Severe postburn contracture deformity of both knee and ankle joint causes severe functional limitations. The mainstay of treatment is early surgical excision of contracture tissue and resurfacing with STSG, local flaps and free flaps. All patients admitted with severe postburn contracture of knee and ankle joint between January 2016 to April 2018. All underwent staged management with excision of contracture tissue followed by continuous skin or skeletal traction. And after correction of residual joint contracture the defect is resurfaced with STSG. In all patient’s correction of flexion deformity was achieved. Graft failure was present in 5 patients, in which 2 required re-grafting. Staged treatment with excision followed by continuous traction and then resurfacing with STSG. Customized post-operative splintage results in full correction with adequate coverage of knee and ankle joint contracture

An analysis of 129 cases of vocal cord polyps was done in this study. It was most often seen in middle aged persons during third, fourth, and fifth decades of life. Maximum incidence was in the 5th decade. The youngest of the patient was 26 years of age and the oldest was of 45 years, with the mean age of 36 years. Vocal cord polyps were found predominantly in males (86%), with a male and female ratio of 6.1:1. In all 129 cases, the lesions were unilateral and mostly situated in the middle of the vocal cords. Smoking (68.2%), vocal abuse or misuse (62.8%), and chronic respiratory tract infection (30.2%) were the main aetiological factors. There were no dysplastic changes in the epithelium. The treatment options for vocal cord polyps included both non-invasive and invasive techniques. Non-invasive techniques included conservative therapy with voice rest, steam inhalation, antiallergics, antibiotics, and antireflux drugs. Conservative treatment was considered as an option in vocal cord polyps which were small and of recent onset. Invasive technique was a combination of surgery and vocal rehabilitation. Conventional microlaryngeal surgery was ideal for the treatment of vocal cord polyps. In 82 cases (63.6%), the histopathological picture was of fibroangioma and in other 47 cases (36.4%) the picture was of chronic nonspecific inflammation with oedema. There were recurrences in 18 cases within one year of surgery. Operating measures did not prevent recurrences of vocal cord polyps. Recurrences were significantly less in the patients who stopped smoking and misusing or abusing their voices after surgery. Voice therapy and cessation of smoking in the postoperative period played important roles in the long term results of vocal cord polyps. Better outcome and rapid improvement were observed in those patients who underwent voice therapy in follow ups.

Coronary artery disease (CAD) is currently one major cause of death in the world [1, 2]. CAD is mainly caused by atherosclerosis, which is considered as a chronic inflammation in response to cholesterol accumulation in the arterial wall [3]. Therefore, biomarkers that can predict the presence for early atherosclerotic process and CAD are desirable. Lipidomics is playing vital role in development of atherosclerosis and in cardiovascular disease. Various inflammatory markers and lipid biomarkers are playing role in diagnosis of CAD. Inflammatory biomarkers such as CRP, cytokines [interleukin (IL)-1, IL-6, IL-8, monocyte chemoattractant protein-1 (MCP-1)], soluble CD40 ligand, serum amyloid A (SAA), selectins (E-selectin, P-selectin), myeloperoxidase (MPO), matrix metalloproteinases (MMPs), cellular adhesion molecules [intercellular adhesion molecule 1 (ICAM-1), vascular adhesion molecule 1 (VCAM-1)], placental growth factor (PlGF) and A2 phospholipases may have a potential role for the prediction of risk for developing CAD and may correlate with severity of CAD..Dyslipidemia is major cause of Cardiovascular disease. Ceramide a lipid biomarker is playing a emerging role in diagnosis of CAD, In this review we tried to focus role of Ceramide in diagnosis of CAD and to further risk stratify patients who may otherwise not receive treatment but would remain at high risk for a serious cardiac event. These are patients who could benefit from more intensive treatment, for example: a higher-dose statin, a nutritionist consult or formal exercise therapy. Cardiologists at Mayo Clinic are already routinely checking Ceramides using the new test.

