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EDITORIAL |
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When perfect is the enemy of the good |
p. 671 |
Amitav Banerjee DOI:10.4103/0975-2870.194179 |
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REVIEW ARTICLES |
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Hormone receptor (ER, PR, HER2/neu) status and proliferation index marker (Ki-67) in breast cancers: Their onco-pathological correlation, shortcomings and future trends |
p. 674 |
Banyameen Mohamad Iqbal, Archana Buch DOI:10.4103/0975-2870.194180 Estrogen receptor (ER) and progesterone receptor (PR) are hormone receptors found on breast cells that pick up hormone signals resulting in cell growth. Similarly, positive human epidermal growth factor receptor-2 (HER2/neu) status of the breast carcinoma means that HER2/neu gene is making too many HER2/neu proteins, which acts as receptors on the cell surface and helps the cells to grow and divide. Hormone receptor studies such as ER, PR, and HER2/neu are routinely done in breast carcinoma. It not only helps in the prognosis of the tumor but also helps in deciding its treatment. The goal of doing this receptor status is to provide right treatment to the right patient. This hormone receptor status is graded using Allred scoring and grading system. Depending on the hormone status, breast carcinomas can be divided into a number of different categories ranging from triple positive through triple negative. Another marker of proliferation (Ki-67) is also being used which is a proliferation index marker. This scoring system has its own limitation and shortcomings, which depends on a lot of pre- and post-analytical factors. Certain new techniques such as genomic assays, PAM50, and HALO screening test are being used nowadays for breast cancer detection. |
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Regulatory framework for "gluten-free" foods in India: Magic bullet for celiac disease patients |
p. 680 |
Puja Dudeja, Arunjeet Dudeja, Gurpreet Singh, Sandip Mukherji DOI:10.4103/0975-2870.194181 Coeliac disease (CD) remains largely unrecognized and actual burden is much more than reported or diagnosed. The treatment essentially remains 'gluten free' foods. Adulteration of these foods with gluten can occur anywhere in the chain from farm to fork. The current Food Safety and Standards Regulations (FSSR) 2011 brought a ray of hope for CD patients by including prevention of contamination of food with gluten and labeling of gluten-free items under regulatory framework. The definition of "gluten-free" includes food items containing <20 ppm of gluten. These guidelines are at par with those given in USA and Canada. These regulations provide a reference point for manufacturers, physicians, and CD patients and ensure easy availability, accessibility, and identification of "gluten-free" food items. This step forward by Government of India constitutes the first comprehensive step taken toward management of the disease. |
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ORIGINAL ARTICLES |
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Comparison of the influence of human epidermal growth factor receptor 2/neu on the markers of aggression in gastric adenocarcinomas and ductal carcinoma breast |
p. 684 |
Anant Kulkarni, Arijit Sen, Mamata Menon DOI:10.4103/0975-2870.194182 Background: Human epidermal growth factor receptor 2/neu (HER2/neu) assessment is carried out in gastric adenocarcinomas (GAC) and invasive ductal carcinoma (IDC) breast to decide upon of trastuzumab targeted therapy. The study the only of its kind which has compared the influence of HER2/neu expression to markers of tumor aggression in these two malignancies in similar target population. Material and Methods: HER2/neu evaluation was conducted by immunohistochemistry (IHC) using the guidelines of Trastuzumab for Gastric Cancer trial for GAC and ASCO-CAP 2013 for IDC breast. The study correlated HER2/neu expression with markers of tumor aggression. Aims: The present retrospective study compares the disease influence of HER2/neu over expression on markers of disease aggression like age at presentation, grade of tumor and lymph node metastasis in GAC and IDC. Results: We have compared 82 cases of GAC with 113 cases of IDC. HER2/neu expression was seen in 23.2% and 36.3% of GACs