Background: Incorrect placement, or subsequent displacement, of feeding tubes into the lower oesophagus or into the lung can lead to aspiration, respiratory compromise, and increased energy expenditure. These effects are potentially detrimental to growth and development. Enteral feeding tubes passed via the nose may be easier to secure to the face than orally placed tubes. In children, orally placed enteral tubes are more frequently malpositioned compared to nasally placed tubes.⁶ Furthermore, orally placed tubes may be easier to displace as they can loop inside the mouth. Objective: To determine the effect of nasal compared with oral placement of enteral feeding tubes on feeding, growth and the incidence of adverse consequences in preterm or low birth weight infants. Methods: Preterm neonates admitted to NICU during the study period were stabilized initially (temperature, perfusion, respiratory status, blood sugars) and feeds were started. Infants were randomised to receive either nasogastric or orogastric feeding. Feeds were given over 10 - 20 minutes by gravity drainage every two or three hours. Results: Nasogastric tube feeding appears to be superior to orogastric tube feeding with less frequency of tube displacement. There is no difference among 2 groups in time to regain birth weight, time to full feeds, and frequency of adverse events. Nasogastric tube feeding group had lesser duration of hospital stay compared to the orogastric tube group, and orogastric tube feeding group reached to oral feeds quickly compared to nasogastric tube feeding group, however, this was not statistically significant. Further good quality randomised controlled trials with a larger population would probably be required to know the significance of this outcome. Conclusion: This study provides sufficient evidence to practice nasogastric tube feeding over orogastric tube feeding in preterm or low birth weight infants.

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Background: There are about 1.2 billion adolescents, a fifth of the world's population and their numbers are increasing. Hence it is essential to assess their nutritional status. Objectives: To study the nutritional status of rural adolescents, to determine the type of malnutrition among them. Methods: The study was conducted among 100 adolescents (12-18 years) of both the sexes in the rural primary health centre Guttigar, Sullia Taluk of Dakshina Kannada district, Karnataka between April - June 2014. Results: Study found that 64% had chronic energy deficiency, 19% - underweight, 16% - normal and only 1% was overweight. it was observed that there was a significant association between BMI and sex; BMI and Age. Conclusion: Findings of the present study indicate that under nutrition is the major problem of adolescents than overweight or obesity. Therefore the study suggests a need to adapt a strong nutritional intervention programme.

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Background: Many biologic processes require a balance between the proteases that initiate the proteolytic pathway essential to life and inhibitors that limit excessive protease activity. Amongst protease inhibitors, serpins appears to control the key intracellular, extracellular pathway. Objective: The study was conducted with an aim to show a relationship between the concentration and activity of protease inhibitors, level of antioxidants (Vitamin C, Vitamin E, and reduced glutathione) and development of obstruction airway disease and bronchiectasis. Methods: A hospital based cross sectional study was carried out among smokers and non smokers. Institutional Ethics committee permission was obtained prior the study. Informed consent was obtained from each and every study and control group patients. The study was conducted over a period of one year. The study included 56 patients in study group out of which emphysema 9 patients, COPD 12 patients, bronchiectasis 14 patients, and bronchial asthma 21 patients. Control group included 25 patients with no respiratory complaints and normal PFT. All patients who satisfied inclusion criteria are included in the study. Results: Our study shows that there is no relationship between the concentration and activity of alpha 1 AT with pulmonary function test. There is no difference between the concentration of alpha 1 AT among smokers and nonsmokers. Alpha 2 MG levels were increased in all pulmonary diseases that we had studied as compared with the normal control group. Levels of Vitamin C are decreased in severe airway obstruction as compared with individuals showing normal pulmonary function test and also are lower in patients with bronchiectasis, COPD, emphysema. Levels of Vitamin E are lower in individuals with mild, moderate and severe airway obstruction as compared with individuals showing normal pulmonary function test, though it is not statistically important. Conclusion: There is an increase in the concentration of reduced glutathione among patients of study group as compared with the normal control group.

