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Rain rain go away: A case report of lady with ombrophobia
Niska Sinha, Rajesh Kumar, Krishna Kumar Singh
January-June 2017, 3(1):48-49
Phobias occur in several forms. The two main types of phobias are social phobia and specific phobia. A marked specific fear of an object or situation is called a specific phobia. Ombrophobia or pluviophobia is a type of natural environmental subtype of specific phobia. We report a case of ombrophobia in a lady with an interesting psychopathology and treatment outcomes.
  1,410 16 -
Evaluation of serum prolactin, FSH and LH in infertile females with thyroid disorders
Vibha Sushilendu, Kalpana Singh, Uday Kumar, Rekha Kumari
January-June 2020, 6(1):18-20
Background: Infertility represents a common condition, with important medical, economic and psychological implications. Thyroid dysfunction interferes with human reproductive physiology. It reduces the likelihood of pregnancy and adversely affects pregnancy outcome, thus becoming relevant in the algorithm of reproductive dysfunction. Aims and objectives: To estimate serum prolactin, FSH and LH in hypo, hyper and euthyroid female subjects and find their association with thyroid status. Material methods: a cross-sectional observational study was done . 100 infertile females of age group 20-40 years, who were then subdivided into euthyroid, hypothyroid and hyperthyroid cases Serum Prolactin, FSH, LH,TSH,TotT3,TotT4 were estimated by Chemi-luminescence immunoassay method Results: The infertile women with hypothyroidism had significantly higher prolactin levels than the other groups Conclusion: TSH has a positive correlation with serum Prolactin level.Assessment of serum TSH and prolactin levels should be made mandatory in the work up of all infertile women, especially those presenting with menstrual irregularities
  881 242 -
A Review of CAD -CAM in Dentistry
Krishnan Amudhalakshmi, Arthi Sethalakhsmi, Krishna Prasad Biswas
July-December 2016, 2(2):16-21
  979 99 -
“A comparative evaluation of intraarticular bupivacaine and neostigmine with bupivacaine and fentanyl for post operative analgesia in arthroscopic knee surgeries: A prospective randomized study”
Raj Bahadur Singh, Mohd Asim Rasheed, Sanjay Choubey, Saurav Shekhar, Ritu Singh
January-June 2020, 6(1):13-17
Context : Now a days arthroscopic surgeries are very commonly performed and are associated with post-op pain. Various method of relieving pain is present like NSAIDS, Opiods, peripheral nerve blocks and local anaesthetics. In this study we are trying to search a novel method to control post operative pain . The present study aims to compare the effects of intraarticularly instilled Bupivacaine and Neostigmine with Bupivacaine and Fentanyl for pain relief following knee arthroscopic surgery. Aims and objective : To compare the efficacy of bupivacaine and Fentanyl with bupivacaine and Neostigmine administered intraarticularly for postoperative pain relief in patients undergoing knee arthroscopic surgeries and comparing duration of analgesia, hemodynamic parameter and side effects if any. Material and Method- It is a prospective randomized study. Sample size was 75 divided in three groups. ◼ GROUP P - Intraarticular injection 19ml of 0.25% bupivacaine as control group + 1 ml NS ◼ GROUP N- Intraarticular injection of 19 ml of 0.25% bupivacaine + 1 ml (500 mcg ) of neostigmine. ◼ GROUP F- Intraarticular injection of 20ml of 0.25% bupivacaine + 1 ml (50 mcg )of fentanyl. Result : Demographic variable amongst all three groups were matched. In this study mean duration of analgesia time in group P is significantly lower than group N and Group F (p value < .05)however duration of analgesia time in Group N and Group F are comparable but Group N showed slightly higher duration of Analgesia. Conclusion : Thus, we found that addition of neostigmine or fentanyl to bupivacaine increases the duration of analgesia in the post-operative period.
  953 99 -
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.
