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Background: Workplace violence is any physical assault, threatening behavior or verbal abuse in circumstances relating to work, involving an explicit or implicit challenge to the safety, well-being or health of the employee. Doctors are facing violence in increasing numbers and there are less data available. Hence the study was carried out in an attempt to identify the magnitude of these problems and to assess the attitudes of the doctors regarding this problem. Objectives: To determine the prevalence and attitude of workplace violence among the postgraduate students. Materials and Methods: A cross-sectional study was conducted from January to June, 2011, at the Regional Institute of Medical Sciences, Imphal, Manipur. A self-administered questionnaire was used among the postgraduate students and findings expressed in the form of percentages. Chi-square test was used. Data were analyzed using database software. Ethical approval was obtained from RIMS Institutional ethics committee. Results: Of the total 286 PG students, 230 responded. 78.26% had experienced at least one form of violence, with the escorts of the patients committing 68.33% of the violence. Verbal threats were the commonest form. Maximum violence was committed at the emergency services (48.88%). Male doctors faced more workplace violence than females (P < 0.001). 78.26% of the respondents wanted work place violence to be a non-bailable offence. Conclusion: Our study found a high prevalence of workplace violence. Doctors face the possibility of being victims of aggressive and violent incidents while caring for the patients. Hence doctor's view regarding the punishment for workplace violence as a non-bailable offence should be taken into consideration.

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Background and Objective: Due to increased risk of uterine rupture with prostaglandins in previous cesarean patients, its use has been discouraged as ripening agent in previous cesarean patients. This study was conducted to compare the efficacy and safety of Foley catheter with low dose oxytocin as cervical ripening agent in women with previous cesarean section (CS). Materials and Methods: This was prospective randomized study, including 60 women (30 in each group) with previous CS with unfavorable cervix who needs induction of labor after 28 weeks. Outcomes were analyzed in terms of change in Bishop score (BS), route of delivery and complications. Results: The BS before and after ripening between the two groups was similar (P > 0.05). However, the change in BS within each group was 3.07 and 3.30 in Foley and oxytocin group respectively and this was statistically significant (P < 0.001). Twenty (66.7%) patients in Foley group had a vaginal delivery and 18 (60%) in oxytocin group did so. There were two cases of scar dehiscence in oxytocin group and non in Foley group. Conclusion: Both Foley and low dose oxytocin are good cervical ripening agents in previous cesarean patients. However, the two cases of scar dehiscence in low dose oxytocin group is a concern of safety.

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Objective: To study the pattern of various oral cavity lesions in a tertiary care hospital in Manipur, India. Materials and Methods: This is a 5 year retrospective study from January 2006 to December 2011. All the oral cavity specimens received in the Department of Pathology, Regional Institute of Medical Sciences (RIMS) during the study period was included for the study. Data such as age, sex, and site of the lesion was collected and restaining of the slides with hematoxylin and eosin (H and E) was performed whenever required. Data's collected were analyzed. Results: A total of 119 cases was analyzed during the study period. Age ranged from 3 to 90 years in the study. Overall females were affected more than the male with male:female (M:F) ratio of 1:1.5. Buccal mucosa (26.9%) was the commonest site involved followed by tongue (26%). Neoplastic lesions accounted for 61.4% cases and nonneoplastic accounted for 38.6% cases. Among the neoplastic lesion, squamous cell carcinoma (SCC) was seen in 82% cases; verrucous carcinoma and ameloblastic carcinoma in 5.1% cases each; and mucoepidermoid carcinoma, adenosquamous carcinoma, and small cell carcinoma in 2.6% cases each. Most of the neoplastic lesions were located in the tongue (30.8%), followed by buccal mucosa (28.2%), alveolus (5.1%), floor of mouth (10.3%), and palate and lips (12.8%) each. The M:F ratio of the neoplastic lesion was 1:1.2. Chronic inflammatory lesions accounted for the maximum number of nonneoplastic lesions (26.1%), followed by fibrosis (23.9%), and fibrous hyperplasia and cystic changes, 17.4% each. Epulis accounted for 10.8% and ranula and hamartoma accounting for 2.2% each. The commonest site of involvement was gingiva and buccal mucosa with 32.6% each. Conclusion: A variety of lesions were encountered in the study with predominance of malignant lesions. SCC was the commonest malignant lesion. A larger epidemiopathological study in this region needs to be carried out.

