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   Table of Contents - Current issue
January-June 2023
Volume 25 | Issue 1
Page Nos. 1-104

Online since Sunday, March 26, 2023

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Navigating the labyrinth of genetic testing p. 1
Deepika Gulati, Manoj Gopinath, Anuj Singhal
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Antimicrobial resistance an alarming global concern: Antimicrobial stewardship is the key p. 4
Subhash Chandra Shaw, M Mahesh, Anuj Singhal
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Burnout of a peripheral government surgeon: Need to extinguish? p. 7
Shrirang Vasant Kulkarni, Manish Kumar Sondhi
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Stone clearance rate and postoperative recovery of mini percutaneous nephrolithotomy: A single-institute study p. 10
Amit Kumar Shah, Manoj A Upadhye, H Deepak, Naveen Kumar Goud, Akshat Shah
Introduction: During the last two decades, the evaluation and management of renal and upper ureteric stones has vastly altered. The era of endoscopic surgery replaced open pyelolithotomy or nephrolithotomy which caused a significant morbidity. During this decade we saw evolution of endoscopic surgery where Mini PCNL (Mini Perc), Ultra Mini and Micro Perc have further achieved stone clearance with better outcomes pertaining to reduced morbidity because of reduction in caliber of tract dilatation, even avoiding a nephrostomy post rocedure in select cases. Aim of this study summarizes the outcome of patients undergoing Mini Perc. The primary objective of the study was to get post-Operative evaluation of complications associated with Mini Perc by Modified Clavien Dindo Grading and secondary objectives were to see Post-Operative pain assessment by Visual Analogue scale and to see Stone clearance rate of the surgical procedure. Materials and Methods: Research was carried out in the form of a Hospital-based prospective observational study as per the guidelines shared by the Prospective Observational Clinical Studies Good Research Practices Task Force (formed May 16, 2010). Hospital-based prospective observational study of 78 consecutive patients who underwent Mini Perc between Aug 2018 and May 2020 at tertiary care centre were vetted against the criteria for inclusion and exclusion. The management policy for pelvicalyceal calculi at the study centre has closely followed those of the American Urological Association (AUA) guidelines for managing renal stones. Results: The mean age of the group was 43.3 years (range 16-84) with 47 males and 38 females. Mean stone size was 20.11 mm (range 11-38 mm) and mean operative time was 44.5 min (range 29-98 min). Double J (DJ) stent was placed in all patients as a prophylaxis to prevent obstructive uropathy / post op urinary leak. Postoperatively, the most commonly noted complication was fever recorded in 12 (15.38%) patients followed by bleeding at the surgical site in 03 (3.84%) patients. Sepsis was noted in 02 (2.56%) patients, pleural injury in 01(1.28) patient. Haemorrhage requiring intervention was recorded in 01 (1.28%) of patients. Pain assessment done at specified interval showed progressive decreasing trend in intensity as evaluated by visual analogue scale. The stone clearance rate in our study was 96.15% at the end of one month following post op period. Conclusion: The study shows that Mini Perc remains standard of care for management of Renal and upper ureteric stone. The technique beyond doubt is safe, efficient, feasible and economical in achieving excellent stone clearance rates. The Modified Clavien-Dindo system of grading for perioperative complications is easy to use and reproducible. It can be used as an objective and reliable method for describing the complications of the surgical procedure.
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Learning Behavior and Perspective of Medical Students in India on COVID-19 Pandemic p. 16
Suraj Kapoor, Vivek Anand, SK Kaushik, Arun Kumar Yadav
Introduction: Medical colleges in India are opening gradually for resumption of medical education. Assessment of learning behavior and perspectives of students toward COVID-19 pandemic is essential for effective medical education as well as to assess their role in pandemic if need arises. Hence, the present study aims to assess learning behavior and perspective of medical students on COVID-19 pandemic. Materials and Methods: A descriptive cross-sectional study was conducted from September to December 2020 among 392 medical students at various medical colleges of the country. An online self-administered questionnaire was designed to assess learning behavior of medical students about infection prevention and control practices in COVID-19 adopted during the course of pandemic. Snowball sampling method was used for data collection. Results: On assessment of 392 medical students about preventive measures during COVID-19 pandemic, more than 80% of medical students were aware of the importance of facemask, social distancing, frequent hand washing, and use of digital tools such as Aarogya Setu app in surveillance. Majority of students were aware of the symptoms, testing, and treatment protocols along with importance of self-reporting. Most of the students were aware of various sources of getting scientific and relevant information about pandemic. While majority of students were aware of rationale of quarantine, appropriate waste management technique, and post-COVID precautions, there was a lack of knowledge about appropriate disinfection measures. Conclusions: Medical students are an asset to health care; learning behaviors adopted by them can certainly help to assist health-care system in COVID times.
