Background : Objective Structured Clinical Examination (OSCE) has been widely used in the assessment of students' clinical performance. One of the strategies to improve the effectiveness is through assessing feedback from students on OSCE. These data are important to ensure the learning objectives of the OSCE are achieved besides to improve the effectiveness and to ensure it will be practicable in clinical settings. Objective : This study aims to identify nursing students' perceptions on OSCE. Methodology: A cross sectional study using convenience sampling was conducted among 91 nursing students who have experienced in sitting OSCE in International Islamic University Malaysia (IIUM), Kuantan, Pahang, Malaysia. Results : The findings showed that the majority of respondents (85.3 percent) has the positive perception on OSCE whilst 14.7 percent of respondents have the negative perception. For the association between socio-demographic and year of study and gender, it showed both have no significant association with the nursing students' perception. Conclusion: The majority of respondents was identified to have positive perceptions on OSCE. However, some of them have negative perceptions on OSCE. Thus, the relevant authorities should take a step to improve the quality of OSCE exam, as well as its accuracy and reliability. It is hoped that the OSCE will be one of the main assessment in IIUM and other health care courses at the other universities.

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TORCH infections are unique in their pathogenesis and have potentially devastating clinical manifestations. We present a case of concomitant Rubella and CMV infection in a newborn with unusual hematological and immunological features which ended fatally.

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Radiolucency in mediastinum may be caused by congenital cystic mass, pneumomediastinum or pneumopericardium. Most cases of pneumomediastinum occur in preterm newborns with surfactant deficiency receiving treatment with positive pressure ventilation. Spontaneous pneumomediastinum in term neonates is rarely reported.

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A worldwide debate is going on for increasing the use of generic drugs over branded drugs. Before starting arguments in favor or disfavor of preferential use of generic drugs in India, we need to first understand various terms related to the generic and branded drugs worldwide and in our country. This article deals with definitions, process of discovery, nomenclature, and types of generic drugs available in India and worldwide.

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Background: Customs in a community will play a key role while providing health services. Misunderstandings about these customs result in poor services. Objectives: 1) to know the various social customs practiced by mothers during pregnancy and the reasons behind them. 2. To educate the merits and demerits of these customs with the women and dais (old women who conduct deliveries in villages) as a gesture of service. Methods: A cross-sectional descriptive study in urban, urban slum and &rural settings. 150 out- patient women attending Urban and Rural health centres were enquired about the General customs, Dietary customs and Customs regarding rest, Personal hygiene& breast feeding. Results: Seemantham (bangle ceremony) was practiced by 70% urban women and only by 30% rural women. All women stayed indoors during solar eclipses. Urban mothers avoided papaya, fish, green dal and green leafy vegetables (24-92%).Rural mothers consumed special foods like Kayam, (78%) Fried jeera (60%) but less by urban mothers (22%).More urban mothers (70%) and less rural mothers (30%) commenced breastfeeding in the first day. Colostrum discarding was more (90%) among by rural mothers than among urban mothers (10%). Conclusion: Most of the customs are traditional in nature. Some are conducive to positive health while some are harmful.

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Background: Dermatophytosis is a superficial infection of keratinized tissue. It is the most common type of cutaneous fungal infection seen in human beings affecting skin, hair and nails. Tinea corporis is one of the most common clinical forms of dermatophytosis. Objective: To compare two oral antifungal drugs, Griseofulvin and Terbinafine in the treatment of Tinea corporis Methods: This is an open-label, randomized, parallel, comparative study which was carried out in 100. Patients with tinea corporis infection who attended the outpatient Department of Dermatology, Dr. PSIMS & RF, Chinaoutpalli, Krishna (Dist), between October 2009 and Aug 2011. This study was approved by the institutional Ethical Committee of Dr. PSIMS & RF. Written consent was taken from all the patients enrolled in the study. Results: tinea corporis in the present study was more common between 18-45 yrs of age group and it is more common in females. In the Griseofulvin group, I patient showed no clinical improvement, 13 showed partial improvement and 32 patients (69.57%) were completely cured. In the Terbinafine group, 5 patients showed partial improvement and 43 patients (89.58%) were completely cured by the end of 4^th week. Conclusion: Terbinafine 250 mg tablet taken once daily for 2 weeks is more effective in complete cure (both clinical and mycological cure) and showed an early clinical response in treatment of tinea corporis compared to Griseofulvin 250 mg tablet taken twice daily for 4 weeks. There was no significant difference between the two drugs regarding tolerability.

