Kakatiya Medical College Research Articles

Management of fracture both bone of forearm with dynamic compression plating and its outcomes

Introduction: Forearm fractures are one of the most common injuries encountered by an orthopaedic surgeon. Before AO (Association for Osteosynthesis), they were treated with cast immobilization and also other fixation techniques which were described such as intramedullary k-wire, intramedullary nail, external fixator etc. Though still relevant today, however they have been demonstrated to be successful only in selected cases, with high rate of non-union, malunion and with ill effects on the functions of the forearm. The most effective method of producing rigid internal fixation by the use of compression plates was developed by AO School in Switzerland. Objective: The aim of this study is to assess the results of fixation of fractures of shaft of both bone of forearm with dynamic compression plating (DCP) and its advantages and its complications Setting: This study was conducted at the orthopedics department of a teaching hospital in India. Design: This was 2 years prospective, longitudinal, hospital based, observational study, and its outcomes. Participants: The study was done in 30 patients (22 males and 8 females) with fracture both bone of the forearm, who were treated with open reduction and internal fixation with dynamic compression plate and screws at Mahatma Gandhi Memorial Hospital (attached to Kakatiya Medical College, Warangal), between January 2017 to January 2019. Results: Anderson’s criterion was employed to categorize the functional results. Good or full range of mobility of elbow and wrist joints, with excellent and satisfactory results was present in 28 patients (94%), 1 patient (3%) having restriction of elbow motion and pronation and supination and 1 patient (3%) with non-union of ulna, who recovered with bone grafting. Conclusion: Based on our experience and results, we conclude that with anatomic open reduction and rigid internal fixation with dynamic compression plate is a good fixation procedure for displaced diaphyseal fractures of both bone of the forearm. Adherence to strict asepsis, AO principles, proper post-operative rehabilitation and patient education are more important to obtain excellent results.

Evaluation of e-cadherin expression in gastric cancer as a prognostic marker

Introduction: Carcinoma of stomach is a common malignancy and globally stands at fourth position frequency- wise. E-cadherin, is a major cell adhesion molecule, the loss of which gives rise to invasive and metastatic properties to the cancer cells. Aim of the Study: To study the E-cadherin expression in gastric carcinomas by immuno-histochemistry and to correlate its pattern of staining with tumor differentiation, invasion, histological variants, and lymph node status. Materials and Methods: A two year prospective study was done from September 2011 to August 2013 at Kakatiya Medical College and MGM Hospital, Warangal. The resected specimens of stomach and endoscopic biopsy specimens taken from carcinoma stomach in this study period were considered. Routine histopathology and immunohistochemistry for E-cadherin were done on the sections. Results: 60 cases were studied of which 26 were gastric biopsies and 34 were gastrectomy specimens. The patient age ranged from 41-72 years and the male to female ratio was 1.6:1. There were 70% and 30% cases that showed intestinal type and diffuse type morphology respectively. Preserved E-cadherin was mainly seen in intestinal type tumors 14/42 (33.33%) with grade 3 staining, while majority of diffuse adenocarcinomas 8/18 (44.44%) were negative for E-cadherin staining. Higher stage tumors and poorly differentiated adenocarcinomas showed reduced E-cadherin staining. Cases with positive lymph nodes 22/29(75.86%) had diminished / absent E-cadherin staining. Conclusion: Normal gastric mucosa on IHC shows strong membranous E-cadherin positivity. There is a gradual decrease in intensity and percentage, and the pattern changes towards cytoplasmic staining in gastric carcinomas. Keywords: Gastric carcinoma, E –Cadherin expression, Prognostic markers, Immunohistochemistry.

Comparison of clinical and functional outcome of intra-articular fractures of distal end of radius with conservative versus surgical treatment: A prospective study

A prospective study constituted a total of n = 90 subjects with intra-articular distal end of radius fractures was conducted in Kakatiya Medical College, Warangal, Telangana, India, for a period of eighteen months. The objective of the present study was management for a distal end radius fracture for accurate restoration of range of motion and grip strength and to achieve a good functional outcome with return to normal functional status of the patient at the earliest possible and to compare clinical and functional outcome with conservative and surgical management. The present study sample consisted of n = 90 subjects of which n = 44 subjects were treated with conservative management, n = 46 with surgical method. Among n = 46 cases treated surgically, n = 11 were managed by pinning, n = 11 by ligamentotaxis with external fixator and n = 24 with plating. Excellent results were observed in 30% of the cases in conservative group and 47.5% in surgical group. Excellent and good results were seen in 85% cases in plating group and 52.17% in K-wire in surgically managed group. Excellent and good outcome results in conservative group were observed in stable, minimally comminuted and minimally displaced fracture pattern. Excellent and good outcome results were seen in many of such fracture pattern among surgical group. The best outcome or results were seen among young individuals.

