Guntur Medical College Research Articles

Decoding Blue Round Cell Tumours using Immunohistochemistry- A Prospective Cohort Study

Introduction: Small blue round cell tumours are heterogeneous group of neoplasms characterised by small, round and relatively undifferentiated cells. These tumours pose a great challenge to the histopathologist for definite diagnosis and Immunohistochemistry (IHC) plays an important role in the further evaluation of these tumours. Aim: To analyse the round cell tumours according to site, gender and age of the patient and ascertain the significance of IHC for its accurate morphological characterisation. Materials and Methods: This prospective cohort study was conducted at Department of Pathology, Guntur Medical College, Andhra Pradesh, India, which included 53 patients from August 2013 to August 2015. Immunohistochemical studies were done to categorise the tumours using the relevant panel of immunohistochemical antibodies streptavidin biotin detection method. Frequency and percentage statistics was used to present the results. Results: Out of 53 cases there were 29 cases of Non Hodgkin Lymphoma (NHL), eight cases of Ewing’s Sarcoma/PNET, four cases of Esthesioneuroblastoma, three cases of small cell carcinoma, two cases of medulloblastoma, each one case of ependymoblastoma, alveolar rhabdomyosarcoma, sinonasal Undifferentiated Carcinoma (SNUC), mesenchymal chondrosarcoma, nephroblastoma, desmoplastic small round cell tumour and small cell carcinoma ovary. Conclusion: Most common tumour was NHL with highest incidence in males and age group of more than 40 to 60 years years. Immunohistochemistry represents an adjunctive tool for accurate typing and classification of round cell tumours.

Analytical Study of Railway Accidental Deaths

Travel but on the other hand caused lot of damage to human lives in the form of accidents. The present study conducted at Guntur medical college, Guntur over the period of two years among the autopsies done in the forensic medicine department. Out of 1748 autopsies railway accidental deaths were 114 with male predominance. Most of the railway accidental deaths were seen in the middle age. More deaths were due to decapitation.

A comparative study of open drainage versus suction drainage and primary closure in the management of breast abscess at a tertiary care center

Background: Breast abscess, localized collection of pus in the breast, are most common in young lactating women. Aim & Objectives: The main aim of the current study were to compare open versus closed modalities of treatment of breast abscess and also to develop an effective technique for management of breast abscess with less morbidity and its efficacy over conventional method. Methods: A cross sectional prospective study was conducted in Department of Surgery from October 2017 to October 2019 at Guntur Medical College & General Hospital, Andhra Pradesh, India, among the breast abscess cases (both open and closed) was conducted in a group of 100 cases of breast abscess, divided in to two groups, the open group comprising of 60 cases and closed group comprising of 40 cases. The pain in the post-operative patients measured by using Visual analogue scale (VAS). The statistical analysis was done by the unpaired t-test. Results: The incidence of breast abscess was most commonly seen in young women between the age group 21-30 years (35%). The VAS in group A and group B at days 1,2,3,4 respectively in both the groups were 9±1.2, 6.2±1.1; 7.2±2.1, 4.2±0.9; 5.2±1.2, 3.1±1.6; 2.5±1.2, 1.2±0.7. We observed that there was a significant (p

Study on mandibular parameters of forensic significance

Introduction: Bones often survive the process of decay and therefore provide the major evidence of human age and sex after death. The identification of human skeletal remains is a critical problem and is very important in medico-legal and anthropological works. The determination of sex of an individual is important and necessary both in the living and dead for medico-legal purposes. The aim of this study is to measure and analyze the various parameters of the mandible and to assess the reliability of the above parameters in terms of percentage accuracy in sex determination. Material and Methods: A total of 106 whole-adult human mandibles of unknown sex, between the age group of 18–60 years, were collected and studied at the Department of Anatomy and Forensic Medicine, Guntur Medical College, Guntur from 2014 to 2015. The following parameters studied were symphyseal height, mandibular body length, bicondylar diameter, bigonial diameter, inter incisor width, and mandibular angle. Results: Of the six parameters studied, highly significant (statistically) difference in sex was observed in bigonial diameter (82.15% accuracy) and mandibular angle (81.5% accuracy). Discussion and Conclusion: The inference of the study is that no single parameter gives 100% accuracy in the determination of the sex of the individual. Hence, a judicious consideration of the highly significant parameters of the mandible may be taken into account in the determination of the sex of the individual.

