Thursday, 3 August 2017

Medical Journal- July issue 2017

Medical Journal: Published volume-3, Issue-7, July 2017 with ad publications

Trends of steroid modified tinea at tertiary care hospital in India

Abstract—Dermatophytes are the common fungal agents implicated in superficial skin infections worldwide, commonly known as tinea. They include species of Trichophyton, Microsporum and Epidermophyton. Infections of this organism have dramatically increased in last one decade by misuse of topical corticosteroids cream alone or in combination with topical antibacterial and antifungal agents. So this study was conducted with the aim to study about culprits (prescribers) and various offending agents. This study was conducted on 1239 consecutive patients of tinea between ages 1-70 years. Tinea was diagnosed by detailed history and clinical examination. Detailed inquiry was made for topical steroid use by recall method or relevant prescriptions. It was found that out of 1239, 1000 (80.7%) patients were using topical corticosteroid in any form. Most common age group was 21-30 years (38.3%). Pharmacist appeared as chief culprit (50.4%) and Clobetasol was major offending agent (34.8%). Majority (55.3%) of patients applied these formulations for 4 week or more. Study concluded that use of topical corticosteroids in tinea has become menace because of unethical manufacture, sales, prescription and end misuse by patient.

Keywords: Dermatophytes, Topical corticosteroids, Tinea, Culprits, Offending agents.

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Alarming tropical steroid misuse on face: A descriptive study

Abstract— Acne vulgaris is a chronic inflammatory disease of the pilosebaceous unit. The clinical lesions are non-inflammatory open and closed comedones and or papules, pustules and nodules of varying degree of inflammation and depth. A lot of steroid, cosmetic and Ayurvedic products containing unlabeled depigmenting agent and steroids are available readily over the counter sale. The side effects of these products are not documented and can lead to adverse effects of continuous usage. This study was aimed to find out various offending depigmenting agents (topical unlabeled steroid containing cosmetics) for treatment of Acne and its side effects with type of offering persons. This study was conducted on 1110 OPD patient of which 1000 (90.10%) patients are using steroid and unlabeled steroid containing cosmetics and only 110 (9.90%) patient not using any topical application. Mostly affected common age group was 11-20 years (58%) with slight female preponderance (M:F 0.96). Urban patients were more affected than rural (74% v/s 26%). Unmarrieds (76%) were more affected than married (24%). Friends appeared as chief culprit or suggestions given to them (39%) followed by family member(13.5%), self-application (12%) influenced by advertisements, chemist(11.5%), general practitioner (9.5%), neighbor (4.5%), compounder(1.5%), parlor(2%) and only 2% by dermatologist. Betamethasone (32.5%) was major offending agent followed by Clobetasol (25%), unlabeled steroid containing cosmetics (12.5%), Aloe Vera gel (7.5%). Monomorphic acne was main side effect diagnosed in 79% of patients followed by pustular acne (8%), nodular acne (4%), rosacea (4%), nodulocystic acne (3%) and perioral dermatitis (2%). Study concluded that misuse of topical steroids and unlabeled steroid containing cosmetics causing various side effects. It is unethical to sale and use without the prescription of an authorised person. So these depigmenting agents should be banned to sell without authorization and without the prescription of an authorised person.

Keywords: Acne, steroid, Culprits, Offending agent, cosmetics.

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Biochemical characteristics of Malaria patients with their association with severity of disease

Abstract— Malaria is one of the oldest and most widespread disease which affects more than 2400 million people, over 40% of world's population, in more than 100 countries in tropics from South America to Indian Peninsula. This study was designed to assess the platelet counts, haematocrit & liver enzymes (Alanine transaminase, Aspartate transaminase, Alkaline phosphatase) in patients of Plasmodium vivax & Plasmodium falciparum malaria and its association with the severity and prognosis of disease. In a hospital based observational descriptive study, 100 patients with Plasmodium falciparum and/or vivax positive diagnosed by peripheral blood film examination and/or by MPQBC (Malaria Parasite Quantitative Buffy Coat) method were included and submitted to a complete clinical & laboratory evaluation. Patients who were ≤ 14 years and who refused to give consent were excluded. They were divided into Plasmodium vivax and Plasmodium falciparum positive group; evaluated, compared and statistical analysis done. Out of total 100 cases of malaria positive, P. falciparum constituted 66% and P. vivax constituted 34%. The pathophysiological processes causing the haematological changes in malaria are complex and multiple. Thrombocytopenia presents with bleeding manifestations and it increases the severity of disease with poor prognosis.

