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Comparative evaluation of conventional method versus polymerase chain reaction for detection of methicillin resistant staphylococcus aureus isolated from blood stream infections
Shreyashi Tuladhar, Narayan Raj Bhattarai, Ratna Baral, Keshav Rai, Basudha Khanal
January-June 2020, 6(1):38-42
Background: Clinically significant bloodstream infection (BSI)due to Staphylococcus aureus(S.aureus)isa significant pathogen in community acquired and nosocomial BSI. Methicillin Resistant Staphylococcus aureus (MRSA) are resistant to methicillin and all χ-lactam antibiotics due to possession of mec A gene. Several phenotypic methods for laboratory detection of MRSA: oxacillin screening test, oxacillin or cefoxitin disc diffusion method, oxacillin minimum inhibitory concentration test are used routinely in our setting. Aim: We aim to detect MRSA among blood culture isolates by conventional method (cefoxitin disc) and also to confirm identity of these MRSA strains by molecular method i.e. mecA detection by Polymerase Chain Reaction(PCR). Materials and Methods: This cross sectional study was carried out on 139 S. aureus clinical isolates in Department of Microbiology from blood samples submitted for culture and sensitivity test. Once the isolate was identified as S. aureus, it was further identified as MRSA or Methicillin Sensitive Staphylococcus aureus (MSSA) by use of antimicrobial discs. DNA extraction was done by boiling method. Results: Antimicrobial susceptibility pattern documented resistance of 48.9% of isolates to cefoxitin (MRSA). 80.2% and 63.3% of isolates were resistant to penicillin and cotrimoxazole respectively. All isolates were susceptible to vancomycin. Conventional PCR was carried out for all 139 samples. 51.1% of isolates harbored mecA gene thus identified as MRSA. Conclusion: As expected PCR performed superior, however due to less cost, simplicity and easy availability, cefoxitin disc diffusion test holds a significance as an alternative to PCR for detection of MRSA on routine basis in a resource limited setting like ours.
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Primary peritoneal tumor: A rare malignancy with atypical presentation
Jyotsna Rani, Kavya Abhilashi, Pratibha Kumari, Satya Kumari, Sangeeta Pankaj, Vijayanand Choudhary
January-June 2020, 6(1):84-86
In females abdominal masses are mostly of uterine or ovarian origin. Rarely primary serous peritoneal tumors may present in similar fashion and should be considered as one of the differential diagnosis. A 62 year-old female patient presented to us with an abdominal mass. Her CA-125 was significantly elevated and the radiological picture was suggestive of solid adnexal mass with lymphadenopathy but no ascites. Optimal debulking surgery was performed including Total hysterectomy, bilateral oophorectomy, total omentectomy, lymphadenectomy and appendectomy. Histopathological examination revealed the excised specimen possessing characteristics of metastatic adenocarcinoma of mullerian origin however uterus and adnexa were unremarkable. After excluding other primary causes of metastatic adenocarcinoma, diagnosis of a primary peritoneal carcinoma was finally established. The objective of sharing this case is to emphasize over keeping PSPC in mind while establishing diagnosis of abdominal tumor without ascites for better management and patient outcome.
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Malignant peritoneal mesothelioma: A case report
Kavya Abhilashi, Bipin Kumar, Jyotsna Rani, Pratibha Kumari, Satya Kumari, Sangeeta Pankaj
January-June 2020, 6(1):92-93
Mesothelioma is a rare condition with 1 in 1 million incidences. Pleura being the commonest site followed by peritoneum. Malignant peritoneal mesothelioma (MPM) presents difficulties and delay in diagnosis due to non-specific symptoms. Here we present a case of 22 year old female who presented with the complaints of abdominal pain and distension. No history of asbestos exposure was reported. A lump was palpable on abdominal and pelvic examination. Computed tomography (CT) scan was suggestive of large solid tumour with fat stranding. Laparotomy was done and a solid mass lesion seen on left side mesentery attached to bowel. The mass was removed. Final diagnosis was possible with histopathological documentation of tumor characteristics, which were consistent with dictating a mesothelial origin.