Diagnosis of Acoustic Neuroma through Telemedicine

A 65-year-old male individual presented to an electronic urban primary health center with complaints of impaired hearing in the left ear, loss of sensations on the left side of the face, loss of sensation of taste of the left side of the tongue, and tingling and numbness of the left side of the face for 2 months. He had a history of diabetes for 8 years and hypertension for 5 years and on regular medication. The patient was completely evaluated by the medical officer and referred to a general medicine doctor for teleconsultation. The general medicine specialist had clinical evaluation, and after detailed discussion with the medical officer, he was referred to a neurosurgeon for further evaluation and management to Guntur Medical College. He had evaluated the client and recommended magnetic resonance imaging scans, and imaging revealed an extra-axial cerebellopontine angle solid mass lesion of size 3 cm × 2 cm with cystic component, arising from the left internal auditory canal causing mass effect on the middle cerebellar peduncle, suggestive of left acoustic neuroma without mass effect. He had specialized radiation therapy of 30 fractions of 25 gray in 5 cycles from July 20 to August 5, 2019, currently on regular medication for diabetes and hypertension and Vitamin B12 supplements, and follow-up scheduled in July 2020.

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A study of various patterns of ligature mark produced in cases of hanging brought to the mortuary, GGH, Guntur

Background: Amongst all form of asphyxial death, hanging is most frequently encountered by forensic experts. Easy availability and presence of wide range of ligature materials at home itself makes hanging a preferred method of committing suicide over other methods. Findings over neck vary from case to case depending upon various factors like position of knot over neck, composition of ligature material, duration of suspension etc. Aim & Objectives: The aim of the present study is to identify the various pattern of ligature mark produced in cases of hanging brought to the mortuary. Methodology: The present prospective study was carried out in the Department of Forensic Medicine &Toxicology, Guntur Medical College& GGH Hospital, Guntur, during the period from Feb to December 2017 and includes a total of 40 cases of death due to Hanging, brought to the mortuary of the hospital for medico-legal postmortem examination. Results: In the present study, Majority of cases observed were young adults in third decade i.e., 21-30 years – 20 (50%) followed by individuals in fourth decade i.e., 41-50years – 07(17.5%). Most of the victims belong to middle and lower socio economic strata - 15(37.5%) and 25 (62.5%) respectively. In the present study most of the victims belongs to urban 28 (70%) areas than the rural areas 12 (30%). In our study chunni was the major ligature material for hanging observed in 16 (40%) cases. Postmortem findings revealed that majority of cases showed that bluish colour nails, lips and earlobes. Microscopic examination - breaking, wrinkling and compression of skin along with micro haemorrhages and inflammatory changes in sub- cutaneous tissues were notified. Conclusion: The correlation of external, internal and microscopic findings leads to easy formulation of final opinion these cases. It also, to some extent helps to delineate antemortem cases of hanging with postmortem cases.

A study of significance of diatoms test in drowning vs non-drowning cases

Background: Drowning is a form of asphyxia due to submersion or immersion in liquid, which are mostly accidental. Death by drowning is difficult to determine and often done by eliminating other causes of death. One of the most important criteria in the study of drowning is the search for a sensitive and specific test. The diatoms are major group of eukaryotic algae and stand as the strongest biological forensic evidence. Aims & Objectives: The study aim to compare the significance of diatoms test in drowning and non drowning cases.Methods: The study carried out in the Dept. of Forensic Medicine, Guntur medical College, Mortuary, Government General Hospital, Guntur during the year January 2017 to December 2017.After selection of the cases during the post-mortem examination the tissues or organs are taken and diatoms test is done as per the procedures in drowning and non drowning cases. The various types of diatoms are studied in detail. The sample of drowned water was also examined for presence of diatoms. A comparison is made for similar types of diatoms to get the significance of diatom test. The relevant water samples in the particular rural locality also are examined and compared in non-drowning cases.Results: In the present study out of 40 cases, 35 are true positive and 5 cases were true negative. We found 20 non drowning cases 18 were true negative and 2 are false negative cases were recorded in our study.Conclusions: Diatom test in drowning is significant even though occasional diatoms may be recovered in lungs and stomach mucosa of non-drowning cases. This diatom test is very valuable in drowning deaths especially in decomposed states as other findings of drowning may be lost or obscured due to decomposition.

