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Leiomyoma of the appendix: A familiar lesion at an unfamiliar location
This report examines the rare case of a 22-year-old male diagnosed with an appendiceal leiomyoma after presenting with abdominal pain and intermittent fever, similar to an episode experienced six months prior mimicking appendicitis. Such leiomyomas are exceptionally rare in medical literature, with few documented cases. The discussion emphasizes the challenge in distinguishing this condition from similar pathologies like gastrointestinal stromal tumours (GISTs), leiomyosarcomas, and schwannomas, highlighting the critical need for precise diagnostic methods.
Appendix, Leiomyoma, Leiomyosarcoma, Immunohistochemistry.
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Histopathological insights into dysgenetic gonads: A comprehensive case series analysis
Normal sexual development relies on the synergistic action of numerous activating and repressing factors interacting in a precise spatio temporal environment. Disorders of sex development (DSDs) can be classified into various categories, usually associated with abnormal development of chromosomal, gonadal, or anatomic sex. Females with DSDs can present with either ambiguous genitalia or with delayed puberty and infertility in later ages. Herein, we report all the dysgenetic gonads cases detected in our setting for a period of 5 years and discuss extensively on the same. This is a retrospective cross sectional study carried out in the histopathology section of Department of Pathology, SCB Medical College and hospital, Cuttack. The total duration of the study was 5years extending from June 2019-June 2024. All the histopathological confirmed cases of sertoli cell syndrome in clinically diagnosed 46 XY phenotypes was analysed. The radiological investigations like ultrasound where collected to confirm the same. We found a total of 10 patients diagnosed with sertoli cell only syndrome in clinically diagnosed phenotypic females. The mean age of patients was 21.11 years with age varying from 15yrs to 29 yrs. Testicular tissue structure identified showed hypospermatogonia with predominant sertoli cells and thickened basement membrane with interstitial leydig cell hyperplasia. Comprehensive evaluation, proper counselling to patients and their parents benefits from review of this information. Chromosomal karyotyping, microarray analyses, and next generation sequencing techniques are helpful to diagnose and identifies new genes involved. Multidisciplinary approach can help in surgery if given consent by the parents and the patient.
Dysgenetic gonads, Karyotype analysis, Sertoli cells.
Non transfusional haemochromatosis in patient of thalassemia minor
Haemochromatosis as an acquired form is seen in hematological conditions which necessitates chronic blood transfusions. Beta thalassemia minor patients are generally transfusion independent but still can have secondary iron overload like condition which affects heart, liver, pancreas. Our patient was diagnosed to have thalassemia minor while getting investigated for iron overload state with chronic liver disease and diabetes which turned out to be secondary haemochromatosis on liver biopsy.
Secondary haemochromatosis, Thalassemia minor, Iron.
Celiac disease presenting as peripheral neuropathy- A rare case report
Celiac disease is an autoimmune disorder usually presenting with gastro-intestinal symptoms and very rarely presents as extra gastro-intestinal manifestations like peripheral neuropathy, arthritis and gluten ataxia. This is a case of an 8 year old girl, diagnosed with celiac disease who developed weakness in upper and lower limbs after she resumed gluten containing diet. Nerve conduction studies showed pure motor polyneuropathy involving all limbs with raised anti- tissue transglutaminase levels (more than 10 times of upper normal limit). Child was put on gluten free diet and symptoms improved after that. Child was still on regular follow up and doing well. Celiac disease should be kept in differential diagnosis if any child present with features of peripheral neuropathy.
Peripheral neuropathy, Gluten free diet, IgA Transglutaminase levels, Pure motor neuropathy
Reversible pancytopenia: A diagnostic dilemma
Hydroxychloroquine (HCQS) is a medication initially developed for treatment of malaria. It is used for various rheumatological and skin disorders with various side effects and drug reactions. A 61 years old female presented with fever and pancytopenia with polymorphic skin lesions and sore throat. After exclusion of the common causes, a diagnosis of HCQS induced pancytopenia was made which is a rare side effect of HCQS. The pancytopenia improved following stopping HCQS and the case was diagnosed after detailed history and examination and considering the differentials. The importance of the case lies in the fact that clinicians should consider drug induced pancytopenia, as it is a reversible cause and can be diagnosed with ease after stopping the offending drug.
Extraskeletal myxoid chondrosarcoma of the finger mimicking a glomus Tumour: A rare case scenario
Extraskeletal myxoid chondrosarcoma (EMC) is an extremely uncommon soft tissue neoplasm of chondroblastic origin, predominantly seen in middle-aged and elderly individuals and is more prevalent in males. It exhibits a predilection for the deep soft tissue of proximal extremities and limb girdles. It is a rare tumour with distinct histology and a characteristic chromosomal translocation, usually t (9;22) (q22;q12.2), fusing EWSR1 to NR4A3. Despite its nomenclature, EMC exhibits no genuine hyaline cartilaginous differentiation and is classified as a tumour of uncertain differentiation in the WHO classification. Histologically, it exhibits myxoid/reticular histology, necessitating immunohistochemistry to aid in its diagnosis. However, molecular methods like fluorescence in-situ hybridization (FISH) are necessary to obtain a definitive diagnosis. In this instance, we detail an uncommon example of an EMC developing in the finger of a middle-aged female that was clinically thought to be a glomus tumour. Owing to its rare presentation, aggressive nature and tendency to recur, a high index of suspicion by a pathologist is required to diagnose this tricky entity, which can otherwise be readily missed.
