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  Citation statistics : Table of Contents
   2015| March-April  | Volume 8 | Issue 2  
    Online since March 13, 2015

 
 
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ORIGINAL ARTICLES
Job satisfaction among hospital staff working in a Government teaching hospital of India
Poonam Jaiswal, AK Gadpayle, Ashok K Singhal, Sandeep Sachdeva, Rajesh Kumar Modi, Rabindra Padaria, V Ravi
March-April 2015, 8(2):131-137
DOI:10.4103/0975-2870.153136  
Background: In a resource-limited and high burden disease setting, satisfied human resource is an asset in terms of high productivity, efficiency and quality care. Aim: To assess job satisfaction among permanent employees working in a government hospital. Materials and Methods: A sample of 200 staff members was interviewed using 34-item, Likert response based, modified job satisfaction scale. Key factors for job satisfaction were identified after subjecting data to principal component analysis, varimax rotation and multivariate analysis using step-wise regression procedure. Results: The mean job satisfaction index was computed to be in a similar range, but was found to be highest for nurses (0.68), followed by doctors (0.66), support staff (0.63) and technicians (0.62). Nine uncorrelated and critical factors related to job satisfaction that explained 68.09% of the variability was identified, that is, communication, pay/salary, working conditions, organization supervision system, co-workers, workload, benefits, career aspects and rewards. A positive association was reported between job satisfaction score and factor scores (units) of communication (0.133), benefits (0.110), working condition (0.027) and co-workers (0.032) and a negative relation with organizational supervision system (0.118), workload (0.093), rewards (0.035), pay/salary (0.034) and career prospects (0.017) respectively for all categories of respondents. However in case of doctors, co-workers (0.023 units) showed a negative relation. Conclusion: There is scope for interventions to enhance job satisfaction and concomitant continuous monitoring can be useful in determining various service aspects that necessitate improvement. By enhancing job satisfaction, hospital administrator can improve not only the mental, psychological and social well-being of work-force, but also the financial health of an organization.
  8 13,787 1,145
CASE REPORTS
Desmoplastic fibroma of mandible
Yadavalli Guruprasad, Dinesh Singh Chauhan
March-April 2015, 8(2):254-257
DOI:10.4103/0975-2870.153180  
Desmoplastic fibroma is a rare benign intraosseous tumor with locally aggressive behavior. The mandible is the most frequent site of involvement. It causes bone destruction with a tendency to invade the soft-tissues if untreated. It has a high propensity for local recurrence if treated inadequately. We report a case of desmoplastic fibroma of the mandible treated with a wide margin of excision.
  3 8,812 423
Perforated duodenal ulcer in a child: An unusual complication of malaria
Neeraj K Dewanda, Manojit Midya
March-April 2015, 8(2):261-263
DOI:10.4103/0975-2870.153182  
Gastrointestinal symptoms such as dyspepsia, vomiting, diarrhea, hepatitis, gastrointestinal bleed, abdominal pain, subacute intestinal obstruction like presentation and acute abdomen are common in acute malaria. However, perforated duodenal ulcer (PDU) complicating acute malaria in a child is a rare occurrence and uncommonly heard of. The exact mechanism of duodenal ulcer perforation in malaria is not clear due to the paucity of reported cases, and it may be multifactorial in etiology. The treatment of PDU in children is similar to adults that is surgical by omental patch repair of the perforation. We present an unusual case of PDU in a pediatric patient of malaria. The search of English literature revealed only one more reported case of PDU associated with malaria.
  3 4,515 231
ORIGINAL ARTICLES
Teething myths among nursing mothers in North-Western Nigeria
Ibrahim Aliyu, Ashimi Adewale, Lawal O Teslim
March-April 2015, 8(2):144-148
DOI:10.4103/0975-2870.153139  
Background: Teething has over the years been associated with complains of systemic symptoms from parents, and at times are over treated by health-care professionals. This study seeks to determine common teething complaints reported by nursing mothers. Materials and Methods: This study was multicenter involving 224 nursing mothers. It was cross-sectional and questionnaire-based relevant information collected were: The socio demographic characteristics, knowledge of teething and myths associated with teething, and the attitude of nursing mothers toward the use of teething remedies. Results: Two hundred and three (90.62%) of them believed teething caused symptoms; common complaints that were attributed to teething by mothers were diarrhea, vomiting, increased salivation; however, fever was the predominant complaint, and their parents were the most common source of information on teething in 50% of them, while only a mother (0.4%) was informed on the process of teething at the hospital. Furthermore, the number of children did not affect the desire to seek for medical care for teething symptoms. Common remedies used were as follows: 59 (26.3%) nursing mothers used teething syrup, 43 (19.2%) nursing mothers used teething powder, 16 (7.2%) of them used traditional herbs while 8(3.6%) of them used multiple preparations; however 91 (40.6%) of them did not use any remedy. One hundred and seven (47.8%) of the mothers believed that these remedies worked, 67 (29.9%) of them disagreed while 50 (22.3%) were not sure of their efficacy. Conclusion: Parents should be educated on normal expectations of the teething process; and not to undermine the seriousness of illnesses erroneously attributed to teething.
