Background: Postpartum hemorrhage is the most common and dreaded complication of third stage of labor. Third stage of labour is always a time of anxiety as the normal case can within a minute become abnormal and successful delivery can swiftly turn into a maternal mortality. India has a maternal mortality rate of 4/1000 live births, whereas it is 0.1 – 0.4 / 1000 live birth in developed countries. Objective: To evaluate the effectiveness of simple technique of placental drainage in control of third stage blood loss Methods: A hospital based randomized controlled trial was conducted among 500 women during third stage of labour. They were divided into study and control groups. The study group was one in whom, cord clamping was not done the natural drainage of placenta was allowed, whereas, in the control group, cord clamping was performed. The outcome was assessed by measuring the mean duration of third stage of labour and the complications. Results: Women characteristics were similar for both the study group and the control group both for primigravida and multigravida. The obstetric characteristics like epidural anesthesia, and duration of first and second stage of labour was similar in both the study and control group. But the duration of third stage labour was prolonged in control group where cord was clamped compared to study group for primigravida and multigravida both. The numbers of cases with complications are more in the control group than study group. Conclusion: The mean duration of third stage labour was significantly lesser in placental drainage group compared to cord clamp group. Also the complications were less in the placental drainage group. Thus it can be concluded that the placental drainage is more effective than the cord clamp method.

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Background: Tuberculous pleural effusion has been known to phuysicians since antiquity, having been well des ribed by Hippocrates and Celsus. Involvement of the pleural surfaces in patients with tuberculosis is still one of the two most common extraparenchymal manifestation of tuberculosis (TB), the other being lymphatic involvement. Pleural effusion accounts for 26.6% of extra pulmonary TB. In India, TB is the most common cause of pleural effusion. Objective: To compare the results obtained by BACTEC method and LJ medium Methods: A hospital based cross sectional study was conducted among 60 patients. Institutional Ethic Committee permission was obtained. Informed consent was taken from patients. Data was recorded by taking history, thorough clinical examination, and investigations were done. Results: The results of BACTEC culture (radiometric) showed that there were 15 cultures positive out of 60 cultures (25%). The week wise analysis ofthese positive results revealed that most of the positive results occureed in the 3^rd and 4^th week i.e. 10 out of 15 (66.67%), 5 positive cultures were obtained in 6^th week (33.33%). Conclusion: BACTEC radiometric method is superior to LJ medium for culture of mycobacterium tuberculosis. The average period for BACTEC to detect mycobacteria by culture is 4.5 weeks. Even though smear for AFB is negative BACTEC could detect the mycobacteria by culture.

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Background: Colorectal cancer burden has been steadily rising in women. It was the fourth most common cancer in 1975 and has reached the second position by 1990, with about 49% increase in the number of cases globally over a period of 15 yrs. From 1999–2008, the rate of people dying from colorectal cancer has varied, depending on their race and ethnicity. Objective: To study Bcl-2 and p-53 immunostaining expressions in colonic carcinomas. Methods: The present study is both a retrospective and a prospective study. The study is based on histomorphological evaluation of 30 resected specimen of Colorectal Carcinomas received at the department of Pathology, Osmania General Hospital in a 2 year period from June 2009 to May 2011. The most representative block for all 30 cases was then selected for immune histochemical analysis of p-53 protein and Bcl-2 Oncoprotein for p-53 immunostaining, we used the DO-7 monoclonal antibody (dilution 1:30; DAKO), and, for Bcl-2, the monoclonal antibody 124 was used (dilution 1:80; DAKO). Results: Positive staining for p-53 protein was detected in 56.67% ( 17/30 ) of colorectal adenocarcinomas. There is statistically no significant association observed between p53 expression and Dukes' stage, TNM stage or Histological grade (p value > 0.05). Similarly no association was found between expression of p-53 and other patient variables, such as age, sex, location of tumor, & tumor differentiation. In the present study statistically there is no significant association between Bcl-2 & p-53 either individually or combined together with any of the parameters (like age, sex, tumor location, Dukes' stage, Histological grade & TNM stage). Conclusion: Though not statistically significant, to comment as the optimism expressed by certain investigators due to the low number of cases taken up for the present study, a large study group is needed to comment on the prognostic significance of the Bcl-2 & p-53 immuno profile individually and in a combined variation to predict the clinical outcome.

