iosr-JDMS   Volume-19 ~ Issue-2 ~ February 2020

Abstract: Background: Fournier's gangrene is an aggressively spreading infection that initially affects the genitalia and perianal regions with progression to the abdomen and thoracic wall. The hall mark of the disease is gangrene of skin and subcutaneous tissues due to thrombotic occlusion of subcutaneous vessels caused by necrotizing fasciitis. Methods: This is prospective study including 35 cases of Fournier's gangrene at Surgical wards at PDU Civil Hospital, Rajkot between Dec 2017 to October 2019.Patient were diagnosed on basis of clinical examination. FGSI score calculated by vital parameters (heart rate, respiratoryrate, temperature) and laboratory studies (serum sodium, potassium, creatinine, bicarbonate, leukocytes count, hematocrit)........

Key Word: FGSI(Fournier's gangrene severity index), Necrotisingfaciitis.

[1]. Litchfield WR. The bitter sweet demise of Herod the Great. J R Soc Med 1998; 91:283-4.
[2]. Fournier J-A. Gangrene foudroyante de la verge. SemaineMedicale 1883; 3: 345-8.
[3]. Meleney FL. Hemolytic streptococcus gangrene. Arch Surg 1924; 9: 317---64.4.Wilson B. Necrotizing fasciitis. Am Surg 1952; 18:416-31.
[4]. Gray JA Gangrene of the genitalia as seen in advanced periurethral extravasation with phlegmon. J Uro11960; 84:740-5.
[5]. Luckett WH. Large phagedenic ulcer of abdomen. Ann Surg 1909; 50: 605-8.

Abstract: Oral Transmucosal Fentanyl Citrate (OTFC) is a labelled Paediatric Sedative. These are available in different colours for different doses and sweetener added to these so that the children suck these easily. Doses greater than 20 micrograms/Kg are associated with a high incidence of postoperative nausea and vomiting and respiratory depression. We studied the safety and efficacy of OTFC in different doses compared with placebo group. Method: Sixty patients of ASA I and II for Patent Ductus Arteriosus Ligation were randomized into three equal groups.Children between age four to ten years were included in the study. Those patients having associated other congenital cardiac anomalies and history of hypersensitivity to the drug used for study were excluded from the study.......

Key Word: Oral Transmucosal Fentanyl Citrate Lollipop, Premedication ,Paediatric Patients , Patent ductus arteriosus ligation

[1]. Schecter NL, Weisman SJ, Rosenblum M, et al. The use of oral transmucosal fentanyl citrate for painful procedures in children. Paediatr 1995;95:335-39
[2]. Schutzman SA, Liebelt E, Wisk M, Burg J. Comparison of oral transmucosal fentanyl citrate and intramuscular mepridine,promethazine,and chlorpromazine for conscious sedation of children undergoing laceration repair. Ann Emerg Med 1996;28:385-90
[3]. Streisand, JB, Stanley, TH, Hague, B, Van Vreeswijk, H, Ho, GH, Pace, NL. Oral transmucosal fentanyl citrate premedication in children. Anesthesia and Analgesia1989; 69: 28– 34.
[4]. FradkinDM,Scott-Warren VL, Vashisht R, Rolfe SE. An Evidence Based Guideline for the Preoperative Sedation of Children. J Pediatr Neonatal Care 2015;2(6)
[5]. KarSK,Ganguly T, Dasgupta C.S, et al.Preoperative Anxiety in Pediatric Population: Anesthesiologist's Nightmare. Transl Biomed.2015,6:4

Abstract: AIM: To evaluate retinal nerve fibre layer (RNFL) thickness in women with iron deficiency anemia (IDA). METHOD: This observational hospital based study was performed between December 2018 to April 2019. This study included 59 female patients with IDA and 44 controls. RESULTS: Nasal and inferior quadrant RNFL thickness of IDA group were thinner than the control group (p<0.001). CONCLUSION: RNFL thickness measured by OCT is thinner in adult female of child bearing age group with IDA. It may have significant effect in management of various disorders like glaucoma and neuro-ophthalmological diseases.