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Ocular trauma is one of the most common reasons for ophthalmology consultation in emergency department. Ultrasonography is a non-invasive simple and effective diagnostic method which enables visualization and evaluation of intraocular injuries in opaque media. CT orbit can detect certain types of foreign bodies, lens dislocation, rupture globe, choroidal or retinal detachment, and cavernous sinus thrombosis and thus compliments bedside ophthalmic examinations which are limited in the setting of trauma. MRI is an important modality in special circumstances such as soft tissue assessment or with organic foreign bodies.

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Chemotherapy regimens most commonly used are Bonnadonna designed CMF (Cyclophosphamide Methotrexate 5fluorouracil), doxorubicin based CAF (Cyclophosphamide Adriamycin 5fluorouracil) or AC (Adriamycin Cyclophosphamide) regimen along with hormonal therapies which have been shown to significantly control disease progression, relief from symptoms and improve survival. Because of substantial evolution in the management of advanced breast carcinoma neoadjuvant treatment with chemotherapy is being used increasingly with minimal possible side-effects. Hence CAF and CMF have been tried in the present study to observe the feasibility and efficacy of neoadjuvant chemotherapy in cases of locally advanced breast cancer. CMF (Cyclophosphamide Methotrexate 5fluorouracil) was used in 66.67% of cases and, doxorubicin based CAF (Cyclophosphamide Adriamycin 5fluorouracil) was used in 33.33% of cases. All patients on chemotherapy developed the side effects of GIT, Hematological and alopecia. Of all the patients, 25 needed all six cycles of chemotherapy, three were given only one cycle and two patients were given only two cycles of chemotherapy. Radiotherapy was given in 92% of patients. The response of advanced breast cancer to treatment with combination chemotherapy along with hormonal therapy is an index of nature of the carcinoma and this response provide a guide for the selection of further treatment. Therefore, careful serial recording of the objective measurements of any change in lesions is invaluable as an aid in evaluating the nature of the response.

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Background: Assessment of severity by echocardiography includes two-dimensional planimetry of the valve orifice and doppler-derived measurements of the gradient, pressure half-time (PHT), and deceleration time. For that Transesophageal echocardiography (TEE) or transthoracic echocardiography (TTE) can be used. Data regarding the comparison of TEE and TTE in assessment of severity of MS during mitral valve replacement surgery is inadequately available. Objective: To assess severity of MS using TTE and TEE compared with actual MVA measured directly with the help of Hegar's dilator. To determine the superiority of TEE over TTE. Methods: The present prospective observational study was carried out in the department of Anesthesiology (CVTS OT), Government Medical College and Superspeciality Hospital, Nagpur from November 2012 to October 2013. Thirty five patients of MS undergoing mitral valve replacement surgery were included in present study. For every patient, after the induction of general anesthesia TTE and TEE was performed and primary outcome measures were noted. During the mitral valve replacement surgery, after opening left Atrium, direct measurements of MVA were done with the aid of Hegar's dilator in every patient. Results:The mean age was 35.26±10.35 years, mean weight was 54.26±9.62 kg; mean height was 155.97±5.61 cm. There were 15 male and 20 female patients in the study. When TEE and TTE were compared with direct measurement, it was found that both the methods were comparable i.e. as per our hypothesis, TEE was not found superior over TTE. Conclusion: Based on these study findings, we conclude that both TEE and TTE are comparable and no method is superior over the other.

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Government of India (GOI) declared 2012-13 as the year of Intensification of Routine Immunization (IRI) for rapidly raising the coverage in needy states/districts and blocks depicted by DPT3 coverage as per DLHS 3 2007-08. This simulation pilot study was conducted with the objective of operationalizing one of the key strategies of conducting 4 Immunization Weeks (IWs) in 4 successive months and to share the operational impact for statewide application in Jharkhand. Method comprised intervention with enumeration format for enumerating cum line-listing and 4 in 1 format for preparing subcentre level micro-plan blended with supportive supervision, data collection/analysis/providing technical assistance and feedback. Results were encouraging with significant rise in vaccination coverage: in the rural area, BCG coverage rose from 89 to 98%, DPT 3 from 75 to 99%, Measles 1^st dose from 78 to 93%, DPT Booster from 58 to 86%, OPV booster from 44 to 85% and Measles 2^nd dose from 41 to 84%. In the urban area all three rose to 68%; DPT booster from 33%, OPV booster from 19% and Measles 2^nd dose from 12%.

