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  Citation statistics : Table of Contents
   2016| May-August  | Volume 43 | Issue 2  
    Online since May 18, 2016

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Devastating posttraumatic primary cutaneous mucormycosis in a diabetic patient
Poongodi Lakshmi Santhana Kumarasamy
May-August 2016, 43(2):85-88
Mucorales are saprophytic fungi causing mucormycosis, which is a life threatening infection manifested as rhinocerebral, pulmonary, gastrointestinal, cutaneous, and disseminated forms. The cutaneous form is further divided into primary and secondary forms. The major risk factors include uncontrolled diabetes mellitus with or without ketoacidosis, other forms of metabolic acidosis, and trauma. We report here a case of primary cutaneous mucormycosis caused by Rhizopus oryzae, in a diabetic after a road traffic accident.
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Success and failure in medical research
Rajat Sanker Roy Biswas, Chand Roy Biswas
May-August 2016, 43(2):106-107
  1 1,652 184
Diagnostic performance of urine dipstick test for urinary tract infection screening in individuals with spinal cord injury
Patpiya Sirasaporn
May-August 2016, 43(2):62-66
Objectives: To determine the diagnostic performance of urine dipstick test for urinary tract infection (UTI) screening in spinal cord injury (SCI) patients. Study Design: A cross-sectional diagnostic study. Setting: Srinagarind Hospital, Khon Kaen, Thailand. Participants: SCI patients with neurogenic bladder. Materials and Methods: This study was a cross-sectional diagnostic study that compared the urine dipstick test (index test) with the National Institute on Disability and Rehabilitation Research (NIDRR) criteria (gold standard test) in SCI patients. The urine dipstick test reported positive and negative results. Moreover, the NIDRR criteria classified participants as patients with UTI and patients with no UTI. The diagnostic performance of urine dipstick test for UTI screening was measured in terms of sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (+LR), and negative likelihood ratio (-LR) and was summarized in percentage with 95% confidence interval (CI). Results: Out of the 77 participants, most of participants were paraplegia (74%). The combined nitrite and leukocyte esterase urine dipstick test showed the highest sensitivity (93%), PPV (79%), NPV (85%), and +LR (2.39), respectively. The urine dipstick test of nitrite gave the highest specificity (69%). The most common uropathogen was Escherichia coli (33%). Conclusion: In SCI patients, the combined positive nitrite and leukocyte esterase urine dipstick test showed the highest sensitivity. The combined nitrite and leukocyte esterase urine dipstick test should be promoted as a screening test for UTI in SCI patients.
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Electrocardiogram and echocardiographic study of left ventricular hypertrophy in patients with essential hypertension in a teaching medical college
K Venugopal, Srikant R Gadwalkar, P Ramamurthy
May-August 2016, 43(2):75-79
Background: Left ventricular hypertrophy (LVH) is the adaptive mechanism for increased left ventricular (LV) stress and is associated with many adverse events. This study was undertaken to study LVH in patients of essential hypertension and to correlate between clinical, electrocardiogram (ECG), and echocardiography (ECHO) in the identification of LVH. Materials and Methods: One hundred patients attending the outpatient department and those who were admitted in our teaching institute from January 2013 to June 2014 were the study subjects. All cases of essential hypertension, irrespective of the duration of hypertension and type of treatment received were included in the study. Patients with secondary hypertension, ischemic heart disease/myocardial infarction, ischemic cardiomyopathy, congenital heart disease, and valvular heart disease were excluded. Conclusion: Out of the different ECG criteria, total QRS criteria showed a high sensitivity of 60%. ECG criteria have a high specificity but low sensitivity and hence, have limited use as a screening method. However, in a resource-poor country such as India where ECHO facilities are not available in all rural regions, improved ECG criteria such as total QRS voltage can be recommended as a routine investigation for LVH because of its cost-effectiveness and easy availability despite certain limitations.
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Disulfiram-induced dystonia
Vishwanatha Sham Alamela, Mahesh Desai, C Arunkumar
May-August 2016, 43(2):80-81
Disulfiram (DSF) is most commonly used as avertive therapy in day to day practice in deaddiction devision, have many side effects but dystonia is an uncommon side effect. Here we report a case of 34 year-old-male who is suffering from disulfiram induced dystonia. clinician should be aware of this side effect as this may influence the drug compliance and maintainig abstinence from the alcohol.