Complex maxillofacial injury in an alcoholic-road to reconstruction
Road traffic accidents are the eighth leading cause of death worldwide, with a significant impact on individuals aged 5 to 29 years as per WHO. Traumatic maxillofacial injuries, often resulting from road traffic accidents, account for a substantial proportion of these injuries. Facial reconstructions following such injuries demand top priority. In this study, we present the management of a 25-year-old male patient with multiple complex maxillofacial fractures and soft tissue defects, emphasizing the crucial role of skilled and multispecialty management in such cases. The following article elucidates the importance of skilled and multispecialty management in a complex maxillofacial injury case.
Road traffic accident (RTA), Maxillofacial Injuries, Plastic Surgery, Trauma, Fractures.
A rare convergence: Unveiling the uncommon presentation of trichoblastic carcinoma with cylindroma – A singular case report
Trichoblastic carcinoma is an infrequent and malignant neoplasm of cutaneous adnexal origin, arising subsequent to follicular differentiation. Clinically, it manifests as a well-circumscribed, solitary lesion, predominantly observed on the scalp. Cylindroma, conversely, is a benign and indolent adnexal tumor, with a predilection for the scalp, head, neck, and trunk, exhibiting a higher incidence in females.A 54-year-old female presented with a 2 cm swelling on the left anterior chest wall, which had progressively enlarged over the course of one month, accompanied by severe pain and mild pruritus. Her family and surgical histories were unremarkable, and clinical examination yielded no significant findings. The initial diagnosis of an infected sebaceous cyst was reconsidered following FNAC, which suggested a granulomatous lesion. Biopsy revealed a 2 cm globular mass containing yellowish-white material.Microscopic examination disclosed highly pleomorphic basaloid and malignant stromal cells arranged in an irregular pattern, along with a cylindromatous component exhibiting the characteristic jigsaw pattern. Immunohistochemical (IHC) analysis demonstrated strong PanCK and EMA positivity, leading to a final diagnosis of trichoblastic carcinoma with coexisting cylindroma.Trichoblastic carcinoma, a rare malignant cutaneous adnexal tumor, originates from the external root sheath of the hair follicle. Key histological features include highly pleomorphic basaloid and stromal cells with densely packed, hyperchromatic nuclei and abundant mitotic activity. Cylindromas may present as solitary or multiple lesions, though their histogenesis, whether apocrine or eccrine, remains ambiguous. Notable characteristics include a biphasic cell population arranged in a jigsaw pattern.
Adnexal tumor, Trichoblastic carcinoma, Cylindroma, Immunohistochemistry.
Acute kidney injury in hospitalized children with dengue infection: A tertiary care hospital study
Background: Dengue viral infection (DVI) is a prevalent arthropod-borne illness, particularly common in tropical regions, manifesting in various clinical presentations ranging from undifferentiated fever to severe hemorrhagic fever and shock. Despite its recognition, acute kidney injury (AKI) remains a lesser-known complication associated with DVI. This study aimed to investigate the incidence of AKI among pediatric patients diagnosed with DVI and analyze its clinical implications. Materials and Methods: This cross-sectional observational study was conducted in the Department of Pediatrics at a Tertiary Care Hospital. A total of 202 pediatric patients aged 6 months to 18 years diagnosed with DVI were enrolled in the study. Demographic data, clinical characteristics, and AKI incidence were analyzed. AKI severity was classified according to the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Results: Among the participants, 11.4% were diagnosed with AKI. Patients with multi-organ dysfunction syndrome (MODS) tended to have longer hospital stays, indicating the severity of their condition. Demographic analysis revealed vulnerabilities among children, particularly males and urban residents. The prevalence of AKI underscored the importance of vigilant monitoring of renal function in pediatric DVI cases. Conclusion: The study highlighted the significant prevalence of AKI in pediatric patients with DVI, emphasizing the importance of early recognition and management to improve outcomes. Further research is warranted to explore preventive measures and optimize clinical management strategies for this vulnerable group.
Dengue viral infection, Acute kidney injury, Pediatric patients, Tropical regions, Arthropod-borne illness, Clinical implications.
Assessment of microalbuminuria and urinary albumin-to-creatinine ratio in patients with type 2 diabetes mellitus at a tertiary care hospital
Introduction: Urinary albumin-to-creatinine ratio (UACR) in random samples has been considered as the most appropriate investigation to detect early renal impairment. Present study was conducted to assess the microalbuminuria (MA) and UACR in patients with type 2 diabetes mellitus (T2DM) and to evaluate the factors associated with MA at a tertiary care hospital. Materials and Methods: This observational, cross-sectional study was conducted at a tertiary care hospital over a period of three months. Adult subjects of 18-70 years attending the diabetic outpatient department (OPD) who were advised for investigation of UACR were included. The subjects were interviewed using a pre-designed and pretested data collection form to collect the relevant data including demographic characteristics, co-morbidities and investigational reports of urine samples. Results: Majority of the subjects were female (51.48%) and belonged to the age group of 50 – 59 years (33.73%). Mean (± SD) duration of diabetes was 7.10 (± 7.27) years. Hypertension was the most common co-morbidity (60.94 %). Mean (± SD) value of urinary microalbumin, creatinine and UACR were 63.15 (± 140.56) mg/dl, 94 (± 81.3) mg/dl and 73.04 (± 146.51) respectively. MA was found in 33.73% study subjects. A significant positive correlation was detected between MA and UACR (r=0.4335, p=0.000756). Conclusion: About one third of our study subjects were found to have MA. For early detection of diabetic nephropathy regular assessment and monitoring of UACR should be considered.
