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EDITORIAL |
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Industry and the medical profession: Sleeping with the enemy |
p. 1 |
Amitav Banerjee DOI:10.4103/0975-2870.108622 |
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GUEST EDITORIAL |
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Bending the truth ostensibly for public good: The case of the pneumococcal conjugate vaccine |
p. 3 |
Jacob Puliyel DOI:10.4103/0975-2870.108623 |
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REVIEW ARTICLES |
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Dexmedetomidine: Expanding role in anesthesia |
p. 5 |
Jyotsna S Paranjpe DOI:10.4103/0975-2870.108625 The potential uses of dexmedetomidine (DEX), a highly selective α2 - adrenoceptor agonist are very diverse. DEX appears to mimic many of the actions of mythical 'ideal' sedative/analgesic agent. Although not orally active, DEX shows good bioavailability when administered via various other routes like intranasal, buccal, IM than intra-venous. DEX has similar pharmacokinetics in all age groups. Its side effects are predictable and easily treatable, hence it has found place as a part of fast-tracking anesthesia regimens in children. DEX is the sedative of choice for peri-operative use in high risk patients, since it is cardioprotective, neuroprotective and renoprotective. Premedication with DEX obtunds the autonomic pressor responses due to laryngoscopy and endotracheal intubation when used as an adjuvant to general anesthesia. DEX in high doses offers another approach to managing morbidly obese patients and patients with a compromised airway; without causing any cardio-respiratory depression. It is near ideal hypotensive agent used for controlled hypotension. Its value as a primary sedative and analgesic is becoming more accepted and evident in critically ill patients; in adult and paediatric intensive care units. Besides use in locoregional anesthesia, it is also used as an opioid substitute, for treatment of substance withdrawal, as an anti-shivering agent, for treatment of delirium and as an end of life medication. Availability of an antidote (Atipamezole) with similar elimination half life is taking the drug into new frontiers. However, use of DEX is contraindicated in patients with hepatic failure, hypovolemic shock, advanced heart block or ventricular dysfunction. |
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Psychogenic dyspnea |
p. 14 |
Tushar R Sahasrabudhe DOI:10.4103/0975-2870.108627 Dyspnea is a very common presenting complaint of a patient. Though commonly due to an organic disease, dyspnea can be a manifestation of underlying anxiety disorder. Three typical patterns of psychogenic dyspnea, viz. panic attack, psychogenic hyperventilation, and compulsive sighing, have been reviewed in this article. The article also comments on the diagnostic features and treatment of these patterns. The overlap with organic causes of dyspnea such as bronchial asthma and Chronic Obstructive Pulmonary Disease (COPD) has also been discussed. For literature review, a Medline and Pubmed search was conducted using appropriate keywords. Articles were also identified from the authors' own knowledge of the literature as well as reference lists in articles retrieved. |
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COMMENTARY |
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Broadening horizons in psychiatry and respiratory medicine |
p. 19 |
Darpan Kaur |
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ORIGINAL ARTICLES |
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Pulmonary functions in air conditioner users |
p. 21 |
Sandip M Hulke, Avinash Thakare, Prashant Patil, Shrikant A Shete, Yuganti P Vaidya DOI:10.4103/0975-2870.108629 Context: In the modern lifestyle, use of air conditioner (AC) has become very common. Aims: The present study was planned to assess the effect of ACs on pulmonary functions in young healthy non-smoker adults. Settings and Design: This study was a cross-sectional observational study. Sixty-six young adults (40 males and 26 females) using ACs were compared with 70 non-AC users (young adults, 40 males and 30 females). Materials and Methods: Pulmonary function test was done using medical international research (MIR) Spirolab II during home visits. Statistical Analysis Used: GraphPad Prism 5 software was used for analysis. Unpaired t test was used for lung function parameter. Chi- square test was used for the comparison of respiratory symptoms. Results: The results showed significant decrease in forced vital capacity (FVC) (P < 0.05), forced expiratory volume in 1 s (FEV1) (P < 0.05), FEV1 as percentage of FVC in % [FEV1 (%)] (P < 0.05), peak expiratory flow rate in L/s (PEFR) (P < 0.05), forced expiratory flow rate in L/s in 25% of FVC (FEF25%) (P < 0.05), and maximum voluntary ventilation (MVV) (P < 0.01). Frequency of respiratory symptoms was higher in AC users. Conclusions: The results are suggestive of predisposition of AC users toward respiratory disorders in the form of mild airflow obstruction. |
