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Efficacy of different types of phototherapy units on neonatal hyperbilirubinemia
Krishna M Adhikari, Sheila S Mathai, Sathya M Moorthy, Naveen Chawla, Sandeep Dhingra
July-December 2017, 19(2):99-102
Context: Phototherapy is the mainstay of treatment for about 3% of neonates in India who develop significant jaundice in phototherapy range. New devices have been introduced in the market over the past few years. Aims: To compare the efficacy of three types of phototherapy machines, namely Blue and White, Compact Fluorescent Lamp, and Light Emitting Diode type. Settings and Design: A non-randomized prospective interventional study conducted in a tertiary care hospital of Western India. Material and Methods: Ninety neonates with phototherapy range hyperbilirubinemia were assigned into three groups of 30 neonates each to receive phototherapy using one of the three types of phototherapy machines. Need for exchange transfusion, total serum bilirubin (TSB) at 24 hours post-phototherapy and side effect profile were recorded. Decision to stop phototherapy was based on acceptable reduction of serum bilirubin to below phototherapy range. Statistical analysis used: Medcalc® Version Software was utilised. Comparison of mean TSB was done using one way ANOVA. P-value of <0.05 was considered significant. Results: Baseline parameters, TSB at 24 hour post-phototherapy and at the point of stopping phototherapy in the three groups was not significantly different. None of the babies required exchange transfusion or stopping of therapy. Transient rash was the most commonly observed side effect. Conclusions: The three types of phototherapy equipment studied were comparable in efficacy as measured by need for exchange transfusion and mean TSB values at 24 hrs post-phototherapy. The side effect profile was similar and was not significant enough to stop phototherapy.
  4,218 215 1
Study of lifestyle diseases among workers of an ammunition factory
Arun Gupta, Neeti Goyal, AK Jindal, Raj Kumar
January-June 2017, 19(1):43-47
Background: Lifestyle diseases which include hypertension, type 2 diabetes mellitus, obesity, and stroke are caused by influences on the human body by the way people live their lives. This study is an effort to describe the prevalence of various lifestyle diseases; factors associated with their causation and suggest measures for improvement of the health status among the industrial workers. Materials and Methods: A total of 351 workers were included in this study. The prevalence and pattern of lifestyle diseases among industrial workers were studied. The survey had two principal components, namely, the pretested standardized questionnaire and clinical examination. Blood sugar levels were assessed by a glucometer. Results: Hypertension was the most common lifestyle disease, seen among 43.0% of workers. It was significantly related to age, socioeconomic status type 2, body mass index (BMI), and habit of tobacco chewing. Only one-fourth were aware of their blood pressure status. Other diseases brought out were diabetes type 2 mellitus (7.7%) and obesity (4%). In this study, among those with type 2 diabetes mellitus, 29.63% were not aware of their blood sugar status. Diabetes was significantly related to BMI and increased significantly with increase in age. Also, one-third of the study population was overweight. Conclusion: Lifestyle diseases were found to be the major causes of morbidity among the study participants. Hypertension, type 2 diabetes mellitus, and overweight/obesity were the common morbidities. These conditions were associated with factors such as age, socioeconomic status, BMI, and history of tobacco chewing.
  2,298 141 -
Medical challenges of women combatants: Looking to the future
Sheila S Mathai, Ravi Kalra
January-June 2018, 20(1):1-3
  2,089 224 -
Talcum powder and photoprotection
Jandhyala Sridhar, CR Srinivas
January-June 2017, 19(1):48-50
Context: Talcum powder is a popular daily use cosmetic product in India with a high urban and rural penetration. Aim: To examine the photoprotective ability of a popular brand of talcum powder. Design: Nonrandomized controlled efficacy study. Subjects and Methods: Minimal erythema dose (MED) following narrowband ultraviolet B irradiation among ten volunteers was recorded. Sun protection factor (SPF) of talcum powder was determined by standard in vivo method. Percentages of zinc oxide in the test sample and ten other commercially available brands of talcum powder were estimated by atomic absorption spectrophotometry. Statistical Analysis Used: Calculation of mean. Results: The mean MED of volunteers was 310 milli Joule (mJ) without talcum powder and 400 mJ with talcum powder. The mean SPF of talcum powder was 1.29. The percentage of zinc oxide in the test sample was estimated to be 1.5%. Conclusions: Talcum powder offers low photoprotection due to low zinc oxide content.
