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SSIMS&RCNH-4, Bypass Road, Davangere - 577 005.Phone : 08192-261805, 261806, 261807

261808, 261809 FAX : 08192-262633, 266310E-mail : [email protected]

Website : www.ssimsrc.com

Disclaimer :Views and opinions expressed in this newsletter are notdirectly that of the editor or the editorial board. For anyclarification, author of the article is to be contacted.

Editorial Desk 2

Reports:

Departmental Activities 2 - 7

1. A Case Of Foreign Body GettingLodged In Trachea During Removal

13 - 15

2. Giant Congenital Melanocytic Nevi -A Report Of Two Cases

15

17 - 19

Congratulations 20

PATRONS

Dr. Shamanur Shivashankarappa Sri S.S. MallikarjunaMLA, Honorary Secretary, BEACabinet Minister, Karnataka.

MLA, ChairmanSSIMS&RC, Davangere

Editor in Chief: Editors:

Executive MembersDr. A. V. Angadi Dr. Dileep V Deshpande

Dr. L. Krishnamurthy Dr. Dhanya Kumar. SDr. Shivamurthy K. C

Student Representatives:Dr. Balaji V, Dr. Apoorva B M, Jayanth S S, Vandana M

Technical SupportDevaraj V H S. D. ASanthosh Kumar. D.M Photographer

S.S. Institute of Medical Sciences & Research Centre

NEWS BULLETIN COMMITTEEEditorial Office: DEPARTMENT OF PHARMACOLOGY

Extn. No. 08192 - 266345

Publications of SSIMS-ites 8

Informative articles 8 - 10

Pharmacovigilance Cell 10 - 12

Case Reports:

Dr. ShivashankaramurthyAssociate Professors

Co-Editors:Dr. Raghu Prasada M.S Mr. Harish Kumar V.SMr. Pradeep A.N Mr. Chethan Kumar.S

Dr. Sathisha Aithal

Dr. Mallikarjuna.C.R Dr. Umakant N PatilDr. P. Shashikala Dr. Basavarajappa. K. GDr. Arunkumar. A Dr. Ramesh. S. DesaiDr. Anil. S. Nelvigi Dr. Prakash. V. SuranagiDr. Prasad B.S. Dr. Veerendraswamy. S. MDr. Sreepada Bhat.S. Dr. Hemant K KulkarniDr. Vijayakumar. B. Jatti Dr. Bheemayya BadesabDr. Jagannath Kumar. V Dr. Vinod. G. KulkarniDr. A. M. Shivkumar Dr. Prema PrabhudevDr. Narendra. S. S Dr. P. Mallesh

Advisory Board:Dr. P. Nagaraj PrincipalDr. N.K.Kalappanavar Director (Medical)

Associate ProfessorDepartment of PharmacologyPhone: 08192- 266345E-mail: [email protected]

Contents Page No.

Student Union Activities 16

S.S. INSTITUTE OF MEDICAL SCIENCES & RESEARCH CENTRE Vol.9. Issue: 2, Apr – June-2014SS IM S T IM ES

Dear Friends and Colleagues,

The gift of blood is gift of life. Everytwo seconds someone needs blood. One timeblood donation can help to save lives of up tothree persons. If an individual starts donatingblood at the age of 18 and donates every 90days until he/she reaches 60, he/she would havedonated 30 gallons of blood, potentially helping500 lives.

It’s a great pleasure to hear that the staff

I conclude with a message of SwamiVivekananda “Your duty is to go on working,and then everything will follow of itself”.

Dr. Sathisha AithalEditor

World Health Day on 07-04-2014:

The theme for this year is “Small bite, big threat;protect yourself from vector borne diseases”.World Health day was observed by giving healtheducation to undergraduate students on thetheme. Dr. Ayesha Nawaz, Asst Professor, spokeon the theme.

Continued Medical Education on 26-04-2014:

Department of Community Medicine incollaboration with District Health & Familywelfare organized one day CME on the theme ofWorld Health day, “Small bite, big threat;protect yourself from vector borne diseases”.

Mr. Hemachandra, CEO, Zilla panchayat wasthe chief guest and Dr. Balu P.S, Professor, Deptof Community Medicine, JJMMC, was theobserver from Karnataka Medical Council. Dr. PNagaraj, Principal, presided over theinauguration programme. Dr. Vishwanath,District Health Officer and Dr. Raghavan,District Tuberculosis Officer were present on theoccasion. Dr. Ratnaprabha, Asst Prof, co-ordinated the CME.

About 400 delegates registered for the CME.Postgraduate students, faculty from variousmedical colleges in Karnataka and Medicalofficers from different PHC of Davangereparticipated in the CME.

DEPARTMENTOFCOMMUNITYMEDICINE

Men should be taught to be practical, physically strong. A dozen such lions will conquer the world,2 not millions of sheep - | Swami Vivekananda |

I am very happy for appointing me asEditor and also for constituting a neweditorial team for the "SSIMS Times" from this edition. It is an honour and privilege tome for take part in this work. I believe that new responsibility is an opportunityand challenge. I request all the staff ofSSIMS and RC for their continuous support andco-operation.

and the students of our college participated involuntary blood donation camp on the occasionof birthday of Dr. ShamanurShivashankarappa, Hon. Secretary, BEA,Davangere and Minister of Agriculturalmarketing and Horticulture, Government ofKarnataka.


3

Sl.No. Name of the Speaker Topic

1Dr. Pragathi V.CAssociate Professor,Dept of Community Medicine, SSIMS&RC

Introduction and epidemiology of vectorborne diseases.