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Background: In 1934, Heaney 1st reported vaginal hysterectomy with few modifications and this method is favoured commonly in the preset days. In the early decades of 20^th century, hysterectomy began to be used more often in the treatment of gynecologic disease and symptom. As the surgery became safer, skillfull gynecologists concentrated on developing newer surgical procedures to help the patients. Note worthy contributors were more to the techniques of gynecologic surgery by Sims, Werthieins, Schauta, Kelly, Clarhe, Mayo, Meigs and many others. Objective: To compare total abdominal hysterectomy, vaginal hysterectomy and laparoscopic assisted vaginal hysterectomy. Methods: In this study, 90 cases of hysterectomy were analyzed over a period of two years for comparison between abdmonial, vaginal and laparoscopic assisted vaginal hysterectomies. Of which 30 were abdominal, 30 were simple vaignal and remaining were LAVH. Results: LAVH took longer operative time i.e. around 120 minutes when compared to TAH and VH. TAH & VH took almost same operative time without much difference. In the present study associated intra operative problems were observed in 7.7% of cases. In the present study, 6.6% of cases were associated with cystic ovaries and among them most of them underwent TAH. We found that 6.6% of women had hemorrhage in TAH and 3.3% in VH. The incidence of bladder injury was 1.1% in the present study. Parker RB et al found bladder injury in 0.67%. One patient had bowel injury due to multiple adhesions which is recognized on 3^rd post operative day and laparotomy was done. Conclusion: Among all three methods of hysterectomies the preferable method of choice is vaginal hysterectomy and LAVH is the second method of choice and the abdominal route is last choice.

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Background: Chronic renal failure, which is an inevitable terminal pathway of any chronic renal parenchymal disease, is more known for its morbidity than for its mortality. Objective: To note the alteration in different lipoprotein fractions among chronic renal failure patients. Methods: 70 Cases of chronic renal failure were taken for study. These patients were divided into two groups of 35 each. One group consisting of 35 Patients who were on conservative treatment, and the other group of 35 patients were on regular short term hemodialysis (6 months – 2 years). Patients were selected from Kasturba Medical College Hospitals and from Wenlock Government Hospital, Mangalore, from April 2001 to December 2003. Results: The HDL – cholesterol level was found to be significantly lower compared to control group. The total cholesterol and LDL was not raised significantly. The HDL/TC ratio was significantly reduced. Conclusion: Significant rise in triglyceride and VLDL concentration was seen in chronic renal failure patients.

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Peripheral blockade remains a well-accepted component of comprehensive anaesthetic care, which is a blend of art and science that has long been recognized and promoted. The study was conducted to study anesthetic profile of patients undergoing operative procedures of upper extremity below distal end humerus. In Sc BPB group 86.66 % (26 of 30) and in Ax BPB group 90 % (27 of 30) patients were from ASA Grade I. Among ASA Grade II in Sc BPB group 3.33% (1 of 30) and 10 % (3 of 30) patients had respiratory and cardiac problems respectively. In Ax BPB group, respiratory problem was with 6.66 % (2 of 30) and cardiac involvement in 3.33 % (1 of 30) of patients.The age was 37.73 ± 15.95 (Mean ± SD) years in the Sc BPB group, while it was 45.56 ± 15.11 years in the Ax BPB group. In Sc BPB group male population was 70 % and in Ax BPB group male and female population was equal. The weight was 48 ± 10.49 (Mean ± SD) kg in the Sc BPB group, while it was 45.05 ± 5.31 kg in the Ax BPB group.

