Author Archives: pisrt

Abstract: Background: Hoarseness of voice is a common manifestation of structural or functional anomalies affecting the glottis. A detailed examination is necessary to ensure accurate diagnosis and management. Patients from rural areas often present with the condition at a later stage, emphasizing the need for creating awareness to facilitate early diagnosis and treatment. Indirect or video laryngoscopy (IDL/VDL) is the preferred method for evaluating hoarseness.

Abstract: Background: Pilon fractures are complex fractures of the lower limb in adults that can be managed by various modalities, including open reduction and internal fixation (ORIF), external fixation, and conservative management.
Materials and Methodology: In this study, 30 patients with pilon fractures were treated with external fixation at a tertiary care center. The patients were followed up for 12 months, and their functional outcomes were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle and Hindfoot Score.
Results: The results showed that the use of external fixation led to a significant improvement in functional outcome in patients with pilon fractures, including range of motion, pain, and anatomical reduction.
Conclusion: External fixation is a less invasive and less time-consuming surgical modality for the treatment of pilon fractures. This technique has a favourable functional outcome and can be considered as an effective option for managing this complex fracture in adults.

Abstract: Background: Proximal humerus fractures are one of the most common fractures of the upper limb in older individuals and can be managed by multiple modalities, from ORIF to K-wire fixation, and can even be managed conservatively.
Materials and Methodology: Thirty patients with proximal humerus fractures were treated with K-wire fixation at a tertiary care center and followed up for six months to evaluate the functional outcome using the Neer scoring system.
Results: The patients who underwent K-wire fixation had a significant functional outcome in terms of range of motion, pain relief, and anatomical reduction.
Conclusion: K-wire fixation is a simpler, less invasive, and less time-consuming surgical modality of treatment with a favorable functional outcome for proximal humerus fractures.

Abstract: Background: Oral squamous cell carcinoma is a carcinoma with squamous differentiation arising from the mucosal epithelium. The pathogenesis of oral cancers is multifactorial. P53, guardian of the genome regulates cell cycle progression, DNA repair, cellular senescence and apoptosis. Ki-67 is a cell cycle associated nuclear protein used as a proliferation marker to measure the growth fraction of cells in human tumours.
Aims and Objectives: To compare demographic factors like age, sex and predisposing factors. To evaluate grade of differentiation, expression of p53, Ki67 and their comparison in various grades of differentiation in oral squamous cell carcinomas.
Materials and Methods: This study comprises of 35 cases of oral squamous cell carcinoma After processing of representative tissue block, H\&E and IHC stain with Ki-67 and p53 immunomarkers were carried out.
Results: Out of 35 cases of oral squamous cell carcinoma,20(57%) were well differentiated, 14(40%) moderately differentiated, 1(3%) was poorly differentiated. The age range was 26-85 years. Sex ratio was 2:1. The most common risk factor for development of cancer was found to be smoking (57%) followed by betel quid chewing (43%). The most common clinical presentation was non healing ulcer (80%). Sensitivity of Ki67 and P53 is 100% and 63% respectively.
Conclusion: P53 positivity was demonstrated in majority of cases indicating that it is most common genetic mutations in oral cancers. The present study showed an inverse correlation between the degree of tumour differentiation and the rate of cell proliferation obtained by the expression of Ki-67.

Abstract: Background: Thoracic epidural analgesia (TEA) remains a critical tool for anaesthesiologists to use in acute pain management. Present study was aimed to investigate the analgesic effect of buprenorphine and fentanyl as adjuvant with bupivacaine in thoracic epidural anaesthesia in patients undergoing open cholecystectomy.
Material and Methods: Present study was prospective, randomized, blinded study, conducted patients 18-50 years, of either sex, ASA physical status I and II, posted for elective open cholecystectomy under thoracic epidural anaesthesia. The patients were randomly allocated into 2 groups, A (buprenorphine) or B (fentanyl) of 30 each.
Results: Onset of analgesia in group A was 5.97 min while that of group B is 5.43 min at T10 level. There was no difference in the onset of analgesia between the two groups. Mean duration of analgesia of group A is 701.53 min while that of group B is 477.17 min, which is statistically significant with p value <0.0001. So, duration of analgesia is higher in buprenorphine compared to fentanyl as an adjuvant with bupivacaine in thoracic epidural anaesthesia. Mean two segment regression time of group A is 129.96 min while that of group B is 120.7 min, which is statistically significant with p value 0.0057. VAS is statistically significant in group B at 6th ,12th and 20th hrs. In the Group A, 20 % patients show nausea and 10% shows vomiting, while in the group B, 10% complained of nausea and 36.67% complained of pruritus.
Conclusion: Open cholecystectomy cases can be done under thoracic epidural anaesthesia with 0.5% bupivacaine and buprenorphine or fentanyl as an adjuvant. Buprenorphine having prolong duration of analgesia can be better than fentanyl even in postoperative period.