Tertiary Medical College Hospital Research Articles

Golden Hours in Severe Paraquat Poisoning-The Role of Early Haemoperfusion Therapy.

Paraquat is a commonly ingested poison especially in Southern India. There is no antidote for paraquat poison and consumption is often fatal. The usual cause of death is either acute lung injury or multi-organ failure. To evaluate the role of early haemoperfusion as a therapy in paraquat poisoned patients. This study was a retrospective analysis of patients admitted to a Tertiary Medical College Hospital between January 2012 and December 2015 with history of paraquat consumption, comparing outcomes in those who received only gastric lavage and symptomatic treatment with those who received haemoperfusion as a therapy. The role of early haemoperfusion (≤ 6 hours) vs late haemoperfusion (> 6 hours) in paraquat poisoned patients was also compared. The data of these patients was extracted and analysed with respect to age, sex, mode of treatment, the outcome in patients who received early and late haemoperfusion. A total of 101 patients were studied out of which 62 died. Deaths were more in those patients who received only gastric lavage with symptomatic treatment as therapy compared to those who received haemoperfusion i.e., 92.1% vs 42.9% respectively. We also found that, the survival rate was better in patients who received early haemoperfusion. Early haemoperfusion was helpful in the management of severe paraquat poisoning and improved the survival rate in these patients.

Outcome of Very Low Birth Weight Neonates in a Tertiary Level Hospital Outside Capital of Bangladesh: A Study in Faridpur Medical College Hospital

Very low birth weight (VLBW) is an important cause of infant mortality and still a challenge for achieving Millennium Development Goal (MDG) in Bangladesh. Our study was to see the risk factors and its outcome of VLBW neonates in a tertiary level Faridpur Medical College Hospital (FMCH), outside capital Dhaka. This prospective cross sectional study was conducted in neonatal Unit of pediatric department in FMCH. All neonates who were admitted here had been selected and we find out the very low birth weight neonates for our study purpose. All anthropometric measurements were taken by us in our department. We took all the informations about neonates within our study period of six months (November 2013 to April 2014) through a prescribed protocol. Total 1126 neonates admitted within our study period of 6 months. Among 1126 neonates 76 of them were VLBW. Among 76 VLBW neonates 38 (50%) were male and 38 (50%) were female, but 22 of them were expired, which was 28.94% of total VLBW neonates. Most expired on month of March which was 38.46%. Among expired VLBW neonates 10 (45.45%) of them were male and 12 (54.55%) of them were female. Total 48 (63.15%) mothers of VLBW neonates delivered at hospital of them Caesarean section occurs in 40 (52.63%) mothers of VLBW neonates and normal vaginal delivery (NVD) occurs in 36 cases (47.37%). Home delivery occurs in mothers of 28 VLBW neonates. Among them 15 (53.57%) were done by traditional birth attendance (TBA), 8 (28.57%) by local dai and 5 (17.86%) by relatives of the family of VLBW neonates. We found mothers of 41 (53.95%) VLBW neonates had premature rupture of membrane (PROM), 8 (10.53%) had eclampsia, 4 (5.26%) had leaking membrane and 4 (5.26%) had history of accident. Maternal age of VLBW neonates are more common between 18 to 24 years of age that was 53.95% (41 in number) but 27 mothers (35.52%) were below 18 years of age . We found in our study that the survival rate of VLBW neonates in our institute is not like developed countries but it is better than many developing countries around the world.Faridpur Med. Coll. J. Jan 2016;11(1): 15-19

Experience of Persistent Gestation Trophoblastic Disease in a Tertiary Medical College Hospital, Bangladesh