2 Dr. Ravi Kumar.K, Ex-Senior RegionalDirector, MOH&FW

Clinical profile and currentrecommendation in the management ofDengue, Malaria & KFD.

3 Dr.Saroja Bai, District Surveillance Officer,DHFWS

Lab diagnosis of common vector bornediseases and role of IDSP.

4 Dr.Nagarajachari A, Prof & Head, Dept ofCommunity Medicine, JJMMC

Epidemiological approach in the controlof vector borne diseases.

5 Mr. Satish Malgi, Chief Entomologist,DHFWS, Davangere Integrated vector control

6 Dr. P.B. Patil, District Malaria Officer,DHFWS

NVBDCP in 12th plan and NationalHealth Mission.

7 Dr. Ravi Kumar.K, Ex-Senior RegionalDirector, MOH&FW

Recent advances in prevention andcontrol of vector borne diseases.

DEPARTMENTOFMICROBIOLOGYDr.K.G. Basavarajappa, has been elected asPresident, Dr. V.L.Jayasimha as Secretary & Dr.C.S.Vinod Kumar as Treasurer of IndianAssociation of Medical Microbiologist-Karnataka Chapter for the year 2014-15

Dr. V.L.Jayasimha delivered a lecture on“Prospects for Medicine for CET aspirants”. Thisprogramme was organized by Deccan Heraldgroup at Bapuji Auditorium on 21st May 2014.

Dr. Kruthika P was awarded best paper on topic“Study on Candida species from NosocomialUrinary tract infection and its virulence factor” inthe CME conducted by Indian Association ofMedical Microbiologists - Karnataka Chapter atVijayanagara Institute of Medical SciencesBellary on 21st June 2014.

Ms Shubha V. Hegde, III Year MBBS studentgot ICMR-STS 2014 project for the topic“Analysis of Infections in skin graft patients in a

tertiary health care centre. This topic was guidedby Dr. Vinod Kumar C.S.

Rajiv Gandhi University of Health Sciences hassanctioned the grants for the research projectentitled “Biologic characterization of HIV-1exposed serodiscordant married couples in atertiary care hospital in Bangalore”. This projectis jointly submitted by Dr. Asima Banu ofBangalore Medical College and ResearchInstitute and Dr. Vinod Kumar C.S. fromS.S.Institute of Medical Sciences and ResearchCentre.

Ms Sonika, II Year MBBS student was awardedbest paper on the topic “Public transport: Alarge scale fomite of MRSA”, Internationalconference held at KIMS, Bangalore on 12th &13th April 2014. Her presentation was guidedby Dr. Vinod Kumar C.S.

Compromise makes a good umbrella, but a poor roof- | Lowell |


4

DEPARTMENTOFPATHOLOGYA voluntary blood donation camp was organizedby Biomedical Engineering Department BIETDavangere, in Association with S.S.Blood bank,Davangere in BIET campus on 12th Apr 2014. Atotal of 104 units were collected. Blood BankOfficer Dr. Shwetha. J.H and postgraduates Dr.Udayashankar, Dr. Chethan, Dr. Shwetha Paiwere attended.

A voluntary blood donation camp was organizedon 4th May 2014, by Legislator of Hirekerur,Haveri (Dist), in Hirekerur in Association withSSIMS Blood Bank. About 22 units of bloodwere collected. Post graduates attended: Dr.Udayashankar S.K. Dr. Sujoy Kumar De.

Dr. Shashikala P. Prof & Head and Dr. KavitaG.U. Professor were guest speakers at WorldThalassaemia day celebration at Child HealthInstitute on 8th May 2014 and spoke on the topic“Guidelines of Transfusion in Thalassaemia” andcreated awareness among parents ofThalassaemia patients.

A voluntary blood donation camp was organizedon 23rd May 2014, by Sparsh hospital at VasaviSanga Auditorium, Chitradurga in Associationwith SSIMS Blood Bank. Post graduates Dr.Udayashankar S.K. Dr. Sujoy Kumar Deattended & conducted the camp.

Dr. Shamila presented case on “40 years old ladywith breast lump: FNA showed atypical cells,wide excision done” at KCIAPM Slide Seminarat Bangalore Medical College on 25th May 2014.DDS given were papillomatosis, sclerossingpapilloma. Final diagnosis was atypicalpapilloma by the moderator.

DEPARTMENTOFORTHOPAEDICS

Bone mineral density(B.M.D) free test was doneon 28/04/14 at department of Orthopaedics,SSIMS &RC, Davangere

Dr. Chetan .M.L delivered lecture ‘EducationalMethodology’ on 19th & 20th May 2014,Conducted by RGUHS Bengaluru.

Dr. Sachin S.Nimbragi attended District

Dr. Ramesh Pujar attended District DisabilityResearch Centre[ DDRC] camp on 19/05/14 atHarihara[T] Nandigavi & 31/05/14 at Jagalur[T]Sokki

Dr. Chetan.M.L, attended District DisabilityResearch Centre [ DDRC] camp on 27/05/14 atHaraihara[T] Devarabelakeri.

Mr. Jagadish Reddy.K.N, Physiotherapistattended District Disability Research Centre[DDRC] camp on 15/05/14 at Channagiri[T]Nuggihalli, 19/05/14 at Harihara[T] Nandigavi,22/05/14 at Jagalur[T] Kaythanahalli, 27/05/14 atHaraihara[T] Devarabelakeri, 29/05/14 atChannagiri[T] Benkikeri, 31/05/14 at Jagalur[T]Sokki .

