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Charcot’ osteoarthropathy (COA) is a rare, often misdiagnosed inflammatory debilitating complication of conditions most common being diabetes that needs to be discussed further to prevent associated morbidity. The natural history of the disease sees four stages and requires prompt diagnosis and treatment to ensure the desired outcome. We describe a case series of two cases of diabetes-associated osteoarthropathy and their management. A 72-year-old male with the early COA was managed with a total contact cast for both lower limbs and an 80-year-old male with the early COA with bone marrow edema in the tibia and talus, as well as, subtalar effusion, managed conservatively. The follow-up review documented clinical recovery in the form of a marked reduction in swelling of the lower limbs with the resolution of the functional status of lower limbs. It is the responsibility of every physician to ensure the goals of management which includes immediate offloading and good glycemic control.
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Background:Pulmonary regurgitation is imminent after transannular patch (TAP). We analyze the long?term performance of untreated autologous pericardium (UAP) as valve substitute at pulmonary position in patients requiring TAP. Material and Methods: This cross?sectional study include patients operated between 2007 and 2012 (n = 92). A sample of 19 patients was selected for this study which had a follow?up of more than 3 years. This includes patients with no TAP (n = 4) and with TAP and valve substitute, a monocusp (n = 11) or a tricuspid valve (n = 4) at neopulmonary annulus. Patients underwent echocardiography for assessment of right ventricle function and 18 fluoro?deoxyglucose PET CT scan for measurements of valve substitute at neopulmonary annulus. The target to blood ratio (TBR) of uptake of glucose by monocusp was measured at the cooptation edge of the neopulmonary valve. Results: The median age of the patients is 14 (9 – 37). RV function is preserved (TAPSE 18.9 (10.6 – 22.8)) at a mean follow?up of 4 years (3?9). The measurements of monocusp shows a shrinkage in height of the cusp by 35.5% (70% – 1.0%) and length by 7% (?44% ? +104%). There was less shrinkage observed in patients below 15 years of age. The TBR of monocusp was 0.945 (0.17 – 3.35) with a strong correlation between the TBR values of aortic valve leaflet and monocusp leaflet of same patient. Conclusion: The UAP is functional and successful as a valve substitute at neo pulmonary annulus at long?term follow?up. It has resisted calcification and has shown uptake of glucose in physiological limits.
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Objective@#Willingness to undergo deep brain stimulation (DBS) among patients with Parkinson’s disease (PD) and their overall satisfaction with the procedure is highly dependent upon expectations, which are based on the core concepts of knowledge, attitude and perceptions. The present study aims to evaluate these factors in patients and caregivers with PD from a single tertiary care hospital in India. @*Methods@#A structured questionnaire designed to assess the knowledge, attitude and perceptions about DBS in PD was administered to 400 patients with PD and their caregivers. @*Results@#A very small proportion of patients and caregivers were aware of DBS. Even those who claimed to be aware of DBS were inadequately informed and had incorrect knowledge, which led to wrong attitudes and perceptions. @*Conclusion@#There are very significant knowledge gaps and misconceptions regarding DBS among patients with PD and caregivers. Adequate and appropriate education is necessary to clarify these misconceptions to avoid the development of unrealistic expectations and poor satisfaction.
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Background: Serum uric acid (sUA) levels were previously found to be correlated with hypoxic states. We aimed to determine the levels of sUA in COPD patients and to evaluate whether sUA level can be used as predictors of exacerbation risk and disease severity.Methods: This cross-sectional study included COPD patients and healthy controls. The sUA levels in each group were evaluated and their correlations with the study parameters were investigated. ROC analyses for exacerbation risk were reported.Results: The study included 106 COPD patients and 110 healthy controls. The mean sUA levels were significantly higher in patients with COPD compared to healthy controls (p<0.05). Mean sUA levels were compared with different stages of COPD according to GOLD criteria. Stage 4 COPD subjects had highest sUA levels compared to other stages. Statistically significant trend was observed for GOLD staging of disease (p<0.05). Surprisingly non-smokers were having higher uric acid level than smokers (p<0.05). The ROC analyses indicated that sUA levels can be useful in predicting exacerbation risk (AUC, 0.412) especially at higher cut-off values, but with low specificity.Conclusions: Study suggested that sUA levels increased in patients with COPD compared to healthy controls. At higher cut-off values sUA levels might be useful in predicting COPD exacerbation risk and disease severity. However, more prospective cohort studies with large number of participants are needed to further analyse the possible different prognostic roles of hyperuricemia.
