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font-size: 14px;"><strong><span style="font-family: 'lucida sans unicode', 'lucida grande', sans-serif;">International Journal of Medical and Biomedical Studies</span></strong></span><span style="text-align: justify; font-size: 14px; font-family: 'lucida sans unicode', 'lucida grande', sans-serif;"><strong>&nbsp;(IJMBS)</strong> is an international, peer-reviewed, open access, online journal dedicated to the rapid publication of full-length original research papers, short communications, invited reviews, Case studies and editorial commentary and news, Opinions &amp; Perspectives and Book Reviews written at the invitation of the Editor in all areas of the Medical and Biomedical Studies.</span></p> <hr> <p style="text-align: justify;"><span style="font-family: lucida sans unicode,lucida grande,sans-serif;"><span style="font-size: 14px;"><strong>Medical Studies||&nbsp; Biomedical Studies ||&nbsp;</strong></span></span></p> <p style="text-align: justify;"><span style="font-family: lucida sans unicode,lucida grande,sans-serif;"><span style="font-size: 14px;">Anatomy, Physiology, Anesthesia,<strong>&nbsp;</strong>Biochemistry, Molecular Biology, Cell biology, Genetics, Hematology, Pathology, Immunology, Microbiology, Virology, Parasitology, Surgery, Dental Sciences, Sports Physiology,&nbsp;Histopathology, Toxicology and all major disciplines of Biomedical Sciences,&nbsp;Pharmacokinetics,&nbsp;Molecular Drug Design, Phytochemistry, Toxicology, Biomedical Analysis, Clinical Research, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology and all major disciplines of&nbsp;Medical and Biomedical Studies.</span></span></p> <p style="text-align: justify;"><span style="font-family: lucida sans unicode,lucida grande,sans-serif;"><span style="font-size: 14px;">Articles are published as they are accepted and are freely available on the journal’s website to facilitate rapid and broad dissemination of research findings to a global audience.</span></span></p> <hr> <p style="text-align: justify;"><strong style="font-size: 14px; 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Most of children (74.00%) were 5-10 Yrs age group. According to clinical symptoms and investigations, 47(47.00%) children had symptoms suggestive of IBS, 25 (25.00%) children had Dyspepsia, 11 (11.00%) children had Functional pain abdomen, 4 (4.00%) children had FAPS, 2 (2.00%) children had Giardiasis, 1 (1.0%) children had right ovarian cyst, 3 (3.00%) children had coeliac disease, 2 (2%) children had cystitis and 5(5.00%) children had gastritis.</p> <p><strong>Conclusion:</strong> Functional pain abdomen is a common complaint of childhood with associated familial, psychological, and co-morbid conditions. Epidemiologic studies of Functional pain abdomen in children may offer information on the evolution of functional bowel disorders through the lifespan.</p> <p><strong>Keywords:</strong> Bowel disorder, Functional abdominal pain (FAP), Chronic abdominal pain.</p> Dr. Laxminarayan Nagal, Dr. Jagdish Dabi, Dr. Harish Kumar Mourya ##submission.copyrightStatement## Thu, 05 Sep 2019 12:37:36 -0400 ROLE OF SERUM ZINC LEVEL IN CHILDREN WITH FEBRILE CONVULSIONS <p>Background: The aim of the present study was to determine whether there were any changes in serum zinc level in children with febrile seizure in comparison with febrile children without seizure.</p> <p><strong>Methods:</strong> A prospective observational study was done on 100 children, admitted in a tertiary care centre. Of these 50 children were diagnosed to have febrile convulsions. The other 50 were febrile children without seizures. Serum zinc levels were measured in all 100 subjects using calorimetric methods. Data was analyzed using SPSS version 22.</p> <p><strong>Results:</strong> In present study, we studied 50 children (36 males, 14 females) with febrile seizure and a control group of 50 patients (37 male, 13 female). The mean ages of patients in the febrile seizure and control group were 25.01±14.07 months and 26.07±13.6 months, respectively. Mean zinc level was 69.78±13.13mcg/dl and 80.72±10.21 mcg/dl in study and control groups respectively and this difference was found statistically highly significant (p&lt;0.001).</p> <p><strong>Conclusion:</strong> Our findings revealed that serum zinc level was significantly lower in children with febrile seizure in comparison with children without seizure.</p> <p><strong>Keywords:</strong> febrile seizure, children, epilepsy.</p> Dr. Laxminarayan Nagal, Dr Jagdish Dabi, Dr. Harish Kumar Mourya ##submission.copyrightStatement## Thu, 05 Sep 2019 12:50:32 -0400 COMPARISON OF RETINAL NERVE FIBER LAYER THICKNESS BETWEEN EMMETROPES AND HIGH MYOPES <p>Background: The present study aims to compare RNFL thickness of high myopes of &gt; - 6D and compare with emmetropic patients, so as to interpret and distinguish the physiological changes of high myopia from accompanying diseases in such individuals.</p> <p>Methods: This was a prospective cross-sectional study. All subjects underwent a full ophthalmic examination, refraction and visual field analysis. Optical coherence tomography was used for RFNL thickness measurement. The mean peripapillary RNFL thickness between groups was compared using both analysis of variance and analysis of covariance.</p> <p>Results: The mean value of average RNFL thickness in both groups was found to be 85.40 in group 1 and 99.34 in group 2. P value was 0.0001, showing that there was significant statistical difference between both the groups and average RNFL thickness was thinner in myopic group.</p> <p>Conclusion: RNFL was found to be significantly thin in high myopia.</p> <p><strong>Keywords:</strong> RNFL thickness, Myopia, Emmetropes</p> Neha Yadav ##submission.copyrightStatement## Thu, 05 Sep 2019 13:08:57 -0400 PREVALENCE OF HYPOTHYROIDISM IN TYPE 2 DIABETES MELLITUS <p><strong>Introduction</strong>: Thyroid hormone deficiency can lead to adverse health effects even death, if left untreated. It is a pathological condition known as hypothyroidism. Most common symptoms of hypothyroidism in adults are weight gain, fatigue, lethargy, cold intolerance, constipation, and dry skin. These clinical presentations can differ with age and sex, among other factors. Thyroid Stimulating Hormone (TSH), is associated with an increased risk of developing a number of clinical conditions, like cardiovascular diseases, diabetes, lung disease, malignant condition, and psychiatric disorders, both before and after the diagnosis of thyroid dysfunction. Type 2 Diabetes Mellitus (T2DM) is the chronic endocrine disease which is characterized by hyperglycemia resulting in impaired insulin secretion insulin resistance.