ISSN: 2278-5310 (Print)

ISSN: 2395-0188 (Online)

ISSN: 2278-5310 (Print)
ISSN: 2395-0188 (Online)
Frequency: Bi-annual
Editor-in-Chief: P. Shanmuga Raju 



Journal of Chalmeda AnandRao Institute of Medical Sciences is non-profit, scientific peer reviewed, open access journal. It is published bi-annually (January-June, July December). The journal covers subject on basic sciences, medicine, surgery, super specialties and allied health sciences. Journal of CAIMS is to publish scientific articles like original articles, review articles, clinical case reports, short communication articles, editorials, book reviews, and pictorial CME. Editorial board of journal of Chalmeda AnandRao Institute of Medical Sciences works under the principles of the International Committee of Medical Journal Editors (ICMJE), Committee on Publication Ethics (COPE), Council of Scientific Editors (CSE), and The World Association of Medical Editors (WAME).


Aims and Scope

Journal of Chalmeda AnandRao Institute of Medical Sciences (JCAIMS) ISSN: 2278-5310 (print), ISSN: 2395-0188 (online) is an indexed, peer reviewed Journal. It is published bi-annually (January-June, July- December) and formerly known as “CAIMS Medical Bulletin” (2008-2010). The main aim is to encouraging scientific research papers and providing a platform for young researchers, academicians and post graduate students in the field of Medicine.

Journal of CAIMS is to publish scientific articles like Original articles, review articles, clinical case reports, short communication articles, editorials, book reviews, pictorial CME and letters to the editor.

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The Journal is indexed or included in the following: Index Copernicus, Indian Citation Index, Indian Science Abstracts, Genamics/Journal seek, J-Gate, ROAD/Directory of open Access Scholarly Resources, Ulrich’s Periodicals directory, NLM Catalog, World cat, OCLC, National Science Library, and Elektronische Zeitchriften bibliothek.

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Editorial and publication processes of the journal are shaped in accordance with the guidelines of the international organizations such as the International Council of Medical Journal Editors (ICMJE), the World Association of Medical Editors (WAME) and the Committee on Publication Ethics (COPE).

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P. ShanmugaRaju


Department of Physical Medicine & Rehabilitation

Chalmeda AnandRao Institute of Medical Sciences


Telangana, India



Associate Editors

E. Rama Devi

Professor&HOD of OB&G

Chalmeda AnandRao Institute of Medical Sciences, Karimnagar, India


Madoori Srinivas

Professor&HOD of Pediatrics

Chalmeda AnandRao Institute of Medical Sciences, Karimnagar, India


Ezhilarasi Ravindran

Assoc. Professor of Radiation Oncology

Chalmeda AnandRao Institute of Medical Sciences,Karimnagar, India


Assistant Editors

Ravinder Thota

Professor of Pathology

Chalmeda AnandRao Institute of Medical Sciences

Karimnagar, India



Professor of Community Medicine

Chalmeda AnandRao Institute of Medical Sciences

Karimnagar, India


Advisory Board - National

Sanjeev Misra


All India Institute of Medical Sciences, Jodhpur, India


Rajesh Malhotra

Professor&HOD of Orthopaedics

All India Institute of Medical Sciences, New Delhi, India


Prasanta Kumar Mitra

Professor and Head of Biotechnology

Sikkim Manipal University, Gantok, East Sikkim, India


Parvaiz A Koul

Professor and Head, Internal & Pulmonary Medicine

Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India


AU Siddiqui

Asst. Professor of Anatomy

All India Institute of Medical Sciences, Raipur, India


Vikas Bhatia


All India Institute of Medical Sciences, Bhubaneswar, India


Pragna Rao

Dean, Kastruba Medical College, Mangalore, India


Janaki MG

HOD of Radiotherapy

MS Ramiah Medical College, Bangalore, India


G. Bhasker

Osmania Medical College, Hyderabad, India


J. Mohana Krishan


Jawaharal Nahru Post Graduate Institute of Medical Education and Research, Puducherry, India


Prashant Kokiwar

Professor&HOD, Community Medicine

Malla Reddy Institute of Medical Sciences,  Hyderabad, India


Advisory Board - International

Madhu Sudan R Yakkanti

Assistant Program Director, Department of Orthopedic Surgery, University of Louisville, KY


Devender Katkoori

NGPG Urology, University of Miami Miller School of Medicine, Georgia, USA


Governing Body

Chief Patron

Chalmeda AnandRao, Advocate

Ex-Minister of Law, Government of A.P


C. Lakshmi NarasimhaRao, Chairman

Editor Emeritus

V. Bhoom Reddy

Past National Vice-President, IMA

Research and Development Editor

V. Suryanarayana Reddy, Director

Executive Editor

Syed Ali Aasim, Principal


Volume 22, Issue July-December 2021


Study of first episode psychiatric morbidity during the period of lockdown at a tertiary care centre, Hyderabad

Rama SubbaReddy, Sreenivasa Rao Sireesha, Ravikishore Sadula
Background:Covid-19 pandemic has caused havoc worldwide. India is also going through a challenging situation as the number of infected/positive cases is increasing day by day with strict preventive measures and restrictions by the Indian government in the form of nationwide lockdown, the citizens are going through a range of psychological and emotional reactions, fear and uncertainty being one of them.

Aim:To determine incidence, diagnosis of first episode psychiatric morbidity and its association with socio-demographic factors, psychosocial factors during lockdown period.

Materials and Methods:A retrospective study conducted using case sheets of the patients attended Institute of mental health, Hyderabad from 23rd March to 31st May 2020.

Results: Out of 1571 registered cases, 833 presented with first episode psychiatric morbidity (53.02%). ICD-10 diagnostic criteria were applied. Majority were diagnosed under mental and behavioral disorders due to psychoactive substance use (89.3%), followed by Neurotic stress related and somatoform disorder(7.1%), Mood(Affective) disorders(2.4%), Schizophrenia, schizotypal and delusional disorders(1.2%). Psychiatric morbidity was more in middle aged group from 46-60 years(68.8%) (p=0.00), male gender(71.40%) (lower and upper lower socioeconomic group (46%)(p-0.000). Possible psychosocial stressors that might have precipitated psychiatric illness were lockdown related stressors like unavailability of substance (59.4%) and financial stress (26.3%) than fear of infection (7.6%).

Conclusion: Incidence of psychiatric morbidity was more because of the lockdown rather than the fear of infection. Those who suffered more were middle aged males belonging to upper-lower socioeconomic class. Patients presented more with psychoactive substance related disorders predominant reason being sudden unavailability of alcohol due to lockdown.

Keywords: Psychiatric morbidity, covid19, prevalence, psychoactive substance related disorders

Epidermal growth factor receptor mutation status in non small cell lung carcinomas in lung biopsies

Vidyadhara Rani P, Edla Sai Krishna Priya
Background:With an estimation of approximately 1.6 million deaths and 1.8 million new cases per year, lung cancer is the leading cause of cancer-related death and represents the most common cancer type worldwide

Aim:The aim of the present study was to evaluate EGFR mutation status in NSCLC in lung biopsies for successful targeted therapies.

Materials and Methods:Lung biopsies of patients received in the Department of Pathology, Chalmeda Anand Rao Institute of Medical Sciences during a period of December 2019 to May 2021 will be studied prospectively. All lung biopsies are fixed in 10% neutral buffered formalin and routinely processed and stained with hematoxylin and eosin (H & E).

Results: Out of 30 cases of NSCLC cases, 24 cases (80%) were diagnosed as adenocarcinoma and 6 cases (20%) as squamous cell carcinoma on histopathological examination. The age and sex distribution, correlation with presenting complaints, histopathological and IHC findings with EGFR, Exon mutation status were studied separately for NSCLC

Conclusion: We observed that Adenocarcinoma in female patients with exon 19 mutation have a favourable response to oral Tyrosine Kinase Inhibitors.

Keywords: Epidermal growth factor receptor, adenocarcinoma, exon mutation status, lung biopsies

Comparison of cardiovascular autonomic neuropathy (CAN) in type 2 Diabetes mellitus with and without Gastroesophageal reflux diseases

Thilip Kumar Gnanadurai, Prabhavathi K, Poornima Kumbakonam Nagarajan, ANR Lakshmi
Background:Autonomic nervous system dysfunction is quite common yet often unrecognized. Recently the researcher found that the Cardiovascular Autonomic Neuropathy (CAN) is an early and recurrent complication of diabetes mellitus with an account of 7-15 % in newly diagnosed cases. On the other hand the complication of Gastro esophageal reflux diseases is increased among the uncontrolled diabetes mellitus patients because the transient lower esophageal sphincter relaxation. Not much awareness about the T2DM with GERD group and none of the study showed clear evidence between the diabetes mellitus with GERD and autonomic dysfunction.

Materials and Methods: Group 1 includes 40 Type 2 diabetes mellitus patients (T2DM) and group 2 includes 40 Type 2 diabetes mellitus with Gastroesophageal reflux diseases (T2DM with GERD). We analyzed the status of sympathetic and parasympathetic nervous system on heart by using Ewing’s cardiovascular autonomic nerve function test in these 2 groups. Qualitative data was analyzed by Chi Square test which express the frequency and percentage of the data.

Results: Our study showed that, in both the group the maximum number of CAN was distributed in the range of HbA1c > 8 with the percentage of 30 in diabetes mellitus group and 42.5 percent in diabetes mellitus with GERD group where as the percentage was more in later group.

Conclusion: We have highly recommended the clinician to check the degree and severity of cardiovascular autonomic neuropathy in diabetes patients with and without GERD by a simple non-invasive technique with Ewing’s cardiovascular autonomic function test for the betterment of patient’s life.

Keywords: Cardiovascular autonomic neuropathy, type 2 diabetes mellitus, gastro esophageal reflux diseases

Maternal and neonatal outcome in placenta previa

Mamata N, Ramadevi E, Mamatha CH, Himasai Lakshmi Prasanna M
Background: Placenta previa refers to the presence of placental tissue that extends over or lies over the internalos, and associated with complications and severe bleeding and preterm birth, as well as the need for caesarean delivery. Placenta previa should be suspected in any woman beyond 20 weeks of gestation who presents with painless vaginal bleeding.

Aim:The aim of study was to study the incidence, risk factors, mode of delivery, maternal and neonatal outcome of placenta previa.

Materials and Methods: A prospective observational study was conducted at the Department of Obstetrics and Gynaecology, Chalmeda Anand Rao Institute of Medical Sciences, Karimnagar. All the antenatal women with placenta previa beyond 28 weeks of gestational age, confirmed by ultrasound were selected.

Results: In view of antepartum haemorrhage, totally 39.08% (20) preterm deliveries. 30.45 % (16) patients delivered between 32 and 36 weeks 6 days, 6.89%(3) patients delivered between 28 and 31 weeks 6 days, 1.72%(1) patients delivered less than 28 weeks.

Conclusion: Placenta previa leads to increased maternal morbidity due to Antepartum Haemorrhage, operative procedures, multiple blood transfusions. Neonatal morbidity depends on gestational age at the time of delivery. Optimum care during the antepartum and intrapartum period reduces maternal and fetal morbidity and mortality.

Keywords: Placenta previa, maternal morbidity and mortality, neonatal morbidity and mortality, antepartum haemorrhage

Effectiveness of taping in the management of pain, functional disability and navicular drop among treadmill runners with shin splint

Kalaiselvi K, Mahendran P, Mahalakshmi S
Background &Aim:Shin splints are commonly described as pain within the anterior aspect of the leg which develops during or after prolonged weight bearing. Taping technique frequently utilized by clinicians with in the management of lower limb Musculo skeletal pain and injury. The aim of the study was to seek out and compare the effectiveness of taping and selected strengthening exercises on pain, functional disability and navicular drop among treadmill runners with shin splint.

Materials and Methods: 30 treadmill runners with shin splint were selected for the study and consecutively divided into 2 equal groups. Group A (n=15) was treated with taping with selected exercises, B (n=15) was treated with selected exercises alone. Pain, functional disability and navicular drop were measured by visual analogue scale, lower extremity functional scale and navicular drop test respectively.

Results: In Group A and B for pain, functional disability and navicular drop the calculated paired‘t’ values are 27.44, 20.40, 14.81, 15.87, 27.28 and 8.26 respectively, and therefore the ‘t’ table value is 2.977 at 0.005 level. Since all the calculated paired ‘t’ values are more the ‘t’ table value it's concluded that there's significant difference within the values of all dependent variables following the intervention. In between group analysis the calculated unpaired ‘t’ values for pain, functional disability and navicular drop are 9.88, 6.49 and 5.29 respectively, and also the ‘t’ table value is 2.763 at 0.005 level.

Conclusion: The results of this study shows that both taping with selected strengthening exercises and selected strengthening exercises alone were effective in reducing pain, functional disability and navicular drop among treadmill runners with shin splint. But when comparing both it absolutely was found that taping with selected strengthening exercises is simpler and effective than selected strengthening exercises alone in reducing pain, functional disability and navicular drop among treadmill runners with shin splint.

Keywords: inflammation, pain, functional disability, navicular drop, lower extremity functional Scale (LEFS), VAS, navicular drop test (NDT)

A study to evaluate postoperative drop in serum albumin as a marker for surgical stress and predictor for clinical outcome in laparotomy patients

Venkataramana N, Amarsimha Reddy, Sathya Dev, Suryaranaryana Reddy V, Danaboina Vishali
Background:Surgical interventions trigger a metabolic stress response of varying magnitude which contributes to complications, delayed recovery and prolonged hospital stay. The present study aims to assess serum albumin levels as a response indicator for surgical stress and as a predictor of adverse outcomes.

Materials and Methods:The study design was prospective observational clinical study, total 50 patients were included in this study. Preoperative and postoperative albumin levels were measured for the patients and correlation between the post-op fall in albumin level was compared with the incidence of post-op complications as determined by Dindo-Clavien scoring.

Results: A prospective study was done for eighteen months of cases undergoing laparotomy both elective and in an emergency between the age group of 16 to 70 years. A repetitive measures ANOVA with a Greenhouse-Geisser correction determined that mean serum albumin differed statistically significantly between time points (F (2.321, 113.750) =69.895, P< 0.0005).

Conclusion: Our study results showed that the values of albumin dropped post operatively by 10 g/L which correlated with the length of operation, complications and clinical outcomes. In this study, the fall in serum albumin levels was related to the magnitude of surgery and the surgical stress associated with it. Clinical outcomes were also related to the postoperative albumin levels.

Keywords: Serum albumin, Postoperative drop, dindo-clavien scoring, laparotomy Patients

A prospective study of microbiological pattern in burn wound and burns ward in a tertiary care center

Vijaya Chandramouli, Subodh Kumar, Ramesh P, Mahendar E, Jhansi Rani C, Sarojini C
Background: Burns are one of the most common and devastating forms of trauma. Patients with serious thermal injury require immediate specialized care in order to minimize morbidity and mortality. Infection causes 50% to 60% of deaths in burn patients in spite of intensive therapy with antibiotics both topical as well as intravenous.

Aim:The aim of study was to study the bacteriological pattern of burn wound in a tertary care center.

Materials and Methods:This is a observational prospective study, a total number of 112 swab culture samples, 56 blood culture samples were collected from 56 patients with burns wound admitted at Gandhi Medical college Hospital, Secunderabad. The samples were processed in the Central Service Laboratory, Gandhi Medical College Hospital.

Results: Out 56 swab culture isolates, 15 samples (28.30%%) were gram positive and 38 samples (71.70%%) were gram negative. Gram negative bacteria Klebsiella was the predominant isolate 16(28.50%) in second week in this study.

Conclusion: This study focusses on aspects of history, pathophysiology, microbial etiology and microbial analysis of burn wound infection with special emphasize laid on the surveillance of burn wound infections and its culturing techniques.

Keywords: Burn wound, infection, colonization, septicaemia, swab

Radiological comparative study of carcinoma cervix in CT and MRI

Venkata Ramana Nyalakonda, Santhosh Babu R, Korrapaty PrashanthRaju, Pingali Yashwanth
Background:Carcinoma of cervix is the second most common cancer in woman worldwide. There is a potential role for accurate non-invasive staging of cervical carcinoma. For these reasons, CT and MR imaging may become more accurate substitute for clinical staging of cervical carcinoma.

Aim:The purpose of the study was to compare CT and MRI findings, in evaluation and staging of Uterine Cervical Carcinoma.

Materials and Methods:Patients presenting to the departments of Oncology and Gynaeocology, Chalmeda Anand Rao Institute of Medical Sciences, Karimnagar with clinical suspicion of Uterine Cervical Carcinoma who may or may not have had other screening investigations will be included in this study. The numbers of patients proposed to be included in the study are twenty.

Results: MR imaging has several other advantages over CT, such as high- contrast resolution and multiplanar capability which usually demonstrate well the relationship of the uterus, the vagina, the urinary bladder, and the rectum on Sagittal images. Our study illustrates few cases to show these advantages of MR imaging over CT.

Conclusion: We conclude that MR imaging should be used as routine for imaging study for preoperative staging of uterine cervical carcinoma.

Keywords: Cervical Carcinoma, CT, MRI, Preoperative Staging


Lobular Capillary Hemangioma over Nasal Vestibule in a 38 Year Old Male: A Case Report

Manoj Gunde, Vamshi Krishna Koppula, Deepak Kumar Phulwani
Lobular Capillary hemangioma is a benign lesion of the skin and mucous membranes which has a property to grow rapidly. It has no predilection for age and it is seen in the third to fifth decade and most commonly in females. It can be categorized into capillary, cavernous and mixed type. Hemangioma is a disease of head and neck commonly seen in buccal mucosa, gingiva, tongue, but its presence in the nasal cavity is rare. The most common symptoms are epistaxis and nasal obstruction. The treatment is by surgical excision with or without the aid of endoscope depending on the site of lesion along with base cauterization. We present a case report of a 38 year old male patient with Lobular Capillary hemangioma who presented with mass in the vestibule along with epistaxis. The diagnosis of Lobular Capillary hemangioma must always be kept in mind when discussing the differential diagnosis of a bleeding mass of the nasal cavity even though it is a rare entity and surgical excision is still the preferred first line treatment. Keywords: Lobular capillary hemangioma, nasal vestibule, surgical excision



Vol 21 | Issue 1: Jan- June 2021


Vol 21 | Issue 1: January- June 2021


Study of clinical profile of urinary tract infections in Diabetics and Non-Diabetics

Pavan Kumar D, Anish Reddy P, Sanjay H Kalbande
Background: Diabetics are more prone for infections than non diabetics.Urinary tract infection (UTI) is the most important and most common site of infection indiabetic patients. Bacteriuria is more common in diabetics than in non-diabetics because of a combination of host and local risk factors. Hence, the study was undertaken to determine if there are differences in clinical and microbiological features and antibiotic sensitivity pattern in patients of UTI between diabetic and non-diabetic subjects

Materials and Methods:This study was done on patients, who were admitted to Chalmeda Anand Rao Institute of Medical Sciences Hospital during a period of April 2019 to February 2020. A total of 120 diabetics (65 female, 55 male) and 80 non-diabetics(49 female, 31 male) with culture positive UTI were studied.

Results: Almost 64% of diabetic patients and 48 % of non-diabetic patients presented with fever, 46 % of diabetics and 32% of non-diabetics presented with dysuria as presenting symptom of UTI. 28% of diabetic females and 27 % of diabetic males were asymptomatic. 22% of non-diabetic females and 26 % of non-diabetic males were asymptomatic. Benign prostatic hypertrophy is the most common predisposing factor of UTI in males in both diabetics and non-diabetics. Indwelling catheter is the most common predisposing factor of UTI in females in both diabetics and non-diabetics. E.Coli is the most common organism isolated and most common cause of pyelonephritis and recurrent UTI in diabetics. E.Coli is most sensitive to meropenem in diabetic and non-diabetics followed by cefoperozone and sulbactum. Majority of diabetics with UTI had HbA1c greater than 8%. Septicemia is the most common complication of UTI in both diabetics and non-diabetics followed by AKI.

Conclusion: Fever and Dysuria are the most common presenting symptoms of UTI in diabetics and non-diabetics. Asymptomatic bacteriuria is present in almost 1/3 rd of diabetics. E Coli is the most common organism isolated and is most sensitive to meropenem. Prevalance of pyelonephritis is higher in diabetics. Majority of diabetic patients with UTI had HbA1c greater than 8%

Keywords: Urinary tract infection, asymptomatic bacteriuria, diabetic patients, E. coli

Evaluation of occupational stress among software professional in South India: A cross sectional study

Kannan K, Rajini S, S. Soundarya, N. Sowmya Devi, Vaishnavi R, K. Vignesh
Background Stress is defined as a highly subjective phenomenon and it is a nonstxspecific response of a body to any demand for change and it has touched all professionals posing threats to mental and physical health. Software organization such as IT sector are often observed under huge stressors

objectivesSince IT sectors seems to be lacking in terms of assisting the employees on knowledge about stress and coping for psychological problems and the research on these grey areas are limited, we would like to assess the magnitude of stress among IT professional in South India and to recommend the need for remedial action Materials and Methods:A cross sectional study was done in 154 IT professionals during the period of November to December 2019 Using a Validated Professional Life Stress Scale (PLSS), questionnaire through google form.

Results: Finding suggest that females and freshers are more stressed but there is no significant association

Conclusion: The level of stress can be reduced by providing better work environment,frequent counselling and screening and adequate reward for their work

Keywords: Stress, IT professional, Mental Health

Attenuation of cardiovascular response to laryngoscopy and intubation a comparative study between i.v. Esmolol Hydrochloride and Fentanyl

Rajkumar Reddy I, SA Aasim, Trivikram, Shravya T
Background Laryngoscopy and endotrachial intubation is a integral part of anaesthetic management and critical care. It is associated with mechanical stimulation of the upper respiratory tract leading to sympathetic adrenal stimulation. The aim of study was to determine efficacy in order to blunt intubation and laryngoscope stimulation response. Durgs like Esmolol, beta blocker and opiod like Fentanyl studied scientifically to establish best drug to prevent the complications of upper respiratory tract stimulation and smooth conduction of anaesthesia and to determine efficacy of esmolol 2 mg/kg IV bolus and fentanyl 2 mcg/kg bolous attenuated sympathetic response to laryngoscope and Tracheal intubation and ascertain the effectiveness of Esmolol and Fentanyl in supressing sympathetic

Materials and Methods:This study was conducted in 60 patients aged 20-50 years and patient were devided in two groups.Group I Fentanyl Group-II Esmolo group with laryngoscope intubation response in each group undergoing general anaesthesia

Results: This study was undertaken to compare the attenuation of laryngoscope and intubation response during general anaesthesia. 2 mg/kg IV bolus Esmolol and 2 mcg/kg fentanyl IV before laryngoscope at Department of Anaesthesia Chlameda Anand Rao Institute of Medical Sciences, Bommakal, Karimnagar. During period Esmolol found to better drug to blunt laryngoscope and intubation.

Conclusion: Esmolol 2 mg/kg I.V bolus significantly attenuate the laryngoscopy and intubation sympathetic response.

Keywords: Esmolol, fentanyl, laryngoscopy, intubation, heart rate, blood pressure.

A cross-sectional study of referral pattern and utilization of consultation liaison psychiatry services in General Hospital setting

Gireesh Kumar M, Prasanna Lakshmi, Pavan Kumar K, Preethi G, Gopinath S
Background : Utilization of Consultation Liaison Psychiatry services is a key to identify psychiatric problems in patients presenting to other departments. It is very common, owstxing to the lack of awareness and stigma, most patients with psychiatric problems present to medical and surgical departments.

Aims and Objectives To study the referral pattern to General Hospital Psychiatry Unit and to identify the nature, source of referrals and correlations among the same.

Materials and Methods: All successive referrals to the Department of Psychiatry for a period of eighteen months were included in the study. Socio demographic characteristics of the patients were analyzed, they were classified according to the referring department, the reason for referral and current psychiatric diagnosis

Results: Our study resulted in a gross referral rate of 1.25% of all admissions. The most common reason for referral was Medically Unexplainable symptoms (12.77%), followed by Altered Sensorium (11.46%), Abnormal Behaviour (10.31%). Most of the referrals were from Medical Specialties (54%) and the most common diagnoses were Alcohol Withdrawal Delirium, Unipolar Depression, Somatoform Disorders and Other Organic Mental Disorders. There is a significant correlation with Age group being 40-60 years constituting highest number with utilization these services.

Conclusion: here is a need to improve Consultation Liaison in Psychiatry Services to provide best and optimal care to the patients, a multi-disciplinary approach should be encouraged of patients who attend general hospitals, in order to facilitate early recognition and management of psychiatry problems.

Keywords: Consultation liaison psychiatry, general hospital psychiatry unit, referral topsychiatry, referral pattern

Nerve conduction velocity of medial and lateral plantar nerve: A predictor of Diabetic foot among Diabetic population

Khushboo A. Rajput, Sumi Rose
Background Diabetic foot ulcer, one of the frequent in addition to severe complication of diabetes about 12-25% people has risk of developing diabetes. Diabetic foot ulceration can be identified as a very well-demarcated full thickness injury at distal part of the ankle

Aim The aim of the current study was to explore whether medial plantar nerve conduction velocity and lateral plantar nerve conduction velocity can predict the diabetic foot among diabetic population

Materials and Methods: 50 subjects diagnosed with diabetic mellitus type-2 were recruited based on inclusion and exclusion criteria. Subjects were explained about the NCV. Medial plantar and lateral plantar nerve, both side CMAP (Compound motor action potential) and SNAP (Sensory nerve action potential) were documented.

Results: Results showed that the subjects were having normal conduction in motor NCV in both male and female. There was decrease in root mean square value of sensory NCV of 39.69=M, 38.66=F, lateral plantar sensory nerve left side, showed decrease in the conduction velocity though it was not statistically significant change.

Conclusion: Motor conduction and Sensory conduction velocity of Medial plantar and Lateral plantar nerve could not predict the diabetic foot among diabetic population. There is no significant changes in Medial plantar nerve motor and sensory conduction velocity but left side lateral plantar sensory nerve conduction showed some changes in SNAP though it was not statistically significant change

Keywords: Diabetic mellitus type-2, diabetic foot, NCV, lateral plantar nerve, medial plantar nerve, CMAP, SNAP

Association between foetal middle cerebral artery and umbilical artery doppler ratio with foetal distress in 38-40 weeks of Gestational age

Ramadevi E, Mamata N, Madhavi G.B, Tulasi, Sneha P
Background Identifying foetal distress is of atmost important to prevent neonatal morbidity and mortality. A colour Doppler forms an essential non invasive tool capturing change in flow velocity waveforms in the fetal vascular beds to detect inadequate oxygen or nutrient supply.

Aims and objectivesThe study aim was to determine the relationship between Middle cerebral artery, pulsatile index and Umbilical artery Doppler ratio with fetal distressn at 38-40 weeks of gestation.

Materials and Methods:The study was a prospective cohort study, 100 pregnant women with 38-40 weeks of gestation age who came to OPD were selected during the period of June 2020 to June 2021. Colour Doppler was done for all of them, and the association of this ratio with fetal distress was assessed.

Results: Among 100 women, cerebroplacental ratio less than fifth centile was seen in 84 of cases, there is also significant correlation between cerebroplacental ratio less than fifth centile and low APGAR score. Fetal outcomes for cerebroplacental ratio less than fifth centile were observed such as low birth weight (75%), emergency cesarean section (97%), NICU admission (80%), low APGAR score(100%), Meconium aspiration syndrome (70%), Respiratory distress syndrome (75%), Oligohydramnios (73%), IUGR (70%), were also observed .

Conclusion: Cerebro- placental ratio i.e; fetal Middle cerebral artery and Umbilical artery Doppler ratio less than fifth centile is significant in predicting fetal distress at 38-40 weeks and can help to reduce the risk of perinatal mortality by timely intervention at delivery

Keywords: Cerebroplacental ratio, middle cerebral artery, umbilical artery, fetal distress, Doppler.

Role of fresh frozen plasma (FFP) and single donor platelets(SDP) in treatment of Dengue and Dengue like illness

Seshagiri G, Mahesh Reddy J, Samar Rania Mazhar, Abhignya CH, Ram Narasimha Reddy V
Background Dengue is the most common mosquito borne, epidemic arboviral infection. The case fatality rate is 20% but with timely intervention can be reduced <1%, bleeding and shock are its dreaded complication. In this study transfusion of blood is not taken into consideration as it may lead to adverse effects like volume overload hence this study is on efficacy and outcome after transfusion of fresh frozen plasma and single donor platelets in cases of dengue and dengue like illness.

