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EDITORIAL |
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The Indian health paradox: Lessons from Bangladesh |
p. 411 |
Amitav Banerjee DOI:10.4103/0975-2870.135250 |
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COMMENTARY |
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The Indian health paradox: Lessons from Bangladesh |
p. 413 |
Carol Vlassoff |
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REVIEW ARTICLE |
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Chronic fatigue syndrome: A review |
p. 415 |
Srinivas Balachander, Pradyumna Rao, Siddharth Sarkar, Shubh Mohan Singh DOI:10.4103/0975-2870.135252 Chronic fatigue syndrome is a disorder that is characterized by severe and debilitating fatigue of at least 6 months duration not explained on the basis of medical and psychiatric illnesses and has other associated characteristics. The disorder has a resemblance to many other disorders described in the past including myalgic encephalitis and post-infective fatigue; however, the term itself and the criteria for diagnosing this disorder were first laid out in 1988. The disorder has received attention from a wide range of clinicians and researchers. The mechanism of causation of this disorder has been poorly understood, though biological, psychological and social factors seem to play a role. The disorder causes significant impairment and is highly comorbid with other disorders. Non-pharmacological measures like graded exercise therapy and cognitive behavior therapy seem to work better for treatment than pharmacological measures. This narrative review takes an overview of chronic fatigue syndrome from a generalist standpoint and looks into the clinical features, etiopathogenesis and management of this disorder. |
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COMMENTARY |
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Cognitive impairments in chronic fatigue syndrome |
p. 422 |
Suprakash Chaudhury |
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ORIGINAL ARTICLES |
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Study of intimate partner violence against women in an urban locality of Pune |
p. 425 |
Kevin Fernandez, Dhrubajyoti J Debnath DOI:10.4103/0975-2870.135254 Context: Intimate partner violence against women has an adverse effect on the health of women. Aims: To estimate the proportion of physical, emotional, economical and sexual violence against women by the husband (intimate partner) and to identify factors that may put women at risk of violence by their husbands. Setting and Design: Cross-sectional study. Materials and Methods: A convenience consecutive sample of 369 married women (18-49 years age) attending the Out Patient Department (OPD) of the Urban Health Training Centre (UHTC) of a Medical College in Pune was interviewed using a pretested semi-structured questionnaire after obtaining informed consent. Statistical Analysis Used: Chi square test and Odds ratio (OR) with 95% confidence intervals (CI) were used to identify the risk factors. Results: Almost half of the study sample had experienced some form of violence. The associated factors with intimate partner violence were drinking alcohol by husband (OR = 4.54, 95% CI = 2.52, 8.18, P < 0.001), aggressive nature of husband (OR = 11.81, 95% CI = 3.53, 39.47, P < 0.001) and family history of domestic violence (OR = 11.0, 95% CI = 3.83, 31.63, P < 0.001). Conclusion: Intimate partner violence was high in our study. Risk factors for domestic violence were alcohol use by husband, aggressive nature of husband and family history of domestic violence. |
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Maternal hydration and L-arginine supplementation improves liquor volume in patients with decreased liquor and prolongs pregnancy |
p. 429 |
Shripad Hebbar, Lavanya Rai, Prashant Adiga DOI:10.4103/0975-2870.135255 Background: Oligohydramnios (reduced amniotic fluid) may be responsible for the problems of malpresentations, umbilical cord compression, meconium staining of amniotic fluid in the liquor, and difficult or failed external cephalic version. Simple intervention maternal hydration has been reported as a way of increasing amniotic fluid volume in order to reduce some of these problems. Objective: To assess the influence of maternal hydration and l-arginine supplementation in improving liquor volume in patients with decreased liquor. Study Design: Prospective nonrandomized interventional study. Materials and Methods: 50 patients remote from term, with decreased liquor [amniotic fluid index (AFI) < 8] were enrolled in the study. Before the proposed intervention, the antenatal risk factors were studied. Patients with hypertensive disorders of pregnancy were administered l-arginine (one sachet 3 g, two times daily) and others received both arginine and intravenous hydration (500 ml of fructodex which contains 5% dextrose and 5% fructose, and lactated Ringer's solution daily). The treatment was continued till the liquor improved significantly. However, patients were considered for delivery if the liquor remained less than 5. Mean increase in liquor, intervention delivery interval, and neonatal outcome were studied. Results: The mean