and IDCs respectively. The mean age of HER2/neu positive GACs was found to be 3.47 years greater than their negative counterpart but the pattern was reversed in cases of IDC breast where the mean age of HER2/neu positive tumors was 6.09 years less than their negative counterpart. Though no correlation was found between grade of tumor and HER2neu status in GACs (P = 0.2930), however in IDC breast a significant correlation HER2neu positivity was found with higher grade (P = 0.0002). Similarly though we did not find any correlation of HER2neu status with nodal metastasis in GACs (P 0.0511) but in IDCs a significant correlation was found of nodal metastasis with HER2/neu positivity (P = 0.0001). Conclusion: We conclude that HER2/neu expression is more frequent in IDC breast and is significantly associated with markers of aggression in contrast to its influence on the same markers in GACs. |
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Neuropsychiatric manifestation of celiac disease: A case-control study in North India |
p. 690 |
Mahendra Nimel, Charan Singh Jilowa, Krishan Kumar Sharma, Omprakash Choudhary DOI:10.4103/0975-2870.194183 Background: Celiac disease (CD) is an immune-mediated disease dependent on gluten. Prevalence of CD is about 1% and beside gastrointestinal complaints, neuropsychiatric symptoms may represent an atypical feature of CD. Some studies suggest that a gluten-free diet is effective in treating them. Settings and Design: This case-control study of 49 cases was done during the period of January to March 2013. Aim: To know the spectrum of psychiatric manifestations and cognitive functions in children with CD. Materials and Methods: We took 49 diagnosed cases of CD (based on the demonstration of IgA tissue transglutaminase antibodies and duodenal biopsy) and compared with demographically matched control group (n = 50) on Seguin Form Board Test for cognitive functions and Behavioral Summarized Evaluation-Revised scale for assessment of psychiatric and behavior disturbances. All possible psychiatric diagnosis was made on the basis of International Statistical Classification of Disease and Related Health Problems-Tenth Revision criteria. Statistical Analysis: Statistical analyses were done by using Chi-square test and two-tailed P-values. Results: Neuropsychiatric manifestations were seen in 29% of cases as against 4% of controls which was statistically significant (P=0.001). Only four cases and 1 control fount to be mild mental retardation (P = 0.16). Autism, dyslexia, developmental delay, disruptive behavior disorder, and tic disorder present in cases were not found. Conclusion: Clinical manifestations of CD vary from typical malabsorption syndrome to neuropsychiatric manifestations. Those psychiatric patients who are not responding to standard pharmacological modalities, a diagnosis of CD should be taken into consideration. Only behavioral problem can be the sole clinical manifestation of CD. |
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Drug prescription behavior in a Teaching Hospital of Western Maharashtra |
p. 695 |
Gurpreet Singh, Anuj Bhatnagar, Sandip Mukherji, Dhruv Goel DOI:10.4103/0975-2870.194184 Context: To identify drug prescription behavior and thus, guide further actions to recommend evidence-based module for learning in postgraduate curriculum. Aims: To determine drug prescribing behavior of postgraduate residents. Settings and Design: Retrospective historical data-based cross-sectional study in a tertiary care, multispecialty teaching hospital. Materials and Methods: Calculation of sample size and sampling procedure was based on standard recommendations of the World Health Organization for investigation of "drug use in health facilities." A sample size of 1200 was selected from a sampling frame of 86,213 prescriptions using systematic random sampling. Statistical Analysis Used: The data were entered in MS Excel and analyzed for determining core drug use prescription indicators, namely, average number of drugs per encounter, percentage of drugs prescribed by generic name, percentage of encounters with an antibiotic prescribed, percentage of encounters with an injection prescribed. Additional indicators suggestive of drug prescribing behavior such as polypharmacy, type of drug prescribed, department wise distribution, percentage of prescription forms with patient