Materials and Methods:The study design was a prospective and analytical observational study over a sample size of 200 patients who were diagnosed with dengue or dengue like illnesswith platelet count of less than 30000 requiring FFP and SDP transfusion were recruited

Results: 100 patients out of 200 were given FFP transfusion alone with increase in mean platelet with p value of <0.001 which is highly significant and in this study 26 patients out of 200 were given SDP transfusion alone the mean increase in platelets with p value of 0.023. And 74 patients out of 200 were given FFP followed by SDP with mean increase of platelets with a p value of <0.001. The mean duration of hospital stay with FFP followed by SDP has significant p value

Conclusion: A rise in platelets with significant p value was found in patients given FFP alone, SDP alone and in FFP followed by SDP. The mean duration of hospital depends on platelet count and number of transfusions given accordingly. Hence significant p value was found to be seen in FFP followed by SDP where there was not only increase in platelets but also effective in hospital stay wise.

Keywords: Thrombocytopenia, bleeding, fresh frozen plasma, single donor platelet

A comparative study of mental health of non- psychiatric and psychiatric Doctors and Nurses in Hospitals during COVID-19 pandemic: A cross-sectional study

Phanikanth K, Navyaja, Vivaswan Boorla
Background Since its inception in December 2019 in the Hubei province of China, the novel coronavirus disease (COVID-19) is spreading rapidly both locally and internationally. The mental health of medical and nursing staff has been greatly challenged during the immediate wake of the viral epidemic

Settings and Design: Cross sectional study Materials and Methods: After ethics committee approval, an informed consent taken from all four group participants through online mode (50 Non-Psychiatric Doctors, 50 Psychiatric doctors, 50 Nurses from Non-Psychiatric department and 50 nurses from Psychiatric Department). The self-report questionnaire is prepared by using the following tools. Semi Structured Intake proforma containing social demographic data, type of department and any medical comorbidities. DASS-21 questionnaire- Depression, anxiety and stress scale, 21 Item self-report questionnaire.

Results: In the study, among 200 health care workers, aged 25 to 52, out of which 46 male and 154 females. 163 participants are married, and with working experience of (16%) <2 years, (27%) 2-5 years, (56.5%) >5 years. Type of family being 70% nuclear, 29% joint. Preference to stay during pandemic being at home (73%), away from home (27%). Distress to risk of transmission to family members and presence of medical co-morbidities being high in nurses. 22.5% have symptoms of depression-psychiatric doctors (4%), non-psychiatric doctors(4.5%). Psychiatric nurses (8%), non-psychiatric nurses (9%). 49.5% have symptoms of anxiety– psychiatric doctors (5.5%), non-psychiatric doctors (7%), psychiatric nurses(10.5%), non-psychiatric nurses(26.5%). Distress being 52.5%- psychiatric doctors (10.5%), nonpsychiatric doctors (12%), psychiatric nurses (13%), non-psychiatric nurses (17%).

Conclusion: This cross sectional survey revealed high prevalence of mental health symptoms among health care workers -52.5%, 49.5%, 22.5% of all participants reported symptoms of distress, anxiety and depression respectively. Non psychiatric participants reported more severe symptom on all measurements, out of which nurses had more severity of symptoms. Together, our findings present concerns about the psychological well-being of doctors and nurses involved in COVID-19 pandemic.

Keywords: COVID-19, mental health, depression, anxiety, distress


Synchronous papillary thyroid carcinoma and follicular carcinoma of thyroid - A rare case report

Sumalatha Kasturi, SanthoshBabu Rendla, Vamshi KrishnaRao Koppula, Ravinder Thota
Papillary thyroid carcinoma(PTC) and Follicular thyroid carcinoma(FTC) are the first and second most common cancers comprising about 85% and 10% of all thyroid cancers. Simultaneous occurrence of Medullary thyroid carcinoma and papillary thyroid carcinoma has been reported, but collision tumor of FTC and PTC is an unusual event that is rarely reported . We describe a 48 year old man with synchronous FTC of oncocytic type in the right lobe and PTC in isthmus in thyroid. Pathologists and surgeons should be aware of collision tumors to avoid possible misdiagnosis

Keywords: Synchronous tumor, follicular carcinoma, oncocytic, papillary thyroid carcinoma

A rare cause of pneumonia: Tracheo-bronchopathia osteochondroplastica

Vinay Kumar A, Rajkumar K, Praveen Kumar Ch, Soumya Rani K, Sony Reddy S, Monica Y, Akshai Kumar D
Tracheobronchopathia osteochondroplastica is a rare disorder with a benign course. It is characterized by the accumulation of diffuse cartilaginous and osseous nodules protruding into the mucosa of the trachea and bronchus. We report the case of a 50 year old male who presented with fever, cough and shortness of breath and he was diagnosed on bronchoscopy, radiologically and clinicopathologically to have Tracheobronchopathia osteochondroplastica.

Keywords: Tracheobronchopathia osteochondroplastica , bronchoscopy, radiology



Vol 19 | Issue 1: Jan- June 2020

Vol 20 | Issue 2: July- Dec 2020


Vol 19 | Issue 1: January- June 2020


Evaluation of the Alvarado score and serum C-reactive protein in patients with acute appendicitis: A prospective observational clinical study

Venkataramana N, Sathish Kumar B, Suryanaryana Reddy V, Manne Nishant
Background: Acute appendicitis (AA) is a common surgical condition and a frequently suspected differential diagnosis in patients presenting with acute right lower abdominal pain. The aim of study was to assess the alvarado score and serum Creactive protein as a predictor of severity in patients with acute appendicitis

Materials and Methods:Total 200 patients were included in this study. Patients with acute appendicitis admitted to the Department of General Surgery, Chalmeda Anand Rao Institute of Medical Sciences, Karimnagar. Alvarado score which takes into account symptoms, signs and the laboratory parameters were ascertained to each of the patient in this group. The total score was not calculated until after the appendicectomy.

Results: Age of patients varies from 13 to 65 years and it is observed that maximum number of patients were in the age group of 13 to 25 years which accounted for 46% of total cases. It is evident that the appendicitis is more common in young adults.

Conclusion: The majority of appendicitis cases were seen in young adults of age 13 to 25 years. There was a positive correlation between the alvarado score and CRP elevation in cases of acute appendicitis.

Keywords: Alvarado score, Serum C - reactive protein

Utility of fetal kidney length as a predictor of gestational age: A comparative study

HimaBindu K, Krishnamurty S, Amol Kamble
Background and Objectives:In today’s practice of obstetrics and gynecology, one of the important components is estimation of fetal gestational age. There are various parameters available to estimate gestational age like Head Circumference, Femur length, biparietal diameter etc. but in late trimester these parameters found inaccurate to estimate gestational age. In this study we planned to estimate correlation between fetal kidney length and gestational age.

Materials and Methods:A prospective hospital based study was conducted between May 2019 to January 2020 on 100 singleton uncomplicated pregnancies in their late trimester who were sure of their last menstrual period. After measurement of conventional parameters, FKL was measured, and correlation was obtained with GA and its efficacy was compared with other parameters.

Results: In this study total 100 cases were participated, between the age group of 18 to 36 years having mean age of 24.52 ± 3.66 years. Correlation coefficient between gestational age and fetal kidney length was 0.87with a significance P< 0.001, which showed strong positive and linear correlation.

Conclusion: On the basis of results found we are concluding that fetal kidney length is reliable and accurate parameter to estimate gestational age and can be added with other routine parameters to know the estimated date of pregnancy

Keywords: Femur length, head diameter, gestational age, fetal kidney length

A Clinical study of fever with thrombocytopenia with infectious etiology

Vamshikrishna TV, Pavan Kumar D, Sanjay H Kalbande
Background and Objectives:Fever is a pervasive and ubiquitous theme in human myth, art and science. The aim of the study was to elucidate possible infective etiology for fever with thrombocytopenia and to correlate clinical features, laboratory studies and etiology

Materials and Methods: This study was done on patients, who were admitted to Chalmeda Anand Rao Institute of Medical Sciences Hospital during a period of August 2018 to December 2019. We prospectively collected a series of 120 patients with fever and thrombocytopenia. All the adult patients aged 16-65 years with fever and thrombocytopenia of infective etiology

Results: In the present study subjects were in the age group of 16-65 years. Youngest 16 years old and oldest 64 years. Out of 120 patients of fever with thrombocytopenia, had definitive diagnosis with Dengue 62 cases as the commonest cause, followed by, Malaria 22 cases, Mixed malaria and dengue 2 cases, Leptospirosis 3 cases, Septicemia 3 cases, varicella 2 cases, and unknown/viral 28 cases.

Conclusion: Among the diagnosed cases, Dengue fever (62) formed the largest group.Other cases diagnosed were of Malaria (22); Leptospirosis (3), Septicemia (3), varicella (2) and unknown infective cause. Bleeding manifestation of thrombocytopenia was present only in 35 cases and in 85 cases it was not present. 100% of patients of very severe thrombocytopenia and 25% patients with severe thrombocytopenia manifested with bleeding diathesis.

Keywords: Fever, thrombocytopenia, infectious etiology

Depression and quality of life among patients on maintenance Haemodialysis

Preeti Gudlavallety, Nagender Rao Y, Prasanna Lakshmi S
< Background and Objectives:Chronic renal failure is a debilitating disorder effecting 100-200 per million people in India. Its chronic, progressive nature imposes healthcare burden taking toll on psychological, social, physical well being of an individual. Assessment of quality of life (QOL) and its correlation with depression can help in improvement of QOL via amelioration of depression among these patients. The aim of study was to assess the socio-demographic data, depression and the relationship between depression and quality of life in chronic renal failure (CRF) patients on haemodialysis.

Materials and Methods: A cross-sectional study enrolling 31 CRF patients (age group18-65 years) who are on maintenance haemodialysis for more than 6 months were administered Mini Mental Status Examination (MMSE) to rule out organicity, Hamilton Depression Rating Scale (HAMD) and World Health Organisation Quality of Life Brief (WHOQOLBREF). Data was analysed using Statistical Product and Service Solutions (SPSS) software, version19. Statistical measures obtained included descriptive (percentages, proportions, mean and standard deviation), tests of significance (Fischer’s exact test) and Pearson’s correlation coefficient.

Results: A total of 31 patients consented and participated in the study among whom, 16(51.6%) obtained scores higher than 7 on the HAMD scale while the remaining 15 (48.4%) were not depressed. There were no significant differences across age (P0.78), sex (P0.609), marital status (P0.6), family type (P0.886) and duration of dialysis(P0.623) across the depressed and non-depressed groups. There was a significant strong negative correlation-ship between the HAMD scores and the physical (r=-0.651, P0.001) and psychological (r=-0.684, P0.001) domains whereas the social (r=-0.521, P0.003) and environmental (r=-0.542, P0.002) domains exhibited a moderate negative correlation-ship.

Conclusion: To improve the quality of life in CRF patients on haemodialysis, it is important to alleviate depression among them

Keywords: Haemodialysis, depression, quality of life

A study on screening for cervical carcinoma, its prevalence and influence of socio-demographic factors in urban/rural population of Karimnagar district

Soujanya D, Shravankumar J, Rajamouli J, Manasa S
Background and Objectives:Carcinoma of cervix is a worldwide problem, it accounts for 15% of all cancers. It is second most common cancer in women globally and 80% were in developing countries. The objectives of study was to find out the prevalence of cervical carcinoma cases by screening with VIA test followed by colposcopy guided biopsy.

Materials and Methods:A cross sectional study was performed among females aged 20 to less than 65 years in Karimnagar town & Ramadugu mandal by screening camp approach for cervical cancer, registered females were subjected to VIA test, positive cases subjected to colposcopy guided biopsy at cancer hospital CAIMS

Results: from 25495 total females population 6726 (26.4%) have attended the camps and 2336 (34.7%) women were screened with VIA test after taking informed consent. 640 (27.4%).women were VIA positives and 559 VIA positives subjected for colposcopy guided biopsy. 476(86.9%) were normal, 83 cases in different stages disease. Among them CIN1 - 55, CIN 2 -14, CIN 3 -11 and cervical CX -3.

Conclusion: VIA followed by colposcopy guided biopsy is an useful screening method for detection of cervical malignancy and confirmed cases referred for treatment and follow up at tertiary care Cancer Hospital, CAIMS, Karimnagar, Telangana

Keywords: Cervical cancer, VIA test, colposcopy.

Knowledge and Attitude about HIV transmission and condom usage among college going adolescents in Pondicherry: A cross sectional study

Kannan K, Rajini S, Karthikapriya SK, Saran S
Background and Objectives:Adolescents need to know how to protect themselves from HIV/STDs for this sex education is the best way. Sex education should be an integral part of the learning process beginning in childhood and continuing into adult life, because it is lifelong process. The aim of study was carried out to identify the knowledge and attitude about HIV transmission and condom among collage going adolescents between age group of 18-25 years.

Materials and Methods:A cross sectional study design was used to study the knowledge and attitude about HIV transmission and condom usage. A total of 212 adolescents from age group of 17-21 year were studied, using self-designed semi-structured questionnaire to assess the knowledge regarding HIV transmission and condom usage among adolescents

Results: The mean age of study subjects was 19.7 years, majority of the study population were male gender (71%). Students had a satisfactory level of knowledge on HIV/AIDS prevention. Having adequate knowledge did not imply engaging in safe practices

Conclusion: Students had a satisfactory level of knowledge on HIV/AIDS prevention. Having adequate knowledge did not imply engaging in safe practices. This study none-theless highlighted some misconceptions about HIV transmission, which can be corrected by reinforcing sex education curriculum as sex education in collages was their main source of information on HIV.

Keywords: Knowledge and Attitude, HIV transmission, condom usage, adolescents

Study of efficacy of pleural biopsies in comparision to pleural fluid cytology in diagnosis of suspected malignant pleural effusion

Vinay Kumar A, Soumya Rani K, Monica Y
Background and Objectives:Medical thoracoscopy/pleuroscopy is used increasingly by chest physicians and has become, after bronchoscopy, the second most important endoscopic technique in respiratory medicine. The purpose of study was to comparatively evaluate the role of pleural fluid cytology and pleural histopathology by means of biopsy in diagnosis of suspected malignant pleural effusion

Materials and Methods:A Hospital based prospective and observational study of inpatient and outpatient in department of Pulmonary Medicine of Chalmeda Anand Rao Institute of Medical Sciences, Karimnagar

Results: Among 50 patients with suspected malignant pleural effusion, mean age of patients is 59.2 years. Pleural fluid cytology is positive for malignant cells in 21 cases with yield of 43%(21 of 48 cases) and cell block showed presence of atypical cells in 34 cases with yield of 70% (31 of 48 cases). Diagnostic yield of thoracoscopic biopsy is about 92% (46 of 50)

Conclusion: Our study concludes that Medical thorocoscopy is a safe and effective procedure with high diagnostic yield -92% in our study and accurate in diagnosis

Keywords: Malignant pleural effusion, cytology, pleural biopsy

Mammographic and sonographic evaluation of breast masses: A comparative study

Santhosh Babu R, Naveen Kumar S, Anil Kumar S, Mahesh Ch
Background and Objectives:Ovarian cancer accounts for 3% of all cancers in females. Ovarian tumors present with a wide spectrum of clinical, morphological and histopathological features. Treatment and prognosis of these tumors is based upon accurate surgical staging and a thorough pathological evaluation. Early diagnosis is difficult due to its asymptomatic nature, inaccessible site and limited use of FNAC. The aim of the study was to study the incidence and histopathological spectrum of ovarian neoplasms

Materials and Methods:This retrospective study was done for a period of 2 years in the Department of Pathology, Chalmeda Anand Rao Institute of Medical Sciences, Karimnagar. All the ovarian specimens received were fixed in 10% formalin for 24 hours. Processed tissue sections stained with haematoxylin and eosin were analysed

Results: In the present study, 90 cases of ovarian tumors were studied during the period of 2 years. Age range from 15-80 years with majority of cases included among 41-50 years age group with 30(33.3%) cases. Overall, benign tumors were 58(64.5%), malignant were 30 (33.3%)) and border line were 2(2.2%). Epithelial tumors (87.8%) formed the majority in cases followed by germ cell tumors (8.9%), sex cord stromal tumors (2.2%) and others(1.1%). Among the surface epithelial tumors, serous cystadenomas were most common (32 cases; 35.6%).

Conclusion: Ovary is a common site of tumor in the female genital tract and usually presents with a variety of clinical, morphological and histological features. Surface epithelial tumors are the most common type of ovarian tumors. A precise histopathological diagnosis and staging is important for therapeutic and prognostic purpose

Keywords: Ovarian tumors, benign, malignant

Histopathological study of spectrum of Ovarian Neoplasms: A 2 year study

Lavanya Kanigiri, Sanjeev Kumar Srigiri, Sravani Ramma Modey, Ravinder Thota
Background and Objectives:Breast lump is the clinical presentation of various breast diseases that range from benign cyst to malignant lesions. Differentiation of benign from malignant is the most important aspect for patient care and proper management. The Aim and objectives was 1). To study the mammographic and sonographic characteristics of the breast lesions. 2).To study the sensitivity of combined mammography and ultrasound compared to that of individual modalities in diagnosing malignant lesions of the breast 3). To compare results the present study with similar studies available in the present literature

Materials and Methods:This is a prospective study done on 60 patients over a period of 18 months in Department of Radio Diagnosis, Chalmeda Anand Rao Institute of Medical Sciences, Karimnagar.

Results: In present comparative study in 60 solid masses Diagnosing palpable breast masses by mammography alone. Benign cases were 19, Malignant cases were 26, Suspicious cases were 15 Diagnosing benign/malignant tumour by mammography alone was Sensitivity 89%, Specificity 94%, Positive predictive value 92% Negative predictive value 91% values.Our sample size for the study was fairly small compared to many of the other studies referred to for comparison. Also, we have considered only those masses that were palpable.Hence, there may be a slight variation in the results and percentages

Conclusion: In present comparative study diagnosing benign/malignant cases by mammography alone has sensitivity 89% positive predictive value 92%. Diagnosing Benign /malignant cases by sonography alone has senisitivity 92% positive predictive value 92%. Diagnosing benign /malignant cases by combined sonography & mammography has increased sensitivity & positive predictive values up to 100% &100% respectively which indicates combined study is better than individual alone studies. Hence it can be concluded that combined mammography and high resolution ultrasound yields highest diagnostic accuracy in evaluating palpable breast lesions, especially in relatively young patients or in radiologically dense breasts

Keywords: Mammography, sonography, breast lesions

The Relavance of serum total calcium and ionized calcium to Intact PTH ratios in secondary hyperparathyroidism patients with CKD during Haemodialysis

Sudhakar T, JaiBheem K, Bhagavan Reddy K, Sabitha V, Rajkumar G, Raja Adithya
Background and Objectives:The Secondary hyperparathyroidism (SHPT) describes a complex alteration in bone and mineral metabolism that occurs as a direct result of chronic kidney disease (CKD). During early secondary hyperparathyroidism, the blood calcium levels are normal or low, but the PTH level is high. The parathyroid gland plays a central role in controlling serum calcium concentrations by regulating secretion of parathyroid hormone(PTH).

Materials and Methods:In the prospective case-control study, 50 samples of blood from haemodialysis patients with SHPT attending to Department of Biochemistry, Chalmeda Anand Rao Institute of Medical Sciences, Nephrology OP & IP in a multispecialty Hospital in, Karimnagar, Telangana and 11 healthy control samples were also collected after proper consent were taken, the samples were processed for iPTH, total calcium and ionized calcium. Intact PTH assay were done by Chemiluminiscence method in Snibe Maglumi 1000 and Total calcium estimation by colorimetric method were done in Randox Daytona analyser. The ratios of Serum Calcium to Intact PTH and ionized Calcium to Intact PTH were done by calculative method using data of parameters in this study and statistical significance for P value were done by using student t-test.

Results: The mean and SD values of patient group of intact PTH were 321.81±225.92 and control group were 49.35 ± 15.45 with p value less than 0.0001 extremely significant. The mean and SD values of ionized calcium were 3.84 ±0.52 and control group are 4.34 ±0.28 with p value less than 0.0001 which were also extremely significant

Conclusion: The relavence of ratios for serum calcium-intact PTH and ionized Calcium intact PTH highlights the significance of activities among haemodialysis patients in the diagnosis of secondary hyperparathyroidism. There by it should be included along with reference panel determinations as a parameter for early detection of complication of the SHPT.

Keywords: Relavence of ratios of serum total Calcium-intact PTH and ionized Calcium – intact PTH in SHPT

The Association between neonatal sepsis and C-reactive protein: A cross sectional study at tertiary care Hospital, CAIMS, Karimnagar, T.S

Prakash K, Rajamouli J, Sachin G
Background and Objectives:All neonates treated for suspected bacterial infection were prospectively evaluated using a standardized clinical pathway. Infants were proven sepsis by clinical and laboratory findings (bacteria isolated from blood, cerebrospinal fluid and urine cultures, with consideration of serum C-reactive protein (CRP) levels. The aim of study was to evaluate association between neonatal sepsis and CRP levels for diagnosis of neonatal infection.

Materials and Methods:A cross sectional hospital based study conducted at regional intensive care nursery unit in Tertiary care hospital Karimnagar, Telangana State. Infants whose blood cultures yielded skin flora but who demonstrated no other signs of bacterial infection has not considered having sepsis.

Results: Sepsis was suspected in 262 infants and among them 145 (55.2%) blood culture positive. 114(78.5%) infants had early-onset of sepsis < 72 hours after birth as compared 31 Neonates (21.5%) had late onset septicaemia. 56.75% Gram negative organisms were causative agents as compared to 43.24% gram positive organism in study group. Increased CRP level is a marker in neonatal septicaemia but still blood culture is gold standard for diagnosis of septicaemia. Proven or probable sepsis 39.4% sensitivities and 64.6% for and 35.0% and 61.5% for proven sepsis in early-onset and late-onset episodes, respectively.

Conclusion: Neonatal septicemia is still a leading cause of mortality and morbidity in developing countries like India. In view of the changing spectrum of the causative agents of neonatal septicemia and their antibiotic susceptibility patterns from time to time and from one hospital to another, a positive blood culture and the antibiotic susceptibility testing of the isolates are the best guide to the antimicrobial therapy. Blood culture is still the “Gold standard” for the diagnosis of septicemia in neonates and should be done in all cases of suspected septicemia prior to starting the antibiotics.

Keywords: Neonate, septicaemia, premature, C-Reactive protein.


Dumbell shaped C1-C2 schwannoma: A case report

Durga Prasad Bukka, Vishal Chakati, SrinivasRao E, Shivanand Reddy, ShyamSunder Anchuri
Patients with C1-C2 dumbbell shaped cervical nerve root schwannomas approach to the hospital with common clinical presentations of neck or head pain and radiating pain up to the back and head. A 57-year-old female was referred to neuro care center in view of a slow-growing lump in the left sided posterosuperior aspect of the neck since 20 years. The lump was asymptomatic. Radiological examinations done, Magnetic resonance imaging revealed probably neurofibroma/schwannoma, C1-C2 level extending from spinal canal through neural foramina into left para spinal soft tissue, at C2 level the lesion causing mass effect over cord. Related biopsies of the lesion showed spindle cells arranged in bundles with nuclear palisading verucay bodies consistent with a schwannoma. The lesion was surgically excised by left sided far lateral approach Keywords: Schwannoma, cervical root, dumbbell, lateral, neurofibroma

Vol 20 | Issue 2: July- December 2020


Study of lipid profile in type-2 Diabetes Mellitus

Anish Reddy P, Vamshi Krishna, Sanjay H Kalbande
Background: Diabetes is the commonest metabolic disorder affecting the people all over the world. The relationship between alteration of serum lipids and vascular complications is more significant in diabetics than in the general population. The aim of the study was to determine the association between lipid profile in general and triglycerides in particular with type 2 Diabetes Mellitus with respect to age, sex and duration of Diabetes in the studied patients and to study the occurrence of vascular complications in Type 2 diabetes mellitus among the studied patients

Materials and Methods:This study was done on patients, who were admitted to Chalmeda Anand Rao Institute of Medical Sciences Hospital during a period of June 2018 to June 2019. We prospectively collected a series of 100 patients with type 2 diabetes (T2DM) and dyslipidemia, of which 50 were type-2 diabetic patients and not on Lipid lowering agent, the remaining 50 formed healthy control group. Of these fifty study patients, thirty seven were males and thirteen were females. Serum total cholesterol (TC), serum low-density lipoprotein cholesterol (LDL-C), serum very low-density lipoprotein cholesterol (VLDL-C), serum high-density lipoprotein cholesterol (HDL-C) and serum triglycerides (TG) were assayed using enzymatic estimation kit (ERBA-Diagnostics Manheim, GmbH, Germany)

Results: A higher percentage of dyslipidemia (92%) has been found in type-2 diabetic in present study as compared western data (60%– 80 %) the major concern with this study is the high percentage of HDL dyslipidemia (72%) while LDL was 60% similar to western data (60 – 80%)5. While hypertriglyceridemia of more than 200 mg/dl was seen in 48% as compared to 39% of PROCAM study

Conclusion: Results indicate a significance increase in serum VLDL, TG and LDL along with a significant decrease in serum HDL among diabetics as compared to nondiabetics.

Keywords: Diabetes, lipids, high density lipoprotein(HDL),Very low density lipo-protein (VLDL), low density lipoprotein(LDL), total cholesterol (TC)

A clinical study of different modalities in management of Hydrocele at tertiary care Osmania General Hospital, Hyderabad, Telangana

Jithendhar P, Shravan Kumar J, Shirisha J
Background Hydrocele is abnormal collection of serous fluid in some portion of the processes vaginalis commonly in the tunica vaginalis. There are several methods in the treatment of hydrocele and it is mainly surgical. Apart from surgery Sclerosant therapy is also available.

Aims and Objectives:

1.To analyze the age of occurrence, etiology and presentation of hydrocele. 2. To study the various modalities of management and complication associated with different modalities. 3. To analyze the simplicity, expenditure and effectiveness of different modalities

Materials and Methods:Study group selected from the OPD of Osmania General Hospital of OMC, Hyderabad. A total of 60 patients will be selected after applying the various inclusion and exclusion criteria. The patients will subjected to various modalities of management like Lord’s plication, Jaboulay’s procedure, Radical excision of sac and tapping with sclero-therapy depending on the presentation

Results: 60 patients were selected, 50 patients were subjected to open surgeries while the remaining 10 patients were subjected to Aspiration Sclero-therapy. The following study reveals that among open surgeries, techniques in which no dissection or excision of the tunica vaginalis is done are superior since they have less post-operative complications. Results of aspiration sclero-therapy reveal that complications are minimal than open surgeries.

Conclusion: Among open surgeries Lord’s plication is better than Joboulay’s procedure and Radical excision of sac with respect to effectiveness, complication and post-operative hospital stay. Aspiration sclera-therapy can be utilized as an effective alternative to open surgery in patients who are not fit for surgery or those who refuse surgery

Keywords: Hydrocele, processes vaginalis, sclerotherapy0

A study on surgical anatomy of middle thyroid vein

Vijaya Chandra Mouli, Jhansi Rani C, Sarojini C
Background and Objectives:Understanding the anatomic variability of thyroid vessels and laryngeal nerves is of vital importance to minimize the occurrence of eventual complications in thyroid surgery. The purpose of this prospective study was to determine the prevalence of Middle Thyroid Vein together with its macroscopic characteristics and to evaluate possible statistical correlations between the vein presence and some clinical and pathological variables.

Materials and Methods:This study was performed prospectively with the goal of evaluating the prevalence of Middle Thyroid Vein in 200 patients who underwent thyroidectomy in the Department of General Surgery, Government General Hospital, Kakinada, Andhra Pradesh, India.

Results: Over all middle thyroid vein identified in 93 of 200 patients (46.5%). Highest prevalence in age group between 21-30 years 34(47.8%). In benign Thyroid diseases, middle thyroid vein is identified in 79 cases in total 152 patients. In malignant thyroid diseases middle thyroid vein is identified in 14 cases in total 48 patients.

Conclusion: Total of 200 patients were included in this study, overall prevalence of Middle Thyroid Vein 46.5% in 200 patients. Middle Thyroid Vein frequently identified between 21 to 30 years of age.

