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Ventriculoperitoneal shunt migration into the scrotum is a rare phenomenon that has been reported in nearly 35 patients in the literature till date. Genitalia-related complications of ventriculoperitoneal shunts in children like inguinoscrotal migration usually occur during 1st year of the shunt procedure due to factors like raised abdominal pressure and patency of process vaginalis. We report a case of scrotal migration of tip of ventriculoperitoneal shunt in a 2-month-old infant presenting to us with communicating hydrocephalus. In a patient with inguinoscrotal swelling and ventriculoperitoneal shunt, migration of shunt should be suspected. Prompt diagnosis and management of this condition is important due to various complications like shunt dysfunction and testicular lesions. Treatment of this condition is surgical closure of the patent processes vaginalis and shunt reposition.

Introduction: As a result of the coronavirus disease (COVID-19) pandemic, more than 28 million planned surgeries worldwide could be cancelled leading to patients facing long waiting period for their treatment. The outbreak of COVID-19 caused by severe acute respiratory syndrome coronavirus (SARS CoV-2) has spread to more than 220 countries around the world and has almost stopped all routine surgical work. In children, the delay in the management of surgical diseases could result in significant morbidity and mortality. Material and Method: Herein, we describe our experience with the management of Paediatric Surgical patients at our centre which is a tertiary level hospital catering to both COVID-19 positive and Non-COVID patients in all specialties. Observation and Results: During the COVID-19 pandemic, 69.41% fewer paediatric surgical patients underwent surgery relative to the corresponding period 1 year earlier. However, the number of emergency cases performed increased during the COVID pandemic by 62.12%, mostly involving, urological and gastrointestinal emergencies. Conclusion: As we gain experience in effective protocol-based management, which can be revised based on the evolving scientific evidence. It will be appropriate to resume the elective work in selected patients, following the appropriate level of precautions.

Introduction: Blunt abdominal trauma comprises 1–1.5% of total admissions for trauma. In India every year more than a lakh persons die due to accidents. It is in fact the automobiles traveling at a greater speed than ever before that account for an amazing frequency of admissions in civilian hospitals. These injuries present a challenge to the most astute diagnostician, mainly because of the many organs involved, complexity of the hidden and vital structures involved and also because other frequently overshadow the early symptoms associated injuries to the head and chest. The figure is increasing every year, for example, from 1965 to 1966 and an increase by 8.4% was recorded. Methods: The present study consists of 70 cases of blunt abdominal trauma treated in surgical indoors of Hamidia Hospital and associated Gandhi Medical College, Bhopal within the period of 3 years. Abdominal paracentesis was done in all cases and diagnostic peritoneal lavage (DPL) done in those cases, where paracentesis was negative or doubtful. Ultrasonography was also done in almost all the cases admitted. Results: In our study, the accuracy and sensitivity of DPL marginally exceeds that of ultrasonography and accuracy and sensitivity of paracentesis is relatively less. Conclusion: Our study establishes that safety and accuracy of peritoneal tapping as a diagnostic aid in acute abdomen. It is particularly useful in several centers, where radiological facilities do not exist. Comparing all the above diagnostic tools, ultrasonography and DPL were considered are the most accurate, sensitive, and specific diagnostic modalities in cases of blunt injury abdomen.

Introduction: Early appendicectomy has been found to be a safe and better alternative for management of appendicular mass in various studies in adults, while very few studies report such advantages in the paediatric population. We conducted this study to assess the safety, efficacy and need of early laparoscopic appendicectomy (ELA) in child patients with appendicular mass. Materials and Methods: All patients with appendicular mass who underwent ELA at our institute between September 2011 and August 2014 were retrospectively reviewed. Appendicular mass was defined as a right iliac fossa mass in a case of acute appendicitis, diagnosed by clinical, laboratory and radiological evaluation, and palpation under anaesthesia, the patient being subjected to laparoscopic treatment. Results: Forty-eight (48) patients were confirmed to have appendicular mass intraoperatively and were included in the analysis. There were 30 males and 18 females, with ages ranging 7-13 years (mean 9 years). In the present study, appendicular complications included appendicular abscess (62.5%), gangrenous appendicitis (25%), sloughed-out appendix (8.33%) and appendicular perforation (4.16%). The average operative time was 72 min (range 45-93 min). One case (1.92%) required conversion to open procedure due to failure of identification of the appendicular base of a sloughed-out appendix. Post-operative complications were found in 4 (7.69%) patients, of whom 3 (5.76%) had minor wound infection at the umbilical port site and 1 (1.92%) had post-operative pelvic abscess, which was managed with percutaneous aspiration. Discussion: ELA avoids misdiagnosis, treats complicated appendicitis at its outset, and avoids complications and/or failure of non-operative treatment of a potentially lethal, diseased appendix. This approach is associated with minimal complications in experienced hands and is a safe and feasible option in children with appendicular mass.