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Insulin therapy among outpatient department patients of diabetes mellitus in a tertiary care hospital: Do they have adequate knowledge about insulin? p. 21
Prabhakar T Teli, T Ekambaram, Arun Kumar Yadav
Introduction: Insulin is one of the most effective agents in reducing hyperglycemia when used in appropriate doses. However, insulin may have risks if used inappropriately. Insufficient knowledge of insulin self-injection can result in complication, adverse patient outcomes, and invariably poor glycemic control. Methods: A cross-sectional observational study was conducted among patients with diabetes mellitus attending the outpatient department of the hospital in western Maharashtra. Data on sociodemographic factors and knowledge and attitude with insulin syringes were collected. Results: A total of 93 participated in the study. The mean age of the participant was 55.5 years, and most were male (52, 55.9%). Seventy-five (80.7%, 95% confidence interval [CI]: 71.1–88.1) were having adequate knowledge. Higher education was associated with adequate knowledge. The attitude was adequate in 24 (25.8%, 95% CI: 17.2–35.9) participants. Higher duration of illness of diabetes mellitus was associated with good attitude. Conclusion: The study found that there are gaps in knowledge and attitude for the use of insulin syringes. Opportunistic or one-to-one health education may be taken to improve knowledge and attitude regarding insulin syringes.
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Functional and radiological outcome after cervical arthrodesis using polyetheretherketone or tricortical iliac bone graft for degenerative and traumatic spine pathologies: A single-center experience p. 25
Jithin Veliyath Thankaraj, Geo Senil Kidangan, Bijukrishnan Rajagopala Warrier, Pranav Veepanattu
Introduction: Anterior cervical discectomy and fusion (ACDF) is the most common surgical procedure used for decompression and fusion of adjacent cervical vertebral bodies. Iliac bone graft was widely accepted for fusion during ACDF to the introduction of polyetheretherketone (PEEK) spacers. Even though PEEK spacers have the advantage of reducing donor-site complications, in cases with doubtful supporting ligament continuity, the long-term outcome of cervical spine stability is not confirmed. In this study, we are comparing the clinical and radiological outcomes of both substitutes. Materials and Methods: We did a retrospective analysis of 111 patients who underwent single-level ACDF using PEEK or tricortical iliac bone graft for various disc pathologies at our institution in the past 10 years along with clinical and radiological presentations and outcome of the procedure at 3 weeks, 6 months, and after 1 year. The study population was divided into two groups: Group “P” (PEEK spacer) and Group “G” (bone graft spacer). Distribution of clinical presentation in terms of radiculopathy, myelopathy, and myeloradiculopathy was evaluated and correlated with the demographic parameters. The standard deviation and P value of the radiological variables were calculated. “Mann–Whitney U-test” for the Japanese Orthopaedic Association score at 1-year follow-up and “Pearson's Chi-square” value for the Odom's score of both groups were used to analyze the correlation. Results: All the radiological parameters were analyzed by the Wilcoxon signed-rank test after checking for normality distribution. The improvements reported above in all domains were found to be statistically significant at P < 0.001. When analyzing the radiographic evidence of bony fusion at 1 year by Bridwell fusion grading, only two patients in Group P had poor fusion and all the patients in Group G had Grade 1 or 2 fusion. The clinical improvement analyzed by evaluating the ODOMS score after 1-year follow-up showed significant improvements in both groups. Conclusions: In our study, PEEK spacers have got definite advantage over iliac bone grafts in maintaining the disc segmental height, segmental angle, cervical lordosis, and fusion segment height without adding any donor-site morbidity.
