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Purpose: The main objective of this study is to explore the efficacy of olopatadine 0.1% treatment in the resolution of symptoms of vernal keratoconjunctivitis (VKC) among the Indian population. Methods: This single?center, prospective cohort study involved 234 patients with VKC. Patients were treated with olopatadine 0.1%, twice daily for a period of 12 weeks and then followed up in 1st week, 4th week, 3rd month, and 6th month. The extent of relief in the symptoms of VKC was measured using total ocular symptom score (TOSS) and ocular surface disease index (OSDI). Results: In the present study, the dropout rate was 5.6%. Total of 136 males and 85 females with a mean age of 37.68 ± 11.35 years completed the study. TOSS score reduced from 58.85 to 5.06 and the OSDI score reduced from 75.41 to 11.2 with statistical significance (P < 0.01) from 1st week to 6th week after olopatadine 0.1% treatment. The data showed relief in subjective symptoms of itching, tearing, and redness, and relief in discomfort in functions related to ocular grittiness, visuals like reading, and environmental like tolerability in dry conditions. Further, olopatadine 0.1% was effective in both males and females, and patients across ages 18–70 years. Conclusion: Based on TOSS and OSDI scores, the findings of this study validate safety and tolerability as revealed by low adverse effects and moderate efficacy of olopatadine 0.1% in reducing VKC symptoms in a broader age group (18–70 years) of both genders.
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Purpose: To study the prevalence of dry eye disease (DED), further categorize using DEWS II protocol, grade squamous metaplasia in each group, and determine associated risk factors in a tertiary care hospital. Methods: This cross?sectional hospital?based study screened 897 patients ?30 years via systematic random sampling. Patients with both symptoms and signs as defined by the Dry Eye Workshop II protocol were considered as DED, further categorized, and subjected to impression cytology. Categorical data were assessed using the Chi?square test. P value < 0.05 was considered statistically significant. Results: In total, 265 (of 897) patients were defined as DED based on the presence of symptoms (DEQ?5 ?6) and at least one positive sign (fluorescein breakup time [FBUT] <10 s or OSS ?4). DED prevalence was thus 29.5% with aqueous deficient dry eye (ADDE), evaporative dry eye (EDE), and mixed type seen in 92 (34.71%), 105 (39.62%), and 68 (25.7%) patients, respectively. The risk of developing dry eye was higher in the age above 60 years (33.74%) and in the third decade. Females, urban dwellers, diabetics, smokers, history of previous cataract surgery, and usage of visual display terminal devices were found to be significantly associated with risk factors of DED. Squamous metaplasia and goblet cell loss were more severe in mixed compared to EDE and ADDE. Conclusion: Hospital?based prevalence of DED is 29.5% with a preponderance of EDE (EDE 39.62%, ADDE 34.71%, and mixed 25.71%). A higher grade of squamous metaplasia was seen in the mixed type compared to other sub?types.
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Purpose: The present study aims to determine the macular and choroidal optical coherence tomography angiography (OCTA) biomarkers in the assessment and monitoring of diabetic macular edema (DME) and diabetic macular ischemia (DMI) in patients with non?proliferative diabetic retinopathy (NPDR). Methods: In this cohort study, a total of 176 eyes of 110 patients with NPDR were investigated at our institute over a period of 10 months. Eyes were divided into four groups based on the severity of NPDR. Each eye was subjected to OCTA (Topcon 3D OCT?1 Maestro2) macula 6 × 6 mm2 en face. It features IMAGEnet 6 software for dynamic viewing of OCTA and imaging data. Four OCTA biomarkers for the macula were identified: foveal avascular zone area (FAZ area), foveal avascular zone contour irregularity (FAZ?CI), capillary dropout areas (CDA), and perifoveal intercapillary areas (PICA). The choroidal OCTA biomarker was the number of choroidal circulation flow voids (CCFV). For all analyses, P < 0.05 was considered statistically significant. Results: Increase in FAZ area and number of CDA were statistically significant (p < 0.0001) with an increase in central foveal thickness, suggesting a correlation of ischemic changes with an increase in DME. FAZ?CI, enlarged PICA, and CCFV were significantly associated with more severe NPDR patients. Conclusion: A correlation between DME and DMI in a patient of NPDR and its progression can be evaluated in a single visit. A unique feature of our study is it revealed novel diagnostic biomarkers of OCTA for DMI and DME.
