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   2020| January-March  | Volume 17 | Issue 1  
    Online since March 17, 2020

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Diagnosis, pathophysiology, and treatment of normal pressure hydrocephalus: A review of current perspectives
Charchit Gupta, Pushpendra Nath Renjen, Dinesh Chaudhari, Anjali Mishra
January-March 2020, 17(1):10-15
Normal pressure hydrocephalus (NPH) is a potentially reversible syndrome characterized by enlarged cerebral ventricles (ventriculomegaly), cognitive impairment, gait apraxia, and urinary incontinence. A critical review of the current prospectives in the diagnosis and treatment of both idiopathic and secondary NPH has been done in our article. NPH is an important cause of potentially reversible dementia, frequent falls, and recurrent urinary infections in the elderly. The clinical and imaging features of NPH may be incomplete or nonspecific, posing a diagnostic challenge for medical doctors, and often requiring expert assessment to minimize unsuccessful surgical treatments. Recent advances resulting from the use of noninvasive magnetic resonance imaging methods for quantifying cerebral blood flow, in particular arterial spin-labeling, and the frequent association of NPH and obstructive sleep apnea, offer new avenues to understand and treat NPH.
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Postoperative ileus after orthopedic and spine surgery: A critical review
Vishal Kumar, Abhishek Vaish, Raju Vaishya
January-March 2020, 17(1):16-21
Constipation and abdominal discomfort are the most common complaints after orthopedic surgery. Still, there is still not much development in the knowledge about postoperative ileus (POI). It is evident due to the lack of published literature on Post Operative Ileus (POI) and its sequel. A comprehensive review of the literature was conducted to identify the risk factors, mechanism, and treatment to treat POI. The literature search was performed using search engines such as PubMed, MEDLINE, SCOPUS, and Google Scholar databases on April 1, 2019. After applying the inclusion and exclusion criteria, we selected nine publications for this review. Only six of these studies were related to POI after orthopedic (4) or spine surgery (2). These studies comprised a total of 231,773 patients of POI. The results showed that invariably, all the patients after gastrointestinal surgeries developed POI, but it was not restricted to it. POI was also seen after orthopedic surgery, with its incidence being maximum in patients undergoing spine and arthroplasty surgery. POI is multifactorial and is invariably an unavoidable cause in the postoperative period leading to increased morbidity and hospital stay. In order to deal with this, identifying the risk factors in a patient in the preoperative period, modifying the anesthesia technique, early mobilization, adequate pain management, recognizing the clinical signs and symptoms of ileus, and treating it promptly lead to achieving the optimal outcomes. The multimodal approach of management of POI is advisable.
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Radiotherapy for glomus jugulare tumors: A single-institution experience
Renuka Masodkar, GK Jadhav, Sapna Manocha Verma, Sudheer Kumar Tyagi
January-March 2020, 17(1):6-9
Introduction: Glomus jugulare tumors are rare and usually benign tumors arising within the jugular foramen of the temporal bone. The management options for these locally aggressive tumors include surgery, radiotherapy, and observation. Here, we report outcomes of treating these tumors with radiotherapy. Materials and Methods: Twelve cases of glomus jugulare were treated with radiotherapy from August 2014 to July 2019. The patients were treated using Novalis Tx linear accelerator. The median follow-up period was 45 months (range: 5–60 months). The patients were evaluated for treatment outcomes, neurological status, and treatment-related side effects. Results: Nine patients (75%) were female. The median age was 47 years (range: 32–60 years). Eight patients (66.6%) had left-sided tumor. The median volume of the tumor was 10.81 cm3 (range: 4.4–207.62 cm3). All the patients had cranial nerve deficits ranging from cranial nerves V and VII–XII. The most common symptom was headache (75%), followed by loss of hearing and tinnitus (66.6%). All patients tolerated radiotherapy well with no Grade — reactions. There were no breaks during radiation due to toxicity. One patient reported improvement in swallowing and speech quality during the course of treatment. On follow-up, 5/12 (41.66%) patients reported improvement in neurological symptoms. The rest of them had stable neurological status. Follow-up magnetic resonance imaging showed regression in three patients and stable disease in the rest of them. Conclusion: Radiotherapy is a safe and effective treatment for glomus jugulare tumors. With newer techniques and image guidance, precise treatment delivery to the tumor is possible with protection of normal tissues. In our series, we report a local control of 100%. Hence, radiotherapy could be considered as modality of choice in these tumors.