Mega Camp was conducted on 07/06/14, atChallakere ,Chitradurga. Dr. Anil.S.Nelivigi Prof

A voluntary blood donation camp was organizedon 2nd May 2014, by Sparsh, Mr. Ravi Kumar

Dr. Siddesh Patil.G.S attended District DisabilityResearch Centre[ DDRC] camp on 22/05/14 atJagalur[T] Kaythanahalli.

Disability Research Centre[ DDRC] campon 15/05/14 at Nuggihalli, Channagiri[T] & 29/05/14 at Channagiri[T] Benkikeri.

Neither money pays, nor name, nor fame, nor learning; it is CHARACTER that can cleavethrough adamantine walls of difficulties - | Swami Vivekananda |

Davangere, at Veerashiva Samaja,Veeraktha Matta, Davangere in Association withSSIMS Blood bank. 18 units of blood werecollected. Dr. Shashikala P. Prof &HOD inaugurated the function, blood bankofficer, Dr. Kavita G.U and post graduatesDr. Udayashankar S.K, Dr. Sujoy Kumar Dewere attended.


5

& HOD, Dr. Praveen.M.Anvekar Asso.Prof, Dr.Ramesh Pujar Asst Prof, Dr. Chetan.M.LAsst.Prof, Dr. Siddesh Patil.G.S Asst Prof &House surgeons were present.

CME ON RHEUMATOLOGY 13TH APRIL, 2014

Organised by Dept. of Orthopaedics, Dept. ofGeneral Medicine & Dept. of Paediatrics.

The programme was inaugurated by ourbeloved ;

Dr. Manjunath.J. Professor, Dept ofOrthopaedics ,SSIMS&RC,

Dr. Kalappanavar N.K., Professor & HOD,Dept of Paediatrics & Medical DirectorSSIMS&RC,Dr. S.Sree Pada Bhat ,Professor, Dept. ofGen Medicine, SSIMS&RC,Dr. Nagaraj.S., Consultant Rheumatologist,SPARSH Hospital,Dr. Prasanna Anaberu, Professor & K.M.C.Observer,Dept. of Orthopedics, J.J.M.M.C.Davangere,

DEPARTMENTOFOBSTETRICS&GYNEACOLOGY

Dr. Prema Prabhudev, Pro. & HOD was attendedOBG CME at JNMC, Balgaum as KMC observer on26th April 2014.

Dr. Rashmi P.S. Asso. Professor has undergonetraining in Basic Ultrosonsography under Dr. ChitraGanesh, Director, Mediscan Bangalore from 20th

January to 28th February 2014.

CME ON OVULATION INDUCTION & IUI 21ST

JUNE 2014:Organized by Davangere OBG Society, dept. ofOBG, SSIMS & RC., JJMMC and KISAR in

collaboration with RGUHS, Bangalore at S.S.Auditorium SSIMS hospital block. KMC has allotted2 credit hours for the CME.

Dr. Prema Prabhudev and Dr. T.G. Shashidhar wereCME organizers.

OBG society office bearers as follows:Dr. Prema Prabhudev- President,Dr. Rashmi Shetty - Vice President,Dr. G.Y. Agasimani - Treasure,Dr. Ashwini. M.N. - Secretary andDr. Vijaykumar. M.M. - Joint Secretary.

Scientific Programme as follows:

Moderator –Dr. Bina vasanPanelists –Dr. Ramesh . A.,CDr. RavigowdaDr. Ashwini. G.B.Dr. Savitha Mahesh

Optimising ovulation induction protocols in IUI

Dr. B.G.Dharmanand, ConsultantRheumatologist,SAKRA HospitalBengaluru.

Speakers SubjectDr. Dharmareddy Predictors of ovarian reserveDr. Nivedita Shetty Patient selection for IUI in whom and how manyDr. Shobana Patted Ovulation induction for IUIDr. Santhosh Gupta monitoring OI cycle in IUIDr. Bina Vasan Legal aspects of Donor IUIDr. Ashwini. G.B Luteal Phase support in IUIPanel discussion:

It is impossible to change humanity by political mechanism- | Sri Aurobindo |


6

Dr. Sreenivas. M.S

*Reproduction andrology: Linking laboratory to clinical practice. Semenanalysis what has changed in 5th manual?*Sperm processing for IUI and video demonstration of swim up anddiscontinuous gradiant technique / How to establish IUI – Do’s andDon’ts

Panel discussion:

Moderator -Dr. Madhuri PatilPanelists –Dr. Nivedita ShettyDr. MavintopDr. Shobha DhananjayaDr. Anuradha Narvekar

How to improve success rates with IUI

DEPARTMENTOFEMERGENCYMEDICINE

Dr. Vinaykumar, postgraduate presented a casestudy on ‘hypertensive emergencies’ atKAPICON-2014 held at KMC-Hubli, on May16th to 18th.

Dr. Mallikarjun.M.P, postgraduate presented astudy report on ‘Need for ventilator support inOP compound poisoning’, at KAPICON-2014

Dr. Narendra.S.S, Head of the Department,attended ‘’Comprehensive emergency care andlife support-JEEVAN RAKSHA’’ trainingprogram which was conducted by UNIVERSITYOF UTHAH, USA, hosted by RGUHS-Bangalore from 23rd-28th June.

DEPARTMENTOFDERMATOLOGY

Post-Graduate External Speciality postings:

Dr. Harshavardhana K.N, 2nd year PG Studentattended External Speciality postings at BMCRIBangalore from 19/3/2014 to 18/4/2014.

Dr. Sankeerth V, 2nd year PG Student attendedExternal Speciality postings at St. John’s MedicalCollege, Bangalore from 3/5/2014 to 2/6/2014.