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A comparison of two techniques of internal jugular vein cannulation: Landmark-guided technique versus ultrasound-guided technique p. 31
Josemine Davis, Deepak Dwivedi, Sadhan Sawhney, Amit Rai, Amit Dua, Satyen Kumar Singh
Background: This study was designed to compare the overall success rates and complications of two techniques of internal jugular vein (IJV) catheterization, namely the landmark (LM)-based technique and ultrasound (US)-guided technique in a heterogeneous Indian population at an Armed Forces Tertiary Care Hospital. Methods: Ninety consenting patients were assigned to two groups: LM and US groups. Patients with known coagulation abnormalities, body mass index > 30, infection at the insertion site, known vascular abnormalities, burn contractures, and other dermatologic conditions that precluded an LM technique were excluded. Central venous catheterizations during the code blue scenarios were excluded due to the emergent nature of the procedure. Three operators from the author group with requisite experience in LM and US techniques performed the 90 catheterizations. In LM group, a finder needle with a 2 ml syringe was used to aspirate venous blood from the IJV. A 16G needle was guided in the same direction as the finder needle till venous blood was aspirated, followed by guidewire insertion and cannulation. In the US group, a 6–12 MHz linear US probe was used to identify the IJV in real time and a 16G needle was used to access the IJV under US guidance in the cross-sectional view. Results: The overall success rate was 84.4% in LM group and 100% in US group (P = 0.0059). The first attempt success rate was similar in both groups (71.1% and 86.6%, P = 0.07). The overall complication rates in LM group were 20%, whereas complications in the US group were 2.2% (P = 0.0073). Notably, vascular complications occurred less frequently in US group with fewer arterial punctures and hematomas. Hemothorax and pneumothorax did not occur in any group. The mean cannulation time decreased by 69 s, i.e., from 276 s in the LM group to 207 s in the US group (P < 0.001). Conclusion: US-guided central venous catheter insertion to IJV improves the overall success rate and reduces cannulation time as compared to conventional LM-based technique.
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Fast-food culture – Prevalence, pattern, and preference trends and its association with body mass index of medical students p. 37
Kumar Pushkar, SK Kaushik, P Nagarjuna, Gautam Mukherjee, Prabhakar Teli, Arun Kumar Yadav
Background: Fast-food culture is an uprising trend among the younger age groups. Stressful life due to increased study load, staying away from home, peculiar working hours, etc., negatively influences the food choices of medical students. Hence, this study was conducted to describe the prevalence, pattern, and preferences of fast-food consumption and also to determine the relationship of frequency of fast food with body mass index (BMI) of students of a medical college in Western Maharashtra. Methods: A cross-sectional study was done among 398 students of a medical college in Pune for 6 months. The data collection was done using a self-administered pretested structured questionnaire and analyzed using Microsoft Excel and SPSS version 20 software. Results: Three hundred and ninety-eight medical students responded. We found a 100% prevalence of fast-food consumption with different frequencies. 13.8% of the students were found to be overweight. Pizza was the most frequently consumed fast food. The taste factor was the most common reason to consume fast food among both sexes. The majority of the study participants (98.5%) were aware that fast foods are hazardous to health. A statistically significant association was found between the frequency of consumption of fast food with the type of diet (P = 0.008) and BMI (P = 0.023). Conclusion: High prevalence and preference for fast-food consumption can result in various noncommunicable diseases among students of the medical profession and is a major concern. Thus, there is a need for educating the students regarding nutritional information and counseling to bridge the gap between their knowledge and practice about healthy eating behavior.
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A prospective cohort study of auditory and visual comorbidities in children with cerebral palsy p. 43
Manas Ranjan Mishra, KM Adhikari, Nikita Kumari Panigrahi
Introduction: Cerebral palsy (CP) is a group of disorders involving movement, posture, and motor function with the uniqueness of being an outcome of a static insult and ever-changing clinical course. Early identification and rehabilitation of associated morbidities are the keys to comprehensive management. Materials and Methods: This was a prospective observational study conducted in a tertiary care teaching hospital in western India, from January 2016 to June 2017, to determine the prevalence of ocular and hearing morbidity in children with CP. All children presenting with developmental delay and diagnosed as a case of CP were serially recruited in the study. Data were collected by using a predesigned pro forma. Results: The study included 80 children with CP. Male-to-female sex ratio of 2.08:1 was observed. The prevalence of visual morbidity was 67.5%, with the most common morbidity being squint followed by refractive error and nystagmus. Auditory morbidity was present in 22.5% of cases with the predominant type being sensorineural hearing loss. Conclusions: This study emphasizes the importance of prompt identification of auditory and visual morbidities in these children, as early intervention is the key to management and is vital for optimal speech, vision, developmental, and neurocognitive outcomes in these cases.