Objectives: To study the clinical presentation and risk factors of persistent trophoblastic disease and its outcome of treatment with chemotherapy.Materials and methods: This observational study was carried out on fifty patients of persistent trophoblastic disease who were admitted in the Department of Obstetrics & Gynaecology, Mymensingh Medical Hospital (MMCH) during one year period. Evaluation of disease was done by thorough clinical examination and a set of investigations including chest radiography, ultrasound scan of abdomen and pelvis and estimation of serum â hCG. The four factors under analysis of PTD were age of the patient, clinical presentation, gestational age at diagnosis of molar pregnancy and nature of antecedent pregnancy. Patients with non-metastatic trophoblastic disease and low risk metastatic trophoblastic disease were offered single agent chemotherapy with methotrexate and folinic acid rescue in consultation with the oncologist. When â hCG response was inadequate, multi-agent chemotherapy was given. Complications of chemotherapy were also observed and supportive treatment was given.Results: Out of 50 patients, 49 (98%) patients had antecedent molar pregnancy and 1(2%) had missed abortion. In cases of post molar trophoblastic disease, 28 (57.58%) were in 20-30 yrs. Mean ± SD was 31.35 ± 7.25. In these cases gestational size of molar pregnancy was between 16-20 weeks in 24 (48.98%), <16 wks in 19 (38.78%) and >20 wks in 6 (12.24%) cases. Mean ± SD was 16.78 ± 4.45 wks (p<0.001). Associated theca lutein cysts were present among higher number of cases (57.14%) but not statistically significant. Regarding clinical presentation, 40 (80%) patients presented with irregular pervaginal bleeding, 3(6%) patients with features of metastasis. Most of the of the study subjects 43 (86%) were treated with chemotherapy and 7 (14%) had undergone both hysterectomy and chemotherapy. Single agent methotrexate was given in 47 (94%) cases and multiple agent (EMA-CO) in 3 (6%). After giving 4 cycles of chemotherapy 11 (22%) patients were cured, 38 (76%) had declining â hCG level and one had static â hCG level. Overall remission was 98 %. Complication of chemotherapy was observed in 5 (10%) patients.Conclusion: Theca lutein cyst are important in the prediction of persistent disease after molar pregnancy. Methotrexate chemotherapy is effective and well tolerated in treating patients with nonmetastatic and low risk metastatic gestational trophoblastic neoplasia.Bangladesh J Obstet Gynaecol, 2012; Vol. 27(2) : 50-56

Characterisation and Isolation of Candida Species from ICU Patients in Nobel Medical College Teaching Hospital, Biratnagar

Background Fungi have emerged as major causes of human diseases. Intensive Care Units (ICU), harbor almost all the risk factors for opportunistic fungal infections. Among these, Candida infections are very common with recent trends being rise in the non-Candida albicans (NCA) species along with an increase in resistance of these species to antifungal drugs. Increament in invasive Candidasis during last three decades have been reported in several studies, among all Candida species the Candida albicans is considered as the most common infectious agent the other non-albicans like C. Tropicalis, C. glabrata, C. parapsilosis C. krusei, and C. dubliniensis were raised as infectious agents. The aim of current study is to characterize the candida species from the clinical specimens of patients admitted in the ICU of Tertiary Care hospital in Eastren Nepal and to perform their antifungal susceptibility.Material and Methods The study was carried out in the tertiary care hospital Nobel Medical College and Teaching Hospital Biratnagar Nepal over a period of 6 monthsbetween September 2015 to February 2016. The following techniques were employed to characterize the isolates in the study – Gram’s stain, culture on Sabouraud’s Dextrose Agar, Germ Tube test, morphology in Cornmeal Agar and chromogenic agar media, sugar fermentation and sugar assimilation tests, and the results were interpreted by using standard protocols.Results Out of 50 candida isolates from different clinical samples including 37 blood samples, 9 urines and 4 Endo Tracheal (ET) tube, the most common species was C.albicans (44%) followed by C.tropicalis (26%), C.Glabrata (18%), C.Parapsilosis (08%), C.Krusei (02%), and C.Dubliniensis(02%).Conclusion The purpose of the study is to show the value of species isolation, identification and antimicrobial sensitivity testing of the ICU & NICUs patients.Journal of Nobel Medical CollegeVolume 5, Number 1, Issue 8, January-July 2016, 61-65

Knowledge of Family Planning Methods and Factors Affecting Its Utilization among Mothers

Background: Family planning allows couples to determine and ascertain the desired number of children as well as the spacing of their births. It has a direct impact on health, wealth and well-being of people. Contraceptive use not only decreases unintended pregnancies but also reduces IMR, MMR and morbidity. Family planning is still a step back role in preventing population growth. Aims: To develop a health education pamphlet based on the knowledge of postnatal mothers on Family Planning methods. Setting: A Rural tertiary level medical college Hospital and a descriptive research design. Material and Methods: With descriptive research design, using purposive sampling technique 150 postnatal mothers were assessed for knowledge and factors affecting the usage of family planning methods. Based on their knowledge, a health education pamphlet was prepared and distributed to all the postnatal mothers. Results: Majority, 104 (69.3%) of postnatal mothers had poor knowledge, 40(26.7%) of them had average knowledge and only 6 (4%) of them had good knowledge score on family planning methods. There was a statistically significant association of knowledge score with parity, education and place of residence. Conclusions: Awareness regarding family planning among postnatal mothers was poor. Hence health care workers should focus on educating the mothers regarding family planning methods and who in turn will educate the family and society. Key-words: Knowledge, Family planning, Family planning methods, Post natal mothers, health education pamphlet

Manipal Cervical Scoring System by Transvaginal Ultrasound in Predicting Successful Labour Induction.