Key word: Retinal nerve fibre layer thickness, Iron deficiency anemia, OCT

[1]. The prevalence of anemia in women: a tabulation of available information. Geneva, World Health Organization: 1992 (available at:
http://whqlibdoc.who.int/hq/1992/WHO MCH_MSM_92.2.pdf).
[2]. Beard JL and Connor JR. Iron status and neural functioning. Annu Rev Nutr 2003; 23:41-58.
[3]. DeMaman AS, Melo P, Homem JM, et al. Effectiveness of iron repletion in the diet for optic nerve development of anaemic rats.
Eye (Lond) 2010; 24: 901-908.
[4]. Algarin C, Peirano P, Garrido M, et al. Iron deficiency anemia in infancy: long lasting effects on auditory and visual system
functioning. Pediatr Res 2003; 53: 217-223.
[5]. Lonneville YH, Ozdek SC, Onol M, Yetkin I, Gurelik G, Hasanreisoglu B. The effect of blood glucose regulation on retinal nerve
fibre layer thickness in diabetic patients. Ophthalmologica 2003;217:347-50.

Abstract: Background: Postpartum Haemorrhage is one of the leading causes of maternal mortality and morbidity .Aim: To evaluate the efficacy of B-Lynch sutures in controlling atonic post partum hemorrhage at caesarian section. This prospective observational hospital based study was conducted at Government General Hospital Vijayawada from Jan 2019 to Dec 2015. All women who underwent caesarean section and who developed atonic post partum haemorrhage and were refractory to medical management were included in the study. Exclusion criteria were those cases who developed Disseminated Intravascular Coagulation, bleeding diathesis and traumatic pph. Results were tabulated and analysed using SPSS version 22.....

Keywords: Atonic postpartum hemorrhage, B-Lynch suture, maternal mortality

[1]. Mousa HA , Alfirevie Z. Treatment for primary postpartum haemorrhage. Cochrane Database sys Rev. 2007; Issue I : CD003249
[2]. Cunningham FG, Leveno KJ , Bloom Sl , Hauth JC, Rouse DJ, Spong CY . Obstetric haemorrhage. In: Williams obstetrics, 23rd edn. Newyork: McGraw Hill Medical , 2010.pp.757-803.
[3]. B-lynch C, Coker A, lawal AH et al . The B-lynch surgical technique for the control of massive postpartum haemorrhage; an alternative to hysterectomy? Five cases reported Br J ObstetGynecol 1997; 104:372-5.
[4]. Nahar SNS Khannam M . Simple technique of uterine compression sutures for prevention of primary postpartum haemorrhage during caesarean section . Park J Med Sci 2010 ;26:319-323.
[5]. World Health Organisation .WHO Recommendation for the Prevention and Treatment of postpartum haemorrhage .Genova : WHO;2012.

Abstract: Aim:To compare the effect of intravenous Esmolol, Fentanyl and Dexmedetomidine on haemodynamic response to laryngoscopy & tracheal intubation in patients posted for elective surgical procedures and to study the safety and side effects of these drugs.
Settings and Design:Prospective, randomized & double blind study. Methods and Material:150 elective surgical patients of aged 18 to 65years were included in study. All patients underwent elective surgical procedures under general anaesthesia. Patients were randomized into three groups. Group A: Received Esmolol 2mg/kg, Group B :Received Fentanyl 2μg/kg, Group C :Received Dexmedetomidine 1μg/kg. The following parameter (HR, SAP, MAP, DAP, and SpO2) levels were measured and recorded: - Average of three readings taken in operation theatre were considered as baseline and all other measurements were compared with the baseline.........

Keywords: Esmolol, Fentanyl, Dexmedetomidine, haemodynamic, rate pressure product.

[1]. Jakusenko N, Kopeika U, Mihelsons M, Nagobade D, Vija Putniña A, Pavārs A. Comparison of stress response performing endotracheal intubation by direct laryngoscopy, fibreoptic intubation and intubation by the glidescope laryngoscope. In Proceedings of the Latvian Academy of Sciences. Section B. Natural, Exact, and Applied Sciences. 2008 Jan 1 (Vol. 62, No. 4-5, pp. 176-181). [2]. Reid L C, Brace D E. Irritation of respiratory tract and its reflex effect upon heart. Surg., Gynaec. and Obst. Feb 1940 ; 70 : 157-162. [3]. Bhana N, Goa KL, McClellan KJ. Dexmedetomidine. Drugs. 2000 Feb;59(2):263-8. [4]. Gupta S, Tank P. A comparative study of efficacy of esmolol and fentanyl for pressure attenuation during laryngoscopy and endotracheal intubation. Saudi journal of anaesthesia. 2011 Jan 1;5(1):2. [5]. Louizos AA, Hadzilia SJ, Davilis DI, Samanta EG, Georgiou LG. Administration of esmolol in microlaryngeal surgery for blunting the hemodynamic response during laryngoscopy and tracheal intubation in cigarette smokers. Annals of Otology, Rhinology & Laryngology. 2007 Feb 1;116(2):107-11.

