International Journal of Medical Science and Public Health
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Editor: Dr. Jay Charan
ISSN: 2320–4664 (Print)
Frequency: 3 issues a year
Language: English
Open Access Peer-reviewed journal
Web site: https://www.ijmsph.com/
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Item 27G Quincke spinal needle for spinal anaesthesia in Caesarean section: A study of 50 cases.(2013-10) Parmar, Siddharthkumar; Sheikh, Abdul Nasir; Mankad, PreranaBackground: Post dural puncture headache (PDPH) is a serious complication of spinal anaesthesia and incidence is more particularly in parturient. Aims & Objective: The present study was designed to investigate the use of 27 Gauge (G) spinal needle for spinal anaesthesia in Caesarean section in terms of success and PDPH rate. Material and Methods: We included total 50 female patients of aged 20-40 years old, were administered spinal anaesthesia with 27G Quincke spinal needle for Caesarean section by same investigator having enough experience. Redirections and attempts for lumbar puncture, success rates of spinal anaesthesia and PDPH were recorded. Results: We succeeded in 49 patients (98%) to administer spinal anaesthesia. The mean attempt and redirections for lumbar puncture were 1.1 and 1.24 respectively. We found PDPH in 1 patient (2%), which was mild in severity and subsided within two days. Conclusion: Spinal anaesthesia using a 27G Quincke spinal needle, in experienced hands can have successful spinal block with reduced PDPH rates in patients undergoing Caesarean section.Item Aberrant Right Subclavian Artery (Arteria Lusoria): A Case Of Asymptomatic Rupture.(2014-01) Erdem, Kemalettin; Ozden, Ahmet; Erkuran, Mansur Kursat; Ocak, Tarık; Daglar, BahadırA 65-year-old male patient was referred to our hospital for sudden onset of shortness of breath and chest pain. His medical history had an abdominal aortic aneurysm about six years ago. His vital findings were normal. Laboratory findings showed leucocytosis (white blood cell count was 12 000/mm3, haemoglobin was 14.5gr/dl, and C-reactive protein value was 15 mg/dl). About four hours after the admittance to the hospital, ecchymosis occurred on his anterior neck region. The patient reported no discomfort on swallowing and did not have any history of previous important chest trauma or injury. A ruptured aberrant right subclavian artery (ARSA) was demonstrated by computed tomography-angiography and magnetic resonance angiography. To the best of our knowledge, this is the first case report of a patient presenting with ecchymosis on anterior neck region with acute onset due to the ruptured ARSA.Item Abnormal origin of right subclavian artery – A cadaveric study.(2014-01) Chavda, Hiren; Varlekar, Padma; Khatri, Chirag; Saiyad, S S; Bhatt, RakshaBackground: During early embryonic life, the aortic arch undergoes complex development and normally results in the formation of a left aortic arch from which three arteries arise: (1) the brachiocephalic artery, which divides into the right common carotid and right subclavian arteries, (2) the left common carotid artery and (3) the left subclavian artery. In the present study we found an aberrant right subclavian artery arising from the arch of aorta distal to the left common carotid artery. Aims & Objective: Abnormalities of branches of arch of aorta are not uncommon and they have been identified more frequently with increasing use of imaging studies. However, the clinician should be aware of the wide range of anomalies that occur in the arch & the great vessels. This could help in adequately managing these variations in emergency approaches to the arch & the great vessels when imaging studies are not available. Our aim is to report the occurrence of the abnormal origin of right subclavian artery in a sample of western Indian population. Material and Methods: Present study was conducted on embalmed cadavers in Anatomy Department at various medical colleges in Gujarat. Branches of arch of aorta were dissected & observed for any variation. Results: A total of 70 cadavers were dissected. In one cadaver we found abnormal origin of right subclavian artery from the arch of aorta. The anomalous artery was passing behind the oesophagus. (1.43%, n = 70) Conclusion: An aberrant right subclavian artery is a rare vascular anomaly & it is also an unusual cause of problems with the passage of solid food through the oesophagus. Recently it has been suggested that it occurs more frequently in patients with Down syndrome. Knowledge of this anomaly is important while evaluating feeding difficulties in patients with Down syndrome as well