Renal involvement and early prognosis in patients with Covid-19 pneumonia in tertiary health care centre

Background: The corona virus disease (Covid-19) is a pandemic which is rapidly evolving and expanding, has infected a population of more than 77 million across the globe and around 10 million in India as of 25th December 2020. This virus was first recognized in December 2019 in Wuhan of China when pneumonia of unknown origin came into limelight. It was identified as Covid -19, a neo virus causing severe pneumonia that rapidly led to a major health crisis with devastating consequences not only in India but also in major developed countries of the world. Initially data from China and Italy, which was identified as caused by Covid-19, shows that death rate worsens in persons with increasing age more than 50 years and also leads to higher risk due to co-morbidities like hypertension (HTN), cardiac disease, diabetes mellitus, chronic renal disease, cancer, etc. Severe acute respiratory viral infections are frequently accompanied by multiple organ dysfunction, including acute kidney injury (AKI). While diffuse alveolar damage and acute respiratory failure are the main features of Covid-19, and the incidence of AKI is not well described. The present study was conducted to assess the Renal Involvement and its association with Prognosis among Patients admitted with Covid- 19 Pneumonia. Aim: To assess the renal involvement and its association with prognosis among patients admitted withCovid-19pneumonia. Materials and methods: A single centered cross-sectional study was conducted at Malla Reddy Institute of Medical Sciences during 15th March to 1stMay 2021 where 151 Patients admitted with Covid-19 Positive on RT-PCR were included. Renal function tests include Creatinine and Urea. The most commonly used endogenous marker for the assessment of glomerular function is creatinine. The calculated clearance of creatinine is used to provide an indicator of GFR. Urea is a nitrogen- containing compound formed in the liver as the end product of protein metabolism and the urea cycle. Serum urea levels increase in conditions where renal clearance decreases (in acute and chronic renal failure/ impairment). Urea may also increase in other conditions not related to renal diseases such as upper GI bleeding, dehydration, catabolic states, and high protein diets. Data entry was done using Excel 2013 and analysis using SPSS v16. Student t test and chi-square test were used to find the significant association without come. Results: A total of 151 patients who had tested positive for COVID-19 were included in the study. The mean age in years of the study participants was 47.76�.85. 72.8% were male and 27.2% were female. The mean serum creatinine was 1.44�94 and mean Blood urea was 41.35�.06. Mortality observed in the study was 44.4%. Significantly high levels of serum creatinine (2.06�10) were reported among those who died due to COVID-19 compared to those who recovered (0.93�28) (p<0.0001) in the study. Our study poses a conclusion of increase in serum creatinine in COVID 19 affected patients that shows a temporal association of SARsCOV�with AKI. Conclusion: The Covid pandemic has posed major challenge around the globe. Renal clinical presentation ranging from mild proteinuria, hematuria to progressive AKI necessitating renal replacement therapy (RRT), thrombotic microangiopathy and rhabdomyolysis. More research is needed to obtain adequate evidence to support current clinical approaches and to develop new approaches to management. Kidney failure occurs in most patients with COVID-19 pneumonia. Although proteinuria, hematuria and AKI are usually resolved in such patients within 3 weeks after the onset of symptoms, kidney problems in COVID-19 have been associated with higher mortality. AKI is independent predictor of mortality in Covid-19

Spectrum of thyroid disorders in tertiary care hospital at Patancheru, Sangareddy, Telangana, India - A clinical study

Malnutrition, particularly iodine deficiency, is one of the major contributing factors to thyroid disorders in India. Poverty in India is contributing to the increase of thyroid disorders through malnutrition, poor sanitation, and lack of access to medical facilities. Another factor is the lack of awareness about the symptoms and risk factors of thyroid disorders. Intake recommendations for iodine are provided in the Dietary Reference Intakes (DRIs) developed by the Food and Nutrition Board (FNB) at the Institute of Medicine of the National Academies. WHO recommends universal iodinization of salt. High levels of iodine intake sometimes are associated with an increased risk of hyperthyroidism, hypothyroidism, or autoimmune thyroiditis. We conducted a retrospective study at our hospital from December 2017 to January 2023. A total number of 57 cases were studied. Out of 57 patients, 46 patients presented with hypothyroidism and 11 with hyperthyroidism. Various clinical presentations, pathologies and socioeconomic problems are discussed.

