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   Table of Contents - Current issue
October-December 2019
Volume 16 | Issue 4
Page Nos. 207-256

Online since Thursday, December 12, 2019

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Editorial Highly accessed article p. 207
Rajendra N Srivastava
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Magnetic resonance imaging diagnosis of rotator cuff tears in subacromial impingement syndrome: A retrospective analysis of large series of cases from a single center p. 208
Reddy Ravikanth, Pooja Majumdar
Background: The most frequent painful shoulder diagnosis is subacromial impingement syndrome. It is important to establish valid diagnostic methods for these patients to potentially improve the management and treatment of this syndrome. Magnetic resonance imaging (MRI) is an excellent modality for imaging of soft tissues of the shoulder joint considering a possibility of multiplanar image acquisition and noninvasive nature of the study. The purpose of this study was to evaluate the prevalence of partial and complete rotator cuff tears in magnetic resonance images of patients with subacromial impingement syndrome and to review the literature on the causes and classification of rotator cuff tears. Materials and Methods: After obtaining institutional ethical committee approval, we retrospectively analyzed the results of 200 shoulder MRI examinations with rotator cuff tears performed in 78 women and 122 men in the department of radiology and diagnostic imaging at a tertiary care hospital between April 2014 and December 2018. Examinations were performed using GE Brivo 1.5T device, including spin echo and gradient echo sequences with T1, T2, and proton-density-weighted as well as fat-saturation sequences in axial, coronal, and sagittal oblique planes. Results: Partial and complete supraspinatus tendon tears were the most frequently reported injuries, with a minority of injuries showing complete tear of subscapularis. Among the 200 patients in the study population, 195 patients suffered from shoulder pain, including 117 patients with a history of trauma. There were 59% men and 41% women among patients with shoulder pain. Posttraumatic shoulder pain was predominantly reported by men, whereas women comprised a larger group of patients with shoulder pain not preceded by injury. Subacromial impingement commonly involved supraspinatus tendon, and supraspinatus tear was the most commonly identified pathology. Subscapularis muscle and infraspinatus tendon tears were less common. Isolated involvement and complete tear most often involved supraspinatus muscle tendon followed by infraspinatus and least often involved subscapularis tendons. Conclusion: Rotator cuff disorders are among the most common causes of shoulder pain and disability encountered, and subacromial impingement syndrome in particular is the most common disorder. Isolated supraspinatus tendon injury or complete tearing is most frequent, rather than in conjunction with injuries to other rotator cuff tendons. Isolated complete tears of infraspinatus and subscapular muscle tendons were rarely encountered in our study.
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Incidence and outcomes of delirium in nonintubated critically ill patients: A prospective observational cohort study p. 213
Hari Naveen, Sooraj Kumar, Ramesh Venkataraman, Nagarajan Ramakrishnan, Bharath Kumar Tirupakuzhi Vijayaraghavan
Objective: Delirium in intubated patients is associated with worse outcomes. However, there is a paucity of data in nonintubated patients. Our study describes the incidence, risk factors, and outcomes for delirium for this population. Methods: We conducted a prospective observational study at a tertiary care intensive care unit (ICU). Data were collected over 2 months and delirium was screened using Confusion Assessment Method for the ICU tool. Only patients with at least 48 h stay in the ICU were included. Patient demographics, risk factors for delirium, and outcomes were recorded. Results: Among 75 patients screened, 13 patients (17.3%) screened positive for delirium. Delirium was more common in patients with higher disease severity and in those with a history of prior hospitalization. In addition, physical restraint use and neurological diagnoses also seemed to be associated with delirium. The presence of delirium did not affect key outcomes. Conclusion: Delirium is common among nonintubated critically ill patients and warrants routine monitoring.
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Prevalence of hypertension and associated risk factors in Suburban Tamil Nadu p. 216
S Mohanraj, Krishnan Swaminathan, G Velmurugan, Thomas Alexander, Nalla G Palaniswami
Background: Hypertension (HTN) is an important risk factor for cardiovascular mortality in India. HTN prevalence data are predominantly available for urban and rural populations in India but not in the mushrooming suburban areas. This study was conducted to estimate the prevalence of HTN and associated risk factors in suburban Tamil Nadu. Methods: In this Kovai Medical Center Hospital Non-Communicable Disease Study, we enrolled adults >20 years of age residing at Thadagam (suburban) in Coimbatore district, Tamil Nadu, India. All participants had a detailed questionnaire and anthropometric measurements. Blood samples were taken for glycosylated hemoglobin, nonfasting lipid profile, and serum creatinine. Prevalence of HTN (self-reported cases of HTN or systolic blood pressure ≥140 mm Hg and or diastolic blood pressure ≥90 mm Hg) was estimated. Multivariable logistic regression analysis was used to identify factors influencing HTN. Results: A total of 1030 participants were involved in this study. The prevalence of HTN was 47.1% in this area, with similar prevalence in both genders. The ratio of known HTN to newly diagnosed HTN was 1:1.3. Nearly 5% of adults between 20 and 39 years had HTN in this cohort. On multivariate logistic regression, after adjustment for age and sex, HTN was significantly associated with diabetes and atherosclerosis. Conclusions: This study identified a high prevalence of HTN in suburban region of Tamil Nadu. Aggressive screening protocols and targeted treatment are the need of the hour to reduce the burden of HTN and cardiovascular diseases in suburban India.