gestational age at the time of recruitment was 33.4 1.9 weeks. The mean AFI at the time of enrolment was 6.9 (SD 0.8). These patients were delivered at 36.3 1.3 weeks, and thus, pregnancy could be prolonged by 2.9 weeks. The mean AFI at the end of therapeutic intervention was 9.3 (SD 1.7), and thus, an AFI increase of 2.4 could be obtained. There was no significant neonatal morbidity in these patients. Significant improvement in liquor volume was obtained in these patients after intervention with either or both l-arginine and fructodex infusion (P < 0.0001). The pregnancy could be prolonged from 33.4 weeks to 36.3 weeks. Conclusion: Treatment with l-arginine and fructodex resulted in significant improvement in liquor and prolongation of duration of pregnancy by around 3 weeks, which enabled us to administer steroids for lung maturation (in indicated cases). Thus, treatment with l-arginine and fructodex seems to be promising in improving fetal outcome in pregnancies complicated by decreased liquor. |
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Study of the role of mobile phones in the transmission of Hospital acquired infections |
p. 435 |
Kalpana M Angadi, Rabindranath Misra, Urvashi Gupta, Savita Jadhav, Moumita Sardar DOI:10.4103/0975-2870.135256 Nosocomial infections are an important cause of morbidity and mortality. The inanimate objects like mobile phones in the immediate environment of the patients can act as a source of infection. Infectious agents from patients can be transferred on to the hands of the health care workers and in the absence of adequate hand hygiene practices can be transferred on to the mobile phones during their use and this can serve as a vehicle for the transmission of nosocomial pathogens from one patient to another. Aim: To evaluate the role of mobile phones in the transmission of pathogens by health care workers in health care centres. Materials and Methods: Mobile phones and hands were tested for micro-organisms before and after application of a disinfectant. A total of 60 mobile phones were tested for micro organisms, 30 from the health care workers (study group) and 30 from relatives of patients attending Out Patient Department (control group). Swabs taken from their hands were also cultured. Results: Hands of all the health care workers and 27 mobile phones showed microorganisms on them. Only Staphylococcus aureus was isolated. The hands and mobile phones of 11 health care workers were contaminated with Methicillin sensitive Staphylococcus aureus (MSSA). Methicillin resistant Staphylococcus aureus (MRSA) was isolated from the hands of 24 (80%) and mobile phones of 16 (53.3%) health care workers. Ethyl alcohol was found to be 100% effective in disinfecting hands and mobile phones. Conclusions: To prevent the potential spread of infections through mobile phones, strict infection control practices, hand hygiene, and routine decontamination of mobile phones with alcohol should be advocated to prevent the spread of infection in the hospital settings. |
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Comparison of antibiotic susceptibility pattern of community- and hospital-acquired methicillin-resistant Staphylococcus aureus with special reference to inducible clindamycin resistance in a tertiary care hospital in southern India |
p. 439 |
Tandra Chadha, Syeda Nazia Kulsum, Shashikant Adlekha, Prabhakar C Mailapur DOI:10.4103/0975-2870.135257 Background: Methicillin-resistant Staphylococcus aureus (MRSA) is a major cause of nosocomial and community infections. Its prevalence varies markedly across different countries and among hospitals of the same country. Aims and Objectives: To estimate the prevalence of MRSA strains and investigate their antibiogram with special reference to inducible clindamycin resistance. Materials and Methods: All S. aureus isolates obtained from the clinical samples of microbiology laboratory were included in the study. All the isolates were identified by standard methods, and antimicrobial susceptibility testing was performed by Kirby Bauer disk diffusion method. Methicillin resistance was detected by combined cefoxitin and oxacillin disk diffusion method. Results were interpreted as per the Clinical and Laboratory Standards Institute (CLSI) guidelines. Results: A total of 362 S. aureus strains were isolated, of which 36.1% (131/362) isolates were MRSA. Of these, 79.4% (104/131) were hospital-acquired MRSA (HA-MRSA) and 20.6% (27/131) were community-acquired MRSA (CA-MRSA). All the isolates were sensitive to vancomycin. Inducible clindamycin [macrolide-lincosamide-streptogramin B (iMLS B )] resistance (D test) among MRSA isolates was 12.3% (16/131). HA-MRSA isolates showed 12.5% (13/104) D test positivity, as compared to 11.2% (3/27) seen in CA-MRSA isolates. Conclusion: The reported rate of MRSA incidence is alarming. Regular surveillance of hospital-acquired infections, isolation nursing of patients who carry MRSA, monitoring of antimicrobial susceptibility pattern, and formulation of a definite antibiotic policy may be helpful. |
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Comparative study of muscle strengthening exercises for treatment of chronic low backache |
p. 443 |