Study of spectrum of thyroid neoplasms with emphasis on immunohistochemistry

Introduction: Thyroid neoplasms represent the most common neoplasms of endocrine system and pose significant challenge to pathologists, surgeons and oncologists. Conventional methods of evaluation of thyroid diseases include clinical history, physical examination, thyroid function tests, thyroid imaging and ultrasonography. Histopathological analysis of surgically resected specimens provides the most definitive diagnosis. Aims and Objectives: To study the spectrum of neoplastic lesions of thyroid with the use of immunohistochemistry. Materials and Methods: A retrospective study on thyroid neoplasms was conducted in the Department of Pathology Guntur Medical College, Guntur over a period of two years from June 2011 to May 2013. The data necessary for study has been received from the histopathology records at the department. The type of specimens included total thyroidectomy specimens, hemithyroidectomy specimens and trucut biopsies. The applied nomenclature is adopted by the 2007 WHO classification. Results: The incidence of spectrum of thyroid neoplasms was studied. Study was conducted in the Department of pathology, Guntur Medical College. The conventional criteria on the basis of histopathology was applied to all neoplasms. Immunohistochemistry was used in cases where definite diagnosis could not be established. Ck 19 was used in all cases of FVPTC. Follicular adenoma is most common benign neoplasm and papillary carcinoma is the most common malignant lesion.Conclusion: Malignant thyroid tumours predominated in the present study in contrast to many other studies because the study is conducted in a tertiary care referral hospital. Papillary thyroid carcinoma is most common malignant neoplasm. Almost all variants of papillary carcinoma have been reported of which the most common were classical variant followed by follicular variant. Immunohistochemistry has a definite role in thyroid neoplasms and is helpful in establishing diagnosis in cases medullary carcinoma and non hodgkins lymphoma where histopathology was not very conclusive.CK 19 postivity in FVPTC in the present study is 40% indicating that more careful histopathological evaluation for nuclear features is needed along with IHC correlation.

Role of cartridge -based nucleic acid amplification test (CBNAAT) for early diagnosis of pulmonary tuberculosis in HIV

Background: Pulmonary Tuberculosis (PTB) is the commonest opportunistic infection and leading cause of death among people living with HIV (PLHIV). The role of cartridge based nucleic acid amplification test (CBNAAT) has potential to diagnose PTB and rifampicin resistance within two hours in PLHIV is promising. Methodology: 100 PLHIV patients with age of >18years having signs and symptoms greater than or equal to two weeks of duration and / or Chest X-ray findings suggestive of pulmonary tuberculosis who are attending to the department of Pulmonary Medicine, Guntur Medical College, Guntur from November 2016 to October 2017 are included in the study. Sputum samples sent for CBNAAT, AFB stain. Positive samples of CBNAAT and AFB stain are sent for conventional culture. Results: Out of 100 sputum samples, 45 were positive in CBNAAT, and 16 were AFB smear positive. All these 16 smear positive samples have 100% sensitivity in CBNAAT. These positive samples (45) were sent for culture. In culture out of 16 smear positive samples 15 are culture positive 1 is culture negative, which is false positive in CBNAAT also. In culture out of 45 CB-NAAT positive samples 29 culture positive, 16 culture negative. Sensitivity, specificity, PPV, NPV of smear in sputum samples are 46.88%, 98.5%, 93.75%, 79.76%, while that of CB-NAAT are 90.6%, 76.47%, 64. 44%, 94.55% respectively. Primary rifampicin resistance was detected in 1 case (2.22%) in CBNAAT and culture. Conclusions: CBNAAT is a rapid, reliable tool with least bio-safety concern and requires minimally trained staff, is best alternative to conventional methods of tubercular diagnosis and detects rifampicin resistance simultaneously within 2 hours. Keywords: CBNAAT; Sputum; TB.

