iosr-JDMS   Volume-18 ~ Issue-4 ~ April-2019

Abstract: Background: The incidence of sepsis and the number of sepsis-related deaths are increasing, although the overall mortality rate among patients with sepsis is declining.Sowith reference to current situation analysis and limited number of studies related to association of the mortality with the high density lipoprotein level in the patients with sepsis in the ICU, the present study will be undertaken on the association of the mortality with the high density lipoprotein level in the patients with sepsis in the ICU. Material & Methods: This is a prospective cohort study done on 50 patients with sepsis and septic shock admitted in intensive care unit in Mahatma Gandhi Medical College & hospitals, Jaipur, Rajasthan from January 2017-june 2018.Patient's included in study are based on initial assessment by qSOFA scoring system. Those patient in which qSOFA score more than.......

Keywords : HDL, Survivors, non-survivors, AKI, Sepsis, SOFA score

[1]. "Sepsis Questions and Answers". cdc.gov. Centers for Disease Control and Prevention (CDC). 22 May 2014.[cited 2018, June 11] [2]. In Tintinalli, Judith E.; Stapczynski, J. Stephan; Ma, O. John; Cline, David M.; et al. Tintinalli's Emergency Medicine: A Comprehensive Study Guide (7th ed.). New York: McGraw-Hill. pp. 1003–14. [cited 2018, June 11]

[3]. Surviving Sepsis Campaign Guidelines Committee including The Pediatric Subgroup; Dellinger, RP; Levy, MM; Rhodes, A; et al. (2013). "Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock: 2012" (PDF). Critical Care Medicine. 41 (2): 580–637. doi:10.1097/CCM.0b013e31827e83af. PMID 23353941. [cited 2018, June 11]

[4]. Deutschman, CS; Tracey, KJ. Sepsis: Current dogma and new perspectives. Immunity,2014; 40 (4): 463–75. doi:10.1016/j.immuni.2014.04.001. PMID 24745331. [cited 2018, June 11]

[5]. Rhodes, Andrew; Evans, Laura E . "Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2016". Critical Care Medicine,2017; 45 (3): 486–552. doi:10.1097/CCM.0000000000002255. PMID 28101605. [cited 2018, June 11]..

Abstract: Background and Aims: Femoral nerve block for total knee replacement (TKR) patients is one of the renowned techniques for post-operative pain relief,but it delays ambulation. Saphenous nerve block, (sensory branch of femoral nerve) has been used in a few studies to compare analgesia and muscle strength. We aimed at comparing saphenous and femoral nerve blocks for pain relief, sensory block, muscle strength and patient satisfaction score in patients undergoing unilateral TKR. Methods: 50 ASA I, II and III patients posted for unilateral TKR were divided into two groups in a randomized double-blind study. Group A received 15 ml of 0.75% ropivacaine in femoral nerve block and group B received the same drug in blocking the saphenous nerve. Duration of analgesia, muscle strength, sensory block and patient satisfaction score were studied..........

Key Words: Total knee Replacement, Saphenous Nerve block, Ropivacaine

[1]. Allen HW, Liu SS, Ware PD, Nairn CS, Owens BD. Peripheral nerve blocks improve analgesia after total knee replacement surgery. AnesthAnalg. 1998;87:93-7.
[2]. Hadzic A, Houlett, Capdevila X, Ilfeld BM. Femoral nerve block for analgesia in patients having knee arthroplasty. Anesthesiol. 2010;113:1014-5.
[3]. Andersen HL, Gyrn J, Møller L, Christensen B, Zaric D. Continuous saphenous nerve block as supplement to single-dose local infiltration analgesia for postoperative pain management after total knee arthroplasty. RegAnesth Pain Med. 2013;38:106-11.
[4]. Choi PT, Bhandari M, Scott J, Douketis J. Epidural analgesia for pain relief following hip or knee replacement. Cochrane Database Syst Rev. 2003;CD003071.
[5]. Task Force on Taxonomy Part III. Pain Terms.A Current List with Definitions and Notes on Usage. International Association for the Study of Pain Web site, http://www.iasp-pain.org/Content/ NavigationMenu/ GeneralResource-Links/PainDefinitions/default.htm;Published 1994. Accessed 12.01.11.

