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Aim: The aim of this study was to find out the prevalence and causes of piriformis syndrome in patients with complain of low back pain/buttock pain with sciatica attending Regional Institute of Medical Sciences (RIMS), Imphal. Materials and Methods: All the patients in the study group attending Orthopedic and Physical Medicine and Rehabilitation Out-patient Department in RIMS, Imphal were examined. Those with increased symptoms on sitting, localized significant tenderness on palpation of the muscle, presence of one or more of the following tests: Freiberg, pace, beatty, and FAIR (Flexion , Adduction and Internal Rotation) maneuvers with negative X-ray, ultrasound, computed tomography and magnetic resonance imaging findings were subjected to piriformis muscle injection of lidocaine (2%) 2 ml and methyl prednisolone 2 ml (40 mg) for confirmation of diagnosis. Result: Out of 2910 patients, 182 cases (M: 28, F: 154) in the age range of 19-75 years with a mean age of 43 years were clinically diagnosed as piriformis syndrome. Prevalence of piriformis syndrome was 6.25%. Conclusion: Piriformis syndrome is one of the differential diagnoses of low back/buttock pain with Sciatica. Individuals of all activity levels can be affected. Females are more affected than males. Causes are overuse, prolonged sitting, trauma, and vigorous massage. Diagnosis is by exclusion of other causes. Simple injection with local anesthetic and steroid in the piriformis muscle is both therapeutic and confirmatory of diagnosis. Early diagnosis and treatment with injection of piriformis muscle can prevent further complications and risks of surgery, which is also not 100% curative. With proper care, piriformis injection can be carried out without any complication. Long-term study is needed to evaluate the recurrence after injection treatment.

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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: Diabetes mellitus (DM) is an endocrinal disorder characterized by chronic hyperglycemia. Managing DM without side effects is a challenge till date that attracts researchers toward plant-based new products. In some studies, seeds of Syzygium cumini were found to have anti-diabetic and anti-hyperlipidemic properties, attributed to saponins, glycosides, and flavonoids. Hence, it should be further explored for its benefits. Aims and Objectives: To study the effect of jamun seed powder on glycemic control in type 2 DM. Materials and Methods: Patients with type 2 DM and uncontrolled blood sugar (n = 99) were randomly divided into two groups - Group A (n = 50) was supplemented with 10 g/day jamun seed powder and Group B (n = 49) was given placebo powder. Oral hypoglycemic agents (OHAs) were continued as before. Patients and investigators were blinded about the treatment allocated. Fasting plasma glucose (F.P.G.) and post-prandial plasma (P.P.) glucose were noted at baseline and 30^th, 60^th, and 90^th day and HbA1c on 0 and 90^th day. Observations and Results: In Group A, F.P.G. decreased by 9%, 18%, and 30% and P.P. glucose by 8%, 15%, and 22% after 30, 60, and 90 days, respectively. In Group B, F.P.G. increased by 3% and P.P. glucose by 2% after 90 days. HbA1c in Group A reduced from 8.99 ± 1.39% to 8.31 ± 1.40% on 90^th day (P < 0.05), while a nonsignificant rise from 8.70 ± 1.17% to 9.03 ± 1.31% was noted in Group B. Conclusion: Supplementation with jamun seed powder improves glycemic control significantly in type 2 DM with poorly controlled glycemic levels on diet and OHA. However, before recommendation, multicentric trial with larger sample size, dose, and duration should be planned.

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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 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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Background: The study of patient satisfaction with care received is of paramount importance in the context of providing quality patient care services. Objectives: This study planned to assess the satisfaction and associated factors among in-patients attending a tertiary care government health facility. Materials and Methods: A cross-sectional study was conducted among all eligible in-patients of a government health care facility in North East India during March and April 2015 using a semi-structured questionnaire assessing seven domains related to patient care services. Descriptive statistics such as mean, standard deviation, percentiles, and percentages were generated and Chi-square test was applied to look for association between the level of satisfaction and other variables such as income, gender, age, and department admitted. Ethical approval was obtained from the Institutional Ethics Committee. Results: A total of 751 patients were interviewed with males constituting 275 (36.6%). Almost one-third 244 (32.5%) of the patients were highly satisfied with the overall care received. Patient education domain was unsatisfactory for 185 (24.6%) of the patients. Patients admitted to surgery and allied departments showed a significantly higher satisfaction level (P < 0.001) with care received than those admitted in other departments. Conclusion: Although the satisfaction level of physician and nursing care domains were high management needs to improve on the comfort and cleanliness of the wards and quality of food service to bring an overall improvement in the quality of care provided and to augment patients' loyalty.

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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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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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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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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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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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The Russell's viper is one of the most dangerous and commonly encountered vasculotoxic poisonous snakes in India that is responsible for most snakebite mortalities. Usually hemorrhagic stroke is the sequel of viper bite; however, ischemic stroke is increasingly recognized and reported in the literature. In rural areas, there is a need to keep the possibility of cerebral infarction as one of the differential diagnoses of neurological deterioration following Russell's viper's bite, as early identification of neurological complications can lead to a more effective treatment. In the present article, we discuss a case of a young male who was presented with both supra- and infratentorial infarcts.