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Postoperative complications of mesh hernioplasty for incisional hernia repair and factors affecting the occurrence of complications |
p. 25 |
Karan Vir Singh Rana, Gurjit Singh, Niteen A Deshpande, Viju K Bharathan, Srihari Sridharan DOI:10.4103/0975-2870.108634 Context: Incisional hernia is one of the common postoperative complications of abdominal surgery. Mesh hernioplasty represents the standard of care for incisional hernia repair. Aims: We report our experience with the use of mesh for hernia repair, with respect to the postoperative complications and factors affecting the occurrence of complications. Settings and Design: Fifty four cases of incisional hernia presenting to the institute between April 2008 and September 2010 were included in the study. Materials and Methods: The predisposing risk factors were identified. Mesh hernioplasty was done by the onlay technique and the patients followed up for at least 6 months. Statistical Analysis Used: An association of complications with various risk factors was explored with chi-square test and odds ratio with 95% confidence interval. Results: Twenty four patients developed at least one complication, the most common being seroma (12 cases) and surgical site infection (9 cases). The factors that showed a significant relationship with the occurrence of complications were diabetes mellitus, obesity, smoking, hypoproteinemia, advanced age, size of fascial defects, and number of defects. The recurrence rate was 3.7% (mean follow up: 13.05 months). Conclusions: Mesh hernioplasty gives acceptable results for incisional hernia repair. A sound understanding of the factors affecting the occurrence of complications and recurrence is required to improve the results of the procedure. |
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COMMENTARY |
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Changing trends in the management of incisional hernias |
p. 31 |
Subhash Chawla |
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ORIGINAL ARTICLES |
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Treatment of high-energy tibial plateau fractures by the Ilizarov circular fixator |
p. 33 |
Osman A Mohamed, Salah Aldeen A Youssef DOI:10.4103/0975-2870.108637 Background: We treated 30 patients with high-energy fractures of the tibial plateau by the Ilizarov fixator and transfixion wires. Ten fractures were open, and 20 patients had complex injuries. Of all, 15 were treated by ligamentotaxis and percutaneous fixation, eight by limited open reduction, and seven by open reduction bone graft and screws. There is, however, no "gold standard" procedure for this complicated and multi-disciplinary problem. Objectives: Evaluation of Ilizarov circular fixation method of treatment for these fractures when extensive dissection and internal fixation are contraindicated due to trauma to the soft tissue, deficiency of bone stock, and bony comminution. Materials and Methods: Between October 2007 and October 2011, we treated 30 consecutive patients with severe bicondylar fractures of the tibial plateau by the Ilizarov fixator. They were reviewed 24 months postoperatively and the level of function, clinical and radiological findings, and the patients' opinion were assessed. There were 20 men and 10 women with a mean age of 39 years (18 to 69 years). Six patients were car drivers or passengers, 12 were pedestrians struck by motor vehicles, and seven were motor-cycle riders. Four had been injured by falls from a height and one had a crush injury caused by a collapsed wall. Ten (33.3%) of the fractures were open. There were 10 Schatzker (1987) type-V and 20 type-VI fractures; 20 (66.6%) were comminuted. Results: All the fractures united within mean duration of 14.4 weeks. The femoral fixator could be removed within mean period of 6 weeks (range, 4 to 7 weeks) and the tibial fixator was retained for a mean of 13 weeks (range, 12 to 20 weeks). Full weight-bearing was allowed at a mean of 14.4 weeks (range, 12 to 24 weeks). The patients were followed up for a mean of 36.5 months (range, 24 to 53 months). The results were assessed according to the criteria of Honkonen and Järvinen (1992) which considers the subjective opinion of the patient, the clinical state, the function, and the radiological assessment. On the basis of the clinical criteria, outcome in ten cases were excellent, ten good, five fair, and five poor. Conclusion: Our study confirms the low morbidity and good outcomes associated with the Ilizarov method. The technique is appropriate for complex fractures of the tibial plateau when extensive dissection and internal fixation are contraindicated due to comminution at the fracture site and compromise of the soft tissue. |
