The observational study was aimed at assessing the effectiveness and tolerability of Heptral (brand of ademetionine 1,4-butane disulfonate) in Indian patients presenting with intrahepatic cholestasis (IHC) due to chronic Non alcoholic liver disease (NALD). The study also aimed at understanding the prescribing practices of physicians as well as the profile of patients being prescribed Heptral. This Prospective observational study included 250 patients across 23 sites in India. The assessments of health-economic parameters, liver biochemistry, signs and symptoms of IHC (fatigue, jaundice, and pruritus) were performed at two visits, i.e., at baseline and after six weeks of Ademetionine treatment. Ademetionine was prescribed as part of the routine medical treatment as per the local label and not as a study intervention. Full analysis set (FAS) population included 244 patients. The mean age was 43.75 +/- 11.14 years and 75.5% (184/244) patients were males. 30.7% (75/244) of FAS population presented with cirrhosis. Concomitant medications were recommended to 44.4% (108/243) patients. Ademetionine treatment resulted in statistically significant reduction (p < 0.0001) in burden of disease parameters (number of days off work and number of visits to doctor), levels of biochemical markers and signs and symptoms of IHC. Physicians had favourable opinion for effectiveness and tolerability of Ademetionine for majority of the patients. Administration of Heptral in patients with NALD and IHC resulted in significant improvement in burden of disease, laboratory markers, signs and symptoms of cholestasis. The treatment was well tolerated.

Angiolymphoid hyperplasia with eosinophilia and Kimura's disease share many clinical and histological features. Although they were once considered different stages of the same disease, they are now known to represent separate entities. Here a case is reported in a 14-year-old girl who presented with bilaterally symmetrical gradually progressive peri-ocular swelling involving both upper and lower eyelids of two months' duration. Peripheral blood showed eosinophilia, MRI scan of orbit revealed soft tissue mass in both lids encroaching into the globe, histopathology of biopsy specimen revealed angiolymphoid hyperplasia with eosinophilia. The case is reported for the peculiarity of presentation and rare location of the disease.

The temporoparietal fascia flap with its long rotational axis and extensive mobilisation properties, can provide vascularised tissue to repair the most distant areas in the orofacial region. The donor site morbidity is minimal with a well-concealed scar hidden in the hair-bearing scalp. However, the temporoparietal fascia flap is usually used together with a split thickness skin graft. This leads to one more donor site causing increased morbidity. In this case temporoparietal fascia flap was used for an intra-oral reconstruction in a case of oral submucous fibrosis, without a split thickness skin graft cover. The healing was excellent and the flap provided a good surface for remucosalisation.

The porphyrias are a group of rare metabolic disorders, each arising from a predominantly hereditary catalytic dysfunction of one of the eight enzymes in the porphyrin-haem biosynthetic pathway. Acute intermittent porphyria is the commonest type of porphyria worldwide. The disease is more common in women than men. It is therefore important for the obstetricians to know about this entity as many women present with abdominal pain during pregnancy. This case shows that if acute intermittent porphyria is properly treated in a mother there is normal maternal and foetal outcome. A case of acute intermittent porphyria known before pregnancy has been reported in a patient who had three spontaneous abortions in the past, she was delivered by elective caesarean section. The pathogenesis of the disease, its' symptoms, diagnosis, therapeutic approach both during and out of pregnancy have been also discussed.

Surgical intervention results in a wound. In practice of surgery, wounds and their management is a fundamental job. Various surgical wounds are created by surgeons including abdominal laparotomy wounds. Therefore disruption of a repaired laparotomy wound is an acute wound failure. Burst abdomen, abdominal wound dehiscence, dehiscence of fascial layers is a postoperative complication and the reported mortality rate is about as high as 45%. Incidence of dehiscence as described in literature ranges from 0.4%-3.5%. No specific single cause is one reason for all wound disruption. Abdominal wound dehiscence, which may occur at any age, has been subject to numerous investigations in the past and reviews of many series of cases have been there in the literature. A good knowledge of risk factors is essential for prophylaxis. High risk cases may get benefit from close observation and early intervention.

