 1 More than 90% of this burden is due to the sequelae of infections with the hepatitis B virus and hepatitis C virus.1 Prevention can reduce the rate of new infections. In the absence of additional efforts, 19 million hepatitis-related deaths are anticipated from 2015 to 2030. 1 Materials and Methods: We conducted a case control study among patients attending the Gastroenterology Department of Kurnool Medical College, Kurnool, AP. It is a tertiary care hospital and hence the patients from the peripheral areas of the state and neighbouring states are coming here. Data were collected after getting written consent from the respondents. Information collected includes background demographic, socioeconomic and health aspects. Results: The determinants of transmission of Hepatitis B was found statistically significant which included sex, religion, socioeconomic status, education, 'other related risk factors' which include earlier infection of HBV, diabetic and family history of hepatitis infection. Conclusion: There is a need to create awareness about determinants and transmission of Hepatitis B in this area. The vaccination against Hepatitis B should be strongly recommended for high risk groups like family history of infection. Majority of the respondents are not immunized. Since the disease is highly infective but preventable, awareness and prevention are factors of importance.
Endometrial polyps are localised hyperplastic overgrowths of endometrial glands and stroma around... more Endometrial polyps are localised hyperplastic overgrowths of endometrial glands and stroma around a vascular core that form a sessile or pedunculated projection from the surface of the endometrium. Incidence is unknown because many polpys are asymptomatic. Prevalence is reported to be between 7.8% to 34.9% and in women with postmenopausal bleeding, it is around 37.7%. Malignancy is uncommon and occurs in 0% to 12.9% of endometrial polyps. Out of 113 cases with postmenopausal bleeding, 14 patients were suspected to have endometrial polyps. Diagnosis was based on transvaginal USG. Out of 14 patients, 8 patients underwent hysterectomy, 2 underwent saline sonogram with hysteroscopy and 4 underwent hysteroscopy.This study was carried out to emphasize that hysteroscopic removal can be preferred to hysterectomy because of its less invasive nature, lower cost and reduced risk to patient. Removal of histologic assessment is appropriate in postmenopausal women with symptoms, but needs further follow up.
www.iosrjournals.org 45 | Page NATURE OF LESION-subglottis and trachea being slightly ovoid struc... more www.iosrjournals.org 45 | Page NATURE OF LESION-subglottis and trachea being slightly ovoid structures stenotic segments were mostly circumferential , very few were partial and also pinhole type of stenoses Glottis lesions were in the form of anterior web. Supraglottis was distorted due to multiple adhesions to surrounding structures.
Breast cancer is the second most common cause of death from cancer in women. The aim of this stud... more Breast cancer is the second most common cause of death from cancer in women. The aim of this study was to determine which is more accurate imaging test among mammography ,ultrasound and color doppler ultrasound for diagnosis of breast cancer based on the women's age and breast density. We examined 81 patients with breast symptoms, by clinical breast examination which is cofirmed by mammography ,ultrasound and color doppler. A total of 81 breast lesions were compared with final histopathology of the lesion taking it as the gold standard. Sensitivity varied significantly with age and breast density. Adding color Doppler with ultrasound provides a better diagnostic accuracy.
Background: Nephrotic Syndrome is one of the most common renal disorders in pediatric age group, ... more Background: Nephrotic Syndrome is one of the most common renal disorders in pediatric age group, which predisposes to various systemic infections. Of all the infections urinary tract infections remains the most important cause for most of the relapses. The present study was conducted to find out the prevalence of urinary tract infections and their microbiological profile in children with Nephrotic Syndrome. Methods: A cross sectional descriptive study which included all children less than 12 years of age admitted with Nephrotic Syndrome between August 2017 and July 2018. All the data regarding history, clinical findings and investigations were recorded in a pre-designed Performa. A clean catch mid-stream urine sample was collected from all the children at the time of admission for culture and sensitivity pattern. Results: Among the 32 children with Nephrotic Syndrome, urinary tract infection was detected in 8 children (25%). The most common microorganism isolated was Escherichia coli (62.5%), followed by Klebsiella (25%) and Proteus (12.5%).Conclusion: About 25% of children with Nephrotic Syndrome have urinary tract infection at the time of admission. Gram negative enteric bacilli remain the most common agent. As urinary tract infection is found in a considerable rate among children with Nephrotic Syndrome, routine urine culture should be carried out in all children with Nephrotic Syndrome.
Thyroid gland is located anteriorly in the neck at the level of 5,6,7cervical &1thoracic vertebra... more Thyroid gland is located anteriorly in the neck at the level of 5,6,7cervical &1thoracic vertebrae. It lies deep to sterno thyroid& sterno hyoid .The morphological variations are usually diagnosed incidentally during examination for other thyroid diseases. This study was done to observe the gross anatomical features of the thyroid in 30 cadavers [21male 9female] 20 from anatomy&10 from forensic medicine at Rajiv Gandhi institute of medical sciences ongole, Andhra Pradesh. In our study we observed lobes of thyroid, absence of isthmus, pyramidal lobe, levator glandulae thyroidea, accessory thyroid tissue. This study highlights the various developmental anomalies of the thyroid gland which is an useful information in the treatment and for safe and effective surgeries to clinicians.
