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  Citation statistics : Table of Contents
   2016| September-December  | Volume 43 | Issue 3  
    Online since September 14, 2016

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Skills and practices for the postgraduate trainees of community medicine, public health, and hospital administration courses in India: Learn to demonstrate and imbibe
Sandeep Sachdeva, Tilak R Sachdev
September-December 2016, 43(3):109-111
  3 3,446 3,845
Diagnostic efficacy of fine-needle aspiration cytology in the evaluation of cervical lymphadenopathy
P Arul, Suresh Masilamani, C Akshatha
September-December 2016, 43(3):117-121
Background: Fine-needle aspiration cytology (FNAC) is a first-line investigation modality for the evaluation of cervical lymphadenopathy. Aim: This study was undertaken to assess the utility and diagnostic efficacy of FNAC in the evaluation of cervical lymphadenopathy. Materials and Methods: A total number of 497 lymph node FNACs were retrieved and evaluated retrospectively between March 2012 and August 2015. Of these, 188 cases had subsequent histopathological follow-up. Their FNAC diagnoses were compared and correlated. Results: Among 188 FNAC cases, 157 (83.5%) were benign, 14 (7.4%) were suspicion of malignancy, and 17 (9.1%) were malignant. On correlation of subsequent histopathology, 151 cases were confirmed as benign (true negative) and 28 cases were confirmed as malignant (true positive). There were three false positive and six false negative results. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive values of FNAC were 82.4%, 98.1%, 95.2%, 90.3%, and 96.2%, respectively. Conclusion: Our study concluded that FNAC in the diagnosis of cervical lymphadenopathy was sensitive, specific, and accurate. FNAC is a useful and reliable diagnostic tool that also appears to be a safe and minimally invasive procedure that provides preoperative information for the appropriate management.
  2 5,006 517
Vitamin D-dependent rickets type 2: Alopecia responding to 1,25 hydroxy Vitamin D
Prithi R Inamdar, Roopa M Bellad, Veena H Herekar
September-December 2016, 43(3):155-157
Vitamin D-dependent type two rickets (VDDRII) is a rare autosomal recessive disorder caused by mutation in the vitamin D receptor gene, leading to end-organ resistance to 1,25(OH) 2 vitamin D3. It presents with refractory rickets and growth retardation presenting in the first year of life. It is frequently associated with alopecia totalis. Due to target organ resistance, its response to vitamin D is poor. The recommended treatment is giving supraphysiological dose of 1,25(OH) 2 vitamin D3 and a high dose of oral or intravenous calcium. The response of alopecia to treatment is generally poor. We present a 3-year-old male child with VDDRII whose alopecia and rickets partially responded to 1,25(OH) 2 vitamin D3.
  1 15,029 508
Shedding light on some common dietetic misconceptions
Virag Ganesh Gokhale
September-December 2016, 43(3):144-146
Certain misconceptions in dietetics are so deeply ingrained in the minds of people that it is difficult to convince them as to what the truth is. Busy family physicians often skip queries on such topics or give some casual replies that may further support the misunderstanding. Some of these misconceptions can even be harmful. A few such misconceptions like - that ghee is harmful or that beetroot is good for treating iron deficiency, that Sunflower oil is heart friendly, that a patient of hepatitis should avoid fatty food, or that vegetarian proteins are poor quality proteins are some such beliefs. That the truth is contrary to such beliefs is pointed out with scientific evidence.
  1 2,811 238
Proximal humerus fracture associated with delayed axillary nerve injury
Patpiya Sirasaporn
September-December 2016, 43(3):147-150
Axillary nerve injury is the most common complication in humerus fracture. The symptoms that are caused by affecting axillary nerve vary according to the structures involved such as sensory disturbance and weakness of muscles, e.g., three parts of deltoid and teres muscles in an affected limb. The severity of injury is classified in demyelinating and axonal lesions, which usually occurs at the onset of fracture. The author reports a case of humerus fracture with delayed axonal lesion of axillary nerve result from inadvertent traction.
  - 16,789 427
Successful management of difficult airway: A case series
Balraj Hariharasudhan, Rajesh S Mane, Vandana A Gogate, Mallikarjun G Dhorigol
September-December 2016, 43(3):151-154
Management of difficult airway is widely recognized as one of the important tasks of an anesthesiologist. The problems related to it are known to be primary causes of life-threatening consequences. Herewith, we present a case series of difficult airway scenarios managed successfully with different techniques and airway gadgets. The following cases were managed successfully with appropriate airway techniques: 1) Ludwig's angina for drainage with awake fiberoptic intubation, 2) temporomandibular joint (TMJ) ankylosis for bilateral gap arthroplasty with fiberoptic intubation, 3) burn contractures for the release managed with intubating laryngeal mask airway (ILMA). Airway management is one of the vital aspects of clinical care provided by an anesthesiologist. The airway-related complications have significantly decreased due to better knowledge, skills of the anesthesiologist, and an array of airway gadgets. The three case scenarios of difficult airway were successfully managed with the appropriate airway gadgets suitable for each case without any untoward complication. Most airway problems can be solved with available gadgets and techniques, but clinical judgement borne of experience and expertise is crucial in implementing the skills in any difficult airway scenario.