Keywords: P. Vivax, P. Falciparum, Platelet, Haematocrit, Liver enzymes.

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KIKUCHI-FUJIMOTO DISEASE (KFD): A Rare Case Report

Abstract— Kikuchi-Fujimoto disease (KFD) is a rare disease. It has a worldwide distribution with a higher prevalence in Asians. KFD is usually a self limiting disease and benign in nature. Clinically it presents as regional cervical lymphadenopathy and sometimes may presents as generalized lymphadenopathy as well. Night sweats and low grade fever may also be associated in some cases. A case of a 36 year old female had attended in SMS Hospital. She presented with fever, weight loss and tender cervical lymph nodes. Diagnostic significance of KFD lies in that it may mimic some of the common diagnosis like SLE (Systemic Lupus Erythematosis), Tuberculosis, lymphoma and rarely adenocarcinoma. Diagnosis is usually made by biopsy of lymph node which shows fragmentation, necrosis and karyorrhexis. On thorough investigation this case was found of Kikuchi-Fujimoto disease (KFD) which is a rare disease. So case presenting with fever, weight loss and tender cervical lymph nodes should also be investigated for Kikuchi-Fujimoto disease (KFD).

Keywords: Kikuchi-Fujimoto disease (KFD).

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Hereditary Spherocytosis in a 17 year girl: A case report

Abstract— Hereditary spherocytosis (HS) is a familial hemolytic disorder with marked heterogeneity of clinical features, ranging from an asymptomatic condition to a fulminate haemolytic anaemia. Although a positive family history of spherocytosis increases the risk for this disorder, it may be sporadic in some cases. Seventeen years old girl presented with mild anaemia, jaundice and moderate splenomegaly. Her haematological parameters supported diagnosis of hereditary spherocytosis. Appropriate treatment was started with an advice to patient to undergo splenectomy as an active part of management of the disorder. Mother and other siblings were normal.

Keywords: Anaemia, Jaundice, Splenomegaly, Hereditary, Spherocytosis.

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Outcome analysis of Intra-articular distal end radius fracture treated with volar plating

Abstract—Fractures of distal end radius are most common fractures of the upper limb. Various techniques have been described including closed reduction, percutaneous fixation and open reduction and fixation. This study was conducted to assess the functional and radiological outcomes of volar plate osteosynthesis to manage intra-articular distal end radius fracture. For this study, 30 patients with intraarticular distal end radius fractures involving radiocarpal joint operated with open reduction and internal fixation with the volar plate were taken. Minimum follow up 6 months were done. During the follow-up, radiological parameters were assessed in terms of radial length, radial inclination, radial (palmar) tilt, articular step-off, functional parameters were assessed in terms of range of motion i.e.dorsifleion, plantar flexion, pronation, supination radial and ulnar deviation and Gartland and Werley score. Mean age of patients was 46.8 years with male: female ratio 6:4. Mean radial height was 11.2mm, mean radial inclination was 21.8 degree and mean radial (palmar) tilt was 10 degrees. Average Gartland and Werley score was 3.6. Average dorsiflexion was 71 degrees, palmar flexion was 68 degrees, mean radial deviation was 16 degrees and mean ulnar deviation was 29 degrees. Mean pronation was 72 degrees and mean supination was 75 degrees. It was concluded that volar plating has good outcome for intraarticular distal end fractures of radius with minimal complications. So, it should be considered as the first line of management for intraarticular distal end radius fracture.

Keywords: Intraarticular, Distal end Radius, Volar Plate, Gartland and Werley Score.

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Thrombocytopenia burden and its associating Risk factors: A cross-sectional study at a tertiary care set up

Abstract—Thrombocytopenia is a very common finding in the neonatal intensive care unit. This study was designed with aim to study the risk factors associated with neonatal thrombocytopenia. In this cross-sectional observational study, 263 newborns admitted in the NICU from October 2016 to December 2016 were enrolled in the study. Proportion of thrombocytopenia was found along with its various neonatal and maternal risk factors associated. Chi-square test was used to find out association. Neonatal thrombocytopenia was found in 29% of neonates; 64 % had early onset and 36 % had late onset thrombocytopenia. Mild, moderate and severe thrombocytopenia was found in 49 %, 34 % and 17 % respectively. Thrombocytopenia was found to be associated with APH and PROM among maternal factors and with LBW, prematurity and birth asphyxia among neonatal factors.