</p> <p><strong>Material and Methods</strong>: This prospective observational study was carried out at OPD of Dept. of Medicine at Govt. Doon Medical College and Hospital. The study period was between jan2019 to August 2019. The anthropometric measurements and demographic characteristics of patients included in the study were recorded. The clinical details and medications are entered into Excel sheet of Microsoft Excel 2013. Biochemical tests were done and reports were entered.</p> <p><strong>Results</strong>: Prevalence of hypothyroidism in T2DM is found to be 10.94% in our study. Average BMI was observed to be 28.01 kg/m<sup>2</sup> with SD of 3.39 kg/m<sup>2</sup>. Level of T3 and T4 were observed to be 0.98(0.23) ng/ml and 1.24(0.29) ng/ml respectively. Fasting blood glucose level was 133.05(17.81) mg/dl and post prandial blood glucose level was 201.54(27.33) mg/dl. Among all 112 patients, 71(63.39%) of cases had a family history of diabetes.</p> <p><strong>Conclusion</strong>: It is noted that one-tenth of patients with type 2 diabetes mellitus has hypothyroidism. BMI was noted to be more than 28 kg/m<sup>2</sup> among all patients. Hypothyroidism may be prevalent in T2DM patients due to duration of diabetes, obesity. To confirm the findings, more studies in this area are required.</p> <p><strong>Keywords:</strong> T2DM, Hypothyroidism, TSH, T3, T4.</p> Dr. Harish Basera, Dr. K.C. Pant ##submission.copyrightStatement## Fri, 06 Sep 2019 04:06:01 -0400 MORTALITY PREDICTORS IN PATIENTS WITH ACUTE EXACERBATION OF CHRONIC OBSTRUCTIVE PULMONRY DISEASES <p><strong>INTRODUCTION</strong>: COPD is a chronic disease which involves the airways, lung parenchyma, and pulmonary vasculature and also has considerable systemic manifestations.&nbsp;This disease is progressive and there is gene–environment interaction and hence can be prevented by avoiding exposure to the noxious particles. Commonest attributing risk factor is cigarette smoking in any form or air pollution.The in-hospital mortality rate for acute exacerbation of COPD may range from 2.5% - 25%; readmission rates from 25% to 55% for those who survived, and 25% -50% of these patients may die within one year. Most important single most crucial parameter to determine the risk of mortality in patients experiencing acute exacerbation of COPD is the forced expiratory volume in one second (FEV1).&nbsp;This DACF score can be useful in severely ill patients to predict mortality. This study was carried out to evaluate the DACF score as a clinical prediction of mortality for patients with acute exacerbation of COPD.</p> <p><strong>MATERIAL AND METHODS</strong>: All patients admitted for an acute exacerbation of COPD during study period were included in the study. All included patients were cases of COPD confirmed with pulmonary function test i.e. forced expiratory volume in one second/forced vital capacity &lt;0.7 and irreversible airway obstruction and were treated with a combination of various bronchodilators.&nbsp;The study included patients aged 40 years or older and who were admitted in the hospital and had a primary clinical diagnosis of AECOPD. Sociodemographic data was recorded which includes age, gender, comorbidities, and number of previous AECOPD. Plain chest x-ray, spirometry, electrocardiogram was carried out. Relevant tests such as ABG analysis, complete blood count, kidney function test, liver function test, and serum electrolytes were done. DACF score was calculated.</p> <p><strong>RESULTS</strong>: A total of 124 patients were included in the study, out of which 104 (83.88%) survived and were placed in group 2 and 20 (16.12%) patients died during the hospital stay were placed in group 1. Hence, the overall in hospital mortality rate for AECOPD was 16.12%.FEV1 in non-survivors group was 38 ± 12.98 while in survivor group it was 45 ± 11.55. Long-term oxygen therapy was given to 11 (55%) in non-survival group while it was given to 20 (19.23%) in survivors group.DACF score was calculated, most common score was 3 (48, 39%). On DACF score 1 there were 2(10%) non survivors and 34 (33%) survivors.35% mortality was seen in score 4, while no survivor was found on same score, this was statistically significant (P&lt;0.0001). on DACF score three, 25% patients died while 41% survived. Purulent sputum was observed in 90% of non survivors and 49% of survivors. Respiratory rate/min in Non-survivors&nbsp;(n=20) was 29.2±5.4 and in Survivors&nbsp;(n=104) was 25.4±3.8. Arterial blood gases analysis pH in Non-survivors&nbsp;(n=20) was 7.29±0.04 and in Survivors&nbsp;(n=104) was 7.45±0.08. paCO2&nbsp;(mm Hg) in Non-survivors&nbsp;was 50.78±13.44 and in Survivors&nbsp;was 43.11±11.49. Body mass index (kg/m2) in Non-survivors&nbsp;was 21.65±7.4 and in Survivors&nbsp;was 26.97±8.9.63.</p> <p><strong>CONCLUSION</strong>: DACF score can predicts mortality&nbsp;and effectively stratifies COPD patients admitted with acute exacerbations&nbsp;into survivors and non-survivor’s category and clinical tests such as PaCO<sub>2</sub>, arterial pH,&nbsp;purulent sputum can be used to predict&nbsp;the mortality in AECOPD.</p> Dr. Rajendra Kumar Saini, Dr. Jai Prakash Singh ##submission.copyrightStatement## Sun, 08 Sep 2019 07:27:00 -0400 DEVELOPMENT OF QUANTITATIVE PROTOCOL FOR IMATINIB IN HUMAN SERUM BY LIQUID CHROMATOGRAPHY TANDEM MASS SPECTROMETRY FOR THERAPEUTIC DRUG MONITORING <p>Estimation of therapeutic levels of Imatinib and its correlation with clinical response has become important to monitor response of this drug in chronic myeloid leukemia (CML) patients. Various attempts have been made to develop quantitative protocols for imatinib in human serum using different analytical tools. A simple, sensitive and specific quantitative method was developed in the present study for monitoring of imatinib levels in human serum by applying high performance liquid chromatography (HPLC) and QQQ tandem mass spectrometry. An efficient simple sample extraction method was developed using solid phase extraction (SPE) method for extraction of imatinib in human serum with a recovery of around 80-85%. The developed method was successfully tested on 30 human serum samples who have been receiving imatinib for CML.</p> <p><strong>Keywords</strong>: Imatinib, LCMS, MRM, methanol, serum</p> Santhosh SR, Ashwini Kumar ##submission.copyrightStatement## Sun, 08 Sep 2019 00:00:00 -0400 COMPARISON OF INTRATHECAL BUPIVACAINE WITH OR WITHOUT CLONIDINE FOR PERIOPERATIVE ANALGESIA IN LOWER LIMB ORTHOPEDICS SURGERIES <p>Background: The newer adjutants for spinal anaesthesia (SA) have seen numerous modifications over the last two decades. Various doses of clonidine have been tried in past but optimal dose which balances the ill effects has to be discovered. Therefore, this study was designed to study the effect of clonidine as an adjuvant in SA in terms of duration and complication.</p> <p>Methods: Two groups I and II ( with 60 patients each)&nbsp; received either 3.0 ml of Bupivacaine 0.5% heavy + 0.5 ml of normal saline and 2.5 ml of bupivacaine 0.5% heavy &nbsp;+ 0.5 ml (75µg) of preservative free clonidine respectively. Various haemodynamic parameters and complication were recorded at baseline than 30 min, 1,2,4,6 and 8 hours after SA.