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EDITORIAL |
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Disconnect between principles and practice of medical education technology |
p. 691 |
Amitav Banerjee DOI:10.4103/0975-2870.144827 |
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ORIGINAL ARTICLES |
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Interactive teaching: Understanding perspectives of II MBBS students in Pathology |
p. 693 |
Archana C Buch, Shirish S Chandanwale, Sunita A Bamnikar DOI:10.4103/0975-2870.144828 Background and Context: In medical education, lectures comprise an important mode of teaching. A lecture running into an hour can become monotonous and fails to hold attention until the end. There is a need to explore innovations in planning lectures so as to sustain interest. Aim: Introduce interactive teaching methods during lectures and elicit students' perception about them. Materials and Methods: A number of interactive methods such as group discussions, brainstorming, question answer sessions, multiple choice questions (MCQs), confusion technique and summaries were introduced in the course of the lectures in a batch of 150 medical students. Later the perceptions of the students were elicited regarding these sessions using a questionnaire based on Likert scale, which was validated in a pilot study. Results: Validation of the scale indicated good internal consistency with Crohnbach's alpha coefficient of 0.9. Majority (73%) of the students agreed or completely agreed to like the sessions. Similarly, 75% agreed or completely agreed to like teamwork. Most popular interactive mode was MCQs (76% agreed to completely agreed), followed by brainstorming (64% agreed to completely agreed) and confusion technique (53% agreed to completely agreed). Most students were also of the view that interactivity during lectures improved communication skills, helped in retention of the topic, improved attention span and would want the method introduced for all lectures. Conclusion: A paradigm shift toward interactive sessions during lectures is required to make them effective. |
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Assessment of the impact of short term studentship program on attitude of undergraduate medical students toward future research |
p. 696 |
Charusheela R Gore, Sudhir L Jadhav, Siddharth P Dubhashi, Archana C Buch, Shirish S Chandanwale DOI:10.4103/0975-2870.144847 Context: Exposure to research is essential in modern undergraduate (UG) medical curriculum. In India, various bodies like Indian Council of Medical Research (ICMR) and Department of Science and Technology, Kishore Vaigyanik Protsahan Yojana are promoting this. The ICMR initiated short term studentship (STS) program in 1979 to promote interest and aptitude for research in medical and dental students. Objectives: To analyze the STS program as a tool in sensitization of UG medical students toward research activity and to study the effect of UG research experience on student learning and attitude. Materials and Methods: The UG students from this institute who had completed STS projects were included in the study. They were given a questionnaire and briefly interviewed. Analysis of the factors contributing and inhibiting to take up research was done. Mainly qualitative methods were used. Results: A total of 72 students participated in the study. Among them were 20 (27.7%) were boys and 52 (72.2%) were girls Thirty (41.7%) students took up project to get oriented toward research, while 20 (27.8%) had interest in research. Inhibitions for taking up the projects were lack of knowledge, time constrains and lack of confidence. Factors attributed for successful project completion were constant support from guide, self-enthusiasm and proper time management. About 97.2% felt project has made significant difference in understanding of the subject. Totally 41% students were unable to present or publish the work done. The main hurdle faced for not presenting or publishing the work done was time constraint due to voluminous UG medical curriculum. Conclusion: Overall impact of this program was good. Though, the students showed good attitude toward research, the factors which are inhibiting the other students to come forward for projects needs to be addressed. |
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COMMENTARY |
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Research in undergraduate education: A transformational change |
p. 701 |
Avinash N Supe |
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ORIGINAL ARTICLES |
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Attitudes and perceptions toward rural health care service among medical students |
p. 703 |
