Audiological, Phonatory and Cardiac Correlates of Individuals Exposed to Low-Frequency Noise or at Risk of Vibroacoustic Disease

Abstract Introduction Low-frequency noise (LFN) is hazardous to hearing. Long-term exposure to LFN may lead to vibroacoustic disease (VAD), which not only affects a specific organ but the physiological function of entire systems, such as the auditory, phonatory, respiratory, and cardiac systems. Moreover, VAD may lead to many psychological problems and hence affect the quality of life. Objective To investigate the adverse effects of LFN on hearing, acoustic and perceptual correlates of the voice, blood pressure, cardiac rate, and anxiety level. Method A total of 20 subjects exposed to LFN and 20 not exposed to LFN were included, and a detailed case history was recorded. The patients were submitted to pure tone audiometry, otoscopic examination, acoustic and perceptual analyses of the voice, maximum phonation time, and an assessment of the s/z ratio. We also assessed blood pressure, and the results of a voice-related quality of life questionnaire and of the Hamilton anxiety rating scale. Results The results indicate that LFN had an adverse impact on the high-frequency threshold. The present study found a significant difference in shimmer and harmonics-to-noise ratio (HNR) values. Few subjects had high blood pressure and showed the sign of anxiety on the Hamilton anxiety rating scale. Conclusion Low-frequency noise has adverse effects on entire systems of the body and causes many psychological issues, which, in turn negatively affect quality of life.

Cluster outbreak of Pseudomonas stutzeri acute endophthalmitis following phacoemulsification: A report of 14 cases from North India

Purpose: To report clinical features, antibiotic susceptibility profile, management, and outcomes of a cluster outbreak of post?cataract surgery Pseudomonas stutzeri endophthalmitis. Methods: This was a hospital?based case series in which 14 patients with acute postoperative endophthalmitis who underwent cataract surgery on the same day were included. Based on severity of presentation, they either underwent pars plana vitrectomy (PPV) with intraocular antibiotics (IOAB) or vitreous tap with IOAB. Vitreous aspirates and environmental surveillance samples were inoculated on culture media and further processed by MALDI?TOF MS for identification and Vitek3 for susceptibility profile. Results: There were 8 females and 6 males with a mean age of 62.14 ± 8.08 years. Presenting signs included corneal folds (100%), hypopyon (57.1%) and fibrin (50%). Ten patients with mild presentation underwent vitreous tap with IOAB. Four patients with severe presentation underwent PPV with IOAB. Pseudomonas stutzeri was isolated from the vitreous samples and was pan?sensitive. Six eyes required multiple interventions. Favorable outcome was obtained in 12 eyes, one eye developed phthisis, and one patient was lost to follow?up. Conclusion: We report the first ever cluster outbreak of Pseudomonas stutzeri endophthalmitis following phacoemulsification with IOL implantation in a single surgeon setting. Majority of the patients had a mild presentation and responded well to targeted anti?microbial treatment.

Neuroborreliosis in India – A Diagnostic Challenge and a Great Mimicker: A Case Series

Background: Many studies found that only hypomagnesemia, but not hypermagnesemia is linked with increased mortality. However, reports of mortality due to magnesium dysregulation in the critical care setting are controversial. Objectives: To study serum magnesium levels in critically ill patients on admission in intensive care unit (ICU) and its correlation with patient’s need and duration for ventilator support, duration of ICU stay, incidence of cardiac arrhythmias and mortality. Methods: Two hundred forty six critically ill patients admitted in ICU with Acute Physiology and Chronic Health Evaluation (APACHE) II scores>10, were included for this prospective observational study. Serum total magnesium level was measured at the time of admission to ICU. Primary outcome measure was ICU mortality whereas, secondary outcome measures were patient’s need and duration for ventilator support, duration of ICU stay, and incidence of cardiac arrhythmias. Categorical and continuous variables were tested using Chi-square/Fisher’s exact test and analysis of variance respectively. Multivariate logistic regression analysis was carried out to determine association of serum magnesium levels with ICU mortality. Results: Incidence of ICU mortality was significantly higher in group of patients with hypomagnesemia compared to those with normal magnesium levels. Hypomagnesemia was associated with need and longer duration of ventilator support, longer duration of ICU stay, higher APACHE II score, QTc prolongation, higher incidence of cardiac arrhythmias compared to patients with normal magnesium levels. Hypomagnesemia was an independent and statistically significant determinant of ICU mortality. Conclusions: Hypomagnesemia was associated with higher mortality rate, longer duration of ventilator support and ICU stay, and higher APACHE II score in critically ill patients.