Background: To evaluate 490 consecutive children who underwent hernia repair over a 3-year period. Technical details and clinical results are reported. Methods: Retrospective study of open and laparoscopic inguinal hernia repair performed in dept. of pediatric surgery, NSCB Medical College, Jabalpur, M.P. during July 2009 to July 2012 was done. The variables evaluated were age, sex, type of inguinal hernia, presence of an associated hydrocele, side of hernia, incarceration, obstruction, strangulation, occurrence of opposite-side hernia, recurrence, and other associated complications and conditions. Correlation between radiology and intraopearative findings was done. A total of 540 open internal rings were closed surgically in 490 children (boys and girls, aged 02 days to 14 years, mean 32 months). 400 cases underwent open repair by standard technique and 90 cases underwent laparoscopic surgery. In laparoscopic technique one 5-mm and two 3-mm instruments were used to access the peritoneal cavity. The internal inguinal ring was closed with a non-absorbable suture or tacker as described in paper. Results: There were no significant intraoperative complications. Length of procedure ranged between 20 and 50 minutes with a mean of 35 minutes in laparoscopy and 20 min in open surgery. Postoperative hospital stay ranged from 1 to 3 days. Five children who presented with a right-sided hernia and three with a left hernia (total of 8) were found to have a patent contralateral internal ring on laparoscopy. Mean follow-up was 20 months. There were 2 hernia recurrences (0.4%) 1 in open and 1 in laparoscopic group. Conclusions: Ultrasonography of inguinal region is good adjuvant for diagnosis in doubtful cases. Majority of hernia cases were operated by standard open surgical technique. Laparoscopic hernia repair in children is a safe and feasible technique. There is clear visualization of structures and vas remains untouched and opposite patent ring is seen which can be managed in same setting. As per our experience the recurrence rate is comparable to that of the traditional open approach with a superior cosmetic result.

Background: Haemorrhoids is a common disease affecting humans. Surgical treatment of haemorrhoids includes by using stapler and conventional or open method. Both the methods have its own advantages and disadvantages. This study is done to evaluate the efficacy of both the procedures in our settings. Objective of the study was to study the efficacy of two surgical methods of treatment of hemorrhoids, in terms of (1) operation time; (2) post-operative pain; (3) hospital stay; (4) return to normal activity and return to work; (5) complications; (6) recurrence; (7) patient satisfaction. Methods: A comparative study was done between open and stapling methods for the treatment of symptomatic hemorrhoids in CMCH, Bhopal, India over a period from November 2011 to December 2014. Results: There was major statistically significant difference was seen among different parameters between these two procedures of haemorrhoidectomy, open versus stapler procedure for prolapsing hemorrhoids (PPH). Conclusions: In present study there is definite difference noted between two surgical methods as evident from table 1- 10 as evident from p-value. As far as satisfaction of patient is considered in both the groups satisfaction is similar except for the cost of device which added for the most cause of dissatisfaction.

Aims: To evaluate the technique of Paediatric Percutaneous Nephrolithotomy in terms of safety, outcome and efficacy in age group 1 to 14 years. Material & Methods: The observational study was donefrom October 2011 to October 2014 in Chirayu Medical College Bhopal. 25cases of renal stone in paediatric age group were admitted in our hospital and evaluated for size of the stone, number of stones, associatedcongenital anomalies and complications. PCNL was done by standard technique. Results: A total number of 25 children were operated. Sex distribution in our study was male 15 and female 10, most of the patients were of age group 10-14 years 15(60%).Most of the children15(60%) had large stones >2cm stones and small stone was seen in 6(24%) cases.Malrotated kidney having stone was seen in 8(32%) cases.Complications as fever and haematuria was observed in 1 (4%) case. The maximum sheath size used inchildren was 24 F. Out of 25 children, only one patient required blood transfusion. Conclusion: Paediatric PCNL is safe procedure in expert and experienced hands. Minimal invasive procedures are beneficial in paediatric age group because of longer life expectancy andmore riskof recurrence.

Introduction: Study was planned to compare the safety and efficacy of Fentanyl and Midazolam combination with Ketamine and Midazolam combination for “procedural sedation” in pediatric patients. Methodology: Sixty ASA1and 2 pediatric patients satisfying inclusion criteria were included in the study. These patients were enrolled by convenience sampling. They were randomized to receive ketamine or midazolam/fentanyl. Both the groups were comparable with respect to age, sex and body weight and proposed procedures. Hemodynamic and respiratory changes occurring during sedation, surgical procedure and during recovery, after administration of the test drug were studied. Measures used for efficacy of drug, that is quantification of distress, pain, anxiety, sedation and complications were also evaluated. Results: On Comparison of age, gender, weight at different time intervals of cases between both groups were comparable with respect to age and weight of patients. On comparison of Pulse Rate at different time intervals of cases between K/M and F/M groups. The mean value of Pulse Rate in K/M and F/M groups is statistically significant (p

Background: Mesenteric adenitis is self-limiting inflammatory process mimicking appendicitis and affects the mesenteric lymph nodes in the right lower quadrant. Ultrasonography with graded compression is the main modality to diagnose this entity. Aim: of this study was to evaluateand analyse the incidence of enlarged mesenteric nodes with ultrasound in pediatric patients referred for abdominal pain. Material and Method: A total 100 patients attending paediatric and paediatric surgery clinic in Chirayu Medical College and hospital Bhopal, from May 2011 to May 2014 presenting with abdominal pain of various causes were included in this study. The presence of enlarged nodes, their location, size and other ultrasonographic findings were recorded. Final diagnosis was established after patient management and follow up. Result: On the basis of this study, it was observed that the incidence of enlarged lymph nodes increases with age with the peak incidence is at around 7 years range (5-8) years and decrease thereafter.A review of the dimensions of the lymph nodes detected shows that the transverse diameter of the lymph nodes was by and large always greater than the antero- posterior diameter .The maximum transverse diameter values was seen between 10- 14 mm whereas antero- posterior diameter values was seen between 4-8 mm. Our study also showed that the 80% of the lymph nodes were seen in the right lower quadrant followed by 12% in the left lower quadrant and 8% in the peri-aortic region. Conclusion: The possible variation in the clinical presentation of abdominal pain due to mesenteric lymphadenitis is a challenging task for physicians to diagnose. Mesenteric lymphadenitis is found to be self limiting entity, usually viral in origin. Hence surgical intervention can be avoided if diagnosis is accurately made.