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COMMENTARY |
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Tibial plateau fractures |
p. 41 |
Samar K Biswas, Ajit Swamy |
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ORIGINAL ARTICLES |
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Management of closed tibial plateau fractures with percutaneous cancellous screw fixation |
p. 43 |
Tushar Agarwal, Anil Salgia, Samar Kumar Biswas, Sahil Sanghi, Subash Rajendra Puri DOI:10.4103/0975-2870.108639 Background: Tibial plateau fractures, intra-articular in nature and caused by high-velocity trauma, constitute approximately 1% of all fractures. Primary goal in the management of proximal tibial articular fracture aims for a stable, congruous, pain-free, mobile joint. Objective: To study the technique, results, and complications of percutaneous cancellous screw fixation for tibial plateau fractures. Materials and Methods: Twenty-three men and seven women aged 18-65 years (mean = 36.8 years) underwent closed reduction and percutaneous screw fixation for closed tibial plateau fractures with <5 mm depression. According to the Schatzker classification, patients were grouped as type I (n = 18), type II (n = 4), type III (n = 0), type IV (n = 8), type V (n = 2), and type VI (n = 1). Closed reduction was achieved by manual ligamentotaxis technique under image intensifier control and fixed percutaneously with two cancellous screws (6.5 mm) with or without washers in a parallel fashion. Results: Functional outcome was evaluated using the Mason Hohl evaluation system. A total score of 19-24 was considered as excellent, 13-18 as good, 7-12 as fair, and <6 as poor. Outcomes were excellent in 10 patients, good in 15, fair in 4, and poor in 1 patient. Patients were allowed partial weight bearing with walker after 1 month and full weight bearing after radiological union in approximately 3-4 months. The mean period of hospital stay was 5 (range 2-15) days. All the fractures united radiologically after a mean of 3 (range 2.5- 5) months. Patients were evaluated at a mean of 3 years after injury. No patient had any complication like infection, wound dehiscence, or hardware problem. Conclusion: Percutaneous cancellous screw fixation for closed tibial plateau fractures is minimally invasive. It reduces hospital stay and cost, enables early mobilization with minimal instrumentation, and achieves satisfactory outcomes. |
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Operative management of fracture of shaft humerus by dynamic compression plate versus interlocking intramedullary nailing: A comparative prospective study of 30 cases |
p. 49 |
Subhash R Puri, Samar K Biswas, Anil Salgia, Sahil Sanghi, Tushar Aggarwal, Ashish Kohli DOI:10.4103/0975-2870.108641 Background: Uncomplicated diaphyseal fractures of the humerus successfully healed in over 90% of cases when treated
conservatively by reduction and immobilization. Open reduction with internal fixation, is preferred for open, segmental and pathological fractures. Objective: To compare functional outcomes, union and complication rates in patients treated with locked intramedullary nailing or dynamic compression plating for humeral shaft fractures. Materials and Methods: We randomized prospectively 30 patients with fractures of the shaft of the humerus were treated by open reduction and internal fixation by dynamic compression plate (DCP) in 15 cases and closed reduction and internal fixation with interlocking intramedullary nail in 15 cases. Patients were followed up for a minimum of six months. Result: There were no significant differences in the function of the shoulder and elbow, as determined by the American Shoulder and Elbow Surgeons' score, the visual analogue pain score, range of movement, or the time taken to return to normal activity. In our study, complications in DCP and IMN groups common were radial nerve injury and shoulder impingement. We had to perform secondary surgery on four patients in the IMN group, but on only one in the DCP group. Conclusion: Our findings suggest that open reduction and internal fixation with a DCP remains a better treatment option for fractures of the shaft humerus. Fixation by IMN may be indicated for specific situations, but is technically more demanding and has a higher rate of complications. |
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The effect of Helicobacter pylori infection on oxidative stress status in erosive reflux disease |
p. 55 |
