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   2016| July-August  | Volume 9 | Issue 4  
    Online since July 12, 2016

 
 
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COMMENTARY
Elevated troponin levels and typical chest pain: Is always acute coronary syndrome?
Anil Kumar
July-August 2016, 9(4):505-506
DOI:10.4103/0975-2870.186073  
  33,993 285 -
REVIEW ARTICLES
Laboratory evaluation of thyroid function: Dilemmas and pitfalls
MK Garg, Namita Mahalle, K.V. S. Hari Kumar
July-August 2016, 9(4):430-436
DOI:10.4103/0975-2870.186054  
Among all endocrine disorders, thyroid dysfunction is possibly most common endocrine disorder barring obesity. This implies that thyroid function tests (TFT) are routinely ordered for laboratory test for its evaluation. Furthermore, recently laboratory values of thyroid function, thyroid-stimulating hormone (TSH), free thyroxine (FT4), and free triiodothyronine (FT3), have gathered importance in view of rapidly changing cut-offs for treatment of thyroid disorders during pregnancy. Most of the times, interpretation of TFT is easy, indicating euthyroidism (normal FT4 and TSH), hypothyroidism (low FT4 or FT3 with high TSH), or thyrotoxicosis (high FT4 or FT3 with low TSH). However, the normal ranges reflect two standard deviations around the mean. Hence, 2.5% of the population may show minor abnormalities on both side of normal range in spite of being euthyroid. Sometimes interpretation becomes difficult when there is an alteration in relation between thyroid hormones and TSH. These pitfalls in investigations will cause dilemma in physicians and patients mind alike. Problems in hormonal evaluation can be preanalytical, analytical, and postanalytical. In an ambulatory patient, TFTs have limited preanalytical interferences such as age, pregnancy, medications, genetic mutations, systemic diseases, and critical illnesses. Analytical errors occur due to heterophile antibodies and macro-TSH. Postanalytical errors include wrong entry of the result, mistakes in the units of the parameter checked and failure to identify the normal data.
  22,591 1,331 1
ORIGINAL ARTICLES
Obstructive jaundice: Its etiological spectrum and radiological evaluation by magnetic resonance cholangiopancreatography
Ankur Attri, Ritu Dhawan Galhotra, Archana Ahluwalia, Kavita Saggar
July-August 2016, 9(4):443-450
DOI:10.4103/0975-2870.186049  
Background: Magnetic resonance cholangiopancreatography (MRCP) has reached a level of resolution and reliability where it may replace diagnostic endoscopic retrograde cholangiopancreatography. We studied the role of MRCP in adult patients with obstructive biliopathy to analyze its etiological spectrum and radiological findings. Materials and Methods: Total fifty patients referred for mrcp with a clinical diagnosis of obstructive jaundice were included in our study. Imaging findings were correlated with the final diagnosis made by histopathological or cytological findings and with the therapeutic outcome. Aim: To evaluate the role of MRCP in the determination of the etiological spectrum, to evaluate level and degree of biliary obstruction in cases of obstructive jaundice and to correlate findings on mrcp with surgical findings where possible. Results: Of fifty patients, 29 were benign lesions and 21 were malignant lesions. Among the benign lesions, 12 had choledocholithiasis and 16 had benign strictures. One case was of a choledochal cyst. Among the malignant lesions, 12 were gallbladder carcinoma, six were cholangiocarcinoma, two were periampullary carcinoma, and one was a case of metastatic deposit. The overall sensitivity of MRCP was 96.5%, specificity was 95.2%, and with an accuracy of 96% for benign lesions. The accuracy, sensitivity, and specificity of MRCP in the diagnosis of benign strictures was 92%, 93.7%, and 91.2%, for choledocholithiasis was 92%, 75%, and 97.3%, and for malignant lesions was 95.2, 96.5%, and 96%, respectively. Conclusion: MRCP is a relatively quick, accurate, and noninvasive imaging modality for the assessment of obstructive jaundice, in ruling out potentially correctable underlying cause.