Soumya Ghosh, Soma Datta, Suravi Nayak, Arunima Chaudhuri, Pitchai Dhanasekaran DOI:10.4103/0975-2870.135258 Background: Low back pain is a major cause of musculoskeletal disability worldwide. Objectives: To study the outcomes of different muscle strengthening exercises in treatment of low back pain Materials and Methods: One hundred and twenty patients in the age group of 20-40 years with mechanical low back pain were randomly divided intotwo groups and instructed to perform two different types of exercises for three months (Mckenzie exercise andSwiss ball exercise). Patients were assessed by Visual Analogue Scale (VAS), Modified Schober Test (MST) for extension and Oswestry Disability Index (ODI), based on pain intensity levels, range of motion, functional disability before starting the exercise programmes and after 3 months of intervention. Results were analysed using Students T Test. Results: There was no significant difference in the pre-treatment session between the two groups. VAS and ODI Values were significantly lower in post-treatment sessions as compared to pre-treatment values in both Groups but MST Values in post-treatment sessions in Group practicing Mckenzie exercise showed significant decreases. Significant decrease in VAS, MST and ODI Valueswere found in subjects practising McKenzie exercise when comparison was done between the two groups after 3 months of treatment. Conclusion: McKenzie exercise and Swissball exercise in patients with mechanical Low back pain reduce pain intensity, increaserange of movementand decrease functional disability. McKenzie exercise seems to have higher efficacy as compared to Swissball exercise. |
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Effect of benzodiazepines on thyroglobulin, anti-thyroglobulin, anti-thyroid peroxidase, and thyroid stimulating hormone in rat |
p. 447 |
Mohammad-Hasan Khadem-Ansari, Ali Ahani, Peyman Mikaeili, Yousef Rasmi DOI:10.4103/0975-2870.135259 Background: Benzodiazepines are widely used as psychoactive agents and the side effects of benzodiazepines to the endocrine system are reported. Objective: This study was designed to explore the effects of the benzodiazepines - lorazepam and clonazepam - on thyroglobulin (Tg), anti-thyroglobulin (aTg), anti-thyroid peroxidase (aTPO), and thyroid stimulating hormone (TSH). Materials and Methods: Eighteen male Wistar rats were randomly divided into three groups: control (C), lorazepam-treated, and clonazepam-treated groups. The changes in Tg, aTg, aTPO, and TSH in these three groups were compared after 4 weeks. Results: The levels of Tg and aTg in the lorazepam-treated and clonazepam-treated rats significantly increased compared to the control group. But there was no significant difference in the levels of TSH and aTPO between lorazepam-treated and clonazepam-treated rats in comparison with the control group rats. Conclusion: The thyroid gland is affected by lorazepam and clonazepam, which are used in epilepsy, bruxism, anxiety, insomnia, and other psychic disorders. |
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Knowledge and practices concerning malaria in rural community of Pune district |
p. 450 |
Ganesh Madne, Ashok K Jindal, Barun B Patel, Rekha Sharma, Ravi Kant DOI:10.4103/0975-2870.135261 Background: India is in the malaria pre-elimination stage. It is particularly entrenched in low-income rural areas of eastern and northeastern states, but important foci are also present in the central and more arid western parts of the country. In this situation community-based strategies are important for malaria control. In order to intensify elimination activities we need to have a better awareness of malaria in these rural communities. Objective: To assess Knowledge and Practices (KAP) about malaria in a rural community of Pune District. Materials and Methods: A community-based cross-sectional study was conducted during January 2012 to April 2012 at the field practice area of a Medical College near Pune. All 246 households in the village were visited and the head of the household or other responsible adults were interviewed using a structured and pretested questionnaire. Results: Majority of the participants were aware about malaria symptoms 150 (60.9%) and transmission 206 (83.7%). A total of 202 (82.1%) subjects were aware that mosquitoes bites during dusk and night while only 78 (31.7%) participants had knowledge that malaria can be fatal. A total of 209 (85%) of people had opinion that malaria suspect should visit hospital for confirmation through blood testing while 179 (72.8) participants believed that malaria can be treated by drugs. 93.7% of participants were using one or other anti-adult mosquito measures whereas only 7.3% participants were employing engineering methods to prevent water stagnation. Conclusion: The knowledge, attitudes and practices of respondents in this survey about malaria were fairly good. It might be because of continuous IEC activities as RHTC being in the village. Still, there is scope for public health engineering; therefore further emphasis should be given to environmental modification and manipulation. |
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Investıgatıon of malignancy in diabetic patients with anemia |
p. 454 |
