Amoebiasis is a food-borne protozoan infection, caused by Entamoeba histolytica. Here a case of hepatopleuropulmonary amoebiasis, which was detected after fibre-optic bronchoscopy is reported. Bronchial aspirate showed t...Amoebiasis is a food-borne protozoan infection, caused by Entamoeba histolytica. Here a case of hepatopleuropulmonary amoebiasis, which was detected after fibre-optic bronchoscopy is reported. Bronchial aspirate showed trophozoites of Entamoeba histolytica. The patient was treated with tinidazole and responded favourably.
Bhattacharyya B, Ghosh SK, Dhibar T
… +4 more, Chattopadhyay A, Ghosh SN, Bhadra AK, Ghorai PK
J Indian Med Assoc
· 2013 May · PMID 24765699
Extramedullary haematopoiesis leading to spinal cord compression is a rare complication of thalassaemia. An interesting case has been reported where a diagnosis of thalassaemia intermedia was made at the age of 35 years...Extramedullary haematopoiesis leading to spinal cord compression is a rare complication of thalassaemia. An interesting case has been reported where a diagnosis of thalassaemia intermedia was made at the age of 35 years in a male patient with no history of blood transfusion, who presented with compressive myelopathy caused by extramedullary haematopoietic tissue in epidural space. The patient recovered after surgical decompression.
Kamat CA, Rangalakshmi S, Keshavmurthy M
… +1 more, Pawan
J Indian Med Assoc
· 2013 May · PMID 24765698
Oesophageal webs are thin (2-3mm) membranes of normal oesophageal tissue consisting of mucosa and submucosa. They can be congenital or acquired. Congenital oesophageal webs are very rare and usually present in adulthood....Oesophageal webs are thin (2-3mm) membranes of normal oesophageal tissue consisting of mucosa and submucosa. They can be congenital or acquired. Congenital oesophageal webs are very rare and usually present in adulthood. This report describes an unusual presentation of congenital web in lower oesophagus in a premature neonate with respiratory distress who was posted for diagnostic bronchoscopy and oesophagoscopy under general anaesthesia to rule out tracheo-oesophageal fistula or tracheomalacia. Endoscopic dilatation of the web was done and the baby improved after the procedure.
Bandyopadhyay AK, Thakur SK, Banerjee B
… +3 more, Chatterjee SS, Biswas PN, Bhaduri G
J Indian Med Assoc
· 2013 May · PMID 24765697
Primary angle closure in a high myopic patient is rare. Here is presented a report of one such patient who presented with acute primary angle closure in one eye. Conservative management followed by laser iridotomy was ef...Primary angle closure in a high myopic patient is rare. Here is presented a report of one such patient who presented with acute primary angle closure in one eye. Conservative management followed by laser iridotomy was effective in the treatment of this patient.
Auto-immune hepatitis first presenting in the early postpartum period is rare. Immunosuppressive effects of pregnancy result in delayed manifestation of auto-immune hepatitis, and in established cases, the spontaneous im...Auto-immune hepatitis first presenting in the early postpartum period is rare. Immunosuppressive effects of pregnancy result in delayed manifestation of auto-immune hepatitis, and in established cases, the spontaneous improvements are there. Auto-immune hepatitis should be considered in the differential diagnosis of liver dysfunction first presenting in the early postpartum period. A case of postpartum hepatitis of auto-immune aetiology is being presented here. It is disease of unknown aetiology, characterised by inflammation of liver (as evidenced by raised serum transaminases, presence of interface hepatitis on histological examination), hypergammaglobulinaemia (> 1.5 times normal), presence of auto-antibodies [(antinuclear antibodies (ANA)], smooth muscle antibody (SMA) and antibody to liver-kidney microsome type 1 (LKM1) in the absence of viral markers ie, hepatitis B (HBsAg) and C (AntiHCV) and excellent response to corticosteroid therapy.