Abstract: Background :liver abscess was first described as early times of Hippocrates ,earlier laparotomy&drainage was the mainstay, with better imaging modality aspiration & catheter insertion is treatment now a days. Aim:1. To study incidence /age & sex distribution 2. To analyze clinical features 3. To throw light on the radiological imaging & plan management accordingly

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[3]. Dela Rey N.J, Simjee AE, Patel A.Indication for Aspiration of Amoebic liver abscess.SAfr med.J.1989:75:373.
[4]. Balasegaram M.Management of Hepatic abscess. CurrSurg 1981 18:283
[5]. Bailey and love's short practice of Surgery. 24th Edition..

Abstract: Colorectal carcinoma is one of the commonest cause of death worldwide. Folkman first proposed that tumor angiogenesis could serve as a potential target for anticancer therapy. Sustained angiogenesis has been the one of the hallmarks of malignancy. Angiogenesis has been studied using immunohistochemical (IHC) staining of microvessels with markers like CD 31, CD34, CD105, Factor VIII related antigen, PECAM -1 and vWF then by calculating the Micro vessel density (MVD) and other morphometrical parameters like vessel caliber(VC),micro vessel cross-sectional area(VCSA) and % Total vessel area (%TVA). The objective of the study is two fold first to compare intratumoral microvessels density and extratumoral microvessels density, second to find out any significant positive correlation between intratumoral microvessel density with grading and staging by using CD34 and CD105.......

[1]. Weitz J, Koch M, Debus J, et al. Colorectal cancer, Lancet 2005; 365:153–65.

[2]. Hermanek P, Gospodarowicz MK, Henson DE, et al. Prognostic Factors in Cancer. Berlin: Springer 1995:64–79.
[3]. Folkman J. Tumor angiogenesis: therapeutic implications. N Engl J Med 1971; 285: 1182–86

[4]. Saad RS, Liu YL, Nathan G, et al. Endoglin (CD105) and vascular endothelial growth factor as prognostic markers in colorectal cancer. Modern Pathology 2004; 17:197–03
[5]. Weidner N, Semple JP, Welch WR, et al. Tumor angiogenesis and metastasis – correlation in invasive breast carcinoma. N Engl J Med 1991; 324:1–8

Abstract: Doctors are known to work under the highest levels of stress,and even the medical students suffer a high degree of stress, as seen by reportsfrom some countries across the globe.No remedial measures have been instituted so far, asproper quantification of the problem and its causes are an essential prerequisite. An assessment of stress levels in the first year medical students, just after joining the course, and an enquiry into itscause were attempted in this study.Perceived stress was compared by the well-known tool incorporated from PSS-10, along with background data.55.2% of the 1st year students showed significant stress with 17.6% suffering from severe stress. Performance in school-leaving.......

Key words: Medical students, Nuclear family, Physicalactivity, PSS-10,Stress.

[1]. Cohen S, Janicki-Deverts D, Who‟s Stressed? Distributions of Psychological Stress in the United States in Probability Samples from 1983, 2006, and 2009,Journal of Applied Social Psychology, 42(6), 2012, 1320–1334. doi: 10.1111/j.1559 1816.2012.00900.
[2]. Jafri SA, Zaidi E, et al, Stress Level Comparison of Medical and Non-medical Students: A Cross Sectional Study done at Various Professional Colleges in Karachi, Pakistan,ActaPsychopathologica, 3(2:8), 2017, 1-6.

[3]. Wong SS, Zhou B, Goebert D, Hishinuma ES, The risk of adolescent suicide across patterns of drug use: a nationally representative study of high school students in the United States from 1999 to 2009,Soc Psychiatry PsychiatrEpidemiol., 2013 Jun 7. PMID: 23744443

[4]. Meng H, Li J, Loerbroks A, Wu J, Chen H, Rural/urban Background, Depression and Suicidal Ideation in Chinese College Students: A Cross-Sectional Study, PLoS One, 8(8), 2013 Aug16;e71313. PMID:23977015.

[5]. Supe AN, A study of stress in medical students at Seth G.S. Medical College, J Postgrad Med., 44(1), 1998 Jan-Mar, 1-6, PMID:10703558.

Abstract: Hysterectomy is one of the most common gynaecological procedures done in the females worldwide as it provides definitive cure to a wide range of gynecological diseases, both benign and malignant. The cause for hysterectomy being done varies from country to country and region to region. The most frequent indications for hysterectomy are Fibroids, Abnormal Uterine Bleeding and Uterovaginal prolapse. Histopathological analysis of the hysterectomy specimens is mandatory for diagnostic purposes and to assess the pattern of lesions common in the uterus and adenexa. The objective of this study is to present the Histopathological patterns of various uterine and adnexal pathologies in the hysterectomy specimens and also to correlate its pre-operative clinical diagnosis with Histopathology.

