Study of Incidence of Depression, Anxiety and Stress Among the First Year Medical Students in Government Medical College

To study the incidence of depression, anxiety and stress in first year MBBS students of governmentmedical college Jammu. Materials and Methods: the study was conducted on 120 first year MBBS studentsof Govt. Medical College Jammu after informed consent and ethical clearance. All of them were asked tofill DASS - 21 questionnaire without disclosing their identity. Only 118 students responded by filling up theform. The DASS - 21 questionnaire forms so obtained were analyzed, statistically and tabulated. Themean scores for depression was 6.66+5.82, (range-0.00-21), Anxiety was 5.16 ± 3.79 (range-0.00-19.00)and stress was 7.88±5.03 (range-0.00-21). The scores are more in male hostler and student less than 19years of age. Medical studies are highly demanding and cause stress, depression and anxiety to medicalstudents and so should be rescheduled and made student friendly

Study of Nasal Index in Different Zones of Jammu and Kashmir

The anthropometry of nose is an important index to identify a pure race from mixed races . Nasal index isa very sensitive index in nasal anthropometry, as it varies with sex, race and habitat of the person. Theanthropometry of face in general and nose in particular has been used in forensic investigations,reconstructive surgeries and genetic counselling. To study the nasal index in different zones of Jammu andKashmir. 120 students of first professional MBBS Government Medical College Jammu were used assubjects. All of them were in the age group of 18 to 22 years. The length and breadth of the nose wasmeasured by means of digital calliper and the nasal index was calculated using the formula NASAL. Theresults so obtained were tabulated and analysed. LTS. Sexual dimorphism was seen in all the recordedparameters. Anthropometric variation for nasal index is seen in different zones of Jammu and Kashmir.Mean nasal index was 65.98+9.36 for males and 72.15+11.30 for females. Most common type of nasalform in both males and females is leptorrhine or moderately narrow nose.Nasal index plays a significantrole in determining sex and race and so is helpful to forensic investigators .It is also useful for plasticsurgeons while performing rhinoplasty of a particular region as it shows ethnic specificity.

To Determine the Incidence of Accessory Foramen Transversarium

To find the incidence of accessory foramen transversarium in dried cervical vertebrae. 150 dried cervicalvertebrae were collected from Postgraduate department of Anatomy Government Medical College Jammuand examined for the accessory foramen transversarium.Out of 150 cervical vertebrae, only 24 hadaccessory foramen transversarium with preponderance in sixth cervical vertebrae. Amongst the vertebraewith accessory foramen transversarium, 14 were bilateral and 10 were unilateral. In the present study theincidence of accessory foramen transversarium was 16%. This is important for Radiologists to interpretComputed Tomography Images and Magnetic Resonance Imaging of cervical spine.

A Study of Carrying Angle of Elbow Among Young Adults of Jammu & Kashmir

Introduction - carrying angle is the angle between the median axis of arm with the median axis of fullyextended & supinated forearm. This angle is important for swinging of arm during walking & carryingobjects. There is variability in the carrying angle among different age groups, gender and races. Currentstudy was done to evaluate carrying angle in young adults of J&K. The study was conducted in 150 (75male and 75 female) healthy MBBS students of Government medical college Jammu after obtaininginformed consent. Measurements for carrying angle were taken in both the arms of volunteers. Goniometerwas used to measure the carrying angle. Carrying angle was more in females than males (15.2 in femalesand 12.9 in males) however it was not statistically significant. The carrying angle was more on thedominant side in both the gender i.e. in males right side 13.09, left side 11.2 and females right side 16.54,left side 14.9. All subjects were right handed. No significant sexual dimorphism found though carryingangle was more in females and also on dominant side in both the sexes.

Oncological outcome following TORS in HPV negative supraglottic carcinoma

Objective: The aim of this study was to determine the oncological and functional outcomes following transoral robotic surgery (TORS) in human papilloma virus negative supraglottic cancers. Study Design: A prospective observational study at a tertiary cancer care center, New Delhi, India. Materials and Methods: From February, 2013 to December, 2015, 45 patients with supraglottic lesions underwent TORS using the da Vinci® surgical system. Results: Forty-five patients underwent TORS for supraglottic laryngectomy (SGL), with all patients undergoing bilateral neck dissection. The most common site was Ary-epiglottic fold. 47.9% were cT1 and 52.1% were cT2. Average robotic set-up time was 8.8 min and average robotic operative time was 42.9 min. A positive or close margin was seen in 12 patients (26.7%) on frozen, which were revised intraoperatively. On final histology, 3 (6.7%) patients had a margin of <5 mm. The average closest margin was 5.7 mm. Patients tolerated oral feeds within 2 weeks of procedure. All patients were HPV negative. Postoperatively, all patients had adequate swallowing and speech. Follow-up ranged from 24 to 58 months. Thirty-eight (84.4%) patients were alive and disease free. Conclusion: TORS is a safe, feasible, minimally invasive, and oncologically safe procedure in patients with early HPV supraglottic cancers. It has less morbidity and offers benefits in terms of early airway and feeding rehabilitation and avoids complications resulting from radiation therapy for these patients.

