iosr-JDMS   Volume-14 ~ Issue-4 ~ April-2015

Abstract:Background: Hypertension is a major public health problem affecting people from all socio-economic strata across the globe. Hypertension causes considerable mortality, morbidities and disability worldwide. Over the years, raising prevalence of hypertension has been reported not only from urban area, but also from rural areas of India. Aims and Objectives: 1) To determine prevalence of hypertension in a rural area of Jharkhand, and 2) To find the association between hypertension and selected socio-demographic variables.

[1]. Sharma AK, Bhardwaj S, Chaturvedi S. Predictors of hypertension in an urban Indian population. Indian Heart J 2006;58:21-7.
[2]. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, et al. The seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: The JNC 7 report. JAMA 2003;289:2560-72.
[3]. Anand MP. Epidemiology of hypertension India. Indian Heart J. 2010;62:378-383.
[4]. WHO, World Health Statistics, 2012. http://www.who.int/gho/publications/world_health_statistics/2012/en/
[5]. Midha T, Bhola Nath, Kumari R, Rao YK, Pandey U. Prevalence of hypertension in India: A meta-analysis. World J Meta – anal, 2013, August26;1(2): 83-89.
[6]. Meshram II, Arlappa N, Balakrishna N, Rao KM, Laxmaiah A, Brahmam G. Prevalence of hypertension and its correlates and awareness among adult tribal population of Kerala state, India. J Postgrad Med. 2012;58:255-61.

Abstract: High origin and superficial ulnar artery (SUA) is a rare anatomical variant that usually arises either in the axilla or the arm and runs a superficial course in the forearm, enters the hand, and participates in the formation of superficial palmar arch. During the routine dissection of cadavers in the department of anatomy, whilst preparing the specimen for medical students, We observed a unilateral case of high origin and superficial ulnar artery in a 60 year old male human cadaver. It originated from the right brachial artery in the lower third of the arm, 2cms above the elbow joint. From its origin it passed downwards in the medial part of the arm and forearm in a superficial plane compared to normal ulnar artery. In the hand, the Superficail ulnar artery anastomosed with the superficial palmar branch of the radial artery, creating the superficial palmar arch. The existence of a SUA is undeniably of interest to the clinicians as well as anatomists. Knowledge of these variations is important during vascular and reconstructive surgery and also in evaluation of angiographic images. Superficial position of ulnar artery makes it more vulbnerable to trauma and more accessible to cannulation. Keywords: variations ulnar artery.

[1]. Aharinejads.Nourani and Hollen Steiner H (1997) rare case of high origin of ulnar artery from the brachial artery: clinical anatomy 10:253-258.
[2]. Arey LB (1957) Developmental Anatomy 6th Edn. WB Philadelphia Saunders Co. 375-377.
[3]. Bozer C, Ulucam E.Kutoglu T. (2004) A case of originated high superficial ulnar artery. Trakia Journal of Sciences 2:70-73.
[4]. Chin KJ, Sing K. (2005)The Superficial ulnar artery – a potential hazard in patients with difficult venous access. Br.J. anaesth 94:692-3.
[5]. Hollinshed WH.( 1971) Anatomy for surgeons. Vol.3. The Back and Limbs. 2nd Ed. New York : Harper & Row pp;428-41.
[6]. Krishnamurthy A, Kumar M, Nayak SR, Prabhu LV.(2006) High origin and superficial course of ulnar artery a case report Firat Tip Dergisi.11:66-67

Abstract: Here is a case of a G3P1L1A1 with cirrhosis with portal hypertension complicating pregnancy who presented to us with Page 1 Abruption. After delivery, the patient was investigated further with complete liver and coagulation profiles. Ultrasound Abdomen and Pelvis and upper GI endoscopy was done. The management of this case has been discussed.

Keywords: Abruption, Cirrhosis, Portal Hypertension, Splenomegaly, Varices.

[1]. Cheng YS: Pregnancy in liver cirrhosis and/or portal hypertension. Am J Obstet Gynecol 1977; 128: 812 – 21.
[2]. Britton RC. Pregnancy and esophageal varices. Am J Surg 1982;143:421-5.
[3]. Lee WM. Pregnancy in patients with chronic liver disease. Gastroenterol Clin North Am 1992;21:889-903.