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Background: Failure to provide postoperative pain relief is morally and ethically unacceptable. Combination of nonopioid analgesics is being increasingly used to reduce opioid-related side effects. Pregabalin, having an inhibitory modulation of neuronal excitability, is being evaluated in this randomized controlled trial. Materials and Methods: Following institutional ethical clearance, 90 adult females (aged 18-60 years, ASA I and II) undergoing elective abdominal hysterectomy were randomized into two groups (n = 45). Group A patients received pregabalin 150 mg and Group B patients received placebo (vitamin C), 1 h prior to induction of anesthesia. Intraoperative analgesia was provided with paracetamol infusion 1,000 mg over 15 min. Postoperative pain (visual analog scale/VAS), postoperative nausea and vomiting ( four point ordinal scale ) and sedation scale ( Ramsay ) were monitored at 0, 0-4, 4-12, and 12-24 h time intervals. Results: Both static (at rest) and dynamic (during coughing) pain score (VAS) and the consumption of rescue analgesia (ketorolac) were significantly (<0.001) less in the pregabalin group. There were no significant differences in the postoperative nausea and vomiting, and Ramsay sedation scale. Conclusion: Preoperative pregabalin had significant effect in relieving postoperative pain when given as an adjuvant.

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Joint replacement is a highly effective intervention that significantly improves patients' quality of life, providing symptom relief, restoration of joint function, improved mobility, and independence. Prosthetic joint infection (PJI) remains one of the most serious complications of prosthetic joint implantation. PJI positions a substantial burden on individuals, communities, and the health-care system, and thus early diagnosis and appropriate intervention are extremely important. Determining the various host and environmental factors that put an individual at risk for development of PJI may reduce the morbidity and cost of total joint arthroplasties. Microbial agents implicated in the causation of PJI range from Gram-positive to Gram-negative bacteria. PJI with fungi is commonly seen in immunocompromised patients. Numerous novel, uncultivable, and fastidious organisms have been identified as potential pathogens with the use of non-culture techniques. The majority of cases of PJI require surgical treatment, while the use of antimicrobials is essential when prosthetic removal is not possible or contraindicated. The microbiology and treatment of PJI in the light of improved culture and diagnostic methods are reviewed.

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The Government of India adopted the National Policy on Older Persons in 1999, which defines a "'senior citizen' or 'elderly' as a person who is of age 60 years or above." In India the elderly population accounted for 8.2% of the total population in 2011 and the number is expected to increase over the next decades. The link between aging and disability is a biological fact, and disability in the elderly is an important health indicator pointing to jeopardized quality of life. But at the same time, aging should not be treated as synonymous with disability as a large proportion of older people live with good health status. There are many studies from India that have addressed disability in the elderly population; however, they lack uniformity in defining disability and largely address mostly one aspect, that is, the medical model of disability. It is well recognized that "disability and elderly" encompasses a much larger spectrum of the conditions with unique requirements and needs to be studied as a much broader concept.

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Extraction of impacted third molars is a common surgical procedure performed by oral surgeons and dentist. Dislodgement of the molar tooth into the maxillary sinus cavity can occur during the procedure. It comprises 0.6-3.8% of iatrogenic foreign body entrapment in the paranasal sinus. We report an unusual case of impacted maxillary third molar tooth that was accidentally displaced into the maxillary sinus during extraction and remained almost 1 year without any symptoms and removed via endoscopic sinus surgery.

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Valproic acid is a branched chain aliphatic carboxylic acid which is widely used as antiepileptic drug. Valproic acid-induced acute pancreatitis is an uncommon cause of acute pancreatitis. Hereby we describe a 23-year-old unmarried female, who developed acute pancreatitis following the 12 ^th day of valproate monotherapy prescribed for seizure disorder. Valproate was immediately stopped and replaced with levetiracetam. She improved on conservative management.

