Placenta accreta is described as anchoring placental villi directly contact the myometrium resulting in firm attachment of the placenta to the myometrium. The incidence of placenta accreta is increasing parallel to raising cesarean section rate. Women at greatest risk of placenta accreta are those who have myometrial damage caused by a previous cesarean delivery with either an anterior or posterior placenta previa overlying uterine scar. Control of bleeding is the main goal in such cases, which usually necessitates hysterectomy or hypogastric artery ligation; embolization of uterine artery that is done by expert interventional radiologists. However, alternative methods are useful when retaining fertility is important in young women with low parity. We present a 28-year old G5P2+0+2+2 who was admitted at 33 weeks of period of gestation for antepartum hemorrhage (APH) with previous cesarean. Even after conservative treatment for APH, she delivered still born preterm baby at 34 weeks with retained placenta where manual removal of placenta failed to remove the placenta. Placenta was removed piecemeal leaving major portion of placenta, which was morbidly adherent. After 13 days of delivery ultrasonography (USG) showed plenty of placental tissue in the uterine cavity with peripheral vascularity and increased serum beta-human chorionic gonadotrophin (β-hCG) level (1980mIU/ml). Injection methotrexate was administered on the 18 ^th post-partum day following the regime of 1, 3, 5 and 7 days. Repeat USG after 1 week of treatment showed decrease size in placental mass with a decrease in serum β-hCG level and after 6 ^th post-partum week D&E done with complete removal of placental tissue and at 8 ^th post-partum week USG shows normal with no retained products of conception and the patient was stable. Hence, methotrexate can thus be helpful as conservative treatment for placenta accreta in conserving the uterus and hence, the fertility.

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Cystic lesions of the adrenal gland are uncommon and mostly asymptomatic. They demonstrate a spectrum of histological changes and may vary from pseudocysts to malignant cystic neoplasms. Adrenal pseudocysts are rare cystic lesions surrounded by a layer of fibrous tissue that lack a recognizable lining layer. They are most often discovered incidentally during radiological studies or at autopsy. The radiographic appearance of adrenal pseudocysts though characteristic, can be difficult to distinguish an adrenal pseudocyst from an adrenal neoplasm with prominent cystic change, presenting as diagnostic conundrums. Extensive sampling of resected tissues is important to rule out malignancy in patients, with cystic adrenal lesions. Herein, we present a 47- year-old male with a non functional and asymptomatic left adrenal pseudocyst. The literature is reviewed and the different diagnostic and management options are discussed.

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Background: Date rape is a type of acquaintance rape wherein non-consensual sex occurs between two people who are in a romantic relationship. The aim of the present study was to find out the pattern of date rape cases in Imphal. Materials and Methods: A retrospective study was carried out in our center on all the cases of alleged sexual assault cases during the period of 7 years, i.e., from 2007 to 2013. A case of sexual assault where the victim and the offender are or have been in some of personal social relationship has been considered as a case of date rape. A detailed study of the history given by the police and the victim, and the medical examination findings was carried out and the findings were analyzed. Results: Out of the total 210 cases of alleged sexual assault cases, 17 (8%) were date rape victims. Most of the victims of date rape were Meitei girls below the age of 20 years (70.5%), and 58.8% of these cases were assaulted in the afternoon and 52.9% of the assaults occurred in restaurants. The history of consumption of beverage in the form of alcohol offered by the perpetrator was present in 52.9% of the cases. Conclusion: The true incidence of such cases may be higher than identified because of non-reporting. The exact type of the drug/agent used in some of the cases could not be established because of delayed reporting and untimely collection of samples. The spread of consciousness of date rape among the young girls is indeed a need of the hour. They may be advised to be cautious and avoid suspicious food or drinks.

