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   Table of Contents - Current issue
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July-September 2017
Volume 14 | Issue 3
Page Nos. 147-195

Online since Friday, October 27, 2017

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EDITORIAL  

Editorial p. 147
RN Srivastava
DOI:10.4103/am.am_46_17  
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REVIEW ARTICLES Top

Stroke chameleons: Uncommon presentations of a common disease p. 148
Pushpendra Nath Renjen, Dinesh Chaudhari
DOI:10.4103/am.am_33_17  
Stroke is one of the major causes of death and morbidity worldwide and carries an important economic impact. The diagnosis is still a clinical one, supported by brain imaging. However, up to 30% of suspected stroke presentations have a different diagnosis. In these cases, two scenarios must be considered: a false positive diagnosis, or “stroke mimic”, and a false negative or “stroke chameleon”. The diagnosis of acute ischemic stroke is often straightforward. The sudden onset of a focal neurologic deficit in a recognizable vascular distribution with a common presentation - such as hemiparesis, facial weakness and aphasia - identifies a common syndrome of acute stroke. But differential diagnostic problems remain because there are several subtypes of stroke and also because some non-vascular disorders may have clinical pictures that appear identical to strokes. Acute ischemic stroke (AIS) with neurological deficit is a very debilitating condition, especially in younger patients and the rate of false positive diagnosis of ischemic stroke labeled ''stroke mimics'' ranges from 1.3% to 25%.
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Early detection of hearing loss with connexin 26 gene assessment p. 150
Santosh Kumar Swain, Mahesh Chandra Sahu, Manash Ranjan Baisakh
DOI:10.4103/am.am_13_17  
Hearing loss is the most prevalent type of sensory impairment in human beings. Hearing loss is a global problem. Genetic alteration accounts for 50% of the congenital deafness. The connexin 26 (Cx26) mutations are the most common cause behind the nonsyndromic hearing loss and it is easily identified by polymerase chain reaction. Genes responsible for hearing loss are being mapped and cloned progressively. Mutations in the gene (gap junction beta 2) encoding Cx26 have been associated with congenital hearing loss either alone or as part of a syndrome. Cx26 is a part of a large family of gap junction membrane proteins that help electrical and metabolic coupling between adjacent cells. This review article focuses on genetic analysis of nonsyndromic hearing loss, as genetic alteration in this type of deafness recently begun to be identified, epidemiology, diagnosis criteria, and emphasis in early detection.
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ORIGINAL ARTICLES Top