Osteo-arthritis is the chronic degenerative disease associated with joint pain and loss of joint function. It is caused by 'wear and tear' on a joint. Knee is the most commonly Involved joint. Disease is so crippling tha...Osteo-arthritis is the chronic degenerative disease associated with joint pain and loss of joint function. It is caused by 'wear and tear' on a joint. Knee is the most commonly Involved joint. Disease is so crippling that patient is unable to walk independently from bed to bathroom. The major causes of osteo-arthritis are age, gender, obesity, medical condition and hereditary. The signs and symptoms of osteo-arthritis are pain, joint stiffness, joint swelling, and loss of function. No blood tests are helpful in diagnosing osteo-arthritis. Management of osteo-arthritis includes non-pharmacological, pharmacological and surgical. A relatively new procedure is viscosupplementation, in which a preparation of hyaluronic acid is injected into the knee joint. Hyaluronic acid is a naturally occurring substance found in the synovial fluid. It acts as a lubricant to enable bones to move smoothly over each other and a shock absorber for joint loads. The decrease in the elastic and viscous properties of synovial fluid in osteo-arthritis results from both a reduced molecular size and a reduced concentration of hyaluronic acid in the synovial fluid. Viscosupplementation may be a therapeutic option for individuals with osteo-arthritis of the knee. Viscosupplementation has been shown to relieve pain in many patients who cannot get relief from non-medicinal measures or analgesic drugs. This article is to know the mechanism of action, patients' selection criteria, rationale and efficacy of viscosupplimentation in the management of osteo-arthritis of knee.
India continues to have the highest number of TB cases in the world, and over 2 million cases are reported in India every year. The private sector in India is an important source of TB care with over 50% of TB patients s...India continues to have the highest number of TB cases in the world, and over 2 million cases are reported in India every year. The private sector in India is an important source of TB care with over 50% of TB patients seeking TB treatment in the private health sector. Early and accurate diagnosis is the first critical step in controlling TB. All persons with cough lasting two weeks or more, or with unexplained chronic fever and/or weight loss should be evaluated for TB. For pulmonary TB, Sputum is the most critical sample for laboratory testing. Although blood is a popular sample in the Indian private sector, there is no accepted, valid blood test for pulmonary TB. There are three accepted, validated sputum tests for active TB: Sputum smear microscopy for acid-fast bacilli; molecular or nucleic acid amplification test (NAAT); and culture. Chest radiography is useful but is not specific for the diagnosis of pulmonary TB. Therefore, chest radiography cannot provide a conclusive diagnosis on its own, and needs to be followed by sputum testing. If sputum smears and NAATs are negative, and TB is still suspected, cultures are the most sensitive tests available for TB. Culture is therefore very useful in diagnosing smear-negative TB; and drug-resistant TB. Blood-based antibody tests (eg, IgG/IgM tests) and Interferon-gamma release assays (eg, TB Gold) are not accurate and should not be used for pulmonary TB diagnosis. In fact, use of serodiagnostic tests for TB is banned by the Government of India.
To describe maternal complications and neonatal outcomes caused by gestational diabetes mellitus a descriptive observational study was conducted in the department of obstetrics and gynaecology at Ramakrishna Mission Seva...To describe maternal complications and neonatal outcomes caused by gestational diabetes mellitus a descriptive observational study was conducted in the department of obstetrics and gynaecology at Ramakrishna Mission Seva Pratisthan and Vivekananda Institute of Medical Sciences, Kolkata, over a period of one year from July 2009 to June 2010. Women diagnosed by oral glucose tolerance test as gestational diabetes mellitus were enrolled as study subjects and were followed regularly at outpatient department. Blood glucose levels controlled by diet or with insulin. Foetal well-being was assessed by ultrasonography, foetal kick count and cardiotocography. Time and mode of delivery were decided on admission depending upon the complications encountered. Intrapartum blood glucose level was monitored and foetal monitoring was done. After delivery all the babies were assessed by the paediatrician. After discharge patients were advised oral glucose tolerance test at 6 weeks postpartum. Out of 644 women delivered, 58 (9%) were diagnosed gestational diabetes mellitus and were studied. Mean age was 30 years and 55.2% were multigravida; 50% were obese (BMI > or = 30 kg/m2); 60.3% required insulin therapy to achieve glycaemic control. Most common maternal and neonatal complications observed were premature prelabour rupture of membrane (10.3%) and jaundice (29.3%) respectively. Caesarean section was done in 60.3% gestational diabetas mellitus mothers. A total of 57 babies (98.2%) were delivered alive.
Rizvi G, Pandey H, Roy SB
… +3 more, Pant H, Jha AK, Maitra S
J Indian Med Assoc
· 2013 May · PMID 24765692
The study included 431 patients who underwent breast FNAC over a period of five years between 2003 and 2008. The required clinical details were obtained from the requisition forms. The Information about the level of educ...The study included 431 patients who underwent breast FNAC over a period of five years between 2003 and 2008. The required clinical details were obtained from the requisition forms. The Information about the level of education and occupation were collected by interviewing the subjects. The number of cases of breast carcinoma was significant constituting 14.84% (n = 64). The study showed that the peak age for breast carcinoma was between 41 and 50 years. This correlates with the national figure where most of the cases observed belonged to the reproductive age group. Most of the females were married (93.75%) and were multiparous (92.18%). Maximum number of patients had only received primary education. There was not much difference in the number regarding whether they lived in urban or rural areas. Middle and lower socioeconomic class contributed the bulk of the cases and it were the housewives who were in majority (85.93%).