Raghavendra Aswini Dutt, Siddharudha Shivalli, Manipady Bhima Bhat, Jagadish Rao Padubidri DOI:10.4103/0975-2870.144850 Introduction: Each year, students get admitted to medical colleges with definitive objectives and attitudes. They are destined to serve the humanity in need irrespective of the geographical distribution of their placements. Now-a-days students graduating from the medical institutions are opting to work in urban than rural areas. This has resulted in acute shortage of qualified medical doctors serving the rural India. This alarming increase in population-to-doctor ratio in rural areas is a cumbersome issue for the governments. Aim: To study the attitudes toward rural health service and difference in their perceptions, career preferences, if any, based on gender, nationality and year of study among the medical students; the present work was carried out. Materials and Methods: A total of 160 students of 1 st year and final year course of a Private University Medical College in Karnataka state, India were included. 113 were Indians and 47 Malaysians. Content, construct validity and test retest reliability were applied to a questionnaire. Responses were compiled and statistically analyzed. Results: The results revealed that huge majority of students want to pursue postgraduation and work in urban than rural areas, which is equally seen among the study group. They were all aware about the health needs of rural population, but can work only for few years. Conclusion: Multiple factors contribute to the lack of motivation among the medical students to take up rural service. Well-planned rural incentive packages with effective retention strategies should be provided in a definitive framework benefiting the health workers. |
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Prevalence and patterns of internet addiction among medical students |
p. 709 |
Venkata Venu Gopala Raju Srijampana, Ananda Reddy Endreddy, Koilada Prabhath, Bhagawan Rajana DOI:10.4103/0975-2870.144851 Background: There has been an explosive growth in the use of internet not only in India, but also worldwide in the last decade. There were about 42 million active internet users in urban India in 2008 when compared to 5 million in 2000. India now has the world's third-largest national digital population, with approximately, 120 million Internet users in 2011. Aims: The aim was to study prevalence and pattern of internet usage among medical students in Guntur. Materials and Methods: A cross-sectional study was conducted among medical students (n = 211) belonging to two medical colleges, to assess the pattern of internet usage. A semi-structured proforma along with Young's Internet Addiction scale was used. Results: Of 211 medical students, 57.2% were females and 42.8% were males. The users were divided into groups: 64.4% as average users, 11.8% as possible addicts, 0.4% as addicts, and in 23.2% of medical students internet usage was less than average user. Significant usage differences were evident based on the gender of user. Medical students used the internet mostly for social networking (59.7%), downloading media files (18.9%), online gaming (12.3%), and academic purposes (0.1%). About 63% of the medical students were using mobile phones to access the internet. Conclusion: Internet usage for the purpose of social networking (Facebook, WhatsApp, Mails etc.) was very high among the medical students. Availability of high speed internet on mobile phones may be the reason for spending more time on social network websites. |
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A study of awareness and lifestyle related practices regarding global warming among the teaching staff of a medical college in Navi Mumbai |
p. 714 |
Aasawari N Nalgundwar, Deepa H Velankar, Sumedha M Joshi, Madhavi J Mankar, Violet N Pinto DOI:10.4103/0975-2870.144854 Context: Global warming has been defined by the World Health Organization as "the observed and projected increase in the average temperature of the earth's atmosphere and oceans." It is also a significant and emerging threat to the public health. Aims: The current study was carried out to determine the level of awareness regarding global warming and to study the lifestyle related daily practices among the teaching staff of a medical college. Materials and Methods: This study included 105 teaching staff members. Each participant was given a self-administered, pretested, predesigned questionnaire. Statistical Analysis Used: Epi Info version 7 using proportions and percentages. Results and Conclusion: All the participants were aware of global warming and almost all of them (96%) opined that global warming was a man-made phenomenon rather than a natural one. Two-third (66%) perceived the threat of global warming as severe. Majority (82%) could correctly name at least two activities responsible for global warming. Half (56%) could correctly name any two greenhouse gases. Majority showed awareness about various daily lifestyle related practices, which if practiced by everyone, will help in reduction of global warming. These responsible choices at individual level can contribute to a significant change globally. |
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Prevalence of anxiety and depression in mothers of children with profound bilateral sensorineural hearing loss: A brief report |
p. 717 |
Sima Noohi, Susan Amirsalari, Elham Sabouri, Shahryar Moradi, Amin Saburi DOI:10.4103/0975-2870.144855 Background: Stress caused by physical disorders of offspring, such as deafness, is the potential reason of depression and anxiety in their parents. This study assessed the prevalence of depression and anxiety in mothers of children with sensorineural hearing disorders. Materials and Methods: An analytical cross-sectional study was conducted on 59 mothers of children diagnosed with profound sensorineural deafness who were referred to Baqiyatallah university hospitals in 2009. Depression and anxiety were assessed by depression and anxiety questionnaire (Beck Second edition). Results: The mean ages of children and mothers were 18.31 ± 4.72 months and 29.42 ± 4.39 years, respectively. The prevalence of depression and anxiety were 39 out of 59 (66.10%) and 47 out of 59 (79.66%), respectively. Conclusion: Depression and anxiety in mothers of children with profound sensorineural hearing loss have a high incidence and psychological complications must be considered substantially in mothers of children with hearing disorders. |
