202-Article Text-341-1-10-20180620

Morbidity and mortality after implantation of St.
Jude
medical, bileaflet mechanical heart valve
Cardiovascular & Thoracic Surgery, Sher-i-Kashmir Institute of Medical Sciences, Srinagar
Tasneem Muzaffar,
ABSTRACT
GN Lone
INTRODUCTION: To assess our experience with cardiac valve

replacement with the St. Jude Medical bileaflet mechanical heart valve.
METHODS: Retrospective and prospective observational study.
RESULTS: Between 2003 and 2014, 430 patients underwent single aortic (n
= 98), single mitral (n = 229), or double aortic and mitral (n = 103) valve
replacement with the St. Jude Medical valve at our hospital. There were 199
male patients and 231 female patients. Ages ranged from 19 to 65 years (mean,
39.16 years). The early mortality rate was 5.5% (25 patients). Follow-up was
94.8% complete. Thirty-six patients died, for a late mortality rate of 9.3%.
Twenty-two patients had thromboembolic episodes (1.35/100 patient-years).
Seventeen patients (1.05/100 patient-years) had anticoagulant-related
hemorrhage, four (0.2/100 patient-years) had prosthetic valve endocarditis,
seven (0.4/100 patient-years) had nonstructural valve dysfunction, and four
(0.2/100 patient-years) underwent reoperation. The total number of valve-
related deaths was 21. The probabilities of freedom from thromboembolism
and anticoagulant-related hemorrhage at 12 years were 94.1% and 94.1 in
aortic valve replacement, 94.7% and 96.6% in mitral valve replacement, and
93.5% and 94.6% in double valve replacement, respectively. The event-free
rate, including all complications and late deaths, at 12 years was 77.6%,
75.36%, and 72.8% in aortic valve replacement, mitral valve replacement, and
double valve replacement, respectively.
CONCLUSION: The St. Jude Medical valve is an excellent mechanical valve
in terms of durability and low thrombogenicity and remains our prosthetic
valve of choice when valve replacement with a mechanical valve is indicated.
Journal of Medical Sciences 2015;18(1) 1

Transatrial-Transpulmonary correction of TOF with CMR as
a definitive diagnostic tool: Replacement of conventional
cardioangiography
Departments of Cardiovascular & Thoracic Surgery, *Cardiology and **Radiology, Sher-i-

Kashmir Institute of Medical Sciences, Srinagar
Mir Mudasir Sidiq,

GN Lone,
Khursheed Aslam*,
ABSTRACT
Naseer Ahmad Choh**
INTRODUCTION: The objective of this study was to evaluate the
associated cardiac anomalies, coronary and pulmonary artery abnormalities
and aorto-pulmonary collaterals in patients of TOF with preoperative CMR
and to correlate the CMR findings with intra-operative findings.
METHODS: 28 patients (male: female ratio of 1:1.33) who had TOF were
prospectively evaluated using CMR and underwent complete repair using the
transatrial-transpulmonary approach. Efficacy of CMR as a tool for pre-
operative assessment of patients with TOF was evaluated by comparing CMR
findings with intra-operative findings.
RESULTS: On pre-operative CMR associated congenital cardiac anomalies
were present in 13 patients including additional muscular VSD, coronary
artery abnormalities, LSVC, PFO, PDA, right aortic arch and MAPCA's.
Pulmonary artery variations were detected in 9 patients with LPA stenosis
being the commonest lesion present in 3 patients followed by supravalvular
stenosis and Isolated MPA hypoplasia. All the associated cardiac anomalies
were confirmed intra-operatively except one MAPCA's in which PDA was
found. One Mitral valve cleft found and repaired intra-operatively was missed
by CMR and one LPA stenosis was over diagnosed on CMR. Post-repair
RV/PA gradient was 10mmHg in 27 (96.43%) patients and one patient had
11mmHg. Mean post-repair Prv/Plv ratio was 0.51.
CONCLUSIONS: In patients of TOF, CMR is superior to traditional
echocardiography and alternative to conventional angiography which gives
detailed anatomic and functional information without risk of radiation and
contrast reactions to iodinated agents.
2 Journal of Medical Sciences 2015;18(1)

Effect of metformin on thyrotropin levels in treatment naive
type 2 diabetes and related traits
Department of Endocrinology, *Immunology & Molecular Medicine and **Cl.

Biochemistry, Sher-i-Kashmir Institute of Medical Sciences, Srinagar
Idrees Mubarik,
Shariq R. Masoodi,
ABSTRACT Zafar A. Shah*,
Syed Mudasar**
INTRODUCTION: Metformin is the drug of choice for initiating
treatment in type 2 DM, recently it has been found that metformin also
suppresses TSH. We also tried to study this thyroidal effect of metformin
METHODS: We recruited 72 patients, 56 of type 2 diabetes and 16 had
PCOS, all subjects were treatment naive and we treated them with metformin
1000 mg and 500 mg respectively. We took samples at baseline and after 6
months of treatment, we measured thyroid functions and insulin resistance
parameters both at baseline and 6 months.
RESULTS: TSH decreased from a mean of 3.32±1.99 to 2.90±1.65 µIU/ml.
(p = 0.07). Total T4 levels dropped 8.33±1.71 to 7.55±1.26 µg/dl, (p=0.04)
There was no significant change in free T4. Change in TSH was significant
only in whom HOMA IR also decreased, in these subjects TSH changed from
3.48±2.01 to 2.89±1.63; P=0.033.
CONCLUSION: Metformin causes a suppression of TSH levels in those
subjects in whom it also causes decrease in HOMA IR. T4 levels were also
decreased probably because of altered protein binding.

Pattern of metabolic abnormalities in patients with
hyperprolactinemia - Response to treatment with
Cabergoline
Department of Endocrinology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar
Nazir Ahmad Pala,

Bashir Ahmad Laway ABSTRACT
BACKGROUND: Hyperprolactinemia has been associated with changes in

body composition and metabolic abnormalities. Normalization of prolactin
with dopamine agonists has been found to reverse these metabolic
abnormalities.
MATERIAL & METHODS: Prospective case controlled study. Twenty
consecutive patients, 18 women and 2 men with hyperprolactinemia and 20
age, gender (18 women and 2 men) and body mass index matched controls
were included in the study. Anthropometric data and metabolic variables were
studied in both cases and controls at baseline and again at 3 and 6 months after
cabergoline treatment in patients with hyperprolactinemia.
RESULTS: Patients with hyperprolactinemia had significantly increased
level of fasting plasma glucose, LDL-cholesterol, triglycerides, leptin and
lower levels of estradiol as compared to age, gender and weight matched
healthy controls. Anthropometric data revealed a significant decrease of body
weight (p< 0.001), body mass index (p<0.001), waist circumference
(p=0.02), waist-hip ratio (p=0.02) and total body fat (p=0.003) at 6 months of
cabergoline treatment. Similarly, there was significant decline in abnormal
metabolic parameters like plasma glucose (p<0.001), total cholesterol
(p=0.004), LDL cholesterol (p<0.001), triglycerides (p<0.001) and leptin
(p=0.013) after 6 months of cabergoline treatment. Serum estradiol levels
improved significantly with marginal improvement in insulin sensitivity (as
measured by HOMA IR) at 6 months.
CONCLUSIONS: Patients with hyperprolactinemia had high body weight,
body mass index, leptin, lower estradiol concentration, adverse glucose and
lipid profile. Normalization of prolactin with cabergoline corrected all the
metabolic abnormalities.

Management and outcome of hepatitis B reactivation in
immunocompromised patients
Department of Gastroenterology, *Medical Oncology & **Cl. Haematology, Sher-i-

Manzoor Ahmad Wani,
Jaswinder Singh Sodhi,
Sheikh Aejaz Aziz*,
ABSTRACT Sajad Geelani**,
Showkat Ali Zargar,
Imtiyaz Wani
INTRODUCTION: Hepatitis B virus reactivation(HBVR) is known to
occur in cancer patients receiving chemotherapy. HBVR has high rate of
mortality even after treatment.
MATERIAL AND METHODS: This prospective study was conducted
from October 2012 to January 2015. All adult malignancy patients with
evidence of HBVR were included in the study. Patients with co-infection with
other hepatitis viruses or HIV and HCC were excluded. Patients were
randomized to receive either entecavir or tenofovir. Efficacy of two drugs was
compared by assessing the reduction in HBV DNA level at 6 months and the
proportion of patients with undetectable HBV DNA and HBsAg loss at 48
weeks.
RESULTS: 92 patients of HBVR were seen, 46 received entecavir and 46
received tenofovir. HBV DNA level decreased from a mean of 7.749(±1.19)
log IU/ml at baseline to 3.175(±0.89) log IU/ml at 6 months in entecavir
group with reduction of 4.7 logs where as HBV DNA level decreased from a
mean of 7.879(±1.08) log IU/ml at baseline to 2.655(±0.58) log IU/ml in
tenofovir group with reduction of 5.224 logs(p= 0.029). At 1 year, 35.1% had
undetectable DNA and 40.5% had HBsAg loss in entecavir group whereas
46.9% had undetectable DNA and 40.6% had HBsAg loss in tenofovir
group(p=0.32 & 0.99). No HBVR related death was seen in any group.
CONCLUSION: Both entecavir and tenofovir are very effective and equally
effective in the treatment of HBVR in cancer patients.

Profile of non small cell lung cancer, treatment outcome
and quality of life – A retro-prospective analysis
Mohmad Hussain Mir, Department of Medical Oncology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar
Gull Mohd. Bhat,
Shiekh Aejaz Aziz,
Abdul Rashid Lone, ABSTRACT
Burhan Wani,
Nadeem Shouket,
Namita Sharma INTRODUCTION: As per Globocan 2012 lung cancer is the most
commonly diagnosed cancers worldwide (1.8 million, 13.0% of the total
cancer), and the most common cause of cancer deaths. Non small cell lung
cancer constitutes 80-85% of total lung cancer cases.
MATERIAL & METHODS: Lung cancer constituted 12% of total
registered cancer cases in 2014 at RCC SKIMS. The present study was
undertaken to analyze the clincopathological profile of non small cell lung
cancer, its treatment outcome and quality of life It was a retro-prospective
study from January 2008 till July 2014. The case records and patients were
analysed for clinical presentation, radiological features, staging, EGFR
mutation and ALK translocation, treatment given its outcome & QOL.
RESULTS: A total of 1557 non small cell lung cancers were registered during
the period.70% were rural and 30% urban with Srinagar district having highest
number of cases. The median age was 58.0 years (ranges 22 to 95 years). Males,
79% (n=1231) and females constituted around 21% of patients (n=326).
Around 77.39% were smokers and Hookah, was the most common form of
smoking in our patients (65.06%). Squamous cell histology was common
67.5% followed by adenocarcinoma 24.9%. Most patients had ECOG 1-
2(79%) and 62.66% had stage IV disease. Chemotherapy was single largest
treatment modality (35%). EGFR mutation was present in 36.1% of
adenocarcinoma and ALK translocation in 4.67%. TKIs markedly improved
the QOL. Median overall survival was 11.0 months.
CONCLUSION: Lung cancer is increasing in incidence and proportion of
adenocarcinoma is increasing among non small cell lung cancers at our centre.

Clinical and laboratory profile of non-Hodgkin's
lymphoma at SKIMS
Department of Medical Oncology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar
Ulfat Ara Wani,

ABSTRACT Sheikh Aejaz Aziz,
Gull Mohamad Bhat
BACKGROUND: Non-Hodgkin's lymphoma is one of the most

commonly occurring haematologic cancer among adults. The majority of
NHL cases arise in lymph nodes, but primary extranodal disease now accounts
for 20-30% of all cases.
OBJECTIVE: To define clinical and laboratory profile of NHL patients,
distribution of various subtypes, stage, prognosIs, treatment modalities and
survival patterns.
METHODS: NHL diagnosis was based on biopsy, subtyping on immuno-
histochemistry. All patients were analyzed for clinical presentation, type of
treatment, stage, WHO class. Staging workup included lab parameters, bone
marrow aspiration and biopsy, CECT, PET. Prognostication of patients was
done by IPI score, or FLIPI-1(follicular), MCLIPI(mantle cell).
RESULTS: Age of the subjects ranged from 4 to 91 years with mean (±SD) of
49.27±18.75 years (Median, 53). Paediatric lymphoma (≤19 years) comprised
8.5% of the total. Lymphadenopathy is the commonest presenting
complaint(44.1%). DLBCL is the most common (63.2%) subtype followed by
follicular (7.2%), mantle cell (5.2%) NHL.
CONCLUSIONS: There was no significant association of smoking with
NHL. Farming showed significant correlation with NHL. B symptoms,
extranodal disease,T cell lymphoma, were less in magnitude as compared to
other Indian studies. T cell lymphoblastic lymphoma was the predominant
subtype in paediatric patients. Stage I was the most common followed by stage
III. A higher proportion of patients received treatment and less patients failed
to complete treatment despite low socioeconomic background and low
literacy.

Association of ACE Gene I/D polymorphism with migraine
1
Departments of Neurology, and 2Immunology & Molecular Medicine, Sher-i-Kashmir
Institute of Medical Sciences, Srinagar
Irfan Yousuf Wani 1,

Sheikh Saleem1, ABSTRACT
Zafar Amin Shah2
INTRODUCTION: Migraine is a complex, recurrent headache disorder

that is one of the most common complaints in neurology practice. The role of
various genes in its pathogenesis is being studied. We did this study to see
whether an association exists between ACE gene I/D polymorphism and
migraine in our region.
MATERIAL AND METHODS: The study included 100 patients
diagnosed with migraine and 121 healthy controls. The study subject were age
and gender matched. The analyze was based on Polymerase Chain Reaction
(PCR) and included following steps: DNA extraction from blood, Polymerase
chain reaction ( PCR) and Restriction Fragment Length Polymorphism.
RESULTS: Out of 100 cases, 69 were females and 31 were males. 57 were
having migraine without aura and 43 had migraine with aura. 45 of the cases
had II polymorphism, 40 had ID polymorphism and 15 had DD
polymorphism in ACE gene.
CONCLUSION: We were not able to find a statistically significant
association between ACE gene I/D polymorphism with migraine. The reason
for difference in results between our study and other studies could be because
of different ethnicity in study populations. So a continuous research is needed
in this regard in order to find the genes and different polymorphism that
increase the susceptibility of Kashmiri population to migraine.

To study the clinical profile, etiological diagnosis and
outcome in patients of acute viral meningoencephalitis in
a tertiary care centre
Departments of Neurology and *Immunology & Molecular Medicine, Sher-i-Kashmir

Sawan Kumar Verma,

ABSTRACT Mushtaq Ahmad Wani,
*Dilafroze
INTRODUCTION: Viral Encephalitis/Meningoencephalitis is an acute

clinical syndrome of the CNS, often associated with fatal outcome or severe,
permanent damage including cognitive and behavioural impairment, affective
disorders and epileptic seizure. HSV, VZV, EBV, & enteroviruses are
considered the most frequent pathogens involved.
METHOD: Patients with acute febrile illness with neurological symptoms
and signs suggestive of viral meningoencephalitis/encephalitis were included.
A detailed history, clinical examination and relevant investigations were done.
Final outcome was analysed at the time of discharge and 4 weeks thereafter. A
total of 50 patients were included in this study.
RESULTS: out of 50 cases, 27 (54%) were males & 23 (46%) were females.
The most common clinical feature was headache (n=46, 92%) followed by
fever (n=45, 90%), neck stiffness (n=39, 78%), vomiting (n=38, 76%) &
seizure (n=24, 48%). CT head was abnormal in 10/46 (21.73%) patients and
MRI was abnormal in 23/46 (50%) patients. CSF PCR for HSV1 was positive
in 30(60%) patients, followed by VZV in 5 (10%) and Enterovirus in 5(10%)
patients. 25(50%) patients made good recovery at the time of discharge and
after 1 month. The overall survival in our study was 96% whereas mortality
was 4%.
CONCLUSION: HSV1 is the most common cause of viral meningo-
encephalitis / encephalitis and early detection and treatment is important to
improve the outcome.

Study of hepatobiliary and pancreatic ductal system
abnormalities in children with hepatobiliary pancreatic
ductal system disorders
Department of Paediatric Surgery, Radiology and Gastroenterology, Sher-i-Kashmir
Raashid Hamid,
Nisar Ahmad Bhat,
ABSTRACT
Feroze Shaheen,
Gulzar GM
BACKGROUND: Hepatobiliary and pancreatic disorders in children are
infrequent and include duct malunion (APBD union), Extrahepatic biliary
atresia (EHBA), Caroli's disease, primary sclerosing cholangitis, pancreas
divisum and pancreatic duct abnormalities. Investigations used for evaluation
of these disorders in children range from USG, HIDA Scan, CT, ERCP,
Cholangiography and MRCP. Among these MRCP is a non-invasive
investigation which has the potential to delineate the hepatobiliary pancreatic
ductal system pre-operatively to help surgeon in diagnosis and operative
planning
AIMS AND OBJECTIVES: The purpose of this study is to determine
whether MRCP is feasible in paediatric age group patients and to look for the
possible measures to optimize the pediatric MRI.
MATERIAL AND METHODS: This study was a prospective and
descriptive study between Oct-2012 to Jan-2015. We examined 50 consecutive
children (28 boys and 22 girls), who were suspected of having
pancreaticobiliary disease. Besides base line USG, MRCP was performed in
all patients. The findings of MRCP were compared with those of
intraoperative cholangiography (IOC).
RESULTS: A total of 50 children (7 neonates, 17 infants and 26 older
children), 30 children with ductal dilatation and 20 children with cholestatic
jaundice. The sensitivity, specificity and accuracy of MRCP were 50%, 75%
and 60% respectively in detecting the APBD-union in our series.The
sensitivity, specificity, accuracy, Positive predictive value and Negative
predictive value of MRCP were 84.61%, 85.71% and 85%, 91.66% and 75%
respectively in detecting biliary atresia. For patients with neonatal cholestasis,
biliary atresia was excluded if there was visualization of normal extra-hepatic
biliary system at MR cholangiography. Sedation was required in 10 patients for
an optimal MRCP.
CONCLUSION: MRCP is effective in delineating choledochal cyst type,
and helpful in diagnosing related pancreaticobiliary anomalies, such as
APBD–union. But more evaluation needs to be done to assess the MRCP
ability to detect APBD–union. Furthermore from our preliminary results, we
can conclude that BA can be ruled out if complete extrahepatic bile duct
(EHBD) is delineated on MRCP.

Mandibular reconstruction with vascularised free fibula
flap
Department of Plastic and Reconstructive Surgery, Sher-i-Kashmir Institute of Medical

Sciences, Srinagar
Bashir Ahmad Bhat,

ABSTRACT Adil Hafeez Wani
OBJECTIVE: To study etiology mandibular defects, the functional and

cosmetic outcome in patients undergoing mandibular reconstruction.
METHODOLOGY: Study group consisted of patients who underwent
mandibular reconstruction by free fibula flap from DEC-2013 to DEC-2014.
The etiology of mandibular defect in majority of cases was post tumor excision
in 85% of cases (17 patients), in 2 patients mandibular defect was secondary to
fire arm injury and there was one case of post bear maul mandibular defect.
RESULTS: The study included 20 patients; there were 14 males and 6
females. Osteocutaneous flap was harvested in majority of patients (90%),
bone only flap was used in two patients (10%). The average length of bone flap
was 10 cm (range 6cm to 14cm), skin paddle measuring an average of 12x6cm
(range 8x6cm to 16x9cm) was transferred with bone flap in osteocutaneous
flap. Functional result was good in sixteen patients (80%), fair in three patients
(15%), and poor in one patient (5%). Cosmetic result was good in fifteen
patients (75%), fair in four patients (20%), and cosmetic result was poor in one
patient (5%). Complications developed in four patients (20%). There was
partial graft loss at donor site in one patient (5%). Donor site complications
occurred in five patients (25%).
CONCLUSION: Free fibula flap is a versatile and reliable option for
microvascular reconstruction of large mandibular defects.

Estimation of natural radiation levels and associated
hazard evaluation
1
Department of Radiological Physics & Bio-Engineering, Sher-i-Kashmir Institute of
Medical Sciences, Soura, Srinagar, 2Department of physics, University of Kashmir,
3
Srinagar, School of Advanced studies, Vellore Institute of Technology, Vellore, Chennai,
4
India, and Department of Radiation Oncology, Sher-i-Kashmir Institute of Medical
Sciences, Srinagar.
Mudasir Ashraf1,3,
Shakeel Ahmad2,
Chanderashekaran Anu Radha3, ABSTRACT
Malik Mohib-ul-Haq1,
Nazir Ahmad Khan4
High levels of natural radiation areas occur in some part of the world and have
been a subject of concern among regulators, workers, and public at large in the
past decades. Natural radionucleides are omnipresent and to fix a level above
which it is judged to be appropriate to introduce radiation protection measures
is sometimes challenging and hard to convenience. The experimental
measurement of Ra226, Th232, K40, Cs137and Raeq activities in and around
lignite belt have been carried out using the NaI(Tl) gamma-ray spectrometer.
The lignite, surface soil samples and soil samples of the locality surrounding
the lignite belt were randomly collected in and around the lignite belt. The
average values of specific activity concentration of Ra226, Th232, K40, Cs137
from the lignite samples were found to be 45.4±1.2, 21.4±0.9 and 40.5±2.1
Bq[kg]^(-1) respectively. The average values of specific activity
concentrations for Ra226, Th232 and K40 in soil sample of the surrounding
locality have found to be 56.6±1.5, 75.0±2.7 and 40.7±1.2 Bq[kg]^(-1)
respectively, which higher than the world average of 50 Bq[kg]^(-1) for
Ra226 and Th232. The radiation Hazard indices calculated are well below the
limits.
CONCLUSION: The average value of the specific activity concentration in
soil Samples of the locality surrounding the lignite belt were found to be
higher than the world average of 50 and the radiation hazard indices calculated
are well below the limits.

A prospective, randomized double blind and placebo
controlled study to evaluate the analgesic efficacy and
safety of epidural clonidine for post operative analgesia
in patients undergoing lumbosacral surgery
Department of Anesthesiology & Critical Care, Sher-i-Kashmir Institute of Medical

Sciences, Srinagar
Nahila Mahajan,
Imtiyaz A. Naqash,
ABSTRACT
Velayat Nabi Buchh
BACKGROUND: Relieving postoperative pain in spine surgeries has

become an indespensible component in anaesthesiology. A prospective
randomized study was carried out to evaluate the efficacy and safety of
epidural clonidine for postoperative analgesia after lumbosacral surgery.
METHODS: 70 patients of ASA PS I and II of either sex, in the age group 18-
60 years undergoing lumbosacral surgeries were allocated to two groups of 35
patients each, to receive epidurally either clonidine (group I) or saline (group
II). Both the groups were evaluated for VAS scores, total morphine
consumption over 24 hours.
RESULTS: The demographic characteristics were comparable in both
groups. The haemodynamic parameters in group I were significantly lower.
Mean VAS score was significantly lower in group I compared to group II
(p<0.05). The cumulative dose of morphine in group I was significantly lower
than that in group II (9mg vs 16mg) (p<0.05). The percentage reduction in
morphine consumption in group I was 40% in comparison to group II. There
was no statistically significant difference in the sedation scores among the two
groups. Only 3 patients in group I and 11 patients in group II had postoperative
nausea and vomiting (p=0.017).
CONCLUSION: Epidural clonidine, as a sole analgesic agent, provides
adequate analgesia in spine surgeries. It produces few side effects of its own
and by reducing the consumption of morphine, may reduce the side effects of
the latter.

A prospective, randomized study to evaluate the efficacy
and safety of dexmedetomidine for sedation in
neurosurgical patients requiring short term postoperative
mechanical ventilation: Comparison with propofol
Department of Anaesthesiology & Critical Care, Sher-i-Kashmir Institute of Medical

Aayushi Mahajan, Sciences, Srinagar
Imtiyaz A Naqash,
Sheikh Irshad
ABSTRACT
BACKGROUND: Neurosurgical patients requiring short term

postoperative ventilation need sedatives and analgesics. Dexmedetomidine, a
short acting 2 agonist possesses anxiolytic, hypnotic and analgesic properties.
This study compared the efficacy of dexmedetomidine and propofol.
MATERIALS AND METHODS: 60 patients of either sex, aged 18-60
years, ASA PS I or II, preoperative GCS 15, undergoing neurosurgery and
requiring short term postoperative ventilation were included. The patients
were randomly divided into two groups of 30 each. Group I received
dexmedetomidine 1 μgkg-1 over 10 minutes followed by maintenance
infusion at a rate of 0.2-0.5 μgkg-1hr-1. Group II received propofol as a bolus
of 1 mgkg-1, followed by an infusion of 0.5-1 mgkg-1hr-1. Analgesia was
provided by fentanyl infusion.
Measurements: Heart rate, mean arterial pressure, Ramsay sedation score,
fentanyl requirement, ventilation and extubation times.
RESULTS: Ramsay sedation score was comparable for dexmedetomidine
and propofol (p=0.152). There was 53.6% reduction of fentanyl consumption
in dexmedetomidine group. Dexmedetomidine group had significantly lower
heart rates compared to propofol group, (p<0.05). No difference was found in
mean arterial pressures of two groups. Extubation times were similar and rapid
in both groups. No adverse events occurred in either group.
CONCLUSION: Dexmedetomidine is safe and equally effective agent
compared to propofol, withextubation time comparable to propofol. Patients
were easily arousable in the dexmedetomidine group. Dexmedetomidine also
reduced fentanyl requirements.