Key words: Hysterectomy; Fibroid; Uterovaginal prolapse; Adenomyosis; Abnormal Uterine Bleeding.

[1]. Karthikeyan T M, Veenaa N N, Ajeeth Kumar C R, Eliz Thomas. Clinicopathological study of Hysterectomy among rural patients in a tertiary care centre. IOSR journal of Dental and Medical Sciences, May 2015; 14(2): 25-7.
[2]. Vaidya S, Vaidya S A. Patterns of lesions in hysterectomy specimens in a tertiary care hospital. J Nepal Med Assoc, Jan-March 2015; 53(197):18-23.
[3]. Verma R. Histopathological study of Hysterectomy specimen in tertiary care centre of rural Bihar. International Journal of Recent Scientific Research, Feb 2016;7(2):9021-23.
[4]. Usha K, Maheshwari J. Histopathological spectrum of lesions in Hysterectomy specimens at a tertiary care hospital- one year study. IOSR Journal of Dental and Medical Sciences, Oct 2017; 16(10): 34-8.
[5]. Yadav D P, Yadav R, Bhati I. Abdominal Hysterectomy: analysis of clinicopathological correlation in Western Rajasthan, India. International journal of Reproduction, Contraception, Obstetrics and Gynaecology, 2017 March; 6(3):1012-1015

Abstract: Background: In type 2 diabetes, fibrinogen levels have been demonstrated to predict the progression to overt nephropathy .Hyperfibrinogenemia, an indicator of inflammation, is also associated with the presence of endothelial dysfunction, insulin resistance, hypercoagulability, and increased blood viscosity and is a marker of unstable atherosclerotic lesions. Increase in blood viscosity and other hematological changes are now seen to contribute to the development of diabetic retinopathy much more than previously known. Objectives: Aim of my study was to establish the association between Plasma Fibrinogen with microvascular complications in type 2 diabetes mellitus ( Retinopathy and Microalbuminuria) . Methods: It is a tertiary hospital based observational cross sectional study held from March 2013 to June 2014 where 100 type 2........

Keywords: Type 2 diabetes mellitus, retinopathy, nephropathy,ACR,fibrinogen

[1]. Mezzano D, Pais EO, Aranda E et al. Inflammation, not hyperhomocysteinemia, is related to oxidative stress and hemostatic and endothelial dysfunction in uremia. Kidney Int 2001; 60: 1844-1850.
[2]. halfaoui T, G Lizard, Ouertani-Meddeb A. Adhesion molecules (ICAM-1 and VCAM-1) and diabetic retinopathy in type 2 diabetes. J Mol Histol. 2008; 39: 243-249.
[3]. Chen W, Jump DB, Grant MB, Esselman WJ, Busik JV, et al., Dyslipidemia, but not hyperglycemia, induces inflammatory adhesion molecules in human retinal vascular endothelial cells. Invest Ophthalmol Vis Sci. 2003; 44: 5016-5022.
[4]. J. Lin, F.B. Hu, E.B. Rimm, N. Rifai, G.C. Curhan, The association of serum lipids and inflammatory biomarkers with renal function in men with type II diabetes mellitus, Kidney Int. 2006; 69: 336-342.
[5]. Y. Aso, Y. Fujiwara, K. Tayama, K. Takebayashi, T. Inukai, Y. Takemura, Relationship between soluble thrombomodulin in plasma and coagulation or fibrinolysis in type 2 diabetes, Clin. Chim. Acta 2000; 301 135-145

Abstract: Background: The Centres for Disease Control and Prevention reported that the hysterectomy rate in 2000–2004 was 5.4 per 1000women per year. Types of Hysterectomies include Abdominal hysterectomy (AH), Vaginal Hysterectomy (VH), Laparoscopic hysterectomy and Robotic hysterectomies. These procedures have undergone important changes recently. Abdominal hysterectomy is carried out in cases of gynaecological disorders like Abnormal Uterine Bleeding(AUB), Fibroids, endometriosis, and in malignancies.
Materials and Methods: In this study, 150 cases of hysterectomy were analysed from April 2016 to August 2017 at RIMS, Kadapa..........

