iosr-JDMS   Volume-17 ~ Issue-12 ~ December-2018

Abstract: BACKGROUND: Transdermal patch of Diclofenac is as effective as intramuscular Diclofenac in relieving mild to moderate post-operative pain of elective laparoscopic cholecystectomy. However, transdermal route is non-invasive and with lower incidence of systemic adverse effects as compared to oral or parenteral routes. PATIENTS AND METHODS: In this prospective randomized clinical study, 60 patients of either sex with ASA-1 and ASA-2, undergoing elective laparoscopic cholecystectomy were randomly allocated to two groups, each of 30 patients. Group-1 patients received 75mgs (I/M) of Diclofenac sodium post incision and Group-2 patients received 100 mgs of Diclofenac transdermal patch, 6 hours prior to surgery. Post-operative analgesia was assessed using Visual Analogue Scale (VAS)...........

Key Words:Transdermal, Intramuscular, Diclofenac, Post-operative, Analgesia.

[1]. Dubois F., Lcard P., Berthelot G., et al. Coelioscopic cholecystectomy: Preliminary report of 36 cases. Ann Surg 1990; 211:60-62
[2]. Millers Anesthesiology: 6th Edition. Page 2285, chapter 57.
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[4]. Downs SH., Black NA., Devlin HB., et al. Systematic review of the effectiveness and safety of laparoscopic cholecystectomy. Ann R Coll Surg Engl. 1996; 78: 241-323.
[5]. Lau H., Brooks DC. Predictive factors for unanticipated admissions after ambulatory laparoscopic cholecystectomy. Arch Surg. 2001; 136: 1150-3.

Abstract: Sheehan's syndrome is a condition characterized by hypopituitarism secondary to ischaemic necrosis of pituitary gland. In Sheehan's syndrome necrosis occurs due to hypotension and shock resulting from massive postpartum haemorrhage. This disease is becoming rare now due to better postpartum care but is still prevalent in developing countries especially in rural areas and if occurs, it often develops slowly which can be missed and a delayed diagnosis increases mortality and morbidity in affected individuals. Here we present a case of a 37 year old female who presented at our institute with complaints of fever and generalised weakness. She had not attained menses for last 15 years. Patient gives history of post-partum haemorrhage and scanty lactation in her last pregnancy which was............

[1]. Sheehan, H. L. Postpartum necrosis of the anterior pituitary. J. Pathol. Bact. 45, 189–214 (1937).

[2]. Diri, H.et.al. Extensive investigation of 114 patients with Sheehan's syndrome: a continuing disorder. Eur. J. Endocrinol. 171, 311–318 (2014).

[3].Asa,S.L.Pituitary histopathology in man: normal and abnormal. Endotext https://www.ncbi.nlm.nih.gov/books/NBK279003(updated 10 June 2007).

[4]. Young, W. F. Jr. in The Netter Collection of Medical Illustrations: The Endocrine System (ed. Young, W. F. Jr) 1–7 (Elsevier, 2011).

[5]. Matsuwaki, T., Khan, K. N., Inoue, T., Yoshida, A. & Masuzaki, H. Evaluation of obstetrical factors related to Sheehan syndrome. J. Obstet. Gynaecol. Res. 40, 46–52 (2014)..

Abstract: Anaesthesiologists come across a wide spectrum of cases which are critical and have a diagnostic dilemma. Rare cases are referred to ICU management by Intensivits/Anaesthesiologist for symptoms and features for life support makes the treatment and outcome of such rare cases a challenge for the ICU team. Here also we are reporting a case of Subacute Sclerosing Panencephalitis (SSPE) which was a diagnostic challenge with a challengable management. SSPE is a chronic form of progressive brain inflammation caused by mutated measles virus. In developing countries where immunization is still poorly practised health-care. The incidence of SSPE is as high as 1 in 6091 cases and often has a fatal outcome. Incidence is high in Asia and Middle East...........

[1]. Bellini WJ, Rota JS, Lowe LE, Katz RS, Dyken PR et al (2005): Journal of Infectious Disease.192(10):1686-1693.
[2]. Dyken PR. Subacute Sclerosing Panencephalitis. Current status Neurol Clin. 1985;3:179-196.
[3]. Deniz Yilmaz et al (November 2006): Journal of Brain and Development. Vol28,Issue 10,649-652.