Background: Increasing array of medical intervention available to modify the likelihood of developing recurrent episode of myocardial ischemia, it is important to identify patients of risk of provocable myocardial ischemia before discharge. Material Methods: It was a cross-sectional study carried out in a tertiary care hospital of central India, during July 2012 to October 2014. During the monitoring period, the patient was once subjected for 100-meter brisk walk. Result: Out of 64 cases, 6 (9.5%) cases developed ischemia during Holter, in male it was 5(10.2%) while in female it was 1(6.67%). 13.33% of cases with tobacco consumption developed ischemia on Holter monitoring and this was found to statistically significant ( x 2 = 5.36, p

Background: Patient satisfaction is one objective of care, and along with recovery from illness or amelioration of presenting problem, it is therefore an outcome of care too. The objective of the study was to evaluate the satisfaction level among surgical patients before and after counselling and to studies the relationship of literacy and acceptance for surgery. Methods: Patients coming to surgical OPD, having definite surgical problem and who needs surgical intervention are taken into consideration.108 patients were selected on pilot basis. Depending on the common complaints by patient regarding doctor patient relationship and satisfaction of patient after consultation at our institute, a five point questionnaire was prepared with an option to answer as satisfied, partially satisfied and not satisfied with reasons. Results: In our study total 108 patients coming to surgical OPD were taken. Out of which 66 (61.11 %) were males and 42 (38.88%) were females. All of them are above 18 years of age group. The youngest was 18 years and oldest was 66 years of age. Females were found to be more satisfied after patient empowerment and counselling as compared to males. Older patients were found to be more satisfied than younger ones which are comparable with the international studies. In our study, females took much time for empowerment, understanding and counselling but found to be more firm on the decision once taken by them. In our study, overall satisfaction level of patients has increased after counselling and patient empowerment (from 37% - 63%). Conclusions: Making of a successful surgeon requires apart from extensive knowledge of his subject, he should be able to know the psyche of patients , hearing them and giving them sufficient time will solve most of problems for flourishing his practice, becoming a good ,sensible and famous surgeon and will help to avoid so many unnecessary medico-legal litigations against innocent surgeons.

Background: The lifetime prevalence of kidney stone disease is estimated at 1-15%. The various treatment options available for urinary calculus disease are open surgery, ureterorenoscopy, percutaneous nephron-lithotomy retrograde intra-renal surgery & extracorporeal shock wave lithotripsy. The aim of the study was to study whether performing extracorporeal shockwave lithotripsy (ESWL) under intravenous anesthesia can reduce no. of sessions by increasing intensity of shockwaves and its comparison with ESWL under local anesthesia and also to study the safety of higher intensity shock waves. Methods: The nucleus of this prospective study done between March 2011 to February 2015 was 60 patients with renal or upper ureteric solitary calculus less than or equal to 2 cm in size, in which ESWL is elected as the treatment. These were randomized into one of the two groups with 30 patients in each - Group I: in which patients underwent ESWL under IV anesthesia & group II: in which patients underwent ESWL under local anesthesia. Results: For age group, P value of age difference of the two groups was 0.6 and not significant. During the study it was found that there was statistically significant reduction in number of sessions required for complete stone clearance in Group I. In group I the average number of shock waves used was 3800, whereas in group II it was 5967. The P value of difference between the means was extremely significant (P =0.003). Time taken for clearance of stone in group I was 1 month in 22 patients and 3 months in 8 patients with the average being 1.53. In group II time taken for clearance was 1 month in 9 patients and 3 months in 21 patients and the mean was 2.4. Conclusions: The use of total intravenous anesthesia (TIVA) for ESWL reduces the number of sessions significantly by allowing higher intensity and number of shock waves & improved fragmentation due to regular and controlled respiratory excursions, and immobility of the patient, leading to significantly less wastage of shockwaves when compared to ESWL without TIVA.

Background: Hydrocoele fluid closely surrounds testes and by virtue of this, it is liable to cause some change in the external environment of testes. This can be in the form of increased pressure, increased temperature. This can ultimately result in the morphological alteration of testes, which in turn can affect spermatogenesis and steroid genesis. Methods: It was a cross-sectional study conducted in the department of surgery, Peoples college of Medical Sciences and hospital, Bhopal. A total of 92 cases of unilateral scrotal hydrocoele were studied. Bilateral cases were excluded from the study. Results: In our study, we found the association between the duration of hydrocoele with histopathological changes and impaired spermatogenesis is highly significant and also the association between size of hydrocoele with histopathological changes and impaired spermatogenesis is significant. Conclusions: There are few variables which did not show significant association with impaired spermatogenesis in presence of hydrocoele were pain, fever, family history of hydrocoele, cord thickening, amber colour of fluid and lymphadenopathy. To sum up it would seem that big hydrocoele of long duration impair spermatogenesis and may lead to sub-fertility or infertility.