  11,128 662 2
BRIEF RESEARCH COMMUNICATION
Multiple radiation-induced late changes seen in pelvis in a single patient
Ayush Naik, Virendra Bhandari, KL Gupta, Mehlam Kausar
July-August 2016, 9(4):489-494
DOI:10.4103/0975-2870.186058  
Background: Radiation sequelae can be early or late depending on the duration of occurrence. Early reactions are temporary, but late reactions tend to be permanent and occur many years after treatment. Late reactions can be seen in skin, subcutaneous tissue, muscle, and bone in the irradiated area. Materials and Methods: We present here a report in which we saw all the late reactions in a single patient, 18 years after radiotherapy to pelvis for cancer cervix. Results: Our patient had bone fracture, new bone formation, bone marrow widening, muscle hypertrophy, subcutaneous fibrosis, and angiokeratoma after 18 years of radiotherapy to pelvic area. Conclusion: All these types of late toxicities are rarely seen in the same patient and we could not find any such reports in the literature.
  8,145 353 -
CASE REPORTS
Klippel–trenaunay syndrome: A case report with radiological review
Amit T Kharat, Rajul Bhargava, Vidhi Bakshi, Akhilesh Goyal
July-August 2016, 9(4):522-526
DOI:10.4103/0975-2870.186069  
Klippel–Trenaunay Syndrome is a congenital disorder with a rare incidence of 3-5/1,00,000. It is characterized by a triad of capillary malformation (hemangioma or port-wine stain), venous varicosities, and bony or, soft-tissue hypertrophy. The malformation in the capillary is usually limited to a single extremity though multiple extremities can be involved. This disease is subject to significant morbidities such as bleeding, deep vein thrombosis, and embolic complications. Our case study was a young male of 6 years suffering since birth, from a painful port-wine stain on the lateral aspect of the right thigh, enlarged right femur, and soft tissues. Vascular Doppler ultrasound, skeletal X-ray, and magnetic resonance imaging of the limb indicated a Klippel–Trenaunay disease. This article describes a case study of a child presenting with Klippel–Trenaunay including a review of the syndrome and treatment recommendations.
  7,738 552 5
Pure yolk sac tumor of testis in a 50 years old : A rare case report
Pradhan M Pagaro, Bedarshi Banerjee
July-August 2016, 9(4):499-502
DOI:10.4103/0975-2870.186078  
Yolk sac tumor (YST) is most common in infants and children in age range of 3-8 years in pure form; however in adults, YST rarely occurs in pure form, but commonly occurs in association with other germ cell tumors as mixed forms. Less than 10 adult testicular pure YSTs have been reported in literature. We report a 50-year-old male with testicular neoplasm involving the left testis, with pain following trauma. Alpha-fetoprotein was markedly raised 5726 IU/ml, and on histopathology, characteristic features of YST with abundant Schiller–Duval bodies associated with reticular and microcystic pattern, and focal solid areas of nests and trabeculae of cuboidal cells, with prominent nucleoli and mitotic figures, were noted, and extensive histopathological search did not reveal presence of any other type of tumor.
  6,944 380 3
Wolf-Hirschhorn syndrome presenting with cardiac manifestations at birth
Sudhir D Malwade, Sharad Agarkhedkar, Swapnil
July-August 2016, 9(4):531-533
DOI:10.4103/0975-2870.186060  
Wolf–Hirschhorn syndrome (WHS) is a condition of developmental delay and dysmorphology caused by a deletion of short arm of chromosome 4. The main characteristics of WHS are intra and extrauterine growth retardation, mental retardation with typical facial dysmorphism, microcephaly, and midline fusion defects. The diagnosis is based on clinical features and chromosomal analysis, e.g., microsatellite analysis or molecular cytogenetic techniques and fluorescence in situ hybridization (FISH) to detect the deletion. Prenatal diagnosis is possible by FISH. Though no specific treatment is available, supportive management can be fruitful. Here, we describe a female baby with a 4p deletion, who had the majority of the main phenotypic features of WHS and severe congenital heart disease manifesting at birth. The case emphasized that any fetus with intrauterine growth retardation, dysmorphic features on antenatal scan, and midline defects should raise a suspicion of WHS. Conventional cytogenetic studies can miss the diagnosis; hence, these cases should be further investigated using molecular cytogenetic techniques such as FISH or array-comparative genomic hybridization.