A comparative Study of parenteral versus oral antibiotics in the treatment of severe pneumonia in children under five years of age

Introduction: Pneumonia is a disease known to mankind from antiquity. Pneumonia is an acute inflammation of the pulmonary parenchyma that can be caused by various infective and non-infective origins, presenting with physical and radiological features compatible with pulmonary consolidation of a part or parts of one or both lungs. Objective: This study is aimed to compare parenteral versus oral antibiotics in the treatment of severe pneumonia in children under five years of age. Materials and Methods: This is a prospective observational comparative study. This study was conducted in the department of pediatrics, MGM hospital, Kakatiya Medical College, Warangal. A total of 268 patients were recruited for the study as per the inclusion and exclusion criteria of the WHO guidelines for community acquired pneumonia. Results: A total of 268 children have been enrolled in the present study. Treatment Failure rate in oral amoxicillin group is 12.6% and in Inj. ampicillin plus amikacin group is 11.1%. The difference in treatment outcome in the two treatment groups is NOT statistically significant. A total of 17 out of 134 children in oral amoxicillin group have progressed to treatment failure which amounts to a failure rate of 12.68%. More than half (7/15) of the children who progressed cumulatively to treatment failure in the inj ampicillin plus amikacin group have developed at least one of the signs of WHO defined very severe pneumonia. Conclusion: In the present study it has been observed that there is no statistically significant difference in the failure rate in oral amoxicillin group and Inj. Ampicillin plus Inj. Amikacin group, suggesting similar outcome for severe pneumonia treated with oral amoxicillin and Inj. Ampicillin plus Amikacin.

A study on clinical and pathological correlation of benign breast lesions

Background: Benign breast diseases are common in females among young age group. Most common presentation is painless lump in the breast. Clinical and pathological correlation is essential. Fibroadenoma is the commonest among all other benign breast diseases. The aim was to study the age distribution of benign breast diseases. To study different types of benign breast diseases, their mode of clinical presentation and to correlate with radiological examination, cytology and histopathology of breast diseases.Methods: This was a prospective study conducted in the outpatient department of General Surgery in MGM hospital, Kakatiya Medical College, Warangal over a period of 2 years. A total of 250 patients diagnosed as benign breast diseases on clinical examination were studied and clinical findings were correlated with radiological, cytological and histopathological findings.Results: Patient age ranged 11 to 59 years. Majority of cases 150 (60%) were among 21-30 years. There were 98.8% female patients. Fibroadenomas were 57.6%, fibrocystic disease cases were 13.2%, breast abscesses were 1.6%, Intraductal papilloms 2.0%, simple cysts were 4.8%, Galactoceles 1.8%, Benign phyllodes were 3.6%, proliferative breast disease without atypia were 5.2% and gynaecomastia were 1.2% cases.Conclusions: Benign breast diseases are common among young females. Most of them present as painless mobile breast lump. Breast pain and nipple discharge are the other symptoms. Fibroadenoma is the commonest in our study, followed by fibrocystic changes Clinical diagnosis was correlated with cytology and histopathology.

Evaluation and surgical management of bimalleolar fractures of ankle joint

Objective: The objective of the present study was to assess the functional outcome of surgically managed bimalleolar fractures of ankle joint. Material and Methods: The surgical study was conducted on twenty seven patients at Kakatiya Medical College, Warangal, Telangana, India, for a period of eighteen months. All the cases were treated by open reduction and internal fixation technique. The functional outcome was evaluated using the Baird and Jackson’s ankle scoring system. Results: In our study the operative results we achieved were good in 83.2% cases, 8.3% fair results, 8.3% poor results. Good functional results were obtained by surgical management of bimalleolar ankle fractures. Early weight bearing and mobilisation was achieved in these patients. Open reduction and internal fixation restores the articular congruity of the ankle joint. There were no intra operative complications observed in this study. Conclusions: Anatomical reduction is essential in all intra articular fractures, more so if a weight bearing joint like ankle is involved. Open reduction and internal fixation guarantee high standard of reduction besides eliminating chances of loss of reduction. Functional outcome and the results of surgery treatment were found to be good.