Role of dexmedetomidine pre-medication on
haemodynamic response to laryngoscopy, endotracheal
intubation & intraocular pressure changes following
suxamethonium administration in patients undergoing
elective non-ophthalmic operations under general
anaesthesia

Sciences, Srinagar
Shaista Yaqoob,
ABSTRACT A Q Lone
BACKGROUND: Patients with penetrating eye injury often present with

full stomach. These patients require rapid sequence induction(RSI) without
increasing intraocular pressure(IOP). Succinylcholine, most common drug
for RSI increases IOP. Laryngoscopy & intubation further aggravates this rise
in IOP besides causing a haemodynamic pressor response manifesting as
tachycardia & hypertension.
AIMS:To study effect of dexmedetomidine premedication in attenuating
haemodynamic pressor response to intubation & rise in IOP associated with
suxamethoniumadministation, laryngoscopy & endotracheal intubation.
METHODS:100 ASA I/II patients undergoing general anaesthesia for
elective non-ophthalmic surgery included in this double blind, randomized,
prospective study were allocated into two groups of fifty each to receive
0.4μg/kg Dexmedetomidine or normal saline i.v over 10 mins,10 mins before
induction. IOP, HR & MAP were recorded at baseline,1 min after
suxamethonium & 1,2,3& 5 mins after endotracheal intubation.
RESULTS: Dexmedetomidine administration resulted in decrease in
HR,MAP & IOP from baseline values. Suxamethonium caused increase in
IOP in control group. In study group IOP never increased above baseline.
Also, increase in HR & MAP in the study group was less than that seen in the
control group.
CONCLUSION: Dexmedetomidine 0.4μg/kg body weight given i.v as
premedication prevents the rise in IOP associated with suxamethonium
administration, laryngoscopy & endotracheal intubation & also attenuates
haemodynamic pressor response to laryngoscopy and endotracheal
intubation.

A prospective, randomised, placebo-controlled
comparative trial, studying the effectiveness of oral
pregabalin in attenuation of haemodynamic pressor
response of airway instrumentation during general
anaesthesia: a dose response study

Sciences, Srinagar
Khalida Parveen, ABSTRACT

Zahoor Ahmad Shah
AIMS: Comparing the effectiveness, safety and efficacy of oral pregabalin in

different doses to attenuate haemodynamic pressor response to airway
instrumentation under general anaesthesia.
METHODS: A total of 120 normotensive adult patients aged 24-56years of
both genders with ASA I& II were randomly allocated into three groups of
fourty patients each. Group I received oral placebo, group II oral pregabalin
75mg and group III oral pregabalin 150mg 1 hr before induction. Anaesthetic
technique was standardized and all groups were assessed for pre-operative
sedation, haemodynamic changes after premedication, before and after
induction, after laryngoscopy and intubation, along with intraoperative
haemodynamic stability. Data analysis done by ANOVA, post hoc and Chi
square test.
RESULTS: Pre-operative sedation levels were higher with pregabalin
premedication. Significant increase in heart rate ,systolic blood pressure,
diastolic blood pressure and mean arterial pressure was observed in groups I
and II after airway instrumentation, while statistically significant attenuation
of systolic, diastolic and mean arterial pressures was seen in group III. No
significant decrease in heart rate was observed in any group.
CONCLUSION: Oral pregabalin in the dose of 75 mg given 1 hr before
induction was not effective in controlling the pressor response of
laryngoscopy and endotracheal intubation, while as oral pregabalin in the dose
of 150 mg was effective in attenuating the pressor response of laryngoscopy
and endotracheal intubation.

A randomized double-blind study to compare the efficacy
of palonosetron over granisetron for prevention of post-
operative nausea & vomiting in patients undergoing
thyroidectomy

Sciences, Srinagar
Yasir Nisar,
ABSTRACT Showket Hussain Nengroo
INTRODUCTION: Postoperative nausea and vomiting (PONV) are

frequently encountered after thyroidectomy. For PONV prevention, selective
serotonin 5-HT3 receptor antagonists are considered one of the first-line
therapy. Palonosetron is a second-generation 5-HT3 antagonist that has
recently been approved for prophylaxis against PONV. The study was aimed
to compare the prophylactic effects of intravenously administered
palonosetron over granisetron for prevention of postoperative nausea and
vomiting in thyroidectomy patients after general anaesthesia.
METHODS: This prospective, double-blind, randomized study, comprised
120 female patients of ASA grade I and II, posted for elective thyroidectomy.
Patients were randomized into two equal groups of 60 patients each. Group P
received injection palonosetron (0.075 mg) and group G, inj. granisetron (2.5
mg) intravenously five minutes before induction of anesthesia. The incidence
of PONV, severity of PONV, requirement for rescue antiemetics, and adverse
effects were evaluated during 0-2 and 2-24 h and 24-48 hours postoperatively.
At the end of the study, data collected was decoded.
RESULTS: The incidence of PONV was statistically insignificant (p > 0.05)
between the two groups at 0-2 hours and 2-24 hours but highly significant
(p=0.001) at 24-48 hours postoperatively with PONV more common in
patients receiving granisetron compared to Palonosetron.
CONCLUSION: Palonosetron is more effective for antiemetic prophylaxis
of PONV in patients undergoing thyroidectomy under general anaesthesia
when compared to granisetron.

Combined central venous oxygen saturation and lactate as
markers of occult hypoperfusion and outcome following
cardiac surgery
Departments of Anaesthesiology & Critical Care, *Clinical Biochemistry, Sher-i-Kashmir

Santosh Devi,
Showkat Ahmad Gurcoo, ABSTRACT
Syed Mudassar*
BACKGROUND: Routinely monitored parameters may not reliably detect

perfusion abnormalities. However, ScvO2 & lactate levels can detect occult
hypoperfusion and identify patients at risk for complications. This study was
aimed to examine the occurrence of postoperative occult hypoperfusion,
determined by the combination of low ScvO2 and elevated lactate and its effect
on outcomes after cardiac surgery.
MATERIALS AND METHODS: The study included 100 patients
undergoing different cardiac surgeries under CPB. Postoperative ScvO2 &
arterial lactate were obtained on arrival to the ICU & at 24 hours after ICU
admission. Moderate GTH was defined as ScvO2 <70% and lactate 2 to 4
mmol/L & severe GTH was defined as ScvO2 <70% & lactate >4 mmol/L.
Occult hypoperfusion was defined as moderate to severe GTH with MAP>65
mmHg, CVP>8 mmHg & urine output >0.5mL/kg/h.
RESULTS: 37 patients had occult hypoperfusion on arrival to Cardiac
Surgical ICU. Patients with occult hypoperfusion on ICU admission had
significantly longer ICU/Hospital LOS & ventilation time(p<0.001). Patients
with severe GTH(n=15) had significantly longer Hospital LOS &
significantly more no of complications per patient(p<0.05) as compared to
those with moderate GTH(n=22). Patients who persisted with occult
hypoperfusion at 24 Hr (n=14) had significantly longer time on ventilator,
ICU/Hospital LOS & no. of complications(p<0.05).
CONCLUSIONS: The incidence of GTH is high after cardiac surgery.
Postoperative ScvO2 & lactate may be valuable measurements to identify
patients with occult hypoperfusion & subsequently guide hemodynamic
optimization to positively affect postoperative outcomes in patients after
cardiac surgery.

Effects of bispectral index monitoring on isoflurane
consumption and recovery profiles for anesthesia in a
Kashmiri population

Sciences, Srinagar
Heena Amin,
ABSTRACT
Zahoor Ahmad Shah
BACKGROUND: Isoflurane is a commonly used inhalational anaesthetic

agent to maintain the depth of anaesthesia. Excessive usage of volatile
anaesthetics can cause significant morbidity because delayed recovery. From
all the devices available only bispectral index monitoring has been proven
effective. The objectives of this study were to evaluate the effect of BIS
monitoring on Isoflurane consumption during maintenance and recovery
profile at the end of anaesthesia. This Quasi experimental study was
conducted for a 2 year period at the main operating units of a tertiary care
hospital
MATERIALS AND METHODS: Total 90 patients of age 18-60 years who
had to undergo lower abdominal and urological surgeries were enrolled in
either standard practice (SP) or (BIS) group. In the SP group, the anaesthesia
depth was maintained as a routine clinical practice, while in BIS group it was
maintained by monitoring the BIS score between 45 and 55. Standard
anaesthesia care was provided to all of the patients. Data including
demographics, isoflurane consumption, hemodynamic variables and recovery
profiles were recorded in both groups
RESULTS: The mean isoflurane consumption was lower (P = 0.001) in the
BIS group. The time to eye opening, extubation and ready to shift was shorter
(P = 0.0001) in BIS group. The patients in BIS group had higher Post
anaesthesia recovery score (P = 0.0001) than the SP group.
CONCLUSION: The use of BIS in a Kashmiri population resulted in 40%
reduction of isoflurane usage. The patients having BIS monitoring awoke
earlier and had better recovery profiles at the end of anaesthesia.

Effect of intravenous dexamethasone in combination with
caudal analgesia on postoperative pain control in
paediatric orchidopexy

Sciences, Srinagar
Azka Sunain Khan

Waqar-ul-Nisa ABSTRACT
INTRODUCTION: Dexamethasone has a powerful anti-inflammatory

action and has demonstrated reduced morbidity after surgery. The aim of this
study was to examine the effects of a single intravenous dose of dexamethasone
in combination with caudal block on postoperative analgesia in children
undergoing orchidopexy.
METHODS: Eighty children, aged 2–5 years, undergoing unilateral
orchiopexy were included in this prospective, randomized, double-blinded
study. After induction of general anaesthesia, children received either
dexamethasone 0.5 mg/kg (maximum 10 mg) (n=40) or the same volume of
saline (n=40) intravenously. A caudal anaesthetic block was then performed
using 1.5 ml/kg of ropivacaine 0.1% in all patients. After surgery, rescue
analgesic consumption, pain scores and adverse effects were evaluated for 24h.
RESULTS: Significantly, fewer patients in the dexamethasone group
required fentanyl for rescue analgesia (12.5% vs 35%) in the post-anaesthetic
care unit (PACU) and acetaminophen in ward (30% vs 70%) compared with
the control group. The time to first administration of acetaminophen was
significantly longer in the dexamethasone group (8.33±0.98 vs 6.00±1.15
hours). Postoperative pain scores were significantly lower in the
dexamethasone group and there were no significant differences in the
incidence of adverse effects.
CONCLUSION: Intravenous dexamethasone 0.5 mg/kg in combination
with a caudal block augmented the intensity and duration of postoperative
analgesia without adverse effects in children undergoing orchidopexy.

Comparative study of fentanyl vs dexmedetomidine as an
adjunct to epidural bupivacaine

Sciences, Srinagar
Tantry Tariq Gani

ABSTRACT
Kharat Mohammad
BACKGROUND AND AIMS: This prospective, randomized, double-

blind study was undertaken to establish the effect of addition of fentanyl
ordexmedetomidine, as an adjuvant, to epidural bupivacaine in subumblical
surgeries.
MATERIALS AND METHODS: Ninety ASA (American Society of
Anaesthesiologists) group I, group II and Group III patients undergoing
subumblical surgeries were enrolled to receive either bupivacaine with saline
(Group I) or bupivacaine with fentanyl (Group II) or bupivacaine with
dexmeditomidine (Group III) for surgical anaesthesia. All the study subjects
received an epidural anaesthesia with 20 ml of 0.5% bupivacaine along with
either saline (Group I) or fentanyl (1mcg/kg)(Group II) or dexmedetomidine
(1mcg/kg) (Group III). The onset of motor and sensory block, duration of
block, hemodynamic parameters, and any adverse events were monitored.
RESULTS: Analgesia in the postoperative period was better in Group III,
duration of sensory and motor blockade was significantly prolonged in Group
III and incidence of sedation was more in Group III.
CONCLUSION: Hence, addition of dexemedetomidine to epidural
bupivacaine can be advantageous with respect to increased duration of motor
and sensory blockade and arousable sedation.
Key words: Dexmedetomidine, epidural block, fentanyl.

Oral dexmedetomidine verses oral midazolam for
premedication in children

Sciences, Srinagar
Aarif Rashid Lone ABSTRACT

Syed Amer Zahoor
INTRODUCTION: Midazolam is the most commonly used

premedication inchildren. Clonidine, an a2 agonist, has been suggested as an
alternative. Dexmedetomidine is a more a2 selective drug with more favorable
pharmacokinetic properties than clonidine.
AIMS: To compare oral Dexmedetomidine and oral Midazolam as
premedication in pediatric patients.
DESIGN: Prospective randomized double blind study.
SETTING: Department of Anaesthesiology and Critical care, Sher-i-
Kashmir Institute of Medical Sciences Soura, Srinagar, J&K.
MATERIAL AND METHODS: 100 patients (6 to 12 yrs) were randomly
allocated to group D(n=50) and group M(n=50) and given Inj.
Dexmedetomidine 3 μg/kg diluted in 5ml 5% dextrose oral one hr prior to
induction and Inj. Midazolam 0.5mg/kg orally accordingly. Level of sedation,
parent separation, hemodynamic consequences, respiratory consequences,
post operative analgesia and recovery was noted.
Statistical Analysis Used: student's t-test and chi square test used in this study.
P value <0.05 was considered significant.
RESULTS: There were significant differences in parental separation, level of
sedation, post-op analgesia and recovery. When compared with group D,
patients in group M were significantly more sedated % minutes after
premedication (P<0.001). Parent-child separation, Post operative analgesia
and recovery was better in group D in comparison with group M. Patients in
group D had significantly lower levels of MAP and HR after premedication.
Patients in Group M had significant respiratory depression.
CONCLUSIONS: Dexmedetomidine is superior than Midazolam as
premedication in pediatric patients with excellent parent separation,
favourable induction conditions, better postoperative analgesia and recovery
along with hemodynamic stability and no respiratory depression.

Evaluation of the effect of magnesium sulphate versus
clonidine as an adjuvant to epidural bupivacaine in lower
abdominal and lower limb surgeries

Sciences, Srinagar
Majid Jehangir
ABSTRACT Muhammed Syed Qazi
For treatment of intra and postoperative pain, no drug has yet been identified
that specifically inhibits nociception without associated side effects.
Magnesium has antinociceptive effects in animal and human models of pain.
The current prospective randomised double-blind study was undertaken to
establish the effect of addition of magnesium or clonidine, as adjuvant, to
epidural bupivacaine in lower abdominal and lower limb surgeries. A total of
90 American Society of Anesthesiology (ASA) grade I and II patients
undergoing lower abdominal and lower limb surgeries were enrolled to
receive either magnesium sulphate (Group B) or clonidine (Group C) along
with epidural bupivacaine for surgical anaesthesia. All patients received 19 ml
of epidural bupivacaine 0.5% along with 50 mg magnesium in group B, 150
mcg clonidine in Group C, whereas in control group (Group A), patients
received same volume of normal saline. Onset time, heart rate, blood pressure,
duration of analgesia, pain assessment by visual analogue score (VAS) and
adverse effects were recorded. Onset of anaesthesia was rapid in magnesium
group (Group B). In group C there was prolongation of duration of
anaesthesia and sedation with lower VAS score, but the incidence of shivering
was higher. The groups were similar with respect to haemodynamic variables,
nausea and vomiting. The current study establishes magnesium sulphate as a
predictable and safe adjunct to epidural bupivacaine for rapid onset of
anaesthesia and clonidine for prolonged duration of anaesthesia with sedation.

Evaluation of intravenous lipid emulsion as a novel
therapeutic antidote in severe organophophorus
poisoning

Sciences, Srinagar
Shabnam Majeed,
Bashir Ahmad Dar
ABSTRACT
AIMS: Assess the efficacy of intravenous lipid emulsion as an antidotal

therapy in organophosphorous poisoning and evaluate whether addition of
intravenous lipid emulsion affects the primary outcome i.e., mortality and
secondary outcomes like need for ventilatory support , incidence of
intermediate syndrome, and ICU stay.
METHODS: A total of 100 adult patients were taken. Group I (atropine +
PAM) and group II (atropine + intravenous lipid emulsion), each group
comprising 50 patients. The randomization was done as per computer
generated Random number tables and patients straightway allocated to either
into group I (atropine +PAM) or group II (atropine +intravenous lipid
emulsion). Parameters recorded were: GCS, Heart rate, Mean arterial
pressure, serum cholinesterase levels. Fisher's exact test, Chi square test and
independent sample test were done to compare the efficacy parameters
between the two groups.
RESULTS: There was rapid improvement in GCS, mean arterial pressure
and serum cholinesterase levels in group II than group I .There was no
significant difference in the atropine requirement and heart rate between the
two groups. All patients in group I and 42 patients in group II were ventilated.
Mean duration of ventilation, ICU stay and mortality was more in group I
than group II.
CONCLUSION: Intravenous lipid emulsion is highly effective in severe
organophosphorus poisoning. It improves GCS, mean arterial pressure,
cholinesterase levels and decreases need for ventilation, duration of
ventilation, ICU stay and overall mortality of organophosphorus patients.

Prevalence of irregular antibodies in blood donors in a
tertiary care hospital, a one year study
Department of Blood Transfusion and Immunohaematology, Sher-i-Kashmir Institute of

Medical Sciences, Srinagar
Zakir Ahmad Bhat,

ABSTRACT Javaid Rasool,
Fahmeeda Akhtar
INTRODUCTION: Irregular antibodies are antibodies other than naturally

occurring Anti-A or Anti-B. Alloimmunization occur when an incompatible antigen
introduced in an immuno-competent host evokes an immune response. Rh, Kell, JK
and MNS blood group systems are most important irregular red-cell alloantibodies
in daily transfusion practice. Of these, D antigen is most immunogenic. The
techniques applied to detect irregular RBC antibodies are indirect anti-globulin test
and red cell panel studies. In case of an irregular antibody detected, RBC's lacking the
corresponding antigen are transfused. Problems of alloimmunization include
delayed hemolytic transfusion reaction and clinical hemolysis. Studies in general
population report antibody frequency after transfusion of <1-3% but in multi
transfused patients it is upto 70%.
METHODS: Irregular antibodies were detected in our study by using indirect anti-
globulin test (IAT).
RESULTS: One year study was done in the department of Blood Transfusion and
Immuno-haematology at SKIMS Srinagar from June 2013 to June 2014.A total of
11,700 donors were screened by indirect Coombs test (98% males,2% females ).A
total of 28 donors tested positive (Prevalence 0.24% ).
CONCLUSION: Frequency of irregular antibodies in this study was
0.24%.Prevalence was more in females (0.85% ) than males (0.23% ).Most common
factors for alloimmunization were transfusion history, pregnancy, bad obstetric
history and ethinicity. Alloimmunization due to foreign RBC antigens is an
important adverse effect of blood transfusion. Allo-immunization can be prevented
by extensively matched blood and extended phenotype matching.

Clinical spectrum and prognosis of patients with acute
kidney injury in acute coronary syndrome
Department of Cardiology, Sher-i-Kashmir Institute of Medical Science, Srinagar
Sheenam Gazala
ABSTR ACT
Vicar M. Jan
INTRODUCTION: Acute kidney injury (AKI) is common in patients

hospitalized with an acute myocardial infarction (AMI), developing in 1 in 5
patient. Development of AKI is associated with adverse long-term outcomes,
including development of permanent renal impairment and end-stage renal
disease. Moreover, even minor increases in serum creatinine level are
associated with increased in mortality.
METHOD: It was a prospective study which was conducted under
cardiology department of Skims, where patients admitted with ACS were
assessed for AKI. Sample of 200 patients will be taken. Sr. creatinine at time of
admission, 24,48hrs, predischarge. UAAP patients 3ml blood was taken in
plain vial and after centrifugation serum creatinine level and eGFR were
calculated. Follow up of the patient for short term (30 days) and long term
period (1 year) was done.
RESULT: In our sample of 200 patients, we have shown that there has been a
significant increase in 1 year mortality and morbidity in those patients who
developed AKI.
In our study Incidence of AKI in acute MI patient is 17.5%.Mortality of AKI
patients with Acute MI is 17.1% and in MI patients without AKI is
3%.Smoking and dyslipedemia were the main risk factors in patients with AKI.
Among AKI patients 77.1% developed CKD.
CONCLUSION: In our study we have showed that development of AKI was
an independent risk factor of 1-year mortality after MI. our findings highlight
importance of dynamic serum creatinine monitoring to short term
stratification of ACS patients.

Correlation of cardiac Troponin I levels with infective
endocarditis and its adverse clinical outcomes
Departments of Cardiology & Immunology & *Molecular Medicine, Sher-i-Kashmir

Zubair Ahmad Thokar,

ABSTRACT Khurshid Aslam Khan
Shah Zaffar Amin*,
Rashid I
INTRODUCTION: Troponin T and I are well established markers of
increased risk in acute coronary syndromes and are highly specific for
irreversible myocardial cell death. It has become well recognized that
conditions, sometimes seemingly unrelated to the heart and obstructive
coronary disease, also have the potential to cause a rise in serum troponin
titers. These include acute pulmonary embolism, heart failure, end stage renal
disease (ESRD), noncardiac critically ill emergency department patients and
Infective Endocarditis (IE), which is associated with considerable morbidity
and mortality.
METHODS: The patients enrolled were those with IE diagnosed by
Modified Duke Criteria. All patients had at least 3 ml of blood drawn and
harvested serum was stored at -20°C. Patients with conditions known to
increase cardiac troponin I levels and unrelated to IE were excluded from the
study. The serum cardiac Troponin I assay was performed by ELISA. A cardiac
troponin I level >1.0 ng/ml was considered increased. All data was analyzed by
independent- samples t test using SPSS V 16.0.
RESULTS: The study showed 35% patients had increased cardiac troponin I
levels, using Enzyme Linked Immunosorbent Assay (ELISA) method for
quantitative estimation. The adverse clinical outcomes (including in-hospital
mortality, CNS events and perivalvular invasive infection) occurred in 78% of
patients with increased cardiac troponin I levels versus 6% of patients with
normal cardiac troponin I levels (p<0.0002).
CONCLUSION: Patients with IE and increased cardiac troponin I levels
have worse prognosis with increased incidence of adverse clinical outcomes
than those with IE and normal cardiac troponin I levels.

Clinical and angiographic profile of patients undergoing
PCI at a tertiary care institute
Department of Cardiology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar
Abid Hussain Bhat

ABSTRACT
Hilal A. Rather
BACKGROUND: Percutaneous coronary intervention (PCI) is widely used

to achieve revascularization of the myocardium in patients with symptomatic
IHD and suitable stenosis of epicardial coronary arteries.
OBJECTIVES: To study the clinical and angiographic profile of patients
undergoing PCI at a tertiary care institute and to prepare baseline data.
METHODS: We conducted prospective and retrospective study of patients
with CAD at SKIMS Srinagar. The angiographic characteristics including type
of lesion, extent of lesion, number of vessels involved, size and number of
stents used were assessed.
RESULTS: A total of 580 patients were enrolled. The mean age of study
group was 57.2±9.17 years. The commonest risk factor was smoking (80.5%)
and hypertension (75.3%) and multiple risk factors (≥3) were seen in 222
(38.3%) patients. SVD was the most common (49.83%) followed by DVD
(35.52%) and TVD (14.65%). LAD was the most common vessel involved
(63.1%) with majority of lesions causing 70-99% occlusion. A total of 758
stents were used in 565 patients with (Mean±SD) number of stents per
patient of 1.33±0.622 and majority of stents were used to treat LAD. All stents
used were drug eluting stents (DES). A total of 19 patients had procedure
related complications of which 2 patients died and 3 patients had coronary
artery dissection.
CONCLUSIONS: A significant association was found between obesity and
CAD. TVD was significantly found in patients with three or more risk factors.

Vitamin D levels in patients with chronic stable angina
Departments of Cardiology and Immunology & *Molecular Medicine, Sher-i-Kashmir

Abdul Hamid Raina,

ABSTRACT Mohamad Sultan Allai,
Zafar Amin Shah*
INTRODUCTION: Vitamin D is crucial for cardiovascular health.

Receptors for Vitamin D have been found in cardiomyosites and vascular
endothelial cells leading to wide range of vascular effects. Globally, over one
billion people are vitamin D deficient.
OBJECTIVES:
1. To study the association of vitamin D deficiency with chronic stable
angina.
2. To find any correlation of vitamin D levels with symptom and disease
severity.
3. If there is an association, what is its prevalence?
STUDY DESIGN: A hospital based prospective case-control study.
METHODS: 100 angiographically documented cases of chronic stable
angina were compared to 100 matched controls. Vitamin D was assayed using
ELISA. The serum 25-hydroxyvitamin D level of 30ng/ml was taken normal,
20-30ng/ml as insufficiency and below 20ng/ml as deficiency.
RESULTS: The prevalence of vitamin D deficiency among cases and controls

was 75% and 10%, respectively. The overall prevalence was 42.5%. 75% of
cases were vitamin D deficient (< 20ng/ml); 12% were Vitamin D insufficient
(20-30ng/ml) and 13% had normal vitamin D levels (31-150 ng/ml). The
mean vitamin level among cases and controls was 15.53 and 40.954ng/ml,
respectively (p ≤ 0.0001). Comparing these results, cases were vitamin D
deficient compared to controls (p=0.0001). However, we did not find any
statistically significant relation of vitamin D deficiency with BMI, sex, season,
smoking and symptom or disease severity.
CONCLUSION: We observed a high prevalence of hypovitaminosis D in
our patients of chronic stable angina. Our results add to the existing evidence
suggesting that low vitamin D levels may be an independent, potentially
mofiable cardiovascular risk factor. However cause- effect relation cannot be
drawn from our study.

