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Rhino orbital Mucormycosis caused by filamentous fungus of mucoraceae family was considered a rare disease affecting immunocompromised and diabetics with ketoacidosis until the recent COVID 19 pandemic. We are presenting a series of six cases of Rhino orbital cerebral Mucormycosis with central retinal artery occlusion. All six cases had common history of COVID 19 infection in recent past with sinusitis, proptosis and total ophthalmoplegia with central retinal artery occlusion on presentation. MR imaging showed invasive pan sinusitis with orbital and cerebral involvement. Urgent debridement was done and histopathological examination showed broad, filamentous aseptate fungi suggestive of Mucormycosis. All patients inspite of intravenous Amphotericin B with local debridement did not show any improvement and expired within a week of presentation. Hence our study shows poor prognosis of post covid 19 associated Mucormycosis with central retinal artery occlusion.
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Background: Dyslipidemia is defined as the high-density lipoprotein and apolipoprotein A (apo A) levels <10th percentile and/or total cholesterol, triglycerides, low-density lipoprotein (LDL), apolipoprotein B, or Lipoprotein (a) levels more than the 90th percentile. Aim and Objectives: This study aimed to compare the efficacy and safety of the fixed-dose combination of Atorvastatin and Ezetimibe with Atorvastatin monotherapy among patients with dyslipidemia. Materials and Methods: The present study was a randomized, double-blinded, prospective, and parallel-group study. Ninety-two outpatients of age in between 18 and 70 years from the Department of General Medicine who attended the hospital for the treatment of dyslipidemia were selected as study participants. Among 92 patients, 12 patients did not meet the study criteria. The remaining 80 patients were divided into two treatment groups at random and under double-blind conditions (39 in Group A and 41 in Group B). Each patient in both groups was followed for a period of 4 weeks after initiation of therapy. Total cholesterol and LDL-cholesterol levels were recorded at day 1, 2 weeks, and 4 weeks of therapy. Results: In this study, by the end of the study period (4 weeks), tablet Atorvastatin + tablet Ezetimibe combination therapy showed statistical significance difference in reducing mean total cholesterol and mean serum LDL levels in dyslipidemia cases than the group receiving Atorvastatin monotherapy. Conclusion: Atorvastatin in combination with Ezetimibe was more efficacious than Atorvastatin monotherapy in reducing total blood cholesterol and serum LDL levels. Atorvastatin plus Ezetimibe is equally safer as Atorvastatin monotherapy and well tolerated with fewer adverse effects.
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Purpose: Aim of this study was to compare the efficacy of sodium hyaluronate (SH) and carboxymethyl cellulose (CMC) eye drops in treating mild to moderate dry eye disease in terms of relief of symptoms, mean change in tear film breakup time, Schirmer’s test, and impression cytology of conjunctiva from baseline. Methods: An observational study was carried out during a 2?year period in our tertiary referral hospital. The study consisted of 60 patients randomly allotted to two groups to receive SH and CMC eye drops for an 8?week period. Ocular surface disease index, tear film breakup time, and Schirmer’s test were performed at baseline visit and 4 and 8 weeks of treatment, and impression cytology of conjunctiva was performed at baseline and 8 weeks. Results: Significant improvement in patient symptoms, tear film breakup time, and Schirmer’s test from baseline was seen in both SH and CMC groups at 8 weeks posttreatment, whereas impression cytology of conjunctiva in both groups did not show significant improvement at 8 weeks of treatment. Data analysis using unpaired t?test showed comparable results. Conclusion: Both CMC and SH demonstrated equal efficacy in treating mild to moderate dry eye disease.
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We report a case of pyrexia of unknown origin (PUO) in a 19-year-old male, who was admitted with a history of pyrexia for 2 weeks. The diagnosis remained uncertain despite multiple investigations and the patient subsequently had various clinical manifestations similar to those seen in coronavirus disease 2019 (COVID-19). Since it was initially presumed to be pyrexia due to viral origin or enteric fever, patient was started on empirical treatment. The diagnosis of COVID-19 was confirmed by corroborating various biochemical markers that had a greater association with COVID-19. Patient was discharged after 21 days with empirical antibiotics, anticoagulants and other supportive medications. He required no further hospital admissions and has been on regular follow-up.