The effect of levosimendan on the right ventricular function in patients with right ventricular dysfunction undergoing mitral valve surgery

Background: Right ventricular (RV) dysfunction is an important predictor of both immediate and long-term outcomes in valve surgeries. Levosimendan has proven beneficial in improving RV function. Aims: The objective was to study the effect of the addition of levosimendan to the conventional treatment on RV function in patients with RV dysfunction undergoing mitral valve (MV) surgeries. Setting and Design: Prospective randomized double-blinded controlled study at a tertiary care institution. Materials and Methods: Sixty adult patients aged 15� years, with preoperative transthoracic echocardiography (TTE) findings of RV dysfunction posted for elective MV surgery, were randomized into levosimendan (L) group and placebo (P) group. Patients in the L group were administered levosimendan at a rate of 0.1 mcg/kg/min after induction for 24 hrs, whereas patients in the P group were given multivitamin infusion at the same rate. Both the groups received standard inotropic therapy. The hemodynamic and echocardiographic parameters of RV function (RV size, Inferior vena cava (IVC) diameter, RV fractional area change (RVFAC) Tricuspid annular plane systolic excursion (TAPSE), and Systolic Pulmonary Artery Pressure (SPAP) were compared between the groups at 6 hrs, 24 hrs, and 7th day postoperatively. Results: All hemodynamic and echocardiographic parameters of RV function like RV size, IVC diameter, RVFAC, TAPSE, and SPAP improved from baseline to 24 hrs in both groups. Levosimendan caused a significant improvement in RV function compared to the P group at 24 hrs and 7th day postoperatively. Conclusions: The present study concludes that levosimendan is a promising option in patients with RV dysfunction undergoing MV surgeries.

Coexistence of Hyperparathyroidism and Multinodular Goiter with Hashimotos Thyroiditis and Hyperthyroidism � A Rare Case Report

Thyroid disease and hyperparathyroidism (HPT) are among the most common endocrine disorders. Thyroid hormones play an important role in bone and calcium metabolism. The rate of HPT is greater in patients with thyroid disease than in the general medical population. Simultaneous occurrence of hyperthyroidism and hyperparathyroidism in the same patient is a rare combination. The clinical manifestations of hyperthyroidism may overshadow the more subtle and varied symptoms and signs of primary hyperparathyroidism. It poses difficult diagnostic and therapeutic problems. Both diseases, however, may have a profound influence on calcium metabolism. The resulting disturbances in thyrotoxicosis may simulate hyperparathyroidism. Contrariwise, the diagnosis of an associated parathyroid adenoma may be missed, or unnecessarily delayed because hypercalcemia is known to occur in hyperthyroidism. The coexistence of thyroiditis and thyroid nodules with parathyroid disorders is also known. Graves� disease (GD) and primary hyperparathyroidism (PHPT) are two common endocrine disorders. However the co- occurrence of hyperthyroidism and primary hyperparathyroidism (PHPT) is rare. However, the link between the two disorders remains unclarified. Hypercalcemia in Graves' hyperthyroidism should warrant a thorough investigation for concomitant primary hyperparathyroidism. Concomitant thyroid nodular disease and hyperparathyroidism (PHPT) disease has been also documented. PHPT is also reported in patients with thyroid malignancy. We hereby report a rare case of a patient who presented with coexistence of Hyperparathyroidism and Multinodular Goiter with Hashimotos Thyroiditis and Hyperthyroidism.