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BACKGROUND Antenatal care (ANC) is the essential regular care of women that prevents potential health problems during pregnancy. In India, the proportion of women who received four or more antenatal visits was only 51% (National Family Health Survey, 2015–2016). An even worse situation prevails in urban areas where women from poor communities face greater health risks. We assessed various barriers women residing in these areas come across in availing ANC services. METHODS This study is a part of a mixed-methods, community-based study, and we report its qualitative component. We conducted the study at the residence of the study participants in September–October 2019. The study participants were women who had less than four antenatal visits throughout the pregnancy. Twelve in-depth interviews were conducted based on data saturation. Data were transcribed and themes were drawn concerning the gender analysis framework. RESULTS Through this study, we found how gender relations affect the utilization of antenatal services concerning access to resources, division of labour, social norms including the belief of husband and other family members towards pregnancy and decision-making power of women. CONCLUSION Our findings underline the importance of making the urban health system gender-sensitive and responsive to the needs of women during pregnancy. There is a need to educate men regarding maternal health so as to allay such social norms that label pregnancy as a woman’s responsibility and encouraging them to accompany their wives during pregnancy visits, thus making men a part of antenatal services.
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Purpose: To assess Photo Activated Chromophore for Infective Keratitis?Cross Linking (PACK?CXL) and its efficacy as a treatment modality in managing microbial keratitis. Methods: Single Centre prospective interventional study in infectious keratitis. A total of eleven patients were taken who had corneal thickness (CT) more than 400?m. PACK?CXL was performed according to Dresden’s protocol. The response was assessed by slit lamp examination, BCVA and AS?OCT at the time of complete healing. Results: The mean visual acuity at presentation was 1.207logMAR (0.3?3) which improved to mean value of 0.53logMAR (0.3?1). Mean time taken for complete epithelization was 17.45 days (14? 30 days) and that for complete healing was 33.72 days (21? 60 days). Mean CT at the baseline was 650.5± 108?m which reduced on consecutive follow up visits. There was reduction in the symptoms in nine patients except in two. One case reported increase in symptoms with worsening increase in endoexudates and hypopyon, and the other developed drug toxicity due to topical medications. Conclusion: Patients who underwent PACK?CXL showed good and early healing, good remodelling of cornea and improved visual acuity. The recalcitrant cases became responders to the same medications after PACK?CXL. Thus, PACK?CXL works well for both fungal and bacterial keratitis
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Background:Cartilage oligomeric matrix protein (COMP), is an extracellular matrix (ECM) non-collagenous glycoprotein that is mainly localized within the cartilage, and also be found in tendon and synovium.RecentstudiesinwestandAsiaPacificregionhasshownthatCOMP, is a prognostic marker in Rheumatoid arthritis(RA).Objective:To correlate serum COMP levels with disease severity and cartilage destruction in rheumatoid arthritis.Methods:The study was conducted in Department of Pathology and Rheumatology, Ziauddin University Hospital, Karachi from June 2018 to May 2019. Patients were recruited as per American College of Rheumatology (ACR) 2010 classification criteria. The study populationconsists of 88 healthy subjects and 88 RA patients. Sandwich ELISA technique was used to assess serum COMP level. Other inflammatory markers such as erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) antibodies like rheumatoid factor, and anti-cyclic citrullinated protein (anti-CCP) were also assessed. Results were analyzed using SPSS-20 and P-value ≤0.05 was considered as significant.Results: Serum COMP levels were significantly higher in RA patients 51.35ng/ml than controls 21.454ng/ml with significant p value=<0.0001. There was strong positive correlation between COMP level and disease severity in RA patients with moderate as well as high disease activity score (DAS) with significant p value. Serum COMP showed 96% sensitivity and 83% specificity at level of 27.01ng/ml for diagnosis of RA.Conclusions:COMP has significant positive correlation with severity of RA. Serum COMP can be utilized as a biomarker to quantify cartilage destruction in RA patients
