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  Citation statistics : Table of Contents
   2013| July-September  | Volume 6 | Issue 3  
    Online since July 5, 2013

 
 
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ORIGINAL ARTICLES
Role of sepsis screen in the diagnosis of neonatal sepsis
Rabindra N Misra, Savita V Jadhav, Purbasha Ghosh, Nageswari Gandham, Kalpana Angadi, Chanda Vyawahare
July-September 2013, 6(3):254-257
DOI:10.4103/0975-2870.114649  
Background: Neonatal sepsis is the single most important cause of neonatal deaths globally. The incidence of neonatal sepsis in India is 30/1000 live births. Though blood culture is the gold standard, but it is not always positive even if clinical features of sepsis are present in the neonate. Materials and Methods: Blood cultures and sepsis screen was carried out on 115 neonates. Out of 115 neonates with clinical features of sepsis, 75 were blood culture positive. Sepsis screen was carried out with total leucocytes count, absolute neutrophils count, ratio of immature neutrophils (band forms) to total neutrophil count, C-reactive protein. The identification of the causative organism was carried out by standard identification tests and antibiotic sensitivity testing as per Clinicaland Laboratory Standards Institute (CLSI) guidelines. Results: In this study, out of 115 cases of clinical neonatal sepsis 75 (65.2%) were culture positive. Among isolates, number of gram negative bacilli were 39 (52%) was more than gram positive cocci 36 (34.8%). However, Staphylococcus aureus 24 (32%) was most predominant. Forty (34.8%) were culture negative out of which 15(13%) neonates were positive for two or more sepsis screen tests. Conclusion: Blood culture and sepsis screen should be carried out in neonates suspected of sepsis; however, an immediate institution of empirical antibiotic therapy should be considered as culture positive and sepsis screen may not be positive in all the clinical sepsis cases to save lives.
  7 10,010 951
EDITORIAL
The publication rat race: Who will bell the cat?
Amitav Banerjee
July-September 2013, 6(3):219-220
DOI:10.4103/0975-2870.114636  
  5 7,802 642
ORIGINAL ARTICLES
Quality of life impairment in depression and anxiety disorders
Neha Pande, Vishu Tantia, Archana Javadekar, Daniel Saldanha
July-September 2013, 6(3):229-235
DOI:10.4103/0975-2870.114640  
Background: Most common mental disorders (CMDs) such as anxiety disorders and depressive disorders run a persistent and long course. This results in significant impairment of quality of life (QOL) of patients and their families. Evidence-based psychosocial interventions using findings in our own socio-cultural context would help clinicians in holistic management. Objectives: To document illness profile, treatment satisfaction, and QOL in various domains of life in study population and normal controls. Study Design: Cross-sectional analytical study of patients group and their normal family members as a comparison group. Materials and Methods: A total of 100 consecutive patients of depressive disorders and anxiety disorders (ICD-10 clinical diagnosis) attending outpatient clinic of the medical college hospital and their age- and gender-matched relatives as the control group were recruited. Socio-demographic profile was documented along with illness parameters: Severity of illness, treatment satisfaction, and QOL was measured using semi- structured interview, HAM, Beck's depression Inventory, and WHO-QOL scale. Results: The study group measured significantly low on QOL than the comparison group. The two groups differed significantly on the paired " t" test of significance and the variation had a genuine assignable cause. Notwithstanding some variables having a confounding effect and the limitations of a cross-sectional study, the study was conclusive in demonstrating statistically significant impairment of QOL of patients with CMDs, making a strong case for clinicians to pay attention to holistic management of patients. The study has generated QOL data on a small but significant normative population which may serve purpose in future QOL studies.
  5 5,922 575
CASE REPORTS
The axillary arch muscle (Langer's muscle): Clinical importance
Vaishaly K Bharambe, Vasanti Arole
July-September 2013, 6(3):327-330
DOI:10.4103/0975-2870.114680  
This was a cadaveric study aimed at studying the incidence of axillary arch muscle and the extent of its different attachments, and discussing its clinical importance. Totally, 30 upper limbs were meticulously dissected to locate the axillary arch. Wherever found, the arch was dissected from its origin to insertion and its nerve supply and blood supply was noted. The dimensions of the arch were measured. Its relations to the structures in axilla were studied in detail. Any additional related variations were investigated. The axillary arch was present in one right upper limb i.e., an incidence of 3.33%. The muscle extended from the lateral border of latissimus dorsi muscle across the axillary vessels and nerves lying superficial to the coracobrachialis, short and long heads of biceps brachii muscles, finally dividing into multiple slips of insertions into fascia covering the deep surface of pectoralis major muscle, fascia covering the biceps brachii muscle, and some slips extending into the capsule of shoulder joint. Across the middle of the axillary arch, a tendinous intersection was observed. The muscle was supplied by a branch of the thoraco-dorsal nerve. The presence of the axillary arch must always be kept in mind due to the possibility of such a muscular arch causing axillary vein entrapment, lymphatic compression, and shoulder instability by neurovascular compression, impeding the access to axillary lymph nodes during breast cancer surgeries and in latissimus dorsi transplants. It may also restrict abduction at shoulder joint.