Induction of labour (IOL) nowadays is a common procedure in obstetric practice. The success of IOL largely depends upon "favourability" or "readiness" cervix which is traditionally assessed by manual examination and Scored as Bishop Score. However, this method is limited by subjectivity and reproducibility and though done in all the patients prior to IOL, several studies have demonstrated poor correlation between Bishop Score and outcome of labour. To evaluate the role of preinduction transvaginal ultrasonographic (TVS) cervical assessment in predicting labour outcome and to compare its performance against Bishop Score in patients undergoing induction of labour (IOL). A tertiary medical college hospital in Southern India. Prospective observational and investigational study. Transvaginal ultrasound was performed in 131 patients who underwent labour induction at term with intact membranes and live fetus. Bishop Score was assessed by pervaginal examination and was compared with preinduction TVS cervical Score (parameters being cervical length, funneling, position of cervix and distance of presenting part from external os). Labour was induced within one hour of cervical assessment. The labour induction was considered successful if patient could get into active labour i.e., onset of regular uterine contractions (at interval of 2-3 minutes) and cervical dilatation of 4 cm or greater within 24 hours of induction. Labour induction was successful in 86.9% of patients. At cut off Scores of ≥ 4, TVS cervical Score performed better than Bishop Score (Sensitivity 77% vs. 65%, Specificity 93% vs. 86%). ROC analysis indicated that Area Under Curve (AUC) was more for TVS Score (0.90, 95% CI 0.84 - 0.95), compared to Bishop Score. It was found that an increase in cervical length and distance from the os by 1 mm from their means were associated with an increase in odds for failure of induction and there by caesarean delivery by 6.5% and 11% respectively. In women experiencing labour induction, transvaginal ultrasound score comprising of five different parameters indicated success of induction better than Bishop Score. Further, two of its components (longer cervical length and increased distance of presenting part from external os) demonstrated significant and independent prediction of the likelihood of failure of induction and risk of operative delivery.

A study of adverse vaccine events among pediatric age group in a tertiary medical college hospital

Background: Vaccines are pivotal health products that are used and administered prophylactically to a large number of healthy individuals. A significant proportion of vaccines are administered to the pediatric age group, particularly to the neonates and infants as part of the national immunization programmes. As with any drug, untoward reaction can occur with the administration of vaccines. Most of the clinical trials with the vaccines are conducted and validated in a relatively small sample size. Active monitoring as part of the Pharmacovigilance programme is imperative to identify rare or deferred adverse vaccine events (AVE). Methods: A prospective, single center, observational, naturalistic study on report forms in pediatric age group, who may develop AVE in Sapthagiri Institute of Medical Sciences and Research Center, Bengaluru, was conducted during the study time widow, from February 20, 2014, to April 20th, 2014. Children under 5 years of age were included in the study. All children more than 5 years of age were excluded from the study. The causality assessment were attempted to be recorded as per the Naranjo score, which is used to quantitatively evaluate the association between AVE and vaccines. Results: 19.04% of children aged 1-5 years of age documented with adverse event following immunization (AEFI) (p=0.036). It was found that either a naive or the fully immunized children suffered from the AEFI most of which was trivial. Fever was the most common AEFI reported followed by an excess cry. The incidence of fever reported was substantially high following the DPT vaccine. Conclusions: All the AEFI received through the telephonic calls were documented. There was no mortality or a major adverse event reported. Maximum AEFI were documented in the neonates and the children 1-5 years of age which was statistically significant. In addition, the study provides a scope for further research with reference to the inter-age group variability. The immune mechanism behind such a difference also needs to be explored.

Predictive value of middle cerebral artery to uterine artery pulsatility index ratio in hypertensive disorders of pregnancy.