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Background: With the introduction of cytospin, the sensitivity of diagnosing malignancies has increased mainly due to the increase in cellular yield. Cell block also gives the advantage of ancillary testing and allows for retrospective studies. Immunocytochemical markers are used to differentiate and subtype various malignancies in body effusions.Aim of the study was to compare the morphological features of both technique and to assess the diagnostic utility of cell block methods in the cytodiagnosis of pleural effusions.Methods: This was a Prospective observational comparative study of two cytopreparatory techniques. All samples were examined and processed by cytospin and cell block techniques. Continuous data were expressed as Mean±SD (standard deviation) while categorical data were expressed in number, percentage and compared by chi-square (χ2) test.Results: The final diagnosis of both cytospin (147 cases) and cell block (150 cases) techniques was divided into four broad categories: Inadequate, Benign, Suspicious and Malignant. The significant diagnostic cytospin (AUC=0.857, p<0.001) in discriminating positive and negative malignant cases with 75.00% sensitivity (95% CI=53.3-90.2) and 100.00% specificity (95% CI=86.7-100.0) and with 100.0% positive predictive value and 81.2% negative predictive value. In contrast, cell block also showed significant diagnostic but with higher accuracy (AUC=1.000, p<0.001) and sensitivity 100.00% (95% CI=86.7-100.0) and specificity 100.00% (95% CI=86.7-100.0) and 100.0% positive predictive value and 100.0% negative predictive value than cytospin technique.Conclusions: Cell block as a technique should be used in routine practice as it not only increases the diagnostic yield but ancillary test can also be done.
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Introduction: Floating knee, referred to as ipsilateralfractures of the femur and tibia, is usually associated withseveral complications and mortality. This study was designedto present our experience with treatment of this injury.Demographic parameters like age, sex, mechanism of injury,associated injuries, method and results of treatment, andcomplications of floating knee are discussedMaterial and Methods: This Prospective study wasperformed between January 2014-July 2016. All patientswith floating knee injuries who were admitted to the PMCHfulfilling the inclusion and exclusion criteria were included.The information about the 20 cases of floating knee injurieswere gathered, particularly the demographic parameters, modeof injury, bones involved, condition of skin, other associatedinjuries and their neurovascular status. The patients werefollowed for a minimum of one year duration and functionaloutcome was assessed.Result: Most of the patients were between 21-30years of age(45%). The floating knee injuries were more common in males(85%). FraserType I fracture was observed in 70% of cases.Roadtraffic accidents(RTA) was the most common cause ofsuch injuries. 18 out of 20(90%) cases were having associatedinjuries while only 10%were cases of isolated floating knee.The most common early and late complications were infectionand knee stiffness respectively. The final outcome as perKarlstrom criteria was excellent and good in 11 out of 14 casesof Fraser type I fracture and in 3 out of 6 cases of Fraser type IIfracture, and this was statistically significant (P=0.05).Conclusion: This study revealed that the complication rateassociated with floating knee injuries remain high and theprognosis mostly depends on type of injury and associatedinjuries. This study also advocates early aggressive approachfor management of these injuries.
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Introduction:Chronic nonhealing ulcers, with varied etio-pathologies, are difficult to manage and warrant meticulous, early and prolonged directed treatment to prevent their development and complications.Methods:Patients of chronic ulcers (>3 months’ duration), having undergone surgical management at our Institute, VCSGGMS&RI-UT, between January 2018 –August 2019, numbering one hundred twenty five (N= 125), were included in this concurrent observational study, aimed at identifying implicated microrganism(s) and their antibiotic susceptibility, for promoting wound healing, along with surgical measures Results:Male patients (M:F :: 87:38; 69.6% males) in the “20-50 year” age-group (74; 59.2%), with diabetic ulcers (35;28.0%), burns etc. (21;16.8%) and traumatic ulcers (18;14.4%) etc. predominated in the chronic non-healing state. Gram positive (68; 54.4%) organisms (including Staphylococcus) were the major isolates from the ulcers; organisms showing higher sensitivity to the newer generations/groups of antibiotics. Uncontrolled Diabetes, other prolonged illnesses &/or under-nutrition were important causative factors, requiring their remediations and also debridements ± skin/flap coverage (45; 36.0%) with prolonged course of antibiotics and occasional amputations (18; 14.4%) for adequate treatment.Conclusion:Skilled intensive multidisciplinary effort is essential to achieve satisfactory healing and prevent disfigurement and to limit disability and death (11; 8.8%) among the patients.
