iosr-JDMS   Volume-17 ~ Issue-4 ~ April-2018

Abstract: Stroke is the second leading cause of death worldwide.Intracerebral haemorrhage (ICH)accounts for ~10% of all strokes, and about 35–45% of patients die within first month. Incidence rates are particularly high in Asians and blacks. Hypertension, coagulopathy, sympathomimetic drugs (cocaine, amphetamine) and cerebral amyloid angiopathy cause the majority of these haemorrhages. Advanced age and heavy alcohol consumption increase the risk and cocaine and amphetamine use is one of the most important causes in the young.Intracerebral haemorrhage is often discovered on noncontrast CT imaging of the brain during the acute evaluation of stroke. Because CT is more widely available and logistically easier, CT imaging is the preferred method of acute stroke evaluation.1 The aim of this work is to study the risk factors, causes, sites and early prognosis of ICH and determining the clinical and radiographic features.

[1]. Wade SS, Johnston SC, Hemphill JC. Cerebrovascular Diseases. In:Kasper DL, Hauser SL, Jameson JL, Fauci AS, Longo DL, Loscalzo J, eds. Harrisons Principles of Internal Medicine. 19th ed. New York: McGraw-Hill Education;2015:2559,2582

[2]. Kothari RU, Brott T, Broderick JP, Barsan WG, Sauerbeck LR, Zuccarello M, Khoury J. The ABCs of measuring intracerebral hemorrhage volumes. Stroke. 1996 Aug 1;27(8):1304-5.

[3]. Jennett B, Bond M. Assessment of outcome after severe brain damage: a practical scale. The Lancet. 1975 Mar 1;305(7905):480-4.

[4]. Go GO, Park H, Lee CH, Hwang SH, Han JW, Park IS. The outcomes of spontaneous intracerebral hemorrhage in young adults-a clinical study. Journal of cerebrovascular and endovascular neurosurgery. 2013 Sep 1;15(3):214-20.

[5]. Brott TH, Thalinger KA, Hertzberg VI. Hypertension as a risk factor for spontaneous intracerebral hemorrhage. Stroke. 1986 Nov 1;17(6):1078-83...

Abstract: Tricalcium silicate based cements like MTA though initially introduced as root end filling materials, have found wide acceptance in other treatment modalities like pulp capping, pulpotomies, apexification, perforation repairs because of their biocompatibility, sealing abilities etc. At the same time its limitations like longer setting time, difficult handling characteristics, potential to cause tooth discoloration have led to the exploration of modifications of the material. This article reviews a newer modification 'Pozzolan Dental Cement' which has been evaluated and compared with the existing tricalcium silicate-based cement.

Key Words: MTA, Portland Cements, Pozzolan Dental Cement, Tricalcium Silicate Based cements

[1]. Cytotoxicity of newly developed pozzolan cement and other root-end filling materials on human periodontal ligament cell, Minju Song et al, Restorative Dentistry & Endodontics, 2013
[2]. Washout resistance of fast-setting pozzolan cement under various root canal irrigants, Ga-Yeon Jang1, Su-Jung et al, Restorative Dentistry & Endodontics, 2013
[3]. Tooth Discoloration after the Use of New Pozzolan Cement (Endocem) and Mineral Trioxide Aggregate and the Effects of Internal Bleaching, Ji-Hyun Jang et al, JOE — Volume 39, Number 12, December 2013
[4]. Camilleri J, Sorrentino F, Damidot D. Investigation of the hydration and bioactivity of radiopacified tricalcium silicate cement, Biodentine and MTA Angelus. Dent Mater. 2013 May;29(5):580- 93. PMID: 23537569.
[5]. Antonijevic D, Medigovic I, Zrilic M, Jokic B, Vukovic Z, Todorovic L. The influence of different radiopacifying agents on the radiopacity, compressive strength, setting time, and porosity of Portland cement. Oral Investig. 2014 Jul;18(6):1597-604.

Abstract: Purpose: To determine retrospectively various risk factors leading to the development of Diabetic Foot ulcer (DFU). Methods: A retrospective analysis of 250 Diabetic patients, who had attended the Surgical OPD during a one year period from feb 2017 to feb 2018 was conducted. Among them 150 had DFU and 100 did not have DFU(NDFU). Various aspects like patient age and gender, duration and control of DM, history of smoking, type of occupation of the patient and presence of peripheral neuropathy by clinical examination were analyzed as possible risk factors. Results: The prevalence of DFU was higher among males (86.7%) compared to females (13.3%) with p value of 0.001249. Among DFU patients a significantly greater number of patients had DM for > 10 years (60%, p value <0.00001), HbA1c values >7.5% (88%, p value <0.00001), history of smoking (68.5%, p value <0.00001), presence of peripheral neuropathy (65.3%, p value 0.00) and had manual labour as occupation (85.3%, p value<0.00001), compared to non-DFU patients..........

