Background: Anal fistula (plural fistulae), or fistula-in-ano, is a chronic abnormal communication between the epithelialized surface of the anal canal and (usually) the perianal skin. The conventional laying - open will lead to division of most of the anal sphincter muscles resulting in incontinence, thus making anal fistulae, especially high anal fistulae difficult to treat. Objective: This study attempts to compare the two techniques, fistulectomy and Ksharasutra in the treatment of fistula-in-ano. Methods: A Randomized Controlled study with 168 patients of fistula in ano was conducted in a tertiary care hospital, Rajahmundry. All those with low anal fistulae were included in the study. Chi square test was used to compare categorical variables. Independent t-test was used to analyze the difference among continuous variables. A P-value of < 0.05 is considered statistically significant and 0.000 is very highly statistically significant. Results: Most of the patients 84 (50%) belonged to 30 - 39 years. Mean age was 34.6 years in fistulectomy patients and 36.7 years in ksharasutra treatment group. Most of them 131 (78%) were males. Majority of the patient had single external opening 148 (88%). Most of the external openings were located postero-lateral 109 (65%). MRI showed that 128 (76%) cases had inter- sphincteric fistulae, 35 (21%) trans-sphincteric fistulae and 5 (3%) sub mucosal fistulae. Ksharasutra required significantly (p = 0.000) lesser duration for surgery, experienced significantly (P = 0.000) less pain post-operatively. The mean duration of healing was significantly (p 0.000) more (34.95 ± 1.8 days) in Ksharasutra group. Ksharasutra group had significantly (P 0.000) few days “off-work”. Ksharasutra required significantly (P 0.000) lesser duration of hospital stay. Cost incurred in rupees was comparatively lesser Rs.1200 for Ksharasutra. The recurrence rate at 1 year was 2 (2.38%) with ksharasutra which is significantly (P 0.000) lower compared to 6 (7.14%) with fistulectomy. Only four cases (4.76%) of incontinence were seen, of which, one (1.2%) case of major incontinence occurred in fistulectomy group. Conclusion: Ksharasutra is a better alternative to fistulectomy in the treatment of fistula in ano, in terms of duration of surgery, pain, hospital stay, cost, post-operative discharge, time for healing, days of absence from work and post-operative complications such as incontinence and recurrence.

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Background: Diabetes mellitus is a group of etiologically different metabolic defects characterized by hyperglycemia resulting from defect in insulin secretion as well as insulin action or both. The role of trace elements in type 2 diabetes like serum magnesium and total serum iron is essential in glucose homeostasis at multiple levels with complex interplay which exist between glucose and magnesium. The aim of the study was to determine the role of iron and magnesium in type 2 diabetes and its complications. Objective: To identify the persons with type 2 diabetes mellitus and state their iron status, magnesium levels in serum for early detection of risk factors which indicate the severity of diabetes and its complications. Methods: A total of 50 subjects aged >35 years were selected from Chalmeda Anand Rao institute of medical sciences, Bommakal, Karimnagar. Total serum iron is determined by Ferrozine method, serum magnesium is determined by xylidyl blue with ATCS method. Results: The mean and SD of serum Random Blood Glucose in controls is 114.5±9.75 as compared to 207.5±31.5 in cases. The mean and S.D of serum Iron in control is 114.36±20.35 as compared to 286.08± 96.35 in cases. The mean and S.D of serum Magnesium in control is 1.9±0.1 as compared to 0.88± 0.1 in cases. Conclusion: Our study was concluded that serum magnesium is decreased and serum total iron is increased in type 2 diabetes which plays a pathogenic role in diabetes and its complications

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Background: Adolescence represents an important stage for the development of healthy nutrition behaviors. Inadequate diet during adolescence period can result in decreased learning ability, delayed sexual maturity, iron deficiency anemia, lack of concentration, impaired school performance and slow growth. Objectives: 1. To study the nutritional status of rural adolescents. 2. To educate the general public regarding commonest illness causing malnutrition and some habits like (smoking, alcohol, chewing tobacco) causing malnutrition. Methods: The study sample of about 100 adolescents, between the ages 12-18 years of both the sexes were selected randomly for the study which was conducted in the rural primary health care centre Guttigar, Sullia Taluk of Dakshina Kannada district, Karnataka in the month of April -June 2014 when come to PHC as OPD attendant, patient’s attendant and some surrounding locality adolescents. The study variables include bio-data and food habit questionnaires. Results: From the results, by using Wilcoxon test it was found that there was a significant association was found between before and after intervention scores (p<0.001). Conclusion: The showed a good improvement in the food habit of adolescents after intervention. Therefore conducting nutrition education will help to improve the food habit as well as nutritional status of the study subjects.

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Background: Depression and diabetes having bidirectional association and depression being 2 to 3 more common among diabetic population can have profound risk of poor outcome and serious implications. Objective: To assess the magnitude of depression among diabetic population residing in rural field practice area of a medical college in Hyderabad, as well as to study the association of various socio-demographic factors with depression Methods: A cross-sectional survey was conducted among 94 adult Population with diabetes residing in the rural field practice area of a medical college in Hyderabad. The sample size was calculated using 4pq/d2 and systemic random sampling was employed. Those who were willing to participate voluntarily were included. The study was conducted for a period of 1 month using a pre-tested and predesigned tool to measure depression and the data collected was analyzed using SPSS 16.0 Results: mean age of the study participants was 58.66 ± 11.517 years, 34% of the study participants with diabetes mellitus were found to have depression, of which most (46.87%) of them were found to be suffering from mild mood disturbances. Marital status was found to be the significant predictor of depression (p<0.05) Conclusion: Prevalence of depression was high among study Participants, further research is warranted to rule out various risk factors involved and to employ preventive strategies.