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Background: A wide spectrum of cutaneous manifestations ranging from Maculopapular rash to severe Toxic Epidermal Necrolysis (TEN) can be produced by different classes of drugs. Some severe ACDRs may result in serious morbidity and even death. Objective: To assess the causality and identify the offending drug. Methods: The present hospital based study was carried out for a period of one year at Mahatma Gandhi Memorial Hospital, Warangal. The study subjects were those who had adverse cutaneous drug reactions. Patients willing to participate in the study with ACDR were included. Any cases with doubtful drug reaction were excluded. Complete history was taken and detailed clinical examination was done. Regular follow up of cases was done. Data was entered in the Microsoft Excel Worksheet and analyzed. Results: Maculopapular rash and FDE were commonly caused by Antibiotics, while urticaria was due to NSAIDs and Acneiform eruptions was caused by Steroids. Severe Cutaneous Adverse Reactions (SCARs) was seen in 7 patients. Amongst SCARs, SJS followed by TEN and AGEP was seen in 4, 2 and 1 case respectively. Antibiotics were the commonest offending agent for SCARs. Antimicrobials were the commonest offending group of drugs responsible for the adverse cutaneous drug reactions; however when individual drugs were considered, Diclofenac was leading drug followed by Amoxicillin and Phenytoin. Commonest reaction caused by NSAIDs was Urticaria followed by Maculopapular rash. Antiepileptics and Antipsychotics commonly caused Maculopapular rash whereas FDE was commonly seen with Antibiotics. Acneiform eruption was commonly caused by Systemic Steroids followed by SSRIs. Conclusion: Antimicrobials as a group were the most common offending agents. However, when individual drugs were taken into considerations then Diclofenac (15%) followed by Amoxicillin (9%) and Phenytoin (8%) in the order were the offending drugs.

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Dermatoglyphics is the study of patterns and configurations on volar aspects of hands and feet. This helps in identifying patients suffering from medical diseases and to screen relatives of patients with chromosomal disorders. The objective of present study was to use Dermatoglyphs as a diagnostic tool to identify children suffering from Atrial septal defect (ASD) by comparing dermatoglyphs of 100 children with congenital heart disease aged between 3-12 years with that of dermatoglyphs of 100 normal children (controls – CON) of same age group. Among the parameters analyzed in the present study, ulnar loops showed increased percentage incidence (65% in ASD and 56% in CON) and whorls showed decreased percentage incidence (25% in ASD and 34% in CON) are statistically significant. Incidence of Hypothenar patterns showed statistically higher values in children with ASD (25% right hand & 14% left hand) incidence in control group is less (9% right hand & 8% left hand). Incidence of statistically significant wider atd angles is higher in children with ASD (50% in right, 61%in left) and less in control group (16% in right, 15%in left). Hence, Dermatoglyphs may be used as a diagnostic tool to identify atrial septal defect in children with a family history of congenital heart diseases.

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Spontaneously regressing retinoblastoma is a retinal lesion consisting of one or moregray, translucent retinal masses, calcified nodules and retinal pigment migration and clumping in adjacent areas. Female child of 7 years presenting with esotropia LE was referred from pediatric Ophthalmology department to Vitreo-Retinal clinic of Sarojini Devi Eye Hospital, Hyderabad for fundus evaluation. Vision in RE is 6/6. LE –Perception of light positive, PR inaccurate in all quadrants. RE anterior segment examination is unremarkable and in LE – relative afferent pupillary defect. On fundus examination, RE – Normal, LE – Large circumscribed excavated area temporal to optic disc noticed. Spontaneously regressed retinoblastoma carries the same genetic implication as an active retinoblastoma.