  3 5,644 368
Clinical and histopathological profile of lesions of umbilicus
Vandana Laxmidhar Gaopande, Sanjay D Deshmukh, Siddhi Gaurish S Khandeparkar, Monica Anil Suryavanshi, Vinod R Patil
March-April 2015, 8(2):179-181
DOI:10.4103/0975-2870.153152  
Background: Although lesions of umbilicus are encountered in clinical practice on a regular basis, surgical intervention is rarely required for them. Umbilical tissues are uncommonly received for histopathology. They formed 0.18% of the total specimens received. Aims: To study the clinical and histopathological characteristics of umbilical lesions received in the Surgical Pathology Department of a tertiary care hospital. Materials and Methods: This is a 2-year retrospective study. Records of the cases were reviewed and the histopathology slides were reassessed. Results: A total of 15 cases were found between the age range of 9 months and 45 years, with a male preponderance. Complaints of umbilical discharge/wet umbilicus and umbilical mass were the most common. In four cases, the umbilical lesion was associated with underlying congenital anomaly. Umbilical sinus (four cases) and umbilical granuloma (three cases) were the most common histopathological diagnosis. Two of the sinuses were pilonidal sinuses, which are rare lesions in this location. Conclusion: Umbilical mass or discharge associated with abdominal symptoms requires careful evaluation for congenital anomalies. Pilonidal sinus should be considered in a young hirsute patient with wet umbilicus.
  3 17,054 604
Electrocardiographic changes in patients with acute pancreatitis
Selcuk Yaylaci, Ibrahim Kocayigit, Ahmet Bilal Genc, Mehmet Akif Cakar, Ali Tamer, Mustafa Ihsan Uslan
March-April 2015, 8(2):196-198
DOI:10.4103/0975-2870.153159  
Background and Aims: Multiple organ system dysfunctions especially cardiovascular manifestations are frequently seen in severe acute pancreatitis (AP). The aim of this study was to investigate the frequency and type of electrocardiographic (ECG) abnormalities present in patients with AP. Materials and Methods: Patients with AP admitted to our hospital, the National Tertiary Referral Center, from January 2009 to December 2010 were included in the study. The diagnosis of AP was made by acute abdominal pain and tenderness, elevated serum enzymes and typical findings detected by abdominal ultrasonography and/or contrast-enhanced computed tomography. A 12-lead derivation ECG was recorded, and serum electrolytes were performed on admission in all cases. ECG abnormalities were recorded. ECG findings were summarized in terms of frequencies, means, and standard deviations. Results: A total of 64 AP cases 19 males (29, 7%), 45 females (70, 3%) were included into the study. Among patients included in the study, 42 (65.7%) were biliary, 20 (31.2%) were idiopathic, and 2 (3.1%) were drug-related. There were 42 (65.6%) patients with one or more serum electrolyte disturbances. 56.3% of the patients with AP had normal sinus rhythm, 43.7% had changes in ECG; and the T-wave negativity was the most frequent ECG abnormality. Twenty-five (89.2%) of the 28 patients with ECG abnormalities had one or more electrolyte abnormalities. Conclusion: The study results suggested that ECG changes may be observed frequently in patients with AP, and more attention should be paid to the cardiac patients with electrolyte imbalance.
  3 5,507 342
CASE REPORTS
An incidental ovarian mass: A case of ovarian hemangioma with prominent stromal luteinization
Babak Shirazi, Mohammad Hossein Anbardar, Negar Azarpira, Minoo Robati
March-April 2015, 8(2):227-230
DOI:10.4103/0975-2870.153172  
Ovarian hemangioma is a rare benign tumor of female genital tract. Stromal luteinization in ovarian hemangioma is an uncommon process and the pathogenesis is controversial. In this regard, two hypotheses have been suggested whether luteinization is a reactive process or it is the stimulator for development of ovarian hemangioma. Here, we report a case of a 55-year-old woman who referred to our center due to incidental finding of left ovarian mass in pelvic sonography. Microscopically, the mass showed a mixed cavernous and capillary hemangioma and the peripheral stroma contained several small and large clusters of stromal cells, which were luteinized. It should be noted that an ovarian hemangioma could be associated with stromal luteinization although its pathogenesis is not clearly known. Yet, we believe the stromal luteinization around ovarian hemangioma could be a reactive phenomenon.