Abstract: The objective was to study the incidence of premature rupture of membranes at term, evaluate the risk factors , risk of operative delivery ,the effects and complications of premature rupture of membranes at term and its influence on maternal and perinatal outcome. The study was a prospective study where patients with confirmed premature rupture of membranes at term were recruited and monitored for progress of labour, mode of delivery and evaluated for maternal and perinatal outcome. The incidence of premature rupture of membranes was higher in women of lower socioeconomic group, unbooked cases and in those with previous history of abortions and premature rupture of membranes. The rate of caesarean delivery was increased with a concomitant increase in incidence of maternal morbidity and perinatal morbidity and mortality with an increase in the duration of labour and delivery.

Keywords: Premature rupture of membranes ( PROM ) , maternal and perinatal outcome

[1]. Text book of OBG : Williams 22 nd edition , page 855
[2]. Amira El-Messidi, Alan Cameron etal : Diagnosis of Premature rupture of membranes : Inspiration from the past and insights for the future , JUNE JOGC JUIN 2010 , page 562-567
[3]. Alberto Bacchi Madena etal : Prelabour rupture of membranes : recent evidence pages 5-10
[4]. L.Eslamian and Asadi etal : the caesarean section rate in cases with premature rupture of membranes at 36 th week of pregnancy or later, pages 83-86
[5]. David R Doody etal : risk factors for recurrence of premature rupture of membranes , pediatric and perinatalogy supplement , 1997, 11, 96-109
[6]. Sita Ram shrestha , Paban Sharma etal : fetal outcome of prelabour rupture of membranes , N.J.Obstet. Gyaecol Vol.1 , no.2 , page 19-24 ,nov- dec 2006
[7]. Kodkany BS Telang MA : Premature rupture of membrane – A study of 100 cases , Indian journal of obstetrics and gynaecology 1991;41:492-6

Abstract: Renal Cell Carcinoma (RCC) is a rare malignancy but it is the most common renal neoplasm. Its presentation is usually in advanced stage if not diagnosed incidentally. This study sought to document the presentation, histological pattern and treatment of the RCC. This is a hospital-based retrospective study of 22 patients, who presented with RCC over a period of 7 years from June, 2007. Patients' records were retrieved to collate data which were subjected to statistical analysis. A total of 22 patients presented with RCC during the 7 year study period. The mean age of the patients was 52±16 years (range, 24 – 89 years) and male/female ratio was 1: 1.2. Most of the patients were in the age range of 40 – 49 years. All the patients presented with features of advanced disease. The classical triad of symptoms of RCC was found in 10(45.5%) patients. Seventeen (77.3%) patients had both abdominal ultrasound and computed tomography of the abdomen to further characterize the tumour.

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[7]. Odubanjo MO, Oluwasola AO, Ikuerowo SO, Akang EE. Histopathological pattern of Renal Cell Carcinoma in Ibadan. Afr J Med Sci.2010; 39: 317 – 321.

Abstract: Background /Aims: To assess the port site infections in patients who underwent laparoscopic surgeries in department of general surgery in a medical college hospital and how to prevent and treat port site infections . Design: prospective study Material & Methods: In this descriptive study , a total number of 104 patients who underwent laparoscopic surgeries for various diseases between October 2013 to March 2015 at our hospital were observed for port site infections . Culture sensitivity were taken for all patients who developed port site infections .Variables like number of ports used in surgery , port site , port size, time duration from abdominal incision to primary trocar entry , causative organism , surgery – infection interval and indication of surgery were analysed using appropriate statistical analytical tests.

[1]. Anmad G , Duffy JM , Philips K , Watson A Laparoscopic entry techniques .cochrane database syst rev 2008 ;2; CD 006583
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[3]. Hakki – siren , Kurki T – A nationwide analysis of laparoscopic complication.Obstet Gynecol 89 : 108 -112, 1997.
[4]. Ramesh H, Prakash K . Lekha V ,Jacob G, Venugopal A , Venugopal B – port site tuberculosis after Laparoscopy: Report of eight cases . Surg Endosc .17 (6): 930- 932 ,Jun 2003.
[5]. Garner JS , Jarvis WR , Emori TG , Horan TC , Hughes JM :CDC definition for nosocomial infections . Am J Infect control :1988; 85 :818 – 827.
[6]. Atul K.sharma , Rakesh Sharma , santhosh Sharma, post site infection in laparoscopic surgeries- Clinical study Indian Medical Gazette-june 2013 ,224-229

Abstract: Ileoileal knotting is one of the rare cause of intestinal obstruction.We report a case of ileoileal knotting in a elderly female. Because of its rarity , we are presenting this case.