</p> <p>Results: Group II shows that addition of clonidine had altered the heart rate and blood pressure significantly for initial two hour duration(p&lt;0.05). No difference in the onset of sensory and motor blockade in both groups. Majority of patients in both group had level of sensory block upto T7 level. Mean VAS score was significantly lower in group II (p&lt;0.001). Group II has prolonged duration of motor blockade (p&lt; 0.00l). The difference in mean duration of analgesia among both the groups was significant indicating that addition of clonidine prolongs the duration of analgesia (p&lt;0.0001). In group II incidence of hypotension and bradycardia is more as compared to group I.</p> <p>Conclusion: Intrathecal clonidine in the dose of 75 µg along with bupivacaine 0.5% heavy prolonged postoperative analgesia and motor blockade. It produces sedation in which patients were asleep and easily arousal and haemodynamic changes which could be easily managed.</p> <p><strong>Keywords: </strong>Intrathecal, Bupivacaine, Clonidine, Orthopedics surgeries, VAS score</p> Dr Rajit Kumar, Dr Shalendra Singh, Dr Sunny Eapen, Dr Raghavendra Kumar Giri, Dr Priya Taank, Dr Munish Sood ##submission.copyrightStatement## Sun, 08 Sep 2019 08:46:44 -0400 IDENTIFICATION OF RISK FACTORS AMONG MYOCARDIAL INFARCTION PATIENTS ATTENDING DARBHANGA MEDICAL COLLEGE AND HOSPITAL. <p><strong>INTRODUCTION</strong>: Coronary heart diseases (CHD) is the most common serious disease in developed countries and an acute developing health problem in developing countries and have imposed numerous social and economic costs in developed countries. It is known that MI is caused by smoking, which also causes endothelial dysfunction. There are about 80% cases of MI in developing countries but the studies on risk factors are mostly done in countries which are developed.&nbsp; It seems to be important to emphasize on studies on risk factors of MI. The mortality of these diseases are shown to increase in developing countries due to lack of familiarity with risk factors associated to coronary heart diseases and failure to comply with preventive measures.&nbsp;</p> <p><strong>MATERIAL AND METHODS</strong>: In this prospective case-control study information was collected on demographic characteristics, history of cardiovascular disease, lifestyle (smoking) and risk factors using structured questionnaire. Critically ill patients with HIV/AIDS or other major diseases like liver failure, kidney failure, etc. were excluded from the study.</p> <p><strong>RESULTS</strong>: In present study 118 cases and same number of matched controls were included. It was found that in this study, 97(82.2%) cases had smoking habits whereas 61(51.7%) of controls were smokers. Statistically significant smokers were observed in cases. Among all MI patients, 76(64.4%) had family history of CAD while it was present in 32.2% non-MI patient, difference was statistically significant. A significant proportion of cases (72.3%) had high serum lipid levels compared to controls (43.2%). Among all cases 94(79.7%) were hypertensive and 82(69.5%) controls suffered from hypertension, but the difference was not statistically significant. Prevalence of diabetes among cases 72(61.0%) and controls 68(57.6%) was not statistically significant, although prevalence was high in cases. 5(4.2%) of cases had Coronary artery bypass graf(CABG). <strong>CONCLUSION:</strong> Most common predictors of MI in our study were smoking, high serum lipid levels, family history of CAD, hypertension and diabetes. Early identification and modification of the risk factors is important for preventing MI.</p> Dr. Kumari Suruchi, Dr. Kumar Durgeshwar, Dr. Pradeep Kumar Sharma, Dr.P. K. Sinha ##submission.copyrightStatement## Thu, 12 Sep 2019 09:47:54 -0400 CORRELATION OF TOTAL COUNT (WBC), NEUTROPHIL COUNT AND CRP TEST AMONG FEBRILE PATIENTS IN NAVIMUMBAI. <p>150 febrile patients included children (50), adult (50) and neonates (50) from outpatient departments and inpatients of private clinics and hospitals. Patients presented with fever and chills for more than 1 day to 3 days, throat infection, ear infection and cold and fever and only fever as the principal symptoms. After clinical examination all the patients were prescribed for Complete Blood Count (CBC) with differential count(DC) and C-reactive protein(CRP) tests, and in children below 14 years anti-Streptolysin O(ASO<u>)</u> tests ( 75<strong>)</strong> were prescribed.</p> <p>Patients treated with antibiotics previously two weeks before the study period were not included. Qualitative and quantitative tests were performed on all patients’ samples included in the study depending on the need/prescription by the physician or paediatrician. CBC, neutrophil count and CRP have been very useful indicators and significant in the diagnosis and treatment as well as follow-up of the febrile condition of the patients specially in patients suffering with bacterial infections. Even in patients with Dengue and malaria it gives a fair idea if there were leucocytosis or leukopenia, neutrophilia or neutropenia, thrombocytosis or thrombocytopenia.</p> <p>CBC: Complete blood count, DC: Differential count; MP: malarial parasite, CRP: C-reactive protein, ASO: Anti-Streptolysin O.</p> Dr. Sarita Shrivatstva, Dr. Narayana Kamath, Mrs. Ashwini Panchmahalkar ##submission.copyrightStatement## Sat, 14 Sep 2019 02:42:06 -0400 PREVALENCE OF MICROALBUMINURIA IN HYPERTENSIVE PATIENTS IN DARBHANGA MEDICAL COLLEGE LAHERIASARAI DARBHANGA AND HOSPITAL <p><strong>Introduction</strong>: There are two mechanisms proposed for the greater urinary albumin excretion (UAE) in patients with essential hypertension: increased glomerular hydrostatic pressure or increased selectivity of the glomerular basement membrane. In hemodynamic mechanism regulation of the glomerular hydrostatic pressure is regulated by the relative vasoconstriction vasodilatation of the afferent and efferent glomerular arterioles. Hypertension is one of the major public health problems in the world. In India the prevalence of hypertension is about 25% in urban and 10-15% in rural, adult population as compared to west which is 30%. Essential hypertension is responsible for producing clinical proteinuria and a significant reduction in renal function in 5-15% of patients. Several studies have shown that proteinuria and microalbuminuria are independent predictors of cardiovascular morbidity and mortality in patients with hypertension. Some data suggest that reduction of albumin excretion rate reduces the risk of adverse renal and cardiovascular events (CVEs).