Effect Of TXA On Intraoperative Blood Loss In Mandibular Fracture Surgeries A Prospective, Double Blinded Randomized Clinical Trial

Background:The aim of this doubleblind prospective study was to determine whether administering 1 gm Tranexamic Acid (TXA) would the intraoperative blood loss during the Open Reduction and Internal Fixation (ORIF) surgery of mandibular fracture via the intraoral approach operated under local anesthesia (LA).Material And Methods:20 patients who underwent ORIF surgery ofmandibular fractures under LA were randomly allocated to two groups. Study group was administered 1 gm TXA diluted in a 500 ml Ringer Lactate solution one hour before thesurgery. Control group did not receive any such IV infusion. All the surgeries were performed by the same surgeon.Result:Mean difference in Intraoperative blood loss between the two groups was found out to be statistically insignificant. Effect of age, gender or site of fracture was also found out to be insignificant. Conclusion:There is not much effect of TXA on intraoperative blood loss during ORIF of a mandibular fracture via the intraoral approach. Even without tranexamic, if area is infiltrated with adrenaline, proper flap reflection and tissue handling technique is used, and vital structures avoided; blood loss will be minimal.

A Case of Adenocarcinoma – Primary Versus Secondary

Introduction: Adenocarcinoma is the most common form oflung cancer. It is a type of non small cell carcinoma of lung,most commonly seen in women. Adenocarcinoma occurs inmore peripheral lung location and may be associated with thehistory of smoking.Case report: A 54 year old female caretaker presented withcough with expectoration since 1 month, gradual in onset,non progressive, scanty in amount associated with decreasedappetite since 1 month and breathlessness on exertion since 1week. She had a history of exposure to tuberculosis patient andwas diagnosed with meningioma. There was history of passivesmoking. General examination showed right supraclavicularlymph node enlargement. Respiratory examination showeddecreased chest movements bilaterally along with coarsecrepitation all over lung fields along with decreased intensityof breath sounds bilaterally. Chest x-ray was suggestive ofmetastasis. HRCT chest also suggested metastasis. FNAClymph node and sputum of cytology suggestive of metastaticadenocarcinoma. USG abdomen and pelvis as well as CECTabdomen was done to rule out primary lesionConclusion: As survival rates vary significantly depending onthe type of adenocarcinoma, the survival rate after five yearsdepends on the stage of cancer. So early detection is criticalfor better outcome. The prognosis for different metastaticpattern of intrathoracic metastasis of Lung distinct in EGFRmutant lung adenocarcinoma patient. Early diagnosis andprompt initiation of treatment is key for the prognosis.

Importance of HAS-Bled Score in Patients on Warfarin Therapy for Atrial Fibrillation

Introduction: Bleeding is a significant complication whenpatients are on anticoagulant therapy. The risk of bleedingoverall when anticoagulant therapy is used is 3.8%. A numberof risk factors are associated with increased bleeding whenpatients are on anticoagulants. A practical risk score HASBLED score was developed to estimate 1year risk for majorbleeding in patients with atrial fibrillation. This study aimedto understand to assess the relevance of HAS-BLED scorein predicting bleeding in patients coming to AJ institute ofmedical sciences.Material and methods: We conducted a case control studyin patients on Warfarin therapy for Atrial fibrillation whopresented with major bleeding manifestations betweenSeptember2017-2018 in a tertiary care centre in AJ InstituteOf Medical Sciences in South India. Patients or their medicalpower of attorneys provided written informed consent. Atotal no of 100 patients were enrolled based on the inclusioncriteria patients aged more than 18 years. They were groupedinto cases who had bleeding and controls who did not havebleeding. HAS BLED score was calculated. The data wasentered in Microsoft Excel and was analysed with SPSSResults: Total of 100patients (50cases and 50controls) werestudied. On analysing the HAS-BLED score the P valueshowed significant difference between the case and controlgroups. The sensitivity was 80% and specificity was 68%. Thepositive and negative predictive value of HAS-BLED valueswere 71.4% and 77.27% respectively.Conclusion: Our study emphasises the need for making betteruse of HAS-BLED score in predicting bleeding and the needfor monitoring the INR regularly and educating patients onWarfarin therapy about frequent monitoring, the risks ofbleeding and to seek early medical attention on developingbleeding.

