Importance Of Non–dipping Pattern In Chronic Kidney Disease Patients

Introduction: Hypertension was prevalent in 80 to 90% of patients with chronic kidney disease (CKD), Hypertension was widely known to accelerate the progression of CKD and increase the risk of cardiovascular (CV) events. In essential hypertension, it was observed that 24hr ambulatory BP and a non–dipping profile were closely associated with increased target–organ damage and a worsened CV outcome than clinic BP. Objective: The purpose of this study was to evaluate the relation between non dipping pattern, traditional risk factors such as age, gender, cholesterol, asymptomatic atherosclerosis markers (LVMI, Carotid IMT, ABI) and cardiovascular mortality in CKD patients. Methodology: Patients attending hemodialysis unit and the outpatient department of the Osmania General Hospital were formed as the material of study. Results: According to the Sleep /Awake BP ratio> 0.9 in their ambulatory BP recordings; The percentage of non dipping pattern was observed in 72% and the remaining 28% had dipping phenomenon. The estimated glomerular filtration rate (eGFR) calculated by Modification of diet in renal disease study (MDRD) equation has ranged around 4.8 to 77 ml/mim/1.73m2 and was negatively correlated with sleep/awake BP ratio. The percentage of diabetes was observed to be higher in the non–dippers. The non–dipping phenomenon was significantly associated with asymptomatic atherosclerosis markers (LVMI, Carotid IMT, and ABI). There was a high prevalence of CV events (1 in dipper and 17 in non–dippers) and CV related deaths (1 in dipper and 9 in non–dippers) in non dippers.

Correlation between Ultrasound Features and Histopathological Findings in Adnexal Masses – A Study in a Tertiary Care Center in Central India

Background: Ovarian cancer has emerged as one of the most common malignancies affecting women in India. Amultidisciplinaryapproach is needed for the optimal management of patients presenting with adnexal mass wherein the radiologist and thepathologist play an important role in assisting in clinical decision-making. The present study is done to correlate the ultrasoundfindings with the histopathological findings and to study the whole spectrum of adnexal masses.Methods: This is a prospective observational study carried out on 60 patients with adnexal masses and pre-operative ultrasoundassessment and who underwent surgical resection of their masses in a tertiary care center.Results: The pre-menopausal age group was more frequently affected than post-menopausal age group. A large number ofadnexal masses were of ovarian origin. The incidence of neoplastic adnexal masses is much higher than the non-neoplasticmasses. Among the neoplastic adnexal masses majority were ovarian tumors. The incidence of benign ovarian tumors is higherthan malignant tumors. Among the malignant tumors, serous cystadenocarcinoma was the most common tumor. Majorityof the ovarian tumors diagnosed by ultrasonography (USG) as purely cystic in architecture were proven benign tumors onhistopathology. Of the solid-cystic tumors, 50% were benign, and 50% malignant on histopathology solid architecture of thetumors was the least common, and the majority were malignant. USG diagnosis of adnexal masses revealed a sensitivity of94.4%, specificity of 83.3%, positive predictive value of 70.8%, and negative predictive value of 97.2%.Conclusions: USG is a sensitive and specific modality in pre-operative diagnosis of the malignant nature of lesions. Thepresence of solid component in an ovarian mass was a highly accurate predictor of malignancy.

Morphologic and morphometric analysis of glenoid cavity of human scapula

Background: To study the morphometry and morphology of glenoid cavity of dried scapula bone and in CT scan of glenoid cavity. The present study aimed at calculating three dimensions i.e. vertical diameter, horizontal diameter of the upper segment and horizontal diameter of the lower segment of the glenoid cavity and describing the incidence of its different shapes.Methods: This study was done on 100 dry, unpaired adult human scapulae of unknown sex. 50 scapulae belongs to right side and 50 scapulae belongs to left side obtained from Department of Anatomy, SRM Medical College and Research Institute. The above mentioned diameters are measured using Vernier caliper and the mean dimensions are calculated, morphological variations are studied. 3D CT images of scapulae, obtained from Department of Radiology, SRM Medical college and Hospital, Potheri, were also analysed.Results: In the current study, various dimensions and incidence of various shapes of glenoid cavity were measured. The incidence of both pear and inverted comma shape in right side is greater than in left whereas the incidence of oval shape in left side is greater than right side. The SI diameter of right glenoid is greater than the left, which is statistically significant. The Antero-posterior diameters (AP-1, AP-2, AP-3) of right glenoid is greater than the left, but not statistically significant.Conclusions: The knowledge of the above said variations of glenoid cavity is important in manufacturing the glenoid component of shoulder prosthesis, repair of Bankart’s lesion, procedures like posterior glenoid osteotomy.

Comparative Study Of3ed95 Rocuronium Versus Succinylcholine A Intubating Agent In A Pediatric Patient Drshruti Desai,Dr Manisha Skapdi

Background: succinylcholine is routine muscle relaxant for paediatric patients. Rocuronium is newer non depolarising muscle relaxant.Aims & objectives: To assess time, course and duration of both relaxants as well as intubation conditions.Material & Methods:The randomized blind study was carried out to evaluate the intubating condition with two different muscle relaxants in 50 ASA grade I and II pediatric patients with age group of 2-6 years,having duration of surgery less than 30 minutes.Patients were anaesthetized with injection rocuronium 0.9 mg/kg i.v. or with injection succinylcholine 1.5 mg/kg after injection fentanyl 1ug/kg and injection thiopentone 5 mg/kg. Neuromuscular blockade was assessed by twitch response of adductor pollicis longus after supra-maximal stimulation of ulnar nerve. Tracheal intubating conditions were assessed by blinded anaesthetist after 60 seconds and then after every 15 seconds, till patient got intubated. Along with this, time of onset and percentage of neuromuscular blockage was also assessed. Observations and results:Time course and duration of action were more in case of rocuronium group as compared to succinylcholine group.Intubating conditions are comparable in both groups

