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   Table of Contents - Current issue
July-September 2019
Volume 16 | Issue 3
Page Nos. 135-203

Online since Wednesday, September 11, 2019

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Message from Dr. Prathap C. Reddy Highly accessed article p. 135
Prathap C Reddy
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Editorial p. 136
RN Srivastava
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Use of social media as a tool for antibiotics awareness Highly accessed article p. 137
K Raksha
Objective: Antimicrobial resistance (AMR) is a global health threat; public perception about AMR is a huge lacuna which many researchers, doctors, and policymakers fail to pay attention to. Infection control is often limited to diagnosis and treatment in hospitals, presentations, and panel discussions. On the other side of the fence, usage of social media to spread information about health care is a common practice among the public today. Twitter is one such online platform.Materials and Methods: This was a cross-sectional tweet-based poll titled “antibiotic awareness survey” for 7 days with five simple yet pertinent questions asked to the participants in the Twitter poll and also to retweet (RT) the questions to their followers. The questions were designed keeping in mind the limitation of tweets on the timeline and the necessity of addressal to the issue among the random group. Results: Seventy-two percent responded saying they procure antibiotics based on doctor's prescription. The most common reason to stop antibiotics for 35% of the participants was symptomatic relief and the perception that it is okay to stop, but 56% said they always complete the course. 52% of the participants said that the treating doctor does not explain to them about the antibiotics while prescribing, but 81% said that the doctor advises them on completing the course. 75% of the participants said that antibiotics are in danger and require regulation, 22% said maybe to an extent. Conclusion: Social media plays a critical role in dissemination of AMR-related information; the unrestricted and unregulated access to knowledge shapes the views and opinions of society. The perception and practices were thus reflected through this weeklong discourse about antibiotics on Twitter, and we doctors of today have a responsible role to play.
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The puzzle of spontaneous versus traumatic subarachnoid hemorrhage p. 141
Ezequiel García-Ballestas, Yeider Durango-Espinosa, Romario Mendoza-Flórez, Luis Rafael Moscote-Salazar, Ravish Keni, Harsh Deora, Amit Agrawal
Subarachnoid hemorrhage (SAH) is a neurological emergency occurring frequently and has significant morbidity and mortality. Etiological classification divides it into traumatic and nontraumatic or spontaneous. Even though it has been referred that these are almost the same pathology, there is a slight difference between them regarding several aspects, such as epidemiological, pathophysiological, clinical, and diagnostic approach and treatment. These differences deserve detailed understanding to help physicians treat this disease more efficiently. We reviewed all available literature regarding these two types of SAH and tried to elicit differences between them with respect to etiology and treatment. The differences were made keeping in mind the utility of the same to a general physician so that rapid and informed decisions can be made at that level. Pathophysiological differentiation of these two diseases is of paramount importance, and etiological diagnosis determines prognosis. Knowledge of the same is essential and lifesaving.
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Neurological uses of cannabis Highly accessed article p. 148
Pushpendra Nath Renjen, Dinesh Mohan Chaudhari, Anjali Mishra, Abhas Kumar
Cannabis preparations have been used as medications since the 19th century in Europe and much longer as a traditional medicine in other cultures. The American Academy of Neurology recently published a position statement and concluded that medical marijuana is “probably effective” for some symptoms of multiple sclerosis (spasticity, central pain, painful spasms, and urinary dysfunction), “probably ineffective” for levodopa-induced dyskinesias of Parkinson's disease, and of “unknown efficacy” in nonchorea symptoms of Huntington's disease. This article is focused on review of the medicinal use of cannabis in neurological disorders.
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Prevent falls in older adults p. 152
OP Sharma, Raju Vaishya
Falls are common in the elderly and may lead to serious injuries. Recurrent falls are also frequent and are responsible for significant morbidity and mortality in older adults. The most serious injuries due to these falls are head injury and the fractures. The effect of a fall on an older person can be a devastating event, resulting in chronic pain, loss of independence, and reduced quality of life. Hence, the prevention of fall is better than the treatment of the injuries resulting from it.
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Edaravone: A new hope for patients with amyotrophic lateral sclerosis p. 157
Shivangi Garg, Dinesh Chaudhari, Pushpendra Nath Renjen, Anjali Mishra, Abhas Kumar, Rajendra Pradhan
Although the exact pathophysiology of amyotrophic lateral sclerosis (ALS) remains unclear, oxidative stress is known to play a pivotal role. There is no cure for ALS, but there are two drugs available to slow the progression of the disease. Till recently, riluzole, a glutamatergic neurotransmission inhibitor, was the only drug approved for ALS. However, in May 2017, edaravone, which is a potent-free radical scavenger, was also approved by the Food and Drug Administration for the treatment of ALS. In this article, the mechanism of action of edaravone and clinical trials establishing its efficacy are reviewed.
