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Endodermal sinus tumor is malignant germ cell tumor of ovary. Endodermal sinus tumours (EST) also know as yolk sac tumor are rare about 1% of ovarian malignancies and highly malignant tumours occurring primarily in children and young women. Overall survival is poor. In present case patient was breast cancer survivor and completed her treatment for breast cancer 10 years back. Later on she developed rapidly growing bilateral ovarian mass. Tumor markers of epithelial ovarian tumor were raised. Gross examination was suggestive of Krukenberg tumor and on histopathological examination that was suggestive of endodermal sinus tumor, Finally, Immunohistochemistry helped to conclude the diagnosis of metastatic ovarian tumor from breast carcinoma.
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Background: Approximately 22% of gynaecologic cancers are of ovarian origin, but 47% of all gynaecologic cancer deaths occur in women who have ovarian cancer. Ovarian cancer is usually diagnosed at an advanced stage because most of the symptoms are nonspecific, hence, the difficulty in diagnosis at early stages. In general, there is no effective screening test for ovarian cancer. Aim was to evaluate the ability of risk of malignancy index 4 (ROMI 4) to differentiate benign from malignant ovarian tumors.Methods: A prospective observational study was conducted in April 2019 to march 2020.Results: In the present study the ROMI 4 score at cut-off ? 450 had sensitivity, specificity, PPV and NPV of 74.3%, 65.3%, 42.6% and 88% respectively for malignant ovarian tumor.Conclusions: Preoperative ROMI 4 score ?450 will lead to rational basis for further referral to higher centre or gynaecology oncologist timely for appropriate surgical intervention/ management.
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Background@#Opioids administered as bolus doses or continuous infusions are widely used by anesthesiologists worldwide for major and day care surgeries. Opioid-free anesthesia is a multimodal anesthesia and analgesia technique that does not use opioid drugs, thereby benefitting patients from opioid-related adverse effects. In this study, we compared the postoperative analgesic requirements of patients scheduled for elective laparoscopic cholecystectomy under opioid-free and opioid-based anesthesia. @*Methods@#This study included 88 patients aged 18–60 years with American Society of Anesthesiologists physical status 1 and 2 who underwent elective laparoscopic cholecystectomy. Participants were randomly divided into two groups with forty-four participants in each group. The opioid-free anesthesia group was administered an intravenous bolus of ketamine and dexmedetomidine, whereas the opioid-based group was administered fentanyl with conventional general anesthesia. The primary outcome was to compare the total amount of fentanyl consumed by both groups during the 6 h postoperative period following extubation. Episodes of postoperative nausea and vomiting (PONV) and vital signs were noted throughout the postoperative period to analyze the secondary outcomes. @*Results@#Both the groups had similar demographic characteristics. The opioid-free group required less postoperative analgesia within the first 2 h (61.4 ± 17.4 vs. 79.0 ± 19.4 of fentanyl, P < 0.001), which was statistically significant. However, fentanyl consumption was comparable between the groups at the sixth postoperative hour (opioid-free group 152 ± 28.2 vs. opioid group 164 ± 33.4, P = 0.061). Compared with 4.5% of the participants in the opioid-free group, 34% of those in the opioid-based group developed moderate PONV. @*Conclusions@#The opioid-free anesthesia technique in patients undergoing laparoscopic cholecystectomy reduced the requirement of analgesia in the first two hours of the postoperative period and was associated with decreased PONV.
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Struma ovarii is a rare ovarian tumour, first described in 1889 by Boettlin. It is defined by the presence of thyroid tissue comprising of >50% of overall mass. It comprises 1% of all ovarian tumours and 2-5% of all ovarian teratomas. Preoperative diagnosis of struma ovarii is difficult because symptoms, clinical presentation and ultrasound are often similar to that of ovarian carcinoma. Hence most of the patients are diagnosed post operatively. Most cases of strum aovarii are benign and can be treated by excision of the ovary or by unilateral salpingo-oophorectomy. In a small number of cases, there are complications, the most important being the development of malignancy or ascites associated with pleural effusion producing a pseudo-Meigs' syndrome. This is a case of struma ovary presented with features of pseudo-Meig’s syndrome. A 68 year old post-menopausal woman presented with acute abdomen and respiratory distress with an ultrasound diagnosis of ovarian torsion, ascites and pleural effusion and found to have atrial thrombus on evaluation. She had undergone staging laparotomy, TAH+ BSO, omental biopsy and peritoneal fluid cytology. Histopathology revealed predominantly benign and mature colloid filled thyroid follicles of varying sizes lined by cuboidal epithelium surrounded by lymphocytic infiltrate and congested blood vessels, which was suggestive of struma ovary.
