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   2013| September-December  | Volume 40 | Issue 3  
    Online since October 19, 2013

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Challenging aspects of and solutions to diagnosis, prevention, and management of hypoglycemia in critically ill geriatric patients
Vishal Sehgal, Sukhminder Jit Singh Bajwa, Upinder Khaira, Rinku Sehgal, Anurag Bajaj
September-December 2013, 40(3):128-134
There is a worldwide pandemic of diabetes. Also there is a gradual and steady increase in the elderly population. Often clinicians are faced with managing dysglycemia in the elderly with underlying sepsis and multiple comorbidities. This predisposes the elderly to potentially increased chances of hypoglycemia in inpatient settings. This article reviews the altered renal physiology and its effects in the management of dysglycemia in the elderly population. It also emphasizes the role of renal insufficiency and sepsis as the main etiological factors for hypoglycemia in both diabetics and nondiabetics in the inpatient settings.
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Update on Psoriasis
Aanchal Puri, Shamindra Sengupta, Bhudev Sharma, Robin Sabharwal, Karan Kapoor
September-December 2013, 40(3):121-127
Psoriasis is a common skin disorder characterized by focal formation of raised plaques that constantly shed scales derived from excessive growth of skin epithelial cells. The disease is characterized by a series of linked cellular changes in the skin: hyperplasia of epidermal keratinocytes, vascular hyperplasia and ectasia, and infiltration of T lymphocytes, neutrophils, and other types of leukocyte in the affected skin. Psoriasis is now considered as a T cell-mediated inflammation of the skin. Types of psoriasis that may be clinically encountered include plaque psoriasis, guttate psoriasis, erythrodermic psoriasis, pustular psoriasis, nail psoriasis, psoriatic arthritis, and scalp psoriasis. Psoriasis is believed to be genetically linked but can also be triggered by mechanical, ultraviolet, and chemical injury; various infections; prescription drug use; psychological stress; smoking; and other factors.
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Impact factor: Do we have better assessment tools?
Rajendra B Nerli
September-December 2013, 40(3):119-120
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A study of management of fracture shaft femur in children in a rural population
Soumya Ghosh, Souvik Bag, Soma Datta, Arunima Chaudhuri, Debasis Singha Roy, Abhijit Biswas
September-December 2013, 40(3):135-139
Background: Femoral shaft fractures account for 1.6% of all bony injuries in children, and the mode of treatment for children between 6 and 16 years of age is still debatable. Objectives: To compare the merits and demerits of operative and conservative managements of fracture shaft femur in children in a rural population in a developing country. Materials and Methods: Forty patients in the age group of 6-14 years with transverse fractures of shaft of the femur and two different treatment protocols were selected. The patients treated in skeletal traction or fixed traction in Thomas' splint were included in one group and patients who were treated operatively with titanium elastic nails comprised the other group. Data was analyzed using Chi-square test. Results: The commonest cause of injury was motor vehicle accident, accounting for 70% of the cases, with left femur (60%) more commonly injured. All fractures in the operative group united clinically by 8 weeks and radiologically by 10 weeks, and, in the conservative group, by 9 weeks clinically and 12 weeks radiologically. The difference was statistically significant. Shortening and angular mal alignments were found more commonly in the conservative group, and the difference was significant. The follow-up for 1 year of all cases were uneventful. Conclusion: Internal fixation with titanium elastic nails provides better results than conservative treatment in traction.
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Histopathological spectrum of lesions in nephrectomy specimens: A five-year experience in a tertiary care hospital
Aiffa Aiman, Kuldeep Singh, Mir Yasir
September-December 2013, 40(3):148-154
Context: Nephrectomy is a common procedure in surgical practice. It is indicated in patients presenting with a wide range of clinical conditions ranging from symptomatic chronic infections, obstruction, calculus disease, and severe traumatic injury to renal cell carcinomas. It is performed increasingly in the context of end-stage renal disease and to treat renovascular hypertension from non-correctable renal artery disease, or for severe unilateral parenchymal damage resulting from nephrosclerosis, pyelonephritis, vesicoureteric reflux, and congenital dysplasia. Objective: This study aimed to assess the patterns and morphology of lesions in nephrectomy specimens in a tertiary care hospital, observe variations if any from the conventional pattern, and clinico-morphological correlation for proper postoperative management. Materials and Methods: A hospital-based five-year study included all nephrectomy specimens received in the department over a period of five years (November 1, 2005 to October 31, 2010). Results: A total of 140 cases over a period of five years were studied. A wide range of lesions were found on histopathological examination. The histopathological analysis correlated well with the clinical diagnosis; however, few benign lesions like xanthogranulomatous pyelonephritis may be misdiagnosed clinically as malignant. Similarly, cases of cystic diseases of kidney, renal sarcomas, renal squamous cell carcinomas, and angiomyolipomas were confirmed on histopathological analysis only. Conclusions: The present study provides a fair insight into the histological patterns of lesions in nephrectomy specimens at our institution. In conclusion, a wide range of lesions are encountered on histopathology of nephrectomy specimens, many of which may be misdiagnosed clinically and radiologically; therefore, it is mandatory that every nephrectomy specimen be subjected to detailed histopathological examination for a clinico-morphological correlation to ensure proper management.
