iosr-JDMS   Volume-18 ~ Issue-1 ~ January-2019

Abstract: Objective- To compare Totally Extra Peritoneal (TEP) repair with Trans Abdominal Pre Peritoneal (TAPP) repair of inguinal hernia. To compare the operative time, technique, intraoperatve and postoperative complications of TEP and TAPP repair of uncomplicated inguinal hernia. Material And Methods: The study is prospective & randomized clinical trial in nature. A sample of size 60 was studied in the DEPARTMENT OF SURGERY, at the SUBHARTI MEDICAL COLLEGE ,MEERUT.The sample size was calculated by using the formula n=4σ2/L2. where σ2 =variance of sample observations and L2 = least permissible error. In our study, the variance was maintained 1.36 & least permissible error was fixed at .02 (2%) .The Patients, who underwent LAPAROSCOPIC REPAIR OF GROIN HERNIA between 1st May, 2016 and 31st March, 2018 were randomized to either TEP or TAPP repairs. The two types of surgical methods were analyzed by making the frequency tables of 60 patients. The significant difference b/w TEP & TAPP surgeries was observed by un-paired/student's "t" test at .01 level of significance.The p- value less than .01 was considered as significant .i.e.P<.01.Further, all the statistical analysis was done by using S.P.S.S. software 23.0 version...........

[1]. Wake BL, MeCormack K, Fraser C. Vale L, Perez J, Grant AM Transabdominal pre-peritoneal (TAPP) versus totally extraperitoneal (TEP) Cochrane Database Syst Rev. 2005; 25
[2]. Odwyer P, Macintyre I, Grant A. Laparoscopic versus open repair of groin hernia: a randomized comparison. The MRC Laparoscopic Groin lernia Trial Group. Lancet 1999;354: 185-90
[3]. Neumayer L Giobbie-Hurder A, Jonasson O. Open Mesh versus Laparoscopic Mesh Repair of Inguinal Hernia. N Engl J Med 2004, 350 1819-27.2. 3. 4.
[4]. Avinash N Katara, Davide Lomanto Managing intra-operative complications during totally extraperitoneal repair of inguinal hernia Journal of Minimal Access Surgery, July-September, 2006

[5]. F. Köckerling, C. Roessing, D. Adolf, C. Schug-Pass, and D. Jacob.Has endoscopic (TEP, TAPP) or open inguinal hernia repair a higher risk of bleeding in patients with coagulopathy or antithrombotic therapy? Data from the Herniamed Registry Published online 2015 Aug 15

Abstract: Introduction: Urinary tract infections (UTIs) are amongst the most common infections encountered in clinical practice. Urinary tract infection can be caused by gram negative bacteria such as Escherichia coli, Klebsiella species, Pseudomonas species, Proteus species, Enterobacter species and gram positive bacteria like Staphylococcus aureus, Enterococcus species and coagulase-negative Staphylococcus species. Escherichia coli is the most common organism isolated from the patients of UTI followed by Klebsiella species. Injudicious and irrational use of antibiotics and extended spectrum beta-lactamase enzyme (ESBL) production by Enterobacteriaceace family may be the main reason for emerging antibiotic resistance..............

[1]. Gatermann SG. Bacterial infections of the urinary tract in: Borriello P, Murray PR, Funke G, EDITORS. Topley & Wilson's microbiology & microbial infections, London: Hodder Arnold Publishers 10th ed, 2007; vol III:p 671-683.
[2]. Sobel JD,Kaye D. Urinary tract infections. In: Mandell GL, Bennet JE,Dolin R, editors. Mandell, Douglas and Bennet's principles and practice of infectious diseases. Philadelphia, USA: Churchill Livingstone Elsevier publication 7th ed, 2010; vol 1:p 958-972.
[3]. Stamm WE, McKevitt M, Roberts PL, et al. Natural history of recurrent urinary tract infection in women. Rev Infect Dis 1991; 13(1): 7-84.
[4]. De Backer D, Christiaens T, Heytens S, de Sutter A, Stobberringh EE, Verschraegen G. Evolution of bacterial susceptibility pattern of Escherichia coli in uncomplicated urinary tract infections in a country with high antibioitic consumption. A comparision of two surveys with a 10 year interval. J Antimicrob Chemother 2008; 62: 364-8.
[5]. Rock W, Colodner R, Chazan B, Elias M, Raz R. Ten years surveillance of antimicrobial susceptibility of community acquired Escherichia coli and other uropathogens in Northen Israel. (1995-2005). Israel Med Assoc J 2007; 9: 803-5.