Keywords: Middle thyroid vein, thyroid gland, venous drainage

Role of detection of Helicobacter pylori in cholecystectomy specimens by using giemsa stain

Sanjeev Kumar Srigiri, Lavanya Kanigiri, Neelima Pavuluri, Ravinder Thota
Background and Objectives:Helicobacter pylori is a gram negative and microaerophilic organism. A dominant human pathogen, Helicobacter pylori (H- pylori) is related to the development of gastric adenocarcinoma and MALT lymphoma in the stomach. H. pylori is also a causative agent of gallbladder cancer by causing chronic cholecystitis due to gall stones and later developing dysplasia, metaplasia and carcinoma. The aim of the present study was to report the Helicobacter pylori(H-Pylori) in gall bladder lesions of cholecystectomy specimens in two years in our pathology department

Materials and Methods:The present study is a prospective study undertaken at the Department of Pathology, Chalmeda Anand Rao Institute of Medical Sciences, Karimnagar over a period of two years. A Total number of 55 cholecystectomy specimens have been studied, out of which 5 were confirmed to be positive for Helicobacter pylori by Giemsa Stain.

Results: The study is conducted to identify the gross and microscopic morphological features of cholecystectomy specimens and to find Helicobacter pylori (H-pylori) positive cases by using simple Giemsa stain. Most of the Helicobacter pylori (H-pylori) positive cases are seen in chronic calculous cholecystitis and Females are more commonly affected

Conclusion: The present study shows Gall bladder pathology is more common in females than in males and affects people mainly in the third to fifth decades of life. Early detection of Helicobacter pylori in cholecystectomy specimens raises chances of potential prevention of gall bladder cancer by eradication of H. pylori through medical therap

Keywords: Helicobacter pylori, Cholecystectomy, gastric adenocarcinoma, MALT lymphoma.

Study of aetiology and prevalence of urinary tract infection in febrile children less than five years age

Ramya C, Naveen Reddy Cheruku, Pavithra Velagandula
Background Urinary tract infection (UTI) is one of the most common pediatric infections. It distresses the child, concerns the parents, and may cause permanent kidney damage. Febrile infants younger than 2 months constitute an important subset of children who may present with fever without a localizing source. The workup of fever in these infants should always include evaluation for UTI.

Aims and Objectives:1). To determine the prevalence of urinary tract infection in febrile children, less than 5 years of age. 2). To know the etiology by assessing the validity of microscopic urine analysis and urine culture in the diagnosis of urinary tract infection.

Materials and Methods:Total 370 febrile children between age group of 1 month to 5 years were taken up for the present study and were evaluated for the causes. Those who had UTI where pus cells >5/HPF were included in the study and were further investigated on Urince culture, and USG.

Results: Out of 370 children between 1months to 5 years of age presenting with febrile period, 48 children had UTI. Urine Culture and USG abdomen of the subjects revealed 73% pyuric children showed no growth on culture, and in those who have shown growth, E.Coli (69.33%) was the commonest organism followed by Acinetobactor. Pseudomonas (7.6%).

Conclusion: Clinicians should be aware of the possibility that febrile children may have urinary tract infection and should consider obtaining a urine culture specimen as part of their diagnostic evaluation. E. coli, which was the most common causative pathogen of UTI in children.

Keywords: Urinary tract infection, pyuria, E.Coli, under five children

To estimate prevalence and risk factors of corneal blindness among patients visiting a district Hospital in southern Andhra Pradesh: A Cross Sectional Study -A note on prevention strategies

Sireesha G, Sree Kumar V
Background After the cataract, corneal blindness is considered as second leading cause of blindness in most of the developing countries of the world population. It is estimated that 4.92 million people suffer with corneal blindness worldwide who could be restored vision through corneal transplant surgeries

Aims and Objectives:1). To estimate the prevalence of corneal blindness among patients visiting outpatient department of a district level teaching hospital in southern Andhra Pradesh. 2).To determine the demographic& clinical factors associated with corneal blindnessamong outpatients visiting the hospital

Materials and Methods:This is a hospital based descriptive cross sectional study conducted in a district level teaching hospital in southern Andhra Pradesh for about 8 months. This includes patients from both rural& urban areas with all age groups. After screening for visual acuity, anterior segment examination and fundoscopy findings, related factors of corneal blindness of age, gender, and occupation are considered.

Results: The most frequent causes of unilateral corneal blindness includes childhood keratitis (26.7%), trauma (18.6%), keratitis during adulthood (15.75%). The most vulnerable group is older age people occupied in agriculture & outdoor work. Bilateral corneal blindness is more common in rural people. In most cases trauma is the cause of unilateral corneal blindness where as infective & immunological reactions leads to bilateral corneal blindness.

Conclusion: About 94% of all causes of corneal blindness was due to avoidable factors. Improvement of eye health promotion strategies and rising awareness about the causes and prevention methods regarding corneal blindness is a great concern.

Keywords: Trauma, keratitis, xerophthlmia, keratoplasty, optical rehabilitation

The diagnostic value of TTF-1 and P63 immunostaining in the classification of Non Small Cell Lung Carcinoma

Vinay Kumar A, Raj Kumar K, Praveen Kumar Ch, Y Monica
Aims and Objectives:The aim of the present study was to differentiate non small cell lung carcinomas (NSCLC), especially for distinguishing adenocarcinoma and squamous cell carcinoma by Immunohistochemistry

Materials and Methods:A prospective study of all the patients presented to department of Pulmonary Medicine, Chalmeda Anand Rao Institute of Medical Sciences, suspected of having lung carcinoma

Results: Among, 30 cases of Non Small Cell Lung Carcinoma (NSCLC), 21 cases were diagnosed as adenocarcinoma and 9 cases were squamous cell carcinoma. Patient age ranged from 41-80 years with peak incidence between 61-70 years (40%). Males are affected most commonly than females (63%). Weight loss (47%) and cough (43%) were the commonest presenting symptoms. 73% cases were associated with smoking. In the present study 100% cases diagnosed as adenocarcinoma on histomorphology showed TTF-1 positivity , 100% cases diagnosed as squamous cell carcinoma on histomorphology showed P63 positivity .

Conclusion: Analysis of a lung biopsy is very important as many lung tumors cannot be resected. To get a concrete diagnosis the use of molecular techniques as well as IHC in concert is very important. TTF1 and P63 are complementary for differentiating adenocarcinoma and squamous cell carcinoma and is now important because new therapies have been developed that have different therapeutic or adverse effects depending on the histologic type.

Keywords: Lung carcinoma, adenocarcinoma, squamous cell carcinoma, TTF-1, p63

A Cross-sectional study of animal bites reported to District Hospital, Karimnagar

Aswan Gaddala, Pratima Matli, Rajamouli J
Background and Objectives:Rabies is an endemic, highly fatal disease in more than 150 countries. 18 to 20 thousand deaths occur annually in India due to Rabies. The aim of study was to describing the socio demographic profile of animal bites reporting to the Karimnagar District Hospital.

Materials and Methods:A cross-sectional retrospective record-based study was done from June 2018 to September 2018, at Government District Hospital, Karimnagar, for all the animal bites that were registered during the previous year (2017). For the same period, the records of all the animals that were vaccinated at the District veterinary hospital were studied. The data was entered and analyzed by SPSS v16.0.

Results: A total 2349 animal bites were registered. The mean age of victims of animal bites was 31.82 years (SD ±19.82). 65% of the bites reported were in males where as 35% were in females. Dog bites were highest that is 88% and 6.4% of the bites were reported by monkey bites. An average of6.43 cases were registered per day. In the concurrent period, a total of 945 animals were vaccinated at Veterinary Government Hospital of which 99% of the vaccinated animals were dogs.

Conclusion: The burden of animal bites is high in Karimnagar, most cases being dog bites. Rate of vaccination of pets and domestic animals are low.

Keywords: Animal bites, rabies, dog bite, monkey bite

Cell proliferation marker Ki-67, its prognostic and predictive value in squamous epithelial dysplasias and squamous cell carcinoma of orophaynx

Aruna Kumari Pagalla, Prashanth Gunde, Manoj Gunde
Background Antigen Ki-67 is a nuclear histone protein associated with cellular proliferation and expressed in certain phases of cell cycle (S, G1, G2, and M). Over expression seen in malignant tissues and associated with poor prognosis hence it is used as biomarker in neoplastic tissues

Aims and Objectives:Antigen Ki-67 is a nuclear histone protein associated with cellular proliferation and expressed in certain phases of cell cycle (S, G1, G2, and M). Over expression seen in malignant tissues and associated with poor prognosis hence it is used as biomarker in neoplastic tissues

Materials and Methods:The sample consisted of 100 formalin-fixed, paraffinembedded specimens of oral pharyngeal squamous epithelial dysplasia (OPSED), oral squamous cell carcinomas (OPSCC)were conventionally stained with hematoxylin and eosin then immunohistochemically stained with Ki-67 monoclonal antibody.

Results: Expression of Ki-67 was restricted to the basal layers in the normal oral epithelium whereas Ki-67 positive cells were located in the basal, suprabasal and spinous layers, Ki-67 expression was increased in high-risk cases. Ki-67 positive cells in well-differentiated OPSCC were located mainly in the periphery of the tumor nests, in moderately-differentiated OPSCC were located in both peripheral and part of a center of the tumor nests whereas it was diffused in most of the Poorly-differentiated OPSCC. Statistical analysis indicated a significant difference be-tween the expression in OPSED and OPSCC .

Conclusion: This study has concluded that Ki-67 antigen could be used as a marker for the histological grading of and OPSCC (Oropharyngeal squamous cell carcinoma), Expression of Ki 67 increased according to the severity of squamous epithelial dysplasias and squamous cell carcinomas.

Keywords: Ki-67 antigen- Oropharyngeal squamous epithelial dysplasia (OPSED)- Oropharyngeal squamous cell carcinomas (OPSCC).


Ascaris worm in nasogastric tube aspirate

Sravya Inavolu, Kurimilla Archana, Rajesh B, Vamshi Krishna TV, Sanjay H Kalbande
Most cases of round worm infestations are asymptomatic. Their migration to various unusual sites in the gastrointestinal tract and respiratory tract may cause complications. Accumulation of worms inside the intestinal lumen can lead to obstruction, intussuception, or volvulus. However, migration of the worm in the stomach and consequent hematemesis is a very rare complication. Mechanism of hematemesis is assumed to be erosion of the mucosa either by mechanical process or by the secretions of the worm. We report a case of 23 years, young female admitted in intensive care unit , for organophosphorous poisoning, on invasive mechanical ventilation, who had coffee ground contents and later ascaris worm in her nasogastric tube aspirate, around 4 days after admission which interfered with the ongoing treatment and prolonged hospital stay

Keywords: Ascaris lumbricoides, hematemesis, gastric ascariasis, nasogastric tube, aspiration



Vol 17, Jan-June 2019

Vol 18 | Issue 2: July- Dec 2019


Current Issue Vol 17, Jan-June 2019


A Comparative Study of the Effects of Intrathecal Midazolam(1Mg) and Fentanyl(25 Micrograms) as Additives to Intrathecal Hyperbaric Bupivacaine (0.5%) for Spinal Anaesthesia

Raja Bhushanam, Sunil Kumar , Syed Ali Aasim, RajeethKumar Reddy
Background and Objectives:The purpose of study was to compare the effects of intrathecal midazolam (1 mg) and fentanyl (25 micrograms) as additives to intrathecal hyperbaric bupivacaine (0.5 %) with spinal anaesthesia.

Materials and Methods:The study was prospective clinical study, total sampling 100 patients of ASA physical status 1 and 2 in the age group of 18 years to 60 years; posted for elective lower limb, lower abdominal, gynaecological and urological surgeries under spinal anaesthesia.

Results: The mean onset of sensory block in group A was 227.9 sec and in group B, mean onset of sensory block was 223.6 sec. There were no differences between the two groups with respect to the onset of block as significance value obtained from independent sample’s t test was more than 0.05

Conclusion: In conclusion, there were no differences in the durations of complete and effective analgesia when fentanyl 25 micrograms or midazolam 1mg was used as additive to intrathecal hyperbaric bupivacaine for spinal anaesthesia.

Keywords: Intrathecal Midazolam, fentanyl, intrathecal hyperbaric bupivacaine, spinal anaesthesia

The Dosimetric Influence of Central Vaginal Cylinders in High Dose Rate (HDR) Iridium (Ir192) Brachytherapy Treatment

Giridharan Sampath, Satheeshkumar Anbazhagan, Chandrakant D. Lokhande
Background and Objectives:In the brachytherapy treatment plan dose calculations, the effect of applicators densities is neglected. Most commercially available planning systems are using dose calculation algorithm based on TG 43 formalism. In this formalism, whole medium is considered as homogenous water. However in the treatment delivery, applicators are placed inside the patient can cause some dosimetrical changes

Materials and Methods: In this study the dosimetric influence of central vaginal applicators of different diameters (2, 2.5, 3.0 and 3.5 cm) and plastic catheter (consider as without applicator) were measured from source center to range of distance (2.0 to 6.0 cm) in the water medium. The measurement is carried out in radiation field analyzer (RFA) with help of 0.125 cc ion chamber and EDR2 radiographic films. The experimentally measured doses and treatment planning system (TPS) doses are compared

Results and Discussion:The experimental values of plastic catheter measurement data well agreed with TPS calculated data due to homogeneous medium used in the measurement. The difference in the doses is observed when high density applicator is used in a measurement

Conclusion:Larger differences in doses of 13 cGy were observed when using a small diameter of applicator, measurement at minimum distance from the center of the source, due to scattered photons and secondary electrons produced in the applicator material. For increased distance from the center of the applicators, doses were well agreement with TPS calculated doses due to lesser range of scatter components in the medium.

Keywords: Brachytherapy, dosimetry, EDR2 film, ion chamber, iridium-192

Screening of Healthcare personnel for Human Immuno Deficiency Virus (HIV), Hepatitis B (HBV) and Hepatitis C(HCV) Infections in Mahathma Gandhi Memorial Hospital, Warangal, Telangana

G.V. Padmaja, A. Mrudula
Aims and Objectives: 1. To screen health care personnel for HIV, Hepatitis B and Hepatitis C infections at Mahathma Gandhi Memorial Hospital, Warangal. 2. To alert health care personnel regarding modes of transmission of these infections and prevention by proper vaccination. 3. To know their knowledge about biomedical waste guidelines and management of biomedical wastes. 4. To know the seroprevalence of HIV, HBV, HCV in Health care personnel.

Materials and Methods: A prospective study was done by filling a proforma consisting of questions regarding modes of transmission of these infections, history of vaccination, blood transfusion, needle stick injuries and disease prevention practices followed by the health care personnel working at Mahathma Gandhi Memorial Hospital, Warangal, Telangana. After taking an informed consent 498 blood samples were collected, which include 298 blood samples from study group i.e, health care personnel and 200 blood samples from general healthy population (control group). Blood samples were screened for HIV antibodies by HIV Tridot test, for Hepatitis B surface antigen by ELISA (HepaLISA) and for HCV antibodies by ELISA (erbaLISA HCV Gen3 [V2] )

Results: : Seroprevalence of Hepatitis B surface antigen in health care personnel was 0.67%, HIV antibodies was 0.34%, and no antibodies were detected for HCV in health care personnel

Conclusion: Our results show prevalence of Hepatitis B antigen and HIV antibodies in health care personnel at Mahathma Gandhi Memorial Hospital, Warangal is slightly higher to that of general healthy population and no prevalence HCV in the health personnel was detected on screening. This indicates proper practice, training, knowledge about handling biomedical waste which prevent transmission of HIV, HBV, HCV infections from patients to health care personnel.

Keywords:Healthcare personnel, seroprevalence, HIV, HBV, HCV

A Comparative study of Fetal Weight Estimation by Various Methods at Term Pregnancy

Arjumand Bano, Madala Kalyani
Background:Estimation of fetal weight in term pregnancies is very important in deciding when to deliver the baby and mode of delivery. Estimated Fetal weight (EFW) is now incorporated in the standard antenatal evaluation of pregnancies. There are various clinical and ultrasound methods to estimate fetal size and weight in utero.

Aims and Objectives: The aim of this study was to estimate fetal weight in term pregnancies by various methods and compare it to the actual birth weight in term pregnancy.

Materials And Methods:This study was a prospective study done on 50 pregnant women with term gestation between 37- 40 weeks admitted for delivery in the Department of Obstetrics and Gynaecology in Chalmeda Anand Rao Institute of Medical Sciences from January 2018 to January 2019. Ultrasonographically the fetal weight is estimated by using Hadlock’s formula in which weight is estimated by using fetal measurements like Bi Parietal diameter(BPD), Femur Length (FL), Head circumference (HC), Abdominal Circumference (AC).

Results: : Among the various methods used ultrasonography method has a superior edge in prediction of birth weight. Of the clinical methods Insler’s formula is comparable to actual birth weight next to Ultrasound.

Conclusion: Of the various methods used to estimate fetal weight ultrasound has more accuracy. However clinical methods of estimation remain a valuable alternative where ultrasound is unavailable. The clinical methods are of significance in developing countries where health care workers can predict the baby weight and can make use of referral services to decrease the perinatal mortality and morbidity.

Keywords:Fetal birth weight, insler’s formulae, johnson’s formulae, dawn’s formulae, hadlock’s formulae

Radiological Anatomy of the Lumbar Canal: A MRI study

Mohammed Awais Ahmed, Aditya, Anitha, Sailaja
Aim: 1. To examine the morphometric dimensions of the lumbar spinal canal in relation to gender in symptomatic Telangana state population and to relate the acquired data with other populations. 2. To determine whether mid-sagittal and transverse diameters vary with gender or not.

Materials and Methods: : The mid-sagittal and transverse diameters of the lumbar spinal canal (L1-L5) from 80 symptomatic adults were recorded using Magnetic Resonance Imaging (MRI) at the Radiology department of Chalmeda Anand Rao Institute of Medical Sciences, Karimnagar, Telangana. Individuals with former lumbar spine surgery, vertebral trauma, tumours and infections or congenital anomalies were excluded from the study.

Result : The mean transverse diameter of the lumbar canal was significantly larger in males. There was no statistical gender difference observed for the average mid-sagittal diameter. The smallest average mid-sagittal diameter for both the genders was observed at L3 level which was responsible for hour-glass shape of the canal.

Conclusion: The present study gave us an idea regarding the anatomical dimensions of the human lumbar canal of clinically symptomatic patients in relation to basic parameters like gender and race. Also since transverse diameter was the largest dimension of spinal canal, it indicates that mid-sagittal diameter is clinically the most significant dimension of spinal canal and valuable in diagnosis of lumbar spinal stenosis.

Keywords: Lumbar spinal stenosis, lumbar spinal canal, mid-sagittal diameter, transverse diameter

The Ratios of Glycosylated Haemoglobin to Mean plasma glucose in Diabetes Mellitus Type -2 patients in predicting the early complications of the disease

Jyotsna,Sudhakar,Sanath Kumar,Sabitha, G Raj Kumar
Background And Aim: The Measurement of hemoglobin A1c (HbA1c) is considered the gold standard for monitoring chronic glycemia of diabetes patients. There some studies of importance in monitoring glycemia which had showed events to established a direct relationship between mean blood glucose (MBG) and the development and progression of chronic diabetic complications.

Materials and Methods: 50 samples of non-Diabetic were taken as healthy controls and 50 samples of Diabetic patients of ages ranging from 35-80 years were studied by assessment of Glycosylated Haemoglobin and calculation of Mean plasma glucose were accounted for documentation in the study. The study was conducted in Chalmeda Anand Rao Institute of Medical Sciences, Karimnagar, Hospital Central Lab for which the samples were analysed, sent from OP and IP of various dept in the hospital from September 2018 to February 2019.

Result : The mean, SD of Glycosylated Haemoglobin in controls (non -Diabetic) and subjects in the study group with Diabetes type-2 with long duration are shown in table-1 and 2 as 4.76± 0.62 in non –Diabetic controls and 8.44 ± 2.07 in Diabetic patients for GHB and It has been shown as 89.40 ± 24.90 in non-diabetic controls and 223.02± 73.80 in Diabetic patients for MPG . The ratios of GHB & MPG were shown in figure-2 as 18.78 for non-Diabetic and 26.42 in Diabetic patients respectively showing mean of subjects of diabetic patients increase than non- diabetic. The P values showed highly significant less than 0.0001 and for ratios which were calculated was less than 0.0014.

Conclusion: The Glycosylated Albumin [GA]/GHbA1C ratio was unpredictable but the ratio of GHbA1C/ Mean plasma glucose showed that it is better parameter to use in clinical practice in the present study for the containment of complications in Diabetic patients due to easy to interpretation and as there is correlation between GHB and Mean plasma Glucose.

Keywords: Ratios of GHbA1C, Mean plasma glucose in diabetic patients

Study of Suicidal Deaths in Married Women in a Tertiary Care Hospital at Warangal: Medico-Legal Analysis

RajaRao, Rajesham
Background And Aim:Each suicide is a personal tragedy that prematurely takes the life of individual and suicidal deaths in married women dramatically affecting the lives of families, friends and society. The aim of study was to know the causative factors and how to prevent the suicidal deaths in married women.

Materials and Methods: This study was a retrospective study, which includes medico legal cases of autopsies conducted at Department of Forensic Medicine, Kakatiya Medical College, Warangal (T.S.) from 1st January 2007 to 31st December 2012, were reviewed the postmortem reports, Inquest reports.

Result:Out of 5308 autopsies conducted 1104 cases belongs to suicidal deaths in married women aged between 25-40 years. The factors related to suicide deaths are 90% illiterate, 30% illhealth reason, 20% dowry reasons

Conclusion: Family problems and ill health were major causes for suicidal deaths in married women and committing suicide by poisoning followed by burning, hanging and drowning.

Keywords: Suicide, married women, dowry deaths, poisoning, burns.

A Clinical Study of Multiple Cranial Nerve Palsies

Sanjay Kumar Venatesh, Rajesh
Aim:The aim of study was to examine the seats and causes of multiple cranial neuropathies 50 patients who attended at tertiary care Hospital, Karimnagar.

Materials and Methods: The study was a cross sectional study includes with multiple cranial nerve palsies. The study was conducted in Chalmeda Anand Rao Institute of Medical Sciences, Karimnagar between September 2016 to December 2018. Data were collected on age, sex, type of cranial nerve palsy, history of diseases such as diabetes mellitus, hypertension and cardiovascular disease.

Result: Total 50 patients with multiple cranial neuropathy met the inclusion criteria, out of which 31(62%) were males and 19(38%) were females. Vascular disease was responsible for 20 (40%) of the 50 cases. Out of 20 cases of vascular disease, acute stroke was responsible for 16 cases, Ischemic polyneuropathy was responsible for 3 cases, CSVT is responsible for one case.

Conclusion: In our study showed that vascular causes constitutes most common cause of cranial neuropathy. Mean age of presentation of vascular disease was 50.5 years, in which male patients are affected in 65% of cases and female patients are affected in 35%.

Keywords: Multiple Cranial nerve, neuropathy, vascular disease

Giant ileal lipoma causing ileo-colic intussusception in Adult : A Case Report

Vissa Shanthi,Nandam Mohan Rao, Byna Syam Sundara Rao, Bhavana Grandhi, Divya Tejaswi
Abstract:Intussusception occurring in adults is rare and constitutes 5% of all intussusception cases. Lipomas are benign tumours and occur infrequently in gastrointestinal tract. Gastrointestinal lipoma leading to intussusception is uncommon. We report a case of 45 years female patient presenting with features of acute abdominal obstruction. On exploratory laparotomy, ileocecal intussusception was noted with lipoma as lead point. Histopathology confirmed the diagnosis.

Keywords: Intussusception, ileocolic, lipoma, adults

Multi-Disciplinary Therapeutic Approach of Cerebral Atrophy Ammonia: A Single Case Study

Abstract: Cerebral atrophy ammonia, a neuro developmental disorder, is a rare, progressive that has been reported only in the girl child. A case of an 8-year-old girl with Cerebral atrophy ammonia is presented here. The present study observed who have normal development till the age of 3 years. However, gradually over the next few months, she lost her acquired, purposeful hand skills; expressive and receptive language; and reciprocal social interaction; she gradually developed a broad-based gait and typical stereotyped hand movements. EEG and MRI were abnormal. Awareness of this disorder is required for early diagnosis and prompt treatment. The inclusion Criteria which consists of partial or complete loss of acquired purposeful hand skills. Gait abnormalities; impaired (dyspraxia) or absence of ability. This case report emphasizes the importance of being aware of rare yet significant disorders of interest to paediatric physiotherapist.

Keywords: Cerebral atrophy ammonia, methyl ECP pervasive developmental disorder, neurodevelopmental disorder

Unicentric Castleman’s Disease- A Case Report

Prashant Kumar Dontula, Sumalatha Kasturi, Praveen Kumar Manikyam
Abstract: Castleman’s disease or angiofollicular lymph node hyperplasia is a rareclinicopathological entity characterised bybenign proliferation of lymphoid tissue. Two clinical forms have been described. A unicentric presentation with the disease confined to a single anatomic lymph node which is more common and a multicentric presentation characterised by generalised lymphadenopathy and a more aggressive course. Pathologically three histopathological subtypes have been described: Hyaline vascular type, plasma cell type and a mixed variant. Preoperative diagnosis of hyaline vascular type of Castleman’s disease is difficult and the definitive diagnosis is based on the histopathological examination of post- operative pathological specimen. The definitive treatment of unicentriccastleman’s disease is complete surgical excision.

Keywords: Castleman’s disease, unicentric, hyaline vascular.

A Rare Presentation of Pyrexia of Unknown Origin as Subdural Empyema in a Tertiary Care Hospital – A Case Report

Madoori Srinivas, Majaz Ahmed Khan, Abhignya Verma
Hospital visit in pediatric population is most commonly due to fever. It causes considerable anxiety in parents especially when the cause of fever is unknown. Infections are the most common cause of fever in children. Fever is often due to self-limited viral infection but in certain cases it may be a sign of serious underlying bacterial infection like Pneumonia; UTI; Meningitis; Osteomyelitis; Arthritis; Empyema and Enteritis. Routine laboratory investigations aids in identifying the cause of fever. However in a minority of patient’s extensive investigations including invasive procedures may be needed to identify cause of fever. Subdural Empyema is a very rare condition in children. Fever, altered mental status, headache, seizures and focal neurological deficit are the common presenting complaints in a child with subdural empyema. In this case report we present a 5 year old male child who had fever of unknown origin without neurological complaints or predisposing factors and who was diagnosed with subdural empyema

Keywords: Fever, subdural empyema, fever of unknown origin

Vol 18 | Issue 2: July- Dec 2019


Effect of Iridium-192 (Ir 192) HDR Brachytherapy Source Decay during the Treatment Time in Gynecological intracavitary Brachytherapy Treatment

Giridharan Sampath, Satheeshkumar Anbazhagan, Chandrakant D. Lokhande
Background: In brachytherapy treatment, a small error in the planning gives larger dosimetrical difference in treatment delivery. Basically Iridium-192 decays about 0.5% every 12 hours and 1% per day. Therefore during the treatment time, the source decay would affect the treatment doses. In the commercial available brachytherapy dose calculation planning system the Iridium (Ir192) source decay during the treatment period is not considered. The purpose of this study was to quantify the effect of Iridium (Ir192) source decay during the treatment time in cervical brachytherapy treatment plans

Materials and Methods: For this study, 48 intracavitary brachytherapy treatment plannings are analyzed. The Iridium (Ir192) High Dose Rate (HDR) radioactive source is used for the treatment planning. In every planning, each dwell position time was corrected related to their respective Air kerma strength. The reduction in the Point A doses and bladder and rectum point doses are noted in actual and decay corrected plans in the range of 10 Curie (Ci) to 1.8 Curie (Ci) activity.

Results: It found that maximum 0.23, 0.16 and 0.11 cGy dose differences in Point A, bladder, and rectum, respectively of 1.8 Ci activity plans

Conclusion: The minimal dose difference in maximum activity plans is due to small dwell position times in plans and the maximum dose difference in minimum activity plans is due to larger dwell position time in the plans. It is concluded that dose differences are not only depending on activity, but also on the position of the point A and bladder and rectum from the lower most dwell position.