Effect of Covid-19 Pandemic on Formal Education of Primary School Children (6-11 Years) Studying in Selected Municipal Corporation Primary Schools of East Delhi

The sudden closure of schools in the Covid-19 pandemic has affected formal and informal education of the students especially belonging to socially disadvantaged groups. To explore the impact of this pandemic on the formal education of primary school children an online Google Meet Parent Teacher Meeting Survey was conducted after 16 months of school closure to learning pattern, reading material, reading frequency of Hindi and English, daily study, and its association with socio economic background. This web-based school study used descriptive design. A sample of parents of 400 students age group 6 to 11 years from fi ve selected schools of East Delhi Municipal Corporation available on Google Meet was selected through stratifi ed random sampling. Data was collected through a Structured Interview Schedule with closed ended multiple choice questions designed into Google doc forms and fi lled by researchers simultaneously during survey. Data was analysed using SPSS (26) software descriptive statistics. This study showed an increase in the variety of reading material availability for students as well as increased reading frequency per week of basic languages i.e., 33.8 percent to 90.3 percent for Hindi and 23 percent to 40.3 percent for English along with total study time per day, 39.2 percent to 78.6 percent. Further, guardian education and guardian income have a direct effect on reading frequency of primary school children and total study time during periods of lockdown. Parents'#39; engagement and sensitisation is required for problems faced by the students in adaptation to online education to reduce learning gap and improve outcomes of teaching-learning process due to lockdown and sudden school closure. Reading material can be provided to students to sustain their interest and reading ability during Covid-19 pandemic

An observational study to determine the status of serum and RBC folate in drug resistant epileptic children at a tertiary care centre in Western Rajasthan, India

Background: Drug resistant epilepsies constitute about 10-20% of childhood epilepsies and treated with higher doses and multiple AEDs. AEDs increases folate metabolism by enzyme induction thus causes deficiency of folic acid.Objective was to evaluate the effect on serum and RBC folate in children having drug resistant epilepsy.Methods: In a prospective observational study 83 drug resistant epileptic children of age 6months to 180 months fulfilled the inclusion criteria enrolled in study, from Oct 2014 to Nov 2016 for a period of two years. Serum and RBC folate levels were done in these children. Epileptic children already receiving folic acid supplementation/treatment were excluded from the study. Children with serum folate level <5ng/ml and RBC folate <280ng/ml was considered as folate deficiency.Results: Total 83 children had drug resistant epilepsy (defined by ILAE). Mean age of children with drug resistant epilepsy was 71.39±49.76 months. 71.08 % were male and 28.91% were female. Mean serum folate in these children was 7.75±2.77 ng/ml and RBC folate 381.63±164.54 ng/ml which was significantly lower as compared to healthy children or epileptic not receiving AEDs. 14.45 % children in drug resistant epilepsy had serum folate <5ng/ml while 20.89% were found to be RBC folate deficient (RBC level <280ng/ml).Conclusions: Antiepileptic drugs are associated with lower blood folate status which deteriorates further with increasing number and doses of AEDs in drug resistant patients. Therefore blood folate monitoring should be done in all children on AEDs on regular intervals and should be considered in the etiologic differentials of drug resistant epilepsy.

Unanticipated Difficult Mask Ventilation: Cystic Swelling- The Culprit

Introduction: Difficulty in mask ventilation is quitechallenging to an anaesthesiologist because mask ventilation isthe primary technique of ventilation and the rescue techniqueif the tracheal intubation fails. Unanticipated difficulty in maskventilation is even more challenging to the anaesthesiologist.Case report: Here we report a case of unanticipated difficultmask ventilation due to cystic swelling on left side ofepiglottis.Conclusion: Prudent and cautious corrective measures takenat the right time, ensures patient safety

Primary intratesticular rhabdomyosarcoma: a rare aggressive childhood neoplasm

Testicular tumors are relatively uncommon in children. The tumors of germ cell origin are still frequently encountered. The pure embryonal rhabdomyosarcomas of testis, not associated with sarcomatous component of the germ cell tumor, is a very rare entity. It is a highly aggressive tumor of childhood and young adolescents. In testes, it arises commonly from paratesticular tissue; primary intratesticular being extremely rare. To the best of authors knowledge, only fifteen cases of primary pure intratesticular tumor have been reported in the literature so far. We report a case of eight-year-old child who presented with a progressive painless right testicular enlargement over two months. Ultrasonography showed a heterogenous intratesticular mass. High orchidectomy was performed. Histopathological examination of the specimen assisted with immunohistochemistry revealed embryonal rhabdomyosarcoma.