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Liver function test abnormalities: Do they correlate with severity in dengue infection? An Indian perspective p. 48
Sreegeetha Ravilla, KV Padmaprakash, N Arun, Ravi Kanth
Introduction: Involvement of the liver is frequently reported among patients with dengue infection, and liver enzymes are commonly deranged in dengue infection. Raised levels of alanine aminotransferase (ALT) in dengue infection were linked to worse outcomes. The present study was an attempt to study the liver function test abnormalities in dengue fever (DF) and its correlation with the severity of the disease. Methods: The present study was undertaken as a hospital-based retrospective study of DF patients in the age group of 15–60 years. Five hundred and thirty patients who met the eligibility criteria and were admitted to the study hospital during the duration of data collection period (July 2018 to July 2021), comprised the study sample. Differences in means were tested using ANOVA or Kruskal–Wallis test. The difference in proportions was tested using the Chi-square test. Results: Majority of the patients were males (73.4%) with a mean of 30.3 ± 9.7 years. A significant association was observed between clinical features of jaundice, hepatomegaly, splenomegaly, ascites, effusion, bleeding, organ failure, and severe forms of DF. There was a significant positive correlation between aspartate aminotransferase, ALT, and serum bilirubin values among patients with severe forms of DF. Conclusion: Significant proportions of patients with DF without warning signs and severe DF had deranged liver function parameters. A statistically significant association was observed between liver function parameters and the severity of dengue disease.
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Revisiting “Do People Living with HIV/AIDS Have Better Quality of Life” – Findings from a cross-sectional study p. 53
SR Manjunath, Ravishekar N Hiremath, Raj Kumar, Anurag Khera, Kasi Viswanath
Introduction: HIV/AIDS is a challenging disease affecting multiple facets of life. From being a communicable disease alone, it is now posing mental health problems and adjustment disorders as the longevity of HIV/AIDS patients is increasing. In the present study, the quality of life (QOL) among HIV patients was studied, in physical, psychological, environmental, and social domains using the World Health Organization Quality-of-Life Scale (WHOQOL-BREF). Methodology: A cross-sectional, observational study was conducted to assess QOL among 140 randomly selected HIV/AIDS patients attending an antiretroviral therapy (ART) center. The WHO QOL BREF questionnaire was used as a tool for collecting data. Results: The overall QOL among people living with HIV/AIDS (PLWHA) was 14.29 (±1.9), with the highest mean score in social domain with a mean of 15.42 (±2.73) and the lowest in physical domain with a mean of 14.01 (±2.73). A statistically significant association was found between age, gender, place of residence, disclosure status, and overall QOL. PLWHA with high CD4 count and patients on ART had better QOL. Conclusion: Overall QOL in PLWHAs is comparable with other countries, indicating the success of National AIDS Control Programme. Few aspects, if incorporated, can increase further improve QOL among HIV patients.
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Comparative analysis of preoperative high-resolution computed tomography temporal bone and intraoperative surgical findings in cases of cholesteatoma p. 58
Ranjit Singh Lahel, Shailendra Tripathi, Amit Chail
Introduction: Cholesteatoma has been described as an accumulation of desquamated keratin debris in a pocket of squamous epithelium over a matrix within the middle ear cleft. A prospective study was carried out to establish a correlation between preoperative high-resolution computed tomography (HRCT) temporal bone findings with intraoperative findings in cases of cholesteatoma. Methods: Fifty patients of chronic otitis media, active squamous type, i.e. clinically suspected cholesteatoma, scheduled to undergo tympanomastoid exploration were selected. The positive and negative findings of the scan were documented as per the parameters to be analyzed. The important intraoperative surgical findings were then analyzed with preoperative HRCT findings. Results: Agreement between surgical and HRCT findings ranged from 86% (facial canal erosion) to 100% (external bony canal involvement). HRCT had higher detection rate as compared to surgery for scutum erosion (40% vs. 36%), tegmen erosion (6% vs. 4%), facial canal erosion (28% vs. 14%), lateral semicircular canal erosion (6% vs. 2%), incus erosion (78% vs. 64%), sinus tympani involvement (14% vs. 4%), attic involvement (44% vs. 42%), mastoid involvement (88% vs. 80%), and aditus widening (54% vs. 44%). The higher detection of scutum erosion, tegmen erosion, facial canal erosion, lateral semicircular canal erosion, and incus erosion is probably due to partial volume averaging. Conclusion: The findings of the present study showed that HRCT is an essential and indispensable tool for preoperative evaluation of cholesteatoma. It was highly sensitive and adequately specific for a significant number of findings. These findings are pivotal in planning the surgery and preparing for necessary anticipatory reconstructive procedures.