  82 4 -
A clinical study of abdominal wound dehiscence with emphasis on its risk factors
Pratibha Kumari, Pravin Kumar, Satya Kumari, Sangeeta Pankaj
January-June 2020, 6(1):34-37
Objective : Abdominal wound dehiscence (AWD) is a terminology which is commonly used to explain partial or complete disruption of abdominal wound closure with or without protrusion of abdominal contents. It is among the most feared post operative complications faced by surgeons and is of greatest regard because of risk of burst abdomen, with mortality rates reported as high as 45%. Incidence in literature ranges from 0.4% to 3.5%. This study is designed to highlight the risk factors associated with wound dehiscence, the incidence rate and curative measures to prevent or reduce the occurrence of wound dehiscence and to predict the outcome of the management of abdominal wound dehiscence. Material and Methods : This retrospective study was done in which total number of 50 Patients admitted in the department of gynecological oncology who underwent routine laparotomies and who developed abdominal wound dehiscence were included in the study. Results : A total of 50 patients who developed wound dehiscence were included in the study, Out of these, 05 patients had developed complete disruption of abdominal wound (burst abdomen). 45 (90%) cases had the dehiscence occurring in laparotomies done for malignancy cases. Incidence was highest in cases of midline incision. Conclusion : Burst abdomen is a serious sequel of impaired wound healing. It occurs most commonly in the 31-40 year age group, predominately in laparotomy for malignancy and vertical midline abdominal incisions. Many factors can pre-dispose to this grave complication. Knowledge of the more common mechanisms and how to avoid or overcome these hazards should help to reduce the incidence of this dangerous complication.
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Clinical manifestations and complications of scrub typhus: A study from tertiary care centre in Bihar
Anwar Alam, Md Shahid Iqubal, Pallavi Anand, Ritika Singh, Awanish Kumar Singh
January-June 2020, 6(1):62-65
Background: Scrub typhus is a rickettsial infection that can be life threatening. There are several outbreaks of scrub typhus have been reported from different parts of India, but still clinicians are not much aware of this. We studied the diversity of clinical manifestations, laboratory investigations, complications and outcomes of scrub typhus in a tertiary care hospital. Materials and Methods: All the cases of acute febrile illness diagnosed as scrub typhus over a period of 10 months (march 2018 to December 2018) were analysed. Diagnosis was based on positive Weil-Felix with titre of ? 1:80. Results: A total of 13 cases of scrub were diagnosed and analysed during the study period. The most common symptoms among the patients were fever in 100% cases, headache, seizure and altered sensorium in 61.5% cases. Other symptoms were nausea, vomiting, breathlessness and urinary symptoms. The pathognomonic features such as eschar was seen in only one case (7%). On investigations, deranged liver function tests (LFT) were present in 61% of cases and deranged renal function tests (RFT) were present in 38% of patients. Thrombocytopenia (92%), meningoencephalitis (61%), acute respiratory distress syndrome (ARDS) (30%) were common complications of scrub typhus in this study. All patients responded dramatically to doxycycline and there was no mortality in this study. Conclusion:- Scrub typhus should be considered as an important differential diagnosis of acute febrile illness if it is associated with thrombocytopenia, deranged LFT and deranged RFT. Although eschar is pathognomonic of scrub typhus, even in the absence of eschar and lymphadenopathy a high index of suspicion and empirical addition of doxycycline is crucial for decreasing mortality.
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Long upper pouch overlapping with lower pouch associated with esophageal atresia and trachea-Esophageal fistula
Zaheer hasan, Digamber Choubey, Vinit Kumar Thakur, Vijayendra Kumar, Ramdhani Yadav, Sandeep Kumar Rahul, Ramjee Prasad
January-June 2020, 6(1):96-97
Esophageal atresia (EA) with tracheoesophageal fistula (TEF) is one of the common neonatal surgical emergencies presenting with excessive salivation, and inability to swallow or pass a firm cathether into the stomach. The present report describes an unusual case of EA-TEF with a long upper esophageal pouch that overlaps the lower esophageal pouch reaching just above the dome of diaphragm. The lower pouch fistula was present at the usual site (Kluth type IIIb6). The redundant upper pouch was excised and TEF was ligated and divided, and an end-to-end esophageal anastomosis was performed. In the post-operative period baby developed sepsis and could not be revived. However, the case was described due to rarity of presentation.
