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To gain insights on the diverse practice patterns and treatment pathways for prostate cancer (PC) in India, the Urological Cancer Foundation convened the first Indian survey to discuss all aspects of PC, with the objective of guiding clinicians on optimizing management in PC. A modified Delphi method was used, wherein a multidisciplinary panel of oncologists treating PC across India developed a questionnaire related to screening, diagnosis and management of early, locally advanced and metastatic PC and participated in a web朾ased survey (WBS) (n = 62). An expert committee meeting (CM) (n = 48, subset from WBS) reviewed the ambiguous questions for better comprehension and reanalyzed the evidence to establish a revote for specific questions. The threshold for strong agreement and agreement was ?90% and ?75% agreement, respectively. Sixty?two questions were answered in the WBS; in the CM 31 questions were revoted and 4 questions were added. The panelists selected answers based on their best opinion and closest to their practice strategy, not considering financial constraints and access challenges. Of the 66 questions, strong agreement was reached for 17 questions and agreement was achieved for 22 questions. There were heterogeneous responses for 27 questions indicative of variegated management approaches. This is one of the first Indian survey, documenting the diverse clinical practice patterns in the management of PC in India. It aims to provide guidance in the face of technological advances, resource constraints and sparse high?level evidence.
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FNAC (Fine Needle Aspiration Cytology) is an essential tool in the preoperative diagnosis and preoperative planning for surgery of solitary thyroid nodules. It is a cost effective procedure that provides specific diagnosis rapidly with minimal complication. The purpose of the study was to evaluate the accuracy of Fine Needle Aspiration Cytology as a diagnostic tool in detecting malignancy in case of solitary thyroid nodule by correlating the preoperative fine needle aspiration cytology (USG Guided) findings with post-operative histopathology findings of the excised specimen in a sub Himalayan tertiary medical college & hospital.METHODSIt was a cross sectional hospital based study conducted on 30 patients in the period from April 2015 to March 2016 after acceptance from West Bengal University of Health Sciences and approval from ethical committee. All admitted patients having solitary thyroid nodule (confirmed clinically & ultrasonographically), biochemically euthyroid and giving consent for surgery were included in this study. Patients who are medically unfit for surgery, biochemically hypo- or hyper-thyroid and not giving consent for surgery were excluded from the study.RESULTSThe sensitivity, specificity, accuracy, positive predictive value and negative predictive value of FNAC for diagnosis of neoplastic solitary thyroid nodule were 75%, 94.44%, 86.67%, 90% and 85%. Commonest malignancy detected was papillary carcinoma in 9 patients.CONCLUSIONSIt is evident from our study that USG guided FNAC should be regarded as the investigation of choice and first line investigation in evaluation of cases with solitary thyroid nodule due to its simplicity, high diagnostic accuracy, easy to perform procedure and absence of significant complications.
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Background: The aim of the study was to study the socio-demographic factors in cases of pregnancy induced hypertension and its associated risk factors in a tertiary care hospital.Methods: The present retrospective study was conducted in the obstetrics and gynecology department of Shrimati Heera Kunwar Baa Memorial Hospital, Jhalawar, Rajasthan from December 2018 to November 2019. A total of 80 cases of pregnant women with PIH were studied. The socio-demographic data like age, parity, gestational age of presentation, mode of delivery, maternal and perinatal complications were noted from the hospital records and studied.Results: The incidence of PIH was found to be 8.16% in pregnant women attending the SHKBM Hospital. Majority of the study subjects were rural dweller (70%). A higher incidence of PIH was found among illiterate women (51.25%). 53.75% cases were in the age group of 25-30 years and 25% were in the age group of 19-24 years. In the present study, incidence of PIH was found to be highest among primigravidas (67.50%) as compared to multigravidas (32.5%). Most cases were delivered by caesarean section (73.75%) and 26.25% were delivered vaginally. Out of 80 cases, 16.25% of cases were complicated by eclampsia, Severe PIH in 12.5%, abruptio placentae in 2.5% and HELLP Syndrome in 1.25% cases.Conclusions: PIH is a very common complication encountered in pregnancy associated with adverse maternal and fetal outcome. The risk is higher among young primigravidas and in rural population. Better health care facilities and awareness among the pregnant women will help in reducing the incidence of PIH and its associated complications.
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Background: The most commonly used light sources in the conventional phototherapy units are compact fluorescent lamp (CFL), halogen spotlights and fiberoptic blankets. Recently light emitting diodes (LED) has emerged as better light source for phototherapy and almost replacing all the available conventional light sources. Comparative studies on the efficacy of LED versus conventional phototherapy are limited from India. That is why; this study was undertaken.Methods: 48 neonates of ≥35 weeks gestational age with hyperbilirubinemia were participated in this study. Among them, 24 neonates received conventional phototherapy and rest of them received LED phototherapy. The rate of fall of bilirubin levels at 6 hours and at completion along with total duration of phototherapy in both groups was measured. Results analysed by standard statistical methods.Results: LED phototherapy units showed higher rate of fall in bilirubin at six hrs (LED group: 0.38±0.05 mg/dl/hr versus conventional group: 0.30±0.04 mg/dl/hr, p<0.05) and after completion of therapy (LED group: 0.32±0.03 mg/dl/hr versus conventional group: 0.26±0.03 mg/dl/hr, p<0.05) compared to conventional group. Significant difference was documented in total duration of phototherapy in LED group (30.8±1.8 hours) when compared to conventional group (34.6±0.7 hours). None of the neonate showed phototherapy failure. Side effects were minimal and comparable in both the groups.Conclusions: The LED phototherapy units are more efficacious in terms of higher rate of fall of bilirubin levels and lesser duration of phototherapy compared to conventional phototherapy units.