Keywords: Brachytherapy, dosimetry, decay, HDR, Iridium-192

Role of Double J Stent in patient with Renal Stones undergoing Extracorporeal Shockwave Lithotripsy

Role of Double J Stent in patient with Renal Stones undergoing Extracorporeal Shockwave Lithotripsy
Background and Objectives:The use ureteral stents can reduce the complications after extra corporeal shock wave lithotripsy (ESWL). However, the insertion of double J stents during ESWL is controversial. This study was aimed to determine whether the stenting prior to ESWL will increase the stone clearance rate in patients with renal calculi less than 2 cm.

Materials and Methods: Patients who had lower ureteric calculi of size ranging from 5-20 mm in diameter and treated with ESWL were included.

Results and Discussion:Total 60 patients were included in the randomized prospective study. Gender, stone side and stone nature had no significant influence on clearance. Features like dysuria, pyuria, requency and urgency showed significant correlation with stented patients

Conclusion:Stenting prior to ESWL significantly increases the stone clearance rate in patients with renal calculi. Parameters like gender side or stone nature had no influence in clearance following ESWL. Frequency, urgency, dysuria and pyuria were significantly more in stented patients

Keywords:Corporeal shock wave lithotripsy, double J stenting, renal calculi

Evaluation of Thrombocytopenia in Dengue Infection in Correlation with Clinical Profile and Immunological Status along with its Seasonal Variation

Aruna Tekumalla, Neelima Pavuluri, Ravinder Thota
Aims and Objectives: Dengue is a rapidly spreading mosquito born Arboviral infection, clinical spectrum of which ranges from self limited Dengue fever (DF) to life threatening severe Dengue, Dengue haemorrhagic fever (DHF) and Dengue shock syndrome(DSS). The aim of study was to evaluate thrombocytopenia and to correlate with clinical profile and immunological status in dengue infection and also to see the seasonal variation of the disease.

Materials and Methods:The present study is a prospective cross sectional study conducted over a period of 2 years, January 2017 to December 2018, in patients admitted in Chalmeda Anand Rao Institute of Medical Sciences, Karimnagar. A total of 1386 suspected fever cases have been studied, out of which 250 were confirmed to be serologically positive as Dengue infection. Platelet count was evaluated by automated cell counter and also confirmed by manual examination by peripheral smear.

Results: A majority of patients were below 30 years with a male preponderance. There was a significant positive predictive value between the age groups and severity of thrombocytopenia. NS1 positivity is seen in 18% of suspected patients, out of which 42% IgM positive and 19.2% IgG positive. Severe thrombocytopenia was seen in patients who were both IgM and IgG positive, with a significant p-value. Also the majority of cases were observed in postmonsoon period with a significant seasonal variation of the disease

Conclusion: The present study could comprehensively assess the prevalence and severity of thrombocytopenia and its association with clinical and immunological status in Dengue patients along with seasonal variation of the disease

Keywords:Thrombocytopenia, dengue infection, immunological status, seasonal variation.

Role of Electron Beam Therapy in the Management of Keloids: A Tertiary Institute Experience

Ezhilarasi Ravindran, Anand Kumar P, Indumathi
Aims and Objectives:Keloids are debilitating fibrous skin proliferations with a high recurrence rate after surgical treatment. Postoperative radiotherapy (PORT) is a well-tolerated adjuvant treatment to reduce the risk of recurrence, but the optimal regimen for this combined treatment remains unknown. The aim of this study was to evaluate the efficacy of combining surgical excision and immediate PORT

Material and Methods:We retrospectively reviewed the records of patients with keloid lesions treated with adjuvant PORT in the period 2013 to 2019 at Chalmeda Anand Rao institute of medical sciences (CAIMS) cancer hospital and research institute, Karimnagar. Main outcomes were the cosmesis, including the patient and observer scar assessment scale satisfaction scores.

Results:14 patients with keloids were eligible. No major complications were observed. The overall patient and observer satisfaction rate was excellent

Conclusion: Surgical excision combined with immediate electron beam PORT is aneffective and easy treatment with good esthetic results and an acceptable modality oftreatment. It should be considered for patients with persistent keloid formation after failure of other treatments and those at high risk of relapse.

Keywords:Keloid, scars, radiotherapy, intralesional excision, scars correction

A Study to find the Risk of Knee Injuries in Non-Professional Football Players

Hemant Hamal, Sumi Rose
Background Non-professional football players are those who play occasionally and mostly, do not possess the physical attributes and are untrained unlike professional players.The high intensity of football activities is related to the risk of injury in professional, non-professional, amateur and youth players

Aim and objectivesTo find the risk of knee injuries in non-professional football players.

Materials and Methods: The purposive sampling of 200 subjects (n=200) from the community and colleges in and around the Bangalore were assessed and screened. Nonprofessional Players between 18-27 years of age were included in this study. Demographic data was collected, and the bilateral Q-angle was recorded from the athletes. Knee outcome survey - activities of daily living (KOS-ADL) questionnaire was given to athletes

Result : The current study could not predict the risk of knee injuries in non-professional football players

Conclusion: Based on the results of this study, it is concluded that higher Q angles alone might not be responsible for knee injuries. Though the results of the study found the significant positive correlation between right and left Q angles, it showed moderate to poor correlation between right and left Q angles with KOS-ADL scale. Therefore, this study could not predict the risk of knee injuries in the non-professional football players

Keywords: Amateur Football players, Q angles, KOS-ADL, knee injuries

A Study on Electrocardiogram Changes in Hypothyroidism

Sirish Ardhapurkar, Raghu Ramulu, Srinivas S, Shiva Subramanyam P
Background:Hypothyroidism is very common endocrinological disorder in Worldwide. Iodide uptake is a critical first step in thyroid hormone synthesis. The aim of study was to assess the electrocardiogram changes in the patients with hypothyroidism

Materials and Methods:Total study samplings were 140 patients. The age group is between 20 years and 60 years. The study period was from October 2018 to September 2019. The investigations advised are T3 T4 TSH and 12 lead electrocardiogram. The inclusion criteria is patients who are known case of hypothyroidism and on L-thyroxine. The Exclusion criteria is pts who are on ß -Blockers, Hypertension, coronary artery disease and COPD and left sided pneumothorax.

Result:Hypothyroidism patients among 140 patients, females were 96 and males were 44. The age group is between 20 years and 60 years. The common age group in our studyis 30 years to 40 years, after care full history talking and clinical examination 12 leadelectrocardiograms was taken. The common ECG abnormalities noted were sinus bradycardia, T wave inversion and low voltage complexes and incomplete RBBB also noted.

Conclusion: Hypothyroidism is a common medical problem worldwide and in India also. After T3 T4 TSH estimations electrocardiogram is useful investigation in hypothyroidism. Coronary artery disease is common in hypothyroidism. By taking periodical ECG’s can reduce the complications because of hypothyroidism

Keywords: Hypothyroidism, electrocardiogram, low voltage complexes, pericardial effusion, bradycardia

A Single Dose of 0.75% Epidural Ropivacaine is ideal for Lower Limb Orthopedic Surgeries - Quashing the Myth

Chada Sirisha, Pavan Kumar A, Syed Ali Aasim
Background:The efficiency of 0.75% Ropivacaine as a single shot epidural anaesthetic in comparison to 0.5% Bupivacaine has been widely studied and proven to be a safer alternative to the later. The present study aim was to focuses on the impact of motor blockade with Ropivacaine on long duration lower limb orthopedic surgeries

Materials and Methods:The present study was done with 0.75% Ropivacaine and 0.5% Bupivacaine in epidural anaesthesia in lower limb orthopedic surgeries given as a single shot technique in eighty patients of ASA I/II and divided to two groups of forty each and fifteen milliliters of the drug given. Duration of surgery was calculated as the difference between the administration of epidural anaesthesia and the last suture of the surgical wound. Onset of the motor blockade with Modified Bromage scale Iand regression to Scale 0 was assessed and thus duration of motor blockade of epidural anaesthesia was calculated individually in group R and group B respectively.

Result:Onset of motor blockade was faster in group R than in group B and regression was faster in group R than in group B. Also, intensity of block was greater in Group B.

Conclusion: It can be concluded that duration of motor block in epidural anaesthesia was shorter and less intense with 0.75% Ropivacainethan 0.5% Bupivacaine, in which group surgeries outran anesthesia

Keywords: Epidural Anaesthesia, 0.75% ropivacaine, 0.5% bupivacaine, lower limb orthopedic surgeries

Study of Pregnancy Outcome after Emergency/Rescue Cerclage

Arjumand Bano, Meenakshi C Koteeswaran
Background:Cervical incompetence is defined as the inability to support a pregnancy to term due to a functional or structural defect of the cervix. The aim of study was to evaluate the effectiveness and safety of emergency cervical cerclage in women with advanced cervical dilatation and bulging of fetal membranes

Materials and Methods:This is a retrospective study of case files of 35 patients who underwent emergency second trimester cerclage with advanced cervical dilatation (2 to 4 cm), some with bulging of fetal membranes during the period January 2019 - January 2020. The McDonald technique was employed in all the cases

Result:Out of the 35 patients for whom emergency cervical cerclage was performed, four patients had spontaneous abortion after cervical cerclage and twelve of these patients had term delivery. Thirty one fetuses were live born after the period of viability. Twelve of these babies (35 percent) were admitted to NICU and 19 neonates (55 percent) required only regular perinatal care

Conclusion: Post emergency cervical cerclage, the outcome in terms of prolongation of pregnancy, live births and neonatal survival is better

Keywords: Cervical dilatation, emergency cerclage, McDonald

Study of Variation of Knee Joint Space in Relation with Age using the Radiographs

Aditya M, Mohammed Awais Ahmed, Anitha T
Background: Knee joint is a compound joint having two condylar joints between the femur and tibia and a sellar (saddle) joint between patella and femur

Objective:1. To measure the joint space width of the medial and lateral joint spaces in knee joint radiographs
2. To study the variations of joint space width in relation with age

Materials and Methods: The present study was conducted at Chalmeda Ananda Rao Institute of Medical Sciences, Karimanagar from October 2017 to October 2018 on radiographs of both the knees of 150 individuals

Result:The mean medial joint space width of the right and left knee was 4.87±0.44 and 4.89±0.30 respectively. The mean lateral joint space width of the right and left knee was 5.87±0.43 and 5.87±0.30 respectively

Conclusion: The medial and lateral joint space widths were studied, in relation with age. The values were found to decrease with increasing age

Keywords: Knee joint, medial joint space width, lateral joint space width, osteoarthritis

Study of Lung Function and Cardiac Function in Patients of Chronic Obstructive Pulmonary Disease

Raj Kumar K, Sony Reddy, Monica Y
Background:Chronic obstructive pulmonary disease (COPD) is the name of a group of chronic and slowly progressive respiratory disorders characterized by reduced maximal expiratory flow during forced expiration

Objective:To assess lung function and cardiac function in COPD patients and to correlate the severity of COPD and cardiac dysfunction

Materials and Methods: A Hospital based cross sectional study of inpatient and outpatient in department of Pulmonary Medicine of Chalmeda Anand Rao Institute of Medical Sciences.

Result:Among 100 patients with COPD, maximum patients- 36% were found to be in Stage II and majority (82%) were males with mean age between 50 – 80years. The mean BMI was less in severe and very severe COPD compared to mild stage. Increase in the duration of illness was associated with more severe disease. ECG abnormalities were found in 49% of the patients. The frequency of pulmonary hypertension in various stages of COPD from Stage I to stage IV was 8%, 47.2%, 57.1% and 90%. The incidence of systolic dysfunction was found in 12% and diastolic dysfunction was found in 41% of the patients

Conclusion: In our study, majority of the patients belonged to the moderate, severe and very severe stage of COPD according to GOLD staging. Increase in severity of COPD was associated with an increase in pulmonary artery pressure. A significant increase in the incidence of diastolic dysfunction or severity of diastolic dysfunction in comparison with the severity of COPD could not be found in our study. Diastolic dysfunction was found in patients even with normal pulmonary artery pressure

Keywords: Chronic obstructive pulmonary disease (COPD), ECG, pulmonary artery pressure, diastolic dysfunction

Seroprevalence of Syphilis and Biological False Positive Reactions among Different Population Groups attending a Tertiary Care Hospital, Warangal

Sreedevi S, A. Mrudula S
Background:Syphilis is a sexually transmitted infection, remains an important cause of morbidity in developing countries like India. The purpose of this study was to determine the true picture of seroprevalence of syphilis and biological false positive reactions in different patient groups at a tertiary care hospital, Warangal

Materials and Methods:A total of 4571 serial serum samples obtained over a period of 1 year (August 2017 to July 2018) from different patient groups were screened by RPR (Rapid Plasma Reagin) test both qualitatively and quantitatively. RPR reactive sera were confirmed by Treponema pallidum hemagglutination assay (TPHA)

Result: The overall seroprevalence of syphilis by RPR test was 5.81% and biological false positive rate in test population was 1.09%.

Conclusion: All the sera positive with RPR test must be confirmed as positive by TPHA.

Keywords: Syphilis, RPR, TPHA, Biological false positive


A Rare Case report on Dentigerous Cyst Associated with Impacted Supernumerary Tooth

Jadi Lingaiah, Ramtenki Nishanth, Vamshi Krishna Rao K, Deepak Kumar Phulwani
Dentigerous cyst is an odontogenic cyst of developmental origin, formed due to collection of fluid between reduced enamel epithelium and enamel surface of a formed tooth. In a case of dentigerous cyst the history and radiological investigations suffice and leads to diagnosis and a treatment plan. Here, we report a case of a 7 year old boy with painless swelling in right upper jaw since 1 month, on examination and further investigations, it was found to be a case of dentigerous cyst of an impacted maxillary supernumerary tooth, which is a rare entity. During surgical exploration 2 supernumerary teeth were found which were surgically removed with enucleation of the cyst. It is quite rare to see dentigerous cyst caused due to a supernumerary tooth and here in this case, there were 2 supernumerary teeth, thus making it a rare entity requiring a detailed discussion and publication for the same.

Keywords: Impacted supernumerary tooth, dentigerous cyst, trapezoidal flap

Graded Epidural Anaesthesia for Intertrochanteric Fracture Femur with Recent Inferior Wall Myocardial Infarction: A Case Report

Syed Aasim Ali, Maheshwar Reddy K, Nikhitha P
Intertrochanteric fracture of femur with inferior wall Myocardial Infarction (MI) is rare. The aims of operative management for elderly patients with inferior wall MI intertrochanteric fracture are to prevent general complications, early mobilization and to relieve pain. We present a case of 80 year old man with intertrochanteric fracture of femur with recent inferior wall MI. The fracture was managed surgically with epidural anaesthesia for ORIF with PFN.

Keywords: Myocardial ischemia, ropivacaine, graded epidural

A Case of Drug Induced Acute Pancreatitis

Jhansi, Venkatrajam G
Pancreatitis is a common presentation in clinical medicine. A 65 year old woman nonalcoholic presented with chief complains of acute pain abdomen since 2 days, vomiting since 2 days. Pain abdomen is sudden in onset located in the epigastric region radiating to the back, deep seated, boring in nature more in lying down and during walking, less in sitting and leaning forward, associated with vomiting. Associated with fever since 2 days, low grade, intermittent, associated with chills. She is a known pulmonary TB on antitubercular drugs [HRZE] since one month developed drug induced hepatitis. INH, Rifampicin was stopped and was kept on Levofloxacin and Streptomycin along with other drugs 5 days prior to hospital admission. She developed signs and symptoms of acute pancreatitis. Cause of pancreatitis was thought to be drug induced

Keywords:Pancreatitis, levofloxacin, anti-tuberculoid drugs, hepatitis



Volume 15(1): Jan- June 2018

Vol 16 :July- Dec 2018


Volume 15(1): Jan- June 2018


A Cross-Sectional Study on Households fuel Consumption and its Health Effects among the Women in Rural area under RHTC, Annaram

Dasari Gayathry, Rajamouli J, Anil Moluguri, Sachin G, Manoj P

Quantify One Minute Walk Test and its Relation with Physiological Cost Index (PCI) in Children among Little Disease

Karthikeyan, Bhadri Narayan

A Comparative Study between Intramuscular and Oral Methylprednisolone Acetate in the Treatment of Asthma Exacerbation Following Discharge from the Hospital

Kishore Kumar K, Sai Samrat K, Sony Reddy S

Clinico-Pathological Study of Endoscopic Gastric Biopsies

SumalathaKasturi, Raju Mulaka

Experimental Evaluation of Anti-Inflammatory activity of Punica granatum peel extract in Albino Rats

Shakira Fathima Syeda, Sam Pavan Kumar G, Pushpalatha Ch, Mohammed Mohsin

Effects of Yoga in Primary Dysmenorrhea among Young Female Students to Reduce Sickness Absenteeism at Class

Kalaiselvi K, Mahendran P, Surobi Debnath


Diastematomyelia: A Case Report with Review of Literature

Kishore PVK, Gnaneshwar P, Sudha, Divya

Breast Lump (SubPectoral Lipoma): Clinical Diagnostic Dilemma

Ramlingam P, Ramesh, Mohd Shafeeq, Anand Kumar P

Primary Plasma Cell Leukemia Presenting as Acute Kidney Disease

Vidyadhara Rani P, Swetha Annaram

A Case Report of Cherubism

Anil Madurwar, Kuruakula Harika, Shalini Priya Nadimetla, Swapnil Sudhakar Gaikwad

Vol 16 | Issue 2: July- Dec 2018


A 10 year retrospective study on HIV-2: A Neglected Cousin of HIV-1

S Sreedevi, A.Mrudula S
Background:Though HIV-2 has slower rates of progression to AIDS and death,differentiating it from HIV-1, is important as choice of ART (antiretroviral therapy) is different.

Materials and Methods:A retrospective study of 10 years was carried out from January 2008 to December 2017 in persons attending Integrated counselling and testing centre (ICTC) at Mahathma Gandhi Memorial Hospital, Warangal.

Results: Comparison between HIV-1, HIV-2, HIV 1 & 2 positive groups for age, gender,route of transmission was made using chi-square test. P value<0.05 was considered as significant. Of the total 61,741 serum samples tested, 8397 (13.60%) were positive for HIV antibodies.

Conclusion: Though HIV -1 epidemic is progressing faster than that of HIV-2, monitoring of HIV-2 epidemic is essential to determine the extent of problem in India. HIV reactive sera must be differentiated in two types of HIV infection as HIV-2 treatment regimen is different from HIV -1, or else we have to face serious resistant strains of HIV-2.

Keywords: Prevalence, HIV-2, ICTC

The effect of dexamethasone added as an adjuvant to Bupivacaine for brachial plexus block in upper limb surgeries

Inugala RajKumar Reddy, Rajabhushanam M, Trivikaram N, MD Shareef
Background and Objectives:The aim of study was to evaluate the onset time, duration and analgesic efficacy of bupivacaine 0.25%, and to compared the Bupivacaine + Dexamethasone 8 mg for brachial plexus block by supraclavicular approach and Hemodynamic variables for the upper limb surgeries.

Materials and Methods: The study was a randomized single blinded study conducted on 60 patients undergoing upper limb surgeries aged between 18 to 65 years under supraclavicular brachial plexus block at Chalmeda AnandRao Institute of Medical Sciences, Karimnagar, Telangana.

Results and Discussion:The mean time for onset of motor block in group B was 9.16 ± 1.34 min and in group BD was 5.40 ± 0.89 min. The mean duration of motor block in group B was 2.36 ± 1.26 hours and in group BD was 4.46 ± 0.71. The mean duration of sensory block in Bupivacaine group was 4.56 ± 3.22 hours in BD group was 6.14 ± 0.63 hours.

Conclusion:our study showed that the addition of dexamethasone 8 mg as an adjuvant to bupivacaine (0.25%) has following effects: Faster onset of sensory and motor block, longer duration of sensory and motor block.

Keywords:Upper limb surgeries, brachial plexus block, dexamethasone bupivacaine

A prospective analysis of magentic resonance imaging and computed tomography in staging with uterine cervix carcinoma- A single centre experience

Harashavardhan NS, Naveen Kumar S, Uday Kumar NS, Ezhilarasi Ravindran, Bhavani B
Aims and Objectives: Uterine cervical cancer is the most common cancer in Indian women. The purpose of study was to compare the magnetic resonance imaging and CT evaluation in staging with uterine cervix cancer.

Materials and Methods:This study was prospective, correlative analysis study, included 25 patients with diagnosed as uterine cervical cancer. This study was conducted at Department of Radiology and Radio-oncology, CAIMS, Karimnagar. MRI and CT imaging was performed before any operative procedure. All patients underwent radical hysterectomy or abdominal hysterectomy and had detailed histopathological evaluation.

Results: Both MRI and CT image findings are gold standards methods. The Magnetic resonance imaging was superior to CT in tumor detection. Overall distribution shows that in all the clinical staging in MRI giving maximum positive results particularly in stage IVA and IVB in age group 40 to 50 years and 51 to 60 years than the computed tomography.

Conclusion: The present study concluded that MRI is superior to CT in the staging with uterine cervical cancer.

Keywords:MRI, CT, uterine cervical cancer, staging

Quantify and influence of age on hamstring tightness in apparently healthy 5 to 59 years old population

Moorthy AS, Karthikeyan T, Preeti Singh
Design: Experiment Design.

Aims and Objectives:Influence of age on hamstring tightness in apparently healthy individuals

Subjects: 360 healthy individuals.

Measurements and Intervention:360 healthy individuals were divided into 6 groups and their hamstring tightness was checked and they were compared.

Results:The data was analyzed using Independent test, ANOVA and paired test. ANOVA was used to compare left and right hamstring tightness between Group 1, 2, 3, 4, 5 and 6. Independent test was used to compare left and right hamstring tightness between males and females. Paired t test was used to find out the difference between left and right hamstring tightness in all 6 groups (P value < 0.05) was considered significant.

Conclusion: The findings of this study suggest that hamstring tightness is present in early childhood and increases with age in apparently healthy subjects.

Keywords:Hamstring muscle tightness, male and female.

Assessment of ischemic stroke severity in relation to glycemic status at presentation- a prospective observational hospital based study

Thirunadhar R, Rajashekar G , Sanjay H Kalbande , Ravi Teja A
Aim: The aim of present study was to investigate the prestroke glycemic status, severity, and outcome in patients with ischemic stroke

Design:The prospective hospital based study

Materials and Methods: Total 60 patients were included in this study. During this study period, all patients presenting with acute cerebral infarction and fulfilling the inclusion criterion were included in the study

Result : The mean age of the patients in the study group was 53.9 + 12.9 years. Maximum number of patients of cerebral infarction belonged to age groups 51-60 years and 61-70 years. The diabetes group have a higher baseline score among the glycemic groups (p>0.05). Stress hyperglycemia group has a slow progression of score from baseline compared to the diabetes group (p<0.020).

Conclusion: In conclusion of our study showed that the stress hyperglycemics had poor recovery on NIHSS scores for both medium and large sized infarcts from the baseline score.

Keywords: Prestroke, glycemic status, ischemic stroke, NIHSS, stroke severity

Evaluation of haematological parameters and lipid profile in patients with diabetes mellitus

Domala Prasad, Srinivas Ch
Aim: The main objective of this study is to evaluate hematological parameters and lipid profile in patients with diabetes mellitus.

Background:Diabetes mellitus is now a major health problem including both developed and developing countries throughout the world.

Materials and Methods: The present study was conducted on 30 subjects of type 2 Diabetes in age group (30-65 years). Hematological parameters like HbA1C, FBS, PLBS, platelet count, APTT and lipid profile were estimated in CAIMS, Karimnagar

Result : There is a significant rise in HbA1C, FBS, PLBS, platelet count, LDL and triglyceride levels and there is a significant reduction in APTT and HDL levels.

Conclusion: Hypercoagulability and dyslipidemia are important complications of diabetes mellitus and are important risk factors for various cardio and cerebrovascular diseases.

Keywords: Type 2 diabetes, HbA1C, APTT, HDL

Experimental evaluation of anticonvulsant property of myristica fragrans

Sam Pavan Kumar G, Laxmipathi Kodam, Pushpalatha Chinnam
Background:Myristica fragrans (Nutmeg) has been traditionally known since ancient days for its nutritive and various effects in the body. In traditional medicine, Myristica had been used for its digestant, carminative and anti-ulcer property, as an analgesic, antiinflammatory, anti-convulsant and many more.

Aim:The aim of the present study is evaluation of anticonvulsant property of extract of Myristica fragrans in albino rats.

Materials and Methods:Five groups consisting of six rats each were taken, Gr1 served as control, Gr 2 as standard, given phenobarbitone, Gr 3, 4 and 5 were test groups with various doses of Myristica extract. The convulsions were induced by Pentylenetetrazole. The effects anticonvulsant effects of Myristica are compared with standard anticonvulsant Phenobarbitone.

Result:Myristica fragrans extract showed statistically significant anticonvulsant property in test group.

Conclusion: Myristica fragrans extract has to be tested with other species and electrically induced convulsions also.

Keywords: Myristica fragrans, pentylenetetrazole, phenobarbitone.

Morphometric study of glenoid cavity and suprascapular notch of scapula

Anwer Unisa Sabry, Anitha T
Aim:To compare morphometric differences of glenoid cavity and suprascapular notch of left and right scapula and to calculate glenoid cavity index.

Period of Study:July 2016-August 2018

Materials and Methods:The Present study was conducted on 300 dry human scapulae in the Department of Anatomy, Chalmeda Anand Rao Institute of Medical Sciences, Karimnagar, Telangana. This study excludes any scapula having deformity or pathology.

Result:Present study includes 140 right and 160 left scapulae for which length of glenoid cavity, maximal depth of suprascapular notch and superior transverse diameter of suprascapular notch were more on right scapula and breadth of glenoid cavity was more on left scapula. Scapulae with longer superior transverse diameter of suprascapular notch (63.33%) were more than scapulae with longer maximal depth of suprascapular notch (36.70%). Superior transverse scapular ligament was completely ossified in 2.66% of cases.

Conclusion: The explanation for parameter being more on right side is on the basis of more muscular activity on right side in comparision to left. The ossification of superior transverse scapular ligament was complete in 2.66% of cases which can lead to entrapment of suprascapular nerve.

Keywords: Morphometric, glenoid cavity, suprascapular notch, scapula

Incidence of duodenal perforation in relation to socioeconomic status in a tertiary care hospital at karimnagar

Venkata Reddy M, Sathish Kumar B, Suryanarayana Reddy V, Joopali Puneeth
Background:Acute perforation of the duodenal ulcer produces one of the most dramatic pictures of acute abdominal catastrophe. The classical card board like rigidity, hypotension and its associated life threatening complications like sepsis and multi organ dysfunction syndrome are quite striking in most cases. The purpose of study was to corroborate with age and sex, socioeconomic status and addictions incidence in relation to duodenal perforation.

Materials and Methods:Fifty patients admitted to emergency Department Chalmeda AnandRao Institute of Medical Sciences, Karimnagar during the period May 2011 to Oct 2013 with diagnosis of duodenal perforation with peritonitis participated in this study.

Result:Majority of patients belong to the age group of 41-50 years and common in males. Most of the perforations are common in low socio-economic group and inpatients addicted to alcohol, smoking followed by NSAIDS and steroids. The open surgery, simple closure with Graham’s patch technique is the commonly done procedure with minimum complications.

Conclusion: We concluded that the duodenal ulcer perforation is common in 5th decade, in males and related to heavy smoking, anxiety, chronic alcoholism, intake of NSAIDS and also long standing untreated duodenal ulcer. It is more common in patients belonging to Low socioeconomic status.

Keywords: Duodenal perforation, duodenal ulcer, low socioeconomic status

Management of diaphyseal lower limb fractures in paediatric age group with elatic stable intramedullary nailing

Chokkarapu Ramu, Rajender K, Sravan Kumar
Aim:The purpose of this study is to analyze the efficacy of elastic stable intramedullary nailing(ESIN) in the treatment of fracture shaft of femur and tibia in children aged between 4 to 15 years with special emphasis on complications.

Materials and Methods:This was a prospective ,observational study conducted in chalmedaanandrao institute of medical sciences, karimnagar. All children and adolescent patients between 4 and 15 years of age with diaphyseal fractures of femur and tibia meeting the inclusion and the exclusion criteria during the study period were the subjects for the study. Totally, 20 cases were studied without any sampling procedure. Patients were followed up at 4 weeks, 8 weeks 12 weeks, 6 months and 1 year after surgery and assessed clinically and radiologically. The final outcome is assessed as per Flynn’s criteria as excellent/ satisfactory/ poor.