Abstract: Mandibular fracture is the second most common facial fracture and angle of the mandible is the most common mandibular fracture. For the diagnosis of angle fracture conventionally two radiograph perpendicular to one another are required. Ultrasonography was used in the diagnosis of superficially placed facial bone fracture. In this study we compared the conventional radiography with ultrasonography for the diagnosis of mandibular angle fracture.The purpose of this study is to evaluate the effectiveness of USG as an alternative method for conventional radiography in the diagnosis of mandibular angle fracture.Cohort study conducted during December 2014 to December 2016. Total 24 patients were selected for this study. Sensitivity and positive predictive values for ultrasonography was calculated compared to Conventional radiography using SPSS version 16. The sensitivity and positive predictive value of ultrasonography as compare to OPG and posteroanterior view of skull were 100% and 100% respectively.............

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Key words: Angle of mandible, conventional radiography, fracture, Ultrasonography.

[1]. Hwang K, You SH. Analysis of facial bone fractures: An 11-year study of 2,094 patients. Indian J PlastSurg 2010;43:42.
[2]. Kirk L. Fridrich, Gustavo Pena-Velasco and Robert A.J. Olson. Changing Trends With Mandibular Fractures: A Review of 1,067 Cases. J Oral Maxillofac Surg. 1992;50:586-589.
[3]. Wagner WF, Neal DC, Alpert B: Morbidity associated with extraoral open reduction of mandibular fractures. J Oral Surg. 1979;37:97.
[4]. James RB, Fredrickson C, Kent JN: Prospective study of mandibular fractures. J Oral Surg. 1981;39:275.
[5]. Chuong R, Donoff RB, Guralnick WC: A retrospective analysis of 327 mandibular fractures. J Oral Maxillofac Surg. 1983;41:305.
[6]. Iizuka T, Lindqvist C, Hallikainen D, et al: Infection after rigid internal fixation of mandibular fractures. A clinical and radiologic study. J Oral Maxillofac Surg. 1991;49:585.

Abstract: Introduction: Cytological evaluation of body fluids is a rapid, simple, cost-effective and relatively patient compliant investigation. Serving both as a diagnostic as well as therapeutic intervention. Material and Method: This was aretrospective study done over aperiod of one year from January 2018 to december2018 in the department of pathology, LN Medical college and research centre, Bhopal. This study included 150 cases of Pleural, Peritoneal, Pericardial, CSF, and Synovial fluids. Result: Out of the 150 cases examined, the most common specimen was pleural fluid with 75 cases[50%] followed by Ascitic fluid with 35 cases [23.5%].The most common pathology noted in all the fluids was Infective/Inflammatory followed by malignancy. Male to Female ratio was 1:1.7.Conclusion:Body fluid cytology is a rapid, simple and cost effective diagnostic modality employed primarily for diagnosis in malignant and non-malignant cases which provides an assess to both clinician and pathologist to reach to a final diagnosis for further patient management.

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Key words: Body fluids, cytology, malignancy, effusion.

[1]. Exfoliative cytology of body fluids: an analysis Wasim M. Khatib1* , Pankti M. Patel2,Rakesh B. Demde2, Vidya C. Aher.
[2]. Cytology of body fluids - an aid to primary diagnosis :Shulbha V S1,*, Dayananda B S.
[3]. Cytologic analysis of body fluids with an emphasis on malignant effusions : Ayyagari Sudha1, Padmaja Korti2,*, Shailaja Prabhala3, Ashok Kumar Deshpande.
[4]. Analytical and Cytological Study of Effusions: Priavadhana Rajan Prasaad1, Bheema Rao G2, Natarajan Suresh3
[5]. Cytomorphological Assessment of Different Body Fluids: A 5 Year Retrospective Study!! A.R.Piyush1, Sadaf Haiyat1, ZeeshanNahid1,Himanshi1, Kiran Alam1
[6]. Evaluation of Pathological Body Fluids: An Important Diagnostic Aid 1Mahima Sharma, 2*Anuja Sharma, 3Arvind Khajuria, 4 Shivani Gandhi4.