  - 6,933 537
Intrarenal foreign body mimicking an ureteropelvic junction stone
Vikas Sharma, Prasad V Magdum, Rajendra B Nerli, Shishir Devaraju, Shridhar C Ghagane
September-December 2016, 43(3):158-160
Prevention of retained/forgotten foreign bodies, including surgical sponges and gauzes is clearly better than the treatment of the complications, and strict safeguards can ensure prevention of such complications. We report on a very rare case of leftover piece of gauze within the renal pelvis of a child that mimicked a urinary stone.
  - 2,557 218
Not "right" is not wrong
Virag G Gokhale
September-December 2016, 43(3):161-162
  - 2,446 224
A study to evaluate host factors for musculoskeletal injuries secondary to trauma among elderly people of Northwestern India
Sunil Kumar Raina, Lokesh Thakur, Bhanu Awasthi, Shivam Pathak
September-December 2016, 43(3):112-116
Introduction: As the population ages, the problems related to falls and fractures are expected to grow. This poses a great challenge to the health-care systems. Meeting these challenges requires a clear understanding of the prevalence and nature of falls. It also means identifying factors responsible for injury causation. The current study was conducted with the aim to evaluate host factors responsible for musculoskeletal injuries (MSIs) in the elderly. Materials and Methods: A hospital-based, questionnaire-based, descriptive study was conducted on all elderly (60 years) patients attending a tertiary care teaching hospital with MSIs secondary to trauma between 2013 and 2014. Results: A total of 200 elderly with MSIs secondary to trauma attending the tertiary care center between 2013 and 2014 were evaluated for the purpose of this study. Exactly half of them (50%) were more than 70 years of age. Intoxication and presence of visual and hearing impairment were observed as significantly associated with occurrence of MSIs. Discussion: Trauma is a common cause of MSI among the elderly. Therefore, identification and evaluation of host factors are important as this can help in planning prevention of injuries in elderly. Conclusion: MSIs due to trauma are a focus of public health practice as they pose a serious health threat, occur frequently, and are in most situations preventable.
  - 2,856 2,035
Comparison of surgical versus medical therapy in the patients with malignant cerebral infarctions-A retrospective study from Southern India
Karkal Ravishankar Naik, Aralikatte Onkarappa Saroja, Daanish Aijaz Chhapra
September-December 2016, 43(3):122-126
Introduction: Large hemispheric infarctions secondary to occlusion of middle cerebral artery (MCA) are termed "malignant MCA territory infarctions" due to high mortality and morbidity resulting from large infarction volume and herniation. Decompressive craniectomy has been found to improve the outcome in these patients. Objectives: To evaluate the outcome with surgical management in comparison with conservative management in the treatment of malignant MCA territory infarction. Materials and Methods: The patients with malignant MCA territory infarction admitted from August 2009 to January 2014 were included in the study. Clinical, laboratory, and radiological data were collected from hospital records. The outcome was measured at discharge and at last follow-up. Results: Out of 692 patients with MCA territory infarctions 66 had malignant MCA infarctions (9.53%). Among them 31 underwent surgical decompression (age 45.77 ± 15.33 years) and 35 were medically treated (age 56.11 ± 14.99 years). There was no significant difference in the sex ratio, comorbidities, blood sugars, incidence of hemorrhagic transformation, and herniation between the two groups. Admission Glasgow coma scale (GCS) was higher in surgically treated patients. In-hospital mortality among the patients in the surgical group was 19.35% and in the medical group was 17.34%. Thirteen patients were lost for follow-up. In the remaining 53 patients, there was statistically nonsignificant increase in the death and severe disability in medically treated patients (75% and 78.5%, respectively) in comparison with Surgically treated patients (52% and 68%, respectively). Conclusion: Decompressive craniectomy can improve long-term survival and functional outcome in the patients with malignant MCA territory infarctions.
