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Rupture of the free wall of the left ventricle (LV) is a catastrophic complication occurring in 4% of patients after myocardial infarction (MI) and in 23% of those who die of MI. It is caused by myocardial rupture contained within the pericardium and is characterized by the absence of true myocardial tissue in its wall unlike, a true aneurysm which involves the full myocardial wall thickness. Early diagnosis is mandatory using noninvasive modalities such as TTE and CMR or less commonly used nowadays invasive modalities such as coronary arteriography and left ventriculography. Due its high liability for fatal rupture urgent surgical intervention is of paramount importance in management of this pathology. We present a rare case of Left Ventricular Pseudo aneurysm in young patient who underwent previous surgery for peri-cardial effusion. The surgical goal is to preserve or to remodel the ventricular chamber anatomy. Left ventricular angiogram is the definitive test to clinch the correct diagnosis. A high index of clinical suspicion is needed to avoid missing the diagnosis. This particular patient might have developed left ventricular pseudo aneurysm as a result of trauma from previous surgery

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Sinus of Valsalva aneurysm (SVA) is an uncommon cardiac anomaly that can be congenital or acquired. Sinus of Valsalva aneurysm (SVA) is one of the rare congenital anomalies described in the literature, prevalence being 1% of all congenital anomalies of heart and circulation. Risks associated with SVA include rupture, compression of adjacent cardiac structures and development of aortic regurgitation. Rupture is the most dreaded complication of SVA. Ruptures of sinus of valsalva aneurysm are most commonly seen rupturing into cardiac chambers. In our case, the rupture was into inter ventricular septum which is very rare. The rent in the sinus of valsalva should always be closed using patch material and we should never close directly. We should always excise one side of the cavity preferably towards left ventricle. Rupture of sinus of valsalva to inter ventricular septum is very rare. Accurate pre operative diagnosis and proper treatment will help in long term survival.

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Background: Prevalence of metabolic syndrome (MetS) amongst people with Type 2 diabetes mellitus (T2DM) is high. Though, diabetic kidney disease (DKD) is an increasingly important cause of morbidity and mortality worldwide, its association with MetS is not profoundly evaluated in Indian population. Objectives: We aim to assess the prevalence of MetS and evaluate the impact of MetS on the occurrence of DKD amongst people with T2DM. Methods: The demographic, anthropometry, blood pressure, lipids, CVD (based on ECG and history of CVD) and DKD (based on e-GFR < 60 ml/min/1.73 m²) data of 1037 T2DM was obtained. MetS was defined by NCEP - ATP - III guidelines. Association of DKD was evaluated with other variables including MetS and its components in terms of unadjusted OR. The Odds Ratios were adjusted by considering covariates like age, gender, duration of diabetes and HbA1c in the logistic regression model. Results: The prevalence of MetS was 86.98% (female-91.3%, male-84.5%), DKD 6.85% and CVD 13.5%. Waist circumference contributed the most to MetS (91.69%) followed by HDL-C (71.73%) and TG (63.08%). Age and duration of diabetes showed significant positive association in occurrence of DKD. OR for people with MetS to develop DKD was high in univariate and multivariate analysis, though statistically insignificant. T2DM with hypertension are at higher risk of DKD with OR 2.1957 [95% CI: 1.1618, 4.1496] versus those without hypertension (p = 0.0154). Conclusion: Indian people with T2DM have high prevalence of MetS, where waist and low HDL-cholesterol are major contributors. MetS insignificantly, while hypertension significantly increases the risk of DKD in people with T2DM having MetS.

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Background: Neonatal jaundice became a pediatric emergency in all the populations. Though it was usually managed by phototherapy consideration of its maternal and child causes was a better choice for its prevention, Objectives: 1) To know the maternal and child factors associated with the occurrence of Neonatal jaundice (NNJ) and their influence regarding the outcome of phototherapy. Methods: Records of 65 children suffered from NNJ were scrutinized by two resident doctors, for the maternal and child factors associated with NNJ and for their influence on phototherapy. Results: NNJ was more observed in rural children, 45 (70%) and in children below 2 years of age 47 (72%). Child factors associated with NNJ were Low birth weight (93.8%) preterm delivery (81.5%) breast feeding (75.4%) IUGR (50%), poor Apgar score (23%) and infections (23%) Maternal factors associated with NNJ were Poverty (91%) less education (90%), unskilled (86%) Young age (78.5%), maternal infections (78.5%), Primigravida (70.8%), and abnormal deliveries (53%) were the leading factors associated with NNJ. Low birth weight in 51 (78%) breast feeding 46 (70%), Preterm delivery 42 (64%) poor Apgar score 7 (10%), and infections 8 (13%) were the predominant child factors affecting outcome of phototherapy. Maternal infections 42 (64%), primigravida 40 (61%)) and abnormal delivery practices 22 (33%) were the maternal factors influencing the outcome of photo therapy. Conclusions: Both the maternal and child factors contribute a lot while managing NNJ. They will also play a part in its management by phototherapy. Due consideration to these factors is essential while managing and preventing NNJ.

