iosr-JDMS   Volume-18 ~ Issue-12 ~ December-2019

Abstract: Background: Coronary heart disease is a major cause of death and is a global health problem and reaching epidemic in both developed and as well as in developing countries. In patients with acute myocardial infarction baroreceptor mediated hormonal activation has a prognostic value. Clinical importance of hyponatraemia in ST-elevation acute myocardial infarction has not been fully understood. Objective: To assess the hospital-In Outcomes in Acute ST- Elevation Myocardial on Effects of Early Development of Hyponatremia. Methods: Hyponartaemia was defined as a sodium concentration <135 mmol/L. Hyponatremia which developed at 72 hours after admission was defined as early developed hyponatraemia. This study is a prospective observational study. A purposive sampling technique was used to select the sample. In this study data on 100 patients with ST-elevation acute......

Keywords: Hyponatraemia, In- hospital outcome, Acute STEMI, Thrombolysis.

[1]. Chaturvedi V, Bhargava B. Health care delivery for coronary heart disease in India where are we headed? Am Heart Hosp J 2007; 5: 32-7.
[2]. Kim MC, Kini AS, Fuster V. Definition of acute coronary syndromes. In: Fuster V, Walsh RA,Harrington RA, 13th ed. Hurst's The Heart. New York: McGraw Hill, 2011. pp. 1287-95.
[3]. Rogers WJ, Canto JG, Lambrew CT. Temporal trends in the treatment of over 1.5 million patients with myocardial infarction in the US from 1990 through 1999: National Registry of myocardial infarction 1, 2 and 3. J Am CollCadiol 2000; 36: 2056-63.
[4]. Clayton JA, Le Jeune IR, Hall IP. Severe hyponatraemia in medical in-patients: Aetiology, assessment and outcome. QJM 2006; 99: 505–11.
[5]. Upadhyay A, Jaber BL, Madias NE. Incidence and prevalence of hyponatremia. Am Med J 2006; 119: S30–5.

Abstract: Scrotal swellings are common in all age groups representing various causes. In older age scrotal swelling may be due to herniation, hydrocele or testicular tumor. Calcification of walls of hydrocele is not very commonly seen, its hard consistency mimics neoplastic nature. Evaluation with radiography, scrotal sonography and CT findings, diagnosis is confirmed pre operatively and prevents over surgery

Keywords: Hydrocele Wall Calcification, Eggshell Calcification, Scrotal swelling, Scrotal Ultrasonography SU, CT Scrotum

[1]. Aliper Dilli,Umit Y A Osman R K Hikmet T Demet Y Baki H.Chronic complicated hydrocele with eggshell calcification:A case report. Clin Exp Med Lett,2011;52(1-2):79-82.
[2]. BaroliaDK,Gupta SP,Sethi D et al. Eggshell Calcification of Hydrocele Sac- A Rare Case.Int J Health Sci. Res.2016;6(3):305-307.
[3]. Virseda RodriguezJA.Hernanez Millan,I.Segura Martin M: Calcification of the tunica vaginalis.Arch Esp Urol.1997;50:406-7.
[4]. Kokotas n,KontogeorgosI.Kyriakidis A: calcification of the tunica vaginalis ,Br J Urol.1983;55:128.
[5]. Kickham CJE.Calcified hydrocele of the tunica vaginalis testis: case report.New Engl J Med 1935;212(10):419.

Abstract: Urinary tract infection is identified by the presence of pyuria and at least 50,000 colonies/ml of single pathogenic organism in urine sample collected appropriately. In young children the only symptom may be fever, there may be other signs like irritability, poor feeding, vomiting. Aim: To study the prevalence of urinary tract infection in children < 2 years of age with fever presenting to hospital and compare urine analysis and urine culture to detect urinary tract infection (UTI). Methods: All children from 1 month to 2 years of age with fever without focus admitted to the paediatric ward Private hospital Dhanbad were included in this study.......