  4 9,017 481
ORIGINAL ARTICLES
Lipid profile and electrocardiographic changes in thyroid dysfunction
Prasanna K Satpathy, Pradnya M Diggikar, Vishal Sachdeva, Mukesh Laddha, Anunay Agarwal, Harmandeep Singh
July-September 2013, 6(3):250-253
DOI:10.4103/0975-2870.114647  
Background: The study was designed to explore lipid profile and electrocardiographic changes associated with thyroid dysfunctions. Materials and Methods: A total of 72 patients of thyroid dysfunction having either hypothyroidism or hyperthyroidism were investigated with lipid profiles and electrocardiogram (ECG). Hypothyroids with ST-T ECG changes who were symptomatic for coronary artery disease were subjected to further investigations and were benefitted by either medical therapy or revascularization procedures following coronary angiography. Results: Out of the 72 patients, 44 (61.11%) were suffering from hypothyroidism, while hyperthyroidism was present in 28 (38.89%). Female:male ratio was 4.5:1. Maximum number of hypothyroid patients (73%) had either borderline high (36.6%) or high (36.36%) serum cholesterol; 67.86% of the 28 hyperthyroid patients had serum cholesterol levels <200 mg%. In hypothyroidism, ST segment and T wave ECG changes (ST-T changes) were the commonest electrocardiographic findings. Conclusion: Hypothyroidism was associated with high serum cholesterol levels whereas maximum patients with hyperthyroidism had normal serum cholesterol levels. Correlation was found between ST-T changes on ECG and high serum cholesterol levels in hypothyroidism.
  4 15,501 713
A comparative study of onlay and retrorectus mesh placement in incisional hernia repair
Kundan Kharde, Bharat Bhushan Dogra, Sunil Panchabhai, Karan V. S. Rana, Srihari Sridharan, Sai Kalyan
July-September 2013, 6(3):258-262
DOI:10.4103/0975-2870.114650  
Introduction: Incisional hernia after abdominal surgery is a well-known complication and the incidence of incisional hernias continues to be 2-11% after laparotomy. The repair of incisional hernia has always been a challenge to the surgeon. Various operative techniques for the repair of incisional hernia are in practice; however, the management is not standardized. The retro-rectus mesh placement or the sub-lay technique, popularized by Rives and Stoppa in Europe, has been reported to be quite effective, with low recurrence rates (0-23%) and minimal complications. Aims and Objective: The purpose of this study was to compare the traditional on-lay mesh and retro-rectus mesh placement in incisional hernia repairs in terms of time taken for surgery, early complications (wound infections, Mesh extrusion), and Delayed complications (Recurrence). Materials and Methods: This is a prospective study which was conducted in the surgical department of our hospital. A total of 50 cases were included in this study. Of these cases, 25 cases were operated by the on-lay mesh method and 25 by retro-rectus mesh placement. Only the patients with midline hernias up to 10 cm in diameter were included in the study. Result: The operative time for retro-rectus mesh placement was insignificantly higher than that of on-lay mesh repair, whereas, complications like superficial Surgical site infection SSI were identical in both the study groups, but deep SSI leading to infection of mesh was higher in on-lay mesh repair. The recurrence rate was found to be 4% in on-lay mesh repair and 0% in retro-rectus mesh repair. Conclusion: The follow-up period in this study was 6months; hence, late recurrences were not taken into account. However, the low rate of local complications and the low recurrence rate indicate that retro-rectus mesh repair has an advantage over traditional on-lay repair.