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Multiple cardiac masses were incidentally detected in a neonateon twelve day of life. Failure to thrive, feeding difficulty andsevere dynamic right ventricular outflow tract obstructiondeveloped at 7 months of age. Surgical resection of intracardiacmasses relieved symptoms and histological studies confirmedrhabdomyoma. Progressive increase in the size ofrhabdomyoma during infancy is an uncommon presentation andsurgery can be life-saving.
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Background: Chikungunya virus, an alphavirus belonging tothe Togaviridae family, caused large scale outbreaks in severalparts of southern, western and eastern India in 2006. Wereport Chikungunya outbreak in Jamshedpur region in 2011.Objective: To know the seroprevalence and seasonal trendsof Chikungunya infection among the patients of the diseasewho attended to MGM Medical College, Jamshedpur, A tertiarycare hospital during 2011 to 2014.Materials & Methods: Present retrospective observationalstudies were conducted in the Microbiology Department ofMahatma Gandhi Medical College, Jamshedpur from August2011 to December 2014.Result: Serum samples of 323 patients presenting with fever,arthralgia, rash etc. were tested for anti-Chikungunya IgMantibody using MAC ELISA. 148/324 (47.9%) samples werepositive for anti Chikungunya IgM antibody. More males wereaffected compared to females. The most common age groupaffected was 29-49 year. Characteristically, pediatrics agegroup was least affected. The number of cases increased withincreasing age group.Conclusion: Screening for Chikungunya infection in theendemic areas, especially in monsoon season would improvethe quality of arboviral surveillance and potentially aid in clinicalmanagement of the disease.
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Objectives: The study was designed to evaluate the role ofMagnetic Resonance Imaging (MRI) to localize andcharacterize the MR imaging features of cerebellopontineangle (CPA) schwannomas and to compare withsurgical/histopathological findings.Methodology: Thirty eight patients of clinically suspected &MRI diagnosis cases of CPA Schwannoms were selected inthis cross sectional study in different places of Bangladesh{Mymensingh Medical College Hospital Mymensigh, Sher-EBangla Medical College Hospital, Barisal, Popular DiagnosticCentre Gazipur & Lab Aid diagnostic Centre Barisal. Surgery ofall MR diagnosed cases were done in Dhaka Medial CollegeHospital & National Institute of Neuroscience Hospital, Dhaka}during the period from April 2008 to August 2019. All patientsincluded in the study were subjected to detailed clinical historyand physical examination following which MRI was carried outon 1.5 Tesla & 0.3 Tesla MR machine and the standardprotocol consisted of T1WI, T2WI, DWI and FLAIR images inaxial, sagittal and coronal planes.Results: MRI was erroneous in giving provisional diagnosis ofschwannoma in two cases, which on subsequent surgery andhistopathology was found to be a meningiomas. The sensitivityof MRI for correctly diagnosing vestibular schwannoma was100 % and specificity was 92.86 % with a positive predictivevalue of 94.12 % and accuracy of 96.67 %. MRI is consideredas an excellent noninvasive investigation for CP angleschwannoma’s. It can identify the site and extension of thelesions as well as the characteristic signal.
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Background: Cancer of uterine cervix is one of the commoncarcinoma among females. The global incidence of cervicalcancer varies (5 lakhs new cases/year), highest in developingcountries with >50% dying. In India, cervical cancer contributesto approximately 6–29% of all cancers in women. Prevention ofcervical cancer, whether primary or secondary requires activeparticipation of the community. This study is to assess thePrevalence, Pap screening, knowledge, attitude practice andprevention regarding cervical cancer. Identification of riskfactors is necessary to curb the disease.Methods: A cross-sectional study was conducted in differentCHC, PHC and MGM Medical college Jamshedpur area ofKolhan region of Jharkhand. A sample of 499 women aged 15-70 years was taken from January 2017- August 2019 and wasselected and subjected to Pap smear test of cervix andabnormal smears, Histopathological report of HSIL/invasivecarcinoma, Factors like menarche, coitarche, age at marriage,parity, contraception, smoking habit and socio-economic statuswere noted.Results: In our study, HSIL was 0.2% and invasive cancer was2.8%. Out of the 499 respondents most of them belonged tothe 15-39 years age group. About 81.96% were Hindu, morethan all the other religion respondents 79.75% of the womenwere educated in primary level. Around 85.17% of therespondents were housewives by occupation. Majority of thembelonged to the lower socio-economic strata. The awarenessabout Pap smear where p>0.05 not significant.Conclusions: Early menarche, early coitarche, early marriage,high parity, use of contraception other than barrier, lowsocioeconomic status, poor habitat and HPV infection, carrieda high risk of developing cervical cancer. HPV infection wasthe most important risk factor. Improvement of socioeconomicstatus, education and cervical cancer screening of the high-riskgroup can reduce cervical cancer mortality and morbiditysignificantly.