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Background: Dysmenorrhea is one of the common problems experienced by many adolescent girls after the onset of menarche. Objectives: This study had the following objectives: 1. To determine the prevalence of dysmenorrhea among adolescent girls; 2. To determine the association between dysmenorrhea and selected variables of interest; 3. To assess the effect of dysmenorrhea on quality of life; 4. To assess treatment-seeking practices for dysmenorrhea. Materials and Methods: This was a cross-sectional study conducted among higher secondary schoolgirls of Imphal West district, Manipur from December 2012 to September 2014. The sample size was calculated to be 660. Participants were selected by stratified two-stage cluster sampling. Data were collected using a self-administered questionnaire. Data were entered and analyzed using IBM SPSS version 20 (Armonk, New York, USA). Analysis was done using chi-square test and chi-square test for trend. Results: Among the 703 respondents, the prevalence of dysmenorrhea was 76.0%, and about one-fifth (21.2%) of the respondents were suffering from severe dysmenorrhea. Painful menstruation caused school absenteeism, poor exam grades, and poor interpersonal relationships, decreased concentration in class and affected daily physical activities in the majority of respondents. Only 37.5% of the dysmenorrheic girls were receiving treatment for painful menstruation, of which medication was the common, but only 13.1% of the dysmenorrheic girls took medication on prescription by a doctor. Conclusion: Health education on issues related to reproductive health should be incorporated early enough in the school curriculum to prepare girls for menstruation and inform them about available treatment options for dysmenorrhea.

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Background: Spinal anesthesia is the most common preferred technique for cesarean delivery. However, it is associated with hypotension which is detrimental to both the mother and fetus. The study has been undertaken to determine the effect of bolus intravenous ephedrine in ameliorating spinal-induced hypotension. Materials and Methods: Fifty primiparous parturients scheduled for cesarean section were randomly allocated into two groups of 25 patients each: Group 1 (study) and Group 2 (control) to receive either 1 ml of 5 mg bolus intravenous ephedrine or equal volume of normal saline, respectively, just after 10 mg of 0.5% intrathecal bupivacaine. Results: Significant fall in systolic blood pressure from its baseline value occurs at all time intervals in both the groups, except up to the 4 ^th min in the ephedrine group. The incidences of hypotension between the two groups were 60% and 72% in the ephedrine and control group, respectively (P > 0.05). Conclusion: Prophylactic use of intravenous ephedrine did not significantly decrease the incidence of maternal hypotension.

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Background and Objective: Asthma is a serious health problem throughout the world, affecting people of all ages. It is a chronic inflammatory respiratory disorder. There are a few short-term studies with least number of the patients showing the impact of yoga on forced expiratory volume during the first second of the forced breath (FEV ₁ ) and peak expiratory flow rate (PEFR). To assess the efficacy of yoga on pulmonary functions in asthma patients. Setting and Design: It was a randomized controlled trial, conducted at a tertiary-care teaching hospital in Lucknow, UP, India. Materials and Methods: The study was carried out in mild-to-moderate persistent asthma (FEV ₁ > 60%) patients aged between 12 years and 60 years. The patients were recruited from the Department of Pulmonary Medicine and were randomly divided into two groups as follows: "the case group" and "the control group." Their spirometric assessments were done at the baseline, third month, and sixth month. Statistical Analysis Used: The statistical analysis was done by using GraphPad inStat version 3.05 software Inc., year 2000 (Version. 3.05 GraphPad software, Inc., California, USA). Results and Conclusion: No significant changes were found in spirometric variables in "the control group" during the course of the study. In contrast, "the yoga group" got significantly better improvement in spirometric variables. The result shows that yoga can be an adjuvant therapy along with standard medical treatment for the better management of asthma.