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Introduction Dental erosion is defined as a non-carious lesionhaving superficial tooth loss initiated by a chemical processeither intrinsic or extrinsic, without involvement of bacteria.The incentive of this study was to assess and compare dentalerosion associated with the intake of carbonated drinks amongdental students; day scholars and hostel residents of theUniversity College of dentistry, Lahore.Materials and Methods: A cross-sectional descriptive studywas carried out on 183 dental students. Dental erosion wasestimated using the index of Basic Erosive Wear Examination(BEWE).Results: 31.6% hostel residents and 11.2% day scholarsconsumed carbonated drinks multiple times daily. Highererosion index values were seen in hostel residents than dayscholars. 48.6% was the prevalence of dental erosion amongthe study participants.Conclusion: Hostel residents consume more carbonateddrinks than day scholars. Erosion of teeth by carbonated drinksis influenced by the frequency, quantity, type, carbonateddrinks temperature and persons drinking habits.
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Background: This study was conducted to observe thehistological Effects of Radiations and Combined Effect of 2gmobile Phone Radiations with Turmeric (curcuma longa) ongerm cells of Testis in Albino Rats.Subject and Methods: The study was conducted on 32 malealbino rats. They were divided into four groups A, B, C, D.Group A was control group. Group B was exposed to radiationsfrom cell phone (2G mobile 900-1900 Mhz). Group C wasgiven curcuma longa orally and group D was exposed to bothradiations and curcuma longa given orally.Results: After given two month of mobile phone radiation theanimals were sacrificed by cervical dislocation method andtestis were used for observation of germ cells. the regularly cellphone radiation exposure on testis decrease the number ofgerm cells.Conclusion: The regularly exposure of radiation leads todecrease the number of germ cells, the harmful effect could bedecrease by cucuma longa.
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Background: Chronic obstructive pulmonary disease (COPD) is a common preventable and treatable disease that is characterised by persistent respiratory symptoms and airflow limitation. COPD is characterised by an intense inflammatory process in the airways, parenchyma, and pulmonary vasculature. It is possible in some cases that the inflammatory process may overflow into the systemic circulation, promoting a generalised inflammatory reaction. Patient with COPD often have concomitant chronic illness (co-morbidities). The aim of this study is to know the pattern of co-morbidities in COPD patients.Methods: This study was a cross sectional observational study conducted on 172 COPD patients (IPD and OPD) diagnosed on the basis of GOLD guideline 2017. Co morbidities were diagnosed as per standard defined criteria laid down in the respective guidelines.Results: 55.3% of the patients with COPD had co morbidities. 18/88(20.5%) patients presented with multiple co-morbidities. 49/88, 55.7% COPD patients were affected with cardiac (either only cardiac or had multiple organs affected besides cardiac), the commonest co-morbidity. Amongst cardiac, hypertension and congestive heart failure (CHF) was the commonest (n=19/49, 38.8% each) followed by CAD/CSA/IWMI/IHD/AF. Others were metabolic (n=14/88, 15.9%), GERD (n=13/88, 14.8%), Depression (n=11/88, 12.5%). Less prevalent co-morbidities were Osteoporosis (n=8/88, 9.1%), Lung cancer (n=6/88, 6.8%), Bronchiectasis (n=5/88, 5.6%) and OSA (n=3/88, 3.4%).Conclusions: Urban indwelling, advancing age and duration of illness, presentation with low mood, loss of pleasure/ interest, appetite disturbances and heart burn with relief on taking proton pump inhibitor can be predictors of co-morbidities in COPD patients. Chance of finding co-morbidities may be multifactorial. Thus, it is important to look out for co morbidities in each and every COPD patients.