A rare case of tuberculous polyserositis � A case report

Polyserositis is defined as chronic inflammation of several serous membranes with effusions in serous cavities like Pericardial, Pleural and Peritoneal membranes, resulting in fibrous thickening of the serous membranes and sometimes constrictive pericarditis. There are various causes of polyserositis which include autoimmune diseases, neoplasia, endocrine diseases, drug � related causes and infectious diseases such as tuberculosis. Polyserositis in disseminated TB is a very rare presentation. Diagnosis is often delayed due to the non-specific presentation like polyserositis and its unusual nature. We herewith report a rare case of TB polyserositis, involving pleura, pericardium and peritoneum.

Miliary Tuberculosis with Addisons Disease - in old case of pulmonary tuberculosis, and tuberculosis of seminal vesicles - A rare case report

Addison's disease is a rare endocrinal disorder that was first described by Thomas Addison in 1855. Addison抯 disease occurs as a result of a lack of production of adrenocortical hormones, which is a rare but fatal disease if left untreated. The two most common causes of Addison's disease are autoimmune adrenalitis and tuberculosis which refer to hypoadrenalism caused by total or near total destruction or dysfunction of both adrenal cortices. Usual manifestations involve chronic fatigue, muscle weakness, loss of appetite, nausea, vomiting, diarrhoea, hypotension, and hyper pigmentation of the skin. A substantial proportion of patients presenting with extra-pulmonary tuberculosis (TB) have urogenital TB (UG-TB), which is easily under diagnosed because of non-specific symptoms, which are chronic and have cryptic protean clinical manifestations. Most of the clinician are not aware of the possibility of UG � TB. Calcification of seminal vesicle found in this case is a rare condition, which is commonly associated with diabetes, hyperparathyroidism, and genitourinary tuberculosis. We here in report a rare case of adrenal insufficiency due to miliary tuberculosis involving adrenal gland, old pulmonary tuberculosis and genitourinary tuberculosis (seminal vesicles calcification) in a 31 year old male person. He presented with multiple episodes of vomiting, and giddiness which wasalso accompanied with atypical hyperpigmentation. His symptoms resolved after starting anti tuberculous therapy.

Randomized Control Study of Nebulized Colistin as an Adjunctive Therapy in Ventilator?Associated Pneumonia in Pediatric Postoperative Cardiac Surgical Population

Background:Ventilator?associated pneumonia (VAP) with multidrug?resistant (MDR) gram negative organisms is a common problem in intensive care unit (ICU). Aerosolized antibiotics enhance the efficacy of systemic antibiotics when added as adjuvants. Aim: The primary objective of the study was to compare the clinical and bacteriological outcome of patients with VAP who were administered intravenous (IV) antibiotics alone with those patients who were treated with adjunctive nebulized colistin (NC) along with IV antibiotics. The secondary objective was to study the occurrence of any adverse events during colistin nebulization. Settings and Design: The study was a prospective, randomized, double?blinded controlled study conducted at a tertiary?care teaching institution. Materials and Methods: Ninety?eight children from surgical ICU aged less than 12 years who were diagnosed with VAP due to gram negative bacteria following cardiac surgery were chosen and divided randomly into two groups. The experimental group (NC group) was treated with systemic antibiotics along with NC, whereas the control group (NS group) was administered systemic antibiotics with nebulized normal saline (NS). Clinical and bacteriological outcomes were noted. Statistical analysis was done using SPSS Version 20.0 software. The patient characteristics were compared using independent Student’s t test and Chi?square test. Results: There was a statistically significant reduction in the duration of mechanical ventilation, postoperative ICU and hospital stay (P < 0.05) in the NC group compared with the NS group. Conclusion: Aerosolized colistin may be considered as an adjunct to systemic IV antibiotics in pediatric patients with VAP due to gram negative bacteria susceptible to colistin.

