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Background: Surgical excision of all thyroid nodules would result in a large number of unnecessary procedures. Fine needle aspiration cytology is safe and minimally invasive OPD procedure for the pre-operative assessment of patients with a thyroid nodules . The purpose of our study was to assessment of diagnostic significance of FNAC and its applicability to detect which patients need follow-up and who need surgical intervention. Patients and methods: A prospective cross sectional study was conducted on 76 patients with thyroid lesions at Surgical oncology unit in department of General surgery, Zagazig university hospital who had FNAC, underwent surgery and histopathological results was obtained from the period of December 2019-May 2020 were recruited in the study. Results: In this study, benign thyroid lesions were the commonest found in 58 patients (76.3%). Out of all benign lesions, simple colloid goiter (36.8%) was the most common. Thyroid lesions showed female preponderance, with 88.2 % females and 11.8 % males and a male: female ratio of 1:7.5. , The sensitivity, specificity, and diagnostic accuracy of FNAC were 83.33%, 100 %, and 76.5 %, respectively. Conclusion: Fine needle aspiration cytology (FNAC) is a simple and safe procedure and devoid of any serious complications. it is a sensitive, specific, and accurate initial diagnostic test for the preoperative evaluation of patients with thyroid swellings.

Background The female preponderance in heart failure with preserved ejection fraction (HFpEF) is a distinguishing feature of this disorder, but the association of sex with degree of diastolic dysfunction and clinical outcomes among individuals with HFpEF remains unclear. Methods and Results We conducted a prospective, multicenter, observational study of patients with HFpEF (PURSUIT‐HFpEF [Prospective Multicenter Observational Study of Patients with Heart Failure with Preserved Ejection Fraction]: UMIN000021831). Between 2016 and 2019, 871 patients were enrolled from 26 hospitals (follow‐up: 399±349 days). We investigated sex‐related differences in diastolic dysfunction and postdischarge clinical outcomes in patients with HFpEF. The echocardiographic end point was diastolic dysfunction according to American Society of Echocardiography/European Association of Cardiovascular Imaging criteria. The clinical end point was a composite of all‐cause death and heart failure readmission. Women accounted for 55.2% (481 patients) of the overall cohort. Compared with men, women were older and had lower prevalence rates of hypertension, coronary artery disease, and chronic kidney disease. Women had diastolic dysfunction more frequently than men (52.8% versus 32.0%, P P =0.336). Female sex was independently associated with the echocardiographic end point (adjusted odds ratio, 2.839; 95% CI, 1.884–4.278; P P =0.004). Conclusions Female sex was independently associated with the presence of diastolic dysfunction and worse clinical outcomes in a cohort of elderly patients with HFpEF. Our results suggest that a sex‐specific approach is key to investigating the pathophysiology of HFpEF. Registration URL: https://upload.umin.ac.jp ; Unique identifier: UMIN000021831.

Introduction. The solid pseudopapillary epithelial neoplasm (SPN) is a rare form of pancreatic neoplasm with an incidence of 2-3% of all pancreatic tumours. The recent increase in incidence is attributed to the increasing use of imaging techniques for nonspecific abdominal complaints. We report our institutional experience in the management of this tumour over the last decade. Method. We retrospectively analyzed from a prospectively maintained database of patients from January 2011 to December 2020 who were operated upon for SPN. All the patients were followed till date. Results. Of 479 patients operated on for various types of pancreatic tumours during this period, 15 (3.1%) had SPN. The mean age of presentation was 28 years with a female preponderance (12/15, 80%). The most common location was the body and tail of the pancreas (66%), and the mean size was 6.4 cm (2–15 cm). The tumour extent was defined as ‘borderline resectable’ in 20% of cases. Distal pancreatectomy was done in 11 patients with spleen preservation in 3. R0, R1, and R2 resection were done in 12, 2, and 1 patient(s), respectively. The operative mortality was 6.7%. All the patients are doing well on follow-up. Conclusion. SPN is a low-grade malignant tumour with a strong female predilection. Clinical manifestations have no specificity, imaging examination only contributes tumour location, and the final diagnosis rests on pathology. Surgery is the main modality of treatment and carries a good prognosis.

Objectives. Although the incidence of skin cancers in India (part of South Asia) is low, the absolute numberof cases may be significant due to large population. The existing literature on BCC in India is scant. So, thisstudy was done focusing on its epidemiology, risk factors, and clinicopathological aspects.Methods. A hospital based cross-sectional study was conducted in Punjab, North India, from 2017 to2019. History, examination and histopathological confirmation were done in all the patients visiting skindepartment with suspected lesions.Results. Out of 36 confirmed cases, 63.9% were females with mean ± SD age being years. Mean durationof disease was 4.7 years. Though there was statistically significant higher sun exposure in males comparedto females ( value being 0.000), BCC was commoner in females, explainable by intermittent sun exposure(during household work in the open kitchens) in women. Majority of patients (88.9%) had a single lesion.Head and neck region was involved in 97.2% of cases, with nose being the commonest site (50%) withnodular/noduloulcerative morphology in 77.8% of cases. Pigmentation was evident in 22.2% of casesclinically. Nodular variety was the commonest histopathological variant (77.8%).Conclusions. This study highlights a paradoxically increasing trend of BCC with female preponderance,preferential involvement of nose, and higher percentage of pigmentation in Indians.

Sacro coccygeal teratoma (SCT) is the most common extra gonadal neoplasm in the pre sacral area occurring in neonatal period. They mostly occur in the midline with a female preponderance. They are usually attached to coccyx, They are believed to be arising from totipotent cells that originate from primitive knot (Hensen’s node), hence are usually attached to coccyx. Infection in a sacrococcygeal teratoma has been rarely reported. Here is a report of a case of vague gluteal mass in a neonate and challenges in its diagnosis and management.

Introduction: Thyroid gland is the most superficial endocrine gland of the human body in the region of theneck and is easily accessible to both clinical and Radiological examinations. The thyroid masses must bediagnosed and managed as early as possible to avoid any malignancy.Objectives: To evaluate the socio-demographic profile of patient including age and gender distribution inthyroid lesions.Materials and Method: This prospective study was a cross-sectional descriptive one, which was conductedover the 50 subjects with thyroid masses. The collected data were subjected to a statistical analysis whichwas performed using a Statistical Package for the Social Sciences (SPSS) software version 20.0. Descriptivestatistical method were computed, and the statistical significance was tested by chi-square test and student’st-test. A p-value of less than 0.05 was considered statistically significant. Ethical clearance was taken fromethics committee (H).Results: There was a female preponderance of 70% associated with this disease entity, against its malecounterpart as 30%. The male to female ratio is 1:2:33. A maximum number of patients in our study is in theage group of 31-40 years of age, i.e. 40%. Most of the patients (76%) are from a rural area.Conclusion: Female preponderance of thyroid masses in the age group of 31-40 years was observed and wasmore in rural areas. The sociodemographic profile is useful for better future planning of the management ofthyroid masses.

Patella instability is a clinical condition in which patella dislocation had occurred at least twice, or where patella instability following initial dislocation had persisted for more than three months. It can be unilateral or bilateral. Females are more affected, and it can affect the quality of life of the individual affected. This study is a retrospective survey of all patients who had recurrent patella dislocation at National Orthopedic hospital, Dala, Kano between January 2009 and November 2019. A total of 49 patients were treated with recurrent patella dislocation were found with a predominant young age (11-20 years-old) and a female preponderance (56.4%). Pain, instability or both are the main forms of presentation. Trauma, ligamentous laxity as well as hypoplasia of femoral condyle were risk factors identified. Arthroscopic medial plication and lateral release and was done in 28 (71.8%) patients as a means of treatment. Three patients (7.7%) had medial patellofemoral ligament reconstruction (MPFLR) while the remaining 8 patients (20.5%) were managed non-operatively.