Abstract: Background and objectives: Lung cancer is the most frequent and one of the most deadly cancer types with an incidence of 1.8 million cases per year. The present study was done to know the cytomorphological diversity of localised lung lesions and its correlation with histological findings. Materials and Methods: A study was conducted over a period of one year from August 2017 to July 2018 in the Department of Pathology and Department of Radiodiagnosis in Indira Gandhi Institute of Medical Sciences, Patna. Computed tomography (CT) guided fine needle aspiration cytology (FNAC) was carried out, and aspirates were drawn, examined, and compared with their histological diagnoses. Results: A total of 58 cases presented as solitary.............

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Key words : Lung carcinoma, Solitary lesion, Metastatic deposit, CT guided FNAC.

[1]. Silverberg G.S., Mario J.S., Nester L. Muller: Localized disease of bronchi and lung: Principles and practice of surgical pathology and Cytopathology: Ed. 3: Ronald A.D., William J.F., Churchill Livingstone, 1997.
[2]. Salazar AM, Westcott JL, "the role of transthoracic needle biopsy for the diagnosis and staging of lung cancer," Clinics in Chest Medicine. 1993;14(1) 99–110.
[3]. SahaA, KumarK, ChoudhuriMK. Computed tomography–guided fine needle aspiration cytology of thorasic mass lesion; A study of 57 cases,J cytol2009;26(2):55-59.
[4]. Shaham D., Guralnik L.: The Solitary Pulmonary Nodule: Radiological Considerations. Seminars in Ultrasound, CT and MRI 2000; 21(2): 97 – 115.
[5]. Travis WD, Brambilla E, Burke AP, Marx A, Nicholson AG. WHO Classification of Tumours of the Lung, Pleura, Thymus and Heart. Lyon: International Agency for Research on Cancer, 2015

Abstract: Background and objectives: Gallbladder (GB) carcinoma is prevalent in the Gangetic plains of the Eastern Uttar Pradesh and Western Bihar regions of India. The present study was done to assess the utility of ultrasound (US) guided fine needle aspiration (FNA) in diagnosing GB carcinoma. Materials and Methods: A study was conducted over a period of one year from August 2017 to July 2018 in the Department of Pathology and Department of Radiodiagnosis in Indira Gandhi Institute of Medical Sciences, Patna. US guided fine needle aspiration was carried out, and aspirates were drawn, processed and evaluated. Results: Out of 117 aspirations, 93 (79.4%) were adequate.............

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Key words: Gall bladder carcinoma, Gall bladder mass, Mural thickening, US guided FNA.

[1]. Das DK, Tripathi RP, Bhambhani S, Chachra KL, Sodhani P, Malhotra V. Ultrasound-guided fine-needle aspiration cytology diagnosis of gallbladder lesions: a study of 82 cases. Diagn Cytopathol 8:258–64 [2]. Hsing AW, Gao YT, Han TQ, et al. Gallstones and the risk of biliary tract cancer: a population-based study in China. Br. J. Cancer. 97 (11): 1577–82.
[3]. Misra S., Chaturvedi A., Misra NC., Sharma and I. D. Carcinoma of the gallbladder. Lancet Oncol, 4,167–176.
[4]. National Cancer Registry Programme (2013).Three-year report of population based cancer registries:2009-2011. NCDIR-ICMR, Bangalore.
[5]. Lazcano-Ponce EC, Miquel JF, Muñoz N, Herrero R, Ferrecio C, Wistuba II, et al. Epidemiology and molecular pathology of gallbladder cancer. CA Cancer J Clin 2001;51:349-64.

Abstract: Aims: Although radiology request forms are essential communication tools, their significance is extremely underestimated. We set out to evaluate the adequacy of completion of radiology request forms, and to assess adequacy of the current request form purposed for radiological investigations. Methods: All request forms received during the audit period (1- working week) by the radiology department from 7:30 am to 3:00 pm were reviewed. For each request, blank/inadequately filled field got zero, and adequately filled field got one. This study was supervised by two directors, a Radiologist as a direct supervisor and SOBA's secretary of research and audit office as an audit professional. Results: Total number of 216 requests were assessed and all were not adequately completed. The most frequently missed data were Referrer contact...........