  2,187 90 -
Seroprevalence of cytomegalovirus infection in antenatal women in a Tertiary Care Center in Western India
Mahadevan Kumar, Mohammad Bashir Nizam, M Mugunthan
January-June 2017, 19(1):51-54
Context: Human cytomegalovirus (CMV), otherwise called human herpesvirus 5, is a member of the Herpesviridae family. Maternofetal transmission of CMV can occur during pregnancy following primary or recurrent infections in the mother. Infections in utero are associated with fetal abnormalities, intrauterine growth retardation, and intrauterine death. In India, 80%–90% of the adult population show presence of CMV antibodies; however, there are few articles showing the prevalence of CMV infection in pregnant women. Aims: The aim of this study is to assess seroprevalence of CMV infection in antenatal women. Settings and Design: This is a cross-sectional, observational study, study population: women reporting for antenatal care to the OPD at a tertiary care hospital. Subjects and Methods: Three hundred and seventy serum samples drawn from antenatal women attending OPD in a tertiary care center were tested for IgG and IgM antibodies by enzyme-linked immunosorbent assay. Statistical Analysis Used: Statistical significance was estimated by calculating “P value.” Results: Of the 370 samples tested, 83% showed the presence of CMV IgG and 9.46% were positive for CMV IgM. All those cases which were IgM positive were seropositive for CMV IgG as well. Sixteen percent of the antenatal women were both IgG and IgM negative. Conclusion: The prevalence of CMV IgG in antenatal women in this region is high. Around 16% of the women showed lack of IgG. It would be beneficial to screen pregnant women for CMV IgM antibodies is beneficial and will help guide the testing of newborns suspected to be infected with CMV in order that appropriate therapy of the infected infants can be instituted promptly and appropriate advice can be rendered on prevention of transmission.
  1,669 146 -
Food poisoning outbreak in a training establishment: A retrospective cohort study
Maramraj Kiran Kumar, Vijay Bhaskar, Sougat Ray
January-June 2017, 19(1):28-33
Background: An outbreak of food poisoning occurred among recruits in a training establishment. Investigation of outbreak was undertaken with active preventive interventions concurrently to arrest the current outbreak as well as to avoid such incidents in future. Materials and Methods: A retrospective cohort study was undertaken among all recruits, regardless of presence or absence of symptoms. The risk ratios (relative risks) and attributable risks were calculated for each food item of the suspected meal to assess the association between consumption of individual food items and subsequent illness. An environmental survey was undertaken to investigate into the course of food processing and storage facilities at trainees' galley (cookhouse) and other relevant eating establishments. Results: A total of 494 recruits reported with symptoms of gastroenteritis in a span of 3 days. Of those affected, only 9 were admitted and rest recovered with treatment on OPD basis. The overall attack rate was 22.9%. No deaths were reported. It was a classical point source, single exposure gastroenteritis outbreak. When food histories and sickness histories were analyzed, the attributable risk (24.17) and relative risk (5.11) were highest for the “Flavoured milk,” which was an outsourced item. The statistical findings were substantiated with environmental and epidemiological evidence. Conclusion: Epidemiological investigation incriminated dinner of the previous day as the meal responsible for the outbreak with flavored milk as the most attributable food item.