Incidence of lung malignancy in a tertiary care centre – A one year study

Background: Lung cancer is the most common type of cancer in males and the leading cause of death in both sexes. It accounts for 11.3% of all new cancers in India and also associated with a mortality rate of 13.7%. This desolate mortality necessitates for the early diagnosis of lung cancer. The study was conducted to evaluate incidence, gender and age wise distribution of lung cancer and its association with smoking. Methodology: This study was done in the department of pulmonary medicine in Guntur Medical College from September 2016 to august 2017. The study includes 52 patients having clinical and radiological suspicion of lung cancer. All the cases were subjected to USG guided transthoracic needle aspiration was sent for cytology. Inconclusive and malignant cases were further subjected to histopathological examination for confirmation. Results: Out of the 52 patients suspicious of malignancy, 32 patients were finally diagnosed as malignant, 5 patients had benign/inflammatory lesions, 6 cases had no evidence of malignancy/non-specific inflammation, 8 had no opinion possible. Most common type is adenocarcinoma followed by squamous cell carcinoma with an incidence rate of 71.8% & 15.7% respectively. The highest incidence of lung malignancies is seen in 5th decade in both sexes. Conclusions: There is increase in the incidence of lung malignancies in females, throwing light on the causes other than smoking like bio-mass fuel exposure and second-hand smoking. Adenocarcinoma is the most common type. Further, USG guided transthoracic needle aspiration has a good sensitivity in detecting lung malignancies. Keywords: Adenocarcinoma; Transthoracic fine needle aspiration; Lung malignancy.

Item analysis to identify quality multiple choice questions/items in an assessment in Pharmacology of II MBBS students in Guntur Medical College of Andhra Pradesh, India

Background: In medical education, multiple choice questions/Items are the more frequently used assessment tools to assess the knowledge abilities and skills of medical students, for being their objectivity, wide coverage in less time. However only the Quality Items gives a valid and reliable assessment. The quality of an Item is determined by difficulty index (DIF I), Discrimination Index (DI) and Distractor efficiency (DE). Aim of the study was to know the quality of Items in pharmacology by Item analysis and to develop a MCQs bank with quality Items.Methods: The present study was conducted on 150 II MBBS students of Guntur Medical College, AP, India. A class test containing 50 Items with 150 distractors from topic chemotherapy was conducted. Item with the correct choice/response was awarded with one mark and with the wrong choice zero marks, no negative marks. Each test Item was analysed with DIF I, DI and DE and the results were tabulated and tested statistically, with unpaired "t" test.Results: Mean DIF I, DI, DE values with standard deviations in the present study are 44.72+17.63%, 0.30+0.12%, 84.48+24.65 respectively. DIF I of 32 (64%) items was good to excellent range (31%-60%) 9 (18%) Items were easy (>61%) and 9(18%) Items were difficult (>30%). DI of 10 (20%) Items was good (0.15 to 0.24.) 29 (58%) Items were excellent with DI > 0.25 and 11 (22%) Items were poor with DI <0.15. Among 150 distractors, 127 (85%) were functional distractors (FDs) and 23 (15%) were non-functional distractors (NFDs). DE of 33 (66%) items with nil NFDs was 100%, for 12 (24%) Items with one NFD, was 66.6%, for 4 (8%) items with 2 NFDs was 33.3% and for 1 (2%) Item with 3NFDs DE was 0%. When unpaired "t" test was applied to the means of "difficult" and "easy" Items, 96.22+11.33% SD, 51.44+29.31% SD respectively, the p-value obtained was 0.00058, which was highly significant.Conclusions: The study showed that Item analysis is a valid tool to identify quality Items, which assess, the students’ knowledge abilities and discriminate different levels of performance abilities of students effectively.