Pulmonary hypertension is an important cause of dyspnoea in human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) patients. The effect highly active antiretroviral therapy on pulmonary artery pressure has been an area of controversy. The purpose of this study was to evaluate the effect of antiretroviral therapy on pulmonary hypertension in HIV patients. This prospective cohort study was performed in a peripheral medical college of West Bengal with 88 patients from October 2008 to September 2011. By echocardiography, pulmonary artery pressure was recorded before initiation of antiretroviral therapy. After one year of antiretroviral therapy repeat echocardiography was done and pulmonary artery pressure was evaluated. The values were analysed. The present study showed that highly active antiretroviral therapy improves pulmonary artery pressure in HIV/AIDS patients if instituted at early stages (WHO classes I and II). However, at more advanced stages of pulmonary artery hypertension, it does not have any significant effect on reduction of the same. The present study documents that early detection of pulmonary artery hypertension in HIV/AIDS patients is essential and prompt institution of highly active antiretroviral therapy should be considered in them even when those patients do not fulfill the conventional criteria for initiation of this treatment.

Since significant number of cases of bronchial asthma are first seen by general practitioners (GPs) and physicians, the present study was undertaken to assess the asthma management practices among GPs and physicians in and around Pune city of Maharashtra. It was a prospective study in which 40 GPs and 30 physicians were personally administered a questionnaire dealing with use of diagnostic methods and management plan in chronic asthma. Spirometry was used for diagnosis by 16 physicians (53.3%) and 7 GPs (17.5%) and peak flow meter by 1 GP (2.5%) and 5 physicians (16.6%). Nine GPs (22.5%) and 12 physicians (40%) preferred inhalation therapy solely. Twenty-six GPs (65%) and 20 physicians (66.6%) preferred combination of inhalation and oral therapy. Thirty-two GPs (80%) and 11 physicians (36.6%) were using inhaled short acting beta2-agonists on regular basis. Thirty-seven GPs (92.5%) and 25 physicians (83.3%) were prescribing inhaled and oral bronchodilators together. Twenty-nine physicians (96.6%) and 12 GPs (30%) were prescribing inhaled corticosteroids on regular basis. Twenty-two GPs (55%) and 12 physicians (40%) were prescribing inhaled and oral steroids concurrently. Twenty-two GPs (55%) were prescribing inhaled and oral steroids as on required basis. Thirty-two GPs (80%) and 20 physicians (66.6%) did not explain the importance of inhaled steroids to their patients. Single dose dry powder inhaler was prescribed by 24 GPs (60%) and 27 physicians (90%), metered dose inhaler was prescribed by 9 GPs (22.5%) and 12 physicians (40%). Spacer was prescribed by 4 GPs (10%) and 6 physicians (20%). Inhalation technique for metered dose inhaler was incorrect in 22 GPs (61.2%) and 6 physicians (20%) and for single dose dry powder inhaler it was incorrect in 15 GPs (35%) and 2 physicians (6.6%). None of the GPs and only 5 physicians (16.6%) were monitoring their patients as per GINA guidelines. Four GPs (10%) and 7 physicians (23.3%) delivered asthma education in the form of only verbal communication. Overall management skills of physicians were better than GPs. However, they need to be educated about more frequent use of spirometry or peak flow meter in confirmation of diagnosis, increasing use of inhalation therapy, emphasising the role of inhaled steroids to patients and providing optimal asthma education to all patients. There is an urgent need to educate GPs in almost all aspects of asthma management.

Swimming is a mass-oriented, well organised and health directed sport which helps to acquire good health for the participants. In our country it is started mostly in the 8-9 years of age and when compared to developed countries the children start the practices around the 3-6 years of age. In swimming like other sports, injury can happen particularly during practice and events competition. The different types of injuries like shoulder joint injury, knee joint injury, red eyes, ear-nose infections, muscle cramps, etc, so happened during swimming practice and swimming competition, affect the performances of the swimmers on many different levels, in both training and in swim meets. This is an ongoing problem for many swimmers, moreover swimming is an intense workout, so it's important to make sure for getting adequate nutrition throughout the day. Proper nutrition and dieting play a large role in optimising swimming performance. A poor diet has a negative effect on athletic performance, as it is also evident in this study where most of the swimmers are suffering from nutritional anaemia as detected by the low level of haemoglobin in their blood and so today the study work has obviously thrown some light on this aspect to highlight the problems and their solutions.