[1]. Kallio.E.D. 1932 . Die Knotenbildungen des Darmes. Acta chirurgica Scandinavia suppl,21,1-276 .
[2]. Frimann – Dahl .J.,1942. Roentgen findings in intestinal knots. Acta radiologica, 23 ,22-33
[3]. Mikal S,Byers JA.,Closed loop obstruction of the ileum due to an appendiceal knot J Am Med Assoc 1956 ;160;49-50 .
[4]. Shepherd JJ . The epidemiology and clinical presentation of sigmoid volvulus .Br J Surg 11969;56;353 -359 .
[5]. Shepherd JJ., Ninety-two cases of ileo-sigmoid knotting in Uganda .Br J Sur 1967;54;561- 566.

Abstract: Prostate cancer is the number one cancer in men with increasing incidence, morbidity and mortality in men of black ancestry. Early detection and appropriate treatment of majority of solid tumours including cancer of the Prostate, (CAP), usually lead to a reduction in cancer-related mortality and morbidity. Such goals can only be attained when patients are aware of the disease, present early and are willing to be treated when diagnosed. Most of our patients present late and so are hardly good candidates for 'curative' treatment options if detected; hence the need to know why the late presentation and opinion on treatment of asymptomatic early stage cancer of the prostate in the developing world.

[1]. M. Garcia, A. Jemal, E.M. Ward, M.M. Center, Y. Hao, R.L. Siegel et al. Global cancer facts and figures 2007.American Cancer Society, Atlanta, GA (2007)
[2]. Oyiogu F. N Ozoemena, Benjamin Ayogu, Joseph Ezugworie, Ikenna .I. Nnabugwu. Effects of electronic massager on patients with advanced cancer of the Prostate. OJM, January - December 2010; Vol. 22 (1-4); pp 42-46.
[3]. Kamangar F, Dores GM, Anderson DF. Patterns of cancer incidence, mortality and prevalence across five continents: defining priorities to reduce cancer disparities in different geographic regions of the world. J. Clin Oncol. 2006 May 10; 24(14): 2137‐50.
[4]. Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics. CA Cancer J. Clin. 2011 Mar‐Apr; 61(2): 69‐90. Doi:10.3322 / Caac; Epub 20107.
[5]. Siegel R, Ma J, Zou Z, Jemal A. Cancer Statistics, 2014. CA Cancer J Clin. 2014 Jan‐Feb; 64(1): 9‐29.
[6]. Fedewa SA, Jemal A. Prostate cancer disease severity and country of origin among black men in the United States. Prostate Cancer Prostatic Dis. 2013 Jun; 16(2): 176‐80.

Abstract: Early diagnosis and treatment of the newborn infant with suspected sepsis are essential to prevent severe and life threatening complications. In this era of multidrug resistance, it is mandatory to avoid unnecessary use of antibiotics to treat non‐infected infants. Thus rapid diagnostic test(s) that differentiate infected from non‐infected infants, particularly in the early newborn period, have the potential to make a significant impact on neonatal care. The purpose of the sepsis screen is to rule out sepsis rather than to rule in sepsis. Traditionally, the sepsis screen consists of 4 items: C-reactive protein (CRP), absolute neutrophil count (ANC), immature to total neutrophil ratio (ITR) and micro-erythrocyte sedimentation rate (μ-ESR).

[[1]. A.K. Mane, N.V. Nagdeo, VR Thomdura - Study of neonatal septicemia in tertiary care hospital – rural Nagpur, 2010. 110.
[2]. Agarwal DS, Chowdary P, Srivastava G, Saini L – Study of neonatal infection. Indian Pediatr 1985: 122. 3d
[3]. Aggarwal R, Sarkar N, Deorari AK, Paul VK. – Sepsis in the newborn. Indian J Pediatr. 2001; 68 (12): 1143 – 7. 12d
[4]. Ahmed Ghafoor T, Waqar T, Ali S, Aziz S, mahamud S. – Diagnostic value of C-reactive protein and haematological parameters in Neonatal sepsis JCPSP. 2005; 15 (3) : 152 – 6. 11d
[5]. Alojipan LC, Andrews BF - Neonatal sepsis, Clin. Pediatr 2005: 14:181-185. R14

