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CASE REPORT
Gayathri P Mashar, Navya Shree, Yeshaswini Katari, Hiremathada Sahajananda, Seema J Mahabaleshwarappaa

Ultrasound-guided Quadratus Lumborum Block as Postoperative Analgesic Technique for Radical Prostatectomy

[Year:2018] [Month:January-March] [Volumn:4 ] [Number:1] [Pages:30] [Pages No:17-19][No of Hits : 559]


Abstract

Postoperative pain after radical retropubic prostatectomy can be severe unless adequately treated, with potential implications for the quality of recovery and length of hospital stay. Ultrasonography-guided quadrates lumborum block (QLB) involves the injection of local anaesthetic solution adjacent to the anterolateral aspect of the quadrates lumborum muscle. QLB is used for postoperative pain relief in abdominal surgeries. We report here a case of 65yr old male with adenocarcinoma of the prostate gland. He underwent radical retropubic prostatectomy under General anaesthesia with QLB. Post operative analgesia was optimal.

Keywords: Postoperative analgesia, Quadratus lumborum block, Radical retropubic prostatectomy.

How to cite this article: Mashar GP, Shree N, Katari Y, Sahajananda H, Mahabaleshwarappaa SJ. Ultrasound-guided Quadratus Lumborum Block as Postoperative Analgesic Technique for Radical Prostatectomy. J Med Sci 2018;4(1):17-19.

Source of support: Nil

Conflict of interest: None


 
BRIEF COMMUNICATION
R Nagarathnamma, Thingujam James, Nagendra Prasad

Pregnancy Outcome in Uterine Anomalies

[Year:2017] [Month:January-March] [Volumn:3 ] [Number:1] [Pages:33] [Pages No:31-33][No of Hits : 1460]


ABSTRACT

Maternal with congenitial anomalies are known to have higher incidence of infertility, intrauterine growth restriction, fetal malposition, preterm labor, preterm premature rupture of membrane and increased cesaerean section rate.

Study Design: This is retrospective study, the pregnancies with uterine anomaly confirmed by ultrasound between Jan 2016 to jan 2017 at our hospital was taken and its outcome is observed.

Reults: The majority of preterm delivery in our study are mainly associated with septate and bicornuate uterus. Cesaerean section comprised of 80% and its major indication is due to fetal malpresentation (breech) .Thus Pregnancy outcomes of individual depending on the type of uterine anomalies.

Keywords: Malpresentation, Preterm birth, Preterm premature rupture of the membranes, Uterine anomalies.

How to cite this article: Nagarathnamma R, James T, Prasad N. Pregnancy Outcome in Uterine Anomalies. J Med Sci 2017;3(1):31-33.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
N Bhavya, V Ajith Kumar

Study of Association between Microalbuminuria and Microvascular Complications in Type II Diabetes Mellitus Patients in RajaRajeswari Medical College and Hospital, Karnataka

[Year:2017] [Month:January-March] [Volumn:3 ] [Number:1] [Pages:33] [Pages No:6-10][No of Hits : 724]


ABSTRACT

Introduction: India is claimed to be the diabetes capital of the world. Many studies had proven that persistent hyperglycemia and associated metabolic syndrome features like hypertension, dyslipidemia, and obesity contribute to the development of vascular complications. The risk of chronic complications increases as a function of the duration of hyperglycemia; they usually become apparent in the second decade of hyperglycemia. Since type II diabetes mellitus (DM) often has a long asymptomatic period of hyperglycemia, many individuals with type II DM have complications at the time of diagnosis. The vascular complications of DM are subdivided into microvascular (retinopathy, neuropathy, nephropathy) and macrovascular (coronary artery disease, peripheral arterial disease, cerebrovascular disease) complications. The present study aims to study the occurrence of microalbuminuria in patients with type II DM and note its association with the duration of diabetes since diagnosis and microvascular complications of DM.

Study design: Prospective observational study.

Materials and methods: The study is a clinical, prospective, and observational study of 100 type II diabetics attending the medicine department outpatient/inpatient of RajaRajeswari Medical College & Hospital, Bengaluru, Karnataka, India, who form the subjects for the study conducted from August 2015 to July 2016 (12 months) and who matched the inclusion criteria.
Data were collected after obtaining informed/written consent from patient. After detailed history, detailed clinical examination, and general physical and systemic examinations, fundoscopy was carried out and relevant laboratory investigations were done.

Results and conclusion: The overall occurrence of microalbuminuria was 38%. The occurrence of microalbuminuria showed a direct relationship with increasing age (p = 0.053) and increasing duration of diabetes since diagnosis. A hemoglobin (Hb)A1c value above 7% is associated with 50% or higher incidence of microalbuminuria (p = 0.018). Patients with a body mass index of more than 25kg/m2 have increased risk of developing type II DM and significant increase in microalbuminuria. The incidence of microalbuminuria is significantly associated with the presence of retinopathy (p = 0.061), peripheral neuropathy (p = 0.009), and hypertension (p ≤ 0.001). Microalbuminuria is inversely associated with high-density lipoporotein (p = 0.089). During the evaluation of diabetic patients and the occurrence of microalbuminuria, the possibility of microalbuminuria and its correlation with various complications of DM should be kept in mind.

Keywords: Incipient diabetic nephropathy, Microalbuminuria, Type II diabetes mellitus.

How to cite this article: Bhavya N, Kumar VA. A Study of Association between Microalbuminuria and Microvascular Complications in Type II Diabetes Mellitus Patients in RajaRajeswari Medical College and Hospital, Karnataka. J Med Sci 2017;3(1):6-10.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Anita Bhosale, MV Krishna, Das Suraj, M Gautam

Study of Atherosclerotic Risk Factors in Patients with Prediabetes and Type II Diabetes Mellitus with Special Reference to Carotid Intima–media Thickness

[Year:2017] [Month:January-March] [Volumn:3 ] [Number:1] [Pages:33] [Pages No:15-19][No of Hits : 697]


ABSTRACT

Background: The present study was carried out to study various atherosclerotic risk factors in prediabetes and type II diabetes mellitus (DM) patients, with special reference to carotid artery intima-media thickness (CIMT). The mean value of CIMT as an indicator of early atherosclerosis was determined and the various atherosclerotic risk factors in patients with prediabetes and type II DM were studied.

Materials and methods: A Comparative two group study was conducted involving 50 patients each with prediabetes and type 2 diabetes mellitus in the age group of 30 to 65 years, Confirmed by FPG/2hour PG/HbA1C/Random plasma glucose values according to ADA criteria, over a period of one year. The study consisted of interview regarding demographic profiles, vascular risk factors, fundoscopy and investigation like FPG, 2hour PG with OGTT, HbA1C, lipid profile, Renal function tests, urine for microalbuminuria, ECG, 2DECHO and CIMT Measurement using B mode ultrasonography.

Results: The association between age of the patients and occurrence of type II DM and prediabetes was found to be statistically significant. Mean duration of type II DM in our study was 6.64 ± 6.71 years. 66% Diabetics and 62% Pre-Diabetics had a BMI over 23. Mean TGs levels in diabetics and Prediabetics where 268 mg/dl and 193mg/dl respectively. Mean CIMT in Diabetics and Pre-diabetics were 0.81mm and 0.67mm respectively. Incidence of hypertension in diabetics and Prediabetics were 30% and 26% respectively. CIMT had a positive association with hypertension, smoking, and a moderate significance with alcohol use.

Conclusion: The present study emphasizes on the role of CIMT measurement as a routine investigation among diabetics and pre-diabetics for early recognition of atherosclerosis and cardiovascular risk reduction.

Keywords: Body mass index, Carotid intima-media thickness, Diabetes mellitus, Fasting blood sugar, High-density lipoprotein, Impaired fasting glucose, Impaired glucose test, Low-density lipoprotein, Postprandial blood sugar, Triglycerides, Very lowdensity lipoproteins.

How to cite this article: Bhosale A, Krishna MV, Suraj D, Gautam M. Study of Atherosclerotic Risk Factors in Patients with Prediabetes and Type II Diabetes Mellitus with Special Reference to Carotid Intima-media Thickness. J Med Sci 2017;3(1):15-19.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
J Vidyashree, Mamatha B Patil

Posterior Circulation Ischemic Stroke

[Year:2017] [Month:April-June] [Volumn:3 ] [Number:2] [Pages:26] [Pages No:59-61][No of Hits : 686]


ABSTRACT

Posterior circulation stroke syndrome has a lesser incidence compared with anterior circulation stroke with an incidence rate of 10 to 15%. Males are commonly affected than females. Patients most commonly present with symptoms of dizziness, diplopia, dysarthria, dysphagia, and dystaxia. The hallmark of posterior circulation stroke is crossed hemiplegia with cranial nerve involvement on the same side of the lesion and motor or sensory involvement on the opposite side. We report a case of a 60-year-old woman who presented with vertigo, nausea, vomiting, unsteady gait, and tendency to fall on either side.

Keywords: Ischemic stroke, Posterior cerebral circulation, Vertebra-basilar system.

How to cite this article: Vidyashree J, Patil MB. Posterior Circulation Ischemic Stroke. J Med Sci 2017;3(2):59-61.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Madhuram Chowdry, KM Gopinath, BNR Kumar, TR Kanmani

Comparative Study of Efficacy between Platelet-rich Plasma vs Corticosteroid Injection in the Treatment of Lateral Epicondylitis

[Year:2017] [Month:January-March] [Volumn:3 ] [Number:1] [Pages:33] [Pages No:1-5][No of Hits : 614]


ABSTRACT

Introduction: Tennis elbow is a common condition with unpromising several modalities of treatment. Many of these are not aimed at treating the disease process. Platelet-rich plasma (PRP) contains biological healing factors and shows promising results in tendinopathies.
In this study, our aim was to evaluate the efficacy of autologous PRP vs steroid injection in the treatment of chronic recalcitrant lateral epicondylitis.

Materials and methods: A prospective randomized control trial was conducted in our tertiary care hospital. Sixty patients with chronic lateral humeral epicondylitis, not responding to oral medications, tennis elbow belt, and physiotherapy, aged between 18 and 60 years were included in the study. Patients were randomized into PRP or steroid injection group based on a computer-generated block randomization chart. All patients had a baseline assessment including visual analog pain scores, Disability assessment of Shoulder and Hand score (DASH), and Nirschl (Injury, Prevention, Cure and Care - Nirschl Pain Phase Scale of Athletic Overuse Injuries) scores, and the same was repeated at 2 weeks, 6 weeks, 3 months, and 6 months postintervention.

Results: Steroid treatment shows better outcome in shortterm (p < 0.001) and PRP shows better outcome in long-term (p < 0.001) follow-up. All three scores - visual analog score (VAS), DASH, Nirschl - showed significant linear improvement with PRP treatment, whereas with steroid injection initially there was significant improvement up to 3 months and later recurrence of symptoms. No complications were noted with PRP injection.

Conclusion: Use of autologous PRP injections for the management of lateral epicondylitis has better long-term outcomes compared with steroid injection in terms of VAS, DASH, and Nirschl scores. Also in our trial we had no recurrence of symptoms in the PRP group, whereas pain recurred in six patients in steroid group and was treated successfully with PRP.

Keywords: Disability, Lateral epicondylitis, Pain, Platelet-rich plasma, Steroid injection.

How to cite this article: Chowdry M, Gopinath KM, Kumar BNR, Kanmani TR. Comparative Study of Efficacy between Platelet-rich Plasma vs Corticosteroid Injection in the Treatment of Lateral Epicondylitis. J Med Sci 2017;3(1):1-5.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
P Sneha, C Sarojamma, R Nagarathnamma

Cardiac Disease complicating Pregnancy: A Tertiary Care Center Experience

[Year:2017] [Month:April-June] [Volumn:3 ] [Number:2] [Pages:26] [Pages No:41-44][No of Hits : 574]


ABSTRACT

Introduction: Cardiac disease in pregnancy is a major problem worldwide, particularly in developing countries. It often poses a difficult clinical scenario with the responsibility of the treating obstetrician also extending to the unborn fetus. In the present study, we aim to know the maternal and fetal outcomes in pregnancies complicated by cardiac disease.

Materials and methods: All pregnant patients with cardiac disease who delivered at our institution during 2014 to 2016 were evaluated to look for the final pregnancy outcomes.

Results: Out of 36 study cases, 44.44% had no maternal complications, while 88.89% had good fetal/neonatal outcome. The commonest maternal cardiac complication was sustained tachyarrhythmia/bradycardia followed by pulmonary edema, while intrauterine growth restriction was encountered in fetal outcome.

Conclusion: Multidisciplinary team management of cardiac disease, led by an experienced obstetrician and cardiologist, reduces the adverse outcomes in pregnancies complicated by cardiac diseases.

Keywords: Fetal outcomes, Maternal heart disease, Pregnancy outcomes.

How to cite this ar ticle: Sneha P, Sarojamma C, Nagarathnamma R. Cardiac Disease complicating Pregnancy: A Tertiary Care Center Experience. J Med Sci 2017;3(2):41-44.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
A Sreehari, BM Rupakala, C Sarojamma

Ovarian Yolk Sac Tumor: A Case Report with Review of Literature

[Year:2016] [Month:January-March] [Volumn:2 ] [Number:1] [Pages:25] [Pages No:15-17][No of Hits : 799]


ABSTRACT

A total of 3 to 5% of all ovarian malignancies include malignant ovarian germ cell tumors (MOGCTs). They are subdivided into germinomatous and non-germinomatous tumors. Common types of non-germinomatous tumors include yolk sac and immature teratoma. Ovarian yolk sac tumors (YST) are the second most frequent histological subtype of MOGCTs, after ovarian dysgerminoma. They account for 20% of MOGCTs and are frequent especially in childhood and in early adulthood. We report the case of a yolk sac tumor of the ovary in a 13yrs years old female.

Keywords: Alpha-fetoprotein, Ovarian germ cell tumors, Yolk sac tumor.

How to cite this article: Sreehari A, Rupakala BM, Sarojamma C. Ovarian Yolk Sac Tumor: A Case Report with Review of Literature. J Med Sci 2016;2(1):15-17.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
Vishnu Vardhan, Sharath Vishwaraj

A Case of Cyclopentolate Induced Psychosis

[Year:2016] [Month:April-June] [Volumn:2 ] [Number:2] [Pages:17] [Pages No:36-37][No of Hits : 564]


ABSTRACT

Cyclopentolate is the cycloplegic drug of choice in children older than 1 year. Though rare, if absorbed systematically, it is known to cause Central Anticholinergic Syndrome. Children are especially prone due to their lower body weight. Symptoms and signs in children include flushing, tachycardia, feeding intolerance, seizures, and drowsiness. We may also see behavioral changes and transient psychotic reactions. We describe a case in which the patient had acute behavioral and psychotic manifestation following instillation of cyclopentolate.

Keywords: Central anticholinergic syndrome, Cyclopentolate, Psychosis.

Key message: Central Anticholinergic Syndrome, though rare, can occur following topical instillation of cyclopentolate and other mydriatic agent. Clinicians using cyclopentolate must be aware of it.

How to cite this article: Vardhan V, Vishwaraj S. A Case of Cyclopentolate Induced Psychosis. J Med Sci 2016;2(2):36-37.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
T Alpana, R Nagarathnamma, Nagendra Prasad

Management and Outcome of Ectopic Pregnancy in a Tertiary Care Center

[Year:2016] [Month:July-September] [Volumn:2 ] [Number:3] [Pages:13] [Pages No:45-47][No of Hits : 558]


ABSTRACT

Objective: To assess the results of management of ectopic pregnancy with respect to maternal morbidity and mortality and to analyze the risk factors.

Materials and methods: Hospital based cross-sectional study of 52 patients who were diagnosed as ectopic pregnancy in the reproductive age group of 15 to 44 years.

Results: A total of 62 patients with ectopic pregnancy were identified and studied. The rate of ectopic pregnancy was 1.26:100 deliveries. The mean age was found to be 26 years and majority of them were multigravida (Tables 1 and 2). The most common presenting symptom was abdominal pain (96.15%) (Table 3). Most patients had tubal ectopic pregnancy (94.2%). Ovarian ectopic occurred in two cases and 1 patient had heterotopic pregnancy. Emergency laparotomy was performed in 39 (62.90%) patients, 3 (5.77%) patients received methotrexate injection while 18 (29.0%) patients were managed by operative laparoscopy (Table 5). All cases of laparotomy did not require any further procedure. Out of three cases, 2 (66.66%) cases of medical treatment were successful while only 1 (33.33%) case proceeded to emergency laparotomy. No maternal death occurred. Intensive care unit (ICU) stay was needed in 5 patients. Risk factors were found in 67.3% and most common risk factor was found to be previous pelvic surgeries (56.45%) (Table 6). Heterotopic pregnancy was managed by expectant method. Two patients were of post-intrauterine contraceptive device.

Conclusion: Although there was no mortality in our study, morbidity was significant which required multiple blood transfusion and ICU admission. High degree of suspicion, early diagnosis using hormonal studies, sonography, and management in an institutional set up can reduce the associated morbidity.

Keywords: Ectopic pregnancy, Laparoscopy, Laparotomy, Methotrexate.

How to cite this article: Alpana T, Nagarathnamma R, Prasad N. Management and Outcome of Ectopic Pregnancy in a Tertiary Care Center. J Med Sci 2016;2(3):45-47.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL RESEARCH
Maya Nadakarni, Desi Prakruthi, Sahajananda H

A Clinical Audit of Quality Indicators in Anesthesia Practice

[Year:2015] [Month:July-September] [Volumn:1 ] [Number:3] [Pages:14] [Pages No:47-51][No of Hits : 3460]


ABSTRACT

Background: To measure and monitor the quality of care in anesthesia, which is lacking in India. The objective of this audit was to formulate a set of quality indicators and use them to audit our daily anesthetic practice.

Materials and methods: We applied eight quality indicators to audit 4,147 medical records of our hospital. We measured the quality of anesthesia care in the preoperative, intraoperative, and postoperative period by collecting and analyzing the various data.

Results: We found out the weaker areas where quality of anesthesia care could be improved. In 160 (3.85%) patients, preanesthetic check-up was lacking; in 569 (13.72%) patients, anesthesia plan was modified on the day of surgery. A total of 378 (9.11%) patients were ventilated following anesthesia. A total of 123 (2.96%) patients were in recovery room for more than the normal expected time and 187 (4.50%) patients were shifted to the ICU for further intensive care. There was no mortality in our audit findings.

Conclusion: In this audit, we found several areas where improvements could be done. In future, the quality of anesthesia services will be monitored by quality assurance programs using quality indicators, which will improve the perioperative outcome. A dramatic change is expected in anesthesia practice for the betterment of patient care. At present we should try to adopt these practices and improve anesthesia delivery services.

Keywords: Anesthesia, Monitoring, Quality indicators.

How to cite this article: Nadakarni M, P Desi, H Sahajananda. A Clinical Audit of Quality Indicators in Anesthesia Practice. J Med Sci 2015;1(3):47-51.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
PS Sharmila, Kannupriya, MF Paul

Hereditary Elliptocytosis

[Year:2015] [Month:April-June] [Volumn:1 ] [Number:2] [Pages:19] [Pages No:41-43][No of Hits : 1645]


ABSTRACT

Hereditary elliptocytosis (HE) is a group of disorders characterized by the presence of elliptical-shaped erythrocytes on peripheral blood smear. Hereditary elliptocytosis and its related disorders are characterized by clinical, biochemical, and genetic heterogeneity. Manifestations range from the asymptomatic carrier state to severe, transfusion dependent hemolytic anemia. Abnormalities of various membrane protein defects contribute to mechanical defects of the erythrocyte membrane skeleton. We present a rare case of HE, an incidental finding without any clinical symptoms related to it. We also discuss on pathophysiology and being.

Keywords: Elliptocytes, Erythrocyte, Hemolysis.

How to cite this article: Sharmila PS, Kannupriya, Paul MF. Hereditary Elliptocytosis. J Med Sci 2015;1(2):41-43.