Background: Exercise-induced laryngeal obstruction (EILO) is an important cause of exertional breathlessness and wheeze. Epidemiological understanding of EILO remains unclear and arises largely from Scandinavian countries. We provide the first international perspective on the demographic characteristics, laryngeal abnormalities and impact of EILO. Methods: Retrospective database review (from 5 expert centres in Denmark, UK, & USA), for patients undergoing clinical asthma and EILO work-up with continuous laryngoscopy during exercise (CLE) testing between 2014–2018. Results: A total of 1,007 individuals completed CLE, of these 586 (58%) demonstrated EILO. Demographic characteristics for cases with EILO were similar across centres; median age of 21 (80% were ≤ 34), a female preponderance (76%) and median 2-year delay to diagnosis; 20% were found to not have asthma despite prescription of inhalers. Half (49%) of subjects were elite athletes. Supraglottic EILO (i.e. collapse of the arytenoid structures) was the predominant form and only 18% had glottic level (i.e. vocal cord dysfunction [VCD]) closure. Conclusion: This international collaboration reveals similarities in the clinical characteristics of EILO highlighting delay to diagnosis, inappropriate asthma treatment and that exercise induced VCD is a misnomer. These findings help to further define this condition and improve clinician’s recognition.

Purpose To describe the clinical characteristics and outcome of polypoidal choroidal vasculopathy (PCV), also known as aneurysmal type 1 (sub-retinal pigment epithelium (RPE)) neovascularization, in Caucasian patients. Methods Single-centre study in 66 Caucasian patients with a diagnosis of PCV based on optical coherence tomography scan and indocyanine green angiography. Clinical characteristics and multimodal imaging were collected and assessed by an experienced retina specialist. Results This study involved 74 eyes of 66 patients with PCV, with a mean age at onset of 73 years and a female preponderance of 66%. The mean number of polypoidal lesions per eye was 1 (range: 1–5 lesions), out of which 75% was located in the macula and 19% in the peripapillary region. Of the 74 eyes, 37 eyes (50%) had PCV associated with a drusenoidal neovascular age-related macular degeneration (AMD) phenotype (PCV-AMD) and 18 eyes (24%) had PCV associated with non-polypoidal type 1 choroidal neovascularization/branching vascular network (PCV-BVN) without signs of drusenoidal AMD, while 19 eyes (26%) had idiopathic, isolated PCV (iPCV). The mean subfoveal choroidal thickness measured in 22 patients was 245 μm (range: 71–420 μm). In 51% of patients, the initially performed therapy showed good anatomical recovery (resolution of intra- and subretinal fluid). Conclusions A spectrum of PCV (aneurysmal type 1/sub-RPE neovascularization) can be seen in Caucasian patients. PCV associated with a drusenoidal neovascular AMD phenotype in Caucasians is phenotypically and presumably pathophysiologically more associated with neovascular AMD (PCV-AMD: type A PCV). However, this may not be the case for patients with PCV with non-polypoidal type 1 choroidal neovascularization or BVN and no signs of drusenoidal AMD (PCV-BVN: type B PCV), and for patients with idiopathic PCV without associated drusen or BVN (iPCV; type C PCV). Most patients have a thin choroid, even when drusen are absent. For the entire patient group, a moderate anatomical recovery was observed after treatment.

Introduction: Giant cell tumour (GCT) is a common benign bone tumour. Common sites of occurrence in decreasing order of frequency are distal femur, proximal tibia, distal radius. Less frequent sites include distal humerus, pelvis and sacrum. Aims and Objectives: The aim was to highlight the increasing incidence of common GCT’s in uncommon sites such as distal humerus Materials and Methods: We present our series of eight cases (M:F::2:6) of distal humeral GCT between 2008-2017. The diagnosis was confirmed by trucut biopsy and histopathological examination of the resected specimen was also done to confirm the pre-operative diagnosis. All patients underwent wide local resection and reconstruction using custom mega prosthesis performed by our orthopaedic surgical team. Results: There was no evidence of malignant change in any of our patients. All 8 patients were well with good functional outcome with no evidence of tumour recurrence at the latest follow-up. Conclusion: Distal humeral GCT is not as uncommon as once thought. The incidence is increasing due to better and prompt health care access and reporting by medical professionals. A high degree of clinical suspicion, good diagnostic techniques and multimodal team approach towards treatment has a positive effect on clinical outcomes for such complex pathologies. Keywords: Giant cell tumour, Trucut biopsy, Custom mega prosthesis. Introduction Giant cell tumour (GCT) or Osteoclastoma is a common benign tumour affecting the epiphyseal region of a mature skeleton. It commonly manifests in the age group of 25-40 years with a slight female preponderance. The most common site of occurrence of such tumours in decreasing order of frequency are distal femur, proximal tibia and distal radius. However there have been reports in literature of GCT’s presenting in unusual sites such as pelvis, distal humerus and sacrum.[1],[2],[3]In the Indian scenario, the exact number of patients suffer

Immune thrombocytopenia (ITP) occurs with an incidence rate of 1.6 to 3.9 per 100,000 patient-years, which increases with age and has a slight female preponderance. ITP is termed acute, persistent or chronic when its duration is3 months, 3 to 12 months and12 months, respectively. In this narrative review, we discuss the clinical manifestations of ITP in children and adults. ITP is asymptomatic in some patients; however, when present, bleeding is the most common symptom and can be mild as in petechiae, purpura and epistaxis, or severe and even life threatening in cases of intracranial haemorrhage, and massive gastrointestinal or urinary tract bleeding. A platelet count10-20 × 10Die Immunthrombozytopenie (ITP) tritt mit einer Inzidenzrate von 1,6 bis 3,9 pro 100.000 Patientenjahre auf, die mit zunehmendem Alter zunimmt und ein geringes Überwiegen der Frauen aufweist. ITP wird als akut, persistent oder chronisch bezeichnet, wenn die Dauer3 Monate, 3 bis 12 Monate bzw.12 Monate beträgt. In dieser narrativen Übersichtsarbeit diskutieren wir die klinischen Erscheinungsformen von ITP bei Kindern und Erwachsenen. ITP ist bei manchen Patienten asymptomatisch; Blutungen sind jedoch, wenn vorhanden, das häufigste Symptom und können mild sein, wie bei Petechien, Purpura und Epistaxis, oder sogar schwer oder gar lebensbedrohlich bei intrakraniellen Blutungen oder massiven Blutungen im Gastrointestinal- oder Harntrakt. Eine Thrombozytenzahl10–20 × 10

Introduction: The aim of the study was to evaluate the refractive status and ocular biometric parameters in subjects with angle closure in Malaysia. Methods: This cross-sectional study was conducted on 171 primary angle closure patients (268 eyes). Visual acuity, refraction, and ocular biometry (central anterior chamber depth [ACD], axial length [AL], and lens thickness) were recorded. Vitreous cavity length (VL) and relative lens position (RLP) were calculated. Results: A total of 92 Primary Angle Closure Suspect (PACS), 30 Primary Angle Closure (PAC), and 146 Primary Angle Closure Glaucoma (PACG) eyes were included. Chinese ethnicity formed the majority (n = 197, 73.5%), followed by Malay (n = 57, 21.3%) and Indian (n = 14, 5.2%). There was a significant female preponderance with a female to male ratio of 1.85. Mean age was 65.7 ± 7.7 years. Mean spherical equivalent was +0.33 ± 1.29 D. Approximately half (n = 137, 51%) of the eyes were hyperopic (spherical power ≥+0.5), with PACG having the highest percentage of hyperopia (n = 69, 50.4%). Myopia and emmetropia were present in 48 (17.9) and 83 (31%) eyes, respectively. Although AL and VL in myopia patients were significantly longer than emmetropic and hyperopic eyes (p < 0.001), the ACD was not significantly different (p = 0.427). While the RLP is smaller in myopic eyes, lens thickness was increased in hyperopic eyes. PACG was significantly higher in elderly patients compared to PACS and PAC (p = 0.005). A total of 37 (13.8%) eyes were blind (vision worse than 3/60) and 19 of them (51.3%) were female patients. Conclusion: A decrease in RLP is predictive of angle closure disease in myopic eyes, whereas increased lens thickness contributes to angle closure disease in hyperopic eyes.