Result:Twenty patients were enrolled into the study out of which 15 (75%) were boys and 5 (25%) were girls. Average age of patient was 9.8 years and average time taken to heal the fractures (both clinical and radiological) was 10.35 weeks. 4 (20%) had developed pain at site of nail insertion during follow up evaluation, all of which resolved by the end of 16 weeks follow up Superficial infection was seen in1 (5%)case, No patient in our study had major limb length discrepancy (i.e. > ± 2cm). Nail back out was not seen in any of the cases.

Conclusion: Titanium elastic nail fixation is a simple, easy, rapid, reliable and effective method for management of pediatric femur and tibial fractures in patients with operative indications. There may be the chances of complication following the TENS but these are avoidable as well as manageable with careful precautions

Keywords: Titanium elastic nail, paediatric femoral and tibial fractures

Reasons for living in patients suffering from chronic mental illnesses

Gireesh Kumar M, Siva Anoop Y, Umashankar M, Pavan Kumar K
Background:Chronic mental illnesses like schizophrenia, bipolar affective disorder, depression, alcoholism affect the reasons for living in such patients. This is a study done to findout the reasons for living in such chronic patients.

Aim:To study the Reasons for living in patients suffering from chronic mental illness.

Materials and Methods:Reasons for Living inventory is used in this study. 60 patients suffering from chronic mental illness are used as subjects. SPSS software is used for statistical analysis.

Result:RFL mean score is 140.88. Mean Age is 39.27. Significant p-values (<0.05).

Conclusion: Males have more reasons for living, survival and coping beliefs, responsibility to family, child related concerns, fear of social dissaproval, moral objections, physical health, social relationships and environmental domains .

Keywords: Chronic Mental illness, reasons for living, suicidal behavior


Extraskeletal ewing’s sarcoma/ primitive neuro ectodermal tumor: A rare case report

Sumalatha Kasturi, Sreenivas Vemula, Chaitanya Bharathi P, Manasa T, Ravinder T
IntroductionExtraskeletal Ewing’s Sarcoma (EES) is an uncommon round cell malignant tumor of uncharacterized mesenchymal origin.

Case ReportWe present a rare case of extraskeletal ewing’s sarcoma of leg in a 15 year old boy. FNAC was suggestive of a round cell malignant tumor. Excision biopsy revealed the diagnosis of Extraskeletal Ewing’s tumor, which was confirmed by special stain with PAS and immunohistochemistry for CD99 and Synaptophysin. Patient responded well with chemotherapy.

ConclusionExtraskeletal Ewing’s sarcoma although rare in soft tissues, it should be considered in the differential diagnosis of round cell malignancies.

Keywords:Extraskeletal, ewing’s sarcoma, immunohistochemistry

Lymphangioma of neck in a 35-year old female- A case report of rare entity

Ramesh Kumar S, Jadi Lingaiah, Manoj Gunde, Cheeti Apparna
Lymphangiomas are lymphatic malformations which occur mostly in children and uncommonly in adult. Although the lesion can occur anywhere, the most common sites are in the posterior triangle of the neck, axilla, mediastinum, groin, retroperitoneal space and pelvis in a descending order. We hereby report a rare case of a 35 years old woman with lymphangioma of neck who presented in ENT OPD with a slowly enlarging neck swelling on right side of 6 months duration for which excision was done after USG and FNAC and sent for HPE which was suggestive of lymphangioma. The adult lympangioma which is unusual in occurence, prompted us to report this case.

Keywords: lymphangioma, cystic hygroma, cavernous lymphangioma



Volume 13(1): Jan- June 2017

Volume 14(2): July- December 2017


Volume 13(1): Jan- June 2017


Impact of imaging modality in assessing patient setup for different sites in radiotherapy

Sudha Rani, Katta Charu Goutham

Comparative study of Helical blade PFN and double hip screw PFN for intertrochantric f racture fixation

Monica Chappidi, Deepthi Nandan Adla

Prediction of significant neonatal jaundice at cord blood albumin at birth in neonates with completed 35 weeks

Sudhakar Chiluka, Srinivas Madoori, Subhan Basha, Praneet Reddy

Risk factor analysis in sedentary office workers with low back pain

Subramanian S, Arun B

Quality of life and psychiatric morbidity in patients with diabetes mellitus

Vishal A, Pavan Kumar K, Shanthi C, Phanikanth K

Diseeminated omental and liver tuberculosis mimicking metastatic deposit- role of image guided FNA/biopsy- A case report

Majed B Momin, Sandeep S, Anamika Aluri, Abhijeet I, Karishma Rosann Pereira


Haloperidol induced dystonia: A case report

Vyshnavi Biradavolu, Sreekeerthi Nethi, Sai Charitha Sreeram, Surendra Reddy N

Malacolakia of urinary bladder- An incidental finding

Abhijeet Ingle, Suhela Rachakonda, Vijaya Gattu


Eschar- An important clinical clue infebrile illness in rural setting

Aijay kumar Khandal

Vol 14 | Issue 2: July- December 2017


Objective structured clinical examination as a formative assessment tool in postgraduate training

Manohar Badur, Naveen Kumar Cheri, Narimalli Madhavilatha, Shankar Reddy Dudala, Chintham Rishika Jayachandra

Correlation of smoking to various histological types of bronchogenic carcinoma

Vinay Kumar A, Raj Kumar K, Sunil S

Effect of sleep deprivation on the academic performance and cognitive functions among the college students: A cross sectional study

Sumi Rose, Sonumol Ramanan

Role of intralesional measles mumps rubella vaccine in cutaneous warts: A case control study

Vontela Rohit, Manasavadthya, Narender Gajula, Nishitavumma

A comparative analysis of electrical stimulation, isometric and isotonic exercise of quadriceps versus TENS, isometrics and isotonic exercise of quadriceps for the chronic osteoarthritis knee joint patients

Kalaiselvi K, Mahendran P, Sajan Makaju

A comparative study of typhoid and non typhoid small bowel perforations

Mangilal V, Venkat Ramana N, Suryanarayana Reddy V, Manasa, Amar C Sajjan


Cysticercosis of breast- A rare entity

Abhijeet Ingle, Vijaya Gattu, Suhela Rachakonda, Sai Babu, Anamika Aluri

A rare case of primary idiopathic hypothyroidism presented with early infantile seizures

Madoori Srinivas, Sudhakar Chiluka, Anitha K, Subhan Basha, Praneet Reddy N

Giant pleomorphic adenoma of right parotid gland- A case report

Venkat Ramana N, Shashidhar Rao A, Atya Dev, Vidhya Rani, Nikitha Reddy R

Calculi in a female urethral diverticulum

Krishnmurthy S, Ramalingeswar Rao M, Arun Rathi


A case of eyelid tumor in a rural setup

Ezhilarasi Ravindran, AnandKumar Pannerselvam



Vol. 11(1): Jan-Jun 2016

Vol. 12 (2): July- Dec 2016


Volume 12 (2): July- December 2016_2


Study of Various Co-Morbid conditions in 6 months to 60 months in Age Group Children with Severe Acute Malnutrition

Manohar B, Mallikarjuna M, Padmini Priya B, Surendra Reddy N, NaveenKumar C, VenkataRamanaiah D

A Study of Maternal and Foetal Outcomes in Abruptio Placenta – A Prospective Observational Study at CAIMS, Karimnagar

Pranathi Reddy L, Ramadevi E

Effect of Oral Clonidine as Premedication on Perioperative Haemodynamic response for Patients undergoing Laparoscopic Cholecystectomy

Syed Ali Aasim, Vimalatha P, Srikanth Reddy, Anilkumar K, Vishnuvardhan Reddy, Maheshwar Reddy

A Study of Cyto-Histological Correlation in the Diagnosis of Thyroid Swelling

Venkataramana N, Mangilal V, SasidharaRao, Prashanth S, Manoj, Aruna T

Study of Histopathological changes of Endometrium in Abnormal Uterine Bleeding

Aruna Kumari Pagalla, Shyam Sunder Kasapa

A Study to Assess Knowledge on Active Management of Third Stage of Labour (AMTSL) among Nurses in Labour/Delivery and Postnatal Units

Veronika Jones B, Padma B, Gigi Chacko, Shaik Shaffi Ahamed

A Clinical study on Nutritional Health status of Adolescent Girls studying in Urban Government Schools

Srinivas Madoori, Shesha Giri, Shanmuga Raju P, Subhan Basha, Praneet Reddy

Bacteriology of Urinary Tract Infection and Antibiotic Susceptibility Pattern at a Tertiary Care Hospital, Karimnagar

Archana Battula, Swetha G

A Study of State and Trait Anxiety in Medical College Students

Vishal A, Chilasagaram Shanthi, Preeti G, Nikhil Ravindranath T


Gaint Lipoma of Thigh: A Case Report

Ramlingam P, Ashrith Reddy Ch, Dhanunjaya Rao Ginjupally

Xanthogranulomatous Oophoritis – A Case Report

Sravanthi Yerragolla, Sumalatha Kasturi, Renuka Barkam, Vinuthna C, Sravani Ramaa Modey, Ravindra Thota


Strongyloidosis of Duodenum

SumalathaKasturi, Renuka Barkam, SravanthiYerragolla, Ravinder Thota

Vol. 11(1): Jan-Jun 2016


The revised guidelines of the medical council of India for academic promotions: Need for a rethink

Rakesh Aggarwal, Nithya Gogtay, Rajeev Kumar, Peush Sahni


Management of subtrochanteric fractures of femur with proximal femoral nail: A prospective study

Nagamuneendrudu K, SriRanga Rao M, Sridhar S

Management of Subtrochanteric Fractures of Femur with Proximal Femoral Nail : A Prospective study

Nagamuneendrudu K, SriRanga Rao M, Sridhar S


Aim : The study aim was conducted to evaluate the outcome of management of 30 adult patients with sub trochanteric femoral fractures using proximal femoral nail(PFN).

Materials and Methods: This prospective study included 30 patients with sub trochanteric fracture admitted to Osmania General Hyderabad, who underwent intramedullary fixation with PFN from September 2012 to September 2014. Only fresh fractures within one week of injury were included in the study. Pathologic fractures, multiple fractures, fractures in children, old neglected fractures were excluded from the study.

Results: : In our study of 30 patients, mostly are of young patients average age is 37.53 years (range from 21-40 years), there were 25 male and 5 female. 73.33% of the patients admitted were road traffic accidents, 16.66% due to fall from height and 10% due to trivial fall with right side being more common side affected. Russell and Taylor type IB fracture accounted for 46.66%, 1A30%, 11A 23.33% of cases. Mean duration of hospital stay was12.6 days and mean time of full weight bearing was 14 weeks in our patients. All 30 patients, were followed up. Good to excellent results were seen in 83.33% of cases in our study.

Conclusion: PFN is a viable treatment option for sub trochanteric fractures with high rate of fracture union and minimal soft tissue damage. Intra medullary fixation has biological and biomechanical advantages, but the operation is technically demanding. Gradual learning and great patience is needed in order to make this method truly minimally invasive.

Keywords: PFN, Sub trochanteric fractures, russell and taylor

Efficacy of the addition of modified pilates exercises to a minimal intervention in patients with chronic non specific low back pain

Mahendran P, Nikitha Shekhar Amale, Milind Pimprikar, Sonali Dharurkar

Efficacy of the Addition of Modified Pilates Exercises to a Minimal Intervention in Patients with Chronic Non Specific Low Back Pain

Mahendran P, Nikitha Shekhar Amale, Milind Pimprikar, Sonali Dharurkar


Background : The Pilates method has been used to improve function and reduce pain in patients with chronic non specific low back pain, although there is little evidence that describes its efficiency.

Objective: The purpose of the study was to investigate the effectiveness of the addition of modified Pilates exercise to minimal intervention in patients with chronic low back pain.

Subjects: 30 patients with chronic non specific low back pain participated in the study.

Materials and Methods: All participants received an educational booklet containing information about low back pain and were randomly allocated to receive 12 sessions over 6 weeks of exercises based upon Pilates principles or of education alone.

Results: Improvements were observed in pain, disability in favor of pilates group after intervention.

Conclusion: The addition of the modified pilates exercises to an educational booklet provides small benefits compared with education alone in patients with chronic non specific low back pain.

Keywords: Modified pilates, non specific low back pain, roland- morris disability scale, oswestry low back pain scale

Randomized double blind comparative study of tramadol and dexmedetomidine for post spinal anaesthesia shivering

Syed Ali Aasim, Srikanth Reddy A, Vishnuvardhan Reddy, Maheshwar Reddy, Chandrakanth C

Randomised double-blind Comparative study of Tramadol and Dexmedetomidine for Post-Spinal Anaesthesia Shivering

Syed Ali Aasim, Srikanth Reddy A, Vishnuvardhan Reddy, Maheshwar Reddy, Chandrakanth C


Background and Aim: Dexmedetomidine (?2 adrenergic agonist) is used for prevention of post anaesthesia shivering. The aim of this study is to compare and evaluate the efficacy, adverse and haemodynamic effects of dexmedetomidine with that of tramadol, when used for control of post-spinal anaesthesia shivering.

Materials and Methods: A randomised, prospective, and double-blind study was conducted in 60 American Society of Anaesthesiologists Grade I and II patients of age between 18 and 65 years,either gender, scheduled for various surgeries under spinal anaesthesia. The patients were randomised in two groups of 30 patients each to receive either dexmedetomidine 0.5 ?g/kg or tramadol 0.5 mg/kg as a slow intravenous bolus. Onset of shivering, grade of shivering, time for cessation of shivering, response rate, recurrence and adverse effects were observed at scheduled intervals. Unpaired t-test was used for analysing the data.

Results: Nausea and vomiting was observed only in tramadol group (28% and 20% respectively).Time taken for cessation of shivering was significantly less with dexmedetomidine when compared to tramadol. There was not much difference in the sedation profile of both the drugs.

Conclusion: We conclude that although both drugs are effective, the time taken for cessation of shivering is less with dexmedetomidine group when compared to tramadol group. Moreover, dexmedetomidine has negligible adverse effects when compared to tramadol which is associated with significant nausea and vomiting.

Keywords: Dexmedetomedine , Tramadol , Post-spinal anesthesia shivering.

Dosimetry study for Post-Mastectomy Breast Cancer in Intensity Modulated Radiotherapy plans and Field in Field (FiF) forward plans

Chidambaram V, Ezhilarasi R, ShanmugaRaju, Anand Kumar P, Narayan Behera, Sunil Kumar V

Dosimetry study for Post-Mastectomy Breast Cancer in Intensity Modulated Radiotherapy plans and Field in Field (FiF) forward plans

Chidambaram V, Ezhilarasi R, ShanmugaRaju, Anand Kumar P, Narayan Behera, Sunil Kumar V


Aim: The aim of this study, to correlate the planning and delivery efficiency between three dimensional conformal radiotherapy, field in field forward planned intensity modulated radiotherapy (FIF-PF-IMRT) and inverse planned intensity modulated radiotherapy (IP-IMRT).

Materials and Methods: Treatment plans of 20 post mastectomy patients with left and right side breast cancer, treated to a prescribed dose of 50 Gy to the chest wall and to the supra clavicle fossa in 25 fractions. Treatment plans of 3DCRT, FIF-FP-IMRT plans were created by combining two open fields with three to four segments in two tangential beam directions and one anterior field, posterior oblique. Six to seven different beam directions were chosen to create IP-IMRT plans and were inversely optimized. The homogeneity of dose to planning target volume (PTV) and the conformity index were similar for 3DCRT and FP-FP-IMRT, whereas the IP-IMRT plans had better conformity index at the cost of less homogeneity. The 3DCRT and FIF-FP-IMRT plans gives the similar savingthe critical organs. In IP-IMRT gives heart and ipsilateral lung dose was higher than 3DCRT and FIF-FP-IMRT. Also contra lateral Breast receive low dose (0.1-3 Gy) in 3DCRT and FIF-FP-IMRT. Also in IP-IMRT opposite breast getting more than 5 Gy.

Results and Conclusion: Compared with 3DCRT and IP-IMRT, FIF-FP-IMRT gave a simple and good planning technique for breast irradiation. It gives dosimetric advantages of the minimal hotspot and good coverage to PTV. It felt that FIF-FP-IMRT needed less planning time and easy field placements.

Keywords: Post-mastectomy breast cancer, contra lateral breast, 3DCRT, field in field breast plans, intensity modulated radiation therapy, organ at risks

Review Article

Diabetic Ketoacidosis in children: A Systematic Review

Madoori Srinivas, Ramya C, Sridevi D, Dikshitha K

Diabetic Ketoacidosis in Children: A Systematic Review

Madoori Srinivas, Ramya C, Sridevi D, Dikshitha K


Diabetic ketoacidosis (DKA) is an acute life threatning complication of diabetes. It is the most common cause of death in children with type 1 diabetes and unfortunately majority of them present with DKA as an initial presentation. The objective of this article is prevention of DKA through early diagnosis and meticulous management of diabetes in children. Children with T1DM and their parents must be educated regarding DKA, in general and during stressful conditions like infections.

Keywords: Diabetic ketoacidosis, diabetes mellitus, children, prevention


Mucocele of appendix: case report and review of literature

Mangilal V, Suryanaryana Reddy, Sumalatha, Prashanth S, Manoj Kumar D

Mucocele of appendix: case report and review of literature

Mangilal V, Suryanaryana Reddy, Sumalatha, Prashanth S, Manoj Kumar D


Appendiceal mucocele is a rare disease. Sometimes it is discovered accidentally and sometimes it resembles acute appendicitis. Correct diagnosis before surgery is very important for the selection of adequate surgical treatment to avoid intraoperative and postoperative complications. Ultrasonography, and particularly computed tomography, should be used extensively for this purpose. If mucocele is treated incorrectly pseudomyxoma peritonei, which is characterized by malignant process, may develop.

We present a case of a 64-year-old woman who was admitted to the emergency department with the signs of acute appendicitis. Open surgery was performed. At the time of surgery cystic mass of appendix with dimensions 6.9X2.5cm, with inflamed walls, but without perforation was discovered in right iliac fossa. Only appendectomy was performed because no pathologic process was found in the base of the appendix and lymph nodes were not increased in size. Histopathologic diagnosis was mucosal hyperplasia of Appendix.

Keywords: Mucocele , pseudomyxoma peritonei, appendicitis

Secretory carcinoma of the breast

Sreenivas V, Arafeen Aisha , Ravinder T

Secretory carcinoma of the breast

Sreenivas V, Arafeen Aisha , Ravinder T


Secretory carcinoma of the breast is a rare variant with excellent prognosis and indolent clinical behavior. At the microscopic level, the presence of intracellular and extracellular secretory material is the most remarkable feature.We report a case of secretory carcinoma of the breast in a 90 year old female, with classic cytological findings.

Keywords: secretory carcinoma, cytological findings

Scalp arterio-venous malformation: Case report & review literature

Renuka Rao D, PVK Kishore, Jahnavi, Vinay

Scalp arterio-venous malformation: Case report & review literature

Renuka Rao D, PVK Kishore, Jahnavi, Vinay


Scalp arterio-venous malformation (AVM) is a rare condition that usually need surgical treatment. We report a rare case of scalp arterio-venous malformation(AVM). A 35 year old lady presented with a history of pulsatile palpable mass on right parieto-occipital region of scalp. Magnetic Resonance Anigiogram(MRA) of the scalp showed AVM over the right parieto-occipital region.

Keywords: Scalp arterio-venous malformation, magnetic resonance anigiogram(MRA), cirsoid aneurysm


Vestibular stimulation: A Neurophysiological intervention for parkinson’s disease

Archana R, Kumar Sai Sailesh, Jinu KV, Mukkadan JKs



Vol.9(1):Jan-June 2015

Vol.10(2): July-Dec 2015




Posterior Cervical Arthrodesis by Lateral Mass Screws Fixation A Long term Follow up Study

Bhaskar G, Sharath Kumar Maila, Lakshman Rao A, Mastan Reddy A

Posterior Cervical Arthrodesis by Lateral Mass Screws Fixation A Long term Follow up Study

Bhaskar G , Mastan Reddy A1, Sharath Kumar Maila2, Lakshman Rao A3, Mastan Reddy A4


Aim : Posterior cervical arthrodesis using lateral mass fixation by screws and rods is a very well known technique which has gained much popularity in the last two decades. We present here clinical results of 27 patients who were operated for cervical instability of different etiologies by lateral mass fixation at our institution. Results with long term follow up were analyzed.

Materials and Methods: All the patients admitted with cervical spine instability and having indication for posterior stabilization were subjects of the study. A total of 27 cases were operated during February 2010 to January 2015. A standard posterior lateral mass screw fixation and or pedicle screw fixations were done according to the requirement. Results were analyzed during regular followup which ranged from 6 months to 2 years.

Results: Neurologic improvement to the extent of self ambulation was seen in 8 of the 14 patients with traumatic quadriparesis. All patients in the non trauma group showed good clinical improvement. There were 6 deaths in this series in the peri-operative period, not related to the surgical procedure but due to the attendant medical problems. Good fusion was achieved in all the cases at the end of 3 months. There was no evidence of hard ware failure at the end of 2 year follow-up.

Conclusion: This study concludes a good clinical improvement and stable construct with good fusion during the log term follow up. This procedure has several advantages over traditional wiring techniques. Over all it is very safe and efficacious procedure in the hands of an experienced surgeon.

Keywords: Lateral mass fixation, posterior cervical arthrodesis, neurovascular relation

Efficacy of Dip Slide in Diagnosis of Urinary Tract Infection among Children

Kalavathy M, Earnest Daniel Prasad P, Kokiwar PR

Efficacy of Dip Slide in Diagnosis of Urinary Tract Infection among Children

Kalavathy M1,   Earnest Daniel Prasad P2, Kokiwar PR3


Background : In practices, clinicians await confirmation of urinary tract infection (UTI) with a written report which results in delay in diagnosis and treatment. Moreover if a heavy mixed growth is obtained, a repeat culture is warranted. If antibiotic therapy has been initiated already, a confident diagnosis cannot be made and unnecessary investigations and follow up are considered despite lack of clear evidence of initial infection. Empirical antibiotic therapy is also initiated during the week-ends when laboratory facilities are unavailable.

Aim : To study the applicability of dip slide in diagnosing UTI in children.

Subjects : This study includes 60 persons whose mean age was 73.17±5.81 years.

Materials and Methods : Subjects of the present study were selected from the hospital admissions of Kasturba Medical College, Manipal for a period of 9 months. Patients were selected employing the suitable selection criteria. Diagnostic methods like bacteria / HPF, urine analysis, dip slide, and bacteruria were used. Data analysis was done using proportions, sensitivity and specificity.

Results : There was a male preponderance. Fever and failure to thrive were the commonest symptoms (68.8%). Of the 21 cases of UTI 12 correlated with leukocytosis and 15 with fever. Hydronephrosis was the commonest abnormality detected in those cases with proven UTI.

Conclusion : The dip slide is an efficient, easy and reliable method of detecting UTI with a high specificity (100%) and sensitivity (90.4%) rate. The p value of dip slide in this study was 0.0000 which is statistically, highly significant.

Keywords : Urinary tract infection, dip slide, antibiotic therapy, diagnosis, efficacy

Knowledge, Attitude and Practices of Contraception in Rural area of Chhattisgarh

Kishori Nisal, Rekha Ratnani, Poonam Ghormode, Jindal M

Knowledge, Attitude and Practices of Contraception in Rural area of Chhattisgarh

Kishori Nisal1, Rekha Ratnani2, Poonam Ghormode3, Jindal M4


Background : In recent years, the need for knowledge, attitude and practices (KAP) studies to understand the factors determining the fertility and family planning acceptance and practices by particular communities has been felt, so that more specific knowledge can be gained about factors determining family planning acceptance by particular communities, which can then be used for developing suitable program for them.

Objectives : To study the knowledge, attitude and practices related to contraceptive methods.

Materials and Methods: A community based cross sectional study was conducted among 1000 women in the reproductive age group in the rural area of Chhattisgarh. Data was collected in the pre designed study questionnaire. Analysis was done by using proportions.

Results: Female sterilization was the most widely known method of contraception (98%) followed by male sterilization (95%). Mass media (television, newspapers) was the most common source of information about contraceptive methods (70.5%) followed by information from health personnel (55%). Contraceptive advice was accepted by 91% of the candidates. Most common reason for not using contraception was want of more children followed by religious reasons.

Conclusion: Knowledge of primary methods of contraception was good compared to the modern methods. Mass media (television, newspapers) is found to be playing a significant role in spreading awareness among rural population. 91% of the rural women were practicing the contraceptives.

Keywords : Contraceptive knowledge, attitude, sterilization, oral contraceptive

An Analysis of Setup Errors Using OnBoard Imager Technique in External Beam Radiotherapy for Different Cases in Radiation Oncology

Chidambaram V, Ezhilarasi R, Prashant G

An Analysis of Setup Errors Using OnBoard Imager Technique in External Beam Radiotherapy for Different Cases in Radiation OncologyCaims, Karimnagar

Chidambaram V1, Ezhilarasi R2, Prashant G3


Aim : The aim of this study was carried to verify the patient setup errors and immobilization reproducing on the aspects of quality assurance based. The treatment delivers to isocenter on different days and to document efficiency of reproducibility setup errors of treatment.

Materials and Methods: Retrospective study was done out of 80 patients in each cases of radiation treatment such as brain, head and neck, breast and pelvis from this 515 Kv images including CBCTs are taken from the OBI. This Kv images are obtained from OBI system which is attached in linear accelerator. Varian anatomy matching software was used and displacements of three dimensions X, Y and Z were noted to study the patient setup.

Results and Conclusion : This study was shown the probable range of systematic and random errors that occurs in the patient setup during the radiotherapy treatment. In that displacement we calculated mean and average values for different cases such as 4 mm mean deviation for lateral and longitudinal and vertical directions.

Key words: Onboard imager, Kv images, LINAC, immobilization mask, Varian anatomy software.

A Study to Assess the Knowledge and Practices on Nitrous Oxide as Labour Analgesia among Nurses in Labour and Delivery Units

Veronika Jones B, Padma B, Maranda Hernandez, Tengsy Thomas

A Study to Assess the Knowledge and Practices on Nitrous Oxide as Labour Analgesia among Nurses in Labour and Delivery Units

Veronika Jones B1, Padma B2, Maranda Hernandez3, Tengsy Thomas4


Aim:The aim of present study is to assess the knowledge and practice related to the administration of nitrous oxide as labour analgesia among staff nurses and midwives and to identify the gaps in knowledge and practice.

Materials and Methods: The overall aim of this study is to achieve safe administration of Nitrous oxide to the women in labour and to reduce the associated risks for the employees with administration. The research design was quasi experimental one group pre - test post – test by observation method using purposive sampling technique. A total of 34 nurses working in labour and delivery units in King Khalid University Hospital were selected. To test the statistical significance paired sample t - test was used and to test the relation between the demographic variables and the test scores, independent t- test and ANOVA were used.

Results: The results were compared with the latest scientific evidences to identify gaps in the nursing practice on safe administration of Nitrous oxide to the women in labour. A nursing protocol on safe administration of nitrous oxide in labour and delivery was prepared in line with the most recent and updated research findings for the desired outcome. There is significant difference in the pre and post test scores on knowledge of nurses with a mean difference 8.64 in scores, and is highly significant with a much higher ‘t’ value 14.450 and the ‘p’ value of <0.001.

Conclusion: The data over last 6 months shows 5-10% of women in labour are opting for epidural analgesia, while there is no record of information on usage of other modes of analgesia more specifically- Nitrous oxide in labour and delivery. The nurses in labour units have not been trained and educated specifically to the administration of entonox, hence it is been considered as an interesting area to be dealt with because of the wide application in the area.

Keywords: Nitrous oxide, entonox, labour analgesia, active labour.