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Struma ovarii is a rare ovarian tumour, first described in 1889 by Boettlin. It is defined by the presence of thyroid tissue comprising of >50% of overall mass. It comprises 1% of all ovarian tumours and 2-5% of all ovarian teratomas. Preoperative diagnosis of struma ovarii is difficult because symptoms, clinical presentation and ultrasound are often similar to that of ovarian carcinoma. Hence most of the patients are diagnosed post operatively. Most cases of strum aovarii are benign and can be treated by excision of the ovary or by unilateral salpingo-oophorectomy. In a small number of cases, there are complications, the most important being the development of malignancy or ascites associated with pleural effusion producing a pseudo-Meigs' syndrome. This is a case of struma ovary presented with features of pseudo-Meig’s syndrome. A 68 year old post-menopausal woman presented with acute abdomen and respiratory distress with an ultrasound diagnosis of ovarian torsion, ascites and pleural effusion and found to have atrial thrombus on evaluation. She had undergone staging laparotomy, TAH+ BSO, omental biopsy and peritoneal fluid cytology. Histopathology revealed predominantly benign and mature colloid filled thyroid follicles of varying sizes lined by cuboidal epithelium surrounded by lymphocytic infiltrate and congested blood vessels, which was suggestive of struma ovary.
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Purpose: An undergraduate research conducted during the pre?covid times, to highlight the importance of screen time and its association with dry eye in medical students. The aim was to study the prevalence of dry eye among medical students using the ocular surface index (OSDI) questionnaire. Methods: This was a cross?sectional study. This study was conducted among medical students using an OSDI questionnaire in the pre?covid times. Based on the pilot study, the minimum sample size calculated was 245. A total of 310 medical students participated in the study. These medical students answered the OSDI questionnaire. The OSDI score was used to categorize students with dry eye as mild (13–22 points), moderate (23–32 points), and severe (33–100 points). In addition, the associations between the OSDI score and possible risk factors such as gender, contact lens/spectacle wear, laptop/mobile usage, and duration of exposure to air conditioners were also studied. Results: The analysis of the study revealed that out of 310 students, dry eye was seen in 143 (46.1%) and severe dry eyes were seen in 50 (16.1%). A high OSDI score (>13 points) was associated with the usage of a laptop/mobile for more than 6 h in 40 (52.6%) (P < 0.001). Conclusion: The prevalence of dry eye among medical students was 46.1% in the present study. Longer duration of usage of visual display units (laptop/mobile) was the only factor that showed a statistically significant association with dry eye in our study.
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This project aims to analyze the working capital management practices of Hindustan Unilever Limited, and identify opportunities for improvement. The project will involve an in-depth analysis of the company's financial statements, cash flow projections, inventory management, and accounts receivable processes. The results of the analysis will be used to develop a comprehensive working capital management strategy that focuses on optimizing cash flow and reducing working capital requirements. The project will also involve the implementation of best practices in working capital management and the development of a monitoring system to track progress. Ultimately, the project aims to improve the company's financial health, increase profitability, and enhance shareholder value.