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Short-term electrocardiographic and echocardiographic effects of levothyroxine replacement in adults with newly diagnosed hypothyroidism p. 63
Shekhawat Vikram, Soumitra Mohanty, Vineet Behera, Ramamoorthy Ananthakrishnan, Jnanaprakash B Karanth, Nagargoje Mahadev
Background and Aims: Thyroid hormones play a key role in modulating the cardiac function and structure. Expectedly, thyroid hormone deficiency in primary hypothyroidism has a profound and clinically relevant effect on the cardiac structure and function manifesting in characteristic electrocardiographic and echocardiographic (ECHO) abnormalities. The aim is to evaluate the effects of levothyroxine replacement therapy on the electrocardiographic (ECG) and ECHO changes in patients with primary hypothyroidism by assessing the changes in ECG and ECHO before and after 6 weeks of optimal levothyroxine (LT4) treatment in adults with newly diagnosed primary hypothyroidism. Methodology: Prospective, observational study conducted in the department of medicine in an armed forces tertiary care teaching hospital from October 2018 to April 2021. We studied newly diagnosed adults with primary hypothyroidism who were treated with optimal LT4 replacement. Descriptive statistics along with Student's t-test and Chi-square test were used to determine the statistical significance. Results: In 152 participants, the mean age was 41.0 ± 13.2 years and 79% were female. After 6 weeks of LT4 treatment, the proportion of participants with abnormal ECG findings reduced significantly (from 77% to 14.5%, P < 0.0001) with a significant reduction in those having sinus bradycardia (P < 0.0001) and low-voltage complexes (P < 0.0001). On ECHO, there was a significant improvement in left ventricular ejection fraction (P < 0.001), fractional shortening (P < 0.001), and a significant reduction in myocardial thickness parameters. The systolic and diastolic function improved significantly after 6 weeks of treatment. The proportion of patients without pericardial effusion increased from 34.9% to 79.6%. Conclusion: Replacement therapy with LT4 in newly diagnosed primary hypothyroid patients substantially improves cardiac structure, systolic and diastolic function and has a positive impact on underlying pericardial effusion. A large, prospective, trial is necessary to determine the long-term effects after thyroid hormone replacement.
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Iliotibial band friction syndrome: A common cause of lateral knee pain in long-distance runners p. 69
Pooja Gupta, Deep Yadav, Kamlesh Kumar Singh, Saikat Bhattacharjee
Introduction: Iliotibial band friction syndrome (ITBFS) is an injury of the knee joint which is common in long distance runners and cyclists. It is caused by repetitive friction between the iliotibial band and the lateral femoral epicondyle during active flexion and extension of the knee. Methods: Magnetic resonance imaging of the knee was performed for 45 long distance runners who presented with lateral knee pain after long distance running for 6 months. The analysis of the images was done by two radiologists in all the three planes to confirm or rule out any findings suggestive of ITBFS. The various imaging features which were noted in the MRI scans by the radiologists to label it as ITBFS were poorly defined abnormal signal intensity deep to the iliotibial band as the primary finding and other associated MRI findings such as fluid collection medial to the iliotibial band, increased thickness of the iliotibial band and joint effusion. Results: Out of these 45 runners 30 patients had ITBFS, 3 had lateral collateral ligament sprain, 3 had a grade III tear of the lateral meniscus, 3 had synovial effusion and six had normal scans. Discussion: Iliotibial band friction syndrome occurs because of overuse and can be confused with other disorders and MRI is able to differentiate it from other conditions.