The pattern of self-medication practice among undergraduate medical students of tertiary care hospital, Andhra Pradesh, India

Background: According to World Health Organization resources, Self-medication is selection and use of drugs to treat self-diagnosed disorders or symptoms which includes the usage of non-prescription drugs. It is widely seen among undergraduate students especially in developing countries like India. Our objective of the study is to know the pattern of self-medication practice among undergraduate medicos in medical college attached to tertiary care hospital.Methods: This is a Prospective, cross-sectional, questionnaire-based study conducted among 184 medical students of 5th Semester in pharmacology lecture gallery, Guntur Medical College and Hospital, A.P. India. Among 200 students of 5th semester, 184 students gave the written consent for the study and submitted the given questionnaire. Fourteen questionnaires were incomplete and so the remaining 170 were analysed.Results: Results showed that 126 (74%) respondents practiced self-medication. The main health issues for seeking self-medication were found to be upper respiratory tract infection as reported by 39 students (31%) followed by diarrhea (32 students) (25%), fever (23 students) (18%). Drugs commonly used were analgesics (32%) followed by antibiotics (24%). The reasons for practicing self-medication were mild illness for 66 students (52%) and time-saving for 35 students (28%).Conclusions: Though the self-medication practice is inevitable, drug authorities and health professionals need to educate students about the pros and cons of practicing self-medication.

A Study of Pattern of Injuries in Vehicular Accidents

Road traffic accidents will be the third most common cause of disability worldwide. Presently 5 million people are dying worldwide as a result of injuries in vehicular accidents. This number is increasing day by day with increasing technology, urbanization, population, which ultimately leads to increased utilization of vehicles in developed countries and developed countries. The present study was done in the department of forensic medicine, guntur medical college, Guntur basing on the autopsies of vehicular accidents during the period from 1January 2006 to 31December 2006.298 cases were studied out of this most deaths occurred in male in the age group of 31–40 with head injuries.

A Study of Artifacts on Hyoid Bone, Sent for Expert Opinion to Department of Forensic Medicine, Guntur Medical College, Guntur

A Study of Artifacts on Hyoid Bone, Sent for Expert Opinion to Department of Forensic Medicine, Guntur Medical College, Guntur

Mobile phones and seizures: drug-resistant epilepsy is less common in mobile-phone-using patients

BackgroundEpilepsy is a condition where patients have seizures due to abnormal nerve impulses in the brain. The effect of mobile phone radiation on patients with seizures is not known.ObjectiveTo compare...

A Study of Violent Asphyxial Deaths

Asphyxial deaths are commonly encountered in forensic practice. Determining the manner of death whether accidental, suicidal, homicidal, or natural is of utmost significance. In these deaths, a detailed and meticulous autopsy plays a vital role in solving the case while the scene investigation and sample collection have their own significance. Various sociological and demographical parameters were studied. A total of 162 asphyxial deaths autopsies were conducted in the Department of Forensic Medicine, Guntur Medical College, Guntur from January 2010 to December 2010. Asphyxial deaths comprise 13.68% of all forensic autopsies; 29.6% of the cases were aged between 21–30 years; Males constitute 59.88% of all the cases. The most frequent method is hanging (60%), followed by drowning (19.1%). Suicide was found to be the manner of death in the majority of the cases.

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AIMS AND OBJECTIVES: Maternal death is a preventable tragedy. The aim of this study is to analyze the causes of maternal mortality in a tertiary centre. MATERIAL AND METHODS: The study was conducted by reviewing the records for maternal deaths over the period of one year 1-08- 2013 to 31-07-2014 in the Department of Obstetrics and Gynecology, Guntur Medical College, Guntur. Every maternal death was scrutinized for various aspects likely to be related to death such as age, locality of residence, antenatal care, admission death interval and the cause of death. RESULTS: The maternal mortality in the present study is 788/ 1 lakh live births. There were 62 maternal deaths in the study period. Most deaths occurred in the 20-25 age group. 51.6% of deaths occurred in the first seventy two hours after admission. Hypertensive disorders (25.80%) and hemorrhage (12.5%) are the two most common direct causes of maternal death. Post-operative and post abortal sepsis, amniotic fluid embolism, pulmonary embolism and peripartum cardiomyopathy are the other direct causes. Indirect causes of maternal deaths were seen in 34.9% of the cases. Hepatitis (9.64%), severe anemia is the two leading indirect causes of maternal deaths. CONCLUSION: Most of the maternal deaths can be prevented if the high risk antenatal women are identified earlier and referred to the