AIMS AND OBJECTIVES: The presence of a lump in the breast is a great cause of anxiety and apprehension, to the female patients. This may be accrued to the increasing public awareness of breast cancer which is presently the most common female malignancy worldwide. The aim of th is study was to determine the frequency of benign breast diseases (BBD) amongst patients in tertiary care institute of central India. MATERIAL AND METHOD: It was a cohort study. In this study all patients visiting the surgical OPD clinic with breast proble ms were included. This study was conducted at Chirayu Medical College and Hospital Bhopal over a period of four years starting from November 2010 to November 2014. All patients with definite symptoms and sign of malignancy or those who on evaluation were d iagnosed as carcinoma of breast were excluded from this study. RESULTS: A total of 112 patients were included in the study. About 54.4% (61/112) patients belonged to 3rd decade of life followed by 21.4% (24/112) from 4th decade (age between: 31 – 40 years) . The most common benign breast disease, seen in 33.9% (38/112) of patients was fibro adenoma followed by fibrocystic disease seen in about 19.6% (22/112) patients. Breast abscess was seen in 20/112(17.8%) and Mastalgia was present in 15/112 (13.3%) patien ts. CONCLUSION: In females of reproductive age group Benign Breast Diseases (BBD) are common problems. Fibro adenoma is the commonest of all benign breast disease mostly seen in 2nd and 3rd decade of life. Fibrocystic disease of the breast is the next comm on BBD whose incidence increases with increasing age. Routine mammographic screening of high risk groups aimed at early detection of these premalignant lesions is therefore indicated. A biopsy with histological diagnosis of all breast lumps is also recomme nded as this will aid in the detection of premalignant lesions particularly in low resource settings

BACKGROUND: Acute appendicitis is the most common abdominal surgical emergency. The rate of incidence of appendicitis varies for different countries and regions. As epidemiological data is scarce for this entity, the study was done to determine the changes in frequencies of acute appendicitis in different age group, gender and seasons. MATERIAL AND METHODS: The descriptive cross sectional study was performed in the Department of Surgery Chirayu Medical College and hospital Bhopal from November 2011 to November 2014. Data of all diagnosed cases of appendicitis aged 10 years to 70 years were taken from wards and operation theatre. Patients having recurrent disease and those who underwent interval appendectomy were excluded. Data analysis was done SPSS for windows version 17. RESULTS: During this period 108 cases were studied ranging from 10 years to 70 years with a mean age 35±11.2 years. There were 73 males 35 females. (Male: female ratio 2.08:1). Appendicitis was most common in age group 21 to 30years (35.1%) the frequency was highest in rainy season (38.8%) and lowest in winter season CONCLUSION: This study clearly shows the differences in frequencies of appendicitis in various seasons, age groups and gender. The frequency was highest in rainy season and lowest in winter season. Such studies can help in proper

INTRODUCTION: The goal of management of a non-palpable testis is to identify whether a viable testis is present and, if so, either perform an orchiopexy or, in selected cases, an orchiectomy. Management of palpable undescended testis is quite straightforward and diagnostic studies are usually not necessary. However, management of non-palpable testes is more complex. MATERIAL AND METHODS: It was a prospective hospital based study conducted in the department of surgery, Chirayu Medical College, Bhopal during the period of January 2012 to June 2014. 30 patients were selected in the study. Surgical management was not done before 6 months of age. Open orchiopexy was performed in palpable group. For impalpable group, diagnostic laparoscopy was done and managed accordingly. RESULTS: Forty undescended testes were operated upon, of which twelve (40%) were situated in the inguinal canal, twelve (40%) external ring and three (10%) each at the level of internal ring and intra-abdominal respectively. 6 patients (aged five to nine years) with canalicular testes had macroscopically atrophic testes, as did three (aged four to twelve years) with abdominal testes and one (two years) with the testes at the level of the internal ring. CONCLUSION: Laparoscopy is a safe and effective method for the diagnosis of non-palpable and undescended testis. Microvascular orchiopexy is a feasible technique even in small children with good results.

OBJECTIVE: The present study is conducted in a tertiary care institute in central India to develop an effective, safe and minimal anaesthesia technique for neonatal emergency surgery. METHODOLOGY: Prospective study conducted from January 2007 to July 2009 in the paediatric surgical OPD in a tertiary care institute in central India. Types of anaesthesia used were either monitored local anaesthesia and sedation technique (MLAST) or general anaesthesia. The allocation of anaesthesia Decision was arbitrary. RESULT: A total of 237 cases were studied, most common condition presenting as neonatal surgical emergency in the present study is anorectal malformation (68.35%). Overall mortality observed in MLAST group was 12 out of 120 cases (10%) and in GA group is 43 out of 117 cases (36.75%) (p= 0.0001, significant). CONCLUSION: Anorectal malformation was the most common presenting neonatal surgical condition. There is minimal risk, if surgery is performed under monitored local anaesthesia and sedation technique as compared to General anaesthesia. MLAST should be preferred over GA in setup of developed anaesthesia technique in neonatal surgical emergencies.

