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: 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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Background: Hysterectomy is the second most common operation done in women next only to cesarean delivery. Trend of hysterectomy has changed over times with development of newer ideas, techniques, etc. An attempt has been made to study it and to assess the current scenario. Aims: To review and analyze cases of hysterectomy with a view to suggest ways of improving health care. Materials and Methods: A retrospective study was conducted from January 2007 to August 2011 which included 1,285 cases of hysterectomy. Parameters like age, parity, indication, procedure were analyzed and data was presented in percentages and proportions. To avoid biased result, emergency and routine cases were analyzed separately. Result: Most women were of more than 45 years of age in planned cases and between 20 to 45 years in emergency cases. Uterine fibroid was the commonest indication (40.7%). Obstetrical complications were the main cause for emergency hysterectomies. The most common procedure was total abdominal hysterectomy but in emergencies, subtotal hysterectomy was the procedure of choice. The rate of vaginal hysterectomy was 10.7%. Ovaries were preserved in 12.7%. Conclusion: Hysterectomy is usually postponed till 45 yrs of age in planned cases. Uterine myoma is the most common pathology in planned procedure. In emergency, the indication varies. Abdominal route is still the preferred by most gynecologists. The rates of vaginal hysterectomy and preservation of ovaries are much lower than desired.

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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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The term schwannoma(also known as neurilemmoma) refers to a tumor in which the cells are derived from the neurilemma or the nerve sheath, more commonly referred to as the sheath of Schwann. A retroperitoneal location accounts for 0.3-3.2% of all primary schwannomas and 0.3-6.0% of all retroperitoneal tumors. We report the case of a 47-year-old female with a benign retroperitoneal schwannoma as a rare one.

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Objective: 1) To determine the prevalence of human immunodeficiency virus (HIV) seropositive delivery in Regional Institute of Medical Sciences (RIMS). 2) To determine the associated factors affecting the status of HIV seropositive in pregnant women. Materials and Methods: This is a cross-sectional study and the study period was from January 2007 to December 2011. All pregnant women who were registered, counseled, tested and delivered, and whose pregnancies were beyond the period of viability (28 weeks). Data were collected from PPTCT Centre RIMS, Imphal, from January 2007 to December 2011 from PPTCT ward log book. It included the details of age, parity, occupational status, religion and mode of delivery. Descriptive statistics like mean and percentage were used. Statistical analysis was done using SPSS version 16. Results: A total of 191 seropositive pregnant women delivered from January 2007 to December 2011 were included in the study. The mean age of the participants was 27.4 ± 4.9 years. HIV seropositivity rate was highest in the age group of 26 to 30 years and the age group between 21 and 35 years contributes to 84% of the total cases. More than half of the cases had education up to class 10 (52.9%) and were Hindu by religion (55.5%). Majority of the seropositive pregnant women were housewives (94.8%). HIV seropositivity was higher in multipara (57%) compared to primipara (43%). The overall prevalence rate of HIV seropositivity was 0.41%. The highest rate of seropositivity was in 2007 (0.64%). Most of the deliveries were vaginal delivery (71.2%) compared to cesarean delivery (28.8%). Conclusion: Our study showed that the overall prevalence rate of HIV seropositivity was 0.41%. Even though, our study population was not representative of the general population because of ours being a hospital-based study with limited sample size, data show a decreasing trend of HIV prevalence in pregnant mothers.

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Background: Breast milk is the ideal food for a normal infant. Growing evidence points to the impact of early initiation of breastfeeding on neonatal mortality. Neonatal and postneonatal deaths were around five to six times lower in those infants who were fed colostrum than those who were not. Objectives: The study was conducted to determine the time to initiation of breastfeeding in the postnatal ward of a tertiary care hospital. Materials and Methods: This cross-sectional study was conducted from August 2013 to October 2013 among the mothers in the postnatal ward of a tertiary care hospital. The sample size was calculated based on a prevalence rate of 50%, with an allowable error of 6% at 95% confidence level. Assuming a nonresponse rate of 10%, the calculated sample size was 304. A pretested semistructured interview schedule was used for data collection. Ethical approval was taken from the Ethics Subcommittee of the institute. Results: A total of 303 mothers were studied. Only seven (2.3%) mothers gave prelacteal feeds to their newborns. Of the 303 mothers, 35 (11.6%) discarded colostrum and only 53 (17.5%) initiated breastfeeding within 1 h of delivery. Colostrum was given more by the literate mothers than the illiterate ones, and the finding was statistically significant. More mothers from nuclear families initiated breastfeeding within the 1st h of delivery as compared to those from joint families. Majority of the mothers did not receive advice on breastfeeding during antenatal visits and almost all the mothers were not told about positioning and attachment. Conclusion: Even though practices like avoidance of prelacteal feeding and feeding of colostrum were good in this study, the practice of early initiation was quite low. The support system prevailing in the hospital was also unsatisfactory. These observations will help in planning strategies for the promotion of breastfeeding to reduce neonatal morbidity and mortality in the community.