Abstract: The prevalence of Type 2 Diabetes Mellitus (T2DM) today at the Global level is 45 million and is assumed to become 642 million by 2050. T2DM is a major cause for cardiovascular complications and death. The heart rate and blood pressure are said to increase in response to increased myocardial metabolic demand. Rate Pressure product (RPP)is an easily measureable index of increased oxygen demand which can be used. The aimof the study was to find out the association between Rate pressure product and cardio vascular risk in Type 2 DM patients.The Study was conducted in Trichy SRM Medical College in the Department of Physiology and general Medicine in T2DM patients who came for regular checkup. A structured Proforma was used to collect sociodemographic details like age........

Keywords: Cardiovascular Disease, Diabetes Mellitus, Rate Pressure Product.

[1]. International Diabetes Federation. http://www.idf.org/about-diabetes/facts-figures (accessed 11 dec 2016).

[2]. Laakso M Cardiovascular disease in type 2 diabetes: challenge for treatment and prevention. J Intern Med 2001; 249: 225– 235

[3]. Gu K, Cowie CC, Harris MI. Diabetes and decline in heart disease mortality in US adults. JAMA. 1999;281:1291–1297
[4]. Jouven X, Zureik M, Desnos M, Guérot C, Ducimetière P. Resting heart rate as a predictive risk factor for sudden death in middle-aged men. Cardiovasc Res. 2001 May;50(2):373-378

[5]. Cockcroft JR, Wilkinson IB, Evans M, McEwan P, Peters JR, Davies S, Scanlon MF, Currie CJ. Pulse pressure predicts cardiovascular risk in patients with type 2 diabetes mellitus. Am J Hypertens. 2005 Nov;18(11):1463-1467...

Abstract: Objectives: To study the factors which affect outcome of trial of labor Materials and Methods: All pregnant women admitted to Goa Medical College, from October 2013 to June 2015, fulfilling the inclusion criteria were enrolled in this study. Data was collected in a proforma, meeting the objectives of the study. Antenatal/ past obstetric predictive factors with respect to successful TOLAC were analysed. Results: The study included 1,302 pregnant women with history of one or more previous cesarean deliveries, who fulfilled the inclusion criteria. 918 cases (70 %), including 236 subjects with previous 2 LSCS and 682 subjects with previous 1 LSCS; were taken for repeat LSCS (ERCD). Of the 384 cases (30 %) who underwent TOLAC; success rate was 80.5% (309/384). Younger women.........

Keywords: Trial oflabor after cesarean (TOLAC), Vaginal Birth After Cesarean (VBAC), Elective repeat cesarean delivery (ERCD).

[1]. Gabert HA, Bey M: History and development of cesarean operation. ObstetGynecolClin North Am 15:591, 1988
[2]. WHO statement on caesarean section rates: WHO/RHR/15.02; April 2015
[3]. Sancheeta Ghosh and K.S James: Increasing caesarean section delivery: A threat to urban women's health? 2013 princeton.edu/papers/130873
[4]. Vaishnavi S D :Analysis of the extent and cost of caesarean section deliveries in Kerala and Tamil Nadu, India: Evidence from DLHS-3 survey 2005-2006
[5]. David Branch, Robert SIlver: Managing the Primary Cesarean Delivery Rate: Clinical Obstetrics and Gynecology Volume 55, Number 4, 946–960 ; december 2012.

Abstract: Coracobrachialis muscle arises from the tip of the Coracoid process of scapula, blends medially along with short head of Biceps brachii and is usually inserted into the medial border of the middle of the shaft of humerus. The mesenchyme of lateral plate mesoderm differentiates to form muscles of the limb bud. They usually fuse together and lead to the formation of a single muscle bulk. Failure of normal fusion of the different layers of muscle accounts for the accessory insertion. During performing routine dissection in the anatomy department of RIMS, Imphal, accessory slip in addition to the main bulk of the coracobrachialis muscle was noticed. It arose from the tip............

Keywords: Coracobrachialis, accessory slip, median nerve palsy, graft.

[1]. Standring.S. Gray's anatomy. Churchill Livingstone Elsevier: New York; 2008.
[2]. McMinn RMH. Last's Anatomy: Regional and applied. Churchill Livingstone Elsevier: Edinburgh;1990.
[3]. Guha R, Satyanarayan N, Ready CK et al. Variant insertion of coracobrachialis muscle- morphological significance, embryological basis, and clinical importance. J. Coll. Med. Sci. Nepal 2010; 6:42-46.
[4]. Gessini L, Jandolo B, Pietrangeli A. Entrapment neuropathies of the median nerve at and above the elbow. Surg Neurol 1983; 19:112–116.
[5]. Datta AK . The Arm. In: Essentials of human anatomy. Part III. 4th edition. Current Books International, Kolkata; 2009:59-60..