Masoud Sadreddini, Yousef Rasmi, Zahra Shahsavari, Fariba Khosravifar, Mohammad Rahmati DOI:10.4103/0975-2870.108643 Background and Objectives: Helicobacter pylori (H. pylori) infection has been associated with increased production of reactive oxygen species, which leads to oxidative stress in the gastrointestinal mucosa. Nevertheless, the association of H. pylori infection and oxidative stress in erosive reflux disease (ERD) is still unclear. We sought to investigate the association between oxidative stress status and H. pylori infection in ERD. Materials and Methods: Eighty-three ERD patients (45 male/ 38 female; mean age: 40.4 ± 14.3 years) who had heartburn and/or regurgitation and erosion(s)-confirmed by endoscopy-in the distal esophagus were enrolled. Two antral biopsies were taken from the patients for rapid urease test. Blood samples were drawn for measurement of oxidative stress parameters, including malondialdehyde (MDA), ferric reducing antioxidant power (FRAP), superoxide dismutase (SOD) activity, and glutathione peroxidase (GPX) activity. Data were compared among H. pylori(+) and H. pylori(-) patients. Results : The overall prevalence of H. pylori infection was 71% (59/83). There was a significant increase in the levels of MDA in H. pylori(+) patients (0.98 ± 0.28 μmol/l) when compared with H. pylori(-) patients (0.84 ± 0.33 μmol/l; P = 0.048). However, the levels of FRAP in the H. pylori-infected patients were significantly lower than in those without infection (941 ± 211.8 vs. 1060.3 ± 216.6 μmol/l, respectively; P = 0.028). There were no significant differences in SOD activity, GPX activity, age, sex, and body mass index (BMI) of H. pylori(+) vs. H. pylori(-) patients (P > 0.05). Conclusion: Increased levels of MDA in H. pylori(+) patients showed association between oxidative stress and H. pylori infection in EDR patients. Also, considerable changes of antioxidant concentrations indicate a compensatory mechanism to cope with the increased oxidant status in H. pylori(+) patients. It may be concluded that oxidative stress increases in the presence of H. pylori in ERD patients, and antioxidant defense mechanisms, try to minimize oxidative stress damage. |
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A comparative study of lipid profile and autonomic functions in vegetarian and non-vegetarian postmenopausal women |
p. 60 |
Arunima Chaudhuri, Nirmala Gopal Borade, Amit K Bandopadhyay, Samir K Hazra, Sudipta Saha, Sabyasachi Mondol DOI:10.4103/0975-2870.108645 Background: The prevalence of dyslipedaemia, autonomic dysfunction leading to cardiovascular diseases, increases with menopause and an ageing population. Autonomic dysfunction as measured by lower heart rate variability is an established risk factor for cardiac death. Diet and nutrition have been extensively investigated as risk factors for major cardiovascular diseases and are also linked to other cardiovascular risk factors. Objectives: To compare lipid profile and autonomic functions of postmenopausal women on vegetarian and non- vegetarian diet. Materials and Methods: 120 Postmenopausal women (menopausal duration and age-matched) without any gross systemic disease from an Industrial population were selected. Sixty women were on vegetarian diet and 60 on non-vegetarian diet. BMI and waist/hip ratios were calculated, lipid profile was analyzed, and autonomic function tests were carried out. A comparison was done between the two groups using Students t test. Pearson's correlation coefficient was calculated between the independent variable (lipid profile parameters) and the dependent variables (deep breath test, valsalva ratio, 30:15 ratio, OTT, IHG, CPT) to understand the effect of lipid profile on autonomic control of heart. Results : Significant increases in total cholesterol, triglyceride, LDL, cholesterol/HDL ratio were noticed in women on non-vegetarian diet. Results of autonomic function tests, i.e. valsalva ratio, deep breath test, 30: 15R-R intervals ratio, isometric hand grip test, cold pressor test, and orthostatic tolerance test were significantly worsened in postmenopausal women on non-vegetarian diet. Conclusion: Dietary factors may be an important cause of alteration of lipid metabolism. Increased cholesterol decreases heart rate variability and increased LDL cholesterol decreases baroreceptor sensitivity thereby worsening autonomic functions in postmenopausal women. |
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Obesity and weight control measures: Findings from female college students of Agra |
p. 66 |