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Background: Endodontically treated teeth are widely considered to be more susceptible to fracture than vital teeth. To reinforce the instrumented teeth against fracture; sealers are used in conjugation with a core filling material. Methods: The 120 prepared teeth were randomly divided into four experimental groups and two control group of 20 teeth each. One control group of 20 teeth where access opened and left unistrumented and unobturated. Group- I: Teeth obturated with gutta percha and epoxy resin based sealer. Group- II: Teeth obturated with polymer based core and methacrylate based Sealer. Group- III: Teeth obturated with gutta percha and calcium silicate based sealer. Group IV: Teeth obturated with gutta percha and zinc oxide eugenol based sealer. Group V: Teeth instrumented and obturated with gutta percha without use of sealer (Positive control). Group VI – Teeth with no instrumentation or obturation (Negative control). Results: The mean fracture resistance values (in N) are Group I i.e. Epoxy resin root canal sealer – 286.06 N, Group II i.e. Methacrylate resin root canal sealer - 328.77N, Group III i.e. Calcium silicate based root canal sealer - 265.05N, Group IV i.e. Zinc oxide eugenol based root canal sealer - 269.85N, Group V i.e. Positive control (Obturated without root canal sealer) - 258.91N, Group VI i.e. Negative control (No instrumentation and obturation) - 285.41N. Conclusion: Among the root canal sealers; resin based root canal sealers showed higher resistance to fracture than non adhesive sealers
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This review summarizes the state of the current literature relating to the associations of lung disease and adipokines (proteins produced by adipose tissue) in humans. The mechanistic basis for these associations in humans is not established, although a possible role for adipokines has been invoked. Leptin, a pro-inflammatory adipokine, and adiponectin, an anti-inflammatory adipokine, are causally associated with asthma in mice. Although human studies are currently inconclusive, high-serum leptin and low-serum adiponectin concentrations predict asthma, independent of obesity, in select population groups, such as premenopausal women in the United States. In contradistinction, low-serum leptin and high-serum adiponectin concentrations are associated with stable COPD, although these associations are likely confounded by fat mass. Interestingly, leptin may promote systemic and airway inflammation in stable COPD patients. On the other hand, COPD may upregulate systemic and lung adiponectin expression. The precise mechanism and significance of the associations between these adipokines and lung disease at the current stage are confusing and frankly paradoxical in places. It is now known that adipose tissue is not an inert organ simply for energy storage, but regulates systemic inflammation via a variety of secreted proteins (called adipokines). While the associations of obesity and adipokines with cardiovascular, endocrine, and rheumatological diseases are well described, the respiratory effects of obesity and adipokines are less well known. This review will focus on the effect of obesity and adipokines on asthma and chronic obstructive pulmonary disease (COPD) in humans. This area of research needs additional study that may open up novel therapeutic strategies for these lung diseases.
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Background: Dimensional relationship between bodysegments and stature has been the focus of scientists for manyyears. Therefore, prediction of stature from cranial remains isvital in establishing the identity of an unknown individual. Thepresent study was conducted to predict cephalic phenotype bymeasuring cephalic index and to study the correlation betweencephalic phenotype ad cephalic index.Materials and Methods: In this prospective observationalstudy 600 patients attending in the Outpatient department ofmedical, dental and other college’s students of age group 21-25 years in various colleges at Jaipur, India were selected forthe study. Data regarding Head length and Head breadth wascollected. A complete physical examination was carried out.The data collected was compiled, tabulated, analyzed andsubjected to statistical tests. Analysis was done using SPSS.Results: In the present study total sample size was 600 inwhich 300 were male and 300 were female. Mean age offemales was found to be 22.82 and mean age of males wasfound to be 22.96. In our study age group selected was 21 to25 years where 21 were the minimum age found in our studyand 25 being the maximum. In present study result showedthat of the Dolicocephalic Male was 7.66%, Mesocephalic Malewas 82 %, Brachycephalic Male was 10.33%. DolicocephalicFemale 25 was 8.33%, Mesocephalic Female was 84 %,Brachycephalic Female was 7.66% ,Dolicocephalic (Male &female) was 8%, Mesocephalic (Male & female) was 83 %,Brachycephalic (Male & female) 54 was. 9% .Significantdifference was observed in cephalic index between males andfemales.Conclusion: Our study concluded that cephalic index showedsignificant difference.