Key words: Hysterectomy, Abdominal hysterectomy, Laparoscopic hysterectomy, Kadapa

[1]. Altgassen C, Michels W, Schneider A. Learning laparoscopic-assisted hysterectomy. Obstet Gynecol 2004;104(2):308–13.
[2]. Briese V, Ulfig N, Mylonas I. Vaginal hysterectomy. Gynakologe 2002;35:116–24.
[3]. Stang A, Merrill RM, Kuss O. Prevalence-corrected hysterectomy rates by age and indication in Germany 2005-2006. Arch Gynecol Obstet 2012;286(5):1193–200.
[4]. Whiteman MK, Hillis SD, Jamieson DJ, Morrow B, Podgornik MN, Brett KM, et al. Inpatient hysterectomy surveillance in the United States, 2000-2004. Am J Obstet Gynecol 2008;198(1):34.e1–7.
[5]. Yogesh Neena, Bhaskar Honey, "Clinico-pathological correlation of hysterectomy specimens for abnormal uterine bleeding in rural area". Journal of Evolution of Medical and Dental Sciences 2013; Vol2, Issue 39, September 30; Page: 7506-7512...

Abstract: Introduction: Liver is one of the most common sites for both neoplastic and non-neoplastic lesions. Ultrasound guided FNA of liver is safe, cheap and relatively noninvasive procedure with minimum complications. Material and Methods: This study was a prospective cross sectional study over a period of one year from January 2018 to December 2018 with 50 cases and was conducted in the radiology and pathology departments of LN Medical College and JK Hospital, Bhopal. Results: Of the total 50 cases, 13 [26%] cases were Benign and 37 [74%] were malignant, or suspicious for malignancy. All the samples were satisfactory and had good diagnostic yield........

Keywords: Ultrasound, Fine Needle Aspiration Cytology, Liver lesions, Benign, Malignant

[1]. Gatphoh ED, Gaytri S, Babina S, Singh AM. Fine needle aspiration cytologyof liver: a study of 202 cases. Indian J Med Sci 2003; 57(1): 22-5.
[2]. Crowe D, Eloubeidi M, Chhieng D, et al (2006). Fine-needle aspiration biopsy of hepatic lesions: computerizedtomographic-guided versus endoscopic ultrasound-guided FNA. Cancer, 108, 180-5.
[3]. Whitlach S, Nunez. C, Pitlik DA. Fine needle aspiration of the liver. A study of 102 consecutive cases. Acta Cytol 1984; 28:719-25
[4]. Das DK. Cytodiagnosis of hepatocellular carcinoma in fine needle aspirates of the liver, its differentiation from reactive hepatocyte and metastatic adenocarcinoma. Diagn Cytopathol 1999; 21 : 370-7.
[5]. Pedio G, Handolt U, Zobeli U, Gut D. Fine needle aspiration of the liver. Significance of hepatocytic naked nuclei in the diagnosis of hepatocellular carcinoma. Acta Cytol 1988; 32: 437-42...

Abstract: Dens evaginatus is a developmental malformation characterized by the presence of an extra cusp that takes the form of a tubercle arising from the occlusal or lingual surface of tooth. It frequently affects maxillary permanent incisors. Its presence affects esthetics, occlusal accommodation and are more prone for caries. Diagnosis and clinical management of this anomaly is challenging for the dentist. This case report presents a tooth with talon cusp diagnosed as chronic irreversible pulpitis with apical periodontitis.

Keywords: Dens evaginatus, Endodontic, Lateral incisor, Maxillary, Talon cusp

[1]. Mitchell WH. Letter to the editor. Dent Cosm 1892;34:1036

[2]. Mellor JK, Ripa LW. Talon cusp: A clinically significant anomaly. Oral Surg Oral Med Oral Pathol 1970;29:225-8

[3]. Jowharji N, Noonan RG, Tylka JA. An unusual case of dental anomaly: A facial talon cusp. ASDC J Dent Child 1992;59:156-8

[4]. Dankner E, Harari D, Rotstein I. Dens evaginatus of anterior teeth. Literature review and radiographic survey of 15,000 teeth. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1996;81:472-5.
[5]. Abbott P. V. Labial and palatal "talon cusps" on the same tooth-A case report. Oral Surg Oral Med Oral Pathol Oral Radial Endod 1998;85:726-30...

Abstract: Persistent Splenomegaly in pediatric patients with homozygous sickle cell anemia (HbSS) is uncommon. And Hypersplenism is also uncommon. This case report describes a patient with HbSS who, at the age of six, began to experience hypersplenism as manifested by; progressive splenomegaly; Persistent thrombocytopenia; increasing severity of anaemia with the need for repeated blood transfusion, Leukopenia, High reticulocyte count and Circulating nucleated red blood cells. These episodes occurred with sufficient frequency and severity to warrant splenectomy. He has improved after splenectomy, with a resolution of the thrombocytopenia and leukopenia; improvement..........