INTRODUCTION Any type of cutaneous metastasis indicates dismal outcome of the disease. Skin is an unusual location for metastatic deposits from any tumour and has an incidence of about 0.8%-5%. Fine needle aspiration cytology (FNAC) helps in the rapid diagnosis of metastasis with minimum pain. AIM To study the cytomorphological spectrum of cutaneous metastasis on FNAC. MATERIAL AND METHODS A total of 225 patients with diagnosis of cutaneous metastasis on cytology were analysed. May-Grunwald Giemsa and haematoxylin-eosin-stained smears were studied and examined for the cytomorphological spectrum of cutaneous metastasis. Cell block was prepared in a few cases. In a subset of cases, immunohistochemistry was done to pinpoint the primary. RESULTS Amongst the 225 patients studied, the mean age was 53.9 years. There was female preponderance with 125 females and 100 males. The commonest site was abdominal wall (n = 89) followed by chest wall (n = 60). The most common type of metastasising tumour was adenocarcinoma. CONCLUSION Clinicians and pathologists must be aware of the clinico-morphological spectrum of cutaneous metastasis for instant diagnosis followed by prompt management.

Background Duane retraction syndrome (DRS) is a congenital ocular motility disorder most commonly characterized by the inability of the eye to abduct, sometimes limitation of adduction, and globe retraction with palpebral fissure narrowing on adduction. Aim To study the clinical features, management, and outcome of DRS. Patients and methods A prospective, nonrandomized study was carried out on patients attending the Outpatient Clinic of Ophthalmology in Menoufia University Hospital during the period of study from June 2017 to July 2019. This study was conducted on 51 patients with DRS. Ocular and systemic features were studied. Surgery was done when indicated to eliminate upshoot or downshoot, face turn with a horizontal deviation, and globe retraction. Preoperative and postoperative ocular deviation, angle of head turn, and severity of limitation in abduction and adduction were detected and analyzed. Results Type I DRS was more common (70.6%), with female preponderance (52.9%) and a predilection for the left eye (70.6%). Twenty-one (41.2%) cases were operated, by recessing MR and/or lateral rectus (LR) muscles and/or Y-splitting and acceptable improvement was detected. Mean esotropic DRS improved from 18±4.02 to 3±2.8 (P

We performed a retrospective observational analytical study looking at the frequencies and characteristics of multiple sclerosis(MS) and neuromyelitis optica spectrum disorders(NMOSD) in consecutive patients with idiopathic inflammatory demyelinating disease (IIDDs) attending three centers (2009-2017). Of 523 patients with IIDDs, there were 173 patients with NMOSD and 230 patients with MS. The percentage of NMOSD: IIDDs was 33%. The percentage of NMOSD:Total MS and NMOSD cohort was 43%. Of 141 seropositive NMOSD patients, 134(95%) were from the three main ethnic groups. The percentage of seropositive NMOSD to IIDDs and to combined MS and NMOSD was 26.9% and 35% respectively. Ratios of MS to NMOSD were nearly equal at 1.3 to 1.0, reinforcing the high ratio of NMOSD to MS in Asia. Nearly half of the Chinese cohort were seropositive ie; 71/141 (50%) with the remainder being Malays; 56/141 (39.7%) and Indians; 7/141 (5%). Amongst the other indigenous groups seropositivity was seen in 2 each of Iban, Bajau, Kadazan descent as well as one of Bidayuh origin. Comparatively, seropositivity in NMOSD is commoner amongst the Chinese compared to the Malays (p ≤ 0.005) and Indians, p ≤ 0.05 with ratios as high as 10:1. In the MS group of 230 subjects, 123(53.5%) were Malays (ratio of MS:NMOSD of 2:1), 41(17.8%) were Chinese, (ratio of MS:NMOSD of 0.5:1.0) and 54 (23.5%)were Indians (ratios of MS:NMOSD of 5:1 amongst the Indians). The remainder from East Malaysia were made up of 2 each of Kadazans, Ibans and Bajaus including 3 each of Bidayuh and Eurasian descent. Comparatively, in the NMOSD and MS cohorts a female preponderance was noted more so amongst Chinese NMOSD patients, with rare familial occurrence in both but more in Malay MS/NMOSD patients. This study also highlighted some of the inter-ethnic differences in presentation of MS and NMOSD amongst the 3 main ethnic races in Malaysia and confirms indigenous races having MS/NMOSD which needs further research. It also reviewed current literature on similar inter-ethnic differences world wide. To conclude, MS and NMOSD are the commonest demyelinating diseases seen in Malaysia with interesting inter-ethnic differences and similarities.

Mental health problems are often unrecognized and neglected by patients, their relatives and by the society. The objective of the study was to find out the pattern of psychiatric morbidity of the patients attending at the psychiatry outpatient department. This was a cross sectional study carried out in the department of Psychiatry at North Bengal Medical College Hospital (NBMCH), Sirajganj from August, 2015 to July, 2017. For this purpose, 918 respondents attending in psychiatry outpatient department of NBMCH were enrolled in the study by using convenient sampling technique. The results showed that majority (26.3%) were from the age group of 31-40 years with female preponderance (58.7%). Among them 71.8% were married and 71.1% came from rural background. Maximum respondent’s (56.3%) monthly family income was in between 15,000-30,000 BDT. The most common psychiatric morbidity among the respondents was major depressive disorder (38.6%) followed by anxiety disorsers (25.8%). Most (85.1%) of the respondents were referred either by themselves or by their family members, friends or by relatives. The rest (14.9%) were referred by general physicians and specialists of different disciplines. The result of this study may help in the planning for better mental health service in private medical college hospitals.Bang J Psychiatry June 2016; 30(1): 10-13

The peripheral adenomatoid odontogenic tumour is an uncommon subtype of adenomatoid odontogenic tumour (AOT).It has a female preponderance commonly in theage group of 3–25 years. Anterior maxilla is themost frequent site of involvement. Clinically, it is manifested as soft tissue mass on gingiva with infrabony pocket and minimum bone involvement. So this lesion is easily misdiagnosed by the clinician as simple gingival growth.Histopathological features are identical to that of their intra-osseous counterpart.We present a case of 27 years old female who had her lesion on the gingiva of right maxillary canine region which is notausual site of involvement. Few cases have been reported in the literature but all exclusively involved the gingiva of maxillary incisors. In this context extensive study is needed to figure out the exact site distribution and clinical presentation of the disease.