Selcuk Yaylaci, Ahmet Bilal Genc, Mustafa Volkan Demir, Hakan Cinemre, Mustafa Ýhsan Uslan, Ali Tamer DOI:10.4103/0975-2870.135264 Introduction: The etiology of anemia is multifactorial in diabetes and covers inflammation, diabetes, nutritional deficiencies, autoimmune diseases, medications and hormonal changes, in addition to the kidney diseases or may be malignancy. In this study, it was aimed to study the profile of the malignancy in patients with type 2 diabetes mellitus (DM) and anemia. Materials and Methods: The files of the follow-up patients with type 2 diabetes were retrospectively reviewed and 103 patients with type 2 DM and anemia were included in the study. The demographic, hematological and biochemical analysis of the data was performed in the diabetic patients with anemia. The frequency of malignancy in diabetic patients with anemia, the etiology of malignancy, the relationship between the presence of malignancy and anemia type and depth, biochemical parameters in the determination of malignancy, the effects of endoscopic and imaging methods, the presence of anemia in patients without malignancy and the effect of in-depth glomerular filtration rate were investigated. Results: The iron deficiency anemia (69.9%) was the most common. Malignancy was found in 11 of the 103 patients (10.7%). 2 patients (1.9%) had stomach cancer, 4 patients (6.3%) had colon cancer in endoscopic procedures. In computerized tomography images, 5 patients were found to be malignant in addition to the stomach and colon cancer. The erythrocyte sedimentation rate was significantly higher in the group with malignancy. No correlation was found between malignancy and anemia type and depth. Conclusion: Screening for malignancy should be considered in diabetic patients with anemia, especially in patients with elevated erythrocyte sedimentation rate, regardless of the type and depth of the anemia. In addition, tomography should be recommended for malignancy screening in diabetic patients with anemia that have a normal gastrointestinal examination. |
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Role of microwaves in rapid processing of tissue for histopathology |
p. 458 |
Harsh Kumar, Punita Kalkal, Archana Buch, Shirish S Chandanwale, Sunita Bamanikar, Atul Jain DOI:10.4103/0975-2870.135267 Aim: The primary aim of the following study is to study the utility of microwave stimulated rapid processing of tissues for histopathology and the secondary aim is to compare the quality of the final product obtained after microwave stimulated rapid tissue processing with the conventional method. Materials and Methods: During the 3 years period of study, 150 cases were studied which were randomly selected from the tissues sent for histopathology. Tissues were processed by conventional method and by microwave assisted tissue processing. Results: Slides obtained by microwave and conventional tissue processing were statistically analyzed by using Chi-square test. The results obtained showed that the cellular and nuclear features of microwave processed tissues were comparable to conventionally processed tissue. Microwave assisted tissue processing reduced the total time for preparing tissue blocks to about an hour. Conclusion: Microwave stimulated processing provides an attractive alternative over traditional conventional processing. |
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Evaluation of gastric biopsies in chronic gastritis: Grading of inflammation by Visual Analogue Scale |
p. 463 |
Sonam Pruthi, Murali Nirupama, Shrijeet Chakraborti DOI:10.4103/0975-2870.135268 Introduction: Gastritis is a common condition with many etiologies and the classification of the same poses a great challenge to the pathologist. Aim: This study was undertaken to classify gastritis according to the Sydney system guidelines including graded and non-graded variables and simultaneously find association of Helicobacter pylori (H. pylori) with each of these variables. Materials and Methods: A total of 100 biopsies of chronic superficial gastritis received over a period of two years were studied, prospectively. Histology was evaluated with Hematoxylin and eosin, and Giemsa stains, and Gomori's staining method for demonstration of reticulin fibres. Rapid Urease test results obtained from gastroenterology department were compared with histopathology. Chi-square test was used to analyze the correlation between the various variables. Results: Gastritis cases showed a male preponderance and the most common presenting complaint was dyspepsia. H. pylori gastritis usually shows increased neutrophilic activity but can also present with increased mononuclear inflammatory infiltrate and lymphoid follicles in chronic gastritis. Intestinal metaplasia and atrophy indicates the chronicity of the disease. H. pylori were noted in the areas away from the metaplastic gastric epithelium. Conclusion: The study showed that histopathology is the most sensitive test for diagnosing H. pylori on endoscopic biopsies. Though, rapid urease test kit gives gastroenterologist a rapid diagnosis, its specificity is low, and hence should be combined with histopathology, which is the gold standard for diagnosis. |
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Perceived responsibilities and operational difficulties of anganwadi workers at a coastal south Indian city |