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Evaluation of thyroid lesions by the bethesda system for reporting thyroid cytopathology p. 73
Syed Asif Hashmi, Monika Aggrawal, Rahul Pandey, Deepika Gulati, Inam Danish Khan
Introduction: Thyroid swellings are one of the most commonly encountered lesions with most of the thyroid swellings being benign. The cancerous lesions of the thyroid also present as nodules or masses and pose a diagnostic challenge. The thyroid cytology reporting system has been inconsistent with the use of various terminologies. The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) was introduced in 2007 to bring about uniformity in reporting of thyroid lesions. Aim: This study aimed to compare conventional reporting with TBSRTC. Materials and Methods: A retrospective study was done in which 6 years of data were retrieved. Cytology slides were reviewed and categorized as per the TBSRTC and compared with other studies. Results: There were numerous categories in the conventional thyroid fine-needle aspiration cytology reporting system which has been reduced to six categories in TBSRTC. TBSRTC has also streamlined the reporting removing the confusion among cytologists and clinicians. Conclusion: TBSRTC is consistent and reproducible and should be used as a standard method of reporting.
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Relevance of mesenteric lymphadenopathy in children detected on sonography p. 78
Ranjit Singh Lahel, Amit Chail
Objective: Mesenteric lymphadenitis reflects the mesenteric lymph node (MLN) response to an underlying infection of uncertain etiology, usually viral. In children, enlarged MLNs are common findings detected during abdominal ultrasound, whether done for nonspecific pain abdomen or for unrelated clinical presentations. This study was conducted to determine the significance of mesenteric lymphadenopathy in asymptomatic children as compared to those with symptoms of acute abdominal pain or chronic abdominal pain (CAP). Methodology: A prospective hospital-based study was conducted among 72 children aged between 2 and 15 years. These children were referred from the outpatient/pediatric ward department for 1 year, for evaluation by abdominal ultrasonography. Children were grouped into three categories based on their clinical presentations as asymptomatic (controls), those with CAP, and those with acute abdomen. The sonographic findings were tabulated against each, with accounting of parameters such as size, number of enlarged nodes, and site of nodes. Pearson's Chi-square test was used to analyze ordinal variables between groups. About 95% confidence interval was selected with a P = 0.05 taken as statistically significant. Results: Significant enlarged MLNs were comparable in prevalence in all groups. The incidence of significant mesenteric lymphadenopathy in the CAP group was even less than in the control group. The Chi-square statistic was 2.5612. The P = 0.633718. The result is not statistically significant at P < 0.05. This indicates that MLNs on ultrasonography have no significant association with the clinical presentation in children. Conclusion: Our study indicates that reporting of enlarged mesenteric nodes on transabdominal sonography in children is not statistically significant with the clinical symptomatology.
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Can intrauterine infusion of granulocyte colony-stimulating factor or platelet-rich plasma increase implantation rate in women undergoing in vitro fertilization with normal endometrium: boon or bane? p. 81
Seema Rai, K Yasaswi, Rishi Raj, Ravishekar N Hiremath, Smakshi Singh
Objective: The objective of this study was to investigate if intrauterine infusion of granulocyte colony-stimulating factor (G-CSF) or platelet-rich plasma (PRP) can improve endometrial parameters and the pregnancy rate in patients undergoing fresh embryo transfer with normal endometrial thickness. Materials and Methods: We conducted a retrospective observational study, at one of the assisted reproductive technique centers in central India. Data were collected from the institutional record system which was established as per the standard protocols. Data on a total of 225 patients who had an endometrial thickness >7 mm without any adjunct and underwent fresh embryo transfer in their first in vitro fertilization cycle during the past 2 years were collected and were categorized into three groups: Group A who had received intrauterine infusion of G-CSF (n = 75), Group B who received intrauterine infusion of PRP (n = 75), and Group C who (control group) received no intervention (n = 75). Results: The implantation rate was significantly higher in Group A (37.24%) than in Groups B and C (21.91% and 21.37%, respectively). No significant difference was found in the clinical pregnancy rate among Groups A, B, and C (50.68%, 40.54%, and 37.84%, respectively). Endometrial thickness increased significantly in Group A by approximately 2.3 mm. No significant change in other endometrial parameters in the three groups. The number of biochemical pregnancies was higher in the G-CSF group compared to the other two groups. Conclusion: Intrauterine infusion of G-CSF in women receiving fresh embryo transfer with normal endometrial thickness can increase endometrial thickness and the implantation rate without affecting other endometrial parameters and the cumulative pregnancy rate.