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Background: Thalassemias are an important cause of morbidity and mortality worldwide. They create a huge emotional and financial deficit on the affected individuals and their families, society and the country. However, severely symptomatic disease can be prevented by various methods. Aims: The present study was undertaken with an aim to find the prevalence of carriers of thalassemia and other hemoglobinopathies in pregnant females and their husbands so as to identify the couples at risk of having severely affected children. Materials and Methods: The study included 2000 antenatal patients of microcytic hypochromic anemia detected on routine hematological examination. Various formulae used to differentiate between thalassemia and iron deficiency anemia were calculated. Serum ferritin levels were performed, and cases with normal or high serum ferritin were analyzed for hemoglobin variants by high-performance liquid chromatography using Bio-Rad variant II hemoglobin testing system-beta thalassemia short program. Results and Conclusion: Sixty-three of the 2000 women screened (3.15%) were identified as carriers of beta thalassemia trait and other hemoglobinopathies. Most of them that is 59 cases (2.95%) were beta thalassemia carriers while one each were carriers of HbE (0.05%), HbS (0.05%), HbD (0.05%), and double heterozygous for beta thalassemia and HbE. Among the various indices evaluated in the present study, Shine and Lal index could identify almost all cases of beta thalassemia carriers (98.3% sensitivity) whereas all the other indices could not be relied on in the identification of all the cases.

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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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Hydatid disease is an anthropozoonosis. Hydatid disease is caused by Echinococcus granulosus in tropical countries. Humans are accidental intermediate hosts of Echinococcus. Liver is the most commonly involved organ (59-75%) followed by the lung (27%), kidney (03%), and musculoskeletal system (1-4%); any organ of the body may be affected but pelvic hydatid cyst is rarely reported. Preoperative diagnosis can be established by imaging studies such as ultrasonography, computed tomography (CT), and magnetic resonance imaging (MRI). Serology for Echinococcus is also helpful in the diagnosis. However, diagnosis of pelvic hydatid cyst in females is possible only after operation. Preoperative anthelmintic therapy followed by surgery is the preferred treatment for hydatid cyst. Here, a case is presented of pelvic hydatid in a young female who presented with recurrent episodes of urinary retention, along with a hypogastric lump that is an unusual presentation.

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Background: Currently, a greater emphasis is being placed on the active participation of patients and their families; it is time that the attitude and feelings of the families with regard to autopsies are investigated. Objectives: Therefore, the present study was planned with an objective to analyze and ascertain deceased family member's attitudes toward medico-legal investigation and forensic autopsy. An additional objective was to determine factors influencing autopsy refusal by relatives of the deceased. Materials and Methods: Two hundred family members or relatives were selected randomly from the list of address and contact number prepared from all the cases on whom autopsy was performed from 2010 to 2012 at the MM Institute of Medical Sciences. Results: Data of 165 deceased personnel were processed and analyszd. 30.9% of the respondents had a primary level of education while 35.2% of them were illiterates. A high proportion of study subjects considered that autopsy would result in visible disfigurement of the body. Involvement of police/court (92.1%), no use in knowing the cause of death/nature of death (88.6%) and autopsy delays funeral (83.4%) were the three top most causes responsible for autopsy refusal by family members or relatives of the deceased. Conclusion: The experience and opinions of relatives and family members can be utilized in more effective management of medico-legal cases.

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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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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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Background: The present study was designed to compare the effect of intravenous fentanyl and esmolol for the attenuation of hemodynamic responses to laryngoscopy and intubation. Materials and Methods: Ninety patients undergoing elective surgical procedures were allocated into three groups viz., Group I (control): Identical volume of normal saline intravenously (IV) 3 min before induction; Group II (fentanyl): Injection fentanyl 2 mcg/kg IV 3 min before induction; Group III (esmolol): Injection esmolol 0.2 mg/kg i.v 3 min before induction. The heart rate and arterial blood pressure changes were monitored at the following time intervals: Before intubation, at intubation, and after intubation at different time intervals. The results were tabulated and statistically analysed and P ≤ 0.05 was considered significant. Results: Maximum rise in systolic blood pressure was observed at the post-intubation first minute, i.e., 22% (163.60 ± 16.25); 15% (144.13 ± 24.72); and15% (153.80 ± 24.75) in the Group I, II, and III from the baseline, respectively. Changes in the systolic blood pressure (SBP) was found to be minimum with fentanyl and esmolol groups when compared to the control group (P < 0.001). The diastolic blood pressure and mean arterial pressure changes was significant between fentanyl and esmolol groups with the control but not between esmolol and fentanyl. Group II showed better control of heart rate during laryngoscopy and intubation at the first min after intubation compared to other groups (P < 0.05). Conclusion: Fentanyl 2 μg/kg bolus or esmolol 0.2 mg/kg bolus 3 min before induction significantly attenuates the hemodynamic response to laryngoscopy and intubation better than control group.

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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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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: 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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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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