Ascitic And Pleural Fluid Being Positive For Acid Fast Bacilli By Ziehl– Neelsen Stain : A Rare Case Report.

The incidence of extrapulmonary tuberculosis is rising globally due to the increased prevalence of HIV infection. Hence a high clinical suspicion and supportive diagnostics is necessary for the diagnosis . The incidence of Acid fast bacilli being positive by ZN stain is very low, but in our patient who prented with easy fatigability, fever and abdominal distension of 5 months duration found to have both pleural and ascitic fluid positive for the organism.the patient was started with anti-tuberculosis treatment and is improving.

Dosimetric evaluation and clinical outcome in post-operative patients of carcinoma vulva treated with intensity-modulated radiotherapy.

BACKGROUND: To compare dosimetric parameters of intensity‑modulated radiation therapy (IMRT) with 3D conformal radiotherapy (3DCRT) in post‑operative patients of vulvar cancer and to assess clinical outcome and toxicity with IMRT. MATERIALS AND METHODS: A total of 8 post‑operative patients of vulvar cancer were treated with IMRT. All patients were also planned by 3DCRT for comparison with IMRT. The two plans were compared in terms of conformity index, homogeneity index, tumor control probability (TCP) and normal tissue complication probability (NTCP) for the planning target volume and organs at risk (OAR). RESULTS: IMRT resulted in significantly lesser doses to rectum, bladder, bowel and femoral head as compared with 3DCRT plans. Mean conformity and homogeneity indices were better and within range with IMRT. The TCP was comparable between the two treatment plans and NTCP for rectum, bladder, bowel and femoral head was significantly less with IMRT as compared with 3DCRT. Treatment was well‑tolerated and none of the patients developed Grade 3 or higher toxicity. CONCLUSION: IMRT yielded superior plans with respect to target coverage, homogeneity and conformality while lowering dose to adjacent OAR as compared with 3DCRT. Thus, IMRT offers a reduction in NTCP while maintaining TCP.

Pink teeth in toxicology.

Pink teeth may be seen after trauma, a fight or car accident, and barbiturate poisoning. Pink dentine is visible by external inspection, although a case could be made for any pigmentation present originally in the layers of the tooth root having been leached out over the course of time. In the cases reported in the forensic literature two strong factors seem to contribute to the appearance of the pink colouration. This paper reviews the causes, detection and factors responsible for pink teeth.

Ancient cystic pelvic schwannoma presenting as a right iliac fossa mass.

Schwannoma is rare in pelvis. Ancient schwannoma is rarer histological subtype of schwannoma. We report a very rare case of pelvic schwannoma presenting with right sciatica and right iliac fossa pain. Clinical and imaging findings were suggestive of Peritoneal Hydatid cyst. The tumour was resected completely with marked clinical improvement. Histopathological examination showed Ancient cystic schwannoma.

Field investigaton of an outbreak of epidemic dropsy in eastern Nepal.

About 17 cases with clinical syndrome suggestive of epidemic dropsy attended to the B P Koirala Institute of Health Sciences, Dharan, for treatment. These cases were from three villages of Saptari district in eastern Nepal. Some of the mustard oil samples were tested positive with Nitric acid test. In the wake of this, an extensive field investigation was conducted covering a wider area in these villages.

Epidemiology of endemic cretinism in Sikkim, India.