Is CXCL10/CXCR3 axis overexpression a better indicator of leprosy type 1 reaction than inducible nitric oxide synthase.

Background & objectives: Leprosy type 1 reactions (T1R) are acute episodes of immune exacerbation that are a major cause of inflammation and nerve damage. T1R are diagnosed clinically and supported by histopathology. No laboratory marker is currently available that can accurately predict a T1R. Increased plasma and tissue expression of inducible nitric oxide synthase (i-NOS) and chemokine CXCL10 have been demonstrated in T1R. We studied the gene expression and immunoexpression of i-NOS, CXCL10 and its receptor CXCR3 in clinically and histopathologically confirmed patients with T1R and compared with non-reactional leprosy patients to understand which biomarker has better potential in distinguishing reaction from non-reaction. Methods: Gene expression of i-NOS, CXCL10 and CXCR3 was studied in 30 skin biopsies obtained from patients with borderline tuberculoid (BT), mid-borderline (BB) and borderline lepromatous (BL) leprosy with and without T1R by real-time PCR. Further validation was done by immunhistochemical expression on 60 borderline leprosy biopsies with and without T1R. Results: Of the 120 patients histopathological evaluation confirmed T1R in 65 (54.2%) patients. CXCR3 gene expression was significantly (P<0.05) higher in BT- and BB-T1R patients compared to those without T1R. The CXCL10 gene expression was significantly higher (P<0.05) in BB leprosy with T1R but the difference was not significant in patients with BT with or without T1R. Immunoexpression for CXCR3 was significant in both BB-T1R and BB (P<0.001) and BT and BT-T1R (P<0.001). Immunoexpression of CXL10 was significant only in differentiating BB from BB-T1R leprosy (P<0.01) and not the BT cases. i-NOS immunoexpression was not useful in differentiating reactional from non-reactional leprosy. Interpretation & conclusions: Both CXCL10 and CXCR3 appeared to be useful in differentiating T1R reaction in borderline leprosy while CXCR3 alone differentiated BT from BT-T1R. CXCR3 may be a potentially useful immunohistochemical marker to predict an impending T1R.

Primary germ cell tumor of the mediastinum

Germ cell tumors compromise 15-20% of all anterior mediastinal masses; 50-60% of these are benign mediastinal teratoma. There may be mature, immature, and rarely with malignant component within the tumor mass. There are more chances of malignancy with immature type. We are reporting a case in 20-year young male diagnosed as giant benign cystic teratoma which was adherent to superior vena cava. The patient underwent surgical excision. In follow up of 2 years, the patient is not having any complaints

A Rare Presentation of Osler-Weber-Rendu Disease as Severe Anemia.

Hereditary hemorrhagic telangiectasia (HHT) or Osler-Weber-Rendu disease is a rare fibrovascular dysplasia that makes vascular walls vulnerable to trauma and rupture causing skin and mucosal bleeding. It is of autosomal dominant inheritance characterized by recurrent epistaxis and telangiectasia on the face, hands and oral cavity; visceral arteriovenous malformations (AVMs) and positive family history. Epistaxis is often the foremost manifestation. It is associated with AVMs in several organs. There are possible hematologic, neurologic, pulmonary, dermatologic and gastrointestinal complications. Treatment is supportive and helps prevent complications. We report herein a patient with this syndrome who came to Medicine Unit first at our hospital.

Jejunal Leiomyoma Presenting as Intussuception

Tumors of the small intestine are rare. Even though the small bowel accounts for 80% of the length and 90% of the mucosal surface of the gastrointestinal tract, only 3% to 6% of gastrointestinal tumors and 1% of gastrointestinal malignancies arise from the small bowel. Leiomyoma, adenoma, lipoma, haemangioma, fibroma and hamartoma of the small intestine are considered to be benign neoplasm. Most small bowel tumors are incidental findings at operation or autopsy. Here we present a case of benign tumour of the small intestine, histologically diagnosed as leiomyoma, presented in Surgery Emergency Ward with intestinal obstruction, treated conservatively with no improvement and hence subjected to emergency exploratory laparotomy which revealed intusussception and leading cause of which was a benign leiomyoma. The literature is revised emphasizing issues of pathophysiology, specific characteristics and the treatment of this tumour.