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Context: The recent change of using endoscope instead of microscope in performing transcanal type 1 tympanoplasty has encouraged us to compare the results of the surgery. Aims: The aim of this study is to evaluate hearing status in the pre- and post-operative state after endoscopic type 1 tympanoplasty and to correlate the improvement with influencing factors like the age of the patient, site and size of perforation, wet/dry ear, status middle ear mucosa, status of mastoid air cells, and function of Eustachian tube. Settings and Design: An interventional study was carried out in the Department of Otorhinolaryngology, RIMS. Materials and Methods: Thirty cases of diagnosed pars tensa central perforations, aged above 18 years, with a small to subtotal perforation associated with a demonstrable conductive deafness not more than 40 dB was included in the study. Statistical analysis used: Chi-square test. Results: The graft uptake rate in our study is 90% and hearing improvement in terms of airbone (AB) gap within 0-15 dB was achieved in 83.3%. Age, sex, size of perforation, site of perforation, wet/dry ear, and status of the mastoid air cell system were not found to have a significant relation with the successful outcome of endoscopic type 1 tympanoplasty. Presence of mucosal hypertrophy and the nonfunctioning of the Eustachian tube were a significant determinant for the failure of type 1 tympanoplasty. Conclusions: The outcome of endoscopic type 1 tympanoplasty is similar to the outcome of the microscope assisted type 1 tympanoplasty with better cosmesis.

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Objective: Propofol, an intravenous (IV) anesthetic, can irritate the skin, mucous membrane, and venous intima. The main drawback is the pain on injecting it. We compared the analgesic effects of lidocaine, dexmedetomidine, and saline (placebo) in ameliorating propofol injection pain. Materials and Methods: Following the approval of the hospital's Ethics Committee, 105 adult patients of both sexes [aged 18-70 years, American Society of Anesthesiologists (ASA) I and II] were divided into three groups (n = 35) to receive 5 ml of IV saline (placebo), 0.25 μg/kg of dexmedetomidine, and 0.5 μg/kg of lidocaine diluted in 5 ml of saline at an ambient operating room temperature in a randomized and double blinded fashion to compare the pain-relieving effects of the drugs during propofol injection before the patients lost consciousness. The propofol injection pain was assessed according to the McCrirrick and Hunter scale. Result: Dexmedetomidine (as seen in 62.86% of the patients) and lidocane (as seen in 80% of the patients) had complete pain relief as compared to placebo. Conclusion: Pretreatment with 0.25 µg/kg of dexmedetomidine with venous occlusion for one min is also as effective as IV lidocaine pretreatment in alleviating propofol injection pain when compared to placebo, even though lidocaine is better than dexmedetomidine.

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Background: Glucose is the major source of energy for organ function. Hypoglycemia in neonates with its high brain-to bodyweight ratio is associated with an increased risk of morbidity and mortality. The objective of this study was to determine the frequency and clinical characteristics of hypoglycemia in neonates. Methodology: Cross sectional study conducted at the Department of Biochemistry and Obstetrics and Gynaecology, RIMS, from September 2009 to August 2010. 125 newborns delivered at dept of Obst and gynae RIMS were randomly selected for the cases. Gestational age, birth weight and clinical features were recorded on questionnaire. Blood glucose level was checked and any value less than 40mg/dl was considered as hypoglycemia. Data was analyzed by SPSS version 11. Results: Out of 125 neonates, 19 (15.20%) were found to be hypoglycemic. Hypoglycemia was more common in males 11 (32.7%) of 65 male babies, as compared to females 08 (13.33%) of 60 female babies and was more frequent in first 0-24 hrs of life 12 (63.15%) than at 48-72 hrs 3 (15.78%). Hypoglycemia was present in 06 (23.08%) small-for-gestational age,13 (13.13%) appropriate-for-gestational age. Hypoglycemia was seen in 4 (19.05%) preterm and 15 (14.42%) term babies. Jitteriness was the most common symptom of hypoglycemia in 8 (88.88%) cases of 9 symptomatic hypoglycemic cases. Conclusion: Neonatal hypoglycemia is more common in male babies and occurs in the early neonatal age. Blood glucose estimation is mandatory in neonates with signs and symptoms of hypoglycemia.

