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   2018| January-April  | Volume 45 | Issue 1  
    Online since July 27, 2018

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Satisfaction with the semirigid penile prosthesis among couples from a Semiurban Indian population
Amey Y Patil, RB Nerli, Neeraj S Dixit, Murigendra B Hiremath
January-April 2018, 45(1):26-29
Introduction: Insertion of penile prosthesis for treatment of irreversible erectile dysfunction (ED) is a common and well-established treatment in the western countries. Even in the times of the newly available oral medications, penile prostheses continue to have such a nonoptional place in the management of severe ED. In this study, we have assessed the satisfaction among semiurban Indian couples following insertion of the semirigid penile prosthesis. Materials and Methods: Between January 2000 and December 2015, 78 men with ED underwent semirigid penile prosthesis implantation (PPI) at our hospital. The satisfaction of patients and partners was evaluated using the ED Inventory of Treatment Satisfaction (EDITS) questionnaire and EDITS partner survey. Results: The mean age of the patients was 44.84 ± 7.30 years. The mean duration of time with ED in the preimplantation period was 38.69 ± 12.44 months. The satisfaction of patients and partners as assessed by EDITS questionnaire and EDITS partner survey was 80.66 ± 4.49 and 75.66 ± 6.57, respectively, at 12 months after surgery and 71.73 ± 8.10 and 65.6 ± 6.49, respectively, at 24 months after surgery. Conclusions: This study showed a high degree of satisfaction among patients as well as their partners with semirigid PPI. More than 80% of the men reported being very satisfied with their penile implantation surgery.
  7,764 194 1
Evaluation of femoral neck-shaft angle in subHimalayan population of North West India using digital radiography and dry bone measurements
Vipin Sharma, Krishna Kumar, Vishal Kalia, Pawan K Soni
January-April 2018, 45(1):3-7
Background: Femoral neck-shaft angle is an important parameter of proximal femoral geometry. Not only it has an anthropological value but also it gives an insight into possible underlying hip pathology. The present study was conducted with an aim to find femoral neck-shaft angle values in subHimalayan population of Northwest India, and to measure the neck-shaft angle of proximal femur in both gender types using two different methods. Materials and Methods: This study was carried out to determine the average femoral neck-shaft angle in subHimalayan population of Northwest India. Neck-shaft angle in 89 femora was measured by digital radiography using PACS software while 93 dry bones were analyzed by direct measurements. The results obtained were statistically analyzed. Results: The results were analyzed using SPSS software. The mean femoral neck-shaft angle using digital radiography method was 127.45 ± 2.50 when compared to dry bone group 126.90 ± 2.50. Gender-wise males had higher neck-shaft angle values when compared to females in both groups and were statistically nonsignificant. Conclusion: Any increase or decrease in the angle of femoral neck-shaft angle is associated with various clinical conditions. Data from this study would help to establish values for subHimalayan population of Northwest India, provide insight into various associated disease conditions, and also serve as guidelines for manufacturing of orthopedic implants.
  4,784 397 1
“Cricket ball in the scrotum:” Calcification of old hematoma
Suresh Birur Parmeshwarappa, Arunkumar Ragulapadu Vadde, Indhudhar Pyati Balappa, D Aishwarya
January-April 2018, 45(1):34-35
The intrascrotal calculus was first described during surgery by Kickham in 1935 as a “fibrinoid loose body” or “scrotal pearl.” The etiology of scrotal calculi is unclear. They may develop as a sequela to hematomas or inflammatory changes within the scrotum or loose bodies from torsion and infarction of the appendix testis or epididymis. Hardly few cases were reported in the literature. We present a case of painless right scrotal swelling since 6 years’ duration which gradually increased in size after following trauma. Finally, it is diagnosed as calcified hematoma and excision of the scrotal swelling was carried out after the exclusion of other causes (testicular malignancy) of scrotal swelling.