  927 49 -
Retrospective analysis of clinico-pathological characteristics of ovarian cancer and audit of cytoreductive surgery done at tertiary care center in Eastern India
Anjili Kumari, Vijayanand Choudhary, Sangeeta Pankaj, Anita Kumari, Jaya Kumari, Simmi Kumari, Sayed Nazneen, Jyotsna Rani, Pratibha Kumari, Kavya Abhilashi, Satya Kumari
January-June 2020, 6(1):21-25
Ovarian malignancy is a common and highly morbid cancer of females. Advanced stage ovarian cancer warrants extensive surgery to achieve the goal of optimal cytoreduction i.e. no residual macroscopic disease, which is an independent prognostic factor contributing to survival of these patients population. The aim of index study is to describe the incidence, pattern and management of ovarian cancer at a tertiary care center in eastern India and also audit the surgeon’s performance in treating these patients surgically and the improvements if any, over a period of 7 years. No such studies focusing on analysis of pattern of ovarian cancer presentation and the optimal surgery rates alongwith outcomes have yet been published from this region. Method: A retrospective analysis of all operated cases of histologically proven ovarian cancer at our institute from December 2009 to March 2016 was carried out. Results: Ovarian cancer was the predominant cohort undergoing surgery for gynecological malignancies. The most common variant was epithelial ovarian cancer and 30 to 50 years was the commonest age group afflicted. The rate of surgery has been increasing consistently over the years and the rate of achieving optimal cytoreduction has improved significantly. The operability was better in the patients receiving neoadjuvant chemotherapy but the primary surgery arm has also seen improvement in achieving optimal cytoreduction. The probability of achieving R Zero has improved from 0.5 in 2009 to 0.95 in 2016. Conclusion: The operative outcome and quality of life of patients has shown considerable improvement in hand of surgeon dealing with such cases at a high volume tertiary care center. This emphasizes upon the significance and need for well equipped, sophisticated, multi-disciplinary tertiary care center catering to population with a high propensity and prevalence of Gynaecological malignancies.
  904 47 -
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.
  865 57 -
Pedophilic Disorder: A Case Report
Niska Sinha, Rajesh Kumar, Krishna Kumar Singh
January-June 2019, 5(1):87-88
Pedophilic disorder is a paraphilic disorder in a person atleast 16 years or older and is characterised by sexual fantasies and attraction to children who have not yet attained puberty. These fantasies are acted upon causing marked distress or interpersonal difficulties in patient and risks the child victims well being, negatively affecting their psychosocial development. It remains a challenge for clinicians and researchers in terms of under reporting and effective treatment measures. In the present case we report a case with this disorder in order to better understand this clinical construct.
  871 44 -
Climate change and health: Medico-legal framework in India
Nandini Biswas
July-December 2019, 5(2):113-117
Amongst the ballistic missile politics, bitcoin slump, another predominant issue that needs serious redressal not only at international level, but also even at the national and domestic level is Climate Change. Climate Change is for real causing fundamental threat to health with both short and long-term effects. Melting glaciers, rising sea levels, global warming, severe drought, frequent wildfires are some of the effects of the problem. According to National Research Council, evidences of the effects of climate change have been found in tree rings, coral reefs, ocean sediments, and layers of sedimentary rocks. These evidences discloses the fact that the current warming is occurring ten times faster than the average rate of ice-age-recovery warming.[1] The causes of climate change are increased human activities of deforestation, industrialization, burning fossil fuels, carbon emissions by motor vehicles leading to rise in greenhouse gases. To address the problem of climate change at the international level, on 5th October 2016 the conditions for entry into force for Paris Agreement was laid. The Agreement entered into force on 4th November 2016 in accordance with its Article 21, Paragraph 1, which read as: “This Agreement shall enter into force on the thirtieth day after the date on which at least 55 Parties to the Convention accounting in total for at least an estimated 55 per cent of the total global greenhouse gas emissions have deposited their instruments of ratification, acceptance, approval or accession.” Till date, 185 state parties ratified out of 197 signatory parties in the Paris Agreement. Under the United Nations Framework Convention on Climate Change (UNFCCC) which aims to reduce greenhouse gas concentration at a predefined level with the support of the global community, Paris Agreement has successfully helped to remind the state parties that climate change is a common challenge wherein the global community has to identify, mitigate, strengthen and adapt their national and domestic policies. The emergent issue of climate change sees no territorial boundaries. The global community must wake up to the warning that this ‘tragedy of the commons’ should be recognized, mitigated and collective action towards sustainability should be observed at the international, national and domestic level.
  812 25 -
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.