Abstract: Aneurysmal Bone Cyst (ABC) is considered to be a pseudotumor which arises from bone and is locally destructive. The most common locations of its occurrence are proximal humerus, distal femur, proximal tibia followed by spine with its preference being metaphysis of long bones. ABC itself accounts for less than 6% of all bone tumours and is four times more rarer than osteosarcoma(1). The etiology of ABC still remains unclear however many proposed that it may result from local circulatory disturbance which inturn leads to increased venous pressure and local hemorrhage production. It is more common during 2nd decade of the lifetime and is a rare entity above 30 years(2). General histological picture shows that the stroma is filled with dilated capillaries and cavernous channels. The lesions have osteoclast like giant cells with multiple nuclei. Typically the trabeculae are thick and regular and located along the thin fibrous septa around the blood filled channels

[1]. Aneurysmal bone cyst. M. Szendröi, I. Cser, A. Kónya, A. Rényi-Vámos, November 1992, Volume 111, Issue 6, pp 318).
[2]. Windhager R, Lang S, Kainberger F, Universitätsklinik für Orthopädie, Wien. Der Orthopade [1995, 24(1):57-64] [3]. Aneurysmal bone cyst. A clinicopathologic study of 238 cases. Cancer volume 69, issue 12, pg 2921-2931, 1992 . Ariel M. Vergel De Dios, Jeffrey R. Bond, Thomas C. Shives, Richard A. McLeod and K. Krishnan Unni
[4]. JAFFE, H. L., and LICHTENSTEIN, L. (1942): Solitary Unicameral Bone Cyst with Emphasis on the Roentgen Picture, the Pathologic Appearance and the Pathogenesis. Archives of Surgery, 44, 1,004
[5]. Aneurysmal Bone Cyst: A Population Based Epidemiologic Study and Literature Review.Leithner, Andreas MD; Windhager, Reinhard MD; Lang, Susanna MD; Haas, Oskar A. MD; Kainberger, Franz MD; Kotz, Rainer MD. Current Orthopaedic Practice June 1999, Volume 363.

Abstract: This is a case report of SLE complicating pregnancy. During antenatal period anaemia was managed and LSCS was done for IUGR with abnormal doppler. During surgery atonic PPH was developed and managed with medical methods and B- lynch application. In the postpartum period she developed hypertension and antihypertensives were started. Patient discharged in stable condition and followed. Patient was continued on oral hydroxychloroquine and prednisolone thru out pregnancy and postpartum period. Keywords: SLE (systemic lupus erythematosus), Anaemia, IUGR (Intrauterine growth retardation), Doppler, Atonic PPH, B-Lynh, Hydroxychloroquine, Prednisolone

[1]. Lupus and Pregnancy by Michelle Petri. The Johns Hopkins Lupus Center. Retrieved May 2011.
[2]. SLE and pregnancy at Medscape. Author: Ritu Khurana. Chief Editor: David Chelmow. Updated: Sep 20, 2010.
[3]. Williams Obstetrics, 24th edition.

Abstract: Background – In comminuted Colles fractures treated by conventional method , malunion during healing due to progressive radial collapse is a common complication. Many modalities of treatment have been described with their merits and demerits. Ulnocarpal stabilization is an effective method to prevent radial collapse and hence this study. Materials And Methods – A prospective study of 100 patients of comminuted Colles fracture between 20-70 years age irrespective of sex treated by closed reduction and percutaneous stabilization of ulnocarpal articulation and above elbow POP cast for 6weeks has been presented. Patients were evaluated at 1 year follow up and functionally by Sarmiento's modification of Lindstrom criteria and Gartland and Werley's criteria.

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[2]. Bacron RW ,Kurtzke JF. Colle's fracture :A study of two thousand cases from the New York states compensation board. J Bone joint Surg Am 1953;35;643-58
[3]. Fernandez DL ,Jupiter JB, editors. Fractures of the distal radius;A practical approach to management. NewYork.NY;Springer –Verlag ;1996
[4]. Fernandez DL .Correction of posttraumatic wrist deformity in adults by osteotomy, bone grafting and internal fixation. J Bone Joint Surg Am 1982;64:1164-78.