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COMMENTARY |
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Anxiety and depression in mothers of deaf children: Awareness needed |
p. 720 |
Suprakash Chaudhury |
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ORIGINAL ARTICLES |
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Psychiatric morbidity, quality of life and caregiver burden in patients undergoing hemodialysis |
p. 722 |
Bindoo S Jadhav, Hemangee S Dhavale, Shubhangi S Dere, Dimple D Dadarwala DOI:10.4103/0975-2870.144858 Background: Psychiatric illnesses such as, depression, adjustment disorders, delirium, and anxiety disorders are common in dialysis patients and are likely to reduce patient's quality of life (QOL). Presence of chronic medical and psychiatric illness in patients increases burden on caregivers. Aims: The aim was to assess sociodemographic profile and to estimate the prevalence and type of psychiatric morbidity, QOL in patients undergoing hemodialysis. Furthermore, the study aimed to assess perceived burden in caregivers of these patients. Materials and Methods: This was a cross-sectional observational study conducted at hemodialysis unit of an urban tertiary care hospital. Fifty consecutive patients undergoing hemodialysis were included. Sociodemographic profile was assessed through semi-structured proforma. Psychiatric morbidity was assessed using Diagnostic and Statistical Manual IV Text Revised Criteria and World Health Organization QOL Scale-BREF scale was used to measure patient's QOL. Perceived burden in caregiver was assessed using Zarit Burden Interview. Data obtained were tabulated and analyzed using the SPSS software version 17. Results: Majority of patients was males, in middle-age group, secondary educated, unemployed and married. Psychiatric diagnosis was observed in 64% of the patients. Most common psychiatric diagnoses were major depressive disorder, adjustment disorder with depressed mood. Overall QOL score in patients was significantly low in those with psychiatric morbidity. Caregiver's burden was significantly high in those caring for patients with co-morbid psychiatric illness. Conclusions: Psychiatric morbidity in hemodialysis patients is high and impairs their QOL. Perceived burden of care in their caregivers is high in the presence of psychiatric co-morbidity. |
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Perceived levels of stress and its correlates among residents of old age home in Kanchipuram District, Tamil Nadu |
p. 728 |
Geetha Mani, Sharath Udayakumar, Kalaivani Annamalai, D Jegadeesh Ramasamy DOI:10.4103/0975-2870.144860 Introduction: Elderly are vulnerable to stress from various causes. The elderly in old age homes are a distinct population with lack of family and social support contributing to an increased prevalence of stress. This study was carried out to assess the perceived stress among inmates of an old age home in Kanchipuram District, Tamil Nadu. Materials and Methods: A descriptive, cross-sectional study was conducted among 100 inmates of an old age home in Kanchipuram District, Tamil Nadu between May and July 2012, using a semi-structured questionnaire. Perceived levels of Stress among elderly were assessed using the perceived stress scale-10. Results: Nearly 18% of the participants had high stress scores and 60% had moderate stress scores. Gender, co-living status with spouse was found to be significantly associated with stress scores. Conclusion: The perceived stress was high among inmates of old age homes. There is a need for organized family and social support to improve the physical and psychological health of elderly. Exploratory research studies are necessary to identify the problems among elderly, especially those in old age homes. |
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A study on awareness regarding swine flu (influenza A H1N1) pandemic in an urban community of Karnataka |
p. 732 |
K Shilpa, BA Praveen Kumar, S Yogesh Kumar, Amit R Ugargol, Vijaya A Naik, MD Mallapur DOI:10.4103/0975-2870.144862 Background: Globally, India was one among the most affected countries for cases and deaths of swine flu (influenza A H1N1) during 2009 influenza pandemic with lot of public hype and panic. Aims: This study was designed to assess the awareness, attitude, myths and practices regarding Swine flu among urban population of Belgaum district, Karnataka. Subjects and Methods: This study was conducted in an urban community of Belgaum, Karnataka during 2009. A total of 250 households were interviewed using a pretested questionnaire by systematic random sampling. One person from each household preferably head of the family was asked regarding knowledge, attitude and practice during swine flu pandemic. Results: Among the study population, 73.6% had previously heard of swine flu. More than half of the participants said mass media communication was found