  4 8,031 576
Pattern and outcome of patients discharged from chest ward of a university hospital
Ruchi Sachdeva, Sandeep Sachdeva, Krishan B Gupta
July-September 2013, 6(3):240-244
DOI:10.4103/0975-2870.114642  
Aim: To describe morbidity and mortality profile of patients discharged from chest ward of a university hospital. Materials and Methods: Prospectively selected information (age, gender, residence, length of stay, outcome and primary diagnosis) of all consecutive in-patients was recorded for six month reference period. Results: Out of 967 patients, mean age was 50.64 years (±15.71); M:F = 3.5:1; 81.3% were from rural area. Primary diagnosis was tuberculosis/sequel among 528 (54.60%) and non-TB among 439 (45.4%) patients (chronic obstructive pulmonary diseases [COPD] - 20.3%; pneumonia - 15.8%; lung cancer - 5.0%; asthma - 1.6%; bronchiectasis - 0.9%, lung abscess - 0.8%, miscellaneous - 1.0%). Total deaths observed was 142 (14.7%) of all discharges and 54.25% of deaths occurred within 48 hours of admission suggesting criticality/late presentation; time distribution of death was similar considering 8-hourly period of 24-h cycle. Average length of stay for all patients was 6.91 (±5.14) days while it was 7.38 (±4.98) days for discharge live and 4.19 (±5.21) days for expired patients. Conclusion: Study provides a snapshot of patients discharged from chest ward that may aid in decision making, improving quality of care and initiation of educational activities at primary level.
  3 3,382 273
REVIEW ARTICLE
Psychiatric sequelae of traumatic brain injury
Suprakash Chaudhury, Partha Sarathi Biswas, Subodh Kumar
July-September 2013, 6(3):222-228
DOI:10.4103/0975-2870.114638  
Almost half of the people suffering traumatic brain injury (TBI) may later be diagnosed with psychiatric disorders. The literature (PubMed, IndMed of past 30 years) on psychiatric disturbances associated with TBI is reviewed. The authors highlight the close link between head injury and psychiatry and provide an overview of the epidemiology, risk-factors, and mechanisms of psychiatric sequelae including, cognitive deficits, substance abuse, psychoses, mood disorders, suicide, anxiety disorders, dissociative disorders, post-concussion syndrome, and personality changes following head injury. The various psychiatric sequelae are briefly discussed.
  3 11,520 841
ORIGINAL ARTICLES
A study of corneal endothelial changes in soft contact lens wearers using non-contact specular microscopy
Renu M Magdum, Neha Mutha, Rupali Maheshgauri
July-September 2013, 6(3):245-249
DOI:10.4103/0975-2870.114645  
Aim: To study the corneal endothelial changes after soft contact lens wear, to correlate these changes with the duration of soft contact lens wear, and to study the pattern of use and preferences of contact lens among young adults. Materials and Methods: This observational study was carried out in 100 eyes of 50 soft contact lens users aged between 19 and 27 years. Both eyes of 50 medical students who had never worn contact lenses served as controls. Data from each subject were collected using a structured questionnaire of 24 items that included demographic profile, pattern of contact lens use, symptoms, brand name, number of years worn, and hours of daily wear. These data were analyzed using Chi square for association. Specular microscopy was done using TOPCON SP-3000P. Computerized morphometry was used to evaluate central corneal thickness, size, shape, mean cellular density, hexagonality, coefficient of variation, and polymegathism of the corneal cells . Results: It was found that central corneal thickness was 0.532 ± 0.0309 mm in lens users and 0.514 ± 0.03 mm in controls, cell density was 2570.91 ± 432.06 cells/mm 2 in lens users and 2723.17 ± 327.64 cells/mm 2 in controls, while hexagonality was 54.81 ± 39.72% in lens users and 67.65 ± 36.49% in controls. Conclusion: Despite the known effects of long duration of soft contact lens use on corneal endothelial cell morphology, this study could not draw a significant correlation between them. However, a significant difference was found in the corneal endothelial thickness, cell density, and hexagonality. Among the soft contact lens users, 62% used soft disposable type while 38% used soft extended wear contact lens. Contact lenses were preferred over spectacles for better cosmetic appearance, comfort, and wider visual field.