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Background and Objectives@#Traditional sound field localization setups in a free-field environment closely represent real-world situations. However, they are costly and sophisticated, and it is difficult to replicate similar setups in every clinic. Hence, a cost-effective, portable, and less sophisticated virtual setup will be more feasible for assessing spatial acuity in the clinical setting. The virtual auditory space identification (VASI) test was developed to assess spatial acuity using virtual sources in a closed field. The present study compares the legitimacy of these two methods. @*Subjects and Methods@#Fifty-five individuals with normal hearing (mean age±SD: 21± 3.26 years) underwent spatial acuity assessment using two paradigms: 1) the sound field paradigm (localization test) and 2) the virtual paradigm (VASI test). Location-specific and overall accuracy scores and error rates were calculated using confusion matrices for each participant in both paradigms. @*Results@#The results of Wilcoxon signed-rank tests showed that the locationspecific and overall accuracy scores for both paradigms were not significantly different. Further, both paradigms did not yield significantly different localization error rates like right and left intra-hemifield errors, inter-hemifield errors, and front-back errors. Spearman’s correlation analysis showed that all the measures of the two paradigms had mild to moderate correlation. @*Conclusions@#These results demonstrate that both VASI and the sound field paradigm localization test performed equally well in assessing spatial acuity.
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Sensorineural hearing loss (SNHL) is known to be associated with lesions at various sites, including outer hair cell (OHC) and inner hair cell (IHC) injury, as well as auditory dyssynchrony or vestibulocochlear nerve tumors. Therefore, it is important to establish the differential diagnosis of SNHL, which however is particularly challenging in patients with unilateral SNHL. The test battery approach is effective for accurate diagnosis in such cases. In this report, we discuss the usefulness of the test battery approach to accurately detect the site of the lesion in a patient with unilateral hearing loss. A 14-year-9-month-old adolescent who observed decreased hearing sensitivity in the left ear accompanied by difficulty with understanding speech at a distance was diagnosed with unilateral hearing loss in the left ear. In this report, we describe a rare and diagnostically challenging case of unilateral SNHL in a patient with normal OHC function and selective injury to IHCs, which was diagnosed using a test battery approach.
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Abstract Background and objectives Anterior cruciate ligament reconstruction (ACLR) is one of the most frequently performed orthopedic procedures. The ability to perform ACLR on an outpatient basis is largely dependent on an effective analgesic regimen. The aim of the study was to compare the analgesic effect between continuous adductor canal block (cACB) and femoral nerve block (cFNB) during arthroscopy guided ACLR. Method In this prospective, randomized, controlled clinical trial, 60 ASA I/II patients for arthroscopic ACLR were recruited. Patients in Group I received cACB and those in Group II cFNB. A bolus dose of 20 cc 0.5% levobupivacaine followed by 0.125% 5 mL.h-1 was started for 24 hours. Rescue analgesia in the form of paracetamol 1 g intravenous (IV) was given. Parameters assessed were time of first rescue analgesia, total analgesic requirement in 24 hours, and painless range of motion of the knee (15 degrees of flexion to further painless flexion). Results The time-to-first postoperative analgesic request (hours) was earlier in Group II (14.40 ± 4.32) than Group I (16.90 ± 3.37) and this difference was statistically significant (p< 0.05). The cumulative 24-h analgesic consumption (paracetamol in g) was 0.70 ± 0.47 in Group I and 1.70 ± 0.65 in Group II (p< 0.001). The painless range of motion (degree) was 55.67 ± 10.40 in Group I and 40.00 ± 11.37 in Group II (p< 0.001). Conclusion The findings of this study suggest that continuous adductor canal block provides superior analgesia in patients undergoing arthroscopic ACLR when compared to continuous femoral nerve block.