Primary hyperparathyroidism due to parathyroid adenoma is sporadic in nature and seldom symptomatic. Patients usually present with pathological fractures. The objective of this study was to diagnose primary hyperparathyroidism in patients presenting with pathological neck of femur fractures, detection of the adenoma or ectopic tissue, removal of the tissue, and treatment of the fracture. All patients presenting with pathological fracture neck of femur, with clinical features suggestive of hyperparathyroidism were investigated for blood calcium, alkaline phosphatase, parathyroid hormone. If found to be raised patients underwent nuclear scan for detection of primary hyperparathyroidism. Primary hyperparathyroidism (usually parathyroid adenoma) when found was excised. After 2 weeks fixation of fracture was done. Follow-up at 6 weeks, 12 weeks, 6 months, 1 year were done. Time to radiological union, functional assessment and other systemic complaints were noted. Nine patients were included in the study as they presented with pathological fracture due to hyperparathyroidism. All except 1 were due to parathyroid adenoma. Excision of the tumour with early fracture fixation lead to quick rehabilitation of the patient. All fractures united. Hyperparathyroidism is asymptomatic in many patients, and may present only with a fracture. Orthopaedicians should keep this possibility in mind while diagnosing these cases, failure to which may result in disastrous complications.

Sixty-six patients (male 30, female 36) with displaced trochanteric fractures (according to AO classification = A1.2, A1.3 A2 and A3 groups) have been studied during the period November 2011 to September 2013. Displaced stable fractures also have been included because in grossly osteoporotic elderly patients, this may lead to gross uncontrolled collapse and act like unstable fracture and it has fixation failure rate of 1-9%. Mean age of the patients was 8.5 years. DHS was used for the patients with intact lateral cortex and used DCS for the fractures with comminuted lateral cortex extending up to vastus ridge and also in A3 types. The screw placement was inferior to central in AP view, and central to posterior in lateral view. In AP view under reduction was done with slight lateralisation and upward displacement of distal fragment and fixed with DHS/DCS with affected limb in abduction 30 to 40 degree to achieve valgus angle of about 160-170. In lateral view neck shaft angle was maintained to 160-180 degree, on higher side, avoiding retroversion. All the parameters of fixation failure like varus displacement, retroversion, external rotation, medialisation, cut out, collapse and shortening of limb, pullout side plate and implant failure have been studied. Only the patients treated with valgus under-reduction have been included in this study. We conclude that under-reduction in valgus position gives excellent posteromedical stability as it provides controlled collapse as the calcar fragment is abutting against the medial femoral shaft (as in Weyne County reduction) and also prevents shortering by valgus reduction (Parker).

The present study was being undertaken in retrospective and prospective basis to investigate the ultimate outcome of the procedure in type IIIA and type IIIB injuries. We have used simple AO type of external fixator and applied uniplanar double tube frame and unilateral biplanar frame. Frames were selected randomly; unilateral uniplanar frame in some patients having type IIIA wound and in some patients having type IIIB wound. Similarly, unilateral biplanar frames were used in some patients with observations have shown that these external fixators are simple, easy to apply, cost-effective and yield acceptably good results. Thus, the 'external fixator' application for the management of open fractures of tibia may give good results even to the poor patients and may be suitable for underdeveloped and developing countries. A study was undertaken by the committee on fracture and traumatic surgery of the American Academy of Orthopedic Surgeons to evaluate the efficacy and practicability of this method of treatment. The study was carried out in the department of orthopaedics, RG Kar Medical College & Hospital, Kolkata in retrospective and prospective basis since June, 2005. Forty-seven patients were selected from the outpatients department and emergency department having open fracture of shaft of the tibia with or without fracture of the fibula and were treated in the orthopaedic indoor department. The patients were followed up for 6 months to 2 years. Out of 47 cases, 2 patients could not be communicated for follow-up. Normal union could be seen in 25 patients followed by delayed union (n = 11) and malunion (n = 11). Joint shiffness was seen in 16 patients.