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Diabetic Foot Ulcers (DFUs) are complex, chronic wounds, which have a major long-term impact on the morbidity, mortality and quality of patients' lives. Individuals who develop a DFU are at greater risk of premature death, myocardial infarction, and fatal stroke than those without a history of DFU. Unlike other chronic wounds, the development and progression of DFU is often complicated by wide-ranging diabetic changes, such as neuropathy and vascular disease. These, along with the altered neutrophil function, diminished tissue perfusion, and defective protein synthesis that frequently accompany diabetes, present practitioners with specific and unique management challenges.Honey has been used for centuries in wound care. Its therapeutic properties are largely attributed to its antimicrobial and anti-inflammatory activities. This review provides an insight on the mechanisms by which honey affects wound healing. Honey is being used to treat many types of wound, including: traumatic wounds, surgical incision sites, burns, sloughy wounds, and pressure ulcers.The number of publications reporting the use of honey has increased. A great number of studies haves concluded that clinical evidence to support the use of honey in the treatment of superficial wounds and burns was of low quality. Other studies suggested that honey improved healing times in mild to moderate superficial and partial thickness burns when compared to conventional dressings.This was supported by a meta-analysis of systematic reviews of topical and systemic antimicrobial interventions for wounds. Of 109 evidence based conclusions, robust evidence was found to support the use of topical honey to reduce healing times in burns.Yet, there are many studies which did not indicate the positive result on using honey to treat DFU's. Therefore, more studies should be carried out in order to make a solid proof for using honey in treatment of DFU's.

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Eagle's syndrome (ES) represents a group of symptoms that includes recurrent throat pain, dysphagia, referred otalgia and neck pain possibly caused by elongation of the styloid process or ossification of the stylohyoid ligament. It is typically seen in patients after pharyngeal trauma or tonsillectomy. An elongated styloid process occurs in about 4% of the general population, while only a small percentage (between 4-10.3%) of these patients are symptomatic. So the true incidence is about 0.16%, with a female-to-male predominance of 3:1. The symptoms related to this condition can be confused with those attributed to a wide variety of facial neuralgias. We describe the case of a 45-year-old woman who experienced unremitting left neck pain following parotidectomy. This case is being reported because of its unusual presentation, difficulty in diagnosis, its rarity in occurrence and for academic interest.

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Introduction: Hepatitis C virus infection is a major global health problem being the second most common chronic virus infection. It is associated with numerous extra hepatic manifestations of which cardiovascular diseases constitute an important but under diagnosed aspect of the infection. Aim: This study was carried out to evaluate the association between cardiovascular manifestation and HCV seropositivity patients attending Regional Institute of Medical Sciences (RIMS) in Imphal, Manipur. Materials and Methods: From august 2009 to july 2011, 50 HCV seropositive patients in the department of Medicine, Regional Institute of Medical Sciences, Imphal were evaluated. They were subjected to thorough physical examination and baseline laboratory investigations. Above that, echocardiogram was done for each patient. For statistical analysis of data, statistical package for the social sciences (SPSS16.0 version) and student's t-test was used. Results: In this study, the average age of patients was 44 years, ratio of males to females was 3.5: 1. HCV infection is more common in males who are in the sexually active and married age group 30 to 49 years. In the laboratory parameters high serum glutamic pyruvic transaminase (SGPT) and high erythrocyte sedimentation rate (ESR) were significant indicators of cardiac chamber (left atrial and left ventricular) enlargement and left ventricular diastolic dysfunction in HCV seropositive patients. Conclusion: The result corroborated favorably that the more progressed is the inflammation and liver dysfunction due to HCV infection, the more likely to have cardiovascular changes of cardiac chamber enlargement and left ventricular diastolic dysfunction.

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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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Context: Gastrointestinal opportunistic infections occur very frequently in human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) patients and diarrhea is one of the common clinical presentations among these patients. Candida spp. have also been implicated as a causative agent of chronic diarrhea in HIV-infected patients. Aims: This study was carried out to determine the prevalence of fungal pathogen among HIV/AIDS patients presented with diarrhea and their correlation with CD4+ T lymphocyte counts. Settings and Design: This cross-sectional study was conducted in the Department of Microbiology, RIMS, Imphal. Materials and Methods: A total of 158 stool samples were examined, out of which 108 were from HIV-positive patients with diarrhea (study group) and 50 from HIV-positive patients without diarrhea (control group). Specimens were examined by direct microscopy and culture in Sabouraud's dextrose agar. The CD4+ T lymphocyte count of patient was also recorded. Statistical Analysis Used: Data were analyzed by using Statistical Package for the Social Sciences (SPSS) version-16 software. P predictive value) value <0.05 was considered significant. Results: Confluent growth of Candida spp. was detected in stool samples of 28.7% patients with diarrhea and 12% patients without diarrhea. Association between the isolation of Candida spp. and diarrhea was found to be significant (P = 0.01). Isolation of Candida spp. was inversely correlated with CD4+ T lymphocyte count. Conclusion: Intestinal candidiasis must be held in mind as a cause of HIV/AIDS-associated diarrhea, particularly in patient with low CD4+ T lymphocyte count.