Abstract: Treatment of patients with suppurative-necrotic complications of acute destructive pancreatitis is the most challenging section of modern pancreatology. Today this fact is confirmed by high rates of mortality and the incidence of fatal complications such as infection of parapancreatic tissues, retroperitoneum, prevalent purulent peritonitis (1).

[1]. Savelyev V.S., Filimonov M.I., Burnevitch S. Z., Sobolev P.A. Surgery of diffused pancreatonecrosis// Annals of Surgery. – 1998. – No.1. –P. 34-39.
[2]. Filin V.I., Kostyutchenko A.L. Urgent Pancreatology. - S. - Pitersburg, 1994. – 240 p.
[3]. Knaus W.A., Draper E.A., Wagner D.P., Zimmermann J.E. Apache - 11 a severity of classification system.// Crit. Care Med. – 1985. - Vol. 139. –P. 69-82. [4]. Chronic Pancreatitis, British Society of Gastroenterology, 2009 [5]. Levy P, Barthet M, Mollard BR, et al; Estimation of the prevalence and incidence of chronic pancreatitis and its complications. Gastroenterol Clin Biol. 2006 Jun-Jul;30(6-7):838-44.

Abstract: Hand washing by health care workers( HCWs) is the most important measure to prevent hospital acquired infection [1]. Unfortunately, HCWs' attention to hand hygiene recommendations is often poor [2]. Gloving is recommended as a barrier in protecting the HCWs to reduce the risk of contamination during contact with body fluids, mucous membranes or the injured skin of patients [3,4]. Health-workers hands by themselves, or after contact with patients, increase the risk of virus and bacteria transmission that are sometimes resistant to antimicrobial agents (AMA)(5). This is a two-way hazard that could be noxious to both patients and health-care workers, and which depends on the nature and frequency of contact with infectious materials,inoculum and prevalence of susceptible patients(5).

[1]. Kampf G, Kramer A. Epidemiologic background of hand hygiene and evaluation of the most important agents for scrubs and rubs. Clin Microbiol Rev 2004;17:863-93.
[2]. O'Boyle CA, Henly SJ, Larson E. Understanding adherence to hand hygiene recommendations: the theory of planned behavior.Am J Infect Control 2001;29:352-60.
[3]. Garner JS. Guideline for isolation precautions in hospitals. Infect Control Hosp Epidemiol 1996;17:53-8.
[4]. Goldman DA. The role of barrier precautions in infection control. J Hosp Infect 1991;18:515-23.
[5]. Boyce JM, Pittet D. Guideline for hand hygiene in health-care settings: recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Infect Control Hosp Epidemiol 2002;23:3-40.

Abstract: Emergence of extended spectrum β lactamases (ESBLs) producing strains of gram negative bacteria, as one of the leading cause of septicemia often complicates the clinical and therapeutic outcome. The present study was undertaken to investigate the prevalence of ESBLs in bacteria isolated from neonatal septicemia cases along with their antimicrobial sensitivity pattern. Blood samples were collected from 100 suspected cases of neonatal septicemia. Apart from susceptibility testing, all the gram negative isolates were subjected to phenotypic tests for ESBL production. Amongst the positive test samples (n = 40), 25 were gram negative rods. ESBL was detected in 6 isolates. Results indicate that routine ESBL detection should be made imperative and empirical use of third generation cephalosporin must be discouraged.

Keywords: Extended spectrum β lactamase, Drug resistance, Neonatal septicemia.

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[2]. Calil R, Marba ST, Tresoldi AT. Reduction in colonization and nosocomial infection by multiresistant bacteria in neonatal unit after institution of educational measures and restriction in the use of cephalosporins. Infect Control HospEpidemiol 2001; 29:133-8.
[3]. Goldman DA, Jeanne-Leclair MD, Macone A. Bacterial colonization of neonates admitted to an intensive care environment. J Pediatr 1978; 93:288-93.
[4]. Mahapatra A, Ghosh S K, Mishra S, Pattnaik D. Enterobacter cloacae : A predominant pathogen in neonatal septicemia.
[5]. Vinod Kumar CS, Neelagund YF. Extended Spectrum β-Lactamase mediated resistance to third generation cephalosporins among Klebsiellapneumoniae in neonatal septicemia. Indian Pediatr 2004; 41:97-9.