  2 5,432 451
Study of correlation between clinical, magnetic resonance imaging, and arthroscopic findings in meniscal and anterior cruciate ligament injuries
Subhash R Puri, Samar K Biswas, Anil Salgia, Sahil Sanghi, Tushar Aggarwal, Pranav Patel
July-September 2013, 6(3):263-266
DOI:10.4103/0975-2870.114653  
Background: Approx. 28% of patients presents to orthopedic OPD with complaints of knee pain. Common medical complications include an unstable knee, chronic knee pain, and post traumatic arthritis. Aim: To study the correlation between clinical, magnetic resonance imaging (MRI), and arthroscopic findings in knee injuries. Materials and Methods: About 30 cases with history of rotational injury having knee pain and recurrent swelling were subjected to study. Results: MRI had better sensitivity (0.95 vs. 0.85) and specificity (1.0 vs. 0.5) in comparison with clinical examination for medial meniscus. In lateral meniscus injury (sensitivity 0.65 vs. 0.61 and specificity 0.95 vs. 0.92) and in ACL injury (Sensitivity 0.77 vs. 0.8 and specificity 1.0 vs. 0.96) the sensitivity and specificity of MRI versus clinical examination showed minimal difference. Conclusion: Our conclusion is that carefully performed clinical examination can give equal or better diagnosis of meniscal and ACL injuries in comparison with MRI scan. MRI may be used as an additional tool for diagnosis.
  2 4,449 620
A comparison of hamstring autograft versus bone patella tendon bone autograft for reconstruction of anterior cruciate ligament: A prospective study of 30 cases
Sanjay Deo, Ramprasad Rallapalli, Samar K Biswas, Anil K Salgia
July-September 2013, 6(3):267-273
DOI:10.4103/0975-2870.114657  
Background and Aim: Anterior cruciate ligament (ACL) deficient knee usually present with instability of the knee, in our study we are comparing the results of ACL reconstruction using bone-patellar-bone and quadrupled stranded hamstring tendon grafts. Materials and Methods: Thirty patients presenting with chief complaints of the knee instability were diagnosed clinically by Lachman test, anterior drawer test, pivot shift test and confirmed by diagnostic arthroscopy or MRI to have ACL tear. ACL tears that are more than 6 weeks old are included. Fifteen patients were treated with ACL reconstruction using autologous ipsilateral hamstringtendon and 15 patients were treated with bone patellar tendon bone graft through arthroscopy assisted technique. All patients were reviewed and analyzed at the end of 1 year post-operatively. Assessment includes pre-operative, intra-operative findings and post-operative subjective assessment scores and examination findings, pre- and post-operatively the Lysholm score, Tegner activity level, and International Knee Documentation Committee (IKDC) evaluation system were used as scoring systems. Results: Comparisons of results within the same groups showed statistically significant improvement as assessed by IKDC, Tegners and Lysholm operative scores. There was also significant correlation between manual Lachman test and stress laxometry findings. There was no statistically significant difference between scores of two groups (hamstring and bone patella tendon). Conclusions: Arthroscopic ACL reconstruction by either quadrupled hamstring tendon graft or bone patellar tendon graft gives equally satisfactory results.
  2 5,026 410
CASE REPORTS
A rare case presentaion of osteochondroma of scapula
Anil Salgia, Samar Kumar Biswas, Tushar Agarwal, Sahil Sanghi
July-September 2013, 6(3):338-341
DOI:10.4103/0975-2870.114673  
A 17-year-old female presented with complains of swelling in left scapular region since the age of 5 years, which had progressively increased in size. This condition was asymptomatic, but caused visible cosmetic concern to the patient and her parents as she was approaching a marriageable age. An En bloc excision of exostoses scapula was done; the patient had full functional recovery with no visible swelling. Histopathology, the diagnosis of osteochondroma was established. The patient was satisfied after the surgical resection of the tumor as, cosmetically, she looked near normal.
  1 10,118 405
Mixed germ cell tumors: Report of two cases
Pradhan M Pagaro, Charusheela R Gore, Tushar Patil, Shirish Chandanwale
July-September 2013, 6(3):298-301
DOI:10.4103/0975-2870.114658  
Germ cell tumors arise in the ovaries and testis and rarely in other tissues. Mixed germ cell tumors are rare. We report two cases of mixed germ cell tumors, one consisting of seminoma and immature teratoma in the testis of a 30-year-old male and second consisting of a yolk sac tumor and immature teratoma in the ovary of a 17-year-old female. Many combinations of mixed germ cell tumors have been reported but very few cases of the above-mentioned combinations have been reported in literature.