Impact of surgery on haemoangiogenic profile(VEGF) in
lung cancer
Department of Cardiovascular & Thoracic Surgery, Sher-i-Kashmir Institute of Medical

Sciences, Srinagar
Shabir Hussain Rather,

Syed Mudasar, ABSTRACT
Abdul Majeed Dar
INTRODUCTION: Lung cancer is the major cause of cancer-related deaths

worldwide. Recent studies have shown a potential of plasma VEGF, a
haemangiogenic factor, as diagnostic and prognostic marker in lung cancer.
OBJECTIVES: The main objective of the study was to evaluate the serum
VEGF levels pre-operatively and post operatively in lung cancer patients.
Study design: Total of fifty(50) confirmed lung cancer patients along with one
hundred age and sex matched normal subjects as controls were taken into the
study.
METHODS: Plasma VEGF levels were measured preoperatively and four
weeks postoperatively by ELISA technique using the commercially
manufactured ELISA kit for VEGF estimation. Standard statistical tests and
repeated measurement analysis have been used to analyse the data.
RESULTS: VEGF expression was correlated with various clinicopathological
characteristics and the plasma VEGF levels were statistically significant for the
lymph node metastasis, higher pathological stage and tumor grade (P value <
0.05) pre-operatively. Of total 50 patients VEGF was elevated in 21 cases and
decreased to statistically significant levels in 13 of 21 patients (62%) four weeks
after surgery.
DISCUSSION AND CONCLUSION: Of the 50 NSCLC patients in the
study VEGF plasma levels were elevated in 21 cases (42%) preoperatively.
After surgery VEGF levels were decreased to statistically significant levels in 13
of 21(62%) patients thereby suggesting role of VEGF as prognostic and
diagnostic factor in resectable lung cancers.
Keywords: VEGF (Vascular endothelial growth factor), ELISA (Enzyme

linked immunosorbent assay), NSCLC (non-small cell lung cancer)

A prospective randomised comparative study of
comparison between stappled and hand sewn
anastomosis in GE junction and lower esophageal growth
Department of Cardiovascular Thoracic Surgery and *General Surgery, Sher-i-Kashmir

ABSTRACT Khurshid Ahmad Gani,

Shyam Singh,
*Rouf Ahmad Wani
MATERIAL AND METHODS: The study was conducted between June
2012 to September 2014 and included 48 patients (29 male, 19 females) with
mean age of 49 ± 5 years. In 25 patients hand sewn anastomosis was done and
in 23 patients stapler (Linear and Circular) was used for anastomosis.
RESULTS: The mean operating time, as defined from the start of incision to
the complete closure of wound was 227±12.4 minutes in the hand sewn
group & 196±14.37 minutes in the stapler group (p value= < 0.001). The
mean blood loss in the hand sewn group was 972±69.34 ml, while as it was 784
± 69.79 ml in stapled group (p value= <0.001). Anastomotic leak rate:5 out of
25(20.0%) patients in the hand sewn group developed clinical evidence of leak,
as compared to 3 out of 23 (13.0%) patients in the stapled group. The length of
hospital stay(11 days in hand sewn and 10 days in stapled group).
CONCLUSION: Stapling devices in surgery are a versatile tool in the
armamentarium of a surgeon. Anastomosis by stapling devices in GE junction
surgery is better in terms of operating time, intraoperative blood loss, post
operative leak and hospital stay. However there is no difference in the stricture
formation between the hand sewn & stapled anastomosis.

Role of VCR as second line drug in chronic steroid
refractory ITP (Idiopathic Thrombocytopenic Purpura): A
prospective study
Department of Clinical Haematology, Sher-i-Kashmir Institute of Medical Sciences,

Srinagar
Shabir Ahmad ABSTRACT

Javid Rasool
OBJECTIVE: To evaluate the practical role of vinca alkaloids (VCR) as

second line drug in idiopathic thrombocytopenic purpura.
PATIENTS AND METHODS: Our study was conducted in department of
Clinical Hematology SKIMS from august 2012 upto September 2014. Total
number of patients enrolled was 50 and cases included all persons who
fulfilled eligibility criteria. All patients received four doses of VCR 1.5mg/
2
m /wk I/V push each week for a period of four weeks. This was followed by
observing platelet response on day 1, day3 and day7 each week for four weeks.
RESULTS: This study showed that Out of all female patients (40), 2(4%)
showed no response, 29(58%) were partial responders and 9(18%) showed
complete response. In this study we had 10 males out of which 9(18%) showed
partial response and 1(2%) showed complete response. Overall 4% Of patients
showed no response, 76% of patients showed partial response and 20%
showed complete response. Total number of patients which showed response
to VCR including both partial responders and complete responders is 96%
which is significantly high and statistically significant.
CONCLUSION: VCR has a double action (cytostatic and thrombo-
cytopoietic) that would be an advantage compared to other agents. Therefore,
we suggest an effective, economical and second line role of VCR in steroid
refractory ITP.

An epidemiological study of pulmonary morbidity among
manual stone cutters of Hajin Health Block of district
Bandipora, J&K State
Department of Community Medicine, Sher-i-Kashmir Institute of Medical Sciences,

Srinagar
Feroz Ahmad Wani,

ABSTRACT Abdul Majid
INTRODUCTION: Respiratory problem due to stone dust is one of the

major health hazards in dust-exposed workers. The role of occupation is very
important not only in the genesis but also in the control and prevention of
diseases.
METHODS: A community based cross sectional survey was conducted over
a period of one year to evaluate the health status of the workers exposed to
silica dust in their work-place.
RESULTS: The present study showed Mean ± SD age of the study
population 38.43 ± 12.83 (range 16-72) years. Mean duration of work among
the workers was found to be 13.05 ± 8.37 (range 2-45) years. It was seen that
out of all health problems the commonest were the respiratory problems 114
(29.7%). On pulmonary function test (PFT) 59 (15.4%) of the total 384
subjects had restrictive or combined disease and 30 (7.8%) of the total subjects
had obstructive disease. Of the 164 subjects who reported back with good
quality chest radiograph and sputum examination, 41 (25.0%) had silicosis on
X-ray of which 26 (15.8%) had simple silicosis while 12 (7.3%) had
silicotuberculosis and 3 (1.8%) had progressive massive fibrosis (PMF). Only
6 (3.6%) had sputum positive for tuberculosis.
CONCLUSION: The present research has also revealed that continuing the
occupation of quarrying for >15 years may add to the development of several
respiratory morbidities such as wheeze, early morning sputum production,
and chronic bronchitis; this also reduces the pulmonary function tests which
will in turn have deleterious effect on the health status of the population more
so with respiratory morbidity.

An epidemiological study of risk factor profile of major
non-communicable diseases in adult population of block
Hajin
Department of Community Medicine, Sher-i-Kashmir Institute of Medical Sciences,

Showkat Ahmad Khan, Srinagar
M Rafiq Mir
Rauf ur Rashid ABSTRACT
Ruhul Jabeen
INTRODUCTION: Non-communicable diseases (NCDs) and their
associated risk factors have emerged rapidly and have become a major public
health challenge worldwide; the most globally pervasive change has been its
rising burden. Often the prevalence of NCDs in a population is directly
related to prevalence of its risk factors so preventing these risk factors will
prevent these diseases.
METHODOLOGY: A total of 960 individuals were studied. WHO STEP
wise approach was utilized for conducting the study. A cross sectional
multistage cluster sampling design was used based on the WHO STEP wise
Approach.
RESULTS: 324 respondents were males and 636 females; majority were
married, illiterate, in the age group of 35 - 44 years, females engaged in
household work, males as skilled workers with majority of participants
belonging to socio economic class III. The percentage of tobacco users was
28.85%,The prevalence of low physical activity was 29.16%,The prevalence of
over-weight as 28.33%,The prevalence of obesity was 12.29%,The prevalence
of Diabetes Mellitus was 4.16%,The percentage of respondents with waist to
height ratio of greater than 0.5 was 30.25%,The percentage of participants with
sub optimal cholesterol levels was 12.5%,The prevalence of hypertension was
14.47%
CONCLUSION: Our study confirms the high burden of NCD risk factors
in rural areas and reiterates the need to address these issues comprehensively as
a part of NCD prevention and control strategy.

Carotid intima-media thickness in patients with type 1
diabetes
Departments of Endocrinology and Radio-diagnosis, Sher-i-Kashmir Institute of

Huma Noor,
ABSTRACT Mir Iftikhar Bashir.
Feroze Shaheen
BACKGROUND: T1DM is associated with increased incidence of

cardiovascular disease. Measurement of Carotid intima-media thickness
(CIMT) is well established non-invasive imaging technique to identify and
quantify atherosclerosis that correlates with coronary disease.
OBJECTIVE: To assess the CIMT in T1DM and compare it with age and
sex-matched controls and evaluate its relationship with various risk factors.
STUDY DESIGN: Prospective case -control study.
METHODS: One hundred T1DM patients and fifty age and sex-matched
healthy controls were recruited and far-wall CIMT was measured by B-mode
Doppler ultrasonography in six carotid artery segments (right and left CCA,
ICA and Bulb). Overall mean CIMT was calculated as mean of six
measurements for each subject.
RESULTS: Overall mean CIMT was greater in patients with T1DM
compared to healthy controls (0.6±0.1mm and 0.4±0.1mm respectively).
Mean left CIMT (0.66±0.22mm) was more than mean right CIMT
(0.62±0.21mm) in cases as well as controls (0.43±0.11mm and
0.37±0.10mm respectively). CIMT values showed significant correlation
with age, duration of diabetes, BMI, dyslipidemia, SBP, fatty liver and
microvascular complications (p<0.0001). Multiple regression analysis
however, showed significance for systolic BP and weight only.
CONCLUSIONS: This study demonstrates that atherosclerotic burden
assessed by CIMT is increased in our T1DM population. Risk profiling by
CIMT measurement may allow targeting of high risk patients for aggressive
interventions to prevent CVD.
Key words: T1DM, CIMT, Atherosclerosis

Etiological profile of Thyrotoxicosis
Departments of Endocrinology , Sher-i-Kashmir Institute of Medical Sciences, Srinagar
Hilal Ahmad ABSTRACT

Arshad Iqbal Wani
INTRODUCTION: Thyrotoxocosis is a condition resulting from excess

thyroid hormone action regardless of the source.
METHODS: All new patients of thyrotoxicosis were subjected to baseline
investigations, USG neck, Thyroid scan, Anti TPO and TFT.
RESULTS AND CONCLUSION: 48% Graves, 38% Thyroditis 8% TMG,
6% Toxic Adenoma.

Otoendoscopic exploratory tympanotomy in conductive
hearing loss
Department of ENT, Government Medical College, Srinagar
ABSTRACT Oliyath Ali

Sajad Majid Qazi
INTRODUCTION: The endoscopic lens brings the surgeons view into the
depths of the operative field which translates into a better view of the
important middle ear structures during exploratory tympanotomy with
minimal collateral probing and damage to healthy bone.
OBJECTIVES: To evaluate the feasibility and efficacy of using otoendoscope
in exploratory tympanotomy. To correlate the otoendoscopic operative
findings with probable preoperative clinical diagnosis and to assess the
treatment results.
METHODOLOGY: 25 patients of CHL with intact tympanic membrane
underwent exploratory tympanotomy using the otoendoscope performed off
the monitor and digitally recorded. Operative steps, intraoperative findings,
preoperative and postoperative audiometric data were recorded and analyzed.
RESULTS: With the otoendoscope we could get excellent access to the
middle ear with no handling of the chorda tympani nerve in 16 (64%) and no
need for curetting posterosuperior bony overhang in 17 (68%) patients.
Operative findings were otosclerosis in 16 (64%) patients, ossicular
discontinuity in 3 (12%) patients and others in 6 (24%) patients. Most
common hearing reconstruction procedure done was stapedotomy done in 17
(68%) patients. Mean postoperative gain in air conduction (AC) was 29.20 +
10.53dB. Successful stapedotomy resulted in improvement in tinnitus in 9/13
(46.15%) patients.
CONCLUSION: Use of otoendoscope for exploratory tympanotomy is not
only feasible but highly efficient both for diagnosing and treating middle ear
pathologies associated with conductive hearing loss with an intact tympanic
membrane.

Growth retardation in children with EHPVO
Departments of Gastroenterology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar
Toufeeq A. Mir
Showkat A. Zargar
ABSTRACT
BACKGROUND: Children diagnosed with long-established extrahepatic

portal vein Obstruction (EHPVO) are more prone to show growth deficit.
OBJECTIVES: To study the growth parameters and growth-related
hormone profile in children with EHPVO and their comparison with sex-
and-age matched controls and effect of shunt surgery on growth parameters.
METHODS: Thirty patients diagnosed with EHPVO were enrolled.
Anthropometric parameters were measured in patients and controls. GH,
IGF-1, and IGFBP-3 levels were also estimated. Effects of shunt surgery were
studied on growth parameters.
RESULTS: Out of 30 Patients, 18 (60%) had height below 5th percentile
while only 1 (3.3%) out of 30 controls had height <5th percentile. 20 (66.7%)
patients had weight <5th percentile while only 2 (6.7%) of 30 controls had
weight <5th percentile. Mean Z score for height for cases was (-1.797) and
for controls was (0.036), [P<0.001]. Mean Z score for weight for cases was (-
1.258) and for controls was (-0.004), [P<0.001]. Mean BMI for cases was
(16.79kg/m2) and for controls (18.71kg/m2), [P<0.014]. Out of 12 patients
who underwent shunt surgery, 9 (75%) had height below 5th percentile before
surgery. After surgery six patients (66.66%) out of nine showed improvement
in height (>5th percentile).Improvement in weight (>5th percentile) after
surgery was documented in six patients (75%) out of eight. High levels of
mean fasting GH for cases (5.00ng/ml) compared to controls (1.78ng/ml),
[P<0.012]. Low levels of mean fasting 'IGF-1' for cases (1.02 ng/ml)
compared to controls (2.36ng/ml), [P<0.001], and low mean fasting 'IGF-BP-
3' for cases (297.74pg/ml) compared to controls (595.57pg/ml)[P<0.001],
were documented respectively.
CONCLUSIONS: Growth retardation occurs in children with EHPVO in
terms of anthropometric measures.

Role of hepatic venous pressure gradient as a
predictor of response to endoscopic variceal
ligation in patients of cirrhosis
Departments of Gastroenterology and *Cardiology, Sher-i-Kashmir Institute of Medical

Sciences, Srinagar
Shoiab Mohammad
ABSTRACT G M Gulzar
*Mohammad Sultan Alai
BACKGROUND: Portal hypertension is a major hallmark of cirrhosis.

HVPG is currently the gold standard for diagnosis of portal hypertension.
Several studies have been conducted in the recent past to assess the correlation
of HVPG with severity of liver disease and cirrhosis related complications. Till
date no study has been done to assess the influence of HVPG on variceal
eradication by EVL.
OBJECTIVES: To assess the role of HVPG as a predictor of response to
EVL in patients of cirrhosis with esophageal varices in terms of success or
failure of eradication of varices, number of EVL sessions required. Also to
correlate HVPG with severity of liver disease and its complications.
METHOD: After measuring the baseline HVPG of total 40 study subjects(of
cirrhosis with medium/large-sized esophageal varices) patients were subjected
to EVL. In all patients, we assessed success or failure of eradication of varices,
number of EVL sessions required for eradication along with cirrhosis related
complications and clinical characteristics.
RESULTS: In all 40 patients variceal eradication was achieved irrespective of
HVPG level. It was observed that patients with higher mean HVPG levels
required more number of EVL sessions for variceal eradication compared to
patients with lower mean HVPG levels (p < 0.001). Also a significant
correlation was observed between HVPG and Child Class, variceal bleeding
status, ascites and variceal size.
CONCLUSION: In cirrhotics with esophagealvarices, HVPG has a
significant influence on response to EVL, in terms of number of sessions
required for variceal eradication. Patients with high HVPG levels require
more number of sessions. Also HVPG correlates well with the complications
of cirrhosis.

Validation of early dynamic model (EDM) in predicting
the outcome of acute liver failure (ALF) in Kashmir
valley: A prospective study
Departments of Gastroenterology & *Cl. Biochemistry, Sher-i-Kashmir Institute of

Ramees Mohiudin Mir,

Gul Javid, ABSTRACT
*Syed Mudassar
OBJECTIVE: To validate early dynamic model in our acute liver failure

patients to predict the outcome of ALF, to stratify ALF into low risk, moderate
risk and high risk , and to compare EDM with preexisting models like MELD
and KCH.
MATERIAL AND METHODS: In this study 40 patients of ALF were
enrolled (19 males, 21 females), who fulfilled the eligibility criteria. Besides
baseline investigations and etiological workup of ALF, arterial ammonia levels
were taken. The EDM which takes into consideration 4 dynamic variables
(Hepatic encephalopathy, INR, Arterial ammonia levels, and serum bilirubin)
was applied to ALF patients on day 1 and day 3 and accordingly classified into
low risk, moderate risk and high risk.
RESULTS: The mean age of ALF patients was 28.30±16.1 yrs. ALF had a
mortality of 65% in our cohort. The most common cause of ALF was
undetermined (30%) with maximum mortality. ALFED Score classified 8
patients into low risk with 0% mortality, 8 patients into moderate risk with
25% mortality and 24 patients into high risk with 100% mortality. The ALFED
Model showed an excellent area under ROC of 0.992 with std. error of 0.009 at
cut off score of ≥4 with P value≤0.0001 which is highly significant and hence
accurately predicts the outcome in ALF.
CONCLUSION: Acute liver failure Early Dynamic model is simple,
dynamic, reliable model in predicting the outcome of ALF. It assists clinicians
to select appropriate candidates for liver transplantation. ALFED Model is
superior to both KCH and MELD scores even when their 3 day scores are
taken into consideration.

Albumin as an adjuvant to antibiotic therapy in
non-SBP infections in patients with chronic liver
failure, acute on chronic liver failure & acute liver
failure – A prospective randomized study
Departments of Gastroenterology & *Immunology & Molecular Medicine, Sher-i-

Shabir Ahmad Lone,

G.N.Yattoo,
ABSTRACT
*Zafar A Shah
OBJECTIVES: In patients with cirrhosis and SBP, the administration of

albumin prevents the development of renal failure, and improves survival.
Whether albumin has similar beneficial effects in patients with infections
other than SBP, the data is limited.
MATERIALS & METHODS: A total of 95 patients with diagnosis of CLF,
ACLF & ALF were recruited in the study .The patients in albumin group
received intravenous albumin at a dosage of 1.5 g/Kg body wt. at day one; 1.0
g/Kg body wt. at day three whereas patients in control group received
supportive treatment only. The main end points of the study were effects on
renal function, infection resolution, 3 months mortality.
RESULTS: Resolution of infection was achieved in 76% & 65.3% in
Albumin & control groups respectively .The total no. of patients who
developed renal failure in Albumin group (18.4%) was not significantly
different from control group (28.2%).At the end of 3 month follow up period,
30 out of 95 patients (31.6%) included had died [14 in albumin(30.4 % ) & 16
in control group (32.7%)] ( p 0.829). Patients in Albumin group were
associated with decrease in plasma levels of TNF –α, IL-6, hsCRP but only
decrease in hs CRP was statistically significant however patients in Control
group showed increase in plasma levels of TNF–α, IL-6 , hsCRP but increase
in plasma levels of IL-6 was statistically significant.
CONCLUSION: Treatment with albumin may have beneficial effects on the
infection resolution, renal function, 3 month mortality in non-SBP
infections. The relatively low number of patients included in the current study
did not allow performing accurate sensitivity analyses.

Prevalence of H. Pylori, Endoscopic and Pathological
findings Between Chronic kidney disease Patients and
Normal Population
Departments of Gastroenterology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar
Mohammad Tahir, ABSTRACT

Altaf Hussain Shah
OBJECTIVES: The purpose of this prospective study is to determine the

prevalence of H. pylori, endoscopic and pathological findings among patients
of chronic kidney disease and Normal population.
METHODS: This study was carried out at SKIMS Soura from (2012-2014).
70 patients of CKD (Cases) underwent upper GI endoscopy. Endoscopic
changes were described and multiple antral gastric biopsies were taken one for
histopathological examination and another for detection of H. pylori by rapid
urease test. These findings were compared to findings in 50 consecutive
patients (controls) with normal renal function undergoing endoscopy for
assessment of dyspepsia.
RESULTS: The Endoscopic findings were abnormal in 63(90%)among
cases with antral gastritis as most common finding in 29(42%) and among
controls EGD findings were abnormal in 39(78%) patients with antral gastritis
in 16(32%)(p =0.436). Among 70 cases RUT was positive in 57(81.4%),
negative in 10(14.3%) and among 50 controls RUT was positive in 42(84%),
negative in 8(16%) patients (p = 0.445). On HPE for H. pylori detection
among cases H. pylori was positive in 52(74.3%), negative in 15 (21.4%) and
among controls H. pylori was positive in 40(80%), negative in 9(18%) (p =
0.698).The HPE findings on microscopy among cases reveals chronic active
gastritis as most common finding seen in 51(72.9%) and among controls
Chronic active gastritis was seen in 34(68%)(p value=0.166).
CONCLUSION: The prevalence of H. pylori, endoscopic and pathological
findings are same among patients of CKD and normal population with GI
Symptoms with antral gastritis as most common EGD Finding and chronic
active gastritis as common HPE finding.

Alternative reconstruction after pylorus preserving
pancreaticoduodenectomy - SKIMS experience
Department of General Surgery and *Gastroenterology, Sher-i-Kashmir Institute of

Arshad A Baba,
Sameer H Naqash,
ABSTRACT Mubashir A Shah,
*Bashir A Khan
BACKGROUND: Pancreaticogastrostomy has been known as a method of

reconstruction after pancreaticoduodenectomy. The purpose of this study is to
present the results of pancreaticogastrostomy after pancreaticoduodenectomy,
feasibility of cannulating CBD after reconstruction and ability to control post
operative anastomotic bleed at one department of our hospital.
METHODS: We conducted the study in retrospective cum prospective
manner; retrospective from January 2011 to May 2012 and prospective from
June 2012 to October 2014. Pylorus preserving pancreaticoduodenectomy
were performed in 40 cases. The reconstruction was done by invaginating the
cut end of the remnant pancreas into the posterior wall of stomach (end-to-
side Pancreaticogastrostomy). The divided jejunum was taken retrocolically
and anastomosed with the stomach at the divided pylorus (end-to-end
gastrojejunostomy). Hepaticojejunostomy was done about 10cms from
gastrojejunostomy in an end to side manner. In all of them, pancreatico-
gastrostomy was the method of choice for pancreatic-enteric anastomosis.
RESULTS: Out of total 40 patients operated 7 (17.5%) patients developed
post op complications. One (2.5%) developed biliary leak, 3 (7.5%) developed
intra abdominal collection, upper GI bleed was seen in 1 (2.5%) patient and
pancreatic fistula developed in 1(2.5%) patient and 1 (2.5%) developed cardiac
complication (bradycardia). We were able to cannulate CBD in 37 (92.5%)
patients without any major difficulty. One (2.5%) patient required operative
intervention for pancreatic fistula and one (2.5%) patient died during the
hospital stay.
CONCLUSION: We recommend pancreaticogastrostomy as a simple and
safe method of reconstruction after pancreaticoduodenectomy with low
mortality and morbidity rates.

Parameters for therapeutic laparotomy in blunt trauma
abdomen
Department of General Surgery & *Radiology, Sher-i-Kashmir Institute of Medical

Sciences, Srinagar
Younis A Mir,
Khursheed A Wani,
Rauf A Wani, ABSTRACT
*Naseer A Choh
BACKGROUND: The rapid identification of potentially life threatening

intra-abdominal injury is critical for patients who sustain blunt
abdominal trauma. There are certain clinical and radiological parameters
available in the emergency department, which determine the need of
therapeutic laparotomy in them.
METHODS: A prospective observational study was conducted on blunt
abdominal trauma patients and their clinical, laboratory and radiological
parameters were collected. Patients were followed to determine if they
underwent a therapeutic laparotomy or non-operative management.
RESULTS: Out of total 144 patients included in the study, 93 (64.58%)
patients were selected for Non Operative Management (NOM), and 51
(35.4%) patients underwent therapeutic laparotomy. NOM was
successful in 76(81.73%) patients, whereas 17(18.27%) failed NOM and
were operated. Using recursive partitioning analysis, the most important
predictor for a therapeutic laparotomy, was whether the patient has a
ED SBP of ≤ 90mmHg. The other parameters significant ( p < 0.05)
for a need of therapeutic laparotomy include, ED Pulse Rate >110/min;
Total Fast Score >3; Large amount of Hemoperitonium; Presence of
Abdominal Guarding; Hemoglobin levels of less than 10g/dl at
admission; Presence of pallor and Polytrauma.
CONCLUSION: There are certain immediately available clinical, and
radiological parameters, which if validated by a prospective, large sample
size study could help in deriving a decision rule or even a scoring
system that would determine the need for therapeutic laparotomy in
blunt trauma abdomen patients.