Source of support: Nil

Conflict of interest: None


 
Case Report
R Mamatha, MJ Sowmya, KT Venkateshmurthy, H Sahajananda, GS Karthik

Anesthetic Management of a Parturient with Congenital Complete Heart Block posted for Emergency Lower Segment Cesarean Section

[Year:2015] [Month:October-December] [Volumn:1 ] [Number:4] [Pages:17] [Pages No:74-76][No of Hits : 1402]


ABSTRACT

Pregnancy complicated with complete heart block is rare and usually required termination of pregnancy in the past. Improvement in medical technology in the form of cardiac pacing has allowed taking these women to term. Overall, maternal and fetal outcome is not affected in asymptomatic cases. We report here an unbooked, pregnant patient presented at 38+ weeks with complete heart block and pregnancy-induced hypertension for emergency lower segment cesarean section (LSCS). Emergency LSCS was performed under general anesthesia. Maternal and fetal outcome was good.

Keywords: Complete heart block, Pacemaker, Temporary pacemaker.

How to cite this ar ticle: Mamatha R, Sowmya MJ, Venkateshmurthy, Sahajananda H, Karthik GS. Anesthetic Management of a Parturient with Congenital Complete Heart Block posted for Emergency Lower Segment Cesarean Section. J Med Sci 2015;1(4):74-76.

Source of support: Nil Conflict of interest: None


 
BRIEF COMMUNICATION
Prema Dhanraj, MS Mahesh, N Naveen, K Ramesh Babu, Rajashekar Jade

Management of Breast Hypertrophy: Our Experience

[Year:2015] [Month:January-March] [Volumn:1 ] [Number:1] [Pages:25] [Pages No:21-25][No of Hits : 1376]


ABSTRACT

Breast hypertrophy and sagging of the breast are two different benign disorders of breast that can occur during various stages of women’s life from adolescence to menopause. A woman can seek a plastic surgeon for breast reduction for reasons both physical and psychological. Breast reduction surgery or reduction mammoplasty is a plastic surgical procedure by which the sizes of large breasts are reduced. During this procedure, excess skin, fat and breast tissue are removed. The procedure recreates a breast with the desired appearance, contour and volume. Breast lift operation/mastopexy is a procedure where only skin is removed with repositioning of the nipple higher on the chest wall and is the procedure of choice in small but sagging breast.
We present a series of five cases, two presenting with virginal hypertrophy, one with gestational hypertrophy and other two with postmenopausal sagging and hypertrophy. Four patients underwent reduction mammoplasty and one patient underwent mastopexy. None of our patients complained of any problems and were satisfied with the results.

Keywords: Breast hypertrophy, Reduction mammoplasty, Mastopexy.

How to cite this article: Dhanraj P, Mahesh MS, Naveen N, Babu KR, Jade R. Management of Breast Hypertrophy: Our Experience. J Med Sci 2015;3(1):21-25.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
LS Yashaswini, Mamatha B Patil

Stroke in a Young Adult Secondary to Vitamin B12 Deficiency induced Hyperhomocysteinemia

[Year:2015] [Month:January-March] [Volumn:1 ] [Number:1] [Pages:25] [Pages No:10-13][No of Hits : 1350]


ABSTRACT

Stroke in young adults is less frequent than in older population but has major impact on individual and society. Stroke in young justifies an extensive etiologic work up-both common and uncommon. Pernicious anemia is characterized by lack of intrinsic factor in gastric mucosa which is essential for absorption of vitamin B12. Deficiency of vitamin B12 contributes to hyperhomocysteinemia which promotes both arterial and venous thrombosis. We present a rare case of stroke in young adult caused by hyperhomocysteinemia secondary to vitamin B12 deficiency.

Keywords: Homocysteine, Pernicious anemia, Stroke, Vitamin B12.

How to cite this article: Yashaswini LS, Patil MB. Stroke in a Young Adult Secondary to Vitamin B12 Deficiency induced Hyperhomocysteinemia. J Med Sci 2015;3(1):10-13.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
Anil Kumar H, Vikranth V

A Rare Case of Dermatomyositis with Hyponatremia

[Year:2015] [Month:July-September] [Volumn:1 ] [Number:3] [Pages:14] [Pages No:58-59][No of Hits : 1258]


ABSTRACT

Dermatomyositis is a rare type of inflammatory myopathy that represents the largest group of acquired and potentially treatable cause of skeletal muscle weakness. It is characterized by chronic muscle inflammation accompanied by muscle weakness. Here, we present a case of an elderly female who presented with a history of pain in bilateral arm, forearm, thigh, and leg associated with swelling and with a history of rash over the upper extremities. On examination, edema with tenderness was present on both upper limb and lower limb. We also noticed erythematous rash over the arm, forearm, nose, and forehead. Investigations showed hyponatremia, with elevated Cretatinc phosphokinase levels. Hence, a provisional diagnosis of hyponatremia-induced rhabdomyolysis was made. On further evaluation, urine for myoglobin was negative, and in view of the accompanying rash and minimal improvement with sodium correction a provisional diagnosis of dermatomyositis with hyponatremia/hyponatremia-induced rhabdomyolysis was made. Diagnosis of dermatomyositis was confirmed by the muscle biopsy. Dermatomyositis may be accompanied by hyponatremia and atypical rash. It can also be confused with hyponatremic rhabdomyolysis. Dermatomyositis is also a rare presentation and it may be a paraneoplastic manifestation.

Keywords: Dermatomyositis, Hyponatremia, Myopathy.

How to cite this article: HAK, V Vikranth. A Rare Case of Dermatomyositis with Hyponatremia. J Med Sci 2015;1(3):58-59.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
TR Tanusha, Mamatha B Patil

An Atypical Presentation of Chylous Ascites

[Year:2015] [Month:January-March] [Volumn:1 ] [Number:1] [Pages:25] [Pages No:17-20][No of Hits : 931]


ABSTRACT

Chylous ascites (CA) is the extravasation of milky chyle into the peritoneal cavity. Chylous ascites commonly affects adults in 50 to 60 years of age but can also occur in pediatric population. In adults, the most common causes are abdominal malignancies and cirrhosis which account for more than two-third of the cases in developed countries, whereas infectious diseases, such as tuberculosis and filariasis, are prevalent in developing countries. Other causes include congenital, inflammatory, postoperative, traumatic and miscellaneous disorders. We hereby report two atypical cases of chylous ascites and also briefly discuss the causes and treatment.

Keywords: Adenosine deaminase, Antitubercular treatment, Chylous ascites, Contrast-enhanced computed tomography.

How to cite this article: Tanusha TR, Patil MB. An Atypical Presentation of Chylous Ascites. J Med Sci 2015;3(1):17-20.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
Arigala Ganesh, Mamatha B Patil

Neurocysticercosis

[Year:2015] [Month:January-March] [Volumn:1 ] [Number:1] [Pages:25] [Pages No:14-16][No of Hits : 911]


ABSTRACT

Neurocysticercosis (NCC), the most common parasitic brain disease worldwide, is endemic in countries with poor sanitation, and is increasingly being reported in developed countries due to globalization and immigration. One of the most intriguing aspects of NCC is that presumably a high percentage of the individuals harboring NCC remains asymptomatic. It has also been stated that almost any neurological symptomatology may be found, ranging from mild headache or treatable acute seizures to very severe neurological manifestations, such as intracranial hypertension (ICH), dementia or even death.
We are reporting a case of NCC who presented with various clinical manifestations of brain parenchymal lesions, which got cured with treatment. It was confirmed with repeat computed tomography (CT).

Keywords: Extraparenchymal neurocysticercosis, Leptomeninges, Neurocysticercosis.

How to cite this article: Ganesh A, Patil MB. Neurocysticercosis. J Med Sci 2015;3(1):14-16.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
BS Punya, MPA Sailakshmi, Suhasini Akash, R Nagarathnamma

Uterine Necrosis following B-Lynch and Gunasheela’s Global Stitch Sutures for Primary Postpartum Hemorrhage

[Year:2015] [Month:April-June] [Volumn:1 ] [Number:2] [Pages:19] [Pages No:38-40][No of Hits : 895]


ABSTRACT

Uterine atony causing postpartum hemorrhage (PPH) is one of the leading causes of maternal morbidity and mortality. Here by reporting a case of 22-year-old woman who underwent full-term vaginal delivery followed by atonic PPH, for which emergency laparotomy was done and stepwise devascularization along with B-Lynch and Gunasheela’s global brace sutures over the uterus. On postoperative day 9, she developed features suggesting sepsis and magnetic resonance imaging (MRI) showed area of avascularity and features of abscess formation in the uterine wall. She underwent subtotal hysterectomy and histopathology showed uterine necrosis.

Keywords: B-Lynch suture, Gunasheela’s global stitch, Postpartum hemorrhage, Uterine necrosis.

How to cite this article: Punya BS, Sailakshmi MPA, Akash S, Nagarathnamma R. Uterine Necrosis following B-Lynch and Gunasheela’s Global Stitch Sutures for Primary Postpartum Hemorrhage. J Med Sci 2015;1(2):38-40.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
M Pramod Kumar, KM Gopinath, BN Roshan Kumar, GA Gautham Balaji

Closed Pan-talar Dislocation with Posterior Talar Process Fracture

[Year:2015] [Month:April-June] [Volumn:1 ] [Number:2] [Pages:19] [Pages No:32-35][No of Hits : 774]


ABSTRACT

Total dislocation of the talus has been reported as 0.06% of all dislocations and 2% of all talar fractures. It usually occurs from considerable violence. Total dislocation of the talus is frequently an open injury, or the skin may be tented over the dislocated talus leading to skin slough. Closed total dislocation of talus with posterior process injury is rare. The functional prognosis is poor due to osteonecrosis of the talus which develops in the majority of cases. Review of literature reported successful closed reduction in cases of closed pan-talar dislocation under anesthesia. However, there were few cases where there was difficulty in closed reduction. Operative technique has also been described in different reports of similar cases.

Case report: We present a case of pan-talar dislocation of the left talus in a 25-year-old road accident victim, with posterior talar process fracture. Reduction of dislocation was attempted in emergency department by external manipulation. Reduction process failed, and hence planned for reduction under anesthesia. It required a open reduction after a unsuccessful closed reduction attempt. The talus after reduction was found to be unstable hence, stabilized with trans-calcaneotalar Steinmann pin. At 1-year follow-up, the right ankle was pain free and stable. Motion was satisfactory. The talus after a follow-up of 1 year did not show any signs of subluxation or avascular necrosis.

Conclusion: The main obstacle to closed reduction appeared to be talus had button holed through dorsal fascia. The talus after reduction was found to be unstable hence stabilized with trans-calcaneotalar Steinmann pin. The management of the associated fracture will depend on many factors, particularly displacement of the fracture fragments.

Keywords: Closed, Dislocation, Operative treatment, Talus.

How to cite this article: Kumar MP, Gopinath KM, Kumar BNR, Balaji GAG. Closed Pan-talar Dislocation with Posterior Talar Process Fracture. J Med Sci 2015;1(2):32-35.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
R Katyayini, NH Rekha, R Chikkananjaiah

Cardiac Tamponade in a Patient with Primary Hypothyroidism

[Year:2015] [Month:January-March] [Volumn:1 ] [Number:1] [Pages:25] [Pages No:7-9][No of Hits : 575]


ABSTRACT

Hypothyroidism is a common disease with multisystem involvement. It may present clinically in various forms. Pericardial effusion (PE) is one of the cardiovascular manifestation.
Pericardial effusion is the accumulation of fluid in the pericardial space. The occurrence of pericardial effusion in hypothyroidism appears to be frequent manifestation of severe myxedema, than in mild hypothyroidism. The incidence of pericardial effusion in hypothyroidism is 3 to 6%. However, the incidence of cardiac tamponade in patients with hypothyroidism is rare event. The slow accumulation of liquid in the pericardial space leads to the rarity of hemodynamic premonitory signs, even in presence of large effusions.
In this article, we report an elderly female presented with features of hypothyroidism and pericardial effusion which rapidly developed into cardiac tamponade. She did not have premonitory hemodynamic signs.

Keywords: Cardiac tamponade, Myxedema, Pericardial effusion.

How to cite this article: Katyayini R, Rekha NH, Chikkananjaiah R. Cardiac Tamponade in a Patient with Primary Hypothyroidism. J Med Sci 2015;3(1):7-9.

Source of support: Nil

Conflict of interest: None


 
REVIEW ARTICLE
BV Raghunath

The Unborn Patient: An Update on Fetal Therapy

[Year:2015] [Month:January-March] [Volumn:1 ] [Number:1] [Pages:25] [Pages No:1-3][No of Hits : 549]


ABSTRACT

The traditional method of managing a malformed fetus involves either medical termination of pregnancy or postnatal management. Presently, with advancements in radiodiagnosis, almost all of the congenital malformations occurring in these unborn ‘patients’ can be diagnosed antenatally. With this, fetal intervention, though in its baby steps, has become a reality. The present article reviews the advancements made in fetal therapy.

Keywords: Antenatal diagnosis, Fetal therapy, Medical termination of pregnancy.

How to cite this article: Raghunath BV. The Unborn Patient: An Update on Fetal Therapy. J Med Sci 2015;3(1):1-3.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Shashikala Manjunatha, KS Ramya

Reproductive Health and Child Health Profile in the Field Practice Area of RajaRajeswari Medical College and Hospital, Bengaluru: A Descriptive Study

[Year:2015] [Month:April-June] [Volumn:1 ] [Number:2] [Pages:19] [Pages No:27-31][No of Hits : 524]


ABSTRACT

Introduction: Reproductive health, child health and nutrition are core priorities for any country, more so for India, with the world’s greatest burden of maternal, newborn, and child deaths.

Objectives: To assess the reproductive health and child (under 5 years) health profile of the defined population using reproductive health and child health indicators in the field practice area of RajaRajeswari Medical College and Hospital.

Materials and methods: A community-based cross-sectional study was conducted among women of reproductive age group (15-49) using a pretested and semistructured questionnaire which included reproductive health and child health indicators.

Method of analysis: Data ware analyzed using Statistical Package for Social Sciences (SPSS) software.

Results: Among 658 mothers, 60% were using family planning methods, 63% of mothers had full antenatal check-up and 80% had institutional delivery. Around 80% of the children between 12 and 23 months were fully immunized, 60% of children were exclusively breastfed. Ninety-two percent of the women had heard of HIV/AIDS.

Conclusion: Awareness and utilization of various reproductive and child health services among the women of reproductive age group was found to be far from satisfactory and, hence, there is a need to raise the awareness in this regard through effective information, education and communication (IEC) activities.

Keywords: Bengaluru, Child health, Reproductive and child health indicators, Reproductive health.

How to cite this article: Manjunatha S, Ramya KS. Reproductive Health and Child Health Profile in the Field Practice Area of RajaRajeswari Medical College and Hospital, Bengaluru: A Descriptive Study. J Med Sci 2015;1(2):27-31.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
Raghunath BV, Vishwanath Bhat

Spontaneous Hemoperitoneum: An Unusual Presentation of a Common Disease

[Year:2015] [Month:April-June] [Volumn:1 ] [Number:2] [Pages:19] [Pages No:36-37][No of Hits : 501]


ABSTRACT

Intraluminal hemorrhage associated with ectopic gastric mucosa in a Meckel’s diverticulum is a common presentation. However, intraperitoneal bleeding associated with Meckel’s diverticulum, is considerably rare. Herein, we report a case of spontaneous intraperitoneal bleeding caused due to nonruptured, acutely inflammed Meckel’s diverticulum causing erosion of one of the branches of ileocolic artery and presenting with peritonism.

Keywords: Meckel’s diverticulum, Peritonism, Spontaneous hemoperitoneum.

How to cite this article: Raghunath BV, Bhat V. Spontaneous Hemoperitoneum: An Unusual Presentation of a Common Disease. J Med Sci 2015;1(2):36-37.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
MV Krishna, Ashish Jindal, Saurav Das

A Study of Clinical Profile in Chronic Kidney Disease with Special Reference to Echo and Electrocardiography

[Year:2018] [Month:January-March] [Volumn:4 ] [Number:1] [Pages:30] [Pages No:5-9][No of Hits : 346]


Abstract

Introduction: Cardiovascular causes contribute toward a large proportion of increased morbidity and mortality in patients with chronic kidney disease (CKD). Cardiac disease is the major cause of death in the CKD population.

Materials and methods: The present study was undertaken for documentation of various cardiovascular abnormalities in 50 patients with CKD at RajaRajeswari Medical College & Hospital, Bengaluru, Karnataka, India, using electrocardio­ graphy (ECG) and echocardiography as investigation proce­ dures. The present study is a descriptive cross­sectional study and data collected were analyzed by frequency, percentage, chi­squared test, and p­value which is the left ventricular (LV) diastolic dysfunction. Pericardial effusion and conduction abnormalities are more common in patients of CKD.

Results: The ECG was normal in 12 out of 50 cases of CKD (24%), left ventricular hypertrophy (LVH) present in 14 out of 50 (28%), left axis deviation in 8 out of 50 (16%), conduction disturbances in 11 out of 50 (22%), ischemia in 10 out of 50 (20%), arrhythmias in 1 out of 50 (2%), and P mitrale was found in 3 out of 50 cases (6%). The most common ECG change asso­ ciated with cases with CKD was LVH (28%). The most common abnormality found on echocardiography in CKD cases under the study was LVH (56%) followed by diastolic dysfunction (38%).

Conclusion: The LVH is the commonest abnormality observed in CKD both on ECG and echocardiography. Echocardiography is a more sensitive diagnostic procedure to detect LVH. After LVH other most common abnormalities found on Echocardiography in CKD patients on haemodialysis were pericardial effusion and conduction abnormalities.

Keywords: Chronic kidney disease, Echocardiography, Electrocardiography.

How to cite this article: Krishna MV, Jindal A, Das S. A Study of Clinical Profile in Chronic Kidney Disease with Special Reference to Echo and Electrocardiography. J Med Sci 2018;4(1):5­9.

Source of support: Nil

Conflict of interest: None


 
Editorial
Umesh Goneppanavar

CANCER SURGERY: HOW MUCH AN ANESTHESIOLOGIST CAN INFLUENCE CANCER RECURRENCE?

[Year:2018] [Month:January-March] [Volumn:4 ] [Number:1] [Pages:30] [Pages No:iv-v][No of Hits : 332]


Abstract

CANCER SURGERY: HOW MUCH AN ANESTHESIOLOGIST CAN INFLUENCE CANCER RECURRENCE?

Cancer has been among the major contributors to significant death and disability across the globe for several decades.1 Life of the affected individual will be changed forever after the diagnosis of cancer as they are subjected to a wide range of investigations, multimodal therapy for cancer, adverse effects related to cancer therapy and followup.

The main modalities of treatment for cancer include surgery, chemotherapy, radiotherapy, or a combination of them. The best that can be hoped for by the patient is a curative therapy that does not contribute to functional limitation and not to have recurrence subsequently.


 
BRIEF COMMUNICATION
Suheib Muneer, Srinivasan Rangalakshmi, Hiremathada Sahajananda

Comparison of High-flow Oxygen Therapy using Nasal Canula with Standard Oxygen Therapy using Face Mask in Patients with Acute Hypoxemic Respiratory Failure

[Year:2018] [Month:January-March] [Volumn:4 ] [Number:1] [Pages:30] [Pages No:28-30][No of Hits : 304]


Abstract

Introduction: High-flow oxygen therapy through nasal cannula is a technique whereby heated and humidified oxygen is delivered to nose at high flow rates and this generates low levels of positive pressure in upper air ways. This may decrease physi ological dead space by flushing expired CO2 from the upper air way, a process that explains the decrease in the work of breathing. With this we determine whether high-flow oxygen therapy as compared with standard oxygen therapy alone could reduce the rate of endotracheal intubation and outcomes.

Materials and methods: We performed a prospective randomized trial in our intensive care unit (ICU), in which we randomly assigned patients with acute hypoxemic respirator y failure without hypercapnia into two groups. A total 30 patients were taken in our study and were randomly allocated to groups I and II (15 in each group) with type I respirator y failure.

  • Group I: Received high-flow oxygen therapy using nasal cannula
  • Group II: Treated with standard oxygen mask therapy
The outcome of two groups was compared in terms of PaO2 and the propor tion of patients who needed reintubation.