  1,398 184 -
Role of “bladder care bundle” and “infection control nurse” in reducing catheter-associated urinary tract infection in a peripheral hospital
Parli Raghavan Ravi, MC Joshi
July-December 2018, 20(2):116-121
Background: Care bundles are an effective means of reducing catheter-associated urinary tract infection (CAUTI) when they are implemented with high impact interventions. Care bundle approach only works when every element of the bundle is implemented for every appropriate patient, every time and with high impact. Aim: This study aims to study the efficacy of CAUTI Care Bundle and of infection control nurse (ICN) in reducing the incidence of CAUTI in a zonal hospital. Materials and Methods: The study was with an initial baseline phase (observational) of 8 months followed by an intervention Phase of 21 months. The intervention phase was further divided into intervention Phase I (8 months) and intervention Phase II (13 months). Intervention Phase I included a multidimensional approach of education and training of health-care staff for catheter management and prevention of CAUTI and implementation of catheter care bundle. In intervention Phase II education of health-care workers and implementation of catheter care bundle was done under constant supervision and guidance of ICN. Results: We recorded a total of 834 urinary catheter days: 309 in baseline phase, 314 in intervention Phase I, and 211 in intervention Phase II. It was found that the incidence rate of CAUTI, measured as episodes per 1000 catheter days is 64.72 in baseline phase, 25.47 in intervention Phase I, and 18.95 in intervention Phase II. The catheter care bundle approach along with education of the staff reduced the CAUTI incidence by 60.64 and when the same was applied under the constant supervision of ICN for the CAUTI reduction rate was clinically significant with 70.72. Conclusions: The catheter care bundle approach along with the education of the staff reduced the CAUTI incidence by 60.64 episodes/1000 catheter days and when the same was applied under constant supervision of ICN for the CAUTI reduction rate was clinically significant with 70.72
  1,451 88 -
Paramedical training in the armed forces: Need for a paradigm shift
Alhad Anant Pawar, Sheila S Mathai
July-December 2017, 19(2):81-82
  1,211 127 -
War and epidemics: A chronicle of infectious diseases
Kaushik Roy, Sougat Ray
January-June 2018, 20(1):50-54
Disease transmission occurs with a perfect balance of the epidemiological triad consisting of an external agent, a susceptible host, and an environment that brings the agent and host together. Conflict situation is an ideal platform that creates this confluence of agent and host in perfect environmental conditions, for pathogens to tear through soldiers and refugees alike. Classically during armed conflicts, soldiers and displaced population get exposed to unsanitary and overcrowded barracks, trenches, refugee shelters, and concentration camps with disruptive health-care services. Many get susceptible to diseases prevalent in the relocated region and some may introduce pathogens in the native population. The earlier wartime epidemics were considered as divine interventions and wrath of God. As medicinal knowledge advanced, prevention strategies evolved from isolation and quarantine to sanitary measures against miasma and further to chemoprophylaxis and immunization against the pathogen. The advent of antivector chemicals and antibiotics revolutionized the control of epidemics during the World War II. Although not infectious in origin, modern-day outbreaks are mostly health events such as posttraumatic stress disorders in postwar or war-like scenario. This article chronicles the epidemiology of the better-known wartime epidemics.
  1,166 121 -
Use of levamisole in children with nephrotic syndrome: A retrospective study to examine its adverse effects in children with nephrotic syndrome
Suprita Kalra, Madhuri Kanitkar, Kara Tiewsoh
July-December 2017, 19(2):87-90
Introduction: Levamisole, a synthetic imidazothiazole derivative has been used as a steroid sparing agent in children with Frequently Relapsing Nephrotic Syndrome (FRNS) and Steroid Dependent Idiopathic Nephrotic Syndrome (SDNS). Levamisole has been essentially considered a safe drug with minimal toxicity. We conducted this study to re-examine the safety of Levamisole in children with nephrotic syndrome and to describe the clinical profile of these children. Materials and Methods: Records of children with idiopathic nephrotic syndrome between June 2014 and December 2016 were reviewed. We identified frequently relapsing or steroid dependent children between 1-18 years of age who had received Levamisole for at least six months or in whom Levamisole was started but had to be withdrawn due to some adverse events in the first 6 months. Results: 21 children were started on Levamisole in the study period. 13 (61.90%) were FRNS and remaining had a steroid dependent course. Levamisole had to be withdrawn in one child at 1 month 13 days after initiation when the child developed severe headache. Levamisole also had to be discontinued in a 9 years old girl at 13 months after initiation of therapy due to polyarticular arthralgia involving both the small and large joints. Conclusions: The use of Levamisole warrants caution in children with Nephrotic Syndrome and its efficacy needs to be balanced against its potential side effects.