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Supratentorial ependymoma: A rare presentation in an adolescent p. 161
Dilip Rajasekharan, Kanjithanda Subbaiah Bopaiah, Aumir Moin, Jayanth Bannur Nagaraja
Ependymomas are rare primary glial tumors that arise from ependymal cells found in the central nervous system. While usually intracranial, they rarely arise from the supratentorial parenchyma. They have a variable clinical course and are aggressive in nature. Among the important prognostic factors include tumor location, histology, and extent of resection. Total surgical excision is the rule. Diagnosis is confirmed by histopathology. Suspicion of an ependymoma must, however, be borne in mind while dealing with a supratentorial space-occupying lesion.
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Gall stone ileus with cholecystoduodenal fistula p. 164
Elangkumaran Vellode Manoharan, P Kanakarajan, G Ramkumar, E Selvakumar
Gallstone ileus and cholecystoduodenal fistula are rare and life-threatening conditions which are due to cholelithiasis and recurrent attacks of cholecystitis. It predominantly affects female population. The signs and symptoms are non-specific, sometimes only established during surgery. Prompt surgical management would avoid the complications and reduce the hospital stay.
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Pediatric ileocolic intussusception p. 167
Reddy Ravikanth
Intussusception occurs when a more proximal portion of the bowel invaginates into more distal bowel. These patients often present with a wide range of nonspecific symptoms, with <1 quarter presenting with the classic triad of vomiting, abdominal pain, and bloody stools. Thus, the diagnosis continues to rely on clinical suspicion. Intussusception is the most common cause of small bowel obstruction in young infants. Therefore, a high index of suspicion and thorough knowledge of this condition is of major importance to be able to diagnose and treat this potentially life-threatening condition. Surgical intervention in intussusception can be prevented by nonoperative reduction, especially if presented early with no signs of peritonitis. Timely nonoperative reduction can prevent surgical intervention and complications. Here, we present a case of an 18-month-old infant who presented with ileocolic intussusception.
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Antiepileptic drug-induced acute psychotic disorder in a nonepileptic patient: A definite prophecy p. 171
Mohit Dahiya, Amee Pandya, Deepak Malhotra, Pankaj Patel
Psychosis induced by antiepileptic drugs (AEDs) is considerably an iatrogenic adverse drug reaction. Various mechanisms operant in the development of iatrogenic psychiatric manifestations are proposed which necessitates analyzing complaints of psychiatric symptoms related to medication. Herein, we present a rare case of short-term use of phenytoin causing toxicity which manifested as acute psychosis with no Vitamin B12 or folic acid deficiency, who had complete recovery following phenytoin withdrawal.
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An unusual case of xanthogranulomatous orchitis: A tumor mimic p. 174
Kavita Somani, Pretty Singh, Siddhant Verma, Tanmai Tandon
Xanthogranulomatous inflammatory reaction is an uncommon nonneoplastic disease process, which is an even rarer entity in testicles. We present a similar case report of a 20-year-old male with a testicular swelling and a provisional clinical diagnosis of a testicular neoplasm. We hence present this case in view of its rarity and its nature to deceptively mimic a neoplasm.
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A case of paroxysmal nocturnal hemoglobinuria with renal hemosiderosis p. 177
Parimal B Patel, Jayant Hota
Paroxysmal nocturnal hemoglobinuria (PNH) is a clonal disorder of bone marrow. It is characterized by blood cells lacking membrane proteins that are normally attached by the glycosylphosphatidylinositol anchor. It usually presents with intravascular hemolysis, cytopenias, frequent infections, bone marrow hypoplasia, and a high incidence of life-threatening venous thrombosis. Kidney involvement is usually benign and secondary to chronic tubular deposition of hemosiderin. Acute kidney injury may occur in association with a hemolytic crisis. Here, we report a case of a 50-year-old male with hematuria, pancytopenia, and acute renal failure due to PNH. Renal biopsy demonstrated acute tubular necrosis with considerable hemosiderin deposition (hemosiderosis), but no evidence of vascular thrombosis.
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An unusual case of apparent life-threatening event p. 180
Prita Trehan
Apparent life-threatening event (ALTE) occurs in 0.5–10/1000 live births. ALTEs are defined as episodes characterized by a combination of apnea, color change, altered muscle tone, choking, and gasping. All are very frightening to the observer. The most common ALTE etiologies are gastroesophageal reflux disease, epilepsy, and respiratory tract infections, which make up 50% of all ALTE cases.