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Background: Every year 5 million cataract surgeries are performed in India. Two major procedures are used to conduct cataract operations either MSICS/Phecoemulisfication. In both the procedures the loss of endothelial cells are observed. The present study is based on comparison of endothelial cell loss in both the procedures. Objectives: The aim of the study is to compare endothelial cell loss after manual small incision cataract surgery (MSICS) and Phacoemulsification by specular microscopy. Methods: Present study was conducted at Sarojini Devi Eye Hospital, Hyderabad from 2013-14. Total number of eyes studied was 100 in 100 study subjects who were age and sex matched and divided into two groups of 50 eyes of 50 study population. Group I patients underwent Phaecoemulsification & Group II with MSICS by the same operating surgeon from 2013-14. The patients were evaluated on first post operative day, first week, 6 weeks and 6 months for endothelial density. Endothelial density was evaluated through Specular Microscopy EM 3000, Tomey. Best image of 15 shots was taken to evaluate endothelial density. Results: Mean age in both the groups was 58 and 59 years. Equal number was taken sex wise in both the groups. The mean endothelial loss was 200 cells/mm² & 250 cells/mm² in Group I & II respectively. Conclusions: In phacoemulsification group, the maneuvering was performed in the capsular bag and newer advanced phacoemulsification units with better fluidics reduced the chances of endothelial damage. In MSICS group, Visco-expression of the nucleus significantly reduced the endothelial cell loss.

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Background: Surgical Site Infections [SSI] are infections that develop within thirty days of surgery. They are an important cause of Hospital Acquired Infections [HAI]. The Hospital Infection Control Committee [HICC] of a hospital plays an important role in monitoring the incidence of SSI in a hospital, including the clinical audit of any outbreaks, and in suggesting measures to reduce the incidence of SSI. Objectives: The objectives of the study were to identify factors contributing to the incidence of SSI in a tertiary care maternity hospital with a view to implementing practices that would contribute a reduction in the incidence of the same. Methods: We monitored the incidence of SSI in a tertiary care maternity hospital geared for managing high risk pregnancies as well as normal pregnancies and carried out a clinical audit of an increase in the rates of SSI in two months. We present the details of measures which were subsequently put in place to reduce the incidence of such cases in our hospital. Results: In cases of Surgical Site Infections [SSI] in patients delivered by LSCS at a referral tertiary care maternity and neonatology hospital, raised BMI (in 45.45% of cases), emergency versus planned LSCS (in 81.81% of cases), prolonged duration of surgery (in 72.72% of cases), and administration of prophylactic antibiotics beyond the accepted window period (in 72.72% of cases), were all found to be significant risk factors. Conclusion: Careful monitoring of the incidence of SSI in LSCS patients along with regular audit of increase in cases and institution of appropriate preventive measures to lower the risk factors can result in the reduction of such cases.

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Background: It is well established that diabetic nephropathy is a dreaded complication of Type 2 diabetes mellitus. However in the early stages; also known as incipient nephropathy, it can be detected by the presence of microalbuminuria. If the patient is identified in the incipient nephropathy stage itself, effective control measures can be initiated to retard the progression to end stage renal disease. Objective: To know the occurrence of microalbuminuria in patients with Type 2 diabetes mellitus and to correlate it with the glycaemic status of the patients. Methods: This study was undertaken in NRI Medical College and General Hospital, Chinakakani, Guntur District, Andhra Pradesh from Nov. 2010 to August 2012. A total of one hundred randomly selected diabetic patients satisfying the inclusion criteria were selected for the study. All patients were evaluated in detail along with the testing for microalbuminuria with dipsticks (Micral) and their glycaemic status along with other required parameters. Results: The overall occurrence of microalbuminuria in the test series was 38%. The occurrence of microalbuminuria showed a direct relationship with the poor glycemic status (p=0.053) and increasing duration of diabetes since diagnosis (p<0.001). An HbA1c value above 7% is associated with 50% or higher incidence of microalbuminuria (p=0.018). Patients with a body mass index of more than 25 kg/m² have a significant increase in the incidence of microalbuminuria (p=0.027). The incidence of microalbuminuria is significantly associated with the presence of retinopathy (p=0.073), peripheral neuropathy (p=0.009), ischemic heart disease (p=0.011) and hypertension (p=0.001). Microalbuminuria is inversely associated with HDL (p= 0.089). Conclusion: The occurrence of microalbuminuria in Type 2 diabetic patients in the study was quite high and more so in patients with poor glycemic control.