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Background and Objective: A vast spectrum of pathological lesions like neoplastic, inflammatory, congenital and various miscellaneous lesions may present as lung masses. With computed tomography (CT) guidance it is possible to perform a biopsy on almost any portion of lung with high degree of safety and minimal morbidity avoiding more invasive techniques. The objective of present study was to evaluate the diagnostic utility of CT-guided fine needle aspiration cytology (FNAC) in pulmonary mass lesions and to compare with previous similar studies. Materials and Methods: Sixty-one patients presented with undiagnosed pulmonary mass lesions underwent CT-guided FNAC for a period of 18 months. The lesions were localized by CT scan and after the needle tip was confirmed to be in the desired location, aspirations were performed. Smears were fixed with 95% ethyl alcohol stained for Papanicolaou stain and air dried smears were routinely stained with giemsa. Cell blocks were prepared from aspirated materials. Data were analyzed using Epi Info™ version 7. Results: Out of 61 one cases, 56 (91.80%) cases were adequate for evaluation. Considering cell block diagnosis as the standard, sensitivity, specificity, positive predictive value and negative predictive value and diagnostic accuracy of CT-guided FNAC of pulmonary malignant lesions were 95.5%, 84.6%, 94.3%, 91.3% and 91.6% respectively (P < 0.0000096). The mean age of presentation was 65.75 years with male to female ratio of 1.44:1. Squamous cell carcinoma was the most common malignant lesion (35.0%). Hemoptysis and transient pleuritic chest pain were some complications encountered. Conclusion: CT-guided FNAC is simple, safe and has a high sensitivity and diagnostic accuracy with only a few complications.

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Background: Diabetes Mellitus is a metabolic disorder precipitating micro vascular, macro vascular complications and peripheral vascular diseases. Pulmonary complications of diabetes mellitus have been poorly characterized. Although some authors have reported normal pulmonary function, others found abnormalities in lung volumes, pulmonary mechanics, and diffusing capacity. Glycemic status have shown varied impact on lung functions. Objective: To measure lung volumes of type 2 diabetic patients and correlate with their glycemic status. Materials and Methods: Cross-sectional study was carried out among 30 type 2 diabetic patients and 30 age and sex matched non-diabetic controls in the Department of Physiology, Regional Institute of Medical Sciences (RIMS), Imphal. Spirometric recordings were estimated by using Computerized Spirometer-HELIOS 701. Blood glucose level was determined by glucose oxidase method and glycated hemoglobin (HbA1c) was estimated by using Glycohemoglobin HbA1-Test kit; Fast Ion-Exchange Resin Separation Method. Data was analyzed using Student's 't' test and Pearson correlation. Results: The pulmonary functions forced vital capacity (FVC), forced expired volume in one second (FEV ₁ ), peak expiratory flow rate (PEFR) and forced mid-expiratory flow (FEF) _25-75% were decreased while FEV ₁ /FVC was increased in the cases as compared to the controls. Lung functions exhibited rough negative correlation with post prandial blood sugar (PPBS) and HbA1c. Conclusion: The findings demonstrated modest albeit statistically significant impaired lung functions in restrictive pattern. The significant negative correlation between PPBS and FVC was seen. On correlating with HbA1c a significant negative correlation is seen with FVC and FEV ₁ , suggesting that there is a definite association between the glycemic status and decreased lung function, but the exact pathophysiological mechanism to explain this association requires further research.

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Background: A study of visual evoked potentials (VEPs) is an important diagnostic tool used equally by neurophysiologist, ophthalmologist, neurologists, and neurosurgeons. Many neurological disorders present with visual abnormalities and detection of subclinical lesions affecting the visual system which are poorly visualized by MRI or in unreliable clinical examination or ruling out of psychogenic origin, depends mainly on the VEPs. Its prognostic utility are also under investigations. Objectives: To review the clinical utility, brief history, origin, and generator sites of VEPs. Data Sources: Published, peer-reviewed literature on VEPs available both in print or online. Conclusion: VEPs have emerged as an important diagnostic tool in demyelinating diseases of the CNS in the current era. An awareness of the conditions where it can be utilized along with a sound knowledge of origin and generator sites will help the clinician or the neurologist to identify the possible sites of abnormalities and thereby effectively influence the management and treatment outcome in patients with neurological disorders.