Inadequate Response to Adenosine Infusion During Cardiac Stress Magnetic Resonance Imaging

Aim:To determine the factors associated with an inadequate response to adenosine infusion during cardiac stress magnetic resonance imaging (MRI). Study Design: It is a retrospective cohort study. Introduction: Stress cardiac MRI is a highly accurate and non?invasive method to diagnose coronary artery disease (CAD). Stress MRI is performed by inducing stress with adenosine infusion.There is an increase in systemic andmyocardial blood flow (MBF) with vasodilator agents. Capillaries are maximally dilated in a diseased artery and cannot sustain increased myocardial oxygen demand. It results in delayed delivery of contrast, which leads to an area of perfusion defect in the myocardium. These perfusion defects can be accurately seen by cardiovascular magnetic resonance (CMR) and help in the prognosis of patients. Methods: A retrospective study on patients subjected to cardiac stress MRI was conducted in a Tertiary Care Cardiac Center from January 2019 to January 2022. In total, 99 patients underwent adenosine stress perfusion cardiac MRI. All patients received an adenosine infusion of 140 mcg/kg/min for 2 min. Subsequently, the dosage was increased by 20 mcg/kg/min every 2 min to a maximum of 210 mcg/kg/min until an adequate stress response was achieved. Adequate stress was defined as two or more of the following criteria: 1) Increase in heart rate >/= 10 beats perminute. 2) Decrease in systolic blood pressure SBP by >/= 10mmHg Symptoms like chest discomfort, breathlessness, and headache. Patients who satisfied two or more of the above criteria were labeled as responders and the patients who did not satisfy the above criteria with the maximum dose of 210 mcg/kg/min of adenosine infusion were labeled as non?responders. Multivariable logistic regression analysis with forward and backward stepwise selection was used to identify predictors in non?responders. Basic demographic variables with P value </= 0.2 were examined for inclusion in the model. A P value </= 0.05 was considered significant. Results: Nine patients (9.1%) showed inadequate stress response to adenosine infusion even with a maximum dose of 210 mcg/kg/min. Multivariate logistic regression analysis showed that left ventricular end?diastolic volume (LVEDV) was a predictor of inadequate response to adenosine infusion. Conclusion: Inadequate stress response to adenosine occurred in 9.1% of subjects with an infusion of 140–210 ug/kg/min. LVEDV is an independent and strong predictor in non?responders.

A study to assess the effectiveness of warm foot bath therapy on the reduction of blood pressure among hypertensive patients attending a tertiary care setting

Background: The goal of hypertension management is to keep blood pressure within normal bounds while also enhancing elderly patients’ quality of life and health. Warm foot baths are a straightforward, affordable, and effective therapy method that can be used in naturopathy to alleviate hypertension. Materials and Methods: This study used a quasi-experimental design that included two groups, the hypertensive intervention group and hypertensive control group, which was studied over 3 months between March 2020 and May 2020. The necessary ethical committee permissions with reference number VMRF/2020/037 and informed consent from all the patients included have been obtained properly before proceeding with the study. Results: Among the 100 individuals involved in the study, 53% were males and 47% were females. The mean age among the intervention group was 53.62 ± 7.26, and 52.84 ± 6.47 among the control group. The majority of the males included in the study were nonsmokers (69.8%). The mean ± standard deviation of systolic blood pressure (SBP) and diastolic blood pressure (DBP) in the intervention group during the pretest phase was 157.3 ± 13.4 and 88.1 ± 9.4, whereas, after the intervention of foot bath therapy, the measurements of SBP and DBP were reduced significantly to 133.8 ± 9.7 and 76.9 ± 7.2, which was statistically significant with a P value < 0.001. Conclusion: Warm foot bath soak therapy is anticipated to be used as a nonpharmacological treatment for hypertension in older patients.