as in preventing vascular complications in patients with aberrant right subclavian artery.Item Accuracy and utility of intraoperative squash smear cytology in neurosurgical practice(International Journal of Medical Science and Public Health, 2019-02) Khuroo, MS; Hamdani, SM; Alam, SS; Sahaf, BR; Dar, NQ; Bhat, RABackground: Intraoperative squash smear cytology (ISSC) is a rapid and reliable diagnostic tool that provides guidance to the neurosurgeon for precise targeting of the lesion and its surgical resection. It also helps the surgeon to modify the approach at surgery at times based on the preliminary impression of the lesion on cytology. Objectives: The present study was undertaken to assess the utility of ISSC for cytomorphological diagnosis in a resource-limited setting. The accuracy of the method was assessed by correlating cytological diagnosis with histopathological diagnosis. Materials and Methods: A total of 106 cases of central nervous system (CNS) tumors were examined by squash smear technique for cytological diagnosis which were then compared with histopathological diagnosis provided on paraffin-embedded sections. Results: Cytohistological correlation was available in all the 106 cases included in the study. Of these 106 cases, 96 were concordant with the final histopathological diagnosis, while 10 were discordant. Thus, complete correlation with final histopathological diagnosis was observed in 90.56% of cases. Conclusion: Intraoperative squash smear cytology proved to be a simple, rapid, and inexpensive technique for intraoperative consultation of CNS tumors in the absence of frozen section facility.Item Acute hepatitis with concomitant graves' disease.(2014-05) Bastug, Aliye; But, Ayse; Sertçelik, Ahmet; Kayaaslan, Bircan Unal; Akinci, Esragul; Dogan, Bercem AycicekAcute hepatitis A with concomitant Graves’ disease was reported rarely in the literature. To our knowledge there is one case in the literature from New York in which acute hepatitis A infection was not thought predominant. It is difficult to manage these cases because of the limited therapy options especially when cholestasis occurs. A 36-year-old male presented with severe cholestasis who was diagnosed as acute hepatitis A infection together with Graves’ disease. He had severe cholestasis with elevated liver enzymes and bilirubin levels. Thyroid functions tests decreased to normal levels with plasmapheresis therapy and then he was sent to general surgery for thyroidectomy. Plasmapheresis is an alternative therapy option for thyrotoxicosis in patients with Graves’ disease concomitant with acute HAV infection.Item Acute Inflammatory Demyelinating Polyradiculoneuropathy following Plasmodium vivax malaria- a case report.(2014-07) Ete, Tony; Mondal, Sumantro; Sinha, Debanjali; Bhar, Kaushik; Sarkar, Soumik; Pal, Jyotirmoy; Ghosh, AlakenduAcute Inflammatory Demyelinating Polyradiculoneuropathy (AIDP) is usually preceded by infection with certain bacteria and viruses. Parasitic infection has rarely been reported as a causal factor for AIDP. Neurological manifestations following malaria is commonly seen with P. falciparum. There are only few case reports of Guillain–Barré Syndrome or facial diplegia following P. vivax infection. Here we are reporting a patient who developed AIDP and facial diplegia within two weeks following successful treatment of P. vivax infection.Item Acute myocardial injury in multiple bee stings - Case report.(2013-10) Bindu, C B; Manuprakash, S K; Srinivasa, B SAcute myocardial injury due to honey bee sting is rare, only a few studies have discussed the relationship between honey bee sting and myocardial injury. Massive envenomation by honey bees can cause multiorgan dysfunction due to toxic effects of massive envenomation and systemic anaphylactic reactions.Item Adjunctive role of immunohistochemistry to traditional histomorphology in diagnosis and accurate typing of soft tissue sarcoma.(2013-10) Bhagat, Vasudha; Kaptan, Kumarbhargav; Dudhat, Reena; Italiya, Sonal; Tailor, Hemali; Patel, AmitaBackground: Soft tissue sarcomas, compared with carcinomas and other neoplasms, are relatively rare and constitute less than 1% of all cancers. Immunohistochemistry (IHC) especially a panel approach is an important adjunct to histopathological morphology and plays an important role in Soft tissue sarcoma diagnosis and accurate typing. Aims & Objective: Current study is to evaluate the utility of histopathology and immunohistochemistry in soft tissue sarcoma diagnosis and accurate typing. Material and Methods: Total of 50 cases of soft tissue sarcoma studied from January 2010 to October 2012. All cases