  1 4,995 337
Papillary tumor of pineal region: A rare entity
Meena Patil, Manjiri Karandikar
July-September 2013, 6(3):302-304
DOI:10.4103/0975-2870.114659  
Pineal tumors comprise 0.4-1.0% of intracranial space occupying lesions in adults. Papillary tumor of pineal region (PTPR) is a very rare entity. It has been newly described in WHO 2007 classification of brain tumors. Only a few case reports are available in the literature. We report a case of a 60-year-old female presenting with headache, giddiness and reduced vision. Imaging studies showed a pineal mass with areas of hemorrhage. All ventricles were normal. There was a past history of a pineal gland tumor excised 2 years ago. This case is being reported for its rarity and aggressiveness in the form of recurrence. Limited/available immunohistochemistry workup has been done.
  1 2,619 220
Lipoblastoma: A rare benign, pediatric soft tissue tumor
Ghante Nagaraj Srinivas, Anitha B Chalageri, Anjana Gupta, Manjula Vijayanand
July-September 2013, 6(3):305-307
DOI:10.4103/0975-2870.114660  
We report a case of Lipoblastoma in a 4-year-old boy along with a brief review of literature. Lipoblastomas are rare benign tumors that arise from embryonic white fat. These lesions exhibit a wide range of cellular differentiation and maturation. A range of differentiation from unvacuolated spindle cells within the myxoid matrix to increasingly larger and more vacuolated cells to the mature adipocyte, can be noted at high power. These lesions are typically asymptomatic and most cases are diagnosed within the first decade of life. This case report tries to describe the importance of differentiating Lipoblastoma from myxoid Liposarcoma. Lipoblastomas when followed, gradually mature, with the disappearance of the spindle and myxoid elements.
  1 4,346 325
Abnormally hyperdense intracranial vessels on non-contrast computed tomography scan simulating dural venous sinus thrombosis in a case with high hematocrit
Argha Chatterjee, Tapan Dhibar, Debasish Dey
July-September 2013, 6(3):308-309
DOI:10.4103/0975-2870.114663  
Abnormal hyperdensity of intracranial blood vessels on non-contrast computed tomography scan (NCCT) may be found in cases with raised hematocrit. This finding not only simulates the appearance of a contrast enhanced CT scan but also may mimic dural venous sinus thrombosis. Here we report a case of child with Fallot's tetralogy and central cyanosis who showed abnormally hyperdense intracranial vessels on NCCT of head simulating the appearance of dural venous sinus thrombosis. The absence of suggestive clinical findings in the child, hyperdensity of intracranial arteries as well as the veins and a normal magnetic resonance venogram (MRV) suggested that the raised hematocrit is responsible for such appearance.
  1 6,904 328
Atraumatic femoral neck fracture secondary to prolonged lactation induced osteomalacia
Dhammapal Sahebrao Bhamare, Praful Herode, Abhijeet Shroff, Bharati Deokar, Samar K Biswas
July-September 2013, 6(3):313-317
DOI:10.4103/0975-2870.114670  
Presenting a case of atraumatic fracture neck femur secondary to 2 years of prolonged lactation. A 26-year-old lactating mother presented with pain in left hip from last 12 months. She was apparently alright before and during pregnancy. Plain radiograph showed a complete undisplaced fracture of femoral neck. Osteomalacia was diagnosed by radiological and serological investigations. The fracture was fixed using AO type cannulated cancellous screws. The fracture showed good clinical and radiological union at 3 months. Literature review shows that this is a first case of atraumatic fracture of neck femur due to prolonged lactational osteomalacia. It showed that even apparently healthy Indians are susceptible to osteomalacia, more so during pregnancy and lactation and can be presented as atraumatic fracture. Although considered relatively stable, a compression type incomplete fracture neck femur may progress to a complete fracture if not treated in time.
  1 4,393 267
Crouzon syndrome
Neha Rajappa, Sadananda Patra, Abha Gahlot, Snehal Bhalsing
July-September 2013, 6(3):321-323
DOI:10.4103/0975-2870.114675  
Crouzon syndrome is an autosomal dominant disorder with complete penetrance and variable expressivity. Described by a French neurosurgeon in 1912, it is a rare genetic disorder. Crouzon syndrome is caused by mutation in the fibroblast growth factor receptor 2 (FGFR2) gene. Normally, the sutures in the human skull fuse after the complete growth of the brain, but if any of these sutures close early, then it may interfere with the growth of the brain. The disease is characterized by premature synostosis of coronal and sagittal sutures which begins in the first year of life. A case of Crouzon syndrome is presented here. The clinical and characteristic radiological features and the investigations that were carried out, along with the treatment options are discussed.