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Children represent the future of our society and ensuring their healthy growth and development ought to be a prime concern of all. The dental condition of children with special health care needs (SHCN) may be directly or indirectly related to their disabilities. Children with SHCN relatively have poor oral hygiene and increased prevalence of gingival diseases and dental caries. Unfortunately, the importance of dental care for these children has often been overlooked by the health planners. Parents of disabled children usually do not seek dental treatment as they also have the burden of medical treatment. In the past, the emphasis was based on providing basic dental care, but in recent years, the dental profession has shown increased concern in providing complete oral health care to the mentally- or physically-challenged children. The specialty of pediatric dentistry provides both primary and comprehensive, preventive and therapeutic oral health care to children with SHCN. These special children are entitled to the opportunity to achieve appropriate rehabilitation, to enable them to realize their maximal level of functioning, and to assist them in not only “normalizing” their lives but also lengthening their life span.

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Preterm birth is one of the most prevailing complications of pregnancy causing neonatal mortality and morbidity. Cervical length measurement has been the only criteria used till now for the prediction of preterm delivery (PTD). Research on many biomarkers in maternal serum, amniotic fluid, and cervicovaginal fluid (CVF) has been accomplished such as fetal fibronectin (FFN), α-fetoprotein, C-reactive protein (CRP), multiple members of the interleukin family (interleukin-6, interleukin 8, and interleukin 10), matrix metalloproteinases, pregnancy-associated plasma protein A, relaxin, lactate dehydrogenase (LDH), thyroid-stimulating hormone, adrenocorticotropic hormone, vascular endothelial growth factor (VEGF), ferritin, prolactin, ceruloplasmin, alkaline phosphatase (ALP), glucose, placental protein 13, corticotropin releasing hormone, tumor necrosis factor-α (TNF-α), tumor necrosis factor-β (TNF- β), estriol and human chorionic gonadotropin (hCG). Not a single biomarker has been evolved till date, which possesses sensitivity as well as reliability for the detection of spontaneous preterm birth. The variability in results across the studies may have arisen due to dissimilarities in study designs, different timings of collection of blood, and diversities in the study population. Study on a large sample size is needed for the confirmatory conclusion of use of biomarker in PTD. A single biomarker or even in combination, if found for the prediction of preterm labor (PTL), can decrease the hospital cost as well as restrict the treatment.

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Genitourinary tuberculosis is caused by metastatic spread of the organism through the bloodstream during the initial infection. The kidney is usually the primary organ infected in urinary disease, and other parts of the urinary tract become involved by direct extension. Primary prostatic TB is a very rare form of presentation of the tuberculous infection, which is generally caused by the M. tuberculosis, and which has shown an increase in incidence and prevalence, due to an increase of immunocompromised patients and the pandemic of the Syndrome of Acquired Immune Deficiency. However, it can exceptionally be found as an isolated lesion in immunocompetent patients as in this case. Hence we wish to report an unusual case encountered and successfully managed in our department in which primary TB of the prostate produced obstructive urinary symptoms and eventually many months later, the patient presented with anuria and deranged renal function.

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Objective: To evaluate whether the co-induction technique affects the total induction dose requirement of propofol and thereby reduce associated hemodynamic adverse effects. Materials and Methods: 120 american society of anesthesiologist (ASA) 1 and 2 patients undergoing general and gynecological surgeries under general anesthesia were randomly divided into four groups, i.e., group 1: Normal saline (control group), group 2: Midazolam, 0.03 mg/kg body weight, group 3: Thiopentone, 1 mg/kg body weight and group 4: Ketamine, 0.3 mg/kg body weight. After measuring the baseline hemodynamic variables and 2 min after study drug was given, propofol was administered 30 mg/10 s till the end points were reached -loss of verbal command or eyelash reflex. The total dose of propofol used and hemodynamic parameters were recorded following induction of anesthesia and the study was taken as completed and the rest of anesthesia proceeded as per standard technique. Results: Our study reveals that the total induction dose of propofol was reduced by 33.92% (group 2), 35.08% (group 3), and 42.69% (group 4) from that in the control group (group 1). The fall in mean arterial pressure from baseline in the midazolam (group 2), thiopentone (group 3) and ketamine group (group 4) was 10.88%, 14.58%, and 8.37% respectively. Conclusion: Ketamine reduced the induction dose requirement of propofol to the greatest degree and though, all three co-induction agents offered some degree of hemodynamic stability, ketamine provides the best cardiovascular stability.