  6,489 231 -
ORIGINAL ARTICLES
A cross-sectional study of cognitive functions and disability in schizophrenia from a tertiary care hospital in North India
Meha Jain, Shweta Singh, Pronob Kumar Dalal, Anil Nischal, Adarsh Tripathi, Sujita Kumar Kar
July-August 2016, 9(4):457-464
DOI:10.4103/0975-2870.186056  
Background: Cognitive functions are important predictors of day to day functioning. Cognitive functions are significantly affected in schizophrenia and various other psychiatric disorders. There are very few Indian studies studying the relationship between cognitive functions and disability. Aims and Objectives: The purpose of the present study was to assess the cognitive functions in stable patients of schizophrenia and compare them with normal controls and also to study the relationship between cognition and disability in these patients. Materials and Methods: Thirty stable patients of schizophrenia attending psychiatry outpatient clinic of a Tertiary Care Hospital of North India were included in the study. Thirty healthy volunteers with no psychiatric illness matched for age, gender, and education were also included cognitive functions were assessed using Brief Assessment of Cognition in Schizophrenia and disability was assessed using WHO Disability Assessment Schedule 2.0 (WHODAS 2.0). Results: Highly significant difference (P < 0.0001) was found between the cognitive functions of the schizophrenia group and healthy control group. The patients of schizophrenia had a maximum disability in the area of life activities followed by participation and cognition. There existed a significant negative correlation between cognition and mobility (r = −0.45, P < 0.05), getting along with people (r = −0.44, P < 0.05), life activities (r = −0.42, P < 0.05), participation (r = −0.39, P ≤ 0.05), and total scores on WHODAS 2.0 (r = −0.48, P ≤ 0.05). Conclusion: Cognitive functions are an important predictor of disability. Cognitive deficits exist even in the stable patients of schizophrenia which is significantly higher than the healthy group.
  5,119 407 6
Awareness of childhood blindness in parents attending Paediatrics Ophthalmology outpatient department
Radhika Paranjpe, Iqra Mushtaq, Aishwarya Thakre, Anuradha Sharma, Debapriya Dutta, Banyameen Iqbal
July-August 2016, 9(4):451-454
DOI:10.4103/0975-2870.186057  
Background: Blindness is defined by World Health Organisation as having a visual acuity of <3/60 in the better eye. Thirty-seven million people are blind worldwide. One million and four hundred thousand are children. The causes of blindness in children vary according to region and socioeconomic development. The aim of our study is to identify a range of potential issues relating to parental awareness and perceptions of common eye diseases affecting children. Materials and Methods: The type of study was population-based, prospective, cross-sectional study conducted on parents of 200 children ranging from 0 to 16 years of age, attending Paediatric Ophthalmology clinic during the month of August and September 2014. This was an open-ended questionnaire-based study and only the participants who consented were enrolled in the study. Results: The most common eye problem detected among 200 of children was refractive errors. The incidence of refractive errors was found to be 103 out of 200 (51.5%). This is followed by 71 (35.5%) cases of squint/strabismus. Of 200 parents, 150 (75%) think the present eye condition of their child will reduce the eyesight. However, they did not know about the nature of the eye problem. Forty-four (22%) parents did not know anything about the eye condition of their child. Seventy (35%) parents were apprehensive about the use of spectacles in the children suffering from refractive errors. One hundred and six (53%) parents came to know about the eye problem of their child from the teacher of the child and 63 (31.5%) parents got information from their family doctor. Conclusions: As the number of mothers attending the eye department with the child is high, so there is more need of educating the mothers about the eye conditions of the child. Education and socioeconomic conditions affect the knowledge and awareness level of the parents regarding eye problems. Most of the children attending outpatient department were found to be in the age group of 5-8 years. This may point toward factors like dietary deficiency of Vitamin A and other important nutrients. Commonest eye problem was of refractive errors among children.