</p> <p><strong>Material and Methods</strong>: Patients, who had high blood pressure based on JNC 8 (Joint National Commission 8) criteria during three subsequent visits to the outpatient clinic and a creatinine clearance greater than 80 ml/min/1.73 m<sup>2</sup>, were included in the study. A total of 546 essential hypertensive patients whose BP was&gt; 140/90 mm Hg in nondiabetics and BP &gt;130/85 mm Hg in diabetic patients were included in the study. Blood pressure monitoring was done according to the WHO guidelines. Demographic data, age, sex, weight, associated cardiovascular disease, albuminuria, and clinical parameters were all recorded. All routine biochemical tests and microalbuminuria tests were performed by the laboratory. Blood and urine creatinine were measured using an autoanalyzer.</p> <p><strong>Results</strong>: There were 322 (58.97%) male and 224 (41.02%) female included in the study. Left ventricular hypertrophy was observed in 267 (48.9%) of the patients, retinopathy was seen in 54 (9.89%) and microalbimunira was observed in 297(54.4%) of hypertensive patients. 129 (23.63%) were smokers. Statistical significance was observed renal parameters except serum uric acid levels.</p> <p><strong>Conclusion</strong>: Prevalence of microalbuminuria&nbsp;in hypertensive patients warns that screening for microalbuminuria is essential for intervention and prevention of complications and renal diseases. Also it is necessary to screen the patients for early nephropathy to halt the disease progression.</p> Dr. Pradeep Kumar Sharma, Dr. Kumar Durgeshwar, Dr. Kumari Suruchi, Dr.R.K. Das ##submission.copyrightStatement## Sat, 14 Sep 2019 09:18:56 -0400 STUDY OF PREVALENCE OF ANAEMIA IN SCHOOL CHILDREN OF ARMY PERSONAL AT CANTONMENT AREA, JAIPUR. <p><strong>Background: </strong>Anaemia is one of the most common hematological disease of the pediatric age group. in developing countries prevalence of anaemia is much higher in children. The present study was done at&nbsp; Jaipur to identify prevalence of anemia in children.</p> <p><strong>Methodology: </strong>This is a prospective study conducted in school children from June 2018 to June 2019 and includes 500 children residing in cantonment area at jaipur.</p> <p><strong>Results: </strong>Prevalence of anaemia was more among females and vegetarians.</p> <p><strong>Conclusion: </strong>Anaemia is still a major health problem in our country. Childhood anaemia still continues to be a major public health problem in school children between 6-12 years</p> <p><strong>Keywords: </strong>Anaemia, socioeconomic status, Iron Fortification.</p> Dr. Abender Singh Maanju, Dr. K C Verma ##submission.copyrightStatement## Sat, 14 Sep 2019 09:37:41 -0400 EFFECT OF AN IN SERVICE TRAINING PROGRAM FOR INTENSIVE CARE NURSING STAFF IN THEIR PRACTICE - KHARTOUM STATE 2014-2017 <p><strong>Background:</strong> Cardiopulmonary resuscitation is the emergency procedure used to salvage victims of cardiac and respiratory arrest. It should be carried out with great urgency to avoid permanent brain damage or even death that would result if the victim stays from 4 to 6 minutes without oxygen.</p> <p><strong>The aim of study:</strong> To assess the effectiveness of structured teaching program on the skills of cardio pulmonary resuscitation among the nursing staff in the Khartoum Teaching, Ahmed Gasim, Omdurman Teaching, and the Khartoum North Teaching hospitals.</p> <p><strong>Methods:</strong> A quasi experimental design pretest/posttest for the same group. The study was conducted in the intensive care units in Khartoum hospitals. The study sample consisted of 100 nurses. Data was collected by a questionnaire and an observational checklist. The intervention program was in a form of lectures guidelines book. Data were analyzed using Statistical Packages for Social Sciences (SPSS).</p> <p><strong>Results:</strong> the study showed the Nurses' skills before implementation program poor (57%) good (31%) very good (12%). Nurses' skills after implementation program poor (4%) good (18%) very good (78%), (P value 0.002).</p> <p><strong>Conclusion:</strong> The study concluded that educational program had a significant impact related to the improvement of the nurses' practice post application of the program.</p> <p><strong>Key words: </strong>Training program, Practice, Nurses, Intensive Care Unit.</p> Ashraf Abdelrhman Elbashir ##submission.copyrightStatement## Mon, 16 Sep 2019 09:02:51 -0400 ANALYSIS OF THE PERFORMANCE OF MCQs AS A PART OF FORMATIVE ASSESSMENT FOR IST MBBS STUDENTS IN BIOCHEMISTRY <p><strong>Introduction:</strong> Multiple Choice Questions (MCQs) is one of the most preferred tool of assessment in medical education as a part of formative as well as summative assessment. MCQ performance as an assessment tool can be statistically analysed by Item analysis. Thus, aim of this study is to assess the quality of MCQs by item analysis and identify the valid test items to be included in the question bank for further use.</p> <p><strong>Materials and methods:</strong> Formative assessment of Ist MBBS students was carried out with 40 MCQs as a part of internal examination in Biochemistry. Item analysis was done by calculating Difficulty index (<em>P</em>), Discrimination index (<em>d</em>) and number of Non- functional distractors.</p> <p><strong>Results:</strong> Difficulty index (<em>P</em>) of 65% (26) items was well within acceptable range, 7.5% (3) items were too difficult whereas 27.5% (11) items were in the category of too easy. Discrimination Index (<strong><em>d</em></strong>) of 70% (28) items fell in recommended category whereas 10% (4) items were with acceptable, and 20% (8) were with poor Discrimination index. Out of 120 distractors 88.33% (106) were functional distractors and 11.66% (14) were non-functional distractors. After considering difficulty index, discrimination index and distractor effectiveness, 42.5% (17) items were found ideal to be included in the question bank.</p> <p><strong>Conclusion:</strong> Item analysis remains an essential tool to be practiced regularly to improve the quality of the assessment methods as well as a tool for obtaining feedback for the instructors.</p> <p><strong>Key Words:</strong> Difficulty index, Discrimination index, Item analysis, Multiple choice questions, Non-functional distractors</p> Vrushali Prabhunath Suryakar, Surekha T. Nemade, Ganesh D. Ghuge ##submission.copyrightStatement## Mon, 16 Sep 2019 10:24:49 -0400 ASSESSMENT OF ANATOMICAL & FUNCTIONAL SUCCESS IN EXTERNAL DACRYOCYSTORHINOSTOMY BY AIR BUBBLE TEST <p><strong>Aim:</strong> To assess reliability indices of Air Bubble Test (ABT) for anatomical and functional success in external Dacryocystorhinostomy (DCR).</p> <p><strong>Methods:</strong> Prospective case series of nasolacrimal duct obstruction underwent DCR. Functional success defined as Munk score 0 &amp; 1 &amp; anatomical success as free irrigation at followup.ABT performed by putting antibiotic drops into eye&amp; asking patient to exhale while keeping nose &amp; mouth closed. Formation of bubbles at punctum considered as positive test. Specificity, sensitivity, positive &amp; negative predictive values calculated.