were reported using routine (H&E) Hematoxylin- eosin stain and other ancillary techniques including panel approach of immunohistochemistry. Results: Histomorphology confirmed diagnosis in 22 % cases. In 78 % cases it was contributory to IHC. IHC provide confirmative diagnosis (Single diagnosis) in 45 cases (90%), definitive diagnosis (with two possibilities) in 4 cases (8%) and noncontributory in 1case (2%). Conclusion: Despite the rapid development of molecular genetic techniques, IHC still remains the most important diagnostic tool in the diagnosis of soft tissue tumours aside from recognition of morphologic features and clinical correlation. One of its major utilities is to correctly identify a tumour as mesenchymal or nonmesenchymal origin and then accurate typing done according to specific cell lineage. IHC is specifically useful in tumours of uncertain cell lineage and primitive round cell tumours. Indeed IHC has brought Brown revolution in sarcoma diagnosis and accurate typing. But important not to forget histopathology which provide the basic platform for the panel approach of IHC.Item Age wise distribution of coronary artery disease risk factors.(2013-10) Tanna, Nita A; Srivastava, Rakesh; Tanna, VilpaBackground: Coronary Artery Disease (CAD) is the leading cause of death in most industrialised countries (about one-third of all deaths) and somewhat low incidence is observed in the developing countries. Aims & Objective: To study age wise distribution of Coronary Artery Disease risk factors. Material and Methods: The data for this study was collected from Baroda Heart Institute & Research Centre (BHIRC). The total 208 patients were considered for study of CAD. Results: The majority of our patients were from age group of 60-69 years i.e. 67 (32.21%) and only 10 patients (4.32%) were in the age group of ≥80 years. Amongst all patients, 93.27% were lacking exercise, 39.42% were hypertensive, 28.85% were obese, 27.88% diabetic, 10.58% had family history of CAD and 5.28% were smokers. Conclusion: It is essential to identify CAD risk factors amongst the Indians to tackle the problem. So this study would be of great help in this direction.Item Age-sex trends of under nutrition among the adolescent school children in an urban resettlement colony of District Gautam-budhnagar, Uttar Pradesh. A comparative study with WHO 2007 reference standards.(2013-07) Mahajan, Harsh; Srivastav, ShaliniBackground: The World health organization (WHO) defines adolescents as individuals between the ages of 10–19 years and they make up about 20% of the world’s population. Under-nutrition is still highly prevalent among the adolescents of developing countries including India. Aims & Objective: The present study was undertaken to assess the age-sex trends of under nutrition among the adolescent age group school children of 11-18 years age group in District Gautambudh-nagar, Uttar Pradesh. Material and Methods: A Cross-sectional study was carried out in the Government schools in Bhangel, the urban field practice area of Department of Community Medicine. A questionnaire was administered to 392 school students (290 boys and 102 girls) of 11-18 years age group studying in VIth-XIIth standard. All the students were also subjected to measurement of height and weight. Body mass index (BMI) of all students was calculated. The heights and BMI of the students were then compared with the WHO 2007 reference standards. Results: The mean BMI was found to be less as compared to the WHO 2007 reference standards in both the sexes and the difference was found to be statistically significant in almost all age groups. The mean height was found to be less as compared to WHO reference for height in all age groups in both sexes and the difference was statistically significant in almost all age groups. Conclusion: The present study indicates that the nutritional status of the adolescent school children in our country is very poor.Item An alarming prevalence of diabetes and its associated risk factors among college going Indian adults: a retrospective study.