OBJECTIVE: To determine the profile and outcome (discharge from emergency room after observation, admission or death) of pediatric patients presenting with acute poisoning to a tertiary care centre in central India. METHODS: We retrospectively reviewed the last 3-years period from December 2010 to November 2013 hospital records of the pediatric emergency room to profile all cases of pediatric poisoning and noted their outcome. All cases age ≤12 years with definite history of poisoning were included. RESULTS: 95 cases presented to the pediatric emergency with poisoning during the study period. Mean age of our patients was 2.72±1.54 yrs (SD). The majority of our patients (67.2%) were in the 1-3 yrs age group. Males outnumbered females by a factor of two; the majority of our patients resided in urban areas. Kerosene (32.6%), drugs (19.8%) and insecticides (9.7 %) were the agents most frequently implicated. Almost all (96.8 %) ingestions were accidental in nature. Twenty four patients (25.3%) were asymptomatic after 6hrs of observation in the emergency ward; 71patients (74.7 %) developed symptoms related to toxic ingestion. The common serious symptoms included altered sensorium, respiratory distress, seizures, ataxia, hypotension, cyanosis and burns; three patients required intubation and mechanical ventilation. Almost one third of our patients underwent gastric lavage; no patient with kerosene poisoning or any other inappropriate indication underwent the same. CONCLUSION: Comparative data has revealed that while poisoning in developed countries is mostly due to common household products, in developing countries like ours, it is due to toxic substances which should not have been accessible to children in the first place.

BACKGROUND & OBJECTIVES: Tobacco use among school children is becoming a serious problem in developing countries. The early age of initiation underscores the urgent need to intervene and protect this vulnerable group from falling prey to this addiction. The present study was thus undertaken to estimate the prevalence, pattern and correlates of tobacco use amongst the 10-16 year olds in schools of rural area Bhopal. METHODS: Data on tobacco use were collected from 960 students of class 7 to 12 (age: 10-16 yrs) studying in rural blocks of Bhopal city during June 2011 to August 2012, through PPS and random sampling using a self-administered questionnaire. RESULTS: Point prevalence of ever user of tobacco' amongst '10-16 year old was 8.7 %. Almost half of current tobacco users (48.8%) purchased tobacco product in a store and most of them (23.2%) used it at home. Nearly half of the never smokers (54%) were exposed to tobacco smoke outside home and 90 % favored a ban on smoking in public places. A male tobacco user was perceived to have more friends and was reported to make them look attractive. Print media was a predominant source of message. Only one-third (33.6%) reported that the reasons of tobacco usage amongst youth was discussed in formal school settings. INTERPRETATION & CONCLUSIONS: High prevalence of tobacco use among the adolescents. The focus in schools should be to make them tobacco-free. The school authorities should be included in stricter implementation and monitoring of the implementation of legislation.

BACKGROUND AND AIMS: The study was done to know the accuracy of Triple assessment and management strategies for breast cancer patients. MATERIALS AND METHODS: Patients with carcinoma breast were analyzed in a tertiary care hospital of central India from January 2012 to June 2013. Thorough Clinical and physical examination was done, mammography, USG and FNAC was used for diagnosis of cancer Breast. RESULTS: maximum cases (90%) were diagnosed clinically & by FNAC. USG was more sensitive for dense breasts of young patients, whereas mammography was more sensitive for breasts of older patients. Among pathological diagnosis Trucut biopsy was more sensitive than FNAC having diagnostic accuracy of 100% as compared to FNAC whose diagnostic accuracy was 90%. Diagnostic accuracy of triple assessment was 100% for diagnosing carcinoma breast. CONCLUSION: Most common symptom was lump in breast among postmenopausal women from urban area. Lack of education was responsible for their delayed presentation. Left upper and outer quadrant being the commonest site, Infiltrating duct carcinoma was the most common type, diagnostic accuracy of triple modality i.e. clinical, radiological and pathological assessment was 100%.

BACKGROUND AND AIMS: The study was done to know the epidemiology, clinicopathological aspects of carcinoma breast patients in our population. MATERIALS AND METHODS: The epidemiological and clinicopathological data pertaining to demography and risk factors for carcinoma breast were analyzed in patients attending tertiary care hospital of North India from January 2012 to June 2013. Thorough Clinical and physical examination was done, FNAC was done for diagnosis of cancer Breast. RESULTS: In our study mean age of our female breast cancer patients was found to be lower compared to the western world, with an average difference of one decade. Majority of the patients were from urban background. Lump in the breast was a dominant symptom. Familial breast cancer was uncommon. Left sided breast cancer was slightly preponderant. CONCLUSION: Most common symptom was lump in breast among postmenopausal women from urban area. Lack of education was responsible for their delayed presentation. Left upper and outer quadrant being the commonest site, Infiltrating duct carcinoma was the most common type. Modified radical mastectomy was found to be a safe operative procedure. Adjuvant chemotherapy and hormonal therapy was found very effective in early stages. Overall survival for stage IV was 60% for 1 year follow up.