Cysticercosis Breast - A Rare Entity

It is unusual for cysticercosis to occur in the substance of the breast. Diagnosis is usually made incidentally. Only few cases are described in the literature. We here report a case of cysticercosis perched on fibroadenoma of breast found on surgical excision in a 16-year-old unmarried female patient. The patient had no discernible evidence of cysticercosis in the other organs. Surgical excision was performed and histological examination demonstrated the presence of cysticercus cellulosae larvae. Characteristic features of this uncommon location are discussed based on a review of the literature. Thus the possibility of cysticercosis of the breast should be kept in mind while considering the differential diagnosis for a breast lump.

Epithelial mesenchymal transition in urothelial carcinoma: Twist in the tale.

Context: Epithelial to mesenchymal transition (EMT) is a process involving conversion of cells from an epithelial to mesenchymal phenotype. The role of candidate genes promoting EMT and favoring a promigratory phenotype has been demonstrated in epithelial cancer. Existing scientific research has not yielded a clinically relevant biomarker with predictive capacity beyond grade and stage in bladder cancer. Aim: The purpose of this study is to evaluate the immunohistochemical expression pattern of a panel of epithelial and mesenchymal markers in paraffin-embedded archival material of primary urothelial carcinoma as evidence of EMT. Materials and Methods: Immunohistochemical expression of transcription factor twist, epithelial (E-cadherin, cytokeratin) and mesenchymal (vimentin, N-cadherin) markers was analyzed on archival paraffin-embedded tissue samples from 48 patients with diagnosis of primary urothelial carcinoma of bladder. Statistical Analysis: Karl Pearson's χ2 test was used to evaluate the association between the expression of immunohistochemical markers and various clinico-pathologic variables. Non-parametric Kendall's tau-b statistics was used to determine the correlation between categorical variables. Results and Conclusion: The study demonstrated statistically significant association of cytokeratin, E-cadherin, vimentin, and twist with stage and grade of bladder cancer. Since these markers form part of the spectrum of changes associated with EMT, the study establishes proof of concept of the existence of this process in vivo. A significant negative correlation was noted between the expression of twist and E-cadherin. Exploiting its role as a transcriptional repressor of E-cadherin, twist may prove to be a useful candidate for targeted therapy in urologic oncology.

Expression of androgen receptor in breast cancer & its correlation with other steroid receptors & growth factors.

Background & objectives: Breast cancer is the second most common malignancy in Indian women. Among the members of the steroid receptor superfamily the role of estrogen and progesterone receptors (ER and PR) is well established in breast cancer in predicting the prognosis and management of therapy, however, little is known about the clinical significance of androgen receptor (AR) in breast carcinogenesis. The present study was aimed to evaluate the expression of AR in breast cancer and to elucidate its clinical significance by correlating it with clinicopathological parameters, other steroid receptors (ER and PR) and growth factors receptors (EGFR and CD105). Methods: Expression of AR, ER, PR, epidermal growth factor receptor (EGFR) and endoglin (CD105) was studied in 100 cases of breast cancer by immunohistochemistry (IHC). Risk ratio (RR) along with 95% confidence interval (CI) was estimated to assess the strength of association between the markers and clinicopathological characteristics. Categorical principal component analysis (CATPCA) was applied to obtain new sets of linearly combined expression, for their further evaluation with clinicopathological characteristics (n=100). Results: In 31 cases presenting with locally advanced breast cancer (LABC), the expression of AR, ER, PR, EGFR and CD105 was associated with response to neoadjuvant chemotherapy (NACT). The results indicated the association of AR+ (P=0.001) and AR+/EGFR- (P=0.001) with the therapeutic response to NACT in LABC patients. The AR expression exhibited maximum sensitivity, specificity and likelihood ratio of positive and negative test. The present results showed the benefit of adding AR, EGFR and CD105 to the existing panel of markers to be able to predict response to therapy. Interpretation & conclusions: More studies on the expression profiles of AR+, AR+/CD105+ and AR+/EGFR- in larger set of breast cancer patients may possibly help in confirming their predictive role for therapeutic response in LABC patients.