Urine, Microalbuminuria, Diabetes mellitus, Cross-sectional
Neutrophil-to-lymphocyte ratio (NLR) in the acute coronary syndrome patients presenting in the pre and post-COVID-19 era
Background: The inflammatory pathways play a key role in the pathogenesis of acute coronary syndrome and the severe forms of COVID-19 disease. Thus inflammation may play an interrelation between these two critical situations. Materials and Methods: In this study, the records of the patients of ACS admitted to the coronary care unit, were analyzed retrospectively. The two groups had 200 patients each. The group-A was randomly taken from the pre-COVID period of July to December 2019 while group-B patients were taken from the COVID/post-COVID period of July 2021 to December 2021. The two groups were compared for the severity of inflammation, through the leukocyte ratios of NLR and d-NLR. Results: The neutrophil percentage as well as the ANC were significantly higher, while the percentage of lymphocytes and ALC were significantly lower in the group-B patients compared to the group-A patients (p ˂ 0.05). The NLR (mean ±SD) was significantly higher in group-B compared to group-A patients (6.38±4.84 vs 5.34±4.37, p ˂ 0.05), while the d-NLR showed no significant difference. The NLR values were significantly higher in group-B compared to group-A, for patients of age ˂ 45 years (7.13±5.8 vs 4.3±2.73, p ˂ 0.05) and for patients presenting with ST-Elevation ACS (7.17±5.2 vs 5.54±4.22, p ˂ 0.005). Conclusion: The degree of inflammation as indirectly measured by the ratios of NLR and d-NLR, was found to be higher in the ACS patients presenting in the COVID/post-COVID era when compared to those in the pre-COVID era.
COVID-19, Neutrophil percentage, Lymphocyte percentage
Assessment of the epidemiological overlap among morphologically identical species of entamoeba among the patients attending Calcutta school of tropical medicine
Introduction: Parasitic infections like Amoebiasis are endemic to most tropical and subtropical regions of developing countries like India. Among Entamoeba species, Entamoeba histolytica, the causative agent for amoebiasis, is highly pathogenic while the other species are considered as non-pathogenic and needs no medical treatment in most of the cases. Aim & Objective: To estimate the accurate prevalence of infection by different microscopically identical species of Entamoeba in human faecal samples by PCR based identification among patients attending a tertiary care hospital in Kolkata. Materials and Methods: A total of 1837 stool specimens in this study were collected from patients attending department of Calcutta School of Tropical Medicine for a period of 12 months. Stool samples were screened via microscopy for Entamoeba species identification followed by confirmation by conventional Polymerase chain reaction. Data were analyzed with Graph pad Prism 9. Results & Discussion: In the study, 91/1837 (4.95%) samples were microscopically positive for Entamoeba cyst or trophozoite and 81/1837 (4.41%) were Polymerase chain reaction positive for Entamoeba. E. moshkovskii infection (38.27%, 31/81) appeared to be the most predominant, followed by E. histolytica (19.75%, 16/81); E. dispar (9.88%, 08/81) and E. poleki (1.23%, 01/81) while 25/81(30.86%) belonged to other Entamoeba species. Conclusion: The results provide an important data for the clinician about the advantages of PCR over microscopy and also discriminate non-pathogenic Entamoeba species from the pathogenic E. histolytica to avoid unnecessary treatment with anti-amoebic drugs.
Entamoeba, Entamoeba histolytica, microscopy, Polymerase Chain reaction
An assessment of knowledge, attitudes, and practices on hand hygiene among medical students with in a healthcare facility
Background: Hospital-acquired infections (HAIs) are a significant concern globally. Horizontal transmission, where pathogens spread from one patient to another or from healthcare workers to patients, is a common route of transmission for hospital-acquired microbes. Factors such as inadequate hand hygiene, contaminated medical equipment, environmental contamination, and overcrowding can contribute to the spread of these pathogens within healthcare settings. Hand hygiene is one of the most critical meaure to prevent the spread of hospital-acquired infections. When performed effectively, it helps reduce the risk of healthcare-associated infections (HAIs) by removing harmful microbes from healthcare workers' hands, preventing the transmission of pathogens to patients and the surrounding environment. Aim: To evaluate the understanding of hand hygiene practices and critical moments in its implementation among medical students of phase I,II, and III. Materials and Methods: This study was done on a total number of 250 respondents who were enrolled in the MBBS curriculum in phases I,II and III in tertiary care hospital in India. A structured, self-administered questionnaire instrument was employed to evaluate hand hygiene, which consisted of three components: knowledge, attitude and self-reported practice regarding hand hygiene. The Z-test was applied to compare the percentage of correct responses between medical students, with a p-value of less than 0.05 regarded as statistically significant. Result: A total 250 participants were surveyed to assess their knowledge, attitude regarding hand hygiene practices. The results revealed that majority (80.8%) of students had moderate knowledge regarding hand hygiene, with significant difference between the two groups. The study also revealed that the majority of students held poor attitudes towards hand hygiene. Phase II/III students had significantly better attitudes compared to phase I medical students however there was a significant difference between the two groups regarding the confidence with respect to knowledge in hand hygiene. Of the participants, 56% demonstrated good hand-hygiene practice, 26.8% had moderate practices and 17.2% showed poor practice. Conclusion: Evaluating students' knowledge, attitudes, and practices related to hand hygiene is essential for understanding their awareness and behavior in preventing the spread of infectious diseases. The present study emphasizes the need for conducting regular training sessions on hand hygiene practices for healthcare workers. To develop a knowledgeable attitude and effective practices towards hand hygiene, education on the topic should be introduced early in the curriculum, with continuous training provided at regular intervals.