Clinical outcomes of patients living with HIV visiting ART centre at a tertiary care hospital in northern Telangana, India: eight years of experience

The present retrospective study was aimed to provide information about the prevalence and clinical outcomes of patients living with HIV in Warangal District, in the Northern Telangana region, India. The national AIDS control organization and Kakatiya Medical College (KMC) Institutional Review Board reviewed and approved the study. The study reviewed the clinical charts of 12,837 HIV patients who had been registered at the antiretroviral therapy (ART) centre atMahatma Gandhi Memorial Hospital (MGMH) from January 2007 to December 2014. Of the total chart reviewed, 6,438 (50.5%), 5,543 (43.17%), 777 (6.05%), and 79 (0.61%) were males, females, children and transgender, respectively. Increased death rate was observed during 2009 to 2012 [2009 (18.09%); 2010 (17.6%); 2011 (26.6%); 2012 (26.3%)]. Presently, 3,826 (29.8%) patients are alive on ART, out of which 71.77% were on a zidovudine-based treatment regimen and majority of the patients experienced nevirapine-induced skin rashes. Although the incidence of HIV may have plateaued, the HIV pandemic is not in rapid decline. Achieving greater levels of education, prevention, and treatment may well be one of the tools to achieve reduction in HIV/AIDS pandemic.Keywords: HIV patients, Warangal, India, nevirapine, zidovudine

Study of factors of utilisation of antenatal services and awareness among pregnant women in third trimester attending government maternity hospital Warangal, Telangana State, India

Background: Understanding the factors affecting the utilization of maternity care during pregnancy and delivery is required. The present study was carried out to find out the awareness and factors associated with utilization of maternal care services. Methods: A community based observational study was conducted during September to November 2015 on randomly selected antenatal mothers attending Government Maternity hospital, Kakatiya Medical College, Warangal, India. A total of 200 third trimester pregnant women were interviewed using a pre-tested questionnaire regarding utilization and awareness of antenatal services. Statistical analysis: Percentages, Proportions and chi-square test. Results: A total of 200 antenatal mothers participated in the study. Majority (37.5%) belonged to the age group of 20-24 years in which most of the antenatal mothers belong to Hindu religion (86.3%), of which 50.7% lived in a nuclear family. In this study, the percentage of antenatal mother belonging to Upper Lower class was predominant with 26.5%. Association was also found regarding utilization of antenatal services between age of the mother and literacy of the mother. 83.5% of the antenatal mothers had taken the recommended two doses of T.T with a complete booster dose, 87.1% are aware of family planning services, 97.8% of antenatal mothers are aware of immunization and approximately 95% of the antenatal mothers are aware of mother craft classes. Conclusions: The study shows early and wide spread use of antenatal care, but it also reveals that the antenatal visits occur late in the pregnancy. The literacy and age of women has significant bearing on utilization of antenatal care by the pregnant women.

Anatomy of Inferior Mesenteric Artery in Fetuses.

Aim. To analyze Inferior Mesenteric Artery in fetuses through its site of origin, length, diameter, and variation of its branches. Method. 100 fetuses were collected from various hospitals in Warangal at Kakatiya Medical College in Andhra Pradesh, India, and were divided into two groups, group I (second-trimester fetuses) and group II (third-trimester fetuses), followed by dissection. Result. (1) Site of Origin. In group I fetuses, origin of Inferior Mesenteric Artery was at third lumbar vertebra in 33 out of 34 fetuses (97.2%). In one fetus it was at first lumbar vertebra, 2.8%. In all group II fetuses, origin of Inferior Mesenteric Artery was at third lumbar vertebra. (2) Length. In group I fetuses it ranged between 18 and 30 mm, average being 24 mm except in one fetus where it was 48 mm. In group II fetuses the length ranged from 30 to 34 mm, average being 32 mm. (3) Diameter. In group I fetuses it ranged from 0.5 to 1 mm, and in group II fetuses it ranged from 1 to 2 mm, average being 1.5 mm. (4) Branches. Out of 34 fetuses of group I, 4 fetuses showed variation. In one fetus left colic artery was arising from abdominal aorta, 2.9%. In 3 fetuses, Inferior Mesenteric Artery was giving a branch to left kidney, 8.8%. Out of 66 fetuses in group II, 64 had normal branching. In one fetus left renal artery was arising from Inferior Mesenteric Artery, 1.5%, and in another fetus one accessory renal artery was arising from Inferior Mesenteric Artery and entering the lower pole of left kidney. Conclusion. Formation, course, and branching pattern of an artery depend on development and origin of organs to attain the actual adult position.