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State-driven community surgery camps have been organised in India for nearly five decades. Despite their being extremely beneficial to people not having ready access to surgical healthcare (SHC), they continue to be mired in controversies because of negative consequences following free surgery, eg blindness following cataract surgery; infection/death following tubectomy/vasectomy. While the onus of complications during and following surgery camps is commonly ascribed to deficient camp infrastructure/facilities; the contribution of the tendency to achieve high-frequency targets, ie to-do-more-surgery-in-less-time to the problem; continues to escape public scrutiny. Ironically, even the significant and multiple morbid events during surgery camps only evoke a transient public outcry, reflective professional criticism, hyper-media whimpers, and legal turbulence; before fading completely from public memory. This viewpoint piece, by taking into consideration the various ethical burdens that assail community surgery camps (13 deaths in the Chhattisgarh tragedy of 2014, as a case in point); aims to deconstruct inadequate SHC systems and conflicted surgery targets seeking promotion and fame. It also suggests remedial measures to address the problems, especially in terms of identifying a valid end-point for successful surgery, ie surgery completion or surgery outcome; and how the media, polity, professional fraternity, and executives could reorient themselves to respond more sensitively to problems, for the benefit of the patients and community at large.
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Background: Japanese Encephalitis is one of the mostimportant causes of viral encephalitis worldwide, with anestimated 50,000 cases and 15,000 deaths annually. Thepresent study was undertaken to investigate theSeroprevalence and Seasonal Trend of Japanese Encephalitisin Jamshedpur.Methods: It was a hospital-based retrospective studyconducted from August 2011 to December 2017. A total of 571consecutive non-repetitive patients, satisfying the clinical casedefinition of JE as per the WHO guidelines, were included inthe study. Cerebrospinal fluid (CSF) and serum samples weretested for JEV-specific IgM antibodies by the NIV JE IgMCapture ELISA Kit.Results: Out of which 166/571 (29.07%) were JE positivediagnosed by IgM Mac ELISA antibody kit. We have observedthat in a period of six years, the JE positivity rate hassignificantly reduced from 39.84% in 2011 to 7.29% in 2017.Conclusions: A declining trend of JE was seen in this study,however further research work needs to be done to lookfor non-JE causes of JE. Surveillance & effective vaccinationshould be carried out regularly for early detection of animpending outbreak and to initiate timely preventive and controlmeasures.
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Background: Acute pancreatitis though a self limiting in 80-90% of cases, but in 10-20% cases there is pancreatic necrosis, multi-organ failure & recurring pancreatic injury . A simple accurate, clinical scoring system BISAP (Bed side index for severity in acute pancreatitis) collected data within 24hrs of admission to hospital in predicting patients at risk for developing organ failure, persistent organ failure and pancreatic necrosis. Methods: A prospective study done at SCB MCH, from Aug.2016 to Sept.2018. All patients admitted to the hospital as acute pancreatitis are included in this study which is characterized by acute abdominal pain, increased level of serum amylase and/or lipase, USG/CT/MRI of abdomen and pelvis done within 7days of admission which shows findings consistent with features of acute pancreatitis. Each component of the BISAP scoring system was studied for each patient in first 24hrs & each component was awarded one point .Organ failure is defined as a score of ≥ 2 in one or >3 organ as originally described in Marshall score. Oragn – failure was described as transient (<48hrs) or persistent (>48hrs) from the time of admission. All the datas were collected & analysed for patients developing organ failure, persistent organ failure, pancreatic necrosis and death. Results: In our study, out of 108nos. of patients, 67(62.1%) were males & 41(37.9%) were females. Alcohol being the leading cause in 57(52.8%) followed by gall stone in 32(29.6%) cases & others in19(17.6%) cases. Patients with BISAP score ≥3 had developed organ failure in 10 (34.4%)cases and with BISAP score ≤ 3 in 6(7.6%) cases. Out of 16nos. organ failure cases 12 cases were transient organ failure & 4cases were persistent organ failure all with BISAP score ≥3. Pancreatic necrosis developed in 18nos of cases of which 11nos with BISAP score ≥3 & 7nos with score ≤ 3. Conclusion: The BISAP score is simple & accurate method for early identification of patients at increased risk of developing organ failure, persistent organ failure, pancreatic necrosis within 24hrs of admission to hospital.