Etiological Spectrum and Clinical Profile of Patients Admitted with Pancytopenia

Aims:The etiological spectrum and clinical profile of admitted patients presenting with pancytopeniawere studied. Study Design:This was a prospective study conducted on 200 patients presenting to the Department of Medicine, Department of Oncology and the Allied Specialities of Medicine, Dayanand Medical College and Hospital, Ludhiana and were found to have pancytopenia during hospital stay.Results:Mean age of the patients was 45.69 ± 17.05 years with maximum number of patients (23%) in the age group of 51-60 yearsand 119 patients were males and 81 patients were females.Most common physical finding was pallor (95%), followed by splenomegaly (22%) and hepatomegaly (17%). Total of107 patients were vegetarians (53.5%) and 93 patients (46.5%) were non-vegetarians. Mean hemoglobin was 7.16 ± 2.04 g/dl, mean total leucocyte count was 2.51 ± 1.02 x 103/cu.mm, mean platelet count was 54885.37 x 103/ul ± 40320.96 and mean the absolute neutrophil count was 1.59 x 103 /cu.mm ± 0.84. Ten patients of pancytopenia were because of tropical fever which included 4 cases of dengue, 3 cases of malaria, 2 cases of enteric fever and 1case of mixed infection (malaria + scrub typhus).Viral markers were positive in 14 out of the 63 patients tested. Out of these 14 patients, 4 were HBsAg reactive, 7 were HCV +ve and 3 were HIV +ve. Most common red blood cell picture on peripheral blood film was normocytic normochromic (34.5%), followed by mixed morphology (33.5%). Macrocytic and microcytic morphology was seen in 19.5% and 12.5% of the patients respectively. Hypercellular marrow was seen in 82 patients (42.9%), normocellular marrow was seen in 58 patients (30.3%) and hypocellular marrow was seen in 51 patients (26.7%). The most common cause of pancytopenia in this study was megaloblastic anemia in 59 patients (29.5%), the 2nd common cause was leukemias in 28 patients (14%) and the 3rdcause was aplastic anemia in 22 patients (11%). Drug induced pancytopeniawas seen in 21 patients (10.5%) and hypersplenism in 9 cases (4.5%).Conclusion:This study has helped us in knowing the various etiologies of pancytopeniain this hospital. Megaloblastic anemia was the most common etiology in this study followed by leukemiasand aplastic anemia. The study helped us in understanding of the age and gender distribution, the hematological parameters, the peripheral blood film in pancytopenia and the bone marrow picture in these patients.

Evaluation of simple International ovarian tumor analysis ultra sound rules in differentiating between benign and malignant ovarian tumors and their histopathological correlation

Background: IOTA (International ovarian tumor analysis) study is considered one of the largest studies on ultrasound diagnosis of ovarian pathology conducted in literature till date. It was started in 1999 and included nine European countries. It is a standardized technique for preoperative classification of ovarian pathology defined by IOTA group.Methods: A retrospective study was analyzed from a period of January 2016 to December 2017 (2-year period). The records of all the patients operated for benign and malignant ovarian pathology in the gynae department of hospital were retrieved from medical record sections. USG findings were redefined as per IOTA simple rules by sonologist and its histopathological correlation was done using kappa statistical method.Results: In the present study, out of 61 patients IOTA was applicable to 57 patients. The sensitivity where IOTA simple rules were applicable was 92.8% and the specificity was 93%. The accuracy turned out to be 92.9%. If inconclusive results were taken as malignant then sensitivity increased to 94% and specificity decreased to 87%. Good level of agreement was found between sonological and histopathological findings with Kappa statistics application (K = 0.59).Conclusions: The IOTA simple rules can be considered as an important diagnostic modality in differentiation of benign and malignant ovarian tumors, it has an added advantage of abolishing the subjectivity of routine ultrasound. However inconclusive results demand further expertise in the field and need to be taken care of before interpretation of ovarian pathologies.

