• Print ISSN: 2395 - 1400, Online ISSN: 2455 - 8923

JBCR VOL V - Issue 2, July- Dec 2018

EDITORIAL
Innovation in Medicine: New Ideas for Translation

Madhava Sai Sivapuram1

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Original Articles

Comparison Between Sublingual and Vaginal Route of Misoprostol in the Management of 1st Trimester Abortions

R. Subhaprada1, *Sunita Mishra2

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Original Articles

CLINICAL PROFILE OF CASES WITH LEIOMYOMA

Dedeepya Rambhakta,1*N. Madhavi,2

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CASE REPORT

SECONDARY SYPHILIS-BLAST FROM THE PAST

P. Manasa Veena1, M. Arun Kumar2, P. Vidyasagar3, Ch. Vijay Bhaskar Reddy4

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CASE RECORD

Case Records in Kamineni Institute of Medical Sciences:High-Altitude Breathlessness Refractory to Descent.

Dr. L. Srujan Reddy,1 Aarti Sahu,2 Dr. M. Manasa Reddy,3 Dr. Aditya Samitinjay Gade4

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IMAGES IN CLINICAL MEDICINE

ANTLER SIGN OF PULMONARY VENOUS HYPERTENSION

*Dr. Aditya Samitinjay Gade,1

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EDITORIAL

Innovation in Medicine: New Ideas for Translation

Madhava Sai Sivapuram1

Abstract

The term innovation was derived originally from a Latin term 'innovare' which means to ‘introduce new’. Medical innovation means introducing something new to medicine or its related fields which could help or benefit patients resulting in better clinical outcomes or delivery of better quality health care. As we talk about medical innovation, if we look back in time to somewhere around 1000 and 600 BC, on the banks of river Ganges in the city of Kashi, lived the current father of plastic surgery and the author of 'Sushrutha Samhitha' - The great Sushrutha who has innovated around 125 surgical instruments and 300 procedures.1,2

Out of his many astounding accomplishments, his biggest achievement is 'the Indian method of Rhinoplasty' (nasal reconstruction) which is the best and oldest practice stated so far in the literature.1 The reason 'the Indian method of Rhinoplasty' has emerged as the best procedure is because of its requirement and demand in the society. The judicial system that prevailed during Sushrutha’s time was on the lines of Puranas, where cutting of nose and ears was a common punishment. In the epic tale of Ramayana, we notice that Lakshmana cuts off the nose and ears of Shurpanakha as a punishment for her actions.3,4,5

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Original Article

Comparison Between Sublingual and Vaginal Route of Misoprostol in the Management of 1st Trimester Abortions

  • R. Subhaprada1, *Sunita Mishra2

1Senior Resident, Dept. of OBG, Kamineni Institute of Medical Sciences, Narketpally *2Professor, Dept. of OBG, Kamineni Institute of Medical Sciences, Narketpally

Abstract

Introduction: The termination of pregnancy before the period of viability is termed as abortion. Statistical estimates have shown that worldwide approximately 40-60 million abortions occur per year. In the year 1971, MTP was legalised in India. Now a days doctors are preferring oral Mifepristone with Misoprostol administered vaginally. Misoprostol is a PGE1 analogue. The advantages of oral route of administration are its ease of administration and lesser chances of infection. The aim of the study is to evaluate the efficacy and side effects of oral and vaginal Misoprostol in first trimester abortions.

Methodology:The study was a prospective, open labeled, randomised trial, carried out in Kamineni Institute of Medical Sciences, Narketpally from January 2018 to July 2018. 40 patients with pregnancy up to 49 days were selected and were divided into two groups of 20 people each. The first group was given 200mg Mifepristone and 800 mcg of Misoprostol by sublingual route. The second group was given 200 mg of Mifepristone orally and 800mcg of Misoprostol by vaginal route. The efficacy, the induction interval, adverse effects, and the patient’s acceptability for route of administration were the measured outcomes in this study.

Results:Success rate of abortion was 94% in sublingual group and 86% in vaginal group.

Conclusion:Oral and vaginal routes of misoprostol were found to have similar effectiveness for first trimester abortions. Due to its high acceptability and more comfort to the patients, oral Misoprostol can be used as an alternative route to vaginal route of administration.

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ORGINAL ARTICLE

CLINICAL PROFILE OF CASES WITH LEIOMYOMA

Lalitha S M1,Asha T2,Priyanka A A3

1Senior Resident, Dept. of OBG, Kamineni Institute of Medical Sciences, Narketpally *2Professor, Dept. of OBG, Kamineni Institute of Medical Sciences, Narketpally

Abstract

Introduction: Uterine leiomyomas are the most common benign tumours in women of reproductive age group. They are symptomatic in 50% of cases with peak incidence of symptoms in the 30s and 40s. Presentation is quite variable. Majority of fibroids are asymptomatic in the early stages and get less clinical attention due to undiagnosed disease, while symptomatic women complain of pain, abdominopelvic mass, abnormal uterine bleeding, mainly menorrhagia.

Aims & Objectives: To study the clinical manifestations of fibroid uterus.

Materials & Methods: This is a hospital based prospective study of 50 leiomyoma cases during a period of January 2017 to August 2018.After taking consent all cases were enrolled in the study and a detailed history of presenting complaints and associated symptoms were noted, along with menstrual history. A thorough general and systemic examination was performed. Examination assessed the presence or absence of mass on P/A, P/S, P/V examination. All cases underwent ultrasound to detect and know the position of leiomyoma, specimens were sent for histopathological examination and analysed.