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comparison of maintenance strategy in EGFR mutation positive and negative locally advanced and metastatic non squamous lung carcinoma.A tertiary center experience
Avinash Pandey, Vanita Noronha, Amit Joshi, Kumar Prabhash
January-June 2020, 6(1):26-30
Background and Rationale: Induction platin based doublet is standard of care in locally advanced and metastatic NSCLC. Maintenance pemetrexed and tyrosine kinase inhibitior both have shown to improve outcomes in patients with favourable response to induction therapy. Aim: To evaluate and compare outcomes with maintenance pemetrexed and maintenance TKI in EGFR mutation positive and negative patients. Objectives: To calculate and compare Progression free survival, overall survival and factor affecting outcomes with maintenance pemetrexed and maintenance TKI. Material and Methods: Data of patients with locally advanced and metastatic non squamous NSCLC who received induction pemetrexed platin doublet were retrieved from prospectively maintained lung cancer database registered between June 2011 and March 2014.Patients who received maintenance pemetrexed and maintenance TKI being EGFR mutation negative and positive respectively were chosen for final analysis. Kaplan Meir survival analysis was used for Progression free survival and overall survival. Log rank test was used to evaluate and compare factors affecting outcome. Result: Median follow up is 16 months. Out of 268 patients who had favourable response to induction pemetrexed platin doublet, EGFR mutation result was available in 238 (89%) patients. Patients who were EGFRF mutation negative and received maintenance pemetrexed were 138, while those with EGFR mutation positive and received maintenance TKI were 80.Median PFS with maintenance TKI in EGFR mutation positive patients was significantly better than that of maintenance pemetrexed in EGFR mutation negative (11 months versus 8 months; p=0.01), while the overall survival was 19 months and 20 months respectively. Older age, females, non smoker, no baseline effusion and partial response to induction did better with maintenance TKI. Conclusion: Maintenance TKI in EGFR mutation positive non squamous NSCLC delays disease progression more than maintenance pemetrexed in EGFR mutation negative NSCLC. Both option fare favourably to improve outcomes after response to induction therapy.
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Preoperative anxiety in patients posted first in operating list to patients posted late in operating list: A randomized control trial
Swati Singh, Manisha Sharma, Swati Singh
January-June 2020, 6(1):31-33
Background: Preoperative anxiety is not uncommon in patients posted for surgery. The relative position of patients in operating list can be one of the cause of anxiety. Aim: To compare anxiety in patients posted first in operating list to patients posted late in operating list. Materials & Methods: The influence of the relative position in the operating list on pre-operative anxiety was studied in 400 American Society of Anesthesiologist grade 1 patients undergoing major surgery. Two hundred patients were placed first on the operating list (group 1) and 200 were given a time 5 hour later (group 2). Each patient was visited on the evening prior to surgery and again on the morning of surgery. Anxiety was measured at each visit by objective criteria and part 1 of the State-Trait Anxiety Inventory (STAI) questionnaire. Results: In both groups the pulse rate, systolic blood pressure , respiratory rate and STAI questionnaire score were significantly higher on the morning of surgery than on the evening prior to surgery(p<0.05). The increase in pulse rate and systolic blood pressure, respiratory rate was comparable in the two groups. The evening anxiety scores were not correlated with those on the morning visit and could not predict them. Conclusion: There is no effect on anxiety status of the patient due to relative position of patient in operating list.
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Pattern of cervical lymph node metastasis for therapeutic decision-making in squamous cell carcinoma of buccal mucosa
Sanjeet Kumar Singh, Manish Kumar, Shashi Singh Pawar, Ashish Ranjan Singh, Anita Kumari
January-June 2020, 6(1):46-49
A retrospective review of the records of previously treated patients squamous cell carcinoma of buccal mucosa, oral cavity was undertaken from May, 2017 through April, 2018. The cases were studied to ascertain the pattern of lymph node metastases (NM) in neck level. The patients were grouped into three categories, by clinical neck status at the time of neck dissection: elective dissection (ED) in the NO neck, immediate therapeutic dissection (ITD) in the N+ neck, and subsequent therapeutic dissection (STD) in the neck observed which converted clinically to N+. The data support the trend toward selective limited neck dissection in both NO and N+ patients. Further, they provide the foundation for planning of future prospective trials to assess the efficacy of modifications in the extent of neck dissection.