p. 468 |
Monica Tripathy, Sowmini P Kamath, B Shantharam Baliga, Animesh Jain DOI:10.4103/0975-2870.135270 Context: Anganwadi worker (AWW) is an important functionary in integrated child development scheme (ICDS). Aim: To study perceived responsibilities, workload, operational difficulties, and satisfaction level of AWWs. Materials and Methods: Prospective observational cross-sectional study of 66 AWWs using a pre-designed proforma: Analysis using Statistical package for social sciences (SPSS) version 11.5. Results: Pre-school education, house visits, records-keeping were perceived as important activities by 92.4%, 60.6%, and 57.6%, respectively, growth monitoring and immunization by 3% and 4.5%, respectively; 51.5% did not have adequate time for duties, and 74.2% were doing non-ICDS duties. Heavy workload was the major perceived operational difficulty for 66.7% of the respondents. Timely supplementary food was available as per 92.4%. Inadequacies in equipments, workspace, training, and staffing were noted by 47%, 18.2%, 7.6%, 7.6%, respectively. No operational difficulties were seen by 10.6%. Induction job training was provided to 36 (54.5%), and 17/66 (25.8%) felt they were inadequately trained despite yearly refresher courses. Dissatisfaction with monthly honorarium, availability of equipment, supplementary food, and maintenance of registries was reported by 89.4%, 53%, 54.6%, and 43.9%, respectively. Despite this, 62.1% (40/66) were satisfied. Conclusions: Supplementary nutrition, growth monitoring, and immunization of children along with health education though being primary duties were given less emphasis. Heavy workload was the major perceived operational difficulty. Adequate staff, workspace, equipments, timely monthly honorarium should be provided along with training and avoidance of non-ICDS duties would help in achieving the objectives of ICDS. |
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Restructuring the syllabus for MD Pharmacology: Retrospection of bioassay |
p. 473 |
Sarita Mulkalwar, Bhalchandra Rane, Lopamudra Behera DOI:10.4103/0975-2870.135272 Introduction: Career prospects in Pharmacology are witnessing a sea change due to fast and unanticipated development in the field of clinical research. Numerous openings exist now in academia, pharmaceutical industry, Clinical Research Organizations (CRO) or as regulatory consultants, experimental pharmacologists, etc. In short, there are various options to choose from, depending on one's interest. It's high time we ponder now over the training programme for post-graduate students in Pharmacology. It needs to be revised keeping in mind the job prospects & uniqueness of the MD Pharmacology degree. Aim: To take suggestions of experienced pharmacologists on the present syllabus for MD Pharmacology and their opinion on continuation of Bioassay experiment which is currently an important part of it . Materials and Methods: A structured questionnaire was given to 30 experienced pharmacologists to seek their opinion on MD Pharmacology syllabus & continuation of Bioassay as a part of MD practical. Results: Out of 30 participants, 29 (96.6%) did not use their knowledge of Bioassay during their 10 years of post MD career, whether in pharmaceutical industry or in academics. Only 5 of them (16.6%) feel that experiment on bioassay should be continued in the current state. 76.7% of them wish it to be modified to a Dose Response Curve ( DRC) . 6.71% feel that it should be totally scrapped. All the participants feel the need of revising current MD Pharmacology syllabus. Current syllabus is inclined more towards preparing good academicians but it lacks the proper training for creating good clinical research professionals. Medical writing, writing necessary documents for clinical trials including regulatory documents, writing an article for medical journals, marketing communication, product monograph and patient information of a clinical trial could be incorporated. They should be aware of the regulatory requirements for conducting studies on investigational drugs & established drugs as well. Conclusion: Looking at the growing market of clinical research & India being favoured destination for the same, the demand of MD Pharmacologists by pharmaceutical industry is on rising trend. So the revision of the syllabus of MD Pharmacology should be the top priority of experienced Pharmacologists, so as to meet this demand. |
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COMMENTARY |
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Invited commentary: Restructuring post graduate syllabus in pharmacology |
p. 476 |
Anupama Sukhlecha |
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CASE REPORT |
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Domestic violence as an unfortunate cause of splenic injury, fetal demise, and maternal morbidity |
p. 478 |
Shuchi M Jain, Nilajkumar D Bagde, Swarnalata Samal DOI:10.4103/0975-2870.135274 Abuse of pregnant women is a serious health problem with the potential to cause life-threatening injuries to the mother and her baby. This is a case of domestic violence leading to splenic injury and massive intraperitoneal hemorrhage leading to fetal demise. Fortunately, timely interventions saved the mother's life. |