Dr. Krati Mehrotra, 2nd year PG Student attendedExternal Speciality postings at BMCRI Bangalorefrom 3/5/2014 to 4/6/2014.

CME IN DEPARTMENT OF DERMATOLOGY,

VENEREOLOGY

CME Programme for post graduate students andconsultants was conducted by the Dept. ofDermatology on 28/4/2014, Monday at Seminarroom, Department of Dermatology.

Topics for CME –

1. Atopic Dermatitis 2. Acne

Speakers: Dr. Harika C & Dr. Madhuri N

Chairperson: Dr. Jagannath Kumar V, Prof & HOD,

Dept of Dermatology Venereology & Leprosy.

Dr. Karthik Reddy.C.H presented a studyon Aluminium Phosphide poisoning a caseseries at KAPICON-2014.

This life is short, the vanities of the world are transient, but they alone live who live for others,the rest are more dead than alive - | Swami Vivekananda |


7

DEPARTMENTOFPSYCHIATRY

Dr Rajeev Swamy, Assistant Professor and MrsAsha H N Psychologist attended the DDRCcamp at Nuggihalli on 15th May 2014 andKyasahalli on 22nd May 2014

Dr Sushil Kumar and Mrs Asha H NPsychologist attended DDRC camp at Nandigavi

on 19th May 2014, Benkikere on 27th May 2014& Sokke on 30th May 2014.

On 24th may World Schizophrenia Day wascelebrated by display of poster for awareness ofSchizophrenia around psychiatry O P D

DEPARTMENTOFPAEDIATRICS

Dr. N.K.Kalappanavar, Medical Director, Prof &Head.

Participated as chief guest in the annual daycelebration of Bapuji Pharmacy College on12th April 2014.Participated as faculty during Vijay NagarIAP branch inauguration programme CHEand delivered a talk on “Wheezing in under 5year” on 19-04-14.Participated as faculty and delivered a talk on“Pneumonia in children” at Haveri

Dr. B.S.Prasad – Vice Principal, Prof ofPaediatrics & Director of Neonatology

Attended Workshop/CME on ‘Role ofNutrition in Public Health conducted at

JJMMC, Dept. of P&SM and chaired sessionon “Role of Nutrition & Survival rate” on 27-03-14 at JJMMC, Davangere.

Attended 4th Dr. Nirmala Kesaree OrationLecture & CME in Paediatrics, at JJMMC,BCHI & RC on 07-06-14, as a Faculty &Delegate. Presented guest lecture on“Approach to Bleeding Neonate”.

DEPARTMENTOFANAESTHESIA

Dr. Arun Kumar Ajjappa, delivered a guest lectureon “Basic Life Support” in CME on 26/05/2014 atSSIMS&RC, Davangere

Dr. Chirag Babu P.S. delivered a lecture on“Demonstration of Cardio Pulmonary Resuscitation”in CME on 26/05/2014 at SSIMS&RC, Davangere

Dr.Latha.G.S, ProfessorParticipated Rational Antibiotic Therapyfacultytraining programme held at Bangalore on20th April 2014

The uncriticised life is not worth living- | Socrates |

National Co-ordination Centre, PharmacovigilanceProgram of India-Indian Pharmacopoeia Commission

appreciated our Institution for voluntary ADRs reporting


8

Sl.No. Authors Title Volume/

Issue Journal Department

1

Nawaz Ayesha SRevathi S,Niranjan Paul CMane Abhay B

Evaluation of primaryimmunization coverage amongchildren and factors influencingthe immunization coverage in

urban area of Raichur

2014,02(02): 69-

75

Unique Journal ofMedical and Dental

Sciences

CommunityMedicine

2

Dr. Srinath.S.R.Dr. Karibasappa.A.GDr. Anil.S.NelivigiDr. Manjunath.JDr.Venkataramanarao.M

High Energy Tibial CondylarFractures Treated By Hybrid

Fixator-A Clinical study

2014;2(3)

InternationalAcademic Researchfor Multidisciplinary

Orthopedics

3

Dr. Chetan.M.LDr. Karibasappa.A.GDr. Ramesh PujarDr. Anil.S.NelivigiDr. Manjunath.J

A Study on Associated Injurieswith Anterior Cruciate Ligament

Tear

2014;2(1):29-33

J Pub Health MedRes Orthopedics

4Dr. MD. Rashid AhsanLodhiDr. Mallikarjun C.R

Study of Serum Zinc, Magnesium& chromium levels in type-2

diabetics

2013;2(5)

International journalof universal

pharmacy & biosciences

Biochemistry

5Dr. Nagarajappa KDr. Sushma B.JDr. Shweta R. Hebbar

Study of TSH, serum creatinine &uric acid levels in patients with

hypothyroidism

2014;2(2)

International Journalof Pure & Applied

Bioscience Biochemistry

6

Dr. Shweta R. HebbarDr. Nagarajappa KDr. Sushma B.JDr. Mallikarjun C.R

Study of serum calcium,magnesium & phosphorous levelsin patients with thyroid disoders

2014;2(2)