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BACKGROUND - Multi-drug resistant tuberculosis (MDR-TB) is an increasing health problem in India. Globally,3.5% of new TB cases and 18% of previously treated cases had MDR/RR-TB.(GLOBAL TUBERCULOSIS REPORT 2018). As per the India TB Report 2018 the estimated incidence of MDRTB/RR in India was approximately 1,47,000.Outcome of MDR patient put on MDR regime is poor due to high cost, long duration of treatment, and various side effect of second line ATT. MATERIAL & METHOD - Study comprised patients who were diagnosed MDR by culture and DST method from RNTCP accredited lab and initiated CAT–IV treatment in D.R.TB Centre, Department of Tuberculosis & Chest Diseases, S. N. Medical College, Agra. Detailed history and pre clinical evaluation as per guideline were done and at the end of 3rd ,4th,5th and 6th month sputum were send for AFB staining and culture. RESULT – Out of 109 MDR patient put on CAT-IV, culture conversion at 3rd month occur in 52(47.70%) patients, at 4th month in 58 patients (53.21%), and in 5th month 66 patients (60.55%). Out of 109 MDR TB patients 12 patients (11.01%) were found suspected XDR. CONCLUSION – MDR TB is major health problem worldwide. Due to less efficacy and more side effect of second line ATT, longer duration of treatment, MDR TB is difficult to treat even with free supply of ATT through DOTS PLUS. Close attention is needed for early diagnosis of MDR TB , and adequate clinically monitoring of during treatment is essential.
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Background: Pterion is usually marked by an H-shaped formof sutures that forms the union of the frontal, parietal, greaterwing of sphenoid, and temporal bones. The center of pterion isaround 4.0 cm higher to the zygomatic arch and 3.0-3.5 cmposterior to frontozygomatic suture. The present study wasconducted with the aim to determine the location of pterion andits clinical implications.Materials and Methods: The present study was conducted inthe Department of Anatomy, Mahatma Gandhi Medical College& Hospital, Jaipur, Rajasthan, India. The study included 40skulls of unknown gender. PT was taken as the distance fromthe center of Pterion to the superior part of thetemporozygomatic suture. For the linear measurements, onejaw of caliper pointed at the frontozygomatic suture and theother at the pterion center. All the data thus obtained wasarranged in a tabulated form and analyzed using SPSSsoftware. Mean and median values of all the results werecalculated.Results: A total of 40 skulls were studied in the present study.The mean distance on the right side was 3.5 cm and on leftside was 3.6 cm with variation between 2.1 To 4.4 cm on bothsides. The median distance on the right side was 3.46 cm andon the left side was 3.48 cm.Conclusion: The location and the type of pterion variesamongst different ethnic and racial groups. The present studymay be of use to the forensic experts and anthropologists.
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Introduction: Type-2 diabetes mellitus is a common, chronic metabolic disorder with multiple complications if not well controlled. Depression is a very common psychiatric comorbidity in these patients. Multiple environmental and patient related factors are linked with this co-morbidity. It is important to address depression and related factors in these patients for a better outcome. This study aimed to assess depression and distribution of various socio-demographic and clinical details in patients of type-2 diabetes mellitus. Material and Methods: Using a purposive sampling technique, a total of 118 patients of type-2 diabetes mellitus who fulfilled the inclusion and exclusion criteria of this study were enrolled. They were administered Hamilton Depression Rating Scale to assess depression. Overall 66.1% of the patients had co-morbidity of depression. Results: Significantly more number of patients of type-2 diabetes mellitus with co-morbid depression were unmarried (41% vs 15%, χ2=9.029, df=2, p<.05), unemployed/unskilled workers (21.8% vs 5% / 73.1% vs 55%, χ2=24.893, df=2, p<.01), from lower socio-economic status (71.8% vs 52.5%, χ2=4.342, df=1, p<.05), joint family (33.3% vs 7.5%, χ2=9.519, df=1, p<.05) and rural background (82.1% vs 62.5%, χ2=5.453, df=1, p<.05), and had poor control of the level of HbA1c (55.1% vs 2.5%, χ2=41.022, df=2, p<.01) than those without co-morbid depression. There was a significant negative correlation of years in education with HAM-D total score (r=-.471, p<0.01). Conclusion: A co-morbidity of depression is very common in patients of type-2 diabetes mellitus and various sociodemographic and clinical factors are linked to this comorbidity. It is important to address these issues for the sake of overall better outcome in type-2 diabetes mellitus.