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Spectrum of cardiovascular manifestations in homozygous familial hypercholesterolemia p. 88
Nitin Bajaj, Balbir Singh, Ananthkrishnan Ramamoorthy, Arijit Kumar Ghosh
Homozygous familial hypercholesterolemia (HoFH) is a rare, primarily an autosomal dominant genetic disorder that causes markedly elevated low-density lipoprotein (LDL) cholesterol levels predisposing patients to risk of developing premature atherosclerotic cardiovascular diseases. Disease manifestations usually develop in 1st or 2nd decade of life and severity depends on the duration of exposure to elevated LDL cholesterol levels. The mainstay in management is early recognition and treatment with various lipid-lowering agents including lipid-apheresis in severe cases not responding to drug therapy. We report three cases of HoFH presenting to our institute in their 2nd decade of life with different cutaneous and cardiovascular manifestations and discuss challenges in their management.
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Clinical Spectrum of Gossypiboma: Case Series and Review of Literature p. 93
Priya Ranjan, Vijay Chetan Jha, Vipin Venugopal Nair, Sibi Eranki, Onkar Singh
Gossypiboma is a term used to describe retained surgical sponge after surgery. This is an avoidable clinical condition causing significant morbidity and mortality. The clinical presentation is variable and often a diagnostic enigma. The consequences of gossypiboma are undesirable, disappointing, and have medicolegal implications for the surgical team. We report three cases of gossypiboma with varying clinical spectrums. The first case had gastric outlet obstruction due to retained surgical sponge after open cholecystectomy. It had eroded both into the first part of the duodenum and transverse colon. Endoscopic and radiological evaluation helped to establish the diagnosis of duodenocolic fistula with gastric outlet obstruction. The second patient was treated for penetrating abdominal wound and presented with persistent fever with discharging sinus at the wound site. The third patient had undergone exploratory laparotomy for recurrent hydatid cyst of the liver and, in addition to recurrent hydatid cyst, a surgical sponge was also found. All these patients had retained surgical sponges but different clinical presentations. These patients underwent exploratory laparotomy and surgical removal of the retained surgical item (RSI) followed by a successful recovery. Gossypiboma should be considered as a differential diagnosis in all unexplained postoperative sepsis, intestinal obstruction, and intra-abdominal mass. Standard surgical safety measures in the operative room help to prevent the incidence of RSIs.
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Case report: Splenic infarct without splenic vessel thrombosis in a patient with portal hypertension and acute pancreatitis p. 97
Ranjit Singh Lahel, Amit Chail
Splenic infarction without splenic vessel thrombosis is an infrequent presentation in clinical practice. The case discussed here is a 45-year-old male with a history of alcohol abuse, who presented to the hospital with pain abdomen epicentered in the left upper quadrant. On evaluation, the patient was found to be having portal hypertension complicated with alcoholic hepatitis, acute necrotizing pancreatitis, gastric, and paraesophageal varices. The presence of splenic infarction without concomitant splenic vessel thrombosis in this patient merits a discussion of relevant investigations and their findings thereof.
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Tract specific CNS involvement post COVID-19 vaccine: A case report p. 100
Prashant Dubey, Shalesh Rohatgi, Prajwal Rao, Satish Nirhale, Pravin Naphade, Advait Gitay
We hereby report an interesting case of tractopathy following COVID-19 vaccine. Acute transverse myelitis following COVID-19 infection or vaccination is well documented. However, to the best of our knowledge, no case of selective tract involvement following COVID-19 vaccine has been reported so far. One case of tract-specific central nervous system involvement following COVID-19 infection has been reported from India. We report the case of a 46-year-old male who developed clinical and radiological evidence of tractopathy involving the corticospinal tracts and posterior columns following the first dose of the Covishield vaccine.
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Cow dung – An unusual cause of halitosis p. 103
Saurabh Sud, Saumya Shree, Saurabh Bhardwaj, Urikhimbam Surnaprity Devi
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