Keyword: febrile young children, UTI, urine culture, urine analysis.

[1]. Freedman AL; Urologic Diseases in America Project. Urologic diseases in North America Project: Trends in resource utilization for urinary tract infections in children. J Urol 2005;173:949-54.
[2]. Bonadio W, Maida G. Urinary tract infection in outpatient febrile infants younger than 30 days of age: A 10-year evaluation. Pediatr Infect Dis J 2014;33:342-4.
[3]. Ismaili K, Lolin K, Damry N, Alexander M, Lepage P, Hall M. Febrile urinary tract infections in 0- to 3-month-old infants: A prospective follow-up study. J Pediatr 2011;158:91-4.
[4]. Lin DS, Huang SH, Lin CC, Tung YC, Huang TT, Chiu NC, et al. Urinary tract infection in febrile infants younger than eight weeks of Age. Pediatrics 2000;105:E20.
[5]. Nield LS, Kamat D. Fever without a focus. In: Kliegman RM, editor. Nelson's Textbook of Pediatrics. 20th ed., Vol. 1, Ch. 177. Philadelphia, PA : Elsevier; 2016. p. 1280

Abstract: Laparoscopic cholecystectomy (LC) has become the procedure of choice for the management of symptomatic gall stone disease. At times it is easy and can be done quickly. Occasionally it is difficult and takes longer time. But there is no scoring system available to predict the difficulty of LC preoperatively. LC is one of the most common laparoscopic procedures being performed. Mouret introduced laparoscopic cholecystectomy in 1987. Laparoscopic cholecystectomy has replaced open cholecystectomy as the standard of treatment, as the advantages include decreased morbidity, reduced hospitalization, short recovery time, better cosmesis and overall less cost.However LC is technically more demanding and still in a substantial proportion of patients it cannot be successfully performed and for whom conversion to open cholecystectomy is required. A number of relative contraindications are there for LC such as morbid obesity,previous abdominal surgeries, perforated gall bladder, and old age. Also compared to open cholecystectomy......

[1]. Toouli J, Bhandari M. Anatomy and physiology of the gall bladder. In: Clavien PA, Baillie J, editors. Diseases of the gallbladder and bile ducts: diagnosis and treatment.2nd ed. John Wiley & Sons; 2008 Apr 15.
[2]. Fong Y, Blumgart LH, editors. Surgery of the liver and biliary tract.3rd ed. WB Saunders; 2000.
[3]. Wood M. Eponyms in biliary tract surgery. The American Journal of Surgery. 2009;138(6):746-754.
[4]. Dowdy GS, Waldron GW, Brown WG. Surgical anatomy of the pancreatobiliary ductal system: observations. Archives of Surgery. 1962 Feb 1;84(2):229-46.
[5]. Townsend Jr CM, Beauchamp RD, Evers BM, Mattox KL. Sabiston Textbook of Surgery: The Biological Basis of Modern Surgical Practice. Elsevier Health Sciences; 2015 May 26.

Abstract: Cervical cancer being the leading cause of cancer deaths among women inIndia has a major impact on their lives. Although screening programmes in the developed nations are well established, it is estimated that 30% of cervical cancer cases will occur in women who never had a pap test. In developing countries this percentage approaches 60%. Every year in India, 122,844 women are diagnosed with cervical cancer, of which 70-80% are diagnosed in the advanced stage and 67,477 die from the disease .1 Also studies show that in developing countries 80%cases are incurable at the time of detection due to lack of screening..

KEY WORDS: pap smear, colposcopy, cervical cancer, screening test.