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The present study was conducted to assess the knowledge regarding causes and ill effects of household air pollution among residents of selected community in Kozhikode (Kerala). The research design adopted was non-experimental descriptive survey type. The sample was selected using non-probability convenience sampling technique. The data were collected using semi structured questionnaire to assess the knowledge regarding causes and ill effects of household air pollution among residents. The data was tabulated and analysed by descriptive and inferential statistics. The study revealed that majority of the samples (50%) had average knowledge regarding causes and ill effects of household air pollution and 31.7 percent had good knowledge, spiratory illness due to household air pollution.
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The clinical entity termed as long COVID has gained importance in the recent past. As this phenomenon is still evolving, it is important to document the magnitude of the syndrome during different time periods. This scoping review attempts to synthesize evidence generated from longitudinal studies which have follow‑up periods beyond 3 months, up to 12 months. The review also documents the reported prevalence of long COVID for the different regions of the World Health Organization. Longitudinal studies published till March 2022 were systematically searched on PubMed, Google Scholar, and medRxiv. Among the identified 594 studies, 48 were included in this review. Data from selected studies were synthesized. The overall pooled prevalence of long COVID was 49% (40%–58%). The pooled estimates after 3 months, 4–6 months, 7–9 months, and 10–12 months were 44% (32%–57%), 50% (43%–57%), 49% (37%–62%), and 54% (46%–62%), respectively. Eastern Mediterranean Region (EMR) had the highest pooled prevalence of 63% (34%–92%] and the South East Asian Region (SEAR) had the least pooled estimate of 15% (10%–21%). The study brings out the high prevalence of long COVID even after 12 months of follow‑up. It also shows the regional differences in the reported prevalence of the syndrome. This review highlights the need for well‑planned follow‑up studies, especially in developing nations to understand the magnitude and the pattern of long COVID‑related symptoms as they emerge.
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BACKGROUND Persistence of symptoms following Covid-19 infection has now been recognized as an upcoming public health crisis. Understanding these persistent symptoms and quantifying them is vital in planning care for these patients. Studies from India estimating the magnitude of these persistent symptoms are scarce. We aimed to estimate the proportion of symptoms that persist among patients who have recovered from Covid-19 infection. METHODS We conducted this descriptive study among 114 individuals after they recovered from Covid-19 infection. Participants diagnosed as Covid-positive at a tertiary care centre were included in the study. Data were collected from the participants through an online platform. Frequency and proportion of various persistent symptoms were estimated. Analysis was done using SPSS version 16. RESULTS The mean (SD) age of the study participants was 35.5 (15.7) years. Women comprised 62.3% (n=71) of the population. Persistent symptoms were reported by 66 (57.9%; 95% CI 53.07–62.72) participants. The most common symptoms reported were fatigue (n=45, 39.5%) and joint pain (n=23, 20.2%). Those who required hospitalization for longer duration were found to be more associated with having persistent symptoms (p=0.018). CONCLUSION A sizable proportion of individuals had persistent symptoms after recovering from Covid-19 infection. Health facilities should be equipped to address these emerging issues.
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Edward’s syndrome is a genetic disorder characterized by Trisomy 18. Incidence of Edward syndrome is reported to be around 1 in 3500 to 7000. It is known to be second most common Trisomy after Down’s syndrome (Trisomy 21). It is noted to be more common in girls than in boys in ratio 3:1. But here we report the autopsy report of male foetus. Trisomy 18 has multisystem involvement. Cardiovascular system is most commonly involved, followed by extremities, Urinary system, Head and Neck, Gastrointestinal tract and genitals. There are 3 types of Trisomy 18- Full, Partial and Mosaic type. The most common type is Full Trisomy 18, accounting for about 95% of cases. In Full Trisomy 18, every cell of the body has extra chromosome 18. Both Partial and Mosaic type of Trisomy 18 are very rare, In Partial Trisomy 18, each cell has two copies of chromosome 18 plus a segment of extra material from chromosome 18. In Mosaic Trisomy 18, the extra chromosome is present in some of the cells of the body.1In our case we have used Quantitative fluorescent polymerase chain reaction (QF-PCR) to detect Trisomy 18. It has entered the field of prenatal diagnosis to overcome the need to culture foetal cells, hence to allow rapid diagnosis of some selected chromosomal anomalies like aneuploidy in chromosomes 13, 18, 21, X and Y. QF-PCR is feasible on fewer cells, and since the analysis can easily be automated, many samples can be processed at the same time and the whole process taking around 30 min. QF-PCR is based on the amplification of chromosome-specific DNA sequences (STR, short tandem repeats) polymorphic in length between subjects. By means of fluorescent primers, the amplified segments can be visualized and quantified as peakareas on automated DNA scanners. Normal heterozygous subjects are expected to show two peak areas (peaks ratio 1:1) for each chromosome analysed, while trisomies are visualized either as an extra peak (triallelic subjects) or as a 2:1 ratio peak between the two areas.2,3
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Retention, stability and support are the most fundamental and basic principles on which the success of an entire denture relies on. However this factor is often compromised in cases of resorption. Residual ridge resorption is the reduction in size of the bony ridge under the mucoperiosteum. The rate of resorption in mandibular arch is at an increased rate as compared to the maxillary arch; but severely atrophic maxillae with large inter-ridge distance often pose a clinical challenge during fabrication of a successful maxillary complete denture because of the increased weight of the denture, retention is compromised. The present article describes a case of a completely edentulous patient who was successfully rehabilitated with a hollow denture where a simple and deviceful technique of fabricating a light-weight maxillary denture. The present article describes a case of a completely edentulous patient who was successfully rehabilitated with a hollow denture where a simple and deviceful technique of fabricating a light-weight maxillary denture was used using the hollow tubing of salivary ejector apparatus to bring the uniform hollowness.