</p> <p><strong>Results:</strong> There were 103 DCR in 97 patients(23 male,74 female)with mean age 45.56 yr. Anatomical and functional success was 99.02% &amp; 98.05%, respectively.ABT showed sensitivity 96.07%, specificity 100% for anatomical success after DCR. Sensitivity and specificity were 97.02% &amp; 100% for functional success.</p> <p><strong>Conclusion:</strong> As non-invasive procedure ABT is a good tool to assess success of DCR, though lacrimal syringing remains the gold standard.</p> <p><strong>Keywords: </strong>Anatomical, Dacryocystorhinostomy &amp; Air Bubble Test.</p> Dr. Vikas Tantuway ##submission.copyrightStatement## Mon, 16 Sep 2019 10:48:09 -0400 STUDY OF CASES OF ARM IN RURAL POPULATION <p><strong><u>introduction</u></strong></p> <p>Anorectal malformations (ARMs) comprise a spectrum of birth defects in newborn male and female children which include rectum, anal canal, genitalia and urinary tract. ARMs incidence ranging 1:2000-5000 live birth.<sup>1,2</sup>The spectrum of ARM varies from mild anterior displacement of anus to complex anomalies such as cloacal exstrophy.<sup>[4]</sup> The main goal of management is correct diagnosis and surgery so as to achieve good anatomic and functional outcome so that a child can lead his or her life as normal as possible.</p> <p><strong><u>MATERIAL AND METHODS</u></strong></p> <p>All children of pediatric age group from 0 to 15 years admitted in surgical wards and/or pediatric wad of Index Medical College, Hospital and Research Centre, Indore with diagnosis of Anorectal Malformations who will undergo all stage of treatment and follow-up. This was prospective and observational study.</p> <p><strong><u>DISCUSSION</u></strong></p> <p>The management of infants with ARM continues to be a challenge to pediatric surgeons, worldwide. For better results, precise anatomical reconstruction and careful preservation of Structure is required.&nbsp;ARM being a complex group of disorders, is not easy to diagnose at primary healthcare level. The social awareness about the disease is low and it also&nbsp;varies with Sex of child, place of living and education of parents.</p> <p><strong><u>CONCLUSION&nbsp;</u></strong><br> <br> Anorectal malformation is a surgically treatable entity. Early restorative surgery leads to good outcome. Time being the essence, awareness about the condition, hospital delivery and detailed neonatal examination is advisable. In developing countries like India, where illiteracy and poverty are prevalent and where there is neglect of female child, early diagnosis and referral to specialty centres for surgery&nbsp;is always commendable in terms of social acceptance and a sound psyche.</p> Dr Mayur Maheshwari, Dr Jitendra Gothwal, Dr Manish Patel, Dr Ravi Gupta ##submission.copyrightStatement## Wed, 18 Sep 2019 04:39:38 -0400 THE ROLE OF SERUM UREA, CREATININE, URIC ACID IN DIAGNOSIS OF PRE-ECLAMPSIA AND ECLAMPSIA <p>Eclampsia is a serious medical condition that affects women during pregnancy. Symptoms of eclampsia appear in pregnancy as a condition known as <a href="">pre-eclampsia</a>, (condition follows a <a href="">high blood pressure</a>) , the condition can go undetected until it develops into eclampsia. This can create additional complications during pregnancy. Each case of eclampsia is unique, and the pregnant woman may share few or no characteristics with other women who develop the condition. Pregnancy histories, Patient age, Family history, Obesity, High blood pressure are major high risk factors for preeclampsia and eclampsia will vary from patient to patient.</p> <p><strong>Aims</strong> <strong>and Objectives of Study</strong>: To detect the level of urea, creatinine and uric acid in the diagnosis of preeclampsia and eclampsia.</p> <p><strong>Material and Method: </strong>Total 100 subjects were selected for study. Out of 40 were normal pregnant womens, 30 were suffered from preeclampsia and 30 were suffered eclampsia. Blood sample were collected in plane test tube for assay of urea, creatinine and uric acid.</p> <p><strong>Results of Study: </strong>The concentration of urea, creatinine and uric acid is significantly increased found in eclampsia compare to normal subjects. The level of serum urea and serum creatinine increased but insignificant in pre-eclampsia (40.08 ± 9.20 ; 0.78 ± 0.32) compare to normal group (30.47 ± 6.18 ; 0.58 ± 0.14). The level of uric acid was significantly increased found in pre-eclampsia subject (6.42 ± 1.42) than normal pregnant woman (4.82 ± 0.86) (p &gt;0.0001).</p> <p><strong>Conclusion: </strong>On the basis of study findings we, concluded that the increased levels of serum uric acid, serum creatinine and serum urea are better diagnostic and predictive marker for PE and eclampsia and immediate medical attention required for preeclampsia and eclampsia. With the help of these parameters most cases are detected early in the pregnancy before they can progress to eclampsia. While there is no cure for preeclampsia, doctors will often prescribe medications to lower <a href="">blood pressure</a> or anticonvulsant medications to prevent seizures.</p> <p><strong>Keywords</strong>: PE, ECLAMPSIA, UREA, URIC ACID, CREATININE</p> Dr. Ranjit S. Ambad, Dr. Archana Dhok ##submission.copyrightStatement## Wed, 18 Sep 2019 05:13:07 -0400 RISK FACTORS FOR DIABETIC FOOT AND LOWER LIMB AMPUTATION <p><strong>Introduction</strong>: Diabetic foot syndrome (DFS) is the major cause of hospitalization for diabetes-related complications. Protective sensation loss and impaired vision increase the susceptibility for minor feet trauma, which results in diabetic foot ulceration with or without subsequent infection. Peripheral arterial disease is a major cause of impaired ulcer, wound healing and gangrenous diabetic foot. The most important intervention to prevent diabetic foot ulceration and its consequences is early recognition of high-risk patients and their risk factors and referral to appropriate medical departments. There are various risk factors for major lower extremity amputations related to diabetic foot, which includes microvascular diseases, infections, long duration of diabetes, poor glycemic control, peripheral arterial disease, old age and associated cardiovascular comorbidities.</p> <p><strong>Material and Methods</strong>: This study was done on the review of medical records of consecutive type 2 diabetic patients. Admitted patients were treated and managed according to the standard protocol of the hospital. History, clinical and physical examination were carried out on each patient. Ulcer characteristics like infection and depth of the ulcer, site of ulcer were assessed. Associated diabetic neuropathy and peripheral arterial disease was assessed by a clinical method. Age, sex, body mass index (BMI), smoking, duration of diabetes, diabetic control therapy, associated hypertension, cardiac diseases were recorded. The glycated haemoglobin level (HbA1c) were recorded.