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Background: Dengue fever and Dengue Haemorrhagic feveris an acute viral disease caused by Dengue virus. The infectionis transmitted by female mosquito- Aedes aegypti. The presentstudy was undertaken to investigate the trend of Dengue andthe seasonal effect associated with it. During late August 2010,outbreak of dengue symptomatic patients was admitted toMGM Medical college hospital Jamshedpur. ELISA for antidengue antibodies confirmed the case as Dengue.Objective: This retrospective study was done to analyze thecirculating dengue virus seroprevalence and seasonal trendamong the patients of the disease who attended to MGMMedical College, Jamshedpur, A tertiary care hospital during2010 to 2015.Methods: It was a hospital-based retrospective studyconducted from September 2010 to December 2015. A total of342 consecutive non-repetitive patients, satisfying the clinicalcase definition of Dengue as per the WHO guidelines, wereincluded in the study. Serum samples were tested for Denguespecific IgM antibodies by NIV Dengue IgM Capture ELISA Kit.Results: Of the 342 patients attended, 110(32.16%) caseswere positive for Dengue IgM antibodies. There was asignificant reduction in the Dengue positivity rate from 31% in2010 to no cases in 2015. The majority of cases occurredduring the monsoon and post-monsoon season.Conclusions: A declining trend of Dengue was seen in thisstudy, however further research work needs to be done to lookfor non-Dengue causes of Dengue fever. Surveillance shouldbe carried out regularly for early detection of an impendingoutbreak and to initiate timely preventive and controlmeasures.
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Introduction: Tetralogy of Fallot requiring transannular repair of the right ventricular outflow tract (RVOT) are exposed to free pulmonary insufficiency and hence inevitable right ventricular dysfunction. This study analyzes the function and structure of untreated autologous pericardium monocusp used to create a competent pulmonary valve. Materials and Methods: This is a retrospective analysis of 52 cases operated between December 2006 and December 2012. Untreated autologous pericardium was used for creating a competent pulmonary valve following a transannular patch. They are followed for functional and structural assessment of the pulmonary valve by echocardiography. Positron emission tomography (PET) with 18 fluorodeoxyglucose was performed in two cases for profiling the pulmonary valve. Results: Median age was 10.5 years (1–38). The follow-up was complete for 42 (80.76%) patients for 3 years and 25 (48.07%) patients for 5 years. The RVOT gradient was 42 mmHg (16–96) in the year of surgery, which reduced to 26 mmHg (10–58) and pulmonary insufficiency that was present in 8.3% of patients in 1st year was witnessed in 22.7% in the 5th year of follow-up. The monocusp patch was successful in creating a competent valve while maintaining its structure at 3 years; however, it became distorted and retracted at 5 years of follow-up. There was no calcification in any of the patients. PET-computed tomography confirmed the uptake of glucose by monocusp at 1 year of follow-up. Conclusion: The untreated autologous pericardium functioned well when it was used to create a competent pulmonary valve at short term and midterm. Although it changed in its structure; there was no calcification at 5 years of follow-up.
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Background: Febrile illness in children is a common cause of admission to hospital globally, with significant associated morbidity and mortality. Dengue, malaria, scrub typhus, typhoid and leptospirosis have been identified as major causes of acute undifferentiated febrile illness in Thailand, Malaysia, and Nepal. Climate variation, over population and urbanization may all contribute to the emergence and reemergence of infections in tropical regions like Tamil Nadu. The objectives of this study were to describe the aetiology of fever in hospitalized neonatal and Pediatric population. A descriptive study was designed.Methods: A prospective observational study was conducted. All children from 0 to 18 years admitted as in-patients. Sample size was calculated to be 650. Basic laboratory tests were done in all cases.Results: Out of a total of 650 children maximum number (40.7% n=265) of patients had short duration of fever between 1 to 3 days. Majority (56%) of patients had temperature between 100.4 to 101F. Only 5 children were confirmed to have malaria. Maximum number of pus cells found was 80 to 100 in 3 children in urine examination. Total Infectious cases were 631 (97.07%).Conclusions: Infectious aetiology was more common than non-infectious aetiology. Among all aetiologies, viral fever particularly dengue was the most common aetiology. Enteric fever was the second most common infectious cause of fever after viral fever.' Short febrile illness (1 to 5 days) was the most common type of fever in children admitted in hospital. In neonates, the most common cause of fever was probable sepsis followed by dehydration fever.
