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   Table of Contents - Current issue
January-March 2021
Volume 18 | Issue 1
Page Nos. 1-67

Online since Monday, March 22, 2021

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Editorial p. 1
Raju Vaishya, Satish Kumar Agarwal
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“Combating COVID-19 pandemic- Challenges and strategies” at a newly established state medical college of Madhya Pradesh p. 3
Sanjay Dixit, Dhruvendra Pandey, Umesh Sinha
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Evaluation of the impact of the COVID-19 pandemic on the mental health of the health-care professionals across India p. 7
Dhanasekhar Kesavelu, Aarthi Radhika Inuganti, Nehaa Karthikeyan
Introduction: The unprecedented pandemic of COVID-19 has put a huge strain on the global health system and stress on the mental health of health-care professionals. We ventured to perform a virtual analysis of the mental health of our colleagues via an online assessment and sent a questionnaire-based survey. Materials and Methods: A 31-question-based survey was sent to health-care professionals including medical and paramedical staff. This Survey was then sent as an online questionnaire using google forms®. Questions were based on three categories, namely their general health, interpersonal support, and resilience. The General Health Questionnaire, Interpersonal Support Evaluation List-12, and Brief Resilience Scale were used to formulate the questionnaire. Results: The results did not show or highlight any area of significant concern currently, although a repeat survey will be very crucial to assess the impact of the pandemic on the mental health of health-care professionals postpandemic and how it has affected their general health, resilience, and an assessment of the support system. Conclusion: The Covid 19 pandemic as expected is taking a toll on the Health Care Workers and this requires ongoing evaluation and intervention.
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Pattern of admission of stroke in Benghazi Medical Center: A cross-sectional study Highly accessed article p. 12
Mohamed Ali Ibrahim Hamedh, Khaled D Alsaeiti
Background: Stroke is a leading cause of death and disability worldwide, accounting for 11.13% of total deaths, and the main cause of disability worldwide. The aim of this study is to know the pattern of stroke admissions at Benghazi Medical Center (BMC) and the possible risk factors. Materials and Methods: This was a cross-sectional study of 110 patients admitted to BMC who were diagnosed with stroke based on the International Classification of Diseases, Revision 10 (ICD-10), from January to June 2019. Data about age, gender, comorbidities, and medical history were collected. Results: In the study period, the medical records of 110 patients were surveyed for stroke diagnostic code based on ICD-10. Our research protocol identified 110 stroke records, out of which 10 cases were unspecified stroke. Of 100 specified stroke cases, 70 cases described an ischemic incidence and 30 cases reported a hemorrhagic incidence. Analysis of demographic attributes over this dataset showed that 65 men and 35 women with mean ages of 66.4 ± 14.2 and 64.6 ± 12.4, respectively, were admitted with stroke diagnosis, irrespective of stroke type. Further analysis indicated that both ischemic and hemorrhagic stroke subtypes had a high incidence in age ≥70 years (P = 0.003). The relationship between age group and stroke subtype was significant (P < 0.05). The mortality rate in this population based on the stroke subtype indicated that the mortality rate in patients diagnosed by hemorrhagic stroke is higher than those with ischemic attack (P = 0.004). Furthermore, there was no significant statistical difference between stroke subtypes and gender (P = 0.768). Analysis of possible relations between comorbid risk factors and stroke subtypes using the Chi-square test showed that, compared to other comorbid risk factors, diabetes mellitus (P = 0.003) and dyslipidemia (P = 0.001) were significantly prevalent among ischemic and hemorrhagic stroke patients. While hypertension (HTN) was strongly associated with hemorrhagic strokes (P = 0.001). There was no significant difference between ischemic and hemorrhagic strokes with regard to other risk factors. Conclusion: Ischemic stroke was more common than hemorrhagic stroke; overall, HTN, diabetes mellitus, and dyslipidemia were the major risk factors of stroke in our studied population.
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Seizures after posterior fossa surgery: Exploring the unknown: A systematic review p. 16
Ravish Keni, Luis Rafael Moscote-Salazar, Harsh Deora, GA Quiñones-Ossa, Amit Agrawal
Background: Seizures due to posterior fossa lesions is an uncommon phenomenon. In this study, a systemic literature review was done to (i) study the incidence of seizures in posterior fossa lesions, (ii) determine factors associated with high risk for seizures, and (iii) ascertain the role of prophylactic antiepileptic drugs (AEDs) in such cases. Methods: Systemic literature review was done, for the MeSH terms “posterior cranial fossa” AND “seizures” AND “anticonvulsants.” All original research articles, case reports, and systematic reviews pertaining to seizures or the use of anticonvulsants in posterior fossa lesions were considered for inclusion. Results: A total of 79 cases of posterior fossa lesions, identified from 8 studies, were included for analysis. The incidence of seizures in posterior fossa lesions ranged from 1.8% to 5% in various studies. The highest incidence for seizures was reported with medulloblastoma, cerebellar hemorrhage, and during microvascular decompression for cases of neurovascular conflict. The most significant risk factor for seizures in the postoperative period was the use of ventricular shunt or ventriculostomy. AEDs were administered symptomatically after the occurrence of seizures in 78 cases except for the use of prophylactic AEDs in a single case of posterior cranial fossa lipoma. Conclusion: Seizures in association with posterior fossa lesions are rare and associated with a poor prognosis. Clinical detection can often be difficult and electroencephalogram helps in early diagnosis and treatment. Further studies are needed to confirm the role of prophylactic AEDs in high-risk cases.