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BACKGROUND The cornerstone therapy for respiratory diseases is drugs for inhalation. Effectiveness of inhalers can be influenced by factors such as gender, age, educational status, and type of inhaler used and correct inhalation technique. The aim of this study is to provide information about common errors in technique that occur during inhalation.METHODSMale and female patients who met the inclusion criteria (age 18 - 80) years, using inhalers particularly MDI and DPI were included in the study. The study patients were asked to perform inhalation technique and the errors in technique that occur during inhalation were recorded. The sample size was 150 and duration of study was 6 months.RESULTSThe common errors during the use of inhalers included, no exhalation before inhalation, no breath hold, and absence of proper washing of mouth after inhalation. Among the 86 MDI users, no exhalation before inhalation (n=50), no breath hold (n=35) and absence of proper washing of mouth after inhalation (n=21). For the 64 patients using DPI, no exhalation before inhalation (n=68), no breath hold (n=51) and absence of proper washing of mouth after inhalation (n=35).
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Background: Hepatitis B virus is transmitted by body fluids, such as blood and serum. Sexual transmission, vertical transmission, and unsafe injections, including intravenous drug use, are the most common routes of infection for Hepatitis B infection. Medical students have a very important role in preventing the disease by improving the disease knowledge among themselves and the patients they will eventually treat.Methods: A cross sectional study was conducted to assess the KAP among medical students of the first three academic years regarding hepatitis B virus infection. The sample size was 222 students. Data were collected from 230 students using a semi structured questionnaire and analyzed using SPSS v20.Results: Among 230 medical students, 79.1% students had good knowledge about hepatitis B whereas 84.3% of the respondents had the right attitude towards hepatitis B. The practice component was low with only 44.8% of the respondents having correct practice regarding hepatitis B infection.Conclusions: Although the knowledge and attitude regarding hepatitis B infection is high, the practice levels are low indicating the need to encourage proper practices among the medical students.
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Background: The aim of the study was to evaluate average age of menarche, the pattern and types of menstrual disorders and their relation with BMI, dietary habits, physical exercise and stress.Methods: A cross sectional prospective study was conducted on female medical students during the academic year 2018-2019 at Mallareddy medical college for women, Suraram, Hyderabad, India. The various life style factors including BMI, junk food consumption and physical exercise were factored. Prevalence of each different menstrual abnormality were identified and analyzed by Chi-squire test and p value <0.005 was considered as statistically significant.Results: Study included 255 medical students who had attained menarche without known medical problems. Mean age of menarche was 12.81years. The most frequent menstrual disorders were premenstrual syndrome 192 (75 %), dysmenorrhoea 146 (57 %), and irregular cycle 97(38%). Statistically significant association of Body mass index (BMI) related to premenstrual syndrome (PMS) and dysmenorrhoea was reported (both p<0.05). Similarly, statistically significant association of lack of physical activity had greater risk of premenstrual syndrome and dysmenorrhoea (both p<0.0001). Unhealthy dietary patterns had statistically significant higher risk for dysmenorrhoea (p<0.0001).Conclusions: In conclusion premenstrual symptoms, dysmenorrhoea and menstrual irregularities were more prevalent. Majority of symptoms were stress, pain abdomen, irritability, mood swings. Comprehensive education programs on lifestyle modifications like regular physical activities, promoting healthy eating habits should be emphasised to prevent menstrual abnormalities of young students as early as at school level.