[1]. Sreedevi A, Javed R, Dinesh A. Epidemiology of cervical cancer with special focus on India. International Journal of Women's Health. 2015;7:405-414.doi:10.2147/IJWH.S50001.
[2]. KamrunNahar, SariaTasnim, Mirza et al. Colposcopic evaluation of cervix with persistant inflammatory pap smaear.IOSR JDMS p- ISSN 2279-0861, Volume 17, Issue7 Ver.1 july 2018.
[3]. Thulaseedharan.JV,Malila.N,Hakama.M,EsmyPO,Cheriyan.M,Swaminathan.R,Muwonge.R, Sankaranarayanan. R(2012)
[4]. Socio-Demographic and Reproductive Risk Factors for Cervical Cancer in Rural India. APJCP.2012; 13 (6):2991.
[5]. Louie KS, De Sanjose S, Diaz M, et al. Early age at first sexual intercourse and early pregnancy are riskfactors for cervicalcancer in developing countries.Br J Cancer 2009;100:1191-7.

Abstract: Introduction:Peptic ulcer perforation is the commonest surgical emergencies in India. Recent emergency surgical procedures show an increasing trend in perforation in young Indians. This study is carried out with an aim to understand the trend, causation and complications of hollow viscous perforation in young Indians. Methods:A retrospective study of young adult Indian patients operated for emergency peptic ulcer perforation for two year period from May 2017 to April 2019 was carried out. The incidence, causative factors and complications were analysed. Results:In a study of 200 patients, the incidence of hollow viscous perforation in the age group 21 to 30 years was found to be of 42.85%. 80%.........

[1]. Jhobta RJ, Attri AK, Kaushik R, Rajeev Sharma, Jhobta A. Spectrum of perforation peritonitis in India review of 504 consecutive cases. World J Emerg Surg. 2006;1:26.
[2]. Dorairajan LN, Gupta S, Deo SVS, Chumber S, Sharma L. Peritonitis in India- A decade's experience. Trop Gastroenterol. 1995;16(1):33-8.
[3]. Sharma L, Gupta S, Soin AS, Sikora S, Kapoor V. Generalised peritonitis in India-The tropical spectrum. Jap J Surg. 1991;21:272-7.
[4]. Johannes G. Kusters, Arnoud HM, Vliet V, Kuipers EJ. Pathogenesis of Helicobacter pylori infection. ClinMicrobiol Rev. 2006;19(3):449-90.
[5]. Ng EK, Lam YH, Sung JJ, Yung MY, To KF, Chan AC, et al. Eradication of Helicobacter pylori prevents recurrence of ulcer after simple closure of duodenal ulcer perforation: randomized controlled trial. Ann Surg. 2000;231(2):153-8.

Abstract: Background Hypertensive disorders of pregnancy are one of the important causes for adverse maternal and foetal outcome. A proper understanding of this medical disorder in pregnancy is essential to reduce the maternal and foetal complications associated with it. Aim To analyse the incidence of hypertensive disorder complicating pregnancies among pregnant women attending antenatal care at RIMS Government hospital, Srikakulam and study the maternal and perinatal outcome in terms of morbidity and mortality among these women.....

Keywords Hypertension in Pregnancy, Pre-Eclampsia, Eclampsia, Maternal Mortality and Morbidity, Perinatal Mortality and Morbidity. Hypertension in Pregnancy, Pre-Eclampsia, Eclampsia, Maternal Mortality and Morbidity, Perinatal Mortality and Morbidity.

[1]. ACOG Committee on Practice Bulletins--Obstetrics. ACOG practice bulletin. Diagnosis and management of preeclampsia and eclampsia. Number 33, January 2002. Obstet Gynecol 2002;99(1):159-167.
[2]. Virkud A. Modern obstetrics. Chapt- 33. 2nd edn. Mumbai: National Book Depot 2013: p. 301.
[3]. Arias F, Bhide A, Arulkumaran S, et al. Arias practical guide to high risk pregnancy and delivery. Chap- 13. 4th edn. Elsevier India 2015: p. 218.
[4]. World Health Organisation. The world health report 2005: Make every mother and child count. Geneva: World Health Organization 2000[5]. Report of the National High Blood Pressure Education Program Working Group on High Blood Pressure in Pregnancy. Am J Obstet Gynecol 2000;183(1):S1-S22.