Materials & Methods:This is a hospital based prospective study of 50 leiomyoma cases during a period of January 2017 to August 2018.After taking consent all cases were enrolled in the study and a detailed history of presenting complaints and associated symptoms were noted, along with menstrual history. A thorough general and systemic examination was performed. Examination assessed the presence or absence of mass on P/A, P/S, P/V examination. All cases underwent ultrasound to detect and know the position of leiomyoma, specimens were sent for histopathological examination and analysed.

Results: Majority of women were in between the age group of 36-45 years. Majority of women were parous (92%). Most common presenting symptom among the fibroid cases was menstrual irregularity (86%), Followed by lump in abdomen (50%), Pain was reported in 40% of patients. Among the patients with menstrual disturbances, menorrhagia, dysmenorrhea, polymenorrhea were common. Cases of fibroid that had a palpable mass were firm in consistency and mobile.

Conclusion: Thus we conclude that menstrual irregularity was most common presenting symptom, followed by lump in abdomen and pain abdomen. Menorrhagia, dysmenorrhea, polymenorrhea were most common type of menstrual abnormality.

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CASE REPORT

SECONDARY SYPHILIS-BLAST FROM THE PAST

P. Manasa Veena1, M. Arun Kumar2, P. Vidyasagar3, Ch. Vijay Bhaskar Reddy4

1Post Graduate, 2Professor & Head, 3Associate Professor ,4Senior Resident, Department of Dermatology,Venereology and Leprosy, Kamineni Institute of Medical Sciences, Narketpally.

Abstract

Syphilis “the great imitator” was defined by Stokes as an infectious disease caused by Treponema pallidum, systemic from the outset, characterized by florid manifestations on one hand to complete asymptomatic latency on the other, capable of involving practically every organ in its course, simulating almost every disease in the field of medicine and surgery. We present a case of 25 year old female patient who presented, multiple, slightly raised, dark coloured, pea sized lesions on both palms and soles and multiple pale lesions all over the body since one month. Cutaneous examination showed multiple, polysized, annular, scaly, hyperpigmented plaques on both palms and soles, and symmetrical, hypopigmented macules all over the body.No evidence of hair loss, mucous membrane lesions, and arthralgia. Bilateral, nontender, inguinal lymphadenopathy noticed. Blood investigations showed Hb-10gm%, Rapid Plasma Reagin (RPR) positivity with 1:64 dilution, Treponema Pallidum Haemagglutination Assay -positive. HIV status non reactive. Biopsy was conclusive. Patient was managed with Inj Benzathine Penicillin. In follow up for 6 weeks, patient showed clinical improvement as well as fall in Rapid plasma reagin test titre to 1: 32. We are reporting this case in the current scenario as typical presentation of secondary syphilis was revisited in the recent past.

Key words:Secondary syphilis, annular lesions, rapid plasma reagin test, Benzathine penicillin

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CASE REPORT

Case Records in Kamineni Institute of Medical Sciences: High-Altitude Breathlessness Refractory to Descent.

Dr. L. Srujan Reddy,1 Aarti Sahu, 2 Dr. M. Manasa Reddy,3 Dr. Aditya Samitinjay Gade4

1,3,4 Post Graduate, Department of General Medicine, Kamineni Institute of Medical Sciences, Narketpally 2 Undergraduate Medical Student, Department of General Medicine, Kamineni Institute of Medical Sciences, Narketpally

Abstract:

This case was presented in Kamineni Institute of Medical sciences on 20th December 2018. Pulmonary Embolism (PE) and High Altitude Pulmonary Edema (HAPE) are different entities which can present with non-specific but similar symptoms and have differing treatment modalities. While HAPE can resolve with increased oxygen supply during descent from high altitude, the diagnosis of PE requires definitive treatment and if missed may result in death. When a patient with HAPE does not improve with descent and oxygen, then other diagnoses must be suspected including PE. PE can co-exist with HAPE or mimic it and should be considered in any patient with shortness of breath in high altitude areas regardless of thrombotic risk factors.

Key words: Pulmonary embolism, High altitude pulmonary edema, thrombosis

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CASE REPORT

ANTLER SIGN OF PULMONARY VENOUS HYPERTENSION

*Dr. Aditya Samitinjay Gade1

*1 Post graduate, Department of General Medicine, Kamineni Institute of Medical Sciences, Narketpally

Abstract

A 72-year-old man presented with gradually progressive breathlessness for the past 3 months. He did not have any history of chest pain, cough, wheeze, syncope, palpitations, pedal oedema or hemoptysis. He had a long history of smoking and alcohol consumption for more than 3 decades. Routine blood tests returned normal. The CXR-PA view is showing an ‘Antler’ Sign, which is the cephalisation of the left upper lobe pulmonary veins.1 It is the earliest sign of pulmonary venous hypertension visible on chest x-ray. This sign is also called as ‘Hands Up’ sign or ‘Inverted Moustache’ sign. Antler Sign occurs due to elevation of Left Atrial Pressure above (normal range - 5- 10 mm of Hg) 10 to 15 mm of Hg., 2,3 The most common causes of this being Left heart failure and mitral valvular disease. Antler sign also represents Grade 1 Pulmonary oedema, with the pulmonary capillary wedge pressure (PCWP) at 13 – 18 mm of Hg (Normal = 8 to 12 mm of Hg).