Postpartum Hemorrhage in atonic uterus with ‘C’ section is an important complication and commonly encountered condition. We in the present study tried to evaluate the effectiveness of B-Lynch suture to control PPH in atonic uterus. The study was conducted on n=100 patients in the Department of Obstetrics & Gynecology, Rajiv Gandhi Institute of Medical Sciences [RIMS] Adilabad during Feb 2016 to Dec 2017. 50% of patients were in age groups 20-25 years and 26% belonged to age groups 25-30 yrs and 24% were in the age group of 30- 35 yrs. Primi gravida was in 75% of the cases and 25% of cases were second gravid. Hydramnios was present in 20% of cases PET was in 25% of cases, prolonged labour was in 30% of cases and Previous LSCS and PET was present in 25% of cases each. In 76% of cases no blood transfusion was required, 15% of cases required 1 unit blood transfusion, and 9% required 2 units’ blood transfusions. The complications due the procedure were nil and mortality was nil. Conclusion: The B-Lynch suture is still one of the best methods to control Postpartum Hemorrhage PPH in atonic bladder especially in low resource settings. If used properly it can control PPH without need of blood transfusions and complications and the procedure also preserves the uterus functions and future fertility

WBC counts increases in significant number of patients with acute myocardial infarction. Widely available WBC count test can be used as prognostic marker in acute myocardial infarction. To study correlation between complications of acute myocardial infarction and WBC count. Total 50 diagnosed cases of acute Anterior Wall MI were studied. Complications after acute myocardial infarction were more in elevated WBC count. Elevated WBC count within 24 hours was associated with high rate of complications after acute myocardial infarction; however to established association between complications of acute myocardial infarction and WBC count we need further larger study

Fractures fixation with open reduction and compression plates is frequently used in diaphyseal radius/ulna fractures because of advantages like proper alignment, maintaining length and rotational alignment. This study compares the outcomes of treatment of fracture cases with dynamic compression plates and intra-medullary nailing by a square nail in mid shaft radius/ulna fractures. The study was conducted in Rajiv Gandhi Institute of Medical Sciences, [RIMS] Adilabad during the period from March 2014-Dec 2017. The study involved n=55 cases of which n=31 were male and n=24 were female. The common age group involved was 31- 40yrs contributing to 41.81% (n=23) of cases followed by 23.63 % (n=13) cases in 21 -30 yrs age group and 20% (n=11) cases in 41 – 50 yrs age group. Most common type of fracture was Transverse type in 37 cases, oblique in 10 cases and comminuted in 8 cases. Dynamic compression plates were used in 61.82% (n=31) of cases, IM nail was used in 38.18% (n=24) of cases. Dynamic compression plate treated patients had overall 94.11% cases in Excellent and good results and 90.48% of the IM nail treated patients had excellent and good results. To conclude Treatment of diaphyseal forearm is challenging as it because of lack of censuses regarding treatment and it requires judicious selection of cases for using compression plates or IM nail. Within the limitation of the present study, it may be concluded that dynamic compression plate offers better overall outcomes in the treatment of diaphyseal radius/ulna fractures

There are limited study of the risk factors and clinical characteristics of patients presenting with myocardial infarction (MI) at a young age in India. To study clinical profile of young patient with MI in India. The young MI patients were more likely to be male (80%), with high BMI (31 kg/m2), with a family history of premature coronary artery disease (49%) and to be current smokers (57.1%). 36% patients had none or only one traditional risk factor for MI. Male gender, Smoking, obesity and a family history of premature coronary artery disease being particularly prevalent in young MI patients