  5,103 404 6
CASE SERIES
Parathyroid adenomas: A case series and clinicopathological study from a tertiary care center in South India
Amitabh Jena, Rashmi Patnayak, Vaikkakara Suresh, Tek Chand Kalawat, Bobbit Venkata Phaneendra, Amarchala Yadagiri Lakshmi, Alok Sachan
July-August 2016, 9(4):495-498
DOI:10.4103/0975-2870.186072  
Background: The incidence of primary hyperparathyroidism (PHP) in India is 2.5/1000 individuals. The major cause for PHP is parathyroid adenoma. To arrive at the correct diagnosis, clinical setting, biochemical and radiological investigations, the status of other glands assessed intraoperatively and finally histopathologic confirmation is essential. Materials and Methods: We carried out a retrospective analysis of the last 5 years of operated cases of parathyroid adenomas. Diagnosis was based on histological confirmation. In all the cases clinical data, details of biochemical, radiological, and other investigations including histopathological findings were recorded. Results: There were four operated patients of parathyroid adenoma at our center in the last 5 years. Out of four operated cases of parathyroid adenomas, three were symptomatic and one case was detected incidentally. The symptoms were varied and included skeletal, renal, neuromuscular, and neuropsychiatric manifestations. Two of the patients had diabetes mellitus at the time of presentation. They showed improvement in glycemic control after surgery. Histopathologically, all the parathyroid adenomas were of clear cell type without any evidence of capsular or vascular invasion to suggest the possibility of malignancy. Conclusion: Majority of our patients were females who showed symptomatic improvement after surgery. Histopathologically, all the cases were parathyroid adenomas and in one case of papillary carcinoma of thyroid, the parathyroid adenoma was incidentally detected.
  4,122 361 2
CASE REPORTS
A case of severe anaphylaxis following coronary angiography
Anil Kumar, Nalin Kumar Mahesh, Keshavmurthy Ganapathy Bhat, Akhilesh Goyal
July-August 2016, 9(4):527-530
DOI:10.4103/0975-2870.186055  
Anaphylaxis reactions are not uncommon in routine practice and involve multiple systems usually. Cardiovascular collapse is the severest form of reaction. We present a case of severe anaphylactic reaction with cardiovascular collapse without other systems involvement which had to treat with intravenous adrenaline for a prolonged duration (successfully). The case is presented because of the rarity of presentation (single system involvement) and requirement of prolonged use of adrenaline for more than 24 h.
  4,224 220 -
ORIGINAL ARTICLES
Identifying predisposing factors for recurrence after successful surgical treatment of lumbar disc herniation
Farzad Omidi-Kashani, Aslan Baradaran, Farideh Golhasani-Keshtan, Mohammad Dawood Rahimi, Ebrahim Ghayem Hasankhani, Maryam Abbasi Moghadam
July-August 2016, 9(4):469-473
DOI:10.4103/0975-2870.186065  
Background: Recurrent lumbar disc herniation (rLDH) comprises one of the most common complications of lumbar discectomy occurring in about 1-21% of the operated patients. Aim: This study aims to elucidate the role of predisposing factors in producing rLDH in the patients with previous successful lumbar discectomy. Materials and Methods: In this retrospective study, we reviewed 213 patients (133 male; 62%) who underwent simple primary lumbar discectomy in our Orthopedic Department from August 2009 to January 2014. Mean age and follow-up period were 38.1 ± 9.8 years and 48.2 ± 7.3 months, respectively. The term of rLDH referred to those cases who have suffered a relapsed sciatalgia after a primary pain improvement period. We repeated magnetic resonance imaging (MRI) scanning only in those cases with recurrent complaints. Chi-square, Fisher, and Student's t-tests were used for statistics. Results: Recurrent sciatalgia occurred in 39 patients (18.3%), while true rLDH on MRI scanning was detected in 32 patients (15%). Younger age, heavier smoking, and less severity of herniation on primary MRI scanning (protrusion vs. sequestration) play as predisposing roles in creating rLDH, while gender, level or side of LDH, the presence of Modic changes, or body mass index (BMI) have no significant effect. The most common sites of rLDH were same level same side, different level, and same level contra-lateral side, respectively. Conclusion: In the patients who had been successfully treated by simple primary lumbar discectomy, younger age, heavier smoking state, and less protrusion of the herniated disc at the time of the index surgery, were all correlated with more probability of the future rLDH, while BMI, Modic change, sex, level, and side of LDH had no significant role.