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Humanos , Artroscopía/métodos , Bloqueo Nervioso/métodos , Dolor Postoperatorio/prevención & control , Dolor Postoperatorio/tratamiento farmacológico , Estudios Prospectivos , Nervio Femoral , Analgésicos , Analgésicos Opioides , AcetaminofénRESUMEN
Background: India has seen a rise in the use of substance abuse. A national survey in 2019 showed that around 2.1% of the country’s population uses opioids and 2.8% of Indians between the ages 10-75 use cannabis. In order to prevent substance related disorders it is necessary to get in-depth understanding of the various social factors leading to the use of substance use. Methodology: The researcher used Narrative Analysis to gather data from 4 individuals through the use of semi-structured interview. The participants were undergoing treatment at a rehabilitation center in Mumbai. Results: Through narrative analysis 3 common themes namely, friends (peer pressure), curiosity and parental neglect were identified. There were 3 unique themes identified- stamina/booster, bad neighbourhood and resentment towards family. Conclusions: This research identifies some common themes that can help those working in the field of mental health to focus on those areas while working with young children and their families. This research shows the importance of teaching assertiveness training to young children to prevent them from trying substances. The parents need to be trained and informed about various parenting styles and how to develop secure attachment styles with children. This research also paves the way for further research by identifying which other parental styles leads substance abuse
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Background & objectives: The oropharyngeal (OP) and nasopharyngeal (NP) swab samples are the most recommended clinical specimens for detecting SARS-CoV-2 in an individual through the quantitative real-time reverse-transcriptase-polymerase chain reaction (rRT-PCR) method. The primary objective of this study was to compare the performance of NP and OP swabs for the diagnosis of COVID-19 among 2250 concomitant samples (1125 NP + 1125 OP) using rRT-PCR test. Methods: This study was conducted at a tertiary care hospital in southern India. The study compared the specificity and efficacy of the two samples (NP & OP swabs) in 1125 individuals suspected having COVID-19 infection. The rRT-PCR values from all the samples were compared based on gender, age group and viral load. The differences between unmatched proportion and matched proportion were analysed. Agreement between the two methods was assessed using Kappa statistic. Absolute sensitivity, specificity, positive and negative predictive values (PPV and NPV) for OP and NP swabs were analysed. Results: The study identified a fair degree of agreement between OP and NP swabs in diagnosis of COVID-19 (kappa = 0.275, P<0.001). There was also a fair degree of agreement between NP and OP swabs irrespective of gender, age or duration of symptoms. NP swabs had better sensitivity and NPV as compared to OP swabs, however, specificity and PPV were 100 per cent for both. Interpretation & conclusions: The present study showed that both OP and NP swabs had similar sensitivity and specificity for predicting the presence of SARS-CoV-2.
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Background: Pectoral nerve (Pecs) block is an effective component of multimodal analgesic regimens for breast surgeries. In present study we compared analgesic effect of dexamethasone 8 mg as an adjuvant to 0.25% ropivacaine versus 0.25% ropivacaine alone in pectoral nerve block. Methods: The study was conducted in a randomized manner on 60 female patients of American Society of Anesthesiologists (ASA) Grade I and II, aged between 18 to 65 years, scheduled to undergo modified radical mastectomy under general anesthesia (GA). The patients were randomly allocated into 2 groups of 30 patients each. Group A received ultrasound (US)-guided Pecs block with 30 ml of 0.25% ropivacaine and 10 ml normal saline (total volume 40 ml) and Group B received with 30 ml of 0.25% ropivacaine and 8 mg dexamethasone in and 10 ml normal saline (total volume 40 ml). Post-operatively visual analogue score (VAS), duration of analgesia and total analgesic consumption was noted. Student t-test, Mann Whitney U test and Chi-square test were used for statistical analysis. Results: VAS were persistently low for first 4 hours in group B and for first 9 hours in group A (p value < 0.001 at some intervals). The mean duration of analgesia was prolonged in group B as compared to group A (612.33 ± 41.77 min in Group B and 307.70 ± 22.37min in group A) (p <0.001). Total analgesic consumption in first 24 hours post-operatively was also statistically lower in Group B (97.50± 34.96 mg) as compared to group A (177.50± 36.76) (p<0.001). No patient under study reported any adverse effects. Conclusion: Addition of 8 mg dexamethasone as adjuvant to 0.25% ropivacaine for pectoral nerve block increases the duration of analgesia and significantly reduces the amount of analgesic requirement in first 24 hours postoperatively without any significant adverse effects.