Abstract: Chronic progressive external ophthalmoplegia (CPEO) describes an array of hereditary myopathies affecting extraocular muscles (EOMs), commonly manifesting as bilateral ptosis and ophthalmoplegia.It is a chronic, progressive, bilateral, typically symmetric, and external (i.e., spares the pupil) ophthalmoplegia.[1]It is often the only feature of mitochondrial disease, in which case the term CPEO may be given as the diagnosis.Herein we report a 30 year old lady with progressive ptosis without diplopia and without any similar family history,No history of fatiguability, fluctuations in drooping of eyelids. No H/O consanguinity. Neurological examination showed moderate bilateral ptosis and marked limitation of conjugate gaze in all direction. Serum acetylcholine receptor antibody was negative. Neostigmine test was negative. MRI brain normal. Repetitive nerve stimulation test showed no decremental response both at rest and post exercise.Muscle biopsy was not done, referred to higher Centre for the same. Patient was diagnosed as having a mitochondrial myopathy and given supportive therapy

[1]. Lee, A. G. & Brazis, P. W. Chronic progressive external ophthalmoplegia. Curr. Neurol. Neurosci. Rep. 2, 413–417 (2002).
[2]. Wong L.J. Molecular genetics of mitochondrial disorders. Dev Dis Res Rev 2010; 16:154-62.
[3]. Richardson C, Smith T, Schaefer A, Turnbull D, Griffiths P. Ocular motility findings in chronic progressive external ophthalmoplegia. Eye 2005;19:258–263.
[4]. Yu-Wai-Man P, Gorman G.S, Taylor R.W, Turnbull D.M Diagnostic investigations of patients with chronic progressive external ophthalmoplegia. Br J Ophthalmol 2012; 96:1536.
[5]. Yutwai - manC,smith F.E,Tirbanle M.J., Guthrie G, Guthrie S. Extraocular muscle atrophy and CNS involvement in CPEO.

Abstract: Introduction: Ovarian steroid cell tumors are a rare subgroup of sex cord stromal tumors of the ovary and comprise less than 0.1% of all ovarian tumors. Case report: A 12 year old patient presented with abdominal pain and found to have right ovarian cyst, right ovarian cystectomy done for the same and histopathology revealed ovarian steroid cell tumor and the same was confirmed by immunohistochemistry with positivity for Vimentin, Calretinin and Inhibin. Conclusion: Ovarian steroid cell tumours, NOS, are rare tumours. Along with clinical correlation, histopathology is the gold standard to confirm the diagnosis in most of the cases. In atypical cases, immunohistochemistry can be helpful for accurate diagnosis. The treatment varies from ovarian cystectomy to total abdominal hysterectomy with bilateral salpingo-oophorectomy depending on histopathological features of malignancy.

Key words: Ovarian, Steroid cell tumor, Immunohistochemistry, benign, Malignant

[1]. W. Jiang, X. Tao, F. Fang, S. Zhang, and C. Xu, "Benign and malignant ovarian steroid cell tumors, not otherwise specified: case studies, comparison, and review of the literature," Journal of Ovarian Research. 2013;6:53.
[2]. J.Swain, S.Sharma, V.Prakash, N.K.Agrawal and S.K.Singh, "Steroid cell tumor:
[3]. a rare cause of hirsutism in a female," Endocrinology, Diabetes and Metabolism.2013;1.[4]. Patricia Alves, Ines Sa, ,Miguel Brito, Cátia Carnide and Osvaldo Moutinho. An Early Diagnosis of an Ovarian Steroid Cell Tumor Not Otherwise Specified in a Woman. Hindawi Case Reports in Obstetrics and Gynecology ;2019:1-3.
[5]. Baloglu A, Bezircioglu I, Cetinkaya B, Karci L, Bicer M. Development of secondary ovarian lesions after hysterectomy without oophorectomy versus unilateral oophorectomy for benign conditions: a retrospective analysis of patients during a nine-year period of observation. Clin Exp Obstet Gynecol. 2010;37