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Background: Apheresis procedures [plateletpheresis, plasmapheresis, peripheral blood stem cell collection] are usually well tolerated. Occasionally Adverse Events (AEs) of variable severity may occur during or after the procedure. AEs that occur in Donor/ Patients are divided into local reactions and systemic reactions. Objective: To study adverse events associated with apheresis procedures. Methods: A total of 768 plateletpheresis were performed on Haemonetics MCS + cell separator in one of the major blood banks whose annual blood collection was between 8000 and 10000 units. Results: 21 AEs were reported. Out of which the rate of vascular injury (VI) citrate reaction (CR) and presyncopal/syncopal (PS/S) in plateletpheresis were 1.56% (12/768), 0.91 % (7/768) and 0.26 % (2/786) respectively. Conclusion: Apheresis procedures performed on cell -separators are safe with low incidence of significant AE Apheresis procedures are usually well tolerated. However adverse events (AE) of variable severity may occur during or after the procedure. AEs that occur can be divided into local reactions and systemic.

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Background: Prolonged labour can lead to increased maternal and neonatal mortality and morbidities. Active management of labour versus physiological, expectant management has shown to decrease the occurrence of prolonged labour. Administering antispasmodics during labour could lead to faster and more effective dilatation of the cervix. Objective: To know the effect of Drotaverine on dilatation of cervix in uncomplicated deliveries compared to the data obtained in patients without smooth muscle relaxants METHODS: This study was conducted on 200 cases of uncomplicated pregnancies. 100 cases in study group and 100 cases in control group who fulfilled the relevant criteria were admitted in department of OBG in Government Medical College-Nizamabad-Telangana. Cases in study group were given 40mg of Drotaverine IM, when cervix was 3cms dilated and then labour was monitored using partogram. Second dose of Drotaverine was given 2 hrs after the first dose depending on progress of labour. RESULTS: The average duration of dilatation stage was 4 hours and 10 minutes (250mins) in primigravida of study group while it was 6 hours and 30 minutes (390min) in control group. The average duration of dilatation stage was 3 hours (180min) in second gravida in study group, while it was 4hrs 30 min (270min) in control group CONCLUSION: Intramuscular administration of Drotaverine injection in dilatation phase of uncomplicated pregnancies was found to reduce the duration of cervical dilatation, total duration of labour, and incidence of cervical tears with no change in stage 2 and 3 of labour.

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Background: According to the World Health Organization (WHO) global estimation in 2002, more than 161 million people were visually impaired, of whom 124 million people had low vision and 37 million were blind worldwide. Refractive error, as a cause of visual impairment was excluded. It was also estimated that up to 75% of all blindness is avoidable. Glaucoma is the second leading cause of blindness globally as well as in most regions according to the WHO survey 2002. Objective: To study the causes of secondary glaucoma Methods: A Hospital based follow up study was done for two years among 50 patients with secondary glaucoma. Detailed history, Local examination of both the eyes was done including examination of adnexa, eye balls, anterior segment, and posterior segment. Based on these, a clinical diagnosis was formed. Investigations like urine for albumin and sugar, total count, differential count, ESR, x ray of orbit and optic canal were done for each and every patient. On the basis of final diagnosis, patient was subjected to medical or surgical management as per the requirement. Post operatively the specimen was sent for histopathology reporting. All the patients were followed for 4-6 months on monthly basis. Data was analyzed using proportions. Results: It was seen that different variety of causes can cause secondary glaucoma at different ages in different ways. It is clear that lens induced glaucoma was the most common cause. The most common presenting complaint was pain in the affected eye reported by 29.8% followed by redness (23.8%), watering (19.1%) and diminished vision in 15.7%. The most commonly employed surgical technique was lens extraction (60%) followed by broad basal iridectomy (18%). Conclusion: It was concluded that better results were obtained if the primary cause was treated early. But the prognosis in case of ocular inflammation like acute uveitis, traumatic uveitis the results were not satisfactory. On the whole, early the treatment, better the results.