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Successful intubation and securing the airway is a prerequisite for microlaryngeal surgeries. Failed intubation with routine intubation techniques, the unsuitability of supraglottic devices and the unavailability of flexible fibreoptic laryngoscopes led to an innovative use of the sinus rigid video endoscope for intubation. Of the 312 patients, who presented for the microlaryngeal surgery at Nova ENT Hospital Hyderabad over the last five years, in 269 patients, successful intubation could be performed by the rigid laryngoscopic method. Of the remaining 43 instances, sinus endoscopic guided intubation was carried out. This formed the basis of our study. Successful intubation could be accomplished in 41 of them and two other patients, intubation was done in more than two attempts and were considered failures for the purpose of this study. The time taken for successful intubation and the number of patients in whom there was intubation response was comparable to the routine intubation procedures.

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Background: Sebaceous gland tumour is the second commonest tumour of meibomian glands of eye. Presence of other similar ocular conditions of eye, the diagnosis of the disease is usually late. It is more common in old age and more common in women. In one third of the cases, the common site of origin is upper eye lid and may invade overlying epithelium. This condition is multicentric origin and hedge biopsy is needed to confirm the case. Pleomorphic cells with hyperchromatic nuclei and vacuolated nuclei were seen. Wedge biopsy of the lesion from multiple sites is diagnostic of the condition. Cytoplasm is foamy due to fat content. Objective: To study the incidence and clinical behaviour of meibomian gland carcinoma of the lid in patients attending outpatient department of sarojini devi eye hospital, Hyderabad Methods: The present study titled “meibomian gland carcinoma” was a prospective interventional case series study undertaken in patients who attended oculoplasty department , Sarojini devi eye hospital, Hyderabad, between December 2011 to October 2013. The study included 90 eyes of 90 consecutive patients presented with lid swelling who were diagnosed on the basis of history, clinical symptoms and signs, and by histopathological examination as eyelid malignancy. Among these 47 were meibomian gland carcinoma. Cases were treated surgically using standard protocol. Post operative results and follow up were recorded. Results were analysed using statistical parameters. Results: Total number of eyes studied 90 in consecutive cases and 80% of them in the age group of 50-70 years. 60% of the studied cases were females. In 55% of the eyes, left eye was involved. Upper lid was involved in 72% cases. Lower lid was involved in 25% of cases. Excision of tumor and lid constructive surgery was done in 92% of cases. In 52% of cases, the histopathological diagnosis was Meibomian Gland Carcinoma. Conclusion: Incidence of sebaceous gland carcinoma is more common in India compared to western literature. More aggressive biological behavour was observed in India with metastasis.

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Background: Health care Personnel are at higher risk to acquire blood born infections especially nurses who are in continuous contact with the patient during their routine work in health care settings. Needle stick injuries are more frequently occurred among nursing staff and students during their regular works due to improper knowledge about precautions. Methodology: A cross sectional study was conducted among Bachelor of Science (B.Sc) nursing students of Mamata Nursing College, Khammam. A 22 item multiple choice close ended questionnaire was used to assess knowledge and practice of universal precautions among nursing students. The data was analyzed using percentage and t- test. Results: Among the 228 respondents, 75% of them thought that the used needles can be recapped after giving an injection. About 65% of the students thought that the universal precautions are not necessary in situations that might lead to contact with saliva. There was indeed a lack of knowledge regarding universal precautions and their self reported practice. Conclusion: The study on nursing students revealed that they have inadequate knowledge and improper practice of universal precautions. Hence further knowledge on universal precautions should be improved by conducting continuous educational interventional programmes in their regular curriculum.