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Diagnostic imaging review of postoperative complications after spinal surgery and instrumentation p. 20
Reddy Ravikanth, Pooja Majumdar
A variety of surgical approaches are available for the treatment of spine diseases. Complications can arise intraoperatively, in the immediate postoperative period, or in a delayed fashion. These complications may lead to severe or even permanent morbidity if left unrecognized and untreated. Postoperative complications such as incomplete fusion, hardware failure, suboptimal positioning of instrumentation, infection, hematoma, and others may be detected at imaging. The article reviews the potential complications of spinal instrumentation, beginning with a description of biomechanics and an overview of surgical approaches and continuing with a discussion of various types of complications and their appropriate radiologic assessment. This systematic review describes the imaging features of immediate and delayed complications including instrumentation malpositioning.
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The impact of loneliness on physical and mental health among older adults in the era of coronavirus disease 2019 pandemic p. 29
Chidiebere Emmanuel Okechukwu
Coronavirus disease 2019 (COVID-19) pandemic has a significant negative impact on emotions and feelings of loneliness in terms of lack of companionship, social isolation, and connections in older adults. Compulsive loneliness can negatively alter cognition, mental, and physical health and lifespan in the elderly. Isolation and restricted social interaction in the time of COVID-19 pandemic was clearly connected with the symptoms of mood and behavioral disorders in older adults. The aim of this narrative review was to evaluate the impact of loneliness caused by the public health social isolation measures aimed to curtail the prevalence of COVID-19 on the physical and mental health in older adults. Articles regarding the effect of loneliness caused by the public health social isolation measures aimed to curtail the prevalence of COVID-19 on the physical and mental health of older adults were searched on PubMed electronic database. Relevant articles were selected; full-text articles were assessed; and significant evidence were extracted. To avoid the negative impact of social isolation on older adults during the era of COVID-19, it is essential to involve older adults in the activities such as physical activity, playing games with their peers, and sightseeing.
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Is additive manufacturing of patient-specific implant is beneficial for orthopedics Highly accessed article p. 33
Aleena Ariz, Ilma Tasneem, Devyani Bharti, Abhishek Vaish, Abid Haleem, Mohd Javaid
Purpose: Additive manufacturing (AM), mostly referred to as three-dimensional (3D) printing that has the potential to accelerate innovation, minimize materials and energy usage, compress supply chains, and reduce waste. Due to its extensive capability, its applications in orthopedics are enormous. The purpose of this article is to explore the application of this technology for patient-specific implants to improve the functional outcomes of orthopedics' patients. Methods: A brief review of AM and its applications in orthopedics are performed. In this process, we capture the data of the patient using computed tomography scan. Patients' data in 3D format are analyzed by the customized software before being printed by the fused deposition modeling 3D printing technology. A case study with a patient has helped in understanding the benefits. Results: 3D printed, patient-specific models help for understanding the proper planning of the surgery. AM-based processes provided a fast, cost-effective, and efficient solution during the planning of the surgery. Conclusion: 3D printers print any required product from a digital 3D object. The part is manufactured layer by layer, using different materials such as metal, plastic, nylon, and over a hundred other materials. AM allows us to manufacture complicated shapes with much less material and quickly. It is useful in sectors such as manufacturing, industrial design, jewelry, architecture, engineering and construction, aerospace, automotive, dental and medical industries, education, geographic information systems, civil engineering, and many others. The applications of this technology are increasing in orthopedics from surgical planning to actual surgery. The surgical planning undertaken at the clinic helped a musician. The patient returned to the activities of daily living in 3 weeks with a full range of motion, and after 3 months, he was able to play his musical equipment.
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Tubercular meningitis presenting with cortical laminar necrosis p. 41
Manisha Sharma, Bindu Menon, Gayatri Manam
Cortical laminar necrosis (CLN) is a radiological and neuropathological finding which requires thorough evaluation for hypoxic, metabolic, infective, and toxic causes. Hypoxic, metabolic, and toxic etiologies for CLN have been frequently reported in past, but infective causes have never been systematically enumerated and limited literature is available for the same. We describe a case of tubercular meningitis (TBM) presenting clinically with focal visual seizures and radiologically as CLN. It was also challenging to rule out other etiologies for CLN before attributing it to TBM. To emphasize, CLN as a radiological finding needs an approach and detailed evaluation for etiological diagnosis.
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Lithium-induced hyperthyroidism in a patient with bipolar type 1 affective disorder: A rare occurrence p. 44