Hand hygiene, Health care associated infections (HCAI), Hand wash, Nosocomial infection, Hand disinfection.
Expression of telocytes in cardiovascular diseases
Background: Telocytes are recently discovered cells that reprogram the terminally differentiated cardiomyocytes to re-enter the cell cycle. Their activity is also altered in atherosclerotic blood vessels. Telocytes express CD117/c-kit. This study focuses on the significance of changes in the expression of telocytes in the heart and the coronary arteries in various diseases. Materials and Methods: This is a retrospective study. Histopathology of post-mortem examination (PME) of adult and foetal hearts between March 2021 and March 2023 were reviewed. Sections from normal and diseased heart and coronary arteries were selected for immunohistochemistry with CD117/c-kit to highlight telocytes. Telocytes were counted. Results: 62 heart (46 adult and 16 foetal) specimens were examined. All foetal and 11 normal adult hearts showed 5 and 3 telocytes per 10 fields respectively. Recent myocardial infarction (MI) seen in 10 cases showed 10 telocytes per 10 fields in the peri-infarction zone while 8 cases of old scars showed only 1 telocyte per 10 fields. Cardiac hypertrophy was seen in 22 cases. Telocytes were seen in 6 cases only, showing 1 telocytes per 10 fields. 92 coronary arteries were examined. 27 arteries were normal with 4 telocytes per 10 fields. 33 arteries showed marked atherosclerosis with 14 telocytes per 10 fields. Conclusion: An increase in telocytes signifies their stem cell-like activity. In recent MI cases increased telocytes suggest the likelihood of cardiac tissue regeneration after an MI. In cardiac hypertrophy, telocytes increase during a continued stimulus of increased workload, however, the timing of the biopsy plays a significant role. In older lesions with no ongoing stimulus for telocytes, there is no increase observed. In atherosclerosis, telocytes are altered causing vessel wall changes. Modulation of telocytes is a novel step that may change the management of cardiovascular diseases.
Telocytes, CD117/c-kit, Cardiovascular diseases, Atherosclerosis, Heart.
Role of ultrasonography in diagnosing early rheumatoid arthritis and it’s remission
Background: Rheumatoid Arthritis is an autoimmune disorder primarily affecting the synovial tissue. Over the past ten years, advancements in ultrasonography quality have made it possible to employ higher ultrasonic frequencies, leading to an improvement in the quality of ultrasound examinations of superficial structures. Ultrasound has improved to the point where it can now be used to evaluate patients for rheumatic conditions. Grey-scale Ultrasound, which may identify morphological abnormalities such as synovial thickening and bone erosion, and Doppler Ultrasound, which can show blood flow in the synovium and surrounding tissue, are the two forms of Ultrasound that are used. Objectives: 1. To evaluate the efficacy of Ultrasonography in diagnosing early Rheumatoid Arthritis 2. To evaluate the efficacy of Ultrasonography in diagnosing Rheumatoid Arthritis remission. 2. To evaluate the correlation of findings seen on Ultrasonography with clinical parameters in diagnosis of early Rheumatoid Arthritis and it’s remission. Materials and Methods: The study was conducted in Department of Radiodiagnosis, S.N. Medical College, Agra. The study included 72 clinically confirmed cases of Rheumatoid Arthritis. All the cases in the study were followed up for 1.5 years. Conclusion: The study emphasizes how useful Ultrasonography is for the early diagnosis and treatment of Rheumatoid Arthritis. Clinicians can measure disease progression and therapy response more accurately by combining clinical observations with Ultrasonography.
Rheumatoid Arthritis, Ultrasonography, Early diagnosis, Remission.
Prevalence of non-alcoholic fatty liver disease and left ventricular diastolic dysfunction in newly diagnosed type II diabetes mellitus: an observational, cross-sectional study
Introduction: Diabetes mellitus with its micro and macro vascular complication is one of the most researched topic in diabetology, but emergence of non-alcoholic fatty liver disease (NAFLD) and left ventricular diastolic dysfunction (LVDD) as its major complications has been given due consideration recently. Several workers have studied NAFLD and LVDD in diabetes separately. Aim and Objective: In our current study we estimated the prevalence of NAFLD and LVDD in patients of type II diabetes mellitus. Materials and Methods: The study was carried out in the department of internal medicine, IGMC Shimla during July 2017 to June 2018. All patients underwent laboratory investigations, abdominal ultrasound for fatty liver and 2D Echocardiography for LVDD. Results: A total of 208 newly diagnosed type II diabetic patients were enrolled. Among these 179 (86.05%) had NAFLD on ultrasound, 107 (51.4%) had LVDD on 2D ECHO and 107 (51.44%) had metabolic syndrome. Out of 107 patients with diastolic dysfunction, 100 (93.41%) had fatty liver, which was significant statistically (p-0.002). Conclusion: It was concluded that prevalence of NAFLD and LVDD was alarmingly high in patients of type II diabetes mellitus, who had normal blood pressure (Normotensive). As NAFLD and LVDD are linked to high cardiovascular risk in diabetic patients, these patients should be screened for the same at the time of diagnosis of diabetes so that steps for cardiovascular risk modification can be taken.
Diabetes mellitus, Non-alcoholic fatty liver disease, Left ventricular diastolic dysfunction.
