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   Table of Contents - Current issue
April-June 2019
Volume 16 | Issue 2
Page Nos. 69-133

Online since Wednesday, June 19, 2019

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Editorial p. 69
RN Srivastava
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Effect of smoking in patients with ankylosing spondylitis: A cross-sectional study in state of Madhya Pradesh, India p. 70
Akshat Pandey, Ved Prakash, Mimansha Pandey
Aim: Understanding the impact of smoking on the development and severity of ankylosing spondylitis (AS) is pivotal, as it affects the management of the disease. This study investigated the effect of smoking in patients with AS and its outcome on the disease. Methods: This was a cross-sectional study from September 1, 2018, to November 30, 2018, in a rheumatology outpatient department enrolled patients aged >18 years diagnosed with AS and divided into two groups according to their smoking status. Demographic details and hematological and biochemical parameters were noted. Modified Schober's test, chest expansion, and duration of disease measurements were performed. Disease activity and functional state were evaluated using the Bath AS Disease Activity Index (BASDAI) and Bath AS Functional Index (BASFI). Results: A total of 48 patients were enrolled (smoker, n = 20; nonsmoker, n = 28). The mean age in smoker and nonsmoker groups was 39.40 years and 26.18 years, respectively, and male preponderance was observed; the mean duration of disease was 42.90 months and 43.14 months, respectively. BASDAI and BASFI scores were significantly higher in the smoker group (5.08 and 4.51, respectively) as compared to nonsmoker group (3.40 and 2.34, respectively) (P < 0.001). The modified Schober's test showed a significant decrease in the range of spinal mobility in the smoker group (2.67 cm) than in the nonsmoker group (4.40 cm) (P < 0.001). A significant decrease in the mean chest expansion was seen in the smoker group than the nonsmoker group (3.08 vs. 5.68 cm; P < 0.001). Conclusion: Results demonstrate the negative effect of smoking on disease and functional activity in patients with AS.
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Severe maternal outcomes: World health organization maternal near-miss and maternal mortality criteria in University Tertiary Hospital Egypt p. 74
Ahmed Samy El-Agwany
Background: The World Health Organization (WHO) maternal near-miss (MNM) approach was developed to evaluate and improve the quality of obstetric care worldwide. Aim: The aim of this study was to evaluate the incidence of MNM and quality of care at a tertiary hospital in Egypt by applying this approach. Methods: A facility-based, retrospective study was conducted between January 2015 and December 2016. Participants' data were collected from medical records of the intensive care unit. Results: Among 28,877 deliveries over 2 years, 185 women suffered severe maternal outcome (SMO): 171 MNMs and 14 deaths. SMO ratio is 6.5/1000 live birth, MNM incidence ratio of 5.9/1000 live births, maternal death incidence ratio 0.5/1000 live birth, maternal mortality ratio of 48.48/100,000 live births, MNM mortality ratio is 12:1, and a mortality index of 7.5%. Hemorrhage (n = 107, 62.5%) and hypertensive disorders, including fits and hemolytic anemia, elevated liver enzymes, and low platelet count syndrome (n = 44, 25.5%) were the most common MNM conditions. Hemorrhage (n = 8, 57%) was the leading cause of maternal mortality and then cardiac diseases (n = 3, 21.5%). All cases were not receiving antenatal care in the Shatby Hospital or were not compliant to the hospital ANC and were referred or showed up at the time of delivery or after delivery with complication encountered. Nearly 71.5% of the died patients cases were younger than 30 years and 21.5% were primigravida. Conclusions: MNM is common in Egypt. The approach enabled us to identify pitfalls in clinical practice and referral system. The private sector in Egypt needs to evaluated and medical license should not be permanent.
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Surveillance of microorganisms associated with dental caries patients attending at a Tertiary Care Indian Teaching Hospital p. 79
Smarita Lenka, Priyanka Debta, Mahesh Chandra Sahu
Backgrounds: Dental caries patients are developed day by day in all age groups and predominantly in children. It is caused due to microorganisms mainly. Here, we find the organisms associated with dental caries of patients attending at Institute of Dental Science, Bhubaneswar, India. Materials and Methods: This prospective study was carried out from February to May 2018 at Institute of Dental Science, Bhubaneswar, India. A total number of 135 samples were collected from dental caries patients and processed in different agar media for identification of organisms, and the percentage of antibiotic susceptibility was evaluated. Results: Out of 135 patient samples, 112 organisms were isolated and identified with both culture and biochemical tests. Among all, 9 Enterococcus sp. (6.66%), 27 coagulase-negative Staphylococcus aureus sp. (20%), 6 Bacillus sp. (4.44%), and 30 Streptococcus sp. (22.22%) were found as Gram-positive cocci; 3 Acinetobacter sp. (2.22%), 6 Pseudomonas sp. (4.44%), 21 Shigella sp. (15.55%), and 6 Citrobacter freundii sp. (4.44%) were identified as Gram-negative bacteria; and 6 Candida glabrata (4.44%), 3 Candida albicans (2.22%), and 3 Candida tropicalis (2.22%) were identified as budding yeast colonies. In antibiotic resistance patterns, it was revealed that penicillin is the most resistance (92%) and gentamycin is the most sensitive antibiotic (79.2%) for bacteria associated with dental caries. Conclusion: Dental caries caused due to microbial infection is cured with antibiotics. Out of all antibiotics, gentamicin is more sensitive and preferable for dental caries with this study. Hence, a clinician can prescribe gentamicin beside amoxicillin and cefixime for early treatments.