Abstract: Objective: This study investigated the current constraints to utilization of cataract surgical services at Enugu Nigeria from patients' perspective. Cataract is the leading cause of blindness worldwide and constitutes a major public health burden. Despite the therapeutic efficacy of cataract surgery, and efforts made in recent years to improve access to it, utilization has remained suboptimal Methods: This was a descriptive cross-sectional study that employed structured pre-validated questionnaire as research tool. The protocol was approved by a hospital Ethics Committee. The respondents were adult patients of both genders who gave informed consent. Data analysis was carried out using Statistical Package for Social Sciences (SPSS Inc., Chicago, IL)........

Key words: Cataract, Utilization, Surgical services, Blindness, Treatment.

[1]. WHO: Blindness and vision impairment prevention, 2019. https://www.who.int/blindness/ causes/priority/en/index1.html
[2]. WHO: Blindness and vision impairment, 2018. https://www.who.int/news-room/fact-sheets/detail/blindness-and-visual-impairment. [3]. Khairallah M; Kahloun R; Bourne R; Limburg H; Flaxman SR; for the Vision Loss Expert Group of the Global Burden of Disease Study. Number of People Blind or Visually Impaired by Cataract Worldwide and in World Regions, 1990 to 2010. Investigative Ophthalmology & Visual Science 2015; Vol.56, 6762-6769. doi: https://doi.org/10.1167/iovs.15-17201 [4]. Song P, Wang H, Theodoratos E, Chan KY, Rudan I. The national and subnational prevalence of cataract and cataract blindness in China: a systematic review and meta-analysis. J Glob Health 2018; 8(1):010804. doi:10.7189/jogh.08-010804 [5]. Nkumbe, H. Helping Older People get the Eye Care they need. Community Eye Health Journal 2008; vol 21, issue 66, pp 26 - 28''

Abstract: Le syndrome de Sturge-Weber-Krabbe (SSW) est une pathologie neuro-cutanée congénital rare caractérisée par une angiomatose de la peau, de l'oeil et des méninges. Sa physiopathologie est expliquée par une mutation génétique. La présentation clinique neurologique la plus fréquente est les crises épileptiques. Nous rapportons un cas de SSW regroupant les différents éléments de la triade originale : angiome plan de l'hémiface, angiomatose lepto-méningée et angiome choroïdien avec glaucome. Mots clés :SSW, angiomatose, enfant, scanner cérébral.......

Keywords: SWS, angiomatosis, child, CT-scan.

[1]. Sturge-Weber Syndrome withcerebellarinvolvement, M. Smith Pearl, W.M.A. Abdalla, D.D.M. Lin, A.M. Comi, E. Boltshauser, P. Gailloud, T.A.G.M. Huisman, Journal of Neuroradiology (2009) 36, 57—60.
[2]. Adultdiagnosis of temporo-occipital leptomeningeal angiomatosis, P. de la Riva_, M.T. Martinez Zabaleta, M. Arruti González, M.A. UrtasunOcariz, Neurologia. 2015 Jan-Feb;30(1):64-6. doi: 10.1016/j.nrl.2013.02.011. Epub 2013 Apr 18.
[3]. Syndrome de Sturge-Weber : données actuelles de l'imagerie neuroradiologique, M Boukobza, O Enjolras, MR Cambra et JJ Merland, J Radiol 2000; 81 : 765-771© Editions françaises de radiologie, Paris, 2000.
[4]. Spectrum of CT and MR findings in Sturge-Weber syndrome: A case report, Pallavi J. Agrawal, Amit T. Kharat, Rajesh Kuber, SunitaShewale, DOI: 10.4103/0975-2870.135284.
[5]. Sturge-Weber syndrome: CT and MRI illustrations, SiddarthRagupathi, Ajit Kumar Reddy, AnnithaElavarasiJayamohan,PrakashManikkaLakshmanan, doi:10.1136/bcr-2014- 205743.

Abstract: Peutz-Jeghers Syndrome (PJS) is a rare autosomal dominant disease, defined by the association of a lentiginosis and lesion of the digestive, pulmonary and reproductive organs. The PJS gene has been located on chromosome 19p13.13. The skin signs are visible and constitute a telltale sign of the disease, they are type of lentigines, They sit most often on the lips, the oral mucosa.