to be the major source of information. Around 82.6% of the participants said fever was the most common symptom and using facemask was accepted as the important mode of prevention by 81.5% participants. Only 19.0% were willing to leave their locality temporarily if any cases were seen around. Majority of the participants selected government hospital for treatment facilities if they get any symptoms of swine flu. Hand washing, as a mode of prevention was known to 92.4% of the respondents. Around 33.4% of the populations were ready to share knowledge to others if they were given health education regarding swine flu. Conclusions: Knowledge regarding swine flu pandemic was low among study participants. Most of the participants had health seeking behavior. Majority of the respondents were practicing hand washing. Strategies to create more awareness about pandemic through effective mass media are vital for containing the pandemic. |
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Management of closed isolated tibial shaft fracture: A dilemma in a rural set up of a developing country |
p. 738 |
Soumya Ghosh, Saugata Adak, Arunima Chaudhuri, Soma Datta, Debasis Singha Roy, Sarit Kumar Chaudhuri DOI:10.4103/0975-2870.144863 Background: Better results are reported with internal fixation of displaced tibial shaft fractures than nonoperative treatment. Objectives: Effective screening of nonunion risk to decrease the morbidity and subsequent healthcare resource use and cost. Materials and Methods: This pilot project was conducted in a tertiary care hospital of a developing country on 68 patients in a time period of one year. Thirty-four patients were treated with intramedullary nailing (Group I) in the tertiary care hospital while 34 patients received closed manipulation (Group II) in a rural hospital. Johner and Wruh's criteria were used to assess the final outcome. Results: The mean time to union was 19 weeks after management with a cast and 13 weeks after management with nailing (P < 0.05). Excellent result found in 13 cases, good in 6, fair in 2 in Group I and excellent result found in 8 cases, good in 16, fair in 6, poor in four in Group II. The mean time to radiographic union was 19 weeks for Group II compared with 13 weeks for Group I (P < 0.05). Six patients in Group II had shortening of more than 1.5 cms. No patient had shortening of more than 1.5 cms in Group I (P < 0.05). Group I returned to work significantly earlier than the other group. Conclusion: Though results with treatment of isolated, closed tibial shaft fracture with intramedullary nailing is a better option, closed manipulation still remains an alternative method of treatment in a developing country and there is urgent need to upgrade rural centers for improvement of mode of treatment. |
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A comparative study of conventional incision and drainage versus incision and drainage with primary closure of the wound in acute abscesses |
p. 744 |
Aniruddha Kale, Virendra Athavale, Nitin Deshpande, Dakshayni Nirhale, Murtuza Calcuttawala, Mohit Bhatia DOI:10.4103/0975-2870.144864 Purpose: Acute soft tissue abscess is a very common condition. This study was undertaken to compare the outcome of conventional incision and drainage versus incision and drainage with primary closure of wound in acute abscesses with regards to better healing rate, less postoperative pain, less hospital stay, low cost of treatment, and less recurrence rate. Introduction: Acute soft tissue abscesses are common conditions in surgical practice. The established principle of surgical management of abscesses has been incision and drainage. This modality of treatment has been challenged with the introduction of antibiotics. The aim of our study was to compare the conventional method of incision and drainage with the alternative method of incision and drainage with primary closure and negative suction drain. Materials and Methods: In our study, 100 patients admitted with superficial abscess excluding patient suffering from systemic diseases. Deep seated abscesses (e.g., intra-abdominal abscess, pelvic), abscess cavity of internal diameter of >5 cm. Patients were randomly divided into two groups. Group A included 50 patients treated by conventional incision and drainage; Group B included 50 patients treated by the incision and drainage with Primary closure and negative suction drain. Patient were assessed during the hospital stay and follow-up on following criteria for postoperative pain by visual analog score, days of hospital stay, wound healing, treatment cost and recurrence. Results: A total of 100 patients were randomized to primary or secondary closure. The time of wound healing, length of hospital stay and postoperative pain were less for Group B patients than in Group A patients. Results found significant pertaining to wound healing, postoperative pain, days of hospital stay treatment cost and recurrence in Group B than Group A. Conclusion: In our study, incision and drainage with primary closure combined with use negative suction drain is more effective than that of incision and drain. |
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COMMENTARY |
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Changing trends in abscess management |
p. 747 |
Shilpa Patankar |
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GUEST EDITORIAL |
