Post Graduate training involves Patient care, education and administrative activities. But in today's modern life, the patient doctor ratio is so high that it leads to long working hours among PG residents which leads to fatigue & stress, which ultimately affects the care-giver as well as the patients. A survey was done among 20 PG residents to analyse performance, behavior, attitude and practices in patient care by PG Residents and to understand the affliction of their personal life. It was found that the PG Residents are working for an average time of 110 hrs/week ranging from 80–132 hours/week. It was also found to affect their performance, self-care, needle stick injuries & personal life.

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We report a case a patient with an isolated brain metastasis in the CPA from breast carcinoma who was successfully treated with a multidisciplinary approach. There are less than half a dozen case reports in literature. Currently, no therapeutic guidelines for isolated metastasis from breast cancer in this location exist.

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Epidermoid cysts are slow-growing benign tumors usually involving the CP angle and suprasellar region. Epidermoid tumours of the fourth ventricle are very rare with less than a dozen case reports in literature. We present a case report of fourth ventricle epidermoid in a middle aged lady who presented with on and off headache since 15 years.

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Mesenteric cysts are rare intra-abdominal tumours. Mesenteric cysts are usually asymptomatic and are incidentally detected during physical or radiological examination. Although uncommon, complications such as infection, bleeding, torsion, rupture and intestinal obstruction cause an acute abdomen. Spontaneous infection is a very rare complication. We present a case of infected mesenteric cysts in the mesentry of terminal ilium, which caused an acute abdomen. A 08-year-old male child presented with acute abdominal pain in right iliac and lumbar regions. He had tenderness and guarding in right iliac and lumbar area, and on physical examination under anaesthesia a lump was palpable in right iliac ,lumbar and hypogastric areas. Abdominal computed tomography showed a hypodense cystic mass with septation in the mesentry of the terminal ilium. A laparotomy revealed a multiloculated cystic tumors at the mesentry of the terminal ilium which was filled with a yellowish turbid fluid. He underwent exploratory laparotomy and partial excision of the cyst.

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Human tail are reported from various parts of the world. Although medically innocuous, these cause anxiety & social curiosity we report a case of 09 month old child with 8 cm stalked soft tissue lesion in the sacral region. MRI spine revealed a 2 mm intraspinal lipoma in lumbar region. The appendage was excised.

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Cutaneous horns are projections of hyperkeratotic epidermis generally overlying other clinical lesions. We present a case of cutaneous horn overlying a buccal mucosa squamous cell carcinoma. She underwent wide local excision and skin grafting.

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Rhinolith is like a stone formation within the nasal cavity. Although stones rarely form in the nasal cavity, the findings of calcified objects or stones anywhere within the body has long been a subject of interest. Though infrequently observed, nasal concretions can be the source of bad smell from the nose and therefore a social concern for the patient. The salient features of such Rhinoliths and their relevance to modern day clinical practice are discussed.

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In children and infants, neurogenic tumours are most commonly occurring mediastinal space occupying lesions, followed by foregut cysts, germ cell tumors, lymphomas, lymphangiomas and angiomas, tumors of the thymus, and pericardial cysts. Bronchogenic and other types of foregut cyst comprise 10–18% of all mediastinal masses identified in infants and children, 20–32% of all mediastinal masses when all age group included. Approximately two thirds of mediastinal tumors and cysts are symptomatic in pediatric population. Foregut cysts of mediastinum are found most commonly in middle and posterior compartments but have been reported in anterior compartment. These cysts are usually found close to tracheobronchial tree or the oesophagus in infants and children. Most cysts are located in mediastinum near the tracheal carina. Here we describe a case of male neonate antenatally diagnosed with a mediastinal cyst but presented to us at 18 days of age with cough and intermittent dyspnoea. The X ray chest and CT confirmed a septate posterior mediastinal cyst on right side. The Baby was operated and nonseptate cyst arising from the base of lung was removed. The histopathology confirmed it as benign Bronchogenic cyst.

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There are complex issues involved in the surgical management of giant occipital encephaloceles, especially in neonates and young infants. Airway management can cause technical difficulties due to location of lesion, associated abnormalities and the position to be maintained during surgery. We present perioperative challenges we faced in the management of one such case.

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We present a case report of a young military personnel with monostotic fibrous dysplasia of proximal femur with painful, dysplasticlesion of the femoral neck and fatigue fracture who underwent cortical bone grafting using autogenous fibular strut graft and iliac crest bone graft. The fibular cortical grafts was used to bridge the lesion in the femoral neck and were securely anchored to the normal bone of the lateral femoral cortex and a head of the femur. No supplemental internal fixation was required.