[1]. Pappu AK, Sinha A, Johnson A. Microbiological profile of diabetic foot ulcer. Calicut Med J. 2011; 9:1–4.
[2]. Edo EA, Edo GO, Uzeani IU. Risk factors, ulcer grade and management outcome of diabetic foot ulcers in a tropical tertiary care hospital. Niger Med J. 2013; 54:59–63.
[3]. Crawford F, Inkster M, Kleijnen J, Fahey T. Predicting foot ulcers in patients with diabetes: A systematic review and meta-analysis. QJM. 2007; 100:65–86.
[4]. Al Kafrawy NA, Mustafa EA, Dawood AE, Ebaid OM, Zidane OM. Study of risk factors of diabetic foot ulcers. Calicut Med J. 2014; 27:28–34.
[5]. Frykberg RG, Lavery LA, Pham H, Harvey C, Harkless L, Veves A. Role of neuropathy and high foot pressures in diabetic foot ulceration. Diabetes Care. 1998; 21:1714–9.

Abstract: AIM: To estimate the percentage of adhesive small bowel obstruction(SBO),its causes and management either conservatively/surgically. MATERIALS AND METHODS: This cross sectional study was done in Government Rajaji Hospital, Madurai during 1st July 2008 to 30th November 2009. RESULTS: Total 61 cases were included in the study. Common cause for adhesive SBO is gynecological procedures including puerperal sterilization and caesarian section, appendicectomy, lower midline and upper midline surgeries. Majority of conservative patients improved with in 4 days of treatment initiation. Around 16% of the conservative patients required surgical intervention.....

KEYWORDS: adhesion; small bowel obstruction; conservative management

[1]. Jo-Anne P. Attard, Anthony R. MacLean. Adhesive small bowel obstruction: epidemiology, biology and prevention. Can J Surg. 2007 Aug; 50(4): 291–300.
[2]. Moran BJ. Adhesion-related small bowel obstruction. Colorectal Dis. 2007 Oct;9 Suppl 2:39-44.
[3]. Fausto Catena, Salomone Di Saverio, Federico Coccolini, Luca Ansaloni, Belinda De Simone, Massimo Sartelli, Harry Van Goor. Adhesive small bowel adhesions obstruction: Evolutions in diagnosis, management and prevention. World J Gastrointest Surg. 2016 Mar 27; 8(3): 222–231.
[4]. Aquina CT, Becerra AZ, Probst CP, Xu Z, Hensley BJ, Iannuzzi JC, Noyes K, Monson JR, Fleming FJ. Patients With Adhesive Small Bowel Obstruction Should Be Primarily Managed by a Surgical Team. Ann Surg. 2016 Sep;264(3):437-47.
[5]. Tanphiphat C, Chittmittrapap S, Prasopsunti K. Adhesive small bowel obstruction. A review of 321 cases in a Thai hospital. Am J Surg. 1987 Sep;154(3):283-7...

Abstract: AIM: To estimate whether size of the tumour determines the outcome in differentiated thyroid carcinomas. MATERIALS AND METHODS: A retrospective study was conducted in Government Rajaji Hospital, Madurai from September 2016 to January2018. RESULTS: Among 60 cases of Thyroid cancer (TC) papillary thyroid cancer(PTC) is 48, follicular thyroid cancer(FTC) is 11 and the remaining 1 patient is anaplastic cancer. Thyroid swelling is the common presenting symptom(95%). Nodal metastasis is present in 45.83% of PTC and 36.36% of FTC. CONCLUSION: Size of the tumour is an individual parameter that helps to find out the risk for multifocality, invasion and the nodal metastases in both the papillary and follicular carcinoma of thyroid.