  2 6,084 362
ORIGINAL ARTICLES
A comparative study of fasting, postprandial blood glucose and glycated hemoglobin for diagnosing diabetes mellitus in staff members of MMIMSR, Mullana, Ambala
Qazi Najeeb, Jasbir Singh, Rajesh Pandey, Ruhi Mahajan
March-April 2015, 8(2):158-164
DOI:10.4103/0975-2870.153145  
Introduction: For decades, the diagnosis of diabetes mellitus was based on blood glucose criteria, either the fasting blood glucose (FBG) or a 2-h value in the 75-g oral glucose tolerance test. In 2009, an International Expert Committee that included representatives of the American Diabetes Association (ADA), International Diabetes Federation and European Association for the Study of Diabetes recommended the use of the HbA1c test to diagnose diabetes with a threshold of ≥6.5% and this criterion was finally adopted by ADA in 2010. Hence, the study was undertaken to evaluate the predictive efficacy of glycated hemoglobin as a diagnostic tool for diabetes mellitus and to identify individuals at risk of developing diabetes mellitus using Indian Diabetes Risk Score (IDRS). Materials and Methods: This cross-sectional study was conducted on the staff members of the Maharishi Markandeshwar Institute of Medical Science and Research, Mullana, Ambala, Haryana, India. Out of the total 800 staff members, 200 staff members were included in the study (88 faculty members, 37 staff nurses, 12 laboratory technicians, 25 clerical staff, 38 class IV) selected by systemic random sampling. Every fifth member on the list was included in the sample. After obtaining the data, it was coded and analyzed using multivariate logistic regression analysis. Receiver operating characteristics curve analysis was used to predict the sensitivity, specificity, positivity, negativity and overall accuracy of a diagnostic test. A two-tailed test P < 0.05 was considered as statistically significant. Data was analyzed using SPSS 20 (IBM, Chicago, USA). Results: Out of 200 subjects, 19.5% were labeled diabetic using FBG, 23% by postprandial blood glucose (PPBG) and 38.5% by using glycated hemoglobin according to ADA guidelines. A total of 62% had high-risk score out of which majority belonged to group-I (faculty) followed by group-II (nursing staff) and group-IV (clerical staff). With the advancement of age in each gender, IDRS also increased significantly. FBG, PPBG and glycated hemoglobin had sensitivity of 51.1%, 50%, 82.2%; specificity of 89.6%, 89.7%, 74.8%; positive predictive value of 58.9%, 48.8%, 48.6%; and negative predictive value of 86.3%, 85.8%, 93.5%, respectively. FBG and PPBG were better correlated with glycated hemoglobin in males when compared to females. Correlation coefficient between FBG and glycated hemoglobin was stronger than PPBG and glycated hemoglobin. IDRS value ≥60 had optimum sensitivity of 65% and specificity 62.5% for determining diabetes. Conclusion: Combination of FBG and glycated hemoglobin as biochemical parameters for diagnosing diabetes mellitus was better when compared to FBG and PPBG so both can be taken as screening/diagnosing parameters. Glycated hemoglobin may be a useful measure for diagnosing diabetes and supports a possible cut-off point ≥6.5% that is in line with current recommendations.
  2 7,949 488
CASE REPORTS
Multidrug-resistant tuberculosis in children and response to therapy
Ira Shah
March-April 2015, 8(2):199-202
DOI:10.4103/0975-2870.153160  
There is very little information available on drug-resistant (DR) tuberculosis (TB) in children in Indian scenario and especially their response to therapy. We present a series of children who were suffering from multidrug-resistant-TB and their response to therapy.
  1 3,466 254
Foreign body in the knee with no history of trauma
Jesudoss Prabhakaran, Amutha , Justin Prashanth
March-April 2015, 8(2):258-260
DOI:10.4103/0975-2870.153181  
Foreign bodies in the knee joint are not uncommon. We report a case of sewing needle that migrated and embedded inside the knee with no history of trauma. Searching for any small foreign body in the knee joint is not easy in either open or arthroscopic procedures. In this case, the surgery was made by open method avoiding arthroscopy due to technical reasons. We emphasize careful history taking, clinical examination and, preferably, an open procedure for migrating tiny foreign bodies to facilitate accurate diagnosis, superior visualization and easier instrumentation to remove embedded foreign bodies in the knee.
  1 9,079 223
A rare cause of pancytopenia: Sheehan's syndrome
Mustafa Volkan Demir, Selçuk Yaylaci, Tuba Öztürk Demir, Tayfun Temiz, Ahmet Bilal Genç
March-April 2015, 8(2):265-266
DOI:10.4103/0975-2870.153184  
Sheehan's syndrome is characterized by varying degrees of anterior pituitary dysfunction due to postpartum ischemic necrosis of the pituitary gland after massive bleeding. Pancytopenia is rarely observed in patients with Sheehan's syndrome. We present a patient of Sheehan's syndrome presenting with pancytopenia. Complete recovery of pancytopenia was observed after the treatment. Clinicians should consider the possibility of hypopituitarism as a cause of pancytopenia and indicate a series of hormonal examinations. A high index of suspicion is required in women with pancytopenia for possible treatable cause like Sheehan's syndrome.
  1 4,513 256
Quadrigeminal cistern lipoma: A rare case report with review of literature
Dhaval K Thakkar, Abhijit Patil, Dolly Thakkar, Mansi N Jantre, Vilasrao M Kulkarni, Amarjit Singh
March-April 2015, 8(2):267-270
DOI:10.4103/0975-2870.153185  
Two cases, one of a 6-old-year male and another of 18-year-old female with an intracranial lipoma of quadrigeminal region is reported. Intracranial lipomas usually occur in midline areas and are extremely uncommon with an incidence of 0.1% of all intracranial tumors. These were incidentally detected by computed tomography (CT) or by autopsy. Autopsy incidence of intracranial lipoma is 0.08-0.46%, while incidence of CT findings is not >0.03-0.06%. CT and magnetic resonance imaging (MRI) examination usually lead to the diagnosis, because of the very low attenuation values of lipomas on CT and the short T1 and T2 on magnetic resonance. We describe the findings of imaging studies, including CT, MRI along with a brief review of the literature.
