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Uterine leiomyosarcomas are rare aggressive tumors, with high recurrence rates, even when confined to the uterine corpus at the time of diagnosis. It arises from smooth muscle of uterus and is a rare tumor that accounts for 2-5% of all uterine malignancies. These tumors typically spread hematogenously. Patients present with vague symptoms similar to those of patients with leiomyomas. Most patients are diagnosed with leiomyosarcoma postoperatively. Although prognosis remains dismal, various ongoing studies are investigating the role of advanced imaging, multimodality treatment, prognostic nomograms, and unique biomedical pathways to increase understanding of leiomyosarcoma and improve therapeutic options for patients. 46 years old para2 live2 postmenopausal (since 1.5 year) female presented to outpatient clinic with complaints of bleeding per vaginum, foul smelling discharge, unquantified weight loss and something coming out of vagina since 1.5 months. On abdominal examination, an irregular midline mass arising from pelvis corresponding to 20 weeks gestational size of uterus was present. On vaginal examination, 3 infected vaginal growths were present in vagina maximum 4x4cm. Intra-operatively, uterus was nearly 20 weeks size with irregular surface. A 3×3 cm subseroal fibroid with necrotic surface was present on posterior wall of uterus. Cut section of the operative specimen showed myohyperplasia which was compressing the uterine cavity, some necrotic areas were also present. Vaginal growths - 4×4 cm on left vaginal wall near introitus with necrotic surface, 3×3 cm on right vaginal wall, 1×1 cm on right upper vaginal wall present. Excision of vaginal growth was done and was sent for histopathology. Histopathologic examination of sections of uterus showed all features were suggestive of leiomyosarcoma uterus.
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Background and Objective: Glossopharyngeal nerve block (GNB) technique has been used as alternative of treatment of cancer and noncancer pain of the oral cavity. The objective of the study is to compare the two approaches (extraoral and intraoral) of GNB in patients of carcinoma of the tongue in terms of efficacy, duration, and complications. Materials and Methods: This was a prospective comparative randomized study over a period of 1 year. Fifty patients of either sex of ASA physical status and 2, between 21 and 70 years of age, suffering from carcinoma of the tongue, were selected. The patients were randomly divided into two groups. Group I received 4 mL of 0.5% bupivacaine combined with 40 mg, of triamcinolonacetonide by extraoral approach of GNB, and Group II received the same amount of drug by intraoral approach of GNB. Hemodynamic parameters, degree of pain relief using visual analog scale (VAS), number of attempts, effect on quality of life (QOL), and complication were noted during the performance of GNB. Results: Demographic profile in both groups was comparable. Rate of complication and number of attempts to complete intervention were higher in Group I, which was found to be statistically significant. However, mean VAS scores in Group I were significantly higher as compared to those in Group II during most of the study period starting from the 1st follow-up at 30 min to the 2nd month postintervention (P < 0.05). No statistically significant difference in mean QOL scores of two groups was observed for the entire study period except at 1 week when mean scores in Group I were higher as compared to those in Group II (P = 0.011). Conclusion: The intraoral approach of GNB was better with respect to pain control and improvement in QOL whereas the rate of complication and number of attempts was lower in extraoral approach of GNB
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The trends in the acceptability of contraceptives is globally shifting from permanent sterilisation to long acting reversible contraceptive (LARC). With the increasing use of IUCD, the knowledge of its common and rare complications has become pertinent. One of them is cervical perforation in which strings are mostly visible and hence it can be easily missed. Here we present a rare case of cervical perforation which was timely detected before it could have caused more damage. A patient complaining of IUCD associated pain should undergo thorough examination and a probability of perforation should be kept in differential diagnosis despite string visibility. A clinician has to be more vigilant about this rare complication to prevent damage to cervix and avoid unwanted pregnancy.