Clinical Outcome of Direct Pulp Therapy in Primary Teeth A Systematic Review and Meta-analysis

Background: Direct pulp treatment is carried out when a healthy pulp gets mechanically/accidentally exposed during the operative procedures or trauma. Aim: To determine the effects of various direct pulp capping materials as measured by the clinical and radiographic analysis. Design: Two reviewers performed a database search of the studies published between January 2005 and November 2020. The inclusion criteria were papers published in the English language; children aged 3–12 years having deep carious lesions in primary teeth. All potential studies were acknowledged by their title and abstract. The full-text analysis of potentially relevant studies, the selected studies were included in the systematic review. A meta-analysis calculation was performed for the overall data and the subgroup data. Results: The database searching led to 57 articles, which were of direct pulp treatment in primary teeth, after the removal of duplicates, 55 records remained but did not meet all inclusion criteria. A high variability was observed among the papers. Further filtering with criteria led to nine articles, which met all inclusion criteria. Meta-analysis demonstrated the success rates of DPT in primary teeth (95% confidence interval −0.799–0.898); P < 0.001. Clinical assessments of various direct pulp capping materials suggested 84.9% of success irrespective of the material used. The nine studies were heterogeneous according to the random effect model (P < 0.001, I2 = 84.08%). Conclusions: Direct pulp treatment has the advantage of being a conservative vital pulp therapy reducing the need for a more invasive treatment.

Comparative evaluation of antimicrobial efficacy of silver diamine fluoride, chlorhexidine varnish with conventional fluoride varnish as a caries arresting agent. An in vivo sodium dodecyl sulfate-polyacrylamide gel electrophoresis study

Introduction: Silver diamine fluoride (SDF) is employed as an adjunct cariostatic agent in the management of dental caries in high-risk population. Other than fluorides, chlorhexidine (CHX) is the most potent antimicrobial and efficacious agent against Streptococcus mutans. Aim: The aim of this study is to evaluate and differentiate the efficacy of 38% silver diamine fluoride, CHX varnish, and fluoride varnish on carious primary teeth. Materials and Methods: Ninety children having a count of ?1 carious lesion were recruited. Thirty-eighty percent silver diamine fluoride or fluoride varnish and CHX varnish were topically applied on the lesion. The primary outcome measured was the arrest of carious lesion (lesion rendered inactive as per the Nyvad criteria) after a follow-up of 14–21 days. Dental biofilm sample was obtained from each child and subsequently assessed for microbial composition by colony-forming unit method before and after treatment followed by protein analysis by sodium dodecyl sulfate-polyacrylamide gel electrophoresis method. Results: Average proportion of arrested caries lesions in the SDF group was higher followed by CHX and fluoride varnish groups. Decreased total protein amount was found in SDF group. This proves that there is decrease in microbial load posttreatment in SDF group. Conclusion: Thirty-eight percent SDF is more effective than CHX varnish and fluoride varnish in arresting dentin carious lesions in young children.

Study of intrapartum fetal distress with the help of cardiotocography and its correlation with umbilical cord blood sampling

Background: Even in low risk mothers, fetal acidosis occurs as in high risk groups. Aim of fetal monitoring is to detect early response to intrauterine hypoxia and prevent irreversible neurological damage and death. Objective of this study was to correlate the intrapartum fetal distress with the help of cardiotocography CTG with umbilical cord blood sampling.Methods: A total 100 consecutive patients attending the labor ward were studied. Immediately at birth, before the baby’s first breath and before delivery of the placenta, the umbilical cord blood was collected as per the standard guidelines laid down in the standard textbooks. Fetal acidosis was assessed by umbilical cord arterial blood pH. Fetal acidosis was considered when umbilical artery pH <7.2. Cardiotocography features were used to clinically diagnose fetal distress.Results: Most of the mothers were multigravida. They belonged to the age group of 20-25 years. Only 18% had abnormal CTG. Out of 50 mothers with normal vaginal delivery, all had normal CTG. Out of 43 mothers who were delivered by LSCS, no one had normal CTG, 25 had indeterminate CTG and 18 had abnormal CTG. As CTG became abnormal, proportion of mothers with the thick meconium increased. NICU admission proportion increased as CTG changed from normal to the abnormal. There was a significant association between the abnormal CTG and the umbilical cord blood pH being acidic.Conclusions: CTG is a simple test, easy to perform and can alert obstetrician for necessary interventions in case of an abnormal CTG. It can detect fetal distress in labor thus helping to reduce neonatal morbidity by early intervention in cases of abnormal tracing.