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Background: With man’s invention of the wheel, the death knell has continued to toll for many. Death and deformity resulting from the accident has become a common occurrence in the society all over the world and road traffic accident outnumbers the other sources of accidental deaths. WHO considers accident to be an unpremeditated event resulting in recognizable damage. Objective: To study road traffic fatalities and associated factors Methods: The study title “Profile of Road Traffic Fatalities in Coastal Odisha: Autopsy Based Study” seeks to find out not only the various forms of road traffic fatalities and epidemiological parameters but also points out precipitating factors, circumstances, manner and causes of death in the coastal belt of Odisha. Results: It was noticed that while pedestrian and two wheeler riders accounted for the bulk of the victims, four wheeler make for the majority of offending vehicle. Whereas when the victim is a four wheeler driver or occupant, invariably the offending vehicle is a heavy vehicle. No limb injuries could be seen in four wheeler driver or occupants and only 2 cases of fatal pelvic injuries were detected in light motor vehicle drivers. Abrasions and contusions were the injuries predominantly seen in all type of road users, closely followed by lacerations. The overall representation of injury to lungs/pneumothorax/hemothorax though is 5.22% (i.e. 36 out of 690 cases), but when it comes to occupants of four wheelers it is seen in 12 out of 52 cases (i.e.23.08%). It was seen that bulk of the death due to cranio-cerebral injuries has occurred within few hours to few days i.e. within a week. Out of the total 418 cases of death due to cranio-cerebral injuries, in 294 cases fracture of some form or other were noticed. Conclusion: Despite the limitations, the study could put some light on parameters multifarious factors leading to road traffic accidents deaths. Cause of motor vehicle accident crashes and road accidents are multifactorial and the pre-crash factors include people, vehicles and road environment. In developing countries human error accounts for majority of the accidents.

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Background: Anxiety is common among patients who are posted for surgery. It is important to study the psycho-social profile of the patients. This knowledge will help plan things pre operatively which will be helpful to reduce anxiety and other psychiatric problems among patients who are undergoing for elective surgery Objective: To study psycho-social profile of patients with depression and anxiety undergoing elective surgery. Methods: Present study was a hospital based cross sectional study carried out among 80 eligible patients who were posted for orthopedic surgery in the orthopedic ward. Detailed history, clinical examination and assessment were carried out. Results: Majority (36%) were in the age group of 31-45 yrs. There were 61% males. 61% were from rural background. 79% were married. 94% patients were Hindu. 70% were 60% were from Middle socio economic status. 30% patients were with no educational background. 35% patients were those whose occupation was agriculture. 67% patients were those who lived with their spouse and children. 54% patients were those whose monthly family income was more than Rs. 2000/-. Conclusion: Maximum patients were having a better background and pre operative counseling was needed for them. Pre operative counseling was useful to reduce the anxiety and restlessness in majority of the patients.

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Background: Stroke is a major cause of mortality, morbidity, & health care expenditure globally. Carotid artery stenosis accounts for approximately 85% of all strokes. There is great value of safe, noninvasive and low cost screening test; therefore Doppler ultrasound study of carotid system is an important modality. Duplex Sonography, combining high resolution imaging and Doppler spectrum analysis has proved to be popular, non invasive, accurate and cost effective means of assessing carotid artery disease. Objective: 1.To assess carotid arteries with the help of color Doppler and -B mode imaging in carotid artery disease. 2. To correlate cerebrovascular accidents with extra cranial carotid artery status. Methods: This study was carried out in patients who had symptoms and signs of strokes, or transient ischemic attacks at a tertiary teaching hospital from the period of January 2015 to June 2016. The study was carried out on 94 patients. A detailed clinical history was taken and clinical examination findings were recorded. Risk factors like hypertension, diabetes mellitus, smoking and ischemic heart disease were documented. CT scan examination of the brain was carried out in all the patients and the findings were noted. Results: In this study, 79% of the patients were males and only 21% were females. The highest number of stroke patients in our study was found in the age group of 50-59 years which was 28%. Around 17% of patients had right MCA territory infarct, 9% had Left MCA territory infarct. Lacunar infarcts were seen in 33% patients. About 3% patients had right ACA territory infarct, 2% patients had left ACA infarct, 2%patients had right cerebellar infarct & 5% patients have age related cerebral atrophy. Normal study of brain was found in 25 patients in this study, 63% of patients had plaque in the carotid system. 47% of patients had plaque on the right side, 41% patients had plaque on the left side and 12% patients had bilateral involvement. Conclusion: Color Doppler examination is an economic, safe, reproducible and less time consuming method of demonstrating the cause of cerebrovascular insufficiency in the extra cranial carotid artery system and will guide in instituting treatment modalities.

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