Mechanical bowel preparation versus no preparation in
elective colorectal surgery
Department of General Surgery, Sher-i-Kashmir Institute of Medical Sciences, Srinagar
ABSTRACT Altaf Hussain,

Fazl Q. Parray,
Nisar A. Chowdri,
BACKGROUND: Bowel preparation before colonic surgery usually Rauf A Wani
includes broad spectrum antibiotic therapy together with oral mechanical
bowel preparation(MBP).This is a common practice before elective colorectal
surgery followed worldwide even today. Its aim is to reduce the postoperative
infectious complications although MBP may cause discomfort to patients,
prolonged hospitalization and water and electrolyte imbalance. The aim of this
study was to assess whether elective colorectal surgery can be performed
without MBP or not.
METHOD: Patients were randomized into two groups with random number
table method Group-1(Cases) without MBP and Group-2(Control) with
MBP with polyethylene glycol before surgery. To all patients broad spectrum
antibiotic dose was given. One month follow-up done for wound infection,
anastomotic leak and intra abdominal/pelvic collection.
RESULTS: 202 patients were included in this randomized control study
operated for elective colorectal surgery at SKIMS. Group-1 had 98 patients
and Group-2 had 104 patients. Both the groups were comparable in their
preoperative parameters, type of surgery performed intraoperative findings
and type of anastomosis. However the overall complication was 32.6% in cases
and 39.4% in control group. Wound infection, anastomotic leak and intra
abdominal/pelvic collection occurred in 6.1%,2% and 5.1% in cases and 3.8%,
3.8% and 6.7% in control group respectively.
CONCLUSION: MBP in elective colorectal surgery has no additional
benefit rather has deleterious effects on patients. Our study suggested that no
advantage is gained by preoperative MBP in elective colorectal surgery and can
be easily abandoned.

Surgical management of adrenal tumours in a tertiary
care hospital
Department of General Surgery & Endocrinology, Sher-i-Kashmir Institute of Medical

Sciences, Srinagar
Anjum Nazir Lone,

Khursheed Alam Wani, ABSTRACT
*Shariq Rashid Masoodi,
Rauf Ahmed Wani
BACKGROUND: Most of the adrenal tumours are benign and common
surgical mode of treatment is Laparoscopic adrenalectomy (LA).
OBJECTIVE: To study the clinical spectrum and surgical outcome with LA
versus open adrenalectomy(OA) for adrenal tumours..
STUDY DESIGN: A retrospective review of data collected prospectively.
METHODS: Patients who underwent adrenalectomy (LA/OA) from 1995
to 2012 and 2012 to 2014 were selected for retrospective and prospective
analysis respectively. Patient factors, surgical approach, operative outcomes,
and complications were analyzed.
RESULTS: From 1995 to 2014, 125 patients underwent adrenalectomy of
whom histopathological diagnosis available in 97 subjects included
pheochromocytoma (n = 40), adrenocortical adenoma(n=14), myelolipoma
(n=13), adrenal hyperplasia/Cushing's syndrome (n = 8), paraganglioma(n =
7), adrenal cyst(n = 7), Conn's syndrome(n = 2), adrenal Carcinoma(n = 2),
oncocytoma(n=1) and other miscellaneous lesions (n=3). Of the 58
adrenalectomies completed between 2011 and 2014, LA was performed in 32
of whom 5 had to be converted to OA. Mean Tumorsize(±SEM) was 4.6±0.3
cm(range, 1.5 to 8.4)and 7.4±0.6 cm(range, 2.4 to 13.0) in LA and OA
respectively. Compared to OA, patients with LA had lesser tumor size, shorter
surgery time, lesser blood loss, earlier drain removal, earlier feeding, earlier
ambulation and earlier return to work. Mean hospital stay for LA was 4.0 days
compared to 7.3 days for OA.
CONCLUSION: Pheochromocytoma is the commonest functional adrenal
tumour encountered. Despite being on a learning curve, our results are
commensurate with those in the literature for LA.

Role of ligation of intersphincteric fistula tract (LIFT);
technique in management of fistula in ano

Saalim Nazki,
Nisar A Chowdari,
ABSTRACT Fazl Q Parray,
Rouf A Wani,
Khursheed A Wani
INTRODUCTION: A novel sphincter saving technique known as Ligation
of Intersphincteric Fistula Tract (LIFT) involves ligation and division of the
fistula tract in the intersphincteric space without using any biological material.
The aim of the study was to see the feasibility and results of LIFT technique in
managing different types of fistula in Ano and the postoperative complications
and recurrence rates.
METHOD: A prospective study conducted by colorectal division of general
and Minimal Invasive surgery, SKIMS Srinagar over a period of 26 months.
Patients with Fistula in Ano were enrolled for the study. Detailed history,
clinical examination & evaluation were done as per the protocol. Patients were
subjected to standard surgical treatment. All patients were followed regularly
and results analyzed statistically.
RESULTS: Only 38.2% cases of all Fistula in Ano could be treated by this
technique. It is safe and simple technique but difficult in patients with
complex fistula in ano. None of the patients had post-operative incontinence
however 6.4% had post-operative infection and 12.9% had wound dehiscence.
Recurrence was observed in one patient.. While 77.41% cases had less than 1
day post-operative stays in hospital 22. 58% had more than one day hospital
stay among the cases dealt with LIFT technique. On satisfaction score, 67.74%
patients who underwent LIFT technique were satisfied and 22.58% were non-
satisfied. The median follow up was 17.6 months.
CONCLUSION:The ligation of the intersphincteric fistula tract technique
for fistula-in-ano surgery, which aims at total anal sphincter preservation is
safe and easy to perform but has its demerits too. Further modifications are
needed to treat the complex fistulae and fistulas having multiple tract.

Role of Extra anal/Trans anal anastomosis in low lying
rectal Neoplasms
Iqtibas Ahmad,
Nisar Ahmad Chowdri, ABSTRACT
Fazl Q. Parray,
Rauf Ahmad Wani
OBJECTIVES: To evaluate the role of extraanal/transanal anastomosis in low
lying rectal neoplasms in terms of applicability, feasibility surgical outcome
and complications,.
PATIENTS AND METHODS: 26 patients underwent extraanal/transanal
anastomosis from Oct. 2012 to Nov. 2014. After resection of tumor, CAA was
done by using the technique of rectal stump evertion, pull through and
external coloanal anastomosis followed by repositioning of the anastomosis
inside or end-to-end coloanal anastomosis from within the lumen of bowel by
trans anal approach without prolapsing the distal segment through the anus.
RESULTS: Out of 26, carcinoma rectum was in 21(80.76%) and benign
pathology in 5(19.23%) patients. Mean distance of growth from the anal verge
was 6cm. Fecal continence was preserved in 21(84%) of patient, mild
incontinence in 2(8%), moderate in 1(4%) and complete incontinence in
1(4%) patients. The mean frequency of stools was 3.2 times/day at the end of 6
months which got decreased to 2.8 at the end of one year. Local recurrence was
observed in 1 (3.84%) patient. Two deaths were observed in this study.
Morbidity occurred in 6 (23%) of patients.
CONCLUSION: Patients with low lying rectal tumors must be carefully
evaluated to avoid an APR if similar control of disease can be achieved with less
invasive procedure with acceptable complication rate. Small tumors can be
offered safely trans anal excision and larger ones need standard trans
abdominal mesorectal excision with coloanal anastomosis by extra anal/trans
anal approach.

Methylation status of Netrin 1 gene receptor in
Colorectal cancer patients from Kashmir valley
Department of General Surgery and *Immunology & Molecular Medicine, Sher-i-

Sartaj Ahmad Guroo,

ABSTRACT Ajaz A. Malik,
*Dil Afroze
AIMS: To study the hypermethylation status of Netrin-1 receptor gene, role

of methylation status in the prognosis and correlation (if any) of Netrin-1
receptor gene with the clinicopathological characteristics of CRC patients.
MATERIALS AND METHODS: This study comprised of 50 patients with
colorectal carcinoma. Histopathologically confirmed tumor specimens and
normal tissues were analyzed for hypermethylation status in the promoter
region of UNC5C gene by Methylation Specific-Polymerase Chain Reaction
(MS-PCR) using EZ-DNA Methylation Direct™ Kit.
RESULTS: Out of 50 patients 62% of cases exhibited hypermethylation(
66.66% of males and 55% females with p=0.55) while 38% were
unmethylated(p<0.0001). Relationship between hypermethylation and age
does not correlate statistically (p=0.76). Patients with smoking history,
70.83% exhibited hypermethylation whereas 29.16% were non-methylated
(p=0.25). Histopathological findings did not vary statistically with the
methylation status. Patients with active lifestyle,55.88% exhibited
hypermethylation whereas 75% of patients with sedentary lifestyle exhibited
hypermethylation (p=0.25). Patients with stage I & II disease,42.85%
exhibited hypermethylation whereas 75.86% of patients with stage III & IV
exhibited hypermethylation with significant p value (p=0.01)
CONCLUSION: We provide the evidence that most CRCs have alterations
in UNC5C netrinreceptors. The current data suggests that hypermethylation
of UNC5C is a common event in colorectal carcinogenesis that may lead to
loss of UNC5C protein expression. Thus UNC5C may act as a tumour
suppressor gene and UNC5C methylation might present a malignant
potential in colorectal cancer. This emphasizes the importance of Netrin-1
pathway in colorectal cancer.

Effect of preoperative oral calcium and vitamin D
supplementation on postoperative symptomatic and
biochemical hypocalcemia after total thyroidectomy
Department of General Surgery, *Endocrinology, Sher-i-Kashmir Institute of Medical

Sciences, Srinagar
Sumiya Jaan,
Khurshid A. Wani,
*Bashir A. Laway,
ABSTRACT
Rauf A. Wani
BACKGROUND: Hypocalcemia is one of the important problem after
total thyroidectomy. The aim of our study was to study the role of preoperative
oral calcium and vitamin D supplementation on postoperative hypocalcemia
in patients who underwent total thyroidectomy.
METHODS: Patients undergoing total thyroidectomy were prospectively
randomized into two groups, Group-1 received oral calcium and vitamin D
supplement preoperatively for 1 week and then postoperatively for 1 week,
and Group-2 did not receive any calcium and vitamin D supplement. Patients
were followed up for 1 month for signs and symptoms of hypocalcemia.
RESULT: 60 patients were included in this hospital based prospective
randomized control study. 30 patients in Group-1 and 30 patients in Group-2.
The patients in these two groups did not significantly differ in terms of their
disease. At 24 hours there was significant difference between signs and
symptoms among the two groups with P value of 0.015. Four patients
developed carpopedal spasm and were given intravenous calcium carbonate
and these patients were in no supplement group.
CONCLUSION: Our data suggest that routine oral calcium and vitamin D
supplements are effective in reducing the incidence and severity of
hypocalcemia after total thyroidectomy.

Do Phosphodiesterase (PDE) inhibitors improve
Urodynamic Parameters in patients with Suprasacral
spinal cord injury (SSSCI)? A Prospective Study
Department of General Surgery & *Neurosurgery, Sher-i-Kashmir Institute of Medical

Sciences, Srinagar
Muzzain Iqbal,
ABSTRACT Baldev Singh Wazir,
*Sarabjit Singh Chibber
PURPOSE: To analyze urodynamic parameters in patients with SSSCI and

effect of PDE inhibitors in improving these parameters.
MATERIALS AND METHODS: It was a prospective study conducted on
patients with SSSCI from Nov 2012 to Oct 2014 who came for follow up in
Department of Neurosurgery/Urology with lower urinary tract symptoms.
After taking consent, registered patients underwent urodynamic study which
was repeated 1 hour after taking single oral dose of 20mg tadalafil. Parameters
before and after taking drug were compared for final results and conclusion.
RESULTS: Mean bladder capacity(ml) before taking tadalafil in our patients
was 268.39±130.036 which improved after single 20 mg dose of tadalafil to
298.55±112.027(p-value <0.05).In males, Mean bladder capacity before
taking drug was 246.32±120.123 which increased to 286.36±107.06(p-value
<0.05).In females, single oral dose of tadalafil did not show any statistically
significant improvement in any of the parameters. Patients with injury above
D6 level, Statistically significant improvement was seen in bladder capacity
and bladder compliance which increased form 263.33±123.79 ml to
302.67±123.445 ml and from 17.01±5.63 to 21.733±6.73 ml/cmH2O
respectively after 1 hour of single oral dose of tadalafil (P-value<0.05).
CONCLUSION: Our study suggests a positive role of PDE inhibitors in
improving urodynamic parameters in patients with SSSCI patients. We
observed a statistically significant increase in maximum bladder capacity in
whole study group and bladder compliance and capacity in patients with
injury at and above level of D6 spine.

A study of the Neonatal Intensive Care Unit of a tertiary
care teaching hospital of North India with special
reference to its utilization in terms of patient volume,
pattern of disease, treatment/intervention and
consequent outcome of admitted patients
Department of Hospital Administration, Sher-i-Kashmir Institute of Medical Sciences,

Srinagar
Yudhvir Singh Kotwal,

Farooq A Jan, ABSTRACT
Ghulam Hassan Yatoo
BACKGROUND: World over, four million newborn babies die in the first
month of life out of which India contributes to about 1.2 million deaths every
year. India thus faces the biggest newborn health challenge of any country in
the world. A study of Neonatal Intensive Care Unit (NICU) was undertaken
at SKIMS Srinagar to determine the pattern of disease, treatment/ intervention
and consequent outcome of admitted patients, the socio-economic
background profile of the parents of the neonates admitted in NICU and for
the assessment of the existing infrastructure of NICU.
METHODS: A prospective study for a period of one year was conducted for
objective one and objective two by using two different proformas. For the
third objective, a direct observational study was conducted.
RESULTS: 1017 neonates were admitted in the NICU. Neonatal Jaundice
(NNJ) (26.7%) was the most common cause of admission to NICU. The
Neonatal Mortality Rate (NMR) was 9.73%. Prematurity (24.2%) was the
main cause to the mortality. The average monthly income of the families was
13281.4. 30% of the mothers were illiterate and 26.5% of the fathers of
neonates were working as Semi-Skilled Workers. The infrastructure in NICU
is sufficient in quantity and quality. However, an air borne isolation room is
not available in NICU and the number of nurses required is less for NICU.
CONCLUSIONS: The NNJ and Prematurity were the most common cause
of admission and mortality respectively. The overall infrastructure of NICU is
adequate and sufficient but an air borne isolation room is required to be
established and the nurse staffing is required as per staffing norms.

Patient safety with special reference to adverse events
taking place in admitted patients in a tertiary care
hospital in north India

Srinagar
ABSTRACT Moonis Mirza,

Farooq A Jan
INTRODUCTION: Adverse events in hospitals are now widely agreed to

be a serious problem, annually killing more people than breast cancer or AIDS.
OBJECTIVE: To study adverse events at SKIMS by current record review.
METHODS: A two staged prospective study for a period of one year was
carried out. Current records of inpatients were screened for adverse events.
The adverse events were categorized as preventable or non-preventable on the
basis of WHO set confidence score of preventability.
RESULTS: 3150 patients were screened, among which 488 (15.5%) patients
were screened positive for having adverse event. Readmission during last 12
months to any given healthcare for the same health condition (32.8%) were
the most common adverse events seen. Hospital acquired infection/sepsis
(26.64%) were the second most common adverse events seen. 78% of adverse
events presented with untoward outcome among which 23.4% adverse events
were associated with disability at discharge, 35.5% adverse events were
associated with prolonged stay, 81.8% of adverse events resulted in admission
in wards and 4.33% adverse events were associated with death. 67.4% of
studied adverse events showed signs of healthcare team responsible for
causing adverse events, among which 76.8% of adverse events occurred
outside SKIMS before the index admission. 71.3% of adverse events were
categorized preventable. Conclusion: Significant numbers of adverse events
were seen in inpatients. Clinicians should be made aware about the adverse
events taking place and subsequent steps should be taken place to decrease the
percentage of adverse events.

Study of Socio-demographic Profile, Morbidity Pattern
and Problems Faced by Geriatric patients attending
inpatient department of SKIMS

Srinagar
Shahnawaz Hamid,
Farooq A Jan ABSTRACT
BACKGROUND: The percentage of elderly population is continuously

increasing in India due to decline in overall death rate, decline in fertility and
sustained improvement in survival. Elderly friendly hospital services can
facilitate timely recovery and discharge of elderly patients thus reducing care
costs.
METHODS: It was a prospective type of study undertaken on elderly people
(> 60 years). It was a Questionnaire based study.
RESULTS: Out of total 421 cases, 64% were admitted to medical specialties
while 36% cases were related to surgical specialties. Out of total cases studied
44% were in the age group of 60 -70yrs, 40% were in the age group of 70-80 yrs
and 16% were greater than 80 yrs of age. 65% of the Geriatric patients were
males while only 35% were females. Each demographic profile was compared
with morbidity pattern and results were recorded on likert scale. It was seen
that Geriatric age group of age > 80 years is having more morbidity than other
groups and there is need for providing social support during hospitalization to
the elderly patients.
CONCLUSION: Hospitals need to be made Geriatric friendly in the form of
availability of separate admission counters, medical social workers for
assistance and making delivery of care free of charges for elderly patients.
Hospital management needs to introduce practicum in order to train and
retrain the hospital patient care staff including doctors and nurses to improve
their behaviour and skills to deal with the elderly patients so that their stay in
the hospital is facilitated.

Cost analysis of invasive procedures done in Cardiac
Catheterization Laboratory at SKIMS
Department Hospital Administration, and Cardiology Sher-i-Kashmir Institute of

Romana Rashid
Farooq A Jan
ABSTRACT G H Yatoo
Khurshid Aslam
INTRODUCTION: Catheterization laboratory is used to support the
catheterization procedures, which results in increased patient footfall and
reduced costs for the hospitals. Thus need was felt for cost determination and
analysis that would help in making better planning and policy decisions and
enable cost efficient utilization of Catheterization Laboratory Coronary
intervention programme.
METHODS: A prospective study was carried out from 1st January 2013 to
31st December 2013 and all Cardiac Catheterization Cases were reviewed
with the aim to study patient profile, and better understanding of utilization of
New Cardiac Cath. Lab and cost per procedure for invasive procedures that
were done in cath. lab of SKIMS.
RESULTS: There were a total of 770 cases out of which 631 underwent
invasive procedure in Catheterization Laboratory. The patients were in the
age group of 45-59years (58.4%) with average age of 52 years which
predominantly involved 72.3% males and 27.7% females, determining a sex
ratio of 2.6:1.The most frequently performed procedure in cath. lab is
Coronary Angiography (50.4%) followed by Percutaneous Coronary
Intervention (33.12%)Lab usage (utilization coefficient) was determined to be
66.42%. The costs incurred on invasive procedure in cath. lab were
Direct(92.73%) as well as Indirect Costs(7.27%) and average cost per invasive
procedure was Rs.56723/- ($895)
CONCLUSION: The study highlighted the fact that the economic costs are
best determined as the marginal costs of all the resources consumed in
producing a good or service and thus suggested the proposal of setting more
Cath. Lab Rooms at SKIMS that will benefit the patients and hospital itself.

Role of H. pylori induced inflammation in the pathogenesis
of gastric cancer in Kashmir
1 2
Departments of Immunology & Molecular Medicine, General Surgery and
3
Gastroenterology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar
Qurteeba Qadri1,
Zafar A. Shah1,
Roohi Rasool1, ABSTRACT
Sameer Naqash2,
3
G.M. Gulzar
AIMS: Detect the presence of H. pylori infection in gastric cancer patients;
study the role of TLR 4 and IL-8 gene polymorphisms; Cag A subtyping;
study TLR expression in gastric cancer samples.
METHODOLOGY: A total of 200 healthy controls and 130 gastric cancer
patients were studied. Presence of H. pylori infection and CagA subtyping was
detected by PCR and multiplex PCR respectively.TLR4, IL-8 gene
polymorphisms and TLR expression were studied by PCR-RFLP,CTTP-
PCR and RT-PCR respectively.
RESULTS: 80% gastric cancer patients were positive for H. pylori infection
and 58.6% were Cag A positive. Western type CagA was present in all
patients.TLR4 and IL-8 gene polymorphisms were not significantly
associated with gastric cancer.TLR 2 mRNA expression was higher than
TLR4 mRNA expression in the gastric cancer tissues compared to adjacent
normal tissues whereas TLR5 mRNA expression was reduced two fold as
compared to the adjacent normal tissue.
CONCLUSION: Most gastric cancer patients are positive for H. pylori
infection. There is no correlation between the presence of TLR4 and IL-8
gene polymorphisms and H. pylori infection. There is no association between
the presence of CagA and more than one EPIYA-C motifs with the clinical
outcomes, suggesting the role of other host genetic and environmental factors
in the progression to gastric cancer. There is an increase in TLR2 expression
in the gastric cancer tissues as compared to TLR4 and TLR5.

Role of pro-Inflammatory cytokine genes in the
pathogenesis of rheumatoid arthritis in Kashmir valley
a b
Departments of Immunology and Molecular Medicine and Division of Rheumatology,
Internal Medicine, Sher-i-Kashmir Institute of Medical Sciences, Srinagar
Syed Shafia Aalama,
b
Fayaz Ahmad Sofi ,
ABSTRACT a
Dilafroze ,
a
Zafar Amin Shah
AIM: To identify the role of polymorphisms in TNFα, IL-1β and IL6-174

genes in susceptibility to RA in Kashmiri population and to study the mRNA
expression of TNF-α, IL-1β and IL-6 mRNA RA and OA patients.
METHODS: A total of 150 RA cases and 200 healthy controls were included
in this study. The polymorphic analysis and mRNA expression analysis were
carried out by using PCR-RFLP method and qRT-PCR method respectively.
RESULTS: IL1β-511T/C polymorphism was found to be significantly
associated with RA with the carriers of IL1β -511'C' allele having a protective
role for development of RA in Kashmiri population. However TNFα -308
G/A, TNFα-238 G/A, IL1β + 3954C/T and IL6-174G/A polymorphisms were
not associated with RA risk in our population. High expression of these
cytokines was found in both RA and OA but with a higher fold change in RA
than OA.
CONCLUSION: We conclude that IL1β-511T/C polymorphism has a
protective role in the development of RA in our population. The high mRNA
expression of TNFα, IL1β and IL6 support the role played by these cytokines
in the pathogenesis of RA. Also the differences in cytokine gene expression
between RA and OA is more quantitative than qualitative, therefore,
suggesting a more intense inflammatory nature of RA than OA.

Etiological profile of Community Acquired Pneumonia
Department of Internal Medicine, Sher-i-Kashmir Institute of Medical Sciences, Srinagar
Reyaz Ahmad Para,

Parvaiz Koul ABSTRACT
BACKGROUND: Etiology of Community Acquired Pneumonia (CAP)

can be looked at with wider array of diagnostic tools. Updated data about the
incidence of pneumonia may be important to recognize changes in disease
patterns, to assess the new etiological profile according to the new diagnostic
technologies, to evaluate preventive interventions and to allocate health care
and research resources.
OBJECTIVES: To identify common pathogens causing CAP in hospitalized
patients in Kashmir and to evaluate the correlation between etiology and
disease severity and clinical outcome.
METHODS: We conducted a prospective study of patients with CAP
hospitalized at Sher-i-Kashmir Institute of Medical Sciences (SKIMS)
Srinagar, Kashmir. We collected demographic, clinical and laboratory data
(blood and sputum cultures, serology, pneumococcal urinary antigen test, and
Reverse Transcription-Polymerase Chain Reaction (RT-PCR) from
nasopharyngeal swab.
RESULTS: A total of 225 patients were enrolled. Streptococcus was the
commonest organism found (30.5%), followed by Legionella pneumophila
(17.5%) as a second commonest pathogen, followed by influenza viruses
(15.4%), Mycolplasma pneumoniae(7.2%), Chlamydia pneumoniae(5.5%),
Mycobacterium tuberculosis (4.8%), Klebsiella pneumoniae(4.8%),
Methicillin Resistant staphylococcus aureus (MRSA) (3.5%), pseudomonas
aerogenosa (3.1%), Methicillin Sensitive Staphylococcus Aureus (MSSA)
(1.7%), and Acinetobacter sp. (0.8%). 4% of patients had multiple etiologies.
High PSI score correlated with the severity and outcome of the CAP but was
not predictive of any definite etiological pathogen.
CONCLUSIONS: S. pneumoniae, Legionella Pneumophila, Influenza
virus were the most common pathogens isolated. The choice of empiric
antimicrobial treatment for CAP should be made according to local
epidemiologic data.