Aims and Objectives. (i) To determine the predictive value of cerebrouterine (CU) ratio (middle cerebral artery to uterine artery pulsatility index, MCA/UT PI) in assessing perinatal outcome among hypertensive disorders of pregnancy. (ii) To compare between CU ratio and CP ratio (MCA/Umbilical artery PI) as a predictor of adverse perinatal outcome. Methods. A prospective observational study was done in a tertiary medical college hospital, from September 2012 to August 2013. One hundred singleton pregnancies complicated by hypertension peculiar to pregnancy were enrolled. Both CU and CP ratios were estimated. The perinatal outcomes were studied. Results. Both cerebrouterine and cerebroplacental ratios had a better negative predictive value in predicting adverse perinatal outcome. However, both CU and CP ratios when applied together were able to predict adverse outcomes better than individual ratios. The sensitivity, specificity, positive predictive value, and the negative predictive values for an adverse neonatal outcome with CU ratio were 61.3%, 70.3%, 56%, and 78.9%, respectively, compared to 42%, 57.5%, 62%, and 76% as with CP ratio. Conclusion. Cerebrouterine ratio and cerebroplacental ratio were complementary to each other in predicting the adverse perinatal outcomes. Individually, both ratios were reassuring for favorable perinatal outcome with high negative predictive value.

N-acetyl cysteine in the management of rodenticide consumption - life saving?

Rodenticide is a commonly ingested poison in India. Many rodenticides contain hepatotoxic agents and can cause acute liver failure (ALF). There is no antidote for rodenticide poison, and consumption is often fatal. The Role of N acetyl cysteine (NAC) in acetaminophen induced ALF is well established. Additionally some studies have shown that it may be useful in non-acetaminophen induced ALF also. Cases with ALF secondary to suicidal rodenticide consumption have been reported, and some reports show that NAC is beneficial in these cases. Our study was a retrospective analysis of patients admitted with rodenticide consumption, comparing outcomes in those receiving standard of care management and those who were treated with NAC also. Case sheets of all inpatients of a tertiary medical college hospital between January 2010 and December 2012 admitted with an alleged history of rodenticide consumption were surveyed and data was extracted and analysed. Patients were analysed with respect to age, sex, mode of presentation, interval between consumption of rodenticide and starting NAC; the outcome in patients treated with acetylcysteine was compared to outcomes in those not treated with acetylcysteine A total of 100 patients were studied out of which 18 died. Sixteen of the deaths were in patients who had not been treated with NAC. We found that patients who had received NAC had lower mortality, lower peak values of AST/ALT, and shorter hospital stay. NAC may have a role in the management of ALF associated with rodenticide consumption.

Dexamethasone as an additive to bupivacaine in fascia lliaca compartment block: a prospective, randomized and double blind study.

Patients with fracture femur experience severe pain on movement during positioning for spinal anaesthesia. Fascia Iliaca Compartment Block (FICB) has been used effectively for providing analgesia during positioning of the patient for spinal anaesthesia. To test the hypothesis that, adding dexamethasone would significantly prolong the duration of Bupivacaine in FICB. Sixty patients aged 18 to 80 years posted for ORIF (Open Reduction and Internal Fixation) of fracture femur were included to receive FICB. This was a prospective, randomized, double blind study done at tertiary medical college hospital. Thirty patients received 38ml of 0.25 % bupivacaine with 2ml saline and another 30 patients received 38ml of 0.25 % bupivacaine with 2ml dexamethasone (8mg). Thirty minutes after FICB, patient satisfaction during positioning for spinal anesthesia was recorded. In the post-operative period, duration of analgesia and the total doses of rescue analgesics were recorded in both the groups. Patients who received Bupivacaine with dexamethasone had significant prolongation of analgesia and required fewer doses of rescue analgesics as compared to patients who received Bupivacaine alone for FICB. However, the onset of analgesia, VAS scores and patient satisfaction during positioning for spinal anaesthesia were similar in both groups. Our study shows that adding Dexamethasone (8mg) to Bupivacaine for FICB significantly prolonged the duration of block and decreased the requirement of rescue analgesics as compared to patients who received Bupivacaine alone. FICB is relatively easy and safe to perform. In our study we did not encounter any complication while doing the procedures and also by adding dexamethasone.

Factors associated with treatment delay among tuberculosis patients referred from a tertiary hospital in Dhaka City: a cross-sectional study.