A case control study to assess clinical and lipid profile in patients with xanthelasma palpebrarum in a tertiary care centre
Background: Xanthelasma palpebrarum is used to describe xanthoma that occurs on the eyelids or inner canthi of the eyes. It is frequently associated with cardiovascular disease, diabetes, obesityetc. Various authors have found a positive relationship between xanthelasma palpebrarum and lipid profile. Objective: Xanthelasma palpebrarum is a common condition observed in dermatology OPD for the cosmetic problem posed by it. Most of these patients would not have undergone a lipid profile and there is a need to know whether lipid profile is mandatory for all the patients presenting with xanthelasma palpebrarum. Hence this study was undertaken Materials and Methods: In this case-control study, 55 subjects diagnosed with xanthelasma palpebrarum and 55 healthy controls were chosen. All cases and controls underwent detailed clinical examination and fasting lipid profile study. Results: Total cholesterol levels were found increased in 36 cases (65.5%) in contrast to 20 controls (36%) with p=0.004(highly significant).Increase in LDL cholesterol levels were found in 31 cases (56.4%) as against 15 controls (27%) making it statistically significant (p= 0.001). Other cholesterol fractions were not found to have a significant relationship. Conclusion: At the end of this study it was observed that there is a significant elevation in total cholesterol and LDL cholesterol in xanthelasma patients as compared to controls, thereby making lipid profile study mandatory for all patients.
Xanthelasma palpebrarum, Lipid profile, Xanthoma.
Squash cytology- Useful tool to diagnose fungal infection in COVID patient
Objective: This study aims to diagnose fungal infections in post-COVID-19 patients using both squash cytology and histology to minimize morbidity and mortality. Materials and Methods: Conducted at a tertiary medical center over six months, this prospective observational study included hospitalized patients who tested positive for SARS-CoV-1 (COVID-19) and exhibited clinically diagnosed or suspected fungal infections. Representative samples were analyzed using cytological squash smears and histopathology sections, stained with H&E, PAP, MGG, and PAS. Results: Among the 45 patients—34 males and 11 females—35 were diagnosed with mucormycosis through both histology and cytology. Additionally, two patients each were identified with aspergillosis and candidiasis through histology. Conclusion: For prompt diagnosis and management, leading to improved outcomes, squash cytology and histopathology prove to be more efficient and less time-consuming than culture methods.
Squash cytology, Histology, Fungal infections post-COVID-19.
Development and validation of intraoperative severity score during laparoscopic cholecystectomy- An observational study
Background: Various studies have been carried out to evaluate the risk of pre-operative conversion in laparoscopic cholecystectomy. Different pre-operative scoring techniques have been recommended using different criteria which further add to the controversy. Materials and Methods: This prospective observational study of 100 patients was conducted for 18 months in the Department of General Surgery at AIIMS Bhubaneswar, Odisha, India to grade the severity of cholecystitis during laparoscopic cholecystectomy using the intraoperative scoring system devised by Michael Sugrue and to evaluate the spectrum of cholecystitis in cases of laparoscopic cholecystectomy at a tertiary centre. Patients excluded from study were cases directly taken for open cholecystectomy, Carcinoma gall bladder, emergency cholecystectomy, Age <18> 75 yrs., Pregnancy, ASA-III & IV and Biliary pancreatitis. All the patients were classified on the basis of severity of grading scale as mild, moderate and severe for degree of intraoperative difficulty. Results: In this study group of 100 patients, patients having preoperative imaging showing multiple gall bladder stones, thickened gall bladder wall, male patients, high BMI and patients with intraoperative score between 8-10 with degree of difficulty as extreme had more chances of open conversion. Conclusions: Use of this intra-operative scoring system helped us to provide a trigger for a prompt early conversion to avoid intra-operative complications associated with difficult laparoscopic cholecystectomy.
Laparoscopic cholecystectomy, Intraoperative grading system, Severity score
Lipid accumulation product index and TG/HDL-C as a predictor for insulin resistance in diabetes mellitus - A cross-sectional pilot study
Background: The prevalence of type 2 diabetes mellitus (T2DM) is mounting over the world and said to be directly proportional to obesity. It is known that Lipid Accumulation Product Index (LAPI) in T2DM is related with insulin resistance and inflammation. Materials and Methods: An analytical cross-sectional study in 30 patients was done. Result: The correlation analysis revealed a positive non-significant correlation between IR and Triglyceride; HOMA-IR and HDL: Negative correlation (-0.202), but not statistically significant (p = 0.142). HOMA-IR and LAPI: Positive correlation (0.335), statistically significant (p = 0.035). Also, the predictors TG and HDL do not have a statistically significant impact on HOMA -IR and LAPI. The data is suggestive of positive correlation between IR and LAPI suggests a potential link between IR and LAPI. Conclusion: We can conclude that clinical protocols for screening may incorporate LAPI in patients with diabetes for prediction of long term complications like cardiovascular episode.
Lipid accumulation product index, TG/HDL-C, Insulin resistance, Diabetes mellitus.