Clinical profile and outcome of patients of severe sepsis in
SKIMS
Department of Internal Medicine, Sher-i-Kashmir Institute of Medical Sciences,

Srinagar
Suhail Mansoor,
ABSTRACT Showkat Ali Mufti
BACKGROUND: Sepsis remains the most important cause of MODS all

over the world, with high mortality and morbidity.
OBJECTIVES: To study the demographic, clinical and bacteriological
profile of severe sepsis patients. To study outcome at 24hrs,one week, one
month and two months.
METHODS: This observational prospective study was conducted at SKIMS.
We collected demographic, clinical and laboratory data ( CBC, Chemistry,
ABG, Cultures, Coagulogram, Chest Radiograph, USG abdomen) and
followed patients upto two months.
RESULTS: 150 cases of severe sepsis were studied 75 were males and 75 were
females. Fever was the most common complaint (64%) followed by altered
sensorium (52%) and cough(44%). Multi organ involvement was the main
presentation (40%) followed by respiratory system (22%). Blood culture was
positive in 14% of the patients. Gram negative septicaemia was more common
than gram positive septicaemia. Overall mortality in our study at two months
was 34.6% with 75% of deaths in 5th to 9th decade(p 0.22). The clinical and
biochemical factors at presentation which where associated with higher
mortality included higher age, MEDS score of more than 10 (p< 0.0001),
hypotension (p 0.003), low albumin, higher creatinine, low pH, low
haemoglobin, and culture negativity (p 0.029) at presentation.
CONCLUSIONS: Severe sepsis has high mortality. Patients with higher age,
MEDS score of more than 10, hypotension, low albumin, higher creatinine,
low pH, low haemoglobin, and culture negativity at presentation have higher
mortality and need special critical care . Mortality in severe sepsis is not only
acute, it continues even after discharging patients in stable condition.

Procalcitonin as a guide for antibiotic therapy in patients
of acute exacerbation of COPD
Department of Internal Medicine, Sher-i-Kashmir Institute of Medical Sciences,

Srinagar
Mohammad Ashraf Khan,

Rafi A Jan
ABSTRACT
BACKGROUND: Chronic obstructive pulmonary disease is a progressive

disease and hospital admissions are frequently due to acute exacerbations.
Prescription of antibiotics in acute exacerbations of COPD requires predictive
markers. Acute phase reactants are capable of demonstrating the
inflammation; but cannot be employed to differentiate between bacterial and
nonbacterial causes of the inflammation. Procalcitonin (PCT) levels appears
to be useful in order to minimize this problem.
PATIENTS AND METHODS: Between November 2012 and April 2014
86 patients with acute exacerbation of COPD were included in this prospective
study. At presentation before putting antibiotics blood samples were taken for
procalcitonin level and for routine blood tests including ESR and CRP. Blood
and sputum for culture sensitivity was done. Patients were allocated in to three
groups based on procalcitonin value. Group A (pct< 0.25 ng/ml. (normal)
(n=57) Group B ( pct 0.25- 0.5 ng/ml ( local bacterial infection) (n=8) Group
C (pct 0.5-2 ng/ml (systemic bacterial infection) (n=21)
RESULTS: A correlation was seen between procalcitonin value in each
group and WBC count, fever, ESR, CRP, CHEST XRAY and blood and
sputum culture. A significant correlation was seen between PCT value and
WBC count, chest x-ray, smokers, CRP, fever, blood and sputum culture (p
value 0.0001). No significant correlation was seen between PCT value in each
group and ESR (p value 0.043).
CONCLUSIONS: Procalcitonin is a good marker for differentiation
between bacterial and nonbacterial AECOPD. use of procalcitonin-guided
antibiotic.

Tertiary care hospital based study on drug induced liver
injury (DILI) due to ATT, occurrence and risk factors
1 2
Departments of Internal Medicine and Emergency Medicine, Sher-i-Kashmir Institute
of Medical Sciences, Srinagar
1
Muzamil Latief ,
ABSTRACT 2
B A Shah
INTRODUCTION: Drug-induced liver injury (DILI) is a problem of

increasing significance, and has been a long-standing concern in the treatment
of tuberculosis (TB) infection. ATT related hepatotoxicity ranges from
hepatic adaptation to hepatocellular injury to acute hepatic failure.
Asymptomatic transaminase elevations are common during antituberculosis
treatment, but hepatotoxicity can be fatal.
MATERIALS & METHODS: 190 patients were enrolled in the study,
regular clinical and liver function test monitoring was done at the
commencement of ATT and then at 2, 4 and 8 wks in the intensive phase
subsequently at 4 and 6 months.
RESULTS: DILI developed in 16 patients (8.4 %). 10 patients (62.5%)
developed early DILI (2 wks of ATT institution) and 6 patients (37.5%)
developed late DILI. In early DILI group, 5 patients were female and 5 males.
In late DILI group, 5 patients were females and 1 patient was male. Sex,
extrapulmonary tuberculosis was associated with increased risk of DILI. Age,
BMI, Albumin levels were not found to significantly increase DILI risk. All
except one patient in DILI group tolerated reintroduction of ATT.
CONCLUSION: DILI is a common problem among patients on ATT. Early
detection and interruption of therapy is of utmost importance as is the
monitoring of these patients. Most of these patients tolerate reintroduction of
ATT.

Clinical profile and outcome of ALL patients treated with
BFM 90 and MRC UK ALL XII protocols
1
Departments of Internal Medicine & Cl. Haematology, Sher-i-Kashmir Institute of
Javaid A Dar,
Sona-ullah Shah,
1Javaid Rasool, ABSTRACT
1Sajad Geelani
BACKGROUND: ALL is one of the commonest curable malignancies of the

childhood. Different treatment protocols have been developed and
continuously modified in an effort to lower the toxicity and improve the
efficacy. The aim of the study was to prognosticate various upfront treatment
protocols used in ALL.
MATERIALS AND METHODS: This was a retrospective study
conducted in the Department of Clinical Haematology, SKIMS on ALL
patients who received treatment based on BFM and UK ALL XII protocols
between January 2005 and December 2012 and were followed till November
2014. Diagnosis of ALL was confirmed by bone marrow aspiration and biopsy
and cytogenetic analysis. Routine testing for specific cytogenetic
abnormalities by FISH or PCR analysis was also performed.
RESULTS: Out of a total of 132 cases studied, around half the patients in the
study received UK ALL XII protocol. Significant difference was noted in the
outcome of patients on different protocols. Slow early response was seen
maximum in UK ALL XII protocol and minimum in Paediatric BFM(SR).
Complete remission was achieved in about 60% of the cases at the end of the
study, which was significantly less when compared to other protocols.
CONCLUSION: The standard induction therapy used in this study resulted
in a response rates slightly below the anticipated response rates of developed
countries due to poor supportive care in our set up.

Metabolic syndrome in rheumatoid arthritis: a case
control study
1 2 3
Departments of Internal Medicine, Endocrinology and Clinical Biochemistry, Sher-i-
Khalid Hamid Changal1,
Fayaz A. Sofi1,
ABSTRACT Shariq Rashid Masoodi2,
3
Syed Mudassir
INTRODUCTION: The metabolic syndrome (metS) is highly prevalent in

rheumatoid arthritis (RA). The purpose of our study was to study the
prevalence of metS in patients of rheumatoid arthritis and compare with the
control population, to study the association between RA severity and metSin
patients of RA and the association between RA disease related factors and
metS.
METHODS: This was a case-control observational study conducted on 125
patients of RA and 125 apparently normal controls. MetS was assessed using
the NCEP ATP III and IDF definitions. RA was assessed using the 1987 ACR
criteria for RA. Statistical analysis was done using SPSS 20.0.
RESULTS: Using the NCEP ATP III definition 52.8 % of RA patients had
metS compared to 18.4% of the control group (P<0.001). Measures of disease
severity and duration were significantly associated with metS. The patients on
corticosteroids had a lower chance of having metS compared to those who had
never used corticosteroids (P 0.015).
CONCLUSION: The frequency of metS in RA is significantly higher than
in the control population. Disease severity and duration are associated with a
risk of metS.

Non-alcohlic fatty liver disease as an independent risk
factor for Carotid Artery Atherosclerosis and relation of
serum ALT and Cytokeratin-18 levels with it
Department of Gastroenterology, Immunology & Molecular Medicine and Radiology,

Sher-i-Kashmir Institute of Medical Sciences, Srinagar
Abid Rasool,
Mustaq Ahmad Khan ABSTRACT
Roohi Rasool
Feroz Shaheen
OBJECTIVES: The aim of this study was to evaluate that NAFLD is an
independent risk factor for Carotid Artery Atherosclerosis and to find the
relation of serum ALT and Cytokeratin-18 levels with it.
METHODS: NAFLD was diagnosed on the basis of Ultrasonography and
Patients without features of fatty liver on USG were enrolled as controls.
Cytokeratin-18 estimation was performed by using Cytokeratin-18 Elisa Kit.
RESULTS: 200 Patients of NAFLD and 100 controls were studied from
November 2012 to October 2014. The age of these patients ranged from 20-60
years with a mean age of 42.63 in case group and 41.38 in control group. In our
study patients who undergone USG abdomen were having grade -1 fatty liver
(36%), grade-2 fatty liver (39%) and grade -3 fatty liver (25%). In our study we
found that with increase in grade of fatty liver there was increase in the IMT
which was statistically significant (p-value-0.01). In our study we found that
with increase in grade of fatty liver there was increase in the level of serum ALT
levels and was statistically significant (p-value-0.01). We found that with
increase in the grade of fatty liver there was increase in the levels of serum
cytokeratin-18 levels which was statistically significant (p-value-0.01).
CONCLUSIONS: Fatty liver disease has relation with Carotid Intimal
Medial Thickness and serum ALT and cytokeratin-18 levels.

Prevalence of vancomycin resistance in clinical isolates of
enterocoocus : A hospital based study
Department of Microbiology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar
Junaid Ahmad,
ABSTRACT Dalip K Kakru,
Bashir Ahmad Fomda
INTRODUCTION: Vancomycin-resistant enterococci (VRE) are an

increasingly common and difficult to treat hospital acquired infections.
PURPOSE: To find out the prevalence of vancomycin resistance in clinical
isolates of Enterococci and ascertain some of the risk factors associated with
the acquisition of infection due to these bacteria.
METHODS: A total of 400 isolates of Enterococci were recovered using
standard microbiological procedures, during a period of one year.
Antimicrobial susceptibility of these isolates to various antibiotics was
performed according to CLSI guidelines. MIC of isolates found to be resistant
to vancomycin on disc diffusion was done by microbroth dilution method.
Various risk factors like placement of IV line catheter, urinary catheter, hospital
stay and prior use of antimicrobial agents was noted for all the patients.
RESULTS: A total of 25 (6.3%) isolates of Enterococci were found to be
vancomycin resistant, most of them recovered from the blood samples. E.
faecium was the predominant VRE isolated. Factors like stay in an ICU, prior
use of antimicrobials, placement of IV line and urinary catheter were found to
be significantly associated with VRE acquisition.

Glycopeptide resistance in clinical isolates of coagulase-
negative staphylococci: a hospital based study
Lubnaa Samad,
Dalip K. Kakru, ABSTRACT
Bashir A. Fomda
Coagulase-negative Staphylococci (CoNS), are the most commonly isolated

pathogens in clinical microbiology laboratories around the world. Because of
relatively recent changes in the practice of medicine and changes in underlying
host populations, the infection with CoNS has been characterized as related to
“medical progress”. A large proportion of nosocomial isolates are becoming
resistant to multiple antibiotics including glycopeptides. This study was
undertaken to determine the prevalence and antibiotic sensitivity profile of
such clinical isolates with special reference to glycopeptides in this tertiary care
hospital. The study was done in a prospective manner, with samples from
patients of all age-groups and both the sexes attending this hospital during the
study period. Blood, sputum, urine, catheter tips, pus and other body fluids
were processed as per standard procedures. Antibiotic susceptibility testing
was done by the Kirby Bauer disk diffusion method with additional
microbroth dilution tests for vancomycin and teicoplanin. A total of 325
isolates of CoNS were obtained out of which 140 (43.1%) were found to be
clinically significant. Maximum numbers of clinically significant CoNS were
recovered from the 0-9 year age group (19.3%). IV catheter and prolonged
hospital stay were found to be significant risk factors in the development of
infection. Staphylococcus epidermidis was most commonly isolated.
Methicillin resistance was high accounting for 56.4% of isolates. None of the
clinical isolates were found to be resistant to glycopeptides. CoNS isolation in
the laboratory should be taken seriously because their prevalence not only
limits treatment options but also acts as a reservoir of drug resistant genes.

Phenotypic detection of AmpC beta-lactamases in Gram-
negative bacilli
Shugufta Roohi,
ABSTRACT Bashir Ahmad Fomda,
Gulnaz Bashir
PURPOSE: To detect the prevalence of AmpC β-lactamases in Gram-

negative bacilli.
METHODS: Screening for AmpC was done by using cefoxitin discs.
Organisms resistant to cefoxitin were tested for presence of AmpC by AmpC
disc test, Modified Hodge test, Three dimensional spot inoculation test and
Boronic acid disc test.
RESULTS: A total of 1323 non duplicate Gram negative bacilli were isolated
during a period of one year in the Department of microbiology SKIMS. Out of
these 1323 isolates, 530 were ESBLs, 211 imipenem resistant, whereas 432
isolates were either cefoxitin sensitive or showed no antagonism between
cefoxitin and cefotaxim discs and thus were excluded from study. One
hundred and fifty isolates were found to be resistant to cefoxitin and one or
more third generation cephalosporin antibiotics or showed antagonism
between cefoxitin and cefotaxim discs thus fulfilling the criteria and were
included in the present study. A total of 45(30%) were AmpC positive and
105(70%) were AmpC negative. Boronic acid test detected 38 (25.3%), AmpC
disc test 35 (23.3%), MHT 29 (19.3%) and MTDST detected 27 (18%).
CONCLUSION: Inhibitor based test using boronic acid detected the
maximum number of AmpC producing organisms. It is a simple and cost
effective test that can be routinely done in microbiology laboratory. Early
detection of resistance pattern is important in preventing the dissemination of
multidrug resistant organisms and modifying treatment strategies. Infection
control and appropriate antibiotic policy are of utmost importance in this
regard.

Molecular identification of Candida species isolated from
cases of neonatal candidemia using PCR-RFLP in a tertiary
care hospital in Kashmir
Departments of Microbiology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar
Akeela Fatima,
Tehmeena Wani
ABSTRACT
INTRODUCTION: Candida spp. is an emerging cause of blood stream

infections worldwide. Delay in speciation of Candida isolates by conventional
methods and resistance to antifungal drugs in various Candida species are
responsible for the increase in morbidity and mortality due to candidemia. So,
the rapid identification of Candida isolates is very important for the proper
management of patients with candidemia.
AIMS: To retrospectively evaluate the identification of various Candida spp.
by PCR-RFLP and to evaluate the accuracy, speed and cost of conventional
methodology versus PCR-RFLP.
MATERIALS AND METHODS: Ninety consecutive clinical isolates of
seven Candida species, isolated from blood of neonates admitted in NICU of
SKIMS and identified in the Mycology laboratory by routine conventional
methods, were re-evaluated by PCR-RFLP using universal primers ITS1 and
ITS4 for PCR amplification and MspI restriction enzyme for RFLP.
RESULTS: All the isolates were correctly identified to the species level by
PCR-RFLP and the results were in 100% agreement with those obtained using
routine methods. Identification of seven Candida spp. could be achieved
within three work days by both the methods. Our conventional methods
proved to be cost effective than PCR-RFLP.
CONCLUSION: We can continue with our routine methods and PCR-
RFLP can be used for periodic quality control or when conventional methods
fail to identify a species.

Comparison of PCR, RFLP with phenotypic methods for
identification of Candida albicans and Candida
dubliniensis isolated from cancer patients with oral
candidiasis/colonization in a tertiary care hospital in
Kashmi
Departments of Microbiology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar
Abiroo Jan,
ABSTRACT Gulnaz Bashir
INTRODUCTION: C. dubliniensisis, is a novel pathogen that has been

associated with invasive diseases in immunocompromised individuals. It
shares many phenotypic traits with C. albicans and hence there is difficulty in
discriminating between the two based on routine lab methods.
PURPOSE: To reevaluate C. albicans strains isolated from cancer patients for
presence of C. dubliniensis isolates among them. To ascertain the
performance of various phenotypic methods; taking PCR-RFLP as gold
standard to differentiate C. albicans from C. dubliniensis.
MATERIAL AND METHODS: 186 stock strains of C. albicans identified
by routine phenotypic methods were reevaluated for presence of C.
dubliniensis among them by eight phenotypic methods and the results were
confirmed by PCR-RFLP using the universal primers ITS1 and ITS4 for PCR
amplification and BlnI restriction enzyme for RFLP.
RESULTS: Among the strains tested no C. dubliniensis was found by PCR-
RFLP. Results of majority of the phenotypic tests were completely concordant
with those of PCR-RFLP. Identification could be achieved within 48 hrs by
PCR-RFLP, Modified Salt Tolerance test, Growth on Xylose Agar Medium
and Heat Tolerance test. We developed a novel medium “Hypertonic Xylose
Agar Medium” on which two phenotypic features characteristic of C.
dubliniensis could simultaneously be tested.
CONCLUSION: C. dubliniensis can be routinely identified by colony color
on HiCrome agar and growth on Hypertonic Xylose Agar Medium. Both
these tests are 100% accurate, simple, easy to perform and cost effective.

PAD in patients with CKD (KDOQI Stage 3-5): Prevalence
and related risk factors – A tertiary care centre (SKIMS)
based study
Department of Nephrology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar
Bipan Kumar Sharma,

M Saleem Najjar ABSTRACT
BACKGROUND: Patients with CKD are highly predisposed for developing

accelerated atherosclerosis..
OBJECTIVES: To know the prevalence of PAD and its related risk factors in
CKD patients not on dialysis (CKD Stage:3-5)
METHODS: After proper consent, 210 subjects (133 were males (63%) and
77(37%) were females) with CKD (Stg.3-5 not on dialysis) were enquired
about the history of related risk factors (smoking, hypertension, diabetes,
coronary artery disease, stroke and dyslipidemia) and their medical records
were checked.
All patients had eGFR<60 ml/min−1 calculated using Equation from the
Modification of Diet in Renal Disease study. They were administered
Edinburgh Questionnaire of Claudication in PAD and were subjected to
Ankle-Brachial Index by Doppler Ultrasonography.
RESULTS: Statistically significant association of PAD was found with age (p
= 0.498) smokers and ex-smoker (p = 0.039), hypertension (p value 0.015.),
diabetes (p value. 0.001), dyslipidemia (p = 0.031), CAD (p = ≤0.0001) and
low serum albumin (p value 0.044).
In our study no association of PAD was found with sex (p 0.498), BMI (p
0.981), eGFR (p = 0.312), serum calcium (p = 0.201) serum phosphorus (p
value 0.194), calcium phosphorus product (p value 0.08).
Binary logistic regression analysis were done for the variables found
significantly associated with PAD by univariate analysis. Analysis showed
significant association of CAD with PAD (p = 0.001) proving that CAD is
most important Association in CKD patients for development of PAD and
vice versa may be true.
CONCLUSIONS: CKD patients are highly predisposed for developing
PAD due to traditional and non-traditional cardiovascular risk factors which
enhance and accelerate atherosclerosis.

Evaluation of inflammatory status in CKD patients and
comparison between HD and CAPD
Departments of Nephrology & Immunology and Molecular Medicine, Sher-i-Kashmir

Akhil,
Khursheed A. Banday,
ABSTRACT Roohi Rasool,
Imitiyaz Wani
BACKGROUND: CKD is in itself a pro inflammatory state and dialysis adds
to this inflammation.
OBJECTIVES: To determine the inflammatory status in CKD patients
before dialysis and after dialysis; and to compare between HD and CAPD.
METHODS: Overall 50 patients with diagnosis of CKD-ESRD, who
fulfilled eligibility criteria were recruited in the study. Predialysis assessment
was done and subjects were then randomized into HD group and CAPD
group. Patients were subjected to HSCRP and IL6 levels before starting
dialysis and were reassessed 3 months later.
RESULTS: The post CAPD IL-6 as well HSCRP and post HD IL-6 as well
HSCRP is significantly higher than the predialysis values . Post dialysis IL-6 as
well as HSCRP were higher in case of patients who underwent HD rather
than CAPD and the difference was statistically significant. The post CAPD
Albumin as well BMI and post HD Albumin as well BMI is significantly lower
than the predialysis values; however post dialysis BMI were lower in case of
patients who underwent HD rather than CAPD but the difference was not
statically significant in case of BMI , but reverse was true in case of albumin
where it was lower in case of patients undergoing CAPD and the difference
was statically significant. Using Pearson correlation, we proved that there is a
negative correlation between the rising inflammation and serum albumin
level both in CAPD group and HD group ;however the correlation was not
strong enough ; p value being non significant.
CONCLUSIONS: The CKD is associated with chronic inflammatory state
and HD has more of inflammatory burden on the patient as compared to
CAPD patients. Albumin concentration in ESRD patients is correlated
negatively with established markers of inflammation.

To study association of IL-1 β gene polymorphism and allograft functions in
renal transplant recipients
Departments of Nephrology and *Immunology and Molecular Medicine, Sher-i-

Manzoor Ahmad Parry,

M Ashraf Bhat, ABSTRACT
Roohi Rasool*
INTRODUCTION: There is growing evidence of the genetic association

between certain cytokine and acute renal graft rejection. We sought to
investigate the role of recipients' IL-1ß gene polymorphism in acute renal graft
rejection.
METHODS: IL-1ß (-511C/T) and IL-1 ß (+3594) gene polymorphisms
were determined in 91 renal allograft recipients with and without acute
rejection using PCR RFLP. IL-1ß genotypic variants were investigated for
correlation with acute rejection over the two years after renal transplantation.
RESULTS: The risk for rejection appeared significant (OR=2.6) amongst
recipients for IL-1β -511 (P = 0.03). The IL 1β had fourfold risk of rejection
(p=0.069). Haplotype analysis between IL-1 gene cluster revealed that
haplotypes of IL-1 gene +3594 and -511 showed non-significant difference
between Rejection episodes and stable graft function.
CONCLUSION: Our results suggest that high producing genotypes of pro-
inflammatory (IL-1β) cytokine gene in recipients have risk for allograft
rejection. Further analysis of diversity in haplotype variations in large
populations could conceivably provide the basis for defined approaches to
limit the rejection

To study vascular endothelial growth factor 936 C/T gene
polymorphism in renal transplant recipients
Departments of Nephrology & *Immunology & Molecular Medicine, Sher-i-Kashmir

Aadil Bashir Wasil,

ABSTRACT Abdul Rashid Reshi,
*Roohi Rasool
INTRODUCTION: The significance of VEGF and its polymorphisms in

renal allograft rejection has recently become the subject of extensive research.
A C/T polymorphism exists at position 936, and carriers of the T allele were
shown to be associated with good graft outcome. In this study we studied
VEGF 936 C/T gene polymorphism in Renal Transplant Recipients and tried
to elucidate the potential of VEGF 936 C/T gene polymorphism as an early
marker for pretransplant identification of recipients with low risk of renal graft
failure.
METHODS: 147 Kidney Transplant recipients with age and sex matched
controls were included in this study. VEGF 936 C/T genes were studied using
RFLP analysis of the blood specimen of these patients. All patients were
studied for allograft rejection, response to treatment and overall graft survival.
RESULTS: Upon analysis we found that CT genotype and T allele carrier
state were associated with good graft outcome (p value of 0.008 and 0.002
respectively). However no significant association could be demonstrated
between T allele carrier state and number of rejection episodes encountered
by renal allograft recipients (P = 0.880).
CONCLUSION: Our findings suggest that good graft outcome in kidney
transplant recipients is associated with an increased frequency of the VEGF
936 CT genotype and T allele, and that determination of the T allele might be
helpful for the identification of recipients with overall good graft survival but
cannot predict rejection risk.

Correlation of serum progesterone levels with outcome in
severe traumatic brain injury patients
Department of Neurosurgery, Sher-i-Kashmir Institute of Medical Sciences, Srinagar

Adfer Gul,
Altaf Umar Ramzan,
Sarabjit Singh Chibber,
ABSTRACT
Nayil K Malik,
Abrar A Wani,
Arshad Ahmed Baba
OBJECTIVE: To evaluate the serum progesterone levels in severe traumatic
brain injury patients and see whether high levels are associated with good
outcome or not. To evaluate whether serum progesterone vary in different age
groups and to look whether sex difference has any effect on outcome.
METHODS: The prospective study was conducted in the Department of
Neurosurgery and Immunology and Molecular Medicine from November
2012 to November 2014. Total of 100 patients (90 males and 10 females) who
arrived within 10 hours of head injury (GCS 4-8) were enrolled in the study.
Blood sample was taken from all patients and was subjected to centrifugation
to separate the serum which was then subjected to ELISA technique to
evaluate the serum progesterone levels. Outcome was assessed 30 day post
injury by GOS and FIM Score.
RESULTS: Mean progesterone level of patients with FIM Score ≤ 5 was
1.51±0.88ng/ml as compared to 3.81±2.27ng/ml in patients with FIM Score ≥
5 ( P value <0.0001). Mean serum progesterone levels vary with GOS (P value
<0.0001) and with age groups (P value <0.011).
CONCLUSION: Low GCS at presentation was associated with poorer
outcome in terms of GOS/FIM score. Low progesterone level at presentation
was associated with the poorer outcome. Elderly have poorer outcome as
compared to their younger counterparts.