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Acute appendicitis: Common surgical emergency |
p. 749 |
Bharat Bhushan Dogra DOI:10.4103/0975-2870.144866 |
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ORIGINAL ARTICLES |
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Epidemiological aspects of appendicitis in a rural setup |
p. 753 |
Hanumant P Lohar, Murtuza Ali Asger Calcuttawala, Dakshyani Satish Nirhale, Virendra S Athavale, Manish Malhotra, Nishant Priyadarshi DOI:10.4103/0975-2870.144867 Aim: The aim was to study the 3-year epidemiological trend of acute appendicitis in a rural setup. Materials and Methods: This is a retrospective study of patients who were admitted with a diagnosis of appendicitis over a period of 3 years excluding negative appendectomy cases. Totally, 130 cases were diagnosed as an acute appendicitis, on clinical suspicion and investigations during this period. We reviewed and studied these cases regarding incidence of appendicitis in different age groups, sex, according to dietary pattern and seasonal trend. Results: Occurrence of appendicitis was the highest in the 11-20 years age group which constituted 44.6%. Followed by 21-30 years age group, which constituted 36.1%. The incidence of appendicitis between the age group 31 and 40 years constituted 11.5% while between 0 and 10 years age group was 3%. Between 41-50 years and 51-75 years of age group 2.3% each. The youngest case recorded was 8 years of age and the oldest 65 years of age. In this study occurrence of appendicitis in both male and female was almost equal. Nonvegetarians were affected more than vegetarians. The occurrence of appendicitis was peak in the spring and low in the summer. Conclusion: Acute appendicitis should be suspected irrespective of age, sex and socioeconomic status of individual. Age-specific occurrence, sex ratio of appendicitis give the impression that epidemiologic features of acute appendicitis are different with worldwide data. It is difficult to diagnose appendicitis in young children, young women and elderly people. Total leukocyte count, urine microscopy, ultrasonography and computed tomography abdomen should be used as a diagnostic aid in doubtful cases in association with physical findings, but it does not replace the clinical skills of a general surgeon. |
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CASE REPORTS |
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Diverticulosis of appendix |
p. 758 |
Falguni Rakesh Varma DOI:10.4103/0975-2870.144868 Diverticulosis of appendix is rarely encountered. It is an uncommon cause of lower-right quadrant pain. Whether it presents symptomatically or is an incidental finding during surgery understanding its clinical behavior is important for proper management since it can significantly increase morbidity and mortality. It is also likely to be associated with pseudomyxoma peritonei. Appendectomy is the treatment of choice. A case of diverticulosis of appendix is described |
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Laparoscopic management of left-sided appendicitis in situs inversus totalis |
p. 760 |
Sangram Jadhav, Deepak Kulkarni, Siddarth P Dubhashi, Rajat D Sindwani DOI:10.4103/0975-2870.144869 Situs inversus totalis is a rare autosomal recessive inherent disease in which the thoracic and abdominal organs are transposed. Incidence in the general population is only 0.001-0.01%. Symptoms of appendicitis may appear in the left lower quadrant making the diagnosis difficult. We report a case of left-sided appendicitis diagnosed preoperatively after dextrocardia that was detected by X-ray chest and ultrasonography revealed long retrocecal appendix in left iliac fossa with loops of bowel clumped in the area. The patient underwent laparoscopic appendectomy and post-operative recovery was uneventful. Although, technically more challenging because of the mirror nature of the anatomy, we used the conventional 3-port techniques after laparoscopic confirmation of anatomy and not the mirror image technique as is normally practiced. This method also provided the same comfort level to the surgeon. |
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Appendicular perforation caused by fish bone: A rare case report |
p. 764 |
Sunil B Magadum, Kaustubh Mench, Abhijit Anaje, Vasim Mulla DOI:10.4103/0975-2870.144872 Appendicitis and its complications remain a common problem affecting patients of all age groups. Foreign bodies are a rare cause of appendicitis. However, if stiff or pointed objects get into the appendiceal lumen they have a high risk for appendicitis or perforation. These foreign bodies are almost always radiopaque. A case of appendicular perforation due to fish bone treated surgically is reported. |
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Case report of patient with orolingual tremors as post Japanese encephalitis sequelae |
p. 766 |
