Background: The incidence of NTDs is also relatively high in Indian and Eastern Mediterranean populations. The care of these patients requires evaluation and attention to primary lesion and also to the affected systems outside the nervous system, at present and during the life long follow up many of these patients require. Objective: The purpose of study was to evaluate the role of magnetic resonance imaging (MRI) in characterizing the congenital and developmental disorders of spine. Methods: Total 70 patients with clinically suspected spinal dysraphism were included in the study. All the patients were made to undergo MRI spine using GE 1.5 Tesla MRI after taking informed consent for the same. The findings of MRI spine were assessed and analyzed. Results: There is female predominance, female to male ratio being 36:24. The peak occurrence of congenital spinal lesions is seen in age group 0-20 years (70%) and more common is females than males (36:24). Spina bifida is commonly associated with tethered cord (66.7%) followed by Syrinx (56.7%), Diastematomyelia (36.7%) and thick filum terminale (20%). Conclusion: Magnetic resonance imaging (MRI) is an accurate & noninvasive modality for characterizing and diagnosing these disorders of spine. It was also found that magnetic resonance imaging is superior in defining these lesions, which is a big advantage over other imaging modalities.

Background: Diabetics are more prone to infections than their non diabetic counterparts. The urinary tract is the most common site of infection in diabetes mellitus patients. Urinary tract infections (UTIs) most of the time in diabetic patients are relatively asymptomatic, which can lead to renal failure and severe kidney damage. A combination of local risk factors and host factors in diabetes mellitus lead to bacteriuria commonly compared to non diabetics. Objective: To evaluate clinical presentation, need for hospitalisation, microbiology and outcome of UTI in diabetes mellitus. Methods: This prospective, descriptive study was conducted at Kerala Institute of Medical Sciences, a tertiary level multispecialty hospital in South India to study the clinical profile of UTI (clinical presentation, need for hospitalisation, microbiological profile and outcome) in Diabetes mellitus; also to find out reasons for hospitalisation and for UTI in Diabetes mellitus. Results: Among study population, 24% patients were in age group of 30 to 50 years, 52% patients were in age group of 51 to 70 year, 13% were in 71 to 80 year group. 32% (32patients) had growth of E. coli in urine, 14% (14 patients) had growth of k. pneumonia, 10%(10 patients) had growth of proteus, 9% (9 patients) had growth of S. aureus, 5%(5 patients) had growth of C. perfringens, 5% (5 patients) had growth of candida, 4% (4 patients) had growth of pseudomonas and Enterococcus. 52% (52 patients) had sepsis as the reason for hospitalization, 32% (32 patients) had fever as the reason, and 14% (14 patients) had flank pain as the reason and 1 patient each had pelvic pain and vomiting as the reason for hospitalisation. 18% (18 patients) had renal dysfunction and 32% (32 patients) had proteinuria. Conclusion: UTI requiring hospitalization in Diabetes mellitus was more common after 50 years of age and equal in men and women. Diabetics are at risk of an increased susceptibility to infections of the urinary tract and occur with increased frequency and severity, and complications are more common.

Background: Adenosine deaminase (ADA) is considered a valuable tool in the diagnosis of extra pulmonary tuberculosis. Objective: To evaluate the role of ADA and L/N ratio in the diagnosis of tuberculous pleural effusion in patients with exudative pleural effusion and to analyze the cause of non tuberculous exudative pleural effusion. Methods: This hospital based prospective study was conducted from November 2017 to November 2018 with a total number of 100 patients of exudative pleural effusion who were admitted in medical wards of Chalmeda Anand Rao Institute of Medical Sciences, Karimnagar, India. Patients with transudative pleural effusion, age less than 12years and those who were hemodynamically unstable were excluded from the study. Results: A total of 100 patients with exudative pleural effusion were analyzed, of which 69 were males and 31 females. maximum number of cases were seen in age group between 21 and 40 yrs. Total ADA was found to be >40U/L in all cases of TB effusion. All cases of TB effusion were lymphocyte predominant with L/N ratio > 0.75. In case of exudative pleural effusion due to non tuberculous etiology L/N ratio was < 0.75. Conclusion: 100 cases of exudative pleural effusion were analyzed based on Total ADA and L/N ratio. 80 cases were due to tuberculosis. ADA value of >100 U/L was observed only in tuberculous effusion. L/N ratio was >0.75 in 80 cases of TB effusion and in none of the non tuberculous effusion. Combined use of ADA and L/N ratio is more efficient means for diagnosing tubercular pleural effusion than the use of ADA alone.

Background: Recently, interest has been generated in using cystoscopy as an adjunct in management of urethral stricture disease owing to its diagnostic and therapeutic capabilities. However the feasibility of this technique as an adjunct for diagnosing and management of PFUDD are limited. Objective: To assess the advantage of performing the antegrade and retrograde cystoscopy during PFUDD repair Methods: Thirty one perineal urethroplasties combined with antegrade and retrograde cystoscopy was performed on study participants from 2014 to 2018. Informed consent was obtained from all patients. The etiology of lesions, findings of RGU/MCU and operative records of the patients was evaluated, with particular focus on antegrade and retrograde cystoscopy findings during urethroplasty. Data on postoperative outcome were also assessed. Results: We performed 31 perineal urethroplasties in thirty one patients with mean age of 38 (17- 72) years. The mean defect length was 2.5 cm (range 1-7.5 cm). All the defects were located in posterior urethra however one patient had urethro-cutaneous fistula located in anterior urethra. Lesions were secondary to pelvic trauma in all the patients. Mean duration of follow up was 19 (3-38) months. In 27 patients controlled physiological micturition was achieved without any additional intervention. The mean maximum urine flow was 16.5 ml/s and average flow was 12 ml/s on uroflowmetry (Fig 8). However in 2 patients optical urethrotomy was required at 3 months post procedure and in other 2 patients metallic dilation was needed after three weeks post catheter free trial. Conclusion: Cystoscopy is an easy to perform adjunctive modality in PFUDD repair and can be used without incurring any considerable additional cost.