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Background: Dengue fever with estimated 50-100 million infections and 2,00,000 – 500000 cases of DHP per year. Case fatality rate is around 5%.⁴ So early diagnosis and initiation of treatment of Dengue fever prevents mortality and morbidity resulting from DHF and DSS. Objective: To study the clinical profile of patients with dengue fever Methods: Patients admitted in medicine wards during the study period with the history of fever with other non specific symptoms were included in the study. Data was collected in a pretested proforma by meeting objectives of the study hundred patients who fulfilled WHO criteria for dengue were selected by simple random sampling method. The clinical history, physical findings and laboratory investigations that help in diagnosis of dengue fever were analyzed and recorded. Results: In the present study, there were 78 males and 22 females and sex ratio is 3:5:1. In our study, out of 100 patients 99 showed leucopenia and 10 were anaemic and 25 showed platelet count less than 1,50,000 cells/cumm. In our study 17 patients showed hepatic dysfunction who improved after fluied rescuscitition and abnormal coagulation profile was noted in 18% of patients, and 6% patients were in acute renal failure who improved after fluid rescuscitition without dialysis. 4% of patients developed ARDS. But none of them survived inspite of possible treatment. Conclusion: Dengue fever has become major health problem in developing countries like India. Hence early diagnosis and initiation of treatment of dengue fever prevents mortality and morbidity as a result of DHF and DSS.

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Back ground: Sepsis is the commonest cause of neonatal mortality; it is responsible for about 30-50% of the total neonatal deaths in developing countries. It is estimated that up to 20% of neonates develop sepsis and approximately 1% die of sepsis related causes. Sepsis related mortality is largely preventable with rational antimicrobial therapy and aggressive supportive care. Objectives: To isolate and identify the aerobic bacterial pathogens causing both early and late onset septicemia .To evaluate the antimicrobial susceptibility pattern of aerobic bacterial organisms isolated from neonatal septicemia. Material and methods: This prospective study was conducted on 100 neonates with signs and symptoms of septicemia admitted in neonatal intensive care unit, Malla Reddy Medical College for Women Suraram, Hyderabad over a period of one year from January 2013 to December 2014. Results: Blood culture positivity was 35 %. Early onset sepsis 28 (57%) was more common than late onset septicemia 28 (43%). Out of total isolates Gram positive organisms constituted 20 (62.5%). In gram positive organisms coagulase negative staphylococci and Staphylococcus aureus were commonest organisms 9 (45%). Gram negative organisms constituted 15 (37.5%) out of 35 total bacterial isolates. In 15 gram negative isolates klebsiella pneumonia was commonest isolate 8 (52%), followed by Escherichia coli 3 (20%), Pseudomonas auriginosa 3 (20%) and Acinetobacter 1 (8%) Conclusion: The present study suggests that there is a increase in incidence of ESBL producers among Gram Negative pathogens i.e. Klebsiella pneumonia, Escherichia coli, Pseudomonas, Acinetobacter in neonatal septicemia of both Early and late onset and many of them are resistant to commonly used third generation cephalosporin i.e. cefotaxim, ceftriaxone, ceftazidime.

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Local anesthetics are the commonest agents used for spinal anesthesia, but their relatively short duration of action may lead to early analgesic intervention in the postoperative period. The objective of the study was to study anesthetic profile of patients undergoing lower limb surgeries. Study was carried out at Narayana Medical Collage Hospital, Nellore from September 2012 to August 2014 among 50 patients undergoing lower limb surgeries. Patients aged 18-60 years, patients undergoing lower limb surgeries and consenting patients were included in the study. All patients were evaluated for history, physical examination and investigations. There is no statistically significant difference between the groups with regard to demographic data. The mean duration of surgery is higher in Group-A compared to Group - B. There is a significant difference between groups with regard to onset of sensory analgesia, with Group A having a rapid onset compared to B. There is significant difference between the groups in total duration of Sensory Analgesia with Group A having longer duration compared to Group B.