identification details, and demographic characteristics of outpatient department attendees were also calculated. Results: A total of 4096 drugs were prescribed in 1200 prescriptions. Thus, an average of 3.41 (±2.07) drugs per encounter was prescribed. Generic name was used for prescribing 2008 (49.02%) drugs. Antibiotics and injectable were prescribed in 222 (18.5%) and 48 (4%) prescriptions, respectively. Polypharmacy was seen in 286 (23.8%) of prescriptions. Conclusions: Such detailed studies can contribute vital inputs for the development of evidence-based training modules for rational drug use even at the institutional level. Availability and accessibility of essential drugs at affordable prices can be achieved with rationale use of drugs. |
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A survey of knowledge of interns about the instructions given to the patients while prescribing various dosage forms |
p. 701 |
Mahendra Mahadu Gaikwad, Sangeeta Sanjay Dabhade, Rohini Purushottam Jagtap, Balasaheb Baburao Ghongane DOI:10.4103/0975-2870.194185 Introduction: Education of health care providers regarding the proper use of dosage forms is inadequate, contributing to prescription errors. Objectives : The objective of this study is to assess the knowledge of interns regarding the dosage forms and their administration techniques. Materials and Methods: Interns ready to solve questionnaire were allotted to Arm A (n = 153). For each correct multiple choice question (MCQ) answer scored "1" and each incorrect or unanswered MCQ was given "0" mark. The percentage marks obtained was calculated and re-allotted grade as per 10 point grade scale. The participants in Arm B (n = 93) had to perform demonstrations. Demonstrations which included metered dose inhaler (MDI), insulin injection, eye drops, and nasal drops were performed. Score "1" for correct step and score "0" for incorrect step was given. Percentage of interns solved each step in a demonstration was calculated. Both Arm A and B analyzed separately. Results: Analysis of the questionnaire (Arm A) showed the following grades: 6.54%, 24.18%, 28.10%, 22.88% 13.73%, and 4.57% i.e. interns scored grades as excellent, very good, good, satisfactory, sufficient to pass, and fail, respectively. In demonstration techniques (Arm B) for use of MDI, nasal drops, eye drops, preparation of 40 U of 10 U humulin-R and 30 U humulin-N in one syringe and subcutaneous administration of premixed insulin were assessed and it was observed that respectively 13.98% (13/93), 10.75% (10/93), 2% (2/93), 1% (1/93), and 27.96% (26/93) interns could demonstrate correctly. Conclusion: This study suggests theoretical knowledge is not sufficient. Very Few interns could demonstrate correctly this explains the need for emphasis on such exercises in curriculum. |
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COMMENTARY |
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Medical internship: Is it a "one year paid leave" for postgraduate entrance examination preparation? |
p. 706 |
Anupama Sukhlecha DOI:10.4103/0975-2870.194186 |
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ORIGINAL ARTICLE |
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A prospective study of dynamic treatment of fracture phalanx and metacarpals of the hand with Kirschner-wire fixation/external fixator and finger splint: Daycare management (30 cases) |
p. 708 |
Rahul Madhukar Salunkhe, Hitesh Joshi, Tushar Krishna Pisal, Samar Kumar Biswas, Jay Janakbhai Patel, Ashutosh Singh DOI:10.4103/0975-2870.194187 Introduction: Fractures of the phalanx and metacarpals are some of the most frequently encountered orthopedics injuries and constitute between 14-28% of all visits to emergency department which comprises 46% of the hand fracture and out of that mostly involved are the proximal phalanx and metacarpal neck fracture are most common and then the middle and distal phalanx and the base of metacarpal. The commonest complication with surgical treatment were stiff painful joints due to prolonged immobilization at fracture sites. This prospective study was undertaken to evaluate the functional outcome after surgical stabilization of metacarpal and phalanx fracture on day care basis. Materials And Methods: In our study we treated 30 patients who came to our hospital by fixation either with K wire or external fixation or