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Camptodactyly is a rare congenital hand anomaly. It can be a marker for other associated anomalies. It is due to an imbalance between the flexor and extensor forces acting upon the proximal interphalangeal joint. Abnormal lumbrical insertion is the most common contributory factor. FDP absence as a component of camptodacryly is never reported before. Further observations will be needed to know the significance of this finding in planning surgery and the probable outcomes. A brief review of the disease is presented herein.

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Introduction: Drug use pattern is ever changing and has emerged as a global burden as it causes serious public health problems. Aims: To determine the sociodemographic profile and pattern of drug use among the treatment seekers in the deaddiction center, psychiatry department, over a 1 year period. Materials and Methods: Retrospective evaluation of case registries of 222 substance dependence patients in the age group of 18-60 years registering for the first time for treatment in the Drug Deaddiction and Treatment Centre (DDTC), Psychiatry Department, Regional Institute of Medical Sciences, Hospital from January to December 2009 was done. Statistical analysis was done using Statistical Package for Social Sciences (SPSS) 17. Results: We found that majority were males (n = 212). Among the current users, in order of frequency, drugs used were alcohol (84%), tobacco (61%), opioids (17.5%), cannabinoids (14.4%), volatile solvents (5.4%), and sedatives and hypnotics (5%). Also, 5.4% of them were currently injecting drug users and had high risk behaviors like sharing syringes and contact with commercial sex workers. About 13.1% of all the subjects had undergone screening for human immunodeficiency virus (HIV) and one-tenth were positive. Psychiatric morbidity like drug induced psychosis (28%), depression (18%), and anxiety (16%) were reported among 23.4% of the treatment seekers. One-fifth of patients reported physical complications: Hepatitis, neuropathy, anemia, etc. Very few (6.8%) subjects had a history of previous treatment of which only 5.4% were prior hospitalized. Conclusions: Present study can supplement information on drug use pattern and related complications which can be effectively used for local planning.

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Background: Laryngoscopy and intubation causes reflex sympatho-adrenal response in the form of tachycardia and hypertension. The present study compared oral gabapentin with oral clonidine for attenuating hemodynamic responses to laryngoscopy and tracheal intubation. Materials and Methods: Ninety patients of American society of Anesthesiologists (ASA) I and II in the age-group of 18-60 years, of either sex, posted for elective surgeries under general anesthesia were randomly divided into three groups (n = 30). On the morning of surgery, the study medications were given orally with sips of water 2 hour pre-operatively as: Group I received 200 μg clonidine, Group II received 900 mg gabapentin, and Group III received placebo. The heart rate, systolic blood pressure, diastolic blood pressure, and mean arterial pressure were observed and recorded as 0 minute (baseline) and at 1, 3, 5, and 10 minutes after endotracheal intubation. Results: Oral clonidine (200 mcg) attenuated the increase in systolic blood pressure, diastolic blood pressure, and mean arterial pressure better than oral gabapentin (900mg). The increase in heart rate was significantly attenuated by clonidine as compared to gabapentin and placebo (P < 0.001). Gabapentin also attenuated tachycardiac response but it was not completely eliminated. As compared with placebo, gabapentin attenuated rise in diastolic blood pressure and mean arterial pressure at 3 and 5 minutes after intubation (P < 0.38, 0.007 at 3 and 5 minutes. Conclusion: Both clonidine and gabapentin attenuate hemodynamic response to laryngoscopy and tracheal intubation. Clonidine is a better drug compared to gabapentin and tachycardiac response was significantly attenuated.

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A 22-year-old patient came to the emergency department with complaint of severe loss of vision of the left eye following a road traffic accident. He sustained a lacerated injury in the lower lid of left eye with surrounding bruise. External ocular examination revealed subconjuctival hemorrhage, fixed and non-reacting pupil in the left eye. Fundus examination showed pale optic disc, white-out retina and a cherry red spot at the macula in left eye. On the next day fundus examination showed extensive flame shaped and preretinal hemorrhages. A clinical diagnosis of traumatic optic neuropathy with combined central retinal arterial occlusion (CRAO) and central retinal vein occlusion (CRVO) was made. Combined CRAO and CRVO is rare. Our case is the second reported case in English literature of combined CRAO and CRVO following blunt ocular trauma. CRAO and CRVO is a rare disease usually found in patients with cardiac embolic diseases, giant cell arteritis, or systemic vascular inflammations.