Key Word: Peutz -Jeghers syndrome, Lentiginosis, Polyposis, Invagination.

[1]. Heymann WR. Peutz-Jeghers syndrome. J Am Acad Dermatol. 2007;57:513-4.
[2]. Tovar JA, Eizaguirre I, Albert A, Jimenez J. Peutz-Jeghers Syndrome in Children: Report of Two Cases and Review of the Literature. J Pediatr Surg. 1983 Feb;18(1):1-6.
[3]. Higham P, Alawi F, Stoopler ET. Medical management update: Peutz Jeghers syndrome. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010 Jan;109(1):5-11.
[4]. McGarrity TJ, Amos C. Peutz-Jeghers syndrome: Clinicopathology and molecular alterations. Cell Mol Life Sci. 2006 Sep;63(18):2135-44.
[5]. Mehenni H, Gehrig C, Nezu J, Oku A, et al. Loss of LKB1 Kinase Activity in Peutz- Jeghers Syndrome, and Evidence for Allelic and Locus Heterogeneity. Am J Hum Genet. 1998 Dec;63(6):1641-50.

Abstract: Background: Radiotherapy is an integral part of management in all breast conservation surgeries (BCS) and for a large percentage of postmastectomy patients. Conventionally fractionated radiotherapy (1.8-2 Gy/fraction) lasts for 6 weeks in post-BCS patients and 5 weeks for postmastectomy patients. However, over last 02 decades few large randomized control trials have confirmed that appropriately dosed hypofractionated radiotherapy is equally safe and effective. Here we present our institutional experience with hypofractionated radiotherapy in breast carcinoma.....

Key Words: Hypofractionation, Breast cancer, cosmesis

[1]. Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM. GLOBOCAN 2016 v1.2, Cancer Incidence and Mortality Worldwide: IARC Cancer Base No. 10 [Internet]. Lyon, France: International Agency for Research on Cancer. (Available from: http://globocan.iarc.fr)
[2]. National Cancer Registry Programme (NCRP, ICMR). Three year report of population based cancer registries. 2009-2011. Bangalore: NCRP; (available at www.pbcrindia.org)
[3]. Clarke M, Collins R, Darby S. For the Early Breast Cancer Trialists' Collaborative Group (EBCTCG). Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15‑year survival: An overview of the randomized trials. Lancet Oncol 2005;366:2087‑106.
[4]. Nattinger AB GM, Veum J, Yahnke D. Geographic variation in the use of breast-conserving treatment of breast cancer. N Engl J Med 1992;326:1147-49.
[5]. Yarnold J, Ashton A, Bliss J. Fractionation sensitivity and dose response of late adverse effects in the breast after radiotherapy for early breast cancer: long-term results of a randomised trial. Radiother Oncol 2005;75:9-17.

Abstract: Background: Congenital aortic arch malformations present a large spectrum of variations and anomalies that emanate from disordered embryogenesis of branchial arches. These aberrations are the result of either abnormal persistence or involution of embryonic vascular segments. The branching pattern of the arch aorta is important to the clinicians as an unconventional branching pattern of the arch or aorta may be the cause of the symptoms that brought the patient to the hospital; or it may be crucial to the clinician in making the plan of care for the patient. These malformations can be isolated or they may be associated with other intra cardiac and/or chromosomal defects. CT provides high spatial resolution evaluation of vascular anomalies and can be reformatted in multiple oblique planes to provide a complete assessment of the branching patterns and the tracheal and esophageal compression, if any at the same time......

Key Word: Arch of aorta, bovine arch, Thyroidea ima artery, aberrant right subclavian artery, aortic arch anomalies and CT angiography of aorta.

[1]. Lim HK, Ha HI, Hwang HJ, et al. Feasibility of high-pitch dual-source low-dose chest CT: Reduction of radiation and cardiac artifacts. Diagn Interv Imaging 2016; 97:443-9. 10.1016/j.diii.2016.01.007
[2]. McLaren CA, Elliott MJ, Roebuck DJ. Vascular compression of the airway in children. Paediatr Respir Rev 2008; 9:85-94. 10.1016/j.prrv.2007.12.008
[3]. Kau T, Sinzig M, Gasser J et-al. Aortic development and anomalies. Semin Intervent Radiol. 2007; 24 (2): 141-52.
[4]. Dasari TW, Paliotta M. Images in clinical medicine. Cervical aortic arch. N. Engl. J. Med. 2014; 371 (26): e38.
[5]. Bader V, Walayat M, Smith B et-al. Circumflex retroesophageal aorta mimicking aortic interruption: a rare cause of aortic obstruction in a neonate. World J Pediatr Congenit Heart Surg. 2014; 5 (4): 599-602.