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COMMENTARY |
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Intimate partner violence in pregnancy |
p. 480 |
Meenal Patvekar |
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CASE REPORTS |
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Rapid onset pulmonary fibrosis due to paraquat poisoning |
p. 482 |
Jagannath Dhadwad, Govind S Shiddapur, Kapil Borawake, Harshad Patil DOI:10.4103/0975-2870.135277 Grammaxone (paraquat) is trade name for N,N'-dimethyl-4,4′bipyridinium dichloride. It is most widely used as herbicide. It came into disrepute because of accidental or intentional ingestion leading to a high mortality. Paraquat is commonly preferred for suicide by farmers because of easy availability, low cost, low toxic dose. Here we are reporting a case of paraquat poisoning with pulmonary fibrosis developing over 2 weeks. |
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Rhino-oculo-cerebral aspergillus and mucor co-infections in an immunocompromised patient with type 2 diabetes mellitus |
p. 486 |
Kalidas Rit, Rajdeep Saha, Rupali Dey, Gautam Barik DOI:10.4103/0975-2870.135278 Mucormycosis are pathogenic moulds of the mucorales species usually occurring in immunocompromised patients or in patients with uncontrolled diabetes mellitus. Aspergillosis is the clinical condition caused by Aspergillus species and may cause an invasive disease with high case fatality rate, especially in immunosuppressed patients. A 46-year-old male patient with Type 2 diabetes mellitus with underlying malignancy presented with proptosis of left eye. Combined infections of Mucor and Aspergillus were diagnosed by means of computed tomography (CT) scan and biopsy. Treatment with Amphotericin B and Voriconazole was started, the patient died within 3 months, from multi-organ failure. |
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Gossypiboma in the urinary bladder: Time to make new surgical guidelines |
p. 489 |
Nitin Joshi, Rajay Kumar, Vishal Yadav DOI:10.4103/0975-2870.135280 The actual incidence of gossypiboma is difficult to determine possibly due to reluctance to report occurrence arising from fear of legal repercussion, but retained surgical sponge is reported to occur one in every 3000-5000 abdominal operations and is most frequently discovered in abdomen. Here, we report a case of 69-year-old male patient who suffered from severe irritative voiding symptoms with abdominal wall fistula at the incision site due to accidently left surgical sponge in bladder following suprapubic cystolithotomy surgery for bladder stone at some other hospital. |
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Bilateral dermoid cyst of ovary |
p. 492 |
Shastry Srikanth, Gadda Anandam DOI:10.4103/0975-2870.135281 A dermoid cyst (also called as "mature teratoma") is a sac-like growth that may be present at birth. It contains structures such as hair, fluid, teeth or skin glands that can be found on or in the skin. In some cases, especially when in the ovary, it also contains thyroid or brain tissue. Ovarian dermoid cysts, which not uncommonly are found in both ovaries, can develop in a woman during her reproductive years. The word "teratoma" is derived from Greek work "teraton" meaning monster. It was initially used by Virchow in 1863. The term "dermoid cyst" was coined by Leblanc in 1831. |
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Distal renal tubular acidosis and quadriparaesis in Sjögren's syndrome: A cunning congregate |
p. 494 |
Arundhati G Diwan, Sachin A Adukia, Shounak V Annachhatre, Yuraj Singh Chowdhury DOI:10.4103/0975-2870.135282 Sjögren's syndrome (SS) is a chronic autoimmune disease, chiefly affecting the exocrine glandular function of salivary glands and lacrimal glands. Rarely, it involves the kidneys, central and peripheral nervous system, muscloskeletal apparatus and lungs. We report a rare constellation of SS with distal renal tubular acidosis and quadriparaesis in a young female. History of quadriparaesis was acute, with rapid progression. Supplementary treatment for severe hypokalemia was instituted at the earliest, lest the patient develop respiratory muscle weakness. Concomitantly, metabolic acidosis with alkaline urine was suspected and subsequently investigated. Eventually, this was attributed to impaired renal acidification of urine in the distal tubules. History of dryness of eyes and mouth since 6 months justified salivary gland biopsy. The results yielded a lymphocytic infiltrative pathology strongly favoring SS. The patient benefited from prompt potassium replacement therapy and had complete resolution over the next week. Supportive treatment for predictable manifestations was continued along with potassium supplements. |
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Spectrum of CT and MR findings in Sturge-Weber syndrome: A case report |
p. 497 |