An Unusual Presentataion of Malakop lakia - Synchronous Affliction of Ureter and Bladder

Tyagi A, Vasanth Rao P, Bhavani Shankar G, Satish Babu P, Syama Sundara T

An Unusual Presentataion of Malakop lakia - Synchronous Affliction of Ureter and Bladder

Tyagi A1, Vasanth Rao P2, Bhavani Shankar G3, Satish Babu P4, Syama Sundara T5


Malakoplakia is an unusual inflammatory disease known to affect the genitourinary and gastrointestinal tracts, skin, lungs, bones, and mesenteric lymph nodes. Malakoplakia of the bladder and ureter is quite rare. A 26 year old male patient presented with complaints of right flank pain and history of urgency and frequency since 6 months and was diagnosed to have recurrent urinary tract infections. He was evaluated and found to have persistent right hydroureteronephrosis, multiple ureteric strictures. Bladder biopsy showed evidence of malakoplakia. Patient was initially treated with percutaneous nephrostomy and later by right double ‘J’ stenting. Post operative follow up showed no evidence of hydronephrosis and he was relieved of his complaints. This rare case of urinary bladder and ureter malakoplakia in a young male is presented to emphasize up on the fact that malakoplakia can still occur in young male with recurrent urinary tract infection especially in developing countries like India.

Keywords:  Malakoplakia, right double ‘J’ stenting, ureter, bladder

Falciparum Malaria with Multiple Neurological Complications A Case Report

Yogi M, Surender K, Prathibha P, Nagesh A

Falciparum Malaria with Multiple Neurological Complications A Case Report

Yogi M1, Surender K2,  , Prathibha P3, Nagesh A4


Malaria remains the common cause of childhood infections. A 2 year-old female child from a malaria endemic area was admitted to our hospital with high grade fever for 3 days, multiple episodes of generalized tonic clonic seizures (GTCS) for 1 day and altered sensorium on day 4. We report a case of falciparum malaria in a 2 year old girl presenting with seizures and other neurological deficits like hemiplegic, aphasia and cortical blindness.

Keywords: Falciparum malaria, neurological complications, plasmodium falciparum (PF) hemiplegia

A Rare Case of Multiple Soft Tissue Metastases from Carcinoma Breast

Aruna T, Sreedhar Ragi, Aruna Kumari Pagalla, Arun Katari, Neha Gaur, Ravinder Thota

A Rare Case of Multiple Soft Tissue Metastases from Carcinoma Breast

Aruna T1, Sreedhar Ragi2, Aruna Kumari Pagalla3, Arun Katari4, Neha Gaur5, Ravinder Thota6


We are presenting a case of multiple soft tissue metastases from carcinoma breast. 52 year old patient presented with multiple swellings situated over chest, abdomen, axilla, neck and forearm. The patient was giving past history of lumpectomy right breast 4 years back for which histopathological diagnosis is not available. Histopathology, FNAC and IHC confirmed the diagnosis as soft tissue metastases from carcinoma breast. Multiple soft tissue metastases from carcinoma breast even though is a rare occurrence, can present in an advanced stage of the disease as in our case.

Keywords:  Multiple soft tissue lesions, metastasis, carcinoma breast.                   

A Rare case of Instestinal Obstruction due to Meckels Diverticulum with band in Post operative Appendectomy Boy

Mangilal V, Suryanarayana Reddy V, Prashant G, Satyadev, Rajeev Reddy, Vamshikrishna

A Rare case of Instestinal Obstruction due to Meckels Diverticulum with band in Post operative Appendectomy Boy

Mangilal V1, Suryanarayana Reddy V2, Prashant G, 3, Satyadev4, Rajeev Reddy5, Vamshikrishna6


Meckel’s diverticulum is the commonest type of congenital anomaly of small intestine, commonly seen in 2% of the population, seen two feet away from the ileo-caecal junction, with 2 cm in length and usually consisting of two types of heterotrophic mucosa. In our case report, we deal with a presentation of the condition in post appendectomy boy, clinical course, surgical management and post-operative care for meckel’s diverticulum with band. We also briefly review on the latest literature and investigative modalities for the conditions along with best management modalities.

Keywords:  Meckel’s diverticulum, explorative laparotomy.

A Rare case of True Broad Ligament Leiomyoma Mimicking an Ovarian Tumor

Kavitha V, Rama Devi E, Leela R, Sasi priya A

A Rare case of True Broad Ligament Leiomyoma Mimicking an Ovarian Tumor

Kavitha V1, Rama Devi E2, Leela R3, Sasi priya A4


Broad ligament is a very uncommon site for presentation of leiomyoma. On account of their size and nature (pedunculated or sessile), clinically leiomyomas may present variably. We are presenting a rare case of leiomyoma of broad ligament in a 50 year old female patient who presented with complaints of lower abdominal pain of one month duration, with normal menstrual cycles. On clinical and ultrasound examination there was a left sided mass in the pelvic region suspected to be an ovarian mass/ subserosal fibroid. MRI (magnetic resonance imaging) confirmed the diagnosis of left broad ligament fibroid and Total abdominal hysterectomy with bilateral salpingo-oopherectomy was done. On histopathology, it was confirmed to be a soft tissue tumor–Leiomyoma. We are reporting this interesting case with clinical, radiological, and histopathological findings for its rarity.

Keywords: True broad ligament, ovarian tumor.

Anaesthetic Management for Post Burn Contracture- A Unique Challenge in Airway Management

Rajeeth Kumar Reddy K, Syed Aasim Ali, Maheshwar Reddy K, Vishnuvardhan Reddy, Anil K

Anaesthetic Management for Post Burn Contracture- A Unique Challenge in Airway Management

Rajeeth Kumar Reddy K1, Syed Aasim Ali2, Maheshwar Reddy K3, Vishnuvardhan Reddy4, Anil K5


Managing the airway of post burn contracture of neck has always been challenging to anaesthesiologists as it limits the alignment of oro-pharyngo-laryngeal axes because of functional and anatomical deformities that occur as a result of long standing contractures. Post burn contracture (PBC) not only restricts the movement of neck but can also lead to restriction in mouth opening, respiratory difficulty, alteration in position of trachea and distortion of cervical spine.

Keywords : Difficulty airway, post burn contracture, airway management.

Lumbar Intradural Extramedullary Haemangioma

Kishore PVK, Hemaratnan A, Sreenivas V, Sandeep Goud, Varun Babu A, Prashanth S

Lumbar Intradural Extramedullary Haemangioma

Kishore PVK1, Hemaratnan A2, Sreenivas V3, Sandeep Goud4, Varun Babu A5, Prashanth S6


Vascular malformations with histopathological features of more than a single type of malformation present within the same lesion have been previously described. These lesions are very rare and named as mixed vascular malformations. So far only 57 cases have been reported in the literature. We report a case of a lumbar intradural extramedullary capillary hemangioma due to its rarity.

Keywords: vascular malformation, capillary haemangioma, haemangioma.


Cavum Velum Interpositum Cyst

Naveen Kumar S, Vidyadhara Rani P, Shanmuga Raju P

Cavum Velum Interpositum Cyst

Naveen Kumar S1, Vidyadhara Rani P2, Shanmuga Raju P3


A 7 days old baby was referred to MRI in view of interhemispheric cystic lesion in brain diagnosed during routine antenatal obstetric scan of patient. Baby was delivered, cried immediately after birth and accepting feeds well.



Caregiver burden and psychopathology in schizophrenia: A cross sectional study

Mirayala Gireesh Kumar, Pavan Kumar, Sai Sudha Gorthi NV, Neredumali Prasanna Kumar

Caregiver burden and psychopathology in schizophrenia: A cross sectional study

Mirayala Gireesh Kumar, Pavan Kumar, Sai Sudha Gorthi NV, Neredumali Prasanna Kumar


Introduction : In developing countries like India where there is dearth of resources, major share and burden of caretaking of mentally ill patients is taken up by family members. Although lot of literature is available on caregiver burden and its correlates, there is only limited literature on caregiver burden in relation to various stages of schizophrenia and its implications. Our study was conducted to bridge this gap

Material and Methods: : A cross-sectional study of sixty chronic schizophrenia patients admitted to IMH, Hyderabad from January 2015 to April 2015, were studied along with their primary caregivers. Burden Assessment Schedule (BAS), Positive and Negative Syndrome Scale (PANSS) were the scales used.

Results : Negative symptoms were found to be better correlated with caregiver burden than positive or general psychopathology scores(R = 0.39, p = 0.0019). The implications of this finding were discussed.

Conclusion : Chronic stage is characterised by predominant negative symptoms and consequently high caregiver burden. Thus, different interventions are needed for both patients and caregivers in different stages.

Keywords : Care giver burden, schizophrenia, BAS, PANSS

Bacteriological profile of diabetic wound infections with special reference to drug resistance

Sabarinathan T, Aruna rajkumari V, Krishnamurthy S, Khalid Rashid, Amar CS, Yamini K

Bacteriological profile of diabetic wound infections with special reference to drug resistance

Sabarinathan T, Aruna rajkumari V, Krishnamurthy S, Khalid Rashid, Amar CS, Yamini K


Aim : A prospective study was carried out on patients with diabetic foot lesions to determine their clinical characteristics, spectrum of microbial flora and asses their comparative in vitro susceptibility to the commonly used antibiotics.

Material and Methods: : A total number of 100 cases of diabetic wound infections were screened for aerobic and anaerobic isolates. 50 non-diabetic patients with wound infection were screened for aerobic and anaerobic isolates which is taken as control.

Results and Conclusion :Out of 100 wound swabs collected from diabetic wounds, 44 samples were culture positive. From 44 cultures positive samples 48 aerobic bacteria were isolated. Among the 44 culture positive samples 40 were monomicrobial, whereas rest of the 4 culture positives revealed polymicrobial isolates. The incidence of diabetic wound infections were more among males and prevalence is more among the age group 40 – 69 years (mean age of incidence is 59.69 ± 9.71 years).

In the present study Pseudomonas aeruginosa was the predominant isolate followed by Staphylococcus aureus, Escherichia coli, Klebsiellapneumoniae, and Staphylococcus epidermidis. The incidence of wound infection is more among the diabetic patients when compared to non-diabetic patients because several immune defence mechanisms are defective like decrease in leukocyte chemotaxis, phagocytosis and defective intracellular killing. In the present study Pseudomonas aeruginosa 7(20.59%) was the predominat ESBL producer, followed by Klebsiellapneumoniae 4(11.76%) and Escherichia coli 3(8.82%). Total ESBL producers in gram negative isolates was 41.18%. Metalobetalactamases production among the Pseudomonas aeruginosa was 16.67%. The results also had shown the polymicrobial nature of the diabetic wound infection.

Keywords : Diabetes, wound, MRSA, ESBL, MBL

Combined therapy approach of treatment for complex anal fistula: A prospective study

Bapurapu Rajaram, Araboina Upender, Dodda Ramesh Kumar, Madipeddi Venkanna, Ravula Jagadeswar Goud

Combined therapy approach of treatment for complex anal fistula: A prospective study

Bapurapu Rajaram, Araboina Upender, Dodda Ramesh Kumar, Madipeddi Venkanna, Ravula Jagadeswar Goud


Aim : To evaluate the efficacy of combined therapy approach of treatment for complex anal fistula in terms of recurrence rate and anal incontinence

Material and Methods: : Seventy six (76) patients with complex anal fistula, were managed with combined therapy approach of treatment with Surgery, Medical(ATT-anti-tuberculosis treatment), Seton (Khshar sutra) at MGM Hospital, Kakatiya Medical College, Warangal from September 2010 to October 2015. The results were analysed.

Results : Seventy six (76) patients were treated during the five years of study period with the age (mean ± standard deviation) of 32 ± 5 years. The seton (Kshara sutra ) was tightened with a median of 5 times (3–15 times range). All (76) the cases were treated initially with Surgitherapy. 62 cases required ATT (81.5%). 14 cases required setontherapy (18.4%) .All the patients were followed up for incontinence and recurence for minimum period of six months. 71 patients were cured (93.4%), three (2.6%) patients developed mild flatus incontinence (2.6%) with ugly scar and two patients had recurrent fistula (3.8%).

Conclusion :The combined therapy approach treatment with surgery, medical (ATT), seton (khshara sutra) for complex anal fisula is safe, cost effective, low morbidity option with low recurrence rate and minimal anal incontinenece. Hence it should therefore be recomended as the standard of treatment for complex anal fistula.

Keywords : Complex anal fistula, kshara sutra, recurrence, incontinence

Skin and Pregnancy- A clinical study

Dasari Kavitha, Narender Gajula, Sirisha Varukuti, Anusha K, Sindhu V, Anji Babu J

Skin and Pregnancy- A clinical study

Dasari Kavitha, Narender Gajula, Sirisha Varukuti, Anusha K, Sindhu V, Anji Babu J


Introduction : During pregnancy many metabolic, endocrine ,vascular and immunologic changes occur, that are responsible for the changes of the skin and its appendages. Both physiologic and pathological alterations ,ranging from trivial cutaneous changes to changes that are pathological, recurrent and specific to pregnancy can occur. Pregnancy may also alter the course of preexisting dermatological diseases and tumors.

Aim : To find out the pattern and frequency of skin changes in pregnant women.

Material and Methods: : The study was conducted on pregnant females attending the outpatient Department of Gynecology and Obstetrics of our Hospital, CAIMS Karimnagar over a period of 1 year from January 2014 to December 2014.

Results : A total of 408 pregnant women were included in this study. Of these, 202(49.5%) pregnant women were primigravida and 206(50.49%) were multigravida. Skin changes grouped into: physiological changes (all cases), specific dermatoses (11cases) and other dermatoses affected by pregnancy (59 cases). Most common physiological changes were pigmentary alterations (Linea Nigra) seen in 364 (89.2%) followed by striae seen in 350(85.78%) cases. Of the various specific dermatoses of pregnancy, pruritic urticarial papules and plaques of pregnancy (PUPPP) was the most common disorder (5 cases) followed by pruritus gravidarum (4 cases). And other specific dermatoses were Pemphioid gestationis & prurigo gestationis of Besnier. The most common dermatoses affected by pregnancy were candidal vaginitis (15 cases), acne vulgaris (11 cases), eczemas (8 cases) tinea corporis (3 cases) skin tags (3 cases).

Conclusion :: The present study highlights the physiological changes as well as specific dermatoses of pregnancy. Early diagnosis of specific dermatoses of pregnancy may prevent harmful effect on mother and fetus. The pruritic eruptions of pregnancy, which are not a rare entity, can be a source of significant distress to the pregnant female &need timely therapeutic intervention.

Keywords : Linea Nigra , PUPPP, pruritus gravidarum, pemphioid gestationis

Awareness, knowledge and attitude towards glaucoma in rural eye camps of karimnagar, Telangana - A questionnaire based study

Rahu V, JVN Reddy, Anil Kumar Bhupally, Swathi M, Rohini M, Tulasi Priya, Priyanka

Awareness, Knowledge and Attitude towards Glaucoma in Rural Eye Camps of Karimnagar, Telangana – A Questionnaire Based Study

Rahu V, JVN Reddy, Anil Kumar Bhupally, Swathi M, Rohini M, Tulasi Priya, Priyanka


Aim : The aim of this study is to evaluate level of awareness about glaucoma and attitude towards importance of eye screening among rural population of Karimnagar.

Material and Methods: : A questionnaire based study with a sample size of 8000 randomly selected from people in surrounding villages of Karimnagar through health camps from the institute, and were interviewed face to face with a pre structured questionnaire. The questionnaire is to evaluate level of awareness and knowledge about glaucoma and their attitude towards importance of screening for the disease.

Results : Awareness about glaucoma was very poor in the rural population, and females are less aware compared to males and illiterates are less aware compared to literates. Among the 8000 people who enrolled in the survey, the responses from 7635 (95%) participants - 2596 (34%) who were aware of the term glaucoma, 1450 (19%) who know glaucoma causing blindness, 153 (2%) have proper knowledge about disease course. 2825 (37%) showed positive attitude for eye screening, participants 4810 (63%) showed negative attitude.

Conclusion :: There is lack of awareness about glaucoma causing blindness and the attitude for seeking intervention for glaucoma was not encouraging. There is unmet need of community based health education towards eye care to reduce ocular morbidity and irreversible blindness from glaucoma among rural population of Karimnagar.

Keywords : Awareness, attitude, glaucoma, knowledge, rural Karimnagar

Effect of obesity on anti oxidant enzymes and type 2 diabetes

Jhansi Rani C, Sarojini C, Vijaya Chandra Mouli, Bhagya Seela

Effect of Obesity on Anti Oxidant Enzymes and Type 2 Diabetes

Jhansi Rani C, Sarojini C, Vijaya Chandramouli, Bhagya Seela


Introduction : Obesity has become a major health problem in both developed and under-developed countries. Obesity represents an abnormal accumulation of adipose tissue resulting from chronic over nutrition and reduced physical activity. The aim of this study was to determine the effect of obesity on anti-oxidant enzymes and type-2 diabetes.

Aim : The present work aimed at investigating the effect of obesity on type-2 diabetes and anti-oxidant enzyme activity.

Material and Methods: : A total of 50 Subjects (32 males, 18 females) aged > 35 years were selected from Chalmeda Anand Rao Institute of Medical Sciences, Bommakal, Karimnagar. Obesity is determined by the body mass index(BMI). Lipid peroxidation was determined by measurement of thio-barbituric acid reactive substances (TBARS) in plasma of the patients. The anti-oxidant enzymes superoxide dismutase was assayed.

Results : The mean and S.D of Malondialdehyde of controls is 240 + 1.14 as compared to 619 + 0.91 in cases. The mean S.D. of superoxide dismutase of controls 100.2 + .67 and the mean S.D. of cases 50.04+4.69. The mean and S.D. of fasting serum glucose in controls is 88.33+ 6.78 as compared to 146.30 + 11.68 in cases. The mean and S.D of serum total cholesterol, triglycerides, VLDL-C LDL-C in controls are 163.28 + 5.98, 136.88 + 14.62, 26.68 + 2.32, 90.04 + 6.14 respectively as compared to 214.16 + 10.77, 190.56 + 13.77, 38.08 + 2.69, 141.36 + 11.32 in cases. The mean and S.D of serum non HDL-C and TG/HDL-C in controls are 118 + 12.88 and 2.88+ 0.40 respectively as compared to 179.4 + 11.30 and 5.85 + 0.66 respectively in cases. The mean and S.D. of TC/HDL-C in controls is 3.5 + 0.35 as compared to 6.54 + 0.69 in cases.

Conclusion :: Our study was concluded that obesity even in the absence of smoking, renal or liver disease can decrease the body’s protective anti-oxidants and enhance the systematic oxidative stress.

Keywords : Obesity, antioxidant enzymes, oxidative stress, type 2 diabetes

Surgical management of doso-lumbar spinal injuries with posterior instrumentation

Jhatosh Ventateshwarlu, Venkateshwar Rao T, RamKumar Reddy K, Hanmandlu B

Surgical management of doso-lumbar spinal injuries with posterior instrumentation

Jhatosh Ventateshwarlu, Venkateshwar Rao T, RamKumar Reddy K, Hanmandlu B


Introduction : Thoracolumbar segment is second most commonly involved segment in the spinal cord following spinal injuries followed by cervical segment. The goal of treatment of every spinal injury is restoration of the patient to maximum possible function with disability free life. In this study, we stabilize the cases of the unstable thoracolumbar spine injuries with or without decompression and pedicular screw & rod instrumentation. We have evaluated all patients for maintenance of spinal correction and neurological improvement after posterior instrumentation in thoracic and lumbar spinal fractures and clinical outcome in terms of spinal scoring system called as Denis work and pain scale.

Material and Methods: : Twenty adult patients (13 male and 7 female) who underwent posterior instrumentation with pedicle screw and rod system for acute thoracolumbar injuries at single institution were included in this prospective study. The average age of the study group was 38 years.

Results : Fall from height was the main mode of injuries. The most common vertebrae involved in this series were between T11 - L2 to the extent up to 75%. In 75% of the patients, the fractures were reduced by using polyaxial implants and in 25% of the patients both monoaxial and polyaxial implants were used. The average regional angle during pre-operative stage was 16.50 ± 5.020 and 4.450 ± 4.150 during 1 year post-operative period. There was a significant difference between pre op and post-operative regional angles. The mean difference of vertebral height between pre and 12th postoperative week was 8.8 mms, pre and 24th postoperative week was 7.95 mm and pre and 1 year post-operative period was 7.95 mm. During 1 year post-operative period, ASIA grade A was 5%, grade B was 0%, C was 5%, D was 20% and E was 70%. Among all the subjects 20% of the patients returned to their previous work or physically challenging job and 35% were able to return to previous employment to heavy labour with some restriction. About 45% of the patients had no pain and 30% had occasional minimal pain with no need for medication at the end of one year follow up period.

Conclusion :There is restoration of vertebral body height, mean regional angle and mean anterior wedge angle with posterior instrumentation in thoracolumbar fractures. Neurological recovery was seen significantly when all cases with neurological deficits were clubbed together as per ASIA grading. Improved clinical outcome, in terms of work capacity and decrease in pain according to Denis work scale and Denis pain scale respectively.

Keywords : Thoracolumbar fractures, posterior instrumentation, pedicle screw

A study on evaluation of immunization status under five years and breast feeding practices under RHTC area Karimnagar District

Rajamouli J, Ravinder A, Madhusudan S

A study on evaluation of immunization status under five years and breast feeding practices under RHTC area Karimnagar District

Rajamouli J, Ravinder A, Madhusudan S


Introduction : Community based cross sectional study was conducted in the field practice area of Rural Health Training Centre (RHTC) to find out the immunization status of under five children and breast feeding practices among below poverty line and above poverty line group (A.P Classification)from 1st June 2014 to 30th September 2014.

Objectives : 1) To evaluate immunization status of under five children in rural health training centre (RHTC) practicing area.

2) To assess the breast feeding practices under RHTC - Manakondur 1st and 2nd sub centres and Annaram sub centre.

Material and Methods: : Community based cross sectional study was conducted in the field practice area of Rural Health Training Centre(RHTC), Karimnagar.

Results : Mean age of children in the study is 40.7 months with standard deviation of 22.52. Children were immunised (94.37%) up to date. At birth immunisation of children is 99.5%, whereas there is drastic fall (69.3%) in the immunisation of booster doses of DPT,OPV with comparison previous years. Only one child in the present study was not immunized for second dose because of fear of previous reactions. Up to date immunisation status is little lower in below poverty line when compared with above poverty line socio-economic group. The study findings revealed that all the children were breast fed (100%). Initiation of breast feeding within an hour was practiced by only a few mothers (10%). 95% babies were exclusively breast fed till six months. 69% of mothers have continued breast feeding when child is suffering from diarrhoea. only 40% of mothers are aware about birth spacing by contraception

Conclusion :Breast feeding was popular in rural women, though their knowledge it needs to be improved the feeding practices which directly influences the health of the child. To achieve 100 % Full Immunisation has to be improved though at birth immunisation is 99.5% but full immunisation along with booster doses has to be improved by BCC methods. The information regarding the advantages of full immunisation needs to be provided for the community as a whole. Special health education camps and community mobilisation may help in identifying and referring the children for vaccination.

Keywords : Immunization status, breast feeding practice

Use of cardiotogram (CTG) as an admission test as predictor of fetal outcome in labour in low risk group

Ramadevi E, Madhavi GB, Pranathi Reddy L, Anusha Rao P

Use of Cardiotocogram (CTG) as an Admission Test as Predictor of Fetal Outcome in Labour in Low Risk Group

Rama Devi E, Madhavi GB, Pranathi Reddy L, Anusha Rao P


Introduction : Intrapartum fetal morbidity and mortality is not uncommon in a low risk population. If for some reason continuous monitoring cannot be applied, alternative ways of using monitors might be of interest. Such an alternative is the admission test. Objective of the study was to evaluate the role of cardiotocogram (CTG) and to study fetal outcome in low risk group.

Material and Methods: : The study population consisted of 200 low risk patients in labor admitted at Chalmeda Anand Rao institute of medical sciences, Karimnagar during the period of 2013-2015. Patients were subjected to admission test using Philips Avalon FM20 fetal monitor at speed of 1cm/min for 20 minutes. The trace thus obtained will be classified as normal, suspicious and pathological AT. Admission test results were compared with various labor outcome variables i.e., Incidence of fetal distress, mode of delivery, neonatal outcome in relation to AT result.

Results : In this study, there were 168 patients (84%) with normal AT, 14 patients (7%) with suspicious AT, 18 patients (9%) with pathological AT and therefore, a total of 16% patients had abnormal AT. The incidence of fetal distress (88.88% vs. 7.73), caesarean section rate (94.44% vs. 7.73%), low Apgar score at 5’ (50% vs. 4.87%), NICU admission (55.55% vs. 4.76%) was higher in pathological AT group than in normal AT. The sensitivity of the admission test in predicting fetal distress was 57.89%, specificity was 93.82%, and the positive & negative predictive values were 68.75% & 90.47% respectively.

Conclusion :The admission cardiotocography is a simple noninvasive test that can serve as screening tool to detect fetal distress already present or likely to develop and prevent unnecessary delay in intervention. The test has high specificity and can help in ‘triaging’ fetuses in obstetric wards of developing countries with a heavy workload and limited resources. Admission test in this study was helpful in reducing the neonatal morbidity by early intervention in pathological admission test group even when its sensitivity is low in detecting distressed fetus

Keywords : CTG, fetal distress, low risk pregnancy, apgar score, perinatal outcome

Management of fracture of distal end of femur by of different methods: Prospective comparative study

Nagamuneendrudu K, Prabhudheer, Rakesh, Ramakrishna Reddy

Management of fracture of distal end of femur by of different methods: Prospective comparative study

Nagamuneendrudu K, Prabhudheer, Rakesh, Ramakrishna Reddy


Aim : This study is done to elucidate current treatment strategies as well as their evidence based rationale. The commonly done surgical techniques with internal fixation are outlined, the rationale of indications are discussed and the rationale of selection of the procedures are concluded.

Material and Methods: : In this prospective study, carried out at Osmania General Hospital, Dept. of Orthopaedics, Hyderabad from August 2011to July 2013. A total of 52 patients were identified based on defined inclusion and exclusion criteria and constituted the sample. The following variables of each patient record were analyzed, Age, sex, mechanism of fracture, type of fracture according to the AO/ ASIF classification, surgical treatment modality, during the follow-up at postoperative weeks 4, 8 and 12 the following variables were recorded: range of motion of the knee joint, radiologic evidence of healing, and complications. The results obtained at 6th month were assessed using the Neer scale 20.

Results : 52 patients are treated with different with three deferent implants, buttress plating (18cases), Locking plating (17 cases), Retrograde nailing (17 cases). The mean age of the patients was 29 years (range, 18–79 years). 43 are men and 9 women. 22 are supracondylar (AO type A) fractures 7 partial articular(AO Type B)and 23 intercondylar (AO type C) fractures (Table). 17 fractures were open (Gr 1 & 2), and the remaining cases are closed fractures. 38 cases are high velocity and 14 cases are of low velocity. The mean time required to achieve union was 4.3 months (range, 3.0–12.6 months).The healing is good the functional outcome is good, in all cases.

Conclusion : The MIPO-Minimally Invasive Plate Osteosynthesis, LISS less invasive stabilization system is preferred. In the elderly patients with a thin metaphyseal cortex and osteoporotic bone, and wherever one expects to find osteopenic bone, LCP is preferred. Supracondylar nailing is useful for fixation of supra- condylar and less comminuted inter condylar fractures. The simplicity of the procedure also facilitates fracture fixation in patients with multiple trauma, No significant differences were found in the degree of bone healing. The recovery range movement is better with plating, more so with minimally invasive technique, of the two methods of plating locking plate is mechanically more advantageous over the buttress plate, more useful in osteopenic bones and in fractures with comminution.

Keywords : Fracture of distal of femur, neer scale, ASIF


A rare case of herlyn werner wunderrich syndrome- Role of MRI in diagnosis

Santhosh Babu R, Praneeth Kumar K, Narender Reddy P, Ravi Kiran G, Naveen Kumar S

A Rare Case of Herlyn Werner Wunderlich Syndrome - Role of MRI in Diagnosis

Santhosh Babu R, Praneeth Kumar K, Narender Reddy P, Ravi Kiran G, Naveen Kumar S


Herlyn werner wunderlich syndrome (HWWS) is a rare congenital mullerian ductal Anomaly (MDA) characterised by the triad of uterus didelphys, obstructed hemivagina and ipsilateral renal agenesis. It generally occurs at puberty and exhibhits non-specific and variable symptoms with acute or chronic pelvic pain shortly following menarche, causing a delay in diagnosis. Moreover, the diagnosis is complicated by the infrequency of this syndrome, because mullerian ductal anomalies are infrequently encountered in a routine clinical setting. We report here a 15 -year-old female presenting with secondary amenorrhoea and pain abdomen where magnetic resonance imaging (MRI) suggested the diagnosis of HWWS.