A tertiary medical college hospital in Dhaka City Corporation area, Dhaka, Bangladesh. To identify factors associated with treatment delay among tuberculosis (TB) patients referred from a public diagnostic centre to various DOTS treatment centres in Dhaka City Corporation area, Bangladesh. A cross-sectional study was conducted among 123 patients referred from the Dhaka Medical College Hospital to different DOTS treatment centres during July-October 2012. Factors associated with treatment delay (>1 day between referral and initiation of DOTS treatment) were identified. Among the 123 patients referred from the hospital, treatment delay was found to range between 2 and 17 days (median 2). In bivariate analysis, treatment delay was found to be significantly associated with the patient's diagnostic category. In multivariate analysis, World Health Organization ( WHO) Category II patients were found to be four times more likely to have treatment delay than WHO Category I patients, and married patients were much more likely to have treatment delays than unmarried patients. The study findings suggest that the main factors contributing to treatment delay among TB patients were history of previous anti-tuberculosis treatment, marital status and age. Patients should be given extensive information about the dangers of treatment delay before referring them to DOTS treatment centres.

Study on Morphological and Clinical Characteristics of Herpes Zoster In A Tertiary Medical College Hospital

Herpes zoster is caused by reactivation of VZV (varicella zoster virus) following primary infection or vaccination. VZV remains latent in sensory dorsal root ganglion cells. The virus begins to replicate in some later time, traveling down the sensory nerve into the skin. Forty one cases (3 children and 38 adults) of Herpes Zoster were assessed over a period of three and half years. Structured questionnaire, check-list and face-to-face interview were used as tools of data collection. The prevalence of herpes zoster amongst Skin & Eye OPD cases were found 0.60 percent. Maximum cases (23; 63.41%) were above 45 years of age. The male female ratio was 1.4:1.0. By socioeconomic status maximum patient from middle class (13; 31.70%), followed by poor (12; 26.26%) and very poor (11; 26.82%). Prodromal syndrome in maximum cases was paresthesia (13; 31.70%) and pain (11; 26.82%). Cases were mostly presented with pain (35; 85.36%). Twenty-three cases had classic herpes zoster followed by necrotic or ulcerated herpes zoster (16 cases) and hemorrhagic herpes zoster (2 case). Trigeminal dermatome was the most common involvement in 18 cases (43.9%) followed by thoracic dermatome 16 cases (39.02%). Unidermatomal involvement was seen in 97.56% cases (40) followed by multidermatomal 1 case (2.43%). Nine cases were screened for HIV-1 by ELISA, but none was detected as seropositive. . The analysis and findings put this recommendation that large scale study needed to examine the correlation ship between VZV infection and socioeconomic status of patients. Medicine Today 2010 Volume 22 Number 02 Page 80-82 DOI: http://dx.doi.org/10.3329/medtoday.v22i2.12439

Frequency of Tuberculosis in Patients with Enlarged Lymph Nodes and its cost-effective first line of Diagnosis in our Country

Tuberculosis is the commonest infectious disease in the developing world. Tuberculous lymphadenitis is one of the most common form of extrapulmonary tuberculosis.Many diagnostic tests are devised for its detection including direct smear examination. This cross-sectional study was designed to determine the frequency of tuberculosis in lymphadenopathy of different sites and its rapid diagnosis by FNAC and ZN(Ziehl-Neelsen)staining of aspitation smears. A descriptive cross-sectional survey was done on 100 cases of enlarged lymphnodes on different site at two private tertiary medical college hospital of Dhaka. After reporting granulomatous inflammation on papanicolaou staining (PAP stain) of aspirates obtained by FNAC, one unstained slide from each cases was subjected to special stain like ZN, to determine the AFB positivity. Cases positive for AFB on ZN stain were noted down along with their frequency and percentages. Cervical lymph nodes were the most commonly involved site (76%). Forty One cases (56%) of AFB positive smears were reported in granulomatous inflammation. Most cases of AFB-positive smears were associated with caseation necrosis (92%). Male were affected more (63%) than female. Fine Needle Aspiration Cytology (FNAC) is a simple and rapid diagnostic technique, along with ZN staining, that increases the diagnostic accuracy of this technique. Because of early availability of results, simplicity, minimal trauma and complications, the aspiration cytology is now considered a valuable diagnostic aid and is part and parcel of a pathologist's repertoire. DOI: http://dx.doi.org/10.3329/jdnmch.v17i2.12214 J. Dhaka National Med. Coll. Hos. 2011; 17 (02): 34-39