[1]. Depasquale R, Crockford MP: Are radiology Request forms adequately filled in? An audit assessing local practice. Malta Medical Journal; 2005; 17(4):36-38.
[2]. Akintomide, Akintunde O. et al. "An Audit of the Completion of Radiology Request Forms and the Request Practice." Journal of Family Medicine and Primary Care 4.3 (2015): 328–330. PMC. Web. 12 Jan. 2018.
[3]. Irurhe, N & Sulaymon, F.A. & Olowoyeye, Omodele & Adeyomoye, A.A.O.. (2012). Compliance rate of adequate filling of radiology request forms in a Lagos University Teaching Hospital. World Journal of Medical Sciences. 7. 10-12.
[4]. Royal College of Radiologists. Making the Best Use of a Department of Clinical Radiology: Guidelines for Doctors. 5th Edition. London: RCR, 2003.
[5]. Department of Health, UK. The Ionising Radiation (Medical Exposure) Regulations 2000, Statutory Instrument No. 1059. London: HMSO, 2000.

Abstract: This study was performed to observe whether local burn wound coverage with radiation sterilized amniotic membrane provides a better outcome than conventional dressings with non biological medicated tulle (sofratulle).This interventional randomized control trial study was conducted during the period of 15 months from 01, July, 2006 to 30, September, 2007 in Burn Unit of Dhaka Shishu(Children) Hospital. 50 burned patients with 10- 20% of total body surface area and suffering from second degree superficial burn(scald) were allocated randomly into two groups, the first receiving classical dressings with sofratulle, and the second had the burn areas covered with radiation sterilized amniotic membrane dressing. Each patient in both groups received a same standard schedule of general management. Patients were followed up on daily basis for number of dressing changes, development of pyrexia.............

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Key words: Effectiveness, Radiation sterilized amniotic membrane, Medicated tulle (Sofra tulle).

[1]. Bari M.S., Choudhury M.I.M., Khan A.R., Nessa A., 2002. Role of human foetal membranes (amniotic membrane) in the management of burn wounds. Annals of Burns and Fire Disaster, 15, pp.3-8.
[2]. Bari M.S., Choudhury M.I.M., Shimul F.Z., Khan A.R., 2003. Fluid resuscitation of burn patients in Bangladesh- Dhaka fluid therapy, an alternative approach. Annals of Burns and Fire Disasters, 16, pp.1-12.
[3]. Carolyn R., 1996. Pediatric burns. In: Settle A.D., ed. Principles and Practice of Burn Management. 1st ed. Edinburgh: Churchill Livingstone, pp.377-379.
[4]. Caroline W., 2005. Skin and its appendages. In: Standring S., ed. Grays Anatomy, 39th ed. Edinburgh: Elsevier, Churchill Livingstone, pp. 157-163.
[5]. Chung D.H., Herndon D.N., 2005. Burns. In: Aschraft K.W., Holcomb G.W., Murphy J.P eds. Pediatric Surgery, 4th ed. Philadelphia: Elsevier Saunders, pp. 156-159.

Abstract: Pemphigus is a term derived from the Greek word Pemphix (bubble or blister) for a group of potentially life threatening autoimmune mucocutaneous diseases characterized by epithelial blistering affecting cutaneous and/or mucosal surfaces.1 Pemphigus is an autoimmune disease in which a patient's own circulating antibodies become altered so that they attack the points of adhesion of the epithelial cells, one to another, of the skin and mucous membranes. It most commonly develops in the fourth to sixth decades of life. We present an 18 year old patient with pemphigus vulgaris. The etiology was unknown.

[1]. Neville, Damm, Allen, Bouquot. Oral & maxillofacial pathology. 2nd ed. Elsiever, 2008.
[2]. Medscape References. Pemphigus Vulgaris. Available from http://emedicine.medscape.com/article/1064187-overview#a0104. Accessed 1 JAN 2013.
[3]. S. Dagistan, M Goregen, O. Miloglu, B Cakur. Oral pemphigus vulgaris: A case report with review of literature. J of Oral Science 2008; 50:3, 359-362.
[4]. Greenberg MS, Glick M, Jonathon A. Burket's Oral Medicine. 11th ed. Hamilton: BC Decker, 2008.
[5]. Shafer, Hine, Levy. A text book of Oral Pathology. 5th Edition. Diseases of Skin: 808- 899.

