Journal Of The Indian Medical Association[JOURNAL]
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200 papers
Neoadjuvant chemotherapy in breast cancer: review of literature.
Doval DC, Dutta K, Batra U … +1 more , Talwar V
J Indian Med Assoc · 2013 Sep · PMID 24968534
Breast cancer incidence in India is rising and presently, incidence is more than cervical cancer in many urban cancer registries. Majority of breast cancer cases in India at presentation are locally advanced, that is lar...
Breast cancer incidence in India is rising and presently, incidence is more than cervical cancer in many urban cancer registries. Majority of breast cancer cases in India at presentation are locally advanced, that is large breast tumours (> 5 cm in diameter) with skin or chest wall involvement or with involvement of locoregional lymph nodes. These locally advanced breast cancers are treated with neoadjuvant chemotherapy or chemo-immunotherapy with trastuzumab containing regimen in Her2 Neu positive cases. Neoadjuvant hormonal therapy is considered for those who are elderly or medically unfit/unwilling for chemotherapy and strongly positive for oestrogen/progestrogen receptors. Neoadjuvant chemotherapy does not improve overall or disease-free survival but response to neoadjuvant therapy is the best surrogate prognostic marker.
Study of optimal basal insulin glargine dose requirement in Indian population as an add on therapy to oral hypoglycaemic agents to achieve target fasting blood glucose levels.
Agarwal SK, Singh BK, Wadhwa R
J Indian Med Assoc · 2013 Sep · PMID 24968533
Optimal dosing of basal insulin is needed to achieve target fasting blood glucose and to avoid hypoglycaemia on the other hand in patients of type 2 diabetes on bedtime basal insulin and daytime sulfonylureas. This is an...
Optimal dosing of basal insulin is needed to achieve target fasting blood glucose and to avoid hypoglycaemia on the other hand in patients of type 2 diabetes on bedtime basal insulin and daytime sulfonylureas. This is an open label, randomised prospective study done in 40 type 2 diabetics having uncontrolled diabetes. Statistical analysis was performed by the SPSS programme for windows, version 17.0. Continuous variables are presented as mean +/- SD, and categorical variables are presented as absolute numbers and percentage. Data were checked for normality before statistical analysis. Normally distributed continuous variables were compared from baseline to 12th week using paired t-test. The average dose requirement of insulin glargine was 33.55 +/- 11.94 units (mean +/- SD). The average insulin glargine dose requirement per kg body weight was 0.48 +/- 0.17 units/kg body weight. The range of insulin dose was 0.23 to 0.96 units/kg body weight. Dose titration is patient specific and should be done in order to achieve target fasting blood glucose.
Cannon ball lesions on chest x-ray: a rare presentation of pulmonary hypertension.
Sharma R, Chauhan V, Sharma KN … +1 more , Sharma GD
J Indian Med Assoc · 2013 Sep · PMID 24968532
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Subhyaloid haemorrhage in dengue fever.
Gupta S, Das D
J Indian Med Assoc · 2013 Sep · PMID 24968531
In India, the dengue disease has attained an unprecedented proportion with a sharp increase in the size of human population at risk recently. Presentation of the disease varies from asymptomatic illness to haemorrhagic m...
In India, the dengue disease has attained an unprecedented proportion with a sharp increase in the size of human population at risk recently. Presentation of the disease varies from asymptomatic illness to haemorrhagic manifestations and shock. Previously ocular findings were considered rare in dengue fever; but due to increased number of cases various types of ocular complications are described in present day case series. Here, is presented a case of a girl with serologically proven dengue fever who developed a subhyaloid premacular haemorrhage in one eye with superficial retinal haemorrhages and cotton wool spots in both eyes.
Ascariasis: challenges in the diagnosis of single worm disease.
Lakshmi SP, Palaniappan N, Arunagiri A
J Indian Med Assoc · 2013 Sep · PMID 24968530
One of the most common parasitic infections in humans is ascariasis. While most infectionsare asymptomatic, mild to moderate symptoms may occur due to migration of adult worms. The frequency of single worm infection seem...
One of the most common parasitic infections in humans is ascariasis. While most infectionsare asymptomatic, mild to moderate symptoms may occur due to migration of adult worms. The frequency of single worm infection seems to be increasing. Ascaris eggs are not found in the faeces of most cases infected with a single worm because it is an immature male or female. Diagnosis of such single worm infection is challenging.
Laparoscopic removal of persistent muellerian duct structures and orchiopexy.