Pallavi J Agrawal, Amit T Kharat, Rajesh Kuber, Sunita Shewale DOI:10.4103/0975-2870.135284 Sturge-Weber syndrome is an uncommon, sporadically occurring neurocutaneous syndrome characterized by port wine stain (facial nevus flammeus), congenital glaucoma, and anomalous leptomeningeal angiomatous malformation. Port wine stain is usually the first component of the syndrome. Seizures of the side contralateral to the port wine stain occur early in infancy and worsen with age. Radiological investigations, like computed tomography and magnetic resonance imaging are most useful, playing a pivotal role in demonstrating the cerebral changes. We report the case of a 10-month-old infant presenting with port wine stain over face, trunk, and extremities, hemiparesis of the left side of the body, and new onset of seizure. This case highlights the various neurological manifestations of Sturge-Weber syndrome and how imaging helps to characterize each. |
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Solitary eyelid schwannoma |
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Renu M Magdum, Radhika Paranjpe, Megha Kotecha, Pallavi Patil DOI:10.4103/0975-2870.135286 Schwannomas are rare benign tumors arising from Schwann cells of peripheral nerves that form the neural sheath. While there have been reports of such tumors in the orbit, solitary schwannomas arising from the eyelids are very rare. There are reports of schwannomas being erroneously diagnosed as chalazion, inclusion cysts or even eyelid malignancy. We are reporting a case of a 20-year-old female who presented with a painless, non-tender, slow-growing mass in the upper eyelid of the right eye. The external appearance of the mass was suggestive of an implantation cyst of the eyelid and it could be completely excised as it had a well-defined capsule. Histopathological examination showed characteristic hypercellular and hypocellular areas with fusiform nuclei that tended to form palisades. The purpose of reporting this case of schwannoma in a young female is to recommend the inclusion of this entity as a differential diagnosis of well-defined lid tumors. |
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Septo-optic dysplasia with pachygyria |
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Abhay A Lune, Sonali A Lune DOI:10.4103/0975-2870.135288 Optic nerve hypoplasia can be associated with other central nervous system malformations. When associated with the absence of the septum pellucidum or thinning of corpus callosum and pituitary hypoplasia, it is termed septo-optic dysplasia. Pachygyria is a rare congenital disorder characterized by a defect in migration of cerebral neurons resulting in failure of cortical gyri to develop.We report a case of a young learning-disabled male presenting with decreased vision, nystagmus, esotropia,, and seizures since childhood. Fundoscopy revealed bilateral optic nerve hypoplasia. Growth hormone levels were reduced. Magnetic resonance imaging revealed thinned optic nerves, optic chiasma and pituitary infundibulum, absent septum pellucidum, box-shaped ventricles and right frontal cortical thickening with few and broad gyri.This case report highlights a rare case of septo-optic dysplasia with pachygyria. It also emphasizes that every patient with optic nerve hypoplasia should have an endocrinal and neurological evaluation and neuro-radiographic imaging for associated abnormalities. |
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Calcifying odontogenic cyst of anterior maxilla with complex odontoma |
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Yadavalli Guruprasad, Dinesh Singh Chauhan, Vinod Kumar, Prahalad Hunsagi DOI:10.4103/0975-2870.135290 Calcifying odontogenic cyst (COC) is an unusual and unique lesion with characteristics of a solid neoplasm and of a cyst. It shows considerable amount of histopathological diversity, with variable clinical behavior such as cystic, neoplastic and infiltrating malignant behavior. It is a rare developmental odontogenic cyst with notable presence of histopathological features, which include a cystic lining demonstrating characteristic "Ghost" epithelial cells with a propensity to calcify. Odontomes are best known as hamartomatous benign tumors rather than true neoplasms, arising from odontogenic tissues. Histologically, they are classified as compound and complex variety. We report a rare case of COC of anterior maxilla with complex odontome in a 12-year-old female child. |
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Aplasia cutis congenita with two completely different presentations |
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Sanchaita Bala, Sumit Sen, Atul Jain, Amlan K Biswas DOI:10.4103/0975-2870.135294 Aplasia cutis congenita is a rare disorder, which presents with congenital absence of skin. Besides isolated presentation, it may manifest with other developmental malformation of cardiovascular, gastrointestinal, genitourinary and central nervous systems, and malformation syndromes such as chromosomal abnormalities, Adams-Oliver syndrome, Bart's syndrome, and Johanson-Bilzzard syndrome. Here, we present two cases of aplasia cutis congenita, which represent two different types of the disease. The first case presented as non-syndromic aplasia cutis congenita of scalp, and the other case presented as a part of Bart's syndrome. |
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Nodular mesenteric panniculitis of rectum simulating malignancy |