Anirudda Deshpande, Supriya Khardenavis, Aakash Shetty DOI:10.4103/0975-2870.144874 Japanese encephalitis (JE), mosquito-born flavivirus, is a common human viral encephalitis in the world occurring in epidemics throughout Asia. Among the various forms of movement disorders associated with JE, generalized/hemi-dystonia and Parkinsonism are well-documented movement disorders in patients, post JE. As per the available literature, patients with a movement disorder as long-term sequelae have definite lesions on magnetic resonance imaging. Patients present with muteness, generalized dystonia and are associated with lesions in both thalami. Our patient with characteristic orolingual tremors had bilateral thalamic hyperintensities, as is characteristically seen in JE. To the best of our knowledge, orolingual tremors as a manifestation in patient with post JE sequelae, is extremely rare and yet to be reported. However, there is no report of orolingual tremor as post JE sequelae to the best of our knowledge. |
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COMMENTARY |
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Post Japanese encephalitis orolingual tremor |
p. 768 |
Viroj Wiwanitkit |
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CASE REPORTS |
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Papular acantholytic dyskeratosis of male genitalia: A rare entity |
p. 770 |
Swapna S Khatu, Pradeep Mahajan, Suresh Pethe DOI:10.4103/0975-2870.144878 We report a case of a 35-year-old male with minimally pruritic papular eruptions over the genitalia. Histology of lesions revealed focal acantholysis with presence of dyskeratotic cells resembling corps ronds and grains. These clinical and histopathological findings were consistent with persistent papular acantholytic dyskeratosis, which is a rare disorder first described in 1984. We describe a rare case of persistent papular acantholysis over the male genitalia. |
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Intraoral hemangiomas in Sturge-Weber syndrome |
p. 773 |
Hemlata R Iyer, Sonal S Khatavkar, Varsha H Vyas, Surekha S Patil DOI:10.4103/0975-2870.144879 Sturge-Weber syndrome is a rare congenital disease also called as encephalo-trigeminal-angiomatosis, caused by persistence of transitory primordial arterio-venous connections of fetal intracranial vasculature. It is characterized by vascular malformations with capillary venous angiomas that involve face, choroid of eye, and leptomeninges. The main clinical features of this syndrome are port-wine stains, glaucoma, convulsions and angiomas of the airway. Anesthesia management is directed towards keeping the intracranial and intraocular pressures normal, avoiding trauma to hemangiomas, and anticipating difficult airway. We discuss the case of a 13-year-old boy with intraoral hemangiomas resulting in difficulty in speech. Patient was scheduled for digital subtraction angiography (DSA) and sclerotherapy of hemangiomas under general anesthesia. The anesthetic considerations during the peri-operative management, including airway problems, multiple changes in patient position during DSA procedure, precautions during use of radio-contrast media and sclerosing agents are highlighted. |
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A rare case of peripartum cardiomyopathy |
p. 777 |
Shilpa Chaudhari, Priyanka Gupta, Himadri Bal, Devika Bharat Bhikane DOI:10.4103/0975-2870.144880 Peripartum cardiomyopathy (PPCM) is defined as acute onset heart failure without demonstrable cause in the last month of pregnancy or within the first 5 months after delivery. All other causes of dilated cardiomyopathy with heart failure must be systematically excluded before accepting the diagnosis of PPCM. Such a case is reported where a 4th gravida undergoing lower segment caesarean section (LSCS) for pre-eclampsia with abruptio placenta and fetal distress landed up with pulmonary edema and later diagnosed as PPCM. She was diligently managed and subsequently followed up for 6 months and complete reversal of her cardiac function was confirmed. |
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Peripartum cardiomyopathy: An endangering consequence |
p. 780 |
Aparna Girwalkar-Bagle, Sonal Khatavkar, WS Thatte, Jaimy John DOI:10.4103/0975-2870.144881 Peripartum cardiomyopathy (PPCM) is a disease affecting the parturient during late pregnancy or immediately after delivery. This unique disorder not just endangers the life of mother and fetus, but also a financial burden on health system due to its potential to cause prolonged and persistent cardiac function insufficiency in the mother, prolonging hospital stay. Here, we are reporting a case of PPCM diagnosed postoperatively, which initially misdiagnosed as hemorrhagic shock due to postpartum hemorrhage, but with the correct diagnosis and treatment, patient rapidly return to the normal life. |
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COMMENTARY |
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Anesthetic challenges in peri-partum cardiomyopathy: Still a long way to go! |
p. 783 |
Sukhminder Jit Singh Bajwa, Sukhwinder Kaur Bajwa |
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CASE REPORTS |
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A case of coinfection of Ascaris lumbricoides and Vibrio cholerae in a 3-year old child |
p. 787 |
Trupti Bajpai, Ganesh S Bhatambare, Neelesh Gagrani, Vikrant Chitnis DOI:10.4103/0975-2870.144884 A 3-year-old male child presented with multiple episodes of diarrhea and vomiting. Several adult worms of Ascaris lumbricoides were passed in the stool and vomit. Stool was examined and the coexistence of Vibrio cholerae bacteria and Ascaris lumbricoides parasite was confirmed. |
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Atypical Nonne-Milroy syndrome: Complicated with chylous effusion |