  1 15,780 522
GUEST EDITORIAL
Job satisfaction of hospital staff: An emerging challenge
Suprakash Chaudhury
March-April 2015, 8(2):129-130
DOI:10.4103/0975-2870.153135  
  1 7,468 548
ORIGINAL ARTICLES
Primary extranodal lymphomas - spectrum of distribution and morphology with immunophenotyping: A 3-year institutional study
Chinnam Aparna, Inuganti Venkata Renuka, Muthyala Rajani, Garikapati Sailabala, Parvatala Annapurna
March-April 2015, 8(2):138-143
DOI:10.4103/0975-2870.153137  
Background: Malignant lymphomas arising in extranodal sites are intriguing. The histological types of lymphomas vary from one site to another. This study is undertaken to diagnose and categorize extranodal lymphomas using histochemistry and immunohistochemistry (IHC). Materials and Methods: Formalin processed paraffin blocks and hematoxylin and eosin stained sections were used for routine histology. IHC was done in all cases. Results: We have encountered 31 cases of extra nodal lymphomas over a period of 3 years. The tumors occurred at different sites, including brain, nasopharynx, nose, gastrointestinal tract, thyroid, bone, testis, breast, lung, vagina, and skin. Majority of the cases were B-cell lymphomas, while four cases were T-cell lymphomas. Among the B-cell lymphomas diffuse large B-cell lymphoma was the most common variant. Conclusion: This study reiterates the key role of IHC particularly when the differential diagnosis includes an undifferentiated epithelial malignancy and a high-grade lymphoma in the extranodal sites as the treatment modalities and prognosis are different.
  1 4,706 328
Gender equality in primary immunisation
Deepak S Khismatrao, Smita S Valekar, Samir A Singru
March-April 2015, 8(2):169-174
DOI:10.4103/0975-2870.153149  
Context: Immunization, a well-known and effective method of preventing childhood illnesses is basic service under primary health care. Most surveys in India measure primary immunization coverage and quality, but no "Gender Equality." Aims: Assess "Gender Equality" in primary immunization with reference to coverage, quality, and place of immunization. Settings and Design: Cross-sectional survey in a primary health center, Pune, Maharashtra using World Health Organization 30-cluster sampling method with 14 beneficiaries (7 girls and 7 boys) to be selected from each cluster. Instead of 420 children, data collected for 345 children, as requisite numbers of children were not available in low population villages and also children whose mothers were not present during survey were excluded. Materials and Methods: Vaccination data collected from either records and/or history by mother. Children born on or between 13-09-2009 and 13-09-2010, were included. Statistical Analysis Used: SPSS 14.01 version with Chi-square as test of significance. Results: Of the study population, 171 (49.6%) were females and 174 (50.4%) males. A total of 64.1% children had immunization records with female proportion 69.0% and males 59.2%. Primary immunization coverage was 80.0%, with female proportion 82.5% and males 77.6%. One male child was completely unimmunized and remaining partially immunized, with unaware of schedule and illness of child being major reasons for partial immunization. There was no gender wise statistically significant difference observed in Primary Immunization with reference to coverage, quality, and place of immunization. Conclusions: Immunization coverage is nearing 85% benchmark with major contribution from Universal Immunization Program. Gender Equality observed in primary immunization. Preservation of immunization records by community and timely vaccinations are areas for improvement.
  1 7,741 261
Prevalence and covariates of adult hypertension: A community-based cross-sectional study in the rural areas of Nagpur
Sanjay Kumar, Deepanjan Ray, Pushpa Moreshwar Durge, Samim Ferdows, Gautam Ghose
March-April 2015, 8(2):153-157
DOI:10.4103/0975-2870.153142  
Introduction: Hypertension is an iceberg disease. A few hypertensive patients are actually aware of their status and only half of them are actually treated. It is a silent killer disease and hypertensive people die prematurely. A wide disparity exists between the prevalence of hypertension in developed and developing regions. Materials and Methods: A cross-sectional community-based study involving 574 adult people from the rural community in Nagpur was selected through systematic random sampling from December 2008 to April 2009. Blood pressure was measured with a sphygmomanometer properly standardized and anthropometry was performed. Data were analyzed with SPSS statistical software (version 19.0). Results: The prevalence of hypertension was 20.38%, and the prevalence was higher among males. Age and weight were significant covariates for hypertension. Conclusion: In the present study, it is revealed that as the age advances, the prevalence of hypertension also increases. This was statistically significant. Hypertension was more prevalent in males than in females.
  1 3,758 248
CASE REPORTS
Ambras syndrome
Sudhir Malwade, Mohit Gupta, Sharad R Agarkhedkar
March-April 2015, 8(2):271-273
DOI:10.4103/0975-2870.153186  
Ambras syndrome, a form of congenital hypertrichosis lanuginosa, is extremely rare in neonates. It is characterized by typical pattern of hair distribution, dysmorphic facial features and a familial pattern of inheritance. We report a case of Ambras syndrome in a preterm neonate with history of consanguinity and positive family history.
  - 7,307 296
Chronic tendoachilles rupture
Rahul R Bagul, Tushar Agarwal, Mahendra Bendale, Tarun Kukreja
March-April 2015, 8(2):203-205
DOI:10.4103/0975-2870.153162  
We report two cases of chronic tendoachilles (TA) rupture, which was treated with V-Y plasty and turned down flap from the proximal segment to cover the defect. Chronic TA ruptures can be challenging to treat. A number of operations have been described for the repair and augmentation of the chronic TA rupture.