Breus’ mole/chorangiosis/chorangioma of the placenta: a dilemma with a rare fetal outcome report

Massive Subchorionic Thrombohematoma (MST) is a rare condition in which there is a massive collection of blood between the placental membranes and uterine wall separating the villous chorionic plate from villous chorion. It is relatively rare and is poorly understood. Many theories have been proposed to explain the etiology of Breus mole; some suggest it is a fetal haemorrhage, while others claim it has a maternal-origin thrombosis of placental vessels. A 30-year-old healthy Indian pregnant woman was presented at Max Hospital, Shalimar Bagh Delhi, India, during her second pregnancy with a complaint of fever. On routine level-2 ultrasonography (USG) done at 18.6 weeks of gestation showed thick placenta. No fetal tumours or any other anomalies were noted on that scan which was followed by a detailed scan which confirmed a solitary mass arising from fetal side 103x64x82 mm S/O chorioangioma. Serial growth and doppler USG were conducted to monitor placental function, tumor characteristics and future anatomy. The subject received steroids to enhance fetal lungs maturation at Week 30, iron/calcium supplements, Ecosprin tablets, and progesterone support. At 32.5 weeks, the subject developed deranged sugars followed by gestational hypertension at 34.1 weeks. Ultrasonography also showed fetal growth restriction with large chorioangioma. The subject underwent a successful elective caesarean section at 34.4 weeks. On placental examination, 10 cm large mass encasing ¾ of the placenta was identified as a large subchorionic hematoma/chorioangioma (800 g). This study concludes that early identification of a large chorangioma aids in consequent fetal surveillance, management of maternal symptoms, and delivery planning discussions even if the pathological diagnosis turns out to be Breus’ mole with underlying chorangiosis postnatally.

Brazilian consensus on incidental gallbladder carcinoma / Consenso brasileiro de carcinoma incidental de vesícula biliar

ABSTRACT Background: Incidental gallbladder cancer is defined as a cancer discovered by histological examination after cholecystectomy. It is a potentially curable disease. However, some questions related to their management remain controversial and a defined strategy is associated with better prognosis. Aim: To develop the first evidence-based consensus for management of patients with incidental gallbladder cancer in Brazil. Methods: Sixteen questions were selected, and 36 Brazilian and International members were included to the answer them. The statements were based on current evident literature. The final report was sent to the members of the panel for agreement assessment. Results: Intraoperative evaluation of the specimen, use of retrieval bags and routine histopathology is recommended. Complete preoperative evaluation is necessary and the reoperation should be performed once final staging is available. Evaluation of the cystic duct margin and routine 16b1 lymph node biopsy is recommended. Chemotherapy should be considered and chemoradiation therapy if microscopically positive surgical margins. Port site should be resected exceptionally. Staging laparoscopy before reoperation is recommended, but minimally invasive radical approach only in specialized minimally invasive hepatopancreatobiliary centers. The extent of liver resection is acceptable if R0 resection is achieved. Standard lymph node dissection is required for T2 tumors and above, but common bile duct resection is not recommended routinely. Conclusions: It was possible to prepare safe recommendations as guidance for incidental gallbladder carcinoma, addressing the most frequent topics of everyday work of digestive and general surgeons.

RESUMO Racional: Carcinoma incidental da vesícula biliar é definido como uma neoplasia descoberta por exame histológico após colecistectomia videolaparoscópica. É potencialmente uma doença curável. Entretanto algumas questões relacionadas ao seu manuseio permanecem controversas e uma estratégia definida está associada com melhor prognóstico. Objetivo: Desenvolver o primeiro consenso baseado em evidências para o manuseio de pacientes com carcinoma incidental da vesícula biliar no Brasil. Métodos: Dezesseis questões foram selecionadas e para responder as questões e 36 membros das sociedades brasileiras e internacionais foram incluídos. As recomendações foram baseadas em evidências da literatura atual. Um relatório final foi enviado para os membros do painel para avaliação de concordância. Resultados: Avaliação intraoperatória da peça cirúrgica, uso de bolsas para retirar a peça cirúrgica e exame histopatológico de rotina, foram recomendados. Avaliação pré-operatória completa é necessária e deve ser realizada assim que o estadiamento final esteja disponível. Avaliação da margem do ducto cístico e biópsia de rotina do linfonodo 16b1 são recomendadas. Quimioterapia deve ser considerada e quimioradioterapia indicada se a margem cirúrgica microscópica seja positiva. Os portais devem ser ressecados excepcionalmente. O estadiamento laparoscópico antes da operação é recomendado, mas o tratamento radical por abordagem minimamente invasiva deve ser realizado apenas em centros especializados em cirurgia hepatopancreatobiliar minimamente invasiva. A extensão da ressecção hepática é aceitável até que seja alcançada a ressecção R0. A linfadenectomia padrão é indicada para tumores iguais ou superiores a T2, mas a ressecção da via biliar não é recomendada de rotina. Conclusões: Recomendações seguras foram preparadas para carcinoma incidental da vesícula biliar, destacando os mais frequentes tópicos do trabalho diário do cirurgião do aparelho digestivo e hepatopancreatobiliar.