  776 41 -
Management of dental trauma-how to manage lateral luxation injury
Drishti Kaushal, Krishna Prasad Biswas, Naveen Mishra
July-December 2019, 5(2):178-181
Traumatic dental injuries are a trivial dental issue affecting teeth and their supporting structures. This case report describes a clinical case of dental trauma in an 18 year old girl which resulted in laceration of upper lip along with affecting the dentition in the form of lateral luxation, subluxation, uncomplicated and complicated crown fracture in her anterior maxillary and mandibular dentition. The management included suturing of laceration followed by repositioning of teeth by digital pressure and stabilization of teeth with the help of a semi rigid splint, root canal treatment for tooth 11, 21 and 31 followed by removal of splint when the teeth were reportedly asymptomatic and composite build up to re-establish the aesthetics for the patient. The follow up was done up to 1 year and no periapical pathology or complications were observed and the patient was relatively asymptomatic thus indicating successful intervention.
  740 43 -
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.
  717 43 -
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.
  704 19 -
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.
  686 27 -
Effects of Ambient Air Pollution on Pulmonary Functions of Traffic Policemen
Tarun Kumar, Manish Kumar, Sunita , Pooja Sakshi, Ashok Sharan
January-June 2019, 5(1):42-45
Background: Air pollution is a major threat to human health. World Health Organization (WHO) estimated 4.2 million premature deaths due to ambient air pollution in 2016. It's a serious problem in metropolitan cities like Delhi, Patna and Gwalior in India. Average daily exposure of traffic policemen to dust particles and toxic gases from automobile exhaust exceeds about 8-10 hr/day. Aims: The purpose of this study was to determine the effects of ambient air pollution on pulmonary functions of the traffic policemen. Materials & Methods: A cross-sectional study with 100 traffic policemen was conducted. The inclusion criteria were non- smoker males, aged between 25-50 years, working for last 1-5 years in the traffic department. The exclusion criteria were history of respiratory or cardiovascular disease or declined participation. Anthropometric measurements of the subjects were taken as per standard protocols, approved by the WHO. Pulmonary functions of the traffic policemen were assessed by determination of Forced vital capacity (FVC), Forced expiratory volume in 1st second (FEV1), FEV1/FVC%, Peak expiratory flow rate (PEFR) and Forced expiratory flow during 25-75% of expiration (FEF25-75%) by using the nomogram of Indian settings with a computer based Spirometer, Spiro Excel manufactured by Medicaid Systems Pvt. Ltd. The association of percentage of predicted values of the pulmonary function parameters with the duration of exposure to air pollutants was analysed by using Pearson correlation. Results: There were significant correlation between the duration of exposure to ambient air pollution and pulmonary function parameters FEV1(r=-.041), FEV1/FVC% (r=-.349), PEFR (r=-.027), & FEF25-75% (r=-.401) expressed as correlation-coefficient (rvalue). Conclusion: The findings showed that prolonged exposure to ambient air pollution leads to a trend of development of obstructive features among traffic policemen.
  682 25 -
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.
  630 25 -
A Comparative Study on Role of Grief Counselors & Trained Nurses and their Impact on Increasing and Sustaining Eye Donation in an Institutional Settings in India
Radhika Tandon, Rajesh Harsvardhan, Alok Ranjan, BK Arpan Subhashish, Anand Ranjan
January-June 2019, 5(1):49-54
The burden of corneal blindness is increasing in India and estimates currently suggest that there are 1.6 Million people suffering from the disorder. Despite being treatable, the number of corneally blind people during 2005 and 2011 has grown by 0.34 Million in India. This suggests that the treatment of corneal blindness is currently taking place much slower than its incidence. One of the main reasons for this is the fact that there is a huge mismatch between the total corneas collected and that required for transplantation. In order to increase the number of cornea collections WHO and AIIMS undertook this project to examine and evaluate how effective grief counselors can be in the collection of eyes in comparison to trained nurses. Before the project was initiated there were already 4 senior grief counselors working with the national eye bank. The project involved appointing 5 additional junior grief counselors to analyze their impact in cornea collection. During July-November 2011, it was found that the number of cornea collections were directly proportional to the number of grief counselors. Results also suggested that the significance of grief counselors in cornea collections was more than that of hospital staff. This can be attributed to the fact that grief counselors are appointed specifically for cornea collection while hospital staff can only spend a limited time on counseling for cornea collection.