Results: Demographic data (Table 1) were not significant between the two groups. Ar terial blood gas (ABG) analysis (Table 2) showed PaO2 of 92 + 32 mm Hg in high-flow nasal oxygen (group I) receiving patients compared with PaO2 of 85 ± 31 mm Hg in standard oxygen therapy patients (group II). The intubation rate (Table 2) was 46% (7/15) in highflow nasal oxygen group (I) and 66% (10/15) in the standard oxygen therapy group (II).

Conclusion: Patients with nonhypercapnic acute hypoxemic respirator y failure treatment with high-flow nasal oxygen have significantly better outcome compared with oxygen therapy with the standard oxygen therapy with face mask.

Keywords: High-flow oxygen therapy, Nasal canula, Nonhypercapnic acute hypoxic respirator y failure.

How to cite this article: Muneer S, Rangalakshmi S, Sahajananda H. Comparison of High-flow Oxygen Therapy using Nasal Canula with Standard Oxygen Therapy using Face Mask in Patients with Acute Hypoxemic Respirator y Failure. J Med Sci 2018;4(1):28-30.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Swapnav Borthakur, Deepesh K Maurya, Nitin Nyaharkar

Impact of Levothyroxine Therapy on Lipid Profile Value in Patients with Subclinical Hypothyroidism

[Year:2018] [Month:January-March] [Volumn:4 ] [Number:1] [Pages:30] [Pages No:10-13][No of Hits : 299]


Abstract

Aim: To study the effect of levothyroxine treatment on lipid profile in patients with subclinical hypothyroidism.

Materials and methods: This study was a randomized controlled trial, prospective study conducted on 22 cases of subclinical hypothyroidism with 22 controls at Down Town Hospital, Guwahati, Assam, India. Inclusion and exclusion criteria were under taken. Levothyroxine therapy was given and follow-up was done af ter 3 months with thyroid and lipid profile tests. Pretreatment and posttreatment values were compared using paired t-test using Statistical Package for the Social Sciences (SPSS), version 19.

Results: Statistical significance bet ween pretreatment and posttreatment values was found to be in values of thyroid- stimulating hormone (TSH), cholesterol high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, and triglycerides (p < 0.05). There was no significant dif ference in the pretreatment and posttreatment triiodothyronine (T3) and thyroxine(T4) values. There was mild increase in value of HDL, and significant decrease in value of TSH, cholesterol, ver y low density lipoprotein (VLDL), and triglycerides.

Conclusion: ipid profiles are altered in patients with subclinical hypothyroidism compared with controls. Levothyroxine therapy has beneficial ef fect on lipid profile in patients with subclinical hypothyroidism.

Clinical significance: Levothyroxine therapy in patients of subclinical hypothyroidism reduces TSH levels and thus prevents conversion to overt hypothyroidism and also reduces cardiac morbidity.

Keywords: Levothyroxine, Lipid profile, Subclinical hypothyroidis.

How to cite this article: Borthakur S, Maurya DK, Nyaharkar N. Impact of Levothyroxine Therapy on Lipid Profile Value in Patients with Subclinical Hypothyroidism. J Med Sci 2018;4(1):10-13.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
Misbah Anjum, Sharmila P Surhonne, Pannaga P Kumar, S Swarna Kamala, Rizni Mansoor

Chondrosarcoma masquerading as an Abscess in the Gluteal Region

[Year:2018] [Month:January-March] [Volumn:4 ] [Number:1] [Pages:30] [Pages No:20-22][No of Hits : 261]


Abstract

Pelvic chondrosarcomas (CHSs) are malignant cartilaginous tumors. Due to their slow growth, CHSs tend to cause symptoms over a prolonged period of time, and their diagnosis might be delayed. Since radiotherapy and chemotherapy have proved ineffective in the treatment of CHSs, wide surgical excision remains the treatment of choice. Although CHSs rarely metastasize and have a very good prognosis after surgery, local recurrence is a quite common occurrence especially following inadequate excision. In this report, we present a case of pelvic CHS mistaken for an abscess.

Keywords: Abscess, Arthritis, Chondrosarcoma, Gluteal swelling.

How to cite this article: Anjum M, Surhonne SP, Kumar PP, Kamala SS, Mansoor R. Chondrosarcoma masquerading as an Abscess in the Gluteal Region. J Med Sci 2018;4(1):20-22.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
MR Shruthi Gowthami, Dipiya Tikoo, Sumitha M Prakash, Mahanthachar Veerabasappa, Sharmila P Surhonne

A Rare Case of Splenic Pseudocyst

[Year:2018] [Month:January-March] [Volumn:4 ] [Number:1] [Pages:30] [Pages No:25-27][No of Hits : 261]


Abstract

We present here a case of pseudocyst of spleen, a rare entity. In our case, the patient presented with pain abdomen since 5 to 6 months. She gave the history of abdominal trauma 2 years ago. Ultrasonography (USG) and computed tomography (CT) of abdomen and pelvis showed a well-defined cyst arising in spleen. Open splenectomy was followed. Histopathology of the splenectomy specimen showed features of pseudocyst.

Keywords: Pseudocyst, Splenectomy, Splenic.

How to cite this article: Gowthami MRS, Tikoo D, Prakash SM, Veerabasappa M, Surhonne SP. A Rare Case of Splenic Pseudocyst. J Med Sci 2018;4(1):25-27.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Vineeta Yadav, Rangaiah Nagaratnamma, Nagendra Prasad

Comparison of 50 μg Oral and Vaginal Misoprostol Tablets in Induction of Labor at Term

[Year:2018] [Month:January-March] [Volumn:4 ] [Number:1] [Pages:30] [Pages No:1-4][No of Hits : 254]


Abstract

Objective: To compare ef ficacy and safet y of 50 µg mi soprostol administered vaginally, with oral route for induction of labor at term.

Materials and methods: One hundred women at term gestation, Bishop score = 4, with various indications for labor induction were randomized. Fifty women received 50 µg misoprostol orally and 50 women received 50 µg vaginally, four th hourly (maximum six doses) or till the women went into active labor.

Results: In vaginal misoprostol group, induction delivery interval was significantly less (8.70 vs 17.47 hours) and successful induction was significantly higher (70 vs 6 0%) t han or al gr oup, within 24 hours of induction. In vaginal group, 46% women needed two doses for deliver y compared with 8% in oral group. A maximum of six doses were required.

Conclusion: Vaginal route of misoprostol is more ef fective in inducing labor than oral administration.

Keywords: Induction of labor, Oral misoprostol, Vaginal misoprostol.

How to cite this article: Yadav V, Nagaratnamma R, Prasad N. Comparison of 50 µg Oral and Vaginal Misoprostol Tablets in Induction of Labor at Term. J Med Sci 2018;4(1):1- 4.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
Grama S Karthik, Madihalli JI Sowmya, Hiremathada Sahajananda, S Shruthi Shree, Ramegowda Sudheer

Epidural Anesthesia for a Patient with Ebstein’s Anomaly posted for Transurethral Resection of Prostate

[Year:2018] [Month:January-March] [Volumn:4 ] [Number:1] [Pages:30] [Pages No:23-24][No of Hits : 244]


Abstract

Ebstein’s anomaly is an abnormality of the tricuspid valve in which valve leaflets are malformed or displaced downwards into the right ventricle. Patient may develop supraventricular dysrhythmias leading to syncope, cyanosis, congestive heart failure and sudden death.

The choice of anaesthesia is individualized and remains a challenge. We managed one such patient under Epidural Anesthesia successfully. Epidural Anesthesia in a fractionated and graded manner provides a hemodynamically stable patient with adequate intra and post-operative analgesia.

Keywords: Congestive heart failure, Ebstein’s anomaly, Epidural anesthesia, Tachyarrythmias, Transurethral resection of prostate.

How to cite this article: Karthik GS, Sowmya MJI, Sahajananda H, Shree SS, Sudheer R. Epidural Anesthesia for a Patient with Ebstein’s Anomaly posted for Transurethral Resection of Prostate. J Med Sci 2018;4(1):23-24.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
Ankitha Sunand, Chikkegowda Sangeetha, Pawan, Hiremathada Sahajananda

Accidental Inferior Turbinectomy with Airway Obstruction during Nasal Intubation

[Year:2018] [Month:January-March] [Volumn:4 ] [Number:1] [Pages:30] [Pages No:14-16][No of Hits : 238]


Abstract

Synchronous tumors of different histological types involving the salivary gland are rare. There have been cases reported in the literature of such tumors occurring in the parotid gland. Head and neck surgeons frequently request nasotracheal intubation for their surgical procedures. Complications of nasal intubation include epistaxis, sinusitis, bacteremia, or dislodgement of adenoids from trauma of the intubation.

We describe a case report of accidental removal of the inferior turbinate with nearly complete airway obstruction, during nasotracheal intubation. This case report demonstrates the importance of early detection and management of this potentially dangerous complication.

Keywords: Nasal intubation, Pleomorphic adenoma, Ring adair elwyn endotracheal tube, Turbinectomy.

How to cite this article: Sunand A, Sangeetha C, Pawan, Sahajananda H. Accidental Inferior Turbinectomy with Airway Obstruction during Nasal Intubation. J Med Sci 2018;4(1):14-16.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Ankita Das, B Niranjana Murthy

A Study of Cytohistopathological Correlation of Palpable Breast Lumps

[Year:2018] [Month:April-June] [Volumn:4 ] [Number:2] [Pages:31] [Pages No:52-56][No of Hits : 168]


Abstract

Introduction: Breast diseases are showing rising trend worldwide. Benign breast disease (BBD) is the most common cause of breast problem among women with prevalence rate of 68% among all breast lesions in India. It is more frequent than malignancy. Making an early diagnosis and planning the treatment help in alleviating unnecessary anxiety about breast cancer, and those with an increased risk of malignancy like atypical hyperplasia are given prompt treatment, follow-up, and awareness regarding the risk of breast cancer. Fine needle aspiration cytology (FNAC) is a relatively simple, reliable, nontraumatic, complication-free technique for breast lump evaluation.

Materials and methods: This study was done on a total of 55 female patients attending hospital for a period of 1 year in Tumkur, Karnataka. The FNAC technique was done with 23G needle attached to 10 mL syringe inserted into palpable breast mass. Cellular material aspirated and smeared on glass slide, fixed in 95% methanol, stained with hematoxylin and eosin. Air-dried slides were stained with Giemsa. Histopathological diagnosis was correlated with FNAC details in all cases.
All the collected data were transferred into a master sheet and fed into computer for statistical analysis using Pearson’s Chi-square test.

Results: In our study the patients belonged to age group of 14 to 65 years with a median of 37.5 years. Irrespective of sides, maximum numbers of cases were found in upper and outer quadrants. Maximum malignant lesions were in the age group of 45 to 49 years, whereas benign lesions were maximum in 30 to 34 years age group. The commonest pathology found in our study was fibroadenoma (51%) followed by ductal carcinoma (27%).
In our study out of 55 patients, 2 cases where FNAC showed benign proliferative breast disease, histopathological examination (HPE) report suggested infiltrating ductal carcinoma (IDC). Another 1 case where FNAC showed fibrocystic disease with atypical ductal hyperplasia (ADH), HPE report turned it out as IDC. Sensitivity of 75% specificity 100%, positive predictive value (PPV) 100%, and negative predictive value of 93% were obtained.

Conclusion: Fine needle aspiration cytology is a very important preliminary diagnostic tool in palpable breast lumps and results show high degree of correlation with final HPE report.

Keywords: Breast disease, Fine needle aspiration cytology, Histopathology.

How to cite this article: Das A, Murthy BN. A Study of Cytohistopathological Correlation of Palpable Breast Lumps. J Med Sci 2018;4(2):52-56.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
B Mamatha Patil, V Shreyas Kumar, Kotha Anusha

A Clinical and Etiological Study of Anemia in Patients with Primary Hypothyroidism

[Year:2018] [Month:April-June] [Volumn:4 ] [Number:2] [Pages:31] [Pages No:48-51][No of Hits : 161]


Abstract

Introduction: Hypothyroidism has significant hematological manifestations. Overt and subclinical hypothyroidism both are associated with anemia. This study was done to evaluate the clinical and etiological profile of anemia in patients with primary hypothyroidism.

Materials and methods: B ased o n t he s ymptoms a nd hormonal assay, 200 primary hypothyroidism patients were subjected to detailed examination. Patients were investigated before the thyroid hormone replacement therapy.

Results: Hypothyroidism is more prevalent in women than in men. Higher percentage of hypothyroid women (54%) suffer from anemia than hypothyroid men (45%). Normocytic normochromic anemia (58.49%) was the most common type of anemia followed by microcytic hypochromic anemia (20.75%), macrocytic hypochromic anemia (12.26%), and dimorphic anemia (8.49%). Among the symptoms and signs elicited, the most common was generalized weakness seen among 49.5% of the subjects with clinical hypothyroidism, followed by weight gain (34.5%), bradycardia (27.5%), peripheral edema (23%), menstrual irregularities in females (12.5%), and cold intolerance seen in 12% of the study population. Few subjects presented with more than one sign and symptom. Majority of the subjects were investigated only after they presented with one of the signs and symptoms, hence falling under the category of clinical hypothyroidism (78%). Antithyroid peroxidase (TPO) antibodies were present in only a minor percentage (15%) of the study population, majority of them being in the 4th decade of life and incidence decreasing as age progressed probably because the mean age group of the study population was in the fourth decade of life. Women (17.41%) had a slightly higher incidence of autoimmune hypothyroidism compared with men (13.63%).

Conclusion: Hypothyroidism is common in females, maximum in the third decade probably because the mean age of the study population was 32.53 years. Majority of the patients (53%) were diagnosed with anemia. Of them, majority presented with symptoms of hypothyroidism and were found to have normocytic normochromic anemia followed by microcytic hypochromic anemia. A systematic study was done to know the relationship of hypothyroidism with anemia and a study of the symptomatology of hypothyroidism. The identification of patients with hypothyroidism is an important individual and public health issue. Hence, early detection and initiation of hormone replacement therapy can minimize the incidence of associated anemia.

Keywords: Anemia, Antithyroid peroxidase antibodies, Hypothyroidism.

How to cite this article: Patil BM, Kumar VS, Anusha K. A Clinical and Etiological Study of Anemia in Patients with Primary Hypothyroidism. J Med Sci 2018;4(2):48-51.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
MD Abhilasha, Umashankar Nagaraju

A Study on Effectiveness of Platelet-poor Plasma as a Media in Autologous Noncultured Epidermal Cell Suspension in the Treatment of Stable Vitiligo.

[Year:2018] [Month:April-June] [Volumn:4 ] [Number:2] [Pages:31] [Pages No:42-47][No of Hits : 155]


Abstract

Introduction: Replenishing melanocytes selectively in vitiliginous macules by autologous noncultured epidermal cell suspension (NECS) is a promising approach. Limitation of this surgery is its expensive reagents. Platelet-poor (PPP) plasma may replace these expensive reagents.

Objective: To evaluate the surgical results when two reagents, namely trypsin inhibitor and Dulbecco’s modified Eagle’s medium (DMEM), are replaced by patient’s PPP as media in NECS.

Materials and methods: Descriptive and inferential statistical analysis has been carried out in a clinical study that enrolled 60 stable vitiligo lesions from 60 patients who formed the study group. Patients received melanocytes suspended in their own PPP.

Results: Results show that 96.7% repigmentation was achieved in 29 of 30 lesions. Additionally, 3.3% lesions achieved poor repigmentation. Statistical analysis revealed no significant differences with respect to the repigmentation achieved or adverse effects observed.

Discussion: Trypsin inhibitor can be replaced by blood plasma as plasma contains alpha 1 antitrypsin, which covalently binds and inactivates action of trypsin. Effective results with blood plasma was possibly due to growth factors in serum which may enhance activity of melanocytes. It also enhances the viscosity of suspension.

Conclusion: Platelet-poor plasma can be one of the novel surgical modalities. It is cost-effective and beneficial for our vitiligo patients.

Keywords: Dulbecco’s modified eagle’s medium, Noncultured epidermal cell suspension, Platelet-poor plasma.

How to cite this article: Abhilasha MD, Nagaraju U. A Study on Effectiveness of Platelet-poor Plasma as a Media in Autologous Noncultured Epidermal Cell Suspension in the Treatment of Stable Vitiligo. J Med Sci 2018;4(2):42-47.

Source of support: Nil

Conflict of interest: None


 
BRIEF COMMUNICATION
Shashikala Manjunatha, Subramanian Aishwarya, Rangenahalli V Anuradha

A Brief Review of Integrated Counseling and Testing Center in RajaRajeswari Medical College and Hospital, Bengaluru, Karnataka, India

[Year:2018] [Month:April-June] [Volumn:4 ] [Number:2] [Pages:31] [Pages No:60-62][No of Hits : 150]


Abstract

Introduction: The National AIDS (acquired immunodeficiency syndrome) Control Programme Phase four has envisaged the strengthening activities for prevention and control of AIDS through Integrated Counseling and Testing Center (ICTC)—a unit, where a person is counseled and tested for human immunodeficiency virus (HIV) through direct access or by physician referral. For HIV/AIDS victims, ICTCs are nodal points for preventive, curative, and supportive services.

Objective: To assess the patient’s profile in an ICTC of a private medical college hospital in Bengaluru, India, during the years 2014 to 2017.

Materials and methods: The study was conducted by record review and interviewing of patients attending ICTC of a private medical college hospital in Bengaluru. Statistical tests applied included univariate analysis and Chi-square test.

Results: This study depicted the functions and utilization pattern of services from a hospital-based ICTC attached to a medical college, through public-private partnership. The brief details of clients attending ICTC are reflected here. Among the total patients of 46,152 for 3 years referred to ICTC, 265 were HIV positive.

Conclusion: Here HIV positive cases are more among agriculturists and lower socioeconomic status persons, and sexual mode is the predominant mode of transmission.

Keywords: Human immunodeficiency virus positives, Integrated Counseling and Testing Center, Lower socioeconomic status.

How to cite this article: Manjunatha S, Aishwarya S, Anuradha RV. A Brief Review of Integrated Counseling and Testing Center in RajaRajeswari Medical College and Hospital, Bengaluru, Karnataka, India. J Med Sci 2018;4(2):60-62.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
AN Dhanya, B Niranjana Murthy

Role of E-cadherin Expression in Breast Carcinoma

[Year:2018] [Month:April-June] [Volumn:4 ] [Number:2] [Pages:31] [Pages No:38-41][No of Hits : 147]


Abstract

Introduction: Cancer of breast has emerged as the leading site of cancer in India. E-cadherin (E-CD) is one of calciumdependent transmembrane glycoprotein mediating cell-cell adhesion. It has its application in differentiating invasive ductal carcinoma not otherwise specified (IDC-NOS) vs invasive lobular carcinomas (ILCs) and predicting the aggressiveness of the tumor. In this study, we intend to see E-CD expression in breast carcinoma by immunohistochemistry (IHC), comparing its status with histological grade and type.

Materials and methods: A total of 47 breast tissue specimens were included in the study. The histomorphological grading (Modified Scarf Bloom Richardson system) and immunohistochemical scoring were done. Chi-square formula was applied to check the association between E-CD expression and various variables.

Results: The mean age was 51 years. The most common type was IDC-NOS (79%) and grade II (38%). Majority (62%) were lymph node negative. The E-CD IHC performed showed most cases (55%) were severely reduced E-CD, while wellexpressed E-CD and moderately reduced E-CD were 28 and 17% respectively. The E-CD expression was statistically significant (p < 0.05) with histological grade and lymph node status. Though the p-value of E-CD expression vs histopathological type was not significant, all ILCs showed complete loss of E-CD expression compared with IDC-NOS.

Conclusion: The E-CD expression is well preserved in welldifferentiated carcinomas and reduced in poorly differentiated carcinomas. Loss of E-CD expression is seen in lymph node metastasis breast carcinomas and in high-grade breast carcinomas, which proves E-CD can be used as a marker of tumor invasion and tumor aggressiveness. Complete loss of E-CD is seen in all ILC, which can also be helpful in differentiating IDC NOS from ILC.