Repetitive transcranial magnetic stimulation of the prefrontal cortex for fibromyalgia syndrome: a randomised controlled trial with 6-months follow up

Abstract Objectives Fibromyalgia Syndrome (FMS), is a chronic pain disorder with poorly understood pathophysiology. In recent years, repetitive transcranial magnetic stimulation (rTMS) has been recommended for pain relief in various chronic pain disorders. The objective of the present research was to study the effect of low frequency rTMS over the right dorsolateral prefrontal cortex (DLPFC) on pain status in FMS. Methods Ninety diagnosed cases of FMS were randomized into Sham-rTMS and Real-rTMS groups. Real rTMS (1 Hz/1200 pulses/8 trains/90% resting motor threshold) was delivered over the right DLPFC for 5 consecutive days/week for 4 weeks. Pain was assessed by subjective and objective methods along with oxidative stress markers. Patients were followed up for 6 months (post-rTMS;15 days, 3 months and 6 months). Results In Real-rTMS group, average pain ratings and associated symptoms showed significant improvement post rTMS. The beneficial effects of rTMS lasted up to 6 months in the follow-up phase. In Sham-rTMS group, no significant change in pain ratings was observed. Conclusion Right DLPFC rTMS can significantly reduce pain and associated symptoms of FMS probably through targeting spinal pain circuits and top-down pain modulation . Trial registration: Ref No: CTRI/2013/12/004228.(AU)

Diversity of ethnomedicinal plants in Churdhar Wildlife Sanctuary of district Sirmour of Himachal Pradesh, India

Himachal Pradesh has a great altitudinal range (300–7,000 masl), with varied species, habitats, communities,populations, and ecosystems. There are more than 3,400 different species of plants are reported to be found inHimachal Pradesh. In the state, excess of thousand plant species identified as aromatic and medicinal appear intemperate forests, Shiwalik hills, alpine and sub-alpine pastures. Majority of the inhabitants in Himachal Pradeshbelong to different communities and cultures, with specific traditional knowledge. In the remote areas, especiallyhigh-altitude regions are contemporary medical amenities, and therefore tribal and rural society mainly depends onnative medicinal plants. Herein, we compiled 41 medicinal plant species belonging to same or different families usedby migratory shepherds in Churdhar Wildlife Sanctuary of district Sirmour in Himachal Pradesh. This survey will helpthe medicos, pharmaceutical industry for refining the public healthiness amenities, and maintenance of wild medicinalplant prosperity of the studied zone.

Influence Of Music Therapy On Anxiety, Pain Perception, Heart Rate And Blood Pressure Of Patients Undergoing Endodontic Treatment - A Randomized Control Trial

There is a very peculiar role of “Kshar Karma” (an Anushastra), in the management of Arsha, as described by Sushrutacharya.Acharyas have mentioned Kadali as suitable for the Kshara formulation. Patients suffering from AbhyantaraArsha are subjected to KadaliPratisaraneeyaKshar and efficacy ofKadaliKsharPratisaran and inj. Setrol is compared in the management of AbhyantarArsha. In Clinical study an Open randomized controlled clinical trial is conducted of trial group A and control group B for 30 patients in each group.In observations a detailed explanation is given aboutdistribution of patients according to age, sex, occupation.The results of the study are analyzed statistically compared and are presented in tables and graphs form. By highlighting the outcome of the study along with limitations and scope of further improvement it is concluded that KadaliKsharpratisarana gives potent effects in AbhyantarArsha.