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Multi-drug resistant gram-negative bacilli in lower respiratory tract infections at IGIMS, Patna: A tertiary care hospital
Md Shabbir Azad, Namrata Kumari, Richa Sinha, Kumar Saurabh, Shivendra Kumar Shahi
January-June 2020, 6(1):50-53
Background: Lower respiratory tract infections are among important causes of morbidity and mortality for all age groups. The emergence of multidrug resistant gram-negative organism (MDRO) is an issue of increasing concern. Aims & Objectives: This study was focused on obtaining a comprehensive insight into the microbial profile, its prevalence and the susceptibility patterns of the gram negative bacilli isolates including multi drug resistance in lower respiratory tract infections. Materials and Methods: A total of 1144 respiratory samples (sputum, broncho-alveolar lavage fluid and endotracheal aspirate) were processed for microscopy, culture and susceptibility testing following standard laboratory protocols. Multidrug resistant gram-negative bacilli causing lower respiratory tract infections were studied for their causation of disease. Results: A total of 349 gram-negative pathogens were isolated from respiratory samples during the study period. Among these 213 (61%) gram-negative pathogens were found to be multidrug resistant. Although the percentage of multi drug resistance was higher among Escherichia coli (88% MDRO) and Acinetobacter spp. (80% MDRO), the predominant multidrug resistant gram-negative bacilli isolated were Klebsiella spp. 119 (34%) and Pseudomonas spp. 108 (30%). Among MDROs, other isolates were Citrobacter spp., Enerobacter spp., Proteus spp. and Providentia spp. Conclusion: A large majority of pathogenic gram-negative bacilli isolated were found to be the multidrug resistant. Regular surveillance which directs appropriate empirical therapy and good clinico-microbiological workup of each case of lower respiratory tract infection can reduce the morbidity and mortality associated with MDROs. Bacteriological diagnosis and antibiotic resistance surveillance are indispensible in the effective management of lower respiratory tract infections.
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Clinical evaluation and management strategy of hospitalized patients with atrial fibrillation at tertiary care centre -IGIMS, Patna, Bihar
Ravi Vishnu Prasad, Soni Talreja, Nirav Kumar, BP Singh
July-December 2019, 5(2):150-154
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia diagnosed in the general population. The study was conducted at tertiary care centre-IGIMS, Patna to study clinical profile of hospitalized AF patients and various management strategies employed in these patients. A total of 132 patients with AF were enrolled in the study. The most patients fall below 50- year of age group. Elderly (>60 years) age group comprise 24% of AF patients. There was marginal female predominance - female (53.8%) and male patients (46.2%) with ratio of 1.2: 1. Rheumatic heart disease (RHD) was the most common etiology of AF (59.8%), followed by coronary artery disease(CAD) (11.3%), hypertension (7.5%) and cardiomyopathy (6%). Rheumatic etiology commonly presented below 50 years but CAD and hypertension presented after 50 years. Palpitation was the most common presentation (88%), followed by dyspnea (56%), chest pain (40%), pedal edema (32%) and hypotension (28%). The rate control strategy was adapted in 76 % cases. Stroke prevention strategy was oral anticoagulation (warfarin or acitrom) in 63.6% cases and antiplatelets in 30.3% patients. The beta blockers (59%) were the most common pharmacological treatment followed by amiodarone (39.9%), calcium channel blockers and digoxin (31.8% each). Novel oral anticoagulants (NOAC) were used in 10 patients of non- valvular origin. Heart failure (49.2%) was most common complication noted in AF patients followed by angina (25%), hemoptysis (18.2%) and stroke (7.5%). Among valvular involvement, most patients have mitral valve involvement. Out of 79 cases, 88% have mitral valve involvement ranging from mild to severe variety in isolation and combinations with other valves. Commonest cause was mixed lesion (mitral stenosis with mitral regurgitation). AF with valvular heart disease has shown maximum LA enlargement, normal LV Ejection fraction and predominance LA clot as compared to non valvular AF.
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Femoral nerve block versus fentanyl & dexmedetomidine analgesia for positioning patients with fracture femur for administering subarachnoid block: A comparative study
Mahima Lakhanpal, Ritesh Kumar, Sanjeev Kumar, Harshwardhan , KH Raghwendra
July-December 2019, 5(2):167-172
Fracture of the femur is one of the common traumatic injuries encountered in the emergency departments. Satisfactory pain relief prior to subarachnoid block for surgical interferenceis desirable for patient’s co-operation. Such relief can be provided byuse of systemic analgesics, local anaesthesia, or femoral nerve blocks. This study was conducted on 60 patients after randomly allocation into two groups of 30 patients each. Group A has been received the femoral nerve block with 20 ml of 0.5% bupivacaine 15 minutes before the subarachnoid block while group B has been received intravenous fentanyl at 0.5^g/kg single shot & intravenous dexmedetomidine 1 ^g/kg over 15 minutes before the subarachnoid block and concluded that femoral nerve blocks produces a more intense analgesia with fewer side effects than systemic analgesic.