HK Thakkar, K Srivastava, SK Misra, SC Gupta DOI:10.4103/0975-2870.108648 Context: Obesity has negative health impacts. Obese people have higher risk of non-communicable diseases (NCDs). Overweight and obesity during young adulthood can track into later adulthood along with its higher risk for NCDs. Aims: To identify the weight control intention and dietary practices used among normal, overweight, and obese college females and to know the reasons for discontinuation among ever tried subjects. Settings and Design : A cross-sectional study conducted in urban and rural colleges of Agra. Materials and Methods: This was a cross-sectional study among 400 female college students. Height and weight were measured to assess body composition according to BMI (Body Mass Index) criteria (WHO 2002). Study included a semi-structured and semi-open-ended instrument to assess practices related to weight control. Their responses were collected, tabulated, analyzed, and interpreted. Statistical analysis used: Frequency. Results: The prevalence of overweight and obesity was found to be 18.5% and 4.5%, respectively, according to BMI (WHO 2002). One third of the subjects were recording their weight monthly. Slightly less than half of the subjects (46%) were trying to maintain optimum weight. Almost one third of these subjects (33.5%) were presently trying to lose weight. About one fifth of total 400 subjects (20.5%) were not concerned about their weight status. Majority of the subjects (85%) irrespective of their obesity status did not take any professional advice. More than half (52.7%) were resorting to physical activity to lose weight. Taking more fruits/vegetables (44.7%) was found to be the most common healthy dieting practices and most unhealthy was fasting (15.3%). More than one fourth (28.8%) of the subjects abandoned weight control practices because of shortage of time followed by 22.4% due to physical weakness. Conclusions: Collectively, results indicate female college students, regardless of weight status, would benefit from open discussions with health educators regarding healthy and effective dieting practices to achieve/maintain a healthy body weight. |
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Screening of β-thalassaemia trait by means of red cell indices and derived formulae |
p. 71 |
Shashikant Adlekha, Tandra Chadha, Ram Mohan Jaiswal, Ashina Singla DOI:10.4103/0975-2870.108649 Context: Thalassaemias are a group of genetic disorders with tremendous morbidity and mortality that are present widely across the globe. Aim of the Study: To evaluate the usefulness of automated haematology analyser-based red cell indices and formulae derived from these indices in β-thalassaemia trait (BTT) detection. Settings and Design: Prospective study conducted over a period of 1 year. Materials and Methods: The study included 301 cases with mild-to-moderate reduction in haemoglobin (Hb) with a lower cut-off value of 8 g/dl. Automated haematology analysis was done by using an "Arcus Diatron" (2000) for all these cases. A cut-off value of mean cell volume (MCV) < 76 fl and serum ferritin level < 12 ng/ml were taken for high-performance liquid hromatography (HPLC) screening. Based on these indices we evaluated eight automated analyser red cell indices and formulae - red blood cell count (RBCC), MCV, mean cell Hb (MCH), red cell distribution width (RDW), red cell distribution width index (RDWI), Mentzer index (MI), discriminant score (DS) and mean density of Hb per liter (MDHL) - for all 301 cases. Youden's index was computed for all derived indices. Results : Out of 98 cases screened by HPLC (D-10 VARIANT; Bio-Rad Laboratories), 88 turned out to be positive for BTT (HbA2 > 3.5%). Indices like RDW, RDW with low MCV, MCH, RDWI and DS were found to have a better discriminating function (higher Youden's index) compared with RBCC, MDHL and MI. Conclusion: Automated haematology analyser-based red cell indices and certain formulae derived from these indices have a high predictive value in screening BTT. |
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Echocardiographic assessment of hypertensive changes in elderly patients with isolated systolic hypertension and its correlation with pulse pressure |
p. 75 |
Shubhangi A Kanitkar, Meenakshi Kalyan, Anu N Gaikwad, Neeti Singh, Amit S Bhate, M Midhun DOI:10.4103/0975-2870.108651 Context: Isolated systolic hypertension (ISH) is increasingly recognized as a cardiovascular risk factor. Increase in pulse pressure is a powerful independent predictor of cardiovascular events. Aims: To study the hypertensive changes by 2D echocardiography in elderly patients with ISH and to compare the hypertensive effects in patients with pulse pressure between 50-70 mmHg and >70 mmHg. Settings and Design: This observational case series study was conducted over a period of 2 years (2009-2011) at a tertiary care hospital in Pune. Materials and Methods: Seventy-six newly diagnosed cases of ISH among the geriatric population over 60 years of age who attended the medicine and geriatric outpatient departments (OPDs) were studied for the hypertensive changes on 2D echocardiography and Doppler. Inclusion criteria were patients ≥ 60 years of age having systolic blood pressure (SBP) >140 mmHg and diastolic blood pressure (DBP) ͳ90 mmHg. The patients were divided into two groups according to pulse pressure (50-70 mmHg and >70 mmHg). Left ventricular hypertrophy (LVH), diastolic dysfunction, and systolic dysfunction were evaluated on 2D echocardiography and correlated with the pulse pressure. Statistical Analysis Used: Chi-square, Odds Ratio (OR) with 95% Confidence Intervals (CI) were done using SPSS. Results: Out of 76 patients, 48 patients (63.1%) had diastolic dysfunction, 46 patients (60.5%) had LVH, and 36 patients (47.4%) had systolic dysfunction on 2D echo. Patients with pulse pressure >70 mmHg showed increased incidence of LVH (75.6%) than those with pulse pressure 50-70 mmHg and (46.2%) respectively. There was no significant change in incidence of systolic dysfunction in the two groups. Conclusions: Incidence of LVH and diastolic dysfunction was more in ISH. Incidence of LVH and diastolic dysfunction was found to be more in patients with wide pulse pressure. |