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Carotid sinus hypersensitivity: Entity warrants a caution in the critical care unit
Sugata Dasgupta, Soumi Das, Arunima Chaudhuri
May-August 2016, 43(2):82-84
Carotid sinus hypersensitivity (CSH) syndrome is an entity caused by an overreaction of the carotid sinus baroreceptors to stimulation. Three subtypes of CSH syndrome are recognized according to the response to carotid sinus massage (CSM): Predominantly cardioinhibitory, predominantly vasodepressor and a mixed subtype. We report here the case of a middle-aged female patient admitted in our critical care unit with respiratory failure requiring mechanical ventilation. There were episodes of severe bradycardia whenever her head was rotated to any side, relieved on neutralizing head position and administering intravenous atropine. CSM revealed she had predominantly cardioinhibitory type of CSH syndrome. A cardioinhibitory form of hypersensitive carotid sinus reflex, which is idiopathic in causation, probably explains the severe bradycardia on head rotation seen in our patient. A heightened awareness of this syndrome is necessary for timely diagnosis and management. CSH syndrome results from an overreaction of the carotid sinus baroreceptors to stimulation, manifesting commonly as bradycardia, hypotension and syncope. It is an entity, which warrants caution during routine critical care practices.
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Intestinal strongyloidiasis in a psoriatic patient following immunosuppressive therapy: Seeing the unforeseen
Poongodi Lakshmi Santhana Kumaraswamy, Revathy Chinnachamy, Nirmaladevi Palanivel, Nepoleon Rajamani
May-August 2016, 43(2):102-105
Strongyloides stercoralis , an intestinal nematode, has a complicated life cycle. Mostly asymptomatic, if symptomatic it has nonspecific, transient clinical manifestations. The two aggressive forms of the disease are: Hyperinfection syndrome (HS) or disseminated syndrome (DS). Several risk factors have been associated with strongyloidiasis including immunosuppressive therapy, human immunodeficiency virus (HIV) infection, diabetes, alcoholism, tuberculosis, impaired bowel motility, surgically created intestinal blind loops, chronic obstructive pulmonary disease, and chronic renal failure. We describe a case of intestinal strongyloidiasis in a psoriatic patient treated with immunosuppressive therapy.
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Anesthetic management of post-coronary artery bypass grafting patient posted for below-knee amputation
Kumari Priyanka Tallur, Chanabasavaraj S Sanikop, Mallikarjun G Dhorigol
May-August 2016, 43(2):89-91
Unilateral spinal anesthesia is a promising alternative to traditional, widely used techniques of spinal anesthesia as it decreases the risk of adverse events and complications.
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Large reccurent gingival growth in the maxilla: A case report
Shwetha Nambiar, Kaveri Hallikeri, Venkatesh Anehosur, Pragati Rai, Veda Hegde
May-August 2016, 43(2):92-95
Gingival growths are one of the frequently encountered types of lesion in the oral cavity. It is the common site for neoplastic and nonneoplastic lesions. Peripheral ossifying fibroma (POF) is one of the inflammatory reactive hyperplasias of the gingiva. It represents a separate clinical entity with diverse histopathological features. Even after adequate surgical excision of the lesion, repeated recurrence is not uncommon. Studies show a recurrence rate of 16-20% in these lesions. The suggested etiology for POF is low-grade irritation due to plaque and calculus. Proper excision of such overgrowths and appropriate oral hygiene instructions will ensure that the lesion does not recur. This case report is of a large, solitary gingival swelling in the maxilla of a 36-year-old male patient that had recurred for the third time after the surgical excision.
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Syringocystadenoma papilliferum: A rare case report with review of literature
Prasmit Amit Shah, Vikas Shyamraj Singh, Surekha Bhalekar, S Sudhamani, Ekta Paramjit
May-August 2016, 43(2):96-98
Syringocystadenoma papilliferum also known as syringocystadenomatosus papilliferus is a benign adnexal skin tumor presenting as exuberant proliferating lesion of apocrine or eccrine type of differentiation. It is said to be common at birth or during puberty but cases in adults have also been reported. It typically develops as a nodular plaque lesion and is reportedly associated with nevus sebaceous in 40% of cases. Most the tumors are located in the scalp and face that present as multiple warty papules. We report a case of scalp swelling in a 19-year-old female who was first clinically diagnosed with keratoacanthoma but later histopathologically she was confirmed to have syringocystadenoma papilliferum.