  1,160 104 -
Thoracic epidural analgesia for breast oncological procedures: A better alternative to general anesthesia
Parli Raghavan Ravi, Pradeep Jaiswal
July-December 2017, 19(2):91-95
Objective: The objective of the study was to compare the outcomes of the incidence of nausea/vomiting and other complications along with the time taken for discharged in patients undergoing Thoracic Epidural Analgesia (TEA) and General Anaesthesia (GA) for breast oncological surgeries. Background: GA with or without TEA or other postoperative pain-relieving strategies remains the traditional anesthetic technique used for breast oncological procedures. We initiated the use of high segmental TEA for patients undergoing these procedures in our hospital. Methods: Eighty patients undergoing breast oncological procedures performed by one surgical team were randomly allocated into two groups receiving TEA and GA. The Chi-square test and Fisher's exact test were used for categorical parameters, paired t-test and Student's t-test was used for continuous measurements. Results: In comparison with GA, TEA was associated with lesser incidence of complications of nausea/vomiting. In lumpectomy with axillary node dissection, 1 out of 18 patients (5.55%) in the TEA group had nausea/vomiting, while 11 out of 19 (57.8%) of the GA group had similar symptoms (P < 0.001). The discharge rate for the thoracic epidural group was 12 out of 18 by day 3 (66.6%) while all patients in the GA group required more than 3 days of hospitalization (P < 0.001). Conclusion: Thoracic epidural anesthesia is a safe technique and its use in breast oncological procedures could improve patients' recovery and facilitate their early discharge to home.
  989 241 -
Robotics & artificial intelligence : The future of surgeons & surgery
KI Mathai, Rajeena Enoch, JS Jishnu
January-June 2016, 18(1):3-8
Robotics and Artificial Intelligence complement surgical technical expertise and judgement. A robot’s accuracy in the programmed performance of predesignated tasks is exquisite. Historically, with the evolution of microsurgery, senior surgeons designated delicate suture placement to more steady handed, sharper eyed young fellows or even nurses. Tactile feedback and ultrasensitive pressure velocity controls make robotics a viable but expensive option to fine surgical assistance. Autonomous surgical robots are however a distinct paradigm. Myriad unfathomed mysteries of human pathophysiology and anatomy confer upon surgical procedures complexities which defy stratification and simplification into sets of preordained tasks. In the current scenario where fuzzy logic, neural networks and intuitive computing are still in early evolution, robots replacing master surgeons seem as improbable as Google self driving cars in formula one racing. Robots have evolved as dextrous, fatigue and tremor free surgical tools. The data crunching capability of computers is improving in speed and in capability for machine learning. Human surgical maturity on the other hand is attained and matures through phases of information assimilation, knowledge consolidation and attainment of surgical wisdom. Human surgeons at the helm will, in this decade harness robotic capabilities and information template paradigms to fine tune many procedures and to augment surgical reach. Quantum leaps and paradigm shifts towards robotic surgical autonomy may be neither desirable nor practical.
[ABSTRACT]   Full text not available  [PDF]
  883 340 -
The evolution and future of combat casualty care
Bipin Puri
January-June 2017, 19(1):1-3
  1,002 180 -
Induction of labor: Our experience
Sushil Chawla, Santosh Kumar Singh, Monica Saraswat, Sakthi Vardhan
July-December 2017, 19(2):96-98
Introduction: Induction of labor is a deliberate attempt to terminate the pregnancy with the aim of vaginal delivery in cases of valid indication. Different methods are being used ranging from nonpharmacological to pharmacological for the same. Induction on demand by patients is also rising in our country. Objectives: The aim of this study is to ascertain the common indications for induction of labor at a tertiary care teaching hospital. Materials and Methods: A prospective observational study, with the study group being all the patients who underwent induction of labor and the total population including all the women delivering at our center, in 1 year. The induction was done using “Dinoprostone” gel or tablet “Misoprostol”. Results: Postdated pregnancy was the reason for induction of labor in 36% of the patients. Hypertensive disorders and gestational diabetes mellitus are other common conditions requiring induction of labor. Pregnancy following assisted reproductive techniques form an important group requiring induction of labor in present day practice. Conclusion: Hypertensive disorders and postdated pregnancy are the most common indication for induction of labor.