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CASE REPORTS |
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Unilateral macromastia in a case of polymastia |
p. 79 |
Bharat B Dogra, Gurjit Singh DOI:10.4103/0975-2870.108653 Macromastia is a condition of abnormal enlargement of the breast in excess of the normal proportion. It can be unilateral or bilateral and generally manifest at puberty when secondary sexual characters start appearing. Other patients may develop this condition at the time of pregnancy (Gestational macromastia). We present a case of young unmarried girl having unilateral macromastia due to polymastia. Unique feature in this case has been presence of two nipple areola complexes over right breast mound, one at normal site and another just superior to the inframammary crease in the line of embryonic milk line. The affected breast was almost double the size of contra lateral breast. Besides she also had bilateral hypertrophy of axillary breasts. Vertical scar reduction mammaplasty along with excision of axillary breasts was successfully carried out with gratifying results. |
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Toluene-induced acute lung injury |
p. 82 |
Abhishek Singhai DOI:10.4103/0975-2870.108655 Toluene inhalation is an important occupational health hazard in persons working in factories manufacturing paint, chemicals, pharmaceuticals, and rubber. The present report describes an unusual case of toluene-induced acute lung injury threatening life. |
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Adult benign multicystic nephroma: A diagnostic dilemma |
p. 84 |
Chandan Chatterjee, Dawood Khan, Utpal De DOI:10.4103/0975-2870.108657 Cystic nephroma, also called multilocular cystic nephroma, is a relatively rare, non-genetic, benign, unilateral renal multicystic lesion. The non-specific clinical findings and the paucity of information from imaging techniques make the preoperative dilemma from othercystic renal neoplasia; thus nephrectomy seems to be the most preferable treatment. We report a case of cystic nephroma in forty years male patient presented with asymptomatic lump in abdomen. |
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A rare case of recurrent pyogenic liver abscess since childhood: A case of Papillon-Lefèvre syndrome |
p. 86 |
Somak K Das, Tanusree Nath, Prabir Ganguly, Chanchal K Jana DOI:10.4103/0975-2870.108659 Recurrent pyogenic liver abscess since childhood is an uncommon finding in clinical medicine. Papillon-Lefèvre syndrome (PLS) is a rare disease characterized by skin lesions caused by palmar-plantar hyperkeratosis, and severe periodontal destruction involving both the primary and permanent dentitions. Till date, more than 200 cases have been reported worldwide. In addition to the skin and oral findings, patients may have immune suppression and an increased susceptibility to bacteria, associated with recurrent pyogenic infections of the skin. Pyogenic liver abscess is an uncommon presentation of this rare syndrome. We present a case of PLS presenting as recurrent pyogenic liver abscess since childhood. |
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Amebic liver abscess and polycystic liver disease |
p. 89 |
Karan V. S. Rana, Trupti Tonape, Bharat B Dogra, Srihari Sridharan DOI:10.4103/0975-2870.108660 Polycystic liver disease is a rare disorder which remains asymptomatic. Infection of cyst is a major complication and is usually pyogenic. We report a rare case of amebic liver abscess in a patient with polycystic liver disease. In our search we found one such case report. Clinical features and radiological findings are usually sufficient, but atypical history and the presence of multiple hepatic abscesses in CT scan delayed diagnosis in our case. Histopathology of the cyst wall and enzyme immunoassay asserted the diagnosis. |
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A case report on Felty's syndrome |
p. 92 |