  1 5,234 380
ORIGINAL ARTICLES
A clinical study of ligamentoaxis using an external fixator, modified frame in the management of a neglected, relapsed, resistant older congenital Talipes Equino varus child
Ajit Shinde, Suhas Kamble, Smit Shah, Raviraj Shinde
July-September 2013, 6(3):274-280
DOI:10.4103/0975-2870.114661  
Background: In an older, relapsed, recurrent, resistant Congenital Talipes Equino Varus (CTEV) child with previous surgical scar, soft tissue release alone is often not sufficient for full correction, particularly at above 2 years of age. Here controlled, fractional differential distraction with Joshi's external stabilization system is a useful option to correct all the deformities. It is a well-established modality but with complication rate of 30%, mainly related to pin loosening and infection leading to instability of frame. We aimed to study a method to increase stability of frame to reduce incidence of pin loosening, infection and to evaluate clinical and functional outcome of the modality along with modification. Materials and Methods: 117 children underwent Joshi's external stabilization system procedure. The principle of correction applied in this study was fractional distraction. Patients were evaluated by Catteral and Simons criteria. Results: Excellent results were obtained in 68.50% of cases, good results in 23.90%, and poor results in 7.60% of the cases. The complication rate reduced to 3% pin tract infections, which eventually healed with outpatient treatment. Conclusion: Fractional distraction method by using Joshi's External Stabilization System is an easy, simple, less invasive method, which corrects all the deformities in resistant, neglected, and relapsed cases of CTEV and modification of the frame we used proved to be beneficial. Teaching and awareness of parents regarding distraction schedule, stability of frame postoperative importance of wearing of corrected footwear for long period are important.
  1 6,240 378
CASE REPORTS
Anesthetic management of a case of congenital diaphragmatic hernia; delayed diagnosis
Smita Joshi, Arun George
July-September 2013, 6(3):281-283
DOI:10.4103/0975-2870.114644  
Congenital diaphragmatic hernia results from the anomalous closure of pericardioperitoneal canal. There are various challenges faced by anesthesiologists during management of such cases which include intraoperative complications including hypoxia and hypercarbia, which leads to pulmonary hypertension and right to left shunt. Mortality remains high because of associated pulmonary hypoplasia and pulmonary hypertension. Here, we describe anesthetic management of a 2-month-old female child with difficulty in breathing since birth following feeding, due to congenital diaphragmatic hernia.
  - 13,769 1,352
Swinging door lateral orbitotomy for management of anteriorly placed orbital tumours
Atreyee Pradhan, Ozhukil K Radhakrishnan, Sadananda Patra, Dhavat Sukharamwala
July-September 2013, 6(3):284-288
DOI:10.4103/0975-2870.114646  
A 70 years old female; who came to us; with drooping of right upper eyelid, gradual progressive diminution of vision with a slowly progressive swelling over right upper outer orbit of 1 year duration. Examination revealed non-axial proptosis with downward and inward deviation of the right eye. An irregular, lobulated nontender swelling was present in the superolateral orbit. CT scan revealed a well circumscribed oval encapsulated lesion with no bony destruction. The mass was removed by a modified lateral orbitotomy without removing lateral orbital rim. Histopathological evaluation showed it to be a pleomorphic adenoma of the lacrimal gland. Patient made an uneventful postoperative recovery. This presentation describes a method of lateral orbitotomy for anterior orbital lesions in which the lateral orbital rim is swung outwards without detaching it from its attachment to the temporalis muscle. This surgical approach may reduce the chance of avascular necrosis of the lateral orbital wall bone and infections of the orbit.