The quality of life and coping skills of patients with human immunodeficiency virus among different occupation

Background: Nowadays, HIV and AIDS has become an important public health issue across the world. Quality of life (QOL) is an important tool to assess general wellbeing of HIV patients. Coping skills are the psychological skills to face the difficult situations like HIV or AIDS. The workplace plays an important role in determining general wellbeing and the psychological problems in HIV patients. Therefore, it is very important to assess the quality of life and coping skills of HIV patients among different occupations.Methods: A cross-sectional study consisting of conveniently selected 200 HIV patients was conducted at ART center LLRM Medical College, Meerut. The study subjects were interviewed by using questionnaire consisting of WHOQOL HIV BREF (WHO quality of life questionnaire) and Brief-COPE scale questionnaires. Descriptive statistics and ANOVA test were used for analysis of the data.Results: 36% of HIV patients were housewives and 26.5 % of HIV patients were drivers. The quality of life score was higher in HIV patients who were in unemployed (14.98) and farmers (14.49) whereas was lowest in all others category (10.73). The housewives, farmers, government jobs or service, drivers and other had maximum adaptive coping in religion and minimum adaptive coping in humour. There was no uniform pattern of maladaptive coping skills of HIV patients among different occupations.Conclusions: Quality of life score was better in HIV patients who were unemployed and farmers as compared to HIV patients who were drivers, housewives, government jobs or service. Religion was most effective adaptive coping strategy and humour was least effective adaptive coping strategy in HIV patients.

Antibiotics-related adverse drug reactions at a tertiary care hospital in North India

Background: Antibiotics are considered to be commonly used drugs in hospital setting due to higher prevalence of infectious diseases especially in India. So, the present study was conducted to assess the incidence of adverse drug reactions (ADRs) due to antibiotics and analyze for causality of adverse drug events reported.Methods: The present retrospective and observational, study was conducted in BPS GMC for women, Khanpur Kalan, Sonepat, Haryana which is a 500 bedded government medical hospital situated in rural area between March 2016 to February 2019 (i.e., 3 years). Patients of either sex or age who developed ADRs by any route were included in the study.Results: 300 (38.65%) cases were reported due to antibiotics out of total 776 ADR cases. 3% cases were serious. Adults (65%) were found to be most commonly affected by ADRs. Among antibiotics, cephalosporins and penicillins (15.98%) were the major culprit to cause adverse events followed by nitroimidazoles (15.2%) and antitubercular drugs and fluoro quinolones (13.16%). The most affected organ system was skin (49.33%) followed by the gastrointestinal system (33%). As per WHO scale of causality assessment, 33.33% and 67.67% reported cases were found to probably and possibly related to adverse events respectively.Conclusions: Antibiotics are most commonly prescribed drugs so its monitoring regarding ADRs may benefit the clinicians in early identification and management of ADRs so that quality of life of patient can be safeguarded at an earliest.

Fibroadenoma/benign phyllodes: a cytologic diagnostic challenge

Background: To study and compare cytomorphological features of histologically proven cases of benign phyllodes and cellular fibroadenoma.Methods: Smears of histologically-proven cases of benign phyllodes and cellular fibroadenoma in one year, were reviewed. The cellular fibroadenoma had epithelial and/or stromal hypercellularity. The stromal and epithelial components as well as the background cells were qualitatively and quantitatively analyzed.Results: Number, cellularity and type of stromal fragments varied significantly in two groups. Higher number, intermediate to large-sized and hypercellular stromal fragments were commonly seen in phyllodes. Hypercellular (3+ cellularity) fragments were seen in 100% cases of phyllodes against 11.1% cases of fibroadenoma. Large-sized stromal fragments were found in 100% of phyllodes while in only 11.1% cases of fibroadenoma. The ratio of number of epithelial to stromal fragments was significantly high (58.5:1) in fibroadenoma against phyllodes (1.3:1). The epithelial architecture, atypia, apocrine metaplasia and presence of cystic macrophages did not very much in the two groups. The cellularity of the dispersed cells in background did not reveal significant difference though the type of cells varied; the proportion of long and short spindle cells was higher in PT group while proportion of oval cells was higher in FA group.Conclusion: The number, cellularity and nature of stromal fragments, ratio of epithelial to stromal fragments, cellularity and type of background cells are helpful in distinguishing benign phyllodes from cellular fibroadenoma. The identification of these features can improve the pickup rate of phyllodes tumor, thereby assisting proper management.