Sahil Sanghi, Tushar Aggarwal, Anil Salgia, Samar K Biswas DOI:10.4103/0975-2870.108662 A 35 years old female came to orthopedic OPD with multiple joint pain since 1 year with history of fever and morning stiffness without any history of trauma and previous infection. On examination there was small joint tenderness involving metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints with splenomegaly. Routine investigation revealed neutropenia and rheumatoid factor (RF) was positive. Patient was diagnosed to be suffering from Felty's syndrome. Treatment was initiated with methotrexate. Overall treatment was tolerated well, except for the development of mild fever, mild arthritis and transient thrombocytopenia. She is currently on methotrexate with reasonable control of her symptoms. |
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Spontaneous mesenteric hemorrhage |
p. 95 |
Karan V. S. Rana, Sunil V Panchabhai, Sridharan Srihari, Kundan Kharde DOI:10.4103/0975-2870.108663 Spontaneous intra-abdominal hemorrhage or abdominal apoplexy is an acute abdominal emergency which can exhibit a wide spectrum of clinical presentation. With the expanding avenues for anticoagulation therapy, this condition is becoming commoner. The association of this condition with antiplatelet therapy is less well established. We present a case of spontaneous mesenteric hematomas causing intestinal obstruction in a patient on antiplatelet therapy for ischemic heart disease. A review of etiology, clinical presentation and protocol of management is also presented. A high index of suspicion on the part of the clinician is essential to ensure a favorable outcome in this condition. |
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Retained surgical sponge: An enigma |
p. 98 |
Gurjit Singh, Siddharth P Dubhashi, Neha Jindal DOI:10.4103/0975-2870.108664 Retained surgical sponge in the body following a surgery is called "gossypiboma". A 27-year-old female who had undergone lower segment cesarean section 4 months earlier was admitted with complaints of pain abdomen with a palpable mass in left iliac fossa. X-ray, ultrasonography, and CT scan findings were suggestive of retained surgical sponge. Surgical sponge was removed following laparotomy. Surgeons must be aware of the risk factors that lead to gossypiboma, and measures should be taken to prevent it. Besides increasing morbidity and possible mortality, it may result in libel suit for compensation. |
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A case of double meningomyelocoele with hydrocephalous in a four months' infant |
p. 102 |
Anuja A Goyal, Vangapuram Raghavachari Rangachari, Chhaya Suryavanshi DOI:10.4103/0975-2870.108665 Meningomyelocoele is a developmental congenital disorder caused by failure of the neural tube to close during the first month of embryonic development thus presenting with herniation of neural elements along with meninges. Myelomeningocoeles most commonly occur in the lumbosacral region, but can also occur at any level in the neuraxis, including occipital/suboccipital areas or nasally (encephalocoele).We report a rare case of double meningomyelocoele in a 4-month-old infant (cervical as well as thoracic meningocele) with weakness in the left lower limb (power grade 0) posted for resection with difficult intubation because of obstructive hydrocephalus, fear of rupture of neuroplaque, positioning and care of blood loss and temperature. The infant was discharged within 15 days, and his hospital stay was uneventful. |
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Septate uterus with cervical and vaginal duplication: A rare Mullerian malformation |
p. 105 |
Meenal Patvekar, Vinayak Mahajan, Gazal Garg DOI:10.4103/0975-2870.108666 A rare case of Mullerian anomaly in a 26-year-old woman who presented with recurrent pregnancy loss and was found to have a longitudinal vaginal septum with cervical duplication and two endometrial cavities separated by a complete septum. The diagnosis of this unusual anomaly was aided by magnetic resonance imaging and was confirmed by hysterolaparoscopy. It was concluded that hysteroscopy aided in the diagnosis and treatment of this Mullerian defect with the highest quality of precision. Hysteroscopy therefore is considered gold standard in the management of septate uterus, thereby helping to regain the anatomical normality and because of its minimally invasive nature, it improves the reproductive outcome. |
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LETTERS TO THE EDITOR |
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Enuresis in people with intellectual disabilities |
p. 109 |
Rajendra C Pande, Neha R Pande DOI:10.4103/0975-2870.108667 |
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Tuberous sclerosis with shagreen patch over the face |
p. 110 |
Milind A Patvekar, Avinash B Jadhav DOI:10.4103/0975-2870.108668 |
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Concept of specialty - OPD for diabetes |
p. 111 |
Vijayashree Gokhale, Neha Chaudhary DOI:10.4103/0975-2870.108669 |
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QUIZ |
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Wordoku: Answers |
p. 113 |
Garima Lakhanpal DOI:10.4103/0975-2870.108670 |
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