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Pediatric Cough p. 87
Santosh Kumar Swain, Sampada Munjal, Suryakanta Pradhan
Cough in the pediatric age group is a common presenting complaint, and the etiology of the cough is often elusive. Although there is a high prevalence of cough in the pediatric age group, the subject is still poorly researched. The management of pediatric cough is different from adults. Cough in children causes a significant anxiety among parents and often leads to the use of inappropriate or unnecessary medications. Cough in the pediatric population is due to multiple underlying causes and the most common are allergy, infections, asthma, foreign body aspiration, and gastroesophageal reflux. Detailed history-taking and physical examination with chest X-ray and spirometry are often recommended for getting the diagnosis. Treatment is done according to the underlying disease, and there is poor evidence for prescribing medications only for symptomatic relief. This review article discusses the etiopathology and clinical characteristics of pediatric cough and its management.
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Skull-base fractures: Pearls of etiopathology, approaches, management, and outcome p. 93
K V. L Narasinga Rao, Padilla-Zambrano Huber Said, Luis Rafael Moscote-Salazar, Guru Duatta Satyarthee, V Anil Kumar, Ranabir Pal, Amit Agrawal
Fractures involving skull bases usually results from high-velocity impacts, i.e., motor vehicular accidents. The estimated incidence of skull-base fracture varies from 4% of all head injuries to 7%–16% of closed head injuries. Many studies have emphasized the importance of the management of basal skull fractures as it can be associated with major neurological deficits, can carry a risk of being missed during clinical evaluation in a busy emergency room and can additionally lead to life-threatening complications including cerebrospinal fluid (CSF) leak and meningitis. In addition to the bony injuries, skull-base fractures can be accompanied by injury to cranial nerves, intracranial blood vessels, and CSF rhinorrhea or otorrhea (particularly fractures involving anterior and middle cranial fossa). In the presence of characteristics clinical features, patient should be thoroughly clinical examination and pertinent investigation with appropriate imaging modality for the presence of additional intracranial lesions and as delayed diagnosis can lead to increase in neurological morbidity and also rarely mortality.
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Cervical epidural anesthesia for radical mastectomy in an elderly patient with severe respiratory compromise p. 97
Vikas Gogia, Chitra Chatterji, Ramesh Sarin
Cervical epidural anesthesia for breast surgery has been described in a few trials on patients with good physical status. This case report describes the successful use of cervical epidural anesthesia in a patient with severe respiratory compromise without any complication. A 72-year-old female patient having infiltrating duct carcinoma of the right breast with coexisting chronic obstructive airway disease and bronchial asthma was planned for modified radical mastectomy with axillary clearance. Her forced vital capacity (VC) was 28% predicted with reversibility of 24% and forced expiratory volume in 1 s was 31% predicted with 35% reversibility. After discussion with the surgical team, a regional anesthetic was planned for the patient and a cervical epidural catheter placed at C7–T1 interspace was used to provide adequate dermatomal anesthesia for the surgery. Dexmedetomidine was used to achieve sedation for patient comfort with minimal respiratory depression. The SpO2 and end-tidal CO2 recordings remained stable throughout the procedure, with excellent intra- and postoperative analgesia. Despite the concerns of bilateral phrenic nerve palsy with the use of cervical epidural anesthesia and associated decrease in VC, a carefully conducted cervical epidural anesthesia can be used for patients with respiratory compromise undergoing major breast surgery. Radical mastectomy, cervical epidural anesthesia, low FEV1, FVC, dexmedetomidine.
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Cervical esophageal perforation during gastroscopy in adults: Case report – Report of two cases p. 100
Apurva Shah, Shravan Bohra
Cervical esophageal perforation is rare and associated with a high morbidity and mortality >20% if misdiagnosed. At least half of the perforations are iatrogenic, mostly related to endoscopic instrumentation used in the upper gastrointestinal tract. We describe two cases of cervical esophageal perforations during negotiating the cricopharynx. Both patients had malignant stricture in mid and lower esophagus, respectively, and developed iatrogenic perforation during palliative metallic stenting – one of the two by a pediatric gastroscope. Both the patients were diagnosed as having esophageal perforation in the first 6 h after procedure and successfully managed with medical management. Patients with small perforations and minimal extraesophageal involvement may be managed with nonoperative treatment.