  4,015 283 3
Introduction of an integrated interactive lecture in the early blocks of 1st year medical students: A pilot study
Anudeep Singh, Aung Ko Ko Min, Sarmishtha Ghosh
July-August 2016, 9(4):484-488
DOI:10.4103/0975-2870.186062  
Background: In an integrated curriculum, topics are integrated at the system block level from semester 2 onward. However, in the basic biomedical block, opportunities to integrate also exist which is often overlooked. Aim: A study was conducted to determine the possibility and acceptability of a new pedagogical approach to aid integration of form and function along with the improvement of understanding. Materials and Design: The study was prospective and questionnaire-based, conducted in an upcoming medical college in Malaysia with 1st year medical students. Materials and Methods: An integrated lecture on the autonomic nervous system was planned for the 1st year medical students in their biomedical science block of the first semester by the lecturers from anatomy and physiology and interactive lecture for 1 h and 30 min was delivered. After the session, responses were taken on a structured questionnaire with 10 questions on the Likert scale and a test was conducted to check their understandability. SPSS version 19.1 was used to analyze the results and data were reported based on descriptive statistics and scores were compared by t-test. Results: About 84.2% of the students wanted more lectures of this kind whereas 15.8% disagreed. About 80% stated that proper integration increased their understandability, whereas 83% preferred this modality in comparison to didactic lectures. Conclusions: This pedagogical approach with careful planning can be extended to involve clinical departments thus reaching vertical integration. Including more such integrated interactive sessions will prove to be significant and an effective tool for teaching and learning.
  3,924 242 -
CASE REPORT
Chlorpheniramine and phenylephrine induced coronary vasospasm manifesting as Kounis syndrome in a patient with moderate mitral stenosis
Altug Osken, Ercan Aydin, Ibrahim Kocayigit, Sibel Osken, Tugba Kemaloglu Oz, Regayip Zehir, Ramazan Akdemir, Huseyin Gunduz
July-August 2016, 9(4):507-509
DOI:10.4103/0975-2870.186053  
We report a case of Kounis syndrome (allergic angina) documented with normal coronary arteries on angiography and echocardiographically proved moderate mitral stenosis in a patient with severe chest pain and electrocardiographic ST-segment elevations but with normal troponin levels.
  3,809 219 -
ORIGINAL ARTICLES
Methicillin and mupirocin resistance in nasal colonizers coagulase-negative Staphylococcus among health care workers
Loveleena Agarwal, Amit Kumar Singh, Anjali Agarwal, Amitabh Agarwal
July-August 2016, 9(4):479-483
DOI:10.4103/0975-2870.186070  
Objective: Coagulase-negative Staphylococcus (CoNS) is a harmless commensal flora of human body but may cause infections related to medical device implant, blood stream infections, and infections of newborns. Health care workers (HCWs) colonizing methicillin-resistant CoNS (MRCoNS) may help in transmission of the microorganism and thus leads to the development of infection. The purpose of this study was to determine the prevalence of methicillin and mupirocin resistance in CoNS as nasal colonizer among HCWs and its antimicrobial susceptibility pattern. Materials and Methods: Nasal swabs collected from 210 HCWs of various categories such as doctor, nurse, nursing student, nursing orderlies, technician, and others working in the hospital were taken in equal representation. Methicillin resistance among the CoNS isolates was identified using cefoxitin 30 μg disc. Antimicrobial susceptibility profile of the isolates was also determined for several antibiotics. Mupirocin resistance was determined by epsilometer test using E-strip. Results: Of 210 nonduplicate nasal swabs collected from HCWs, 69 (32.8%) CoNS, and 16 (7.6%) MRCoNS isolates were obtained. A higher carrier rate of CoNS was found among nursing students (53%) with 50% MRCoNS as compared to other categories of HCWs. MRCoNS strains were significantly associated (P < 0.05) with resistance to most of the antibiotics with 100% resistance to penicillin and a higher resistance to rifampin (88%), clindamycin (69%), septran (63%), and erythromycin (56%). All CoNS isolates were uniformly susceptible to linezolid. Mupirocin resistance detected using E-strip showed 3 (1.4%) MRCoNS isolates had high-level resistance. Conclusion: MRCoNS showed a significant association of resistance to other antibiotics, thus methicillin and mupirocin resistance in CoNS must be detected in HCWs as a routine protocol of hospital infection control policy to limit nosocomial infections.
  3,271 324 4
CASE REPORTS
Elevated troponin levels and typical chest pain: Is always acute coronary syndrome?
Altug Osken, Tugba Kemaloglu Oz, Gokturk Ipek, Isil Atasoy, Sennur Unal Dayi, Regayip Zehir, Selcuk Yaylaci, Ercan Aydin, Salih Sahinkus
July-August 2016, 9(4):503-504
DOI:10.4103/0975-2870.186066  
Aortic dissection is a fatal disease that must be considered in the differential diagnosis of chest pain. If the diagnosis cannot be made in early period, mortality is very high. Here, we present a case of aortic dissection, clinically mimicking acute coronary syndrome.