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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: Epistaxis is one of the commonest otolaryngological emergency. The aim is to evaluate the prevalence of epistaxis, educational status, mode of presentation, and intervention rendered patients with epistaxis at the study centre. Patients and Methods: A retrospective study of all patients presenting with epistaxis at the study centre from January 2002 to December 2012. Results: Hospital prevalence was 0.23%, minimum age at presentation was 1 year and maximum age 75 years, 70 (36.46%) were children and 122 (63.54) were adults, 106 (55.2%) males and 86 (44.8%) females. No formal education in 13% while 32.8% had tertiary education. Sixty seven (34.9%), 56(29.2%), 69(35.9%) had left, right and bilateral nasal bleeding respectively. Etiology in 84 (43.75%) patients being trauma. Sinonasal infection was more prevalent in children while trauma predominates in adults. Bleeding site was identified in 17 (8.9%), 11 (5.7%) had cauterization, 93 (48.43%) had nasal packing while 15 (7.8%) had blood transfusion in addition to other forms of treatment. Conclusion: Epistaxis in Kaduna-Nigeria, has low prevalence and the causative factor is mostly sinonasal infection in children and trauma in adults, bilateral nasal bleeding predominates, anterior nasal bleeding predominates in both children and adults, majority of the patients had tertiary education and nasal packing was found to be an effective management.

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Churg-Strauss syndrome (CSS) is a vasculitis of medium to small sized vessels. Diagnosis is mainly clinical with findings of asthma, eosinophilia, rhinosinusitis and signs of vasculitis in major organs. This is a rare syndrome of unknown etiology, affecting both genders and all age groups. Outcome and long-term survival are usually good with steroids alone or in combination with immunosuppressive agents. The syndrome has a low mortality rate compared with other systemic vasculitides. We report three patients with CSS from Ardabil, who presented with asthma, pansinusitis, peripheral eosinophilia, peripheral neuropathy, cutaneous eosinophilic vasculitis. The diagnosis of CSS was made by the diagnostic criteria of American College of Rheumatology (ACR). CSS is typically suspected in patients whose asthma is poorly controlled on moderate doses of inhaled glucocorticoids. Prolonged treatment of asthma with glucocorticoid therapy may partially or totally suppress the usual clinical signs of untreated CSS. The disease may therefore not become evident until glucocorticoids are reduced or stopped.

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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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Induction of labor is the intentional or artificial initiation of labor before spontaneous onset of labor. At present dinoprostone is the agent of choice but misoprostol is a potential alternative. Objectives: To compare the efficacy and safety of intravaginal misoprostol with intracervical dinoprostone in induction of labor. Materials and Methods: Two groups of 135 subjects received 0.5 mg of dinoprostone gel intracervically and tab misoprostol 25 μg digitally placed at the posterior fornix. Results: In group-one (Dinoprostone gel), 116 (85.9%) had vaginal delivery, 13 (9.6%) had ventouse delivery and six (4.4%) underwent cesarean section, whereas in group-two (Misoprostol), 118 (87.0%) and 12 (8.9%) had vaginal and ventouse delivery respectively, whereas 5 (3.7%) underwent cesarean section. Induction to delivery interval was less than 12 hours in 50% when induced with misoprostol and 33.3% with dinoprostone. Median Bishop score at the time of instillation was found to be 3 (Range 2-4) while equivalent median Bishop score for the latter group is 2 (Range 2-4) in group-one and two respectively. The difference observed was significant (P = 0.026) indicating that misoprostol improves the Bishop score more significantly than dinoprostone. No significant variation in Apgar score and maternal complications was noted in both groups. Conclusion: Both dinoprostone and misoprostol are effective agents for induction. Misoprostol with its shorter induction delivery interval, cheaper cost and less stringent storage conditions may be preferred in developing countries.

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Introduction: Breastfeeding is one of the most important determinants of child survival, birth spacing, and prevention of childhood infections. Aim: To determine factors influencing early initiation of breastfeeding. Materials and Methods: The Multiple Indicator Cluster Survey (MICS) technique with 30 clusters proposed by the World Health Organization (WHO) was used for the purpose of this study. Results: All (100%) children, whose fathers were middle pass, were put on breast feed within one hour, where as only 66.6% of children of post graduate fathers were put on breast feed within one hour. Conclusions: Poor-feeding practices are present across all socioeconomic groups and there is no significant difference to suggest the importance of one single factor.

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