Keywords: Thrombocytopenia, Neonatal Intensive Care Unit (NICU), Asphyxia.

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Gynecological morbidity and co-morbidity in postmenopausal women: A descriptive study

Abstract—Menopause is very crucial phase of woman’s life. There are many health problems that are associated with postmenopausal phase. So this present study was conducted on 215 postmenopausal women with the aim to find out gynecological problems associated with postmenopausal period. This study observed that 70.5% women experienced hot flushes and sweating, 65.5% had insomnia, 37.6% complained of headache. Decreased libido was observed in 80.9% women and 54.4% reported dyspareunia. 78.1% women complained of backache. Joint pain was complained by 52.5% of women. 32% women noted weight loss and 26.5% women complained of weight gain after menopause. Among gynecological problems Genital Prolapse was most common morbidity found in 45.1% of cases followed by Cancer cervix in 12.5%, Fibroid uterus in 9.3%, Senile vaginitis in 5.6%, Ovarian neoplasm in 4.1%, Cancer endometrium 1%, Pyometra in 0.9%, Carcinoma vagina 0.4% and Carcinoma vulva in 0.4% of menopausal women. Genital prolapse was found with PMB in 9.2% cases and with PMB & Vaginal discharge in 10.3% of cases.

Keywords: Postmenopausal Phase, Gynecological Problems.

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Risk factor and outcome with Gestational Diabetes Mellitus (GDM): A Cross-sectional Analysis

Abstract—Gastational diabetes Mallitus (GDM) is a condition in pregnancy which may result bad maternal and neonatal outcomes. So this study was aimed to find out various risk factors associated with GDM. This study was conducted 500 females of 2nd and 3rd trimester pregnancy. They underwent GCT (Glucose Challenge Test) with 50 gm of glucose load which was followed by GTT (Glucose tolerance test) with 75 gm glucose recommended by WHO after 72 hrs of GCT irrespective of result of GCT. Out of 500 pregnant women 27(5.4%) women are diagnosed as GDM. In women with GDM gravida ≥3, age >25 years and positive family h/o of diabetes were found with high proportion of GDM. PIH, preeclampsia and recurrent infections are most common antenatal complication seen in GDM group. It can be concluded from this that universal screening should be done for early diagnosis of GDM so complication related to tit can be controlled and bad pregnancy outcomes may be prevented.

Keywords: Gastational diabetes Mallitus (GDM), Risk factors, Pregnancy outcomes.

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Knowledge and practice of adolescent girls about menstruation: A Cross-sectional study

Abstract— Adolescence constitutes about 20 % of world’s population. Reproductive and sexual health problems are quite common in adolescent girls in India. Bad menstruation hygiene may lead to reproductive health problems. Unsafe menstrual practices expose them to risk thrice as much of contracting RTI, therefore it is important how adolescent girls maintain hygiene during menstruation. This study was conducted to assess knowledge and practices regarding menstruation in adolescent girls. Total 376 eligible adolescent girls were studied, out of that 337 (89.62%) knew about menstruation and out of them 45.10% considered that menstruation starts at puberty, followed by physiological process (34.42%) & sign of reproductive maturity (12.46%) while 39.76% respondents thought it to be due to out flow of dirty blood. Out of 337 who knew about menstrual-cycle, only13.64% knew the fact that conception is not possible during menstrual-cycle. 59.94% respondents had prior knowledge of menarche and majority (51.54%) had this knowledge from their mothers. Out of 325 girls, who were having menstrual period, although 214 (65.84%) were using sanitary napkins but remaining 34.16% were using cloths. When association of this practice with education was evaluated it was found that above primary educated were significantly more (P< 0.001) in using sanitary napkins than girls of up to primary educated (69.47% v/s 40%). When change of material used during menstruation was asked, twice and more was answered in 194 (59.06 %), which was mot found to be associated with education (p=0.65). It was concluded that majority knew about menstruation but practice was not hygienic as they were using cloths and majority of them were less educated. So main emphasis should be given to female education.