An InternationalResearch Journal ofPharmacy & Plant

Science

Biochemistry

7

Dr. Mohammed OmarFarooqDr. Suneel Kumar Reddy,Dr. Raghu Prasada M S

Prescription Pattern of The DrugsAmong Pregnant Inpatients In

Tertiary Care Hospital

2014,8(7),971-

975

Journal of PharmacyResearch Pharmacology

OUTBREAKSOFACINETOBACTERSPECIES.DOWENEEDTOWORRY? Background

Acinetobacter species are pleomorphic aerobicgram-negative bacilli commonly isolated from thehospital environment and hospitalizedpatients. Commonly isolated species areAcinetobacter baumannii and Acinetobacter lwoffi.Multidrug-resistant Acinetobacter is not a new oremerging phenomenon. They are inherently resistantto multiple antibiotics. This organism is often

cultured from hospitalized patient's sputum orrespiratory secretions, wounds, and urine. Theyusually cause respiratory tract infections and catheterassociated urinary tract infections. Most of theinfections are caused by A. baumannii.Most Acinetobacter isolates recovered fromhospitalized patients, particularly those recoveredfrom respiratory secretions and urine, representcolonization rather than infection.(1)

All love is expansion, all selfishness is contraction. Love is therefore the only law of life. Hewho loves lives, he who selfish is dying - | Swami Vivekananda |


9

Microbiological aspects

They are gram negative, nonmotile, nonfermentingcoccobacilli. They are short and plump which aredifficult to decolorize and hence may be identified asgram positive or gram negative cocci (hence calledMima polymorpha).They grow well on MacConkeyagar forming pink colonies although they are nonlactose fermeters. They are catalase positive andoxidase negative. A characteristic feature of A.baumannii which helps in differentiating it from A.lwoffi is its ability to ferment 10% lactose but not 1%lactose. (2)

Pathophysiology

Predisposing factors

Prolonged hospitalization or antibiotic therapyPatients who are intubated and in those whohave multiple intravenous lines or monitoringdevices, surgical drains, or indwelling urinarycatheters

Colonizer or pathogen? (3)

Absence of clinical, imaging, biochemical orhistological signs of invasion, inflammation andtissue reaction favors colonization.An organism which is isolated from a lesion in anormally sterile site like the CSF, blood, pleuralfluid etc., is likely to be a true invader and thecausative pathogenRecovery of the organism from a nonsterile bodysite (e.g. endotracheal secretions, urine in

patients with a Foley catheter) does not indicateor imply an infectious pathogenic role.An organism isolated from a nonsterile specimenlike sputum or a wound swab may be a colonizer.However it may be a true invader if grown inpure culture, or repeatedly, or is from a protectedspecimen, or has a colony count above certainspecified limits.Clinical findings like signs of inflammationpresent at the site of wound infection (A healthygranulation tissue would warrant observationrather than treatment).Positive urine cultures in an asymptomaticpatient need to be treated only in cases whichrequire urological procedures and in pregnantwomen.In catheterized patients, urine cultures often groworganisms as the catheter is a common site forcolonization. Hence, in these subsets of patients,it is necessary to differentiate colonization frominfection to ascertain the need for treatment. Acolony count of greater than or equal to 102

CFU/ml is defined as significant bacteriuria in acatheterized patientIn case of community acquired pneumonia,sputum examination may provide the clue to theetiological agent if the sample is representativeof the lower respiratory tract i.e has more than 25pus cells and less than 10 epithelial cells per lowpower field. This assures that the organisms seenare not oral commensals. In theimmunocompetent patient, organisms likeAspergillus and Candida in the sputum mayrepresent colonizers and warrant therapy only ifthere is evidence of invasive disease such asimaging, histopathology or fungal antigenemiaCorrelation of gram smear from culture findings.(Presence of intracellular organisms may indicatepathogen)In outbreaks, Acinetobacter is often culturedfrom monitoring devices or biological fluidsfrom multiple patients as part of anepidemiological investigation. That doesn’tnecessarily establish pathogenic role of thesebacteria. Epidemiological typing of these isolatesand outbreak isolates should be done to establishrole in outbreak.

Medication

A baumannii is intrinsically multidrug resistant.

Acinetobacter species have low virulence but arecapable of causing infection. Acinetobacterpneumonias occur in outbreaks and are usuallyassociated with colonized respiratory-supportequipment or fluids. Acinetobacter colonization iscommon in patients who are intubated and or inpatients with multiple intravenous lines, surgicaldrains, or indwelling urinary catheters in theintensive care setting. Acinetobacter infections areuncommon and occur almost exclusively inhospitalized patients. Mortality and morbidity ratesin patients who are very ill with multisystem diseaseare increased because of their underlying illnessrather than the superimposed infectionwith Acinetobacter. Because colonization is the ruleand infection is the exception, colonized patientshave no associated physical findings.(1)

Let us love others as God loves each one of us, for he has created us for greater things to loveand to be loved - | Mother Therasa |

S.S. INSTITUTE OF MEDICAL SCIENCES & RESEARCH CENTRE Vol.9. Issue: 2, Apr June-2014SS IMS T IM ES

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Relatively few antibiotics are active against thisorganism. In general, first-, second-, and third-generation Cephalosporins, Macrolides, andPenicillins have little or no anti-Acinetobacter activity, and their use may predisposeto Acinetobacter colonization.

Many culture isolates being colonization rather thaninfections, care should be exercised duringtreatment. While colonization should not be treated,infection must be treated. Medications towhich Acinetobacter is usually sensitive include thefollowing and empiric antimicrobial therapy shouldinclude one of the agents listed below.