Key Words: Thyroid Cancer, Papillary Thyroid Cancer, Follicular Thyroid Cancer

[1]. Nguyen QT, Lee EJ, Huang MG, Park YI, Khullar A, Plodkowski RA.Diagnosis and treatment of patients with thyroid cancer.Am Health Drug Benefits. 2015 Feb;8(1):30-40.
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Abstract: INTRODUCTION : Premalignant lesions have higher risk of developing oral carcinomas. Micronucleus characteristically seen in exfoliated epithelial cell; expresses genotyping alteration caused in process of malignancy during precancerous and cancerous conditions. MATERIALS AND METHODS : Among 98 subjects, 32 were with malignant lesions and 33 with premalignant lesions. Buccal scrapings taken from the lesions ; scrape smears stained by rapid PAP method ; micronucleus observed under microscope ; micronucleus index calculated and compared between above two groups and normal control groups.RESULTS : MN Index found progressively increasing with premalignant and malignant lesions showing statistically significant differences between normal and neoplastic lesions (p<0.001 ) in males as well as females. Significant association found in predominant smokers with disease (p=0.002) and predominant chewers with disease(p<0.001) CONCLUSION : Micronucleus count and micronucleus Index can be used as useful biomarker for screening in oral premalignant and malignant lesions ..

Keywords: Micronucleus, tobacco, premalignant, malignant.

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Abstract: Scarcity of doctorsis an ageoldproblem in India. Manysteps have been taken to tacklethisproblemwith no relief. The presentstudy shows that a simple modification of the MBBS curriculum canimprove the quality of doctors as well as a doctor patient ratio in rural areas.

[1]. Less than one doctor for 1000 population in India: Government tells LokSabha. The Indian Express. 2017 July 21. Available from: http://indianexpress.com/article/india/less-than-one-doctor-for-1000-population-in-india-government-tells-lok-sabha-4760892.
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Abstract: An anatomical understanding is the basis for greater safety in surgical procedures especially in promising techniques. More recently the descending genicular artery has been used more extensively as a source of vascularised cortico periosteal grafts from the medial femoral condyle. In this article anatomical variations in the descending genicular artery such as variation in the pattern of origin of descending genicular artery, the distance between the origin of descending genicular artery and medial joint line of the knee joint and diameter of the descending genicular artery are tabulated and discussed. The purpose of this cadaveric study was to clarify the proximal limit for the sub vastus approach in total knee arthroplasty to decrease the potential vascular injury and to enlighten about the medial femoral condyle grafts..

Keywords: descending genicular artery; femoral artery; diameter

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Abstract: OBJECTIVE: The aim of this study was to determine the effects of total intravenous anesthesia with propofol and fentanyl compared with those of isoflurane and fentanyl on recovery characteristics, postoperative nausea and vomiting (PONV) and duration of hospitalization. METHODS: Patients classified as ASA status I or II undergoing elective short surgical procedures, with duration upto one hour were enrolled in the study. Patients were randomly assigned at a 1:1 ratio to receive total intravenous anesthesia with propofol (1.5–2.0 mg/kg) and fentanyl (1.5 μg/kg) or isoflurane(0.8%–1.2%), nitrous oxide and fentanyl (1.5 μg/kg). Extubation time, recovery time, PONV, postoperative antiemetic requirement and duration of hospitalization were.........

Keywords total intravenous anesthesia, propofol, fentanyl, isoflurane, short surgical procedures

[1]. Paech MJ, Lee BH, Evans SF. The effect of anaesthetic technique on postoperative nausea and vomiting after day-casegynaecologicallaparoscopy. Anaesth Intensive Care. 2002;30:153–159.
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[3]. Ozkose Z, Ercan B, Unal Y, et al. Inhalation versus total intravenous anesthesia for lumbar disc herniation: Comparison of hemodynamic effects, recovery characteristics, and cost. J NeurosurgAnesthesiol. 2001;13:296–302.
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Abstract: Background: Alzheimer's disease (AD) is the most common cause of dementia and its incidence is increasing worldwide along with population aging. Previous clinical and histologic studies suggest that the neurodegenerative process, which affects the brain, may also affect the retina of AD patients. Objective: The objective of the current study was to determine the thickness changes of retina nerve fibers with optical coherence tomography (OCT) in AD patients. Material & Methods: The OCT was used to assess the thickness of retinal nerve fiber layer (RNFL) and macular volume from 21 AD patients and 50 healthy age-matched controls. Results: Compared with healthy age-matched controls, the RNFL thickness of AD patients were much thinner (p<0.05) in all retinal quadrants.Similarly,........

Keywords: Alzheimer's disease, macular volume, OCT, RNFL.

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Abstract: Abnormal uterine bleeding (AUB) in peri-menopausal age group is a commaon but ill-defined entity which needs proper evaluation. goldstein et al.1997 has defined AUB as "Patients having either metrorrhagia defined as vaginal bleeding separated from expected menses or menorrhagia defined as patients subjective complaints of either increased duration or increased volume of flow or both". Ultrasonography and D&C were the most common investigation employed in the evaluation of causes of abnormal uterine bleeding. Hysteroscopy has ushered a new era in the evaluation of abnormal uterine bleeding. By direct visualization of the uterine cavity it is able to pin point the etiology in the majority of the cases. Endometrial biopsy alone may miss some of the lesions in abnormal uterine bleeding in perimenopausal age group women. By combining Transvaginal sonography and Hysteroscopic sampling of Endometirium, the diagnostic accuracy is enhanced.......