Keywords: Adolescent Girls, Menstruation, Knowledge and Practices.

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Medical Journal- June issue 2017

Medical Journal: Published volume-3, Issue-6, June 2017 with ad publications

Effects of Platelet Rich Plasma in Treatment of Androgenetic Alopecia (AGA): An Interventional Study

Abstract— Androgenetic alopecia (AGA) is a common condition having severe psychosocial implications. Numerous modalities of treatment are there but none is satisfactory both to the patient and the treating physician. This present study was carried out on 50 patients of AGA aged between 20 to 50 years to find out the effect of PRP with micro needling on AGA. These selected cases were treated by activation of the procedure site (scalp) by micro needling technique and application of platelet rich plasma on the activated site. A total of 6 such sittings were given to each patient at interval of 30 days each, over a total period of 6 months. Macro photographs were taken at baseline and after 6 months by 2 independent observers who rated those using of standardized seven-point rating scale of clinical change. In this study, 24% patients perceived stoppage of hair fall, 68% patients noticed reduction in hair fall, 6% of the patients perceived no change in hair fall and remaining 2% patients perceived increased hair fall after last visit with minimal or no side effects. So over all 92% patients had noticed some clinical improvement in their condition. So it was concluded that PRP with micro needling is an effective combination in treating AGA. This may be because micro needling has its own action and it would also help in promoting penetration of PRP but the level of evidence of this fact as available published data is low. This demands further studies to gain more evidence before it is used more extensively.

Keyword: Androgenetic Alopecia(AGA), Platelet Rich Plasma (PRP), Micro Needling.

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Seropositivity and seasonal trend of dengue cases in Jaipur (Rajasthan), Western India (2010-2016)

Abstract— Dengue virus infection has emerged as a notable public health problem in recent decades in terms of its increased transmission to urban and semi urban areas. Study was conducted on samples of suspected dengue cases with the aim to find out seropositivity and seasonal pattern of dengue, which is important for effective control of a disease. For this study, samples were received in department of Microbiology, SMS Hospital Jaipur (Rajasthan) for Dengue IgM & IgG during 1st January 2010 to 31st December 2016. Blood samples collected in plain vials were tested for IgM and IgG antibodies for dengue virus serotype DENV-1, 2, 3 and 4 by a solid phase in vitro immunochromatographic test. It was observed that out of 86,538 serum samples tested, 5011 (5.76 %) were found to be positive for dengue infection. Among these seven years, maximum numbers of dengue cases were identified in year 2013(33.12%). Seropositivity ranged from 0.73% in year 2016 to 13.1% in year 2010. Likewise when seasonal trend was explored it was found that 83.87% of total cases were found from September to November with peak in October. In rest of months around 1% of cases were there in each month except few more cases in August and December i.e. 4.23% and 6.25% respectively. It can be concluded that Dengue has become an endemic disease in this area. Occurrence of most of the cases in post-monsoon period indicates a need for acceleration of vector control programme prior to monsoon.

Keywords: Dengue, Seropositivity, Seasonal Trends

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Gum Hypertrophy- Warning Sign of acute myeloblastic leukemia (AML M2): A Case Report

Abstract— Many systemic diseases are early indicated by oral manifestations. Among such systemic diseases Leukemia is one which shows characteristic oral manifestations. Acute myeloid leukemia (AML) is characterized by maturation arrest of myeloid cells which leads to increase in number of myeloblasts in the bone marrow and hemopoietic insufficiency. Patients with AML in general may present with a wide variety of (atypical) symptoms, which may range from minor symptoms to life-threatening complications. Gingival hyperplasia is most commonly seen with the AML subtypes acute monocytic leukemia (M5) and acute myelomonocytic leukemia (M4). Here, an unusual case of diffuse gum hypertrophy in a 25 year old Asian female which led to laboratory studies yielding a rapid and relatively early diagnosis of acute myeloblastic leukemia (AML M2) was reported. This case emphasizes that clinicians and dentists should be well acquainted with the oral manifestations of systemic diseases and stresses the role of gingival hypertrophy as a diagnostic indicator in leukemia.

Keywords: Gingival enlargement, Leukemia, Acute Diffuse Myeloblastic.