Keywords : Herlyn-Werner-Wunderlich syndrome, Magnetic resonance imaging, Mullerian ductal anomaly

An overview of delayed presentation of traumatic diaphragmatic hernia

Mangilal, Lalith, Vamshikrishna, Prashanth S

An Overview of Delayed Presentation of Traumatic Diaphragmatic Hernia

Mangilal, Lalith, Vamshikrishna, Prashanth S


The first traumatic diaphragmatic hernia was reported by Sennertus in 1541. The first two deaths were described by Ambrose Paré in 1578, one from strangulated bowel. The diaphragm is the major muscle of respiration. Diaphragmatic excursion and chest wall expansion increase the negative intrathoracic pressure required for inhalation. The sequelae from diaphragmatic rupture and subsequent herniation of intra-abdominal contents are associated with significant morbidity and mortality. Diaphragmatic hernias can be divided into the following two categories: Congenital defects, Acquired defects.

Congenital diaphragmatic hernias (CDHs) occur because of embryologic defects in the diaphragm. Most patients with CDH present early rather than late in life; however, a subset of adults may present with a congenital hernia that was undetected during childhood. Acquired diaphragmatic hernias stem from all types of trauma, with blunt forces accounting for the majority.

Keywords : Diaphragmatic hernia, strangulated bowel


Pneumocystits jeroveci pneumonia

Sumalatha Kasturi, Santhosh Babu Rendla, Sandhya Rani Bojjam

Pneumocystis Jeroveci Pneumonia

Sumalatha Kasturi, Santhosh Babu Rendla, Sandhya Rani Bojjam

40 year old male presented with fever, productive cough and shortness of breath for 2 months. Chest x-ray showed bilateral opacification with doubtful mass lesion in right upper lobe. Right upper lobectomy was done and the specimen sent for histopathological examination. Cut section of specimen showed gray white to gray brown areas without a mass lesion.



V.7 (1): 1-74 Jan-Jun

V.8 (2): 77-145 Jul-Dec



A comparative evaluation of 0.5% hyperbaric ropivaccine with 0.5 hyperbaric bupivaccine for subarachnoid block elective below umbilical surgeries

MA Qadeer Khan, Syamsundara Rao B, SA Aasim

A Comparative Evaluation of 0.5% Hyperbaric Ropivacaine with 0.5% Hyperbaric Bupiva-caine for Sub-Arachnoid Block for Elective below Umbilical Surgeries

MA Qadeer Khan1, B Syamasundara Rao2, SA Aasim3


Aim : To compare the onset and duration of sensory and motor blockade of intrathecal 0.5% hyperbaric ropivacaine  and 0.5%  hyperbaric bupivacaine for elective below umbilical surgeries.

Materials and Methods: A prospective randomized study was conducted with forty ASA (American society of Anaesthesiologist) grade I and II patients undergoing lower-abdominal or lower-limb surgery under subarachnoid who were selected to receive 3ml of 0.5% hyperbaric ropivacaine  (Group R) or 3 ml of 0.5% hyperbaric bupivacaine (Group B)  randomly. The onset, duration of sensory and motor block and side-effects were observed.

Results: The sub-arachnoid block with the study drugs in both the groups was adequate for the surgery, but there were significant differences in mean time of onset of sensory block.The level of sensory blockade was tested by pinprick and time taken for onset of analgesia at T10 was more rapid in Group R (2.9 + 1.04 minutes) than for Group B (5.3 + 1.34 minutes). In group R, the maximum level of block attained was T7 in 50 % of the cases, whereas it was T6 in 60 % of cases in group B. The total duration of sensory block was shorter in Group R (P=0.0001). The degree and duration of motor block were greater in group B when compared to group R. Mean time taken for complete regression of sensory block was (160 + 9.65 minutes) with group R compared with (201 + 8.65minutes) with group B.

Conclusion: 0.5% hyperbaric ropivacaine provides a reliable and a good quality sub-arachnoid block with better haemodynamic stability but with shorter duration when compared to 0.5% hyperbaric bupivacaine.

Keywords: Local anesthetics 0.5% hyperbaric bupivacaine, 0.5% hyperbaric ropivacaine

Relationship between dual task performance and walking speed in elderly

Mahendran P, Kandarpa Jyoti Das

Relationship Between Dual Task Performance and Walking Speed in Elderly

Mahendran P1,  Kandarpa Jyoti Das2


Aim : Cognitive function specially attention and fast memory processing plays a major role in gait performance. But very limited studies have explored the relationship between dual task performance and walking speed in elderly. So this study is aimed to determine the relationship between dual task performance and walking speed in elderly which can be helpful in gait training to minimize the risk of fall.

Subjects : This study includes 60 persons whose mean age was 73.17±5.81 years.

Materials and Methods : Subjects cognitive function was determined by using mini-mental state examination (MMSE) and balance by Berg balance test (BBT). Those who scored MMSE>24 and BBT>45 were selected for the study and underwent walking speed evaluation for both normal and dual task.

Results : Correlation between age and walking speed in both normal and dual task were negative. There was a significant relation between cognition balance and walking speed in both normal and dual task. Correlation between normal and dual task walking speed were also positive (P>0.001). Due to the results of regression analysis in order to find out the variables most affecting the walking speed.

Conclusion : The study concluded that in elderly people walking speed decreases during dual task due to balance and cognition problem because of advancing age but balance plays a major role in dual task walking. Hence changes in performance while dual task walking could be used to identify subjects who have poor balance and are at risk of falls.

Keywords : Walking speed, elderly, dual task

Evaluation of cardioprotective effect of nigella sativa oil in daunorubicin induced cardiotoxicity in albino rats

Govardhan Reddy Kasireddy, Mohd Moshin, Ravinder T, Pushpalatha Chinnam

Evaluation of Cardioprotective Effect of Nigella Sativa Oil in Daunorubicin Induced Cardiotoxicity in Albino Rats

Govardhan Reddy Kasireddy1, Mohd Mohsin2, Ravinder T3, Pushpalatha Chinnam4


Aim : The main objective of the present study was to see the cardioprotective effect of nigella sativa oil (N.S oil) in daunorubicin (DNR) induced cardiotoxicity in albino rats

Materials and Methods: The effect of nigella sativa oil in daunorubicin induced cardiotoxicity was studied in albino rats. The animals were divided in to 4 groups with 6 rats in each group. Group I served as vehicle control, Group II animals were given only Nigella sativa oil 1ml/kg body weight/day orally for 21 days, Group III animals were given 6 doses of daunorubicin 3mg/kg body weight intraperitoneally on alternate days and Group IV animals were given Nigella sativa oil 1ml/kg body weight/day orally for 21 days + daunorubicin 3mg/kg 6 doses intraperitoneally on alternate days. The animals were sacrificed on 22nd day and heart was subjected to histopathological examination.

Results: Daunorubicin provoked cardiotoxicity was evident from histopathological changes. Supplementation of nigella sativa oil has shown improvement in histopathological changes in heart.

Conclusion: The present study showed that Nigella Sativa oil has protective effect on daunorubicin induced cardiotoxicity in albino rats.

Keywords : Nigella sativa oil, daunorubicin , cardiotoxicity

A study on prevalence of hypertension among chronic kidney disease patients admitted in the nephrology department of CAIMS, Karimnagar

Murari Rajendra Prasad, Gopal Rao Jogdan, Mahesh G, Saritha S, Divya BVSS, Mrudula G

A Study on Prevalence of Hypertension among Chronic Kidney Disease Patients admitted in the Nephrology Department of Caims, Karimnagar

Murari Rajendra Prasad1, Gopal Rao Jogdand2, Mahesh G3, Saritha S4, Divya BvSS5, Mrudula G6


Aim : Chronic kidney disease (CKD) is an increasingly recognized global health problem. Hypertension is a risk factor and complication of chronic renal disease. Studies have shown that better blood pressure control slows progression of chronic kidney disease. To study the prevalence of hypertension among chronic kidney disease patients attending to nephrology department. To know the association of other risk factors with hypertension and chronic kidney disease.

Materials and Methods: Retrospective cross sectional study was done from June to November 2013, chronic kidney disease patients admitted in the nephrology ward are included in the study. Data analyzed by spss software version 20.

Results : Total study subjects - 306, Mean age in years 46.36±11.13, Age ranging from 13 to 73yrs. Age had a significant  association with ckd (86% >40yrs). Prevalence of hypertension amongst patients with ckd is 81.35%. Hypertension is increasingly associated with an advanced stage of chronic kidney disease (90% in stage-4 ckd). Smoking was a significant risk factor for hypertension among ckd patients (88%). Alcohol consumption had a significant association with hypertension among ckd patients (89%).

Conclusion : All efforts should be made to detect and strictly control hypertension in prevention and management of ckd. As an initial step, individuals aged more than 40 years and with family history of ckd should be screened for hypertension and ckd. Increased efforts are needed to identify the reasons for inadequate control of hypertension and approaches to increase blood pressure control among patients with ckd. Ckd patients with hypertension should be regularly screened for cardiovascular disease.

Key words: Hypertension, chronic kidney disease, dialysis, life style changes.

Diagnostic role of aspiration cytology in salivary gland lesions

Vidhyadhara Rani P, Naveen Kumar S, ShanmugaRaju P

Diagnostic role of Aspiration Cytology in Salivary Gland Lesions

Vidyadhara Rani P1, Naveen Kumar S2, Shanmugha Raju P3


Aim: The aim of the present study is to examine the cytological details in aspirated smears from salivary gland swellings and to evaluate the efficacy of Fine needle aspiration cytology (FNAC) in the diagnosis of salivary gland lesions.

Materials and Methods: The present study was carried out in the Department of Pathology, Kamineni Institute of Medical Sciences, Narketpally. In this study 53 patients with salivary gland lesions diagnosed clinically in the ENT and Surgery department of Kims hospital were selected during the period from september 2008 to october 2010.Histopathological follow-up data were acquired in 37 cases. The study was carried out to observe the sensitivity, specificity, anddiagnostic accuracy of FNAC for salivary gland lesions.

Results: The male-to-female ratio was 1:1.1. Parotid gland was involved in 59.37%, submandibular gland in 34.37% and other minor salivary glands in 6.25% of patients. There were 29.73 % cases of non-neoplastic lesions,54.05% cases of benign neoplastic lesions and16.22% of malignant lesions. In our study, the sensitivity was 92.30%, specificity 100.00% and diagnostic accuracy was 94.59%.

Conclusion: The present study has indicated the diagnostic role of fine needle aspiration cytology in salivary gland lesions and its reliability. Re-aspirations and image-guided techniques, coupled with immunohistochemistry, will certainly enhance the diagnostic accuracy

Keywords: FNAC, salivary gland, histopathology, diagnostic accuracy.

Surgical management of distal end radius fractures by various methods: A prospective study

Venkateshwarlu Jhatosh, Venkateshwar Rao T, Ramkumar Reddy, Chandra Krishna Ch, Hanmandlu

Surgical Management of Distal end Radius Fractures by Various Methods: A Prospective Study

Venkateshwarlu Jhatosh1, Venkateshwar Rao T2, Ram Kumar Reddy3, Chandra Krishna Ch4, Hanmandlu5


Aim: The optimal management of fractures of distal end radius has changed dramatically over the previous two decades from almost universal use of cast immobilization to a variety of highly sophisticated operative interventions. To assess the functional outcome of the distal end radius fractures we did a prospective study on 30 patients for a follow up of  20 months duration.

Materials and Methods: All the patients with fracture distal end radius are classified according to the Universal classification after radiographic evaluation.There were 20 males and 10 females between the age group of 20 – 60 years. Injury occurred due to road traffic accident in 50% of cases. The dominant wrist (right) was affected in 60% of cases. Five patients had associated long bone fractures. The results of this study is evaluated by clinician based functional outcomes of Gartland and Werley demerit scoring system and Stewart II scoring system.

Results: Most of the extra-articular displaced fractures were treated with closed reduction under image intensifier control and fixed with percutaneous K-wire. Most of the Intraarticular fractures are treated by internal fixation with plating techniques. Bridging external fixator was the mode of management for 53% of cases of this study which were grossly comminuted fractures. Excellent to good outcomes are seen in 90% of the cases treated by various surgical methods.

Conclusion:Unstable extra-articular and intra-articular fracture were reduced anatomically, and fixed with k-wires. Intra-articular displaced volar barton’s fracture were treated by open reduction and internal fixation with Ellis ‘T’ buttress plate or locking compression plate. Grossly comminuted fractures of distal end radius and compound fractures were stabilized with external fixator.

Keywords:  Distal end radius, elli’s plate, external fixator

Study of fingertip pattern in diabetic patients

Sudagar M, Zafer Sultana, Pimpalkar DS, Tabrej MD

Study of Fingertip Pattern in Diabetic Patients

Sudagar M 1, Zafar Sultana 2,  Pimpalkar DS3,  Tabrej MD4


Aim: To study and compare fingertip dermatoglyphic patterns in the diabetic patients with the control group  and to find out, whether the specific dermatoglyphic trait exist in the patients of diabetes mellitus and whether it is significant.

Materials and Methods: The present study is undertaken with an aim to evaluate the dermatoglyphic features in diabetic patients. The study consists of 150 diabetic patients and 150 normal healthy individuals as controls. They were 75 males and 75 females in each group. Dermatoglyphic prints were taken by “Ink Method” described by Cummins and Midlo and further subjected to statistical analysis to find the variations in the dermatoglyphic features among diabetic patients and control groups.

Results: Loops are decreased in cases but not statistically significant. Loops are significantly decreased in diabetic females (P=0.032). Loops are increased in diabetic males but not statistically significant. Whorls are increased in diabetic patients but not statistically significant. Whorls are decreased in diabetic males but not statistically significant. Whorls are significantly increased in diabetic females (P=0.0482). Arches are decreased in diabetic patients but not statistically significant. Mean value of TFRC is neither increased nor decreased in diabetic patients. Mean value of AFRC is significantly increased in diabetic patients(P=0.05).

Conclusion:  From the present study, it appears that there do exists a variations in the dermatoglyphic patterns in diabetic patients with an advantage of being simple and economical ‘ink’ method. As the specific features of dermatoglyphic patterns are present in diabetic patients, it can be use for mass screening program to segregate the predicted diabetic patients.

Keywords: Loop, whorl, arch, total finger ridge count, absolute finger ridge count


Menstrual blood banking

Padma B, Mamatha N

Menstrual Blood Banking

Padma  B1, Mamatha N2


We adopt many habits to stay healthy. Everyone crave to protect themselves against diseases in their life. Due to age, injury or illness, the body’s natural ability to regenerate itself is broken down leading to degenerative diseases. Currently available medications help manage only the symptoms of these diseases but do not attack the root cause and therefore are not very effective.  Until now, menstrual blood has typically been discarded as unsanitary waste. Existing new research shows that menstrual blood is a rich source of self – renewing stem cells that have a high potential to treat ailments in the future through stem cell  therapy.  Discovering curative power of stem cells has been a revolutionary breakthrough in the field of surgery and medicine till date, which has actually given many- the precious gift of life.

This study is aimed to educate the public to hold the potential to save themselves from future ailments and understand that menstrual stem cells obtained from the menstrual blood offer the best potential to display high concentrations of stem cell growth factors.  As investigators we are happy about this new innovation and feel that it is our duty to educate women about the most miraculous thing of contributing medically to save lives through the endometrial regenerative cells (ERC) or stem cells harvested from discarded menstrual fluid.          

Keywords:  Menstrual blood, menstrual blood banking, endometrial regenerative cells.                   


Hereditary epidermolysis bullosa A case report and review literature

Srinivas Madoori, Ramya C, Sridevi B, Rohini Ponnala, Ramya Madhuri Y

Hereditary Epidermolysis Bullosa A Case Report and Review of Literature

Srinivas Madoori1, Ramya C2, Sridevi B3, Rohini Ponnala4, Ramya Madhuri Y5


Hereditary epidermolysis bullosa(EB) is a rare autosomal dominant disorder. It is characterised by blister formation following minor trauma. Here  we report a case of 7 hours old newborn male baby  presented with bullous lesions (fluid filled cavities or blisters, larger than 0.5 cm ) over left arm and erosion of skin over left eyelid, nape of the neck and right arm since an hour after birth. After a thorough family history and complete physical examination, the clinical findings of this baby were consistent with epidermolysis bullosa simplex generalised formerly known as Koebner variant. Baby was admitted in NICU of Chalmeda Anand Rao Institute of Medical Sciences, Karimnagar and treated with strict aseptic measures, given intra venous fluids, antibiotics. Baby was discharged on 6th day of life, with proper counselling for management of blisters and prenatal diagnosis in future pregnancy.

Keywords:  Blisters, epidermolysis bullosa simplex, new born.

A case of torsion tests salvage by detorsion

Ramlingam P, Prashanth G, MA Rehman

A Case of  Torsion Testis Salvage by Detorsion

Ramlingam P1, Prashanth G2, MA Rehman3


Early diagnosis of testicular torsion is absolutely mandatary for salvage of a viable testis. we present a classical clinical presentation of a boy, in second decade with sudden onset of testicular pain accompanied by tenderness and swelling. Managed by timely manual detorsion and followed by elective orchiopexy.

Keywords: Testicular torsion, salvage by detorsion

Complete motor recovery after acute paraplegia caused by spontaneous cervicodoral epidural hematoma

Kishore PVK, Hemaratnan A, Sahil Gupta, ShanmugaRaju P, Dilip Punnam, Agastya D, Vimal Kumar, Santosh SamRat, Dasaradhi K

Complete Motor Recovery after Acute Paraplegia caused by Spontaneous Cervicodorsal Epidural Hematoma

Kishore PVK1, Hemaratnan A2, Sahil Gupta4, Shanmuga Raju P3, Dilip Punnam4, Agastya D4, Vimal Kumar4, Santosh Samrat4, Dasaradhi K4


Spontaneous spinal epidural hematoma (SSEH) is a rare entity. The incidence of SSEH has been estimated at 0.1 patients per 100,000 individuals and represents less than 1% of spinal space-occupying lesions.  Here we are presenting a case of 65 year old female patient, who presented with sudden onset of backache followed by weakness of both lower limbs, associated with bladder and bowel incontinence. Patient was subjected to MRI spine which shows extradural space occupying lesion seen in posterior spinal epidural space extending from C6- D4 level compressing the cord.  Possible causes of an Acute Paraplegia like AVM bleed, coagulapathies, hemangioma, transverse myelitis, multiple sclerosis were ruled out by relevant investigations. Patient was subjected to surgical evacuation of hematoma after 72 hours of presentation. Postoperative period was uneventful. Physiotherapy was started in immediate post operative period. Sensations improved. Motor weakness also improved from Grade 0 to Grade V in lower limbs. Patient recovered completely during the hospital stay and regained bladder bowel control.

Keywords : SSEH, epidural hematoma, paraplegia, cervico-dorsal

A rare case report of filarial pleural effusion

Rajender M, Aruna T, Shruthi Reddy A, Lokesh G, Raghukanth A, Gnaneshwar Goli

A Rare Case Report of Filarial Pleural Effusion

Rajender M1, Aruna T2, Shruthi Reddy A3, Lokesh G4, Raghukanth A5, Gnaneshwar Goli6


Lymphatic filariasis is common in tropical countries and is endemic in India. It has wide spectrum of presentation. Filarial lung involvement is usually in the forms of Tropical Pulmonary Eosinophilia with pulmonary infitrates and peripheral eosinophilia. Pleural effusion is an uncommon manifestation, and the finding of microfilaria in the pleural fluid is very rare. We report a rare case of pleural effusion which showed microfilaria of wucherania bancrofti cytologically and on nocturnal  peripheral blood smear.

Keywords: Microfilaria, pleural effusion, filariasis.

Malignant mesothelioma of tunica vaginalis

Sreenivas Vemula, Sumalatha Kasturi, Pradeep Kumar Chitumalla, Shobib Zeeshan, Roshni Sumalini

Malignant Mesothelioma of Tunica Vaginalis

Sreenivas Vemula1, Sumalatha Kasturi2, Pradeep Kumar Chitumalla3, Shoib Zeeshan4, Roshni Sumalini5


Testicular mesothelioma is the rarest form of  mesothelioma representing 1% - 5% of all malignant mesotheliomas. To date, less than 100 cases of this type of mesothelioma have been reported. The non specific symptoms, broad age distribution and lack of tumor markers make preoperative diagnosis of malignant mesothelioma of tunica vaginalis difficult and most of the reported  cases were diagnosed at histology. A 70 year old man presented with 3 year history of hydrocele. The patient underwent orchiectomy. Gross examination of operative specimen revealed gray white  nodules studding the thickened tunica vaginalis.  Microscopic examination revealed classical malignant mesothelioma of biphasic type.  Conclusions: The diagnosis of testicular malignant mesothelioma can be difficult, both from clinical and pathological point of views. Awareness and proper recognition of this entity are essential to reach the correct diagnosis.  Radical orchiectomy should be the primary therapy. In some cases adjuvant chemotherapy or radiotherapy is given.

Keywords: Malignant mesothelioma, tunica vaginalis, hydrocele, Calretinin

Successful management of ovarian cyst torsion during pregnancy: A case report

Ramadevi E, Sharda, Padmalatha, Leela R

Successful Management of Ovarian Cyst  Torsion during Pregnancy:  A Case Report

Ramadevi E1, Sharada2, Padmalatha3, Leela R4


In this case we report a 21 –year old primigravida with 10 weeks gestational age presenting with torsion of the ovarian cyst. She presented to the antenatal clinic with acute pain abdomen and vomitings. She was diagnosed to have torsion of ovarian cyst during pregnancy and a cystecomy was carried out. Her histopathology report showed hemorrhagic infarction, twisted right ovary with congestion of fallopian tube. Her pregnancy is being followed up and she is currently at 18 weeks of gestation. Although the safety of antepartum surgical intervention has been accepted, abdominal surgery nevertheless carries some risks to a pregnant woman and unborn fetus, and so the choice of management necessitates a weighing of risks based on characterization of the adnexal mass and gestational age.

Keywords: Ovarian Cyst Torsion, Pregnancy

Vogt koyangi Harada syndrome presenting as isolated ocular disease A case report

Raghu Veladanda, Iram Jowhar, Priyanka Datrik, Tulasi Priya Chennapalli

Vogt Koyanagi Harada Syndrome Presenting as Isolated Ocular Disease – A Case Report

Raghu Veladanda1, Iram Jowhar2, Priyanka Datrik3,  Tulasi Priya Chennepalli4


A 20 year old male patient presented to our outpatient department with the chief complaint of diminished vision of a gradually progressive and painless onset in both eyes since a week. On examination, the anterior segment was normal except that both his pupils reacted sluggishly to both direct and indirect light reflexes. His fundus in both eyes showed peripapillary and macular edema about 3 disc diameters in size with mild perivascular sheathing. Fundus fluorescein angiography (FFA) showed multifocal hyper fluorescent dots at the level of RPE and accumulation of dye in the sub retinal space. B-scan showed localized retinal detachments in both eyes. It was diagnosed as Vogt Koyanagi Harada syndrome presenting as isolated ocular disease. VKH syndrome is an idiopathic multisystem autoimmune disease featuring inflammation of melanocyte-containing tissues such as the uvea, ear and meninges.

Key words: VKH syndrome, peripapillary edema, multiple serous retinal detachments


Effect of satiety over blood glucose levels: A prospective study

Sabitha K, Rajukumar, Venugopal B, Raf

Effect of Satiety over Blood Glucose levels :  A Prospective Study

Sabitha K1, Rajkumar2, B Venugopal3, Rafi4


Aim: Fasting blood glucose reflects pancreatic islet ß- cell function and stands for secretory function of basic insulin and measurement of fasting blood sugar(FBS) is used to diagnose diabetes as it has low positive results. But high levels of postprandial blood sugar(PPBS) alone is the risk factor for mortality in cardio vascular disease(CVD).  The present study aims to know the differences in the post prandial blood  sample given after having breakfast and after having lunch.

Materials and Methods: 125 samples are collected from normal healthy individuals working in Chalmeda AnadaRao Institute of Medical Sciences (CAIMS) hospital.  The samples are collected in fasting, postprandial after breakfast and postprandial after lunch and is analysed for blood glucose levels in semi auto analyzer by kinetic method.

Results and Conclusion: The mean and SD values of postprandial sample after having breakfast and after lunch are 100±5.93, p<0.01(significant). The Post prandial sample collected after having lunch is more appropriate as it gives satiety to stomach and insulin secretion will be according to the contents than postprandial collected after breakfast.   

Keywords: Postprandial blood glucose, insulin, satiety


Fundamentals of musculoskeletal imaging

ShanmugaRaju P, Bheemanathuni Ramesh

Fundamentals of Musculoskeletal Imaging, 4th Edition

Edited by Lynn N. McKinnis

Philadelphia, Pa 19103 F.A. Davis Company, 2014.


Hardback 696 pp, $110.00



Use of Reverse Sural Artery Flap in Lower Leg Defects in 32 Patients

Manjari P, Vimal K, Samrat GS

Use of Reverse Sural Artery Flap in Lower Leg Defects in 32 Patients

Manjari P1, Vimal K2, Samrat GS3


Aim : Soft tissue reconstruction of distal third of leg, heel and ankle region is a difficult problem because of poor vascularity and limited mobility of skin. The free tissue transfer is used to be the choice of reconstruction most of the cases. The reverse sural artery flap with its ideal flap thickness, minimal donor site morbidity, wide arc of rotation and safe vascularity makes it a better alternative for covering such defects in the peripheral outset. To study retrospectively the role of various modifications of reverse sural artery flap to reach the defect and for better survival of flaps.

Materials and Methods: 32 cases of reverse sural artery flaps operated at Chalmeda Ananda Rao Institute of Medical Sciences and other hospitals during the period of 2012 February to 2014 December. It is a retrospective study conducted in our institute. 32 cases of distal leg and foot defects, who underwent reverse sural artery flap coverage were included in the study.

Results: All the flaps were survived. Of which in 12 cases marginal necrosis and in 5 cases partial necrosis was noted. All the flaps survived during the follow up period of 1 year with good functional outcome.

Conclusion: The reverse sural artery flap with its modifications is a very useful for the defects of distal leg, heel and ankle.

Keywords: Reverse sural artery, neurocutaneous flap, peroneal perforator

A Clinical Study on Management of CTEV by JESS Fixation

Lakshminarayana S, Venkat Lakavath, Omprakash T, Pramodh Kumar S

A Clinical Study on Management of CTEV by JESS Fixation

Lakshminarayana S1, Venkat Lakavath2, Omprakash T3, Pramodh Kumar S4


Aim : Our purpose of this study was to evaluate the role of jess fixation for correction of CTEV.

Materials and Methods: This prospective study was conducted in MGM Hospital, Warangal from October 2011to April 2014. 17 patient were included, average age was 2.2 years.unilateral feet and male were more in this study. Used Hospital for joint diseases, orthopaedic institute functional rating system for club foot assessment .

Results and Conclusion : Short term followup results were exallent to satisfactory based on above system (total score of 100, excellent 85 – 100, good 70-84, fair 60-69, poor <60 at followup of 3, 6 and 9 months.)

Keywords: CTEV, deformities, JESS fixation

Prescription Pattern of Antihypertensives in Cardiology Unit at Tertiary Care Hospital

Pushpalatha Ch, Laxman Reddy N, Mohd Mohsin

Prescription Pattern of Antihypertensives in Cardiology Unit at Tertiary Care Hospital

Pushpalatha Ch1, Laxman Reddy N2, Mohd Mohsin3


Aim : The main aim of present study is to know the prescription pattern of antihypertensive drugs in the cardiac unit of hospitalized patients in tertiary care hospital.

Materials and Methods: A retrospective study was carried out in hospital from January to December 2013. A total of 284 case files were taken for the study. The analysis was done for antihypertensives in each prescription, prescribing frequency of individual drug, sex and age frequency, single and combination therapy.

Results: The prescribing frequency of diuretics was (79.2%) followed by Angiotensin converting enzyme inhibitors (30.2%), ß-blockers (26.4%), calcium channel blockers (21.1%), Angiotensin receptor blockers (15.1%), a+ß blockers (8.4%), Vasodilators (7.3%). Two drug combination was predominantly given in 115 prescriptions out of 284 total prescriptions.

Conclusion: The study concludes that most of the hypertensive patients received two drug combination among which diuretics and Angiotensin converting enzyme inhibitors were more commonly prescribed.