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Introduction: Pilonidal sinus is a cavity in the subcutaneous tissue lined by granulation tissue that contains hair and communicates with the surface by a track which is lined usually by squamous epithelium and continuous with the epidermis. It mainly affects the intergluteal furrow. Materials and Methods: It is a hospital-based descriptive study conducted in the Department of General Surgery, Sree Gokulam Medical College and Research Foundation from February 2017 to November 2018. Patients with clinically diagnosed pilonidal sinus disease admitted in the Surgery Department, Sree Gokulam Medical College and Research Foundation. Results: A total of 140 patients were evaluated postoperatively and for a mean period of 12 months (range 6–18 months), every 3 months during their review visit or over phone. Mean operative time was 54.3 min with a median hospital stay of 5 days. Postoperative pain lasted for a median duration of 2 days. Drains were removed at a median of 3 days and sutures at a median of 7 days. Three patients presented with serous wound collection and 12 patients presented with wound dehiscence. Conclusion: Karydakis flap procedure is a safe surgical treatment for sacrococcygeal pilonidal sinus disease due to the associated low complication rate, short hospital length of stay, rapid healing, and a high patient satisfaction rate.
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Introduction: The term varicose is derived from the Latin word meaning – “dilated.” Varicose veins are defined as dilated, usually tortuous, subcutaneous veins 3 mm in diameter measured in the upright position with demonstrable reflux .Although varicose veins were identified prehistorically, only in the present century, considerable knowledge has been gained concerning the anatomy of venous system of the leg, the physiological mechanism of venous return to heart against gravity, and pathology of the disorder, which has led to many newer treatment modalities. One of the pitfalls in venous surgery lies in inadequate knowledge of the venous physiology and anatomy. In contrast to the anatomy of the arteries, the anatomy of veins is characterized by numerous variations.Hence, a thorough and precise knowledge of the anatomical variations of the great saphenous vein (GSV) and SFJ determines the successful outcome of surgery. Materials and Methods: A descriptive study was carried out on 90 patients who were operated for varicose veins in the Surgery Department, Sree Gokulam Medical College and Research Foundation, Venjarmoodu, Trivandrum, during the period of October 2012– April 2014. All patients were examined clinically after taking a detailed history. They were investigated by ultrasonography venous Doppler to confirm the diagnosis. They were subsequently posted for surgery, the intraoperative findings of which were recorded by measurement and photographs. Patients with recurrent varicose veins and perforator incompetence without saphenofemoral incompetence were not included in the study. For those patients posted for surgery, written informed consent was obtained from each patient and basic patient data were recorded in the pro forma. During surgery, documentation of the following intraoperative findings was done: • Measurement of the SFJ from the pubic tubercle. • Description of the tributaries that drain into GSV. • Presence or absence of duplex veins. All details regarding SFJ and tributaries were documented through photography and further analysis was done using standard statistic techniques. Results: During the study period, 90 cases of varicose veins were enrolled in the study, of which 35 were male and 55 were female. These patients were evaluated by clinical examination, investigations, and peroperative recording of the findings in the pro forma and the following interpretations were made and compared with other studies. Conclusions: The purpose of the present study was to assess the position of the SFJ in relation to the pubic tubercle and identify the various tributaries draining into the terminal part of GSV. During the allotted period, 90 cases of varicose veins of the lower limb were studied in detail. Analysis of the findings recorded has enabled this study to arrive at the following conclusions: • The position of SFJ junction is highly variable and should always be marked preoperatively using Doppler. The average measurement of the SFJ from the pubic tubercle was 2.1 cm below and 4.4 cm lateral to the pubic tubercle. There was considerable variation in the number and anatomical course of the tributaries draining into the terminal part of GSV. The most common tributary identified in the study was the superficial epigastric vein and the least identified tributary was the posteromedial vein. Duplication of varicose veins was observed in 9% of the cases. In conclusion, adequate knowledge of the anatomy of the tributaries at the SFJ and ligating them in combination with GSV stripping is associated with a lower rate of the recurrence of varicose veins and a better quality of life. It is always imperative to explore the first 5 cm of GSV precisely to identify all tributaries at the SFJ (about four tributaries by average) to ensure appropriate surgical technique