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Outcome assessment of composite Oro-Mandibular Defect Reconstruction with Double Skin Paddle Free Fibula Osteocutaneous Flap

Abstract— Free fibular flap is the most favored free flap for composite defects of oro-mandibular region. Composite defects involving mucosa, mandible and skin often require two free flaps for the reconstruction. A technique of harvesting two separate cutaneous paddles of free fibular flap each based on a definite peroneal artery perforator was presented in this study. Reconstruction of composite oro-mandibular defect was done with two independent cutaneous paddles (proximal skin paddle based on musculo-cutaneous perforator and distal skin paddle based on septo-cutaneous perforator) in 12 patients. Post operative outcome was good, with 11 cases having no loss of skin paddle. There was an outer skin paddle necrosis in one patient for which cover was given with pectoralis major myocutanous flap. A double paddle free fibula flap can be used to reconstruct composite defects providing inner lining as well as skin cover with good flap success rates and better functional and aesthetic patient outcomes, thus avoiding an additional free or regional flap morbidity and decreased operative time.

Keywords: Oro-Mandibular Reconstruction, Free Fibula Flap.

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Fetomaternal Outcome & Complications of Pregnancy with Fibroids

Abstract—Fibroid (myoma) is the most common benign tumors of the uterus. Chances of complications are approximately 10-40% in the presence of fibroids. This study was aimed to assess the maternal & fetal outcome and complications in pregnancy with fibroids. It was conducted on 20 pregnant women with fibroid. Routine basic investigations were done for all subjects included in the study. Ultrasonography was done at booking visit and during subsequent visits to assess changes in size of the fibroid and associated complications. It was found that Fibroids were more frequent in multigravidae (65%) than primigravidae (35%). Majoriy (70%) were diagnosed as having fibroid during routine antenatal visits and 30% were known case of fibroid prior to conception. Twenty five women had pain, 10% had threatened preterm labor, 15% had spontaneous miscarriage, 30% had anemia and placenta previa was diagnosed in 15% women. Majority (60%) had Lower segment cesarean section (LSCS) and only 40% had vaginal delivery. Though many fibroids are asymptomatic but fibroids during pregnancy can lead to complications during the antepartum, intrapartum, and postpartum period, so they need proper follow-ups and repeated assessment. Overall prognosis depends on their location and size

Keywords: Fibroid, Myoma, Uterus Tumour, Fetomaternal outcome

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Hemimandiblectomy with and without intermaxillary fixation: A Quincy experiment

Abstract— Oral malignancy involving mandible, floor of mouth, tongue, and also palate when treating surgically often requires resection of mandible. Resection of mandible leads to loss of mandibular continuity, deviation of mandible towards resected site, altered mandibular movements, difficulty in swallowing, and impaired speech. Management of this type of mandibular defects without bony reconstruction is complex. Hemimandibulectomy with intermaxillary fixation prevent mandibular deviation and malocclusion.

Keywords: Intermaxillary Fixation, Hemimandibulectomy, Mandibular Deviation.

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Thanatophoric Dysplasia Type I with Bilateral corneal opacities: A Case Report

Abstract— Thanatophoric dysplasia is the most common form of lethal skeletal dysplasia, diagnosed by its characteristic clinical and radiographic features. It has two types distinguished by radiological findings. Specific ocular features associated with Thanatophoric dysplasia have not known to be reported. A baby with clinical findings of a large head, short stature , low set ears, short and curved limbs, small thorax, bilateral corneal opacities and radiographs showing short and curved long bones, femurs like telephone- receiver look, H- shaped vertebrae, small iliac wings was reported. This rare case was thoroughly examined and investigated which came out to be a case of Thanatophoric Dysplasia Type I with corneal opacities. So when a case of Thanatophoric dysplasia Type 1 with bilateral corneal opacities was attended at pediatric department, a detailed report was prepared to publish such a rare case.

Keywords: Skeletal Dysplasia, Corneal Opacities.

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Anthropometric predictors for sexual dimorphism of skulls: A Comparative study

Abstract— Quantitative morphometric measurements with advanced analytical methods are emerging as reliable methods for sex differentiation of skeletal remnants. Aim of present study was to determine the difference in morphometric measurements in male and female skull and to determine the independents predictors and accuracy for sex differentiation using discriminant function analysis. A comparative observational study was conducted using 44 skull of known sex including 24skulls of males and 20 skulls of females. Various morphometric parameters are measured and analyzed using univariate, multivariate and discriminant function analysis. Cranial AP length, Bi Zygomatic diameter, Nasal Height, Nasal width and Mastoid length were found to be significantly higher in male skull. Discriminant function analysis predicted correctly the sex of skull with 79.5% accuracy. Morphometric measurement of cranium can be developed as objective method of sex determination with higher accuracy and repeatability and further enhanced by advanced statistical method like discriminant function analysis.