Topical corticosteroid misuse: observational study to evaluate pattern of abuse and adverse drug reactions

Background: Topical corticosteroids (TC) have a reputation as anti-acne, anti-blemish effects and popularly used as fairness creams. In India, there has been a rise in misuse of TC in last10 years. The present study was conducted to analyse the magnitude of adverse effects of topical corticosteroids abuse in dermatology outpatient department of a tertiary care hospital.Methods: A retrospective observational study was conducted on patients after categorizing them as a TC misuser by dermatologists. The socio-demographic data, chief complaints, details of drugs misuse and adverse drug reaction outcome was collected.Results: A total of 1240 patients was screened, out of which 80 patients misused TC without dermatologist prescription for their skin disease. TC was mainly misused by teenagers (43.8%). Misuse of topical corticosteroids was more common among females (76.3%). Betamethasone valerate (72.5%) was most common TC misused. Most common source of advice of TC misuse was friends (37.5%). Most common purpose of TC misuse was acne (55%) followed by cosmetic purposes (21.3%). The most common morphological varieties of adverse drug reactions were burning and itching sensation (53%) followed by increase severity of acne (44%).Conclusions: TC misuse was more common in teenage females. Most common adverse effect reported is burning and itch sensation followed by increase severity of acne. The study data indicates a significance of problem and requirement of urgent measures to control TC misuse.

Elective versus emergency caesarean section: differences in maternal outcome

Background: Caesarean section is a life-saving surgical procedure when certain complications arise during pregnancy or labour. The use of CS worldwide has increased worldwide unprecedented levels although the gap between higher- and lower-resource settings remains. The present study evaluates the difference in maternal outcome in elective versus emergency caesarean sections in our institute.Methods: The study included first 65 cases of emergency caesarean section (group A) and during the study period, first 65 elective caesarean section (group B) if they fulfilled the inclusion criteria. Various intra operative and postoperative events were recorded which included intra operative complications, postpartum haemorrhage and transfusion indices.Results: The most common indication of caesarean section in group A was fetal distress (27.7%). In group B most caesarean sections were classified under 5 followed by class 6, the most common indication being previous caesarean section (27.6%). It was observed that pre-operative mean haemoglobin in group A was 10.6 g/dl and in group B was 11.2g/dl. A drop of 1.36 g/dl in group A and 1.10 g/dl in group B was observed in the post-op period. Cross match / transfusion ratio 1.5 in group A and  2 in group B, transfusion probability ratio was 60 % in group A and  66.7%  in group B and transfusion index was 1 in group A and  group B. There was significantly higher contraception acceptance in group B compared to group A.Conclusions: Elective caesarean section has more favourable maternal outcome as compared to emergency caesarean section as the former is done under controlled and planned circumstances.  However, there should be stringent audit to scrutinise indication of caesarean section, outcome of caesarean and blood transfusion practices.

Utility of scrape cytology in the diagnosis of ovarian masses

Background: Cytology is a useful adjunct to frozen section for rapid diagnosis of neoplastic pathology. However frozen section facility is available in limited centres. Therefore, we undertook this study to find out role of scrape cytology for diagnosis of ovarian masses.Methods: It is an observational study done in a medical college. One hundred ovarian masses were collected for a period of eighteen months. Cut surface of ovarian masses were scraped with edge of a glass slide. Smears were prepared and stained with H and E stain, examined and a presumptive diagnosis was given. The verification of cytological diagnosis was done by histopathological report. All the data were recorded, tabulated and analyzed with the help of standard statistical methods using Microsoft XL.Results: A total of hundred cases were studied. Left ovary was involved in 38 cases, right ovary in 52 cases and bilateral ovaries in 10 cases. Malignant cases mostly yielded hyper cellular smear. On Chi square test, it was significant with value of less than .001. The overall sensitivity and specificity of scrape cytology in diagnosing ovarian neoplasm, considering HPE as gold standard, are 98% and 78% respectively. In Dysgerminoma, Papillary adenocarcinoma, Mucinous Cystadenoma, Benign cystic teratoma, Granulomatous lesion of ovary, Lymphoma and Mucinous adenocarcinoma, scrape diagnosis corroborated with the histological diagnosis. Notable discrepancy was seen in cases of Endometrioid carcinoma.Conclusions: Scrape cytology can serve as a powerful tool for early diagnosis of ovarian masses in close cooperation of the clinician, radiologist and pathologist. It has a potential for widespread use as knowledge and experience of interpreting cytopathologists increase.