PURPOSE: To assess the perceptions about ophthalmology as a career among undergraduate medical students and to investigate the determinants of career choice in ophthalmology. METHODS: A questionnaire was administered to all medical students (from 4th year to interns) in King Abdulaziz University, Jeddah, Saudi Arabia. A total of 519 students were included in the study. Students who aspire for ophthalmology as a career, i.e., those who mentioned it in their top three choices (Group A), were compared to those who did not (Group B) regarding demographic and academic factors, factors generally influencing career choice and perception about and experience in ophthalmology. RESULTS: Among 519 included students, ophthalmology was the first career choice of 5.6% and in the top three choices of 13.5% of students. Students from Group A had female preponderance and comparable academic skills, by reference to Group B. Group A reported to have a better experience in ophthalmology, including conference attendance, research activity, and community services related to ophthalmology, as well as greater advantage from ophthalmology rotation. Determinants of career choice in ophthalmology included giving importance for workload during their residency (odds ratio [OR] = 3.38; P = 0.021), having concern about challenging instrumental features (OR = 0.29, P = 0.012), believing that ophthalmology should be included in primary care (OR = 13.60, P = 0.002), and having participated in community service activity in ophthalmology (OR = 10.10, P = 0.005). CONCLUSION: Students who aspire for a career in ophthalmology showed to have an early involvement in related academic activities and less concern about instrumental and intellectual challenges, as compared to their counterparts. The formal ophthalmology rotation is the key step to recruit future ophthalmologists by correcting misconceptions and enhancing interest about the specialty.

Examination of the sex ratio (SR, male to female ratio) among carriers of Robertsonian translocations (rob) in newborns in the general population has not previously been given due attention, probably because of focusing on the striking female preponderance among fertile women explained by sterility of male carriers. Meta-analysis of published studies on 68,212 newborns showed differences in SR depending on the type of rearrangements: there were similar rates of male and female reciprocal translocation carriers (34♂/33♀, 0.97 and 0.99‰, correspondingly), but female preponderance among carriers of rob, regardless of their parental origin was observed (27♂/41♀, 0.77 and 1.24‰, correspondingly). Similar results were obtained from the prenatal cohort. Collectively, among carriers of rob with known parental origin, there were 66♂ and 97♀ (SR = 0.68), different from the expected ratio of 1: 1, p = 0.0093; for carriers of reciprocal translocations and inversions a typical slight male prevalence was found. Female-biased SR was demonstrated for carriers of the most frequent rob, t(13;14), with 50♂/85♀ (SR = 0.59, p = 0.0016), but not for carriers of other robs (28♂/27♀, SR = 1.04). A mechanism of female-specific rescue of translocation trisomy, due to loss of maternal chromosome, resulting in female preponderance among carriers of balanced translocations, along with reciprocal male preponderance among carriers of unbalanced translocations, could explain the observed phenomenon. Both female-biased SR among carriers of balanced 45,der(13;14),upd(14) with 4♂/12♀ and malebiased SR among carriers of unbalanced 46,+13,der(13;14) with 16♂/2♀, support the proposed hypothesis.

Background: Associated with the increase in the aging population, there is an increase in the occurrence of hip fractures worldwide. Result following such fractures is influenced by age of the patient. Purpose: This study purposes to evaluate the incidence and early outcome of hip fractures, comparing between different age groups. Materials and Methods: Data of hip fractures collected over a period of five years was analyzed. Patients were divided into three groups, group A (patients under the age of 64), group B (patients between 65 and 84 years of age), and group C (patients over the age of 85). Results: Of the 588 patients included in the study, there were 45 patients in group A, 351 patients in group B and 192 patients in group C. There was a female preponderance across all age groups, and this increased as age advanced (p < 0.0001). A significantly larger number of older patients lived alone and needed aids to walk before the injury (p < 0.0001). There was no significant difference in the type of fracture across the three groups (p = 0.13). A higher proportion of the elderly with intracapsular fractures were treated by replacement arthroplasty. Older patients who had internal fixation of intracapsular fractures had a better walking ability at 4 months. The overall deterioration in mobility was greater in older patients (p < 0.0001). Mortality was higher in older patients. Conclusions: Hip fractures are more common among females irrespective of age group. Older patients have a higher mortality and a greater deterioration of walking ability after such injuries. Internal fixation of intracapsular fractures have demonstrated satisfactory early outcome in the immediate period. This might be attributed to retention of native bone, better proprioception and shorter operation time.

Background : Cervical lymphadenopathy is one of the commonest clinical presentations of the patients in all age groups. FNAC is simple, inexpensive and minimally invasive procedure that can be used as an outpatient procedure for diagnosing lymphadenopathy cases. Aims and Objective: To assess the various causes of cervical lymphadenopathy through FNAC and to see the distribution of various lesions with respect to age and gender and to correlate with histopathological findings. Materials and Methods: The present Analytical cross-sectional study was conducted in the Department of Pathology, Mahatma Gandhi Medical College and Hospital, Pondicherry from January 2010 to July 2016.FNAC was done by standard procedure. All the slides were reviewed and diagnosis was rendered. Cytology findings were compared with histopathological diagnosis where-ever excision biopsy was done. Results: A total of 411 patients were included in the present study. Overall, female preponderance was seen. In benign non-neoplastic lesions, peak occurrence was seen in the 3 rd decade, whereas it was 7 th decade in metastatic lesions. Benign lymphadenopathies were diagnosed in 75.1% of cases, majority being chronic reactive lymphadenitis(34.6%) followed by granulomatous lymphadenitis(30%). The proportion of granulomatous lymphadenitis was more in our study as compared to other studies(p

Introduction: Anemia is a major global health problem, especially in developing countries like India, despite the fact that this problem is largely preventable & easily treatable. Aim: The aim is to study the clinical and hematological profile of anemia in children aged 5 years to 12 years. Material and Methods: It is a prospective hospital based study conducted in children presented with anemia in the department of Pediatrics at Maheshwara Medical College and Hospital, Patancheru, Telangana. 110 pediatric cases of anemia were included in the study. Results: Majority of children were among followed by 5- 6 years. Among different types of anemia studied, iron deficiency was reported predominantly 80/110 (72.7%) followed by megaloblastic anemia 20/110 (18.1%). There was female preponderance. Microcytic hypochromic anemia is seen in 81.8% (90/110). Dimorphic anemia was observed in 9.09 % of children. Conclusion Nutritional deficiency anemia is the most common cause of anemia among children aged 5 years to 12 years. Iron deficiency was found to be most common nutritional deficiency in children followed by megaloblastic anemia.

Background: the initial evaluation of obstructive jaundice involves distinguishing between intra and extra hepatic biliary obstruction. The goal of any radiologic procedure is to confirm the presence of biliary obstructive by detecting biliary dilatation, its exact location, extent and probable cause. Aim of the Study: to evaluate the role of Magnetic Resonance Cholangio-Pancreatography in differentiating benign from malignant causes of biliary obstruction using surgical, ERCP or histopathological findings as a gold standard.Patients and Methods: a prospective study done on 20 patients with clinical and laboratory finding suggestive of biliary obstruction. All patients underwent non enhanced MRCP on 1.5 Tesla machine (Philips). The final diagnosis of MRCP was correlated with results of ERCP in addition to biopsy and histological diagnosis to those patients had neoplasms. Results: Out of 20 cases, there were 11 benign and 9 malignant cases. Mean age of patients with malignant obstruction was more than benign with slight female preponderance. The diagnostic accuracy of MRCP in differentiating benign from malignant biliary obstructive diseases in correlation with surgical, ERCP and histopathological outcome was85.7%, 96.3%, and 93.3% respectively. It was found that irregular, asymmetric and long segment narrowing was more common in malignant stricture. Conclusion: MRCP is a rapid and non-invasive, procedure in assessing cases with suspicions biliary obstructions. It offered a diagnostic accuracy nearly equivocal to ERCP. MRCP can also replace the diagnostic part of ERCP procedure, so that time is spent only on its th erapeutic part, and hence decreasing complications of a lengthy ERCP. Recommendations: benign or malignant nature of biliary obstruction can be assured by MRCP by observation of stricture margin, dilatation, and length and accordingly proceed to next step in management. MRCP is an efficient diagnostic procedure for detection of presence, level, cause of obstruction and routinely advocated before any intervention is planned.