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Laparoscopic management of rapunzel syndrome p. 103
Jayanth Bannur Nagaraja, Shashank Saraf, Nairuthya Shivathirthan, S Srinath
Rapunzel syndrome is caused by ingestion of hairs, which leads to formation of trichobezoar, which can extend up to small intestine especially in girls. Utility of laparoscopic approach for this condition is not well established in this population. We are presenting a case of Rapunzel syndrome in a 14-year-old girl presenting as a cause of gastric outlet obstruction. Early diagnosis and extraction of trichobezoar by laparoscopic-assisted approach in children may be a better approach with respect to cosmesis, lesser morbidity, and early recovery.
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Calcifying epithelial odontogenic tumor of the jaw: A report of two rare cases p. 105
Sanat Kumar Bhuyan, Ruchi Bhuyan, Mahesh Chandra Sahu, Sidhant Bhuyan
Calcifying epithelial odontogenic tumor (CEOT), also recognized as a Pindborg tumor, is a rare benign odontogenic neoplasm of epithelial derivation and is aggressive in the vicinity with a tendency to invade bone and neighboring soft tissues. It accounts for 1% of all the odontogenic tumors. Intraosseous CEOT is more common in comparison to extraosseous variant and is commonly situated at the posterior aspect of the mandible. Here, we report two cases of CEOT situated in the posterior aspect of mandible and both the cases were seen in female young adult age group. Partial mandibulectomy was performed in both the cases, and they were on regular follow-up. Both the cases were without any recurrence of tumor in 6 months of follow-up. Due to rarity of the case, we deliberate the radiologic features, histologic features, clinical presentation, and management of these two cases.
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Bilateral adrenal histoplasmosis in a diabetic patient: A case report and review of cases in India p. 109
Hena Butta, Suranjit Chatterjee, Leena Mendiratta, Kirti Gilotra, Lata Jadhav, Vijay Rawat, Raman Sardana
Disseminated histoplasmosis usually affects immunocompromised and immunosuppressed individuals and may involve various organ systems of our body. The definitive diagnosis of histoplasmosis is very challenging because it usually presents with nonspecific symptoms such as malignancies, tuberculosis, sarcoidosis, and other chronic infections. Hereby, we report a culture-proven case of bilateral adrenal histoplasmosis in a diabetic but immunocompetent patient. The patient showed good response to treatment with antifungal drugs.
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A rare and interesting presentation of ruptured ovarian cystic tumor posing a diagnostic dilemma p. 114
S Ashitha, Shrivalli Nandikoor, Aruna R Patil, Sruthi Jacob, Abhilasha Narayan
An ovarian cyst is the most common gynecological presentation. Majority are benign, with only a few being malignant. Epithelial ovarian tumors account for majority of ovarian neoplasm which usually present with vague symptoms of abdominal pain or asymptomatic and are detected incidentally. Spontaneous rupture of cystic tumors is an unusual presentation. We report here a case of ruptured serous borderline tumor in a young female.
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Derotation gastropexy for a case of chronic mesentericoaxial gastric volvulus p. 118
Suhas Umakanth, Jayanth Bannur Nagaraja, Srinath Subbarayappa
Gastric volvulus is a rare disease with unknown incidence and having significant morbidity and mortality. Unstable vital signs and distressed appearance are not always present and diagnosis can be easily missed. It is the abnormal rotation of the whole or part of the stomach. Normally stomach is in position with the help of 4 ligaments (gastrohepatic, gastrosplenic, gastrocolic, phrenicocolic), laxity leading to volvulus. Organoaxial being common in adults and mesentericoaxial are the two types. They can present as acute, chronic, acute on chronic. Acute volvulus needs immediate resuscitation and urgent laparotomy and Chronic volvulus needs evaluation and elective surgery. Here we present a case of 49 year old gentleman with chronic gastric volvulus, who underwent derotation gastropexy at our institute.
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Abdominal tuberculosis discovered during routine laparoscopy p. 122
Abdul Basith
Tuberculosis is a critical problem in India. There has been a recent rise in the incidence of genital tuberculosis which is usually asymptomatic and discovered only when the married woman presents to the infertility clinic. We report one such patient who had a diagnostic laparoscopy for infertility evaluation and was diagnosed to suffer from disseminated abdominal tuberculosis probably from genital tuberculosis.
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Joint preservation in a middle-aged man with knee osteoarthritis, using novel techniques p. 124
Seyawash Fooladi, Abhishek Vaish, Yash Nigam, Raju Vaishya
The incidence of knee osteoarthritis (KOA) is on the rise and is affecting the younger population. The treatment of these younger individuals is challenging, and the treatment strategies should involve techniques to postpone or alleviate the need for joint replacement for these people. Regenerative treatment methods are useful and effective in the management of KOA at an early age. We present a case of a middle-aged man with KOA, who was managed by combined procedures of the proximal fibular osteotomy, microfracture of the cartilage lesion, and bone marrow aspirate concentrate.
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Quality improvement: A new paradigm in health care p. 128
Ashok Deorari, Parijat Chandra
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Knee Osteoarthritis: Clinical Update p. 132
Om Prakash Sharma
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