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Introduction: Stellate ganglion block (SGB) is used for thetreatment of many vascular disorders and sympatheticallymediated pain including pain of head, neck, cancer, phantom,postherpetic neuralgia, cardiac arrythmia, orofacial pain, andvascular headache. Various modalities to localize stellateganglion use of fluoroscopy, computerized tomography,magnetic resonance imaging, and radionucleotide tracers.Ultrasound imaging is a best tool for SGB due to its clarity,low cost, lack of radiation and portability. In this study weaimed to compare the efficacy of fluoroscopy vs ultrasoundguided stellate ganglion block in lowering the pain usingnumeric rating scale (NRS).Material and Methods: Study was perform in 40 patientssuffering from upper limb and head and neck, neuropathicpain. The first group (Group I) received stellate ganglion blockunder ultrasound guidance while the second group (Group II)received stellate ganglion block under fluoroscopy guidance.The t-test and Man Whitney test were perform to analyses thedata.Results: The requirement of different analgesia werecomparable in both group I and group II patients. Change inpain score was maximum at immediate post-block, 1 h postblock, 6 h post block (65.84% of baseline) while change wasminimum at 48 h post-block (48.45% of baseline). The painwas significantly lower in group I from baseline as comparedto group II at all periods. Range of Ease rating score were alsolower in group I. Block was statistically achieved earlier inGroup I (4.55±0.69 min) as compared to Group II (12.60±2.56min).Conclusion: USG and fluoroscopy are both good techniquesfor stellate ganglion block, but due to less complication, earlyblocking effect time, more precise placement of medicationultrasound guided block is preferred over fluoroscopy method.
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Objective: To assess HIV-free survival and nutritional status of HIV-exposed infants.Methods: This retrospective cohort study was conducted on infants born to woman with HIVinfection born at our Institute between January 2011 to March 2016, and followed usingcurrent National guidelines. HIV transmission rate, HIV-free survival, and nutritional statuswere assessed 18 months age. Results: Of the 155 infants, 10 (6.5%) died before 18 monthsof age. Two of 145 surviving infants were confirmed HIV-positive, the remaining were HIV-negative at 18 months (HIV-free survival 92.3%). Of the 10 infants who died, one wasconfirmed HIV-positive and three negative; the rest died before their HIV status could beascertained. HIV infection rate among the 149 infants for whom the test reports were availablewas 2%. At 18 months age, 14% HIV-uninfected infants were wasted, 28% stunted, and 3%had microcephaly. Conclusions: Infants born to mothers with HIV managed as per thecurrent National guidelines have a good outcome at 18 months of age.
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Background: Apical surgery or Apicectomy is often a lastresort to surgically maintain a tooth with a periapical lesion thatcannot be managed with conventional endodontic treatment.The present study was conducted to assess retrospectivelycases of apicectomy performed in a known population.Materials and Methods: This retrospective study wasconducted to assess the patients treated with apicectomy overthe time of 6 months. Preoperative periapical radiograph wastaken using a parallel technique. Local anesthesia wasadministered and followed by flap elevation.Surgical curette was used to enucleate the pathologic tissueand identify the root apex with/without prior osteotomy. Theapical 3 mm of the root was resected perpendicularly to thelong axis of the tooth with no or minimal bevel. Flaps wererepositioned and sutured. Periapical radiograph was takenafter surgery using the parallel technique. Antibioticsand analgesics medication were prescribed. Follow-upappointments were arranged. The data was included whichcomprises of demographic data, preoperative clinicalexamination type. Statistical analysis was performed using theSPSS software version 21.0 (SPSS Inc., Chicago, IL, USA).Results: In this retrospective study total 87 cases ofapicectomy was recorded over the period of 6 months in which23(26.43%) were male while remaining 64(73.56%) werefemales. Apicectomy cases were prevalent in age group 31-40years (36.78%). Apicectomy cases were prevalent in maxillarytooth(73.56%).Conclusion: Our study concluded that apicectomy cases wereprevalent in females, in age group of 31-40 years and inposterior tooth.
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Objectives: To compare growth, anemia prevalence, and sickness frequency in HIV-exposed uninfected infants on different feeding modes. Methods: In this retrospectivecohort study, 109 HIV-exposed uninfected infants registered atour center were categorizedintothree groups as per their feeding mode during first 6 months viz. exclusively breast fed(n=50), animal milk fed (n=40) and commercial infant formula fed (n=19). Theiranthropometric parameters, hemoglobin and frequency of sickness at the age of 6 monthswere compared. Results: There were no significant inter-group differences in the weightfor age, weight for length, length for age z-scores (P=0.16, 0.37 and 0.12, respectively);proportion of infants with underweight (P=0.63), wasting (P=0.82), or stunting (P=0.82),and mean hemoglobin levels among the 3 groups at 6 month of age. Animal milk fed andformula fed infant had increased risk of sickness compared to exclusively breastfed infants(OR 2.5 and 2.49, respectively; P<0.01). Conclusions: In circumstances wherebreastfeeding is not feasible or preferred, animal milk feeding offers a viable alternative tocommercial infant feeding formula in HIV exposed infants.