Estimation of Serum Vaspin Levels in Humans as a Novel and Therapeutic Biomarker of Visceral Obesity

Background: Obesity is associated with metabolic complications and significantly increases the risk of developing insulin resistance. Visceral fat is potentially dangerous as it is the major player in the adverse metabolic consequences of obesity. In this context, one of the recently discovered and interesting adipokines that provide a new insight into the physiology, pathology, and treatment of obesity is vaspin. Vaspin is a visceral adipose tissue-derived serine protease inhibitor with insulin-sensitizing effects and its upregulation in obese individuals may be a defensive and a protective mechanism aimed to reduce insulin resistance in humans. Aims and Objectives: This study aims to determine the circulating serum vaspin levels in humans with visceral obesity to assess its association and link to obesity-related metabolic alterations. Materials and Methods: A cross-sectional study consisting of 120 obese subjects in the age group of 30–55 years having a body mass index (BMI) of ≥35 (Group I) and another 120 subjects of the same age group with a normal range BMI (Group II) was done with their measures of obesity and serum vaspin levels measured. Results: The obese subjects (Group I) showed significant differences in the BMI, measures of obesity, and the serum vaspin levels (P ˂ 0.001). Pearson’s correlation revealed that the serum vaspin levels were positively correlated with the measures of obesity. Conclusion: From this study, it can be demonstrated that vaspin may be used as a circulating biomarker for early identification of obesity-related metabolic alterations and vaspin also plays an important role in the pathogenesis of obesity and its related metabolic disorders.

Utility of surgical APGAR score in predicting post-operative morbidity and mortality in patients undergoing laparotomy – A prospective study

Background: The best model to determine the postoperative complications must be simple and easily applicable to the majority of surgical patients. The complications and their incidence should be precisely defined and estimated. The model should also have a low threshold to identify them. The ASA classification was initially intended as a means to stratify a patient’s systemic illness but not post-operative risk. Although the ASA classification has proved to be a predictive pre-operative risk factor in mortality models, its subjective nature and inconsistent scoring between providers make it less than ideal for performing evidence-based post-operative risk calculation. Aim of the study: The aim of the study was to determine the applicability of the Surgical Apgar Score in post-operative risk stratification for morbidity and mortality during the 30 days postlaparotomy. Materials and methods: In this study, 152 in-patient Visiting Government Stanley Medical College General Hospital from March 2017 to April 2018 had been studied. Patients undergone laparotomy at Department of General Surgery, Government Stanley Medical College were managed by a tier of doctors from anesthetic technicians, medical officer interns, medical officers, postgraduates in general surgery and anesthesiology and their consultants. Interns and postgraduates in general surgery provided the pre and postoperative care and participate in general surgical procedures whenever indicated. Anesthesiologists apart from providing anesthesia during surgery extended their care in the intensive care unit. Parimala, G. Venkatesh, P. Vijayaraghavan. Utility of surgical APGAR score in predicting post-operative morbidity and mortality in patients undergoing laparotomy – A prospective study. IAIM, 2019; 6(6): 67-74. Page 68 Results: 132 patients were operated as an emergency and only 20 patients were operated selectively. 86.8% of the surgeries were emergency laparotomies and only 13.2% of the surgeries were elective. This showed our efficient functioning and round the clock services of our emergency theatres. The most common causes in descending order include penetrating injury, intestinal obstruction, peritonitis, perforated duodenal ulcer, blunt injury abdomen, intra-abdominal abscess, hydatid cyst, obstructed hernia, mesenteric ischemia, cholecystitis. A significantly higher complication was noted among female patients at 63.2% compared to male patients at 33.3%. 43.9% of the postoperative complications occurred in emergency setting whereas only 20% of the complications occurred in the elective setting. When the complications were compared with the duration of surgery, those surgeries that lasted more than 120 minutes had a higher complication rate of 68.6% whereas surgeries with a shorter duration only had a complication rate of 26.7%. Conclusion: Surgical Apgar Score is very effective in identifying high-risk patients who are capable of developing significant complications following laparotomy within the first 30 postoperative days. This identification of high-risk patients helps us in the judicious use of healthcare resources towards the proper monitoring and follow up of these patients.