(2013-07) Shiju, T M; Madathil, Deepa; Viswanathan, PragasamBackground: The prevalence of diabetes among college going Indian adults is lacking. Aims & Objective: This study was aimed to bring in awareness about the prevalence of diabetes and its associated risk factors among college going Indian adults. Material and Methods: This was a cross sectional retrospective study. Data were collected from the records maintained in VIT University Health Centre, Vellore, India. The records were selected randomly and observed for parameters such as blood glucose, blood pressure, cholesterol, triglycerides and anthropometric measurements. The chi-square test, P value and odds ratio indicating the association between each risk factor and diabetes were calculated using the statistical program SPSS v 16.0 for windows. Results: Of the 1001 records scrutinized, 9% were found to be diabetic. Among the diabetic population, 95.5% had type-2 diabetes and only 4.5% had type-1 diabetes. Obesity (OR 2.21, 95% CI 1.37-3.57), hypertension (OR 4.65, 95% CI 2.87-7.55), hypercholesterolemia (OR 5.5, 95% CI 3.08-9.93), hypertriglyceridemia (OR 4.1, 95% CI 2.2-7.63), anaemia (OR 2.4, 95% CI 1.2-4.82), and stress (OR 1.53, 95% CI 1.01-2.32) were found to be significantly associated with diabetes. Conclusion: We conclude that the sedentary and affluent life style accompanied by stress among college going adults have made them fall prey to obesity, hypertension and dyslipidaemia which is ultimately reflected by an increase in the prevalence of diabetes. Hence it is high time to encourage the adults to be aware of the importance of physical activities and protect them from metabolic disorders such as diabetes and obesity.Item Albumin-adjusted calcium: Are previously published regression equations reliable for your laboratory? - A pilot study.(2013-04) Pawade, Yogesh R; Ghangale, Suresh S; Dahake, Hemant SBackground: Most of the laboratories use previously published regression equations for estimation of calcium which may not fit for their population. So deriving locally a regression equation for albumin-adjusted calcium (CaAd) is a mainstay to avoid population-based differences. Aims & Objective: To derive regression equation for albumin-adjusted calcium in our laboratory and validate it for the local population. Material and Methods: Total 575 normal healthy individuals of 35-65 years were included in the present study and were estimated for serum total calcium (CaT), ionized calcium (Ca2+), and albumin. The linear regression equation for the binding of calcium and albumin was derived in a cohort of 450 normal healthy individuals of 35-65 years, and the albumin-adjusted calcium equation was internally validated in a separate cohort of 125 subjects. The performance of this equation was compared with a previously published equation: CaAd (mmol/L) = CaT (mmol/L) + 0.02 (40 - [albumin] (g/L). Results: The local adjustment equation obtained from the derivation subset was expressed by the relationship; CaAd (mmol/L) = CaT (mmol/L) + 0.03 (37.33 – [albumin] (g/L)). The equation was internally validated with an adjusted r2 shrinkage value of 0.0009 in a validation subset. Bland-Altman plot showed statistically significant difference (Mean = 0.13 mmol/L) when both formulae were compared for the population. Conclusion: A locally derived and internally validated albumin-adjusted calcium equation differed significantly from previously published equations. Individual laboratories should determine their own linear albumin-adjusted regression equation for calcium rather than relying on published formulas.Item Alcohol consumption and associated sociodemographic factors among medical students in an urban locality(International Journal of Medical Science and Public Health, 2019-01) Halgar, PK; Anandi, BS; Indupalli, AS; Biradar, S; Reddy, SBBackground: India has experienced a substantial increase in alcohol consumption especially young adults engaged in harmful drinking habits and medical college students constitute an important high-risk population for this hazard. Different population groups have different factors which determine alcohol consumption, differential vulnerability to alcohol-related problems with varying needs for intervention. These differential behaviors and outcomes are influenced and maintained by structural and cultural factors (which internship is influenced by sociodemographic determinants). Thus, tailored strategies to improve outcomes by targeting specific social determinants among vulnerable groups play an important role. Objectives: The objective of the study was to find an association between sociodemographic factors and alcohol consumption habits among medical college students in Kalaburagi district. Materials and Methods: A cross-sectional study was undertaken among 255 medical college students studying in different phases. Study duration was for 3 months from April to June 2018. Screening for alcohol use disorders was undertaken using alcohol use disorders identification test questionnaire. Multivariate logistic regression analysis was undertaken to assess significantly associated sociodemographic factors with alcohol consumption. Results: Prevalence of alcohol consumption, hazardous drinking and alcohol dependency were 25.5% with 95% confidence interval (22.36–28.63), 19.2% and 8.7%, respectively. On multivariate analysis, sociodemographic factors such as total family income and past place of residence were significantly associated with alcohol consumption. Conclusion: Early identification of at-risk groups and timely brief interventions of behaviors inclined toward developing hazardous drinking habits is crucial by addressing specific sociodemographic determinants such as isolation and limited access to services.Item Alertness regarding malaria in rural community of Vadodara.