Benign peripheral nerve sheath tumors : A 10 year
hospital based study
Department of Neurosurgery, Sher-i-Kashmir Institute of Medical Sciences, Srinagar
Malik Abdul Rouf,

ABSTRACT Altaf Rehman Kirmani,
Abdul Rashid Bhat
MATERIALS AND METHODS: The patients of peripheral nerve sheath

tumors who have been treated from January 2005 to May 2012 were analysed
retrospectively and those admitte from June 2012 to October 2014
prospectively. Study included 49 patients, 33 schwanomas and 16
neurofibromas with an average age of 38 years (range 7-65 years). The
diagnostic tools like FNAC, NCV, USG, & MRI were used in location &
provisional diagnosis, surgical excision was performed and final diagnosis
achieved by histopathological examination.
RESULTS: The incidence of isolated peripheral-nerve sheath tumors in our
study was 4.9 per year with hospital based prevalence of 49 over the period of
ten years. In case of schwannomas upper limbs were involved more frequently
than lower limbs (2:1), while neurofibromas were more evenly distributed
(1.16:1).Average duration of symptoms was 4.5 years presenting symptom
being mass, pain, weakness, dysaesthesia. All tumours were excised
completely with intracapsular excision using loupe magnification and
microsurgical dissection techniques. At an average follow-up of 6 months, in
case of schwannomas pain syndromes had complete resolution in the two
third, paresthesia 80% and motor strength restored to normal in 45.5%
patients,. While inneurofibromas, pain syndromes had complete resolution
in 44.4%, paresthesia 50% and motor strength restored to normal in 6.25%
patients.
CONCLUSION: Meticulous dissection with intracapsular tumour removal
under magnification can achieve complete tumour removal without
neurological loss or recurrence.

Perinatal outcome in patients with oligohydramnios at
term
Department of Obstetrics and Gynaecology, *Radiology, Sher-i-Kashmir Institute of

Enas Mushtaq,
Shameema Parveen, ABSTRACT
*Feroze Shaheen
INTRODUCTION: The purpose of this study was to evaluate the perinatal

outcome in patients with oligohydramnios at term with special emphasis on
isolated oligohydramnios.
METHODS: A prospective study was conducted from Nov. 2012 to Nov.
2014.Patients were divided into two groups (AFI > 50 mm and ≤ 50 mm).347
patients with AFI ≤ 5cm at term were included in the study. Out of these, 146
patients had isolated oligohydramnios. These were compared with those
having AFI > 5 cm (n = 500).
RESULTS: The two groups were similar with regard to maternal age, parity
and mean gestational age. Isolated oligohydramnios was associated with
higher rate of induction of labour (68.49% vs. 21.8% , p < 0.001),
nonreassuringfetal heart rate (45.20% vs. 13.2% , p < 0.001), cesarean section
for fetal distress (51.61% vs. 28.47%, p < 0.001), meconium stained amniotic
fluid (32.2% vs. 21.6%, p = 0.008). However, there was no statistically
significant difference between the two groups in terms of Apgar score at 1
minute, NICU admissions and still births.
CONCLUSIONS: Isolated oligohydramnios is associated with increased
risk of obstetric interventions particularly due to fetal distress. Nonetheless,
fetal distress due to oligohydramnios did not lead to increased risk for low
Apgar, NICU admissions, still births. This may be reflective of aggressive
intrapartum management that these patients received.
Keywords: Oligohydramnios, Amniotic fluid index(AFI), per

Reliability of maternal serum creatine kinase in diagnosis
of tubal pregnancy
Department of Obstetrics and Gynaecology, Sher-i-Kashmir Institute of Medical

Sciences, Srinagar
Simrath Shafi
ABSTRACT Mehbooba Beigh
Rifat Ara
INTRODUCTION: There is lack of a submucosal layer in the fallopian

tube. The trophoblast usually invades the muscle layer leading to increase
in creatine kinase.
METHOD: The study was conducted on 100 patients as cases and 75 as
controls.
INCLUSION CRITERIA
- Patients with features suggestive of tubal pregnancy as cases.
- Patients having confirmed intrauterine pregnancy as controls.
Maternal venous blood was taken for estimation of serum creatine kinase
before any invasive procedure.
Statistics methodology: Student's independent t-test, chi- square test and
fisher's exact test.
RESULTS & CONCLUSION: The mean CPK level was significantly
higher in ruptured tubal pregnancy (111.71±41.56 IU/L) than in unruptured
tubal pregnancy (84.12±11.36 IU/L).
The mean CPK level was significantly higher in the study group (97.64±33.08
IU/L) than in the control group (53.20±9.75 IU/L).
A cut-off level of > 69.2 IU/L of CPK may serve as an important tool in
diagnosis of tubal pregnancy.

Prediction of gestational hypertensive disorders by
uterine artery doppler velocimetry
Department of Obstetrics and Gynaecology, *Radiology, Sher-i-Kashmir Institute of

Syed Taskeen Rasool,
Abida Ahmad,
Cimona L Saldanha, ABSTRACT
Rabia Khurshid,
*Naseer Choh
AIMS AND OBJECTIVES: To evaluate the predictive value of uterine
artery Doppler in gestational hypertensive disorders and to evaluate the best
single marker (Doppler index) with highest sensitivity & specificity in the
screening of pre-eclampsia.
MATERIALS AND METHODS: This prospective study was conducted in
the department of Obstetrics & Gynaecology at SKIMS, Srinagar. 226 enrolled
subjects were subjected to uterine artery Doppler velocimetry at 24 to 26
weeks gestation and were followed throughout their antenatal course &
outcome measured as pre-eclampsia& gestational hypertension.
RESULTS: This was tabulated and calculated with statistical analysis.
Among 226 nullipara, uterine artery Doppler abnormalities were detected in
34 (15%) of cases. 8 patients developed proteinuric hypertension (pre-
eclampsia/eclampsia) with sensitivity & specificity of 80% and 88%
respectively with positive predictive value & negative predictive value of 23.5%
& 98% respectively. 4 patients among 34 patients with abnormal second
trimester uterine artery Doppler developed non-proteinuric hypertension
(gestational hypertension) with sensitivity & specificity of 33.3% and 89%,
respectively with a negative predictive value of 96%.
CONCLUSION: Uterine artery Doppler velocimetry is one of the vital tools
for prediction of pre-eclampsia (proteinuric hypertension). Women with
normal second trimester uterine artery Doppler velocimetry have low risk of
developing obstetric complications - hypertensive disorders.
Keywords: Doppler velocimetry, pre-eclampsia, gestational hypertension,
uterine artery Doppler.

Clinico metabolic characteristics of Polycystic Ovary
Syndrome in adolescents: Comparison between
Amsterdam 2012 criteria for adolescents and Androgen
Excess Society, 2006 criteria
Department of Obstetrics and Gynaecology, *Endocrinology, Sher-i-Kashmir Institute of

Medical Sciences, Srinagar Seema Khan,
ABSTRACT Rifat Ara,
INTRODUCTION: PCOS is one of the most prevalent female *Shariq Masoodi
reproductive endocrinopathies & emerging health problem in adolescents. It
is characterized by chronic anovulation, hyperandrogenism with
oligomenorrhea, infertility, hirsutism & acne. In adolescents diagnosing
PCOS is challenging as many characteristics are physiologic.
METHODS: was cross sectional study. Included 150 subjects. Inclusion
criteria- adolescents girls aged 15-19 yrs. Exclusion criteria-pregnancy, other
causes of oligomenorrhea, use of hormones, insulin sensitisers or lipid
lowering agents within 3 months.
Detailed history (menstrual)
Examination: BMI, waist hip ratio, BP
Investigations: USG (Ovarian vol), hormones (LH, FSH, TSH, Prolactin,
testo, 17 OHP), metabolic (LDL, HDL, TG, T. Chol, GTT, insulin fasting)
RESULTS & CONCLUSION
Complaints-oligomenorrhea(91%), wt gain(23%), hirsutism(18%), acne (13%)
O/E-clinical hyperandrogenemia(91%) with hirsutism in 65.7% & acne in 53.7%
Positive family h/o PCOS in 37%
24.1% were overweight, 37% were obese.
58% had W-H ratio more than 0.8 & 42% had waist>80 cm
Mean ovarian volume was 12.17ml
High LDL in 87%, low HDL in 46.3%, high TGs in 39.8%
Impaired fasting glucose in 18.6%
32.4% had fasting Insulin above upper quartile
28% had Insulin Resistance
55.6% had LH/FSH >2
40.7% had testo>55ng/dl
23% had metabolic syndrome
Prevalence of PCOS in subjects with menstrual irregularities was 94.7% as per
Rotterdam,72% as per AES criteria & 52% as per Amsterdam 2012 criteria.

Role of low dose misoprostol in cervical ripening and
induction of labour beyond age of viability and its effects
on maternal and fetal outcome
Department of Obstetrics and Gynaecology, Sher-i-Kashmir Institute of Medical Sciences,

Srinagar
Humaira Ali,
Tabasum Parveiz, ABSTRACT
Cimona L Saldanha
INTRODUCTION: Compared orally administered misoprostol (50µg)

with vaginally administered misoprostol (25µg) for cervical ripening and
labour induction.Study the complications of labour induction with
misoprostol.
METHODS: 200 subjects with indication for induction of labour were
randomly assigned to two groups. In one group 25µg of misoprostol was put in
posterior fornix of vagina, and in other 50µg of misoprostol was given orally.
Dose was repeated every four hours to a maximum 6 doses for those who did
not get adequate uterine contractions and the outcome assessed in terms of
induction delivery time, delivery within 24 hrs and maternal and fetal
outcome.
RESULTS: 2 women were excluded from study. Mean induction vaginal
delivery time was significantly lower in vaginal misoprostol group
(16.70±7.12hrs) than in oral misoprostol group(20.55±5.59hrs) with p value
of <0.001.There was no significant difference between two groups in terms of
number of women who delivered within 24 hrs, incidence of maternal and
fetal complications. Oxytocin augmentation was required in significantly
higher number of patients in oral misoprostol group than in vaginal
misoprostol group( 81% vs 68%, p-value 0.027).
CONCLUSION: Vaginal misoprostol 25 µg 4hrly is more effective and as
safe as oral misoprostol 50 µgm 4hrly for cervical ripening and induction of

Observations on operative treatment of peritrochanteric
fractures with proximal femur locking compression plate
Department of Orthopaedics, GMC, Srinagar
Sulaiman Sath,
ABSTRACT A.R. Badoo
INTRODUCTION: Peritrochanteric fractures in elderly are osteoporotic

and site of stress concentration. We used proximal femoral locking
compression plate for these common peritrochanteric fractures to counter
effects of osteoporosis.
METHODS: The Study was conducted at Department of Orthopaedics,
GMC, Srinagar from October 2012 to May 2014, included 40 cases in patients
aged 60 years and above of both sexes. Singh's index of osteoporosis was used
to grade the degree of osteoporosis and fractures were classified using AO
Classification.
RESULTS: Mean Age in our study was 69.77 years with females forming
62.5% of total patients. Trivial trauma was most common mode of i9njury
(82.5%) and most patients belonged to AO 31 A1 subgroup. Grade II
osteoporosis was found to be most common. Mean duration of surgery was
68.87 minutes and mean duration of hospital stay was 9.8 days. Final results
were good to excellent in 92.5% according to Harris Hip Score.
CONCLUSION: Proximal femur locking compression plate is an effective
and feasible treatment modality for treatment of peritrochanteric fractures in
the elderly with good to excellent results and minimal complications.

Early outcome of management of displaced intra-articular
calcaneal fractures by Ilizarov Ring Fixator
Shameem Ahmad Bhat,

Khursheed Ahmad Kangoo ABSTRACT
INTRODUCTION: Controversy continues to exist regarding treatment of

displaced intra-articular calcaneal fractures with no consensus on definitive
treatment modality. Management of such fractures with use of ilizarov ring
fixator in closed fashion or in combination with minimal open approach is a
promising and novel method of treatment.
METHODS: Our study included 30 cases of displaced intra-articular
calcaneal in adult professionally active patients. Fluoroscopically assisted
reduction of posterior facet utilizing skeletal traction with minimal open
reduction of depressed articular area and or Essex-Lopresti joy stick maneuver
with use of shanz screw incorporated in ilizarov ring was used. Outcome
measures including patient age, gender, social and occupational history,
mechanism of injury and fracture types and classification recorded.
Functional scoring done by American Orthopaedic Foot and Ankle society
Hindfoot Scale (AOFAS).
RESULTS: Out of 30 cases 3 were open, 4 had significant blisters as per
Sanders classification 5 were type II, 14 types III and 11 type IV with 12 cases of
excellent, 16 cases of good and 2 cases of fair results. 12 cases of pin tract
infection 7 heel broadening and 3 cases of regional sympathetic dystrophy. No
case of nonunionmalunion and secondary reconstructive surgery needed.
CONCLUSION: indirect reduction and Ilizarov ring fixation is a useful
sometimes preferred alternative for displaced intra-articular calcaneal
fractures with advantages of shorter time to operating room, early weight
bearing, fewer serious wound problems and no residual device.

Evaluation of results of primary cementless total hip
arthroplasty in osteoarthritis
Qazi Manaan Masood,

ABSTRACT
Manzoor Ahmad Halwai
INTRODUCTION: Total hip arthroplasty is one of the most successful

surgical procedures. It relieves pain and functional disability experienced by
patients with moderate to severe osteoarthritis of the hip, improving their
quality of life.
MATERIALS AND METHODS: This study was done on patients
admitted in the Post Graduate Department of Orthopaedics, Government
Hospital for Bone and Joint Surgery, an associated hospital of Government
Medical College, Srinagar from October 2012 to October 2014. Thirty
patients were taken up for the study. This was a prospective study with a
minimum of 12 months follow up.
RESULTS: Excellent or good pain relief and function was obtained in 83.33%
of cases. The mean total pre-operative Harris Hip Score was 32.93 which
improved to 88.967 post-operatively. The most common complication was
persistent anterior thigh pain in 2 patients.
CONCLUSION: Our study suggests that the current generation of
cementless implants provide satisfactory clinical and radiographic outcomes.
Though the study was not free of complications, the overall clinical and
radiological outcome showed encouraging results.

Observations on the operative treatment of comminuted
and oblique olecranon fractures by locking plate
Maajid Shabeer,
Bashir Ahmad Mir
ABSTRACT
INTRODUCTION: Olecranon fractures are one of the most commonly

seen Orthopaedic injury in emergency room, accounting for 10-38% of elbow
fractures. The present study was undertaken to evaluate the results of locking
compression plate in comminuted and Oblique olecranon fractures.
MATERIALS: It was a prospective study carried out from March 2013 to July
2014 in Post Graduate Department of Orthopaedics, Government hospital for
Bone and Joint Surgery, GMC, Srinagar. 30 cases of comminuted and oblique
olecranon fractures were treated by olecranon locking plate.
RESULTS: Majority of patients were males. Most cases were comminuted
Mayo Type III B. Union noted clinically and radiologically in 11.9 weeks.
Excellent results were seen in 63..33% patients, good in 26.66% and fair in 10%
with no poor results. Symptomatic metal prominence was seen in 30%.
CONCLUSION: It is concluded that ORIF with locking plate compression
plate is an effective means of treating olecranon fractures.

Observations on the “Mini Open repair of Rotator Cuff
Tears”
Adil Bashir Shah,

ABSTRACT
Munir Farooq
INTRODUCTION: Rotator Cuff tear has long been recognised as a source

of pain and disability. The indications and benefits of procedures used to repair
are still debated.
METHOD: This was a prospective study conducted in Post Graduate
Department of Orthopaedics, GMC, Srinagar from March 2013 to May 2014
with cases followed up for a minimum of 6 months. Study included a 25
patients of either sex with non-massive/ full thickness tear.
RESULTS: Mean UCLA improved from 11.06 to 30.72. 88% patients
achieved an excellent or good results. Stiffness occurred in 2 patients.
CONCLUSION: The study resulted in significant improvement in
functional scores and improved quality of life.

Role of prophylactic probiotics in prevention of necrotising
enterocolitis and sepsis in premature neonates
Department of Paediatrics and *Microbiology, Sher-i-Kashmir Institute of Medical

Sciences, Srinagar
Gousia Mukhtar,
Sheikh Mushtaq, ABSTRACT
*Dalip Kumar Kakru
INTRODUCTION: Advances in medical technology have allowed for

increased survival of very premature infants. These tiny infants are at
increased risk for numerous complications, ofwhichnecrotising enterocolitis
and nosocomial sepsis are among the most common and devastating. It is a
continuous endeavour of neonatologists throughout the world to develop
newer preventive and therapeutic protocols to tackle them. Probiotics have
emerged as a novel protective strategy against sepsis and NEC.
METHOD: All infants admitted in our NICU till Oct 2014 with birth
weight less than 2 kg or gestational age less than 35 weeks were enrolled. The
study group received a mixture of lactobacillus acidophilus, lactobacillus
rhamnosus, bifidobacteriumlongum and streptomycesboulardii in a dose of
1.25 X 109 CFU twice daily started with the first feed and continued till
discharge.
RESULTS: The frequency of primary outcome, sepsis was significantly
lower in probiotic group(P = 0.001),as was the frequency of NEC(P =
0.047).The duration of hospitalization was also significantly lower in the
probiotic exposed group (P = 0.04).No differences were observed when time
to establish full feeds were compared between the two groups (P=
0.40).Though, Mortality was seen more in controls than cases , the difference
was not statistically significant (P=0.12).Episodes of feed intolerance were
also significantly lower in cases than controls ( P = 0.02).
CONCLUSIONS: We found a statistically significant reduction in
incidence of late onset sepsis and NEC in our cases as compared to controls
consistent with published data.

Efficacy and safety of intravenous phenytoin, intravenous
Levetiracatam, and intravenous valproate for acute
seizure control in children
Department of Paediatrics & *Neurology, Sher-i-Kashmir Institute of Medical Sciences,

Srinagar Mudasir Nazir,
Syed Wajid Ali,
Mushtaq Ahmad Bhat,
ABSTRACT *Ravouf Asmi
The aim of this study was to compare efficacy of iv phenytoin, iv levetiracetam

and iv valproate for acute seizure control in children presenting with status
epilepticus. This study was a Prospective, randomized hospital based study,
done in the department of pediatrics and neonatology SKIMS hospital
Srinagar.
The demographic characteristics were comparable in all the three groups
(p>0.05). At 24 hours seizures were controlled in 44 (88%) patients out of 50
patients in phenytoin group, 39(78%) out of 50 patients in levetiracetam
group and 46(92%) out of 50 patients in valproate group (p-value 0.115).
There was no significant difference in the three groups in various vital
parameters like heart rate, systolic blood pressure, SpO2 and respiratory rate (p
> 0.05).
The mean time to regain consciousness in phenytoin, Levetiracatam and
valproate groups was 122.3(± 45.4), 120.8(±42.8) and 75.0(±30.7) minutes
(mean±S.D) respectively. Patients in valproate group regained consciousness
earlier than both phenytoin and levetiracetam group patients(p<0.0001). Out
of all patients in the three study groups only one patient from valproate group
had a repeat seizure at the end of first week (p=0.372). At 3 month follow up,
7(14.28%) out of 49 patients in phenytoin group, 14(28.57%) out of 49 in
levetiracetam group and 2(4%)out of 50 patients in valproate group had a
seizure recurrence (p 0.0032 ANOVA).
In our study we found that both iv levetiracetam and iv valproate safe and
efficacious and were comparable to iv phenytoin in terms of seizure control in
acute setting.

Neuroprotective role of erythropoietin in perinatal
asphyxia: A randomized placebo controlled trial
Department of Paediatrics & *Radiodiagnosis, Sher-i-Kashmir Institute of Medical

Sciences, Srinagar
Rahid Rasool Malla,

Mushtaq Ahmad Bhat, ABSTRACT
*Feroze Shaheen
OBJECTIVE: To study whether erythropoietin improves the neurological

outcome at discharge and at 6 months follow-up in term neonates with
perinatal asphyxia with moderate and severe hypoxic ischemic
encephalopathy (HIE).
METHOD: Eighty term neonates with moderate and severe HIE were
randomized into treatment group and placebo group (40 neonates in each
group) in a longitudinal placebo controlled trial. The treatment group
received erythropoietin 500 units/kg/dose in 2 ml saline on alternate days for
a total of 5 doses with the first dose given within 6 hours of birth and
placebo group received only 2 ml of normal saline similarly for a total of five
doses . Both groups also received standard treatment for perinatal asphyxia as
per the unit protocol.
RESULTS: Baseline demographic and other variables were similar between
the two groups at admission. Number of patients with moderate and severe
HIE were similar (48% vs.52% and 52% vs.48% respectively) in both the
groups. There was a significant improvement in the Thompsons HIE score in
the treatment group during the hospital stay (p=.05) and Oral feeds (sucking)
could be started earlier (p<.006) than in the placebo group. Lesser number of
babies had abnormal neurological examination (p=.005) and abnormal EEG
(p=.02) at discharge in the treatment group. At 6 months follow-up abnormal
neurolodevelopemental examination (p=.003) and abnormal DDST II
(p=.01) was seen in more babies in the placebo group.
CONCLUSION: Erythropoietin improves the neurological outcome at
discharge and at 6 months follow-up in neonates with moderate and severe
hypoxic ischemic encephalopathy.

Clinical profile and chromosomal analysis of patients with
ambiguous genitalia & other DSDs
Department of Paediatrics & *Immunology & Molecular Medicine, Sher-i-Kashmir

Sheeraz,
ABSTRACT Bashir Ahmad Churu,
*Zafer Amin Shah
ABSTRACT: Disorders of sexual development are a very peculiar and
serious problem affecting not only the patients,.
OBJECTIVES: To study the clinical profile and chromosomal analysis of
children with disorders of sexual development.
PROCEDURE: This study was carried out in the department of Paediatrics
and Neonatology SKIMS. All the patients with suspected disorders of sex
development in the age group of 0 to 19 years were analyzed and evaluated
with respect to their clinical history, complete physical examination, baseline
and other needed investigations like karyotyping hormonal profile and
biopsy findings.
RESULTS AND RECOMMENDATIONS: we found that 46XX DSD
was the most common form of DSDs, with 51% patients having congenital
adrenal hyperplasia from 21-hydroxylase deficiency. Eleven patients with
CAH (52.38%) presented with features of shock from adrenal crisis. These
patients were evaluated and diagnosed well in time and all of them survived the
adrenal crisis. They were subsequently put on glucocorticoid and
mineralocorticoid replacement treatment. The high proportion of CAH
patients presenting with adrenal crisis and shock emphasizes on the need to
include routine neonatal screening for 21-hydroxylaze deficiency on national
level in our country on the lines of same protocol being followed in USA.

Renal scarring in children 1-36 months of age with first
febrile UTI
Department of Paediatrics, Sher-i-Kashmir Institute of Medical Sciences, Srinagar
Khalid Mohiuddin Kawoosa,

Syed Wajid Ali
ABSTRACT
BACKGROUND: Paediatric UTI is well recognized as a cause of acute and

chronic medical conditions, such as hypertension and renal insufficiency in
adulthood. The goal of imaging studies in children with a UTI is to identify
anatomic abnormalities that predispose to infection.
AIMS: To find the frequency of renal scarring in patients admitted with first
febrile UTI, 1 – 36 months of age & to find role of various imaging modalities
in identifying patients who develop renal scarring.
RESULTS: A total of 108 children were included in the study. Of 108 USGs,
63(58%) were normal, the rest being abnormal . 37 patients had USG findings
suggestive of hydronephrosis (34.2%).VCUG was performed after a period of
1 month in 69(64%) of 108 children who either had an abnormal USG or
evidence of acute pyelonephritis on initial DMSA or both. 39 had VUR
(56.5%). DMSA scan performed 6 months later, showed scarring in 22
patients (20.3%) of overall patients. All children whose initial scans were
normal, had normal scans at follow up. Renal scarring was more likely to occur
in children with documented VUR than those without VUR (17/39 vs 5/30).
Among the patients with VUR, scarring was seen to occur more likely in
patients with higher grades of VUR (p value < 0.001)

Role of pulse oximetry in screening of critical congenital
heart disease (CCHD) in asymptomatic neonates
Mohmad Rafiq Lone,

ABSTRACT Niyaz Ahmad Buch
Our aim and objectives were to determine sensitivity, specificity and

predictive value of pulse oximetry in screening of Critical congenital Heart
Disease (CCHD) in asymptomatic newborns. The study was a hospital based
prospective study conducted on all asymptomatic neonates attending in
neonatology section of SKIMS-Medical College and SKIMS-Trust hospital
A single determination of postductal saturation on all asymptomatic
newborns was done on day 2 of life .All newborns found to have a post-ductal
saturation ≤ 95% underwent additional evaluation by echocardiography. 2600
neonates were included and 7 cases of CCHD were diagnosed with 2 false
positive and 2 false negative were detected on clinical follow-up, giving a
prevalence of 0.27 %. Sensitivity, specificity, positive predictive value and
negative predictive value of pulse oximetry for detection of CCHD were
77.78%, 99.92%, 77.78% and 99.92%, respectively.
We conclude that pulse oximetry is safe, easily available and reasonably
accurate for screening of CCHD with sensitivity better than antenatal
screening and clinical examination. Its specificity and negative predictive value
are very high, making second stage confirmatory echocardiography highly
cost-effective. Thus, the results of this study add to the already growing
evidence that strongly supports introduction of pre discharge pulse oximetry
screening as a routine procedure in healthy newborn babies.