p. 790 |
Rupam Kumar Ta, Kaushik Saha, Mrinmoy Mitra, Arnab Saha, Arnab Roy, Pratik Barma DOI:10.4103/0975-2870.144886 Nonne-Milroy syndrome is a rare primary lymphedema characterized by firm non-pitting edema of the lower extremities of the whole leg or may be limited to the feet or toes since birth or infancy. We are reporting a 51-year-old male who presented with dry cough for the previous 7 months and dyspnea for the previous 4 months due to bilateral chylous effusion and that was associated with firm edema of the lower extremities, was waxing and waning since birth. Duplex ultrasound of the lower limbs showed patent blood vessels. Lymphoscintigraphy demonstrated aplasia of the lymphatics in both lower limbs. The patient was diagnosed as primary lymphedema or Nonne-Milroy syndrome after excluding other congenital causes of primary edema. He was treated by bilateral pleurodesis with tetracycline for his chylous effusion and no recurrence was observed after 1 year of follow-up. |
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Hepatic necrosis due to the umbilical vein catheter malposition: A case report with review of literature |
p. 793 |
Sanjay Mhalasakant Khaladkar, Aditi Gujarathi, Vilas Moreshwar Kulkarni, Amarjeet Singh DOI:10.4103/0975-2870.144888 A preterm infant was admitted to the neonatal intensive care unit because of prematurity and respiratory distress syndrome. An umbilical venous catheter (UVC) was inserted for central line access and for giving total parenteral nutrition and antibiotic therapy to the patient. UVC tip location was confirmed with X-ray and was removed after 10 days. She was referred for ultrasonography abdomen for persistent fever. Ultrasound showed anechoic fluid collection in the center with peripheral mixed echoic solid lesion in left hepatic lobe along course ductus venosus suggestive of extravasated fluid with hepatic necrosis. Superadded infection could not be ruled out. Possibility of displacement of catheter during nursing care due to poor fixation was likely. The purpose of this case report is to create awareness of hepatic findings due to the umbilical vein catheter malposition. |
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COMMENTARY |
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Hepatic necrosis due to umbilical vein catheter malposition |
p. 796 |
Satish Naware |
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CASE REPORTS |
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Solitary extramedullary plasmacytoma of mesentery: A rare presentation |
p. 798 |
Shashikant H Kulkarni, Shobhana R Agashe, Vaibhav P Mane, Moses Ingty DOI:10.4103/0975-2870.144892 A case of "extramedullary plasmacytoma of mesentery" is being reported due to its rarity. To date only six cases have been reported in the literature out of which only one is from India. Subsequent investigations for myeloma like urinary Bence-Jones proteins, serum electrophoresis, radiological skeletal examination, bone marrow biopsy were negative. The diagnosis of plasmacytoma was confirmed by pathological and immunohistochemical studies. Surgical excision of the mass was done. |
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Magnetic resonance imaging in pseudotumor cerebri: A case report |
p. 802 |
Dhaval K Thakkar, Abhijit Patil, Dolly Thakkar, Parag Patil, Mansi N Jantre DOI:10.4103/0975-2870.144894 Idiopathic intracranial hypertension (IIH) is characterized by symptoms of raised intracranial tension (ICT) as headache and visual disturbances due to raised cerebrospinal fluid pressure, however without any ventricular enlargement or space occupying lesion. The characteristic findings include papilledema which is usually bilateral, however which may be unilateral or asymmetrical. We report a case of 35-year-old female patient who came with complaints of headache and diplopia. She underwent magnetic resonance imaging of the brain which showed changes in bilateral globes, optic nerves and sella, which were suggestive of increased ICT. The ventricles and basal cisterns were normal. No other abnormality was seen. The magnetic resonance venogram was also normal. Thus, we concluded the diagnosis of IIH. The patient underwent therapeutic lumbar puncture after which she showed significant improvement in symptoms. |
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Tumefactive demyelination mimicking neoplasm |
p. 806 |
Digish Shah, Abhijit Patil, Parag Patil, Shoubhi Bhatnagar, Villas Kulkarni DOI:10.4103/0975-2870.144895 Tumefactive demyelination is a large solitary demyelinating lesion, which mimics intracranial brain tumor. This information is particularly valuable to both physicians and surgeons who should be aware that inflammatory demyelinating diseases when present as a mass lesion is difficult to distinguish from a tumor, both clinically and radiologically, especially when there is no evidence of temporal dissemination of this disease. Distinguishing tumefactive lesions is necessary from other causes of intracranial space-occupying lesions to avoid unnecessary and expensive surgical intervention. We report a case of demyelinating disease with tumor-like presentation. |
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Post traumatic microstomia: A surgical challenge for repair, rehabilitation |
p. 809 |