  943 136 -
Renal cell carcinoma with inferior vena cava extension: An anesthetic challenge
MK John, Nihar Ameta, Jacob Mathews, Sarvesh Shrivastava
January-June 2017, 19(1):70-71
  901 153 -
Analysis of normal retinal nerve fiber layer thickness by age and sex using spectral domain tomography
R Aiswarya, Hemant Singh Trehan
January-June 2017, 19(1):11-14
Background: To analyze the nerve fiber layer thickness in a heterogeneous Indian population according to age and sex and to compare this parameter to published normative data on the Caucasian population to better understand the racial differences. Materials and Methods: A total of 400 patients of both gender belonging to various age groups were evaluated using Cirrus HD optical coherence tomography (OCT), Carl Zeiss, Meditec, Dublin. The results were evaluated and compared to determine the normal retinal nerve fiber layer thickness (RNFLT) and its variations with age and sex. Results: Average nerve fiber thickness along the 3.4 mm diameter circle around the optic nerve head was approximately 90.57 ± 11.59 μm. There was no significant difference seen between males and females for mean, quadrant, and clockwise RNFLT. This was the same in all the subgroups of our study. Conclusions: Our results provide the variations of RNFL in Indian population. To the best of our knowledge, this is the first study in our country done with a high sample size in the Cirrus HD-OCT machine.
  919 98 -
Antimicrobial susceptibility testing of rapidly growing mycobacteria isolated from cases of surgical site infections by microbroth dilution method at a Tertiary Care Center
Raghu Sriram, Prasanna Sarangan
January-June 2017, 19(1):6-10
Aim: The study was carried out to ascertain antimicrobial susceptibility pattern of rapidly growing mycobacteria (RGM) isolated from cases of surgical site infections from May 2013 to May 2014 at a tertiary care center in Pune. Materials and Methods: This study included the isolation of RGM from surgical site infections from May 2013 to May 2014 at a tertiary care center in Pune. The specimens were processed for microscopy (Ziehl–Neelsen stain) and culture (Lowenstein–Jensen media) using conventional methods. The minimum inhibitory concentrations of each of the isolates were determined by microbroth dilution, using Sensititre RAPMYCO manufactured by the firm TREK Diagnostic Systems from Thermo Scientific. Interpretations of results were done as per the Clinical and Laboratory Standards Institute M24-A. Results: Of the RGM isolated, Mycobacterium abscessus was the predominant isolate followed by Mycobacterium fortuitum and Mycobacterium chelonae. Of the 102 isolates, 64 (53.3%) were M. abscessus, 30 (25%) were M. fortuitum, 8 (6.67%) were M. chelonae, and 18 (15%) were other atypical Mycobacterium species. All 102 isolates of RGM were tested for antibiotic susceptibility testing by microbroth dilution. M. fortuitum and M. chelonae were sensitive to most of the antibiotics tested with few exceptions. All isolates (M. fortuitum and M. chelonae) were resistant to cefoxitin except few M. abscessus. Maximum resistance was seen with M. abscessus and they were sensitive to amikacin, tobramycin, tigecycline, and clarithromycin only. Out of 64 isolates, 32 (50%) were resistant to linezolid and imipenem. Conclusions: This study was carried out to highlight the importance of RGM and their susceptibility testing in all clinical microbiology laboratories.