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Impact of laryngopharyngeal reflux on professional singers p. 220
Santosh Kumar Swain, Suryakanta Pradhan
Laryngopharyngeal reflux (LPR) is retrograde flow of gastric content to the larynx and pharynx where these materials come in contact with the upper aerodigestive tract. It is an inflammatory disease associated with voice disorders and lesions in vocal fold. Presence of LPR among professional voice users such as singers can have a dramatic impact on voice quality. Singers are high-risk candidates for LPR because of necessary air support involving higher intra-abdominal pressure, more stress due to professional career, uncomfortable schedules, late meals before going to sleep, and bad food habits such as increased intake of citrus products, fatty, and spicy foods. The objective of this article is to review the current etiopathogenesis, clinical presentations, diagnosis, treatment, and lifestyle modification in cases of singers suffering from LPR and to propose a new patient-related outcome.
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Impact of obesity on disease activity and other health outcome measures in ankylosing spondylitis p. 225
Akshat Pandey, Harmeet Singh Saluja, Arvind Mittal
Obesity is a rapidly increasing pandemic, with almost one-third of the world population being affected. It has its impact on various systems, of which musculoskeletal system is also majorly affected. Its impact on rheumatoid arthritis and psoriatic arthritis are already known, but its association with ankylosing spondylitis is debatable and very few studies are being conducted to support its impact. The below article is a review of the association and impact of obesity on the disease activity, factors involved in its pathogenesis, impact on others underlying diseases, and therapeutic affections. This article also urges the need for the physicians to treat obesity as a separate disease condition which requires treatment like any other disease to improve the quality of life of individuals and to limit the progress of other diseases.
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Is it feasible to develop and implement a successful regional breast cancer screening program in India? p. 229
Lavandan Jegatheeswaran, Payal Haria, Byung Choi, Thin Kyi Phyu Naing, Ed Babu, Arunmoy Chakravorty
Breast cancer is now one of the most prevalent cancers in Indian cities and certain rural areas. India lacks a dedicated breast cancer screening program. This review explores the barriers to the successful implementation of breast cancer screening in India and aims to offer plausible pathways in potentially making this initiative a reality.
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Cortical venous thrombosis – A case series and review of recent updates p. 232
Shivangi Garg, Dinesh Chaudhari, Pushpendra Nath Renjen, Kamal Ahmad, Abhas Kumar, Rajendra Pradhan, Anjali Mishra
Thrombosis of the dural sinus and/or cerebral veins (cerebral venous thrombosis [CVT]) is an uncommon form of stroke, usually affecting young individuals. Early diagnosis and timely institution of appropriate treatment is usually associated with a good outcome. However, its non-specific and extremely varied clinical presentation makes it difficult to diagnose. In this article, we review the etiology, clinical features, diagnostic tools, and mainstay therapy of CVT with recent advancements to help clinicians keep a high degree of suspicion for this disease in appropriate clinical scenarios. We also provide two clinical case scenarios from our hospital as an example of its diverse presentation.
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Fahr's disease presenting with pure dementia: A case report and literature review p. 236
Jamir Pitton Rissardo, Ana Letícia Fornari Caprara, Juliana Oliveira Freitas Silveira
Fahr's disease (FD) is a rare inherited or sporadic disorder characterized by symmetrical calcium deposits in the basal ganglia and dentate nuclei with the absence of biochemical abnormalities. Clinical manifestations can start at different ages with a variety of presentations. We report a case of a 68-year-old male who presented to our service with clinical signs and symptoms of pure and progressive dementia. Afterward, he developed mood changes, and finally, movement disorders, probably due to a sporadic form of FD. Noncontrast cranial computed tomography scan demonstrated scattered brain parenchyma, bilateral calcifications in the basal ganglia, and dentate nuclei. Standard blood tests were within the normal limits. In this way, FD can present with pure dementia at onset, reflecting a wide range of neurological manifestations. The diagnosis is challenging, and we proposed an acronym to facilitate the learning of the diagnostic criteria.