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Background: Tumors within the cord are referred to as intramedullary and account for 10-15% of spinal tumors. Intramedullary tumors consist mainly of astrocytomas and ependymomas making up to 70% of intramedullary tumors. Other lesions include hemangioblastoma, paraganglioma and cystic lesions. Objective: To study and correlate the pathological and radiological features of spinal lesions Methods: The study included all the specimens of spinal cord lesions received at Upgraded Department of Pathology, Osmania General Hospital over a period of three years from June 2010 to May 2013. Relevant clinical data and imaging details were also reviewed. Results: Cervical region include 8 cases [16%] with [2 non neoplastic and 6 neoplastic], Thoracic region constitute 28 cases [54%] with [8 non neoplastic and 20 neoplastic], Lumbosacral region constitute 29 cases [30%] with [18 non neoplastic and 11 neoplastic]. Most common symptom was Motor weakness followed by Pain, Sensory disturbance and Bladder dysfunction. Among spinal cord tumors common were Schwannomas [32%] followed by Neurofibromas [22%], Ependymomas [11%], Meningiomas [11%], Astrocytomas [8%], and Teratomas [5%]. Conclusion: Meningomyeloceles were common non neoplastic lesions and most were found in lumbosacral region, extradurally whereas schwannomas were common neoplastic lesions and most seen intradural extramedullary in thoracic region with both having slight female predominance. Ependymomas and astrocytomas were common intramedullary tumors whereas schwannomas, neurofibromas and meningiomas were common intradural extramedullary tumors.

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Background: Emphasis will be given usually for personal problems like smoking, unhealthy diet and physical activity as the causes for cardiac morbidity, often ignoring the underlying family problems. Objectives: 1) to study the family problems causing cardiac problems/diseases and 2) to advise the families regarding the mitigation of the preventable family problems. Methods: A descriptive study was conducted in both urban and rural communities of two health centres. Statistical techniques used were proportions and X² test. Two resident doctors enquired 150 patients suffering from cardiac diseases/problems and collected information using a pretested questionnaire regarding the family problems: Family size, financial difficulties, dowry problems, lonely living, kith & kin problems etc. A group meeting was also conducted with an intention to educate the patients and their family members regarding the mitigation of these family problems and prevention of the cardiac problems. Results: Cardiac problems, especially, hypertensive heart disease and conduction defects were seen in patients in the age group of 40-60 years,(53%) urban (54%) middle class (56%)patients. The main family problems associated with cardiac problems were: Large family size (95%), nuclear families (78.6%) and financial problems like loans, property losses (83%) and dowry problem for unmarried daughters (31%). Conclusions: People belonging to large families with financial stress and other social problems appeared to be the victims for the cardiac problems.

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Current study is to evaluate the dermatoglyphs, which can be used as a diagnostic tool for an easy, economically viable and early detection of ventricular septal defect (VSD), a congenital heart disease in children with a family history. Hand prints were taken by the INK METHOD described by Cummins & Midlo (1961). The dermatoglyphs of 100 children with congenital heart diseases aged between 3 to 12 years were compared with dermatoglyphs of 100 normal children (controls – CON) of the same age group. Present study showed statistically significant increased percentage of incidence of ulnar loops in children with VSD (74%) than in controls (56%). Whorls showed significantly decreased percentage of incidence in disease group than in controls (17% - VSD, 34% - CON). Incidence of Hypothenar patterns showed statistically higher values in the disease group (34% - right hand & 23% - left hand) than in the control group (9% & 8%). Children with VSD showed statistically wider atd angles (62% - right hand & 65% - left hand) than in control group (16% & 15%). So Dermatoglyphs analysis may be used as a diagnostic tool to detect congenital heart diseases in children with a family history of congenital heart disease.