Study of breast feeding practices in rural field practice area of Kakatiya Medical College, Warangal, Telangana state, India

Background: Infant mortality rate (IMR) is considered as one of the most sensitive indicators of health status of a community. Breast feeding in rural areas appears to be influenced by beliefs, social, cultural and educational factors. This study aimed to access awareness and practices towards exclusive breast feeding and awareness towards the nutritional status and assessment and positioning of baby as per IMNCI guidelines in rural area, Warangal. Methods: A community based cross-sectional study conducted on mothers with children aged 0-2 years residing in rural field practising area, Kakatiya Medical College, Warangal. A total of 200 mothers with children aged 0-2 years were interviewed using a pre-tested questionnaire. Statistical analysis: percentages, proportions and chi-square test. Results: A total of 200 mothers with children aged 0-2 years participated in the study; majority (46.2%) belonged to the age group of 21-23 years in which most of the mothers belong to Hindu religion (90%), of which 67% lived in nuclear family. In this study, the percentage of mothers with children 0-2 years belonging to upper class was predominant with 47.5%. Association was found between education and practice of not giving prelacteal feeds and also with initiation of breast feeding (IBF). Association was also found between knowledge and practice. There is a significant awareness between EBF and IBF. About 83.8% mothers feed their child with colostrum, of which 28% mothers said that they don’t know the reason of practising colostrum. Around 70% babies have good suckling and 54.3% babies were born with prematurity. Conclusions: Nearly 76% mothers were lack of awareness regarding health condition of both baby and mother on breast feeding practices. The literacy and age of women has significant association on breast feeding practices.

Strangulated Groin Hernia Repair: A New Approach for All.

The available classical approaches for Groin hernia are multiple. The change of approach with change of incision is needed with these approaches when the bowel is gangrenous. To evaluate the efficacy and safety of a new approach for all strangulated groin hernias (inguinal, femoral and obturator), in terms of change of approach/complications. It was conducted in surgical unit-2 of MGM Hospital, Kakatiya Medical College Warangal, Telangana State, India, from Nov 2000 to Oct 2010. Total 52 patients operated with classical approach were compared with 52 patients operated present new approach. All the cases (52+52) were with gangrenous bowel which required resection and end to end anastomosis of bowel. All the cases (52+52) were managed with mesh repair and the results were analysed. In classical approach: Three cases required laparotomy (5.7%). Twelve cases required change of approach with change of incision (23%). Eight cases developed wound infection after mesh repair (15%). Four cases required removal of mesh (7.6%). Two Cases developed recurrence (3.8%). In present new approach: No laparotomy (0%), no change of incision (0%), no removal of mesh (0%) and no recurrence(0%). Only 2 cases (3.8%) developed wound infection at lateral part of incision ie. p<0.05. This new approach for all - gives a best approach for strangulated groin hernias as it is easy to follow. It obviates the change of incision and need for a laparotomy. It further retains normal anatomy, prevents contamination of the inguinal canal and permits a mesh repair leading to decreasing the chances of recurrence.

Study of knowledge and practices of hand washing among mothers having children under 5 years of age in urban field practicing area of Kakatiya Medical College, Warangal, Telangana, India

Background: Hand washing is viewed as most cost effective intervention for reducing global infections like diarrhoea, acute respiratory tract infections. According to WHO estimates, 3.8 million children aged less than five die each year from diarrhoea and ARI. WHO defines hand washing as washing hands with soap and water (HWWS) thoroughly following the five critical moments i.e. after defecation, after cleaning child’s bottom who had defecated, before cooking, eating and feeding child. Objectives of the study was to study the socio demographic profile of mothers, to study the hand washing practices among mothers having children under 5 years of age and factors influencing them and to impart knowledge about the importance of hand washing Methods: A community based descriptive cross sectional study was undertaken on mothers randomly selected in rangampet, urban field practising area of KMC, Warangal. A total of 150 mothers were interviewed using a pre-designed semi-structured questionnaire. The data was analyzed using SPSS version 22.00. Results: Mothers who washed their hands with soap and water after defecation (79.3%) and after cleaning child’s bottom (82.7%) before cooking (44.7%), before eating (44.7%) and before feeding the child (41.3%). The women who didn’t wash their hands properly (used only water) after defecation (20.7%) and after cleaning a child who has just defecated (17.3%) cited the absence of soap or water at the designated site of hand washing as the reason for not doing so. 78.7% have told that hand washing is important in prevention of diseases. 16.7% have given the response that they don’t know the importance of hand washing. Conclusions: The study shows hand washing after critical moments is critically low. It can be suggested that interventions by educating target an increase in hand washing practices. Innovative social marketing approaches may help in adoption of proper hand washing behaviour.