An association of non-alcoholic fatty liver disease with insulin resistant metabolic syndrome and hypothyroidism has been suggested. Aim of the present study was to explore the above association and also to establish the...An association of non-alcoholic fatty liver disease with insulin resistant metabolic syndrome and hypothyroidism has been suggested. Aim of the present study was to explore the above association and also to establish the correlation between hypothyroidism and insulin resistance in patients with nonalcoholic fatty liver disease. Study group comprised 40 cases of non-alcoholic fatty liver disease and 30 healthy controls. Serum samples were analysed for fasting glucose, insulin, lipid profile and thyroid hormones. Insulin resistance was assessed by homeostatic model of assessment calculation. Nonalcoholic fatty liver disease patients demonstrated significantly higher insulin resistance, TSH values and significantly lower FT4 values as compared to controls, which illustrates the prevalence of insulin resistance and hypothyroidism in patients. A significant positive correlation between TSH and Insulin resistance (r = 0.87, p < 0.001) and a significant negative correlation between FT4 and insulin resistance (r = -0.14, p < 0.001) were established in the cases. Moreover TSH was significantly related to low density lipoprotein cholesterol, independent of insulin resistance. There have been some doubts over the clinical correlation between insulin resistance and hypothyroidism to delineate increased risk of cardiovascular disease. So earlier detection and treatment of risk factors may have a significant impact on progression of non-alcoholic fatty liver disease.
Deshpande K, Shivaswamy MS, Diwan V
… +3 more, De Costa A, Bhattacharya A, Mahadik VK
J Indian Med Assoc
· 2013 May · PMID 24765690
An interventional study was carried out under a Government of Madhya Pradesh, India supported project with aims to describe establishment of a social club (a youth club), incorporating strategy of life-skill-based educat...An interventional study was carried out under a Government of Madhya Pradesh, India supported project with aims to describe establishment of a social club (a youth club), incorporating strategy of life-skill-based education and its potential as a tool for creating HIV/AIDS awareness among adolescents of age 15-19 years living in slums of Ujjain city. The social club activities included AIDS education by combined methods, vocational training and recreational activities for the adolescents. Establishment of social club was feasible with available local resources. Social club activities were need based, thus received good response from adolescents (94% had attendance above 75% in AIDS awareness sessions). Knowledge and attitude improved and misconceptions reduced significantly by AIDS education. Majority (86%) of the participants contributed as AIDS messengers in the community. The social clubs seem to have potential to improve HIV/AIDS awareness and empower adolescents to adopt healthy lifestyle through combination of teen friendly activities and atmosphere.
Lymphadenopathy is one of the commonest clinical presentations of the patients attending hospital outdoor. Aetiology varies from Inflammatory process to malignant conditions. Fine needle aspiration cytology has become an...Lymphadenopathy is one of the commonest clinical presentations of the patients attending hospital outdoor. Aetiology varies from Inflammatory process to malignant conditions. Fine needle aspiration cytology has become an integral part of the initial diagnosis. Histology remains the gold standard. But there exists some gray zones both in cytology and histology where immunohistochemistry plays a major role for final diagnosis. In this study, an attempt has been made to evaluate the importance of immunohistochemistry in this field. Fifty cases were studied. Clinical history was noted and examination done. All cases were examined both cytologically and histologically. Immunocytochemistry was done in all the cases by monoclonal antibody against p53 and Ki67. The results were tabulated and analysed according to unpaired 't' test. Reactive hyperplasia was present in maximum number followed by tuberculosis, non-Hodgkin's lymphoma and Hodgkin's lymphoma. All of these lesions showed statistically significant difference in p53 and Ki67 expression both in cytology and in histology. To conclude, fine needle aspiration cytology is an adjuvant to histology for early diagnosis and immunohistochemistry can help us in the gray zones.