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It is rare for a pituitary adenoma to present with isolated 3^rd cranial nerve palsy. pituitary adenomas come into medical attention because of endocrine or visual abnormalities. Here is a 50 year old Female presented to OPDof mamata hospital, khammam with headache which was sudden in onset more on frontal region associated with vomiting and diarrhea, after few days patient again presented with unilateral left sided ptosis for which patient underwent thorough examination and found to have left sided dilated pupil with restriction of eye movements on left side. Patient underwent Subsequent routine blood investigations which were with in normal limits and hormone essays which showed hypothyroidism. MRI-Brain was done which revealed a pituitary macro adenoma. All the 3^rd nerve palsy features recovered slowly after few days with out any surgical intervention.

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Background: As population is affected with primary open angle Glaucoma is large. It is important to evaluate drugs which effectively control the intraocular pressure. These drugs must be financially cheaper, easily available and control the intraocular pressure effectively. Therefore we have planned in our study to know the effects of Brimonidine (alpha selective adrenergic agent) and Timolol (sympatholytic agent) on Glaucoma. Objective: To compare brimonidine and timolol in treatment of glaucoma Methods: A total of 100 patients of glaucoma were studied. They were divided into two groups. One group consisting of 50 patients received Timolol and the other group with same number received Brimonidine. They were followed for 6 months. Initially they were examined at 1^st week, 2^nd week and then every month till six month. The results were compared. Results: We found that timolol eye drops effectively reduced intra ocular pressure (IOP) when compared to brimonidine eye drops. The mean average IOP between these two drugs was found to be 1.9 actually. Brimonidine eye drops in initial phases of the study showed more variation in reducing IOP when compared to timolol eye drops. Conclusion: Timolol eye drops effectively reduced IOP in primary open angle glaucoma than Brimonidine when instilled twice daily.

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Background: It is observed that the patients of falciparum malaria with liver function abnormalities are more vulnerable to the development of dreaded complications of plasmodium falciparum infection. Objective: To study clinical profile of plasmodium Falciparum malaria with special reference to liver function test abnormalities and random blood sugar levels. Methods: Hospital based cross sectional study was carried out from October 2010 to October 2012 among 100 patients of malaria at M.N.R. Medical College & Hospital, Sanga Reddy. All diagnosed cases of plasmodium falciparum malaria were included in the study. Complete detailed history, thorough clinical examination and investigations were done. Results: Blood sugar between 41-60 mg/dL was observed in 4 patients. Blood urea level was raised in 40 patients and serum creatinine level was raised in 40 patients. Maximum blood urea level was 126 mg/dl and maximum creatinine level was 3.8 mg/dl. Serum bilirubin was raised in 90 cases and maximum total bilirubin noted was 31.2 mg/dl. Patients with clinical jaundice showed mean 2-3 fold raise in AST levels, along with ALT levels. Majority of cases of jaundice had normal ALK level 6 of them showed modest increase above normal. Serum proteins found to be normal in all cases, 4 cases showed raised prothrombin time. Conclusion: Mild and transient hepatic dysfunction along with presence of hepatomegaly and jaundice and increased level of serum enzymes has become of common feature of falciparum malaria. Presence of jaundice is bad prognostic indicator. Hospital stay increases with multiorgan dysfunction Mortality was 4% in this study.

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Aspiration pneumonia is the chief cause of mortality and morbidity in stroke patients. Both modifiable and non modifiable risk factors determine the incidence of this complication. The present study a prospective study to determine the incidence and risk factors associated with aspiration pneumonia in all types of stroke patients. Of the 138 stroke patients studied over a 2 year period 32 cases 27.5%) had developed aspiration pneumonia. Of the continuous variables high NIHS score and low ASPECT score were directly related to the incidence of aspiration pneumonia(p<0.05) while of the categorical variables left sided strokes, posterior circulation strokes and use of proton pump inhibitors significantly increased the chances of aspiration. The volume of bleed in hemorrhagic strokes was not related. Awareness of these risk factors will help initiate early aggressive measures and avoid mechanical ventilation, prolonged ICU stay and substantially decrease the cost of stroke care.

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