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HbE/β-Thalassemia is a rare condition which pose challenges in the management of a pregnant patient. We present a case of 27 years old primigravida who attended Obs and Gynae OPD at 27 weeks of gestation with complain of easy fatiguability, generalised weakness and breathlessness. She gave a history of similar episodes in the past and history of one unit blood transfusion at 9 years of age due to anaemia. On examination, she had severe anaemia with hepatosplenomegaly and was admitted for further evaluation and was diagnosed as a case of HbE/β-Thalassemia after doing Hb electrophoresis. She was then admitted on four occasions for blood transfusion to correct her anaemia. At 37 weeks of gestation her Hb fell to 6.9 gm/dl and she was hospitalised in antenatal ward for safe confinement and three units of blood was transfused. A total of 13 units of blood was transfused antenatally. At 38 weeks of gestation she had PROM with unfavourable cervix and labour was induced but due to non progress of labour, emergency Caesarean section under spinal anaesthesia was done. She delivered a healthy baby weighing 2.5 Kg and there was no intra/post operative complications. One unit of blood was transfused post delivery. The patient was discharged from hospital on day 7 in stable condition.

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Involvement of breast by lymphoma is rare. It occurs as a primary breast tumor or as an extranodal manifestation of a systemic disease. Bilateral primary breast lymphoma (bilateral PBL) is still rarer. The most common type is diffuse large B-cell lymphoma (DLBCL). We are reporting two cases of primary breast lymphoma (PBL), one in a 62-year-old married female and another in a 26-year-old unmarried female. Both the cases were diagnosed by aspiration cytology and confirmed by immunohistochemistry. Early diagnosis of PBL by fine-needle aspiration cytology (FNAC) can avoid unnecessary surgical treatments.

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Today, in the era of ever-growing advancement of technology, technology is no longer limited to smartphone or notebook. Information technology has started playing a crucial role even in the health care sector. The emerging technology is helping both software as well as hardware engineers to design lots of high-tech medical equipment, thereby helping medical professionals and even patients in several ways. Much transformation has occurred and evolved from telepathology to virtual microscopy, and now to a new dimension and concept called "digital pathology."

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Introduction: Eclampsia is a major cause for perinatal morbidity and mortality worldwide and perinatal outcome is much worse in developing countries even today. The reasons are multi-fold and may be because eclampsia is poorly managed and not up to the prescribed standards as in industrialized countries. Also prematurity usually iatrogenic one is a major cause for high perinatal morbidity and mortality in eclampsia due to non-availability and of neonatal intensive care unit (NICU) facilities. Materials and Methods: All eclampsia patients admitted to the antenatal ward in JIPMER from October 2009 to May 2011 were followedup. The pregnancy outcome was duly recorded and analyzed. Results: Majority of the patients were unbooked, young and primigravida. Majority (65%) of women required labor induction in one or more forms. In the study 20% of cases required cesarean section for delivery. Sixty percent of the cases were preterm deliveries and 44% required NICU admissions. There were 52 (17.2%) stillbirths. There were a total of 16 neonatal deaths; mostly due to prematurity (62.5%). The perinatal mortality rate is 231 per 1000 births. Hundred babies had birth weights <1.5kg; and 212 babies less than 2.5 kg. Average birth weight was 1.825kg, which is much lesser than the institutional Average birth weight. of 2.88 kg during the same period. Prematurity was the most common cause for NICU admissions as well as neonatal deaths. Conclusions: Majority (65%) of the cases required induction of labor and only 23% went into spontaneous labor. Twenty percent of eclamptic women required cesarean delivery. Major indication for caesarean section as anticipated was fetal distress. Most common cause for neonatal death was prematurity and its attendant complications.