Study of histomorphological patterns of ovarian tumors

Introduction: Ovarian tumors have various histomorphological patterns. Histopathological examination plays an important role is classifying ovarian tumors for better prognosis. Ovarian tumors are classified into surface epithelial tumors, germ tumors and sex cord stromal tumors. This study was done to know various histomorphological patterns of ovarian tumors. Materials and Methods: Both retrospective and prospective study done from March 2013 to April 2015 for 2 yrs in the department of pathology, Kakatiya Medical College Warangal and private histopathological laboratories. On microscopy histomorphological patterns of ovarian tumors were noted. Sections were given and slides were stained with H &amp; E. Special stains like reticulin, PAS, mucicarmine were done where ever necessary. Results: 154 ovarian tumors were studied, 78.5% (121/154) were benign and 21.4% (33/154) were malignant. Surface epithelial tumors were most common (61.6%), followed by germ cell tumors (29.8%). Sex cord stromal tumors comprised only 4.5 % (7/154) of all ovarian tumors. Metastatic tumors of ovaries were far less common than primary ovarian tumors. They comprised only 3.8 % (6/154) of all ovarian tumors. Age ranged from 15-65 with majority of cases were reported among 35- 45yrs 81 (52.5%). The youngest patient of our series was a girl of 16 yrs with dysgerminoma and the oldest patient was a 65 yrs, a case of mucinous cystadenocarcinoma ovary. Conclusion: Surface epithelial tumors were most common followed by germ cell tumors. Majority of tumors were reported amongage group 35- 45yrs. Metastatic tumors of ovaries were less common.

Clinical Outcome of Ppiucd (Copper-380A)-Intracaesarean Insertion

Background: This study examines the factors responsible for acceptability of the post placental intracaesarean insertion of IUCD among the clients in the study and evaluates the safety and efficacy and occurrence of complications like bleeding, missing strings, infection, pregnancy and expulsion and their incidence of occurrence after a follow up of 6 months post insertion. Aim: To assess the acceptability, efficacy, feasibility and safety of IUCD insertion immediately after expulsion of the placenta in a caesarean section. Materials and Methods: We have conducted a study on 220 patients delivering by caesarean section at our hospital, Kakatiya Medical College, Warangal, INDIA. After taking informed consent and explaining the patients about the advantages and limitations, we have succeeded in inserting intrauterine device cu-t380A immediately after expulsion of placenta in patients delivering by caesarean section in 220 patients and followed up the patients at 2-6 weeks and 6weeks-6months period to evaluate the safety, efficacy and complications occurring and their incidence of occurrence. Results: Total women counseled were 480, Accepted in 231, Declined in 249. Intrauterine cesarean insertion was done in 220 patients and deferred in 11 patients due to post partum hemorrhage. Out of 220 patients, 28 patients lost to follow up, Removal rate was 20 and continued in 160. The total complications are 68 (Expulsion 12,Bleeding 20, Strings not visible 32,Infections 4,Pregnancy 0),These results were comparable to other national and international studies. We compared complications between elective and emergency intracesarean insertions and their statistical significance were evaluated. Conclusion: Advantages of immediate post-partum insertion include high motivation, assurance that the woman is not pregnant, and convenience. However, expulsion rates appear to be higher than with interval insertion. The popularity of immediate post-partum IUCD insertion in countries as d

Primary Tuberculosis of Tonsil in a Diabetic Patient—A Case Report

Though Tuberculosis is one of the most common causes of ill health and death worldwide, people with diabetes have 2 - 3 times higher risk of tuberculosis when compared with people without diabetes. Though tuberculosis can affect any part of the body, oral and oropharyngeal tuberculosis is rare, but reported. And it’s association with diabetes mellitus because of the decreased host mechanism, is still rare, but reported. A 50-year-old female diabetic who was on insulin therapy came to OPD of MGM hospital, Kakatiya Medical College, Warangal with complaints of severe pain in throat for the last 6 months. On examination, right tonsil was enlarged with granular surface. Left tonsil and rest of the oropharynx were normal. Examination of chest was normal and there was no evidence of pulmonary tuberculosis. Punch biopsy revealed tuberculosis of tonsil. Isolated cases of primary tuberculosis of tonsil without evidence of pulmonary tuberculosis are rare. Presence of diabetes mellitus makes patients 2 - 3 times more vulnerable for tubercular infection.