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Objective: To enquire about the level of awareness regarding various important aspects of palliative medicine among doctors of various departments in four medical colleges in Kolkata through a questionnaire. Materials and Methods: A questionnaire was developed by few members of Indian Association of Palliative Care. It was distributed, to a convenience sample of doctors who worked in various departments in all four teaching hospitals in Kolkata. The distribution and collection of questionnaires was carried out within 4 months. Results: The results suggested that 85% doctors felt that cancer was the commonest reason for the palliative care teams to be involved. Seventy four percent mentioned that pain control was their prime job; 53% said that they are enjoying their encounter with palliative care, so far; 77% thought breaking bad news is necessary in further decision making process; only 22% reported the WHO ladder of pain control sequentially, 35% believed other forms of therapies are useful in relieving pain, 35% thought they give enough importance and time for pain control; 77% said that they had heard about a hospice, among them still 61% thought patients should spend last days of their life at home. Thinking of the future, 92% of the doctors think more and more people will need palliative care in the coming days. Conclusion: Amongst doctors of various departments, there is a lack of training and awareness in palliative care. Almost all the doctors are interested and they are willing to have more training in pain control, breaking bad news, communication skills and terminal care.

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Background and Objectives: Scoring system in all areas of medicine is receiving close attention because of the need to evaluate and monitor healthcare delivery and outcomes. The main application is in comparative surgical audit to monitor quality of care provided to the patient with a risk adjusted scoring system rather than using crude morbidity and mortality rates. In this prospective study, the validity of P-POSSUM is tested in patients undergoing major surgery and risk factors for low outcome were noted. Materials and Methods: A total of 277 major general surgical procedures as defined by the POSSUM scoring system criteria were included in the study during the period from September 2010 to February 2012, and final analysis was done. Results: The observed mortality rate was compared with the P-POSSUM predicted mortality rate. On using P-POSSUM the predicted mortality was 37 deaths. An O: P ratio of 0.91 was obtained. There was found to be no statistically significant difference between the observed and predicted mortality rates (χ2 = 7.859, DF = 5, P -value = 0.164). On analysing risk-factors we found that out of the 17 factors considered 10 are found to have significant rate of increment, whereas remaining 7 don't have significant change statistically. Conclusion: This study therefore, validates P-POSSUM as a valid means of assessing adequacy of care provided to the patient.

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Objective: The objective of this study was to determine the incidence of congenital hypothyroidism (CH) in neonates by measuring umbilical cord thyroid stimulating hormone (TSH), born in a Teaching Hospital in Manipur. Materials and Methods: The study was based on the findings from cord blood samples collected from 1,000 babies born to mothers having no systemic (especially thyroid disorders) and obstetrical complications in the last 2 years. Estimation of serum TSH level was carried out by enzyme-linked immunosorbent assay method using Eliscan ^TM (Diagnova) kit manufactured by Ranbaxy Fine Chemicals Ltd. (RFCL) India in the Department of Physiology, Regional Institute of Medical Sciences, Imphal. Results: The mean, median and standard deviation for the TSH values of the samples were 8.833 mIU/L, 6.824 mIU/L and 7.059 mIU/L respectively. Nearly, 29.3% of the babies had TSH greater than 10 mIU/L. One baby was found to be having CH out of the 1,000 screened. Conclusion: CH represents one of the most common preventable causes of mental retardation. The finding of 1 case of CH out of 1,000 new-borns screened indicates that incidence is high in this state. Screening of all new-borns in the future is highly recommended.

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