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Background: Ectopic pregnancy is an obstetric emergency with high morbidity and mortality. Incidence of ectopic pregnancies has been increasing in last two to three decades with reduction in mortality. The presenting symptoms include irregular vaginal bleeding. The present study was undertaken to study the clinical features of ectopic pregnancies in a tertiary care hospital.Methods: The present study on ectopic pregnancies was carried out in department of obstetrics and gynaecology, jhalawar medical college, Jhalawar, Rajasthan, India from January 2019 to October 2019. All patients admitted with diagnosis of ectopic pregnancy, either ruptured or unruptured where included in the study.Results: Total 52 patient of ectopic pregnancy were studies. Majority (63.46%) of patients belong to the age group 21-30 years. Ectopic pregnancy was most commonly noted in nulliparous woman (44.23%) Majority of the case (31%) had no risk factors among remaining (34.61%), previous MTP (17%), (17-30%) previous ectopic (9%) and PID (15-38%) were identified risk factors. Ampulla (75%) was the most common site for ectopic pregnancy. 57% of the cases were on the right side. The common presenting complaints were pain in abdomen (81%) bleeding/ spotting per vaginal (42%). There was no mortality.Conclusions: Surgical treatment was done more often because of patients reporting late to the hospital screening of high-risk case, early diagnosis and early intervention reduce the morbidity and mortality in ectopic pregnancies.
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Rosai-Dorfman disease, previously known as sinus histiocytosis with massive lymphadenopathy (SHML) is one of the rare benign idiopathic proliferative diseases of phagocytic histiocytes. Majority of the patients present with painless massive cervical lymphadenopathy but intrathoracic involvement is rarely reported. Here, we report the case of a 57-year-old male with a history of chest pain, shortness of breath and generalized weakness of two-month duration. The diagnosis was formed by core biopsy of the axillary lymph node with typical emperipolesis and Immunohistochemistry markers
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Stem gall (Protomyces macrosporus Unger), a serious disease that affects leaves, petioles, stems and fruits of coriander (Coriandrum sativum L.) causing heavy loss in yield. Genetic improvement of coriander for stem gall disease is indispensable. Coriander cultivars of stem gall resistance (ACr-1) and susceptible (CS-6) leaf samples were utilized and transcriptome sequenced using Illumina NextSeq500 platform. After trimming low-quality reads and adapter sequences, a total of 49,163,108 and 43,746,120 high-quality reads were retained and further assembly resulted validated transcripts of 59,933 and 56,861. We have predicted 52,506 and 48,858 coding sequences (CDS) of which 50,506 and 46,945 were annotated using NCBInr database. Gene ontology analysis annotated 19,099 and 17,625 terms; pathway analysis obtained 24 different functional pathway categories; signal transduction, transport, catabolism, translation and carbohydrate metabolism pathways etc. were dominated. Differentially expressed genes analysis predicted 13,123 CDS commonly expressed of which 431 and 400 genes were significantly upregulated and downregulated, respectively, in which Rgenes, stress inducible transcription factors such as ERF, NAC, bZIP, MYB, DREB and WRKY and antifungal related genes were predicted. The real-time PCR analysis of HSP20 gene expression in resistance showed upregulation by 10-fold over susceptible sample and 18s used as a housekeeping gene for normalization. The present results provide an insights into various aspects underlying the development of resistance to stem gall in coriander.
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Primary breast lymphoma is one of the rare tumors that commonly presents as a lump with <0.5% incidence rate. It may be misdiagnosed as poorly differentiated carcinoma on routine fine-needle aspiration cytology. With appropriate treatment, this breast malignancy has a relatively better prognosis. Here, we report the case of a mammary T-cell rich B-cell non-Hodgkin lymphoma in a pre-menopausal woman diagnosed by biopsy and later confirmed by immunohistochemistry.
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Background: Acute respiratory tract infections and otitis media (RTI/OM) are frequent among children and are commonly treated with antibiotics. In randomised trials, antibiotics have only small or negligible short-term effects on OM and RTI such as pharyngitis, bronchitis, laryngitis, and common cold, comparable to their side-effect potential. Aim of the study: To assess efficacy of Anthroposophic and Conventional Treatment with Antibiotics in Children with acute respiratory or ear infections. Methods: The study was conducted in the department of Department of Pediatrics and Department of General Medicine of the Mahatma Gandhi Hospital, Bhilwara, Rajasthan, India. For the study, we selected patients reporting to OPD of the pediatric clinic with chief complaint of sore throat, cough, or ear pain and onset within 7 days. A total of 60 patients were included in the study. Results: A total of 60 patients participated in the study. Number of male patients in Group A was 13 and in Group C was 17. On comparing the results, statistically significant results were observed with respect to response on Day 7, response on Day 14, recovery on Day 7 and on 14th. Conclusion: The rate of improvement of symptoms and rate of recovery with Anthroposophic treatment for acute respiratory infections and ear infections is significant and it should be encouraged in pediatric patients.