Adjuvants are commonly used during general anesthesia in order to reduce the requirements of the general anesthetics. Dexmedetomidine is one of an important general anesthetic adjuvant used because of its useful properties like sedative, analgesic and anxiolytic. It has other important useful properties like cardioprotection, neuroprotection and minimal respiratory depression. We in the present study tried to evaluate the efficacy of dexmedetomidine in different concentration when used as an infusion during general anesthesia in patients undergoing routine abdominal surgeries. Methods: the study was conducted in Rajiv Gandhi Institute of Medical Sciences and Hospital [RIMS], Adilabad. The patients were selected from those undergoing abdominal surgeries. They were randomly divided into three groups. Group A (n=20) patients acting as controls received IV saline 10ml. Group B received Dexmedetomidine 0.5 µg/Kg/hr IV and Group C received Dexmedetomidine 1 µg/Kg/hr IV. Anesthesia was maintained with N2O to O2 mixture of 60:40. MAP values were maintained within 25% of the baseline values. Recovery times from tracheal extubation, modified Alderete score, VAS scores, tolerating liquids, and passage of flatus was noted. Results: The mean duration of surgery in Group A was 145.45 ± 20.06 minutes, mean duration of anesthesia was 180 ± 25 minutes. The mean duration of infusion of dexmedetomidine was 160 ± 20. For group B the values were 130.12 ± 24.75, 160.0 ± 22.0, and 140 ± 90 minutes respectively. The values for group C were 121.59 ± 18.16, 145 ± 26 and 125 ± 15minutes. The P values between group A and C were significant in Mean duration of anesthesia and mean duration of infusion. The time to suction catheter response was significantly higher in Group C. The modified Aldrete scores in Group B and Group C were found to be significant when compared to Group A similarly postoperative nausea and vomiting was significantly lesser in group C and VAS scores of pain were also significantly lesser in the Group C as compared to Group A and B. conclusion: Dexmedetomidine is low concentrations may be useful to provide sedation and mild analgesia at the same time preserving the cardiovascular and respiratory functions. Therefore dexmedetomidine when used as a general anesthetic adjuvant during routine abdominal surgeries reduces the sevoflurane and opioid requirements and results in better recovery of the patients.

A zero coronary calcium score was obtained in out study in 28.33 % participants of which only 4 (13.35% of cases) patients who developed ACS had a zero CACS, while 13 (43.3% of controls ) people among control had a zero CACS. In this study, we analysed the distribution of Coronary artery calcium scores in patients of ACS who do not have traditional risk factors namely obesity, diabetes, smoking, dyslipidemia, hypertension was significantly different as compared to asymptomatic people without CAD and having none of above mentioned risk factors. Even though there were no traditional risk factors coronary calcium scores were significantly higher in patients who developed ACS as compared to controls

‘Poison’– The term first appeared in English Literature around the year 1230. It refers to a substance with an inherent property of being harmful to life or health. The earliest used poison, used in wars and official executions, included plant extracts, animal venoms and minerals. The aforementioned poisons are still used in the present day though they are not amongst the more prevalent ones, the trends having changed over the last millennium. Aluminium Phosphide poisoning occurs most commonly through ingestion and is seen more frequently in young males in their third decade. Fresh AlP is associated with higher and quicker fatality with respect to stored poison, less survival, more mortality.

Genes are the smallest functional units of the genetic system, which control the development and function of all organisms. A gene is a linear sequence of DNA that codes for a particular protein. Gene therapy is based on principle that a normal gene is inserted to compensate for a nonfunctional gene and abnormal gene can be repaired through selective reverse mutation. It uses purified preparations of a gene or a fraction of gene to treat diseases. Gene therapy can be used to treat wide range of diseases ranging from single gene disorder to multi-gene disorder. It has variety of applications in the field of dentistry like in cancerous and precancerous condition, salivary gland disorders, autoimmune diseases, bone repair, DNA vaccination, bone repair etc.

There is need for more of scientific studies on the validity of traditional neurological teaching of clinical sign. Many textbook mention several cerebellar signs, but what the evidence base for these mention statements? A thorough search in the literature did not found the incidence of these cerebellar signs in cerebellar disorder and there validity. To assess sensitivity and positive predictive value of each cerebellar sign in cerebellar disorder. Residents in the department of medicine asked to examine healthy control or patients in a random order without giving them any information about the subject. Inability to do Tandem walking, Ataxic-gait, intention tremor, dysdiadochokinesi, dysarthria are having higher sensitivity while hypotonia and pendular knee jerk have lower sensitivity. Out of these 12 cerebellar signs, except Hypotonia and pendular knee jerk all were having statistically significant association.