  - 4,138 301
An interesting case of herpes zoster ophthalmicus
Avinash Mishra, Vinod K Baranwal, Vinod K Patra, Vijay K Srivastava
July-September 2013, 6(3):289-291
DOI:10.4103/0975-2870.114651  
Approximately 20% of the world's population suffers from herpes zoster at least once in a lifetime, with about 10% to 20% of these having an ophthalmic involvement. Timely diagnosis of Herpes Zoster Ophthalmicus (HZO), with an early recognition of its various associated complications as well as their management along with an early referral to an ophthalmologist are critical in limiting visual disability. Here we report an interesting case of HZO in a young individual who in addition to the corneal involvement also had anterior uveitis as well as grossly raised intra ocular pressure
  - 9,934 404
Surgical repair of giant inguinoscrotal hernia containing the urinary bladder
Suryapratap Singh Tomar, Saranjeet Singh Bedi
July-September 2013, 6(3):324-326
DOI:10.4103/0975-2870.114677  
Inguinal hernia repair is one of the commonest operations in surgical practice. Unusual contents of hernia sac are uncommon, but are likely to be encountered by a surgeon in his career due to the frequency of hernia repair. The bladder is involved in less than 4% of inguinal hernias. These patients usually present with frequent episodes of urinary tract infection, difficulty in walking and difficulty in initiating micturition because of incarceration of the urinary bladder into the scrotum. The incidence may reach 10% among obese men who are 50-70 years old. Most cases are asymptomatic and are usually found incidentally during radiographic evaluation or at the time of herniorrhaphy. Massive inguinoscrotal bladder hernia, also known as scrotal cystocele, is very rare. In India, there was only few reported case of inguinoscrotal bladder hernia. Here we report a case of left inguinoscrotal bladder hernia who presented with a scrotal mass. We also provide a review of the relevant literature.
  - 4,740 241
Pharyngocele opening in vallecula: An unusual presentation
Gundappa D Mahajan, James Thomas, Priya Shah, Rashmi Prashanth
July-September 2013, 6(3):318-320
DOI:10.4103/0975-2870.114672  
Pharyngocele is a benign anomalous pouch formed by hernial protrusion of the mucous membrane through a defect in the hypopharynx. Here we report a 58-year male presenting with large submandibular swelling with complaints of dysphagia and regurgitation. MRI suggested presence of a large pharyngocele. In view of size of swelling external surgical approach was considered as a therapeutic option for the management.
  - 8,320 332
Transverse testicular ectopia: Pre-operative diagnosis and management
Shreeprasad Patankar, Shilpa Patankar
July-September 2013, 6(3):310-312
DOI:10.4103/0975-2870.114667  
Transverse testicular ectopia (TTE) is an extremely rare variety of undescended testis where both the testes migrate to one side. Common presentation is non-palpable testis on one side and inguinal hernia on opposite side. Pre-operative clinical diagnosis may not be always possible and usually TTE is diagnosed during surgery for inguinal hernia. High-index of suspicion, investigations like ultrasonography and laparoscopy would help in pre-operative diagnosis and management.
  - 3,889 297
Steele Richardson Olszewski syndrome
Vijayashree S Gokhale, Zubin Sharma, Neha Chaudhari
July-September 2013, 6(3):342-345
DOI:10.4103/0975-2870.114671  
Parkinson's disease and its plus syndromes are an important cause of morbidity in the geriatric age group. Its plus syndromes show a myriad of clinical features characterized by progressive symptoms. Here we present a 65-year-old woman with progressive "Parkinsonian-like features," i.e., mask-like face, slowness of all movements and tendency to fall, and difficulty in eye movements, leading to the diagnosis of Steele Richardson Olszewski Syndrome or progressive supranuclear palsy.
  - 8,576 308
Arched abdominal aorta and altered course of right ovarian vessels in a female cadaver: Clinical significance and embryological explanation
Sneha Guruprasad Kalthur, KS Siddaraju, Anthony Sylvan D'Souza
July-September 2013, 6(3):331-333
DOI:10.4103/0975-2870.114681  
Variations in the vascular origin of ovarian artery have been reported in the past. However, the reports on altered course of ovarian artery are very few. In the present paper, we discuss about multiple variations observed in formalin fixed female cadaver. The right ovarian artery was 22 cm long and ran unusually behind the inferior vena cava (IVC). The right ovarian vein drained in to right renal vein at right angle instead of draining into IVC directly. In addition, to these variations, the cadaver had arched abdominal aorta and retro-aortic left renal vein.
  - 6,006 252
Tortuous abdominal aorta with right testicular vein terminating into right renal vein: A report from cadaveric dissection
Amol Shinde, Manvikar P Rao, Parmatma P Mishra, Vaishali Paranjpe
July-September 2013, 6(3):334-337
DOI:10.4103/0975-2870.114678  
During routine dissection, tortuous abdominal aorta along with tortuous common iliac arteries was noticed in a male cadaver of approximately sixty years of age. There was no dilatation or reduction in vessel wall thickness as is usually seen in aneurysms. Abnormal path of a vessel and more so tortuosity is said to be the result of localized atherosclerosis. Concurrently gonadal vein abnormality was also seen. Normally the right gonadal vein terminates into inferior vena cava, but in this case, it was seen terminating into right renal vein. Anomaly in gonadal vein termination can be explained on embryological basis. Tortuosity of abdominal aorta has bearing on procedures involving catheterization. Arterial manipulation with catheter in such cases needs to be discouraged as blocking of catheter lumen has been reported in angioplasty. Gonadal venous anomaly can be a key factor in successful ligation of vessels for treatment of varicocele. This case is reported with relevance to clinical implication during catheterization and probable indication for pre-procedural imaging study in suspected cases. An unusual association with venous anomaly is unique in this report.