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Tunica vaginalis flap in hypospadias repair: A preliminary experience
Digamber Chaubey, Sandip K Rahu, Vijayendra Kumar, Ramdhani Yadav, Vinit K Thakur, Zaheer Hasan, Ramjee Prasad, Nitesh , Rupesh Keshri
January-June 2020, 6(1):75-77
Aims and Objectives : To investígate the results of Hypospadias repair in patients having Tunica Vaginalis flap as a second layer after urethral reconstruction Methods: A prospective study on all patients of Hypospadias who had Tunica Vaginalis used as a second layer after urethroplasty was conducted between 01.11.2017 to 31.10.2019. Data regarding nature of hypospadias, any previous surgery, duration of surgery and any postoperative complications were collected. Results collected were analyzed. Results: A total of ten patients had the use of Tunica Vaginalis flap during surgery. Among these, 90% had proximal hypospadias and 10% had distal hypospadias. 50% patients (4/10 proximal & 1/10 distal) had this flap used in Redo-urethroplasty cases with 100% success. 40% cases had this flap used during primary urethroplasty, of which 50% cases had successful repair and other 50% had fistula formation. One patient who had Bracka-stage 2 surgery with this flap reported good cosmetic results. Conclusion: Tunica Vaginalis Flap is a well vascularized, locally available flap that can be used in difficult cases of Hypospadias with tissue deficiency with good results and minimal complications.
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Primary management of anorectal malformation: Initial result at a tertiary care centre
Zaheer Hasan, Vijayendra Kumar, Ramdhani Yadav, Sandip Kumar Rahul, Digamber Chaubey, Ramjee Prasad, Vinit Kumar Thakur
July-December 2019, 5(2):131-134
Background : Anorectal malformations [ARM] are common neonatal surgical emergencies. They can be treated either by staged procedure or by single-stage procedure. In the present study, we have performed single-stage surgery of ARM in both male and female. Materials and Method: Retrospective review of cases of ARM operated over 3 years in the Department of Paediatric surgery at a tertiary care centre from January 2015 to December 2018 was done. In this study, we compared the results of single stage repair of Anorectal malformation (category1) with that of staged procedure performed earlier (category 2).In male babies 43 patients were operated by primary PSARP (posterior sagittal anorectoplasty) and remaining 11 by primary APP (abdomino-perineal pull through) procedure. Out of 65 female patients, PSARP was performed in 39 (60%) cases of recto vestibular fistula, ASARP in 23 (29.2%), Primary Abdomino-perineal pull-through in 4 (6.1%) cases of common cloaca. The result of this procedure was compared with that of staged procedure. (Category 2) Result : Mean post- operative hospital stay in category 1 was 11 days and 32 days in category 2. Mean duration of surgery in category 1 was 1hour and 15 minutes and 3 and half hours in category 2 that included initial colostomy, PASRP or APP and colostomy closure. In category 1, 41 (75.9%) cases had stool frequency 3- 5 per day while in category 2, 20 (51%) patients had the same frequency at the age of three years which was found to be statistically significant (P value? 0.001). Similar findings were observed in female patients. Conclusion : Single-stage surgical repair of Anorectal malformation in both male and female patient are reliable and can be safely performed with advancement of surgical expertise and better anaesthetic support with few exceptions. Early results are encouraging. However, long term study is required for its justification.
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A randomized controlled trial comparing outcomes of K wire removal at 3weeks vs. 6weeks of lateral condyle fractures of humerus in children
Anand Shankar, Santosh Kumar, Raju Rijal, Shiv Raj Paneru, Reetesh Roshan
January-June 2020, 6(1):70-74
Background & objectives: Lateral condyle humerus fractures are the most common distal humeral epiphyseal fracture. They are usually associated with relatively high rate of complications and the results of non-operative management are not always good. So a randomised controlled trial comparing outcomes of K-wire removal at three weeks vs. six weeks for lateral condyle fractures of humerus in children was done. Methods: All patients aged one to fourteen years with traumatic fractures of the lateral condyle fracture of humerus presenting to the Department of Orthopaedics, BPKIHS giving written consent for the trial were included and randomised in two groups. Fractures duration more than seven days old were excluded. Cases taken were put and randomized according to random excel number generation. After open reduction and internal fixation the k-wire removed at three weeks in one group and at six weeks in another group. The clinic radiological outcomes were evaluated and noted for infection and radiological union. The collected data were evaluated and various statistical tests applied. P value of less than 0.05 was taken as significant. Results: We found statistically significant difference in comparison of union with different age groups (p<0.05). Other parameters were statistically not significant. Three patients developed skin infection, one in group A and two in group B . Three patients did not show radiological union at the expected time of k-wire removal two in group A one in group B and all the cases were above ten years of age. Conclusion: Our study has shown that fracture of lateral condyle of humerus united earlier than 6 weeks and shows no significant difference in short term outcome of K-wire and back slab removal at 3 weeks or at 6 weeks regarding union and infection.