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Background: Cervical cancer is the most common gynecological cancer in India. It is only cancer which can be detected in the pre-cancerous state by Pap smear cytology. Objective: To study correlation between cytology and histology in cervical lesions Methods: The present study was conducted at V. S. S. Medical College, Burla from August 03 to July 04. 110 symptomatic women were included in the study. Routine gynecological examination was followed by Pap smear for cytology. A cervical scrape was taken from the squamocolumnar junction of cervix and the smear was stained according to Papanicalaou’s technique. The cytological findings were graded into normal G - I, inflammatory G – II, mild dysplasia G – III, moderate to severe dysplasia G – IV and frank cancer G – V according to the classification laid by WHO study group. In the selected cases biopsy was done after applying 3% acetic acid from ace to white area. Results: Maximum number of cases was in the age group of 31-40 years (36.3%). Most common gynecological symptoms were found to be leucorrhoea & metrorrhagia. The most common clinical lesion of cervix was hypertrophied unhealthy cervix (52.7%). Maximum number of cases showed inflammatory cytology (69%). Maximum number of cases shows chronic cervicitis (65.6%). Pap smear cytology and histology of cervical biopsy were correlated. All patients with Chr. Cervicitis on histology had G – II finding on cytology. Of 6 patients with CIN-I on biopsy, 3 had G – II cytology and 3 had G-III finding on cytology. Of 2 patients with CIN-II, both had G-IV finding on cytology. 26 cases of squamous cell carcinoma on biopsy 24 had G- V and 2 had G-IV finding on cytology. All cases of G-V and two cases of G-IV cytology were confirmed to be squamous cell carcinoma on histology. Conclusion: Pap smear cytology is a cheap, risk free and acceptable method with high degree of correlation with histology. This simple test can be used for screening of high risk population for early detection of cancer cervix.

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Background: Supracondylar fractures are the most frequent elbow injuries in children, reported to occur in 55% to 75% of patients with elbow fractures. Objective: This study has been undertaken to observe the results of management of supracondylar fractures by closed reduction and percutaneous K-wire fixation and open reduction and K-wire fixation. Methods: Patients selected for this study were children below 12 years with Gartland’s type III fractures who were admitted and treated in the Nizam’s Institute of Medical Sciences between January 2007 & May 2012. Results: Excellent to good results were obtained in about 90% of cases of closed reduction and K wire fixation and excellent to good results in 70% of cases operated by open reduction and K wire fixation. The indication of open reduction remains limited because of risk of stiffness of injury due to iatrogenic soft tissue injury. Conclusion: Open reduction and internal fixation is an effective and safe method of treatment if indicated and is associated with good outcome.

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Background: The treatment of pterygium is still quite controversial, with various treatments being advocated in the scientific literature. Unfortunately, there are very few well-conducted controlled clinical trials of treatments. Objective: To assess the efficacy and safety of no glue, no stich technique of conjunctival autograft after pterygium excision. Methods: A hospital based cross sectional study was carried out. A total of 30 patients were included in the present study using the selection criteria. Institutional Ethics Committee permission was taken. Patients were informed about the nature of the study and their informed consent was obtained. The study was carried out for a period of one year at Department of Ophthalmology, Sarojini Devi Eye Hospital, Hyderabad. Results: Maximum patients were in the age group of 40-50 years (27%). Only one patient was above 60 years of age. 90% of patients were females. All patients presented with fleshy growth. 55% of patients presented with cosmetic problems. Watering was reported by 50% of the patients. All patients had nasal pterygium. Majority i.e. 60% had grade III pterygium. Half of the patients had type III pterygium. Graft edema and hemorrhage were the complications noted in 20% of cases but no one was found to have graft dislocation. Conclusion: No glue and no stich technique of limbal conjunctival autografting following pterygium excision is safe effective and economical option for the management of primary pterygium requiring surgical intervention. However there is a risk of graft retraction, graft dislocation and recurrence in small percentage of cases.

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Background: Malpresentations and malpositions as such are associated with increased incidence of adverse feto-maternal outcomes when compared to cephalic vertex presentations. Scarred uterus predisposes to malpresentations per se, adding accelerated morbidity and mortality to the fetus and the mother. When compared with general incidence of malpresentations, h/o caesarian section is observed to increased incidence of malpresentations leading to an added indication for caesarian section Objective: To evaluate incidence of the fetal mal presentations in Scarred and Unscarred Uteri and scarred uterus as an etiological factor for malpresentation leading to adverse feto-maternal out come Methods:- 300 cases taken up for Cesarean section with history of previous one/two Caesarean sections and 300 cases of primary caesarian sections with singleton pregnancy with 37 completed weeks of gestation are selected at random during the same period the criteria noted-Age, Parity, Scarred/Unscarred uteri, type of presentation, mode of delivery ,Intra and post operative events and fetal outcome. Results: High incidence of malpresentations, more elective surgeries, and more intra operative complications including hemorrhage and placenta previa are noted in scarred uteri. Conclusion: In this present study, previous scarred uterus is seen as an etiological factor for malpresentations worsening the prognosis of malpresentation further with added difficulty in delivery, scar extensions, intra operative hemorrhage and bladder trauma. Scarred uterus is an etiological factor for malpresentations and increased morbidity and mortality for both mother baby fetal outcomes is almost the same in both groups.

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