Bharat Bhushan Dogra, Subodh Kumar Agarwal, Ashwani Kandari, Priyanka Pathare DOI:10.4103/0975-2870.144897 Microstomia due to isolated orofacial injury arising from the explosion of cell phone battery is extremely rare. Such devastating injuries are generally associated with warfare. We recently encountered a case in an 18-year-old student, whose lower face was literally blown off in a cell battery blast injury. Initial resuscitation, debridement and primary repair were carried out in a local plastic surgery clinic. Six months later, he reported to us with gross microstomia; inability to eat solid foods and look after his oral hygiene. Secondary repair was undertaken to correct his deformity utilizing local soft tissues to achieve satisfactory mouth opening. Subsequently, prosthodontic rehabilitation was carried out by providing complete dentures to allow him resume near normal life. |
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Acute Intermitent porphyria and early hematin treatment before confirming the diagnosis |
p. 813 |
Mustafa Volkan Demir, Tayfun Temiz, Selcuk Yaylaci, Ali Tamer DOI:10.4103/0975-2870.144898 The term porphyria refers to a heterogeneous group of metabolic diseases resulting from variable catalytic defects of the enzymes involved in the heme biosynthesis pathway. Acute intermittent porphyria (AIP) is an autosomal dominant disorder resulting from a partial deficiency of porphobilinogen (PBG) deaminase. A 21-year-old woman presented to us with the complaints of abdominal pain and vomiting. Her father and sister are diagnosed as acute intermittent porfiria. The laboratory findings showed profound hyponatremia, hypokalemia and high values of creatine kinase. AIP was suspected because of family history and clinic of patient. Our initial management consisted of continuous infusion of 10% glucose and 3% NaCI solution. We decided to start hematin treatment because of no clinical response with current therapy. After the hematin treatment she had regained consciousness, the abdominal pain subsided. The hyponatremia and elevation of creatine kinase was corrected. The analysis of PBG in 24-h urine confirmed the diagnosis of AIP. |
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COMMENTARY |
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Acute intermittent porphyria and early hematin treatment |
p. 816 |
Viroj Wiwanitkit |
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CASE REPORTS |
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Ocular toxoplasmosis: A case report with review of literature |
p. 818 |
Abhay A Lune, Sudeep N Pujari, Sonali A Lune DOI:10.4103/0975-2870.144900 Ocular toxoplasmosis is a potentially blinding necrotizing retinitis with a progressive and relapsing course. It presents as a localized retinochoroidal lesion in most of the cases and is the most common cause of posterior uveitis, world-wide. The incidence of ocular infection is very high, most of which are subclinical. Hence to highlight this blinding disease, which may escape detection and to emphasize its preventive measures so as to prevent the visual disability arising from it. We report a case of a 35-year-old male who had diminution of vision in his right eye since 10 years. His best-corrected vision in that eye was three meters finger counting. Fundus examination showed a well-defined pigmented scar on the macula in the right eye and 2 small peripheral pigmented scars in the left eye. Since it is a potentially blinding disease with recurrences, preventive measures should be taken to avoid it. Proper washing of hands and strict food hygiene are important. Pica prevention is an important measure in children. Pregnant women should avoid contact with cats. Patients with a retinochoroidal scar harbor cysts and are to be periodically monitored due to the high risk of recurrence. Prophylactic treatment is recommended for these patients before undergoing cataract surgery. Immunocompromised patients with ocular toxoplasmosis should undergo a complete neurological evaluation due to the high risk of intracranial involvement. |
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Cytomegalovirus retinitis: A case report |
p. 822 |
Rajendra P Gupta DOI:10.4103/0975-2870.144901 A 35 years old male patient came with the complaints of sudden diminution of vision in the right eye with floaters and flashes of light. He was found to be HIV positive 8 years back. He was diagnosed as a case of CMV retinitis and intravitreal ganciclovir was administered along with systemic treatment after which choroiditis in the right eye resolved. |
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LETTERS TO THE EDITOR |
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Is marsupialization still the treatment of choice for large unicystic lesions of the jaws? |
p. 825 |
Yadavalli Guruprasad, Dinesh Singh Chauhan DOI:10.4103/0975-2870.144902 |
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Exercise induced activation of sodium channels in augmentation of action of local anesthetics |
p. 826 |
Shankar Ray, Arunima Chaudhuri, Debashis Saha, Sumanta Ghosh Maulik DOI:10.4103/0975-2870.144904 |
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RETRACTION NOTICE |
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C - reactive protein: A boon in managing acute pancreatitis: Retraction |
p. 829 |
Amitav Banerjee DOI:10.4103/0975-2870.144906 |
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