MeropenemColistinPolymyxin BAmikacinRifampinMinocyclineTigecycline

And soon after the antibiotic sensitivity results areavailable, the antibiotic should be changed to theantibiotic to which the isolate is sensitive and hasnarrowest spectrum. (1)Further Inpatient Care

Initiate supportive care, depending on the organsystem involved. Colonized or infected lines, drains,shunts, or other devices should be removed orreplaced as required. A consultation with aninfectious disease specialist is advised todifferentiate colonization from infection and forantibiotic recommendations if infection is present.Precautions should be taken to prevent colonized

patients from colonizing other patients, particularlyin the ICU.(1)

Prevention

Although Acinetobacter colonization rarely results ininfection, colonization does precede infection.Colonization in one patient may result in infection inanother patient. For these reasons, every attemptshould be made to isolate patients who are colonizedwith Acinetobacter in order to prevent other patientsfrom becoming colonized.(1)

Prognosis

The prognosis of Acinetobacter infection depends onthe underlying health of the host and the extent oforgan involvement; it is the same as for other aerobicgram-negative bacillary infections.(1)

References:

1. 1Burke AC, Michael SB. Acinetobacter. 2013Jan 31 [cited 2014 Jun 25]; Available from:http://emedicine.medscape.com/article/236891-overview

2. Ananthanmicrobiology. Hyderabad: University Press;2009.

3. Soman R. Colonization Versus Infection. [cited2014 Jun 25]; Available from:http://apiindia.org/pdf/medicine_update_2008/chapter_42.pdf

PHARMACOVIGILANCECELL

Summary of reported ADRs and reported drugs

from the month of February 2014 to April 2014

This analysis is based on the reported ADRsfrom the month of February 2014 to April 2014.

Pharmacovigilance Quarterly Reportanalysed from different departments of theInstitution (Figure 1).

If you do not allow one to become a lion, he will become a fox - | Swami Vivekananda |


Diclofenac were found to be the most common drugs causing Adverse Drug Reactions followed byAzithromycin, Cefoperazone, Cefixime and Doxycycline. The profiles of drugs are given in the Figure 2.

Figure 2: ADRs profile of reported drug

0

2

4

6

8

10

12

14

16

0 02

0 0 1 0

4 30

15

0 0 0

Department Wise Reported ADRs

11

Figure 1: Department wise reported ADRs

An injury is much sooner forgotten then the insult: Lord Chester Field - | Lord Chester Field |


Out of 38 drugs, most commonly observed Adverse Drug Reactions were related to skin and appendagesdisorders accounting for 84%, followed by gastro-intestinal disorders (12%) and central and periphery nervoussystem disorder (4%) shown in Figure 3 and Table 1.

Skin & appendagesdisorders

Diclofenac Artesunate Cefpodoxmine ProxetilCremaffin Phenytoin Cefazolin

Azithromycin Neosporin RanitidineCefotaxime Iron Sucrose Carbamazepine

Metronidazole Cefixime DoxycyclineGentamycine Paracetamol Piperacillin

Fentanyl Citrate Ceftriaxone AmikacinCefoperazone+Salbactam Cefuroxime Axetil

Gastro-intestinal systemdisorders Asenapine Amitriptyline

Central & Peripherynervous system disorders Risperidone

Table 1:Correspondence Address:

Chethan Kumar. S,Research Coordinator, Pharmacovigilance Cell, Department of Pharmacology,S.S Institute of Medical Sciences and Research Centre, Davangere -577005.Email: [email protected]

84%

12%

4%

Adverse Drug ReactionsSkin and appendages disorders Gastro-intestinal disorders Central and Periphery nervous system disorders

12 Are you unselfish? That is the question. If you are, you will be perfect without reading a singlereligious book, without going into a single church or temple - | Swami Vivekanada |

S.S. INSTITUTE OF MEDICAL SCIENCES & RESEARCH CENTRE Vol.9. Issue: 2, Apr June-2014

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1. ACASEOFFOREIGNBODYGETTINGLODGEDINTRACHEADURINGREMOVALDrArunkumarAjjappa,Prof&Head,DrMamathaHK,AssistantProf,DrGirirajPatil,Postgraduate,DeptofAnaesthesia,SSIMS&RC,Davangere.ABSTRACT

Foreign body aspiration in the adult airway is veryrare. A neglected foreign body can occur when thepatient is mentally challenged or is in anunconscious condition such as following trauma. Thediagnosis can be difficult and may be missed even byexperienced doctors because the initial chokingepisode is not witnessed. It is important for cliniciansto maintain a high index of suspicion for thediagnosis of foreign body aspiration. Removing theaspirated foreign body under appropriate anaesthetictechnique needs skilful expertise. Retrievalprocedure is risky and sudden decompensation of thepatient can occur especially when the foreign bodygets lodged in the trachea during removal. In ourcase while attempting to remove the foreign body, itgot lodged in trachea, making ventilation impossible.We report a case of successful anaestheticmanagement of a foreign body in the airway,intraoperatively causing life-threatening hypoxemia.

Keywords: Arecanut, bronchoscopy, foreign bodyaspiration

INTRODUCTION

Foreign body aspiration is a condition seencommonly in children. Foreign body aspiration inadults is common in the setting of advanced age,underlying neurological disorder, poor dentition,alcohol consumption and sedative use. It can presentin a variety of ways, ranging from no or trivialsymptoms to irreversible damage to the lung whichmay be life threatening. Aspiration of organicmaterial such as nuts, seeds, vegetables and boneshave been described in adults. A retained foreignbody can result in inflammatory response andgranulation tissue formation around the object.Extraction of this sort of object is complicated by the

smooth, hard, curved surface which preventsgrasping of the object, especially in the confinedspace of the bronchus. We report a case of a foreignbody aspiration which remained in the rightbronchus for 15 days, successfully removed by rigidbronchoscopy.