hybrid fixation under local anaesthesia depending on the type of fracture between 2013 to 2014 with the average age 28 years with the youngest being 18 years and the oldest being 41 years with transverse, spiral, oblique closed fracture, grade 1 compound fracture, intraarticular, extraarticular, comminuted and non comminuted fracture of phalanx and metacarpals.These were day care treatment. Patient was allowed to begin his daily routine work from post operative day l. During this course the operated site was protected with splinting. Results: Clinical Outcomes were assessed as Excellent, Good, Satisfactory and Poor. Radiological assessment was done by taking x-ray to check radiological union.There were 24 cases had excellent outcome, 5 cases had good outcome and only 1 case had satisfactory outcome which occurred due to mal-union. There were 3 cases of pin-tract infection which subsided with oral antibiotics, and 3 cases of malunion. Conclusion: This was a day care procedure, patient were admitted, treated and discharged on the same day & encouraged to begin mobilization of the joints of hands from day 1. |
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COMMENTARY |
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An overview in the context of the paper on day care management of fractures of the hand bones |
p. 714 |
Shanmugasundaram Kumaravel DOI:10.4103/0975-2870.194188 |
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ORIGINAL ARTICLE |
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Prevalence and severity of metabolic acidosis in patients on maintenance hemodialysis in India |
p. 716 |
Atul D Sajgure, Tushar A Dighe, Jayraj S Korpe, Charan B Bale, Ashwini O Sharma, Nilesh S Shinde, Abhishek A Goel, Atul V Mulay DOI:10.4103/0975-2870.194189 Aim: Metabolic acidosis is a feature of chronic kidney disease (CKD) due to the reduced capacity of the kidney to synthesize ammonia and excrete hydrogen ions. Among the many goals of hemodialysis (HD), the role in correction of metabolic acidosis is an important one. To assess the prevalence and severity of metabolic acidosis in the Indian patients of CKD, who are on maintenance HD (MHD). Methods: This is a cross-sectional study on 35 patients conducted at two centers in Western part of India. The demographic, clinical, and laboratory assessments were done on chronic stable patients receiving MHD. The prevalence and severity of metabolic acidosis were evaluated. Results: Metabolic acidosis was found in 22 out of 35 patients (62.85%), with mean predialysis serum pH and HCO3 of 7.32 ± 0.083 and 20.37 ± 4.94 mmol/L, respectively. Conclusion: Metabolic acidosis is significantly prevalent in patients on MHD in India. |
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COMMENTARY |
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Prevalence and severity of metabolic acidosis in patients on maintenance hemodialysis in India |
p. 720 |
Dileep B Kadam, SP Salvi DOI:10.4103/0975-2870.194190 |
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ORIGINAL ARTICLE |
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Pathology of emphysematous pyelonephritis: A study of 11 cases |
p. 722 |
Archana Laxman Khade, Shilpa K Lad, Vinaya B Shah DOI:10.4103/0975-2870.194191 Objective: The objective was to study the pathological features of emphysematous pyelonephritis (EPN). Materials and Methods: A total of 11 nephrectomy specimens of EPN received in the surgical pathology section of a tertiary hospital in a metropolis city during the period 2005-2014 are included in this study. Clinical details were obtained from the patients' records. All the patients had undergone total nephrectomy. All the specimens were fixed in 10% buffered formalin and processed for paraffin wax sectioning. The sections were stained with hematoxylin and eosin stain. Results: The most common symptoms were fever and costovertebral pain. Diabetes mellitus was present in 9 out of 11 cases and one case had calculus in the pelvis. One patient had underlying diabetes which was undiagnosed during the nephrectomy. Diagnosis of EPN was confirmed by the presence of gas and fluid in the renal tissue by computed tomography. The left kidney (nine cases, 81%) was more frequently affected than the right kidney (two cases, 19%). EPN occurred in 40-60 years of age (mean age 51.5%), and out of 11 patients, 8 (81%) were female. Escherichia coli was the commonly isolated organism from urine. Eight cases were of Type II EPN and three cases were Type I EPN. Histopathologic examination of all the cases of EPN showed acute suppurative (necrotizing) inflammation of renal parenchyma and perirenal tissues associated with vasculitis of vessels and infarction. Conclusion: EPN is most commonly seen in patients with diabetes mellitus, and E. coli is the most common causative organism. |