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A study to evaluate the pattern, cause and type of traumatic major limb amputation in Eastern Nepal
Anand Shankar, Santosh Kumar, Raju Rijal, Shiv Raj Paneru, Reetesh Roshan
January-June 2020, 6(1):78-83
Background & objectives: The amputation of injured extremities has been performed for over 2,500 years. Despite the advances in limb prosthetic technology, traumatic amputations continue to have a major impact on daily activities and subsequent quality of life. The loss of a limb often has profound economic, social and psychological effects on the patient and their family. However in many cases, amputation of the limb is the only viable option to save the patient’s life. We also did a study to evaluate the pattern of amputation after major trauma and its outccome. Methods: Total sixteen patients were included in the study. All patientswith traumatic injury to the limb leading to non-viability of the major part of the limb (above wrist and above ankle) coming to emergency of BPKIHS giving written consent for the trial were included in the study.All patients underwent emergency amputation. The clinico-radiological outcomes were evaluated for involved limb, level of involvement, cause, active bleeding, Blood pressure, Pallor, infection, type of amputation, infection, phantom pain, phantom limb, Mangled Extremity Severity Score. Collected data were evaluated and various statistical tests applied. Results : Upper limb involvement is more than lower limb, crush injury is more common than road traffic accident, only one case has Ischemic heart disease, only two patients had intact neurology, two case had compartment syndrome, none of the patients had viable distal limb, only three closed amputation was performed primarily, post operatively three had infection, five had phantom limb and pain none of the cases had change of job. Conclusion : Traumatic major limb amputation can occur both in upper and lower limb. Better prosthetic fitting and rehabilitation is needed to make the patient conduct his near normal life style.
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Study of ascorbic acid levels in hypothyroid patients
Ranjana Kumari, Poonam Sinha, Ravi Shekhar
July-December 2019, 5(2):144-146
Introduction : Ascorbic acid has role in wound healing, collagen formation, enzymatic action, anti-oxidants, hormone action, synthesis of neurotransmitters etc. Thyroid hormone regulates a wide range of genes and plays a crucial role in the regulation of mitochondrial oxidative metabolism. Disorders of thyroid hormones, overt hyperthyroidism and hypothyroidism represent opposite clinical conditions. Increased concentrations of thyroid hormones result in increased production of large quantities of reactive oxygen species which enhance oxidative stress, even low concentration of thyroid hormone ie hypothyroidism has been associated with increased oxidative stress, but is controversial. This study was aimed to correlate the ascorbic acid level in patients of thyroid disorder. Material and methods : The blood samples of 150 patients were collected after the analysis of thyroid profile. The samples of the patients in the study were categorized in three groups- euthyroid, subclinical hypothyroid and overt hypothyroid based on free T3, free T4 and thyroid stimulating hormone (TSH). The ascorbic acid was estimated using 2,4-Dinitrophenyl hydrazine method. Result : The ascorbic acid levels in the patients of hypothyroid disorder was ranging from 0.43-2.60 mg/dl Conclusion : There was no correlation observed between ascorbic acid and hypothyroid disorders in the study. The dietary intake of ascorbic acid in the study group must be adequate.
  22 1 -
Unilateral ultrasound guided - Erector spinae plane block as an independent technique for right anterolateral chest wall lipoma
Swati , Swati Singh, Swati Shiromani
July-December 2019, 5(2):185-186
Ultrasound guided -Erector spinae plane block (US-ESP)has been reported till now along with general anesthesia for postoperative pain management. We report here using the same as an independent technique for excision of a tumour present on right anterolateral chest wall.