CASE PRESENTATION

A 29-year-old woman presented with a fifteen dayhistory of distressing dry cough along with a threeday history of fever and right chest pain. Patient alsogave history of sudden onset cough and choking onchewing betel quid 15 days back. On physicalexamination, she was febrile and appeared toxic.Chest examination revealed right basal dullness topercussion with reduced breath sounds onauscultation. A chest radiograph (fig.1) showed aright middle and lower lobe collapse. A virtualbronchoscopic CT thorax done, showed a foreignbody in the right bronchus intermedius withsurrounding oedema.

Patient was posted for rigid bronchoscopy forforeign body removal on the same day. In theoperation theatre patient premedicated with injectionglycopyrrolate 0.02mg/kg and fentanyl 2microgram/kg. Preoxygenated with 100% oxygenand induced with IV propofol 2mg/kg, paralysedwith IV succinylcholine 2mg/kg and anaesthesiamaintained with 100% oxygen, isoflurane andintermittent apnoeic ventilation through side port ofventilating rigid bronchoscope. Due to friability ofoedematous foreign body many attempts were madeto remove it. As the surgeon needed longer time toremove the foreign body patient was furtherparalysed with injection vecuronium. Whileattempting to remove the foreign body, it got lodgedin trachea, making ventilation impossible. Patient

with onset of hypoxia and

CASE REPORTS

When you meet a man, you judge him by his clothes; when you leave, you judge him by hisheart - | Russian Proverb |


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bradycardia interrupting further removal of foreignbody. Surgeon was requested to push the foreignbody back into the diseased bronchi. We took overthe airway and positive pressure ventilation initiated.Initially there was resistance to ventilation, later theventilation was smooth and oxygen saturationreturned to baseline.

Bronchoscope reinserted and repeat foreign bodyremoval attempted. The big chunk of foreign body(fig.2) was successfully taken out. Bronchoscopewas brought out after confirming that there were noremnants of foreign body in the airway. Furtherpatient was intubated and ventilated electively.Injection hydrocortisone 1mg/kg and salbutamolnebulisation given. Patient was reversed withspontaneous ventilation efforts. Patient extubatedafter confirming adequate breathing efforts andadequate conscious level.

DISCUSSION

Although foreign bodies which are present in thetracheobronchial tree are rare in adults, cliniciansmust be aware of their likelihood. In our casediagnosis was missed previously, and was treatedwith antibiotics based on clinical and radiologicalsuspicion. Our case highlights the potentialdiagnostic challenge posed by this condition, andillustrates the importance of obtaining a good historyand maintaining a high index of clinical suspicion toarrive at the correct diagnosis. Coughing, wheezing,dyspnea and noisy breathing are the commonpresentations. Failure of early interventions can alsolead to complications such as hypoxia, stenosis, andinfection.

Tracheobronchial obstruction by a foreign body wasrst described as a cause of wheezing by Struthers in

1852. In adults, the most commonly aspirated

impairment, alcohol and drug intoxication and poor

adults. However, as seen in this case, foreign bodyaspiration can occur, even in the absence of

Foreign bodies that are able to pass through the vocalcords often lodge at the carina and right main stembronchus. Knowing the location, type, degree ofairway obstruction is very important because it willinfluence the approach for removal and foranaesthetic technique. A long-standing foreign bodycan move into bronchus by migration andendobronchial erosion from the lung parenchyma. Incurrent practice, flexible bronchoscopy becomes thefirst choice for initial evaluation of bronchial foreignbody and this allows successful removal in majorityof cases. However, rigid bronchoscopy is stillconsidered a reasonable option for removal ofbronchial foreign body, especially in children.

During bronchoscopy under general anaesthesia withapnoeic ventilation the foreign body was removed inpiece meal because organic foreign bodies absorbwater and increase in size and tend to be slippery,thus making their retrieval difficult. Attempt wasmade to remove a big part of foreign body, whichlodged in the trachea. The diseased lung was alreadycompromised due to inflammatory reaction ofbronchial mucosa to foreign body. Due toobstruction of the trachea ventilation becameimpossible.

CONCLUSION

A retained foreign body can result in inflammatoryresponse and granulation tissue formation around theobject which make the foreign body removaldifficult and needs anaesthetist and surgeonvigilance during its removal. As in our case foreignbody got lodged in trachea producing obstruction ofboth lung and making the clinical situation worse

My children, the secret of religion lies not in theories but in practice. To be good and to dogood-that is the whole of religion - | Swami Vivekananda |


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Fig.1. Chest X-ray showing Fig.3: Photograph shows the bigright middle and lower lobe collapse chunk betel nut foreign body

2.GIANTCONGENITALMELANOCYTICNEVI-AREPORTOFTWOCASESDr.JagannathKumarV,Prof&Head,Dr.HarshavardhanaK.N,2ndyearPostgraduatestudentINTRODUCTION:

Congenital Melanocytic Nevi(CMN) are found inabout 1% of new born infants. Giant CMN are rare,with an incidence of 0.005%(1 in 20000). Forpractical purposes, CMN are classified based ontheir sizes as Small- <1.5cm, Medium sized- 1.5 to19.5cm & Large(Giant)- >20cm(in adults; 9cm onhead & neck & 6cm on the trunk in children). AllCMN have got malignant potential, but its incidencevaries with the size, No. & position/distribution ofnevi.

CASE 1: A 8 months old female child came withH/O hyperpigmented black coloured patch with hairgrowing over it, extending from lower 1/4th of armto the wrist of left upper limb measuring around25cm & it is present since birth with its sizeincreasing proportionate to the growth of that part.On examination, the patch has a verrucous surfacewith increased skin markings. There aremultiple(around 20) similar hyperpigmented patchesof varying sizes noted over the scalp, posterioraspect of lower trunk, gluteal region, thighs & legs.