</p> <p><strong>Results</strong>: A total of 128 patients with diabetic foot were included in the study of which 76(59.4%) were male and 52(40.6%) were female. Of the 76 male 6 (4.7%) had major amputation and out of 52 female 4(3.1%) had major amputation, thus total number of major amputations were 10(7.8%). Statistically significant difference was observed in HbA1C and duration of diabetes group in amputation. High HbA1C and more duration of diabetes was associated with the higher number of amputation. The rate of amputation was much higher among patients hypertension, smoking, cardiac diseases and stroke. <strong>Conclusion</strong>: Poor glycemic controls and duration of diabetes are the important independent risk factors for diabetes-related major lower extremity amputations.</p> <p><strong>Keywords</strong>: DFS, BMI, smkoing, DM</p> Dr. Uday Prakash, Dr. Kumar Durgeshwar, Dr.R.K. Das, Dr. Lalji Chaudhary ##submission.copyrightStatement## Wed, 18 Sep 2019 07:57:53 -0400 COMPARATIVE STUDY OF LUNG VOLUMES AND CAPACITIES IN SMOKERS AND NON-SMOKERS OF 5 YEARS DURATION <p><strong>Background: </strong>&nbsp;Smoking is a common habit prevalent in both urban and rural areas of India. Cigarette smoking has extensive effects on respiratory function and is clearly implicated in the etiology of a number of respiratory diseases, particularly chronic bronchitis, emphysema, and bronchial carcinoma. An attempt has been made to study the pulmonary function tests among the smoking and non-smoking population in the urban area of Secunderabad, Telangana, South India.</p> <p><strong>Objective: </strong>The primary objective of this research was to study the influence of smoking on pulmonary functions.</p> <p><strong>Design: </strong>This was a cross-sectional study.</p> <p><strong>Duration: </strong>One year i.e. from November 2014 to October 2015.</p> <p><strong>Setting: </strong>Gandhi Hospital, Secunderabad, Telangana, South India.</p> <p><strong>Participants: </strong>80 patients attending the Medicine Out Patient Department, Gandhi Hospital.</p> <p><strong>Methods: </strong>The study subjects were classified as smokers or non-smokers based on WHO suggested classification criteria. After recording detailed history, smoking index was calculated for smokers to evaluate dose-duration response relationship. Spirometry was performed to assess the pulmonary function of the subjects. The results are given as Mean ± Standard deviation and Standard error values. Comparison performed using student’s t-test for 2 groups. The P value of 0.05 or less was considered significant.</p> <p><strong>Results: </strong>57.5% of smokers were light smokers, 27.5% were moderate and 15% heavy smokers. FVC was significantly lower in smokers compared with non-smokers(p&lt;0.05), Also this decrease was significantly higher as the no. of cigarettes smoked per day increased(p&lt;0.05). FEF<sub>25-75%</sub> was also found to be significantly reduced in smokers compared with non-smokers. PEFR was significantly reduced in smokers and even this parameter showed a comparable fall(p&lt;0.05) with intensity and duration of smoking. FEV<sub>1</sub> also showed a significant decrease in smokers especially those with greater duration and amount of smoking (p&lt;0.05). FEV1/FVC ratio showed a significant fall in smokers compared with non-smokers(p&lt;0.05), but this fall was not so significant as the no. of cigarettes smoked per day increased(p&gt;0.05), however like other indices FEV1/FVC showed a significant decrease(p&lt;0.05) as the duration of smoking increased.&nbsp;</p> <p><strong>Conclusion: </strong>It may be concluded that smoking causes definite pulmonary function impairments, especially the obstructive type.</p> <p><strong>Keywords: </strong>Lung Volumes, Lung Capacities, Comparision, Smokers, Non-Smokers.</p> Dr. S. P. Srinivas, Dr. Kamble Ganesh ##submission.copyrightStatement## Wed, 18 Sep 2019 08:27:37 -0400 STUDY OF ALTERED GLUCOSE LEVELS IN CASES OF ACUTE ISCHEMIC STROKE AND ITS EFFECT ON PROGNOSIS <p>Introduction<br>Globally about 20 million people suffer from stroke each year. Stroke is a medical condition in which poor blood flow to the brain results in cell death. The risk factors causing stroke are high blood pressure, high blood, tobacco smoking, obesity cholesterol, diabetes mellitus and previous Transient Ischemic Attack (TIA).<br>Objectives: To determine the association of stress hyperglycemia at admission with outcome of acute ischemic stroke<br>Materials and Methods: A study was done at Thiruvalla, Kerala for a period of one year. All new cases of cerebral infarction admitted comprised of 70 cases, 35 each in Euglycemia and Stress hyperglycemia group who were classified at the time of admission based on random blood glucose estimation with the features of stroke. All necessary investigations for the work-up of case required were done. Glasgow Outcome Score for the assessment of recovery in patients was scored, based on National Institute of Health Stroke Scale (NIHSS) on day 1, at the time of discharge and then again on day 30 to assess the clinical outcome. Standard descriptive statistics were used to report the data. Fisher's exact test and Students t test were used to compare the two groups. Binary logistic regression analysis was done.<br>Result: Patients with stress hyperglycemia were found to have increased NIHSS scores on admission and this was more prominent at time of discharge on compared to euglycemic group. Poor recovery was associated with small and medium infarct size in stress hyperglycemia. However, prognosis worsened if size of infarct increased in both groups.<br>Conclusion: Adequate control of blood glucose levels should be maintained immediately during admission and during follow-up to improve prognosis.<br>Keywords: Stroke, Glucose levels, Prognosis</p> Dr. Sunil I Mathew ##submission.copyrightStatement## Wed, 18 Sep 2019 08:57:53 -0400 A STUDY OF MODIFIED DECAF SCORE IN PREDICTING HOSPITAL MORTALITY IN PATIENTS OF ACUTE EXACERBATIONS OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE <p><strong>Background:</strong> &nbsp;COPD is a leading cause of morbidity and mortality worldwide and results in an economic and social burden that is both substantial and increasing .The modified DECAF score was derived for accurate prediction of mortality and risk stratification to inform patient care.</p> <p><strong>Methods</strong>: Hospital based descriptive type of observational study was. After applying inclusion and exclusion criterias, study population for acute exacerbation of COPD was selected. Admission clinical data, including modified DECAF indices, and mortality were recorded.