Background: The lifetime prevalence of substance use disorders is at least 40% in bipolar I patie... more Background: The lifetime prevalence of substance use disorders is at least 40% in bipolar I patients. Although high smoking rates have been reported among bipolar patients, only a few studies examined the prevalence of smoking in bipolar disorder, and their findings are inconsistent Aims and Objectives: To study the prevalence and clinical correlates of nicotine dependence among patients with Bipolar Disorder. The objectives of this study are to study the prevalence of Nicotine dependence among Bipolar Disorders, socio-demographic variables of the Bipolar patients with Nicotine dependence and to determine the clinical correlates of Bipolar patients with Nicotine dependence. Materials and Methods: A cross sectional study was conducted at Psychiatric Department, at Maharajah's Institute of Medical Sciences, Vizayanagaram, for a period of 2 years on a sample of 92 patients who were diagnosed as having Bipolar Affective Disorder. The tools used were self structured socio-demographic schedule and Fagerstrom Test for Nicotine Dependence which is a widely used measure of severity of Nicotine Dependence. Results: The total sample size was 92 bipolar patients. The mean age of the sample was 33.62±10.573, out of 92 patients, 28 (30.4%) were from 18 to 27 age group; 31 (33.7%) from 28 to 37 age group, and 15 (16.3%) were from 38 to 47 age group. 15 (16.3%) from 48 to 57 age group and 3 (3.3%) from 58 to 67 years age group. In our study 39 (42.4%) were compliant and 53 (57.6%) non compliant. Among the 56 dependents 18(32.1%) patients were compliant, 38(67.9%) were non compliant. Conclusion: that the prevalence of Nicotine dependence was high among the BPAD patients and significantly varied with age, marital status, family history of Alcohol abuse, Total number of episodes and Drug compliance.
Problem of unanticipated difficult intubation is worldwide and search continues for tests that ar... more Problem of unanticipated difficult intubation is worldwide and search continues for tests that are reliable, accurate & rapid to predict difficult intubation. Our aim was to compare the ability to predict difficult intubation from six preoperative airway tests-Upper lip bite test, Modified Mallampati, Interincisor gap, Head & Neck movements, Thyromental distance, Ratio of height to Thyromental distance, compared individually & to confirm the same with Cormack Lehane score for difficult intubation. Airway was assessed in preanesthetic checkup using these six tests by the principle investigator & anesthesiologist assessing glottic exposure was blinded from the preoperative test results. Sensitivity, specificity, positive & negative predictive values & accuracy of each tests was calculated. Statistical significance was compared using Kappa statistics & p value <0.05 was considered significant. All the tests were significant, of which Modified Mallampati showed maximum agreement with gold standard Cormack Lehane score. However, a combination of tests in parallel is more sensitive and has higher predictivity than single tests alone.
La Thrombophilie constitutionnelle est une maladie rare, de mécanismes assez complexes. Plusieurs... more La Thrombophilie constitutionnelle est une maladie rare, de mécanismes assez complexes. Plusieurs facteurs sont incriminés, notamment les facteurs environnementaux mais surtout les facteurs génétiques impliquant parfois plusieurs anomalies. Devant la survenue des manifestations thrombotiques à un âge jeune ou en cas d'antécédents familiaux de celles-ci, l'origine constitutionnelle de la thrombophilie est fortement suspectée et impose la recherche de l'anomalie génétique causale. A travers nos deux observations et une revue de littérature de cette pathologie, nous rappelons les mécanismes physiopathologiques, tout en mettant le point sur les différentes étiologies de la thrombophilie constitutionnelle. Mots clés : thrombophilie, constitutionnelle, physiopathologie, étiologie. Abstract : Constitutional thrombophilia is a rare disease, with rather complex mechanisms. Several factors are incriminated, including environmental factors but especially genetic factors sometimes involving several anomalies. Faced with the occurrence of thrombotic manifestations at a young age or with a family history of these, the constitutional origin of thrombophilia is strongly suspected and requires the search for the causal genetic anomaly. Through our two observations and a literature review of this pathology, we recall the physiopathological mechanisms, while highlighting the different etiologies of constitutional thrombophilia.
Various bio-compatible materials can be used to restore the function and esthetics of any congeni... more Various bio-compatible materials can be used to restore the function and esthetics of any congenital or acquired defects. Proper assessment, examination, planning and rehabilitation of the distorted body parts has been the target of clinical maxillofacial prosthodontics. The aim of this article is to present a case report of fabrication of silicone prosthesis for a patient with a congenital bilateral auricular defect.
Le léiomyosarcome du col utérin (LMS) représente une entité histologique particulièrement rare et... more Le léiomyosarcome du col utérin (LMS) représente une entité histologique particulièrement rare et agressive. Nous rapportant les observations de cinq patientes traitées à l'institut national tunisien de cancérologie Salah Azaïez entre 1998 et 2014 pour un LMS du col confirmé histologiquement dont deux cas survenant après une hystérectomie subtotale pour des pathologies bénignes. L'âge moyen de nos patientes était de 48.6 ans. Une patiente était classée au stade IV de FIGO 2009, trois patientes étaient au stade Ib2 et une autre patiente était au stade IIb. Nous avions réalisé une colpo-hystérectomie totale avec lymphadénectomie pelvienne bilatérale (CHL) chez trois patientes, une cervicectomie associée à une colpectomie et annexectomie bilatérale chez la patiente au stade IV, une cervicectomie associée à une colpectomie et un prélèvement sous-veineux iliaque bilatéral chez la 5ème patiente ayant déjà eu une hystérectomie subtotale d'hémostase. La radiothérapie externe (RTE) adjuvante était indiquée dans trois cas et la chimiothérapie(CT) était administrée dans un but palliatif chez une patiente. Deux patientes sont actuellement en rémission complète, deux patientes avaient présenté une récidive sarcomateuse dont l'une était traitée par une exentération antérieure suivie d'une RTE avec rémission et la 5ème patiente d'emblée métastatique était décédée après progression sous CT. Devant la rareté de cette entité, aucun standard thérapeutique n'était établi et chirurgie représente la base du traitement.