  857 156 -
Vascular closure device in cardiac cath laboratory: A retrospective observational study
Ravi Kalra, R Ananthakrishnan, Sudhir Joshi, Jnanaprakash B Karanth
January-June 2018, 20(1):4-8
Objective: This study is to share our experience of using vascular closure device (VCD) after anterograde femoral arterial access at cardiac cath lab. Background: Vascular access site management is crucial to safe, efficient, comfortable, and cost-effective diagnostic or interventional percutaneous cardiac procedures. As per the literature, femoral artery access site complications following angiographic procedures range from 1% to 5%. The Angioseal VCD has been shown to be safe and effective in reducing the time to hemostasis following angiographic or other cardiac interventional procedures. Materials and Methods: This is a retrospective, observational study carried out at a tertiary care hospital of the Armed Forces. All patients in whom Angioseal (St. Jude Medical) were deployed after undergoing either diagnostic coronary angiography or percutaneous coronary intervention (PCI) through common femoral artery access. All patients from January 2011 to December 2016 in whom VCD was either deployed or attempted were included in the study. Results: A total of 16245 patients were taken up for femoral access for diagnostic procedures and PCI from 2011 to 2016. We observed 98.52% success rate with Angioseal and a mere 1.48% complication rate. Out of the complications observed, only 2 (0.13%) patients had the serious complication of limb ischemia rest were all minor complications. Conclusion: Our observations and experience with the Angioseal VCD are a safe, efficient, and resulting in more favorable patient outcomes.
  898 110 -
Transversus abdominis plane block: A multimodal analgesia technique – Our experience
Deepak Dwivedi, Vidhu Bhatnagar, Harindra Kumar Goje, Arijit Ray, Pawan Kumar
January-June 2017, 19(1):38-42
Context: A retrospective observational study conducted to assess transversus abdominis plane (TAP) block as a tool for providing multimodal analgesia postoperatively for abdominal surgeries. Aims: The aim is to compare the visual analog scale (VAS) of pain and the requirement of rescue analgesia postoperatively in patients undergoing various abdominal surgeries (open and laparoscopic) where TAP block was given for postoperative analgesia and was compared with patients who received pain relief according to the institutional protocol. Settings and Design: Retrospective observational study conducted in a tertiary care hospital. Subjects and Methods: Retrospective data from anesthesia records of patients, who underwent abdominal surgeries from January 2016 to December 2016, were analyzed and were divided into two groups. Group A (n = 250) consisted of patients who received the conventional standard postoperative analgesia protocol of the department of anesthesia. Group B (n = 136) consisted of patients who were administered TAP block postsurgery for the postoperative analgesia by the trained anesthesiologist. Primary outcome considered was (i) average VAS at 02, 06, 12, and 24 h and (ii) average opioid/nonsteroidal anti-inflammatory drug consumption at 24 h postoperatively. Secondary outcome considered was time to first rescue analgesia. Statistical Analysis: All parametric data were analyzed using unpaired t-test. Data are expressed as the mean ± standard deviation. A SPSS version 17 (SPSS Inc., Chicago, IL, USA) was used for statistical analysis. Results: Average pain scores (VAS) were lower in Group B as compared to Group A in all subcategories of surgery postoperatively. Patients given TAP block (Group B) required less rescue analgesia in the postoperative period with time to first rescue analgesia being prolonged. Conclusions: On the basis of our retrospective study, we suggest that TAP block can be utilized as a part of multimodal analgesia regimen for abdominal surgeries, laparoscopic as well as open. Tap block has demonstrated a good safety profile in experienced hands; it is easy to perform and has displayed consistent analgesia over a prolonged period. It reduces postoperative morbidity and supports early ambulation.
  874 119 2
Staged total penile reconstruction using flap prefabrication and arteriovenous loop
Pauline Babu, Pallab Chatterjee, Parli Raghavan Ravi
January-June 2018, 20(1):79-82
Loss of penis due to injury or disease is physically and psychologically devastating to any male. While the technique of penile reconstruction continues to evolve in conjunction with the evolution of flaps in reconstructive surgery, the free tissue transfer using radial artery forearm flap (RAFF) in a single stage is recognized as the most preferred method at present. However, to avoid the complications often seen in such single-stage method, we used a novel two-stage technique for total penile reconstruction in two cases after penile loss. We prefabricated the neophallus in the forearm and constructed saphenofemoral arteriovenous loop in the groin in the first stage to allow all the suture lines to heal and provide for easy and reliable recipient vessels. The neophallus was transferred after 4 weeks and vessel anastomoses done conveniently in the groin with adequate sized vessels with robust inflow. Both the patients recovered well without any need for urinary diversion and quickly attained the ability to pass urine in standing position. We offer that the two-stage method of penile reconstruction using free RAFF is reliable, easy to perform and can avoid many of the complications seen with single-stage reconstruction.