Keywords: Abnormal uterine bleeding,Transvaginal sonography,Hysteroscopy,Endometirial sampiling and histopathalogical examination

[1]. Acharya Veena, Mehata Seema, Randar Anitha; Evalution of DUB by TVS, hysteroscopy and histopathology: the journal of Obstetrics & Gynaecology of india: Vol 53 No. 2; March/April 2003, pg. 170-177.
[2]. Anjali sing, Saroja sing, Veena Mathur Kalpana Sing, TVS in DUB & its correlation with histopathology: Journal of obtertrics & Gynecology of India : Vol 51, No. 6; Nov/Dec 2001, pg 116-119.
[3]. Arthur C. Fleischer, Donna M. Kepple; Normal pelvic anatomy ad depicted with TVS; Sonography in obstetrics & Gynaecology: Principles & Practice, 5th edition.
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Abstract: Synovial sarcoma is a rare malignant neoplasm accounting for 8% of all mesenchymal tumours. We hereby report a rare case of unsuspected biphasic synovial sarcoma of dorsal and ulnar aspect of left hand, which was diagnosed on fine needle aspiration cytology. Cytology smears revealed biphasic pattern comprising of spindle cells and epithelial cells. Cytodiagnosis of biphasic synovial sarcoma was suggested. Diagnosis was confirmed on histopathology

Keywords: Synovial sarcoma, Fine Needle Aspiration Cytology, Mesenchymal tumor.

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Abstract: To estimate the levels of Troponin1 and ProBNP in Acute Coronary Syndrome. Materials And Methods:75 patients diagnosed with Acute Coronary Syndrome were taken from The mergency Department of Indus Hospital ,Vishakapatnam and their blood samples were estimated for Troponin1 and Pro BNP. Results:The mean of Troponion1 in cases was 0.2481 with SD of 0.32 and Pvalue of 0.1570.The mean of Pro BNP was 597.34 with P value >0.05. Conclusion:Troponin 1 and Pro BNP levels were significantly elevated in patients with Acute Coronary Syndrome. Acute Coronary Syndrome1 is an acute and life threatening event.It usually results due to a plaque in one or all three of the coronary.........

[1]. Goodacre S, Pett P, Arnold J, Chawla A, Hollingsworth J, Roe D, Crowder S, Mann C, Pitcher D, Brett C (November 2009).Clinical diagnosis of acute coronary syndrome in patients with chest pain and a normal or non diagnostic electrocardiogram. Emergency Medicine Journal. 26 (12): 866–870
[2]. Amsterdam, E. A.; Wenger, N. K.; Brindis, R. G.; Casey, D. E.; Ganiats, T. G.; Holmes, D. R.; Jaffe, A. S.; Jneid, H.; Kelly, R. F.; Kontos, M. C.; Levine, G. N.; Liebson, P. R.; Mukherjee, D.; Peterson, E. D.; Sabatine, M. S.; Smalling, R. W.; Zieman, S. J. (23 September 2014). "2014 AHA/ACC Guideline for the Management of Patients With Non-ST-Elevation Acute Coronary Syndromes: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines". Circulation. 130 (25): e344–e426.
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Abstract: Breast cancer is the most common cause of death in middle aged women in western countries. In 2010, approximately one and three quarter million patients were diagnosed world wide. Breast cancer is the most common site specific cancer in women and is the leading cause of death from cancer for women aged 20 to 59 years. It accounts for the 26% of all newly diagnosed cancers in females and is responsible for the 15% of the cancer related deaths in women. An observational study was conducted in the Department of Surgery, Rajendra Institute of Medical Sciences, Ranchi to assess the different risk factors of carcinoma breast. 74 patients were included in this study. Maximum breast cancer cases were in the age group 40-59 years. The risk factors such as occupation, diet, late attainment of menopause, history of Haria (a local made beverage made by fermentation of rice) intake, were associated with increased risk of breast cancer.