Effect of risk factors on grades of gastroesophageal reflux disease p. 154
Batool Mutar Mahdi, Riyadh Mohamad Hasan, Wafaa Hazim
DOI:10.4103/am.am_38_17  
Background: There are many risk factors associated with degree of development erosive esophagitis and its complications. Aim of the Study: To evaluate the effect of risk factors on severity of esophagitis and identify the most important risk factors among patients presenting to gastroscopy unit. Patients and Methods: Patients with upper gastrointestinal tract (GIT) symptoms were enrolled in gastroscope examination. For each participant, the body mass index (BMI), waist circumference, and immunoglobulin G Helicobacter pylori were done. Results: A total of 195 patients with upper GIT symptoms were examined by gastroscope. One hundred and twenty patients had erosive esophagitis (Grade II and III) (Group A): 75 of them were men (62.5%) and 45 (37.5%) were women. The rest 75 had gastroesophageal reflux disease Grade I (Group B), 52% of them were males, and the rest were females. Group A patients were more likely to be non-steroidal anti-inflammatory (NSAID) users (42.5%) than Group B (P = 0.0002). Group A was more likely to be obese (body mass index >30) (37.5%) (P = 0.015). Men have waist circumference >102 cm and women have a waist circumference >88 cm constitute 92.5% (P = 0.0001) of Group A. Patient with Group A who had hiatus hernia (HH) were (20%) (P = 0.0001) and those with H. pylori (35%) (P = 0.001). Conclusions: Obesity, abdominal obesity, NSAID, HH, and H. pylori infection are strong risk factors for gastroesophageal reflux grades.
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Prognostic significance of glycemic control in burn injury patients: A study in Tertiary Care Hospital of Odisha p. 160
Srikanta Panda, Amit Bagur Lokesh, Anshuman Sarangi
DOI:10.4103/am.am_36_17  
Background: Thermal injury is associated with anatomic, physiologic, endocrinologic, and immunologic alterations, which require specialized care. Advances in medical care have changed the principal cause of death in burn patients from burn shock to wound sepsis. An intervention that has drastically changed this outlook is early excision and primary closure of wounds. We used insulin for glycemic control and attenuating systemic inflammation. Materials and Methods: Patients admitted to S. C. B Medical College hospital were divided into 2 groups of 34 each: control group (n = 34) which did not receive insulin and study group (n = 34) which received insulin. Serum C-reactive protein (CRP), fibrinogen, albumin white blood cell, and blood cultures were done every 7th day. Results: Albumin levels decreased over 7 days followed by gradual recovery which was faster in the study group. CRP levels rose and attained its peak by day 14, then declined. CRP peak in the study group was found to be lower than control. Fibrinogen levels showed identical trend as CRP. Leukocytosis was higher in control compared to study group. Blood culture positive was higher in control compared to study group; Pseudomonas and Candida were most common organisms, but study group patients were resistant to Candida. Out of 29 deceased patients, 55% were from control group. Conclusions: Insulin administration in severely burned patients has demonstrated benefits among various parameters. In critically ill burn injury patients, obtaining tight glycemic control with intensive insulin therapy was shown to reduce morbidity and mortality.
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Frequency of alopecia areata in patients with autoimmune thyroid diseases p. 165
Aynure Oztekin, Ahmet Metin, Saliha Can Kirbas, Coskun Öztekin
DOI:10.4103/am.am_16_17  
Background: Alopecia areata (AA) is higher in patients with thyroid dysfunctions such as Hashimoto's thyroiditis and Graves' disease than in general population. Our aim was to assess AA frequency in patients with thyroid diseases. Materials and Methods: This prospective study included 550 patients with autoimmune thyroid disease (AITD), 126 patients with non-AITD (NAITD), and 100 healthy subjects. Results: Twenty-eight (4.1%) patients were diagnosed with AA based on either medical history or physical examination (P = 0.039). AA was not determined in healthy subjects. The rate of AA was higher among the patients with NAITD than those with AITD (5.6% vs. 3.8%; P = 0.075). Among the AITD patients, 5 (23.8%) patients were diagnosed with AA after being diagnosed with thyroid disease, whereas 15 (71.4%) patients were diagnosed with AA before being diagnosed with thyroid disease. The mean ages at the diagnosis of AITD and at the onset of AA were 36.6 ± 10.8 years and 30.3 ± 13.0 years, respectively. Among the NAITD patients, the mean ages at the onset of thyroid disease and at the onset of AA were 45.3 ± 9.3 years and 37.3 ± 13.3 years, respectively. Other autoimmune-based diseases such as vitiligo, chronic urticaria, and type 1 diabetes were also detected. The patchy pattern of AA was the most common type (n = 27). Conclusions: The frequency of AA was higher in patients with NAITD and AITD compared to the healthy population. Clinicians should be aware of these findings, and accordingly, it would be suitable for them to screen AA patients for thyroid diseases.
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CASE REPORTS Top