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PURPOSE: The aim of this study was to evaluate safety and therapeutic efficacy of lutetium 177 prostate-specific membrane antigen (Lu-177-PSMA) in metastatic castration-resistant prostate cancer (mCRPC) patients with low performance status.METHODS: Twenty-two patients already treated with anti-androgens and docetaxel were enrolled for one cycle of Lu-177-PSMA therapy. Haemoglobin, total leukocyte counts, platelets and serum creatinine for toxicity profile while prostate specific antigen (PSA), Eastern Cooperative Oncology Group (ECOG) performance status, visual analogue scale (VAS) and analgesic quantification scale (AQS) for therapeutic efficacy were recorded pre and 8 weeks post therapy. Wilcoxon signed-rank and ANOVA tests were used for statistical analysis.RESULTS: Partial response (PR), stable disease (SD) and progressive disease (PD) for PSAwere seen in 5 (22.7%), 13 (59.1%) and 4 (18.2%) patients respectively treated with mean 6.88 GBq dose of Lu-177-PSMA. 8/22 (36.4%) patients showed ≥ 30% drop in PSA. Grade 3 haemoglobin toxicity was seen in 5/22 (22.7%) patients. No patient developed grade 4 haemoglobin toxicity. No patients had grade 3 or 4 leukocytopenia or thrombocytopenia. Wilcoxon signed-rank test showed statistical significant (P < 0.05) difference in pre and post treatment ECOG, VAS, and AQS scores. The ANOVA test showed statistically significant difference in mean doses of Lu-177-PSMA used in three PSA response groups while difference was non-significant for other variables.CONCLUSION: We concluded that Lu-177-PSMA therapy has adequate pain palliation in end-stage mCRPC patients with low performance status and it has a potential to become effective therapeutic option in properly selected patients.
Subject(s)
Humans , Creatinine , Leukocyte Count , Leukopenia , Lutetium , Membranes , Prostate , Prostate-Specific Antigen , Prostatic Neoplasms , ThrombocytopeniaABSTRACT
PURPOSE@#The aim of this study was to evaluate safety and therapeutic efficacy of lutetium 177 prostate-specific membrane antigen (Lu-177-PSMA) in metastatic castration-resistant prostate cancer (mCRPC) patients with low performance status.@*METHODS@#Twenty-two patients already treated with anti-androgens and docetaxel were enrolled for one cycle of Lu-177-PSMA therapy. Haemoglobin, total leukocyte counts, platelets and serum creatinine for toxicity profile while prostate specific antigen (PSA), Eastern Cooperative Oncology Group (ECOG) performance status, visual analogue scale (VAS) and analgesic quantification scale (AQS) for therapeutic efficacy were recorded pre and 8 weeks post therapy. Wilcoxon signed-rank and ANOVA tests were used for statistical analysis.@*RESULTS@#Partial response (PR), stable disease (SD) and progressive disease (PD) for PSAwere seen in 5 (22.7%), 13 (59.1%) and 4 (18.2%) patients respectively treated with mean 6.88 GBq dose of Lu-177-PSMA. 8/22 (36.4%) patients showed ≥ 30% drop in PSA. Grade 3 haemoglobin toxicity was seen in 5/22 (22.7%) patients. No patient developed grade 4 haemoglobin toxicity. No patients had grade 3 or 4 leukocytopenia or thrombocytopenia. Wilcoxon signed-rank test showed statistical significant (P < 0.05) difference in pre and post treatment ECOG, VAS, and AQS scores. The ANOVA test showed statistically significant difference in mean doses of Lu-177-PSMA used in three PSA response groups while difference was non-significant for other variables.@*CONCLUSION@#We concluded that Lu-177-PSMA therapy has adequate pain palliation in end-stage mCRPC patients with low performance status and it has a potential to become effective therapeutic option in properly selected patients.
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Rhinolith is defined as a mineralized mass resulting from calcification of an endogenous or exogenous nidus within the nasal cavity. A case of a 25 year old female with a history of unilateral nasal stuffiness and nasal bleed, which was clinically and radiologically diagnosed as rhinolith, is being reported here.
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This hospital-record review describes the clinical profile ofhypernatremic dehydration in neonates. 49 neonates (3.4% of thetotal admitted newborns) developed hypernatremic dehydrationbetween January 2014 and August 2015. The major presentingcomplaints were fever (34.6%), poor feeding (42.8%), loosestools (40.8%) and lethargy (26.5%). The mean (SD) time neededfor correction of hypernatremia was 38.6 (15.1) hours. Exclusivelybreastfed neonates had lesser complication rates ofhypernatremic dehydration.
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Invasive aspergillosis is a major concern in neutropenic patients.We studied the utility of Galactomannan antigen detection test inserum using ELISA technique for early detection of invasiveaspergillosis. Diagnostic accuracy of Galactomannan index (GMI)test was maximum at a cut-off of > 1.5 with a negative predictivevalue of more than 95%