Background: Prolonged unconjugated hyperbilirubinemia is a type of neonatal jaundice, which occurs in infants with high bilirubin levels (>10 mg/dl) persisting beyond 14-21 days. Prolonged unconjugated hyperbilirubinemia is a common problem among newborns, and the prevalence rate has been estimated at 2-15%. According to the literature, breastfeeding is a major cause of prolonged jaundice, and about 40% of infants who are exclusively breastfed are diagnosed with this disorder. Among other pathological causes associated with prolonged hyperbilirubinemia are urinary tract infection (UTI), congenital hypothyroidism and hemolysis. So, this study was done to know the different causes of unconjugated jaundice in newborn.Methods: This Hospital based prospective descriptive study was carried out at outpatients and inpatients in the Department of pediatrics, SMS medical college Jaipur. Total 100 cases were taken and these neonates were evaluated to know different causes of unconjugated hyperbilirubenemia.Results: Most common cause of persistent jaundice in both term and preterm babies is breast milk jaundice (66%), other causes include isoimmunization (10%), cephalhematoma (7%), hypothyroidism (7%), sepsis (4%) and ABO incompatibility (3%). Etiology of persistent jaundice was not significantly different in term and preterm babies.Conclusions: Although breast milk jaundice is considered as a major cause of prolonged unconjugated hyperbilirubinemia in neonates, identification of other etiological factors, such as UTI, congenital hypothyroidism and hemolysis is also of paramount importance. Early diagnosis and treatment of these disorder could effectively prevent further complication in neonates.

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Aim: To assess whether use of 80% oxygen reduces the frequency of surgical site infection in patients undergoing open appendectomy for appendicitis. Material & Methods: A randomised control study was conducted in the department of general surgery at NKP Salve Institute of Medical Sciences & Research Center & Lata Mangeshkar Hospital Nagpur. Sixty four patients undergoing open appendectomy via incision in the right lower quadrant of the abdomen were divided randomly into study group ie. patients receiving 80% oxygen during anesthesia, followed by high-flow oxygen for 2 hours in the recovery room and the control group receiving 30% oxygen, as usual. Surgical site infection will be assessed by the ASEPSIS (additional treatment, serous discharge, erythema, purulent discharge, separation of deep tissues, isolation of bacteria, and stay in hospital prolonged >14 days) system score. SPSS statistical software version 16.0 was used for data analysis. Results:The age distribution between the study and control group was statistically similar with p = 0.627. The sex distribution between the study and control group was statistically similar with p = 0.157. There were no medical comorbidities seen in both groups. The body temperature distribution between the study [mean ±SD = 37.02±0.12)] and control [mean ±SD = 37.06(0.24))] group was statistically similar with p = 0.272. Duration of abdominal pain was not significant with p=0.596. Preoperative analysis like WBC count, abdominal tenderness, Abdominal rigidity, hemoglobin, serum creatinine, blood urea, USG abdomen distribution was statistically not significant with p value >0.05. Duration of operation distribution between the groups was not significant with p=0.874. There was no surgical site infection seen in study as well as control group. All the cases in study as well as control group have satisfactory healing. There was significant (p=0.003) longer hospital stay in control group. Conclusion: Our study concludes that there is no role of supplemental oxygen in reducing surgical site infection in acute appendicitis.

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Introduction: Tuberculosis (TB) is a major health problem in India. The World Health Organization has recently in 2010 endorsed the Gene Xpert MTB/RIF assay for rapid detection of smear negative and multidrug resistance tuberculosis and more recently for extra pulmonary tuberculosis. Objectives: Evaluation of role of Cartridge based nucleic acid amplification test (CBNAAT) in extra-pulmonary tuberculosis (EPTB) in comparison with Ziehl Neelsen (ZN) staining and evaluating rifampicin resistance with the same test. Materials & Methods: Extra-pulmonary samples, including pleural fluid, pus, CSF, lymph tissue & others were divided in 2 parts: one for MTB/RIF assay & other for ZN staining. Both were then compared. Results: A total of 300 extra pulmonary samples were processed in this study, which included 103 pleural fluids, 81 pus, 45 CSF, 35 Lymph node tissue, 20 ascitic fluids and 16 synovial fluid. Out of these 37% (111) patients were Gene Xpert MTB/RIF Assay positive and 36 % (40 out of 111) were ZN smear positive. M.tuberculosis was detected in 56.7% pus samples, 23.3% pleural fluid samples, 54.2% lymph node samples, 33.3 % CSF samples, 20% ascitic fluid samples and 18.7% synovial fluid samples. In this study, we found that Gene Xpert MTB/RIF assay is a rapid method for diagnosis of EPTB as compared to conventional methods along with advantage of detecting Rifampicin resistance. Conclusion: Because of its simplicity, rapidity and sensitivity, this seems to be a very novel tool for diagnosis of extra pulmonary tuberculosis from clinical samples and that it should be researched more thoroughly.