Keywords: Breast Cancer, Risk factor, female

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[2]. Sabiston's Textbook of Surgery; First South Asia Edition; 2017; pp 820-864.
[3]. Babita R, Kumar N, Karwasra RK, Singh M, Malik JS, Kaur A. Reproductive risk factors associated with breast carcinoma in a tertiary care hospital of north India: A case-control study. Indian J Cancer 2014;51:3:251-55.
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Abstract: Shivering is uncomfortable, may aggravate post-operative pain by stretching the surgical incision and occasionally impedes monitoring techniques. It may increase intra ocular and intra cranial pressures. Shivering can double or triple oxygen consumption, may increase metabolic requirement and predispose difficulties in patients with existing intra pulmonary shunts, fixed cardiac output, limited respiratory reserve. Aim : To study the efficacy and potency of dexamethasone in comparison with ketamine and tramadol in the prevention of shivering in the postoperative shivering in patients receiving general anaesthesia

Keywords – Dexamethasone, General Anesthesia, Ketamine, Tramadol, Post-Operative shivering

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Abstract: Background Post-restorative dentinal hypersensitivity is a common occurrence and happens due to the movement of the dentinal fluid in the exposed tubules, which excites the pulpal nerves resulting in perceived sensation. The use of dentin desensitizers has been one of the most common approaches for management of post- restorative dentin hypersensitivity. Material & Methods 36 human premolars extracted for orthodontic purpose were collected after taking patient's consent in Sri Siddhartha Dental............

Keywords: Vivasens. Systemp, Desensitizers, Shear Bond Strength, Composite Resin, Human Dentin

[1] Auschill TM, Koch CA, Wolkewitz M, Hellwig E, Arweiler NB. Occurrence and causing stimuli of postoperative sensitivity in composite restorations. Oper Dent 2009;34:3-10.
[2] AkpataEs, Behbehani J. Effect of bonding systems on postoperative sensitivity from posterior composites. Am J Dent 2006;19:151-154.
[3] Bartold PM. Dentinal hypersensitivity: a review. Aust Dent J 2006;51:212-218.
[4] Jacobsen PL, Bruce G. Clinical dentin hypersensitivity: understanding the causes and prescribing a treatment. Contemp Dent Pract 2001;2:1-12.
[5] Pashley DH, Carvalho RM, Pereira JC, et al. The use of oxalate to reduce dentin permeability under adhesive restorations. Am J Dent 2001;14:89-94

Abstract: Pharyngolaryngeal reflux desease (LPRD) is a type of Gastro-esophageal reflux disease (GERD) that involve upper airway. LPRD affect mainly the larynx by the contact between gastric acid reflux and the mucosa of respiratory tract. LPRD can affect both baby and children. Cough, hoarse and dyspnea represent typical manifestation, but this pathology sometimes present atypical symptoms. In this situation is very important the role of endoscopy of upper airway. We describe a case of a child with atypical manifestation of LPRD and we show the central role of endoscopy in this diagnosis...

Keywords: Laryngopharyngeal reflux desease, Extraesophageal reflux desease, Inspiratory stridor, Respiratory noises

[1] M Kopka, M Małecka, I Stelmach. Chronic cough as a symptom of laryngopharyngeal reflux. Two case reports. Pneumonol Alergol Pol 2016; 84: 29–32
[2] NN Venkatesan, HS Pine, M Underbrink. Laryngopharyngeal Reflux Disease in Children. Pediatr Clin North Am. 2013 August ; 60(4): 865–878.
[3] E Chiou, R Rosen, H Jiang, S Nurko. Diagnosis of supra-esophageal gastric reflux: Correlation of oropharyngeal pH with esophageal impedance monitoring for gastroesophageal reflux. Neurogastroenterol Motil . 2011 August ; 23(8): 717–e326
[4] CA Eckley, W Anelli, A de Campos Duprat. Auditory voice-perception analysis sensitivity and specificity in the screening of laryngeal disorders. Rev Bras Otorrinolaringol 2008;74(2):168-71.
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Abstract: Background:Nalbuphine is a synthetic opioid with mixed agonist-antagonist action, when added as adjuvant to intrathecal bupivacaine acts on kappa receptors in the dorsal horn of the spinal cord producing analgesia. Aim:To evaluate the onset of sensory block, hemodynamicchanges, duration and quality of analgesia, and adverse effects of different doses of nalbuphine with bupivacaine for spinal anesthesia. Materials and Methods:Randomized double blind study done on 90 patients undergoing lower abdominal and lower limb orthopedicsurgeries under subarachnoid block. Patients were randomly allocated to three groups receiving either intrathecal 12.5 mg of bupivacaine + 0.5 mL normal saline alone or 12.5 mg of bupivacaine with either of nalbuphine 0.4 or 0.8 mg............

Keywords: Bupivacaine hydrochloride, nalbuphine hydrochloride, subarachnoid block

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