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Background: Left bundle branch block (LBBB) is a quite common disorder associated with a three to four fold increase in cumulative cardiovascular mortality. Although risk is especially increased for LBBB when accompanied an organic heart disease, it has been reported that mortality is also high in isolated LBBB. Objective: To study clinical profile and etiology of left bundle branch block Methods: The present cross sectional analytical study was carried out among 100 cases of left bundle branch block attending the outpatient department. All cases fulfilling ECG criteria of LBBB were included in the present study. The various criteria for LBBB were QRS duration > 120 msec, broad, notched R waves in lateral precordial leads (V5 and V6) and usually leads I and AVL, Small or absent r waves in right precordial leads (V_{1 and V2) followed by deep S waves, Absent septal q waves in left sided leads and prolonged intrinsicoid deflection (> 60 msec) in V5 and V6. Results: Mean age in low LVEF group was 56.6+9.92 years and in the normal LVEF group it was 53.27+10.71 years. Males predominated in both the groups. In cases of LBBB with valvular heart disease there was no significant difference between two groups of LVEF Conclusion: Hypertension and ischemic heart disease contributed to maximum cases of LBBB. Patient of LBBB with coronary artery disease and dilated cardiomyopathy have low LVEF while the patients of idiopathic LBBB had normal ejection fraction.}

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Background: Early diagnosis and prompt treatment is essential to minimize the spread of disease. Disease control requires treatment of the affected individual and all people they have been in contact with, but is often hampered by inappropriate or delayed diagnosis, poor treatment compliance, inadequate treatment and improper use of topical compounds such as permethrin, lindane or benzyl benzoate. Objective: To study efficacy of ivermectin in the treatment of scabies Methods: 200 patients of age 5 years to 60 years were studied for two years. Routine examinations, microscopic examination of the mite, examination of the skin scrapings mounted with mineral oil or Hoyer's medium for demonstration of organisms. Biopsy of the skin lesions from the involved sites was done in few patients. Patients were randomly allocated for each of the four regimens of following simple random sampling procedure. After detailed history and examination, patients were given one of the following regimens. Results: Response to Ivermectin considering the itching as the parameter, patients who belonged to the grade I were 8 (16%), grade II were 36 (72%) and grade III were 6(12%). Response to Permethrin considering the severity of itching, patients who belonged to the grade I were 12 (24%), grade II were 30 (60%) and grade III were 8 (16%). Response to GBHC (1%) lotion considering the itching as the parameter, patients who belonged to the grade I were 10 (20%), grade II were 25 (50%) and grade III were 15 (30%). Response to B.B. lotion considering the itching as the parameter, patients who belonged to the grade I were 10 (20%), grade II were 35 (70%) and grade III were 5 (10%). Conclusion: Permethrin was found to be more effective among the topical agents.

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Background: Clonidine, a selective partial a2 -adrenergic agonist, is being extensively evaluated as an adjuvant to intrathecal local anaesthetics and has proven to be a potent analgesic free of opioid-related side effects. Objectives: To Compare Intrathecal Clonidine and Intrathecal tramadol for Prolongation of Neuraxial blockade analgesia with 0.5% Bupivacaine in lower limb surgeries. Methods: This study was done in a prospective double blinded randomized manner. Group A (N-25): Received Clonidine hydrochloride (0.25ml) 37.5 mcg and 0.5% Hyperbaric Bupivacaine hydrochloride (3 ml) + 0.75 ml Normal saline. (Total 4 ml). Group B (N-25): Received Tramadol (0.5ml) 25mg and 0.5% Hyperbaric Bupivacaine hydrochloride (3 ml) + 0.5 ml Normal saline. (Total 4 ml). Results: There is no significant difference between the groups in Time to Full Motor to Recovery. There is significant difference in VAS Score at 180 & 240 Minutes. There is significant difference in Bromage Score at 120 & 300 Minutes. There is no significant difference in heart rate between the two groups. Conclusion: Addition of clonidine 37.5 mcg (0.25ml) to 0.5% hyperbaric bupivacaine intrathecally produced faster onset of sensory analgesia and longer duration of analgesia when compared to tramadol without any prolongation in time to full motor recovery and without significant haemodynamic changes or adverse effects.