CASE 2: A 15years old female patient came withH/O hyperpigmented patch with hair growing over iton right half of face since birth. On examination,there is a solitary well defined black coloured patchwhich has a verrucous velvety surface with trimmedhairs, extending from right zigomatic region to rightside of chin involving the cheek, nasolabial fold ,upper & lower lips. It measures about 12.5cm in itslongest dimensions. There are no satellite lesions orabnormalities in the patient.

CONCLUSION:Giant CMNs associated with satellite lesions,posterior axial distribution & those distributed overhead & neck, are having more chances forNeurocutaneous Melanocytosis(NMC) & Primarymelanomas. So all cases of giant CMNs should bethoroughly investigated & monitored periodically.These cases have been reported for their rarity inoccurrence

The eyes believe themselves, the ears believe other people- | German Proverb |


INAUGURATIONStudent union inauguration was held on 24/04/2014evening with Dr. S Parashivamurthy as our chief

medical education system in India. He emphasised

the knowledge in various other fields so as toimprovise the system in India. He regretted about themalnutrition status in the country and advised all thedoctors to work further for the betterment of themalnourished.

Student union president and our Principal, DrP Nagaraj, student union 2014 chairman, DrNarendra S S, vice principals Dr Arunkumar A, Dr BS Prasad, Dr A M Shivkumar were present at theevent.

OCTAFEUDOrganised by the Student Union 2014 in the

month of April, Octafeud was an amazingexperience. It was a joint venture of literary, sports,information & technical committees.

Day 1 was prelims where in a written test,few fun tasks and sports event were conducted.Teams also had to click funny photographs of theopponents which added to the fun. Three finalistteams were filtered and one lucky team made itsentry through wild card after video making round.

Day 2 saw all the teams in full-fledged furrybattle in fun sports.

The event culminated with fun quiz, thegrand finale. It was truly the battle of winds. Afterthorough assessment and culmination of scores of all3 days, 2 best teams were chosen who wererewarded with exciting prizes. This added to

With all this, the whole event concluded witha movie show and hostel visits the next day withexciting prizes for the best rooms too.

On the whole, Octafeud was a remarkablememory for all the participants, organisers andviewers.

Cheers to Student Union 2014!!

On account of the birthday of our beloved DR.Shamanur Shivshankrappaji, Honourable Minister ofAgricultural Marketing and Horticulture,Government of Karnataka and Honorary Secretary,BEA, Davangere: A blood donation camp wasconducted in our S S hospital on 16/06/2014. Many

students, teaching and non-teaching staff volunteeredto make the event a successful one. DR. ShamanurShivashankarappaji, Ex minister B C Patil, PrincipalDr. P Nagaraj, Vice Principal Dr. ShashikalaKrishnamurthy, Student Union Chairman Dr.Narendra S.S were present in the event.

STUDENT UNION 2014

The purer the mind, the easier it is to control - | Swami Vivekananda |

BLOODDONATIONCAMP


Habit, if not resisted, soon becomes a necessity- | Saint Augustine | 17


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±ÉéÃvÁ

The uplift of the women, the awakening of the masses must come first, and then only canany real good come about for the country, for India - | Swami Vivekananda |


DRAWING

By,Pradeep AN, Asst. Professor, Dept. of Pharmacology

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Caution is the eldest child of wisdom- | Victor Hugo | 19


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Hearty Congratulations for the Promoted staff

Hearty welcome to newly Joined staff

Sl. No. NAME DESIGNATION DEPARTMENT DATE01 Dr. Rajani S Associate Professor Biochemistry 01-05-201402 Dr. Sachin Assistant Professor General Medicine 23-06-201403 Dr. Nagaraj Mallashetty Assistant Professor Anatomy 13-05-201404 Dr. Kiran Kumar C K Senior Resident General Surgery 11-06-201405 Dr. Veeresh Itagi Kotrappa Assistant Professor Anatomy 26-05-201406 Dr. Priyadarshini S. Raykar Senior Resident Pulmonary Medicine 22-05-201407 Dr. Lingaswamy S M Professor Radiation Oncology 16-06-2014

Thank you and best wishes to relieved employees.

Sl. No. NAME DESIGNATION DEPARTMENT DATE01 Dr. Chandrashekar Karpoor Professor Physiology 03-05-201402 Dr. Ravikiran K R Assistant Professor Physiology 03-05-201403 Dr. Swapnali Associate Professor Biochemistry 06-05-201404 Dr. Shobha Assistant Professor Anatomy 06-05-201405 Dr. Rajkumar K R Associate Professor Anatomy 12-05-201406 Dr. Srinivas R Professor Radiotherapy 09-06-2014

Sl. No. NAME DESIGNATION DEPARTMENT DATE01 Dr. Latha G S Associate Professor to Professor Pediatrics 01-02-201402 Dr. Karibasappa A G Associate Professor to Professor Orthopedics 01-04-201403 Dr. Zameer ulla Associate Professor to Professor General Surgery 03-03-2014

05 Dr. Sathish S. Patil Assistant Prof. to Associate Prof. Microbiology 01-01-201406 Dr. Dheeraj R. Patil Assistant Prof. to Associate Prof. Anesthesia 21-01-201407 Dr. Jyoti Karegoudar Associate Professor to Professor General Surgery 01-06-201408 Dr. Chethan M L Assistant Prof. to Associate Prof. Orthopedics 14-06-2014

BashaDr. Mohammed Haseen04 Assistant Prof. to Associate Prof. Pediatrics 07-12-2013

Man is the best mirror, and the purer the man, the more clearly he can reflect god- | Swami Vivekananda

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