A study to explore the perception of cadaveric oath taking ceremony in medical students of West Bengal
Background: “Cadaver is our first teacher” is most probably the first line that every medical student hears when they enter the dissection hall for the very first time. Every medical practitioner is indebted to these great souls who donated their body posthumously and to their families. From the year 2016 cadaveric oath taking ceremony was started in our country. In this ceremony 1st year MBBS students take a pledge or oath before touching the cadaver in anatomy dissection hall. The oath marks a formal commitment that underscores the importance of respect and professionalism while working with cadaver. Aims and Objective: This study was conducted to assess the impact of that cadaveric oath taking ceremony among students. Materials and Methods: The study was conducted in the department of anatomy in Murshidabad Medical College, Murshidabad, West Bengal. After taking Institutional ethical clearance a Google questionnaire was formed and validated. 125 students were requested to go through that questionnaire before and after the cadaveric oath taking ceremony. Students’ responses were recorded and analyzed. Result: It has been noticed that, where before cadaveric oath taking 2.4% students were thinking that the ceremony might not be necessary, after oath taking 100% students responded it was necessary. In this study students’ responses were linked to the five-point Likert Scale, a type of psychometric response scale in which responders specify their level of agreement to a statement typically in five points: (1) Strongly disagree, (2) Disagree, (3) Neither agree nor disagree, (4) Agree and (5) Strongly agree. In every question the percentage of students who strongly agreed before ceremony was increased after taking oath. Hence it can be declared that this cadaveric oath taking must influence the students’ mind. Conclusion: The objectives of the study was checked with the result and a positive influence was observed correlating with the cadaveric oath taking ceremony.
Cadaver our first teacher, Cadaveric Oath, Cadaveric oath ceremony, Medical Education, AETCOM
Clinical characteristics and outcome of patients hospitalised with Scrub typus -A tertiary care hospital study in Northern India
Background: Scrub typhus is a re-emerging but under-reported infectious diseases that leads to significant morbidity and mortality, if failed to diagnose at appropriate time. The objective of the present study was to, know the Clinical Characteristics and Outcome of adult patients hospitalised with Scrub typhus in a tertiary care hospital in a hilly state of Uttarakhand. Materials and Methods: A total of 68 patients of Scrub Typhus from June 2020 to December 2020 were enrolled in the study. All hospitalised patients included in study were evaluated by detailed history, laboratory tests and outcome in response to treatment with Scrub typhus active antibiotics. Results: Majority of the cases (54 of 68{79.4 %}) were reported during monsoon and post monsoon season from July to October month. It affects patients of all age group but majority (47 of 68{70.0%}) of patients in our study were young between the age of 18‑40 years. Females were more in number (41of 68, {60.3%}) in comparison to males (27of 68, {39.7%}). Fever in (68 of 68{100%}) was universal complaint associated with severe headache in (18 of 68{26.5%}) patients. Other common symptoms reported were cough & breathlessness in (25 of 68{40.0%}), Nausea and vomiting in (15 of 68 {20%}), abdominal pain in (13 of 68{19.2%}), and altered sensorium in (05 of 68 {8.3%}). GI system involvement in the form of Acute hepatitis with rise in SGOT/SGPT was the most common complication seen in (52 of 68{76.5%}) followed by Respiratory involvement in form of interstitial Pneumonia, interstitial Pneumonia with Pleural effusion, and ARDS was seen in (26 of 68{38.3%}). Renal involvement in the form of AKI with rise in urea and creatinine was seen in (17 of 68{25.0%}) patients. Only 6 (8.8%) of 68 patients received appropriate antibiotics for scrub typhus before admission. Treatment failure, defined by failure to defervescence within 72 hours of scrub typus active antibiotics treatment initiation was noted in 09 (13.2%) patients, out of which 06 (8.8%) patients died in the hospital. No evidence of relapse or reinfection was noted in any patient. Conclusion: The diagnosis of scrub typhus is challenging due to nonspecific sign and symptoms. A misdiagnosis leading to delayed targeted medical intervention with Scrub typhus active antibiotics (Chloramphenicol, Doxycycline, Azithromycin and Clarithromycin) is the likely contributory factors for high mortality (6 of 68, {8.8%}) in our study.
Adult respiratory distress syndrome, Orientia tsutsugamushi, Chigger mites, Scrub typhus active antibiotics (Chloramphenicol, Doxycycline, Azithromycin and Clarithromycin), IV- Intravenous.
Evaluation of mesenteric lymph nodes by ultrasonography and it’s clinical correlation in pediatric patients
Background: Pain abdomen is common symptom in children, increasing use of abdominal ultrasound in the screening and follow-up of patients with pain abdomen, enlargement of the regional mesenteric lymph nodes have become a fairly common finding, particularly in children and young adults. Aims: Evaluation of mesenteric lymph nodes by ultrasonography and its clinical correlation in pediatric patients. Objectives: 1. To evaluate the ultra-sonographic spectrum of mesenteric lymph nodes and assess the various sonographic patterns involved. 2. To study the clinical correlation of mesenteric lymphadenitis with the symptoms of pediatric patients. Materials and Methods: The study was conducted in Radio-diagnosis Department, S.N. Medical College, Agra. The symptomatic patients presenting to the department of Radio-diagnosis with clinical history of fever, abdominal pain, nausea & vomiting referred from department of Pediatrics, SNMC, Agra were included in the study. All lymph nodes undergone grayscale ultrasound (US) & color flow imaging. Conclusion: Enlarged mesenteric lymph node is a common medical cause of abdominal pain in pediatric patients. It is a common self-limiting inflammatory process frequently caused by viral pathogen, affecting mesenteric lymph nodes in the abdomen. There is no any mortality and complication are noted with mesenteric adenitis.
Mesenteric lymphadenopathy, Ultrasonography, Abdominal Pain, SWUF-symptomatic with USG finding, SW/OUF-symptomatic without USG findings.