Keywords: Bloom Richardson score, Breast carcinoma, E-cadherin, Immunohistochemistry.

How to cite this article: D hanya A N, M urthy B N. R ole o f E-cadherin Expression in Breast Carcinoma. J Med Sci 2018;4(2):38-41.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Sharanappa Patil, V Ajith Kumar, Sandhya Subramani

To evaluate Lipid Profiles in Patients with Chronic Kidney Disease in RajaRajeswari Medical College and Hospital, Bengaluru, Karnataka, India

[Year:2018] [Month:April-June] [Volumn:4 ] [Number:2] [Pages:31] [Pages No:31-34][No of Hits : 145]


Abstract

Background and objectives: Dyslipidemia is a fairly common occurrence in chronic renal failure (CRF) patients. Cardiovascular mortality in patients with CRF is related to dyslipidemia. This study was done to identify the lipid abnormalities and its significance in CRF patients by comparing with age, sex, and body mass index (BMI) of matched healthy control population.

Materials and methods: In this study, 56 cases of CRF were taken and three fasting lipid profiles were estimated. Twentyfive age-, sex-, and BMI-matched healthy population were taken as controls. The data were entered in a master sheet and analyzed statistically.

Results: Dyslipidemia is seen in CRF patients. Even though the total cholesterol was high in CRF cases compared with controls, the change was not significant statistically. Triglycerides showed a statistically significant increase in CRF cases. The low-density lipoprotein cholesterol (LDL-C) was elevated in CRF cases but the change was not significant statistically. The high-density lipoprotein cholesterol (HDL-C), on the contrary, showed a statistically significant drop compared with controls.

Interpretation and results: Lipid abnormalities are common in CRF. Total cholesterol changes are not statistically significant. Triglycerides shows statistically significant increase in CRF cases when compared with normal. The LDL-C is increased in CRF patients, but it is not statistically significant when compared with controls. The HDL-C shows a statistically significant decrease in CRF patients compared with controls. These lipid abnormalities may be an important contributing factor to the cardiovascular mortality in patients with CRF.

Keywords: Chronic kidney disease, Dyslipidemia, Lipid profile.

How to cite this article: Patil S, Kumar VA, Subramani S. To evaluate Lipid Profiles in Patients with Chronic Kidney Disease in RajaRajeswari Medical College and Hospital, Bengaluru, Karnataka, India. J Med Sci 2018;4(2):31-34.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Bandi H Reddy, N Nagendra Prasad, R Nagaratnamma, MPA Sailakshmi

Correlation of Predicted Birth Weight at 20–24 Weeks of Gestational Age using the Formula devised by Chi-Feng Su to Actual Birth Weight

[Year:2018] [Month:April-June] [Volumn:4 ] [Number:2] [Pages:31] [Pages No:35-37][No of Hits : 140]


Abstract

Aim: The aim of the study is to use the formula demonstrated by Chi-Feng Su to determine the estimated birth weight (EBW) at 20-24 weeks gestation and try to find out the correlation between the estimated fetal weight with the actual birth weight in our local population.

Materials and methods: It is a retrospective study done at the Department of Obstetrics and Gynecology, RajaRajeswari Medical College, Bengaluru. Fifty patients who were booked, followed up, and delivered at our institution were selected for our study after meeting inclusion and exclusion criteria. Participant’s demographic characters like age, gravida, weight, body mass index (BMI), last menstrual period (LMP), and others were noted down as per the protocol. Their mid-pregnancy BMI, and fetal biometry report at 20-24 weeks were noted. Using the study formula, their anticipated fetal weight was calculated. After delivery, the exact birth weight was noted and was correlated with the predicted weight.

Results: In the study, majority (66%) aged less than 25 years and only 3 patients were aged above 30 years; 50% of the cases were second gravida; 60% of the participants had BMI between 20 and 25, 16% has BMI above 25, and 24% has BMI less than 20. The best correlation was seen in the weight group between 2.6 and 3.5 kg.

Conclusion: The formula demonstrated by Chi-Feng Su had variance as high as 0.303. Our study also showed high variability when the error was +17.6% with birth weight >2.5 kg.

Keywords: Actual birth weight, Body mass index, Estimated fetal weight.

How to cite this article: Reddy BH, Prasad NN, Nagaratnamma R, Sailakshmi MPA. Correlation of Predicted Birth Weight at 20-24 Weeks of Gestational Age using the Formula devised by Chi-Feng Su to Actual Birth Weight. J Med Sci 2018; 4(2):35-37.

Source of support: Nil

Conflict of interest: None


 
Editorial
S Dwajani

Medication Adherence: How Important is It?

[Year:2018] [Month:April-June] [Volumn:4 ] [Number:2] [Pages:31] [Pages No:iv-vii][No of Hits : 137]


Abstract

Medication nonadherence is the most prevalent and complex problem. Nonadherence to medication causes considerable morbidity and mortality, with unavoidable health care costs.1 In 2003, it was estimated by the World Health Organization (WHO) that in developed countries, adherence averages to only 50% in patients suffering from chronic medical illness while in developing countries, the problem is greater.2,3


 
CASE REPORT
Hiremathada Shanmukh, Ravi S Shetty

Hybrid Cardiac Surgery in a Patient with Cardiogenic Shock and Ongoing Myocardial Ischemia

[Year:2018] [Month:April-June] [Volumn:4 ] [Number:2] [Pages:31] [Pages No:57-59][No of Hits : 124]


Abstract

Suitable time for coronary artery bypass grafting (CABG) after acute myocardial infarction (AMI) remains controversial. Many randomized studies have shown that primary angioplasty in AMI may result in better results compared with fibrinolytic therapy and CABG. We herewith report a case of a 72-yearold patient with fracture of femur who sustained massive myocardial infarction (MI). Hybrid cardiac surgery which combines percutaneous coronary intervention and CABG was performed on him.

Keywords: Angioplasty, Coronary artery bypass grafting, Hybrid coronary revascularization, Percutaneous coronary intervention.

How to cite this article: Shanmukh H, Shetty RS. Hybrid Cardiac Surgery in a Patient with Cardiogenic Shock and Ongoing Myocardial Ischemia. J Med Sci 2018;4(2):57-59.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
Ashwin P Surhonne, Sharmila P Surhonne

An Adult Filarial Worm in the Testicular Tissue: A Case Report

[Year:2018] [Month:July-September] [Volumn:4 ] [Number:3] [Pages:26] [Pages No:83-84][No of Hits : 33]


Abstract

Filariasis is a tropical infectious disease and a global public health problem with high incidence in the Indian subcontinent. The clinical manifestations of filariasis vary from person to person depending upon course of infection and the worm load. It is very rare to observe adult filarial worm in the testicular tissues. We herewith report a case of adult filarial worm in the testicular tissue.

Keywords: Filariasis, Swelling, Testis

How to cite this article:, Surhonne AP, Surhonne SP. An Adult Filarial Worm in the Testicular Tissue: A Case Report. Int J Med Sci 2018;4(3):83-84.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
Tanujveer S Chandok, Sudhir Hebbar

A Case of Habit Disorder: Sniffing Smell of Own Breath Using Fingers

[Year:2018] [Month:July-September] [Volumn:4 ] [Number:3] [Pages:26] [Pages No:85-86][No of Hits : 31]


Abstract

Habit disorders and impulse control disorders include conditions involving problems in self-control of emotions and behaviors. These are disorders which people generally neglect in day to day life as the symptoms are not severe, disabling or distressing. However, we present a case of 30 years old male with a habit disorder of sniffing smell of own breath using fingers, who responded well to fluoxetine.

Methodology: Patient who came to Psychiatry OPD, RajaRajeswari Medical College and Hospital was taken for case report. ICD-10: Textbook was used to diagnose patient with Habit Disorder.

Keywords: Fluoxetine, Habit disorder, Sniffing

How to cite this article: Chandok TS, Hebbar S. A Case of Habit Disorder: Sniffing Smell of Own Breath Using Fingers. Int J Med Sci 2018;4(3):85-86.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
R Harshini, S Sangeetha

Catheter-associated Urinary Tract Infection Surveillance in Intensive Care Units in a Tertiary Care Hospital: A Pilot Study

[Year:2018] [Month:July-September] [Volumn:4 ] [Number:3] [Pages:26] [Pages No:79-82][No of Hits : 30]


Abstract

Catheter-associated urinary tract infections (CAUTI) develop either during or after placement of a urinary catheter. CAUTI has been shown to increase patient morbidity and mortality, increase in the length of stay, and add to the cost of care. It is preventable provided appropriate protocols are meticulously followed.

Aims and objectives: This pilot study was conducted over a two month period to determine the rates of CAUTI in the intensive care units of a tertiary care hospital.

Materials and methods: One hundred samples from CAUTI cases were studied for their microbiological profile and antibiotic sensitivity pattern.

Study: Descriptive study.

Results: It was observed that out of 100 samples collected after obtaining informed consent from the Medical Intensive Care Unit (MICU) and Surgical Intensive Care Unit (SICU), 3 cases were reported positive for CAUTI. The sex ratio indicated higher rates for males and lesser for females. Candida albicans was present as a main pathogen followed by Escherichia coli. The overall rate of CAUTI for the two months was 5 per 1000 device days. But this study indicates that precautionary measures need to be properly implemented for preventing CAUTI.

Keywords: Candida albicans, CAUTI, Device Days, E. coli.

How to cite this article: Harshini R, Sangeetha S. Catheterassociated Urinary Tract Infection Surveillance in Intensive Care Units in a Tertiary Care Hospital: A Pilot Study. J Med Sci 2018;4(3):79-82.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Sharmila P Surhonne, Ashwin P Surhonne, Alka V Gosavi, Shobhana R Agashe, Molly A Phansopkar

Clinicopathological Study of Testicular Tumors

[Year:2018] [Month:July-September] [Volumn:4 ] [Number:3] [Pages:26] [Pages No:63-70][No of Hits : 28]


Abstract

Objective: Clinicopathological analysis of testicular tumors as per World Health Organisation (WHO) classification.

Materials and methods: All consecutive cases of testicular tumors diagnosed in the department of pathology for five year were included in this study.

Results: During the span of five years, total 59 cases of testicular tumors were diagnosed. Scrotal mass or swelling was the predominant mode of presentation. Germ cell tumors constituted 89.8% (n = 53) of all testicular neoplasms in which seminoma 32.2% and teratocarcinoma 13.4% were present. Yolk-sac tumor (5.1%) was the commonest testicular neoplasm in children while lymphoma (8.5%) was the predominant neoplasm in elderly population. One case of leukemic infiltration of testis (1.7%) in a known patient of acute lymphocytic leukemia after chemotherapy was also observed.

Conclusion: In this study clinical presentation, age,and frequency of testicular tumors,with few exceptions are similar to other studies from different parts of country, confirming similarity in international literature.

Keywords: Frequency, Germ cell tumor, Testicular tumor, Testis

How to cite this article: Surhonne SP, Surhonne AP, Gosavi AV, Agashe SR, Phansopkar MA. Clinicopathological Study of Testicular Tumors. Int J Med Sci 2018;4(3):63-70.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Srividya Venkatakrishna, Hrushikesh Udupa

Medical Care Satisfaction among Software Engineers in Bengaluru, Karnataka, India

[Year:2018] [Month:July-September] [Volumn:4 ] [Number:3] [Pages:26] [Pages No:71-74][No of Hits : 28]


Abstract

Background: Healthcare in India has seen many changes over the years. The objectives of healthcare changed with the requirements of society and the availability of resources and technology, even though the roles of patients and doctors have remained fixed. There is increased dissatisfaction among the public. It is vital to know exactly what our patients expect of us as their health care providers to practice according to the need of the day; in addition to ethically correct medicine. Bengaluru is known as IT capital of India with most of them being software engineers who often are first among the patients to be aware and informed of the diseases suffered by them or beloved ones. Hence, this study was undertaken with an objective of estimating the satisfaction of the medical care received by software engineers working in multinational companies in Bengaluru, Karnataka, India.

Methodology: The required number of engineers were selected using the snowballing technique until the sample size was met. The participants were given self-administered questionnaire (PSQ-18) after obtaining the consent. The selfadministered questionnaire consisted of demographic profile and 18 questions related to the medical system which were scored from agreeing to disagree strongly. The scoring was done using the scoring method for the PSQ-18 and overall satisfaction with the healthcare found along with subscores. Data were analyzed using SPSS 20 and chi-square was used as a test of significance.

Results: Mean age of the study population was found to be 26.4 years ± 4, with males representing the majority (73.5%) of the study population. Overall satisfaction among engineers was found to be 55.5%. Less satisfaction among participants was found when it came in terms of financial aspect (28.5%) and time spent with doctors (31.5%) followed by accessibility to health services (43%).

Conclusion: A comprehensive approach involving all the stakeholders so as to arrive at a way to decrease the financial burden of the diseases as well as to improve time spent with the doctor is required.

Keywords: Medical care, Satisfaction, Software engineers

How to cite this article: Venkatakrishna S, Udupa H. Medical Care Satisfaction among Software Engineers in Bengaluru, Karnataka, India. Int J Med Sci 2018;4(3):71-74.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Nanjundarao Srinath, Sunil Jhulmaria, Gurvinder S Sethi

A Prospective Randomised Comparative Study of Monopolar Transurethral Resection of Prostate versus for Bipolar Resection of Prostate

[Year:2018] [Month:July-September] [Volumn:4 ] [Number:3] [Pages:26] [Pages No:75-78][No of Hits : 28]


Abstract

We conducted a prospective randomized study to compare bipolar resection of prostate (BRP) with mono-polar transurethral resection of prostate (mTURP). A total of 120 patients of symptomatic benign prostatic hyperplasia (BPH) were randomized into two groups and treated with bipolar resection of prostate with saline as irrigating fluid and monopolar TURP with 1.5% glycine as irrigation fluid. Pre- and post-op findings were recorded up to 6 months in all patients. Both the groups were comparable in age, prostate size regarding volume, international prostate symptom score (IPSS) and hemoglobin levels. The TURP group showed a statistically significant decline in Hb from the preoperative value. Postoperative serum sodium level was significantly low in the mTURP group than in the BRP group. We did not come across transurethral resection (TUR) syndrome in any patient. There was no significant difference in operation time, catheterization time, hospital stay among the two groups. Postoperative improvement in IPSS was similar. The peak urine flow (Q Max) was significantly high in bipolar resection group. Bipolar resection of prostate ha s lower intraoperative complications and improved results compared to monopolar TURP.

Keywords: Benign prostatic hyperplasia, Bipolar resection of prostate , TURP

How to cite this article:, Srinath N, Jhulmaria S, Sethi GS. A Prospective Randomised Comparative Study of Monopolar Transurethral Resection of Prostate versus for Bipolar Resection of Prostate. Int J Med Sci 2018;4(3):75-78.

Source of support: Nil

Conflict of interest: None


 
BRIEF COMMUNICATION
Mamatha B Patil, Faris UK Padikkal, Gowri Ramesh

Clinical Study of Type 2 Diabetes Mellitus in Women with Comorbidities

[Year:2018] [Month:July-September] [Volumn:4 ] [Number:3] [Pages:26] [Pages No:87-89][No of Hits : 27]


Abstract

Introduction: There are evidence-based guidelines for the management of diabetes mellitus (DM). These will not take into account, comorbidity the patient has, and these may come in the way of diabetes management. There are a wide range of comorbidities in Type 2 diabetes (T2DM) which again depends on the study subjects selected and the accompanying diseases.

Methodology: This cross-sectional, observational project was conducted in Rajarajeswari Medical College and Hospital (RRMCH) which included 96 women above the age of 30 years to analyze the number of comorbidities associated with diabetes mellitus. These women were selected based on the criteria and detailed history, and lab investigations were done and tabulated.

Results: Based on the investigations it is found that 67.7% of patients were hypertensive. Thirteen patients had hypothyroidism, 11 patients had dislipidemia and 14 patients had nonalcoholic fatty liver disease (NAFLD). There were 18 patients without any comorbidity in our study.

Conclusion: It was observed that (a) Diabetes mellitus is most commonly associated with hypertension as the comorbidity. (b) As the age advances risk to comorbidities also increases.

Keywords: Comorbidities, Hypertension, Type 2 diabetes mellitus

How to cite this article: Patil MB, Padikkal FUK, Ramesh G. Clinical Study of Type 2 Diabetes Mellitus in Women with Comorbidities. J Med Sci 2018;4(3):87-89.

Source of support: Nil

Conflict of interest: None


 
Editorial
R Srivatsan

Open-source Tool for Data Analysis in Medicine—Are We Ready?

[Year:2018] [Month:July-September] [Volumn:4 ] [Number:3] [Pages:26] [Pages No:iv-v][No of Hits : 16]


Abstract

The vital role played by the statistical analysis in the field of healthcare and pharmaceutical research is well known.
Whether it is the randomization of clinical trials, sample size estimates, statistical testing or modeling the data, every step of medical research extensively uses statistical algorithms.


 
ORIGINAL ARTICLE
M Padmavathi, Jyothi A Raj

Histopathological Spectrum of Non-neoplastic and Neoplastic Lesions of Thyroid: A 5-year Prospective Study in a Tertiary Care Hospital

[Year:2017] [Month:July-September] [Volumn:3 ] [Number:3] [Pages:31] [Pages No:63-68][No of Hits : 464]


ABSTRACT

Introduction: Thyroid gland is unique among the endocrine glands in that it can be affected by a wide spectrum of diseases ranging from functional and immunologically mediated enlargements to neoplastic lesions. Thyroid neoplasms represent the most common malignancies of the endocrine system.

Aims and objectives: To study the frequency of various thyroid lesions in thyroidectomy specimens and categorize neoplasms based on current World Health Organization (WHO) classification.

Materials and methods: All thyroidectomy specimens received in the Department of Pathology, RajaRajeswari Medical College, Bengaluru, India, for histopathological examination over a period of 5 years, from July 2010 to June 2015, were included in the study.

Results: A total of 211 thyroidectomies were examined in the study. The highest incidence of thyroid lesions was seen in the fourth decade (n = 68, 36%) and showed a female predominance (90%). Non-neoplastic lesions accounted for 148 cases (70.1%) and neoplasms accounted for 63 cases (29.9%). The common non-neoplastic lesions were multinodular goiter (37.2%) followed by Hashimoto thyroiditis (35.8%), colloid goiter (16.9%), and adenomatous hyperplasia (5.3%). Benign neoplasms (22.2%) were lower with all cases being follicular adenoma, and malignancies were higher (77.8%) with papillary carcinoma (58.7%) as the most common malignancy in our study. Colloid goiter and multinodular goiter were the common features in peritumoral thyroid tissue, followed by Hashimoto thyroiditis.

Conclusion: Thyroid disorders are commonly encountered endocrine diseases. Histopathological examination is the mainstay for definitive diagnosis and management of thyroid neoplasms. Appropriate categorization of neoplasms according to international guidelines is to be followed for diagnostic accuracy.

Keywords: Morphology, Neoplastic, Non-neoplastic, Thyroidectomies.

How to cite this article: Padmavathi M, Raj JA. Histopathological Spectrum of Non-neoplastic and Neoplastic Lesions of Thyroid: A 5-year Prospective Study in a Tertiary Care Hospital. J Med Sci 2017;3(3):63-68.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
NH Rekha, MS Bharath, SP Channakeshava

Study of Prevalence of Hypomagnesemia in Patients with Type II Diabetes Mellitus

[Year:2017] [Month:April-June] [Volumn:3 ] [Number:2] [Pages:26] [Pages No:55-58][No of Hits : 438]


ABSTRACT

Introduction: Diabetes mellitus is a common metabolic disorder. Prevalence of diabetes is increasing globally and it is one of the major health problems of the 21st century. The disturbance in serum magnesium (SMg) has been reported among patients with type II diabetes mellitus. Hypomagnesemia has negative impact on glucose homeostasis and insulin sensitivity in patients with type II diabetes mellitus.

Aim: This study was undertaken to know the prevalence of hypomagnesemia in patients with type II diabetes mellitus and its relation with glycated hemoglobin (HbA1c). The study was conducted on 200 patients with type II diabetes and 100 healthy controls at RajaRajeswari Medical College & Hospital, Bengaluru.