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Preventing maternal death associated with pregnancy and child birth is one of the greatest challenges for India. Approximately 55,000 women die in India due to pregnancy- and childbirth- related conditions each year. Increasing the coverage of maternal and newborn interventions is essential if Millennium Development Goals (MDG) 4 and 5 are to be reached. With a view to accelerate the reduction in maternal and neonatal mortality through institutional deliveries, Government of India initiated a scheme in 2005 called Janani Suraksha Yojna (JSY) under its National Rural Health Mission (NRHM). In Jharkhand the scheme is called the Mukhya Mantri Janani Shishu Swasthya Abhiyan (MMJSSA). This paper focuses on community perspectives, for indentifying key areas that require improvement for proper implementation of the MMJSSA in Jharkhand. Qualitative research method was used to collect data through in-depth interviews (IDIs) and focus group discussions (FGDs) in six districts of Jharkhand- Gumla, West Singhbhum, Koderma, Deoghar, Garhwa, and Ranchi. Total 300 IDIs (24 IDIs each from mother given birth at home and institution respectively; two IDIs each with members of Village Health and Sanitation Committees (VHSC) / Rogi Kalyan Samitis (RKS) from each district) and 24 FGDs (four FGDs were conducted from pools of husbands, mothers-in-law and fathers-in-law in each district) were conducted. Although people indicated willingness for institutional deliveries (generally perceived to be safe deliveries), several barriers emerged as critical obstacles. These included poor infrastructure, lack of quality of care, difficulties while availing incentives, corruption in disbursement of incentives, behavior of the healthcare personnel and lack of information about MMJSSA. Poor (and expensive) transport facilities and difficult terrain made geographical access difficult. The level of utilization of maternal healthcare among women in Jharkhand is low. There was an overwhelming demand for energizing sub-centers (including for deliveries) in order to increase access to maternal and child health services. Having second ANMs will go a long way in achieving this end. The MMJSSA scheme will thus have to re-invent itself within the overall framework of the NRHM.
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One of the rare complications of choledochal cysts is rupture. In majority of the cases, the cause of rupture is unknown. Reconstructive surgery is the treatment of choice. We describe three patients with choledochal cyst rupture, who were admitted with acute abdomen. Diagnosis of biliary ascites with peritonitis was made in all the three patients. At surgery, two patients underwent T-tube placement, and definitive repair was done electively. One patient underwent definitive repair of ruptured choledochal cyst, but died due to septicemia. External bile drainage would be safer in emergency condition.
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The absence o!!f a hypocalcemic effect of calcitonin (CT) in fishes has been suggested due to exceedingly high plasma levels of CT; the fish may be saturated with respect of circulating CT and therefore unable to respond to exogenously administered CT. Earlier it has been suggested that a hypocalcemic action of injected CT may be obscured by changes in the release of endogenous CT and other calcium regulating hormones. In this study we have used artificial freshwater, calcium-deficient freshwater and calcium-rich freshwater and injected the fish with CT. The aim behind selecting these media were (i) in calcium-deficient medium there would be reduced circulating levels of CT, (ii) in calcium-rich medium there would be diminished secretion of prolactin (this hormone is hypercalcemic in fish), and (iii) by keeping the fish in calcium-rich medium we can test the antihypercalcemic action of CT. Moreover, the present study would reveal the changes in the ultimobranchial gland (UBG) after keeping the fish in all the above three media and/or injecting the fish with CT. Freshwater catfish, Heteropneustes fossilis, were administered intraperitoneally daily with vehicle or 0.5 U/100g body wt of salmon calcitonin (CT) and kept in artificial freshwater, calcium-rich freshwater and calcium-deficient freshwater for 10 days. Blood samples were collected on 1, 3, 5, and 10 days following the treatment and analyzed for serum calcium levels. The ultimobranchial gland (UBG) was also fixed for histological studies on these intervals. In artificial freshwater there was no change in the serum calcium levels of calcitonin-injected fish. The ultimobranchial gland of calcitonin-injected fish exhibited a progressive decrease in the nuclear volume from day 5 onwards. On day 10 vacuolization in the gland was also noticed. In vehicle-injected fish (control) kept in calcium-rich freshwater hypercalcemia has been noticed which persists till the end of the experiment. ...