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A case of coinfection with (H1N1) 2009 influenza and scrub typhus with CNS involvement p. 182
Suneeta Sahu, Rani Sahu, Manoj Chhotray, Sharmili Sinha, Banambar Ray
Prompt antibiotic therapy shortens the course of the disease, lowers the risk of complications, and in turn reduces morbidity and mortality due to rickettsial diseases. Febrile patients with thrombocytopenia and MODS should be investigated for more than one tropical infection. Therefore, there is a distinct need for physicians and health-care workers at all levels of care in India to be aware of the clinical features, available diagnostic tests and their interpretation, and the therapy of these infections.
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Malignant perforation of sigmoid colon in long-standing ulcerative colitis p. 187
GK Adithya, Varun Madaan, Rigved Gupta, Satya Prakash Jindal, Deepak Govil
Chronic ulcerative colitis (UC) is a risk factor for malignancy in longterm disease process. Obstruction, perforation, and hemorrhage are the possible emergency situations in colorectal malignancy. A 68-year-old male with chronic UC for 18 years with steroiddependent disease (on 10 mg prednisolone daily) presented with acute pain abdomen with distention not passing stool or flatus for 2 days. Diagnosed to have perforated sigmoid malignancy, underwent Hartmann's procedure. Following the adjuvant therapy, the patient denied any definitive surgery and opted to stay on Colorectal Cancer Surveillance Programme. At present, patient's positron emission tomography/computed tomography shows pelvic, liver surface, and small bowel deposits, suggestive of recurrence or metastasis. This case report is discussed to emphasis the importance of aggressive surgical treatment in longterm steroiddependent disease and poor prognosis of perforated malignancy irrespective of pathological staging.
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Acute presentation of metastatic testicular seminoma as chronic subdural hematoma with extra-axial brain lesion with severe mass effect: A case report and brief review of literature p. 191
Ajaydeep Singh, Arvinpreet Kour, GS Bindra, Ajay K Gehlot
We present an unusual case of a 33-year-old male, who has been diagnosed with seminoma testes with retroperitoneal lymph nodes involvement 1 year back, the patient had undergone four cycles of the chemotherapy and had undergone left orchidectomy for the same. Past 1 year was uneventful and the patient was living a normal healthy life, with no evidence of any diseases and no symptoms. For the last 1 month, the patient complained of headache with no other symptoms, and on 1 day, the patient had sudden loss of consciousness. Noncontrast computed tomography (CT) head was done, which revealed a large chronic subdural collection with an extra-axial mass attached with the dura on the right parasagittal region. The patient at the time of presentation had a Glasgow Coma Scale of 5/15 with irregular respiration, and the right pupil was fixed nonreacting to the light. Urgent surgery was done, and the patient recovered fully with no deficit and was discharged. The patient will be considered for chemotherapy.
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An unusual vertical swelling over the back p. 196
Vinod Kumar Viswanathan
Skeletal tuberculosis (TB) accounts for 1%–2% of all types of TB. The most common form of skeletal TB is Pott's disease, a disease of the spine; this entity comprises approximately half of skeletal TB cases. Tuberculous cold abscess can present as swelling on the back usually originating from the thoracic spine. Herewith is presented a rare case presentation of a patient who presented with a vertical swelling over the paraspinal region who on evaluation was found to have a cold abscess of tuberculous etiology arising from the ribs and tracking down the paraspinal region. This case is presented here for its rarity being a primary chest wall TB with no pulmonary involvement.
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A rare case of mitral valve replacement in antiphospholipid antibody syndrome p. 199
Akshat Pandey, Mohammed Ali, Siddhant Jain
Antiphospholipid antibody syndrome (APLS) is commonly associated with cardiac valvular abnormalities with the involvement of the mitral valve. The mitral valve replacement (MVR) is a high-risk procedure owing to postoperative complications. The major challenge in the management of these patients is to maintain anticoagulation in pre-, intra-, and postoperative conditions. The optimal choice of prosthesis valve (bioprosthetic or mechanical valve) for MVR depends on the individual patient's clinical condition. Previous reports indicate no clear guidance on the ideal prosthesis for MVR in patients with APLS. In the present case report, we performed MVR using bioprosthetic valve in a 42-year-old female diagnosed with APLS with persistent dyspnea secondary to severe mitral regurgitation.
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Moving forward toward the attainment of universalhealth coverage p. 202
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
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A handbook of geriatric care p. 203
Raju Vaishya
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