  3,319 166 -
EDITORIAL
Diagnostic tests: Doctor's dilemma revisited
Amitav Banerjee
July-August 2016, 9(4):427-429
DOI:10.4103/0975-2870.186047  
  3,119 263 -
SHORT REVIEW
Moving ahead of prostate-specific antigen
Banyameen Mohamad Iqbal, Mushtaq Ahmed Peer
July-August 2016, 9(4):438-442
DOI:10.4103/0975-2870.186079  
Prostate gland is the second most leading site of cancer among males in Indian cities and it is the second most common site of cancer among US men. Prostate cancer (PCa) is the sixth leading cause of cancer death among men worldwide. The worldwide PCa burden is expected to grow to 1.7 million new cases and 499,000 new deaths by 2030. Prostate specific antigen (PSA) is a protein made by the prostate. Biochemically, it belongs to the protease family of kallikrein and is also known as human kallikrein 3. PSA test was originally approved by the Food and Drug Administration in 1986 to monitor the progression of PCa in men who had already been diagnosed with the disease. PSA test is a nonspecific test for PCa. It can be raised in a number of benign conditions of the prostate as well. The most frequent benign prostate conditions that cause an elevation in PSA level is prostatitis and benign prostatic hyperplasia. Moreover, PSA test may give false-positive or false-negative results. Scientists and researchers are experimenting new ways to improve the PSA test to give us the ability to distinguish cancerous from benign conditions. Some new methods/genetic studies such as PCa gene 3, TMPRSS2-ERG fusion gene, micro ribonucleic acid patterns, proteo-imaging, etc., are being developed to detect PCa in its earliest form. These new tests are much more sensitive and specific than the age old PSA test. It is only a matter of time when these new tests will be fully functional and will either augment or fully replace the age old PSA test.
  3,101 256 -
CASE REPORTS
Pulmonary sarcomatoid carcinoma: An uncommon entity in a 40 years female
Sayantan Saha, Somnath Bhattacharya, Atin Dey, Saurav Kar
July-August 2016, 9(4):537-540
DOI:10.4103/0975-2870.186067  
A middle-aged female presented with nonpleuritic chest pain with progressive dyspnea and unmeasured weight loss and anorexia for last 4 months. The patient had pallor, clubbing, but no peripheral lymphadenopathy. Clinically, vesicular breath sound was diminished over anterior, posterior, and lateral aspect of the right hemithorax with a dull note on percussion. Chest radiography showed homogenous opacity involving the right hemithorax with blunting of right costophrenic angle without contralateral shifting of the lower mediastinum. Contrast-enhanced computed tomography (CT) thorax revealed a large mixed density mass lesion occupying the entire right hemithorax with peripheral contrast enhancement. The lesion narrowed the right pulmonary artery and insinuated the adjacent mediastinum, but no evidence of pleural nodularity. CT guided fine-needle aspiration cytology from the mass was inconclusive. Tru-cut biopsy from the mass showed spindle-shaped cells, with nuclear pleomorphism and mitotic figures, arranged in interlacing fascicles. The histopathology was suggestive of spindle cell neoplasm. Immunohistochemistry (IHC) showed pancytokeratin (AE1/3), cytokeratin 7, vimentin, and epithelial membrane antigen positivity, whereas immunonegativity to thyroid transcription factor-1, WT-1, and calretinin. The radiological picture with IHC pattern favored the diagnosis of pulmonary sarcomatoid carcinoma.
  3,105 191 -
Pulmonary arteriovenous fistula mimicking as acyanotic heart disease with shunt reversal
Keshri Singh Yadav, Balvir Singh, Mridul Chaturvedi
July-August 2016, 9(4):541-543
DOI:10.4103/0975-2870.186077  
Pulmonary arteriovenous malformations (PAVMs) or pulmonary arterio venous (PAV) fistula are relatively rare pulmonary vascular disorders. Although most of the patients are asymptomatic, PAVMs can cause dyspnea, clubbing, and central cyanosis and is an important differential diagnosis of common cardiopulmonary problems, such as hypoxemia and congenital heart diseases with reversal of shunt. There is a strong association between PAVM and hereditary hemorrhagic telangiectasia. Chest radiography, contrast echocardiography, and contrast enhanced computed tomography are important initial diagnostic tools, but pulmonary angiography is the gold standard. Therapeutic options include angiographic coil embolization or balloon occlusion and surgical excision.