A survey was conducted in Sikkim to determine the prevalence of endemic cretinism in the state. A household was the basic sampling unit. Villages were selected randomly in the state and from these households were selected randomly using the electoral lists. All members of the households were studied. Total of 17,837 individuals from 3,197 households from 249 villages were studied. There were 8,953 males and 8,884 females. A total of 617 endemic cretins were identified: 316 males and 301 females. The overall prevalence of endemic cretinism was 3.46%: (males 3.53% and females 3.39%). Endemic cretinism was observed in 194 (77.9%) villages studied. Neurological cretinism was the predominant form (98.7%). Deaf-mutism was the most salient neurological feature seen in 472 (76.5%) subjects. Motor system examination revealed proximal spasticity and brisk reflexes, both more marked in the lower limbs. Recording of daily life activities revealed 14.1% of the cretins to be totally dependent and another 23% to be requiring considerable assistance for their daily routine activities. The overall prevalence of goitre found in this survey was 54%. Urinary iodine concentration was estimated from a representative sample of the population; mean 4 micrograms/dl (SD 2.68). This survey shows the existence of severe iodine deficiency in Sikkim.

Thyroid function in a goitre endemia.

A study was conducted to determine the thyroid function in a goitre endemia. Sadam is small village in the south district of Sikkim. Severe iodine deficiency exist in this village (prevalence of goitre 73.5%, cretinism prevalence 4%; mean urinary iodine exeretion 4.13 ng/dl - SD 3.1). Total of 72 out pf 142 households were randomly selected. All the inmates of the households above 14 years of age were examined for goitre and blood samples were collected from them for estimation of concentration of thyroid stimulating hormones (triiodothyroine T-3, thyroixe T-4) and thyroid stimulating hormone (TSH). Total of 244 subjects were examined, (137 males and 107 females). Goitre was detected in 149 (61.1%) individuals. The mean T-3, T-4 and TSH concentrations in the non-goitrous groups were (SD in parenthesis) 110.13 ng/dl (26.19), 10.12 ug/dl (2.38) and 1.01 uu/ml (0.52). The corresponding values for the goitrous group were, 132.22 ng/dl (46.25), 9.06 ug/dl (2.04) and 1.33 uu/ml (1.19). The differences in the mean concentrations between the goitrous and non-goitrous groups were statistically significant. An inverse correlation between the goitre size and T-4 on the one hand, and TSH and T-4 on the other hand was noticed. The result of the study show that functional decompensation of the thyroid occur in the majority of goitrous subjects.

Intellectual and motor functions in school children from severely iodine deficient region in Sikkim.

High prevalence of endemic goitre (54%) and endemic cretinism (3.5%) exist in Sikkim. The level of intellectual functioning and motor performance were assessed in 90 school children in the age group of 10 to 12 years selected randomly from four severely iodine-deficient villages. Bender Visual Motor Gestalt Test, Binet-Kamat Test for mental ability and Raven's Coloured Progressive Matrices were the tests used. The results show an impairment in intellectual and other neuropsychological functions in a high percentage of the children. Visuomotor coordination was poor in 62 (69%). Binet-Kamat test results showed that 19 (21%) children were intellectually subnormal (IQ < 70). Majority of the children (> 80%) had significant impairment in language, meaningful memory, non-meaningful memory, conceptual thinking, numerical reasoning and motor skills. The children did better on non-verbal reasoning and social intelligence. Goitre was detected in 82 (91.1%). Urine samples for iodine estimations was collected from every second child examined. The mean urinary iodine concentration was 4.23 micrograms/dl (SD 2.16). Urinary iodine concentration was less than 2 micro gm/dl in 26.1% (11 children) and less than 5 micro gm/dl in 84.8% (39 children) indicating severe iodine deficiency. The test results show impairment of psychomotor development in children born and brought up in iodine-deficient environment.

Clinical study of endemic cretinism in south Sikkim.

One hundred individuals suffering from Endemic Cretinism were studied. There were 55 males and 45 females. 62% of the cretins had visible goitre. Thirty nine (62.9%) goitrous cretins had grade II goitre. Neurological cretinism was the predominant type encountered (99%) and Myxoedematous cretinism was seen in only one patient. The most salient neurological feature was deaf-mutism seen in 74%. Findings in the motor system were, apart from deaf-mutism, the most characteristic feature of the condition on clinical examination. 58% had exaggerated deep tendon reflexes and 31% had extensor plantar response. Squint was noticed in 29%. Familial aggregation was noticed and was striking. Endemic cretinism is a distinctive and easily identifiable clinical entity and is an important indicator of the severity of iodine deficiency in a community.