</p> <p><strong>Results:</strong> In our study there was a statistically significant value (<em>p</em>&nbsp;&lt;0.05) between grade of dyspnea, respiratory acidosis (pH&nbsp;&lt;&nbsp;7.30) and frequency of admission in the Modified DECAF score and in-hospital mortality of Acute Exacerbation of COPD. There was insignificant relationship between Eosinopenia &amp; consolidation and in hospital mortality</p> <p>&nbsp;Conclusion-We concluded that the Modified DECAF score is a powerful score to predict in hospital mortality from AECOPD.</p> <p><strong>Keywords:</strong> COPD, DECAF, Exacerbations, Modified DECAF.</p> Dr. Sumit Prakash, Dr. Shruti Jain, Dr. Lalit Singh, Dr. Rajeev Tandon ##submission.copyrightStatement## Wed, 18 Sep 2019 09:23:21 -0400 A STUDENT’S PERSPECTIVE ON ANATOMY TEACHING IN MEDICAL COLLEGE <p>Background: Anatomy is an important subject in medical sciences. It has been considered the foundation of medicine for hundreds of years and this view is supported by clinicians, students and general public.</p> <p>Methods: A cross-sectional study was carried amongst the 1<sup>st</sup> year MBBS students.&nbsp; The students were contacted at a suitable, available time. The purpose of the study was explained and participation was voluntary. One hundred anonymous, pre-designed and pre-validated questionnaires containing close and open ended questions were distributed randomly amongst the students.</p> <p>Results: A majority of the students, 99 (99%) found anatomy to be an important subject in MBBS curriculum and a further 95 (95%) felt it is an interesting subject, whereas a mere 1 (1%) did not find anatomy important and 5 (5%) did not find it interesting.</p> <p>Conclusion: The learners agree that anatomy is a core subject and its fundamental role in medical curriculum is undisputed. The traditional teaching and learning (T/L) methods like blackboard teaching, dissection and lectures are preferred by the newer generation learners also and should be integrated with newer teaching modalities and modern technology.</p> <p><strong>Keywords:</strong> Lectures, Dissection, Blackboard Teaching.</p> Dr. Bhabajyoti Bora, Dr. Shobhana Medhi ##submission.copyrightStatement## Wed, 18 Sep 2019 09:36:39 -0400 AN ANATOMICAL STUDY ON HILAR VARIATIONS AND MORPHOMETRIC DIMENSIONS OF HUMAN KIDNEYS <p>Variations in renal hilar arrangement patterns and morphometric dimensions are clinically relevant in this age of advancing modern medicine and minimally invasive surgery. The purpose of the present study is to record variations in renal hilar arrangement patterns and assess renal dimensions of length, width and thickness respectively. Hilar regions of fifty isolated embalmed kidneys were carefully dissected and variations observed were photographed and documented. Renal dimensions were measured with digital calipers and values obtained were tabulated and analysed. Normal anteroposterior hilar arrangement pattern was observed in 72% cases. Anterior and posterior divisions of renal artery were observed in 24% cases with anterior division being the most anteriorly placed structure in 14% cases. The renal pelvis was situated between the divisions of the renal artery in 8% cases. Prehilar segmental branches anterior to renal vein were observed in 4% cases. Other variations seen included extrahilar branches (4%), superior polar artery arising from anterior division of renal artery, prehilar tributaries of renal vein and an additional renal artery in 1 case each. The mean renal length was 9.35+/- 0.98&nbsp; cm for right and 9.25 +/- 1.25 cm for left kidneys, mean renal width&nbsp; 4.93 +/- 0.65 cm for right and 4.95 +/- 0.5 cm for left kidneys and mean renal thickness 3.77 +/- 0.7 cm for right and 3.86 +/- 0.53 cm for left kidneys respectively. No statistically significant difference was observed in the mean values between right and left sides. The clinical implications of these findings have been discussed. The findings of this study may enhance the existing literature and contribute additional information for improving treatment outcomes during clinical and surgical interventions.</p> <p><strong>Keywords:</strong> Variation, Hilum, Kidneys, Morphometry, Arrangement pattern, dimensions</p> Dr. Deepa Devadas, Dr. Urmila Sinha, Dr. G N Trivedi ##submission.copyrightStatement## Thu, 19 Sep 2019 12:58:36 -0400 COMPARATIVE OUTCOMES BETWEEN INHALED BUDESONIDE AND ORAL MONTELUKAST IN MILD PERSISTENT CHILDHOOD ASTHMA <h2>Background: Asthma is a heterogeneous disease, usually characterized by chronic airway inflammation. It is defined by the history of recurrent respiratory symptoms such as wheeze, shortness of breath, chest tightness and cough that vary over time and in intensity, together with variable expiratory airflow limitation.</h2> <h2>Aim: To compare the clinical efficacy of oral montelukast with inhaled budesonide as controller medication in mild persistent childhood asthma.</h2> <p><strong>Methods: </strong>54 Children of both genders aged 3 to 12 years, diagnosed as mild persistent childhood asthma in OPD and in pediatric indoor admissions at the tertiary care Hospital in Mumbai were enrolled in this randomized prospective parallel-group comparative study. 28 (51.9%) patients of group A were started on Oral montelukast &amp; 26 (48.1%) of group B were started on inhaled budesonide.</p> <p><strong>Results: </strong>Amongst patients of Group A, 9 were asymptomatic &amp; 19 were symptomatic at 4 weeks of treatment.10 were asymptomatic &amp; 18 were symptomatic at 3 months of treatment. P-Value was 0.09 suggesting no significant change/improvement in control of asthma symptoms at 3months than at 4 weeks in children treated with oral montelukast. Out of 26 patients of Group B, 6 were asymptomatic &amp; 20 were symptomatic at 4 weeks of treatment. 17 were asymptomatic &amp; 9 were symptomatic at 3 months of treatment. P-Value was 0.046 suggesting a statistically significant improvement in control of asthma symptoms at 3 months than at 4 weeks in children treated with inhaled budesonide.</p> <p>Conclusion: More children on inhaled budesonide were controlled on their asthma symptoms, required significantly less reliever medications, had lesser episodes of night awakening due to asthma symptoms and had improvement in their day-time symptoms and activity than those on oral montelukast.</p> Dr Sushant Mane, Dr Pareekshit Prakash Rampur, Dr Sakina Shabbir Rajagara ##submission.copyrightStatement## Fri, 20 Sep 2019 12:27:40 -0400 EFFECT OF LOW-LEVEL LASER THERAPY ON DIABETIC FOOT ULCERS <h2>Background: Across the globe, diabetes mellitus (DM) is considered as a major health issue because of its prevalence rate tending to increase day by day in a remarkable manner. A foot ulcer is frequently faced complication that is very frequently faced in patients suffering from diabetes mellitus. Diabetic Mellitus is noticed as a severe health issue affecting around 387 million people. The purpose of this study is to study the effect of low level laser therapy on diabetic foot ulcers to control infection, determine best suitable cost-effective technique and aid in studying the role of Low-level laser therapy in the context of treating diabetic foot ulcers.