Results: Out of 200 diabetic patients, 115 (57%) had hypomagnesemia. We observed mean SMg (1.7 mg) significantly low in diabetic patients compared with controls (2.1 mg). We also found HbA1c was high (9%) in hypomagnesemia patients. We found that diabetic hypomagnesemic patients had high mean fasting blood glucose (242.6 mg%) and postprandial blood sugar (313 mg%) than controls.

Keywords: Diabetes mellitus, HbA1c (glycosylated haemoglobin), Hypomagnesemia.

How to cite this ar ticle: Rekha NH, Bharath MS, Channakeshava SP. Study of Prevalence of Hypomagnesemia in Patients with Type II Diabetes Mellitus. J Med Sci 2017;3(2):55-58.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Mamatha B Patil, M Abhishek, BK Pradeep

Role of High-sensitivity C-reactive Protein as a Predictor of Severity of Chronic Obstructive Pulmonary Disease in Correlation with Clinical Parameters

[Year:2017] [Month:April-June] [Volumn:3 ] [Number:2] [Pages:26] [Pages No:50-54][No of Hits : 394]


ABSTRACT

Introduction: Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality throughout the world. By 2020, the World Health Organization predicts that COPD will become the third leading cause of death and the fifth leading cause of disability worldwide. The COPD is a complex disease characterized by slowly progressive and largely irreversible airflow obstruction due to chronic bronchitis and emphysema and associated with systemic inflammation.

Objective: This study aimed to correlate the plasma levels of high-sensitivity C-reactive protein (hs-CRP) with severity of COPD and pulmonary function tests [PFTs; according to Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages] and find out the relation between hs-CRP levels and clinical parameters of age, number of pack years, and body mass index (BMI) of the patient.

Materials and methods: A cross-sectional study of 102 male patients with clinically and spirometrically diagnosed cases of COPD was performed. Data on patient’s demographic characteristics, pack years, BMI, PFTs, and hs-CRP were analyzed.

Results: A total of 76 of the patients had moderate airflow obstruction (GOLD stages II and III), mild airflow obstruction was present in 14 patients (GOLD stage I), and 12 patients had severe airflow obstruction (GOLD stage IV). The hs-CRP was normal in 6 patients, while it was raised in 96 patients. The value of hs-CRP was correlated with age, pack years, BMI, and GOLD stages. There was a significant negative correlation between hs-CRP and BMI and a significant positive correlation between hs-CRP and age, pack years, and GOLD stages.

Conclusion: A raised level of CRP in COPD indicates reduced lung function; it plays an important role in systemic inflammation. This study supports the role of hs-CRP as a simple, costeffective biochemical marker in the staging and determining the severity of COPD other than spirometry.

Keywords: Chronic obstructive pulmonary disease, Global Initiative for chronic obstructive lung disease stages, Highsensitivity C-reactive protein, Spirometry.

How to cite this article: Patil MB, Abhishek M, Pradeep BK. Role of High-sensitivity C-reactive Protein as a Predictor of Severity of Chronic Obstructive Pulmonary Disease in Correlation with Clinical Parameters. J Med Sci 2017;3(2):50-54.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
KT Venkatesh Murthy, Maya D Nadkarni, N Amaranath

Comparison of Efficacy of Different Doses of Clonidine with 0.5% Bupivacaine for Spinal Anesthesia in Lower Limb Orthopedic Surgeries

[Year:2017] [Month:April-June] [Volumn:3 ] [Number:2] [Pages:26] [Pages No:45-49][No of Hits : 386]


ABSTRACT

Clonidine, a centrally acting α2 adrenergic agonist has been under use as an adjuvant with hyperbaric bupivacaine for prolonging analgesia and maintaining hemodynamic stability during lower limb orthopedic and lower abdominal surgeries.
The purpose of our study was to compare the efficacy and safety of intrathecal Clonidine 50 and 75 μg as adjuvant to hyperbaric Bupivacaine 15 mg (3 mL), and hyperbaric Bupivacaine 3 mL with saline 0.5 mL for onset and duration of anesthesia, hemodynamic stability, and side effects if any.
This prospective randomized controlled study was conducted on 120 patients scheduled for lower limb orthopedic surgeries under spinal anesthesia. The study population was divided into three groups with 40 patients in each group. Group I (controlled group) received 3 mL (15 mg) of 0.5% Bupivacaine heavy and 0.5 mL of normal saline. Group II received 50 μg of clonidine followed by Bupivacaine 0.5% 3 mL (15 mg) and group III received 75 μg of clonidine followed by Bupivacaine 0.5% 3 mL (15 mg) intrathecally. Time taken for onset of sensory and motor blockade, duration of anesthesia, and any perioperative and postoperative complications was noted.
We found that clonidine 75 μg given prior to bupivacaine, 3 mL, significantly prolongs the duration of anesthesia with minimal changes in hemodynamic parameters and postoperative complications.

Keywords: Adjuvants, Bupivacaine heavy, Clonidine, Orthopedic surgeries, Spinal anesthesia.

How to cite this article: M urthy K TV, N adkarni M D, Amaranath N. Comparison of Efficacy of Different Doses of Clonidine with 0.5% Bupivacaine for Spinal Anesthesia in Lower Limb Orthopedic Surgeries. J Med Sci 2017;3(2):45-49.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
Ravishankar Shetty, Shanmukh Hiremath

Pericardial Synovial Sarcoma presenting with Cardiac Tamponade

[Year:2017] [Month:January-March] [Volumn:3 ] [Number:1] [Pages:33] [Pages No:28-30][No of Hits : 361]


ABSTRACT

Pericardial synovial sarcomas are very rare and usually associated with poor prognosis if not diagnosed and treated early. It usually presents with symptoms of a massive pericardial effusion and signs of cardiac tamponade and failure. Here, we report the case of a 27-year-old patient with exertional dyspnea and massive pericardial effusion. Echocardiography and magnetic resonance imaging revealed a pericardial mass. The patient was treated by surgical excision and a subsequent histological analysis confirmed the diagnosis of pericardial synovial sarcoma.

Keywords: Cardiac tamponade, Pericardial effusion, Pericardial synovial sarcoma, Pericardium.

How to cite this article: Shetty R, Hiremath S. Pericardial Synovial Sarcoma presenting with Cardiac Tamponade. J Med Sci 2017;3(1):28-30.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
Sowmya Anand, Nitish Suresh, Ajit K Reddy, Anil K Shukla

Imaging of a Rare Case of Diaphragmatic Tumor

[Year:2017] [Month:January-March] [Volumn:3 ] [Number:1] [Pages:33] [Pages No:25-27][No of Hits : 340]


ABSTRACT

Primary tumors of the diaphragm are quite rare. About 150 cases have been reported in the literature. Fibrosarcomas are the most common malignant neoplasms of the diaphragm; however, only a few (less than 20) cases have been reported to date. We present a case of an extremely rare tumor of the diaphragm. A 65-year-old woman presented with history of vague upper abdominal pain since 2 months and distension for 2 weeks. Ultrasonography features were in favor of a mass arising from left dome of diaphragm with evidence of vascularity on Doppler; lesion was displacing spleen inferiorly. Contrast-enhanced computed tomography scan of the abdomen revealed a mass located in the region of the left dome of diaphragm and deriving blood supply from the branches of abdominal aorta. Surgical excision was planned, keeping in mind the diagnosis of a left diaphragmatic tumor. Laparotomy revealed a left diaphragmatic tumor growing caudally into the upper abdomen.

Keywords: Diaphragmatic tumor, Fibrosarcoma, Leiomyosarcoma, Mesothelioma, Rhabdomyosarcoma.

How to cite this article: Anand S, Suresh N, Reddy AK, Shukla AK. Imaging of a Rare Case of Diaphragmatic Tumor. J Med Sci 2017;3(1):25-27.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Jithumol T Thomas, Sathyanarayana P Sathyanarayana, Muninarasimhiah Manjuladevi

Comparison of the Hemodynamic Responses with Laryngeal Mask Airway vs Endotracheal Intubation in Adults undergoing General Anesthesia for Elective Surgeries

[Year:2017] [Month:July-September] [Volumn:3 ] [Number:3] [Pages:31] [Pages No:69-75][No of Hits : 329]


ABSTRACT

Aim: The aim of this study was to compare the hemodynamic response between laryngoscopy with endotracheal intubation and laryngeal mask insertion. The study also compared immediate postoperative complications between laryngeal mask airway (LMA) and endotracheal intubation.

Materials and methods: Fifty-five American Society of Anesthesiologists (ASA) physical status I and II adult patients who underwent elective surgeries under general anesthesia were included in either group I—LMA or group II—ndotracheal tube (ETT). Patients were induced with intravenous (IV) propofol, fentanyl, and atracurium. After intubation/insertion, patients were mechanically ventilated and isoflurane was used to maintain adequate level of anesthesia with N2O/oxygen mixture. Hemodynamic parameters were measured before induction and after insertion of the airway device every minute for the first 10 minutes and every 5 minutes after that for the first half hour following insertion of the airway device.

Results: A significant and longer increase in heart rate (HR) was noted after ETT intubation as compared with LMA group. However, a decrease in systolic, diastolic, and mean arterial pressures (SBP, DBP, and MAP) was noted after both LMA insertion and ETT intubation. The decrease was significantly more in LMA group (p < 0.001). Complications of postoperative sore throat and hoarseness of voice were also significantly more in ETT group.

Conclusion: Pressor responses might be of no clinical importance in the healthy, normotensive patients, but might be harmful in patients with hypertension, aortic or cerebral aneurysm, raised intracranial pressure, or other cardiovascular diseases. In such cases, the attenuated response of the LMA might be desirable. Therefore, where appropriate, the use of the LMA would be recommended in such patients to avoid the marked response produced by the ETT.

Keywords: Endotracheal tube, Hemodynamic responses, Intubation, Laryngeal mask airway, Randomized controlled study.

How to cite this article: Thomas JT, Sankaranarayana SP, Manjuladevi M. Comparison of the Hemodynamic Responses with Laryngeal Mask Airway vs Endotracheal Intubation in Adults undergoing General Anesthesia for Elective Surgeries. J Med Sci 2017;3(3):69-75.

Source of support: Nil

Conflict of interest: None


 
REVIEW ARTICLE
MS Kiran, M Manjunath, Anil K Shukla, S Vidya

Reliability of Ultrasound in the Identification and Measurement of Blood Supply to the Anterior Part of the Mandible

[Year:2017] [Month:January-March] [Volumn:3 ] [Number:1] [Pages:33] [Pages No:20-24][No of Hits : 327]


ABSTRACT

Objective: The aim of this study is to identify in vivo the main blood supply to the bony chin and to determine the efficacy of ultrasound Doppler in determining this aspect and then compare it with radiograph.

Materials and methods: The study was carried on 50 subjects divided into two equal groups. In the first group, the lingual foramen was identitifed on intraoral periapical (IOPA) radiograph of the mandibular incisor region. Ultrasound Doppler identification of blood supply to the anterior part of the mandible was carried out. In the second group of 25 subjects, the procedure was reversed. This was done to avoid procedural bias.

Discussion: In our patients, the midline artery entering the lingual foramen was seen by ultrasound and radiograph. Their average diameters and velocities were measured. It was identified in 46 cases by the ultrasound Doppler examination. The IOPA radiographic examination was successful in identifying the foramen in 30 cases. The average diameter of the midline artery entering the lingual foramen was found to be 0.14 cm. The average velocity of blood flow in this artery was found to be 25.5 cm/second.

Conclusion: The ultrasound Doppler is a reliable tool to visualize and measure the blood supply to the anterior part of the mandible.

Keywords: Blood supply, Lingual foramen, Radiograph, Ultrasound Doppler.

How to cite this article: Kiran MS, Manjunath M, Shukla AK, Vidya S. Reliability of Ultrasound in the Identification and Measurement of Blood Supply to the Anterior Part of the Mandible. J Med Sci 2017;3(1):20-24.

Source of support: Nil

Conflict of interest: None


 
BRIEF COMMUNICATION
CH Chandra Smitha, Mo Orkoth Prasannan Anantha Sailakshmi, Rnagaiah Nagarathnamma

Prevalence of Impaired Glucose Tolerance and Diabetes Mellitus in Women with Polycystic Ovarian Syndrome

[Year:2017] [Month:October-December] [Volumn:3 ] [Number:4] [Pages:23] [Pages No:116-118][No of Hits : 311]


ABSTRACT

In women of reproductive age polycystic ovary syndrome (PCOS) is the common endocrine disorder. It is one of the common causes of infertility due to anovulation. There is no single criterion for the diagnosis of this syndrome. It is crucial to diagnose PCOS early in its course since it has lifelong implications with increased risk for metabolic syndrome, type II Diabetes mellitus (DM), cardiovascular disease, endometrial hyperplasia, infertility and depression. Screening for the impaired glucose (IGT), allows for proper and timely prevention and management of complications. In this cross sectional study, we planned to detect the prevalence of impaired glucose tolerance and diabetes in women with PCOS which will facilitate prevention of long term sequelae. We also studied the extent of the risk for diabetes in patients with PCOS in relation to age, socioeconomic status, rural and urban areas, BMI, waist/hip circumference ratio, family history of PCOS and diabetes mellitus

Keywords: Diabetes mellitus, Impaired glucose tolerance, Polycystic ovarian syndrome.

How to cite this article: Smitha CHC, Sailakshmi MOPA, Nagaratnamma R. Prevalence of Impaired Glucose Tolerance and Diabetes Mellitus in Women with Polycystic Ovarian Syndrome. J Med Sci 2017;3(4):116-118.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
T Rajitha, BG Parasuramalu

Factors influencing Noncompliance to Treatment among Elderly in the Urban Field Practice Area of RajaRajeswari Medical College and Hospital, Bengaluru, Karnataka

[Year:2017] [Month:January-March] [Volumn:3 ] [Number:1] [Pages:33] [Pages No:11-14][No of Hits : 301]


ABSTRACT

Noncompliance to medication is a leading issue and a huge burden in our current health care system. Poor adherence has shown to decrease the effects of prescribed medications or other treatments and increase the likelihood of poor outcomes. A community-based cross-sectional study was conducted in the urban field practice area of RajaRajeswari Medical College and Hospital, Bengaluru, Karnataka, India, among all the elderly aged .60 years, using a semistructured and pretested questionnaire. The study included 153 elderly participants, among whom 89 were males and 64 were females. Out of the 153 participants, 125 (81.69%) had some or the other illness. Out of the 125 who were ill, only 78 (62.4%) were taking treatment regularly. The remaining 47 (37.6%) were noncompliant to treatment. The main factors for noncompliance were forgetfulness 16 (34%) and symptomatic improvement 10 (21.3%).

Keywords: Bengaluru, Elderly, Noncompliance to treatment, Urban.

How to cite this article: Rajitha T, Parasuramalu BG. Factors influencing Noncompliance to Treatment among Elderly in the Urban Field Practice Area of RajaRajeswari Medical College and Hospital, Bengaluru, Karnataka. J Med Sci 2017;3(1):11-14.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Sandeep Shrivastava, Sohael M Khan, Romil Rathi, Gaurav Mundada, Pradeep K Singh, Shounak Taywade

Study on Outcome of Complex Lower Limb Problems treated by Ring External Fixator and Evolvement of Practices toward its Acceptability

[Year:2017] [Month:April-June] [Volumn:3 ] [Number:2] [Pages:26] [Pages No:35-40][No of Hits : 277]


ABSTRACT

Introduction: In the developing world, there is still lack of accessibility and availability of adequate health care. In rural population this further gets limited, due to meager immediate resource at disposition and lack of availability of transports to adequate set ups. This cross-sectional study is undertaken among our rural patients who had undergone this treatment to understand what difficulties they had faced during such treatments and their acceptability toward such treatment. This study was undertaken with the aim to find out the acceptability and adaptability among the rural population for Ilizarov ring fixators.

Materials and methods: The study consisted of 88 consecutive cases (91 lower limbs) of all age groups, who completed the treatment by Ilizarov methodology between July 2005 and July 2012. A retrospective analysis of the procedure was done through the medical records in terms of preoperative, intraoperative, and after the complete treatment. These were analyzed for limb lengthening in centimeters, correction of deformities, total wearing duration, and final outcome. Subsequently, these patients/parents were interviewed with a questionnaire to assess the self-accessibility (ease) toward self-care; selfdistraction; self-adaptability-comfort during wearing time and the difficulties faced.

Results: Overall the functional outcome was excellent in 18, good in 50, fair in 8, and poor in 4. Out of 91 patients, 67 (73.6%) followed up and could be evaluated for adaptability toward Ilizarov fixator. Overall, 91.04% were satisfied with the treatment by Ilizarov fixator. In the remaining the main reason for not accepting the Ilizarov method was difficulty in commuting in the public transport, ugly and threatening looks of fixator with so many wires crossing the leg.

Conclusion: Ilizarov method is a very effective tool for managing the complex lower limb problems, especially among the population with low resources. It will ensure delivery of a very low-cost solution offered to the needy patients, wherein otherwise due to multiplicity of problems, integral solution is difficult to achieve within their resources.

Keywords: Acceptability, Fixator, Ilizarov, Rural.

How to cite this article: Shrivastava S, Khan SM, Rathi R, Mundada G, Singh PK, Taywade S. Study on Outcome of Complex Lower Limb Problems treated by Ring External Fixator and Evolvement of Practices toward its Acceptability. J Med Sci 2017;3(2):35-40.

Source of support: Nil

Conflict of interest: None


 
EDITORIAL
H Sahajananda

Management of Acute Postoperative Pain: Current Recommendations

[Year:2017] [Month:January-March] [Volumn:3 ] [Number:1] [Pages:33] [Pages No:iv-viii][No of Hits : 273]


ABSTRACT

More than 80% of surgical patients experience acute postoperative pain after their surgeries. Among them, 75% of patients with postoperative pain grade the severity of pain as moderate, severe, or extreme.


 
CASE REPORT
KT Venkatesh Murthy, Vani Thanthri, Veeresh Hosur, H Sahajananda

Acute Pulmonary Edema in a Patient undergoing Appendectomy under Spinal Anesthesia

[Year:2017] [Month:July-September] [Volumn:3 ] [Number:3] [Pages:31] [Pages No:76-78][No of Hits : 263]


ABSTRACT

Acute pulmonary edema, accumulation of large amount of fluid in the interstitial and alveolar space, in patients undergoing surgeries poses a great challenge to the Anesthetist. If not treated well, it could be associated with high mortality rate up to 40%. We report a case of a patient aged 21 years undergoing emergency appendectomy under spinal anesthesia who developed acute Negative Pressure Pulmonary Edema and was successfully managed. His preoperative blood investigations were normal and had no other comorbidities.

Keywords: Negative pressure pulmonary edema, Pulmonary aspiration, Spinal anesthesia.

How to cite this article: Murthy KTV, Thanthri V, Hosur V, Sahajananda H. Acute Pulmonary Edema in a Patient undergoing Appendectomy under Spinal Anesthesia. J Med Sci 2017;3(3):76-78.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Umesh Sivanna

Crystalloid Coload vs Colloid Coload following Spinal Anesthesia for Elective Cesarean Delivery: The Effects on Maternal Central Venous Pressure

[Year:2017] [Month:October-December] [Volumn:3 ] [Number:4] [Pages:23] [Pages No:95-101][No of Hits : 257]


ABSTRACT

Introduction: Spinal anesthesia is widely used in the management of uncomplicated cesarean section. Maternal hypotension is the commonest serious problem which decreases uterine blood flow causing fetal hypoxia, acidosis, and neonatal depression. Fluid administration before start of the surgery (preloading) with crystalloid is found to be ineffective due to rapid redistribution of fluids in various tissue spaces. A “coload” given at the time of spinal anesthesia may be more effective. Most studies have concentrated on noninvasive systolic blood pressure (SBP) measurements to evaluate the effect of such regimens. We used central venous pressure (CVP) measurement technique in parturients receiving rapid administration of crystalloid or colloid solution at the time of initiation of anesthesia (coload). We hypothesized that a colloid coload compared with a crystalloid coload would produce a larger sustained increase in volume and therefore reduce vasopressor requirements.