  608 20 -
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.
  574 39 -
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.
  574 35 -
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.
  562 33 -
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.
  563 32 -
The effect of intra-articular PRP (platelet rich plasma) injection in knee osteoarthritis - A short term results
Ashutosh Kumar, Ritesh Runu, Santosh Kumar, Nishant Kashyap, Abhijeet Subhash, Gaurav Khemka, Raj Kumar, Shailesh Kumar
January-June 2020, 6(1):57-61
Pain and functional limitations are important clinical features in knee osteoarthritis. Platelet-rich plasma from autologous blood is being used for symptomatic relief in early knee osteoarthritis. The aim of this study was to assess the efficacy of platelet rich plasma in patients of early knee osteoarthritis. All 50 patients received single intra-articular injection of Platelet Rich Plasma in both knees. Assessment was done by VAS pain scale and WOMAC function score pre injection and 1 week and 3 months post injection. Platelet Rich Plasma showed significant improvement in pain and function at 1 week and 3 months post injection. There was no loss of follow-up. Few patients reported pain for 2 days after the injection which resolved spontaneously. We conclude that Platelet-rich plasma therapy is simple, cheap, feasible and minimally invasive intervention for early knee osteoarthritis. It reduces the analgesic intake and improves the function of knee joint in short term.
  555 38 -
A clinico-pathological study of benign breast disease in tertiary centre of Bihar
Krishna Gopal, Mukesh Kumar, Sanjit Prasad, Sanjeet Kumar Singh, Vivek Kumar Roy
January-June 2020, 6(1):66-69
Background: Benign breast disease is most common problem in female of our society. The aim of study to know the patterns of clinically benign breast disease in females and to co-relate them with the pathological condition. Material and method: This study was conducted on outdoor patients of department of general surgery in Indira Gandhi institute of medical science, Patna Bihar from April 2018 to march 2019. The first 100 one hundred female patients who were treated for benign breast disease were included in this study. Diagnosis was made by a combination of clinical assessment, radiological imaging and tissue biopsy so called triple assessment. Results: In all benign breast disease, the most common presentation was breast lump which comprised 84 cases, of which fibro adenoma is most common with mainly in the age group of 21-30 years. Median age at presentation was 29.5 years. Excision is most commonly used and most satisfactory method of treatment. Conclusions: Benign breast disease present mainly in 21-30 year age group. The clinical diagnosis of the benign breast disease was accurate in 92% cases. The actual factors responsible for this change need further research and study.
  524 31 -
Clear cell sarcoma of rectum with liver and lung metastasis in a young female: A rare case report with review of literature
Kunal Kishor, Dinesh Kumar Sinha
January-June 2020, 6(1):87-89
INTRODUCTION: Clear cell sarcoma like tumor of the gastrointestinal tract (CCS-GI) is an extremely rare type of soft tissue sarcoma with aggressive behavior, which exhibits morphological, immunohistochemical and ultrastructural similarity with malignant melanoma. It is rarely localized in the intestine and the natural history of this tumor is not yet clear[1]. To date, less than 42 cases of CCS-GI have been described in the literature, as far as the best of my knowledge. CASE PRESENTATION: A 20 year nulliparous female presented with something coming out during straining for defecation and bleeding per rectum since 3 months. Patient was also complaining of constipation off and on. The patient underwent contrast enhanced MRI Pelvis, which revealed mass in anorectal region, 6.5x 3.4cm in size at left pararectal wall which was touching muscularis externa at 3 O’clock. There was mid perirectal mesorectal lymph nodes, 2-4 cm in size. Biopsy from anorectal mass was sent for HPE, which was reported as malignant melanoma. In morphology, tumour cells were relatively large, ovoid to epithelioid with pale eosinophilic to clear cytoplasm. Nuclei were centrally located. Necrosis was present. Immunohistochemistry was positive for S100 and Melan-A. The tumor was immunonegative for CK, HMB-45, CD1a,CD68, CD21 and CD23. Ki-67 was70%. Final impression was Clear cell sarcoma like tumor of the gastrointestinal tract (CCS-GI). CONCLUSION: Herein we present a case of CCS-GI, with discussion on its clinical and pathological features and review of the literature on the subject.
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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.
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