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CASE REPORTS |
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A case of cytomegalovirus colitis in an immunocompetent host |
p. 727 |
PP Binny, B Sreeram, Madhavan Indira, Mekkattukunnel A Andrews DOI:10.4103/0975-2870.194192 Cytomegalovirus (CMV) is a common pathogen worldwide. Clinically significant CMV infection is mostly seen in the context of immunosuppression, whether congenital, acquired, or iatrogenic. In the recent past, however, in both adults and children, an increasing number of moderate-to-severe cases of colitis have been described among immunocompetent patients. We describe a rare case of severe CMV colitis in an immunocompetent patient which resolved spontaneously. |
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Dyke-Davidoff-Masson syndrome: A rare case report |
p. 730 |
Charan Singh Jilowa, Parth Singh Meena, Mahendra Jain, Krishan Kumar Sharma DOI:10.4103/0975-2870.194193 Dyke-Davidoff-Masson syndrome (DDMS) is a rare clinical condition characterized by seizures, facial asymmetry, contralateral spastic hemiplegia or hemiparesis, with learning difficulties. It is also called as cerebral hemiatrophy. It is commonly diagnosed in the presence of associated radiologic findings which include cerebral hemiatrophy with homolateral hypertrophy of the skull and sinuses. Here, we report a case of DDMS in a 25-year-old male patient who presented with seizures and mental retardation. Computed tomography of the brain showed hemiatrophy involving the left cerebral hemisphere. |
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COMMENTARY |
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Dyke-Davidoff-Masson syndrome |
p. 733 |
Arzu Canan DOI:10.4103/0975-2870.194194 |
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CASE REPORTS |
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Mucocele of appendix |
p. 734 |
Subhash Chawla, AK Gupta, Gagandeep Singh, Ravi Shankar Lal DOI:10.4103/0975-2870.194195 Mucocele of appendix develops due to obstructive dilatation of the appendix leading to intraluminal accumulation of mucoid material. The incidence is 0.2-0.7% of all appendectomied specimens. Clinical presentation is atypical. The patient presents with pain and lump in the right lower quadrant of the abdomen. Therefore, it may be misdiagnosed as an appendicular lump. It is important to differentiate between these two pathologies before surgery and select adequate surgical approach. If not treated, the mucocele may progress, and pseudomyxoma peritonei may develop, which has a high mortality. We present a case of 45-year-old serving soldier where the mucocele of appendix was diagnosed preoperatively on abdominal ultrasonography and computed tomography scan. Lap converted to open appendicectomy was performed because no pathologic process was found at the base of the appendix, and lymph nodes were not enlarged. Histopathologic diagnosis was mucocele of the appendix. |
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Foreign body retrieval using a flexible video-bronchoscope in a child |
p. 738 |
Shashank Kadam DOI:10.4103/0975-2870.194197 While several articles describe clinical management of foreign bodies (FBs) in proximal airways, most using a rigid bronchoscope; flexible bronchoscopy and its utility in management of airway FB is unclear. This case report aims to highlight the ever increasing evidence of use of flexible video-bronchoscopes in FB removal from airways with minimal sedation and complications, when performed by an expert. A 13-month-old male child presented with a history of peanut aspiration and its removal using a flexible video-bronchoscope under minimal sedation. Rigid bronchoscopy remains the gold standard for removal of proximal airway FB. There is growing evidence that flexible video-bronchoscopy can be used for retrieval too, albeit by expert hands.