(2013-01) Parekh, Alok; Parekh, Malay; Vadasmiya, Divyeshkumar; Kumar, ArvindBackground: Malaria remains a major cause of morbidity and mortality in tropical and subtropical regions of the world, despite decades of malaria control efforts. Aims & Objective: This study looked into the local community understanding of malaria treatment-seeking patterns, preventive measures and practices in rural area of Vadodara. Material and Methods: A descriptive cross-sectional survey was carried out in rural area of Vadodara. A structured questionnaire was administered to 168 randomly selected households. Only one adult person was interviewed per household. The interviewees were the heads of households and in the absence of the heads of households responsible adults above 18 years were interviewed. Results: A substantial number of research participants showed reasonable information of malaria, including correct association between malaria and mosquito bites, its potential fatal consequences and proper treatment practices. 84.1% (n = 168) of the respondents considered that they consult treatment within 24 hours of onset of malaria symptoms, with health facilities as their first treatment option. Conclusion: Despite fair knowledge of malaria in rural area of Vadodara, there is a need for improving the availability of information through the preferred community channels as well as professional health routes.Item Amyotropic lateral sclerosis as a para-neoplastic manifestation of gastric adenocarcinoma - A rare case report.(2014-05) Chakrabarti, Subrata; Pan, KoushikMotor neuron diseases (MND) have been reported as a rare paraneoplastic syndrome of a systemic neoplasm. Amyotrophic Lateral Sclerosis as a paraneoplastic manifestation of gastric carcinoma is even rarer. We present a patient with amyotrophic lateral sclerosis (ALS) in association with adenocarcinoma of stomach. A 48year old man presented with a four months history of progressive dysphagia, spastic dysarthria and marked fasciculation in his atrophic tongue. Gag reflexes were diminished bilaterally. There was significant atrophy in thenar and hypothenar areas of both hands and dorsum of both feet. Electromyography result was compatible with diffuse motor neuropathy with active denervation. MRI brain showed classical findings of ALS. Upper GI endoscopic study showed ulcerated mucosa in body of stomach. Histological biopsy of stomach confirmed the presence of adenocarcinoma. The importance of considering a paraneoplastic syndrome in a patient with presentation of ALS is that it can lead to searching for underlying neoplasm before its apparent signs and symptoms develop and a scope to initiate treatment for primary carcinoma. Again treating the underlying neoplasm may halt or even resolve the neurologic signs and symptoms.Item Analgesic efficacy of surgeon-assisted transverse abdominis plane block in patients undergoing open cholecystectomy.(2013-07) Parmar, Siddharth; Sheikh, Abdul Nasir; Vyas, Atul; Puri, GarimaBackground: Unavailability of ultrasound and unpredictable success with traditional blind technique makes Transversus Abdominis Plane Block under-utilized in developing country like India. Aims & Objective: The present study was designed to evaluate the analgesic efficacy of Surgeon-assisted Transversus Abdominis Plane Block as an adjuvant to routine analgesic in reducing pain score during first 12 hours postoperatively in patients undergoing open cholecystectomy. Material and Methods: This was randomized, double-blinded, controlled, clinical trial carried out in tertiary care, teaching hospital. All the patients received a routine general anaesthesia with standard monitoring. Group A received routine analgesic which included Diclofenac sodium 75 mg intravenously (IV) at 8 hourly and group B received routine analgesic & Transversus Abdominis Plane Block with 15 ml of bupivacaine 0.25% at the end of surgery. Visual analogue score for pain, incidence of post-operative nausea and vomiting and demand of rescue opioid (Tramadol 2 mg/kg IV) in post-operative