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Background: The central features of schizophrenia are cognitive impairments and are related to functional status and other aspects of the illness. Aim: The aim of the study was to compare the neurocognitive deficits in patients with bipolar disorder and schizophrenia. Materials and methods: 50 Schizophrenia patients and 50 Bipolar Disorder patients who were diagnosed as per ICD-10 attending the OPD of Santhiram Medical College and General Hospital, Nandyal were included in the study. Results: The current study measured phonemic fluency using controlled oral word association test, category fluency using animal names test and working memory using N-Back tests (verbal and visual) and the patients with BPAD performed better than schizophrenia patients. The pattern of similarity varied between the two groups in that more number of BPAD patients were able to tell words in the higher ranges and more number of schizophrenia patients were able to tell words in the lower ranges. On N-Back tests the patients with schizophrenia consistently performed poorer than bipolar disorder patients in the higher ranges of performance as shown by the results of both verbal and visual 1-back and 2-back tests hits and errors where the patients with bipolar disorder produced more hits and less errors than the patients with schizophrenia. The mean values showed that patients D. Ravi Kiran, N. Kavitha Prassana, A. Sreelakshmi Latha, C. Gowtham Reddy. Comparative study of neurocognitive deficits in bipolar disorder and schizophrenia. IAIM, 2019; 6(3): 291-299. Page 292 with bipolar disorder produced more hits and less errors than the patients with schizophrenia. On the domain of executive functions, BPAD patients were performing better than schizophrenia patients on all tests with statistically significant differences on N-back tests and statistically no significant differences on Controlled oral word association and Animal names tests. Conclusion: The pattern of non-significant differences between the two disorders followed a trend, which suggests that patients with BPAD were performing better than those with schizophrenia.
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Background and Objectives: Attention deficit hyperactivity disorder (ADHD) is a common childhooddisorder which impairs multiple domains of life. The aim is to study and compare the impact of ADHD andAsthma on Quality of Life (QoL) as measured by child and parent ratings and explore the relationshipbetween QoL and socio – demographic factors, illness variables, severity of symptoms and parenting styles.Methods: Study conducted was of cross sectional design at the outpatient services of a tertiary care hospital.60 children of 8 - 18 years, on treatment (and their parent) were recruited - 30 with ADHD and 30 withAsthma. PedsQL version 4.0 child and parent proxy report was used for QoL, ADHD – RS (ADHD RatingScale) and GINA (Global Initiative for Asthma) guidelines for severity and Parenting PracticesQuestionnaire for parenting stylesResults: Parent and child ratings of QoL in both groups were similar. QoL of Asthma group was worse inPhysical domain, while psychosocial domains and overall QoL were worse in ADHD group. Increasedduration and severity of illness showed reduction in QoL, while treatment showed better QoL in ADHDgroup only. Parenting style had significant impact on QoL in the ADHD group alone.Conclusion: ADHD is a childhood disorder with disability comparable to a physical illness like Asthma.QoL of the child can be significantly improved by treatment and focus on parenting styles.
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A solitary fibrous tumour (SFT) is an unusual spindle cell neoplasm that usually occurs in the pleura but has recently been described in diverse extrapleural sites. Urogenital localisation is rare, and to our knowledge, only 82 cases of SFT of the kidney have been described. Although SFT of the kidney is extremely rare, this tumour must be included in the differential diagnosis, whenever a renal tumour consisting of mesenchymal elements is encountered. We report a case of a large SFT of the left kidney which was clinically and radiologically thought to be a renal cell carcinoma, and a final diagnosis was made after immunohistochemical study.
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Papillary serous carcinomas of testis are very rare, and only case reports have been reported in the literature. These neoplasms are characterised histologically by papillary fronds and numerous psammoma bodies and exhibit immunoreactivity for markers of ovarian serous carcinomas. These are very aggressive and are both chemo and radioresistant with surgery remained the main stay of management.