Background Numbness around the surgical scar can be a source of discomfort or dissatisfaction in a proportion of patients undergoing total knee arthroplasty (TKA). Literature reports wide variation in its prevalence and the consequence of numbness on the outcome of TKA is not clear. We investigated the prevalence of numbness, along with contributing factors, and assessed its effect on the functional outcome of TKA. Methods In total, 258 knees were included in this prospective patient-reported outcome measure case-control study. Demographic details, type and length of incision, pre-operative and 1-year post-operative Knee Society Scores were recorded and compared. Results The prevalence of numbness at 1 year was 53%, with a female preponderance. Patients older than 70 years were less affected. Discomfort due to numbness was recorded in 8.7% of the patients, 75% of which were female. The length of the incision correlated positively with the presence of numbness. The Knee Society Scores did not correlate with the presence or area of numbness. Conclusion Our findings indicate a high prevalence of numbness after TKA. Nevertheless, numbness does not affect the functional outcome.

Background Dermatosis papulosa nigra (DPN) is a benign cutaneous condition which commonly occurs in dark-skinned people, especially Asians and African Americans. Owing to its benign nature and rarity, very few studies have been conducted to date, and dermoscopic studies are practically nonexistent. Objectives To study the clinical and epidemiological characteristics of patients with dermatosis papulosa nigra (DPN) and to correlate the clinical findings with dermoscopic and histopathological findings in DPN. Methods A total of 100 patients attending the Dermatology outpatient department at Father Muller Medical College, Mangalore, India, with clinically diagnosed dermatosis papulosa nigra were included in the study. Histopathology and dermoscopic evaluation of the lesions were done, and the characteristics seen were noted. Results Earlier onset of lesions was noted in our study, i.e. onset in the 4th decade as compared to the 6th decade in most other studies. A female preponderance, positive family history, history of sun exposure, and involvement of the head and neck were other significant associations. Histopathology revealed an acanthotic variant in all the lesions that were biopsied. The predominant dermoscopic finding was fissures and ridges of the cerebriform pattern followed by comedo-like openings. Conclusion Dermatosis papulosa nigra is a benign unaesthetic condition seen in Fitzpatrick skin types IV-VI. The diagnosis is mainly clinical; however, in a few cases histopathology and dermoscopy aid in differentiating it from other benign and malignant tumors. Dermoscopy, in particular, being a noninvasive investigative moiety is a rapid and accurate diagnostic tool.

Background and aims: Rheumatic heart disease is one of the most common cause for heart failure and associated mortalities/morbidities in the young population in developing countries like Nepal imparting huge familial, social and manpower burden. Materials and methods: This is a hospital based descriptive cross-sectional study during June 2014 to April 2016 over a period of 22 months at College of Medical Sciences-Bharatpur including 235 patients with clinical and/or echocardiographic evidence of definite rheumatic heart disease. Results: The age of the patients ranged from 7 to 76 years with mean age 39.82 ± 4.2 years with female preponderance (F:M = 2.1:1) (p

This study aims to examine the prevalence of Cushing’s syndrome (CS) in class 3 obese patients before bariatric surgery. The data of 1037 class 3 obese patients admitted to the endocrinology outpatient clinic for endocrinological evaluation before bariatric surgery between 2012 and 2019were reviewed retrospectively. One milligram dexamethasone suppression test (DST) was used for the evaluation of hypercortisolism in all cases and cutoff accepted as 1.8 μg/dL. The mean body mass index (BMI) was 48 ± 8.9 kg/m2 and age was 42 ± 10 years with female preponderance (F/M: 799/238] being observed in this cohort. Insufficient cortisol suppression was found in 40 patients; confirmed hypercortisolemia was detected in 8 patients. The prevalence of pathologic DST was 3.85% and 0.77% in confirmed hypercortisolism. The specificity for 1-mg DST with the cutoff 1.8 μg/dL was calculated as 96.8%. Hypercortisolism prevalence was found to be low, and 1 mg DST is a sufficient test for the screening of CS in class 3 obese patients evaluated before bariatric surgery.

Objective: To determine the frequency of deep venous thrombosis after abdominal surgery. Study Design: Cross Sectional Study. Settings: Department of Surgery, Bolan Medical Complex, Quetta Pakistan. Duration: Six-months started from 14-06-2014 to 13-12-2014. Methodology: All patients with age 40 years to 70 years of either gender presented with ASA status I or II underwent major abdominal operations lasting more than 30 minutes were enrolled. Patients were followed for 7th postoperative day and final outcome that is DVT was assessed. Results: Patients mean age was 58.40 ±9.59 years. Female preponderance was found to be higher, i.e. 47 (53.40%). Mean BMI of the patients was 25.3 ±5.4Kg/m2. There were 58 (65.9%) patients with HTN, 34 (38.60%) smokers and 42 (47.70%) diabetic patients. There were 14 (15.90%) DVT cases were reported. Conclusion: The frequency of deep venous thrombosis was found in 14 (15.90) patients after abdominal surgery.

Introduction Primary hyperparathyroidism (PHPT) remains a relatively underdiagnosed disease in developing countries. The aim of this study was to assess the demographic, pathological, biochemical, and surgical characteristics of patients with primary hyperparathyroidism in a university hospital department of otolaryngology in eastern Algeria. Materials and method We performed a retrospective analysis of the records of 62 patients operated in our department for primary hyperparathyroidism between January 2002 and December 2013. Results The mean age was 47.7 ± 15 years with a female preponderance (88.7%). The mode of discovery was during a biological assessment for bone syndrome in 42% of cases. The mean calcemia was 2.92 ± 0.6 mmol/L, and the intact serum parathyroid hormone was 867.78 ± 954.50 pmol/L. A total of 54.8% of patients had bilateral neck exploration, and 45.2% had minimally invasive open parathyroidectomy. Postoperative complications were dominated by severe hypocalcemia and hungry bone syndrome. Conclusion The diagnosis of primary hyperparathyroidism in our country is late, and management is often performed after the appearance of bone and renal complications., Highlights • Primary hyperparathyroidism is an underdiagnosed disease in developing countries. • The diagnosis is made after the appearance of bone and renal complications. • Bone manifestations are the most common presenting symptoms. • Biochemical profile is dominated by hypercalcemia and elevated serum parathyroid hormone levels. • Average adenoma weight is very high, correlating with severe hyperparathyroidism. • Hypocalcemia and hungry bone syndrome are the most common postoperative complications.