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Assessment of serum Vitamin D level in patient of mild to moderate asthma
Sunita , Rekha Kumari, Ashok Sharan, Manish Shankar
July-December 2019, 5(2):135-138
Background: Asthma is one of the most common chronic disease affecting millions of population worldwide. It is a chronic respiratory disease characterized by increased airway inflammation and hyper-responsiveness. Several studies shows that deficiency of Vitamin D (25-OH) is related to occurrence of pulmonary diseases as well as reduced lung function and increased airway inflammation leading to poor results in asthmatic patients. In context to India, there were fewer studies which have evaluated the relationship between vitamin D (25- OH) and pulmonary function and its role in asthma. Thus, the present study was undertaken to study the role of vitamin D deficiency or insufficiency in mild to moderate asthmatic patients. Aims: To assess the serum vitamin D(25-OH) level in mild to moderate asthmatic patients. Material & Methods: The present study included 100 subjects of either sex with age group of 15 - 40 years. They were divided into two groups. Group A (control) include 40 healthy individual, and Group B include 60 asthmatic patients based upon GINA guidelines. Pulmonary function test and Vitamin D analysis were performed in both the groups. Results: The study showed that serum vitamin D level was significantly decreased in asthmatic patients when compared with the control group (p<0.01). Conclusion: Vitamin D deficiency is relatively frequent in asthmatic patients and there is a significant inverse relationship between serum vitamin D and severity of asthma symptoms. Therefore, measuring serum levels of vitamin D should be considered in the routine assessment of asthmatic patients. It may serve as a marker of asthma severity.
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Comparative Study of Procalcitonin and C-Reactive Protein Concentrations as Early Marker of Neonatal Sepsis : A Hospital Based Study
Kumar Rahul, Sunil Kishore, Deepak Kumar, Manish Kumar, Anand kumar Gupta, Amit Kumar, Shambahvi Sharan, Jayant Prakash
January-June 2019, 5(1):72-77
Background: Neonatal sepsis is one of the important causes of neonatal morbidity and mortality particularly in the developing countries. In order to avoid unnecessary NICU admissions and antibiotic therapies, it is very important to make early diagnosis of neonatal sepsis with utmost accuracy. Blood culture though gold standard requires lot of time for diagnosis, hence it's necessary to rely on early diagnostic markers such as blood counts, micro-erythrocyte sedimentation rate(ESR), C reactive protein (CRP), Procalcitonin(PCT). Out of the early diagnostic markers available, CRP and pro-calcitonin has the highest sensitivity and specificity rates. Methods: The present study was a hospital based prospective observational study Conducted for a period of one year from 1year (May 2016- April 2017) On neonates admitted to NICU, at Kurji Holy Family Hospital, Patna Bihar which is a tertiary care referral hospital for children. Proper consent was taken from the parents of all neonates. Specimen of blood obtained from each neonate with proper aseptic conditions and prior to commencement of antibiotics. Results: Total of 155 neonates satisfying the inclusion criteria were taken in the study group, based on the above criteria, they were grouped into 3 categories, 93/150 neonates had clinical/no sepsis, 45/155 had probable sepsis and definite sepsis was found in 17/155 neonates. Appropriate investigations were done. Blood culture was positive in 17 neonates. Procalcitonin was negative in 96 neonates, positive (>0.5ng/ml) in 59 neonates, PCT is positive in 12/17 blood culture positive cases. CRP was positive in 43/155 cases, and negative in 112/155 cases. CRP was positive in 11/17 blood culture positive cases. Procalcitonin in comparison with CRP, sensitivity was100%, specificity was 85.72%, positive predictive value (PPV) was 72.88%, and negative predictive value (NPV) was 100%. CRP in comparison with Procalcitonin, sensitivity was 72.88%, specificity was 100%, PPV was 100%, and NPV was 85.72%. Conclusions: Procalcitonin in comparison with CRP shows better sensitivity and negative predictive value.
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Pterygium Surgery with Conjunctival Autograft(CAG)- No glue, no stitch technique
Gyan Bhaskar, Anita Ambastha, Bibhuti P Sinha, MS Ali, Piyush Kumar, Rajnee Sinha
July-December 2019, 5(2):155-157
Introduction : Suturesare used to fixed the graft in pterygium surgery not only time-consuming process but also lead to local complications such as discomfort, scarring, granuloma formation, or infection. A Plasma-derived products fibrin glue may produce possible hypersensitivity reactions, post-operative foreign body sensation. In this study a simple method was described for achieving conjunctival autograft adherence during pterygium surgeryusing autologous blood as a bio -adhesive to avoid potential complications associated with the use of fibrin glue or sutures. Aim of this study was to know the outcome of pterygium surgery with limbal conjunctival autograft without sutures or fibrin glue. Material and methods: It was a prospective interventional study on 40 eyes of 40 patients who presented with primary pterygium to our outpatient department fulfilling the inclusion and exclusion criteria.Post-operative Examination done on Day- 1, end of 1st,2ndand 4th week then after 3rd and 6thmonth. On each visit assessment was done for Graft displacement, Retraction, Inflammatory reaction,Graft failure, Discomfort, Recurrenceand Success rate was assessed.Data was collected and analysed. Results : Outof 40 patients, age of patients ranges from 15 to 73years, male was 30 and female pt. was 10 and right eye was involved in 24 cases and left eye in 16 cases. average surgical time was 18.50±2.00 min.successrate was 95%, one case had graft retraction and one had graft displacement. Conclusion : This is the simple technique for pterygium surgery with comparable success rate, cost effective, quick and also prevent potential adverse reactions encountered with the use of foreign materials.