  871 74 -
Lower radial nerve palsy in mid shaft humerus fracture using medial plating
Ajaydeep Sud, Munish Sood, Amresh Ghai, JP Khatri
July-December 2017, 19(2):114-117
Background: The fixation of the fracture is considered to be the best treatment option for early mobilization in midshaft humerus fracture. The aim of the present study is to compare the functional outcome after fixation of midshaft humerus fracture using medial and anterolateral plating techniques. Materials and Methods: Sixty-one patients with midshaft humerus fracture were operated using medial and anterolateral plating technique. In Group A (n = 30), the patients were operated using medial plating for fixation while in Group B (n = 31), the patients were operated using anterolateral plating. The patients were assessed clinically, radiologically and using Mayo elbow score and the University of California-Los Angeles (UCLA) shoulder rating scale. Results: Both the groups were matched in terms of age, gender, mode of injury, side involved, and duration of injury to surgery. Postoperative radial nerve palsy was observed in four patients in Group B which was found to be statistically significant (P = 0.04). The mean UCLA shoulder score improved significantly, 28.53 in Group A and 29.16 in Group B at the final follow-up (P < 0.001). The mean Mayo's elbow score also improved significantly, 85.33 in Group A and 87.41 in Group B at the final follow-up (P < 0.001). There was no significant difference in terms of functional outcome at the final follow-up while comparing both the groups. Conclusion: The medial and anterolateral plating techniques for midshaft humerus have the similar functional outcome. The medial plating technique is associated with lower radial nerve injuries.
  861 79 -
Medical management of patients with benign prostatic hyperplasia: A study in Indian population
Amit Kumar Shah, Anand Srivastava, SC Karan
July-December 2018, 20(2):104-110
Introduction: At present, the geriatric population has formed a large clientele for medical services, with an increased incidence of lifestyle diseases. Approach to lower urinary tract symptoms due to benign prostatic hyperplasia (BPH) is an upcoming challenge, especially with management showing a paradigm shift toward medical management. This study was basically designed to study the outcome of medical management of BPH on Indian population following the recommendations based on recent guidelines on medical management of BPH. Materials and Methods: With a calculated sample size of 131 based on the prevalence of BPH, a total of 170 patients were enrolled, and their complete profile with clinical examination, imaging and International Prostatic Symptom Score details were taken as per proforma and were followed up while on medical management and assessed on a cross-sectional basis at regular intervals. Results: The mean age in the study group was 64.61 years. We recorded that all patients had some formal education. These patients were prescribed α-1ablockers as monotherapy or combination therapy as per the protocol of the study. They showed improvement while on medical management with significant improvement. Adverse reactions of medical management were not significant enough to warrant discontinuation of therapy. Forty-one patients out of 170 underwent surgery for no response or worsening quality of life. This group was further analyzed which revealed that comorbid condition, prostate size, and body mass index had no association with the outcome. Conclusion: There is sufficient evidence to support the paradigm shift in the management of BPH. The present guideline is to initiate medical management with monotherapy for patients with BPH and prostate size <30 g and combination therapy for larger prostate sized >30 g. Surgery is advised for patients who do not respond to medical therapy and for the subgroup of patients with absolute indication for surgery in BPH.