Comparative study between BISAP score and RANSON score in predicting severity of acute pancreatitis

Background: Acute pancreatitis has widely variable clinical and systemic manifestations spanning the spectrum from a mild, self-limiting episode of epigastric pain to severe, life-threatening, multiorgan failure. Since the morbidity and mortality of Acute Pancreatitis differ markedly between mild and severe disease (mild < 5% vs severe 20–25%), it is very important to assess severity as early as possible. Various scoring systems like APACHE II scoring, RANSON scoring and BISAP have been used to asses Severity in Acute Pancreatitis. Aim and objective: To assess the accuracy of BISAP scoring system vs RANSON scoring system in predicting Severity in an attack of acute pancreatitis. Materials and methods: In this study, 60 in-patients presenting with features of acute pancreatitis Government Stanley Medical College General Hospital from November 2016 to September 2017 had been studied. It was a perspective and a retro prospective study. BISAP score and Ranson’s score was calculated in all such patients based on data obtained within 48 hours of hospitalization. Results: According to Atlanta Revised criteria, 30 patients had mild pancreatitis, 20 patients had moderately severe pancreatitis, 10 patients had severe pancreatitis. Of the 60 patients, 37 patients had Ranson's score less than or equal to 3. 23 patients had a score of more than 3.Of the 60 patients, 39 patients had a BISAP score less than or equal to 3, 21 patients had a score more than 3. Conclusion: From this study, we can conclude that the BISAP scoring system is not inferior to Ranson’s scoring system in predicting the severity of acute pancreatitis. BISAP scoring system is very simple, cheap, easy to remember and calculate. BISAP scoring system accurately predicts the outcome in patients with acute pancreatitis. Moreover, the values in BISAP score are instantaneous and there is no time delay. Ranson’s score takes a minimum of 24 hours.

Variations In The Tributaries Of Inferior Vena Cava – An Anatomical Study In 50 Cadavers

Objectives: To document the variations in the tributaries of inferior vena cava (IVC) with double common iliacveins, retro aortic renal veins and to establish embryological and clinic-anatomical correlations of such variation.Materials and Methods: The findings were noted after thorough and meticulous dissection of the abdomen of 50cadavers in the department of Anatomy, Bhaskar Medical College, India. Photographic documentation of thevariation was also made.Results: Variations were reported in 2 cadavers.1) In one cadaver the left renal vein, after its origin from the kidney passed obliquely behind the abdominalaorta, joined the IVC at the level of 3rd lumber vertebra below the attachment of right crus of diaphragm. Left renalartery was normal in position.2) In another cadaver, there was a communication between the right internal and external iliac veins at the pelvicbrim anterior to the sacroiliac joint. From there two right common iliac veins, one appeared as continuation ofinternal iliac vein(common iliac vein I) and the other as a continuation of external iliac vein (common iliac veinII) ran upwards to join the IVC.Conclusion: The variation can be explained in the light of embryological development. In addition, knowledge ofsuch variation is important for carrying out surgical procedures in the abdomen

Sirenomelia: A Detailed Fetal Autopsy Study.