  - 4,272 218
Role of imaging in Mayer-Rokitansky-Kuster-Hauser syndrome
Sanjay M Khaladkar, Rajesh Kuber, Dhaval K Thakkar, Anubhav Kamal, VM Kulkarni
March-April 2015, 8(2):206-209
DOI:10.4103/0975-2870.153164  
Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome is characterized by congenital absence of the uterus and upper 2/3 rd of vagina with a normal 46, XX karyotype and normally developed secondary sexual characteristics. It affects 1:4000 women. It may be isolated (Type I) or frequently associated with renal, vertebral anomalies and less frequently associated with auditory, cardiac defects (Type II). It presents with primary amenorrhea in young women with normal external genitalia and normal development of secondary sexual characteristics with normal functioning ovaries and karyotype 46, XX without visible chromosomal anomaly. It was considered as sporadic anomaly but an increasing number of familial cases is suggestive of genetic cause in whom it is transmitted as autosomal dominant trait with incomplete penetrance and variable expressibility. This is suggestive of involvement of mutation in a major development gene or a limited chromosomal imbalance. Etiology of MRKH syndrome is still unclear. In order to allow sexual intercourse, treatment is aimed at creation of neovagina. Patients and their families must attend counseling before and throughout treatment as psychological distress is very important in young women with MRKH. We hereby report a rare case of MRKH syndrome in a 19-year-old married female patient presenting with primary amenorrhea, coital difficulty and no other clinical disorder.
  - 7,177 301
Bilateral proptosis as a rare manifestation of neurocysticercosis
Akhilesh K Singh, Prabhat K Agrwal, Juned Ahmad, Ashish Gautam
March-April 2015, 8(2):210-212
DOI:10.4103/0975-2870.153165  
Cysticercosis is the most common parasitic disease of the central nervous system. Although seizure is the most common presenting feature, the presentation depends upon the location of the cysts. The other sites of involvement of cysticerci are soft tissue and eye. Unusual location of the cysts may result in uncommon manifestations. Ocular cysticercosis can involve both the intraocular and extra ocular muscle. Extra ocular muscle cysticercosis is rare. Cysticercosis rarely presents as proptosis. Orbital cysticercosis presents with limitations of ocular motility in 75% of patients. We report a case of disseminated cysticercosis presenting as bilateral proptosis.
  - 3,406 209
Primary cerebral hydatid cyst in a child
Srikanth Shastry, Gadda Anandam, B Swapna Kumari, K Sreelatha
March-April 2015, 8(2):214-216
DOI:10.4103/0975-2870.153168  
Cerebral hydatid disease is very rare, representing only 2% of all cerebral space occupying lesions even in the countries where the disease is endemic. Echinococcal cysts are usually found in the liver and lungs, but can affect any part of the body. Differential diagnosis of hydatid disease should be considered for every cystic mass in any anatomical location, especially in areas where the disease is endemic. Hydatid disease has a worldwide distribution and causes health problems in endemic countries. Here, we are presenting a case of cerebral hydatid cyst in a 7-year-old female child. The main aim of this case is to highlight the rarity of this location and that hydatid cysts must be considered as differential diagnosis in patients with cystic lesions of brain, especially in endemic areas.
  - 2,479 185
A case report of adenoid cystic carcinoma of lacrimal gland
Rajeshwari S Vhora, Sanjay S Vhora, Anand D Katkar, Prajakta S Ghate, Vishwanath B Kamatagi
March-April 2015, 8(2):217-219
DOI:10.4103/0975-2870.153169  
Adenoid cystic carcinoma (ACC) is a rare malignant tumor that can exist in many different body sites. It is most commonly found in the areas of the head and neck, (mainly salivary glands). It is also reported in the breast, lacrimal glands of the eye, lung, brain, sinuses. It is characterized by a prolonged clinical course and fatal outcome. It was first described as `cylindroma' by Billroth in 1859. The long natural history and its tendency for local recurrence is well known. Patients may survive for years with metastases because this tumor is generally well differentiated and slow growing. We report a case of ACC of lacrimal gland. They are rare malignant tumors in a patient presenting with an orbital mass. They account for 1.6% of all orbital tumors. Despite their rarity, they are the second most frequent epithelial neoplasms occurring in the lacrimal gland after pleomorphic adenomas.
  - 4,436 281
Carcinoma of the cystic duct presenting as obstructive jaundice
Sunita Arvind Bamanikar, NK Panicker, Balaji Dhaigude, Sangeeta Choudhary, Archana Buch
March-April 2015, 8(2):220-222
DOI:10.4103/0975-2870.153170  
Cystic duct carcinoma is a rare disease. We present here a case of 33-year-old female patient who presented with obstructive jaundice. An abdominal ultrasound and computed tomography scan showed dilatation of intrahepatic biliary radicals with abrupt narrowing of the common bile duct and markedly distended gall bladder suggestive of obstructive pathology. Following an exploratory laparotomy, a markedly distended gall bladder, cystic duct specimen and infrapyloric lymph nodes were sent for histopathological examination. Histopathological examination revealed a well-differentiated adenocarcinoma of the cystic duct with no lymph node metastasis.
  - 2,871 169
Bilateral ovarian primary Burkitt's lymphoma in a child: A clinico-radio-pathological evaluation
Gujarathi Aditi, Adik Harshad, Agarkhedkar Sharad, Singh Amarjeet
March-April 2015, 8(2):223-226
DOI:10.4103/0975-2870.153171  
Ovarian neoplasms are rare in children. Though ovarian involvement by malignant lymphoma is known to occur in late stages of disseminated nodal disease, primary ovarian lymphoma is a rare entity. We came across a case of a 9-year-old female who came with complaints of dull aching abdominal pain, mainly in the suprapubic region, low grade fever and abdominal distension since 20 days. Ultrasonography revealed two well-defined, mixed echogenic masses in both adnexae. Multiple well-defined mixed echogenic lesions were also seen on the surface of liver with omental thickening and nodularity. Computerized tomography as well as magnetic resonance imaging was done for further evaluation. Ultrasound guided biopsy was performed. The diagnosis of Burkitt's lymphoma involving bilateral ovaries was established after histological, immunohistochemistry, and tumor markers correlation.