Mitra D, Mitra I
J Indian Med Assoc · 2013 Sep · PMID 24968529
The treatment of persistent muellerian duct syndrome with undescended testis usually followed is orchiopexy without excising or partially excising the muellerian duct structures. Since the vas and vessels are intimately...
The treatment of persistent muellerian duct syndrome with undescended testis usually followed is orchiopexy without excising or partially excising the muellerian duct structures. Since the vas and vessels are intimately adhered to the fallopian tubes and body of the uterus, excision of muellerian duct structures is associated with devascularisation or injury to the vas. Following several reported incidences of malignancies in this residual muellerlan duct structures, we decided to excise them along with orchiopexy in this patient. In the literature there are evidences stating that malignancy could develop at any age ranging from a young boy to an old man. A careful and meticulous dissection avoiding electrocautery allowed excision of the muellerian duct structures without injury to the vas and vessels of the testes. The testes were brought down to the respective scrotal sac.
Giant phyllode tumour (cystosarcoma) of breast: a rare size recurrent breast lump.
Gurjar V, Bharaney R
J Indian Med Assoc · 2013 Sep · PMID 24968528
Phyllode tumour is a rare fibro-epithelial lesion that accounts for less than 1% of all neoplasms. It occurs in females in the 3rd and 4th decades. In 15% of patients local recurrence occurs and in 20% of patients distal...
Phyllode tumour is a rare fibro-epithelial lesion that accounts for less than 1% of all neoplasms. It occurs in females in the 3rd and 4th decades. In 15% of patients local recurrence occurs and in 20% of patients distal metastasis is seen. Here we are presenting a case of a very rare size recurrent phyllode tumour with malignant changes which was associated with contralateral breast fibro-adenoma. Patient was investigated and operated successfully for right sided mastectomy for recurrent giant phyllode tumour and wide excision for opposite side fibro-adenoma.
Integration of care with cure in cancer.
Kulkarni P, Ghooi R, Vijayakumar K
J Indian Med Assoc · 2013 Sep · PMID 24968527
Quality of life is as important as quantity of life, if not more. In some life-threatening diseases, the possibility of cure is sometimes poor, and symptoms of the disease reduce the quality of life too. Improvement of s...
Quality of life is as important as quantity of life, if not more. In some life-threatening diseases, the possibility of cure is sometimes poor, and symptoms of the disease reduce the quality of life too. Improvement of symptoms helps the patients to live more comfortably while allowing them to retain their autonomy and dignity despite the life-threatening disease. The total care of such patients, helping them to live as well as possible in spite of their symptoms forms the basis of palliative care. Palliative care is an upcoming discipline, which aims to provide comfort to patients suffering from severe disease-related discomfort. It is not end-of-life support, as previously thought but is recommended to be integrated with therapy right from diagnosis. Studies conducted overseas show that when introduced early, palliative care leads to better outcomes of curative therapies, while making the patient comfortable and pain-free. There are different models and methods of delivery of palliative care and the involvement of family in the care of the patient produces the best outcome. Palliative care can be delivered both at a dedicated centre as well as at the patient's home, depending on the preferences of the patient. This paper discusses the efforts towards providing care for patients in different stages of cancer therapy.
The effects of pegylated interferon--alpha2B on mumps orchitis.
Pal G
J Indian Med Assoc · 2013 Sep · PMID 24968526
To evaluate the effects of pegylated Interferon--alpha2B on mumps orchitis, 80 patients suffering from mumps orchitis, were randomly assigned into 2 groups of 40 patients each. In the first group patients received pegyla...
To evaluate the effects of pegylated Interferon--alpha2B on mumps orchitis, 80 patients suffering from mumps orchitis, were randomly assigned into 2 groups of 40 patients each. In the first group patients received pegylated interferon--alpha2B and the other group did not, acting as controls. All were confirmed by mumps IgM (ELISA) and evaluated by testis size, semen analysis and hormone level. In the first group, the symptoms resolved within average 2.2 days and testicular size returned to normal within average 5.3 days but in 2nd group, those returned to normal within average 5.7 days and 10.2 days respectively. In the 1st group, oligospermia was detected in 11 patients and subsequently returned to normal in all patients and there was no testicular atrophy. In the 2nd group oligospermia was detected in 13 patients and were persistently low in 3 patients and testicular atrophy detected in 2 patients. The results indicated the beneficial role of pegylated interferon--alpha2B in preventing infertility from mumps orchitis.
Plasmodium vivax malaria--is it really benign?