Sirenomelia also known as mermaid syndrome, characterized by fused lower limbs, is a lethal and rare congenital abnormality. This is an extreme example of caudal regression syndrome caused by vascular steal of single umbilical artery. Sirenomelia is found approximately one in 100,000 live births and is usually fatal because of complications associated with pulmonary hypoplasia, abnormal development of the kidneys and urinary bladder. Most of the cases are associated with maternal diabetes and single umbilical artery. We report a case of sirenomelia terminated at 21weeks of gestation due to multiple congenital abnormalities. Antenatal scan of a25-year old primi revealed a single live fetus of 21 weeks gestation with severe olighydramnios, non-visualization of kidneys and bladder and lower part of the spine. This pregnancy was terminated and the specimen sent to the department of anatomy for fetal autopsy. On external examination,a tail like rudimentary single midline lower limb without foot was noted. There were no external genitalia and anal orifice. Internal examination revealed hypoplastic lungs, atrial septal and ventricular septal defects, aberrant right subclavian artery, hypoplastic abdominal aorta distal to the single umbilical artery, complete agenesis of urinary system, rectal agenesis and rudimentary indeterminate gonads. We would like to discuss the clinical features, etio- pathogenesis and review of literature of sirenomelia. Early diagnosis and termination of this lethal congenital anomaly results in minimizing the trauma related to the termination of pregnancy at advanced gestation.

Use of Nicotine Gums, Tablets and Lozenges: A Review.

Difficulty quitting is best predicted by how much one smoke on a daily basis and smoking within 30 min of waking up each day, both of which are measures of nicotine dependence. It has now been established that tobacco smoking often involves dependence to nicotine. This is usually seen as a problem, but often as an opportunity. The cigarette is the most contaminated drug-delivery device. If nicotine is largely what the smoker needs, the use of nicotine from alternative sources to sustain smoking reduction could be exploited for long-term harm reduction to the smoker unable to quit.

A Comparative Study to Evaluate the Mechanical Properties of Zirconium Oxide Added Polymethyl Methacrylate by Two Different Methods at Two different Concentrations – In Vitro Study.

Background: Poly methylmethacrylate (PMMA) is one of the most commonly used denture base material. Various attempts have been used to strengthen acrylic resin by incorporating filler particles. Method: In the present study zirconium oxide is used as a filler material and a silane coupling agent is added for bonding with PMMA by two different methods that is sol gel method and functionalizing zirconium oxide with silane coupling agent. Result: The present study demonstrated a significant increase in impact strength, surface hardness as the percentage of ZrO2 fillers increased. Conclusion: From the study it was concluded that incorporation of Zirconium oxide to PMMA will increase in flexural strength, impact strength and hardness of PMMA and the mechanical property obtained by functionalizing nanoparticles method is better than sol-gel method.

A Study of Anomalies of Left Renal Vein.

Introduction: The left renal vein is preferred over the right in renal transplantation because of its longer length. It is important for the surgeons to know the course of the left renal vein and whether it is pre-aortic or not to avoid unexpected hemorrhage and even death. There are considerable no of radiological studies on Retro aortic Left Renal Vein but anatomical studies other than the Japanese were not found in the literature. In view of its anatomical, embryological, clinical and surgical importance the present study was undertaken. Materials and Methods : The present study was conducted in 60 adult cadavers (10 female and 50 male) allotted to 1st M.B.B.S and M.D P.G students at Pinnamaneni Siddhartha institute of medical sciences & research foundation Gannavaram & N.R.I. Academy of Medical Sciences, Andhra Pradesh, India for routine dissection over a period of 5 consecutive years (2010-2015). Results: Left Renal Vein anomalies can be classified into 4 types in the literature.Type1 is the most common in its occurrence followed by type 3,2and 4.Type 4 was rarely reported .In the present study the percentage of incidence of type 1, type 2 and type3 are 6.6%,1.6%,3.3% respectively and type 4 was not observed. Conclusion: Knowing the variable expressions of the renal venous system allows better understanding of the clinical events. Pre operative CT can be considered mandatory as it helps in safe surgical outcome particularly in the retro peritoneal area.