A study of cognitive function, quality of sleep, and Stroop effect among adolescent girls with premenstrual syndrome
Background: Premenstrual syndrome (PMS) involves various somatic and psychological symptoms related to the luteal phase of the menstrual cycle, ranging from mild discomfort to disability and impacting daily life. Objective: To compare cognitive function, sleep quality, and the Stroop effect between adolescent girls with PMS and healthy controls. Materials and Methods: This cross-sectional study included 60 adolescent girls (30 with PMS and 30 controls) at the Department of Physiology, Government Thiruvarur Medical College. The participants were selected using the Premenstrual Symptoms Screening Tool (PSST). Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA), sleep quality using the Pittsburgh Sleep Quality Index (PSQI), and attention processing using the Stroop effect. Measurements were taken three days before menstruation. Results: The mean age was similar in both groups (PMS: 18.97 ± 0.81; controls: 18.93 ± 0.78). MoCA scores were significantly lower in the PMS group (23.9 ± 2.97) than the controls (25.93 ± 1.76, P < 0.05). PSQI scores were higher in the PMS group (6.67 ± 1.65 vs. 5.3 ± 1.3, P < 0.05), indicating poorer sleep quality. The Stroop effect duration was significantly shorter in the PMS group (48.67 ± 15.18) than in controls (66.7 ± 19.13, P < 0.05). Conclusion: PMS significantly impairs cognitive function, sleep quality, and Stroop task performance in adolescent girls. Early recognition and intervention are crucial to mitigate these impacts on academic and daily activities.
Premenstrual syndrome (PMS), Cognitive function, Sleep quality, Stroop effect, Adolescent girls, Montreal cognitive assessment (MoCA), Pittsburgh sleep quality index (PSQI).
Aerobic microbiological profile and antibiogram in sterile body fluids from a tertiary care centre in Kashmir Valley
Background: Infections involving sterile bodily fluids, particularly those linked to healthcare settings are substantial and major sources of mortality and morbidity. The identification of species-level bacteria and their antimicrobial resistance profile are crucial factors to consider when choosing the right antimicrobials for both empirical and targeted therapy. Aim and Objective: The aim of study was to identify the bacterial isolates in the sterile body fluids and study their antimicrobial resistance pattern. Materials and Methods: A retrospective observational study was carried in the Department of Microbiology of SKIMS Medical College, Bemina, Srinagar, a tertiary care hospital for a period of 1 year. All sterile body fluid samples received in the Microbiology department were cultured aerobically and then identified up to species level using conventional biochemicals in accordance with established microbiological methods. The antimicrobial susceptibility of bacterial pathogens produced in culture was examined using the Kirby-Bauer disk diffusion method, and results were interpreted in accordance with CLSI recommendations. Results: A total of 650 clinical samples were processed for a period of 1 year; of them 72 showed Positive bacterial growth. 52 (72.2%) were Gram Negative Bacteria and 20 (27.7%) were Gram Positive Bacteria. CSF samples (280) constituted 43.07%, pleural fluid samples (188) 28.92%, peritoneal fluid (114) 17.5%, synovial fluid (56) 8.6% and bile (12)1.84.Escherichia coli was the most prevalent of the 52 Gram-Negative isolates (24.50%), and Staphylococcus aureus and CONS (12.5%) were most prevalent in Gram Positives. Most Gram Negatives showed Multi Drug resistance but were fully sensitive to colistin and polymyxin B, In Gram positives, Vancomycin and Linezolid showed 100 sensitivity. Conclusion: This study identified emerging ESKAPE organisms. The presence of multidrug resistance patterns in bacterial isolates highlights the need for further research in various parts of the country to prevent needless antibiotic use and resistance development.
Antimicrobial resistance, Microorganisms, Sterile body fluids, ESKAPE, Antibiotics sensitivity.
Outcome of retrograde facial nerve dissection in superficial parotidectomy
Background: Using retrograde dissection for doing parotidectomy is technically easier avoiding injury to the facial nerve trunk or other branches. The goal is to remove just the part of the parotid gland where the tumor is. This method can lead shorter surgery times and less blood loss. Plus, it doesn’t add extra risk for facial nerve damage. Aims and Objectives: Is to observe the results of Retrograde Facial Nerve Dissection during Superficial Parotidectomy at our institution. Materials and Methods: The study is a clinical observational study comprises of 30 patients attending the outpatient department of General surgery, VIMSAR Burla, Sambalpur between November 2019 to October 2021. The data collected from all the 30 patients after taking the due consent and were evaluated to determine the various intra and post op complication, average duration of surgery, average blood loss and the importance of soft tissue markers for identification of facial nerve. Results: In our study Male to Female ratio is 10:20 i.e., 1:2 with Prevalence of disease is more between the age group 45-55. Maximum 16 cases presented within 1.5 yr. duration of swelling presentation. Mean duration of surgery is 88 minutes with Standard deviation 5.5 and Mean blood loss 68.34ml with Standard deviation 8.34. No significant intra operative complication noted. Out of 30 patients 23 patients did not develop any complications. Four patients showed temporary weakness in their facial nerves, and three had wound infections. Conclusion: Our study suggests that Retrograde Facial Nerve Dissection for Superficial Parotidectomy is easy to do with fewer complications. This technique take short surgical time and minimal blood loss with keeping the risk of facial nerve injury low. It’s especially useful when finding the nerve directly is difficult.
Retrograde, Parotid gland, Superficial Parotidectomy, Facial nerve injury.