Effect of Malnutrition on the Sequence and Time of Appearance of the Ossification Centres of the Wrist and Hand in Malnourished Children.

Appearance of ossification centres of 500 malnourished children (250 boys and 250 girls) from birth to eight years was observed in the radiographs of the wrist i.e. lower end of radius and ulna and the hand i.e. carpals, metacarpals and phalanges. There was no marked difference in the sequence of appearance of ossification centres, capitate and hamate were first to appear followed by other bones as occurs in healthy children. The centres most commonly retarded in the hand and wrist in the children with malnutrition comprising the current series were the middle and distal phalanges and those least retarded were the capitate and hamate.

Light Microscopic Study of The Lumbar Intervertebral Disc Showing Inherent Difference Between Anterior & Posterior Annulus Fibrosus - A Risk Factor For Posterior Disc Herniation.

The present study is based upon the light microscopic observations made on the foetuses to determine the structural discrepancy in anterior and posterior annulus fibrosus in the development of human foetal lumbar intervertebral disc. A morphological comparison of the structure of anterior and posterior annulus fibrosus was made to consider the arrangement of lamellar bundles. As the foetus advances in age, the anterior annulus fibrosus becomes thicker than the posterior annulus. A very intricate structure was observed in posterior annulus with large number of loose and discontinuous lamellar bundles and more fibre-interlacing angles. Loose connection of the lamellar bundles in posterior annulus of almost all the foetuses indicates an inherent weakness which may lead to posterior rupture of the disc in later life.

Undivided Retromandibular Vein Continuing As External Jugular Vein With Facial Vein Draining Into It : An Anatomical Variation.

Despite the fact that the blueprint of the whole body is unravelled, faultlessly during the growth and development of an animal; but amazingly variations do occur. During routine dissection of head and neck in a middle aged cadaver in the Post Graduate Department of Anatomy of this medical college, we found variation in the formation of external jugular vein on both sides, which was formed by the continuation of undivided trunk of retromandibular vein. The facial vein and posterior auricular vein were the tributaries of external jugular vein. The sound anatomical knowledge of variations of the veins of head and neck is essential to the success of surgical procedures. The embryological evaluation of the above anomaly was done and compared with the available literature which showed that the observed variation was rare.

A Giant Inguinoscrotal Hernia.

We report a case of giant inguinoscrotal hernia. Such hernial formations are rare (5% cases) and largely a problem of developing countries. Problems arise in the management for both the patient and the surgeon because of the rarity of the reported cases as there is no standard surgical procedure in place for their treatment. Surgical management of such giant hernias has to be individualised.

Profile of acute pancreatitis in Jizan, Saudi Arabia

The epidemiology of acute pancreatitis in the Kingdom of Saudi Arabia [KSA] may be different from the West. The present study describes the profile of acute pancreatitis in Jizan, KSA. Patients diagnosed as acute pancreatitis in the King Fahd Central Hospital [KFCH], Jizan, KSA over a period of 12 years [1411-1422 Hijra year] were retrospectively analyzed with particular reference to the clinical features, disease severity, and result on management. There were 71 episodes in 62 patients [26 males and 36 females; 53 Saudis, whose ages ranged from 13-82 years [mean age: 42.6 years.]. Of these patients, 5 had 2 episodes each one had 5 recurrent episodes. The etiology included gallstone disease in 26 [42%] cases; endoscopic retrograde cholangiopancreatography [ERCP] in 11 [18%] cases. No cause could be identified in 16 [26%]. Patients. with ERCP - related pancreatitis were asymptomatic. In the symptomatic group [60 episodes], abdominal pain [100%], vomiting [78%] and fever [20%] were the most frequent features. Overall the clinical course was mild in 61 [86%] episodes and severe in 10 [14%]. Ranson's scoring accurately identified 60 of the 61 mild episodes and only 6 of the severe illness. Complications in the latter sub-group of cases, included pseudocyst [4 cases] and pancreatic abscess in 2 cases. Three of the patients died, giving overall mortality of 4.2%. Two deaths were directly related to the severe pancreatitis and one was due to massive vomiting and aspiration. It is concluded that 1. Cholelithiasis is the most frequent cause of acute pancreatitis; 2. Biliary pancreatitis occurred more frequently in elderly females and was associated with higher mean levels of lactic dehydrogenase and aspartate transaminase as compared to patients with non-biliary causes. In Jizan, acute pancreatitis presents in a mild form with low morbidity and mortality, irrespective of the cause