Introduction: Anorectal malformations are commonly associated with craniospinal abnormalities like hydrocephalus, tethered cord syndrome, occult spinal dysraphism, syringomyelia, meningomyelocele and Arnold Chiari malformation. Aim of our study was to identify the incidence of craniospinal anomalies in patients with anorectal malformation and to analyse utility of Ultrasound and MRI as a screening tool in these patients to detect such anomalies. Material and Method: 52 infants male and female of anorectal malformation were included. All underwent ultrasonography of brain and spinal cord and 27 patients underwent MRI to detect craniospinal anomalies. Result: Out of 52 cases 38(73.07 %) were males and 14(26.93 %) were females. High type ARM (34.61 %) and Vestibular fistulas(19.23 %) were most common type in male & female child respectively. On ultrasonography in this series no craniospinal abnormality was found. On ultrasonography subarachnoid space was normal in all cases and central canal diameter was found

Introduction: Cutaneous appendageal tumours are a large diverse group of tumours that are commonly classified according to their state of appendageal differentiation- eccrine, apocrine, follicular and sebaceous. Most appendageal tumors are relatively uncommonly encountered in routine clinical practice. Though some of the appendageal tumors (e.g. syringoma, nevus sebaceous) can be diagnosed clinically with ease but most of them have non-specific morphological appearance and their diagnosis is mainly based on histopathological characteristics. Material and methods: It was a cross sectional descriptive study conducted in the department of dermatology, Chirayu medical college and hospital, Bhopal. A total of 90 patients attending department of dermatology were screened out for appendageal tumors and those 60(66.6%) who were confirmed by histopathological examination of lesional biopsy were included in the study. Results: On the basis of differentiation of tumors, sweat gland tumors were the most common appendageal tumors in our study (79.8%) followed by follicular tumors (11.6%), sebaceous were 8.3%. On individual tumor basis, syringoma constituted maximum numbers of cases (56.6%) followed by multiple trichoepitheliomas and hidrocystoma (both 11.6%). Face was the commonest site of predilection 40(66.6%) followed by scalp 12(20%). Conclusion: Appendageal tumors are relatively uncommon and constitute very small proportion of dermatological disorders. Though clinical appearance might help in diagnosing common appendageal tumors but histological examination remains the gold standard method in diagnosing clinically suspicious lesions

BACKGROUND: Gallbladder carcinoma (GBC) is a highly lethal and aggressive disease with a poor prognosis. The etiology of this tumor is complex, but there is a strong association with gallstones. Owing to its nonspecific symptoms, gallbladder carcinoma is generally diagnosed late in the disease course. METHODS: Hospital based cross-sectional study was carried out at tertiary care institute either as OPD patients or as admitted patients (with gall bladder disease) in surgery department, from Jan 2010 to Dec 2010. RESULTS: carcinoma gall bladder in females was 2.375 times more than males, mean duration of symptoms were 10.36±2.3months in case of females and 9.89± 2.6 months in case of males. Commonest symptoms were pain 92.59% and weight loss 92.59%. Few factors like alcohol were also identified with GBC. CONCLUSION: The proportion was more among the elderly females; the average duration of symptoms at the time of presentation was more

AIM: This study was conducted to compare the speed of induction, intubation, and speed of emergence with sevoflurane and halothane in pediatric patients. METHODOLOGY: All the patients had full preanesthetic check-up and the routine investigation (complete blood count, urine albumin) was done. Patients were kept fasting for 6 hrs. for solid food, 4hours for semisolid and 2 hours for liquid. They were randomly divided into Gr S and Gr H each comprising of 30 patients each to receive sevoflurane and halothane with 60% nitrous and 40% oxygen respectively by inhalation. On arrival in the operation theatre, the standard monitors were applied including an electrocardiogram, pulse oximeter, non-invasive blood pressure and precordial stethoscope and the baseline readings of respective parameters were taken. Anesthetic induction was done with face mask application using incremental dosing of 0.5% for halothane and 1% for sevoflurane every three to five breath to deliver maximum inspired concentration of upto 5% halothane(maximum inspired concentration) or 8% sevoflurane (maximum inspired concentration). Spontaneous ventilation was maintained till loss of eye lash reflex. Following the loss of the eyelash reflex, the vaporizer concentration was decreased to 4% for sevoflurane and 0.86 % for halothane (approximately 2 MAC). Intravenous catheter was inserted. Inhalational agent at the same concentration was given until the loss of corneal reflex. After the intravenous line was secured, inj pentazocine 0.3 mg/kg was given. The patients were intubated with appropriate size endotracheal tube only after the loss of corneal reflex. After successful intubation, intravenous vecuronium 0.1 mg/kg was administered for muscle paralysis and the anesthetic concentrations was adjusted at 1.3 MAC with N2O (0.56% halothane and 2.6% sevoflurane). Time intervals measured: (induction time, intubation time, emergence time) were measured. Vitals recorded: Heart rate, systolic, diastolic blood pressures, and SpO2. The depth of anesthesia was assessed clinically by evaluation of changes in heart rate, and blood pressure during surgery and these were maintained within 20% of baseline values. RESULTS: Induction time was significantly shorter with Gr S(mean(SD) 136.0(19.343)secs) than with Gr H (mean (SD) 156.09(10.651)) secs) (P=0.0001). Intubation time was significantly shorter with Gr S (mean (SD) 242.400(9.940) secs) than with Gr H(mean(SD) 265.769(12.039) secs) (P