Keywords: Sickle cell anemia, persistent Splenomegaly, Hypersplenism

[1]. Olaniyi JA. Multiple Complications in a Sickle Cell Disease Patient: A Case Report. Clinical Medicine: Case Reports. 2008 Jan;1:CCRep-S812.

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[3]. Ingram VM. A specific chemical difference between the globins of normal human and sickle-cell anaemia haemoglobin. Nature. 1956 Oct;178(4537):792.

[4]. Ingram VM. Gene mutations in human haemoglobin: the chemical difference between normal and sickle cell haemoglobin. Nature. 1957 Aug 17;180(4581):326-8.

[5]. Rees DC, Olujohungbe AD, Parker NE, Stephens AD, Telfer P, Wright J. Guidelines for the management of the acute painful crisis in sickle cell disease. British journal of haematology. 2003 Mar;120(5):744-52..

Abstract: Introduction: Pre-use checking endotracheal tube cuff is a daily routine in the practice of anaesthesia. Manufacture defects of endotracheal tubes are not common;hence easily overlooked. Such defects can be catastrophic if corrective measures are not timely instituted. Case Report: We are presenting a case of 12 years female child posted for adenotonsillectomy under general anaesthesia in which there was difficulty to ventilate after intubation due to block present in endotracheal tube connector.Discussion: Conditions like bronchospasm , mechanical obstruction in the tube , kinking of the tube and defect in endotracheal tube must be considered and corrected in cases of difficult ventilation following intubation.Conclusion:manufacturing defects must be anticipated in cases of difficult ventilation following intubation if all the other causes are ruled out.

Keywords: unanticipated difficult airway, endotracheal tube,manufacture defect

[1]. Barst S, Yossefy Y, Lebowitz P. An unusual cause of airway obstruction. AnesthAnalg. 1994;78:195.
[2]. Henderson MA. Airway obstruction with a cuffed single-use plastic endotracheal tube. Anaesth Intensive Care. 1993;21:370–2.
[3]. Famewo CE. A not so apparent cause of intraluminal tracheal tube obstruction. Anesthesiology.1983;58:593.
[4]. NganKee WD. An unusual problem with an endotracheal tube. Anaesth Intensive Care. 1993;21:247–8.
[5]. Baldemir R, Akçaboy Y, Akçaboy ZN, Göğüş N. Endotracheal tube obstruction: A manufacturing defect. Turk J AnaesthReanim 2015; 43: 62-4...

Abstract: Hemi spinal anaesthesia is a promising alternative to traditional, widely used technique of central neuraxial blocks, as it markedly restricts the anesthetized area, thereby, decreasing the risk of adverse events and complications1.Use of conventional doses of Bupivacaine is associated with haemodynamic instability, prolonged blockade. Low dose bupivacaine with lipophilic opioid like fentanyl has been reported to obtain satisfactory hemi spinal anaesthesia and less cardiovascular side effects. This study was done to know effectiveness of low dose Bupivacaine , 2.5mg with 25mcg Fentanyl for hemi spinal anaesthesia in lower limb surgeries in critically ill patients. 30 patients aged 50-80 years of ASA class 3 and 4 were included in this study. They were given hemi spinal.......

Keywords: Hemi spinal anaesthesia, critically ill patients, intrathecal Fentanyl, hyperbaric, bupivacaine

[1]. Karpel E1, Marszołek P, Pawlak B, Wach E. Effectiveness and safetyof unilateral spinal anaesthesia. Anestezjol Intens Ter. 2009 Jan-Mar;41(1):33-6.
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[5]. Enk D, Prien T, Van Aken H, Mertes N, Meyer J,Brüssel T. Success rate of unilateral spinal anesthesiais dependent on injection flow. Reg Anesth PainMed. 2001;26:420-7.

Abstract: The purpose of the present study was to analyze the open versus closed treatment of mandibular condyle fractures. A retrospective study of 54 patients treated for mandibular condyle fractures at Department Dental Surgery, KAP Vishwanatham medical college, Trichy between 2016-2018 was performed. Thirty two patientswere treated nonsurgically and Twenty two patients by surgical treatment. Clinical and radiological parameters were evaluated during the follow up period.In nonsurgical group, 18 patients (56%) had loss of vertical ramus height. In open reduction group temporary facial nerve weakness was seen in 2 patients(9%) and one patients developed post operative infection. None of the patients in both groups had malocclusion. Surgical treatment provided more accurate results clinically as well as radiographically

Keywords: Condylar fracture, Open reduction, Closed reduction

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