Abdominal trauma is responsible for 10% of all the traumatic deaths. With progressing technologies and civilization, the profile and pattern of abdominal trauma is changing. This study was conducted to look into the pattern and early treatment outcome of abdominal trauma in our local setting. Prospective and observational study from 1 February 2017 - 1 February 2018. Records of patients with abdominal trauma were collected from the day they were admitted to final outcome of management at discharge or death. Data analysis was done using IBM® SPSS® Statistics Version 22. Forty-nine patients were admitted with abdominal trauma. The majority was male (87.8%) and Malay (61.2%). Mean age was 31.6 years old (range 3-75). The most frequent type was blunt trauma (95.9%); its most common cause was motor vehicle accident (85.7%). Abdominal trauma was associated with other injuries in 75.5% of cases. The most common associated injuries were chest injuries (44.9%), followed by skeletal (40.8%) and soft tissue injuries (26.5%). FAST were done on 89.8% of patients, CECT scan (61.2%) and ultrasonogram (18.4%). The liver was injured in 49.0% of patients, spleen 49.0% and bowel 14.3%. Fifty-one percent of patient had single abdominal organ injury, 16.3% had 2 organs and 24.5% had 3. The majority of patients were treated non-operatively (61.2%). Four patients died of polytrauma (8.2%). Most trauma patients are young male. Abdominal trauma is commonly associated with other injuries but most can be treated non-operatively

The blood pressure changes are sometimes reflected by changes in Intra-ocular pressure. We in the present study tried to evaluate the changes in IOP with the change in blood pressures in borderline hypertensive to known hypertensive patients graded according to recent ACC/AHA guidelines of hypertension in male and female patients visiting Rajiv Gandhi Institute of Medical Sciences [RIMS], Adilabad. The study was carried in the Department of General Medicine and Department of Ophthalmology. A total of (n=222) patients were involved in the study. Subjects with the history of glaucoma, ocular hypertension, corneal abnormalities or those who underwent ophthalmic surgeries were excluded from the study. Systolic blood pressure was determined at the point at which the Korotkoff’s sounds become audible (first phase) whereas the diastolic BP was measured at the point at which the sounds suddenly become faint (fourth phase of Korotkoff’s sounds). Blood pressure measurements were determined by taking the mean value of three readings at 30 minutes interval. The IOP was measured in the Department of Ophthalmology, of both eyes with help of Goldmann applanation tonometer using 2% fluorescein eye drops by the same examiner to avoid any difference. In this study, we included a total number of (n=222) patients out of which males were (n=120) 54.54% and female were (n=102). The mean age of the individuals involved in the study was 52.25 ± 12.5 years. The overall mean IOP in males was 18.85 ±6.65 [95% CI 17.7 ± 20.0] similarly the overall mean IOP in females was 17.54 ± 5.83 [95% CI 16.4 -18.7]. The differences between the IOP of male and female were statistically insignificant. The Pearson's correlation coefficient was measured for each subgroup of hypertension among the male the all the subgroups showed the positive correlation of IOP with blood pressure and a strong correlation was shown by Hypertension stage II. In females, the correlations were also positive in all subgroups however in hypertension stage II showed weak to the moderate correlation coefficient. There is a strong positive correlation between the blood pressure and IOP, especially in males. Considering IOP as one of the screening means of glaucoma detection we would recommend that every hypertensive patient undergo IOP check regularly to prevent glaucoma.