Materials and methods: We recruited healthy term women scheduled for elective cesarean delivery under spinal anesthesia for this randomized study. Baseline heart rate, baseline mean arterial blood pressure (MAP), and CVP were recorded. At the time of spinal injection, subjects were allocated to receive a rapid 1 L coload of either polymerized gelatin 3.5% (Haemaccel) or Hartmann (crystalloid) solution. The primary outcome CVP was compared between groups, as were secondary outcomes: phenylephrine dose and maternal hemodynamics data.

Results: Maternal demographics, surgical times, and American Society of Anesthesiologists (ASA) were similar between groups. Baseline parameters were similar in all the three groups. Heart rate increased from the baseline in all the three groups; however, mean heart rate was highest in crystalloid group. Mean arterial blood pressure decreased in all the three groups from baseline; however, highest fall was recorded in crystalloid group. The incidence of hypotension was 66.66% in crystalloid group as compared with 36.66% in colloid group. Crystalloid group patients received 6.33 ± 4.54 mg of ephedrine as compared with 2.40 ± 2.82 mg in colloid group. Thus, the incidence of hypotension and ephedrine consumption was significantly higher in crystalloid group as compared with colloid group. We found statistically significant differences in the mean preoperative CVP reading (p < 0.05) between the two groups, the mean CVP reading in crystalloid group being slightly lower. With preloading, similar CVP readings were obtained in both groups. The fall in CVP during subarachnoid blockade was also not significant. The CVP began to fall with the establishment of the block until the delivery of the baby after which it was found to rise. The predelivery CVP was significantly lower than preoperative CVP in both groups—the fall being significantly more in crystalloid group.

Conclusion: In our study, the results showed statistically significant decrease in volume requirement, when colloid coload is used than crystalloid coload using CVP monitor as a guide. Colloid coloading is effective and superior to crystalloid coloading for prevention of maternal hypotension in cesarean section.

Keywords: Central venous pressure, Colloids, Coloading, Crystalloids.

How to cite this article: Sivanna U. Crystalloid Coload vs Colloid Coload following Spinal Anesthesia for Elective Cesarean Delivery: The Effects on Maternal Central Venous Pressure. J Med Sci 2017;3(4):95-101.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
Somanna Prabhakara, V Sreedhar Reddy, Kolandaswamy Anbazhagan, J Vineetha Mercy, Basanth K Reddy

Sex Ambiguity in a 1-year-old Child having Penoscrotal Hypospadias with Bilateral Undescended Testes (Cryptorchidism).

[Year:2017] [Month:July-September] [Volumn:3 ] [Number:3] [Pages:31] [Pages No:79-81][No of Hits : 236]


ABSTRACT

Hypospadias with cryptorchidism is not a very common anomaly in infants and preadolescents. However, it is a perplexing situation to ascertain the exact sex of the child and to assign a proper chromosomal and gonadal sex of the child. The testis can be ectopic, incompletely descended, retractile, absent, or atrophic. In hypospadias, the urethral opening is located on the under surface of the penis, anywhere from the glans to the perineum, depending on the severity of the case. It is associated with chordee, patulous glans, and hooded prepuce. The present case is a 1-year-old child having penoscrotal hypospadias and bilateral undescended testes (cryptorchidism) with genital ambiguity. Our aim of the study was to identify the chromosomal sex and to rule out any microdeletion in the Y chromosome of the child by using conventional cytogenetic and polymerase chain reaction (PCR) techniques. We found that the chromosomal sex was male and there was no microdeletion in the Y chromosome.

Keywords: Chromosomal sex, Cytogenetic analysis, Genital ambiguity, Prepuce.

How to cite this article: Prabhakara S, Reddy VS, Anbazhagan K, Mercy JV, Reddy BK. Sex Ambiguity in a 1-year-old Child having Penoscrotal Hypospadias with Bilateral Undescended Testes (Cryptorchidism). J Med Sci 2017;3(3):79-81.

Source of support: Nil

Conflict of interest: None


 
BRIEF COMMUNICATION
Gabriel M Khan

Sitosterol Blood Levels are Elevated in Diabetics and may be the Cause of Coronary Artery Disease and Stroke

[Year:2017] [Month:July-September] [Volumn:3 ] [Number:3] [Pages:31] [Pages No:89-94][No of Hits : 220]


ABSTRACT

Introduction: Worldwide, diabetes is on the rise. Tight glucose control in randomized control trials has not shown significant improvement in cardiovascular outcomes. It is true that hyperglycemia causes a metabolic syndrome and low-density lipoprotein-cholesterol increases, but atheromatous coronary artery disease (CAD) and cerebrovascular disease are not completely curbed by marked reduction of hyperglycemia. It is necessary, therefore, to search for other culprits that cause atheroma.
High blood sitosterol causes atheromatous CAD and fatal myocardial infarction in young adults with sitosterolemia, in which mutations in either ABCG5 or G8 proteins cause intestinal hyperabsorption of sitosterol and elevated levels. A milder intestinal genetic defect [ABCG5/G8] is present in diabetics. This fact is unknown to endocrinologists, doctors in the field, researchers, and the public. Diabetics consume much vegetable foods that contain sitosterol. The aim of this study is simply to determine if fasting blood sitosterol is elevated in diabetics, particularly in those with CAD.

Materials and methods: Estimation for sitosterol was performed at the Mayo Medical Laboratories for 40 patients with type II diabetes and 17 control subjects.

Results: Sitosterol was elevated in 45% of diabetics, and normal in 100% control subjects; 78.26% of diabetic subjects with CAD showed elevated fasting blood sitosterol levels, 5.1 to 9.5 mg/L (normal range 0-4.9 mg/L).

Conclusion: This novel but preliminary study shows that 12 to 14 hours fasting blood sitosterol levels are elevated in patients with diabetes particularly in diabetics with CAD. The objective was achieved. Most diabetics have elevated blood sitosterol and require treatment as is done for familial homozygous sitosterolemia.

Keywords: Atheroma, Blood elevation, Coronary artery disease, Diabetic, Sitosterol.

How to cite this article: Khan GM. Sitosterol Blood Levels are Elevated in Diabetics and may be the Cause of Coronary Artery Disease and Stroke. J Med Sci 2017;3(2):89-94.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
Nanditha Sheshanna, Gurpreet Sethi, Jyothi A Raj, Sumitha M Prakash, Sharmila P Surhonne

Sudden Death in Sickle Cell Disease: An Autopsy Diagnosis

[Year:2017] [Month:October-December] [Volumn:3 ] [Number:4] [Pages:23] [Pages No:113-115][No of Hits : 211]


ABSTRACT

Sickle cell disease is a common hereditary hemoglobinopathy with high prevalence in the central and northeastern regions of India. A 24-year-old male patient with 3 days’ history of fever was brought dead to the hospital. Morphology showed clogging of blood vessels with sickled red blood cells (RBCs) in all the organs, and an autopsy diagnosis of sickle cell disease was made. As the cause may not be obvious in many cases, most patients remain undiagnosed. It is important to note the circumstances of death, gross finding, and histopathology, with hemoglobin electrophoresis if available, during autopsy to arrive at the diagnosis. This case is presented here to highlight this fact and draw attention to its pathology.

Keywords: Autopsy, Histopathology, Sickle cell disease, Sudden death.

How to cite this article: Sheshanna N, Sethi G, Raj JA, Prakash SM, Surhonne SP. Sudden Death in Sickle Cell Disease: An Autopsy Diagnosis. J Med Sci 2017;3(4):113-115.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
TS Anisha, Ajay K Sahu, Jyothi A Raj, BM Rupakala, M Gautham, PS Sharmila

A Rare Case of Transitional Cell Carcinoma of Ovary: Case Report and Review of Literature

[Year:2017] [Month:July-September] [Volumn:3 ] [Number:3] [Pages:31] [Pages No:82-85][No of Hits : 185]


ABSTRACT

Introduction: Transitional cell carcinoma (TCC) of the ovary is a rare and recently recognized variant of epithelial ovarian cancer. It has been described as primary ovarian carcinoma with definite urothelial features, without benign, metaplastic, and/or proliferating Brenner tumor (BT) identified.

Case report: A 60-year-old lady presented with low back pain, growing abdominal mass, and loss of weight since 15 days. Magnetic resonance imaging (MRI) of abdomen showed a large ill-defined heterogeneous lesion with solid and cystic components. Beta human chorionic gonadotropin (β-hCG) and carcinoembryonic antigen (CEA) levels were raised. Surgery was performed and primary TCC of ovary was reported on histopathology.

Conclusion: Recognition of such tumors is important because of their rarity, favorable response to chemotherapy, and improved patient survival.

Keywords: Histopathology, Ovary, Transitional cell carcinoma.

How to cite this article: Anisha TS, Sahu AK, Raj JA, Rupakala BM, Gautham M, Sharmila PS. A Rare Case of Transitional Cell Carcinoma of Ovary: Case Report and Review of Literature. J Med Sci 2017;3(3):82-85.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
Sowmya M Jois, Kallur Thimmarayappa Venkatesh Murthy, Sadanand Ankitha, Hiremathada Sahajananda

Anesthetic Management of a 9-day-old Neonate with Intestinal Evisceration due to Dog Bite

[Year:2017] [Month:October-December] [Volumn:3 ] [Number:4] [Pages:23] [Pages No:111-112][No of Hits : 178]


ABSTRACT

Intestinal evisceration following dog bite is rare in neonates. We report a successful anesthetic management of a 9-day-old neonate who was brought to our emergency room with history of stray dog bite 1 hour before presenting. Baby was posted for emergency exploratory laparotomy and procedure.

Keywords: Dog bite, Intestinal evisceration, Neonate.

How to cite this article: Jois SM, Murthy KTV, Ankitha S, Sahajananda H. Anesthetic Management of a 9-day-old Neonate with Intestinal Evisceration due to Dog Bite. J Med Sci 2017;3(4):111-112.

Source of support: Nil

Conflict of interest: None


 
Editorial
Amar Bavle

THE PLACEBO EFFECT

[Year:2017] [Month:April-June] [Volumn:3 ] [Number:2] [Pages:26] [Pages No:iv-vi][No of Hits : 170]


ABSTRACT

The word “placebo” comes from the Latin translation, which means “I shall please”. It is a substance that was believed to have no therapeutic effect, and therefore, was used as a control in drug trials in evaluating the efficacy of new drugs. In clinical trials, the placebo is a comparator from a methodological point of view and validates a new treatment, be it pharmacological or non-pharmacological.


 
REVIEW ARTICLE
Prema Dhanraj

Management of Burns

[Year:2017] [Month:October-December] [Volumn:3 ] [Number:4] [Pages:23] [Pages No:102-110][No of Hits : 150]


ABSTRACT

Skin is an essential organ of our body & performs many vital functions. It consists of epidermis & Dermis. Epidermal and burns to superficial part of dermis heal very well with no or minimal scarring. Burns to deep dermis usually heal with hypertrophy and contractures. When skin is burnt, all vital functions of skin are lost. Burns of the face usually heal well due to presence of high proportion of papillary dermis. They should be protected from sunlight. It is known that reticular layer of dermis comes to the defense and protects against formation of contractures. It is also proved that thin layer over eyelids, face and neck is responsible for development of contractures. Thick layer of skin over buttocks & back protects against developing contractures. We should remember that once a scar, it is always a scar. It may not be possible to remove the scars completely, but we can minimize the burn scar. Management of burns includes, management at the site of injury, management in emergency room, management in ICU (intensive care unit), HDU (High dependency unit) and also wards. Meticulous dressings to be done as and when required. When all the wounds have healed advice for massage with oil or moisturizer, active physiotherapy, provision of cervical collar, splints and pressure garments. We should check for compliance of the treatment at regular intervals. Counselling of the patients requires utmost attention. Psychological support and rehabilitation is very essential as many patients may go for psychiatric illnesses. Secondary surgery for correction of deformities after 6 months or as per indication is mandatory.

Keywords: Burns, Dermis, Electrical burns, Epidermis.

How to cite this article: Dhanraj P. Management of Burns. J Med Sci 2017;3(4):102-110.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
KN Mohan Rao, Gundappa Vivek, SV Siva P Reddy

An Unusual Case of Multiple Primary Malignancies with Fungal Infection

[Year:2017] [Month:July-September] [Volumn:3 ] [Number:3] [Pages:31] [Pages No:86-88][No of Hits : 123]


ABSTRACT

A 50-year-old male presented with complaints of cough with expectoration since 2 months with pain during defecation and loose stools since 1 month, and one episode of hemoptysis. Chest X-ray showed bilateral multiple nodular opacities with multiple cavities with air fluid levels. Sputum acid-fast bacilli (AFB) fungal culture showed growth of Aspergillus terreus. Computed tomography (CT) scan of chest and abdomen showed bilateral multiple cavities and nodules with left pleural effusion and adrenal metastasis with rectal mass and narrowing of lumen. Rectal biopsy showed moderately differentiated adenocarcinoma. Computed tomography-guided lung biopsy was also done, which surprisingly came as poorly differentiated large cell carcinoma.
We report a case of synchronous multiple primary malignancy (MPM), rectum and lung, primary lung metastasizing to adrenal glands and lung with secondary fungal infection (A. terreus).

Keywords: Multiple primary malignancies, Multiple primary malignancy with fungal infection, Rectal carcinoma.

How to cite this article: Rao KNM, Vivek G, Reddy SVSP. An Unusual Case of Multiple Primary Malignancies with Fungal Infection. J Med Sci 2017;3(3):86-88.

Source of support: Nil

Conflict of interest: None


 
Editorial
Mamatha Patil

DIABETES IN A WOMAN: HOW UNIQUE IS SHE?

[Year:2017] [Month:October-December] [Volumn:3 ] [Number:4] [Pages:23] [Pages No:iv-x][No of Hits : 100]


ABSTRACT

This year on World Diabetes Day, the World Health Organization theme is “Women and Diabetes—Our Right to a Healthy Future”. A woman is unique as she has to play multiple roles in her lifetime through the various stages of her life. Hence, taking care of women’s health by health care providers is a prime concern.


 
Editorial
Suresh Raghavaiah

PANCREAS TRANSPLANTATION

[Year:2017] [Month:July-September] [Volumn:3 ] [Number:3] [Pages:31] [Pages No:iv-v][No of Hits : 87]


ABSTRACT

Type I diabetes occurs due to immune destruction of insulin-producing beta cells of the pancreas. Lack of insulin produces profound hyperglycemia, and exogenous insulin therapy remains the mainstay of treatment. Although extensive research and technological innovations are developing new automated glucose sensing and insulin delivery devices, it is still at a stage where constant euglycemia has not been achieved. Hence, the patients are resigned to manual checking of glucose levels and subcutaneous insulin injections.


 
ORIGINAL ARTICLE
KC Prajwal, MV Krishna, Sharanappa Patil

Study of Clinical Profile of Community-acquired Pneumonia with Special Reference to C-reactive Protein and Procalcitonin Levels

[Year:2016] [Month:April-June] [Volumn:2 ] [Number:2] [Pages:17] [Pages No:27-30][No of Hits : 456]


ABSTRACT

Introduction: Pneumonia is defined as an infection of the pulmonary parenchyma. Despite being the cause of significant complications and deaths, pneumonia is often wrongly diagnosed, mistreated, and underestimated. The incidence rates are highest in old-aged patients. In the current prospective observational study, we intend to study the utility of procalcitonin (PCT) level and serum C-reactive protein (CRP) level for diagnosing pneumonia.

Design: Prospective observational studies. Materials and methods: The study was conducted in RajaRajeswari Medical College and Hospital, Bengaluru, during the period extending from June to May 2014. Eighty patients, aged more than 18 years, with diagnosis of pneumonia were included in the study. Serum PCT levels were calculated using BRAHMS PCT Kryptor immunofluorescent assay (Biomerieux, France). Other routine investigations, including CRP, sputum culture, and endotracheal secretions cultures, were done. Chisquare analysis was done to assess its prognostic and diagnostic significance. Data were analysed with Statistical Package for the Social Sciences (version 17.0 for Windows).

Results and conclusion: C-reactive protein was positive in 60 (75%) of the patients, and PCT was positive in 45 (56.25%) patients; 28 patients had PCT levels 0.5 to 1.5 ng/mL, 1 (3.6%) had CRP <6 mg/mL, 27 (96.4%) had CRP >6 mg/mL; 17 patients had PCT values >1.5 ng/mL and CRP was positive in all patients (p < 0.001). Streptococcus pneumonia was the most common and isolated in 8 (10%) patients. C-reactive protein is a useful and better adjuvant in the diagnosis of community-acquired pneumonia (CAP). Positive PCT levels indicate a bacterial etiology for pneumonia. A high PCT level is a poor prognostic indicator and is associated with a higher mortality.

Keywords: Biomarker, Pneumonia, Procalcitonin, Prognosis, Prohormone.

How to cite this article: Prajwal KC, Krishna MV, Patil S. Study of Clinical Profile of Community-acquired Pneumonia with Special Reference to C-reactive Protein and Procalcitonin Levels. J Med Sci 2016;2(2):27-30.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
Sonam Sanjay, VV Seetha Pramila, Anil K Shukla, R Nagesh

A Rare Case of Late Presentation of Congenital Diaphragmatic Hernia

[Year:2016] [Month:October-December] [Volumn:2 ] [Number:4] [Pages:13] [Pages No:65-67][No of Hits : 439]


ABSTRACT

Congenital diaphragmatic hernia is a well-described condition that occurs in about 1 in 5,000 live births. A majority of the patients are diagnosed either antenatal or will present in the first few hours of life with respiratory distress. Presentation in adults is extremely rare and accounts for about 5 to 25% of diaphragmatic hernias. Patients, who present with late diaphragmatic hernias, complain of a wide variety of symptoms and diagnosis can be difficult. It consists of herniation of bowel, and occasionally solid organs, into the chest. It is more common on the left side (seen in 80% of cases), as the liver provides a relative barrier on the right side. The major clinical problem is pulmonary hypoplasia, a result of the lung having failed to develop in utero as the thoracic cavity is filled with abdominal contents. These congenital diaphragmatic defects have also been described in the adult population, and the widespread use of computed tomography has led to the recognition that these hernias are not uncommon and are often asymptomatic.

Keywords: Abdominal hernia, Computed tomography, Congenital diaphragmatic hernia, Late presentation.

How to cite this article: Sanjay S, Pramila VVS, Shukla AK, Nagesh R. A Rare Case of Late Presentation of Congenital Diaphragmatic Hernia. J Med Sci 2016;2(4):65-67.

Source of support: Nil

Conflict of interest: None


 
REVIEW ARTICLE
Manish Maladkar, Chitra Tekchandani, Aakash Siddhanti

Touching Greater Horizons in the Management of Diabetic Neuropathy: Epalrestat in Advanced Role

[Year:2016] [Month:January-March] [Volumn:2 ] [Number:1] [Pages:25] [Pages No:9-14][No of Hits : 436]


ABSTRACT

The major factor contributing to the pathogenesis of type 2 diabetes and its various complications is insulin resistance (IR). The lesser known and interesting element that has been unfolding is about the existence of IR in neurons associated with disrupted phosphatidylinositol 3-kinase/protein kinase B (PI3k/Akt) pathway with subsequent adverse effect on nerve function. Hyperactivity of polyol pathway is identified as the prime convincing mechanism elucidating the metabolic link between hyperglycemia and nerve dysfunction. Additionally, in the polyol trail, reduction in glutathione leads to redox imbalance and eventually neuropathy.
Epalrestat, the aldose reductase inhibitor (ARI), has been extensively evaluated for its efficacy and safety in the treatment of diabetic neuropathy. Addition of methylcobalamin to Epalrestat therapy has shown faster and better resolution of neuropathy. Epalrestat-induced activation of PI3k/Akt signaling pathway promotes proliferation and migration of endothelial cells, with potential benefits of improved blood supply to damaged nerves. Further evidences reveal upregulation of nerve growth factor (NGF) by Epalrestat that has resulted in wound healing in diabetic patients. Increase in nerve fiber length is the other compatible finding with Epalrestat therapy in patients suffering from diabetic neuropathy. Moreover, Epalrestat has demonstrated significant protection against oxidative stress via induction of glutathione biosynthesis.