Prevalence Of Urinary Tract Infection During Pregnancy

Urinary tract infections (UTI) are the most common bacterial infections during pregnancy. Untreated UTI can be associated with serious obstetric complications. This cross-sectional study was carried out to determine the prevalence of UTI among pregnant women attending in two private tertiary medical college hospital of Dhaka. A total of 250 pregnant women were enrolled in this study. UTI was diagnosed using mid stream urine (MSU) culture. Using > 105 colony forming unit per milliliter as significant level of bacteriuria, the prevalence was found to be 26.0%. There was a high incidence in 21–25 years age group (44.61%). There was also high incidence of infection in the third trimester of pregnancy (78.46%) comparid to first (9.23%) and second trimester (12.30%). Multiparty is associated with increased urinary tract infection in pregnancy. Regarding education 10% were literate and 90% were illiterate. Prevalence of bacteriuria was 94% in women who had past history of urinary tract infection. 80% were sexually active. E.coli was the most frequently isolated pathogen (88.15%).These findings underscores the importance of screening all pregnant women for significant bacteriuria, so that positive cases should be treated subsequently with antibiotics in order to reduce the adverse effects on both maternal and fetal health DOI: http://dx.doi.org/10.3329/jdnmch.v17i2.12200 J. Dhaka National Med. Coll. Hos. 2011; 17 (02): 8-12

Profile of Oral Squamous Cell Cancer in a Tertiary Level Medical College Hospital: A 10 Yr Study

To know the clinical and epidemiological characteristics & management strategies for the patients who underwent surgery for oral Squamous Cell Cancer (SCC) in a medical college hospital. Data pertaining to clinico-epidemiological factors & surgical management for oral cancer were analyzed in patients admitted to a tertiary level medical college hospital. Records of 139 patients admitted over a period of 10years (January 1998 to December 2007) were used for data analysis. Only patients with complete records were included in the analysis. M: F ratio was 2.2:1 with average age of patients being 50.4years. Tobacco chewing & smoking were major predisposing factors identified. Oral ulcer was the most common symptom while buccal mucosa, tongue & lower alveolus were three most common primary tumor sites. Majority of tumors were stage IV at presentation (52%). Wide excision of tumor was done in 46% of cases while in 54% cases commando procedure was done. Reconstruction after either commando or wide excision was done in half of the patients. Pectoralis major myocutaneous (PMMC) flap was used in majority of cases for reconstruction. Neck dissection was done in 67% patients. Majority (85%) of these were radical neck dissection (RND). Per operative blood transfusions were required in 64% patients while 19% patients needed post operative transfusion. Post operative complications were noted in 34% of the patients. Of these majority were related to wound infection & orocutaneous fistula formation. Hospital stay varied from 7 to 105days with the mean duration of 30days. Two year follow up revealed a recurrence rate of 36%. Majority of the patients presented at an advanced stage due to self as well as professional delay in diagnosis. This leads to difficulty in resection of the primary tumor as well as reconstruction of the defect. A higher rate of recurrence after surgery is also seen. Post operative complications increase the morbidity which is reflected by an increase in the hospital stay (19days Vs 46days).

Interventional Pain Management in Rheumatological Diseases - A Three Years Physiatric Experience in a Tertiary Medical College Hospital in Bangladesh

BackgroundInterventional pain management (IPM) is a branch of medical science that deals with management of painful medical conditions using specially equipped X-ray machines and anatomical landmarks. Interventional physiatry is a branch of physical medicine and rehabilitation that treats painful conditions through intervention in peripheral joints, the spine, and soft tissues.MethodsA cross-sectional study was conducted using three years of hospital records (2006 to 2008) from the Physical Medicine and Rehabilitation Department at Chittagong Medical College Hospital in Bangladesh, with a view toward highlighting current interventional pain practice in a tertiary medical college hospital.ResultsThe maximum amount of intervention was done in degenerative peripheral joint disorders (600, 46.0%), followed by inflammatory joint diseases (300, 23.0%), soft tissue rheumatism (300, 23.0%), and radicular or referred lower back conditions (100, 8.0%). Of the peripheral joints, the knee was the most common site of intervention. Motor stimulation-guided intralesional injection of methylprednisolone into the piriformis muscle was given in 10 cases of piriformis syndrome refractory to both oral medications and therapeutic exercises. Soft tissue rheumatism of unknown etiology was most common in the form of adhesive capsulitis (90, 64.3%), and is discussed separately. Epidural steroid injection was practiced for various causes of lumbar radiculopathy, with the exception of infective discitis.ConclusionsAll procedures were performed using anatomical landmarks, as there were no facilities for the C-arm/diagnostic ultrasound required for accurate and safe intervention. A dedicated IPM setup should be a requirement in all PMR departments, to provide better pain management and to reduce the burden on other specialties.