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Introduction: Cervical cancer is one of the leading causes of cancer in women worldwide. Cervical cancer kills more women in India than anywhere in the world. There is good evidence that IIPV infection precedes the development of carcinoma cervix by a number of decades and that persistent infection with HPV is necessary for the development and progression of pre-cancerous lesions of cervix to cancer. This study was carried out to assess the prevalence of HPV infection in women attending gyneacology OPD in tertiary care hospital and to study sensitivity and specificity of Pap smear in detecting HPV as compared to HPV DNA PCR Material & Methods: This was a Hospital based Observational study in which all women visiting gyneacology OPD with gyneacological complaints were included in the study. A total of one thousand women were screened for HPV with pap smears and HPV DNA PCR test. Results: Out of the total of1000 women tested, 283 (28.3%) were found to be positive for HPV using HPV DNA PCR and 77 (7.7%) tested positive on PAP smear examination. Highest prevalence (31.2%) of HPV infection was seen in marriage age group of 16-20 and higher prevalence (57.1%) of HPV infection was also seen in women having more than 3 children. Pap smear was found to be 16.6% sensitive and 95% specific, whereas Positive Predictive Value and Negative Predictive Value was found to be 61% and 74% respectively. Discussion: The study reveals HPV prevalence rate of 28.3% in women attending gynaecology OPD of a tertiary care hospital and also prevalence of HPV was found to be highest in sexually active individuals with parity of 3 or more. These results are in agreement to many published national and international studies [12,13,14]. The study results also indicate lower sensitivity and higher specificity of Pap smear in detecting HPV infection, however it still remains the most important practicably available test in early detection of cervical carcinoma.

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Objective: Contemporary medical care is subspecialty based. We conducted an audit of workload and outcomes at our tertiary care referral hospital in the department of Neurosurgery from June to December 2013. Outpatient load and various surgical load has been on the increasing trend over the years. Special description of the cranial cases and the myriad of tumours operated with outcomes is presented. Contrary to popular perception, brain tumor resection is not necessarily associated with high morbidity and mortality. Two major factors that decide outcomes are the location and histopathology of these lesions.

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Introduction: Cyclosporine (CsA) is a calcineurin inhibitor immunosuppressive. Although highly effective, CsA is not used widely in India because of high cost and fear of serious adverse effects. Paucity of studies on use of CsA in dermatological conditions in India, led to the conduct of this pilot study. Aim: The aim of this study were to determine the efficacy and safety of CsA in various dermatological conditions. Materials and Methods: A total 10 patients of age 8 to 55 years, 4 of lichen planus, 3 of psoriasis (including 1 of psoriatic erythroderma) and 3 of atopic dermatitis were selected for this study. All patients were exhibited 3 to 5 mg/kg/day of oral CsA for a maximum period of 12 weeks. Results: CsA produced an extremely rapid, almost ‘magical’ response; the side effects were minimal and did not warrant withdrawal of the drug. We found a rapid response in psoriasis, the patient of psoriatic erythroderma showed onset of action in 72 hours while the 2 patients of plaque psoriasis showed 75 % reduction in PASI score in 2–3 weeks. All patients of lichen planus showed rapid onset of action in form of decreased/ no fresh lesions in 3 to 4 days. Patients of atopic dermatitis showed 50% reduction in the six areas six sign atopic dermatitis score at end of 4 weeks. The response in atopics was relatively slower requiring higher doses and relapses were encountered on dose reduction. Relapses were seen in all ten cases on discontinuing treatment. In severe cases with frequent history of relapses, relatively safer and cheaper immunosuppressives like methotrexate or azathioprine may be added while tapering the dose of CsA. Careful patient selection and monitoring are required to produce optimum results.

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OBJECTIVE: To compare the effectiveness of DGC and swim-up wash semen preparation technique on the clinical outcome in sub fertile couple who underwent intrauterine insemination. DESIGN: It is a prospective study of 100 sub fertile couples undergoing 200 cycles of assisted conception using IUI. RESULTS: Seventeen pregnancies out of fifty nine pregnancies (28.81%) resulted in live birth with DGC method as compared to twelve pregnancies out of fifty nine(2034%) resulted in live birth with swim-up method. The pregnancy rate for DGC method was 31% and for swim-up method was 28%.The miscarriage rate for DGC method 16.95% and for swim-up method 6.78%. The incidence of multiple pregnancy rate in DGC method was nil and in swim-up group was 6.78%. The incidence of ectopic pregnancy in DGC method was nil and for swim-up group was 6.78%. CONCLUSION: DGC method of sperm preparation has better outcome in terms of live birth rate and pregnancy rate in couples who have been subjected to IUI treatment. However there is higher multiple pregnancy rate and ectopic pregnancy rate swim-up method of sperm preparation.