Odontogenic tumors: A 35-year retrospective study of 250 cases in an Indian (Maharashtra) teaching institute

CONTEXT: This retrospective study was planned to ascertain the relative frequency of odontogenic tumors (OTs) in an Indian population in the light of the latest World Health Organization (WHO) classification. AIM: To compare data with various reports from other parts of the world. STUDY DESIGN: Retrospective study. MATERIALS AND METHODS: The histopathology records and archived slides of all lesions diagnosed as “OT” in the Department of Oral Pathology and Microbiology of Government Dental teaching institute, Mumbai, Maharashtra, India, were recovered from the period January 1981–December 2016. A total of 250 lesions thus classified were reviewed for age, gender, site of tumor, and histopathologic typing. The tumors were reclassified according to the WHO 2017 criteria. STATISTICAL ANALYSIS: Microsoft Excel 2010 was used for statistical analysis. RESULTS: In all, 250 cases of OTs were reported in a 35-year period. OTs in this study constituted 7.14% of all the 6797 registered biopsies. The most frequent histological type was ameloblastoma (AML) (30.8%), followed by odontoma (19.2%), unicystic ameloblastoma (18.4%), adenomatoid OT (14%), cementifying fibroma (6%), odontogenic myxoma and cementoblastoma (2.4% each), calcifying epithelial OT and odontogenic fibroma (2% each), ameloblastic fibroma (1.2%), squamous OT, dentinogenic ghost cell tumor, peripheral ameloblastoma, ameloblastic carcinoma and ameloblastic fibrosarcoma (odontogenic sarcoma) (0.4% each). CONCLUSION: A frequency of 7.14% of OTs was observed in this study. AML comprised the single most common tumor of all OTs. This study observed geographic variations in the frequency and distribution of Ots.

Comparison Of Asleep Awake Asleep (AAA) Technique, Monitored Anaesthesia Care , Technique For Awake Craniotomy

BACKGROUND:Awake craniotomy is an important technique used for Braintumor excision from eloquentcortex,Epilepsyfoci removalsurgery,Deepbrain stimulation,Lesscommonly formycoticaneurysms,A-Vmalformation near cortical areas.AIMS AND OBJECTIVESMaintaining patients cooperationby provision of optimalanalgesia,sedation,anxiolysis and comfortable position ,Achieving homeostasis with safe airway, adequate ventilationand hemodynamic stability.,Ensure minimal interference with electrocorticographicrecording during mapping.To show the feasibility of dexmedetomidine and scalp blockwith 0.5% bupivacaine for cortical mapping.Material methodsin both group Dexmedetomidiine infusion &scalp block givenIn group A:Igel2nd generation LMA for airway managementafter inj propofol 2 mg/kgIn group B: Nasopharyngeal airway for same

Sudden, unexpected and natural death in young adults of age between 18 and 35 years: A clinicopathological study.

Context: To identify various causes, risk factors, age and sex distribution associated with sudden and unexpected natural deaths (SUNDs) in young adults of age between 18 and 35 years. Materials and Methods: Retrospective analysis of autopsy reports and medical records of all SUNDs that occurred instantaneously or within 24 hours of onset of symptoms in young adults, between 2001 and 2009. Result: Of the total 6453 deaths autopsied during 2001-2009, 64 (0.99%) were SUNDs in young adults, chiefly in males between 30 and 35 years of age. Non-cardiac causes significantly predominated (73.4%) over cardiac causes (7.8%). Most of the SUND cases were due to preventable causes, including infections (54.6% cases), cerebrovascular accidents (9.37%) and ischemic cardiac causes (6.25%). Sudden adult death syndrome (SADS) accounted for 18.75% deaths. Conclusion: SUND in young adults is preventable. A meticulous post-mortem examination with special attention to the conduction system of heart and detailed toxicological analysis can pinpoint the cause of death in SADS.

Recurrent acute transverse myelopathy: association with antiphospholipid antibody syndrome.

A seven-year-old boy presented with a second episode of acute transverse myelopathy. The first episode had responded dramatically to methylprednisolone. The manifestations of the second episode did not respond to methylprednisolone or IVIG. He showed persistently raised levels of antiphospholipid antibodies in the serum. Primary conditions like collagen vascular diseases, malignancy, exposure to drugs and HIV infection, which are known to be associated with the raised titers of these antibodies were ruled out clinically and by investigations. Recurrent transverse myelopathy is a rare event in childhood and reports of its association with Antiphospholipid Antibody Syndrome (APLAS) are scanty. The etiological role for these antibodies remains to be established. However, once the diagnosis is established, it may be prudent to treat the condition with agents and procedures to bring about a decrease in their titers. Long-term therapy to prevent thromboembolic complications of APLAS may also be instituted.

Hematological profile of HIV positive patients.

A series of 500 HIV positive patients referred to our centre for CD4 and CD8 cell enumeration are included in this study. The following parameters were studied in each of these patients: Hb, RBC indicates, WBC count, platelet count, three part differential count, absolute CD4 and CD8 counts. Male:Female ratio of 4.9:1 was noted 30.8% patients has anemia (Hb<10 gm%), with an average Hb value of 8.1 gm%. The anemia was normochromic, normocytic in 61% of patients, microcytic in 33% and macrocytic in 6% patients. The absolute CD4 count was less than 200 ul in 50.2% patients with an average value of 92/ul. Thrombocytopenia was seen in 13% patients with average platelet count 0.92x10(3)/ul.