Abstract: Background Cesarean section (CS) rate has increased rapidly over the past two decades in world. It is serious concern for public health experts globally. Various medical and non-medical factors, such as maternal socio-demographics, are found to be responsible for this upsurge. Like in other countries, the rate of caesarean sections has increased in Nepal as well. Therefore, there is a need to investigate the factors behind this increase. Objectives To identify the factors associate for caesarean section among mothers attending at teaching hospital, Chitwan Methods A cross sectional analytical study was conducted using total enumerative sampling technique in the maternity ward of Chitwan Medical College Teaching Hospital. Interview was done with closed ended Questionnaire for data collection, a total number of 139 mothers after 24 hours cesarean section (CS).......

Keywords: Caesarean section, Factor associated, Indication

[1]. World Health Organization. Statement on Caesarean Section Rates. Geneva: World Health Organization. Geneva. 2015.
[2]. Olorunda T, Otito O, Akinbode A. & Akinbode, O. Knowledge and attitude of mothers on risk factors influencing pregnancy outcomes in Abeokuta South Local Government Area.European Scientific Journal. 2015:11(11).
[3]. World Health Organization. Monitoring emergency obstetric care: a handbook. Geneva, Switzerland; 2009.
[4]. Molina G., & et. al. "Relationship Between Cesarean Delivery Rate and Maternal and NeonatalMortality".JAMA2015:314(21):2263-70. doi:10.1001/jama.2015.15553. PMID 26624825 [5]. Cavallaro, FL, Cresswell, JA, Franca, GV, Victora, CG, Barros, AJ, Ronsmans, C. Trends in caesarean delivery by country and wealth quintile: cross‐sectional surveys in southern Asia and sub‐Saharan Africa. Bull World Health Organ. 2013; 91: 914‐ 922.

Abstract: Introduction: The incidence and treatment of prostate cancer shows variation across the globe. The clinic-epidemiological profile of this disease have been extensively studied in many countries, data regarding this in West Bengal is limited. Aims: To describe the clinic-epidemiological characteristics of prostate cancer and the primary treatment modality in PCa patients in a single tertiary care centre. Materials And Methods: Data were collected prospectively from all patients with newly diagnosed prostate cancer and managed in urology department of Nil RatanSircar Medical College, Kolkata, from January 2018 to January 2019 (n=41). DRE, serum PSA, USG prostate, andT-99 bone scan was done in all patients. Patient's age, clinical presentation, prostate specific antigen (PSA) level, mode of diagnosis, Gleason score, stage of the disease, addiction and main modality of treatment were recorded and analysed........

[1]. Ferlay J, Colombet M, Soerjomataram I et al. Global and Regional Estimates of the Incidence and Mortality for 38 Cancers: GLOBOCAN 2018. Lyon: International Agency for Research on Cancer/World Health Organization; 2018
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[3]. National Cancer Registry Programme. Three-Year Report of Population Based Cancer Registries 2012-2014. Available from: http://ncdirindia.org/NCRP/ALL_NCRP_REPORTS/PBCR_REPORT_2012_2014/ALL_CONTENT/PDF_Printed_Version/Chapter10_Printed.pdf. [Acessed 13th October 2019].
[4]. Jain S, Saxena S, Kumar A. Epidemiology of prostate cancer in India. Meta Gene 2014;2:596-605
[5]. Yeole BB. Trends in the prostate cancer incidence in India. Asian Pac J Cancer Prev 2008;9:141-4

Abstract: Background Cisatracurium, an intermediate duration, non-depolarisingbenzylisoquinolinium neuromuscular blocking drug, appear to have potential clinical advantages, faster onsetwhile retaining hemodynamic stability without chemically mediated histamine release or its associated symptoms.So we planned to design a study to evaluate and compare the intubating conditions and onset of action of the different doses of this drug. Materials and methods The study was a randomized, prospective, double blinded one in which sixty adult patients of ASA I & II, aged 19-65 years, undergoing various surgeries under general anaesthesia were randomized into three equal groups of twenty patients each as to receive 10 ml of cisatracurium -viz 3×ED95(1.5mg/kg), 4×ED95(2.0mg/kg) and 5×ED95(2.5mg/kg) in the group A, B& C respectively. The onset time, intubation score, TOF, haemodynamics parameter and side effects were recorded and analysed......