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Comparative analysis of a rapid detection method and conventional method to ensure microbial quality of drinking water
B Isabella Princess
January-March 2020, 17(1):2-5
Objective: Drinking water analysis is an important quality monitor and forms an integral part of the infection control policy of every hospital. On an average daily basis, 1750 liters of drinking water are used by patients and hospital staff. Presence of contaminating microorganisms in drinking water should therefore be identified at the earliest and necessary action be taken in order to prevent outbreaks through contaminated water. This study was conducted to compare two methods for drinking water analysis and document benefits of the new method. Methods: This cross sectional study was conducted over a period of two years at a tertiary care hospital in Chennai. A newer rapid method of drinking water analysis was evaluated for two years from July 2017 to June 2019. Parallel testing with conventional multiple tube method was performed. All samples collected from various sources during the study period were subjected to parallel testing by multiple tube method (conventional method for most probable number) and presence absence method (new method). Results: The new commercial kit for drinking water analysis comprehensively detects all water borne bacterial pathogens associated with gastroenteritis within 18 hours. The major advantage is marked reduction in turnaround time by 54 hours. False positive/false negative results were not encountered compared to the standard conventional method. Conclusion: Safer, healthier and high quality of water is ensured for use at an earlier and cost effective as well as environment friendly system. There was marked reduction in turnaround time, cost of testing, manpower usage, reagent wastage, waste generation using the kit based presence absence method. The new commercial kit can effectively replace the conventional method as an effective screening tool for drinking water analysis.
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RN Srivastava
January-March 2020, 17(1):1-1
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Extending capabilities of artificial intelligence for decision-making and healthcare education
Mohd Javaid, Abid Haleem, Ibrahim Haleem Khan, Raju Vaishya, Abhishek Vaish
January-March 2020, 17(1):53-59
Medical profession requires extensive knowledge and accuracy from the existing data for improved decision-making. Artificial intelligence (AI) is an appropriate technology used to improve the knowledge, skill, quality of treatment, capability, confidence, and effective decision-making process. It has the capability to revolutionize the healthcare industry. It can identify high-risk patients and their associated treatments and can help train doctors for the understanding of diseases and diagnostic treatment for better patient health. We discuss various advantages and limitations of AI in the context of healthcare sector. Various significant capabilities of AI for decision-making are identified and presented, and its significant capabilities for healthcare education are consolidated herewith. AI is helpful for appropriate planning, diagnosis, and associated activities, such as education, training, research, and development of healthcare. This technology provides some excellent capabilities to notice the changes and predict the disease of the patient. AI is now being applied for developing personal health history, and industry is contemplating a great potential for its implementation. However, cost and privacy issues are yet to be taken care of.
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Superior semicircular canal dehiscence syndrome: Often a missing clinical entity in vertigo management
Santosh Kumar Swain, Sidharth Mohanty, Mahesh Chandra Sahu
January-March 2020, 17(1):22-25
Superior semicircular canal dehiscence syndrome (SSCDS) is a rare and recently described inner ear lesion presenting with disequilibrium and associated with dehiscence of the bony covering of SSC. SSCDS patients may present with a variety of vestibular or auditory symptoms or both. Patients present with vertigo induced by sound or pressure. The diagnosis of SSCDS depends on the demonstration of a defect in the bony wall of the roof of the SSC. A high-resolution computed tomography is helpful for diagnosis. It is usually treated by plugging of dehiscence. The aim of this review article is to discuss the etiopathology, clinical presentation, investigations, and recent treatment of SSCDS.
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Pervasiveness of urinary tract infection in diabetic patients and their causative organisms with antibiotic sensitivity pattern
Zeel Paresh Bhagat, Mahesh Chandra Sahu
January-March 2020, 17(1):26-30
Diabetes mellitus (DM) being polygenic disorder, affects several other organs. One of the major coinfection in DM is urinary tract infection (UTI). Due to increased blood glucose levels, a favorable environment is offered to bacteria for their growth leading to infection. DM also hampers immunologic functions such as phagocytosis, decrease in antibody production, failure of T cells and B cells to fight against pathogens which ameliorate bacterial growth. Not only bacteria but even several fungi can lead to UTI. Several factors such as duration of diabetes, age, gender, route of drug administration, type of drugs used in diabetes, poor glycemic control, obesity, unhygienic conditions, sexual intercourse, and type of DM are enhancing factors for causing UTI in diabetic patients. Day-to-day use of antibiotics has made several pathogenic bacteria resistant to the effects of antibiotics. In long terms, if UTI remains untreated in diabetic patients, then it may have severe complications. Furthermore, the resistance pattern of antibiotics differs according to the geographical locations. Hence, the use of susceptible antibiotics to cure UTI in diabetic patients is now crucial.
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Gonococcal urethritis in present times: Seek and find
B Isabella Princess
January-March 2020, 17(1):31-33
Sexually transmitted infections gained importance after the advent of human immunodeficiency virus infection in 1983. The global incidence of gonorrhea in 2008 was 106.1 million, in 2005 was 87.7 million, and in 1999 was 62 million. Laboratory diagnosis of gonorrhea is challenging due to poor facilities in smaller laboratories of developing countries. This along with nonsuspicion might lead to under-reporting of cases from such countries. We report two cases of gonococcal urethritis from a city in South India within a period of 1 year. Two young/middle-aged patients presented to the urology department with complaints of acute-onset painless urethral discharge. On suspicion of gonococcal urethritis, urethral pus was sent for Gram stain which revealed a plenty of polymorphonuclear neutrophils and a plenty of Gram-negative bean-shaped diplococci. The organism was isolated and identified as Neisseria gonorrhoeae. Contact tracing was not possible in both cases, so they were appropriately counseled and treated. Gonococcal urethritis could be under-reported in India. In the era of automation in microbiology and syndromic approach for diagnosis, simple techniques such as Gram stain and culture coupled with good clinical suspicion can clinch the diagnosis of gonococcal urethritis. Since there is a vast difference in antibiotics used for treating gonococcal and nongonococcal urethritis, it is important to diagnose the etiological agent at the earliest for targeted therapy.