Modified Boytchev is one of good operative procedure for recurrent anterior dislocation of shoulder in terms of recurrence and loss of motion of shoulder by rerouting the conjoined tendon deep to subscapularis. To know the possible mechanism of this procedure, electromyographic study showed the significantly greater recruitment pattern in subscapularis as compared to pre-operative subscapularis electromyographic pattern and other rotator cuff muscles.

A prospective randomised controlled study was conducted at RG Kar Medical College and hospital to compare the efficacy and side-effects of two doses of oral misoprostol, with one dose following mifepristone in early abortion. Two randomly allocated groups of seventy-five women each were formed, which were comparable in all respects and also conformed to the inclusion and exclusion criteria laid down in this study. Both groups received 200 mg of mifepristone on day one. After 48 hours, both groups received 400 microg of misoprostol and 3 hours later one group received 3 tablets of 200 microg misoprostol and the other group received 3 tablets of placebo. The women were then followed up to note the time of expulsion, completeness of the process, amount of bleeding encountered, side-effects if any or any other observation. The most important parameter ie, the completeness of the expulsion when compared showed no statistically significant difference between the two groups (p-value = 0.1025).

Ambulatory blood pressure monitoring provides a more reliable assessment of actual BP than office BP and is a more sensitive risk predictor of clinical cardiovascular outcomes. Recent international guidelines for hypertension have emphasised the usefulness of ambulatory BP for diagnosis and management of hypertension. We used ambulatory blood pressure monitoring to monitor the effect of the pharmacological treatment in patients with stage 1 or 2 hypertension. This was a multicentric randomised controlled trial having 360 subjects with 180 in each treatment arm. The duration of study was 6 months. The patients were randomly selected to receive atenolol or losartan as initial therapy. The dose of atenolol or losartan was 50 mg once daily at 8 am in the morning. Ambulatory BP assessment was done in a subgroup of subjects using Schiller BR-102 plus machine. One hundred and thirty patients were recruited for the study using ambulatory blood pressure monitoring. There were 66 patients in atenolol arm and 64 patients in the losartan arm. A significant white coat hypertension was noticed in both the arms. Out of 130 subjects in the ambulatory group, 41.53% had a white coat hypertension. Statistically significant reduction of office BP was observed with both atenolol and losartan; however, no significant difference in efficacy of the two drugs was found in reducing office BP. However, when using ambulatory blood pressure monitoring, the reduction with either drug was not significant. The dipper status was better in the atenolol group than the losartan group. Neither of the drugs prevent morning surge of BP when administered once daily in the morning. There was high prevalence of white coat hypertension in patients with stage 1 and stage 2 hypertension. There was similar reduction of systolic blood pressure and diastolic blood pressure by the 2 study drugs. Atenolol scores over losartan in converting non-dipper to dipper but its' impact on clinical outcome is not known. Morning surge of BP was unaffected by either of the study drugs.

The objective of this study was to assess awareness regarding otitis media in patients of rural parts of Raichur district, Karnataka. Patients of otitis media attending village health check-up camps conducted by our department were given questionnaire to assess the awareness regarding otitis media. Association between sociodemographic parameters and awareness were studied using Chi-square test. Age group of 10-30 years was the most affected. More than half of the patients had ear discharge of 5 to 15 years duration. Over 50% of the population showed ignorance with regard to the risk factors for otitis media. Earache was either disregarded (32%) or treated with home remedies by most, (63%) while a doctor's opinion was often sought for ear discharge (60%). Lack of awareness about otitis media contributes to its' high prevalence in this South Indian district. Health education is essential to reduce the disease burden.