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Knowledge about and attitude towards HIV/AIDS among first year medical students: A cross-sectional study
Arun V Joshi, Kiran Nikam, Bhagyashri R Hungund, Rajagonda G Viveki, Shashikant V Nikam, AB Halappannavar, Halaki Sunanda
September-December 2013, 40(3):155-158
Background: Acquired immunodeficiency syndrome (AIDS) caused by human immunodeficiency virus (HIV) is a major public health problem in India. It affects mainly young people in sexually active age groups. A number of knowledge, attitude, and practice studies conducted in different parts of India reveal widespread ignorance and misconceptions about the disease among young people. Medical students are the budding doctors of tomorrow and have just entered the noble profession. Thus, there is a need to assess the existing knowledge and attitude towards this HIV/AIDS among them. Objective: The objective was to assess the extent of knowledge and attitude towards HIV/AIDS among first year medical students of a government medical college in North Karnataka. Methodology: This was a cross-sectional study conducted among all (97) first year medical students of a government medical college in North Karnataka. After taking informed consent, the information regarding knowledge and attitude towards HIV/AIDS was collected from them using a predesigned, pretested structured questionnaire. Results: Of the 97 students who participated, 52 were males and 45 were females. All the students were aware of HIV/AIDS in terms of definition and causation. There was no statistically significant difference among males and females about their knowledge of and attitudes towards HIV/AIDS. Conclusion: Though the general level of knowledge of students about HIV/AIDS was not poor, they had a number of misconceptions about it.
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A huge dermoid cyst with thrombocytosis and preoperative intraperitoneal rupture: An unusual presentation
Ramya Shankar, Sujata Narendra Datti, Jayanta Kumar, Rangahanumaiah Manjushree
September-December 2013, 40(3):180-182
Benign cystic ovarian teratoma is the most common ovarian neoplasm accounting for 10-25% of ovarian tumors.They affect women of all age and particularly women of reproductive age group.They may present with a variety of symptoms ranging from being asymptomatic to pain abdomen, dysmenorrhea, pelvic pain, nausea, vomiting, fever, anorexia, loss of weight and shortness of breath. The complications associated with benign cystic teratoma are torsion (16%), malignant degeneration (2%), rupture (1-2%), and infection (1%). Its spontaneous or iatrogenic intraperitoneal rupture is associated with chemical peritonitis. A dermoid cyst has been associated with thrombocytosis in 30% of the cases. Hereby we present a case of huge ovarian dermoid cyst associated with thrombocytosis and spontaneous preoperative rupture with chemical peritonitis.
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Low-grade mucinous neoplasm of the appendix managed with laparoscopic appendectomy
Jonas P DeMuro
September-December 2013, 40(3):172-173
Mucocele of the appendix is uncommon and caused by a variety of pathologies. While the gold standard approach to these lesions has historically been exploratory laparotomy and right hemicolectomy, there is increasing experience with a minimally invasive approach and the resection limited to an appendectomy. A case is presented of an appendiceal mucocele diagnosed preoperatively and managed with a laparoscopic appendectomy. The pathology showed a low-grade mucinous neoplasm, with no evidence of recurrence on 30 month follow-up.