period were assessed every 2 hourly up to 12 hours after the surgery by an investigator blinded to group allocation. Results: Transversus Abdominis Plane block reduced visual analogue scale for pain on emergence and at all postoperative time points up to 12 hours (p < 0.0009). The incidence of post-operative nausea and vomiting, and demand of rescue opioid in the first 12 postoperative hours were also reduced (p < 0.0001). There were no complications attributable to the block. Conclusion: Transversus Abdominis Plane Block is effective as an adjuvant to routine analgesic to reduce pain after open cholecystectomy and reduces post-operative opioid demand and nausea & vomiting.Item Analysis of association between lichen planus with hepatitis B and hepatitis C virus infection in patients attending outpatient department of dermatology at tertiary care hospital in Central Rajasthan(International Journal of Medical Science and Public Health, 2020-01) Kumar, S; Sohu, S; Meena, M; Nain, S; Kothiwala, R; Meharada, ABackground: Lichen planus (LP) is a non-infectious cutaneous disease, characterized by the presence of itchy, flat from top, polygonal, and papular lesions having a strikingly violaceous color. Objectives: The objectives are as follows: (1) To establish the association of hepatitis B and hepatitis C with LP in urban areas of Ajmer and (2) to analyze the derangements in liver function tests of LP patients who attended the outpatient Department of Dermatology in JLN Hospital Ajmer. Materials and Methods: To conduct the study, 102 patients of LP and 100 control subjects were selected between age groups of 18 and 60 years. A detailed history including age, sex, race, residence, clinical symptoms, and their duration was recorded. Control group was selected from blood donors at blood bank of Jawaharlal Nehru Medical College, Ajmer, and was corresponding in age and sex to those of study group. A thorough clinical examination, systemic and cutaneous examination was performed. Clinical findings classical of LP and lesions confirmed histopathologically were used to establish the diagnosis of LP. A rapid test kit was used for detecting seropositivity for hepatitis B virus (HBV) and hepatitis C virus (HCV). Chi-square test and multivariate regression analysis using SPSS version 16 were used to analyze the collected research data. Results: None of the patients of LP in the study group were HCV and HBV positive. None of the control group was positive for both viral infections. In 16 patients (15.68%), the levels of serum aspartate aminotransferase were beyond the normal limits, and higher levels of alanine aminotransferase were detected in 5 patients (4.90%). Bilirubin concentrations higher than the normal limits were detected in total 16 patients (15.68%). Conclusion: No association of hepatitis B and C with LP could be established from the present study. More detailed research is needed to establish the correlation between hepatitis B and C and LP.Item Analysis of bone lesions in tertiary care center - A review of 79 cases.(2013-10) Hathila, Rasik; Mehta, Jigar; Jha, Bharti; Saini, Peeyush; Dudhat, Reena; Shah, MiteshkumarBackground: Bone tumours are comparatively uncommon among wide array of lesions and pose a diagnostic problem as they constitute a small portion of diagnostic experience among pathologist. Aims & Objective: To study the histopathological features of bone lesions and their correlation with age of presentation, site and type of lesion. Material and Methods: The present study was carried out at a tertiary care center from October 2003 to January 2006. A total of 79 bone lesions were analyzed. A detail clinical and radiological history was taken. Bone biopsy was performed by either percutaneous method with needle/drill or Open surgical biopsy. If attached soft tissue was also received, bony tissues were put for decalcification (10% nitric acid) and soft tissue was immediately fixed into 10 % formalin and processed by paraffin embedding. Sections were stained by haematoxylin and eosin stain. Results: Incidence of non-neoplatic and benign neoplastic lesions was 68.40% while that of malignant lesion was only 20.22%.Younger patients (58.24%) and males (59.49%) were more commonly affected. Amongst non-neoplastic lesions, tuberculous lesions (17.72%) were commonest while exostosis (15.19%) and osteosarcoma and chondrosarcoma were common benign and malignant neoplastic lesions respectively. Overall most common bone involved was femur. In tuberculous lesions, vertebrae were commonly involved. Osteolytic lesions were more common. Metaphysis was the commonest site. Conclusion: Though bone tumours are less common lesions and pose a diagnostic problem, if viewed in perspective of clinico-radiology and histopathology, a correct diagnosis can be reached.Item Analysis of FNAC of cervical lymph nodes: Experience over a two years period.