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Abstract Submitral left ventricular aneurysm is a rare cardiac pathology with very few cases reported in the literature. These are nonischemic aneurysms mostly reported from Africa. Patients with submitral aneurysm exhibit varied clinical manifestations. We report a case of calcified submitral aneurysm and its successful surgical management through a transaneurysmal approach.
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Humans , Male , Middle Aged , Heart Aneurysm/surgery , Heart Aneurysm/diagnostic imaging , Heart Ventricles/surgery , Heart Ventricles/diagnostic imaging , Pericardium/transplantation , Calcinosis/diagnostic imaging , Echocardiography , Tomography, X-Ray Computed , Cardiac Surgical Procedures/methodsABSTRACT
Background: Marfan syndrome (MS) is inherited autosomal dominant connective tissue disorder caused by mutations in the FBN1 gene encoding fibrillin-1. Aortic dilatation is present in about 80% patients with MS and is the major cause of premature mortality. The objective of our study was to determine the effect of beta-blockers on aortic root growth rate in patients with MS. Methods: We performed a systematic review of all randomized controlled trials and prospective cohort studies that evaluated the efficacy of beta-blockers in patients with MS. The primary outcome of the study was aortic root growth rate. Secondary outcome was composite of death, aortic regurgitation, congestive heart failure, aortic dissection or cardiovascular surgery. Results: Five prospective trials were identified with similar comparable groups, with a total of 243 patients. In our study mean patient age was 12 years with a mean follow-up 86.5 months. There was a significant reduction in aortic root growth rate (SMD -0.86, 95% CI -1.23 to -0.48, p <0.001) with the use of beta-blockers. No significant difference was observed in secondary outcomes in the beta-blocker group as compared to placebo (OR = 1.80, 95% CI 0.21-15.53). Conclusion: Beta-blockers were associated with a significant reduction in aortic root growth rate with reduction in morbidity and mortality.
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Background: Role of immunosuppression treatment in patients with inflammatory dilated cardiomyopathy is controversial. The aim of this review is to summarize current evidence for immunosuppressive therapy in inflammatory cardiomyopathy. Methods: A systematic literature search was performed using PubMed, Embase and MELDINE to identify trials comparing immunosuppressive therapy with either placebo or conventional medical therapy in adult patients with inflammatory cardiomyopathy. Combined primary outcome in our study was all cause mortality and heart transplantation. Secondary outcomes included improvement in left ventricular ejection fraction (LVEF) and left ventricular end diastolic dimension (LVEDD). Results: Five randomized controlled trials (RCTs) were identified and four trials with similar comparable groups, with a total of 359 adult patients were included for analysis. Pooled data demonstrated no reduction in all-cause mortality and heart transplantation amongst the immunosuppression or the placebo arm (OR 0.98, 95% CI 0.48-1.98). There was a significant improvement in LVEF (1.34%, 95% CI 0.37-2.30) in patients treated with immunosuppressive medications, however no difference was observed in LVEDD [-0.11mm (95% CI -1.92 – 1.71)] in the treatment arm. Conclusion: There was no survival benefit or reduction in heart transplantation events with a significant improvement in LVEF in inflammatory cardiomyopathy patients treated with immunosuppression therapy.
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Background: The discovery of Helicobacter pylori infection in etiology of peptic ulcer disease and proton pump inhibitors (PPI) in management of upper gastrointestinal diseases had been the milestones in medical science. PPI are currently being both overused and misused. In countries like India, where over 500 branded formulations of PPI are available, probability of misuse and abuse increases exponentially. The aim of the study was to find out inappropriate use of PPI, among hospitalized patients.Methods: In order to find answer to the research question a cross sectional study was conducted in indoor patient of a tertiary care private hospital at Jaipur, Rajasthan. Patients of either sex, aged 18 years or above belonging to rural and urban communities were participating in study. The sample size was 500.Results: It was noted that Inappropriate PPI use was observed in most of the hospital admitted patients (78%). Most common diagnosis among inappropriate PPI use was dengue fever (due to increased number of dengue cases during study period), followed by cerebrovascular accidents and urinary tract infection. Most common indication for appropriate PPI use was stress ulcer prophylaxis, again in dengue case (due to cardinal manifestation of thrombocytopenia).Conclusions: Almost all patients were once prescribed PPI after admission and discharged on PPI (99.2%). Thus, we recommend evidence-based prescription of PPI, to reduce side effects and excess cost.