Keyword: Sexual Dimorphism, Morphometric Measurements, Skull.

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Acute Undifferentiated Febrile Illness (AUFI) in adult hospitalized patients: An experience from a tertiary care hospital of western Uttar Pradesh region from North India

Abstract— Acute undifferentiated febrile illness (AUFI) is a common occurrence in low and middle income groups countries like India and constitutes heavy burden on healthcare industry especially from month of June to September. AUFI includes various diseases which are very difficult to differentiate. So this study was conducted on 504 AUFI cases to present an etiological profile of these AUFI cases. It was found that among these 504 AUFI cases, 6.54% were Malaria, 15% Typhoid, 14% Dengue, 3.17% Chickenguniya, 4.56% were mixed infections and 60.7% were undiagnosed.

Keyword: Acute Undifferentiated Febrile Illness (AUFI), Malaria, Undiagnosed Undifferentiated Febrile Illness (UUFI), Dengue, Chikungunia.

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Symptom Score Questionnaire for Nasolacrimal Duct Obstruction (NLDO) in Adults – A novel tool to assess impact on quality of life after Endoscopic Dacryocystorhinostomy

Abstract— Dacryocystorhinostomy (DCR) is a commonly applied surgical technique to treat nasolacrimal pathway obstruction. However, no disease-specific tools to assess the symptoms and the subjective outcome after DCR have been established. A specific Nasolacrimal Duct Obstruction Symptom Score (NLDO-SS) questionnaire was develop to evaluate the outcome and tested it in a prospective. Primary endoscopic dacryocystorhinostomy (EN-DCR) procedures were performed in 60 patients during 2013-2014. Preoperatively and during the three follow-up (3 month, 6 months and 12 months ) visits, the patients were asked to fill the NLDO-SS along with Glasgow Benefit Inventory (GBI) questionnaire. The success rate of EN-DCR was 91.67%. EN-DCR resulted in a significant reduction in all of the eight symptoms scores of the NLDO-S. The GBI scores indicated a benefit at 3 months and more benefit at 6 months, but no further improvement was found between 6 and 12 months. The correlation between the total GBI and NLDO-SS was significant. EN-DCR improves the quality of life as measured by the GBI. The NLDO-SS correlated with the GBI and gave more information about the benefits after EN-DCR than GBI alone. The NLDO-SS proved to be an effective tool to evaluate lacrimal obstructions and ENDCR benefits.

Keywords: Endoscopic Dacryocystorhinostomy, Nasolacrimal Duct Obstruction Symptom Score (NLDO-SS), Glasgow Benefit Inventory (GBI), Quality Of Life.

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Cytomorphometric Study of Effect of Tobacco Smoking on Buccal Mucosa: A Case control study

Abstract—Tobacco smoking is associated with increasing risk of oropharyngeal cancer. Oral cytology, mainly based on the presence of nuclear or cytoplasmic alterations, can easily be performed to detect cancer at an early stage and provides a quantitative technique. The objective of the present study was to assess the effect of smoking on buccal mucosa using cytomorphometry. This case control study included 36 smoker subjects and 36 non-smoker controls between the age of 30 and 70 years. Buccal epithelial cells were collected with a brush and fixed smears were stained with Papanicolaou stain and cytomorphometric analysis performed using image analysis software (Image J v 1.47). Smoker group was found to have higher mean nuclear diameter (MND), lower in mean Cellular diameter (MCD), and higher nucleo-cytoplasmic ratio as compared to normal subjects. This change in nuclear parameters indicates smoking-related cellular adaptation, leading to progression towards dysplasia. Cytomorphometric changes could prove to be the earliest indicators of these cellular alterations.

Keywords: Cytomorphometry, Smoker, Buccal Mucosa.