Comparison of efficacy of combination of inhaled steroids
and long acting beta agonists versus inhaled steroids
alone in childhood asthma
Wasim Ahmad Wani,

Arshad Farooq, ABSTRACT
Mushtaq Ahmad Bhat
AIMS AND OBJECTIVES: The objective of the study is to find out

whether addition of long acting beta agonists to steroids provides better
asthma control.
MATERIAL AND METHODS: 60 patients with moderate persistent
asthma who satisfied the inclusion criteria were divided into two groups. One
group received budesonide/ formoterol and other group received budesonide
alone.
RESULTS: SABA use in Budesonide/formoterol group patients was
significantly less compared to budesonide group patients (1.5±1.1 v/s
2.13±0.9; p-value 0.01). Budesonide/formoterol combination was
significantly better in increasing FEV1% compared to budesonide alone. The
mean FEV1% of patients in the Budesonide/formoterol group was
83.5±2.57, 84.6±2.34 and 86.9± 2.6 at 3, 6 and 9 months of treatment
respectively, compared to corresponding values of 81.7±3.7 , 82.5± 4.35and
84.3± 4.7 in the budesonide alone group. The difference was statistically
significant (p-value <0.05). Both groups experienced decrease in night time
symptoms, acute exacerbations, absolute eosinophil count and IgE levels.
There was no significant difference between the two groups in these variables.
CONCLUSION: Addition of long acting beta agonists to inhaled steroids
provides better asthma control when compared to steroids alone.

A prospective, randomized comparison of surgical and
functional outcomes of stented with stentless
dismembered pyeloplasty for unilateral pelviureteric
junction obstruction in paediatric patients
Department of Paediatric Surgery, Sher-i-Kashmir Institute of Medical Sciences,

Srinagar
Zubair Khurshid,
ABSTRACT Nisar Ahmad Bhat,
Aejaz Ahsan Baba
INTRODUCTION: The impetus for this study has been based on an

assumption that stentless pyeloplasty can be a safe option in children and
putting in a stent is not always necessary.
MATERIAL AND METHODS: 100 pediatric (age 0-14 years) open
Anderson–Hynes dismembered pyeloplasties were performed for primary
unilateral pelviureteric junction obstruction. Patients were randomized into
two groups: group UP, the Unstented group, and group SP, the stented
group(either pyelostomy stent or JJ stent). Outcome was analyzed with
respect tooperative time, hospital stay, postoperative complications,
postoperative effect on hydronephrosis, and improvement in renal function
and drainage in both groups.
RESULTS: The operative time and hospital stay of both the groups were
comparable. There was no significant difference between both groups
regarding the complication rate however, the nature of complications were
unique to each group. Although urinary leaks (>7 days) were more common
in the UP group, most of them settled with time. Similarly stent
migration/extrusion and lower urinary tract symptoms were only seen in the
patients with JJ stents. There was a significant but comparable improvementin
post-operative grade of hydronephrosis, renal function and drainage in both
the groups. The overall success rate was 94% in the UP group and 98% in the
SP group.
CONCLUSIONS: Stentlesspyeloplasty is a well justified option in pediatric
patients when performed by well trained surgeons with proper expertise, with
success rates exceeding 90%.The key to success lies in performing a wide,
dependent and a water tight anastomosis with an adequate length of narrowed
PUJ segment excised which is critical in preventing reobstruction.

Immunofluorescence and histopathological correlation in
skin lesions in patients suspected with immune mediated
skin disorders
Departments of Pathology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar and

Dermatology, GMC, Srinagar
Zeba Choudhary
Khalil M Baba ABSTRACT
Ifat Hassan Shah
INTRODUCTION: Autoimmune skin lesions are encountered in

heterogenous groups of dermatoses. Definite diagnosis of these disorders
requires histopathological diagnosis along with DIF and clinical findings. This
study is undertaken to study the various Immune mediated skin lesions
encountered and to study the utility of DIF and histopathology in their
diagnosis.
METHODOLOGY: A total of 96 cases clinically suspected as having
immune mediated skin lesions were studied over 24 months from July 2012
to July 2014. These cases were mainly referred from the Department of
Dermatology, GMC, Srinagar. Two samples were taken from the patient,
lesional and peri-lesional for HPE & DIF respectively. H& E stain was
applied. Perilesional skin was taken in normal saline for DIF.
RESULTS: In the present study pemphigus vulgaris constituted the most
common disorders with 15.6% followed by bullous pemphigoid 11.5%.
Among the 41(42.7%) Autoimmunobullousdisorders(AIBD) cases, these
constituted 36.6% and 26.8% respectively. Majority of patients presented
between 31-49 yrs of age with female prepondarance. DIF showed positive
findings in 82.5% cases. Besides AIBDs, Connective tissue disorders
comprised 32.3%(31 out of 96) of total cases with vasculitis, SLE and Lichen
Planus. DIF was positive in 77.4% of cases of connective tissue disorders.
CONCLUSION: DIF is not a substitute but supplement to
histopathological diagnosis. Thus a clincopathological correlation with DIF is
required for definite diagnosis and correctly classifying immune mediated
skin diseases and segregating non-immune skin disorders.

Testicular tumors – clinical profile, radiological
characteristics and histopathology
Department of Pathology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar
Sumat-ul-Khurshid,
ABSTRACT Rumana Makhdoomi,
Zubaida Rasool
INTRODUCTION: Testicular neoplasms span an amazing gamut of
anatomic types. Incidence increases after the onset of puberty and reaches
maximum in late twenties and thirties, comprising approximately 1% of all
cancers in men. Diagnosis primarily depends on histopathology.
METHODS: We studied clinical profile, radiological characteristics and
histopathological spectrum of testicular tumors over a period of ten years from
August 2004 to September 2014.
RESULTS & CONCLUSION: 83 patients with testicular malignancy were
evaluated with majority in 3rd and 4th decade of their life (Average age=37.45
years; Age range= 0.3-75 years). Scrotal swelling was the most common
presenting complaint (83.13%). 50.6% had right sided disease while 39.76%
had left sided and 9.64% had bilateral disease. Among 7 patients with bilateral
un-descended testes, 5 had bilateral testicular tumor. Serum tumor markers
were raised in 72.55% germ cell tumors (GCTs). Ultrasonography shows
homogenous pattern being associated with seminomas and heterogenous
pattern with non seminomatous mixed GCTs. 72 cases had GCTs. Seminoma
was most common tumor (43 cases). Mixed Embryonal carcinoma with yolk-
sac tumor was seen in 6 cases. 7 cases of lymphoma (8.43%) were also noted.
Testicular tumors exhibit a varied histomorphology. Germ cell tumors form
the bulk of disease. Scrotal ultrasonography is the standard investigation with
computed tomography used for metastatic evaluation. Serum tumor markers
are raised in maximum number of germ cell tumors but not in any non germ
cell tumor.

Histopathological study of pancreaticobiliary tumors with
special reference to tumors of ampulla of vater
Department of Pathology & *Surgical Gastroenterology, Sher-i-Kashmir Institute of

Saba Shafi,
Parveen Shah, ABSTRACT
*Omar J. Shah
INTRODUCTION: Carcinomas of the Ampulla of Vater are rare tumors,

accounting for 0.2% of gastrointestinal cancers. The area within 2cm of the
ampulla is called “periampullary” region. Periampullary cancers account for
5% of all gastrointestinal cancers, whilst cancer of the ampulla is rare (0.2% of
the cases).
METHODS: The aim was to study the histopathological spectrum of
pancreatobiliarytumors with special reference to tumors of the Ampulla of
Vater. The study included retrospective data analysis for 5 years and a
prospective analysis over a period of 2 years.
RESULTS AND CONCLUSIONS: It included 110 cases, of which there
were 103 specimens of pancreaticoduodenectomy (Whipples procedure) and
7 specimens of localised resection (partial pancreatectomy).
The age range of patients was between 16-80 years with a mean age of 52.64
years. The majority of the cases belonged to the 50-60 years age group. Males
outnumbered females with a male to female ratio of 3:2. Malignant lesions
outweighed benign lesions. Adenocarcinoma was the most common
histologic type seen. Most of the tumors were in the peri-ampullary region
(64.54%), followed by pancreas (19.09%). Most of the tumors were 2 cm in
maximum dimension (25.45%) with a mean of 2.38 cm. Most of the tumors
were stage T2 (58.2%), with 22.7% of T3. 61.8% were N0, 23.6% were N1.

Clinicohistopathological profile of inflammatory bowel
disease with special reference to dysplasia associated
with ulcerativecolitis
Baba Iqbal Khaliq

ABSTRACT Khalil M Baba,
Mohammad Iqbal Lone
BACKGROUND: Last decade has shown increase in IBD cases from Asian
Countries.
OBJECTIVE: To study Clinico-histopathological profile of IBD patients in
SKIMS.
STUDY DESIGN: Descriptive.
METHODS: 5years study extending from June 2009 to June 2014
prospective for 2 & retrospective for 3 years. Biopsies and resected specimen
received were studied in detail.
RESULTS: Study included total of 210 IBD cases. Males were127(60.5%)
and 83(39.5%) were females. M:Fratio was 1.53:1. Age ranged from 1 to 80
years, Mean Age was 39.75 years. Maximum number of cases were seen in age
group of 20 to 30 years(23.33%). Smoking history was absent in79%, history of
junk food & fast food consumption was present in most IBD patients.75.5%
were residing in urban areas. IBD was more common in educated & middle
socioeconomic class. Pain abdomen, bloody diarrhea and hematochesia were
dominant symptoms. Arthritis was present in 4 patients. Mean duration of
disease was2.43years.Haemorrhagic areas, ulcerated and friable areas, loss of
vascularity and oedema were dominant endoscopic findings. Rectum was
involved in119 and sigmoid colon in 84 patients. Cryptitis, mucodepletion,
cryptabscesses, cryptdistortion, cryptatrophy and epithelial erosions were
dominant microscopic findings. Out of total 210IBD patients UC was present
in 86.6%, CD in12.38% and indeterminate colitis in 2 patients. Granulomas
and fissures were present in 9 CD patients. All CD and indeterminate colitis
patients were negative for dysplasia, out of 182 UC patients low grade
dysplasia was present in17 and high grade dyplasia in 4 patients.
CONCLUSION: This study confirms the existence of IBD in this
geographical area.
Keywords: Inflammatory Bowel Disease(IBD), ulcerativecolitis(UC),
crohndisease(CD).

Utility of CT guided Biopsy in evaluation of metastatic
spinal lesions- 2 year prospective study
Departments of Pathology, * Radiadiagnosis and **Neurosurgery, Sher-i-Kashmir

Imza Feroz,
Rumana Makhdoomi,
ABSTRACT
*Feroze Shaheen,
**Nayil Khursheed
INTRODUCTION: The incidence of skeletal metastasis is second only to
pulmonary and hepatic metastasis. The most frequently affected segment of
skeleton is the vertebral column. CT guided biopsy of spine is currently a
valuable diagnostic tool and effective technique for diagnosing and planning a
proper therapeutic strategy for a spinal lesion. The reported diagnostic
accuracy of core biopsy ranges from 77% to 97%.
METHODS: We included all patients with spinal lesions suspicious of
metastasis on MRI, who presented between June 2012 to June 2014 and
underwent CT guided biopsy in the present study.
RESULTS AND CONCLUSION: 30 patients with spinal lesions were
evaluated with majority in 7th decade of their life (average age=53.93; age
range=10-72 years). Male: Female ratio was equal to 1.5:1. Pain was the most
common presenting symptom(100%). Lumbar spine was the commonest site
of biopsy followed by dorsal spine. Biopsy is gold standard in differentiating
metastatic lesions from primary tumours of spine. Metastatic lesion was
diagnosed in 12(40%) cases, plasmacytoma in 12(40%) cases, and non-
Hodgkin lymphoma in 2 (6.66%) cases and small round cell tumour in 1
(3.33%) case. The most common malignancy to metastasize to spine was
adenocarcinoma. The most common primary tumour of spine was
plasmacytoma-multiple myeloma. C.T guided biopsy is a safe procedure and
no procedure related complication was seen in any patient.

Utility of image guided fine needle aspiration cytology in
the evaluation of non-palpable intra-abdominal and
retroperitoneal lesions - A prospective study of two years
Department of Pathology and Radiology, Sher-i-Kashmir Institute of Medical Sciences,

Srinagar
Shaheena Parveen
ABSTRACT Syed Besina
Nasir A Choh
INTRODUCTION: Intra-abdominal masses always remain as an enigma in

surgical practice. The use of imaging techniques combined with the use of
thin needles has revolutionized the approach of percutaneous aspiration
diagnosis of space occupying lesions of the chest and abdomen.
MATERIALS AND METHODS: This was a prospective study of two years
from May 2012 to May 2014 and included 183 patients. Image guided (CT or
USG) FNACs were carried out and on spot quick staining method (e.g Diff
Quik) was used to check for adequacy of the sample obtained. Smears
prepared were stained with MGG.
RESULTS: There were 92 males and 91 females with age range between 1-90
years. Adequate cell sample was obtained in (83.6%) of cases. Majority of the
abdominal masses were arising from the liver (65%). Also, masses from
pancreas (12.02%), kidneys (7.65%), lymph nodes (7.65%), Gall bladder (6%)
omental deposits (1.09%) and adrenal gland (0.54%) were noted. Metastatic
deposits of adenocarcinoma in liver was the most common lesion(68%).
Adenocarcinoma was the most common diagnosis in gall bladder and
pancreatic lesions. Overall sensitivity, specificity and diagnostic accuracy of
image guided FNAC of intra-abdominal and retroperitioneal masses of the
study was 100%, 100% and 93.54%, respectively.
CONCLUSION: Intra-abdominal FNA is a simple, economical and a safe
procedure with high sensitivity, specificity and diagnostic accuracy and it can
be utilized as a pre-operative procedure for the management of intra-
abdominal lesions.

Clinicohistopathological study and immunohistochemistry
in peripheral lung tumors
Duri Mateen,
ABSTRACT
Nassima Chanda
INTRODUCTION: Lung cancer is the second most common cancer and

by far the leading cause of cancer death among both men. Peripheral lung
tumors are defined as located more peripheral than subsegmental bronchi or
as a lesion that is not seen within bronchial tree at fibreoptic bronchoscope.
METHOD: We studied the clinical histopathological spectrum of peripheral
lung tumors from June 2009 to May 2014 in resected specimen.
RESULTS AND CONCLUSION: 97 patients with peripheral lung
tumors(primary or metastatic) were evaluated with maximum number of
cases i.e., 39 were in the age group 50-59 years. Males comprised 84.53%.
75.23% were smokers. Cough was the most common symptom seen in
58.76%.CT Scan revealed contrast enhancing mass in >80% cases. Right lung
was involved in 57 cases. Mean tumor diameter recorded was 4.89 cms. The
commonest histological subtype was SCC in 63 cases. Adenocarcinoma was
the second most common subtype seen in 19 cases. Other tumors seen were
adenocarcinoma (n=19), LCC(n=5), metastatictumor(n=4), Small cell
carcinoma and Mesothelioma 2 cases each, Lymphoma and Chondroid
Hamartoma 1 case each. Lymph node metastasis in 41cases. IHC was done in
19 cases and results were consistent with histopathological diagnosis.

Clinical profile and treatment modalities of groin
malignancies
Department of Plastic Surgery, *Medical Oncology & **Radiotherapy, Sher-i-Kashmir

Arshad Bashir,
Adil Hafeez Wani,
ABSTRACT Fazl Q. Parray,
*Abdul Rashid Lone,
**Fir Afroz
AIMS: To establish what are the various types of malignancies affecting groin,
viz. primary or metastatic and to study their histopathologicaltypes. To project
the clinical profile of groin cancers and to study the various treatment options
used for treating groin malignancies.
MATERIAL AND METHODS: In this observational study a total of 145
patients of groin malignancies were studied in department of General and
Minimal Invasive Surgery and allied specialties, Sher-i-Kashmir Institute of
Medical Sciences, Srinagar. The study was retrospective from April 2012 to
January 2005 and prospective from May 2012 till 2014.
RESULTS: Out of the total of 145 cases almost 95% were metastatic in the
groin and primary groin cancers constituted only 4.9% of the cases. Out of 138
tumors that were metastatic in the groin 108 were squamous cell carcinomas
followed by malignant melanoma in 28 cases. Excision of primary with block
dissection of groin was the commonest surgical procedure performed.
CONCLUSION: Most of the groin malignancies are metastatic to groin and
primary cancers at groin are very rare. Kangri use in our part of the world is the
most important predisposing factor leading to squamous cell carcinoma. The
management protocol followed in order to treat groin malignancy is surgery of
the primary lesion and block dissection of groin. Adjuvant radiotherapy is
given mostly in squamous cell carcinoma and adjuvant Dacarbazine based
chemotherapy is given mostly in malignant melanoma.

Magnetic resonance cholangiography in the evaluation of
portal cavernoma cholangiopathy
Shumyla Jabeen, Departments of Radiodiagnosis, *Surgical Gastroenterology and **Gastroenterology,

Irfan Robbani, Sher-i-Kashmir Institute of Medical Sciences, Srinagar
Omar J Shah*,
Gul Javid**,
Tariq Gojwari, ABSTRACT
Feroze Shaheen,
Bashir A Khan**
INTRODUCTION: Portal Cavernoma Cholangiopathy refers to changes
involving the biliary tree in patients with portal cavernoma. Early and accurate
diagnosis of this entity has a bearing on the course and prognosis of patients
with extrahepatic portal vein obstruction
AIM: The aim of the study was to identify and characterize patterns of biliary
abnormalities in patients with portal cavernoma on Magnetic Resonance
Cholangiography(MRCP)and to correlate these with the vascular changes
METHOD: 52 patients with predocumented portal cavernoma underwent
MRCP on a 1.5 Tesla scanner. Various sequences were used to identify the
biliary and pancreatic changes and delineate the vascular anatomy in these
patients
RESULTS: We observed biliary changes in 42 patients with portal cavernoma.
40 patients showed abnormalities in the extrahepatic ducts. A predilection for
involvement of the suprapancreatic part of the common duct and left hepatic
duct was noted with a decreased CBD angle as a significant finding. The
disease was classified according to morphology, pattern of involvement and
severity. Pancreatic cavernoma was seen in 64%. Superior mesenteric vein
thrombosis was seen in 71% with enlarged choledochal venous plexuses in
95.2% of patients as against gastroesophagealvarices in 26% signifying
preferential portoportal collateralization which may explain the development
of portal cavernomacholangiopathy in these patients
CONCLUSION: MRCP is a versatile non invasive imaging modality which
clearly delineates the biliary and pancreatic abnormalities in patients with
portal cavernoma and their correlation with the vascular changes . It allows
early diagnosis, enables grading, classification and proper therapeutic
decisions

Role of magnetic resonance imaging in evaluation of
rectal cancer: a prospective study
Department of Radiodiagnosis, Sher-i-Kashmir Institute of Medical Sciences, Srinagar
Nowsheen Makhdoomi,
ABSTRACT Feroze Shaheen
OBJECTIVE: The main aims and objectives of the study were to determine
the current role of MRI in locoregional staging of rectal cancer by predicting
the depth of extramural tumor invasion, possible local lymph node
involvement and evaluation of pelvic anatomy and invasion of adjacent
muscles and to determine the accuracy of MRI in prediction of tumor-free
circumferential resection margin (CRM) and to obtain histopathological
correlation.
METHODS: Fifty patients with biopsy proven rectal cancer underwent
imaging using a 1.5-T MRI scanner with external phase-arrayed surface coil.
Each MR image was interpreted together by two radiologists who assessed the
tumor for transmural invasion, mesorectal fascia (CRM) involvement,
involvement of the mesorectal and extramesorectal lymph nodes and adjacent
organ invasion. Tumors were staged according to the TNM staging system
(American Joint Committee on Cancer guidelines). Restaging MRI, after
neoadjuvant treatment, was done in patients who had involved CRM on initial
MRI. Our gold standard was histopathology.
RESULTS: The sensitivity, specificity, accuracy, positive predictive value, and
negative predictive value of MRI for detection of perirectal fat invasion were
100%, 77.8%, 91.8%, 88.5%, and 100% respectively. For detection of adjacent
organ invasion, the respective values were 87.5%, 100%, 97.9%, 100% and
97.6% . The values for detection of the mesorectal fascia involvement were
100%, 92.2%, 93.6%, 72.7%, and 100%, respectively. For detecting malignant
lymphadenopathy, the respective values were 100%, 50%, 88.1%, 86.4% and
100%.
CONCLUSION: Thin-section MRI with a phased-array coil is accurate and
reliable for preoperative evaluation of pelvic anatomy and depth of transmural
tumor invasion.

Utility of magnetic resonance imaging in evaluation of
perianal fistulas
Department of Radiodiagnosis and *General Surgery, Sher-i-Kashmir Institute of

Umar M Siddiqi,
Sheikh Riaz Rasool,
Rouf Wani*, ABSTRACT
Naseer Choh
AIM: The purpose of the study was to evaluate role of MRI in detection and
characterization of perianal fistulae and correlating it with surgical findings.
We also tried to determine the relative value of different MR sequences
METHODS:41 patients with suspected perianal fistulae were subjected to
MRI evaluation. The images were evaluated with respect to type of fistula,
presence or absence of any associated abscesses, determination of any possible
secondary tracts and detection of possible supralevator extension. Findings at
MRI were compared with surgery. A consensus was also made for best
sequence for evaluating perianal fistulas
RESULTS: Amongst total of 41 patients, per-operative findings confirmed
perianal fistulae in 35 patients. The sensitivity and specificity of MRI in
correctly detecting primary tract was found to be 97.14% and 83.33%
respectively; for abscess, 100% and 97.22% respectively and for detection of
accessory tracts, it was 100% and 92.31% respectively. For presence of horse-
shoe fistulas, both sensitivity and specificity values were 100% each and for
detection of internal opening, it was 97.14% and 83.33% respectively. Post-
contrast T1W fat-saturated sequence was ranked as the best overall sequence
for anatomic and pathologic depiction of perianal fistulas and associated tracts
and abscesses
CONCLUSION:MRI is a highly accurate imaging modality for the
detection of perianal fistulas with an accuracy rate of 95%and helps to correctly
predict complex features of perianal fistulas with post contrast T1W fat
saturated sequence appearing to be the best overall sequence.

Evaluation of rotator cuff tendinopathies and tears with
high resolution ultrasonography and MRI correlation
Zubair Ahmad,
ABSTRACT Tariq A Gojwari
AIM OF THE STUDY: To evaluate the role of high resolution USG in

clinically suspected rotator cuff tears and tendinopathies with MRI
correlation.
MATERIAL AND METHODS: It is a prospective study carried out on 40
patients with clinically suspected rotator cuff pathology referred from the
departments of orthopaedics and physical medicine & rehabilitation over a
period of 18 months.
The sonography was performed using Siemens Aloka equipped with a phased
array linear 7.5 MHz transducer according to American Institute of
Ultrasound in Medicine (AIUM) Practice Guidelines (2007). All MRI
examinations were performed with a 1.5-T MR system (MAGNETOM
Avanto, Siemens).
RESULTS: USG found cuff pathologies in 30 patients while MRI diagnosed
32 cases with rotator cuff tears and tendinopathies. The strength of
agreement between USG and MRI was evaluated using kappa coefficient and
was found to be good (kappa=0.714). High resolution ultrasonography
showed reasonably high sensitivity (90.6%) ,specificity(87.5%) and
accuracy(90%) in diagnosing and characterizing rotator cuff pathologies.
CONCLUSION: USG and MRI are comparable modalities for evaluation of
rotator cuff pathologies. USG being easily available, affordable and dynamic
modality with better patient compliance should always be the first
investigation to be asked for the evaluation of rotator cuff pathologies and be
followed with MRI in cases where additional information is needed or when
USG findings are indeterminate.