Predominant ailments among patients attending ENT OPD in Tertiary care centre
Background: Otorhinolaryngological diseases are common in the general population and can have a significant impact on an individual's quality of life. The study aimed to determine the prevalence of otorhinolaryngological diseases in patients attending the ENT OPD in a tertiary care center. Materials and Methods: This was a cross-sectional study conducted over a period of 6 months. A total of 1000 patients attending the ENT OPD were included in the study. The data were collected using a pre-designed proforma, and the diagnosis was made based on clinical examination and relevant investigations. Results: The most common otorhinolaryngological diseases were found to be allergic rhinitis (29.4%), tonsillitis (22.3%), and otitis media (13.6%). The prevalence of otorhinolaryngological diseases was found to be higher in males (55.2%) than in females (44.8%). The study also found that the prevalence of otorhinolaryngological diseases increased with age. Conclusion: The study highlights the high prevalence of otorhinolaryngological diseases in patients attending the ENT OPD in a tertiary care center. The findings of this study can help in the planning and implementation of appropriate interventions for the prevention and management of otorhinolaryngological diseases.
Prevalence, Otorhinolaryngological diseases, ENT OPD (Ear, Nose, and Throat Outpatient Department)
Histopathological study of lung malignancies on small biopsies - A tertiary care experience in Central India
Introduction: Lung cancer accounts for 5.9% of all cancer cases and 8.1% of cancer-related deaths in India. In patients with advanced lung malignancies, CT‐guided needle biopsy (CTNB) was conducted as they are less invasive and are preferrable to resection to make a pathological diagnosis. Materials and Methods: Lung malignancies were diagnosed on small biopsies in the Department of Pathology during the period of January 2021 to December 2022, at a tertiary care hospital in state of Maharashtra in India. A retrospective, observational study was conducted on 82 patients with radiologically proven lung malignancies. Amongst 82 cases, 06 cases were inadequate for interpretation and hence excluded from the study. Biopsies were conducted for all cases. Tissue cores of approximate length 1- 1.5 cm were received in 10% formalin in histopathology section which were processed routinely and stained with haematoxylin and eosin stains. Biopsy specimen was considered adequate when it contained more than 20 alveoli. Results: The histopathological analysis of these specimens showed Adenocarcinoma (36.84%) as the most common lung tumour closely followed by squamous cell carcinoma (34.21%) Subtypes of adenocarcinoma noted included solid pattern (n= 18, 64.29%), acinar pattern (n= 04, 14.29%), mucinous pattern (n= 03, 10.71%) and micropapillary pattern (n= 03, 10.71%). Small cell carcinoma accounted for 15.79% of all cases followed by non-small cell carcinoma (n= 04, 5.26%) adenosquamous carcinoma (n= 03, 3.95%), and metastasis (n= 03, 3.95%). Conclusion: Due to the advanced nature of presentation and unresectable nature of malignancies in majority of lung cancers, diagnosis of lung tumours heavily relies on small biopsies.
Lung malignancy, Adenocarcinoma, Small cell carcinoma
Demographic and immunological status of Seronegative HLAB27 patients in Central India -A prospective study
Introduction: HLA B27 is a class I major histocompatibility antigen, which can cause susceptibility to several diseases, including ankylosing spondylitis, reactive arthritis (Reiter's syndrome), inflammatory bowel disease, and psoriasis. Aim and Objective: The present study aims to analyse the demographic and immunological status of seronegative HLAB27 patients in Central India. Material and Methods: A cross-sectional study was conducted to measure the prevalence of HLAB27 positive cases in Central India among seronegative spondyloarthritis (SSA) patients. HLAB27 was analysed by Real time PCR. Demographic and inflammatory marker status were compared with HLAB27-status. Result: A total of 688 cases of SSA were included in this study from June 2023 to February 2024. Among these, 103 were positive (15%) for HLA B27 on the basis of Real time PCR analysis. Males had a higher prevalence than females in the HLA-B27 positive group (62.1% vs. 37.9%). Among referred 66 juvenile SSA cases, 27 were positive for HLAB27 by PCR (41%) with the highest positivity rate observed among juvenile male patients (55.5%). Both ESR and CRP were found to be higher among juvenile cases. Conclusions: HLA-B27 by PCR can be an indicator for seronegative SpA cases and is recommended to both suspected adults and children to minimise the multiple medical visits and diagnoses.
HLA B27, Seronegative spondylo arthritis, Real time PCR, Central India
Evaluating the impact of a research methodology workshop on medical postgraduates and faculty: A pretest-post-test analysis
Introduction: Research methodology is pivotal in medical practice, providing a structured framework for investigating health phenomena and advancing medical knowledge. However, many medical practitioners lack participation in research activities, and postgraduate training often lacks comprehensive research methodology education. This study addresses this gap by evaluating the efficacy of a research methodology workshop for medical postgraduates (PGs) and faculty members. Materials and Methods: An educational intervention study with a pretest-post-test design was conducted. Participants, including medical PGs and faculty from a tertiary care hospital, were recruited using convenience sampling. The workshop spanned two days, covering study design, data collection, statistical analysis, and research ethics through lectures, discussions, and hands-on activities. Pretest and post-test assessments, consisting of 20 multiple-choice questions, evaluated participants' knowledge before and after the workshop. Data were analyzed using paired-sample t-tests with significance set at p < 0.05. Results: The study included 29 participants, with 28 analyzed. A significant improvement in post-test scores (p<0.05) highlighted the workshop's effectiveness. Comparisons with similar studies, such as Prabhu et al.'s research in Tirupati, reinforced these findings, showing substantial enhancement in research skills among healthcare professionals. Conclusion: This study underscores the importance of structured educational interventions in enhancing research competencies among medical professionals. Continued investment in research methodology training and exploration of innovative educational approaches are essential for fostering research excellence and improving patient outcomes.
Research methodology, Postgraduate education, Faculty development, Evidence-based practice, Medical Education.