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Effect of Caudal Epidural Injection for management of Lumbar Spinal Stenosis: A randomized controlled Trial

Abstract—Chronic low back pain (LBP) is a common cause of morbidity and work absenteeism worldwide. This hospital based randomized, controlled, interventional study is conducted to assess the effectiveness of caudal epidural steroid injection in lumbar spinal stenosis. Study subjects were chronic low back pain patients attending at department of Physical Medicine and Rehabilitation (PMR), Sawai Man Singh Hospital, Jaipur (Rajasthan) India. For study purpose, 60 LBP cases were taken in Study group and 60 cases were taken for control group. To compare the effect between conservative treatment alone and added with caudal epidural injection of steroid plus saline in lumbar spinal stenosis, in study group, a mixture of MPA (3mg/kg body wt.) plus 16 ml of normal saline was injected in epidural space along with conservative treatment and in control group only conservative treatment was given. It was observed in this study that patient had more significant improvement in low back pain, leg pain, walking distance and functional activity after caudal epidural block in the study group than control group for a period of 3-6 months. So it was concluded that when conservative treatments were combined with interventional methods in form of caudal epidural steroid injection the amount of relief gets augmented as compared to the conservative treatment alone resulting in the patient benefiting in terms of much better symptom control and pain relief, improvement in anxiety, depression and activity limitations and quality of life.

Keywords: Chronic low back pain (LBP), Methylprednisolone Acetate.

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Medical Journal- May issue 2017

Medical Journal: Published volume-3, Issue-5, May 2017 with ad publications

Chikungunya fever in children: A Descriptive Study

Abstract—In the Indian sub-continent, first isolation of the chikungunya virus was done in Kolkata during 1963. During 2006 reports of large scale outbreaks in several parts of India have confirmed the re-emergence of this virus in the country. Since the incidence of this disease is increasing. So a retrospective analysis of laboratory confirmed chikungunya patients admitted to pediatric ward was done to study biochemical profile of chikungunya fever in children. Total 51 children were laboratory confirmed for chickungunya, 36 of them had isolated chikungunya infection. Male/female ratio of isolated chikungunya was 2.6:1. Fever was invariably present, associated constitutional symptoms consisted of skin rash, vomiting, diarrhea, pain abdomen, cough, corrhyza, myalgia and bleeding manifestations. The most characteristic feature of the infections in infants was skin manifestations in form of symmetrical superficial vesiculobullous lesions & maculopapular erythematous rash. Nine patients (25%) had neurological manifestations. Joint pain was present in only three patients but none had arthritis. Most common hematological abnormality revealed thrombocytopenia in 39% cases. There was mild to moderate elevation of liver enzymes in 13 patients (36%). Average length of hospital stay was 5.1 days. Thirty four patients recovered completely & two left against medical advise. It is concluded from this study that skin manifestations and neurological manifestations are common in younger age group apart from other constitutional symptoms. Arthralgia and chronic polyarthritis is rare in this age group as found in adults.

Keyword: Chikungunya in Children; Viral Fever; Vesiculobullous Lesions.

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Paraquat Poisoning (Lethal Herbicide):A Rare Case Report

Abstract— Paraquat, chemically 1, 1’ dimethyl-4-4’-bipyridinium, is a green colored herbicide. It is one of the most lethal herbicide and is hazardous in very small quantities. More than 93% of deaths by paraquat are suicidal in nature. Poisoning by paraquat is commoner in developing countries because of agriculture based economy. The presentation of paraquat poisoning varies from case to case and depends on the amount consumed. As the compound is highly lethal, an early suspicion & management is must to prevent complications. Present case is of paraquat poisoning with full blown early picture of mucosal ulceration, pneumonitis and acute kidney injury which later on complicated in esophageal perforation, pneumothorax and pneumomediastinum.

Keywords: Paraquat, AKI, Pneumomediastinum, Pneumonitis.

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Perinatallethal Osteogenesis Imperfecta Type II A with white sclerae:A Case Report

Abstract— Osteogenesis Imperfecta is a genetic connective tissue disorder. It has clinically heterogeneous four types. Type 2 is the most severe and perinatally lethal form having small thorax, curved limbs and blue/gray sclerae. It is further subclassified into 3 types. A baby with sign and symptoms with macrocephaly, retrognathia, low set ears, widely placed eyes with white sclerae, complete cleft palate, narrow chest, curved and shortened limbs, B/L CTEV, left undescended testis with hypospadiasis was reported. This rare case was thoroghly examined and investigated which came out to a case of 'Osteogenesis Imperfecta type 2 A' having white sclerae. So case having such symptoms were should be investigated for Osteogenesis Imperfecta.