(2014) Baji, Shakera N; Anand, Vaishali; Sharma, Richa; Deore, Kunal S; Chokshi, MitalBackground: Cervical lymphadenopathy is a common clinical presentation across patients of all age group. The aetiology may range from a benign nonspecific inflammation to lymphoproliferative disorders and metastatic malignancy. Aims & Objective: The present study was undertaken to study non neoplastic and neoplastic lesions of enlarged lymph nodes by Fine needle aspiration cytology (FNAC) in patients presenting with cervical lymphadenopathy referred to cytopathology department from the OPD/IPD of Civil Hospital, Ahmedabad over a period of two years (November 2011 to November 2013). Materials and Methods: A total of 2018 patients were subjected to FNAC of cervical lymph nodes over two years period (November 2011 to November 2013). Since in 113 patients, either the aspirate was inadequate or the opinion equivocal, the remaining 1905 cases were analysed. Results: Overall tuberculous lymphadenitis was the most common finding (898/1905, 46%), followed by reactive hyperplasia (624/1905, 33%). Malignant pathology accounted for 16% (306/1905) of cervical lymph node enlargement, most of which was due to metastatic squamous cell carcinoma (179/306, 58%). Conclusion: FNAC is an excellent first line of investigation and when used with a proper combination of experience and diligence, it can efficiently help at arriving in exact diagnosis.Item Analysis of various criteria for identification of severe acute maternal morbidity in a rural tertiary health care centre: A prospective one year study.(2014-05) Kushwah, Beenu; Singh, Alok Pratap; Natung, PapyBackground: Maternal mortality has been the indicator of measurement of maternal health. Over the last decade, identification of severe acute maternal morbidity (SAMM) has emerged as a compliment or alternative to investigation of maternal deaths. A review of causes of SAMM will help to find out the potential problems which in turn will enable women to get the treatment on time. Recent researches have suggested that proper identification of SAMM cases can prove to be a better method to monitor the quality and effectiveness of obstetric care than mortality alone. Although there have been many criteria which have been introduced from time to time to identify these cases, because of vast variation of different level of facilities, these criteria cannot be applied across the regions. WHO has recently come up with certain set of criteria which could be more applicable to low resource settings. Aims & Objective: Present study tried to identify SAMM cases through various criteria and compared the applicability of them in our setup which is resource poor setting catering mainly to a huge rural population. Materials and Methods: It is a prospective study done over a period of one year, from September 2012 to August 2013. All severely morbid pregnant women or who had delivered or aborted within 42days were included. Initial identification of these cases was done on the basis of general criteria and later on other criteria were applied according to the primary obstetric event, clinical features, Lab findings or management provided. A comparison was done amongst all criteria and their individual applicability was checked as per the facility available in our set up. Results: During the study period total 7819 women delivered in the hospital out of which 6498 delivered vaginally and 1321 delivered through caesarian section. Total live births during this period were 5219. The present study found an incidence of severe maternal morbidity/near miss ranging from 5.56 to 40 per 1000 live births. Among 244 women suspected to be SAMM/MNM, 179(73%) met Waterstone’s criteria, 48(20%) met Mantel’s Criteria and 63(26%) met WHO criteria, 20% women met Mantel and Waterstone’s criteria both while 17% met all three criteria. Conclusion: The study of SAMM cases and their identification through suitable criteria can contribute to know its magnitude, as well as to identify most frequent characteristics and clinical conditions which will help to recognize the problems in antenatal services, peripheral health care facilities and referral system. The criteria which are available now cannot be applied uniformly, and need to be tailored to identify more specific criteria according to infrastructure of a particular setting in order to utilize resources effectively.