Panagariya A, Sureka RK, Ralot T
… +2 more, Sharma B, Dubey P
J Indian Med Assoc
· 2013 May · PMID 24765688
The objective of this study was to study the clinical features and laboratory profile including acid fast bacillus microscopy, cerebrospinal fluid (CSF) culture and M. tuberculosis polymerase chain reaction (PCR) for an...The objective of this study was to study the clinical features and laboratory profile including acid fast bacillus microscopy, cerebrospinal fluid (CSF) culture and M. tuberculosis polymerase chain reaction (PCR) for an early diagnosis of tuberculous meningitis. Fifty consecutive patients, fulfilling the clinical criteria of tuberculous meningitis, were included in the study. All patients were subjected to detailed clinical and laboratory evaluation and radiological tests. CSF acid fast bacillus microscopy, culture and PCR were carried out in all and results were analysed. Majority of the patients presented with fever, headache, vomiting and signs of meningeal Irritation. Ziehl-Neelsen staining for acid-fast bacillus was positive in 4% cases, culture in 18% cases and CSF PCR for Mycobacterium tuberculosis was positive in 68%. Miliary pattern on chest x-ray was seen in 16% and CNS tuberculomas were seen in 14% cases. The CSF PCR estimation in clinically suspected cases of tuberculous meningitis may be an extremely valuable test for early diagnosis and institution of specific therapy.
Low contraceptive utilisation and high fertility in rural Uttar Pradesh (UP), India, is a major concern for the world's second most populous country. The association between reasons for low contraceptive utilisation and...Low contraceptive utilisation and high fertility in rural Uttar Pradesh (UP), India, is a major concern for the world's second most populous country. The association between reasons for low contraceptive utilisation and maternal factors has been inadequately researched. Data from the 'morbidity and performance assessment' study were analysed to explore reasons for low contraceptive utilisation and their association with maternal factors among 308 women in Maitha, rural UP, India. Chi-square, t-test, ANOVA, and logistic regression analyses were conducted. Majority (84.2%) of the rural women in Maitha, UP, India were not using any contraceptives. Upper caste, literate wives, and wives whose husbands were literate were more likely to use contraceptives. About one-third of the women did not want to use a contraceptive because they wanted another child. Large numbers (65.3%) of women wanted to use contraceptives but were unable to do so due to lack of knowledge (38.9%), fear of side-effects (15.5%), husband/family disapproval (15.5%), inconvenience (10.7%), and other reasons (19.1%). Maternal parity, wives' and husband's literacy were significantly associated with the reasons for low contraceptive utilisation (p < 0.05). Contraceptive utilisation can be Improved by taking into consideration such maternal characteristics. All state subsidised contraceptives should be more widely known, understood and made available.
Bilateral facial paralysis is a rare clinical entity and presents as a diagnostic challenge. Unlike its unilateral counterpart facial diplegia is seldom secondary to Bell's palsy. Occurring at a frequency of 0.3% to 2% o...Bilateral facial paralysis is a rare clinical entity and presents as a diagnostic challenge. Unlike its unilateral counterpart facial diplegia is seldom secondary to Bell's palsy. Occurring at a frequency of 0.3% to 2% of all facial palsies it often indicates ominous medical conditions. Guillian-Barre syndrome needs to be considered as a differential in all given cases of facial diplegia where timely treatment would be rewarding. Here a case of bilateral facial palsy due to Guillian-Barre syndrome with atypical presentation is reported.
A case of glandular odontogenic cyst was diagnosed in a 33-year-old man. The cyst was located in the angle of the mandible, underneath the left molars. This case has been presented for its rarity of location in posterior...A case of glandular odontogenic cyst was diagnosed in a 33-year-old man. The cyst was located in the angle of the mandible, underneath the left molars. This case has been presented for its rarity of location in posterior mandible and presentation as intra-oral papillary growth.
Acute transverse myelitis is a well known neurological complication occurring in systemic lupus erythematosus. Many prior studies have shown a link between transverse myelitis and the presence of antiphospholipid antibod...Acute transverse myelitis is a well known neurological complication occurring in systemic lupus erythematosus. Many prior studies have shown a link between transverse myelitis and the presence of antiphospholipid antibodies. Earlier theories have linked thrombotic tendency to be the culprit in such manifestations but currently there is evidence to support other causative mechanisms. A case of a young female diagnosed as systemic lupus erythematosus has been reported who presented with acute transverse myelitis and was found to be seronegative for antiphospholipid antibody. It is important to pay heed to and accordingly treat complications like acute transverse myelitis that occur regardless of antiphospholipid antibody positivity in a systemic lupus erythematosus setting.