Background. Acute poisoning is a common scenario in the emergency department of any general hospital globally, but its pattern may vary in different parts of the world and even may be a different regional variation in the same country. Objective. Our recent study aims to assess the demographic characteristics, psychological aspect, pattern, and treatment outcome in different acute poisoning. Method. The present cross-sectional study was conducted in the medicine department of Jashore Medical College and Hospital from 1st January to 30th June 2018, which recruited 487 eligible cases of admitted acute poisoning patients. Results. The study reveals that the total incidence of acute poisoning in Jashore, Bangladesh, is 17.1 per 100,000 populations over a 6-month period. The mean age of our study population was 27 ± 11 (SD) years with having significant female preponderance in acute poisoning (female: 253/52% and male: 234/48%; p = 0.002). Female subjects were significantly younger than male (p <0.001). Moreover, the total suicidal intension of acute poisoning in our study was 97.3%, whereas the female subjects were more committed to suicidal attempts (p = 0.027). Organophosphorus compounds (OPCs) were the significant leading agents (66.1%, p = 0.029) of acute poisoning, and even, it had been significantly used as suicidal intention of poisoning substance (65.1%, p <0.001) in our observation. Muslim (97.5%, p = 0.005), 10–29 year age group (68.0%, p = 0.002), rural (99.2%), unmarried (51.3%), middle class (50.1%), students (48.9%), and secondary educational background population (76.4%) were more victimized of acute poisoning. Among different factors, familial disharmony constituted of 56.1% cases of suicidal attempt in acute poisoning. Finally, we had observed that the death incidence by acute poisoning in Jashore, Bangladesh, was 1.9 per 100,000 population over a 6-month period. Conclusion. The recent study reveals that there is high incidence of acute poisoning in Jashore, Bangladesh, with a significant amount of death toll. Organophosphorus compound is the most common agent of deliberating self-poisoning in our study due to its easy availability in our agriculture-based community.

Background: Cranial functional movement disorders (CFMDs) affect the face, eyes, jaw, tongue, and palate. Objectives: We aimed to examine our large series of functional movement disorders (FMDs) patients where the cranial muscles were involved to determine their phenomenology and other clinical features. Methods: This is a chart review of 26 patients who presented with CFMDs. Results: There were 16 (61.53%) females and 10 (38.46%) male patients. The mean ± [standard deviation (SD)] age at the presentation was 33.96 ± 16.94 (Range: 11–83) years. The duration of symptoms ranged from one day to 6 years (Mean ±SD: 402.03 ±534.97 days). According to the Fahn-Williams criteria, CFMDs were documented in 24 patients and clinically established in two patients. The facial [38.46% (10/26)] involvement was the most common in our CFMDs patients. Oromandibular [19.23% (5/26)], ocular [15.38% (4/26)], lingual [15.38% (4/26)], speech [15.38% (4/26)] and palatal [(3.85; 1/26)] involvement was also seen. 10 (38.46%) patients also had associated FMD in the extracranial regions. Precipitating factors were present in 84.61% (22/26) of the patients and associated illnesses were present in 42.30% (11/26) of the patients. At 3 months follow-up, 9 (34.61%) patients had improved, 13 (50%) had partial improvement and 4 (15.38%) had no improvement. Conclusions: There was a slight female preponderance in our patients. CFMDs are more likely to involve facial muscles. Associated medical conditions like neuropsychiatric disturbances and headaches are frequently present in CFMDs patients. Early clinical diagnosis will avoid unnecessary investigations and allow the patient to seek the right treatment.

Correction: In the publication study period was missed. Study period "from 1st June 2017 to 30th November 2017" has been added. Introduction: Dry eye is a disorder of the tear film which occurs due to tear deficiency or excessive tear evaporation. It causes damage to the interpalpebral ocular surface and is associated with a variety of symptoms reflecting ocular discomfort. Materials and Methods: This was a hospital-based prospective observational study conducted to study the demography of dry eye patients and associated attributable risk factors for the disease. Every patient presenting with symptoms suggestive of dry eye was given a questionnaire, as per Salisbury Eye Evaluation Study and thorough ocular examination was done along with two tests for dry eye i.e Schirmer test I measuring less than 10mm and Tear film break up time measuring less than 10 sec. Final data analysis was done using statistical tool SPSS. Results: Demographic profile revealed a female preponderance in the patients with a ratio of 1.9:1. Amongst them, prevalence of premenopausal age was 53%. Dry eye was found to be more common in age group between 30 to 40 years (29%). The modifiable attributable risk factors were urban residence (67%), exposure to air condition and computer user (52%), indoor workers (59%), and environmental pollutants (60%). Conclusions: This study revealed the patients who presented with dry eye were mostly female of premenopausal age group, and exposed to modifiable risk factors which included residing at urban areas, indoor work, and exposure to environmental pollutants.

Background/objectives To determine the role of sex in port-wine stain (PWS) distribution and describe the epidemiologic and anatomic differences between syndrome-associated and non-syndrome-associated PWS using modern criteria. Methods A retrospective review of PWS patients aged 18 years and younger from 1995 to 2018 seen in the Department of Dermatology at an academic tertiary referral center. Cases were reviewed for sex, anatomic location, and presence of associated syndrome. 4,527 records were reviewed on the basis of ICD billing codes for congenital vascular malformations, with 516 meeting inclusion criteria. Results 516 patients were included in the analysis: 234 (45.4%) men and 282 (54.6%) women. A female preponderance of Sturge-Weber syndrome (18 of 23, 78%, P = .03) and a trend toward more female-isolated PWS (149 of 269, 55%, P = .72) were found. No lateral predominance observed for isolated PWS was found: 112(41.6%) limited left-side lesions and 113(42%) limited right-side lesions (P = .41). A trend toward Klippel-Trenaunay syndrome (KTS)-associated PWS occurring more commonly isolated to the left side (76 (45.5%) vs 59 (35.12%) P = .29) was found. Nine percent of SWS patients had a PWS on the body. Five percent of KTS patients had a facial PWS. The lower limb was the most common location overall of body PWS with 33.8% of isolated PWS and 81.5% of KTS patients having a lower limb lesion. Conclusions Female children were more likely to be diagnosed with SWS, and a trend toward more isolated PWS in women was found. No lateral predominance of isolated PWS was found, but KTS-associated PWS was more common on the left. A considerable proportion of lesions do not appear in anatomic locations traditionally considered typical in the setting of associated syndromes, which underscores the importance of conducting a complete physical examination and adhering to diagnostic criteria for those syndromes.

Background Headache has emerged as a global public health concern. However, little is known about the burden from headache disorders in China. The aim of this work was to quantify the spatial patterns and temporal trends of burden from headache disorders in China. Methods Following the general analytic strategy used in the 2017 Global Burden of Disease study, we analyzed the prevalence and years lived with disability (YLDs) of headache and its main subcategories, including migraine and tension-type headache (TTH), by age, sex, year and 33 province-level administrative units in China from 1990 to 2017. Results Almost 112.4 million individuals were estimated to have headache disorders in 1990 in China, which rose to 482.7 million in 2017. The all-age YLDs increased by 36.2% from 1990 to 2017. Migraine caused 5.5 million YLDs, much higher than TTH (1.1 million) in 2017. The age-standardized prevalence and YLDs rate of headache remained stable and high in 2017 compared with 1990, respectively. The proportion of total headache YLDs in all diseases increased from 1990 to 2017 by 5.4%. A female preponderance was observed for YLDs and the YLDs were mainly in people aged 20~54 years. Conclusions Headache remains a huge health burden in China from 1990 to 2017, with prevalence and YLDs rates higher in eastern provinces than western provinces. The substantial increase in headache cases and YLDs represents an ongoing challenge in Chinese population. Our results can help shape and inform headache research and public policy throughout China, especially for females and middle-aged people.