Management of aneurysmal bone cyst using nonvascularized fibula graft: A series of four cases p. 171
Malkesh D Shah, Chirag S Kapoor, Rishit J Soni, Jagdish J Patwa, Paresh P Golwala
DOI:10.4103/am.am_11_17  
Aneurysmal bone cyst (ABC) is an uncommon pathological condition, which leads to weakening and fracture of the affected part of the bone. Radiologically, ABC is an eccentric, metaphyseal, expansile, lytic and non-neoplastic lesion of the bone, giving blown-out/ballooned/soap-bubble appearance. Though benign, malignant transformation is reported. It accounts for 1–6% of all primary bone tumours with incidence rate of 0.14% annually. Usually occurs during second decade of life and most common sites for the lesions are the tibia, femur, vertebra, pelvis, humerus and fibula. The various treatment modalities include selective arterial embolisation, en-bloc/wide marginal resection and curettage with phenol, liquid nitrogen, etc., use of sclerosing agents and use of autogenic/allogenic bone graft or polymethylmethacrylate, with or without osteosynthesis. There exists controversy regarding optimum treatment of ABC as recurrence rate ranges from 5–40% depending upon the treatment method used. Use of non-vascularised fibular strut graft yields good results as per many studies especially in large lesions. Hereby, we present four cases of ABC, treated by extended curettage or En bloc excision of lesions and reconstruction using fibular strut graft.
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Bilateral renal lymphangiectasia: A case of cystic rarity p. 176
Alka Rani T Patil, Vinayaka Hosadurga Sathyanarayana, Venkatesh Murthy Dammaningala Venkataramaiah
DOI:10.4103/am.am_28_17  
Renal lymphangiectasia is a benign, rare disorder of lymphatic system of the kidneys, characterized by dilatation of the perirenal lymphatics. This condition closely mimics other cystic lesions of the kidney such as polycystic kidney disease. The diagnosis can be made with classic radiological finding and other laboratory analysis. We report a 3-year-old male boy, a case of bilateral renal lymphangiectasia, diagnosed on ultrasonography and computed tomography typical imaging findings and the laboratory analysis of aspirated fluid.
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A case of Salmonella typhi sepsis with acute encephalopathy and disseminated intravascular coagulopathy p. 179
Sharmili Sinha, Antaryami Nanda, Indraprava Mandal
DOI:10.4103/am.am_29_17  
Typhoid is a serious systemic illness commonly presenting with fever and abdominal symptoms. However, it very rarely can manifest without any gastrointestinal symptoms and with acute indolent neurological features only which can pose a diagnostic challenge. We had a such a case which took a fatal course later on with sepsis, disseminated intravascular coagulation (DIC) and multi-organ failure. We did a literature survey on the unusual and extra-intestinal features of the disease. We found when associated with serious neurological findings, the disease has a worse prognosis. Vaccines along with public awareness should be promoted in endemic zones as the disease can often otherwise take a complicated course with high morbidity and mortality.
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Gynaecomastia in AIDS patient: An association with zidovudine treatment p. 182
Himanshu Bhusan Sahoo, Prasanna Kar, Bandana Rath
DOI:10.4103/am.am_24_17  
Adverse drug reactions (ADRs) occupy a significant role in the etiology of gynecomastia. Gynecomastia is an ADR, rarely formed due to some antiretroviral drugs. Zidovudine is a first-line drug of choice in AIDS patients, but consumption of this drug has not been reported yet for gynecomastia as an adverse effect. Here, we present the case of a 36-year-old male, who developed bilateral gynecomastia following zidovudine use and was completely regressed after discontinuation. Discontinuation of the zidovudine is quite efficient approach without any pharmacological or surgical treatment.
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Joubert syndrome in siblings: A rare case report with literature review p. 185
Venkatesh Murthy Dammaningala Venkataramaiah, Alka Rani T Patil, Vinayaka Hosadurga Sathyanarayana
DOI:10.4103/am.am_12_17  
Joubert syndrome (JS) is a rare autosomal recessive condition characterized by agenesis of cerebellar vermis, abnormal eye movements with nystagmus, episodes of hyperpnea and apnea, delayed generalized motor development, retinal coloboma and dystrophy, and multicystic kidney disease. We report a case of JS in two siblings who presented with delayed mental and motor milestone development, history of abnormal breathing pattern, generalized hypotonia, and abnormal head movements with nystagmus. On evaluation, magnetic resonance imaging showed hypoplastic cerebellar vermis with hypoplasia of the superior cerebellar peduncle resembling the “Molar tooth sign” in the midbrain, confirming the diagnosis.
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Postpartum hypernatremic encephalopathy with “Wine Glass Sign” on magnetic resonance imaging p. 188
Vinit Suri, Sanjiv Jasuja, Neelam Suri, Rahul Saini, Mohit Kalangi Venkata Naga, Kunal Suri
DOI:10.4103/am.am_3_17  
We report a 28-year-old postpartum female with acute delirium, agitation, confusion, visual hallucinations, and limb weakness. Investigations revealed severe hypernatremia, hyperuricemia, rhabdomyolysis, acute kidney injury, normal serum and urine osmolarity, normal urine spot sodium level, and normal serum antidiuretic hormone level. Magnetic resonance imaging of brain revealed hyperintensities in bilateral corticospinal tracts showing the classical “Wine Glass sign” suggesting hypernatremia-related osmotic demyelination. Patient improved with gradual correction of hypernatremia. We would like to highlight the importance of timely recognition and appropriate treatment of this rare condition which is potentially fatal and may also lead to severe permanent neurological deficits.
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A combination of two rarities: Idiopathic CD4+ lymphocytopenia and cerebellar phaeohyphomycosis p. 190
M Kodeeswaran, Arrjun Sankaran, Lakshmi Narasimhan Ranganathan, Chandrasekhar Piskala Ganeshbabu
DOI:10.4103/am.am_10_17  
Cladosporium bantianum is a neurotropic, dematiaceous fungus that causes deep-seated phaeohyphomycosis in humans. Idiopathic CD4+ T-lymphocytopenia is termed as severe unexplained HIV seronegative immunosuppression. We report a case of Cladosporium cerebellar abscess in a 40-year-old man with idiopathic CD4+ T-lymphocytopenia.
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Pulmonary sclerosing pneumocytoma or sclerosing hemangioma mimicking lung cancer p. 193
Vandana Gite, Maruti Dhakane
DOI:10.4103/am.am_26_17  
Pulmonary sclerosing pneumocytoma or sclerosing hemangioma is an uncommon benign neoplasm, often asymptomatic, affects middle-aged women and usually found incidentally as solitary pulmonary nodule on radiologic examination. It is thought to be derived from incompletely differentiated respiratory epithelium. Histologically, it is distinctive neoplasm of the lung and shows two epithelial cell types, surface cells, and round cells with four architectural patterns, papillary, sclerotic, solid, and hemorrhagic. Preoperative diagnosis of this tumor is difficult, and it is now generally accepted that surgical excision alone is curative without the need for additional treatment.
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