  3,080 196 1
An unusual case of invasive rhinocerebral aspergillosis in an immunocompetent woman
Nupur Pal, Kalidas Rit
July-August 2016, 9(4):518-521
DOI:10.4103/0975-2870.186075  
Invasive rhinocerebral aspergillosis is very rare and commonly seen in immunocompromised individuals with a high rate of morbidity and mortality. It is an opportunistic infection and has a spectrum of presenting features from allergic sinusitis to active invasive disease. Here, we describe a case of invasive rhinocerebral aspergillosis in an immnunocompetent middle-aged woman. She was treated with systemic antifungal medications, but she ultimately succumbed to death.
  3,068 194 -
Mental health perspectives of Hunter syndrome: Case reports of two biological siblings
Kabir Garg, Sujita Kumar Kar
July-August 2016, 9(4):534-536
DOI:10.4103/0975-2870.186068  
Hunter syndrome is a rare X-linked recessive disorder caused by deficiency of the lysosomal enzyme iduronate-2-sulphatase, leading to progressive accumulation of a substance called glycosaminoglycans in nearly all cell types, tissues, and organs. Hunter syndrome presents with facial dysmorphism, airway diseases, skeletal defects, cardiomyopathies, and neuropsychiatric manifestations. Mental subnormality is a cardinal feature in Hunter syndrome. This is a progressive cognitive decline that is not amenable to enzyme replacement therapy. Due to progressive cognitive decline, training the children to improve the adaptive functioning is a challenge that creates immense stress for the caregivers. Patients with Hunter syndrome should undergo serial assessment of intellectual ability and may be trained accordingly.
  3,062 175 -
ORIGINAL ARTICLES
Time of admission and outcome in traumatic brain injury patients
Amit Agrawal, Ashok Munivenkatappa, Neeti Rustagi, Pathapati Rammohan, Bhattara Vishweswar Subrahmanyam
July-August 2016, 9(4):465-468
DOI:10.4103/0975-2870.186064  
Introduction: In spite of heterogeneous manifestation of traumatic brain injury (TBI), it is affected by multiple factors at the time of admission. This pilot study aims to detect the effect of admission time, day, and month with outcome at discharge, among patients with TBI. Materials and Methods: It is a prospective study conducted in the Department of Neurosurgery at Narayana Medical Health Hospital, Nellore. The head injury patient data were documented on a standard proforma. FileMaker Pro Advanced 13 was used for electronic data entry interface. The analysis was done using Stats Direct version 3.0.150. The variables in categories and continuous were evaluated with descriptive and frequencies, respectively. Results: In the study, 337 head injury patients were reported with 7.12% (n = 24) mortality. The hospital discharge outcome was significant with age, gender, severity of injury, and seasons. More number of patients were admitted during 9 pm to 7 am, but was not significant. During all the seasons of a year, there was significance with admittance of head injury patients in working days of a week and patients' undergoing intracranial surgery. Conclusion: The pilot study reports that the outcome at discharge of a head injury patient has significance with admission at week, day, and season.
  2,976 186 2
COMMENTARY
Infection of the pancreas: Myriad of hues
Vishal Sharma
July-August 2016, 9(4):516-517
DOI:10.4103/0975-2870.186076  
  2,994 158 -
CASE REPORT
Acute severe pancreatitis in falciparum malaria
Mrinal Kanti Taye, Dilip Kumar Saloi, Bikash Choudhury
July-August 2016, 9(4):512-514
DOI:10.4103/0975-2870.186061  
Though different organs have been involved in falciparum malaria, pancreas has not been a common organ involved so far. Pancreatitis is a rare complication of Plasmodium falciparum malaria. The patient was admitted with low Glasgow Coma Scale and was febrile and in hypotension, and with oral bleeding. Preliminary investigations revealed leukocytosis, severe anemia, low platelet count, abnormal renal function test, deranged liver enzymes with conjugated hyperbilirubinemia, raised international normalized ratio, and hypoalbuminemia. Arterial blood gas showed metabolic acidosis. The raised pancreatic enzymes with radiological evidence of pancreatitis helped establish the diagnosis. Patient's condition improved with antimalarial, blood transfusion, circulatory support, and hemodialysis. The most possible mechanism of pancreatitis in malaria is microvascular occlusion with resultant ischemia, activation of pancreatic enzymes, and injury to pancreas due to autodigestion. Prognosis was good in our case of malarial pancreatitis.