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Anjali Amarapurkar, Manish Patil, Vinaya Shah, Aniruddha Chaphekar DOI:10.4103/0975-2870.135295 Mesenteric panniculitis is a benign fibroinflammatory process involving adipose tissue of the mesentery. We report a case of a 62 year old male who showed signs of partial bowel obstruction and whose computed tomography of abdomen showed nodular soft tissue densities around the sigmoid junction. Distal colectomy was planned and laparotomy was performed. Anal skin, rectum and sigmoid colon was resected. Microscopic pathologic sections from the serosal nodule showed histo morphologic features of panniculitis while overlying mucosa showed tumor consisting of mucin secreting adenocarcinoma. |
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Intraventricular cysticercal cyst |
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Amit Agrawal, G Malleswara Rao DOI:10.4103/0975-2870.135297 Due to the risk of acute obstructive hydrocephalus and mortality, intraventricular cysticercosis has been considered as a potentially life-threatening emergency that needs an early diagnosis and urgent intervention. In the present article, we discuss the imaging findings in a case of intraventricular cysticercal cyst. Surgical removal of ventricular cysts and establishment of the normal cerebrospinal fluid (CSF) pathway is the mainstay of treatment, which can be best achieved by neuroendoscopy. |
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The giant paratesticular tumor in elderly |
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Parag S Bhirud, Sharad Kankalia DOI:10.4103/0975-2870.135298 Paratesticular tumor is an extremely rare. We present a case of paratesticular tumor in an elderly person of 84-year-old, which was presented as very large localized intrascrotal mass. This required subsequently orchidectomy. Histopathology confirmed the diagnosis as serous cystadenoma. Such a giant paratesticular mass, which was localized, has not been described previously. |
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Unusual presentation of psoas abscess as an abdominal lump |
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Vishal Yadav, Joseph Sengol, Vikas Yadav, Puneet Bansal DOI:10.4103/0975-2870.135299 Psoas abscess is a collection of pus in the iliopsoas compartment that has traditionally been classified as primary or secondary according to its origin. Psoas abscess is an uncommon clinical entity that can be primary following hematogenous dissemination of an etiologic agent, the source of which is usually occult or secondary as a result of local extension of an infectious process near the psoas muscle. We report a case of primary pyogenic psoas abscess caused by β-hemolytic streptococci presenting as a lump in the abdomen and subsequently varying treatment regimens. We present the details of this case as well as a literature review to compare various presentations, etiologies and potential treatment modalities. |
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Erythema ab igne (Unilateral) due to "Chulla" |
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Sumit Kar, Ajay Krishanan, Krishanan Preetha, Atul Mohankar, Neha Singh DOI:10.4103/0975-2870.135300 Erythema ab igne (EAI) is characterized by localized areas of reticulated erythema and hyperpigmentation due to chronic and repeated exposure to infrared radiation. Taking a good history plays an important role in coming to the diagnosis of the disease condition; and at the same time, the particular cultural practices of a place determine its occurrence in the local masses. Herein we report the case of a young lady in her early thirties who presented to us with a dusky hyperpigmentation over her right arm and leg. Her detailed history and cutaneous examination led to the diagnosis of erythema ab igne. |
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LETTERS TO THE EDITOR |
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Universal health coverage: Need or necessity in India |
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Saurabh Pramod Kakade, Khushboo Thakkar DOI:10.4103/0975-2870.135301 |
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The physician and the patient: Biting the bytes |
p. 531 |
PK Satpathy, PM Diggikar, Anunay Agarwal, Gaurav Bachav DOI:10.4103/0975-2870.135303 |
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Comments on "Primary nasal tuberculosis following blunt trauma nose" |
p. 533 |
Vadisha Bhat DOI:10.4103/0975-2870.135302 |
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Authors' Response |
p. 534 |
Kaushik Saha, Mrinmoy Mitra, Arnab Saha, Pratik Barma |
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Angioedema of the face following ingestion of mango fruit |
p. 534 |
Yadavalli Guruprasad, Umashankar Kura, Dinesh Singh Chauhan DOI:10.4103/0975-2870.135293 |
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COMMENTARY |
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Mango and allergic reaction |
p. 536 |
Viroj Wiwanitkit |
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BOOK REVIEW |
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Gender equality and inequality in rural India: Blessed with a son |
p. 538 |
Amitav Banerjee |
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