Gastrocnemius muscle forms the belly of the calf. It arises by two heads. Each head is attached to either condyles of the femur by strong flat tendons and to the subjacent part of the capsule of the knee joint. Normally the upper third and part of the middle third is fleshy and then it becomes tendinous, uniting with the tendon of soleus, to form the tendo-achilles. The tendo-achilles is the thickest and strongest tendon in the human body measuring 15cm in length. It begins near the middle of the leg and gets attached to the posterior, mid level of the calcaneum.

We are reporting new anatomical variations in this case apart from the previously documented ones.

1. Lateral and medial heads of Gastrocnemius are fleshy in its entire length.

2. Fleshy fibres of the lateral and medial heads are discrete and attach directly to the posterior aspect of the calcaneum.

3. Total absence of the achilles tendon.

At the outset these findings have clinical relevance because it has been suggested that the absence of a well developed achilles tendon in the African apes would preclude them from effective running, both at high speeds and over extended distances. Bilateral achilles tendon vibration in the absence of vision has a major impact on postural orientation. Secondly the routine procedure of flap cover for the middle third soft tissue defects of the leg is the usage of soleus muscle flap. To add to the armamentarium of flap cover for middle third defects of the leg, gastrocnemius muscle flap is used as it was found to be fleshy throughout.

Introduction: The inappropriate use of medical technology is a major factor in increased health care expenses and inappropriate use of blood is costly. There is a need for continuous audit of the use of products as therapy. Audits are useful tools in the education of those ordering blood components, potentially resulting in the reduction of inappropriate use of blood components.

Aim: A retrospective clinical audit of blood transfusion requests in patients at a tertiary care hospital.

Material and Methods: This retrospective clinical audit conducted at NKP salve institute of medical sciences & research center & lata mangeshkar hospital Nagpur for a period of 3 months from April 2013 to June 2013. A retrospective analysis of blood and its component requisitions in all patients from different clinical departments was reviewed regarding diagnosis, indication for transfusion, number of units requested and the speciality prescribing it. Reports of silent investigations like hemoglobin, platelet count, coagulogram was also recorded.

Results: Out of 869 requisitions, 301 were for male patients and 568 were for female patients. Total number of blood components distribution request was 1188. 632 were for whole blood, 364 were for packed red cells, 182 were for FFP and 10 for platelet concentrate. Pre transfusion Hemoglobin was >8 gm/dl in 273 requests. Pre transfusion hemoglobin values were not available for 192. The urgency for transfusion was mentioned on 728, indication was mentioned on 804 and diagnosis was mentioned on 755 requisition forms. Multiple blood components requests were 97. The maximum request was from Department of Obstetrics and Gynaecology.

Total blood components issues were 707. Out of which 329 whole blood, 194 packed red cells, 182 FFPs and platelet concentrate were 2. Total donors were 554.

Conclusion: Clinical audits helps to reduce inappropriate use of blood and blood components, avoids blood transfusion reaction and avail the deprived patients.

Objectives: The objective of the study was to compare single layer continuous intestinal anastomosis and double layer interrupted intestinal anastomosis in terms of time taken for the anastomosis and safety. Material & Methods: A prospective comparative study was carried out in the Department of Surgery NKPSIMS and RC, Nagpur from August 2011 to October 2013. All patients who underwent elective intestinal surgeries and bowel anastomosis and consented for the study were included in the study. Patients requiring gastric, duodenal and rectal anastomosis and patients in whom staplers were used were excluded from the study. 30 single layered continuous and 30 double layered interrupted intestinal anastomosis were performed. Data was analyzed using Student t test for continuous variables and Chi square test for categorical variables. Comparison was made in terms of time taken for anastomosis, anastomotic leak and other complications. Results: The mean duration of intestinal anastomosis for the double layer group was 33.06 minutes whereas for the single layer group, it was 23.6 minutes, which was found to be statistically significant. Anastomotic leak was reported in 2 patients in the double layer group and in 3 patients in the single layer group was found to be statistically insignificant. The other complications that included surgical site infection, re intervention and mortality were similar in both the groups. Single layered intestinal anastomosis does not carry any increased risk of anastomotic leak and other complications when compared to double layered intestinal anastomosis and can be constructed in a shorter time. Conclusion: Single layered intestinal anastomosis technique takes less time for construction and does not carry any increased risk of complications