Saini T, Kumhar M, Barjartya HC
J Indian Med Assoc · 2013 Sep · PMID 24968525
It is believed that most of the serious and life threatening complications are caused only by P falciparum infection while P vivax infections are relatively mild and run a benign course and usually not required hospitali...
It is believed that most of the serious and life threatening complications are caused only by P falciparum infection while P vivax infections are relatively mild and run a benign course and usually not required hospitalisation but in the last few years hospitalisation rate and complications are also increasing in P vivax infection; so we planned this study to evaluate the severity and complicated presentation of P vivax malaria. This hospital-based study conducted in Jawahar Lal Nehru Hospital Ajmer, India. One hundred and two indoor patients with isolated P vivax malaria were included in this study with exclusion of other causes of fever including P falciparum malaria. All patients of severe and complicated P vivax malaria were admitted and treated as severe P falciparum malaria. Severe complications like significant hepatomegaly, thrombocytopenia, acute renal failure, severe anaemia, leucopoenia, electrolyte disturbance, acute respiratory distress syndrome, cerebral malaria, multiorgan dysfunction, hepatic dysfunction, pancytopenia, and death seen in 21.57%, 18.63%, 11.76%, 8.82%, 5.88%, 5.88%, 3.92%, 2.94%, 1.96%, 1.96%, 0.98%, 1.96% patients respectively. A significant proportion of morbidity and mortality in malaria also observed in P vivax infection as seen in P falciparum infection and require hospitalisation.
Pattern of traumatic brain injury treated by general surgeons in a tertiary referral hospital.
Chattopadhyay SD, Karmakar NC, Sengupta R … +3 more , SenGupta TK, Ray D, Basus S
J Indian Med Assoc · 2013 Sep · PMID 24968524
The number of polytrauma patient with associated brain injury or commonly referred as 'head injury' has increased tremendously in recent times courtesy to road traffic accident or other causes. This prospective observati...
The number of polytrauma patient with associated brain injury or commonly referred as 'head injury' has increased tremendously in recent times courtesy to road traffic accident or other causes. This prospective observational study was conducted in patients of head injury admitted through emergency in the department of general surgery in NRS Medical College, Kolkata during the year 2011 to determine the pattern of head injury patients admitted and nature of intervention. A total number of 3861 patients were admitted in a single year. Obviously this represents the tip of the iceburg. Traumatic brain injury was the highest in the age group of 31-40 years (33.5%) followed by 21-30 years (29.1%) in the most fruitful phase of life. The traumatic brain injury death was more common in males. The maximum number of cases was from rural areas ie, farmers and labours. To minimise the morbidity and mortality resulting from head injury there is need for better maintenance of roads, improvement of road visibility and lighting, rigid enforcement of traffic rules and imparting road safety education to school children. Despite valiant efforts and advancement in medical sciences and infrastructure in the form of neurosurgery departments and trauma care units to cope with the changing world of trauma, there still remains a huge responsibility and a definite part to be played by the general surgeons to manage head injury patient even in tertiary hospitals.
Role of cerebrospinal fluid adenosine deaminase level estimation in diagnosis of tuberculous meningitis.
Gupta BK, Bharat V, Bandyopadhyay D … +1 more , Chambial S
J Indian Med Assoc · 2013 Sep · PMID 24968523
Five lakh patients of tuberculosis die every year in India. Meningeal tuberculosis is an endemic disease with 7-12% incidence. Delay in diagnosis and in initiating treatment results in poor prognosis and sequelae in upto...
Five lakh patients of tuberculosis die every year in India. Meningeal tuberculosis is an endemic disease with 7-12% incidence. Delay in diagnosis and in initiating treatment results in poor prognosis and sequelae in upto 25% of cases. The aim of the present study is to look for a simple, rapid, cost effective and non-invasive test for diagnosing this disease. Forty patients between 6-24 months of age having symptoms and signs of meningitis were selected and divided into two groups tuberculous and non-tuberculous, depending upon the accepted criteria. Cerebrospinal fluid (CSF) was drawn and adenosine deaminase (ADA) estimated. Out of 19 tuberculous patients, 18 patients had CSF ADA at or above the cut-off value while 1 had below the cut-off value. Out of 21 non-tuberculous patients, 2 patients had at or above the cut-off value while 19 were below this value. Results of this study indicate that ADA level estimation in CSF is not only of considerable value in the diagnosis of tuberculous meningitis, CSF ADA level of 10 U/L as a cut-off value exhibited 94.73% sensitivity and 90.47% specificity in differentiating tuberculous from non-tuberculous meningitis; it also has 90.00% positive predictive value and 95.00% negative predictive value. ADA estimation in CSF is simple, inexpensive, rapid and fairly specific method for making a diagnosis of tuberculous aetiology in TBM; especially when there is a dilemma of differentiating the tuberculous aetiology from non-tuberculous and for this reason ADA estimation in TBM may find a place as a routine investigation.