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Assessment of environmental factors associated with dengue transmission in Udupi Taluk, Karnataka
Ramachandra Kamath, Roshan Gupta, Varalakshmi Chandrasekaran, Sanjay Pattanshetty
September-December 2013, 40(3):159-161
Background: Dengue fever is a major public health problem in India. Dengue is a re-emerging arboviral disease in the World. Assessment of environmental factors in the rural and urban areas is extremely important to understand vectors, its transmission and vector breeding sites. Aim: The study was conducted to assess the environmental factors associated with dengue transmission and its protective factors. Settings and Design: A Community based cross sectional study was conducted in Udupi Taluk. Materials and Methods: The Study period was conducted during March 2012 to August 2012. Sample size was calculated by the formula of estimation of proportion (n = Z 2pq/ͺ2 ) at 95% significance level. Stratified multistage cluster sampling was used. A total of 500 households of Udupi Taluk were selected randomly for the study. Statistical Analysis Used: Data was analyzed using the SPSS version 15, Chicago, IL. Results are presented in proportions. P < 0.05 was considered to be significant. Results: Results showed that foremost risk factor for vector breading was abundance of coconut shells around houses (73%), containers without covers 50.8% (outdoor) and 20% (indoor). The P < 0.05 was significant for usage of mosquito coil or repellents, having a protective screen for windows, doors in living rooms and use of insecticide spray to reduce mosquito density in urban and rural areas. Conclusions: Health education, specific protection and source reduction need to be emphasized to control dengue fever in rural and urban areas.
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Subarachnoid hemorrhage caused by pregnancy induced hypertension: A rare occurrence
Chandrashekhar Anil Sohoni
September-December 2013, 40(3):174-176
This article presents the case of a young primigravida with pregnancy induced hypertension (PIH) presenting with seizure in the post-partum period. Magnetic resonance imaging revealed the presence of isolated convexal subarachnoid hemorrhage (cSAH). The absence of any other demonstrable vascular anomaly or coagulopathy on further investigation suggested PIH as the cause of cSAH.
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Multiple intra cardiac rhabdomyomas in neonate
Veeresh F Manvi, Nidhi Goel Manvi, Nagraj Shavi, Vishwanath M Pattanshetti
September-December 2013, 40(3):183-185
An 18 day old neonate presented with tachypnea. Congenital heart disease was suspected and referred for Pediatric Cardiology opinion. 2D Echocardiography revealed multiple, intra cardiac, highly echogenic, well circumscribed, intramural and intra cavitary rhabdomyomas. There were no systemic manifestations of associated tuberous sclerosis. At present, surgical excision of rhabdomyoma was not indicated and hence child was advised regular follow up with echocardiography evaluation.
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A trifid pelvis in a patient with a solitary kidney with LUTS: An unusual presentation
Guntaka Ajay Kumar, Rajendra B Nerli, Shishir Devaraju, Murigendra B Hiremath
September-December 2013, 40(3):177-179
Trifid pelvis is one of the rarest congenital malformations of the upper urinary tract. Trifid pelvis in a solitary kidney is a very rare presentation. A young male adult presented to us with dysuria and white discharge per urethra since 1 year on and off. Urine examination showed few pus cells and white blood cells. Initial imaging by ultrasonography revealed a solitary right kidney. A computed tomography urogram showed a normal right kidney with a trifid pelvis and left ectopic hypoplastic kidney with focal thickening at the right posterolateral aspect of the vesicoureteric junction. Cystoscopy revealed normal anterior and posterior urethra, verumontanum extending until bladder neck, no ejaculatory duct openings noted, and right ureteric orifice placed slightly laterally, with the left ureteric orifice not visualized. Right RGP confirmed a trifid pelvis. A high index of suspicion is needed for the identification of this rare condition.
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Zolpidem induced delirium
Sameeran S Chate, Raghavendra B Nayak, Nanasaheb M Patil, Sunny Chattopadhyay
September-December 2013, 40(3):164-165
Use of non-benzodiazepine hypnotics like zolpidem for insomnia has become a popular practice because of better safety profile and low abuse potential. However, neuropsychiatric side-effects such as headache, depression, memory deficits and abnormal dreams with zolpidem use have been reported. Delirum is a rare side-effect associated with zolpidem use. Here, we report a case of delirium, which occurred with a single dose of zolpidem. Clinicians prescribing zolpidem for insomnia should look into the risk factors/pre-disposing factors such as old age, female gender, substance abuse/dependence, systemic infections, psychiatric illness and multiple drug interactions. It is recommended to stick to the lowest dose possible whenever indicated.