Abstract: Polyps of gastrointestinal tract (GIT) form a composite group with varied morphology, clinical presentation and course of disease. Although polyps of GIT may occur in any age,they are common in the 6th to 7th decade. They may be seen in oesophagus, stomach and small intestine but are most commonly seen in the colon. They may arise as a result of inflammation, ectopia, hamartomatous or neoplastic proliferation. Aims and objectives: This study aims at studying the polyps and polypoid lesions of gastrointestinal tract, with reference to the incidence, distribution, morphology and their association with cancers in a tertiary care centre of Southern India.Methods:452 specimens of polyps and polypoid lesions were studied with respect to their location, presentation, morphology and association..............

Keywords: colonic polyp, adenoma, hyperplastic polyp, colorectal cancer.

[1]. Plachta A, Speer FD. Gastric polyps and their relationship to carcinoma of the stomach. Am J Gastroenterol, 1957; 28: 160.
[2]. Rosch W. Epidemiology, pathogenesis, diagnosis and treatment of benign gastric tumours. Front Gastrointest Res, 1980; 6: 167.
[3]. Laxén F, Sipponen P, Ihamäki T, Hakkiluoto A, Dortscheva Z. Gastric polyps; their morphological and endoscopical characteristics and relation to gastric carcinoma. Acta Pathol Microbiol Immunol Scand A. 1982 May;90(3):221-8.

[4]. Ismuil-Beigi F, Horton PF. Pope CE II. Histological consequences of gastroesophageal reflux in man. Gastroenterology I970;58:163-174.
[5]. American Gastroenterological Association Medical Position Statement on the Management of Barrett's Esophagus. Gastroenterology 2011;140:1084 –1091.

Abstract: Context: Vasectomy is safe, simple, procedure without major complications, no deaths, fewer selected as family planning method, low prevalence rate of 3.9% in Andhra Pradesh, compared to 95.6% tubectomies with complications even deaths happened. Majority people preferred choice is tubectomy. Hence this study was taken to evaluate of factors influencing for acceptance of vasectomy is necessary Aims: To assess the awareness, knowledge about permanent family planning methods and to study factors influencing in selecting vasectomy as sterilization method. Methods and Material: Cross sectional, hospital based survey carried with 350 men in Government Maternity Hospital Tirupati.............

Keywords: Sterilization, vasectomy, awareness, knowledge.

[1]. Demographics of India [Internet cited on 17-11-2018] Available from: http://en.wikipedia.org/wiki/ Demographics_of_India.
[2]. "Population growth (annual %)". World Bank. Retrieved 20 January 2015. [Internet cited on 17-11-2018]
[3]. https://en.wikipedia.org/wiki/2011_Census_of_India[Internet cited on 17-11-2018]
[4]. National Family Health Survey – 4, 2015-16Ministry of Health and Family Welfare, Governament of India, International Institute for Population Sciences(Deemed University) Mumbai, 2015 -16 http://rchiips.org/NFHS/nfhs4.shtml[Internet cited on 17-11-2018]
[5]. Sonalde Desai GENDER INEQUALITIES AND DEMOGRAPHIC BEHAVIOR INDIATHE POPULATION COUNCIL / NEW YORK 1994 [Internet cited on 20-5-2015] Available from: www.sonaldedesai.org/ desai_1994_ gender_ inequalit.pdf.

Abstract: Renal tubular acidosis (RTA) is a group of transport defects secondary to reduced proximal tubular reabsorption of bicarbonate (HCO3-), the distal secretion of protons (hydrogen ion, H+) or both, resulting in impaired capacity for net acid excretion and persistent hyperchloremic metabolic acidosis. Based on pathophysiology, RTA has been classified into three types: type 1 (distal) RTA; type 2 (proximal) RTA; and type 4 RTA secondary to true or apparent hypoaldosteronism. Type 4 RTA has metabolic acidosis with hyperkalemia that is disproportionately high for the degree of renal insufficency. Child presents with failure to thrive, polyuria, polydypsia, vomiting, listlessness, dehydration, hyponatremia, hyperkalemia & hyperchloremic acidosis; plasma rennin activity & urine and plasma aldosterone levels are greatly............

[1]. Rudolph's fundamentals of pediatrics By Abraham M. Rudolph, Robert K. Kamei, Kim J.Overby
[2]. Bagga A, Sinha A. Evaluation of renal tubular disorders. Indian J Pediatrics 2007; 74(7) : 679-686.
[3]. Ronconi, G.F., Pesenti, P., Usai, A.E., Ronconi, M. & Soffiati, G. Distal renal tubular acidosis with nerve deafness. Pediatric Med Chir 1984, 6: 549-552.
[4]. Santos, F., Rey, C., Malaga, S., Rodriguez, L.M. & Orejas, G. The syndrome of renal tubular acidosis and nerve deafness. Discordant manifestations in dizygotic twin brothers. Pediatric Nephrol 1991, 5: 235-237.
[5]. Ruzena Tkacov'a, R. Roland, A. Bd6rl, Anna Kovacov'a2, Ivica Laziurova3, I. Tkac4, T. Hildebrand and P. gefara .Type IV renal tubular acidosis associated with Alport's syndrome. Postgrad Med J (1993) 69, 823 -825..