  - 3,788 254
Poorly differentiated thyroid carcinoma
Sushama Guruwale, Tushar Kambale, Banyameen M Iqbal, Atul Jain
March-April 2015, 8(2):231-233
DOI:10.4103/0975-2870.153173  
Poorly differentiated thyroid carcinoma is rare and distinctive due to it's a characteristic uniform cells and sometimes insular architectural pattern. These tumors are aggressive and often lethal type of thyroid tumors often has a rapid and fatal outcome despite appropriate treatment. Here we are presenting a case of a 50 yrs old woman with anterior neck swelling more on right side since five years and increasing in size for the last three months.
  - 3,452 251
Small cell carcinoma of prostate presenting with Cushing's syndrome
Selahattin Çaliskan, Gülistan Gümrükçü, Abdurrahman Yigit
March-April 2015, 8(2):234-236
DOI:10.4103/0975-2870.153174  
Small cell carcinoma of prostate (SCPCa) was initially described by Wenk et al. in 1977. SCPCa is a very rare cancer that accounts for only 0.5-2% of all prostate carcinomas. Although, this pathology is usually accompanied with prostate adenocarcinomas, there are a few hypotheses about the origin of SCPCa. Poorly differentiated acinar adenocarcinoma must be distinguished from SCPCa in histopathological examination. These patients may present with different paraneoplastic syndromes. Early diagnosis is very important because of the aggressive tumor behavior. Here, we report a patient who presented with Cushing syndrome and thereafter diagnosed with SCPCa.
  - 620 57
Fibrous dysplasia of bone causing unilateral proptosis
Reshma Ramakrishnan, Saurabh Shrivastava, Anamika Patel, Anjaneya Agashe
March-April 2015, 8(2):237-240
DOI:10.4103/0975-2870.153175  
Fibrous dysplasia (FD) is a slow growing benign noninherited disorder in which normal bones are replaced by fibrous tissue and immature woven bones. Here we report a case of 30-year-old female who presented with unilateral proptosis and lagophthalmos without any visual loss; was diagnosed with polyostotic FD. Patient was taken up for surgery. Osseous reconturing was done by shaving of involved facial bones. Postoperatively, there was a decrease in proptosis and lagophthalmos.
  - 4,745 246
Breakage of cystoscope sheath and detachment of metallic tip, a rare cystoscope dysfunction: A report of two occasions, one with retained metallic foreign body in urinary bladder
Shreeprasad P Patankar, Abhilasha T Handu, Shilpa S Patankar
March-April 2015, 8(2):241-243
DOI:10.4103/0975-2870.153176  
We present two cases of breakage of pediatric cystoscopy sheath, one leading to retention of the broken piece in the patient's bladder and the other occurring just before commencement of the procedure. The first child required a suprapubic retrieval of the foreign body leading to increased morbidity and hospital stay. This is a rare occurrence, which has not been previously reported in pediatric surgical literature. We present these two cases with an aim to increase awareness among pediatric urologists regarding such an occurrence.
  - 3,888 182
Late onset rhabdomyolysis developing secondary to atorvastatin therapy in a coronary artery disease patient
Somak Kumar Das, Saikat Ghosh, Anand Sharma
March-April 2015, 8(2):244-246
DOI:10.4103/0975-2870.153177  
Rhabdomyolysis, a clinical syndrome in which skeletal muscle damage and necrosis, is precipitated by multi-therapy is most frequently described during statin treatment. Rhabdomyolysis is a rare, but serious side-effect that may lead to renal failure and dangerous electrolyte abnormalities in patients. We report a case of rhabdomyolysis after 5 years of atorvastatin therapy in an elderly patient, in multi-treatment for coronary artery disease.
  - 8,328 247
Silent angel: A case report on Rett syndrome
Era R Sharma, Ashish V Debsikdar, Nilesh M Naphade, Jyoti V Shetty
March-April 2015, 8(2):247-249
DOI:10.4103/0975-2870.153178  
Rett syndrome is a disorder characterized by arrested neurodevelopment due to mutation of the MECP2 gene. We present one such case of a 2.5-year-old female with no prior diagnostic intervention. History revealed normal physical and mental development for the first 6-8 months of life, followed by a pattern of deceleration across all growth measurements, especially microcephaly. Characteristic midline hand stereotypical movement along with loss of purposeful hand movements was also observed. Rett syndrome provides us with a diagnostic challenge. Awareness of this disorder is important because early identification and timely intervention can help both the patient and their families.
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Imaging findings in the right aortic arch with mirror image branching of arch vessels: An unusual cause of dysphagia
Guneet Singh, Amit Kharat, Preeti Sehrawat, Vilas Kulkarni
March-April 2015, 8(2):250-253
DOI:10.4103/0975-2870.153179  
We report a case of a 72-year-old female with a right aortic arch with mirror-image branching of arch vessels presenting with dysphagia, and characteristic images on barium esophagogram, contrast-enhanced computed tomography scan, and magnetic resonance aortography. Right-sided thoracic aortic arch with mirror-image branching of the brachiocephalic vessels causing dysphagia without associated congenital cardiac anomalies is extremely uncommon. Right-sided aortic arch is a rare congenital abnormality with incidence of 0.05-0.1% in the normal population. Anomalies of great vessels are usually incidental findings, because they are asymptomatic. Right aortic arch infrequently presents with a vascular ring that can cause complete or partial obstruction of the trachea and/or esophagus. The understanding of this arch anomaly is based on Edward's hypothesis about the double arch system during embryonic developmental.