  3,727 148 -
Cancer incidence around Karwar (Kaiga Nuclear plant) needs further research rather than spread false information
RB Nerli, Shridhar C Ghagane
January-April 2018, 45(1):1-2
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Fatal microangiopathic hemolytic anemia: Two case reports
Majed Abdul Basit Momin, Saroj Kumar Prusty, Anamika Aluri, V Soumya
January-April 2018, 45(1):36-39
The microangiopathic hemolytic anemia (MAHA) characterizing hemolytic anemia with fragmented red blood cells (RBCs) in the peripheral blood smears. Hemolytic Uremic Syndrome (HUS) and thrombotic thrombocytopenic purpura (TTP) are classified under MAHA. We report two cases who presented to emergency room (ER), a 7-year-old female child who was diagnosed with atypical HUS with malignant hypertension on the basis of classic triad of hemolytic anemia, thrombocytopenia, and acute kidney injury. Second case was a 45-year-old female presented with altered sensorium, fever, and multiorgan failure. And finally diagnosed as TTP. Both the cases partially treated at private nursing home initially for few days and then referred to our hospital. This case report emphasizes the importance of correlation of emergency and laboratory physicians’ findings to approach a case of MAHA. As delay in early recognition of these conditions resulting in fatal outcome.
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Nerve conduction abnormalities in patients with newly diagnosed diabetes mellitus
Aditya Prakash Kulkarni, Aralikatte Onkarappa Saroja, Karkal Ravishankar Naik, Vikrant Ghatnatti, Nagabushan Hesarur
January-April 2018, 45(1):30-33
Background: Peripheral neuropathy is the most common neurologic complication of diabetes mellitus (DM). The incidence of neuropathy increases with increasing duration of diabetes. Diabetes may be preceded by a long period of clinically silent impaired glucose tolerance, altering the nerve function by the time diabetes is diagnosed. Objectives: Assessment of early electrophysiological evidence of peripheral neuropathy in patients with newly diagnosed DM. Materials and Methods: Patients with newly diagnosed type 2 DM within 1 month of detection with or without clinical features of neuropathy were prospectively recruited. Nerve conduction studies were performed on the right upper and lower limbs. Sympathetic skin response and heart rate variability were studied. Results: Twenty-four patients (14 men and 10 women) with newly diagnosed DM were included in the study whose age was 57.66 ± 14.52 years. Eight patients had distal paresthesiae in the lower limbs of whom two had sensory deficit and two had mild motor deficit clinically. Thirteen patients (54.16%) had abnormal sensory conductions and nine patients had abnormal motor conductions. F-wave latencies were significantly prolonged in the upper and lower limbs. Sympathetic skin response was absent in four patients and R-R variation was subnormal in ten patients. Nerve conduction parameters showed correlation with increasing age and hyperglycemia values. Conclusion: Patients with newly detected diabetes have high incidence of clinically manifest and subclinical peripheral neuropathy.
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Amniotic band syndrome: A case report and review of literature
Karthik Srevatsa, Manasi Gosavi, Pratap Kangle Ranjit, Krutika Mihirkumar Joshi
January-April 2018, 45(1):40-42
Amniotic band syndrome is a rare disorder with reported incidence of 1 in 15000. The spectrum of the presentation includes a simple Streeter band on one side to multiple anomalies including craniofacial malformation. In the present case, an 18-year-old primigravida with presented with 18 weeks 3 days’ period of gestation and complains of per vaginal leak. A male fetus weighing 520 g with attached umbilical cord measuring 4 cm was received. External examination of the fetus revealed cleft lip with cleft palate, low-set ears, clubfoot on the right side, amputation of left leg 2.3 cm away from the tibial tuberosity and left palm syndactyly. Microscopic examination of the organs was within normal limits. This case is presented with an intention to contribute to the existing literature and to present the range of anomalies that is seen with this condition, with an emphasis on early detection and diagnosis.