  843 87 -
Role of otoacoustic emissions in the early detection and prevention of ototoxicity
Anil Kaul, Tarun Malhotra, Shazia Khan
January-June 2018, 20(1):13-17
Introduction: Evaluating Otoacoustic Emissions (OAEs) is one of the audiological methods for ototoxicity monitoring. The absence of OAEs indicates cochlear damage. The aim of this study was to study the usefulness of OAEs in early detection and prevention of ototoxicity. Materials and Methods: A prospective, comparative study was conducted to evaluate Transient-Evoked OAEs (TEOAEs) and Distortion-Product OAEs (DPOAEs) as they relate to Pure Tone Audiometry (PTA) in cases of ototoxicity. Hearing assessments of study group of 55 individuals exposed to ototoxic drugs were evaluated and compared at regular intervals, within the group and with control group of 25 individuals using PTA, TEOAEs, and DPOAEs. The abnormal OAE responses were calculated as predictive of significant changes in PTA thresholds. Student's t-test (independent samples, two-tailed) and ANOVA used for analysis. Results: PTA thresholds in the study group remained unaffected in the first three follow-ups whereas TPOAEs and DPOAEs were both found affected at the third follow-up, in significant number of ears in the study group. Significantly lower PTA thresholds were found in study group only at the fourth follow-up. Conclusions: Changes in TEOAEs and DPOAEs precede changes in PTA thresholds in ototoxicity and have high sensitivity and specificity in predicting hearing loss in such cases.
  746 127 -
Effect of drill noise on contralateral hearing after mastoidectomy in cases of unilateral Chronic Otitis Media
Varun Jerath, Dilip Raghavan
January-June 2018, 20(1):9-12
Introduction: The mainstay of treatment of Chronic Otitis Media (COM) is Tympanoplasty with or without Mastoidectomy. This study was conducted in patients undergoing Tympanoplasty with Mastoidectomy to assess Sensorineural Hearing Loss (if any) due to drill noise on the contralateral ear. Materials and Methods: A total of 25 patients with unilateral COM scheduled to undergo Mastoidectomy and Tympanoplasty who fulfilled inclusion criteria were recruited in the study, and a prospective, observational pilot study was carried out. Pure Tone Audiometry (PTA) and Transient Evoked Otoacoustic Emissions (TEOAE) were recorded preoperatively and postoperatively to assess hearing loss if any on the contralateral side. Results: There was no change in bone-conduction thresholds in the contralateral ear by PTA postoperatively. However, there was a significant worsening in the values of signal-to-noise ratio of TEOAE at all the frequencies in the postoperative period. The mean TEOAE recordings were, however, above 3 dB SPL. Conclusion: There are statistically significant effects of drill noise on the inner ear function on the contralateral ear as detected by TEOAE; however, the effects are not detectable on PTA. Larger studies with a longer follow-up period will be required to determine if the early postoperative effects on TEOAE are reversible or persist.
  739 117 -
Psychiatric morbidity in psoriasis: A case-control study
Sunil Goyal, Rohith R Pisharody, Shubhranshu Nath
January-June 2017, 19(1):18-23
Objective: Psoriasis is a chronic, relapsing and disfiguring dermatological disorder with a significant effect on occupational, social, and other areas of functioning. Psychological stress has been known to have a significant role in the onset and exacerbation of this illness. To study the prevalence of psychiatric morbidity in psoriasis and the influence of specified demographic, psychological, social and illness-related variables. Methods: The study was carried out at a tertiary care hospital in a large urban setup. In this case–control study, 100 cases of psoriasis were studied in comparison with healthy controls who were matched for sociodemographic profile. The participants were given a sociodemographic questionnaire, clinical profile sheet, and psoriasis area and severity index (PASI). General Health Questionnaire-12 (GHQ-12) was used to screen for psychological distress, and subsequently, Hospital Anxiety and Depression Scale for screening for depression and anxiety and World Health Organization Quality of Life-BREF scale for assessing the quality of life (QOL) were administered. The results obtained were analyzed for evaluating the psychiatric morbidity and its various correlates. Appropriate statistical analysis was done using SPSS 21. Results: Using GHQ-12 cutoff score (≥3) for psychological distress, the overall prevalence of psychological distress was significantly more in cases of in comparison to healthy controls with an odds ratio of 8.54 (95% confidence interval 3.16–23.07, P < 0.0001). Statistical analysis showed a statistically significant correlation of educational status with QOL and severity of skin lesions (PASI) with anxiety level. Severe skin lesions, more so on visible body parts were associated more commonly with psychological distress. Conclusions: All patients of psoriasis should be educated about the nature of the illness and screened for psychological distress. Dermatologists and family members should be educated to recognize the symptoms early and encouraged to seek the help of psychiatrist.
  727 115 -