Objective To determine the clinical and immunological characteristics and short-term outcome of children with systemic lupus erythematosus (SLE). Study design A descriptive cohort study. Place and duration of study Paediatric Rheumatology Clinic, The Aga Khan University Hospital, Karachi, from January 2011 to December 2015. Methodology Clinical and immunological profile and short-term outcome of children less than 16 years of age admitted in the paediatric ward, with the diagnosis of SLE was studied. Demographic data, clinical presentation, laboratory findings, immunological profile and treatment regimens of these children were evaluated. Results Thirty-two children, satisfying the criteria of American College of Rheumatology (ACR) for SLE, were enrolled during the study period of five consecutive years. A female predominance was observed with 28 (87.5%) patients being female (F:M 7:1). Mean age at symptom onset was 10.5+2.7 years; and 8.8+2.1 years in females and males, respectively. The mean age at diagnosis was 11.3+2.8 years in females and 9.4+1.9 years in males. Prolonged fever was the most common non-specific symptom found in 27 (84%), followed by pallor in 13 (41%) patients. Twenty-two (69%) children were found to be anemic and 18 patients (56%) having signs of arthritis at presentation. Renal involvement was observed in 15 (47%) patients. The most common laboratory finding was anemia, found in 22 (69%) of cases. The most common immunological markers were serum anti-neutrophil antibodies (ANA), positive in 28 (88%) patients, followed by anti double-stranded DNA antibodies, raised in 26 (81%) of cases. Out of 32, 12 patients were lost to follow-up. Of the remaining 20 children who were followed for four years, ten (50%) went into remission. Conclusion Childhood-onset SLE encompasses a wide variety of manifestations with a female preponderance. Fever, arthralgia and pallor are the most frequent clinical manifestations among the children. Hemolytic anemia (HA) is the most common laboratory abnormality, with ANA and anti ds-DNA antibodies positivity in the majority of padiatric patients.

Atopic dermatitis is one among chronic diseases characterized by erythema, pruritus, scaling, lichenification, and papulo-vesicles. It is a common condition affecting approximately 17% of the population, with a slight female preponderance. Almost 60% of patients develop Atopic dermatitis within the first year of life, where as 85% by the age of five. Charmadala is caused due to predominance of Vata in which, Charmavadharanaatha is seen. Samanya Nidanas such as due to vitiated breast milk, rubbing with cloths, excessive holding on the lap, due to hot air, heat of sunrays, perspiration, poultices, contact with his own waste products like urine and faces, non cleanliness, compression by hands, over rubbing and due to family tendency, Charmadala can manifest. Usually the Mandala gets distributed over the face, neck, hands, feet, groin region, sacral region and joints. By looking in to the age of manifestation, symptoms like Kandu, Raktavarnata, Twak Parushata and Sputana, and Pidaka; its specific area of manifestation, the Utpata nature of Charmadala, it is quite similar to that of Atopic Dermatitis. The aim of Chikitsa lies in disintegration of the process of Samprapti. The general line of treatment explained for Kushta is applicable to Charmadala. Charaka and Vagbhata mentioned Shodhana Karma to be carried out according to predominance of vitiated Dosha. In the Kushtha of Vata dominance Ghritapana, in Kapha dominance Vamana and in Pitta dominance Virechana and Raktamokshana are to be carried out.

Correspondence to: Omer Nasim Ophthalmology Unit Rehman Medical Institute (RMI), Peshawar Email: discover.omer@gmail.com Purpose: To assess the frequency of different eye morbidities in the patients presenting at a tertiary care Hospital in Peshawar. Study Design: Cross sectional study. Place and Duration of Study: Ophthalmology unit of Rehman Medical Institute (RMI), Peshawar from February 2004 to month of March 2014. Material & Methods: This research involved accessing the data bank kept by the Hospital. All ocular morbidities seen during the study period was included in the study while those who presented with the diseases of the eye due to some other systemic condition were excluded. Patients were categorized according to their gender and year of admission. The age categories were divided into 5 groups, 0-20, 21-40, 41-60, 61-80, 81-100 years’ category. The data collected was analyzed using MS Excel 2013. Results: A total of 1869 patients were examined out of which 49.92% were male and 50.07% were female. The ocular examination revealed that out of the 1869 patients, 57.30% of the patients suffered from Cataract, 4.86% patients suffered from Pterygium, 4.76% suffered from Strabismus, 1.65% patients suffered from Glaucoma and the remaining 31.43% suffered from various spectrum of diseases. Female preponderance was more than males in the sense of general morbidity of ocular disorders.

Introduction. Hemifacial spasm is a common indication for botulinum toxin use. Aim of this study was to find out the efficacy and safety of long-term use of botulinum toxin for hemifacial spasms in Sri Lanka. Methods. A group of 28 patients with hemifacial spasms who had been given botulinum toxin for more than 7 years were included in the study. Botulinum toxin was given at multiple sites including over the eyelid, at the ipsilateral orbicularis oculi, nasalis, orbicularis oris, mentalis and contralateral orbicularis oris sites on a dilution of 2 ml/100 units. Patients were then followed up every 3 months. Degree of improvement, side effects if any, the total number of units used and the information regarding the last injection used were collected. Results. There were 24 females with a female preponderance of 86%. Mean age (SD) at first injection of the patients was 58.7 (9.1) years. Mean (SD) duration of the repeated use was 10.5 (2.2) years. Range of the duration of treatment was from 7 to 15 years. During this duration, mean (SD) number of injections given was 25.2 (8). Average number of units given for each patient during these multiple injections was 20.3 (2.6). Improvement was seen in 96.5% of the times and side effects were seen only in 2.7% of the time and included heaviness of the eye, mild lower facial weakness and pain at the site of injection which did not last long. Patient compliance was good even after repeated long term use. There were no systemic side effects and drug resistance to botulinum toxin was not seen in these patients. Conclusion. These findings show that the long-term use of botulinum toxin for more than 10 years seems to be safe and efficacious for hemifacial spasm.

Background: Chronic otitis media is the most common cause of hearing impairment in the developing countries with serious effects. The aim of the study was to compare the outcome of myringoplasty in dry and wet ears in tubo-tympanic type of chronic otitis media (COM) with respect to graft uptake and hearing improvement.Methods: This is an observational study done in the department of ENT, Mamata medical college, Khammam, during the study period of September 2019 to February 2021 on 40 patients of tubo-tympanic type COM. On simple random basis selected patients underwent myringoplasty by underlay technique. All patients were evaluated during post-operative follow-up.Results: In our study, majority of patients were in the age group of 26 to 45 years with slight female preponderance, with male to female ratio (0.73:1). In our study, the successful graft uptake was seen 90% in dry ears and 85% in wet ears, which seems to be not significant in difference. With respect to hearing improvement, post-operatively there was significant improvement in both the groups, when compared to pre-operative hearing. The maximum improvement in average hearing threshold after surgery, in dry ears with large perforation (12.66dB) and in wet ears with small central perforation (12.44dB) was almost equal.Conclusions: In this study, the success rate of graft uptake and hearing improvement is found almost equal in dry and wet ears by using underlay technique of myringoplasty.

Introduction: Cholelithiasis is the most common and important cause of biliary tract disease. In today’s world, laparoscopic cholecystectomy is the gold standard treatment for gallstones. Decrease in the size or number of ports provide better results in laparoscopic cholecystectomy. Objective: We aim the study to find out feasibility of three port lap cholecystectomy over four port lap cholecystectomy regarding post-op pain, duration of surgery, conversion rate, hospital stay and complications. Materials & Methods: Patients who fulfilled the inclusion criteria were included. 76 patients enrolled for the study and divided into two groups as 3 port and 4 port. Surgical preformed assessment proforma used to collect the data. Results: The mean age of the studied patients was 46.38 years with female preponderance. The Mean operative time for three ports was 66.90 minutes and for four ports it was 75.45minutes. Mean duration of post-operative stay for three port was 4.66 and for the conventional group it was 5.30. Conclusion: Patients who underwent the three port technique had a lesser hospital stay compared to patients who underwent the conventional 4 port technique. Patients had less postoperative pain, lesser requirement of analgesics in three port group. 2 patients from the 4 port group had fever 48 hours after surgery.