INTRODUCTION: When maternal anemia is diagnosed before mid-pregnancy, it has been associated with an increased risk of preterm delivery. High maternal hemoglobin is associated with fetal growth restriction. Several epidemiologic studies have shown that high fetal hemoglobin is associated with lower birth weight and increased incidence of IUGR and intrauterine death. MATERIAL AND METHODS: It was a prospective observational study. All pregnant women attending antenatal clinic with first visit before 18 weeks of gestation were included in the study. Hemoglobin levels were done on women at the first visit to antenatal clinic and also in the third trimester between 34-36 weeks. Outcome criteria were birth weight of neonate, gestational age at delivery, maternal weight gain in pregnancy, development of PIH, IUGR, IUD and preterm labor. RESULTS: Increased weight gain in pregnancy was associated with increase in mean birth weight r=0.23 (P value 0.672). Increase in the hemoglobin concentration was associated with increase in birth weight r=0.36 (P value 0.49). It was observed that high hemoglobin concentration in pregnancy was associated with more length of gestation but it was not significant r=0.31 (P value 0.50). CONCLUSION: During early pregnancy normal hemoglobin concentrations were associated with higher birth weights. Weight gain in pregnancy was associated with lower hemoglobin concentrations at term and higher birth weights. The best outcomes of pregnancy were observed in women who had normal hemoglobin concentrations at the onset of pregnancy and who became anemic at term, presumably due to physiologic hemodilution.

BACKGROUND: Ovarian torsion presents as acute abdominal pain and early surgical management is required to prevent further adnexal damage. It accounts for 3% of all cases of acute abdominal pain in adult women. As signs and symptoms can mimic other acute abdominal conditions, the preoperative diagnosis often remains a challenge for primary care physicians. AIMS AND OBJECTIVES: To study the characteristics of adnexal torsion and factors influencing adnexal preservation. MATERIAL AND METHODS: All 14 patients were admitted in a tertiary endoscopic surgical unit with the complaints of pain in abdomen, nausea and vomiting of varying duration. The minimum duration of symptoms was 3 days and a maximum of 1 year. All patients were evaluated by ultrasound examination preoperatively. The time interval between the onset of symptoms and definitive surgery varied from 3 days to one year. Laparoscopic approach was offered to all patients except one where the patient was antenatal at 10 weeks of gestation. RESULTS: Out of 14 patients the youngest patient was a neonate 28 days old and oldest was 68 years of age. Most patients (n=9) were between 10 to 30 years of age. Intra operatively complete torsion (torsion of both ovary and fallopian tube) was found in 9 cases, 3 were torsion of hydrosalpinx and one case was torsion of a paraovarian cyst. One case was torsion of the adnexa in antenatal period. Adnexal congestion and edema was the most common finding (n=6) simulating hemorrhagic cyst. One patient the oldest in series age 68 years had torsion of an ovarian mass which was histologically confirmed as mucinous cystadenoma. Two patients had ovarian dermoid where ovary was salvaged in one by doing cystectomy and in the other a salpingoophorectomy was performed. In one patient it was torsion of parovarian cyst where cyst wall excision was performed. In antenatal at 11 weeks gestation a mini laparotomy was performed under epidural analgesia and detorsion was performed. In all 4 patients who had hydrosalpinx (n=3) and parovarian cyst (n=1), a salpingectomy and cyst excision was performed respectively. In rest with complete torsion (n=9, excluding fetal adnexal torsion) ovarian preservation was possible in 4 patients (44.45%) and 5 patients (55.55%) required oophorectomy. CONCLUSION: Adnexal torsion affects all ages of women and ovarian preservation is possible, if detorsion is possible. Delay in diagnosis prevents ovarian preservation. Though limited by small sample size it indicated that ovarian debulking may not be needed and detorsion relieves the venous congestion and edema. Laparoscopic approach remains the gold standard for the management of adnexal torsion and enables quick recovery.

BACKGROUND: Hypertension is a growing health problem in Asia, while most studies describe hypertension in older adults and elderly there is paucity of data on hypertension in teenagers and young adults. MATERIAL AND METHODS: A cross sectional study was conducted from Dec 2013 to Jan 2014 in Chirayu medical College and Hospital. A total of 300 students were included in the study those who volunteered for participation. Hypertension was diagnosed based on drug treatment for hypertension or if the blood pressure was greater than 140/90 mmHg - Joint National Committee 7 (JNC VII) Criteria.8 Anthropometric measurements including weight, height, waist and hip measurements were obtained using standardized techniques. RESULTS: Out of total 300 subjects 128(42.6%) were prehypertensives, 20 (6.66%) had stage I hypertension and 04 (1.3%) had stage II hypertension. Out of total 300 subjects 40 (13.3%) subjects had BMI < 18.5, 168 (56%) had BMI between 18.5 and 23.9, 38 (12.6%) had BMI between 24- 26.9 and 54 (18%) had BMI ≥27. CONCLUSION: Overweight and obesity are a major health hazard all over the world and are becoming a major health threat among both the sexes and all age groups. Substantial proportions of young adult medical students are prehypertensives, overweight and obese. Our results highlight the necessity to institute effective prevention and health promotion programs targeting younger age groups.