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Background: Hypomagnesemia has been associated with type 2 diabetic mellitus and is known to be a risk factor for microvascular complications. This study aimed to evaluate serum magnesium levels in patients with type 2 DM and correlate them with microvascular complications. Materials & Methods: A hospital based cross-sectional study was conducted on150 patients with type 2 diabetes mellitus were admitted in the Mahatma Gandhi Hospital, Bhilwara, Rajasthan, India. Serum magnesium levels were assessed in all the diabetic patients and they were also tested for presence of microvascular complications. Results: In the present study majority of the patients (71.33%) were males and male to female ratio was 2.48:1. The commonest age group was > 60 years (50%) and the mean age was 60.38 ± 10.81 years. The duration of diabetes in 45.33% of the patients was between 6 to 10 years and mean duration was 7.43 ± 4.11 years. Hypomagnesemia was associated with microvascular complications including diabetic retinopathy, diabetic nephropathy and diabetic neuropathy (p<0.050). Also, association was found between serum magnesium levels glycaemic control and duration of diabetes (p<0.050). Conclusion: Hypomagnesemia is widely prevalent in patients with type 2 diabetes mellitus and a major risk factor for the development microvascular complications that is, diabetic retinopathy, nephropathy and neuropathy. Key words: Hypomagnesemia, Diabetic nephropathy, Diabetic neuropathy, Diabetic retinopathy, Microvascular complications, Type 2 diabetes mellitus
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Minimally invasive cardiac surgery is establishing itself as the standard of care across the world. MICS CABG is currently performed in only a few centers. Hemodynamics disturbances are peculiar during MICS CABG due to space constraints. We report a 70‑year‑old man who underwent MICS CABG who developed tension pneumothorax during revascularization that was diagnosed in a novel way.
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Minimally invasive cardiac surgery/coronary artery bypass grafting (MICS CABG) is performed through a small 2 inch left thoracotomy incision. Lung isolation is must during MICS CABG. Oxygenation with one‑lung ventilation can be difficult, especially during supine position. We report a case of a 53‑year‑old male patient who underwent MICS CABG with the selective lobar blockade.
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Background: Acute toxic leukoencephalopathy following intrathecal methotrexate administration is well documented but intracranial haemorrhage is extremely rare. Case Characteristics: A 2½-year-old girl with acute lymphoblastic leukemia developed sudden onset neurological deterioration following intrathecal methotrexate. Observations: Computed tomography scan of brain demonstrated intraventricular and subarachnoid hemorrhage. Outcome: Child improved gradually on conservative management. Follow-up neuroimaging showed resolution of hemorrhage. Message: Intracranial haemorrhage is a rare but serious complication of intrathecal methotrexate.
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Background: Association between Joubert Syndrome and Hirschsprung disease is rare. Case characteristics: A 9-month-old girl having developmental delay and chronic constipation. Observation: Molar tooth sign on MRI brain and absence of ganglion cells in rectal biopsy specimen. Outcome: Child underwent surgical repair for Hirschsprung disease. Message: Association of these two rare entities could be explained by ciliopathy.
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Acute Disseminated Encephalomyelitis [ADEM] is a multifocal, monophasic, acute demyelinating disease of the brain and spinal cord, which is commonly preceded by viral infections and occasionally bacterial infections or immunizations. Its occurrence following malarial infection, especially Plasmodium vivax Malaria is very uncommon. We report an 11-year girl who presented with clinical features of encephalopathy and generalized convulsions, 10 days following complete recovery from the Plasmodium vivax Malaria. Diagnosis of ADEM as a complication of Plasmodium vivax Malaria was made based on acute onset of neurological events, characteristic findings on Magnetic Resonance Imaging [MRI] of brain and prompt response to corticosteroid therapy. Follow-up MRI, 6 months after discharge, showed complete resolution of change found on the initial MRI. To the best of our knowledge, only two such cases have been reported in the English literature till date
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Background: Incidence of intracerebral hemorrhage in patients with tuberous sclerosis is rare, and in most of the cases it is associated with either underlying cerebrovascular malformation or hemorrhage into the subependymal giant cell astrocytoma. Case characteristics: A 2-year-old boy presented with a hemorrhagic stroke, and subsequently diagnosed as a case of tuberous sclerosis. Observation: Detailed work-up for stroke did not reveal any definite etiology. Outcome: Weakness gradually improved. Follow-up neuroimaging showed resolution of hemorrhage. Message: Clinician must be aware regarding this rare presentation of tuberous sclerosis.