Background : A meningioma is a tumor that arises from the meninges- the membranes that surround the brain and spinal cord. Objective : This is a retrospective analysis of the recorded data of patients managed for intracranial meningiomas between January 2007 and June 2015 at Apollo Hospital, Dhaka. Methodology : Demographic data was analyzed for all but only patients who had surgery and histological diagnosis were analyzed for outcome. Results : This study shows that meningiomas had female preponderance. Majority cases were above 50 years of age. Convexity is the most common anatomical location of meningioma. Most common symptoms were headache (70%) followed by seizure in 34.3% of patients. 90% of the cases were benign. Malignant meningioma was 1.4% and recurrence was found in 1.4% of cases. Six patients with histological grades I, II and III meningi- omas were sent for stereotactic radiotherapy after incomplete tumor resection or for residual tumour. Total removal was done in 80% cases and the mortality was 1.4%, in patient who had poor GCS score on admission. Pulse Vol.9 January-December 2016 p.22-26

Significant attention has been paid to the potential adaptive value of depression as it relates to interactions with people in the social world. However, in this review, we outline the rationale of why certain features of depression including its environmental and genetic risk factors, its association with the acute phase response and its age of onset and female preponderance appear to have evolved from human interactions with pathogens in the microbial world. Approaching the relationship between inflammation and depression from this evolutionary perspective yields a number of insights that may reveal important clues regarding the origin and epidemiology of the disorder as well as the persistence of its risk alleles in the modern human genome.

Clinical and mycological features of onychomycosis show variation with time and place. Onychomycosis is a major public health problem with high incidence, associated morbidity and long lasting treatment with anti-fungal agents. A study was carried out on 118 patients having clinical diagnosis of onychomycosis, attending the dermatology out-patient department of R. G. Kar Medical College, Kolkata. Nail clippings were subjected to direct microscopy and cultured on Sabouraud's Dextrose Agar with antibiotics. The commonest age group affected was 21-40 years with a female preponderance and housewives were most commonly affected group. Finger nail involvement were more frequent and distolateral subungal onychomycosis (DLSO) was the most common clinical type observed . Out of 118 cases total KOH positivity was in 72 (61.01%) and culture positivity was in 62 (52.54%). Total culture positive cases were 62 and total number of fungi identified were 66 as dual pathogen had been identified in four cases . Among 66 culture positive isolates dermatophytes were 30 ( 45.55%), candida 21(31.82%) and non-dermatophyte moulds (NDM) 15 ( 22.73%) . T. rubrum was the commonest etiological agent. Among dermatophytes, Trichophyton rubrum, and among NDM, Fusarium moniliforme, were the most common isolates identified in our study.

Aim: To analyse the influence of various factors on the visual outcome of Optic neuritis patients Materials & Methods: A total of 116 patients with optic neuritis were studied as a prospective study for two years in the department of Ophthalmology, Dr PSIMS&RF, Chinoutpalli. All cases were investigated for visual acuity, colour vision, APD, visual fields. At the end of the study all the above parameters were recorded and analysed. Discussion: All the patients having optic neuritis were presented with defective vision[100%].70 cases had ocular pain[60.34%].32 patients had defective colour vision[27.58%].28 patients had defective visual fields[24.14%].The study showed a female preponderance with 64% of cases. History of recurrence was noted in 10% of cases. Conclusion: In our study no specific factor is associated with the aetiology of optic neuritis.18% of cases showed bilaterality. After treatment[ONTT],all the cases showed significant improvement in the visual acuity. Colour vision was improved at the end of third month of treatment. ONTT regime has a very significant role in the treatment of Optic neuritis cases.

STUDY OBJECTIVES This study aimed to explore the moderation of pubertal status on the onset of sex differences in the prevalence of insomnia symptoms and their health correlates. METHODS A total of 7,507 children and adolescents (weighted percentage of female: 48.5%) aged between 6-17 y were recruited from thirty-one primary and secondary schools. Participants with difficulty initiating sleep (DIS), difficulty maintaining sleep (DMS), and/or early morning awakening (EMA) ≥ 3 times/week in the past month were considered as having insomnia symptoms. The severity of insomnia was measured by the Insomnia Severity Index (ISI). RESULTS The prevalence of insomnia symptoms increased from 3.4% to 12.2% in girls (3.6-fold) and from 4.3% to 9.1% in boys (2.1-fold) from Tanner stage 1 to 5. There was a significant interaction between sex and Tanner stage in the prevalence of insomnia (P < 0.001) with an emergence of female preponderance at Tanner stage 4 even after controlling for age, family income, and school start time. Similar sex-Tanner stage interactions were found in DIS, DMS, and ISI total score but not EMA. Insomnia symptoms were strongly associated with behavioral problems, poor mental health, and poor general health in both sexes. Boys with insomnia would report more maladaptive lifestyles (smoking, alcohol, and energy drinks) whereas girls with insomnia were more susceptible to emotional and relationship difficulties. CONCLUSIONS Pubertal maturation was associated with a progressive increase in the prevalence of insomnia symptoms with the emergence of female preponderance in both the prevalence and severity of insomnia symptoms at late puberty. CLINICAL TRIALS REGISTRATION Chinese Clinical Trial Register, http://www.chictr.org.cn, ID: ChiCTR-TRC-12002798.

Background: The primary aim of the current investigation was to evaluate the role of NT-proBNP in the diagnosis of diastolic heart failure and its correlation with echocardiography.Methods: Hospital based observational and analytical study undertaken on a total of 65 patients of diastolic heart failure fulfilling clinical inclusion criteria. The enrolled patients had a mean age of 54.5 years with a female preponderance (33 females vs. 32 males). Patients underwent clinical evaluation and echocardiography examination. NT-proBNP estimation was done using autoanalyzer working on principle of electrochemiluminisense. Patients were divided into various grades of diastolic dysfunction on the basis of echocardiography. Statistical analysis was done to find the significance of levels of NT-proBNP and its correlation with the grading of diastolic heart failure.Results: There was a statistically significant higher level of serum NT-proBNP in patients with diastolic heart failure and the increasing levels were directly proportional to severity of diastolic dysfunction. The mean level of NT-proBNP increased from 361.08 pg/ml to 3570 pg/ml in increasing severity of diastolic dysfunction.Conclusions: Results suggested positive correlation of rising NT-proBNP levels with increasing severity of diastolic dysfunction.

Background: As there is paucity of data on harmonic scalpel thyroidectomy from Jammu and Kashmir belt. So, we conducted this study to bridge this gap and also to create awareness about the use of harmonic scalpel. Thyroidectomy has become one of the most common and frequent surgery. Hemostasis in thyroid surgery is of utmost importance for a successful surgery. Our aim was to compare operative factors, postoperative outcomes of thyroidectomy using the Harmonic Scalpel (HS) and Conventional Haemostasis (CH).Methods: In this randomized control trial study, 100 patients who underwent thyroidectomy were enrolled and randomly divided in two groups- HS group and CH group. The inclusion criteria were age>18years, acceptance to participate in the study (signed informed consent form) and scheduled total thyroidectomy. The groups were compared with regards to age, gender, operative time, post-operative drainage volume, postoperative pain, and hospital stay.Results: The mean age in years was 39.8 years for HS group and 43.8 years for CH group with female preponderance. There was a significant difference with regards to operative time, post-operative drainage volume, postoperative pain, and hospital stay (p