  2,986 161 1
ORIGINAL ARTICLES
Study of role of prosthetic replacement for comminuted fracture of head of radius
Rahul R Bagul, Sanjay Deo, Anil Salgia, Mithu Sooknandan, Vivek Patole
July-August 2016, 9(4):474-478
DOI:10.4103/0975-2870.186071  
Objective: We had evaluated our experience in the treatment of Morrey Modified Masons type III and IV radial head fractures with radial head prosthesis. Materials and Methods: From April 2011 to September 2014, modular radial head prostheses were performed in thirty patients. There were twenty female and ten male with mean age of forty years. The follow-up was a mean of 25 months. Fractures of the radial head have been classified by Morrey Modified Masons classification. The indications for a radial head replacement were type III fractures in 24 cases, type IV fractures in 6 cases, and comminuted radial fracture associated with disruption of the medial collateral ligament in 3 cases. Patients were assessed postoperatively and on follow-up based on Mayo Elbow Performance Index (MEPI) Score. Results: By using the MEPI, out of thirty cases, twenty cases had excellent results, seven cases had good results, two cases had fair results, and one case had poor result. Twenty-eight cases had no complications, one case had infection, and one case had implant failure. Conclusion: Modular radial head prosthesis can be used successfully for treatment of the Morrey Modified Masons type III and IV radial head fractures.
  2,926 188 -
COMMENTARY
Drugs inducing Kounis syndrome: The more drugs, the easier, the quicker, and the more severe anaphylaxis
Nicholas G Kounis
July-August 2016, 9(4):510-511
DOI:10.4103/0975-2870.186063  
  2,893 178 -
LETTERS TO THE EDITOR
Cytomorphology of insular carcinoma thyroid: A diagnostic dilemma
Jayanti Mehta, Deepti Sukheeja
July-August 2016, 9(4):549-550
DOI:10.4103/0975-2870.186082  
  2,752 174 1
Eccrine spiradenoma
Sunil Yogiraj Swami, Panchal Shriniwas, Kachru T Dalve
July-August 2016, 9(4):546-547
DOI:10.4103/0975-2870.186052  
  2,642 163 -
COMMENTARY
Thyroid function tests: Possible forgotten error in testing
Viroj Wiwanitkit
July-August 2016, 9(4):436-437
DOI:10.4103/0975-2870.186059  
  2,549 249 -
Childhood blindness: A priority eye disease
Kavita R Bhatnagar
July-August 2016, 9(4):455-456
DOI:10.4103/0975-2870.186048  
  2,425 212 1
Clinical importance of pulmonary arteriovenous malformations
Hasan Ekim, Meral Ekim
July-August 2016, 9(4):543-545
DOI:10.4103/0975-2870.186080  
  2,349 186 -
LETTERS TO THE EDITOR
Comments on “dear editor: why did you reject my paper?”
Vadisha Srinivas Bhat
July-August 2016, 9(4):551-552
DOI:10.4103/0975-2870.186081  
  1,966 192 -
Obesity in school children
Manas Pratim Roy
July-August 2016, 9(4):552-553
DOI:10.4103/0975-2870.186051  
  1,910 192 -
Coexistent perimembranous ventricular septal defect, subaortic membrane, and moderate rheumatic aortic ınsufficiency in a middle-aged woman
Ercan Aydin, Altug Osken, Ibrahim Kocayigit, Selcuk Yaylaci, Salih Sahinkus, Yusuf Can, Tugba Kemaloglu Oz, Huseyin Gunduz
July-August 2016, 9(4):548-549
DOI:10.4103/0975-2870.186050  
  1,913 143 -
COMMENTARY
Malarial pancreatitis
Viroj Wiwanitkit
July-August 2016, 9(4):515-515
DOI:10.4103/0975-2870.186074  
  1,881 124 -