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Acute myelogenous leukemia revealed by acute appendicitis
Sanae El Marzguioui, Sanae Benameur, Abdeladim Babakhouya, Maria Rkain, Noufissa Benajiba
January-March 2020, 17(1):40-41
Acute myelogenous leukemia can rarely involve the digestive tract. We report a case of a girl of 9 years old, admitted for surgical abdomen and operated for acute appendicitis. Complete blood count showed pancytopenia. The pathology study showed appendicular localization of acute myelogenous leukemia.
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Unusual presentation of heterotopic pregnancy
M Poornima, S Mamatha, N Madhuri, HP Sapna, Deepika Bohra
January-March 2020, 17(1):37-39
Heterotopic pregnancy is a rare occurrence in naturally conceived pregnancy and is difficult to assess as pain and bleeding may be due to abortion. We report a case of spontaneous heterotopic pregnancy which was missed in initial transabdominal scan and was reported to be intrauterine pregnancy and was later identified as heterotopic pregnancy with serial beta-human chorionic gonadotropin levels and clinical features. If assisted reproductive treatment procedures are not involved, it is likely to be missed and may lead to serious and delayed consequences.
  170 26 -
Zinc phosphide poisoning precipitating undiagnosed coronary artery disease: successfully managed
Krittibus Samui, Dixit Kumar Thakur
January-March 2020, 17(1):42-43
Zinc phosphide is a rodenticide which reacts with gastric acid and produces phosphine gas which produces systemic effects. We present the case of a 32-year-old patient with alleged history of zinc phosphide ingestion. After 15 h of ingestion, he was brought to us following initial supportive care outside. All routine investigations were done. Electrocardiogram showed antero–inferior wall acute myocardial infarction with right bundle branch block. The patient developed chest pain on the next day of admission. Coronary angiography revealed stenosis of the left anterior descending artery with clot. Percutaneous coronary angioplasty with stenting was done. He was discharged in a stable condition. Zinc phosphide poisoning precipitating acute coronary syndrome is a rare entity. Although patients may not present with initial chest pain, still they need intensive monitoring.
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Giant-cell tumor of the metacarpal in a young female: A rare case report
Seema Singhal, Chander Shekhar
January-March 2020, 17(1):34-36
Giant-cell tumors (GCTs) or osteoclastomas of the bone are locally aggressive tumors with tendency for local recurrence. The tumors show predilection for women with majority of patients in the third or fourth decades of life. Usually, GCT involves the ends of long bones. The most common sites involved are the distal femur, proximal tibia, distal radius, and the sacrum. Unusual locations such as scapula, skull, and small bones of the hand and feet are involved in approximately 2% of cases. Involvement of metacarpal has been reported in few cases so far. We report a case of GCT in the first metacarpal in a 16-year-old girl. We discuss the clinical, pathological, and radiological features. Awareness of this location is important, and GCT should be included in the differential diagnosis of expansile lesions of the small bones of the hand.
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First report of a ganglion cyst of the short head of the biceps femoris: A rare presentation
Reddy Ravikanth, Pooja Majumdar
January-March 2020, 17(1):44-45
This is the first report of a ganglion cyst arising from the short head of the biceps femoris tendon. Intratendinous ganglion cyst is a very rare lesion with an unknown etiology that originates within the tendon. We encountered a case of a 30-year-old female who complained of persistent pain for 2 months in the proximal anterolateral part of the leg. An intratendinous ganglion cyst in the semimembranosus tendon of the short head of the biceps femoris was diagnosed and located by ultrasound. Three months after surgical excision, there we encountered no recurrence. We describe this case with a review of the relevant literature.
  162 21 -
Malignant perforation of sigmoid colon in long-standing ulcerative colitis
GK Adithya, Varun Madaan, Rigved Gupta, Satya Prakash Jindal, Deepak Govil
January-March 2020, 17(1):46-49
Chronic ulcerative colitis (UC) is a risk factor for malignancy in long-term 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 steroid-dependent disease (on 10 mg prednisolone daily) presented with acute pain abdomen with distention not passing stool or flatus for 2 days. The patient was diagnosed to have perforation of colon secondary to rectosigmoid malignancy. Following the adjuvant therapy, the patient denied any definitive surgery and opted to stay on a colorectal cancer surveillance program. At present, the 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 emphasize the importance of aggressive surgical treatment in long-term steroid-dependent disease and poor prognosis of perforated malignancy irrespective of pathological staging.
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Parkinson's disease versus stroke versus seizure
Jamir Pitton Rissardo, Ana Letícia Fornari Caprara
January-March 2020, 17(1):50-51
  148 20 -
The protective anomalous artery
Bindu Menon, Gayatri Manam
January-March 2020, 17(1):52-52
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