Abstract: Acute Leukemia (AL) is one of the few hematopoietic neoplasms in which medicine offers complete cure with as high as 70% children going into complete remission post treatment. Flow cytometric immunophenotyping (FCI) of the blasts is pivotal in the diagnosis and prognosis of AL1. Newer moAbs, improved gating and analytical techniques have improved the utility of FCI in diagnosis and classification of leukaemias2. Many types are known to carry predictable prognosis and specific therapy is warranted. In addition, immunophenotyping can also show blast cell heterogeneity and detect antigen associations rarely seen normally. AL can clearly be assigned a lymphoid or non-lymphoid lineage by immunophenotypic analysis. However, the situation is more complex in cases of morphologically

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Abstract: A series of cases with chronic subdural haematoma operated in neurosurgery is analysed. Materials and Methods: 198 patients treated between 2014 and 2017 were included in the study. Mean age was 76.4 yrs. and male / female ratio was 1.7 / 1. The patients were classified both on admission and at discharge according to the Markwalder Scale. The standard operative procedure consisted of enlarges Single burr-hole, rinsing the subdural space with isotonic normal rating and insertion of subdural drain. Conclusion: In chronic Subdural haematoma, operation is safe and results are comparable to those of major series of the literatures.

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Key words: Chronic subdural haematoma, safe operation, head injury.

[1]. Ernestus R-I, Beldzinski P, Lanfermann H, Klug N. Chronic subdural haematoma : Surgical treatment and outcome in 104 patients. Surg Neurol. 1997; 48 : 220-5.
[2]. Lind CR, Lind CJ, Mee EW. Reduction in the number of repeated operations for the treatment of subacute and chronic subdural haematomas by placement of subdural drains. J Neurosurg. 2003; 99 : 44-6.
[3]. Weigel R, Schmiedek P, Krauss JK. Outcome of contemporary surgery fro subdural haematoma : Evidence based review. J. Neurol Neurosurg Psychiatry. 2003; 74 : 937-43.
[4]. Mellergard P, Wisten O. Operation and re-operations for chronic subdural haematomas during a 25 year period in a well defined population. Acta Neurochir (Wien). 1996; 138 : 708-13.
[5]. Markwalder TM, Steinsiepe KF, Rohner M, Reichenbach W, Markwalder H. The course of chronic subdural haematomas after burr-hole craniostomy and closed system drainage. J Neurosurg. 1981; 55 : 390-6.

Abstract: Our patient,26 year female with 3 months ANC presented with chief complaints of bilateral upper and lower limb weakness since 8-10 days with inability to walk and get up from sitting since 8-10 days.Clinical examination reveals power is diminished in all four limbs and deep tendon reflex absent.There was no history of any drugs taken(Thiazide and Potassium supplementation) Laboratory evaluation revealed hypokalemia, hypomagnesemia, metabollic alkalosis, Increased urinary chloride excretion, anddecreased urinary calcium excretion. Renal function test was within normal limits. Renal ultrasound was normal. A diagnosis of Gitelman syndrome established after excluding other probable diagnosis.

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Key words: Hypokalemia, Metabolic alkalosis, Hypocalciuria, Hypomagnesemia, Gitelman syndrome

[1]. Bettinelli A, Bianchetti MG, Girardin E, et al. Use of calcium excretion values to distinguish two forms of primary renal tubular hypokalemic. Alkalosis, Bartter and Gitelman syndromes. J Pediatr. 1992;120:38-43.
[2]. Gitelman HJ, Graham JB, Welt LG. A new famillal disorder characterized by hypokalemia and hypomagnesema. Trans Assoc Am Physicians. 1966;79:221-235.
[3]. Hsu YJ, Yang SS, Chu NF et al. Heterozygous mutations of the sodium chloride cotransporter in Chinese children, prevelance and association with blood pressure, Nephrol Dial Transplant. 2009;24:1170-1175.
[4]. Knoers NVAM, Levtchenko EN. Gitelman syndrome. Orphanet J Rare Dis 2008;3:22.

Abstract: A 30year old female,known case of hypothyroidism since 4 months on Levothyroxine therapy,had came with circulatory collapse.She also had weight loss and hyperpigmentation of skin since one year. Initially patient was hemodynamically unstable, and also had reduced urine output, patient was started with fluid resuscitation and adequate inotropic support. Appropriate glucocorticoid and mineralocorticoid replacement was started with rapid clinical response. The probable diagnosis was put as primary adrenal sufficiency with acute kidney injury.