  - 9,080 272
Compartment syndrome like picture in metaphyseal comminuted fracture of tibia treated by locking plate due to tight closure
Prafulla Herode, Dhammapal S Bhamare, Bhamare K Biswas, Bharati Deokar
July-September 2013, 6(3):294-297
DOI:10.4103/0975-2870.114655  
A 22-year-old male came to casualty on 5 th May 2012 after a fall from motorcycle. He complained of excruciating pain and swelling over right knee. There was an open wound of 7 × 2 cm over supra-patellar region and diffuse swelling over knee joint with severe tenderness over proximal aspect of right tibia. X-ray showed intra-articular fracture of proximal tibia extending to diaphysis classified as type 6 by Schatzker classification for proximal tibia, with fibula shaft transverse fracture. The skin over the fracture was contused. Debridement with primary wound closure was done in emergency. Skeletal traction was applied through a lower tibial Steinman pin. Patient was operated after 15 days when wound healed and swelling subsided. Locking plate was applied on medial aspect using Minimally invasive percutaneous plate osteosysthesis (MIPPO) technique. Post-operatively over 4 hours patient developed severe pain and swelling in operated leg which mimicked compartment syndrome. Suture removal was done immediately in the ward from the distal aspect, which relieved the symptoms but lead to exposure of the plate. A rotational flap was done to cover the plate in coordination with a plastic surgeon on the next day.
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COMMENTARY
Herpes zoster ophthalmicus
Kavita R Bhatnagar
July-September 2013, 6(3):292-293
  - 2,778 297
Publication rat race
Anupama Sukhlecha
July-September 2013, 6(3):220-221
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LETTERS TO THE EDITOR
Kartagener's syndrome
PK Satpathy, PM Diggikar, Anunay Agarwal
July-September 2013, 6(3):346-346
DOI:10.4103/0975-2870.114664  
  - 1,822 209
Surgical treatment of thoracic outlet syndrome
Ridvan Alimehmeti, Florian Dashi, Mithat Demneri, Mentor Petrela
July-September 2013, 6(3):346-347
DOI:10.4103/0975-2870.114666  
  - 2,193 257
Nasal dermoid cyst with intracranial extention and an atretic dermal sinus
Vinod V Shinde, Nayanna S Karodpati, SC Deogaonkar, Mayur H Ingale
July-September 2013, 6(3):347-348
DOI:10.4103/0975-2870.114668  
  - 1,735 211
ORIGINAL ARTICLES
Seroprevalence of human immunodeficiency virus in voluntary blood donors: Declining trend
Pradhan M Pagaro, Dakshyani Padmakar Pandit, Anand R Patel, Urmi Chaudhari
July-September 2013, 6(3):236-239
DOI:10.4103/0975-2870.114641  
Background: Seroprevalence of human immunodeficiency virus (HIV) in selected groups can produce an indication of secular trends of the infection. In this article, we studied the trend of HIV infection in voluntary blood donors over a period of 7 years. Materials and Methods: The study was conducted in a blood bank of a tertiary care hospital. More than 16,500 donors were screened by enzyme-linked immunosorbent assay for HIV infection over a period of 7 years. Statistical Analysis: Trend analysis was performed to identify the year-wise HIV positivity pattern among the blood donors during the study period. Cochrane-Armitage Chi square for linear trend was applied to the data to observe whether there was any significant decline in HIV seropositivity among the blood donors. Results: In our study, the seroprevalence of HIV declined from 0.57% in 2006 to 0.18% in 2012. This declining trend tended to be statistically significant (Cochrane-Armitage Chi square for linear trend 3.65, P = 0.056). Conclusion: This study indicated the decreasing trend of HIV seropositivity among voluntary blood donors. Long-term surveillance of blood donors can provide important information on the course of the HIV pandemic.
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