Abstract: Hernia and Appendix are two most common surgical problem encountered by a general surgeon. The presence of Appendix within inguinal hernia sac is termed as Amyand's hernia. It is an uncommon condition and rare presentation, estimated to be found in Approximately 1% of adult Inguinal Hernia. Its diagnosis is very difficult preoperatively, generally diagnosed accidentally and intra-operatively. We present a case of Inguinal Hernia where normal Appendix was found intra-operatively during repair of right inguinal hernia in a 60 years male patient. Mesh Hernioplasty was done without appendicectomy..

Key Words: Amyand's hernia, Inguinal hernia, Appendix

[1]. Ivashchuk G, Cesmebasi A, Sorenson EP, Blaak C, Tubbs SR, et al. (2014) Amyand's hernia: A review. Med Sci Monit 20: 140-146.
[2]. IvashchukGalyna. Amyand's hernia: a review, Med Sci Monit. 2014;20:140–146. [PubMed]
[3]. Ramsingh Jason, Ali Ahmad, Cameron Caroline, Al-Ani Ahmed, Hodnett Robert, Chorushyj Catriona. De Garengeot's hernia: diagnosis and surgical management of a rare type of femoral hernia. J Surg Case Reports. 2014;(2) [PMC free article] [PubMed]
[4]. Michalinos A., Moris D., Vernadakis S. Amyand's hernia: a review. Am J Surg. 2014;207:989–995.[PubMed]
[5]. Ortega-León L.H. Hernia de Amyand: Presentación de un caso y revisión de la literatura. Rev Med Hosp Gen Méx. 2011;74(2):98–100.

Abstract: The periosteum is highly cellular connective tissue with rich vascularity and regenerative potential, which make it suitable autogenous graft. The inverted periosteal technique utilized periosteal for coverage of denuded root surface. The purpose of this case report was to evaluate the inverted periosteal technique that involves a single surgical site, in terms of root coverage, gingival height, and probing depth. A patient with Miller class I gingival recession of 3.0 mm, gingival height of 2.0 mm and probing depth of 2.0 mm was treated by the inverted periosteal technique. At the end of 6 months, satisfactory results were achieved. The inverted periosteal technique can be used for the treatment of gingival recession defects in further.

Keywords: Gingival recession; Inverted periosteal technique; Periosteum, Root coverage

[1]. American Academy of Periodontology, editor. Glossary of periodontal terms. American Academy of Periodontology; 2001.
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Abstract: We conducted a case-control type of descriptive study during October 2017 to April 2018 in several private clinics, Jamalpur, Bangladesh. Our aim was to find out risk factors of Typhoid fever in children. The sample was drawn from the selected clinics, were 200 (100 cases and 100 controls). Out of 100 participants in each group 70% cases and 69% controls respondents were mother of the children. Most of the study subjects were under 5 years. Mean ± SD of age were (4.9042 ± 3.35575) for cases and (3.4951 ± 2.49218) for controls. Age distribution of the children was statistically significant where p -value was 0.0001 for t-test and 0.01151045 for chi-square (p<0.05). Most of the children were urban dwellers 90% cases and 96% controls. The difference was statistically significant (χ2 = 4.134, p = 0.04202989) and 35% of cases drunk supply water in comparison with 14% of controls.......

Keywords: Risk factors, Typhoid fever, Socio-economic conditions, Socio-demographic conditions

[1]. Park. "Text book of preventive and social medicine" Banarsidas Bhanot. 16th edition, 2000. page 187
[2]. Crump JA, Luby SP, Mintz ED. The global burden of typhoid fever. Bull World Health Organ 2004; 82: 346-53
[3]. Mrs. R.S. Tambulwadkar, "Paediatric nursing" Vora medical publications, 2nd edition, page 108
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Abstract: 90-95% of cases of acute cholecystitis are caused due to gall stones, i.e. calculous cholecystitis. Rest of the 5-10% cases are caused without the presence of stones, i.e. acalculous cholecystitis. Diagnosis of acute cholecystitis involves clinical, laboratory, and radiographic findings. The present study was conducted in the Department of Surgery, Govt. Medical College, Amritsar. A sample size of 50 patients was taken who were diagnosed as cases of acute cholecystitis either clinically or radiologically referred to the department. The aim of the study is to evaluate the accuracy of clinical, ultrasonographic and intra-operative findings in acute cholecystitis. The mean age of presentation..........