The prevalence of nutritional deficiency especially the iron deficiency anemia is very common in pregnant females of developing countries, more so in the rural and tribal population. We in the present study tried to evaluate the prevalence of anemia in 300 females in 1st, 2nd and 3rd trimester attending ANC in Rajiv Gandhi Institute of Medical Sciences and Hospital [RIMS], Adilabad. The Institutional Ethical committee permission was obtained for the study. 100 patients in each of the three trimesters were included in the study all the pregnant ladies were healthy without any significant medical disorders. The blood samples were collected from the peripheral vein in 5ml vacutainer and send to the Department of Pathology for examination. The Department of Pathology, RIMS Adilabad uses 5 part hematology cell counter (Sysmex Xn 1000 manufactured by Sysmex India Pvt. Ltd Mumbai) to obtain all the hematological parameters. The mean levels of hemoglobin in n=100 patients of 1 trimester were 8.38 ± 1.5 gm/dl, the mean levels of Hb in n =100 patients of 2nd trimester was 8.34 ± 1.24 similarly the mean Hb levels of n=100 patients in the third trimester was 7.75 ± 1.02. The hemoglobin levels of 10.0 – 10.9 gm/dl was classified as mild anemia in our study 10.83% of pregnant ladies had mild anemia. Between 7.0 – 10.0 it was classified as moderate 76.67% of pregnant ladies had moderate anemia, < 7.0 gm/dl was classified as severe 12.5% had severe anemia and < 4.0 gm/dl was classified as very severe (decompensated) anemia no case of very severe anemia was present in this study. The presence of nutritional deficiency anemia is very common in the tribal pregnant females of Adilabad. Although all the pregnant females receive duly the dose of iron and folic acid supplementations during the Antenatal care there needs to be good nutritional supplementation provided to reduce the burden of anemia in the pregnant females of this area.

A novel therapeutic use of Ethosuximide has come to light with the findings of powerful analgesic effects in experimental models as well as in humans.The analgesic effects of Ethosuximide were explored in various nociceptive models. Following intraperitoneal administration, ethosuximide dose-dependently reversed chemotherapy induced peripheral neuropathic pain and capsaicin-induced mechanical Allodynia, and produced antinociceptive effects in the rat-tail flick reflex test in male rats. Analgesia Produced by Ethosuximide is as good as that Produced by Gabapentin in Acute Pain models. Analgesia produced by extract of Ocimum sanctum is as good as that Produced by Ethosuximide, when compared with these drugs individually in acute pain models. In Neuropathic Pain induced by Ethosuximide Produces Significant Analgesia in Thermal Hyperalgesia Models and significantly reduces Cold Allodynia. The Ethosuximide in neuropathic pain relievers Thermal Hyperalgesia as well as cold Allodynia.

Fatty liver disease in absence of alcohol abuse is now emerging as a major health burden in the world. It represents the hepatic manifestation of the metabolic syndrome, a variably defined aggregate of disorders related to obesity, insulin resistance, hypertension and hyperlipdemia. To study the various anthropometric parameters in non-alcoholic fatty liver disease patients. The present study was conducted in the Department of Medicine on 65 patients with ultra-sonographic finding of fatty liver disease with no history of alcohol. Various anthropometric measurements like neck circumference, height, weight, waist to hip ratio, BMI were measured and recorded. For analysis, statistical software SPSS latest Version 20.0 was used. The results were analysed using the appropriate statistics. In our study we found that 45 patients ie 69% are obese and maximum number of the patients ie 95% males and 100% females have their waist hip ratio above the cut off value and 64% male and 98% female have neck circumference more than the cut off value . The study concludes obesity, neck circumference and waist: hip ratio was associated with NAFLD in our study

Sympathetic & Parasympathetic test status may be changed during follicular and late luteal phases of menstrual cycle due to fluctuations of serum estrogen and progesterone levels. Objective is to find out. Sympathetic & Parasympathetic tests between male medical students & luteal phase of menstrual cycle in female medical students. This study evaluates autonomic function tests in different phases of menstrual cycle and concludes that sympathetic activity is highest during luteal phase and lowest in the follicular phase. It is concluded that there is higher sympathetic activity in males as compared to females