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Background: The insertion of a permanent cardiac pacemaker is today one of the most commonly performed interventions on the heart. Various hypotheses have been put forward to explain the high incidence of conduction system disorders in the eastern part of our country. We studied the clinical profiles and outcomes of patients undergoing pacemaker implantation at the Regional Institute of Medical Science Imphal, Manipur, India. Materials and Methods: Thirty-seven patients who satisfied the inclusion criteria and underwent pacemaker implantation were studied. Detailed evaluation was done for each patient. Electrocardiography (ECG), echocardiography, chest x-ray, lipid profile, and other routine investigations were carried out. Patients were followed up for 6 weeks for any acute complication of pacemaker implantation. Results: Of the 37 patients, 21 (57%) were male, and the mean age of the study group was 63.24 years. The indications for pacemaker implantation were atrioventricular (AV) block [in 24 (64.9%) patients], sick sinus syndrome (SSS) [10 (27.1%)], and trifascicular block [3 (4.5%)]. The most common presenting symptoms were syncope (in 59.9% of patients), lightheadedness (62.2%), palpitation (56.7%), and dyspnea (56.7%). Cardic arrhythmias were associated with hypertension (in 59.5% of patients), diabetes mellitus (21.6%), thyroid disease (16.2%), and coronary heart disease (CAD,13.5%). In 32.4% of the patients there were associated comorbid conditions. No further syncopal attack occurred following pacemaker implantation, and the other symptoms improved significantly. The complications observed were pneumothorax and pacemaker implant site wound exudation in one patient each. Conclusion: The major indications of pacemaker implantation were found to be complete heart block (CHB) and SSS. Pacemaker implantation is a lifesaving procedure and improves quality of life dramatically. Complications associated with pacemaker implantation are relatively low.

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Background: In sexual assault investigation, the scientific proof of the alleged crime as well as determination of the time of assault is crucial. Materials and Methods: The study was carried out by analyzing 157 vaginal swab samples collected from women attending a tertiary health care teaching hospital, at Imphal and as well from the sexual assault cases, which were brought for medicolegal examination in the same hospital at different post coital intervals (PCIs). The samples were studied for sperm morphology and acid phosphatase (ACP) levels at different PCI were established. The findings were recorded and statistically analyzed. Results: Complete sperm was seen up to 16 hours and sperm heads were observed up to a PCI of 63 hours. The mean ACP level of >30 King-Armstrong Units (KAU) was observed in PCI of 1 day and >25 KAU in PCI of 2 days. The level of ACP showed more or less a gradual fall with respect to time with significant changes within 3 days. Conclusion: It may be concluded that an estimate of the timing of sexual assault may be given especially within 3 days of the assault, thereby emphasizing the importance of early reporting of such crimes.

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Introduction: Faciomaxillary injuries are very common following trauma, specifically following road traffic accidents. Many a time, those injured present with panfacial fractures. Such patients need urgent surgical attention for stabilization and fixation of the fractures. Materials and Method: The patient is intubated by oral route in the conventional manner with an armored tracheal tube as the first step. This tube is taken out externally via a mucosal incision in the floor of mouth and submental incision and connected with the ventilator. The cuff is inflated and the tube is secured with the suture with the skin. The skin and the mucosal incisions are closed. Discussion: Securing the endotracheal tube during the operation for patients with panfacial fracture without coming in the way of oral procedure always poses a problem for the anesthetist. Fracture of the base of the skull or the naso-orbital ethmoid complex excludes the option of nasal intubation, while oral intubation would prevent the surgeon from obtaining a proper occlusion. In these circumstances, submental intubation is a simple and safe procedure that can be carried out. However, if a patient needs prolonged intubation even after surgery due to upper respiratory obstruction, tracheostomy remains the procedure of choice. Conclusion: Submental intubation is helpful in allowing the surgeon to operate intraorally and ensure proper dental occlusion in patients with panfacial fractures.

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Objective: To find out the accuracy of the modified triple test in the diagnosis of palpable breast lumps. Materials and Methods: This was a cross-sectional study involving 50 female patients with palpable breast lumps attending the Surgical Out Patient Department of the Regional Institute of Medical Sciences, Imphal between October 2011 and September 2013, who underwent clinical breast examination (CBE), ultrasonography (USG), and fine-needle aspiration cytology (FNAC). All the cases irrespective of results underwent either excisional and or incisional biopsy for confirmation. The final histopathological report was considered the reference standard. Results: A total of 50 patients were included. The age range was 18-56 years. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of CBE were 66.6%, 100%, 100%, 90%, and 91.6% respectively; those of USG 91.6%, 100%, 100%, 97.3%, and 97.9% respectively; and those of FNAC 91.6%, 100%, 100%, 97.4%, and 98% respectively. Out of 50 patients, the three tests concurred in 42 (35 benign and 7 malignant) cases. When all the three tests concurred, there were no false positive or false negative cases, and sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were all 100%. Conclusion: The triple test is valid and reliable, with a high degree of accuracy for the diagnosis of breast lumps. Of all the three components of the triple test, FNAC is the most accurate. A patient with a concordant benign triple test report can be safely followed up without the need for biopsy.

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