Keywords - Gall Bladder, Acute cholecystitis, Acalculous cholecystitis, USG.

[1]. Strasberg, SM (26 June 2008). "Clinical practice. Acute calculous cholecystitis". The New England Journal of Medicine. 358 (26): 2804–11.

[2]. Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, Management (10 ed.). Elsevier Health Sciences. 2015. p. 1154.

[3]. Ansaloni, L (2016). "2016 WSES guidelines on acute calculous cholecystitis". World Journal of Emergency Surgery : WJES. 11: 25. [4]. NIDDK. November 2013. Archived from the original on 28 July 2016. Retrieved 27 July 2016.

[5]. Greenberger N.J., Paumgartner G (2012). Chapter 311. Diseases of the Gallbladder and Bile Ducts. In Longo D.L., Fauci A.S., Kasper D.L., Hauser S.L., Jameson J, Loscalzo J (Eds), Harrison's Principles of Internal Medicine, 18e.

Abstract: Aim: To compare the working length in primary teeth using Intraoral digital Radiovisiography and Apex locator with conventional method. Materials and Method: 30 primary teeth which were indicated for pulpectomy in the patients of the age group of 3-9 years. Endodontic treatment was required due to irreversible pulpitis or pulp necrosis. A standardized pre-operative intraoral periapical radiograph of the tooth was taken using conventional method. After this, the pulpectomy procedure was initiated, during the procedure the working length was firstly determined by IOPAR method, simultaneously with digital radiography, and then working length determination was done by Electronic apex locator. The measurements were then compared with the conventional method of root canal measurement technique..........

Keywords: Apex locator, conventional radiography, digital radiography, primary teeth, working length

[1]. IE Neena , Ananthraj A, Praveen P, Karthik V, Rani P.Comparison of digital radiography and apex locator with the conventional method in root length determination of primary teeth. J Indian Soc Pedod Prev Dent 2011; 29(4):300-4.
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Abstract: The world population isageing and thisproblemisemerging over the past few years and itisexpected to be a major issue in the near future. The older population isdefined as thosewhoaged over 60 yearsold.This studyaimed to investigate the association betweenselected variables and comorbidityamongelderly population who are residing in health-care facilities in Selangor, Malaysia. The selected variables are gender, educationallevel, body mass index and quality of life.Cross-sectional studywascarried out, involving 141 participants from four health care facilities.The quality of life of the elderlywasmeasuredbased on WHOQOL-BREF questionnaire.The prevalence of comorbidityamong the participants were 65.9%. This studyfoundthatelderlywithhigher BMI has an increaserisk of gettingcomorbidity.

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[5]. Wang, H.-X., Karp, A., Winblad, B. and Fratiglioni, L. (2002) "Late-life engagement in social and leisure activities is associated with a decreased risk of dementia: A longitudinal study from the Kungsholmen project‟, American Journal of Epidemiology, 155(12), pp. 1081–1087. doi: 10.1093/aje/155.12.1081..

Abstract: Background: Concern about repeat cesareans and their associated risks has prompted an interest in the feasibility and safety of vaginal birth after cesarean (VBAC). Therefore, in women with one previous cesarean and spontaneous labor onset, vaginal birth after cesarean section represents potential alternative to election repeated cesarean section (ERCS) as it can lessen risks of surgical complications, more rapid recovery and mom's morbidity.........

Keywords: Spontaneous labor, maternal outcomes, neonatal outcomes, cesarean section, vaginal birth after cesarean, vaginal birth after cesarean section success rate.

[1]. Landon MB, Hauth JC, Leveno KJ, Spong CY, Leindecker S, Varner MW, Moawad AH, Caritis SN, Harper M, Wapner RJ, Sorokin Y. Maternal and perinatal outcomes associated with a trial of labor after prior cesarean delivery. New England Journal of Medicine. 2004 Dec 16;351(25):2581-9.
[2]. Guise JM, Eden K, Emeis C, Denman MA, Marshall N, Fu RR, Janik R, Nygren P, Walker M, McDonagh M. Vaginal birth after cesarean: new insights. Evidence report/technology assessment. 2010 Mar 1(191):1-397.
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[5]. Dodd J, Crowther C. Vaginal birth after Caesarean versus elective repeat Caesarean for women with a single prior Caesarean birth: a systematic review of the literature. Australian and New Zealand journal of obstetrics and gynaecology. 2004 Oct;44(5):387-91.