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Ultrasound and hormonal (Thyroid stimulating hormone and prolactin) evaluation in mastalgia
Syed Nazneen, Anjili Kumari, Jyotsna Kashyap, Anita Kumari, Jaya Kumari, Pratibha Kumari, Sangeeta Pankaj
July-December 2019, 5(2):158-162
Background: Breast pain (mastalgia) is a significant issue within the general population warranting increased investigation, awareness, and treatment. This study is being performed to study role of ultrasound and to evaluate Thyroid Stimulating Hormone (TSH) and Prolactin levels in our patient population with the complaint of mastalgia . Methods: This was a prospective observational study in which 100 patients of mastalgia were included. Pregnant and lactating women, known cases of breast cancer, patients with palpable breast lumps and those with breast abscesses, women on antidepressants, antihypertensives and oral contraceptive pills were excluded from the study. Ultrasound findings and serum TSH and Prolactin levels were assessed in all patients included in the study. Those with hypothyroidism and hyperprolactinemia were treated with thyroxine and bromocryptine respectively and the response to treatment observed. Results: Mean age of women in study was 35.37 years. Most of them (90%) were multiparous. Ultrasound findings included 57% normal results, 32% benign cystic disease of the breast, 6% small fibroadenomas, 4% duct ectasia and 1 case of filariasis of breast. Out of 100, 18 women (18%) had hypothyroidism (TSH >5). 8 (8%) women in our study with mastalgia had elevated serum prolactin levels. Decrease in mastalgia in 15 women with hypothyroidism and in all women with hyperprolactinemia was observed after appropriate therapy. Conclusion: Sonological findings can be the baseline while starting the treatment in patients with mastalgia. Our study strengthens the association of thyroid dysfunction and raised prolactin levels with mastalgia. Women with mastalgia should be screened for hypothyroidism and for raised serum prolactin levels because simple correction of these changes may result in clinical improvement.
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Retained broken epidural catheter: What to do?
Kriti , Nidhi Arun, Mukesh Kumar, Sangeeta Pankaj
January-June 2020, 6(1):90-91
Background: Epidural anaesthesia / analgesia is a safe and routinely performed procedure by the anaesthesiologists. Although rare, but there have been many instances of epidural catheter breakage. We present a case report of We present a case report of a 38 years old female posted for vaginal hysterectomy under combined spinal epidural anesthesia. During the procedure, while negotiating the epidural catheter in epidural space, it got sheared off at 5cm mark inside the back. Severed catheter in the back could not be visualized under C- arm digital X ray. Plan for spinal epidural lumbar anesthesia was abandoned and surgery was performed under general anesthesia which was uneventful. CT followed by USG was done to locate the severed catheter on 2nd post-operative day. Severed catheter could not be visualized and surgical removal was not attempted. The patient was informed of the event and counselled to report in case of any adverse symptoms. Conclusion: We want to convey that surgical removal of retained broken catheter should not be attempted routinely as it could provide more complication than leaving it in situ.
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Tibial spine avulsions. Treatment by arthroscopic suture fixation
Manish Kumar, Anjani Kumar, Jaya Sharma, Saurabh Kumar, Pankaj Kumar Singh
July-December 2019, 5(2):139-143
Introduction : Tibial spine avulsions are intra-articular fractures .There is avulsion of ACL insertion on the tibial plateau and it behaves like a torn ACL.[1],[2] It was first described by Poncet in 1875.The treatment modality has undergone a great change since then. Arthroscopic fixation is taking place of nonoperative treatment.[3]
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Giant cell tumor of distal end ulna treated by en BLOC resection: A case series
Rajeev kumar, Kumar Chandan, GD Sharma, Manish kumar, Shiksha , Santosh kumar
January-June 2020, 6(1):54-56
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