Keywords: Antihypertensive drugs, prescription pattern, cardiac unit

Clinical Patterns in Insect Bite Dermatitis

Rukmini Reddy P, Narendar G, Kavitha D, Geetha K

Clinical Patterns in Insect Bite Dermatitis

Rukmini Reddy P1, Narendar G2, Kavitha D3, Geetha K4


Aim : Insect bite reactions on human skin receive less attention. Arthropods produce an injury to the skin by variety of mechanisms of which one or more may be involved in a patient.

Materials and Methods: The study was carried out in the Dermatology OPD of our institute on 111 subjects of insect bite dermatitis who were questioned retrospectively about the sequence of events besides their living and environmental conditions.

Results and Conclusions :It was noted that insect bite dermatitis has no gender or age preponderance. However, risk factors were found to be areas with heavy insect manifestations, certain occupations humid conditions and people keeping their windows open at night.

Keywords: Insect bite, dermatitis, papular urticaria

Primary Bipolar Hemiarthroplasty in Unstable Comminuted Intertrochanteric Fractures in Elderly

Raghuram C, Vamshidhar Reddy K, Ramu Ch, venu G,Sridhar K

Primary Bipolar Hemiarthroplasty in Unstable Comminuted Intertrochanteric Fractures in Elderly

Raghuram C1, Vamshidhar Reddy K2, Ramu Ch3, venu G4,Sridhar K5


Aim : Unstable intertrochanteric fracture in elderly is a challenging surgical condition with a high risk of morbidity and mortality. Aim of this study is to evaluate the functional outcome of primary bipolar hemiarthroplasty as an alternative to the standard treatment of Dynamic hip screw fixation in unstable intertrochanteric fractures.

Materials and Methods: Thirty one patients with unstable intertrochanteric fractures treated with primary bipolar hemiarthroplasty were prospectively analysed. The functional outcomes were assessed based on Harris hip score.

Results: The time to full weight bearing, the rate of postoperative complication, and the functional outcomes were significantly better in primary bipolar hemiarthroplasty.

Conclusion: Primary bipolar Hemiarthroplasty for unstable intertrochanteric fractures in elderly results in early ambulation, less hospital stay, provide stable hips with good functional results.

Keywords: Unstable intertrochanteric fractures, primary bipolar hemiarthroplasty, osteoporosis, harris hip Score

Comparison of Quality of Anaesthesia with Propofol Fentanyl and Propofol Ketamine as Total Intravenous Anaesthesia Technique for Short Surgical Procedures

Aasim SA, Syamasundara Rao B, Zubair SI

Comparison of Quality of Anaesthesia with Propofol Fentanyl and Propofol Ketamine as Total Intravenous Anaesthesia Technique for Short Surgical Procedures

Aasim SA1,  , Syamasundara Rao B2, Zubair SI3


Aim : The present study was conducted to evaluate the efficacy of combination of propofol-fentanyl and propofol-ketamine as total intravenous anesthesia to assess haemodynamics, recovery profile of either groups, Postoperative nausea and vomiting and any other side effects.

Materials and Methods : A total of 50 patients undergoing elective surgeries of shorter duration were randomly allocated into two groups of twenty five each. Group A received Propofol 2mg/kg and Fentanyl 2µg/kg for induction and propofol 4mg/kg/hr and fentanyl 1µg/kg/hr for maintenance of anesthesia, Group B received propofol 2mg/kg and ketamine 1mg/kg for induction and Propofol 4mg/kg/hr and ketamine 1mg/kg/hr for maintenance of anesthesia. Hemodynamic variables were recorded at regular intervals. At the end of drug infusion, recovery was assessed by time to spontaneous eye opening and Modified Aldrete scoring system.

Results : Group A combination produced a significantly greater fall in pulse rate and in mean arterial pressure as compared to Group B after induction of anaesthesia.Time to spontaneous eye opening was comparable in both the groups. There was a slight respiratory depression in Group A but not in Group B. Modified Aldrete score was better in Group B than in Group A. Incidence of postoperative nausea and vomiting was seen in 3 patients in Group A and none in Group B.

Conclusion : Both Propofol–Ketamine and Propofol–Fentanyl combinations produce a rapid, pleasant and safe anesthesia with minimal untoward side effects and slight hemodynamic changes. Out of the two, Propofol–Ketamine group is more effective without respiratory depression, better haemodynamic stability and no postoperative nausea and vomiting.

Keywords : Ketamine, propofol, total intravenous anaesthesia, recovery, analgesia, amnesia


Vascular Pedicle Pisiform Bone Grafting for Kienbocks Disease : A Case Report

Nagamuneendrudu K, Valya B, Vishnu Vardhan M

Vascular Pedicle Pisiform Bone Grafting for Kienbocks Disease : A Case Report

Nagamuneendrudu K1, Valya B2, Vishnu Vardhan M3


25 years old female patient presented with pain in the right wrist of 3 years duration, with mild restriction of movements, the case is diagnosed as Kienbock’s disease, the case treated with vascular pedicle pisiform bone grafting.

Keywords : Kienbock’s disease, pisiform bone, vascular pedicle bone grafting.

Lichen Sclerosis with Rare Complications: Two Case Reports

Narendar Gajula, Kavitha D, Geetha K, Razia Begum, Rukmini Reddy

Lichen Sclerosis with Rare Complications: Two Case Reports

Narendar Gajula1, Kavitha D2, Geetha K3, Razia Begum4, Rukmini Reddy5


Lichen Sclerosis is a chronic, progressive, atrophic, sclerosing process involving glans and prepuce. Cause of the disease is unknown. It occurs between 20 - 65 years of age. It manifests usually as atrophic patches, plaques. In severe cases waisting, effacement or muzzling are seen. It can lead tocomplications like meatal stenosis, urethral stricture and rarely carcinoma. Case one presented with lichen sclerosis complicated by squamous cell carcinoma and second case presented with urethral stricture. These two cases are being presented because of it’s rarity and these are likely to be missed. The patients were referred to surgery and urology depts respectively for further management.

Key words: Lichen sclerosis, waisting, effacement, muzzling.

A Rare Case Report of Dengue Fever with Massive Hemothorax

Rajender M, Lokesh G, Nithin Kumar Reddy R, Shanmuga Raju P

A Rare Case Report of Dengue Fever with Massive Hemothorax

Rajender M1, Lokesh G2, Nithin Kumar Reddy R3, Shanmuga Raju P4


20 year young male patient presented with complaints of high grade fever and non productive cough since 10 days, chest radiograph showing right sided massive pleural effusion, blood investigations revealing severe thrombocytopenia with reactive dengue NS 1 antigen. On further evaluation with diagnostic thoracocentesis, pleural fluid is hemorrhagic which is consistent with blood, patient is treated with tube thoracostomy and other supportive treatment, patient is improved clinically and discharged home. We report this case for its rarity.

Keywords: Dengue, hemorrhagic fever, hemothorax.

A Rare Case of Strangulated Parastomal Hernia after 30 years of Stoma Construction

Ramlingam P, Prashanth G, Sri Balram A, Nageshwar Raju

A Rare Case of Strangulated Parastomal Hernia after 30 years of Stoma Construction

Ramlingam P1, Prashanth G 2, Sri Balram A3, Nageshwar Raju4


Parastomal hernias (PSH) are likely to increase the incidence due to more number of cases being operated for carcinoma of colon and rectum. Though there is less literature on this subject our aim is to prevent occurrence of parastomal hernia by various preventive steps like taking transverse incision, repairing with mesh, correcting the patient related risk factors. Early diagnosis and repair of obstructed parastomal hernia is necessary to prevent morbidity and mortality including recurrence.

Keywords:  Parastomal hernias, colostomy, stoma construction.

Spinal Intramedullary Dermoids: Report of 2 Cases and Review of Literature

Bhaskar G, Nagamuneendrudu, Mastan Reddy A, Lakshman Rao A, Saratchandra

Spinal Intramedullary Dermoids: Report of 2 Cases and Review of Literature

Bhaskar G1, Nagamuneendrudu 2, , Mastan Reddy A, 3,  Lakshman Rao A 4, Saratchandra5


Dermoids are rare congenital inclusion tumours of spinal canal with a reported incidence of less than 1% of all spinal neoplasms. They are commonly found in intradural location and are very rare in intramedullary compartment. Very few cases have been reported so far in literature. We report here two cases of dermoids in intradural and intramedullery location in view of the rarity of the lesions. We discuss the clinical features, imaging characters and microsurgical excision techniques along with review of the relavent literature.

Keywords: Dermoid cyst, spinal cord tumour, magnetic resonance imaging.

An Unusual Case of Rupture of Left Horn of Bicornuate Uterus at Twelve Weeks of Gestation

Madhavi G B, Ramadevi E,Mamata N,Shreya G

An Unusual Case of Rupture of Left Horn of Bicornuate Uterus at Twelve Weeks of Gestation

Madhavi GB1, Ramadevi E2,Mamata N3,Shreya G4


Rupture of uterus is a hazardous complication of pregnancy and labour, and carries a high risk for the mother and the fetus. Uterinerupture during early pregnancy is a rare complication but if there is a rupture and not suspectedwithin time, it may have a fatal outcome for the mother. Here we report a case of rupture of horn of bicornuate uterus at 12 weeks of gestation with severe anemiaadmitted with shock at ChalmedaAnandRao Institute of Medical Sciences. Patient was successfully managed by emergency laparotomy with excision of the horn.

Keywords:  Bicornuate uterus, rudimentary horn pregnancy, ultrasound.                   

Strongyloides Stercoralis Hyperinfection in an Immunocompetent

Aruna Rajkumari, Pavani N, Parveen Anjum,yamini K, Sameera Nousheen, Sabarinathan T

Strongyloides Stercoralis Hyperinfection in an Immunocompetent

Aruna Rajkumari1, Pavani N2, Parveen Anjum3,yamini K4, Sameera Nousheen5, Sabarinathan T6


Strongyloides stercoralis is a widespread, soil-transmitted helminth affecting humans. A 35-year-old female presented with diarrhea, vomiting, abdominal pain, severe malaise with low grade fever since 3-4 days. She complained of crampy, severe, upper abdominal pain, anorexia, vomiting and diarrhea. She had loss of appetite for 1 month and had lost 5 Kg weight during the period. We are reporting a case of strongyloides stercoralis hyperinfection in an immunocompetent.

Keywords:  Strongyloides stercoralis, hyperinfection, immunocompetent.

Joubert Syndrome: A Case Report

Srinivas Madoori, Ramya C, Sridevi B, Sandhya Jalagam

Joubert Syndrome: A Case Report

Srinivas Madoori1, Ramya C2, Sridevi B3, Sandhya Jalagam4


Joubert Syndrome (JS) is a very rare autosomal recessive neurodevelopmental disorder. It is characterized by cerebellar vermis hypoplasia, hypotonia and abnormal breathing pattern or abnormal eye movements. We report a case of 13 years old male child with seizures, abnormal eye movements, developmental delay and ataxia. On radiological evaluation MRI of brain revealed “molar tooth sign” and “bat wing appearance” of fourth ventricle.

Keywords: Joubert syndrome, vermian hypoplasia, bat wing appearance, molar tooth sign.

Herlyn Werner Wunderlich Syndrome

Mamatha N, Rama Devi E, Madhavi GB, Pragna Reddy K

Herlyn Werner Wunderlich Syndrome

Mamatha N1, Rama Devi E2, Madhavi GB3, Pragna Reddy K4


Uterovaginal duplication with obstructed hemivagina and ipsilateral renal agenesis is referred to as the Herlyn Werner Wunderlich (HWW) syndrome. Here, we describe a 15year old female patient with HWW syndrome, who was taken up for a diagnostic laparoscopy followed by vaginal septal resection. In addition to a definitive diagnosis, this approach helped in symptomatic relief to the patient. Prompt and accurate diagnosis and treatment of HWW syndrome can significantly prevent future complications.

Keywords : Herlyn werner wunderlich syndrome, laparoscopy, vaginal septal resection.


Pagets Disease of the Breast: Study of 5 Cases with Review of Literature

Sumalatha K,SanthoshBabu R,Pradeep Kumar Ch,Ravinder Thota,Shanmuga Raju P

Pagets Disease of the Breast: Study of 5 Cases with Review of Literature

Sumalatha K1,SanthoshBabu R2,Pradeep Kumar Ch3,Ravinder Thota4, Shanmuga Raju P5


Paget’s disease of the breast has been recognised as a distinct clinical entity. It is defined as the presence of malignant glandular epithelial cells within the squamous epithelium of the nipple and is almost always associated with underlying intraductal or invasive carcinoma of breast or both. It accounts for 1-4% of all cases of breast carcinoma. Its clinical significance, pathogenesis are topics of controversy. The main aim of this review is to describe its clinical features, pathological features, pathogenesis and differential diagnosis.

Keywords: Paget’s disease of breast, carcinoma in situ, invasive carcinoma.


A Case of Adenoid Cystic Carcinoma Intraorbital Extra Corneal tumor

Ezhilarasi Ravindran

A Case of Adenoid Cystic Carcinoma Intraorbital Extra Corneal tumor

Ezhilarasi Ravindran1


Adenoid cystic carcinoma (ACC) is an indolent cancer arising within glands with a poor prognosis.[1] It accounts for less than 1% of all tumors. A recent study identified 1p32-p36 as the most frequent genetic change which was also a marker for poor prognosis.[2] A young male, 26 years presented with blurring of vision and pain over right eye. Underwent surgery right fronto orbital oblotomy. HPR-adenoid cystic carcinoma. Post-operative CT Scan showed residual lesion in intraorbital extra coanal compartment. Bony defects in right lateral wall of orbit and superior right frontal bone.


Clinical Methods in Medicine: Clinical Skills and Practices

Edited by S N Chugh, Eshan Gupta
2/e, 564 pp., illustrated
New Delhi,
Jaypee Brothers Medical Publishers (P) Ltd, 2015
Price: $46.00
ISBN: 978-93-5025-039-6



V.6 (1): 1- 81 Nov





V.5 (1): 1-54 Nov



              Journal of Chalmeda Anand Rao Institute of Medical Sciences

                                                                                              ISSN: 2278-5310(Print)

                                                                                              ISSN: 2395-0188(Online)

Instructions for Authors

The Journal of Chalmeda Anand Rao Institute of Medical Sciences (JCAIMS) is a peer reviewed scientific Journal.  Initially, it was published as the CAIMS Medical Bulletin in year 2008. We publish scientific articles such an Original article, review article, case reports, short communication article, book review, pictorial CME and editorials.

Frequency: Bi-annual publication

Manuscript Submission

Requirements for all Manuscripts:

Manuscript submission fee is free for the Journal of CAIMS. The Journal of CAIMS follow the International Committee of Medical Journal Editors (ICMJE Recommendations) for the Conduct, Reporting, Editing and Publication of Scholarly Work in Medical Journals and to the Committee on Publication Ethics (COPE) code of conduct for editors.

Article Types:

1. Original article

2. Review article

3. Case reports

4. Short communication article

5. Pictorial CME

6. Book Review

7. Editorials

Manuscript submission check lists:

1. Covering letter

2. Manuscript including tables and graphs

3. Figures in jpg format

4. Copyright transfer agreement form signed by all authors

5. Declaration of conflict of interest and source of funding statements

6. Institutional Ethics committee Approval statement

7. Statement of Informed Consent Form

8. Acknowledgement (If appropriate)

9. Reference number consecutively in order in which they cited in the both text and

    graphics (e.g:1,2,3)

Structure of the Manuscript

Covering letter

Use the covering letter to explain why your paper should be published in the journal of CAIMS. Send the manuscript with covering letter that includes the corresponding author’s email address to the Editor-in-Chief, Journal of Chalmeda Anand Rao Institute of Medical Sciences, Karimnagar-505001, Telangana, India. E-mail:

Title page:

A brief title, author’s name(s), preferred degree, affiliation(s) and full address of the authors must be included.  The name and address of the corresponding author should be separately and clearly indicated with email, telephone or mobile details. All pages should be numbered consecutively beginning with the title page, including an abbreviated title of not more than 40 characters.


Journal of Chalmeda Anand Rao Institute of Medical Sciences follows the International Committee of Medical Editors (ICMJE) recommendations for defining authors and contributors.


Abstract should be structured format as, background and aim, materials and methods, results and conclusion in less than 250 characters.


At least, minimum of 3 to 5 keywords.


Journal of Chalmeda Anand Rao Institute of Medical Sciences strongly encourages authors to follow EQUATOR reporting recommendations when presenting original data or findings of a systemic review ( All submitted manuscripts should include page numbers.

Original article:

Research articles should follow the Introduction, methods, results, discussion (IMRD), conclusion format. The number of reference should not exceed 25. The main text should be limited to 3000 words.

Review article:

Review articles on topics of broad interest are desirable.  Review articles should systematically find, select, critique and synthesize evidence relevant to well defined questions about diagnosis, or therapy. Review articles are limited to 3,000 words.

Case reports:

Observations of diseases, clinical findings or treatment. The main text should be limited with 1200 words. Text should be arranged with following subheadings; Abstract, case report, discussion, conclusion, acknowledgements and references. Abstract: should not more than 250 words and references should not be more than 10.

Short communication article:

Short research articles include reports of important observations, original studies, evaluations, unique presentation or first time reports of clinical series. Text should have acknowledgments and references to a maximum of 15.

Pictorial CME:

Any interesting or unusual educational images related to health care with short description (maximum word limited to 250 words). No abstract, discussion and conclusion are required but please include a brief title.

Book review:

Title of the book; name of the editor/authors; name and address of the publisher; year of publication; number of pages; number of illustrations; hard bound or soft bound; price, ISBN number, text of review. As a policy we do not encourage submission of reviews of books that are more than a year old.


Current topic or on papers published elsewhere in the issue. Editorials are generally solicited by the Editor-in-Chief. The abstract is limited to 300 words.


Each table should have a title and be numbered in the order of appearance in the text. Use superscript letters to indicate footnotes typed at the bottom of the table. Quote all tables in the text. Statistical measures such as SD or SEM should be identified in the headings. If tables have been reproduced form another source, a letter from copyright holder (usually the publisher), stating authorization to reproduce the material, must be attached to the covering letter.


All color images file must be high quality and reproductions are not acceptable. The quality of  X-rays, diagrams and graphs must be good enough for reproduction. All images should be submitted separately and not as part of main manuscript. Quote all images in the text as figure numbers in Arabic numerals. Size: figures should be sized to fit within the column (82 mm), intermediate (118 mm) or the full text width (173 mm).

Figure legends:

Type figure legends on a separate page. Include definitions of any symbols used and define/explain all abbreviations and units of measurements.


Acknowledge only persons who have contributed to the scientific content or provided technical support. The corresponding author must also affirm that he or she has listed everyone who contributed significantly to the work in the acknowledgments.

Reference style:

References in text sequentially in the Vancouver numbering style. References should be numbered in the order of appearance in the text. Journal names are abbreviated in their standard form as IndexMedicus / MEDLINE.

List of authors when there are six or more authors, add “et al”. A list of authors should be followed by the authors name, initials, article, journal title, year, volume and page numbers. Ideally no more than 20.


Ottenbacher AJ, Snih SA, Bindawas SM. Role of physical activity in reducing cognitive decline in older Mexican-American adults. J Am Geriatr Soc. 2014; 62:1786-91.


For a book, give names of editors and the publisher, the city of publication and year.

Kronenberg H, Williams RH. Williams Textbook of Endocrinology. 11th ed. Philadelphia, PA: Saunders Elsevier; 2008.

Book Chapter:

For a book chapter or section of a book, also give the authors name, title of the section, and the page numbers.

Wright WK. Esotropia. In: Wright WK, ed. Pediatric Ophthalmology and Strabismus. St. Louis: Mosby; 1995:179-193.

Online Material:

For online material, please cite the URL, together with the date you accessed the website. Online journal articles can be cited using the DOI number.

Avoid citation or reference in the summary. Accessed 24.2.107

Institute Ethics Committee Approval

Authors must state that the protocol for the research project has been approved by a suitably constituted Institute Ethics committee Approval of the institution within which the work was undertaken and that it conforms to the provisions of the Declaration of Helsinki (as revised in Edinburgh 2000), available at: Journal of CAIMS retains the right to reject any manuscript on the basis of unethical conduct of either human or animal studies.

All investigations on human subjects must include a statement that the subject gave informed consent. Photographs need to be cropped sufficiently to prevent human subjects being recognized (eg: an eye bar should be used).

In general, submission of a case report should be accompanied by the written consent of the subject (parent or guardian) before publication; this is particularly important where photographs are to be used or in cases where unique nature of the incident reported makes it possible for the patient to be identified. Any experiments involving animals must be demonstrated to be ethically acceptable and where relevant confirm to national guidelines for animal usage in research.

Copy Right/ Permissions

All rights are reserved to the Journal of Chalmeda Anand Rao Institute of Medical Sciences. The authors must secure reproduction permission from the copyright owner, if any figure(s), illustration(s), tables(s) or extended quotation(s) etc, are taken from material(s) previously published.

The published material of journal of CAIMS may not be reproduced or transmitted in any form or by any means, electronic/ mechanical including photo copy without written permission from editor-in-chief/ publisher of journal of Chalmeda Anand Rao Institute of Medical Sciences.

All authors must read and agree to the conditions and the corresponding author can sign on their behalf. Acceptance of a manuscript is contingent receipt of a signed Copyright Assignment Form.

Informed Consent Form

Patient identifiers will not be published in the Journal of Chalmeda Anand Rao Institute of Medical Sciences, unless written informed consent is given and the content is essential for the scientific purpose and merit of the manuscript.

Photographs of subjects showing any recognizable features must be accompanied by their signed check context authorizing publication, as must case reports that provide enough unique identification of a person (other than name) to make recognition possible. Failure to obtain informed consent of patient prior to submission would result in manuscript rejection.

Conflict of Interest

If there are any conflicts of interest related to individual author’s commitments or project support, it should be clarified and described in the manuscript.

Every author should complete the ICMJE general declaration form, which can be obtained at:

Source of Funding

Source of funding must be acknowledged on the title page of the manuscript. All authors will disclose conflict of interest information. If there is no source of funding, state that” the authors report no external funding source for this study.

Statement of Human/Animal Rights

All articles under consideration that experiment on human subjects and animals in research are required to have institutional review board approval in accord with ethical standards set forth in the Uniform Requirements for Manuscripts Submitted to Biomedical Journals at:

Checking for Plagiarism / Duplicate publication/Text recycling

All research papers, reviews, and non-research material that we are interested in publishing will be checked by editors using CrossCheck / iThenticate tool.

Online Early

Journal of Chalmeda Anand Rao Institute of Medical Sciences publishes abstract, of accepted manuscripts online in advance of their publication in print. Once an accepted manuscript has been edited, the authors must submit any final corrections, and all changes have been incorporated. The manuscript will be published online at:

Manuscript Check List

This checklist must be completed, signed by the corresponding author, and submitted with the manuscript.

Please see Instructions for Authors for details related to this checklist (1-13).

1.Text in MS word(.doc)
2.Type is 12 –pitch, right margin, double –spaced and numbered.
3.Cover Page (1) Complete title (2) Category (3) All author’s name, degree, designation (4) Affiliations, (5) Corresponding author contact information.
4.Abstract (aim, materials and methods, results, conclusion).
5.Keywords/terms less than 3 – 4.
6.Reference number consecutively in the order in which they are cited in the both text and graphics (eg, 1, 2, 3).
7.Tables, figures with legends.
8.Figure files are jpg format.
9.Each necessary permission statement signed by the appropriate source.
10.Institutional, ethical, and review board approval statement at the end of the methods section (When reporting experiments on human subjects).
11.Acknowledgement (if appropriate).
12.Source of funding or statement that “The authors report no external funding source for this study.
13.Conflict of interest statement that “the authors declare no conflict of interest”.


Statement of Informed Consent Form

Patient identifiers will not be published in the Journal of Chalmeda AnandRao Institute of Medical Sciences, unless written informed consent is given and the content is essential for the scientific purpose and merit of the manuscript.

Photographs of subjects showing any recognizable features must be accompanied by their signed release authorizing publication, as must case reports that provide enough unique identification of a person (other than name) to make recognition possible.

Failure to obtain informed consent of patient prior to submission would result in manuscript rejection.

Institutional Review Board Approval

Copies of written informed consent documents should be kept for studies on human subjects. For clinical studies of human subjects, a certificate, agreement, or approval by the Institutional Review Board (IRB) of the author's institution is required. If necessary, the editor or reviewers may request copies of these documents to resolve questions about IRB approval and study conduct.

Conflict of Interest Statement

If there are any conflicts of interest related to individual author’s commitments or project support, it should be clarified and described in the manuscript.

Statement of Human /Animal Rights

All articles under consideration that experiment on human subjects and animals in research are required to have institutional review board approval in accord with ethical standards set forth in the Uniform Requirements for Manuscripts Submitted to Biomedical Journals at



All submitted manuscripts are reviewed initially by a journal editor. Manuscripts are evaluated according to the following criteria: material is original and timely, writing is clear, study methods are appropriate, data are valid, conclusions are reasonable and supported by the data, information is important, and topic has general medical interest. From these basic criteria, the editors assess a paper’s eligibility for publication. Other manuscripts are sent to expert consultants for peer review. Peer reviewer identities are kept confidential, but author identities are made known to reviewers. The existence of a manuscript under review is not revealed to anyone other than peer reviewers and editorial staff. Peer reviewers are required to maintain confidentiality about the manuscripts they review and must not divulge any information about a specific manuscript or its content to any third party without prior permission from the journal editors. Information from submitted manuscripts may be systematically collected and analyzed as part of research to improve the quality of the editorial or peer review process. Identifying information remains confidential. Final decisions regarding manuscript publication are made within the Editorial Team. Specifically, the peer review goes as:

1. Editorial assistants pass submitted manuscripts to the Editor-in-Chief.
2. Depending on the topic of the submitted manuscript, Editor-in-Chief passes the article to Associate Editors or a Member of the Editorial Board with related expertise.
3. The assigned Associate Editor or Member of the Editorial Board with related expertise invites external reviewers. This is done by literature search to identify the external experts.
4. External experts review.
5. External experts make recommendation.
6. External experts’ recommendation plus the assigned Member of the Editorial Board’s review.
7. The Editor-in-Chief makes a decision: accept, minor revision, major revision, re-submit, reject.



A reviewer has committed to review :

Reviews must be thorough and contain a basic amount of information in order for the section editor to generate a composite review:

  • Critique of methodology
  • Statement of impact
  • Strengths
  • Significant limitations that were not addressed
  • Fatal flaws
  • Comment on the necessity and suitability of tables and figures (tables are typically at the end of the manuscript and figures under supplemental content)
  • Comment on clarity, brevity, grammar and spelling. If there are minor errors, please relate them in the review. If there are major errors as a whole, you may relate this fact without having to fix them line by line.

Reviewers must be completed within 1 week from date of the initial request.

The Editor-in-Chief or Associate Editor will register the final decision. The reviewer’s identity will remain confidential throughout the peer review process.

International Committee of Medical Journal Editors. Uniform Requirements for Manuscripts Submitted to Biomedical Journals: Writing and Editing for Biomedical Publication. Available

Contact Details

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Journal Section
Chalmeda Anand Rao Institute of Medical Sciences
Karimnagar-505001, Telangana
Phone: 0878-2285565, 9491398688, 9491398694
Fax: 0878-2285318
E-mail :


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Journal Section
Chalmeda Anand Rao Institute of Medical Sciences
Karimnagar-505001, Telangana
Phone: 0878-2285565, 9491398688, 9491398694
Fax: 0878-2285318
E-mail :

Journal of CAIMS reserves the right to the decline any advertising.


  J CAIMS Submissions

    Feel free to contact us for any article related questions or Inquiries can be directed to:

Editorial and Publishing Office

P. ShanmugaRaju, MPT, MIAP
Journal of Chalmeda Anand Rao Institute of Medical Sciences
Chalmeda Anand Rao Institute of Medical Sciences
Bommakal Village
Karimnagar- 505 001
Phone: 0878-2285565, 9491398688, 9491398694
Fax: 0878-2285318



C. Lakshmi Narasimha Rao, BE, MBA
Chalmeda Anand Rao Institute of Medical Sciences
Arihant Educational Society
Bommakal Village
Karimnagar- 505 001
Telangana, INDIA.
Phone: 0878-2285565, 9491398688, 9491398694
Fax: 0878-2285318