Analysis of FNAC of cervical lymph nodes: experience over a three-year period.
Mitra S, Ray S, Mitra PK
J Indian Med Assoc · 2013 Sep · PMID 24968522
This study was taken up with the aim to investigate the pattern of cervical lymphadenopathy among patients presenting to IPGME&R, Kolkata, a tertiary care institution in Eastern India to evaluate the diagnostic efficacy...
This study was taken up with the aim to investigate the pattern of cervical lymphadenopathy among patients presenting to IPGME&R, Kolkata, a tertiary care institution in Eastern India to evaluate the diagnostic efficacy of FNAC, and to dissect the diagnostic pitfalls. A total of 509 patients were subjected FNAC of cervical lymph nodes over a three-year period (August 2006-July, 2009). Since in 34 patients, as either the aspirate was inadequate or the opinion equivocal, the remaining 475 cases were analysed. Overall tuberculous lymphadenitis was the most common finding (222/475; 46.7%), while reactive hyperplasia was the commonest presentation (45%) in patients less than 20 years of age. Malignant pathology accounted for 13.7% (65/475) of cervical lymph node enlargement, most of which was due to metastatic squamous cell carcinoma (44/65; 67.7%). Histopathology reports were available for comparison in 220 cases. Twelve cases of tuberculosis were missed in FNAC and were reported as either reactive hyperplasia (n = 9) or acute non-specific lymphadenitis (n = 3). Among the 3 cases of metastatic squamous cell carcinoma that were missed in FNAC, one was reported as tuberculous lymphadenitis (due to granuloma formation) and the other 2 as reactive hyperplasia due to sampling error. FNAC is an excellent first line of investigation and when used with a proper combination of experience and diligence, it can greatly reduce the number of errors.
Morbidity pattern in foundry workers--a cross-sectional study in an urban area of north Karnataka.
Shashikanth YK, Katti SM, Mallapur MD
J Indian Med Assoc · 2013 Sep · PMID 24968521
Foundry industry which is a well established in India employs many workers. These workers are exposed to metal dusts, metal fumes, chemicals, heat and high temperature. To determine the morbidity pattern in foundry worke...
Foundry industry which is a well established in India employs many workers. These workers are exposed to metal dusts, metal fumes, chemicals, heat and high temperature. To determine the morbidity pattern in foundry workers, a cross-sectional study was conducted in the semi-urban area of Belgaum in Karnataka. All the workers excluding the administrative staff working in the foundries in the specified area were included in the study. A structured questionnaire was used to collect the data. Thorough physical examination was carried out to find out existing morbidities followed by spirometry test to determine their lung function profile. Altogether 498 foundry workers participated in the study. More than 50% of them were working for five years and above. Most of the workers (91.57%) were not using any kind of personal protective devices and 38.55% were smokers. About 68.50% workers had some kind of morbidity. Respiratory system (18.10%) was involved in most of those with morbidities. Chronic bronchitis was the leading morbidity in these workers. There was an association between chronic bronchitis with increasing age of the workers, the number of years they were working in foundries and their smoking habits, which was statistically significant. Foundry workers are exposed to various risk factors like metal dusts, metal fumes and Chemicals which may affect their health. They suffer from various morbidities, particularly respiratory problems which needs periodic health examination. Personal protective devices use should be made compulsory in these workers.
An effective alternative to only gonadotrophin for controlled ovarian stimulation in unexplained infertility patients undergoing intra-uterine insemination: a clinical trial.
Chaudhury K, Chaudhury S, Khastgir G … +1 more , Purakaystha S
J Indian Med Assoc · 2013 Sep · PMID 24968520
Clomiphene citrate, by stimulating the endogenous gonadotrophin secretion, reduces the dose of exogenous gonadotrophin for controlled ovarian stimulation. However, the benefit of clomiphene citrate may be offset by its o...