Keywords: Osteogenesis Imperfecta Type 2, White Sclerae, Genetic disorder, Perinatally lethal condition.

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Fungal infections in Otorhinolaryngology: A Descriptive Study

Abstract—Fungal organisms are ubiquitous. A common location for these organisms to enter the human body is through the external acoustic canal, oral cavity, and pharynx and sino-nasal cavity. A study was conducted with clinical and mycological analysis of various fungal infections in ENT. Patients suspected for having fungal infections attending at Department of ENT were interrogated and analysed. Swabs collected from these cases were sent for direct microscopy by KOH mounts for fungal examination and fungal culture. Microbiological confirmed 100 cases were finally included in the study Histopathological examination of nasal mass and polyposis was also done. It was observed in this present study otomycosis was most common and accounted for 84% of the total cases followed by candidiasis in oral cavity and pharynx in 9%, allergic fungal rhinosinusitis in 4% and rhinosporidiosis in 3%. Aspergillus niger was that most common fungus isolated in 61% cases, followed by Candida albicans in 24% cases, Aspergillus flavus in 9% cases, Aspergillus fumigatus and Rhinosporodium seeberi in 3% cases each. All the cases of fungal infection of oral cavity and oropharynx were due to Candida albicans.

Keyword: Fungal infection, Otomycosis, Aspergillus, Candida.

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Variation in origin of Lateral Circumflex Femoral Artery: A Case Report

Abstract— Profunda femoris artery and its branches are extensively used in different diagnostic and therapeutic interventions. Knowledge about the anatomical variations is important to prevent iatrogenic complications. During routine dissection for teaching medical graduates, a variant vascular pattern of lateral circumflex femoral arteries was observed in an adult cadaver. The Lateral Circumflex Femoral Artery was found to be arising directly from the Femoral Artery on its posterior aspect, 7.0 cm distal to the inguinal ligament on the left side.

Keywords: Profunda Femoris Artery, Lateral Circumflex Femoral Artery, Femoral Artery.

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Effect of Agave sisalana Perrine extract on the ovarian and uterine tissues and fetal parameters: Comparative Interventional Study

Abstract— Agave sisalana (Agavaceae), commonly known as sisal plant has an anti-inflammatory, analgesic, anthelmintic, bactericidal and insecticidal activities. Its toxic effects on female reproduction are unknown. This comparative interventional study aimed to assess the ovarian and uterine tissues and fetal parameters of rats treated with the extract of sisal waste (100 mg kg-1 body weight), obtained from decortications of the A. sisalana. The control received distilled water. The treatments were performed orally for 30 consecutive days. The results showed that the estrous cycle and ovarian tissue were not affected by plant extract. There was an significant increase (p<0.05)in the thickness of perimetrium in females treated with A. sisalana. The placental and litter weights also increased significantly whereas the litter size significantly decreased (p<0.05) in the group receiving the extract. In conclusion, A. sisalana showed no pathological changes in the ovaries and uterine endometrium, but had a negative effect on the litter size and weight.

Keywords: Sisal, Gonadotoxicity, Reproduction Fetotoxicity.

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Bio-Socio-demographic Risk factors of Gestational Diabetes: A Case Control Study

Abstract—India is second largest country to have people with Diabetes Mellitus (DM) in world. Gestational Diabetes Mellitus (GDM) has bad pregnancy outcomes so this present case control study was conducted on 50 pregnant women (ANCs) with GDM and 50 normal ANCs to assess the bio-socio-demographic risk factors of Gestational Diabetes. It was found that GDM was significantly associated with age, religion, residence and BMI of woman. GDM was found significantly more with increasing age and increasing BMI. ANCs residing in urban areas and belonging to Muslim religion were more pron to have GDM than their counter parts. Family history of diabetes also favors in occurrence of GDM. So clinicians should increase GDM screening at first ANC visit and prompt treatment is recommended to prevent complication. Early identification of woman at risk of GDM may prevent maternal and perinatal morbidity.

Keyword- Gestational Diabetes Mellitus, Risk factors, Impaired Glucose Tolerance, Bio-socio-demographic factors.

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