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Oxidative stress has been found to be associated with most of the diseases. In the past several years, much interest has arisen over the involvement of free radical metabolism in the disturbance in endothelial or intimal cells of blood vessels, which play an important role in the pathogenesis of essential hypertension (HT). Although limited information is available on the activity of antioxidant enzyme erythrocyte superoxide dismutase (SOD) and its relation with blood pressure in patients with HT, alteration in their activity with severity of disease is still obscure. The objective of present study was to estimate the activity of SOD in hypertensive subjects and to determine the variation in erythrocyte SOD activity with increasing blood pressure. In the present study, erythrocyte SOD activity was measured in 90 hypertensive subjects (30-60 years) which were categorized into three groups as pre-hypertension, stage I HT and stage II HT (depending upon their blood pressure) and statistically compared it with that of 30 healthy individuals, served as control. Erythrocyte SOD activity was found to be significantly low in each patient group as compared to control (P<0.001). These activities were also low among three groups of essential hypertension. These findings suggest that depletion in erythrocyte SOD activity with subsequent rise in blood pressure is due to its superoxide anion scavenging action against hypertension induced production of free radical in the body. Thus, erythrocyte SOD activity may be an effective marker of oxidative stress in different stages of essential hypertension and its related complications.

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Background: Now-a-days increasing numbers of patients with sickle cell disease (SCD) are receiving blood transfusions. As a result, these patients require treatment with either chelator drugs or exchange transfusion to prevent tissue injury from iron overload. In such cases, serum ferritin (SF) is a noninvasive measure widely used to monitor iron load. Objective: To assess the iron load in patients of SCD by means of serum ferritin levels Methodology: All the patients of SCD proven by Hb electrophoresis presenting to our hospital & consenting for study were evaluated in terms of history, CBC and reticulocyte count. Iron status was measured by means of measuring SF levels. Results: We found that those patients who had severe anemia ( Hb < 5 gm/dl), required more transfusions and hence serum ferritin levels were highly elevated in severely anemic patients as compared with those who had mild anemia ( Hb> 7 gm/dl). The result was found statistically significant (p value - 0.000) in those who required total blood transfusion more than 100 ml/kg/yr. Conclusion: There is increase risk of iron overload in patients of sickle cell anemia who receive chronic blood transfusions for prevention of various sickle cell crises.

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Background: Health care settings are reported to be the most significant contexts for stigma and discrimination of HIV/AIDS in India, which may lead to severe social consequences and also hampers the treatment and diagnosis contributing to further spread. Objective: The study was planned to study the stigma against PLWHA (People living with HIV/AIDS) among in-service nurses of a private hospital. Methodology: A hospital based cross-sectional survey was conducted among all the nursing personnel, willing to participate in the study of a private hospital in south Karnataka, India. The study was conducted for a period of 3 months using a pre-tested and predesigned tool to measure HIV related stigma and discrimination in health facilities and the data collected was analyzed using SPSS 16.0 Results: About the attitudes of PLWHA, majority (68.6%) reported that, people living with HIV/AIDS do not care if they infect other people. When enquired about the perception of rights of PLWHA and the care provided to them, majority agreed that respective families has the right to know about the HIV/AIDS status (95.71%); women with HIV/AIDS status should not get pregnant if they already have children (92.86%); should be sterilized without their willingness (72.86%) and majority of them were not worried to touch PLWHA clothing and taking their temperature (p=0.014). Most (35%) of the nurses observed other Health care providers giving HIV treatment conditional on use of family planning Conclusion: High level of stigma against PLWHA exists among HCPs and such may lead to prejudicial actions accompanied by discriminatory behavior.

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Background: Iron Deficiency is the most widely prevalent nutritional disorder affecting the world population today. Anaemia has been described as a major health problem in the developing countries. Iron Deficiency Anaemia is readily preventable even in a profound stage by the provision of iron supplements. Objective: The study was conducted to estimate the incidence of iron Deficiency Anaemia in school going children & to create awareness among parents and children regarding the consequences of Iron Deficiency Anaemia & to treat iron Deficiency Anaemia & to improve the IQ for better academic performance of children with iron Deficiency Anaemia. Methods: The study was conducted over a period of 6 months. About 400 children from Indira Gandhi Municipal High School, Kurnool were examined and Only 200 out of these found suitable for the study and were given letters of information and consent. From those who responded favorably, a comprehensive data could be obtained form 100 children from proformas. A formal consent letter from the parents of each child included in the study was obtained after explaining to them the whole procedure. Results: The strength of association between iron therapy and increase of Hb values is highly significant. The strength of association between iron therapy and increase of RBC values is highly significant. The strength of association between iron and increase of PCV is highly significant. The strength of association between iron and increase of MCV is highly significant. Conclusion: It is concluded that iron supplementation along with iron-fortified foods in children with Iron Deficiency Anaemia improves hematological parameters significant extent. The academic performance, and physical well-being and behavioral patterns of the children were also improved.