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Paraneoplastic limbic encephalitis mimicking acute herpetic encephalitis p. 240
Charchit Gupta, Dinesh Chaudhari, Pushpendra Nath Renjen, Anjali Mishra, Shivangi Garg, Rajendra Pradhan
Paraneoplastic limbic encephalitis (PLE) is a rare disorder that typically follows a chronic or subacute course of personality changes, memory loss, seizures, and hallucinations. Early diagnosis is difficult, and characteristic symptoms can be mimicked by a variety of conditions. We present a case of PLE, initially presenting as acute herpetic encephalitis.
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Pericontusional penumbra in patients with traumatic brain injury p. 244
Amit Agrawal, V Anil Kumar, Luis Rafael Moscote-Salazar, VA Kiran Kumar
Recently, a number of studies have recognized the importance of traumatic pericontusional penumbra as a potential target for therapeutic interventions to prevent the secondary brain damage. We report an illustrative case of a 40-year-old female patient who was brought to the emergency room with the alleged history of fall from the bike. Computed tomography scan brain showed left sylvian and left temporoparietal subarachnoid hemorrhage, patchy contusion of the left frontal and temporal lobes, linear fracture of the right temporal bone with edema, mass effect, and mild midline shift. After 6 h of intensive care unit stay, the patient developed pupillary asymmetry and a repeat scan showed significant increase in the size of cerebral contusions with gross pericontusional edema, mass effect, and midline shift. The patient underwent urgent left frontotemporoparietal craniotomy and evacuation of the contused brain and hematoma. Pericontusional penumbra is increasingly recognized and strategies are being suggested to salvage the apparently hypoxic (not yet ischemic) brain to preserve the neurological functions and to improve functional outcome. In future, we need more studies to support the concept of pericontusional penumbra and further characterize the imaging findings for early clinical diagnosis and to plan early appropriate intervention.
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An unusual occurrence of deriphyllin-induced hallucinations: Contingency of concern p. 247
Mohit Dahiya, Nehal R Parikh, Deepak S Malhotra, Shikha V Sood
Deriphyllin has been a mainstay of asthma therapy despite its narrow therapeutic index and a large pharmacokinetic variability between patients. Here, the authors decided to report a rare case of suspected deriphyllin-induced hallucinations in adults for the first time. An 83-year-old male patient who was a known case of recent onset asthma was on tablet deriphyllin 150 mg BD and salbutamol nebulization BD. He underwent emergency drainage of subdural hematoma due to a history of fall 20 days back with head injury. Within 2 days, he improved and was discharged 3 days later with the medicines. On follow-up after 7 days, he was admitted with a chief complaint of hallucinations. After stopping tablet deriphyllin, the patient's condition drastically improved in next few days and neurology was completely normal. Drug dechallenge was positive in this case since the hallucinations subsided after discontinuation of suspected drug deriphyllin. There are no such cases published previously.
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Complete Müllerian agenesis, renal agenesis, and renal ectopia: MURCS association – A rare cause of primary amenorrhea p. 250
Reddy Ravikanth, Pooja Majumdar
Müllerian duct aplasia–renal agenesis–cervicothoracic somite dysplasia (MURCS) association is a rare and unusual constellation of nonrandom findings that include Müllerian duct aplasia, renal aplasia, and cervicothoracic somite dysplasia. The agenesis of the Müllerian duct is the second-most common cause of primary amenorrhea after Turner syndrome. The abnormal development of Müllerian duct often associates with the urinary tract and skeletal abnormalities. MURCS association is a unique and rare developmental disorder with four common features of uterine hypoplasia or aplasia, renal agenesis or ectopy, vertebral anomalies, and short stature. Here, we report a 32-year-old female with aplasia of the Müllerian duct, unilateral renal agenesis, and anomalies of the cervicothoracic somites (MURCS association).
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Laparoscopic sacrohysteropexy: A conservative approach to uterine prolapse p. 252
Meenkashi Sundaram, U Nagashree, P Swetha
Uterovaginal prolapse is a common gynecological problem, mostly seen in 50% of parous women. The surgical management of uterine prolapse in women who wish to retain their uterus remains a challenge. Laparoscopic approach offers both excellent intraoperative visualization of supportive and adjacent structures and quick postoperative recovery. We present a case of third-degree uterine prolapse, who successfully underwent laparoscopic sacrohysteropexy at our center.
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Probiotics may help you lose weight p. 254
Kalpana Singh
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Strategic and holistic approach to respond to the problem of gender based violence p. 255
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
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