Evaluation of intracranial tuberculomas using advanced
MRI techniques such as diffusion weighted imaging,
magnetic resonance spectroscopy and susceptibility
weighted imaging
Arshed Hussain Parry,

Feroze Shaheen
ABSTRACT
AIMS: To evaluate patients of suspected intracranial tuberculomas with new

MRI techniques comprising Magnetic Resonance Spectroscopy, Diffusion
Weighted Imaging and Susceptibility Weighted Imaging.
METHODS: A total of 58 patients of suspected intracranial tuberculomas
were evaluated with new MRI techniques including Magnetic Resonance
Spectroscopy, Diffusion Weighted Imaging and Susceptibility Weighted
Imaging.
2
RESULTS: ADC value of tuberculomas(1.027 ± 0.26)×10-3mm /s was not
significantly different (p > 0.05) from ADC value of metastatic lesions(0.978
2 2
± 0.12) ×10-3mm /s and high grade gliomas(0.892 ± 0.14)×10-3mm /s.
Spectroscopy of tuberculomas and malignant brain lesions revealed reduction
in N-acetylaspartate and Creatine with increase in Choline. NAA/Cr and
NAA/Cho ratios of tuberculomas were not significantly different (p> 0.05)
from that of malignant brain lesions. However, Cho/Cr ratio of tuberculomas
(1.36 ± 0.41) was significantly lower from that of malignant brain lesions
(2.63± 0.99). Lipid-lactate peaks were observed in both neoplastic and
tubeculoma lesions and were relatively non-specific in differentiating
between these entities. SWI revealed a complete and regular hypointense
peripheral ring in 21 cases of tuberculomas (58%) and in none of the malignant
brain lesions.
CONCLUSION: DWI offers no clear advantage in differentiating
tuberculomas from metastasis and gliomas. Tuberculomas may be
differentiated from metastases and gliomas by their unique metabolite pattern.
Presence of a complete and regular peripheral hypointense ring in SWI favors
the diagnosis of tuberculomas.
S_106 Journal of Medical Sciences 2015;18(1)

Role of MRI in dilated cardiomyopathy
Imtiyaz Ahmad Khan

ABSTRACT
Manjeet Singh
AIM: This prospective study was conducted to study myocardial

enhancement pattern in DCM on MRI, differentiate ischaemic from non-
ischaemic cardiomyopathy and correlate LV function obtained by CMR with
that of ECHO.
PATIENTS AND METHODS: Forty DCM patients diagnosed after
clinical and echo evaluation with reduced LVEF (<50%) were enrolled in this
study who underwent M-MODE ECHO and CARDIAC MRI .However,
only 27 (67.5%) patients had adequate window to undergo 2D-ECHO.
Patients with established CAD and LV Dysfunction due to specific causes like
drugs were excluded.
RESULTS: Three patterns of delayed enhancement were noted on CE-MRI:
Subgroup 1-No Enhancement (70%). Subgroup 2 –Ischemic Pattern Of
Enhancement (Subendocardial and Transmural limited to a vascular territory
with normal coronaries-12.5%). Subgroup 3-Midmyocardial Enhancement-
17.5%).LV thrombus was picked by CE-MRI in 6 patients with only 2 patients
detected by Echo. Ventricular functions calculated by ECHO (M mode and
2D) and MRI were significantly different from each other (P≤0.05) except for
2D ECHO and MRI which showed maximum correlation (P=0.442)
CONCLUSIONS :
1 . CARDIAC MRI is an effective tool to identify DCM patients with
ischemic pattern of enhancement in whom angiography should be
performed and anti-ischemic treatment instituted. CMRI is a better
modality in identifying LV thrombi in DCM patients surpassing TTE.
2 . CARDIAC MRI because of 3D approach and lack of geometric
assumptions is preferred technique in assessing ventricular functions in
DCM with 2D-ECHO and Cardiac MRI showing maximum
correlation.

A comparison of imaging guided double percutaneous
aspiration injection (D-PAI) and surgery in the treatment
of cystic echinococcosis (CE) of liver
Tahleel Altaf,
Tariq A Gojwari ABSTRACT
INTRODUCTION: Being less invasive, D-PAI is a promising alternative to

surgery in treatment of CE. Therefore, the results of D-PAI, particularly in
this part of the world, are worth studying
AIMS: To study the response of hepatic CE to D-PAI and to compare the
results and complications with that of surgery
MATERIAL AND METHODS: 43 patients were randomly allocated to D-
PAI group(n=22) and Surgery group(n=21). After the intervention, patients
underwent serological and sonographic examinations at 1, 2,3,6,12,18 and 24
months
OBSERVATIONS: Mean hospital was 2.38 days in D-PAI Group and 8.23
days in the surgery group. Mean follow-up period was 14 months in D-PAI
group and 15.71 months in the surgery group. Response to D-PAI was
categorized as Successful in 95.3% and Incomplete in 4.7%. Response to
surgery was characterized as Successful in 90.5% cysts, incomplete in 4.7% and
recurrence was seen in 4.7%. In the D-PAI group, 8 patients developed
complications; 1 major (high grade fever) and 8 minor[urticarial rash in 9.5%,
pneumothorax 9.5%, transient hypotension in 4.7%, intoxication in 4.7% and
low grade fever in 4.7%]. In the Surgery group, 6 patients developed
complications; 5 major [high grade fever in 9.5%, bile leak in 9.5% and sub-
phrenic collection in 4.7%]and 3 minor [wound infection in 4.7%, low grade
fever in 4.7 % and prolonged tube drainage in 4.7 %]. Both the groups showed
a rise in mean titres 1 month after the intervention followed by a fall to baseline
values at 2 years
CONCLUSIONS: Over a period of 2 years, D-PAI is as effective as surgery
in the treatment of hepatic CE. Probability of cyst disappearance/solidification
shows no statistically significant difference between the two groups.

Prospective vs retrospective ECG-gated coronary CT
angiography in the evaluation of patients with low-to-
intermediate risk for coronary artery disease
Mir Saiqa Shafi,

ABSTRACT Tariq A Gojwari
AIMS: Comparing image quality, stenosis & radiation between retrospective

and prospective CCTA, assessing the influence of heart rate & heart rate
variability on the image quality and studying the distribution of CAC score
across various patient risk groups.
METHODS: Patients were stratified as per Framingham risk groups and
their CAC score was calculated in terms of Agatston score. Two independent
reviewers separately scored coronary artery segment quality for 99 cardiac CT
studies. Patient radiation dose for the actual Z-axis length was recorded & was
normalized to 12cm.
RESULTS: In retrospective gating,4.7% of segments had an IQS of 4 & in
prospective gating,11.0% of segments had an IQS of 4.There was no
significant influence of heart rate on image quality in retrospective group. In
prospective group, the image quality was significantly better in those with
heart rates ≤ 60 bpm. The image quality was better in patients with low heart
rate variability in both groups. Normalized Z-axis effective dose was
17.50±2.17 mSv & 3.47±0.63 mSv in retrospective & prospective groups
respectively. 87.5% of the patients in the high risk had a CAC score of ≥
300.There was a good correlation between percent diameter stenosis
determined by CCTA & quantitative coronary angiography(QCA) for both
CT techniques.
CONCLUSIONS: There is about 80% reduction in the effective radiation
dose with prospective CCTA. Image quality is significantly better with
retrospective CCTA on a 64-slice CT scanner. Regularity of the heart rate
during scanning is a major determinant of image quality in both techniques of
CCTA. There is a significant association between CAC score and
Framingham risk score such that the prevalence and amount of CAC score
increase with increasing risk score.

MRI evaluation of sonographically indeterminate adnexal
masses
Ghulam Mohammad
Tariq A Gojwari ABSTRACT
AIMS OF THE STUDY: To assess the role of MRI in the evaluation of

adnexal masses indeterminate on sonographic evaluation with emphasis on
further characterization, determination of their origin and identifying the
malignant change if present.
MATERIAL & METHODS: The adnexal masses indeterminate on
sonography were evaluated with MRI, delineating their Origin, Tissue
Content, Tissue Characterization, presence or absence of restriction on DWI
MR, whether benign or malignant. On sonography parameters noted were
Origin, Tissue Content and reason for indeterminate diagnosis. Comparison
was made with final diagnosis (mostly HPE) and agreement was obtained
using kappa analysis, sensitivity/ specificity for neoplastic change obtained
using 2x2 tables.
RESULTS: MRI had an excellent agreement with final diagnosis in
determination of origin ((k-0.96,p <.001), tissue content(k-0.99, p- <.001),
tissue characterization(k-0.96, p-<.001), predict the benign character(k-
0.94,p-<.001, specificity of 98.9%) of the studied masses whereas sonography
had poor agreement to determine the origin(k-0.05 p-0.047) and moderate
agreement(k-0.51, p-<.001) to characterize the content of the studied masses.
Addition of DWI imaging added further in prediction of benign diagnosis.
CONCLUSIONS: MRI was able to determine the origin, characterize these
masses and was able to characterize the lesions as benign or malignant with
great confidence. DWI MR imaging added further specificity for making a
benign diagnosis. MRI exam is investigation of choice and an effective tool,
preventing inappropriate cancer surgery in benign lesions while triaging the
malignant lesions for proper surgery and staging procedure.

Patterns of failure in carcinoma breast after radical
treatment
Department of Radiotherapy, Sher-i-Kashmir Institute of Medical Sciences, Srinagar
Zahoor Ahmad Paul,

ABSTRACT Fir Afroz,
M. Maqbool Lone
PURPOSE: To evaluate the patterns of failure in patients with Breast

Carcinoma after definitive treatment modalities in terms of : Local
failure, Regional failure, Distant failure, Disease free survival & Overall
survival.
INTRODUCTION: Breast cancer is the leading cancer diagnosed in
the US women (26%) . It constitutes, approximately 17% of all cancers
registered in our department. The adjuvant treatment modalities decrease
the risk of locoregional failure, distant failure and improve the disease free
survival, overall survival.
MATERIAL AND METHODS: This was a retrospective study done in
Radiotherapy Department, SKIMS. Total number of patients enrolled in
the study were 1238. Inclusion Criteria were followed up.
RESULTS: 96% patients were females and 4% were males. 62%
patients were ≥ 50 years and 38% were < 50 years of age. All patients had
undergone surgical intervention. The chemo-radiation was received by
100% patients, hormonal therapy by 80% and trastuzumab by about 3%
patients. The local failure was seen in four percent of patients (4%). The
regional failure was about (3%). The distant failure was about (23%). The
median disease free survival was 75 months for stage I, 47 months for
stage II and 41 months for stage III. The 5-year survival rates for stage I,
II and stage III were 100%, 85% and 65% respectively.
CONCLUSION: The most common pattern of failure was distant
followed by local and regional . The mean disease free survival for stage I
was more as compared to other stages and same was true for 5-year
survival rates.

Patterns of failure after definitive treatment in non-small
cell lung cancer
Department of Radiotherapy, Sher-i-Kashmir Institute of Medical Sciences, Srinagar

Pawan Kumar,
NA Khan,
ABSTRACT
Fir Afroz,
SA Aziz
INTRODUCTION: Lung cancer is a major health problem worldwide
including Kashmir. The incidence is increasing globally at a rate of 0.5% per
year. It is the leading cause of cancer mortality in most of the countries in the
world, associated with poor prognosis and high failure rates. The motive of the
study is to evaluate the patterns of failure with various treatment modalities to
find the best treatment modality to improve prognosis and survival.
MATERIAL & METHODS: This was a 5 years retro-prospective study in
which patients with histologically confirmed NSCLC, registered at RCC,
SKIMS, Srinagar between January, 2008 to December, 2012 and treated by
Radiotherapy/Chemotherapy/Surgery or any combined modality were
included in the study.
RESULTS: 945 patients were available for analysis out of which 714
completed treatment and 558 were available for evaluation after completion of
treatment. 34(6.09%) had complete response, 128(22.94%) had partial,
122(21.86%) had stable disease and 274(49.10%) had progression. Out of 34
with complete response, 15 received triple modality, 7 received chemotherapy
& surgery, 7 received radiotherapy plus chemotherapy, 2 received radiotherapy
plus surgery, 2 underwent surgery only and 1 received chemotherapy only. 19
out of 34 had recurrence. 3 had local, 2 had regional, 2 had loco-regional, 6 had
distant and 6 had loco-regional plus distant failure. Patients who recurred, 2
had underwent surgery, 5 received chemotherapy plus surgery, 3 received
radiotherapy plus chemotherapy, 8 received triple modality, 1 had received
radiotherapy plus surgery.
CONCLUSION: Better survivals were observed with combined treatment
modalities. Triple modality treatment had highest complete response and
better survival rates followed by chemo-radiation.

Randomized trial comparing two hypofractionated
radiotherapy schedules (20 Gy in five fractions versus
17Gy in two fractions) in advanced non-small cell lung
cancer (Stage IV)
Department of Radiotherapy and Radiological Physics & Bio-engineering, Sher-i-Kashmir

Mushtaq Ahmad Sofi,
M Maqbool Lone,
ABSTRACT Fir Afroz,
Mohib-ul Haq
INTRODUCTION: Palliative radiotherapy alone plays an important role in

poor PS status metastatic NSCLC patients in the palliation of symptomatic
intrathoracic disease & in the preservation of health-related quality of life
(HRQOL).
OBJECTIVE: To investigate the effectiveness and add to the evidence on the
feasibility and equivalence of a two fractions versus five fractions regimen in
advanced non-small cell lung cancer in terms of: Palliation of thoracic
symptoms, Toxicities due to treatment & HRQOL.
METHODS: This was a prospective clinical study that included 60 patients
who were randomly assigned into 2 groups( ARM- A 17 Gy per 2 fractions &
ARM-B 20 Gy per 5 fractions.
RESULTS: A total of 52% patients showed an improvement in grade of cough
in Group A & 59% patients in Group B, 80% patients in Group A & 75%
patients in Group B showed improvement in grade of hemoptysis , 60% &
50% patients in Group A & B respectively showed improvement in grade of
dyspnea & 80% & 68.75% patients in Group A & B respectively showed
improvement in chest-pain. 20% of patients in group A and 26.7% in group B
had developed esophagites after RT. HRQOL was preserved equally in the
two study arms with no significant deterioration in any domain of the EORTC
questionnaires at the follow up times.
CONCLUSION: More protracted radiotherapy renders no improvement in
symptom control or HRQOL as compared to less protracted RT schedules.

Role of CEA Levels as a prognostic factor in Colo-rectal cancer
Department of Radiotherapy, *General surgery and **Immunology and Molecuclar

Medicine, Sher-i-Kashmir Institute of Medical Sciences, Srinagar
Rajpal Singh,
M. Maqbool Lone,
ABSTRACT
Nisar A Chowdri*,
Fir Afroz,
Zafar Amin Shah**
INTRODUCTION: We aim to evaluate the prognostic significance of CEA
level in colo-rectal cancer patients, pre-treatment, during treatment and
follow up and correlate raised CEA with recurrence.
METHOD: A total number of 101 patients were enrolled in the study and
CEA levels were measured at first contact, post-treatment (either surgery or
concurrent chemo radiotherapy), during chemotherapy cycle and then patient
is followed up for 6 months after completion of treatment and last CEA level is
taken at 6 month of completion of treatment by ELISA method in
Immunology department. Results are drawn on the basis of CEA levels at 6
months of follow up. Patient in whom persistent raised CEA levels are seen
were evaluated for metastasis.
RESULT: Mean age of our patient was 46 years and 45% of the patients were
in young age group (<40 years).Male to female ratio was equal in rectal cancer
and male sex was more common (72%) in colon cancer. 64% of patients
presented with bleeding P/R.63% of the patients presented in advance stage
(III). More patients with advance stage had raised CEA levels with sensitivity
of 49.5%.Presence of metastasis was associated with raised CEA levels.50% of
the raised CEA level was documented with metastasis. Most common site of
metastasis was Liver (75%).
CONCLUSION: Persistent high levels of postoperative serum CEA levels
are a clinically important predictor of poor prognosis. The presence of such
levels is an effective measurement of therapy after curative resection.
Surveillance of patients with high postoperative serum CEA with an unknown
cause should be extended, and these patients should be examined with
sensitive diagnostic methods and should, potentially be treated for recurrence
at an earlier stage of disease.

Comparative evaluation of Hyperfractionated concurrent
chemoradiation versus conventional concurrent
chemoradiation in locally advanced NSCLC
Department of Radiotherapy, Radiological Physics & Bio-engineering, Sher-i-Kashmir

Nahida yousuf,
M Ashraf,
ABSTRACT A Majid,
Mohib ul Haq
PURPOSE: To evaluate and compare role of hyperfractionated concurrent
chemoradiation(HFX-CCRT) versus conventional concurrent
chemoradiation in locally advanced NSCLC with regards to: Local control,
Overall& disease free survival and Immediate& delayed toxicities.
INTRODUCTION: Majority of lung cancer patients are
inoperable/unresectable at presentation. Radiation provides the main
treatment modality. Despite advances in imaging techniques and treatment
modalities, the prognosis of lung cancer remains poor.
MATERIAL AND METHODS: 60 patients of locally advanced NSCLC
were divided randomly into two groups: group I(study n=30), HFX RT with
1.2 Gy twice daily to a total dose of 72Gy with concurrent weekly paclitaxel
@50 mg/mt² on day 1 of every week of radiation and group II(control n=30),
conventional fractionation radiation with 2Gy /Fr to a total dose of 66Gy/33 Fr
with concurrent chemotherapy as in group I. In both BED was comparable
and Rx was completed within 6-8weeks
RESULTS: The median survival was 18 months vs 9 month in study
&control group respectively. Overall median survival of both groups was 12
months. The 1-year survival rate was 76%vs 50% and 2-year survival was
40%vs 26% in study and control group respectively. The log-rank test between
the two did reveal a statistical significance of 0.005(p<0.05) which was largely
due to improved local control in group I. Toxicity was slightly more in study
group in terms of esophagitis (70%vs 63.3%), skin reactions (70%vs 63.3%
with grade 3 more in study 13.3%vs 0), and pneumonitis (50%vs 43.3%), with
overall no significance(p >0.05). There was no grade 4 or 5 toxicity in any
group.
CONCLUSION: The combination of HFXRT with weekly paclitaxel is well
tolerable and substantially increased survival rate.

Surgical management and follow up of patients with bile
duct injuries in tertiary health care institute
Department of Surgical Gastroenterology, General Surgery,**Gastroenterology &

***Radiology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar
Shahnawaz Akram,
Sadaf Ali,
Omer Javid Shah,
ABSTRACT
*Khursheed Alam Wani,
**G.N Yatoo,
***Irfan Robbani,
OBJECTIVES: To analyze the presentation and pattern of bile duct injury
Arshad Ahmed Baba
managed at our surgical unit. Operative details, type of surgery and the
complications associated with the repair. Follow up and an assessment of
physical quality of life.
PATIENTS AND METHODS: The study included evaluation of 56
patients who had suffered bile duct injuries and then were subsequently being
managed surgically at our institute retrospectively from oct-2009 to 2012 and
prospectively onwards till October 2014. The mean follow up period in case of
our study was 26.8 months. The follow up LFTs were performed at regular
intervals. MRCP was used as a gold standard for diagnosis.
RESULTS: Jaundice (64.2%) was the most common presentation. Injuries
noted were, type E1 in 16(28.5%),type E2 in 11(19.6%), type E3 in 1(1.8%),
type A in 2(3.6%), type B in 3(5.4%), type C in 5(9%) and type D in 18(32.1%)
of patients. Roux-en-y Hepaticojejunostomy was the common definitive
repair performed (85.7%) with various modifications. The mean bilirubin
levels and ALP levels showed a downward trend in follow up .5 patients were
readmitted with features of cholangitis in which 2 patients were reoperated
and 3 patients were managed conservatively. 2 patients died. The Q.O.L
according to Karnofsky Performance Scale was high (100 points) in most 22
(40.5%) patients with mean score of 84.28.
CONCLUSION: The management of patients following major BDI is a
surgical challenge often requiring the skills of experienced hepatobiliary
surgeons at tertiary referral centers.

Outcome of live related kidney transplants with multiple
renal arteries
Department of Urology & *Nephrology, Sher-i-Kashmir Institute of Medical Sciences,

Srinagar
Jan Mohammad Rather,
Mohammad Saleem Wani,
ABSTRACT *Imtiaz Ahmad Wani
The use of grafts with multiple renal arteries has been considered a relative
contraindication because of the increased incidence of vascular and urological
complications. The aim of the study was to determine whether the kidney
grafts with multiple arteries have an adverse effect on the post transplant graft
function and survival.
METHODS: A total of 107 kidney transplants done in our centre till dec
2013 were reviewed. These were divided in two groups; group A- kidney grafts
with single renal artery. Group B- kidney grafts with multiple renal arteries.
Eighty nine grafts had single renal artery and eighteen had grafts with multiple
renal arteries and hence required multiple vascular anastomoses.
RESULTS: No significant differences were seen in the two groups regarding
serum creatinine (p value of 0.224, 0.248, 0.458 at 3, 6 and 12 months
respectively, DGF (7:2, p value 0.645), RAS (2:1, p value of 0.428), urological
complications (10:3, p value of 0.645). Significant differences were seen in
anastomoses time (29.83: 44.72 mints, p value <0.001), WIT (17.1 : 18.4 sec, p
value of <0.001), CIT (50.9: 77.5 min, p value <0.001), blood loss (157:219
ml, p value of <0.001) and lymphocele formation (4:4, p value of 0.026). The
difference in graft survival between the two groups was insignificant (8:2, p
value of 0.674)
CONCLUSIONS: kidney transplantation using grafts with multiple renal
arteries may be associated with higher rates of lymphoceles, increased blood
loss, CIT, WIT and anastomoses time. However it is equally safe as using grafts
with single renal artery regarding vascular, urological complications as well as
the graft survival.

Semirigid ureteroscopy with intracorporeal pneumatic
lithotripsy in the management of upper ureteric calculi: A
prospective study
Department of Urology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar
Raouef A Bichoo,
Arif Hamid ABSTRACT
OBJECTIVE: To evaluate the operative characteristics, postoperative

complications and outcome of ureteroscopic pneumatic lithotripsy in the
management of upper ureteric stones.
PATIENTS AND METHODS: The study included 106 patients, evaluated
and treated between June 2012 to September 2014. Stone localization was
done by x-ray KUB & USG. IVU was done to determine renal functional
status and degree of hydronephrosis. Ureteroscopic pneumatic lithotripsy was
performed using semirigid Wolf ureteroscope and Swiss Lithoclast. Ureteric
dilatation and DJ stenting was done selectively. The patients were followed
with plain X-ray KUB and USG at one week and three weeks respectively.
RESULTS: The mean age of the patients was 32.89 ± 10 years. The mean
stone size was 13.42mm ± 2.85mm. Mild to marked obstructive changes in
collecting system was seen in almost all patients. Overall success rate was 93%
at 3 weeks. Overall mean operative time was 32.2 minutes; while for impacted
stones mean operative time was 41.18 minutes. Failure was due to stone
inaccessibility (01.88 %) and stone migration (05.66 %). Mean hospital stay
was 1.43 day. Complications included transient hematuria in 26 (26.56%), pain
in 24 (24.49%), low grade fever in 5 (05.10 %) and urosepsis in 3 patients
(03.06%).
CONCLUSION: Semirigid ureteroscopy with pneumatic lithotripsy is
effective and safe treatment modality having unremarkable complications in
the management of upper ureteric stones in experienced hands.

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Morbidity and mortality after implantation of St.

Cardiovascular & Thoracic Surgery, Sher-i-Kashmir Institute of Medical Sciences, Srinagar

INTRODUCTION: To assess our experience with cardiac valve

Journal of Medical Sciences 2015;18(1) 1

Departments of Cardiovascular & Thoracic Surgery, *Cardiology and **Radiology, Sher-i-

Mir Mudasir Sidiq,

2 Journal of Medical Sciences 2015;18(1)

Department of Endocrinology, *Immunology & Molecular Medicine and **Cl.

Journal of Medical Sciences 2015;18(1) 3

Department of Endocrinology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar

Nazir Ahmad Pala,

BACKGROUND: Hyperprolactinemia has been associated with changes in

4 Journal of Medical Sciences 2015;18(1)

Department of Gastroenterology, *Medical Oncology & **Cl. Haematology, Sher-i-

Journal of Medical Sciences 2015;18(1) 5

6 Journal of Medical Sciences 2015;18(1)

Department of Medical Oncology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar

Ulfat Ara Wani,

BACKGROUND: Non-Hodgkin's lymphoma is one of the most

Journal of Medical Sciences 2015;18(1) 7

Irfan Yousuf Wani 1,

INTRODUCTION: Migraine is a complex, recurrent headache disorder

8 Journal of Medical Sciences 2015;18(1)

Departments of Neurology and *Immunology & Molecular Medicine, Sher-i-Kashmir

Sawan Kumar Verma,

INTRODUCTION: Viral Encephalitis/Meningoencephalitis is an acute

Journal of Medical Sciences 2015;18(1) 9

10 Journal of Medical Sciences 2015;18(1)

Department of Plastic and Reconstructive Surgery, Sher-i-Kashmir Institute of Medical

Bashir Ahmad Bhat,

OBJECTIVE: To study etiology mandibular defects, the functional and

Journal of Medical Sciences 2015;18(1) 11

12 Journal of Medical Sciences 2015;18(1)

Department of Anesthesiology & Critical Care, Sher-i-Kashmir Institute of Medical

BACKGROUND: Relieving postoperative pain in spine surgeries has

Journal of Medical Sciences 2015;18(1) 13

Department of Anaesthesiology & Critical Care, Sher-i-Kashmir Institute of Medical

BACKGROUND: Neurosurgical patients requiring short term

14 Journal of Medical Sciences 2015;18(1)

Department of Anaesthesiology & Critical Care, Sher-i-Kashmir Institute of Medical

BACKGROUND: Patients with penetrating eye injury often present with

Journal of Medical Sciences 2015;18(1) 15

Department of Anaesthesiology & Critical Care, Sher-i-Kashmir Institute of Medical

Khalida Parveen, ABSTRACT

AIMS: Comparing the effectiveness, safety and efficacy of oral pregabalin in

16 Journal of Medical Sciences 2015;18(1)

Department of Anaesthesiology & Critical Care, Sher-i-Kashmir Institute of Medical

INTRODUCTION: Postoperative nausea and vomiting (PONV) are

Journal of Medical Sciences 2015;18(1) 17

Departments of Anaesthesiology & Critical Care, *Clinical Biochemistry, Sher-i-Kashmir

BACKGROUND: Routinely monitored parameters may not reliably detect

18 Journal of Medical Sciences 2015;18(1)

Department of Anaesthesiology & Critical Care, Sher-i-Kashmir Institute of Medical

BACKGROUND: Isoflurane is a commonly used inhalational anaesthetic

Journal of Medical Sciences 2015;18(1) 19

Department of Anaesthesiology & Critical Care, Sher-i-Kashmir Institute of Medical

Azka Sunain Khan

INTRODUCTION: Dexamethasone has a powerful anti-inflammatory

20 Journal of Medical Sciences 2015;18(1)

Department of Anesthesiology & Critical Care, Sher-i-Kashmir Institute of Medical