Significance of adjunctive mitomycin C in endoscopic dacryocystorhinostomy

Purpose The purpose of this study is to observe the effect of intraoperative topical application of mitomycin C (MMC) on the results of endoscopic dacryocystorhinostomy. Design This is a prospective, randomized, controlled, single-blind study. Settings Hospitalized treatment was done in a tertiary medical college hospital and research center that deals with a predominantly rural population. Patients Patients with primary acquired postsaccal obstruction causing chronic dacryocystitis were considered. Methods A total of 38 patients were randomized into either a mitomycin group or a control group. Both of these groups were subjected to an identical surgical procedure, except that 0.2 mg/dL of MMC was used in the mitomycin group, whereas normal saline was used in the control group. The follow-up period was at least 6 months. An asymptomatic patient with a visible stoma at nasendoscopy and free flow of saline into the nose with lacrimal syringing after 6 months after surgery was used as criteria for defining a successful result. Results The success rate was 82.3% when MMC was used and 85.7% among the controls ( P > .05). Granulations, adhesions, and obliterative sclerosis occurred in a similar number of patients of both groups. However, granulations and adhesions did not have a bearing on the success rate in either group. Conclusion Mitomycin C did not appear to influence the occurrence of granulations, synechiae, or obliterative sclerosis, nor did it alter the success rate significantly.

P290 Postpartum maternal morbidity requiring hospital admission at tertiary medical college hospital, Agartala, Tripura, India – a descriptive study

P290 Postpartum maternal morbidity requiring hospital admission at tertiary medical college hospital, Agartala, Tripura, India – a descriptive study

Complications in primary and secondary acquired cholesteatoma: a prospective comparative study of 62 ears

Objectives This study aimed to compare the clinicopathologic behavior of complications in primary and secondary acquired cholesteatoma and figure out the differences between them. Design This was a prospective cross-sectional study. Methods This was a study conducted in a tertiary referral medical college hospital comprising of 62 ears, of which 32 were in the primary acquired cholesteatoma group (PACG) and 30 were in the secondary acquired cholesteatoma group (SACG). We compared the 2 groups with respect to 7 prognostic variables, as follows: age distribution, sex, duration of ear discharge, pathology in the ear, predisposing disease focus in nose and throat, pattern of complications, and microbiology of ear. Observation and results The presence of cholesteatoma increased the risk for complications by more than 2 times in PACG, but the presence of granulation tissue did not show the same risk. More than half of the ears with complication contained some or the other predisposing disease focus in the nose or throat. The PACG was 3 times more prone to complications than the SACG in the presence of these foci. They showed a similar pattern of complications. Brain abscess and mastoid infections were the commonest complications. Conclusions The PACG was more prone to complications than the SACG in the presence of cholesteatoma and focus in the nose and throat. Irrespective of the different pathologic origin of the 2 types, the patterns of complications remained the same with no major differences, indicating a common final pathway in the natural course of the disease.

Aural polyps: safe or unsafe disease?

Purpose: To determine whether a case of inflammatory aural polyp constitutes a safe or unsafe disease and to arrive at the most suitable treatment option. Design: Prospective study. Follow-up period of 6 months. Setting: Hospitalized treatment in a tertiary medical college hospital that provides care for a predominantly rural population. Patients: All patients treated for aural polyp, having a postoperative histopathological diagnosis of inflammatory aural polyp. Most patients (72%) belonged to the lower middle class. Results: Forty-two patients treated during a 4-year-period were analyzed. Eleven cases were treated by simple aural polypectomy, of which 78% had either recurrence or persistent disease. Out of 31 patients who underwent mastoid exploration, 52% had extensive disease of the mastoid air-cell system and 35% had an underlying cholesteatoma. Six percent had persistent discharge. The disease was often associated with complications (19%). Conclusions: The presence of an aural polyp signifies well-established disease of the middle ear cleft with a greater potential for complications and often obscures an underlying cholesteatoma. We propose that all cases of aural polyps should be considered as unsafe disease and subjected to a formal mastoid exploration.