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Cervical ectopic pregnancy: A case report of missed diagnosis |
p. 741 |
Yasmeen Khatib, Anuja Khashikar, Reena Wani, Richa D Patel DOI:10.4103/0975-2870.194201 Cervical pregnancy is a rare form of ectopic pregnancy with an estimated incidence of 0.1-1% of all ectopic pregnancies. It is defined as a pregnancy that implants in the cervical canal below the internal os and within the cervical mucosa. Treatment varies from conservative management to hysterectomy depending on the clinical presentation and the time of diagnosis. Diagnosis may be missed unless the clinician and the radiologist are aware of this entity. We present a case of cervical pregnancy in a 30-year-old female who was diagnosed outside as missed abortion and was referred for termination of pregnancy. During suction evacuation, she had severe uncontrollable bleeding. Laparotomy revealed the presence of an ectopic cervical pregnancy for which hysterectomy had to be done. We present this case to highlight the importance of correct diagnosis in these cases to avoid such a catastrophe. |
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A case of solitary pulmonary nodule (large pulmonary chondroid hamartoma) |
p. 744 |
Sanuveda Rajasekhar, Rashmi Patnayak, Pavan Kumar Gururaj Kale, Abha Chandra, Amitabh Jena DOI:10.4103/0975-2870.194203 Chondroid hamartomas are rare benign tumors of the lung which show predominantly cartilage. Usually, they are small, solitary, and asymptomatic lesions. They are detected incidentally on chest X-ray or at the time of autopsy. Occasionally, large pulmonary hamartomas are encountered. We present a case of a 60-year-old male patient with a 6-month history of cough. His X-ray and computed tomography (CT) scan of the chest revealed a well-defined soft-tissue density lesion with popcorn calcification measuring 6.5 cm × 4.8 cm in the left lung upper lobe. A presumptive diagnosis of chondroid hamartoma was made in CT-guided percutaneous biopsy. A posterolateral thoracotomy and left upper lobectomy were done. There was a spherical gray-white firm mass noted in the resected lobectomy specimen. Postoperative histopathological examination confirmed the diagnosis of pulmonary chondroid hamartoma. This is an additional case of large chondroid hamartoma. |
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Posttraumatic herniation of eyeball: A rare case |
p. 747 |
Sachin Parshuram Guthe, Poonam Darade, Pravin Survashe, Vernon Velho DOI:10.4103/0975-2870.194205 Posttraumatic herniation of the eyeball is very rare. There are very few prior reported cases of herniation of eyeball into the maxillary sinus. We hereby add one more case to literature of posttraumatic fracture of floor of the orbit and herniation of the eyeball into the maxillary sinus which was diagnosed on computed tomography scan. |
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A rare case of tuberculous meningitis with pancreatitis |
p. 750 |
Drishti Chandru Tolani, Ira Shah DOI:10.4103/0975-2870.194210 Tuberculous meningitis (TBM) is the most common form of central nervous system manifestation of tuberculosis. However, tuberculous pancreatitis is rarely reported. We present an 8-year-old female child with TBM who had intractable vomiting that persisted even after fever and meningeal signs had decreased after starting antituberculous therapy and did not respond to antacids. She was subsequently detected to have elevated serum amylase and lipase suggestive of pancreatitis. She responded to conservative management. |
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A rare inborn error of metabolism masquerading as meningitis |
p. 753 |
Madhumita Nandi, Sumantra Sarkar, Tapan Dhibar DOI:10.4103/0975-2870.194220 We hereby describe a 7-month-old female baby, born to first-degree cousins, who was initially diagnosed as meningitis based on the features of seizures and dystonia with fever. Detailed review of brain imaging and high urinary 3-hydroxy (3-OH) glutaric acid level confirmed the diagnosis of glutaric aciduria Type I. There is a high probability of these cases getting misdiagnosed as meningitis. Persistent rigidity and dystonia precipitated by a febrile illness and the typical brain imaging picture are clues to the diagnosis of glutaric aciduria Type I, which can be confirmed by raised 3-OH glutaric acid level in body fluids. |
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COMMENTARY |