Clomiphene citrate, by stimulating the endogenous gonadotrophin secretion, reduces the dose of exogenous gonadotrophin for controlled ovarian stimulation. However, the benefit of clomiphene citrate may be offset by its oestrogen-receptor depleting effect on target tissues like endometrium. Letrozole, an aromatase inhibitor, stimulates endogenous gonadotrophin secretion (like clomiphene citrate). However, it does not deplete oestrogen receptors and hence does not have adverse effect on endometrium (unlike clomiphene citrate). To evaluate the effectiveness of letrozole + FSH combination versus only FSH for contolled ovarian stimulation in unexplained infertility patients undergoing intra-uterine insemination, a prospective randomised trial was undertaken among 55 patients with unexplained infertility completed all together 118 treatment cycles of controlled ovarian stimulation and intra-uterine insemination. All these patients were regularly ovulatory women and had folliculometry by transvaginal ultrasound scanning (without any medication) with timed intercourse for Initial 2 cycles before going for controlled ovarian stimulation and intra-uterine insemination. Thereafter, 29 patients, of these 55 patients, who were allotted to one group (letrozole + FSH group) started the treatment cycle of controlled ovarian stimulation and intrauterine insemination. For controlled ovarian stimulation, each of these 29 patients received letrozole 2.5 mg from day 3 to day 7. From day 7 onwards, each patient received FSH injection intramuscular (50-150 IU/day) until the leading follicle is > or = 18 mm. Twenty-six patients, of these 55 patients, were allotted to another group (only FSH group). Each of these patients received FSH injection intramuscular (50-225 units/day) from day 3 until the leading follicle is > or = 18 mm. Monitoring of follicular development was done by transvaginal ultrasound scan, first on day 2/3 of each treatment cycle, then on day 7 and thereafter on alternate day or sometimes on successive days till the leading follicle is 18 mm or more. The dose and duration of FSH was adjusted depending on the number and size of growing follicles. Injection hCG 10000 units intramuscular was administered when the leading follicle was 18 mm or more. Intra-uterine insemination was performed 36 hours following hCG administration. Urine for pregnancy test was performed 21 days later if the patient did not have period by then. In each group, the outcome measures noted are mean of total dose of FSH/cycle, total number of mature follicles (> 16 mm) (on the day of hCG administration), endometrial thickness (on the day of hCG administration), and pregnancy rate/cycle. Statistical analysis was carried by using unpaired 't' test on continuous variables whereas Fisher's exact test was used on categorical variables. There was no significant difference in mean of total number of mature follicles (> 16 mm) and endometrial thickness on the day of hCG administration as well as pregnancy rate/cycle between two groups. However, the mean total dose of FSH/cycle and mean total duration of FSH administration/cycle were significantly less in letrozole + FSH group compared with only FSH group.
Value based education: role in empowerment.
Krishnamurthy TG
J Indian Med Assoc · 2013 Sep · PMID 24968519
Abstract loading — click title to view on PubMed.
Medical Council of India in constitutional crisis.
Vijayakumar K, Saini N
J Indian Med Assoc · 2013 Oct · PMID 24968506
Abstract loading — click title to view on PubMed.
Duane's syndrome involving left eye.
Eswar G, Ramalakshmi K, Seshaiah KV
J Indian Med Assoc · 2013 Oct · PMID 24968505
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Peripartum cardiomyopathy.
Goyal S, Khanna P
J Indian Med Assoc · 2013 Oct · PMID 24968504
Peripartum cardiomyopathy remains a rare but troubling complication of pregnancy. The cardiovascular stress of labour and delivery may lead to cardiac decompensation. These patients require special anaesthetic care durin...
Peripartum cardiomyopathy remains a rare but troubling complication of pregnancy. The cardiovascular stress of labour and delivery may lead to cardiac decompensation. These patients require special anaesthetic care during labour and delivery. Compensated patients may undergo vaginal delivery with appropriate monitoring. For those patients late in pregnancy with more significant haemodynamic compromise, consideration should be given to elective caesarean section with invasive haemodynamic monitoring of the mother. We report two antenatal cases of peripartum cardiomyopathy where a near miss situation was avoided by doing an emergency caesarean section.
Jejunogastric intussusception--a rare variety of intussusception.
Mandal R, Mandal N, Sasmal S … +2 more , Kuiri S, Roy SB
J Indian Med Assoc · 2013 Oct · PMID 24968503
Jejunogastric intussesception is a rare entity in surgical practice. Here a case of a middle aged male patient is reported who was admitted with pain abdomen, vomiting and constipation with surgical history of gastrojeju...
Jejunogastric intussesception is a rare entity in surgical practice. Here a case of a middle aged male patient is reported who was admitted with pain abdomen, vomiting and constipation with surgical history of gastrojejunostomy 22 years back and found to have jejunogastric intussesception. Still now nearly 200 cases have been reported in the literature.
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