Background: The management of gastric outlet obstruction poses diagnostic and therapeutic challenges to general surgeons practicing in resource-limited countries. The outcome of treatment of gastric outlet obstruction may be poor especially in developing countries where advanced diagnostic and therapeutic facilities are not readily available in most centers. Objective: To evaluate the variable presentations and management options of gastric outlet obstruction (GOO) in a tertiary care centre, Karimnagar. Methods: The study was a prospective follow up study; total 30 patients of Gastric outlet obstruction (GOO) have been included in this study. Patients have been selected from those attending to General Surgery Department, Chalmeda Anand Rao Institute of Medical Sciences during the period of November 2015 to November 2017. Results: Out of 30 cases studied 20 cases are males and 10 females with GOO patients. The male to female ratio was 2:1. With regards to individual etiologies carcinoma stomach male to female ratio 1.4: 1 and chronic duodenal ulcers are seen in ratio of 2.5:1. Conclusion: In present day, carcinoma stomach appears to be the most common cause of gastric outlet obstruction. Malignant GOO had poor prognosis and mostly palliation is done. It focuses on the fact that there is delayed presentation with patients of upper gastro intestinal malignancy.

Background: HER2 is an important biomarker in gastric and gastroesophageal junction tumors. Expression of HER2 status by immunohistochemistry is heterogeneous in various patient populations. This overexpression appears to be an important prognostic factor in gastric cancer and its association with other poor prognostic factors may therefore act as a surrogate marker for poor prognosis in gastric carcinoma. We studied our patient population to look for any such association between HER2 status and various clinicopathological parameters. Objective: To study the association between HER2 status and various clinicopathological parameters. Methods: Patients were prospectively enrolled from August 2013 to March 2015. All relevant patient parameters were recorded. After curative resection, surgical specimens of gastric and gastroesophageal junction adenocarcinoma were analyzed for immunohistochemistry for HER2 by using standard methods. IHC score followed Hofmann's criteria. Statistical analysis of relation between HER2 status and relevant patient and disease characteristics such as gender, age at diagnosis, tumor location, histological type of tumor, stage, and size of tumor, was performed. Results: 106 patients were enrolled into this study. Only 18 (17%) cases had HER2 score of 3+, whereas 5 (4.7%) had equivocal score (2+) and the remaining 84 (78%) tumors tested negative. HER2 status was significantly associated with location of primary tumor, gender, histopathological type of cancer, and size of primary tumor. There was no significant relation between HER2 status and age of patient, depth of invasion, nodal metastasis, or overall stage. Conclusion: Further studies are necessary to determine the significance of HER2 status in upper gastrointestinal cancers especially that the patients need follow up where we can predict the HER2 status as an independent prognostic factor for overall survival.

Background: Burden of disease in India (2005) had estimated that there had been an increase in number of stroke cases in India during the last one and a half decade by 17.05%, thus showing worrying upward trends of disease Objective: To investigate the profile, risk factors, and clinical outcomes in patients with acute stroke. Methods: The study design was prospective observational study was conducted including 65 patients aged more than 18 years admitted in medical wards from November 2017 to April 2018. Detailed clinical profile and investigations were done. Results: Total 70 patients were included in this study. There were more male percent (36.17%) than females (63.83%). The age distribution between the Male and Female and association between the age and gender is found not significant at 5% level of Significance. All patients underwent computed tomography or magnetic resonance imaging; 81% had cerebrovascular imaging.. Conclusion: In conclusion, recovery from acute stroke which found to be highly significant at 5% level of significance.

Background: The haemodynamic responses to laryngoscopy and endotracheal intubation have been recognized since 1951. Objective: To compare the efficacy of bolus administration of IV Esmolol and IV Fentanyl to suppress the pressor response during laryngoscopy and endotracheal intubation. Methods: 75 patients of ASA physical status I & II undergoing elective surgical procedure under General Anesthesia with endotracheal intubation were included in the study. Patients belonging to age group of 18-60 years of both sexes were included. The present study was done at Chalmeda Anand Rao Institute of Medical Sciences, Karimnagar during 2014 to 2016. Results: Total 75 patients under this study were categorized into 3 groups. They comprised both sexes with age ranging from 18-60 years. There is high statistically significant difference in mean heart rate across the 3 groups (p < 0.001). The mean heart rate, blood pressure and mean arterial pressure of the esmolol group are the least and this difference with the control group and fentanyl group are statistically significant. Conclusion: We concluded that bolus injection of esmolol (2mg/kg) given 3 minutes prior to intubation provided consistent and reliable protection against increases in mean heart rate and mean systolic and diastolic blood pressure during laryngoscopy and endotracheal intubation and thereafter, compared to control group and fentanyl group.