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Objective of the Study: To investigate retrospectively as well as prospectively the risk of adverse pregnancy outcomes in women presenting with first-trimester threatened miscarriage.( Diagnosed on the basis of documented fetal cardiac activity on ultrasound with a history of vaginal bleeding in the presence of a closed cervix.) Material and Methods: The study was conducted over a period of 24 months, from May 2010 to May 2012 in a tertiary care centre. All patients in the study were selected from consultant OPD .The study was conducted in 120 women with early pregnancy bleeding that were chosen based on the exclusion and inclusion criteria. A detailed obstetrical and medical history was taken, timing and intensity of bleeding, thorough examination of the patient including general physical examination, signs of anemia, detection of icterus, pulse, blood pressure recorded. P/A examination, P/S examination and a gentle P/V was done. Baseline investigations including Hb, blood grouping and typing, BT, CT, TLC, DLC, urine examination, blood sugar, thyroid profile, USG for gestational age & fetal viability was also done. Results: The mean maternal age of the study group was 26.25 yrs (SD −3.549) years and 58 (48.3%) of the mothers were nulli parous while 62 (51.7%) were multi parous women. The complications seen in the study group were preterm premature rupture of membranes 7 (5.83%), placental abruption 2 (1.67%), small for gestation 7 (5.83%) and manual removal of placenta 2 (1.67%). When compared with age and parity matched controls with other studies done in similar fashion, significant differences were obtained. Conclusion: Threatened miscarriage is associated with placental abruption, pregnancy induced hypertension and fetal growth restriction.

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Dementia implies a documented decline in cognitive function and a deficit in performance in two or more cognitive domains. Assuming alarming dimensions in an aging population, awareness of the aetiology of dementia and avenues of its alleviation are essential for all medical practitioners

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The story of civilisation has been crafted and punctuated by wars and social upheaval. In this paper, we trace the evolution of battle injuries and the evolving paradigms of management.

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Sleep-Disordered breathing (SDB) describes a group of disorders characterized by abnormalities of respiratory pattern or the quantity of ventilation during sleep. Obstructive sleep apnea (OSA), the most common such disorder, is characterized by the repetitive collapse or partial collapse of the pharyngeal airway during sleep and the need to arouse, to resume ventilation. It has been estimated that roughly 1 of every 5 adults has at least mild OSA and that 1 of every 15 adults has at least moderate OSA. Sleep medicine is in a developmental stage in India and the problem of sleep disordered breathing is grossly under-recognised. The present time is very exciting for dentistry regarding its contribution and participation in the field of sleep medicine. Dentistry, in general and Orthodontics, in particular, has gained room in sleep medicine in the last few years which can be attributed to the work conducted by specialists in multidisciplinary teams who are directly or indirectly associated with teams that work with sleep medicine. Dentist practitioners can play an important role in preventing SDB and reducing the consequences of untreated SDB by examines patients for less familiar risk factors such as a small maxilla, a high palatal arch, rhinorrhea and mouth breathing. Oral appliances have been recommended for use in patients with primary snoring and mild to moderate OSA. The aim of all oral devices is to improve the patency of the upper airway during sleep by increasing its dimensions and reducing its collapsibility. Clinical Implications: The trained dental professional has the opportunity to assist patients with SDB at a variety of levels, starting with the recognition of a sleep-related disorder, referring them to a physician for evaluation and in assisting the management of sleep disorders.

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Hemostasis is a complex process requiring the delicately coordinated activation of platelets and plasma clotting factors to form a platelet-fibrin clot. It is a fundamental principle of good surgical practice. Hemostasis was first referenced in the battle of troy and has hence been developing along with the science of surgery. The various means to hemostasis in the operating theatre include :Mechanical methods, Thermal/energy based methods, Chemical methods- Topical & Pharmacological.Fibrin sealants, gelatin-based products, oxidized cellulose, and collagen products are the major classes of topical hemostatic agents that have evolved over the last 100 years.

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