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Present case study was associated with successful management of a pregnant doe from dystocia by caesarean section. A 1.5 years old pregnant non-descriptive doe was admitted in the TVCC, C.V.A.Sc., Pantnagar, Uttarakhand with a history of complete gestation period and prolonged labor (more than 12 hours). There was protrusion of both fetal forelimbs from the vaginal opening. Gynaecological examination revealed that the fetus was in Nape presentation. The case was diagnosed as dystocia due to abnormal fetal disposition. The animal was subjected to caesarean operation. The operation was performed under light sedation with 0.1 ml of xylazine and regional inverted L- block was also done with 2% Lignocaine. An oblique incision was given at left flank and recovery of one dead male fetus occurred. Post-operative treatment was done with Inj. Amoxicillin-sulbactum @10 mg/kg intramuscularly, Inj. Tribivet® 5 ml intramuscularly, Inj. Chlorpheniramine maleate @0.5 mg/kg intramuscularly, Meloxicum@0.5 mg/kg intramuscularly and NS 250 ml for five days. Local antiseptic dressing and fly repellant spray was advised for every alternative day. The skin suture was removed on 10th day post-surgery.
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Accurate methods for identifying pelvic lymph node metastasis (LNM) of prostate cancer (PCa) prior to surgery are still lacking. We aimed to investigate the predictive value of peripheral monocyte count (PMC) for LNM of PCa in this study. Two hundred and ninety-eight patients from three centers were divided into a training set (n = 125) and a validation set (n = 173). In the training set, the independent predictors of LNM were analyzed using univariate and multivariate logistic regression analyses, and the optimal cutoff value was calculated by the receiver operating characteristic (ROC) curve. The sensitivity and specificity of the optimal cutoff were authenticated in the validation cohort. Finally, a nomogram based on the PMC was constructed for predicting LNM. Multivariate analyses of the training cohort demonstrated that clinical T stage, preoperative Gleason score, and PMC were independent risk factors for LNM. The subsequent ROC analysis showed that the optimal cutoff value of PMC for diagnosing LNM was 0.405 × 109 l
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Background: During the repairing of facial nerve injurymost common nerve used is the hypoglossal nerve. Aimand Objectives: To measure the distance between theanatomical landmarks, facial nerve and hypoglossalnerve which will be beneficial to locate the facial nerveand hypoglossal nerve more effortlessly and willdecrease the hazard of procedural problems. Materialand Methods: Thirty specimens were dissected.Measurements of the hypoglossal and facial nerveswere taken from various anatomical landmarks. Datawere analyzed using Statistical Package for SocialSciences 16 version. Results: The mean distance of theorigin of the facial nerve to the angle of mandible wascm, the mean distance of the origin of thefacial nerve to the tip of mastoid process wascm, the mean distance of common carotidbifurcation to the hypoglossal nerve where it crossesthe external carotid artery was cm, the meandistance of common carotid bifurcation to thehypoglossal nerve where it crosses the internal carotidartery was cm and the mean distance ofhypoglossal nerve to the tip of mastoid process wascm. Conclusion: The results of this studywill help and prevent any complication in identifyingthe hypoglossal nerve and facial nerve duringhypoglossal-facial nerve anastomosis.
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Background: Multifetal pregnancy constitutes a significant portion of high-risk pregnancies. This is due to the increasing obstetric and perinatal morbidity and mortality rates associated with it. Maternal and perinatal outcome of twin pregnancies has been evaluated in this study.Methods: Total 30 patients with twin pregnancy and having gestational age more than 28 weeks were included in this observational study.Results: Incidence of twins in the study was found to be 2%. Twin pregnancies were more common in multiparous women aged between 20 and 30 years. Most common foetal presentation was vertex- vertex presentation. Most common maternal complication was preterm labour seen in 67% women, followed by anaemia seen in 50% women. Most of the women were delivered by caesarean section (63.3%). Most common perinatal complication was birth hypoxia (41.6%). Other perinatal complications were jaundice, septicemia, intrauterine growth restriction. 71% of the neonates had birth weight less than 2.5 kg. Perinatal mortality was found to be 11.6%.Conclusions: Twin pregnancies are high risk pregnancies associated with higher obstetric and perinatal morbidity. Perinatal morbidity was more common for the second coming twin. Regular antenatal visits, planned delivery and better NICU facilities can help combat these complications. A team of skilled obstetricians and pediatricians along with a multidisciplinary approach is essential for the effective management of twin pregnancies.