BACKGROUND: Echocardiography is the easiest way to evaluate the functions of parts of the heart like ventricles and valves. Some of the studies have shown normal echocardiography in Chronic Obstructive Pulmonary Disease (COPD) but others have shown pulmonary hypertension and cor pulmonale in most of the studies both of which are associated with decreased survival. Our study is also an effort to look for the heart changes in COPD patients and to correlate them with the duration and severity of the disease. MATERIAL AND METHODS: It was a cross-sectional study done in the Medicine department of Chirayu Medical College and Hospital, Bhopal during the period from January 2012 to June 2012. 60 cases of COPD were selected for study. Almost all the cases have varying degrees of overlapping picture of chronic bronchitis and emphysema taken as single entity of COPD. Echocardiography was done in all the 60 patients and looked for Right Atrial Enlargement (RAE), Right Ventricular Dilatation (RVD), Tricuspid Regurgitation (TR) and its severity, Right ventricular systolic pressure, and Pulmonary Arterial Hypertension (PAH). RESULTS: On Echocardiography, patients with moderate and severe grade COPD show RAE and RVD in more than 50%, whereas, patients with mild grade COPD showed RAE in about 40% and RVD in about 60%. In very severe grade COPD patient having TR also had severe grade PHT whereas mild grade COPD patients usually have mild grade PHT. CONCLUSION: Physicians and scientists will need to be encouraged to conduct research that will help develop newer, easier and better diagnostic methods and develop newer drugs and inhalation devices, that will not only help further improve symptoms and quality of life, but will also halt, and if possible, revert the progression of the disease.

BACKGROUND: Hysterectomy is one of the most commonly performed obstetrics and gynecology surgical procedure worldwide, second only to cesarean section. Even with use of conservative therapies, approximately 6 lakh hysterectomies are performed each year in United States. MATERIAL AND METHODS: This was a comparative cross sectional study conducted in the Department of Obstetrics and Gynecology of Chirayu Medical College and Hospital, Bhopal from Jan 2011 to June 2013. A total of 50 patients were selected in each group using inclusion and exclusion criteria. Statistical software (SPSS version 20) was used to analyze the data and level of significance for all types of analytical data was set at 0.05 and p value less than 0.05 was considered significant. RESULTS: 64% patients in our study were in age group 36-45 years with mean age of 43.2 years and most of them were multiparous. Six patients were nulliparous with symptomatic large fibroids and failed medical management. Abnormal Uterine Bleeding (AUB) was the most common indication (43.3%)followed by fibroid uterus(33.3%) and pelvic pain(23.3%).The mean size of uterus in our study was 8.87weeks.The mean operation time was significantly higher in laparoscopic method than other routes (P

INTRODUCTION: Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality in India especially in rural areas. COPD is the 5th leading cause of death worldwide. COPD causes hypoxia in lungs triggering the pulmonary vasoconstriction which leads to increase in pulmonary vascular resistance finally involving the heart and causes right sided cardiac complications which can be evidenced by Electrocardiography (ECG). Therefore, the present study was conducted to evaluate the diagnostic values of ECG changes among COPD patients. MATERIAL AND METHODS: This was a cross-sectional study done in the Medicine department of Chirayu Medical College and Hospital, Bhopal during the period from January 2012 to June 2012. 60 cases of COPD were selected for study. The diagnosis of COPD is based upon the clinical history, clinical examination, X-ray chest and Pulmonary Function Test (PFT). ECG was done in all the 60 patients and looked for heart axis, Right Ventricular Enlargement (RVE), Right Atrial Enlargement (RAE) and Right Bundle Branch Block (RBBB). RESULTS: ECG analysis shows the features suggestive of RAE in >40% of COPD patients having duration of >10 yrs. Out of total 60 patients 24 patients had Forced Expiratory Volume First(FEV1) ≥80% (mild COPD), 30 had FEV1 50 % to 79% (moderate COPD), 5 patients had FEV1 30-49% (severe COPD) and 1 patient had FEV1 < 30% (very severe COPD). When the disease severity is compared with the Manifestations in ECG RAE, RVE and RBBB was found in 3 (60%) of the patients out of 5 patients who had severe disease. CONCLUSION: The prevalence of ECG abnormalities related to cardiac diseases, in general is higher in those with more severe pulmonary obstruction and ECG findings should be taken into consideration when diagnosing these patients of COPD for delivering a more integrated pulmonary and cardiovascular care.

BACKGROUND: After P. falciparum, P.vivax is the most significant malaria species, often both may coexist. Clinical features include fever, chills, sweating, headache, diarrhoea, abdominal pain, distension, cough, hepatomegaly and splenomegaly. Large studies from Islands of New guinea now show a strong association between P. vivax infection and severe disease and even death. MATERIAL AND METHODS: This was a cross sectional study, carried out in the department of Medicine, Surat Municipal Institute of Medical Education & Research during the period of June 2009 to August 2010. Patients of age 18 years or above fitting in the case definition of malaria with positive peripheral smear for P.vivax were included in the study. The details of the patients along with their clinical features, routine hematological and biochemical investigations were recorded in a standard proforma. The diagnosis of P.vivax was made from thick smear examination and if positive it was further confirmed by examining a thin smear slide. RESULTS: Most common clinical presentation was fever which was high grade, intermittent along with chills seen in 99% of patients. Bodyache, headache was observed in 65% & 61% respectively. Out of 140 patients 46(32%) had Hb >12gm% and 5(4%) had Hb