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CLINICAL IMAGES
Transillumination test: A bedside aid for differentiating meningocele from myelomeningocele: Point of care testing
Aakash Pandita, Deepak Sharma, Sweta Shastri
March-April 2015, 8(2):276-277
DOI:10.4103/0975-2870.153189  
Transillumination test is a bedside and simple technique to illuminate the body cavity by transmission of light through the cavity. Transillumination test is used in a variety of conditions like hydrocele, Hydrocephalus, pneumoperitonium and pneumothorax in neonatology. We describe use of transillumination for differentiating meningocele and myelomeningocele.
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COMMENTARY
Peptic ulcer disease in children
Bharat Bhushan Dogra
March-April 2015, 8(2):263-264
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Neurocysticercosis and proptosis
Viroj Wiwanitkit
March-April 2015, 8(2):212-213
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EDITORIAL
Principles and practice of plagiarism: Perpetrators' perspective
Amitav Banerjee
March-April 2015, 8(2):127-128
DOI:10.4103/0975-2870.153134  
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LETTERS TO THE EDITOR
Coping with academic Anarchy: An appeal to reviewers, authors, and readers to raise the bar
M Banyameen Iqbal
March-April 2015, 8(2):274-274
DOI:10.4103/0975-2870.153187  
  - 2,442 142
The most frequent parasites in HIV-infected patients in Asia and Africa
Seyed Hossein Shahcheraghi, Jamshid Ayatollahi, Marzieh Lotfi, Mohammad Sadegh Raeeszadeh
March-April 2015, 8(2):274-275
DOI:10.4103/0975-2870.153188  
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ORIGINAL ARTICLES
A cross-sectional study to determine the pattern, health-related problems and social aspects associated with alcohol use among adults of the rural population in Pune, Maharashtra
Vijaykumar K More, Sougat Ray, Renuka Kunte, Kapil Pandya, Shilpa Katoch, Barun Bhai Patel
March-April 2015, 8(2):165-168
DOI:10.4103/0975-2870.153148  
Background: The increasing production, distribution, promotion and easy availability of alcohol have resulted in alcohol-related problems emerging as a major public health concern. It is a causal factor in more than 60 major types of diseases and injuries and results in approximately 2.5 million deaths each year. It is also a known risk factor for increasing crime, work absenteeism, loss of productivity, damage to property and physical and emotional abuse of women and children. Objectives: The aim was to find out the pattern, health related problems and social aspects associated with alcohol use among adults of a rural population of Pune, Maharashtra. Materials and Methods: A cross-sectional study was carried out in a rural field practice area of the Medical College in Pune among 300 respondents during January 12 and February 12. Pretested WHO designed alcohol survey questionnaire was used for collecting data by interview after obtaining informed consent. Results: Out of 300 respondents 45.7% (137) were found to be alcohol-user. Among these 35.77% were "daily drinkers.' The most common alcoholic drink consumed was desi (country) liquor (33.5%). Daily drinking was found to be related to adverse health related events. Poor health status, deprivation of family, increasing occurrence of unintentional and intentional injury, the greater extent of health problems were significantly higher among users. Conclusion: Alcohol consumption was high among adults in rural population. The study has also revealed negative impact of alcohol on both, user and their family.
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Comparison of dyslipidemia among the normal-BMI and high-BMI group of people of rural Tamil Nadu
Seetharaman Ranganathan, Tuman US Krishnan, Shankar Radhakrishnan
March-April 2015, 8(2):149-152
Background: Overweight and obesity are considered major epidemic health problems in both developed and underdeveloped countries, as many studies showed a remarkable rise. One of the causes of dyslipidemia is obesity. Body mass index (BMI) correlates reasonably well with laboratory-based measures of adiposity for population studies, and is extremely practical in most clinical settings. Aim: The aim of the study is to evaluate the lipid profile of patients with normal BMI and high BMI. Materials and Methods: A cross-sectional study of 400 subjects attended the medical outpatient department (OPD) of a private medical college hospital at Salem from March 2010 to August 2011. The subjects were divided into two groups (200 in each group): (1) high BMI (BMI 25 and above) and (2) normal BMI (BMI less than 25). The laboratory parameters; cholesterol (TC), low-density lipoprotein (LDL), high-density lipoprotein (HDL) and triglyceride (TG) were determined directly by using an automated chemistry analyzer. Statistical Analysis: The Student's t-test was used for comparison between categorical variables, i.e. lipid profile, high-BMI and normal-BMI subjects at P ≤0.05. Results: The total cholesterol, LDL and very LDL cholesterol and the TGs are found to be relatively high among the subjects with high BMI when compared with normal BMI persons, and this difference was found to be statistically significant (P < 0.05), whereas HDL cholesterol had not shown any significant difference between the two groups (P > 0.05). Conclusion: By analyzing the results of the study conducted, it was concluded that there was an increased risk of dyslipidemia among the high-BMI group compared with the normal-BMI people. Hence, a community-based education in this regard is of utmost importance.