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Penile strangulation by polyvinyl chloride plastic pipe ring: Case report of sexual perversion
Prasad V Magdum, Vikram Prabha, Vikas Sharma, P Srikanth, Shridhar C Ghagane, Ankur Agarwal, Murigendra B Hiremath
May-August 2016, 43(2):99-101
Penile constriction rings are either used for erotic or autoerotic purposes or to increase sexual performance. Various objects, both metallic and nonmetallic, can be used as constricting devices. Potentially, they can become irremovable, resulting in reduced blood flow, leading to edema and, sometimes, gangrene. We report an case of penile strangulation with a polyvinyl chloride (PVC) plastic pipe ring presenting as an urological emergency. It was removed with the help of a dental drill after failed attempts of the use of orthopedic instruments. Management of such cases can be challenging and removal of such objects requires the help of various orthopedic and dental instruments.
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Medical ghostwriting
Rajendra B Nerli, Prasad V Magdum, Shridhar C Ghagane
May-August 2016, 43(2):61-61
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Effect of obesity on osteoporosis: A DEXA scan-based report in urban population of Belagavi
Saumya Agarwal, Rajendra B Uppin
May-August 2016, 43(2):67-69
Introduction: Obesity and osteoporosis are two major emerging challenges. Body mass index (BMI) is widely used as an index of the degree of obesity. Osteoporosis is a skeletal disease characterized by excessive skeletal fragility and susceptibility to low-trauma fracture among the elderly, it is typically defined in an individual with a bone mineral density (BMD) T-score, that is, 2.5 or more and standard deviations (SD) below normal (T-score ≤ -2.5). Aims and Objectives: To examine association between BMI and BMD among the urban population of Belagavi, Karnataka, India. Materials and Methods: 500 patients, 25 years of age and above, who underwent Dual-Energy X-ray Absorptiometry (DEXA) scan from the period of June 2013 to May 2015 in KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, Belagavi, Karnataka, India, were divided according to BMI (kg/m 2 ) and age groups: 25-39 years, 40-59 years, and 60 and above. Results: (1) Overweight people are less osteopenic and less osteoporotic than normal people. (2) Older people have low BMI. (3) Older people have low BMD. (4) Females have high BMI. (5) Females have low BMD. Conclusion: BMD was found to be significantly higher in overweight patients as compared to the BMD of the normal weight category. In addition, significant negative correlation between age and BMI was observed. Age and BMD correlated negatively as well. Females were found to be more obese and osteoporotic than males, signaling toward the culprit - Estrogen. Further studies are required to investigate the effect of other factors such as exposure to sunlight, calcium intake, and other habits like smoking and diet.
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Determining the prevalence of patterns of pregnancy-induced pelvic girdle pain and low back pain in urban and rural populations: A cross-sectional study
Arati Mahishale, Sudini Santosh Borkar
May-August 2016, 43(2):70-74
Background: Biomechanical changes during pregnancy impose postural deviations, leading to various musculoskeletal pain syndromes. Commonly noted pain syndromes are the pelvic girdle pain (PGP) and low back pain (LBP), which were experienced by pregnant women globally. There is a prevalence of pregnancy-related PGP (PPGP) and pregnancy-related LBP (PLBP) in Western population. Data of the same in Indian pregnant population lack evidence. Objective: To find the rates of incidence and prevalence of different patterns of PPGP and PLBP in the urban and rural pregnant women. Materials and Methods: A total of 580 pregnant women were screened for inclusion criteria. Confirmation of diagnosis of PGP and LBP was done for 457 subjects using Modified Oswestry Disability Index (MODI) questionnaire and the pelvic girdle questionnaire (PGQ). Once diagnosed, all participants were subjected to nine clinical tests to differentiate the site of pain and to classify them accordingly into three different groups, namely group A (LBP), group B [posterior pelvic pain (PPP)], and group C [anterior pelvic pain (APP)]. Results: The point prevalence of pain in group A (LBP) was 31%, in group B (PPP) was 65%, and in group C (APP) was 15%. The prevalence of PGP and LBP was 75% in the urban pregnant population and 25% in the rural pregnant population. Conclusion: The prevalence rate of PPP (65%) is higher than that of LBP (31%) and APP (15%). Also PPP is reported to be highest in primiparous with gestational age of 38 weeks. The urban population showed 75% and rural population showed 25% of PGP and LBP.
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