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Glutaric aciduria type-I: A potentially treatable and easily diagnosable neurometabolic disorder |
p. 756 |
Mahesh Kamate DOI:10.4103/0975-2870.194223 |
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CASE REPORTS |
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Cystic hygroma: A surgical challenge |
p. 758 |
Mohit Bhatia, Aastha Mattoo DOI:10.4103/0975-2870.194225 Cystic hygroma (CH) is a congenital malformation of lymphatic system. The incidence of CH is approximately 1 in 6000 live births. In most of the cases, it presents as a painless, fluctuant swelling. Due to its variable presentation its optimum treatment often poses a potential challenge. |
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Subarachnoid block in kyphoscoliosis: A reliable technique? |
p. 761 |
Shilpi Misra, Aparna Shukla, Keshav Govind Rao DOI:10.4103/0975-2870.194226 Subarachnoid block in patients with kyphoscoliosis always present a unique challenge to the anesthesiologist owing to the deformity of spine. The asymmetry in bilateral spread of local anesthetic has been reported earlier. We present a case report of poliomyelitis patient with fracture femur (left) with thoracolumbar kyphoscoliosis posted for open reduction internal fixation. Anesthesia planned in this patient was subarachnoid block with modified paramedian approach which resulted in unilateral sensory block. |
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Management of a case of ankylosing spondylitis for percutaneous nephrolithotomy in prone position under combined spinal epidural anesthesia |
p. 765 |
Preeti Rustagi, Geeta A Patkar, Bharati A Tendolkar DOI:10.4103/0975-2870.194228 Management of a case of ankylosing spondylitis (AS) can be very challenging where airway and central neuraxial blockade, both are difficult. Surgical positioning under anesthesia in these patients is also demanding due to risk of iatrogenic fractures and spinal cord trauma. We present a case of AS for percutaneous nephrolithotomy in prone position performed under combined spinal epidural anesthesia successfully. Regional anesthesia gave us the advantage of having an awake patient who could maintain his head and neck posture thereby minimizing the risk of any neurological deterioration while positioning.
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A case of uncorrected adult tetralogy of Fallot for emergency decompressive craniotomy: An anesthetic challenge!! |
p. 768 |
Amruta Vinod Hippalgaonkar, Sanjay S Yadav DOI:10.4103/0975-2870.194230 Cyanotic heart disease (CHD) includes those anatomical heart defects that produce a limitation in pulmonary blood flow or result in mixing of oxygenated and deoxygenated blood. Both conditions lead to decreased blood oxygen content and cyanosis. The most frequent defects seen in the outpatient adult congenital setting include tetralogy of Fallot (TOF). The cardiovascular anatomy and physiology of adult CHD is complex and requires specific knowledge of the defect and its anesthetic implications. Hence, they should receive care with multidisciplinary collaboration among anesthesiologists, cardiologists, surgeons, and intensivists. We hereby report the anesthetic management of such a case of head injury in an adult uncorrected TOF with a good outcome. |
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LETTERS TO THE EDITOR |
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Megaloblastic anemia: Clinical spectrum and hematological profile |
p. 771 |
Anirban Mandal, Puneet Kaur Sahi DOI:10.4103/0975-2870.194231 |
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Antenatal care: Attitude and practices |
p. 772 |
Manas Pratim Roy DOI:10.4103/0975-2870.194233 |
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The most common bacterial infections in HIV-infected patients |
p. 773 |
Seyed Hossein Shahcheraghi, Jamshid Ayatollahi, Mohammad Dehghan Niri, Azam Fazilati DOI:10.4103/0975-2870.194234 |
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Addressing the issue of shortage of oral cholera vaccines on the global front |
p. 774 |
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava, Jegadeesh Ramasamy DOI:10.4103/0975-2870.194236 |
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BOOK REVIEW |
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Essentials of Biostatistics |
p. 776 |
Amitav Banerjee DOI:10.4103/0975-2870.194237 |
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