  2,853 196 -
Clinical, ultrasonographic, and biochemical correlates of polycystic ovarian syndrome: A case–control study from a Tertiary Care Center in North India
Vipul Gupta, Satyabushan Sharma, Sunil Kumar Raina, Gurdeep Kaur Bedi
January-April 2018, 45(1):8-12
Introduction: Polycystic ovarian syndrome (PCOS) is a common endocrinopathy typified by oligo-ovulation or anovulation, signs of androgen excess, and multiple small ovarian cysts. Materials and Methods: The study participants included fifty clinically diagnosed PCOS patients (diagnosed using according to the Rotterdam criteria) and twenty group-matched healthy female attendants of these patients. All controls had self-reported spontaneous regular menstrual cycles and no history of sub/infertility. Results: The mean fasting blood sugar levels in the study group of PCOS patients were 79.92 ± 8.55 mg%, the mean body mass index was 26.54 ± 5.14 kg/m2, and mean luteinizing hormone (LH) levels in the study group and control group were 10.46 ± 3.02 mlU/ml and 5.89 ± 2.12 mlU/ml, respectively. The mean difference between two groups was found to be statistically significant (P < 0.001). The mean LH-follicle-stimulating hormone (FSH) ratio in the study group was 1.97 ± 0.83, and in control group, it was 1.17 ± 0.37. The mean LH-FSH ratio was higher in study group than in control group and this difference was found to be statistically significant (P < 0.001). The mean thyroid-stimulating hormone in study group was 2.42 ± 0.99 μIU/ml, and in control group, it was 2.48 ± 0.72 μIU/ml. The difference between them was found to be statistically nonsignificant (P = 0.811). Thirty-six patients, i.e., 72% cases were found to be positive for polycystic ovaries on ultrasonography, while in control group, all women had normal ovaries. Conclusions: The possible pathophysiological mechanism of ovarian cyst formation in patients with PCOS is immune mediated and possibly similar to subclinical hypothyroidism.
  2,389 269 -
Profiling estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2/neu in breast carcinoma: Study of 111 consecutive cases
Muninder Negi, Satish Kumar, Soma Devi, Sunil Kumar Raina
January-April 2018, 45(1):13-16
Background: Breast cancer is a major health problem for women throughout the world representing nearly a quarter (25%) of all cancers with an estimated 1.67 million new cancer cases diagnosed in 2012. In India, breast cancer is second only to cancer of the cervix among women. It is considered to the be the leading cancer in some cities such as Mumbai and Bangalore. The present study analyzed the pattern of expression of hormone receptor Estrogen receptor (ER), progesterone receptor (PR), and Her-2/neu in invasive breast carcinoma. Materials and Methods: The data for the present study were retrieved from a hospital-based registry of breast cancer established in the department of radiotherapy of a tertiary care center in rural area of North-West India. Records of 111 consecutive patients extending from October 2015 to September 2017 were profiled. Results: One hundred and ten cases were invasive breast carcinoma, not otherwise specify (IDC-NOS). Age of the patients ranged from 30 to 74 years with median age of 48 years. Approximately half of the patients were postmenopausal (n = 58, 52.2%) and left side breast carcinoma was more common (n = 60, 54.1%). Most of the cases belonged to Grade II (n = 60, 54.1%), followed by Grade III (n = 34, 30.6%) with 60 (54.1%) and 48 (43.2%) of cases found in Stage III and II, respectively. ER, PR, human epidermal growth factor receptor 2 (HER2/neu) positive, and triple negative expression were seen in 59 (53.2%), 50 (45.0%), 37 (33.3%), and 31 (27.9%), respectively. Conclusions: Older patients (>50 years) showed higher positivity of ER/PR/HER2 as compared to younger age group, while triple negativity was higher in younger age group.
  1,996 253 -
Five-year analysis of breast carcinoma, with emphasis on bilaterality of the lesion
Pragati Upasham, Ritika Bhat, Prakash Roplekar
January-April 2018, 45(1):17-18
Introduction: Bilaterality of an infiltrating duct carcinoma (IDC) is an infrequent event. Literary information also reports the low incidence of the same. The present study was undertaken to know the prevalence of breast carcinoma cases diagnosed in our institute with emphasis on finding the bilateral lesion. Aim: Five-year analysis of breast carcinoma and its laterality was done on histopathologically confirmed cases. Materials and Methods: A retrospective study for a period of 5 years was undertaken. Review of data and of histopathology slides (which could be retrieved) was done. The presence of IDC, other variants, and cases with laterality of the lesion was keenly studied. Results: In a duration of 5 years, only two out of 85 cases were found to have bilateral IDC. Conclusion: Bilateral breast carcinomas have a rare occurrence as accounted in our study.