[1]. Bluestein LS, Stinson LW, Lennon RL, Quessy SN, Wilson RM. Evaluation of cisatracurium, a new neuromuscular blocking drug, for tracheal intubation. Can J Anaesth 1996;43(8):925- 31.
[2]. Jammar P, Pathak DB, Begum I, Chauhan RC. A clinical comparative study of two intubating doses of cis-atracurium during general anaesthesia for gynaecological surgery. Int J Basic Clin Pharmacol 2017;6(5):1206-10.
[3]. Doenecke A, Hoernecke R, Moss J, Czeslick E. Onset time, endotracheal intubating conditions and plasma histamine after cisatracurium and vecuronium administration. Anaesth analogue 1998; 87(2):434-8.
[4]. Cooper R, Mirakhur RK, Clarke RSJ, Boules Z. Comparison of intubating conditions after administration of ORG9426(Rocuronium) and Suxamethonium. Br J Anaesth 1992;69(1):269-73.
[5]. Chatrath V, Kaur H, Makhni R, Jaspreet, Sood O. Compare onset time of cisatracurium for tracheal intubation with and without priming dose of rocuronium. Int J Sci Study 2019; 6 (11):102-6.

Abstract: Congenital pseudoarthrosis of the clavicle is a rare occurrence. This congenital defect usually involves the right side, of which the aetiology is still uncertain. The defect is usually benign. Surgical treatments such as plating and k-wiring are not indicated normally, except when there is presence of neurovascular deficit. As of now, this is the first recorded case in our centre

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[2]. Alldred AJ. Congenital pseudarthrosis of the clavicle.J Bone Joint Surg1963 ; 45-B : 312-319.
[3]. FitzwilliamsDCL : Hereditary cranio-cleido-dystosis. Lancet 2 : 1466-1475, 1910
[4]. Ahmadi B. Steel HH : Congenital pseudoarthrosis of the clavicle. Clin Orthop126 : 130-134, 1977
[5]. Bargar WL, Marcus RE, Ittleman FP. Late thoracic outlet syndrome secondary to pseudarthrosis of the clavicle.J Trauma 1984 ; 24 : 857-859

Abstract: Recent legislation aims to improve oral health by increasing access to care and focusing research attention on subjective patient evaluations related to OHRQoL (Oral Health Related Quality of Life). Oral health and quality of life are compromised in radiation and chemotherapy of the head and neck. Given our current economic and healthcare challenges and the resulting political debate around curtailing healthcare costs, access to care is a major policy issue. Using the association between oral health conditions and OHRQoL among oral cancer patients can be an effective mechanism to communicate with policymakers to reveal the importance of oral health and equal access to care. Assessment of OHRQoL may facilitate decision-making for oral cancer patients, healthcare providers, and policymakers. {Dr. Shadab Ali Baig, Assistant Professor, Department of Oral and Maxillofacial Surgery, Dr. Gaurav Sharma, Senior Resident, Department of Public Health Dentistry, SCB Dental College & Hospital, Cuttack, Odisha, Dr. Fathima Kouser, General Dental Practitioner, Bangalore}.