Keywords: Diabetic neuropathy, Epalrestat, Glutathione, Methylcobalamin, Nerve growth factor, Neuronal insulin resistance, Oxidative stress, Phosphatidylinositol 3-kinase/protein kinase B (PI3k/Akt) pathway.

How to cite this article: Maladkar M, Tekchandani C, Siddhanti A. Touching Greater Horizons in the Management of Diabetic Neuropathy: Epalrestat in Advanced Role. J Med Sci 2016;2(1):9-14.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
G Mahesh, KC Kiran, KV Ramesh, Roshan Kumar

Functional Outcome of Locking Compression Plate in Neer’s two-part, three-part, four-part Proximal Humerus Fractures

[Year:2016] [Month:January-March] [Volumn:2 ] [Number:1] [Pages:25] [Pages No:1-8][No of Hits : 400]


ABSTRACT

Introduction: Proximal fractures of the humerus account for about 4 to 5% of all fractures. They are the most common fractures in elderly population. Treatment of unstable, displaced, and comminuted fractures of the proximal humerus remains challenging.

Objectives: The present study is undertaken to evaluate the functional outcome of proximal humerus fractures treated by locking compression plate in 20 patients.

Materials and methods: Prospective study was done involving 20 adult patients with proximal humerus fractures admitted from October 2012 to December 2013 treated by open reduction and internal fixation (ORIF) with locking compression plate. The functional follow-up was done for a minimum period of 3 months and the patients were evaluated by Constant Murley scoring (CMS).

Results: In our series, the majority of the patients were middleaged males, with road traffic accidents (RTAs) being the most common cause of injury, involving 2-part, 3-part, and 4-part fractures of the proximal humerus. The fractures were united in 19 patients and 1 patient had avascular necrosis (AVN). Excellent results were seen in 15% of patients, good results in 55%, moderate results in 15%, and poor results in 15% according to CMS. There were 95% union rates, 5% of AVN, and no failures.

Conclusion: In conclusion, locking compression plate is an advantageous implant in proximal humerus fractures due to angular stability, particularly in comminuted fractures and in osteoporotic bones of elderly patients, which allows their early mobilization.

Keywords: Locking compression plate, Open reduction and internal fixation, Proximal humerus fractures, Proximal humerus internal locking system plate.

How to cite this article: Mahesh G, Kiran KC, Ramesh KV, Kumar R. Functional Outcome of Locking Compression Plate in Neer’s two-part, three-part, four-part Proximal Humerus Fractures. J Med Sci 2016;2(1):1-8.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
Rahul Peswani, BL Chandrakar, Rakesh Thakkar

Bilateral Femoral Neck Fracture due to Electric Shock

[Year:2016] [Month:January-March] [Volumn:2 ] [Number:1] [Pages:25] [Pages No:18-20][No of Hits : 348]


ABSTRACT

Simultaneous bilateral fractures of the femoral neck are rare injuries in patients without underlying pathological conditions. We report a case of a 50-year-old male, who sustained bilateral femoral neck injury resulting from electric shock with 440 V of direct current. Bilateral femoral neck fracture is rare. Bilateral femoral neck fracture due to electric shock is even rarer. This case report highlights bilateral femoral neck fracture without primary and secondary bone disease. Late presentation and unclassified pattern of fracture are the other features.

Keywords: Bilateral adductor tenotomy, Bilateral femoral neck fracture, Electric shock injuries, Violent muscle contraction.

How to cite this article: Peswani R, Chandrakar BL, Thakkar R. Bilateral Femoral Neck Fracture due to Electric Shock. J Med Sci 2016;2(1):18-20.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
Priyakshi Chaudhry, Deepti S Shrivastava, Sindhu Bhute, Suhas Jajoo

A Rare Case of Nocturnal Urinary Incontinence and Menuria after Lower Segment Cesarean Section

[Year:2016] [Month:January-March] [Volumn:2 ] [Number:1] [Pages:25] [Pages No:23-25][No of Hits : 348]


ABSTRACT

Misgav Ladach technique for lower segment cesarean section (LSCS) is considered advantageous universally, but debate still continues about nonclosure in layers and further consequences; hence, careful selection of cases and intraoperative decision of closure in layers is important. The classical Youssef’s syndrome comprises cyclic hematuria, amenorrhea, menuria, and complete urinary continence in a patient who had LSCS. Hereby, we present a case report of a woman who suffered with chronic pelvic pain, menuria, and nocturnal eneuresis after her LSCS for obstructed labor, although not exactly the same as Youssef syndrome but rare in occurrence and relieved after adhesiolysis and gonadotropin-releasing hormone (GnRH) analog therapy.

Keywords: Menuria, Nocturnal eneuresis, Obstructed labor.

How to cite this article: Chaudhry P, Shrivastava DS, Bhute S, Jajoo S. A Rare Case of Nocturnal Urinary Incontinence and Menuria after Lower Segment Cesarean Section. J Med Sci 2016;2(1):23-25.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
Veeresh Hosur, GS Karthik, S Rangalakshmi, H Sahajananda

Nitrobenzene along with Organophosphorous Compound Poisoning

[Year:2016] [Month:July-September] [Volumn:2 ] [Number:3] [Pages:13] [Pages No:56-58][No of Hits : 339]


ABSTRACT

Major cause of premature mortality globally and 113,914 suicides are recorded annually from India. Variety of chemicals have been used. Nitrobenzene is used as a pesticide. Here, we report a case of acute poisoning with nitrobenzene which is an organic compound, where clinical evaluation and timely management, helped to save a life.

Keywords: Acute methemoglobinemia, Atropine, Intermediate syndrome, Methylene blue, Nitrobenzene poisoning, Organophosphorous poison, Pralidoxime.

How to cite this article: Hosur V, Karthik GS, Rangalakshmi S, Sahajananda H. Nitrobenzene along with Organophosphorous Compound Poisoning. J Med Sci 2016;2(3):56-58.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Samantha S Komal, V Srividya

Health-related Quality of Life among Diabetics visiting RajaRajeswari Medical College and Hospital, Bengaluru

[Year:2016] [Month:April-June] [Volumn:2 ] [Number:2] [Pages:17] [Pages No:31-35][No of Hits : 288]


ABSTRACT

Introduction: Diabetes mellitus is independently associated with lower levels of health-related quality of life (HRQoL). Quality of life (QoL) is an important aspect in diabetes because poor QoL leads to diminished self-care, which in turn leads to worsened glycemic control, increased risks for complications, and exacerbation of diabetes overwhelming in both the short run and the long run.

Objective: To assess the HRQoL among diabetics aged ≥18 years and above visiting the Medicine Outpatient Department at RajaRajeswari Medical College and Hospital, Bengaluru.

Materials and methods: We conducted a hospital-based study using a generic instrument, Audit of Diabetes Dependent Quality of Life 18 (ADDQoL 18) to measure the QoL of diabetic subjects aged .18 years. One hundred and forty diabetics, including 68 males and 72 females, were selected from the Medicine Outpatient Department at RajaRajeswari Medical College and Hospital. Data was analyzed using Statistical Package for the Social Sciences for Windows, version 22.

Results: The mean age of the participants was 55.7 ± 12.5 years. Majority of them (75.7%) were Hindu by religion and most of the study participants (60%) had received formal education. Majority (48.6%) belonged to grade 3 socioeconomic status. Diabetic patients who were employed constituted 52.9%. On the type of diabetes, 91.4% of the participants had type 2 diabetes, while 8.6% had type 1 diabetes. The mean duration of diabetes since diagnosis was 8.2 ± 6.5 years.
With regard to presence or absence of complications, 38.6% of the participants suffered from complications of diabetes, while 61.4% did not. With regard to treatment, 59.3% of them were consuming only oral hypoglycemic, whereas 40.7% were on insulin. It was observed that diabetes had a negative impact on the present QoL with a mean negative impact of .0.45 and a mean negative average weighted impact of .5.16 on the individual life domains. The negative impact of diabetes on the QoL was greater among those receiving insulin ± oral hypoglycemic agents and among those who had complications. The domains “freedom to eat,” “freedom to drink,” “enjoyment of food,” and “working life” had the greatest negative impact in all patient subgroups. It was observed that male diabetics had a poorer QoL as compared with female diabetics, but this was found to be not statistically significant.

Conclusion: Diabetes had an adverse effect on the QoL of these study subjects.

Keywords: Audit of diabetes dependent quality of life, Diabetes, Quality of life.

How to cite this article: Komal SS, Srividya V. Health-related Quality of Life among Diabetics visiting RajaRajeswari Medical College and Hospital, Bengaluru. J Med Sci 2016;2(2):31-35.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
S Parinita, KN Mohan Rao, Vivek

Intrapulmonary Solitary Fibrous Tumor of the Lung: A Rare Case Presentation

[Year:2016] [Month:April-June] [Volumn:2 ] [Number:2] [Pages:17] [Pages No:42-44][No of Hits : 282]


ABSTRACT

Localized fibrous tumors of the lung arise from the visceral pleura and are pedunculated. They also project into the pleural cavity. The tumor with an entirely pulmonary location is extremely rare. We present here a rare case of intrapulmonary localized fibrous tumor with review of the literature.

Keywords: Immunohistochemistry, Sphindle cell neoplasim, Solitory fibrous tumor.

How to cite this article: Parinita S, Rao KNM, Vivek. Intrapulmonary Solitary Fibrous Tumor of the Lung: A Rare Case Presentation. J Med Sci 2016;2(2):42-44.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
B Sindhura, Sailakshmi, Suhasini Akash

Ruptured Ectopic Pregnancy in Accessory Horn

[Year:2016] [Month:October-December] [Volumn:2 ] [Number:4] [Pages:13] [Pages No:70-72][No of Hits : 277]


ABSTRACT

Pregnancy in an accessory horn is rare. The incidence of uterine congenital anomalies: Müllerian defects in the normal fertile population are 3.2%. Incidence in pregnancy is 1 in 76,000 to 150,000 pregnancies. There are chances of high rate of spontaneous abortion, preterm labor, intrauterine growth retardation, intraperitoneal hemorrhage, and uterine rupture. Unicornuate uterus is a type II classification with unilateral hypoplasia or agenesis. It can be further classified into communicating, noncommunicating, without cavity, and unicornuate uterus.
Mother and fetus are at grave risk due to rupture of horn in second trimester of pregnancy. We report a case of ruptured accessory horn pregnancy at gestation of 18 weeks. Emergency laparotomy was done and the accessory horn was excised. Patient’s postoperative recovery was uneventful.

Keywords: Accessory horn, Müllerian duct, Rupture.

How to cite this article: Sindhura B, Sailakshmi, Akash S. Ruptured Ectopic Pregnancy in Accessory Horn. J Med Sci 2016;2(4):70-72.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Naveen Kumar, AC Shyam, Vidya

Cost Burden of Dengue Fever in a Rural Ramanagara District of Karnataka State

[Year:2016] [Month:October-December] [Volumn:2 ] [Number:4] [Pages:13] [Pages No:59-61][No of Hits : 242]


ABSTRACT

Introduction: Dengue fever is an arboviral disease caused by dengue virus, which is a single-stranded RNA virus and belongs to family Flaviviridae. Dengue fever (DF) has emerged as a global public health problem in recent years. The problem has become hyperendemic in many urban, peri-urban and rural areas, with frequent epidemics South-East Asia is one of the regions with highest risk of DF and accounts for 52% of the worldwide risk. In India, according to World Health Organization, 70.8% of the total health care expenditure was out-of-pocket in 2010. According to the World Bank, the percentage of out-ofpocket expenditure is as high as 86.4%. Dengue fever causes a significant economic and social burden on the population of endemic areas. This study was conducted with the objective to estimate the direct and indirect cost expenditure on families of dengue affected members and to assess the financial coping mechanisms of the families.

Materials and methods: Confirmed cases of DF with either NS-1 positive or IgM positive or positive for both and willing to participate in the study formed the sample. After taking informed consent, study subjects were interviewed using a pretested, semi-structured questionnaire. Questionnaire included demographic profile and questions related to their financial coping mechanisms. Information on the laboratory bill, hospital bill, and pharmacy bill was collected from the hospital records on the day of patient’s discharge. Indirect cost, such as travel expenses, food, and beverage expenses were collected from the family members of dengue patients. Necessary permission was taken from the hospital and RajaRajeswari Medical College & Hospital, Bengaluru, Karnataka, India. Data were collected and compiled in the MS excel sheet and were analyzed using Statistical Package for the Social Sciences version 20.0. Descriptive statistics-qualitative variables were presented as frequencies and percentages, continuous variables, such as hospital stay and cost are expressed in terms of mean and standard deviation.

Results: Average direct cost per household for treatment of dengue was 5185.395 INR. Average out-of-pocket expenditure per household for treatment of dengue was 6190 INR. Most of the households used savings as a mechanism to cope up with the increased expenditure due to dengue. About 77.6% of the households diverted their savings to pay for the treatment of dengue, 18.4% of households borrowed money from friends and relatives to pay the hospital bills, and the remaining 3% respondents used their health insurance as a financial coping mechanism to get the treatment for dengue.

Conclusion: There is a substantial financial loss to the Indian families of which a significant proportion lies below the poverty line. Government is the only agency working for the prevention of this kind of vector-borne disease. Public awareness in the community about the treatment of dengue is very scant. People use their savings which is the major method to cope up with expenditure due to DF. Significant proportion of the population uses the incurred borrowing as a method to pay for the treatment of dengue, which is a matter of concern.

Keywords: Aedes aegypti mosquito, Arboviral disease, Awareness, Cost burden, Dengue fever.

How to cite this article: Kumar N, Shyam AC, Vidya. Cost Burden of Dengue Fever in a Rural Ramanagara District of Karnataka State. J Med Sci 2016;2(4):59-61.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
Amar Bavle, Sharath Vishwaraj

Methylphenidate-induced Obsessive Compulsive Disorder in Attention Deficit Hyperactivity Disorder

[Year:2016] [Month:January-March] [Volumn:2 ] [Number:1] [Pages:25] [Pages No:21-22][No of Hits : 236]


ABSTRACT

Introduction: Attention deficit hyperactivity disorder (ADHD) is one of the most common childhood psychiatric disorders. It is most often treated with methylphenidate (MPH). A 6-yearold male with ADHD was started on MPH. He developed severe obsessive-compulsive disorder (OCD), which lasted for 1 day and was self-limiting. There was complete remission on stopping MPH, without any specific treatment for OCD.

Keywords: Attention def icit hyperactivity disorder, Methylphenidate, Obsessive-compulsive disorder, Side effects.

How to cite this article: Bavle A, Vishwaraj S. Methylphenidateinduced Obsessive Compulsive Disorder in Attention Deficit Hyperactivity Disorder. J Med Sci 2016;2(1):21-22.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
Ajit K Reddy, Manjunath Narayanappa, Anil K Shukla, Annitha E Jayamohan

Intraventricular Silicone Oil: An Imitator

[Year:2016] [Month:July-September] [Volumn:2 ] [Number:3] [Pages:13] [Pages No:48-49][No of Hits : 235]


ABSTRACT

Introduction: Silicone oils are used in vitreoretinal surgery and it helps in maintaining the shape and fullness of the orbital globe. Rarely, they may get leaked from the orbit and may track to the brain in cerebrospinal fluid spaces like cisterns, ventricles. This can be documented by computed tomography with hyperdense oil. We are presenting a very rare case of the orbital silicon oil seepage into the ventricle.
We report the role of multidetector computed tomography to see silicone oil migrating from orbits to the brain. Not many cases are reported in the literature.

Keywords: Computed tomography, Retinal detachment, Silicon oil.

How to site this article: Reddy AK, Narayanappa M, Shukla AK, Jayamohan AE. Intraventricular Silicone Oil: An Imitator. J Med Sci 2016;2(3):48-49.

Source of support: Nil

Conflict of interest: None


 
Editorial
Rajagopalan S

Editorial

[Year:2016] [Month:July-September] [Volumn:2 ] [Number:3] [Pages:13] [Pages No:iv-vi][No of Hits : 231]


ABSTRACT

Surgical site infections (SSIs) are one of the most common health care associated infections in patients undergoing a surgical procedure and one which every surgeon deals with in day-to-day practice. In the pre-Listerian era, surgeons grappled with large numbers of foul smelling wounds dripping with pus, and gangrenous limbs, clueless as to the exact etiology and causative organism.


 
CASE REPORT
Nayana R Somayaji, Rahul Talwade, Anil K Shukla, V Seetha Pramila, R Nagesh, GU Pravin

Multidetector Computed Tomography Evaluation of Juvenile Nasopharyngeal Angiofibroma

[Year:2016] [Month:April-June] [Volumn:2 ] [Number:2] [Pages:17] [Pages No:38-41][No of Hits : 227]


ABSTRACT

Juvenile nasopharyngeal angiofibroma is relatively uncommon accounting for 0.5% of all head and neck tumors occurring exclusively in adolescent males. It is a microscopically benign, yet locally aggressive tumor with high rates of recurrence and results in severe morbidity. Diagnosis requires high index of suspicion as it mimics other sinonasal conditions, like sinonasal polyp, neurofibroma, nasopharyngeal carcinoma, etc. A case of 14-year-old boy with history of swelling in the right cheek, bilateral nasal obstruction, epistaxis, and watering from right eye referred for multidetector computed tomography is reported in this study.

Keywords: Juvenile nasopharyngeal angiofibroma, Multidetector computed tomography, Nasal obstruction, Pterygopalatine fossa, Sinonasal polyp.

How to cite this article: Somayaji NR, Talwade R, Shukla AK, Pramila VS, Nagesh R, Pravin GU. Multidetector Computed Tomography Evaluation of Juvenile Nasophar yngeal Angiofibroma. J Med Sci 2016;2(2):38-41.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
P Hazif Backer, VV Seetha Pramila, Anil K Shukla, R Nagesh

Multidetector Computed Tomography Evaluation of Malignant Superior Vena Cava Syndrome

[Year:2016] [Month:July-September] [Volumn:2 ] [Number:3] [Pages:13] [Pages No:53-55][No of Hits : 227]


ABSTRACT

Introduction: Superior vena cava syndrome results from the blockage of blood flow through the superior vena cava. It can be a medical emergency if it causes laryngeal or cerebral edema. Hence, prompt diagnosis is of utmost importance.

Case report: A 65-year-old male patient came with complaints of progressive dyspnea and cough since 3 weeks. A contrastenhanced multidetector computed tomography (MDCT) scan was done for the patient, which showed thrombus in the superior vena cava with a rich network of collaterals. The three-dimensional reconstruction was also done to demonstrate the collaterals.

Conclusion: The MDCT provides an excellent tool to diagnose and assess the cause of superior vena cava obstruction.

Keywords: Multidetector computed tomography, Superior vena cava syndrome, Three-dimensional volume rendering technique.

How to cite this article: Backer PH, VVP Seetha, Shukla AK, Nagesh R. Multidetector Computed Tomography Evaluation of Malignant Superior Vena Cava Syndrome. J Med Sci 2016;2(3):53-55.

Source of support: Nil

Conflict of interest: None


 
REVIEW ARTICLE
Sunayana S Nagendra, Mamatha B Patil

Recurrent Right-sided Massive Pleural Effusion of Pancreatic Etiology

[Year:2016] [Month:October-December] [Volumn:2 ] [Number:4] [Pages:13] [Pages No:62-64][No of Hits : 221]


ABSTRACT

Pleural effusion secondary to chronic pancreatitis is an uncommon condition accounting for less than 1% of patients. Patients are alcoholic but only 50% of patients have clinical symptoms and signs of previous pancreatitis. Symptoms are predominantly respiratory than abdominal. Raised pleural fluid amylase level in hemorrhagic fluid is diagnostic of pancreatic pleural effusion. Presence of pancreaticopleural fistula (PPF) can be demonstrated by computed tomography (CT) imaging or magnetic resonance cholangiopancreatography (MRCP), but these imaging methods sometimes fail to demonstrate fistulous tract. Herewith, we are presenting a rare case of recurrent right-sided massive pleural effusion secondary to chronic pancreatitis.