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OBJECTIVE: Mother to child transmission of HIV is a major route of HIV infection in children. The objective of this study is to analyze the response to implementation of PPTCT programme, the response of the spouses of the seropositive antenatal women to undergo HIV testing, mode of delivery and breast feeding practices adopted by the seropositive postnatal women and the status of infants after delivery at 18 months. METHODS: This retrospective study was done in the Department Of Obstetrics and Gynecology, Guntur Medical College, Guntur, A.P, India and data collected from April 2009 to march 2014, a period of 5 years was studied. PPTCT centre was established in our institution in 2003. The practice in our institution is that all pregnant women attending the Antenatal clinic or Labour Room are counseled for HIV testing, and tested as per NACO guidelines. Babies born to HIV seropositive women are followed up to 18 months for confirmatory testing. RESULTS: The number of antenatal women counseled who opted for HIV testing were 99.4% and women who tested seropositive was 1.6 %, 1.3%, 0.9%, 0.84%, 0.6% for the years 2009-10, 10- 11, 11-12, 12-13, 13-14 respectively showing a declining trend in the prevalence of HIV in antenatal women. 94.6% of women attended the post-test counseling. Spouses of seropositive antenatal women who opted for testing was 52.5% and seropositivity in the spouses tested was 65.87% during the study period. Of the 767 seropositive women who delivered, 542(70.66%) had vaginal delivery 225(29.33%) had LSCS for obstetric indication. Of the 767 seropositive women who delivered 719(93.7%) had live births, 28(3.65%) had intrauterine fetal demise and 20(2.6%) newborns died in the perinatal period. The number of seropositive women opting for exclusive replacement feeding was 54.4% during the study period April 2009 to March 2014. Confirmatory test for infants was done at 18 months and of the 136 infants tested, 14 were found to be seropositive. CONCLUSION: With effective implementation of PPTCT programme, HIV infection in antenatal women is showing a decreasing trend. Women are willing to undergo HIV testing but their spouses need to be counseled for coming to the antenatal clinic for testing.54% of women who were seropositive are opting for exclusive replacement feeding which may contribute to bring down the incidence of HIV in newborn, but as most of the antenatal patients are from the low socio economic status, reinforcement of counseling regarding exclusive breast feeding needs to be done. The seropositive status of the newborns is about 10.29% during the study period which can be brought down still further by

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BACK GROUND: To study and compare the efficacy and safety of intra vaginal misoprostol versus intra cervical dinoprostone gel for cervical ripening and induction of labour. Objectives: 1. To study and compare efficacy and safety of misoprostol and dinoprostone gel. 2. To study the success rate and outcome of induction 3. To Study the average induction -delivery interval 4. To study the side effects during induction with these drugs. DESIGN: It is a prospective study. STUDY AREA: Department of Obstetrics & Gynecology, Government General Hospital, Guntur, affiliated to Guntur Medical College. STUDY SUBJECT: Antenatal Women. SAMPLE SIZE: 100 Antenatal women who were admitted in Antenatal ward in Department of Obstetrics. STUDY PERIOD: September 2013 to September 2014. RESULTS: 100 antenatal women requiring induction of labour were followed 50 received 25 g misoprostol 4th hourly, 0.5 mg of intracervical dinoprostol gel 12 hourly. The result of the study shows induction delivery interval was significantly shorter in misoprostol group than dinoprostone group. Caesarean section rate is low in misprostol group compared to dinoprostone group. With the lower dosage of misoprostol, no maternal complications were observed and foetal complication i.e., meconium stained liquor was seen in 8% of misoprostol group, but Apgar score was good in both group. CONCLUSION: On basis of our study misoprostol is an effective and safe drug to mother and foetus, easy to administer, and stable at room temperature, and misoprostol is a cheaper drug better and effective alternate to dinoprostone gel in a women belonging to resource constrained developing countries.