A 46-year-old female, previously diagnosed with bipolar affective disorder on lithium therapy, presented to us with manic symptoms. The blood investigations revealed elevated thyroxine and reduced thyroid-stimulating hormone with technetium thyroid scintigraphy indicating lithium-induced thyroiditis.
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An unusual presentation of acute osteomyelitis of tibia with superficial venous thrombosis in a child p. 47
Navya Sree Veldanda, Vamshi Krishna Kondle, Rajanna Rajender Paka, Tarun Kumar Suvvari
Acute hematogenous osteomyelitis is the most common cause of osteomyelitis in children. It requires early diagnosis and treatment to minimize the risk of sequela of growth disturbances and deformity. We present a case of an unusual presentation of osteomyelitis of the tibia with Superficial venous thrombosis in a 2½ year male child, which was 1st ever reported association. A high degree of clinical suspicion of venous thrombosis, especially in pediatrics osteomyelitis, is required, with high C-reactive protein and erythrocyte sedimentation rate levels, as the child presents insidiously.
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Incidentally detected muscular sarcocystis with ewing's sarcoma: A case report of a rare combination p. 51
Kavita Somani, Pretty Singh
Sarcocystis is an apicomplexan protozoan, such as Toxoplasma and Plasmodium. Human muscular sarcocystis infection is a rarely reported case. The rarity of the reported cases can be attributed to nonspecific symptoms and nonrecognition of the protozoa on histology. Sarcocystis infection has been catching up recognition in Southeast Asian countries. It is a food-borne zoonosis. There are more than hundred Sarcocystis spp. known and most have been isolated from muscle tissues of various intermediate hosts, including mammals, birds, and reptiles. They are parasites with dual hosts to accommodate their dual life cycles. Humans are the accidental intermediate hosts, as have been reported as intramuscular sarcocysts of unknown species. We report a similar case of 27-year-old male, who underwent wide local excision of Ewing's sarcoma of the right arm, in conjunction with which muscular sarcocystis infection was identified. We report a rare case of muscular sarcocystis in a rarer combination with Ewing's sarcoma, with no such previous case in the literature available.
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Primary testicular lymphoma p. 54
Milan Joshi, Srinath Subbarayappa, Jayanth Bannur Nagaraja
Primary testicular lymphoma is a rare lymphoid neoplasm. It accounts for 1%–2% of non-Hodgkin's lymphoma, occurring in the elderly with high incidence of bilateral involvement. Ipsilateral orchiectomy plays an important role in diagnosis and can achieve therapeutic effect. This is a case report of testicular lymphoma which was incidentally detected after orchidectomy.
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Coronavirus disease 2019 outbreak: Strengthening infection prevention and control measures to reduce hospital-acquired infection p. 57
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
The coronavirus disease-2019 (COVID-19) outbreak has been declared a public health emergency of international concern and now the overall risk of transmission at global level has also been decided as very high based on the available facts. The effective containment of the infection will require a coordinated response from multiple stakeholders and strengthening of infection prevention and control (IPC), surveillance, diagnostics, treatment, risk communication, and research activities. Among all, it will be ideal to give more emphasis toward IPC as it is a major domain in prevention and mitigation of the ongoing outbreak. It is quite obvious that giving only attention to personal protective equipment will not accomplish significant gains unless it is well supported by administrative, environmental, and engineering interventions. In conclusion, in the battle against the COVID-19, the IPC measures need to be strengthened extensively both in hospital and community settings and thus specific attention has to be given toward the same.
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Pandemic management: A welcome initiative for COVID-19 crisis and beyond p. 59

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Glassy cell carcinoma of cervix: A rare case report p. 60

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Wernicke's encephalopathy: It not always alcohol p. 62

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Pancytopenia with autoimmune hemolytic anemia p. 64

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Skeletal fluorosis: Problem that runs deep p. 66
Chaitanya Yerawar, Aditi Kabde, Santosh Durugkar, Prerana Deokar
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