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Key words: Primary adrenal insufficiency, hyperpigmentation, hyperkalemia, APS-2, Autoimmune thyroiditis, Autoimmune adrenalitis.

[1]. Harrisons Principles Of Internal Medicine (19th Edition) Chapter 406 Diseases Of Adrenal Cortex.
[2]. May M. E, Vaughn E. D, Carey R. M. Adrenocortical insufficiency-clinical aspects. In: Vaughan E. D Jr, Carey R. M (eds). Adrenal disorders. Thieme, New York. 1989; 171- 189.
[3]. Hiatt J. R, Hiatt N. The conquest of Addison's disease. Am J Surg 1997; 174: 280-283.
[4]. Mason A. S, Meade T. W, Lee J. A. H, Morris J. N. Epidemiological and clinical picture of Addison's disease. Lancet 1968; 2:744-747.
[5]. Betterele C, ScaliciC,Prestto Et Al . The Natural History Of Adrenal Function In Autoimmune Patients With Autoimmune Adrenalitis.
[6]. Mcdermott Mt. Endocrine Secrets. An Imprint Of Elsevier Inc -2013:429-32.

Abstract: Background: Human blood is the most precious and essential element of human life. Safe and adequate blood supply is a big challenge in developing countries like India. Voluntary blood donors tolerate blood donation very well. Objective: The aim of the study is to estimate and possibly avoid the cause of donor adverse reactions. Materials and methods:The study was conducted over a period of one year from January 2017 to December 2017. The donor population consisted of 2455 donors of which 1823 were males and 632 were females. Donor adverse reactions were analysed. Results: Only 16 (0.007%) donors had adverse reactions like sweating, giddiness, pain, itching and pallor. None suffered severe adverse reactions in the study..............

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Key words: Blood Donation, Donors, Adverse reactions.

[1]. Sharma RK, Verma S, Sharma M, Pugazhendi S (2016) Voluntary Blood Donation: Attitude and Practice among Indian Adults. J Community Med Health 3:436.
[2]. KumariS.Prevalence of acute adverse reactions among whole blood donors: A 7 years study. JAplHematol [serial online] 2015
[3]. Crocco A, D'Elia D. Adverse reactions during voluntary donation of blood and/or blood components. A statistical-epidemiological study. Blood Transfus.2007
[4]. Pathak C, Pujani M, Pahuja S, Jain M. Adverse reactions in whole blood donors:an Indian scenario. Blood Transfus. 2011
[5]. AkankshaBisht, Surinder Singh, NeelamMarwaha Asian J Transfus Sci. 2016 Jan-Jun;

Abstract: Congenital rubella syndrome (CRS) is a consequence of rubella infection that can occur when the virus is transmitted in utero during maternal primary infection. It still affects 110,000 children around the world.5 It has a wide spectrum of presentation which ranges from silent viremia to spontaneous abortions, blindness, deafness, congenital heart disease, and mental retardation.6 Congenital rubella syndrome (CRS) is an important cause of severe birth defects. When a woman is infected with the rubella virus early in pregnancy, she has a 90% chance of passing the virus on to her fetus..............

[1]. Dewan P et al. Burden of congenital rubella syndrome in India. Indian Pediatr. 2012 May;49(5):377-99.
[2]. Lanzieri TM et al. Incidence,clinical features and estimated costs of congenital rubella syndrome after a large outbreak in Brazil 1999-2000.Pediatrinfect Dis J. 2004.
[3]. Edlich RF et al. Rubella and congenital rubella. J long Term Eff Med Implants. 2005.
[4]. WHO. Rubella and congenital rubella syndrome control and elimination-global progress, 2000-2014. Wkly Epidemiol Rec2015;90(39):510-6.
[5]. Eilard T, Strannegard O (1974) Rubella reinfection in pregnancy followed by transmission to the fetus. In: J. Infect Dis 129: 594-596.
[6]. Vijayalakshmi P, Kakkar G, Samprathi A, Banushree R (2002) Ocular Manifestations of Congenital Rubella Syndrome in a Developing Country. Indian J Ophthalmol 50: 307-311.