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Background: Road traffic accidents (RTA) are the major causes of premature deaths. Most of these deaths can be averted by adopting proper measures. Knowledge of mode of occurrence of these accidents may give insight of prevention. The present study has been taken up to know the epidemiological factors of road traffic accidents in Suraram village, Quthbullapur Mandal, Hyderabad (Telangana State) Objectives: To know the social profile of the road traffic accidents on basic of month, time of the day, age and sex and to analyze the road traffic accident as per the type of vehicle involved, mode of accident and the injuries sustained Methods: The present retrospective study was conducted in the department of forensic medicine Malla Reddy Institute of Medical Sciences (MRIMS) in Suraram located village, Quthbullapur Mandal, Hyderabad. MRIMS Hospital is located on NH 9 (Narsapur Road). The hospital has 650 beds with all the specialties and is catering services to the surrounding areas. The Vehicular traffic being high and added is the poor road conditions contributing to increased number of accidents. The study was conducted for 6 months period from April to September 2016. During the study period, 84 cases were reported to the hospital. All the cases reported to MRIMS Hospital were studied in relat Results: the results shows more than 50% of the RTAs occurred in the age group of 15-30 years. Maximum accidents occurred (29.76%) occurred during afternoon 3-6 pm around 50% of the accidents occurred in the month of July .The time interval from the occurrence of the RTA to arrival at hospital was 1-2 hrs in 41.67% of the cases. Majority of the RTA occurred among two wheeler users (52.38%).RTA due to self skidding occurred in 26.19% of the two wheeler users Conclusion: It is observed, among all the categories of vehicles involved in RTA, the two wheeler users were the majority involved in accidents(52.38%).Most of causes of the accidents were due to fault of the driver and in (8.34%)of the cases there was influence of alcohol while driving

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Background: At any given time, about 10% of the adult population globally and about one in three adults attending a primary health centre suffers from a mental disorder. Depression and anxiety (common mental disorders) and substance abuse disorders are the most frequent of all mental disorders. It is no surprise that mental disorders figure prominently in the list of leading global causes of disability. Objective: This intervention targets to know the prevalence, correlates and treatment gap for depression in urban slums in Mumbai. Methods: This study is the community-based cross sectional study conducted from July 2009 to July 2010.This study was conducted in an urban slum in Mumbai. Community Epidemiological Scale –D was used to screen depression Sample size was calculated as 254. Systematic random sampling was used to select the study subjects. Results: The prevalence of depression in this study among urban slum population came out to be 54.3%. Lower socioeconomic status, lower educational qualification, presence of somatic complaints and poor marital status, substance use stood out as correlates of depression. Only 8% respondents were aware that depression is treatable and 100% treatment gap for counseling services or medication was found in the present investigation. Conclusion: Mental health needs to be prioritized in public health system at all levels of prevention. More inclusive and percolating economy policies need to be emphasized to reduce poverty.

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Background: Excellent analgesia and akinesia can be achieved by using peri bulbar anesthesia. It is especially used for cataract surgery worldwide. But sometimes it may lead to serious complications. Comparatively safer method is sub tenon’s anesthesia as there is no use of sharp needles into the orbit. Objective: To study the effectiveness of sub tenon’s anesthesia in comparison to peribulbar anesthesia for small incision cataract surgery and to compare the complications in both the methods. Methods: A hospital based follow up study was carried out among 100 selected patients. They were divided into two groups of 50 each. One group received sub tenon’s anesthesia and the other group received the peribulbar anesthesia. Both the groups were compared for incidence of chemosis, incidence of sub-conjunctival hemorrhage, change in intra ocular pressure, analgesia four hours after post-operatively and akinesia 25 minutes after administration of block. Results: In terms of analgesia, sub-tenon’s anesthesia was better as compared to peribulbar anesthesia. It was also less painful. But the akinesia was incomplete using sub-tenon’s anesthesia. The rate of minor complications like sub-conjunctival hemorrhage, chemosis were more in sub-tenon’s group. In the peribulbar group, a case of retrobulbar hemorrhage was observed. Conclusion: Thus we conclude that sub-tenon’s anesthesia is an effective alternative as well as safer compared to peribulbar anesthesia. It provides adequate akinesia, good analgesia. Sub-tenon’s anesthesia has fewer rate of complications.

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