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Back ground: Malaria is the most common cause of hemolytic anemia and other causes of anemia include defective erythropoiesis and reticulocyte production. Other hematological complications include thrombocytopenia and platelet dysfunction. Coagulopathy abnormalities are also in severe malaria Objectives: To study complications of falciparum malaria. Material and methods: A total of 100 cases of laboratory confirmed and admitted cases of falciparum malaria during the study period of two years, who fulfilled inclusion and exclusion criteria were studied. Complete relevant history, thorough clinical examination was carried out to assess complications. Results: The most common complication of falciparum malaria was renal and hepatic involvement. Among 31 patients with complications, 17 had single complication, 5 had two complications, 5 had three complications, and 4 patients had 4 complications. Elevated blood urea and creatinine was noted in 18 patients among 100 cases .Out of them 88.8 % had longer duration of hospital stay. Elevated bilirubin levels were seen in 18 patients. Conclusion: Falciparum malaria is associated with other complications which include cerebral malaria, renal involvement, hepatopathy, respiratory manifestations, which may lead to increase in the mortality if not detected early and treated properly and adequately.

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Inter-trochanteric fractures of the femur are one of the most common fractures of the hip in the elderly. They occur usually due to low energy trauma like simple falls. The incidence is rising because of increased life expectancy. The prevalence of these fractures is related to numerous factors including osteoporosis, malnutrition, decreased physical activity, impaired vision, neurological impairment and altered muscle balance. The present study was a prospective randomized study consisting of 60 adult patients with fresh inter-trochanteric fractures of the femur who were treated with DHS or PFN at MediCiti institute of Medical Sciences Ghanpur, Rangareddy District, Andhra Pradesh between June 2010 and June 2012. This study was carried out to compare the results of inter-trochanteric fractures treated with DHS and PFN. All the 60 patients were followed up at regular intervals. Inter-trochanteric fractures were most common between the ages of 61-70 years in our series. A trivial fall at home was most common mechanism of injury (70%). Males outnumbered females. Type 1 and 2 (Boyd and Griffin) were most common. Blood loss was less for PFN (197 ml) as compared to DHS (304 ml). There were no significant differences in the intra-operative complications with both implants. The mean time for full weight bearing was 10.75 weeks for PFN and 14.42 weeks for DHS, for radiological union was 19.57 weeks for PFN and 22.04 Weeks for DHS. There were more excellent/good results with PFN (93%) as compared to DHS (78%). There was one poor result with DHS and none with PFN. Limb length discrepancy (>1cm) was equal in both groups (2 each).

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Background: The prevalence of diabetes is rapidly rising all over the globe. India leads the world with the largest number of diabetic subjects earning the dubious distinction of being termed the “Diabetes capital of the world”. Cataract in diabetic patients is major cause of blindness. Objective: To the study the development of cataract and various grades of retinopathy in diabetic patients. Methods: 407 diabetic patients were screened for cataract and retinopathy in a hospital based study. History and demography of patients including the age of onset and duration of diabetes were obtained. Results: 407 diabetic patients were evaluated. Male and female ratio 201:206.Posterior subcapsular opacity (PSCO) observed in 65(15.97%) patients, NPDR in 100 patients (24.57%), NPDR with CSME 9 patients (2.21%), PDR 87 patients (21.37%). Patients with duration of diabetes between 5 to 15 years were 168 patients (41.27%). Patients in the age group of 50 to 60 years with 5 to 15 years duration were 79 patients (19.41%). Patients with PDR between 50 to 60 years age group were 45 (51.72%). Patients with PSCO between 51 to 60 years age group were 28 patients (43.07%) Conclusion: Patients with duration of diabetes between 5 to 15 years had retinopathy at 40-60 years age group. Diabetic cataract also observed at 40-60 years age group. Majority of the patients with complications had blood sugar levels between 100-300 mg% showing duration of diabetes is also essentially important.

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