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A prospective study of biological fixation with either plate or interlocking nail on the mean duration of union in diaphyseal fractures of tibia
Rajendra B Uppin, Satish Nesari, Ullas Mahesh
September-December 2013, 40(3):140-142
Objective: To study the results of Biological plating or Interlocking nail for the closed diaphyseal fracture of the tibia in Department of Orthopedics, KLE University's, Dr. Prabhakar Kore Hospital and Medical Research Center, Belgaum. The aim of this study was the evaluation of the results of biological plating or interlocking nail for closed diaphyseal fractures of the tibia. Materials and Methods: The study included 30 patients. All the patients underwent a comprehensive orthopedic examination and work-up was done to diagnose and classify tibial fractures. The treatment modalities were suggested accordingly. Results: Intramedullary nailing should be the method of choice for treating the closed type of tibial shaft fractures. Biological plating should be considered as an alternative in intramedullary interlocking nail in specific indications. Conclusion: Comprehensive orthopedic examination with detailed study of fracture pattern and type of fracture help to evaluate the different modalities of treatment.
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Management of a case of misadventure with lasers
Rajendra B Metgudmath, Vinita V Metgudmath, Anjali R Metgudmath, Amal Das
September-December 2013, 40(3):169-171
Transoral laser microsurgery in the management of primary as well as recurrent laryngeal carcinoma has been well-established throughout the world as an organ-preserving surgical procedure. We present a patient with early glottic carcinoma who inadvertently underwent several laser excisions and finally ended up with a total laryngectomy.
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A retrorectal tumor: Presacral chordoma
Suresh Birur Parmeshwarappa, Anand Rao, Yashdeep Sharma, Laxmi Rao
September-December 2013, 40(3):186-188
The retrorectal space contains multiple embryologic remnants derived from various tissues and tumors that develop in this space are both grossly and histologically heterogeneous. Most lesions are benign, but malignant neoplasms are not uncommon. Malignancy is more common in the pediatric population than in adults and solid lesions are more likely to be malignant than are cystic lesions. Here, 50-year-old male presented bleeding with mass per rectum and lower abdominal pain. The computed tomography scan showed retrorectal mass with destruction of the sacrum and excision of the presacral mass with removal of involved sacrum from third sacral vertebra to tip of coccyx. Finally, histopathology was chordoma of sacrum. Patient had received adjuvant external beam radiotherapy.
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Comparison of healing activity of jethimadh with triphala on experimentally induced thermal burn wound in rats
Meghna Pandey, Pratibha S Worlikar, Arijit Ghosh, Abhijit A Bondekar, Suwarn Chetan
September-December 2013, 40(3):189-190
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An unseen 'face' of hyperkalemia
Dilip Gude, Aslam Abbas
September-December 2013, 40(3):166-168
Hyperkalemia with normal or minimal electrocardiogram (ECG) changes is not commonly encountered. The 'milder' presentation may mask and hence lead to an under-management of a severe hyperkalemia. We discuss a case of severe hyperkalemia secondary to tumor lysis syndrome and its 'innocuous' ECG changes.
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Comparison of the demographic profile among caregivers of schizophrenia and depression
Sateesh R Koujalgi, Shobhadevi R Patil
September-December 2013, 40(3):143-147
Aim: This study aimed to explore the care givers socio-demographic and compare among schizophrenia and depression. Materials and Methods: A series of one hundred schizophrenia and one hundred depression consecutive patients attending psychiatry department who were accompanied by caregivers have been taken up for the study within the age group of 18-63 and above. To identify the primary care givers of above patients Pollack and Perlick scale was used. The International Classification of Disease, Diagnostic Criteria for Research ICD-10 criteria were used for psychiatric diagnosis and caregivers of the patients were assessed and compared on self-developed socio demographic proforma. Analysis was carried out using the SPSS-PC, version 17. Chi-square tests were carried out for comparison of the variables between the two groups. Results: Two groups of caregivers of patients with schizophrenia and depression have differed on variables such as age, gender, education, occupation, family income, length of contact with the patient, and relationship with the patient. Conclusion: The study finds significant difference in caregivers demographic variables in schizophrenia and depressive disorder.
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Anesthetic management of a pregnant patient with a pure red cell aplasia
Channabasavaraj S Sanikop, Prerna Bansal
September-December 2013, 40(3):162-163
Pure red cell disorder is an uncommon disorder in which maturation arrest occurs in the maturation of erythrocytes. Erythroblats are virtually absent in the bone marrow. Surgery poses a very high-risk for these patients because of the several complications that can occur in the perioperative period. In this case report, we report a pregnant patient with a pure red cell aplasia who was optimized pre-operatively and underwent cesarean section under sub-arachnoid block.
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