[1]. Andrade FP, Antunes JLF, Durazzo MD. Evaluation of the quality of life of patients with oral cancer in Brazil. Braz Oral Res 2006;20(4):290-6
[2]. Hussain QA, Awan KH. Effect on quality of life in oral cancer patients after radiation and chemotherapy. J Contemp Dent Pract 2016; 17(2): 97-98
[3]. Panagiotakos DB. Methodological issues in the quantitative assessment of quality of life. Angiology. 2011 Oct; 62(7): 517-9.
[4]. Sheiham A. Oral health, general health and quality of life. Bull World Health Organ. 2005; 83 (9): 644-45.
[5]. Shamrany MA. Oral health-related quality of life: a broader perspective. East Mediterr Health J. 2006;12(6): 894-90.
[6]. Parker et al. An oral health literacy intervention for Indigenous adults in a rural setting in Australia. BMC Public Health 2012;12:461.

Abstract: Background: A modified TEP inguinal hernia repair with two port instead of conventional three port which follows the trend of minimising invasiveness without encompassing the challenges of SILS. Single incision laparoscopic surgery (SILS) has some limitations, including the difficult ergonomics of single incision instruments, the reported increase in port-site herniation following SILS and the relatively steep learning curve. Our aim is to determine the feasibility, safety and long-term outcome of two-port TEP for laparoscopic inguinal hernia repair. Methods: Following institutional approval, data was prospectively collected for 45 patients presenting with inguinal hernia from January 2018 to June 2019. Two-port laparoscopic TEP was offered as first-line treatment for all patients over the study duration. All patients were consented for the possibility of additional port placement and conversion to.....

Keywords: Totally extraperitoneal inguinal hernia repair, Laparoscopic TEP, Two-port TEP, Laparoscopic inguinal hernia repair.

[1]. Bobo Z, Nan W, Qin Q, Tao W, Jianguo L, Xianli H (2014) Meta-analysis of randomized controlled trials comparing Lichtenstein and totally extraperitoneal laparoscopic hernioplasty in treatment of inguinal hernias. J Surg Res 192(2):409–420
[2]. ZhuX, CaoH, MaY, YuanA, WuX, MiaoY, GuoS(2014) Totally extraperitoneal laparoscopic hernioplasty versus open extraperitoneal approach for inguinal hernia repair: a meta-analysis of outcomes of our current knowledge. Surg J R Coll Surg Edinburgh Ireland 12(2):94–105
[3]. M. A. Fuglestad, S. J. Waisbren. Two-port totally extraperitoneal inguinal hernia repair: a 10-year experience (2016) 20: 423.
[4]. Basu S, Chandran S, Somers SS, Toh SK (2005) Cost-effective laparoscopic TEP inguinal hernia repair: the Portsmouth technique. Hernia J Hernias Abdom wall Surg 9(4):363–367
[5]. Kurmann A, Fischer H, Dell-Kuster S, Rosenthal R, Audige L, Schupfer G, Metzger J, Honigmann P (2015) Effect of intraoperative infiltration with local anaesthesia on the development of chronic pain after inguinal hernia repair: a randomized, triple- blinded, placebo-controlled trial. Surgery 157(1):144–154

Abstract: Depression and Anxiety disorders are caused due to abnormalities of the norepinephrine (NE) and serotonin (5HT) neurotransmitter systems. The majority of evidence supports under activation of serotonergic function and complex dysregulation of noradrenergic function, most consistent withover activation of this system (1)The increase in serotonergic function and decrease in noradrenergic function accompany treatment with antidepressants, and these alterations may be necessary for antidepressant efficacy. The selective serotonin reuptake inhibitors (SSRIs) have been the most widely used pharmacological agents for Depression and Anxiety disorders, Monotherapy with SSRIs is often recommended for patients diagnosed with these conditions. (3) SSRIs were devoid of side effects associated with the earlier antidepressant drugs—the tricyclics (TCAs) and MAOIs. These included dry mouth, constipation, sedation, orthostatic hypotension, and tachycardia. (4).....

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[4]. ―Emotional side-effectsof selective serotonin reuptake inhibitors: qualitative study‖, J. Price, V. Cole, and G. M. Goodwin, British Journal of Psychiatry, vol. 195, no. 3, pp. 211–217, 2009.
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