Keywords: Alcoholic, Amylase, Endoscopic retrograde cholangiopancreatography, Magnetic resonance cholangiopancreatography, Pancreatic pleural effusion.

How to cite this article: Nagendra SS, Patil MB. Recurrent Right-sided Massive Pleural Effusion of Pancreatic Etiology. J Med Sci 2016;2(4):62-64.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
PG Rooplata, R Nagarathnamma, Nagendra Prasad

Hypercoagulable Thrombophilic Defect and Hyperhomocysteinemia with Recurrent Pregnancy Loss

[Year:2016] [Month:July-September] [Volumn:2 ] [Number:3] [Pages:13] [Pages No:50-52][No of Hits : 214]


ABSTRACT

Successful fetal outcome in any pregnancy is dependent on adequate placental circulation. Normal physiological changes in pregnancy produce a hypercoagulable state.
Placental vasculature abnormalities may result in a number of gestational defects. They also can cause loss of pregnancy, intrauterine fetal death, intrauterine growth retardation, placental abruption, and preeclampsia.
Hereditary thrombophilias are usually undiagnosed because most carriers are asymptomatic. Placental perfusion may be compromised by increased thrombosis that leads to pregnancy complications and recurrent pregnancy loss (RPL).
We report a case of hypercoagulable thrombophilic defect and hyperhomocysteinemia with RPL.

Keywords: Hyper-homocysteinemia, Pregnancy loss, Thrombophilia.

How to cite this article: Rooplata PG, Nagarathnamma R, Prasad N. Hypercoagulable Thrombophilic Defect and Hyperhomocysteinemia with Recurrent Pregnancy Loss. J Med Sci 2016;2(3):50-52.

Source of support: Nil

Conflict of interest: None


 
Editorial
Shashikala Manjunatha

MENTAL HEALTH

[Year:2016] [Month:April-June] [Volumn:2 ] [Number:2] [Pages:17] [Pages No:iv-v][No of Hits : 205]


ABSTRACT

Mental health problems are an extremely important issue worldwide1 (aggregate point prevalence of 10% for adults and 18 to 20 per 1000 person in India) due to their impact on the human rights and quality of life of those affected and their families.


 
CASE REPORT
Annitha E Jayamohan, Ajit K Reddy, Anil K Shukla, Prakash M Lakshmanan

The Rarest of Rare Case of Scrotal Cystocele

[Year:2016] [Month:October-December] [Volumn:2 ] [Number:4] [Pages:13] [Pages No:68-69][No of Hits : 164]


ABSTRACT

Scrotal cystocele is a type of urinary bladder hernia, where the bladder herniates into the scrotum. They are not common and constitute to less than 4% of the hernias and bear a gender predilection toward males with history of lower urinary tract symptoms. Clinical presentation usually varies with some being asymptomatic while others present with intermittent scrotal swellings and voiding problems.
We report the case of a 55-year-old asymptomatic individual who came with incidentally detected hydroureteronephrosis. Nonenhancing spiral computed tomography revealed large scrotal swelling with bilateral inguinal hernia. The bladder was seen herniating on the right while the colon was the content of the left.

Keywords: Bladder hernia, Computed tomography, Inguinal hernia, Scrotal cystocele.

How to cite this article: Jayamohan AE, Reddy AK, Shukla AK, Lakshmanan PM. The Rarest of Rare Case of Scrotal Cystocele. J Med Sci 2016;2(4):68-69.

Source of support: Nil

Conflict of interest: None


 
Editorial
Anil K Shukla

RADIATION KNOWLEDGE FOR BETTER PATIENT CARE!

[Year:2016] [Month:October-December] [Volumn:2 ] [Number:4] [Pages:13] [Pages No:iv-viii][No of Hits : 144]


ABSTRACT

Wilhelm Conrad Roentgen, a German physicist, discovered X-ray on November 8, 1895. He was awarded with first Nobel Prize for Physics in 1901.1 At present, the status of the standard of radiology in India is at par with the rest of the world. Routine or specialized interventions, anything you name it, is done here.


 
EDITORIAL
Amar Bavle

Editorial

[Year:2016] [Month:January-March] [Volumn:2 ] [Number:1] [Pages:25] [Pages No:iv-vi][No of Hits : 141]


ABSTRACT

Prior to the advent of the diagnostic and statistical manual of mental disorders (DSM-5),1 there were a number of terms used to describe and diagnose a group of children, whose primary disturbance was severe impairment of social reciprocity, inability to understand social situation, and to develop interpersonal relationships.


 
CASE REPORT
PS Sharmila, K Shashikala, K Harish, Padmini Jeychandran

An Unusual Case of Carcinoma Ex-pleomorphic Adenoma of the Parotid Gland: A Comprehensive Clinicopathological Review

[Year:2015] [Month:April-June] [Volumn:1 ] [Number:2] [Pages:19] [Pages No:44-46][No of Hits : 465]


ABSTRACT

Carcinoma ex-pleomorphic adenoma (CaxPA) is a carcinoma arising from a primary or recurrent benign pleomorphic adenoma (PA). It presents approximately 11.6% of all malignant neoplasms of salivary gland and mostly originates from major salivary glands. It is a common histologic subtype of primary parotid malignancy. Location in the minor salivary gland is uncommon and occurs in less than 7% of all cases. The majority of CaxPA develops from epithelial component of PA. Salivary gland tumors are known to have a benign clinical behavior with unrecognized metastatic potential. It often poses a diagnostic challenge to clinicians and pathologists. The entity is difficult to diagnose preoperatively. Pathologic assessment is the gold standard for making the diagnosis. We present a case of a 55-year-old female patient who had a right preauricular mass of 10 years duration, with sudden onset of pain of duration of 1 month.

Keywords: Carcinoma ex-pleomorphic adenoma, Histopathology, Major salivary glands.

How to cite this article: Sharmila PS, Shashikala K, Harish K, Jeychandran P. An Unusual Case of Carcinoma Expleomorphic Adenoma of the Parotid Gland: A Comprehensive Clinicopathological Review. J Med Sci 2015;1(2):44-46.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
KC Madhushankar, K Manjunath, B Saiprasad, M Saishayam

Trichobezoar: Presenting as Primary Intestinal Obstruction

[Year:2015] [Month:January-March] [Volumn:1 ] [Number:1] [Pages:25] [Pages No:4-6][No of Hits : 457]


ABSTRACT

Rapunzel syndrome is a rare type of trichobezoar with an extension of the hair into the small bowel. Clinical presentation is deceptive and vague ranging from abdominal mass to gastrointestinal symptoms.
Bezoars are usually confined to the stomach which is seen in individuals with psychiatric illness, like trichotillomania, trichophagia and gastric dysmotility. Long standing bezoars may extend into the small intestine leading to a condition known as Rapunzel syndrome. Trichobezoars presenting primarily as intestinal obstruction is very rare. Diagnosis can be established by endoscopy, ultrasonography and computed tomography scan. Treatment includes improvement of general condition and removal of bezoar by laparoscopic approach or laparotomy. Psychiatric consultation is necessary to treat and prevent relapse. We present the case of a 6 years old girl, where the trichobezoar was not suspected at all, especially with negative history of trichophagia and trichotillomania. This girl presented with history of intermittent pain abdomen since 3 months and recent onset severe pain abdomen with abdominal distension and vomiting. Skiagram of abdomen revealed dilated small bowel loops with multiple air fluid levels suggestive of intestinal obstruction. Even ultrasonogram of abdomen was also inconclusive for cause of obstruction. At laparotomy, dilated small bowel loops with multiple interbowel adhesions were seen. A hard mass measuring 5 × 6 cm was seen at distal jejunum causing distal obstruction with pressure necrosis over bowel wall. Enterotomy was done which revealed trichobezoar which was removed en masse. Resection and anastomosis of necrosed jejunum was done. Patient recovered completely after the procedure.

Keywords: Intestinal perforation, Primary small intestinal obstruction, Rapunzel’s syndrome, Trichobezoars, Trichophagia.

How to cite this article: Madhushankar KC, Manjunath K, Saiprasad B, Saishayam M. Trichobezoar: Presenting as Primary Intestinal Obstruction. J Med Sci 2015;3(1):4-6.

Source of support: Nil

Conflict of interest: None


 
Case Report
Praveen Halgunaki, GS Karthik, Rangalakshmi, H Sahajananda

Anesthetic Management of an Elderly Patient with Permanent Pacemaker posted for Fixation of Tibial and Radial Fracture

[Year:2015] [Month:October-December] [Volumn:1 ] [Number:4] [Pages:17] [Pages No:77-79][No of Hits : 427]


ABSTRACT

Cardiac patients with pacemaker presenting for noncardiac surgery pose a considerable challenge to the anesthesiologists. In the United States it is said that there are more than 500,000 patients with pacemaker and every year more than 115,000 devices are implanted. Intraoperative care of the pacemaker as well as understanding its anesthetic implication is crucial in the management of these high-risk patients. We hereby present a case of an 85-year-old male posted for plating of tibial fracture with k-wiring of radius fracture who had permanent cardiac pacemaker in situ.

Keywords: Invasive cardiac monitoring, Pacemaker, Regional anesthesia.

How to cite this article: Halgunaki P, Karthik GS, Rangalakshmi, Sahajananda H. Anesthetic Management of an Elderly Patient with Permanent Pacemaker posted for Fixation of Tibial and Radial Fracture. J Med Sci 2015;1(4):77-79.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
Safal Rahim

Squamous Cell Carcinoma under the Veil of a Trophic Ulcer in a Case of Hansen’s Disease

[Year:2015] [Month:July-September] [Volumn:1 ] [Number:3] [Pages:14] [Pages No:60-61][No of Hits : 418]


ABSTRACT

Hansen’s disease is seldom associated with trophic ulcers, which over a period of time when neglected has the potential for malignant transformation. In this case report, a 44-year-old male patient previously treated for Hansen’s disease presented with nonhealing plantar ulcer, who developed squamous cell carcinoma with metastasis in the lymph nodes. We highlight the importance of having a high degree of suspicion in each case as our patient was asymptomatic and repeated biopsies and lymph node Fine needle aspiration cytology (FNAC) were required to diagnosis.

Keywords: Hansen’s disease, Leprosy, Marjolin’s ulcer, Plantar ulcer, Squamous cell carcinoma, Trophic ulcer.

How to cite this article: Rahim S. Squamous Cell Carcinoma under the Veil of a Trophic Ulcer in a Case of Hansen’s Disease. J Med Sci 2015;1(3):60-61.

Source of support: Nil

Conflict of interest: None


 
Original Article
A Sandhya, R Mamatha, Antara Banerjee, H Sahajananda

Postoperative Nausea and Vomiting in Day Care Patients: A Comparative Randomized Controlled Trial of Total Intravenous Anesthesia with Propofol, Air, and Oxygen vs Inhalation Anesthesia with Isoflurane and Nitrous Oxide

[Year:2015] [Month:October-December] [Volumn:1 ] [Number:4] [Pages:17] [Pages No:63-68][No of Hits : 413]


ABSTRACT

Introduction: We compared the incidence of postoperative nausea and vomiting (PONV) after total intravenous anesthesia (TIVA) using propofol-air to inhalational anesthesia with isoflurane-nitrous oxide in day care patients at a tertiary care academic institution.

Materials and methods: We randomized 60 patients and assigned to either group I (inhalational anesthesia with isoflurane- nitrous oxide) or group II (TIVA with propofol-air). Incidence of PONV, use of anti-emetics, and duration of stay in the recovery were recorded for 72 hours by blinded observers.

Results: Total intravenous anesthesia reduced the PONV up to 72 hours by 27% among our patients (from 37 to 10%, p < 0.001). This effect was seen more in the early postoperative period. Overall, 13.3% of patients in the group I received antiemetic compared to 40% in group II. In our study, patients without PONV were discharged from the recovery room 15 minutes earlier after TIVA than after isoflurane and N2O anesthesia.

Conclusion: Total intravenous anesthesia with propofol and air resulted in a reduction of PONV compared with isoflurane- nitrous oxide anesthesia. Overall, patients in group I required less rescue antiemetic, compared to group II. Total intravenous anesthesia resulted in shorter stay in the postoperative anesthetic care unit compared to isoflurane-N2O group.

Keywords: Inhalational anesthesia, Postoperative nausea and vomiting, Total intravenous anesthesia.

How to cite this article: Sandhya A, Mamatha R, Banerjee A, Sahajananda H. Postoperative Nausea and Vomiting in Day Care Patients: A Comparative Randomized Controlled Trial of Total Intravenous Anesthesia with Propofol, Air, and Oxygen vs Inhalation Anesthesia with Isoflurane and Nitrous Oxide. J Med Sci 2015;1(4):63-68.

Source of support: Nil

Conflict of interest: None


 
Review Article
Prema Dhanraj

Infantile Hemangioma: An Overview

[Year:2015] [Month:October-December] [Volumn:1 ] [Number:4] [Pages:17] [Pages No:69-71][No of Hits : 399]


ABSTRACT

Infantile hemangiomas (IH) are benign vascular neoplasms that have a characteristic clinical course marked by early proliferation and followed by spontaneous involution. Hemangiomas are the most common tumors of infancy and usually are medically insignificant. The vast majority of infantile hemangiomas do not require any medical or surgical intervention. Treatment options for clinically significant hemangiomas include, laser surgery, surgical excision or Medication.

Keywords: Flashlamp-pumped pulsed-dye laser, Hemangioma, Laser thearapy.

How to cite this article: Dhanraj P. Infantile Hemangioma: An Overview. J Med Sci 2015;1(4):69-71.

Source of support: Nil

Conflict of interest: None


 
Editorial
S Rangalakshmi

Editorial

[Year:2015] [Month:July-September] [Volumn:1 ] [Number:3] [Pages:14] [Pages No:v-viii][No of Hits : 399]


ABSTRACT

Day Care Surgery: An Overview

Outpatient surgery and anesthesia, which started as a money-saving modality, has picked up momentum even in India over the last two decades due to innovations in surgical techniques and advances in anesthesia. The present generation is one for whom time is as precious as money, and therefore, early discharge is popular. Positive feedback from patients has increased the popularity of outpatient surgery.


 
Case Report
A Gayatri, R Nagarathnamma, Nagendra Prasad

A Rare Case of Bicornuate Uterus with Embedded Intrauterine Contraceptive Device

[Year:2015] [Month:October-December] [Volumn:1 ] [Number:4] [Pages:17] [Pages No:72-73][No of Hits : 372]


ABSTRACT

Early intrauterine contraceptive devices (IUCDs) like Lippes Loop were intended for long-term use until menopause and hence often retained for years, and many patients present well into menopause still bearing a Lippes Loop either deliberately or forgotten. We present a case of a 65-year-old postmenopausal female patient presented with complaints of spotting per vagina since 20 days, associated with white discharge per vagina. Ultrasound abdomen showed calcified endometrium with IUCD in the cervical canal. Hysteroscopy was done. As IUCD could be visualized but could not be removed, hence hysterectomy was done.

Keywords: Bicornuate uterus, Lippes loop, Menopause

How to cite this article: Gayatri A, Nagarathnamma R, Prasad N. A Rare Case of Bicornuate Uterus with Embedded Intrauterine Contraceptive Device. J Med Sci 2015;1(4): 72-73.

Source of support: Nil

Conflict of interest: None


 
Editorial
Sunil R

Editorial

[Year:2015] [Month:January-March] [Volumn:1 ] [Number:1] [Pages:25] [Pages No:v-vi][No of Hits : 310]


ABSTRACT

Myocardial Regeneration: How far have We progressed?

Heart failure remains the leading cause of death in developed and developing countries. Myocardial infarction (MI) results in the loss of heart muscle cells, which causes heart failure. Medical therapy and mechanical left-ventricular assist devices are available for physicians to improve the prognosis of patients with MI and heart failure, but only half of the patients with end-stage heart failure survive for an year.1


 
CASE REPORT
Mamatha Patil, Deepak Jaiswal

Erdheim–Chester Disease

[Year:2015] [Month:July-September] [Volumn:1 ] [Number:3] [Pages:14] [Pages No:55-57][No of Hits : 305]


ABSTRACT

Erdheim-Chester disease (ECD) is an extremely rare disorder that can affect many different organs of the body. This is an unusual form of non-Langerhans-cell histiocytosis. This is characterized by excessive production and accumulation of histiocytes. The normal function of the histiocytes is to fight infections. Histiocytes accumulate in the loose connective tissue of various organ systems of the body and cause thickening of tissues and may become dense and fibrotic. In the absence of successful treatment, the disease is debilitating and can result in multi-system organ failure. Erdheim-Chester disease is often described in the medical literature as an extremely rare1 entity. Erdheim-Chester disease usually presents in adults aged between 40 and 60 years. Here we present a case report of ECD in a 26-year-old young male patient with progressive course over a period of 4 years with symptoms suggestive of multi-organ involvement.

Keywords: Alfa interferon, Erdheim-Chester syndrome, Interleukin-1, Proto-oncogene.

How to cite this article: Patil M, Jaiswal D. Erdheim-Chester Disease. J Med Sci 2015;1(3):55-57.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL RESEARCH
Sudhir Hebbar

Effectiveness and Utilization Pattern of Cognitive Behavior Therapy of Anxiety Disorders: Evidence from a Psychiatry Clinic

[Year:2015] [Month:July-September] [Volumn:1 ] [Number:3] [Pages:14] [Pages No:52-54][No of Hits : 295]


ABSTRACT

Psychotherapy efficacy studies are conducted in highly controlled research settings. In contrast, effectiveness studies are done in routine clinical practice. In India, the literature on psychotherapy outcome is almost nonexistent.

Materials and methods: Here is a retrospective effectiveness study done by a psychiatrist in his clinic. A total of 67 patients visited for the treatment of anxiety disorders, whose data were available for analysis.

Results: Out of this sample, 44 patients opted for cognitive behavior therapy (CBT) of which 20 (45%) patients dropped out of therapy by the 3rd session. Male patients represented 4 times more than female patients. The average number of sessions attended was 5.4. Of the 24 patients who attended 4 and more number of sessions, on Clinical global impression scale, 10 (41%) improved very much, 11 (45%) improved much, 2 (8%) improved minimally, and 1 (4%) did not change.

Conclusion: This indicates CBT is quite effective for anxiety disorders in patients who attend 4 and more sessions. Early dropout is a significant obstacle to the effectiveness.

Keywords: Anxiety disorders, Cognitive behavior therapy, Effectiveness, Efficacy, Psychotherapy.

How to cite this article: Hebbar S. Effectiveness and Utilization Pattern of Cognitive Behavior Therapy of Anxiety Disorders: Evidence from a Psychiatry Clinic. J Med Sci 2015;1(3):52-54.

Source of support: Nil

Conflict of interest: None


 
Editorial
Vasanth Rao Kadam

Ultrasound in Regional Anesthesia: How far have We progressed?

[Year:2015] [Month:April-June] [Volumn:1 ] [Number:2] [Pages:19] [Pages No:v-vi][No of Hits : 260]


ABSTRACT

Ultrasound in Regional Anesthesia: How far have We progressed?

Ultrasound (US) in regional anesthesia has helped us to move from loss of resistance, blind infiltration and paresthesia techniques to more precise placement of local anesthetic (LA) in the desired anatomical area.


 
Editorial
H Sahajananda

Discharge Criteria in Ambulatory Surgery

[Year:2015] [Month:October-December] [Volumn:1 ] [Number:4] [Pages:17] [Pages No:iv-x][No of Hits : 208]


ABSTRACT

Discharge Criteria in Ambulatory Surgery

Day care surgery is also called as outpatient surgery, ambulatory surgery, fast track surgery, and same-day surgery. An anesthesiologist Ralph Waters built, opened, and managed the first independent outpatient surgery, and outpatient anesthesia clinic in Sioux City, Iowa in the early 1900, to provide surgical care to patients whose operations were thought to be highly demanding for a surgeon’s office yet did not require overnight hospitalization.



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