Abstract: Dementia is a syndrome characterized by failure of recent memory and otherIntellectual functions that are usually insidious in onset, but steadily progresses. Alzheimer's disease (AD) is the most common dementia, accounting for 60-70% of cases in the elderly [1](Hebert, Scherr et al. 2003). AD affects 20 to30 million individuals worldwide [2](Selkoe 2005). The prevalence of AD increases with age, affecting approximately 1% to 3% of the population round 60 years of life, 3% to 12%of the population between 70 and 80 years, and up to 25% to 35% of the population older than 85 years [3](Walsh and Selkoe 2004). Life expectancy has been constantly increasing in industrialized countries, predicting that the incidence of AD will increase three fold over the next 50 years. The earliest

[1]. L. E. Hebert, P. A. Scherr, J. L. Bienias, D. A. Bennett, and D. A. Evans, ―Alzheimer disease in the US population: prevalence estimates using the 2000 census.,‖ Arch. Neurol., vol. 60, no. 8, pp. 1119–22, Aug. 2003.
[2]. ― JAMA Network | JAMA Neurology | Defining Molecular Targets to Prevent Alzheimer Disease .‖
[3]. D. Walsh and D. Selkoe, ―Deciphering the molecular basis of memory failure in Alzheimer's disease,‖ Neuron, 2004.
[4]. P. J. Nestor, P. Scheltens, and J. R. Hodges, ―Advances in the early detection of Alzheimer's disease,‖ Jul. 2004.
[5]. P. Hortega, ―Del Río: El "tercer elemento ―de los centros nerviosos. Poder fagocitario y movilidad de la microglia. Bol. Soc. esp,‖ Biol. Madrid.

Abstract: Introduction: Leukemias are a group of neoplasms arising due to malignant transformation of blood forming cells. Ocular involvement inleukemia is most common . Case report :A 11 year old female child presented with defective vision in both eyes more in left eye compared to right eye .Subconjunctivalhaemorrhage present in both eyes.Preretinalhaemorrhages,hard exudates ,cotton wool spots in right eye and vitreous haemorrhage in left eye. Based on clinical finding she was advised systemic evaluation . Discussion: Ocular findings in leukemia mostly due to hyperviscositystatus and medications used in treatment . Conclusion :Ocular involvement has been described in up to 50% of patients at the time of diagnosis .So diagnosis of leukemia based on ocular findings islife saving as survival rate is increasing with chemotherapy

Key words: Leukemia , Acute promyelocyticleukemia .

[1]. Champlin R, Golde DW. The Leukaemias. In: Wilson JD, Braunwald E, et al (Eds). Harrison's principles of internal medicine; 12th Edition, Chapter 296;
[2]. McGraw Hill, Inc, New York, 1991;2:1552-61 Russo V, Scott IU, Querques G, Stella A, Barone A, DelleNoci N. Orbital and ocular manifestations of acute childhood leukaemia: Clinical and statistical analysis of 180 patients. Eu J Ophthalmol 2008;18(4):619-23.
[3]. Frank RN, Ryan SJ Jr. Peripheral retinal neovascularization with chronic myelogenousleukemia. Arch Ophthalmol 1972;87:585‑9
[4]. Nobacht S, Vandoninck KF, Deutman AF, Klevering BJ. Peripheral retinal nonperfusion associated with chronic myeloid leukemia. Am J Ophthalmol 2003;135:404‑6.
[5]. Macedo MS, Figueiredo AR, Ferreira NN, Barbosa IM, Furtado MJ, Correia NF, et al. Bilateral proliferative retinopathy as the initial presentation of chronic myeloid leukemia. Middle East Afr J Ophthalmol 2013;20:353‑6.

Abstract: L'os est le principal site métastatique de nombreux cancers, dits ostéophiles, en particulier, le sein et la prostate. Responsable d'ostéolyse maligne, avec comme conséquence principale, l'augmentation du risque de fracture, d'hypercalcémie et de douleur osseuse augmentant le risque de morbidité et de mortalité. Les métastases osseuses ostéolytiques sont dus a une stimulation des cellules ostéolytiques dont la fonction est une résorption osseuse, par contre ceux qui sont condensantes sont secondaire a une activation des cellules osteoblastiques.

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