  - 2,962 268
Effects of truncal motor imagery practice on trunk performance, functional balance, and daily activities in acute stroke
Priyanka Shah, S Karthikbabu, Nafeez Syed, Ellajosyula Ratnavalli
September-December 2016, 43(3):127-134
Background: Motor imagery is beneficial to treat upper and lower limbs motor impairments in stroke patients, but the effects of imagery in the trunk recovery have not been reported. Hence, the aim is to test the effects of truncal motor imagery practice on trunk performance, functional balance, and daily activities in acute stroke patients. Methods: This pilot randomized clinical trial was conducted in acute stroke unit. Acute stroke patients with hemodynamic stability, aged between 30 and 70 years, first time stroke, and scoring <20 on trunk impairment scale (TIS) were included in the study. Patients in the experimental group practiced trunk motor imagery in addition to physical training. Control group was given conventional physical therapy. The treatment intensity was 90 min/day, 6 days a week for 3 weeks duration. Trunk control test, TIS, brunel balance assessment (BBA), and Barthel index (BI) were considered as the outcome measures. Results: Among 23 patients included in the study, 12 and 11 patients, respectively, in the control and experimental groups completed the intervention. Repeated measures ANOVA, i.e., time* group factor analysis and effect size showed statistically significant improvements (P = 0.001) in the scores of TIS (1.64), BBA (1.83), and BI (0.67). Conclusion: Motor imagery of trunk in addition to the physical practice showed benefits in improving trunk performance, functional balance, and daily living in acute stroke.
  - 4,354 538
The safety and efficacy of minimal dose of mitomycin C in trabeculectomy
Rekha Bellulli Kotrappa, Arvind Y Yakkundi, Bhagyajyothi Balappa Khangavi, Anju Meena, Dhara Shah
September-December 2016, 43(3):135-139
Aim: To evaluate the safety and efficacy of minimal concentration and exposure time of mitomycin C (MMC) (0.1 mg/mL for 2 min) as an adjunct to trabeculectomy and to evaluate the complications of minimal dose of MMC in trabeculectomy. Background: Glaucoma ranks second as the most common cause of blindness worldwide. The introduction of MMC as an adjunct to trabeculectomy was a major advancement in the ability to improve the intraocular pressure (IOP)-lowering efficacy of the procedure. Materials and Methods: In this study, 40 patients, who had primary open-angle glaucoma, were included. Both with MMC in a dose of 0.1 mg/mL for 2 min, 20 underwent trabeculectomy alone, and 20 underwent combined surgery. Postoperative IOP at each follow-up, bleb appearance, the need for postoperative medical glaucoma treatment, and improvement of vision were recorded. We evaluated the IOP, bleb appearance, and complications on day 1, 1 week, 1 month, and 3 months postoperatively. Results: A total number of 40 patients were studied. There were 25 males and 15 females with mean age 65 ± 10 years. The IOP at 3 months follow-up was 12.0 ± 1.5 mmHg, 1 day was 17 + 1.5 mmHg, 1 week was 14.6 ± 5 mmHg, and 1 month was 12.2 ± 5 mmHg. No bleb related complications or any other complications were noted in any of the patients. In all the patients, bleb appearance was grade II-III according to Moorfields classification. Visual acuity in all the 20 patients was between 6/24 and 6/9, who underwent combined procedure. Conclusion: Trabeculectomy with intraoperative MMC in a dose of 0.1 mg/mL and exposure time of 2 min tested to be a safe and effective modality in the management of glaucoma.
  - 4,063 296
Aflibercept as a second-line therapy in metastatic colorectal cancer: A limited Indian experience
Govind Babu, Umesh Das, Kuntejowdahalli Lakshmaiah, Lokanatha Dasappa, Linu Abraham Jacob, Suresh Babu
September-December 2016, 43(3):140-143
Introduction: Aflibercept in combination with FOLFIRI has been shown to improve overall survival in the pivotal VELOUR study. Aflibercept has not yet been marketed in India. Sanofi has made available this drug for Indian patients under a program called Named Patient Access Program (NPP). We present a limited clinical experience with the use of aflibercept at our center. Materials and Methods: We analyzed the data of the patients who received aflibercept under NPP. Aflibercept was given in combination with FOLFIRI as second-line for patients who progressed on oxaliplatin based therapy. Aflibercept was given at 4 mg/kg intravenous (IV) every 15 days. Chemotoxicities were assessed as per CTCAE. Response evaluation was done every four cycles. Results: Five patients were enrolled. The median age was 34 years. The median number of aflibercept cycles administered was 12. Common grade 2/3 toxicities were mucositis, diarrhea, neutropenia thrombocytopenia, and hypertension seen in three (60%), three (60%), two (40%), two (40%), and one patient respectively. After four cycles, the response was assessed as: One complete remission (CR), three partial remissions (PR), and one progressive disease (PD). Three patients completed 12 cycles of chemotherapy and aflibercept. At the end of 12 cycles, one patient still in CR and two patients were in PR. Four patients were alive till date. Conclusion: As we had very less number of patients, it was very difficult to compare it with VELOUR data. It is one of option as second-line in metastatic colorectal cancer (mCRC) who progressed on oxaliplatin chemotherapy. Mucositis, diarrhea, and hematological toxicity were the most common toxicity in our patient.
  - 2,733 177