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The Central Nervous System tumours are unique as they arise from specialized tissue. CNS tumours constitute a wide range of neoplasm that differs in their location, age distribution, extent of invasiveness, morphological features and tendency for progression. We wanted to evaluate the traditional morphological data with knowledge on the prognostication marker Ki 67 antibody in evaluating tumour grade and prognosis of CNS neoplasm.METHODSThis is a cross section study carried out between March 2015 and September 2016 in histopathology department of Dhiraj Hospital on 50 cases of CNS tumours. Immunolabelling of all biopsies was done by horse radish peroxidase technique using rabbit monoclonal antibody to Ki 67 (clone SP 6) (Thermo Scientific, USA). Ki 67 immune positive labelling index was obtained for each tumour and correlated with mitotic labelling index obtained by conventional morphological grading as per WHO 2007 classification.RESULTSIn our study of CNS tumours, all age groups were studied. The mean Ki 67 labelling index (LI) values +/-SD for WHO Grade I tumours were- meningiomas (10) 3.85 (+/1.97) %, schwannoma (3) -3.0 (+/-2.97) %, pituitary adenoma (1) 0.6, craniopharyngioma (1) -1.1% and ependymoma (6) 2.62 (+/-0.60) %. WHO Grade II tumours- atypical angiomatous meningioma (1) -2%, atypical mucinous meningioma (2) -6.15 (+/-1.06) %, gemistocytic astrocytoma (1) -12; pleomorphic xanthoastrocytoma (2) -4.3 (+/-0.99) %, astrocytoma grade ii (2) -3.3 (+/-0.71) %, oligodendroglioma grade ii (4) - 3.9 (+/-0.88) %. WHO grade III tumours- anaplastic astrocytomas (5) -6.82 (+/-2.17) %, anaplastic oligoastrocytoma grade iii (1) -10.8 %. who grade iv-glioblastomas (7) -18.44 (+/-3.97) %; medulloblastomas (1) 20%, metastatic tumour (3) -36 (+/- 22.16) %. In our study, the mean Ki 67 LI (± SD) values for grade II, III and IV glioma is as follows: 4.76 (+/-2.83) %, 7.48 (+/-2.53) % and 18.44 (3.97) % respectively.CONCLUSIONSThis study shows that Ki 67 LI serves as an essential clinical prognostic proliferation marker of particular importance in cases with lower grade histology of Grade II & Grade III astrocytomas, Grade II & Grade III oligodendrogliomas. Ki 67 LI is important in determining benign, atypical and malignant meningiomas, non-invasive and invasive pituitary adenomas.
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@#Introduction: It is very important to accurately estimate the age of foetus for various medicolegal cases. This study is an attempt to establish a relationship between anthropometric measurements and histologic analysis of liver and kidney to identify gestational age of the foetus. Methods: The study was carried on 30 fetuses. Their anthropometric measurements were done using Vernier calipers. The data was statistically analyzed by computation to find out its normative value. Histologic analysis was done by preparing hematoxylin and eosin stained slides and looking under light microscope. The relationship between gestational age and data thus obtained was determined. Results: Size of liver and kidneys increased with every trimester. The kidney showed immature duct system and clustered glomeruli with lack of differentiation into cortex and medulla in first trimester. Tubular differentiation started in second trimester which finished in third trimester with formation of juxtaglomerular apparatus. Size of glomerulus was, however, maximum during second trimester, followed by first and third trimester. In liver, haemopoeisis was observed in first trimester which decreased with subsequent trimesters. Lobular differentiation increased with each trimester. However, full term liver did not have the classic lobular pattern. Size of sinusoids decreased with every trimester. Abundant fibrous tissue was observed around portal triad. Conclusion: There is a relationship between the gestational age and anthropometric measurements and histologic features of liver and kidney of the foetus. This will help in identifying foetal age as well as any congenital kidney and liver diseases.