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Adenoid cystic carcinoma (ACC) is an uncommon tumour usually arise in the head and neck region mainly in the salivary gland and rare in the nose and para-nasal sinuses (PNS). We report a rare case of 35-year-old male with ACC of PNS who presented with nasal obstruction and nasal discharge. The CT PNS and orbits show illdefined minimally enhancing soft tissue density lesion extending into buccinators fossa, PNS, nasal cavity with adjacent bony destruction. Surgical incision was done and biopsy revealed ACC. Radiotherapy was given and regular follow-up done. The ACC of sinonasal cavities has poor prognosis, high recurrence due to peri-neural invasion. Multimodality treatment is the mainstay of ACC
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Materials and methods Retrospective study for period of 2 years was conducted. For this study, we reviewed bone marrow material along with nodal and extranodal tissues. There were 16 cases of mantle cell lymphoma (MCL). Each patient had an absolute lymphocyte count of more than 10 × 109/l at the time of initial evaluation at our institution. Giemsa stained peripheral blood and bone marrow aspirate smears were reviewed, along with haematoxylin-eosin-stained histologic sections of bone marrow aspiration and core biopsy specimens. The immuno-phenotype of the neoplastic cells supported the diagnosis of MCL. The clinical and pathological spectrum will be discussed. Immuno-histochemistry Immuno-histochemical staining for CD3, CD20, CD23, CD1O, KI67 CYCLIN D1 were performed on formalin-fixed, paraffin-embedded tissue sections of either bone marrow aspirate or core biopsy tissue sections in all 16 cases. Results There were 11 men and 5 women with a median age of 68 years (range, 40–74 years). Physical examination revealed splenomegaly in 15 out of 16 patients. Lymphadenopathy involving multiple sites was present in 10 patients. Conclusion MCL can exhibit a wide spectrum of morphologic findings. We suggest that cell size and chromatin characteristics are useful for dividing these cases into two groups: small cell and large/blastoid. The large/blastoid group predicts poorer prognosis and includes cases with large cells, many of which are nucleolated and resemble prolymphocytes, as well as blastoid cells that resemble lymphoblasts. In this study, a cut-off of at least 20% large/blastoid cells best predicted poorer survival.
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Virechana (therapeutic purgation) is a common procedure that is widely practiced among the panchakarma treatments (pentad treatments). Various Virechaka dravyas (purgative drugs) have been described for Virechana. Even after critical analysis of Virechaka dravyas in the literature, still there is difficulty in the fixation of dose. Hence, the retrospective analysis of varied outcomes of Virechana with Danti (Baliospermum montanum) avaleha (linctus) is discussed in this paper. The study included twenty‑seven case reports of patients who were administered Virechana with Danti avaleha. These case reports are of patients suffering from various ailments such as irregular menstrual cycles, polycystic ovarian syndrome, primary and secondary infertility, and psoriasis. Danti avaleha was administered at dose of 10 g and 5 g in the Krura (~strong) and Madhyama (~moderate/normal) Koshta (~GI tract) patients, respectively. Among seven Krura koshta patients, three of them resulted with Pravara (excellent) Shuddhi and other four resulted with Madhyama (medium) Shuddhi. In twenty Madhyama koshta patients, sixteen of them resulted with avara (minimum) Shuddhi and remaining four patients resulted with Madhyama shuddhi. Complications like Udara shoola (spasmodic pain of abdomen) and Vamana (emesis) were observed during Virechana. Majority of the patients suffered with Udara shoola were of Madhyama koshta. Vamana was seen in both Krura and Madhyama koshta patients. Irrespective of the type of Shuddhi and complications, all the patients resulted with Samyak Kaphaantiki Virikta lakshana (signs of perfect purgation with end expulsion of Kapha). The study concluded that the Krura koshta patients were tolerable for dose of 10 g and are expected to attain Pravara Shuddhi. Whereas Madhyama koshta patients were intolerable even to mild dose of 5 g, producing Avara shuddhi.
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Background. Tobacco has long been identified as one of the most hazardous risk factors detrimental to health. To plan and implement anti-tobacco activities in any community, it is necessary to understand the risk it poses in that setting. We assessed the risk of mortality associated with tobacco use in a rural community of Kerala. Methods. This cohort study (PROLIFE) was done in Varkkala, a rural development block of Thiruvananthapuram district of Kerala. Adults aged 20 years and above were included. Age-adjusted mortality rates were computed for both users and non-users of tobacco. The risk of mortality was plotted using Kaplan–Meier curves. Cox regression was used to compute the age-adjusted hazard ratio of mortality among tobacco users. Results. More than one-fourth of the study population used tobacco. The age-adjusted mortality rates were higher among tobacco users. The major causes of death among both users and non-users of tobacco were similar. The incidence proportion of death among all causes of death was higher for tobacco users. The hazard of mortality was significantly more among tobacco users, with the age-adjusted hazard ratio being 1.225 (1.140–1.315). Conclusion. The mortality risk due to tobacco use is high irrespective of the cause of death.