  1,950 198 1
Assessment of work-related health problems among healthcare professionals in a Tertiary Care Hospital
Asha Avirah Malayil Mangalath, Aswathy Alias, Manjusha Sajith
January-April 2018, 45(1):19-22
Background: Healthcare profession is known to be at high risk for work-related health problems that are responsible for lowering the quality of workers life and reducing the productivity. Aims: This study aims to evaluate the work-related health problems and self-medication among healthcare professionals (HCPs). Materials and Methods: A cross-sectional observational survey conducted for 1 month, which included all HCP willing to participate in the study. Data including demographic details, food habits, working schedule, health issues due to work, medication history, and current medication were collected through a self-designed questionnaire. The collected data were analyzed and interpreted using descriptive statistics. Results: Out of 200 HCP, 118 were nurses and 82 were doctors. Most of them were female (77%) within an age group of 21–25 years (69%) and a majority of them were unmarried (78%). Meals were frequently skipped (90%), and most of them had food from outside (70%). A majority of the HCP had work-related health problems, mainly including low back pain (68%), acidity (66%), and muscle pain (60%). Self-medication practice was observed in 92% of the HCP wherein most of them were over-the-counter (OTC) drugs, including ibuprofen + paracetamol (73%), paracetamol (70%), and pantoprazole (63%). Prescription drugs included naproxen (56%) and nimesulide (35%). Conclusions: Majority of the HCP had work-related health problems such as low back pain, acidity, muscle pain, and headache. Self-medication was practiced commonly, mostly including OTC drugs such as ibuprofen with paracetamol combination, paracetamol, and pantoprazole, and prescription drugs such as naproxen and nimesulide.
  1,737 172 -
Unilateral higher division of brachial artery
R Balasubramanian, Chaitanya Subramanium, Rajendrakumar Dundappa Virupaxi, Sanjay Kumar Yadav
January-April 2018, 45(1):43-46
Arterial variations are common in upper extremity. The present article describes a case of higher division of brachial artery. Higher division of brachial artery occurred above the level of insertion of coracobrachialis muscle. Further, the brachial artery proper continues lateral to median nerve in the cubital fossa and divides into radial and ulnar artery at the level of neck of radius. Higher division of brachial artery continues downward and medially, medial to the median nerve in cubital fossa, forming the superficial palmar arch in the palm. Knowledge of such variation is extremely important, especially for the limb surgeons (for carrying out surgeries in arm, creating arteriovenous fistulas for dialysis), routine blood pressure measurements, radiographic imaging, and interventionists. The relevant topics of embryology, anatomy, and its clinical importance have been discussed in the literature review. The purpose of this article is to highlight the need for the awareness of the potential existence of such anatomical variation and how it can be preoperatively detected by color Doppler imaging, which would help the surgeons and clinicians to plan out surgery and therapeutic interventions.
  1,740 150 -
Pattern of epilepsy patients visiting in a psychiatry outpatient department
Rajat Sanker Roy Biswas, Mohammad Gias Uddin, Mohammad Mostafa
January-April 2018, 45(1):23-25
Introduction: Little is known about the epilepsy patients attending in a psychiatry outpatient department (OPD) in the context of Bangladesh. Hence, the aim of our study was to see the frequency and pattern of patients of epilepsy attending in a psychiatry OPD in our context. Methods: One-year patient data were explored from January 2016 to December 2016 recorded in a register book of the psychiatry OPD by consultants themselves and data were extracted manually. The diagnosis was collected, and data were analyzed by Microsoft Xcel. Results: Among the total of 1474 patients visiting the OPD in the year 2016 at the psychiatry OPD, total epilepsy cases were found in 209 (14.2%) patients. Among them, generalized tonic–clonic seizure was found 144 (9.8%), absence seizure 38 (2.6%), partial seizure 5 (0.3%), temporal lobe epilepsy 4 (0.3%), myoclonus 1 (0.1%), and unclassified 17 (1.2%). Electroencephalography confirmation was done in 60 cases which was 4.1% of total patients. Hence, confirmed cases of epilepsy were 4.1%, and probable cases were 10.1% of total patients attending OPD. Conclusion: In conclusion, we can say that visiting of epilepsy patients in a psychiatry OPD is a common behavior and we need to develop expertise in this field more.
  1,681 139 -
A case of chronic arsenicosis from Bangladesh
Rajat Sanker Roy Biswas
January-April 2018, 45(1):47-48
  1,452 114 -
World Health Organization releases the list of blueprint priority diseases
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
January-April 2018, 45(1):49-49
  1,076 126 -