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Single center experience of primary hypospadias repair
Vilas P Sabale, Vikram Satav, Bhupender Kadyan, Sharad P Kankalia, Deepak Mane, Abhirudra Mulay, Parag Bhirud, Rohit Singh
March-April 2015, 8(2):175-178
DOI:10.4103/0975-2870.153150  
Introduction: Hypospadias is a complex congenital deformity which requires meticulous surgical technique. Several techniques have been advocated during the past 150 years to address chordee and construction of neourethra. This study highlights the surgical techniques and experience with primary hypospadias cases. Materials and Methods: A total of 65 patients aged ranges from 1 to 18 years underwent primary hypospadias repair at our center from August 2007 to December 2012. Exclusion criteria - previous surgical attempt or with incomplete follow-up. Patients with inadequate phallic size and age <12 years were administered injection testosterone (Testoviron) prior to the surgery. Patients with significant chordee underwent chordee correction followed by urethral reconstruction by either tubularized incised plate (TIP) or on-lay flap repair/dartos flap repair. In all the patients, infant feeding tube was kept per urethrally for 3 weeks and was removed between the post-operative day 18 th and 21 st day. Results: Out of 65 patients, 24 patients underwent TIP. A total of 41 patients underwent on-lay flap repair; of this six patients of midscrotal/perineal hypospadias underwent a combination of paraurethral skin and on-lay flap repair. Chordee correction was done in all the five cases of chordee without hypospadias (congenital short urethra) and dysplastic, transparent urethra repaired with on-lay flap repair. In our study, complications like flap necrosis and fistula were seen in 10 cases and other minor complications like superficial epidermal sloughing were seen in 13 cases which healed with epithelialization. Meatal stenosis was more commonly observed with TIP (four cases) and in two cases of on-lay repair. Conclusion: Historically, hypospadias surgery was regarded as non-rewarding surgical reconstruction due to higher complication and failure rates. For hypospadias, if planned properly, primary single stage repair; acceptable surgical success is an achievable target.
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A comparison between nitroprusside and nitroglycerine for hypotensive anesthesia in ear, nose, and throat surgeries: A double-blind randomized study
Abhishek Mishra, Raj Bahadur Singh, Sanjay Choubey, Rajni K Tripathi, Arindam Sarkar
March-April 2015, 8(2):182-188
DOI:10.4103/0975-2870.153153  
Context: Blood obscures the operative field and makes precise technique difficult, and to the anesthetist, when the volume of blood lost is large. Practice of induced hypotension in the otolaryngology is a common practice owing to its benefits in providing a better visibility and preventing blood loss. Aims: The aim was to compare controlled induced hypotension for facilitating surgical exposure, and reducing intraoperative blood loss using sodium nitroprusside and nitroglycerin in ear, nose, and throat surgeries under general anesthesia. Settings and Design: A prospective, randomized, double-blind study. Materials and Methods: The study was carried out in 60 adults, American Society of Anesthesiologists grade I and II patients, allocated randomly in to three groups: group A was control group, group B patients received nitroprusside (0.5-10 μg/kg/min) and group C patients received nitroglycerine (1-10 μg/kg/min). Mean arterial pressure was maintained in the range of 50-60 mmHg. Statistical Analysis Used: Statistical Package for Social Sciences version 17.0 (ANOVA) followed by independent samples t-test and Chi-square test. Results: The results of the present study indicate that the use of controlled hypotension provides a better surgical field and reduces the blood loss. Of the two modalities under question, use of sodium nitroprusside gives the desired results in a significantly, shorter time as compared to nitroglycerin; however, the use of sodium nitroprusside must be carried out with caution as it has toxic effects. Conclusions: (1) The achievement of target level was quicker in sodium nitroprusside group as compared to nitroglycerin group. (2) Reflex tachycardia was the main side effect of the nitroglycerin group. (3) Rebound hypertension was the associated side effect of the sodium nitroprusside group.
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Rapid magnetic resonance imaging protocol for detecting femoral head avascular necrosis: A case series-it's utility in the general population in developing countries
M Sanjay Khaladkar, Shubreet Randhawa, Guneet Singh, Gujarathi Aditi, Kuber Rajesh, Sidhu Rajeshwar
March-April 2015, 8(2):189-195
DOI:10.4103/0975-2870.153156  
Introduction: Osteonecrosis of the femoral head is an increasing cause of musculoskeletal disability, common among the younger population, between the third and fifth decade of life, affecting mainly men, thereby requiring prompt diagnosis and early intervention. Aims and Objectives: The aim was to formulate a limited magnetic resonance imaging (MRI) examination protocol for detection of avascular necrosis (AVN) in clinically suspected cases that can be performed rapidly and will be inexpensive. Materials and Methods: Forty-five patients suspected clinically and or on conventional radiography for AVN of the femoral head were referred for MRI hip. MRI hip was done on 1.5 T Siemens Avanto. Of 45, 36 were detected to have AVN (total 58 hips), whereas 9 did not have AVN on MRI. Initially, coronal T1-weighted image (T1WI) sequence was obtained as limited MRI protocol, followed by complete MRI examination. Results: Maximum patients belonged to age group 31-40 (30.5%). 32 (88.88%) patients were males and 4 (11.11%) were females. Bilateral AVN was detected in 44 (61.1%) and unilateral in 14 patients (38.8%). Pre collapsed stage (Stages I and II) was detected in 18 hips (31.03%), collapsed stage (Stages III and IV) was detected in 40 hips (68.9%). Peripheral low-intensity rim was seen on T1WI in all 58 cases of AVN. Double line sign on T2-weighted image was seen in 33/58 (56.8%). Conclusion: Our study concluded that coronal T1W sequence is an easy, rapid and cost-effective method of detecting unilateral or bilateral AVN.
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