</h2> <h2>Aim: To study the role of low-level laser therapy on diabetic ulcers</h2> <h2>Results: The proportion of males was slightly higher than females in both cases and controls. The mean BMI was 26.50±2.444 among cases and mean BMI was 25.27±2.407 among controls. Among 16 grades 1 ulcer, 6 (37.5%) remained in grade 1, 10 (62.5%) ulcers completely healed at the end of 20 days. In group B, 21 subjects had bacterial growth on day-1, and the remaining 19 had no bacterial growth. Out of the 21 with bacterial growth, 15(71.42%) still had growth at the end of 20 days, and 6 (28.58%) had no growth.</h2> <p><strong>Methods:</strong> The current study was a randomized open labelled control study, with randomised two treatment groups [Group A: Intervention group (who received laser therapy in addition to standard management)&nbsp; Group B: Control group (standard treatment group)] and total sample size of 80 performed at the Department of Surgery, Banas Medical College and Research Institute, Palanpur, Gujarat between Jan-17 to Dec-17.</p> <p>Descriptive analysis was carried out by mean and standard deviation for quantitative variables, frequency and proportion for categorical variables. Data was also represented using appropriate diagrams like a bar diagram, pie diagram and box plots. The area of the ulcer was compared between the two groups, using independent sample t-test. The mean differences along with their 95% CI were presented. Association between quantitative explanatory and outcome variables was assessed by calculating the Pearson correlation coefficient and the data was represented with P-value.</p> <p>Conclusion: <strong>It can be concluded that Laser therapy is best-suited therapy for curing the diabetic foot ulcer as it is pain-free, effective on budget, wound contraction as well as re- epithelialisation helped in accelerating the curing of the wound with simple curing process following proper medication and instructions provided with laser therapy. Control of infection becomes easy as compared to any other techniques being used such as split skin grafting, and other secondary expensive procedures attempted to cure DFU.</strong></p> Adha Arunkumar Kailashdan, Bharai Raviraj Arjunbhai ##submission.copyrightStatement## Fri, 20 Sep 2019 13:13:46 -0400 PEMPHIGUS VULGARIS – PATHOPHYSIOLOGY AND RECENT CONCEPTS FOR PULSE THERAPY - A SYSTEMATIC REVIEW. <p>Background: Vesiculo-bullous diseases are a group of chronic cutaneous disorders characterised by mucocutaneous blistering or erosions as a result of development of autoimmunity.</p> <p>Aims: To understand the pathophysiology of pemphigus vulgaris and the recent concepts of Pulse therapy with different modalities and their various actions on different tissue levels. Results &amp;Conclusion- Pulse therapy can be a boon to stomatologists if understood with clarity and applied with precision. It can definitely create miracles in saving lives and help in the outcome of the prognosis of most of the autoimmune disorders.</p> <p><strong>Keywords:</strong> Autoimmune Disorders, Pemphigus Vulgaris, Pulse Therapy.</p> Dr. Indranil Mukhopadhyay ##submission.copyrightStatement## Mon, 16 Sep 2019 09:22:17 -0400 VACTERL-H SYNDROME – A CASE REPORT <p>The exact cause of VACTERL association is unknown; most cases occur randomly, for no apparent reason. In rare cases, VACTERL association has occurred in more than one family member. <strong>VACTERL association</strong>&nbsp;is an association of&nbsp;birth defects&nbsp;that affects multiple parts of the body. It includes vertebral or vascular anomalies, anal atresia, cardiac defects, tracheoesophageal – fistula/esophageal atresia, renal defects, and limbs defects. Other features may include&nbsp;(less frequently)&nbsp;growth deficiencies and failure to thrive;&nbsp;facial asymmetry (hemifacial microsomia); external ear malformations;&nbsp;intestinal malrotation; and genital anomalies. Intelligence is usually normal.</p> <p>The diagnosis of VACTERL-H Syndrome is majorly based upon the complete physical examination and a few specialized tests to ascertain the features of the syndrome. The treatment of VACTERL-H is directed towards the specific symptoms that are apparent in each individual, which often varies greatly. The management of patients with VACTERL/VATER association typically centers around surgical correction of the specific congenital anomalies (typically anal atresia, certain types of cardiac malformations, and/or tracheo-esophageal fistula) in the immediate postnatal period, followed by long-term medical management of sequelae of the congenital malformations. If optimal surgical correction is achievable, the prognosis can be relatively positive. Hence early diagnosis and early interventions are needed to prevent morbidity and mortality.</p> <p><strong>Key words: </strong>VACTERL-H syndrome, congenital malformations, clinical examinations</p> Dr. Priya Singh, Prof. Dr. Ghazi Sharique Ahmad, Prof. Dr. Ahmad Rizwan Karim ##submission.copyrightStatement## Sat, 14 Sep 2019 03:04:09 -0400 DISSEMINATED HERPES ZOSTER IN A 9-MONTH-OLD INFANT <p>Herpes Zoster (HZ) or shingles is a clinical manifestation caused by the reactivation of varicella-zoster virus (VZV). HZ is rarely happening in children, and its incidence increases with age. We report a 9-month-old baby boy with disseminated HZ. There were grouped vesicles on an erythematous base scattered in several dermatomes with dominant lesions in C5-C7 dermatomes. Complete blood count were within the normal limits. Human immunodeficiency virus (HIV) serology was negative both in mother and baby. Patient was treated with 150 mg oral acyclovir 4 times a day for 5 days. The infant experienced significant improvement and recovered completely without sequelae.</p> Adelia Martalova. AJ, Lidya Alexandra, Tjokorda Dalem Pemayun ##submission.copyrightStatement## Mon, 16 Sep 2019 08:19:31 -0400 HENOCH-SCHÖNLEIN PURPURA: A CASE REPORT OF AN EIGHT-YEARS-OLD BOY <p>Henoch-Schönlein Purpura (HSP) is one of the most common causes of small vessel vasculitis mediated by immunoglobulin (Ig) A deposition in children. We present a case of HSP in an eight years old boy with cutaneous, abdomen and joint manifestation of the disease. He had history of upper respiratory tract infection couple weeks before. Physical examination showed erythematous, palpable, purpuric rashes on his both legs and buttocks. Mild bilateral non pitting edema was present over both the legs. Complete blood count (CBC) test revealed thrombocytosis and slightly leukocytosis with neutrophil predominate. The case was treated with oral methylprednisolone for seven days and showed a good outcome.</p> <p><strong>Keywords: C</strong>hildren, Henoch- Schönlein purpura, HSP</p> Putu Yunita Primasari, Yohana Chrisanty Mantara, Adelia Martalova. AJ, Tjokorda Dalem Pemayun ##submission.copyrightStatement## Wed, 18 Sep 2019 08:46:19 -0400