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To analyse the effect of sexed semen on different breeds used in artificial insemination following study was conducted using sexed semen from seven different breeds for artificial insemination in females. All bulls used for sexing by ABS India were genomically tested for Holstein and Jersey breeds. A total of 3034 inseminations with Sexcel were performed with 2589 inseminations in dairy cows and 445 in buffaloes. The conception rate of sexed semen using confirmative pregnancy diagnosis (using peri rectal examination) at 90 days post insemination both in cows and buffaloes was recorded. Sex of the calf was recorded after the birth in each case. The results of conception rate (CR) and pregnancy rate evaluation in different breeds were recorded. The results revealed the average conception rate of Sexcel semen is 49.1% (ranging from 45.1 to 55.3%) in cows and 42.7 % in buffaloes. These figures show a cumulative picture wherein sexed semen was used in animals of different parities (Both primiparous and pluriparous). The current study provides ample insights into the conception rate using sexed semen under various agro climatic conditions in different breeds. The study showed that sexed semen gives good conception in animals of one to three parities provided they are reproductively clean and possess good fertility
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Cortical blindness is a rare form of blindness characterized by the normal anterior visual afferent system. Cerebrovascular diseases, tumor involving bilateral occipital lobe, cardiac surgery or cerebral angiography are common causes for cortical blindness. Some cases may be associated with denial of blindness when it is called Anton syndrome. We came across a 9-year-old male child presenting to us for evaluation of blindness which turned out to be cortical blindness after the examination. EEG and VEP were consistent with cortical blindness with MRI showing parieto-occipital lobe signal intensity alterations. Evaluation for the cause of cortical blindness led to the diagnosis of situs inversus in the patient with an atrial septal defect. The patient had an episode of dehydration due to gastroenteritis which resulted in vascular compromise thereby leading to hypoxic damage to the brain and cortical blindness. Presentation of cortical blindness in a patient of situs inversus is unique and hence being reported
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Background: BPH is a major cause of bothersome lower urinary tract symptoms (LUTS) and affects quality of life (QoL) which deteriorates if not taken care with the passage of time. The aim and objective of the study was to compare the efficacy and safety of combination of silodosin and dutasteride with the combination of alfuzosin and dutasteride in patients of BPH.Methods: A randomized, open label, intention to treat study was carried out on newly diagnosed patients of BPH. Patients were randomly divided into two groups and followed up to 12 weeks. Group 1 of patients received a combination of silodosin 8 mg and dutasteride 0.5 mg (SD) (n=20) while the patients of group 2 received combination of alfuzosin 10 mg and dutasteride 0.5 mg (AD) (n=20). Primary endpoint was measured by changes in the mean baseline International prostate symptom score (I-PSS) and uroflowmetry and secondary outcome with changes observed on ultrasonography.Results: IPSS and IPSS-QOL significantly improved in both the treatment groups (p <0.001) along with mean maximum flow rate (Qmax) and mean average flow rate (Qavg). Prostate volume and residual urine volume showed a significant improvement in both the treatment groups at 12 weeks. However, the intergroup differences in IPSS, uroflowmetry and USG parameters were not significant. Both treatments were well tolerated.Conclusions: The current study established that both the drug combinations i.e. silodosin and dutasteride (SD) and alfuzosin and dutasteride (AD) largely have a comparable effect on both the dynamic and static components of BPH. Further, both drug combinations appear to have a comparable safety profile.
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Background: Septic response is a leading contributory factor for morbidity and mortality especially in intensive care settings. The current research aims to study the co-relation of various hematological parameters in sepsis patients with the objective to see their effects in prognosis of sepsis patients.Methods: The current study was a cross-sectional study with a sample size of 117 patients with sepsis. Various hematological parameters of all the patients were obtained on day of admission (day 1) and seventh day (day 7) using hemogram reports and the difference of their statistical mean and standard deviation was estimated.Results: There was a significant statistical difference in the mean and standard deviation of neutrophil lymphocyte count ratio (NLCR), red cell distribution width standard deviation (RDW SD), Platelet count (PLT) and Platelet crit (PCT) whereas Mean platelet volume (MPV), Platelet distribution width (PDW) and Platelet large cell ratio (PLCR) showed no significant changes on day 1 and day 7 of observation in patients taken for the study.Conclusions: The prognosis of sepsis can be important when we can clinch the hemogram markers early in the period of sepsis and evaluate them according to the etiology of the respective incidences. Targeted approach can be initiated early in the course of hospitalization and may be a specific index of hemogram could be established to further co relate sepsis and its form in particular diseases.
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Background: Bio-ethics i.e. health care ethics is a set of moral principles, beliefs and values that guide us in making choices about medical care. This novel study was carried out with an objective of assessment of knowledge regarding the medical ethics among the resident doctors of Indira Gandhi Medical College, Shimla Himachal Pradesh.Methods: This descriptive analytical cross-sectional study was conducted at Indira Gandhi Medical College (IGMC), Shimla, Himachal Pradesh among the resident doctors using predesigned, structured, self-administered anonymous close-ended questionnaire. We analyzed the data using Stata software version 12.Results: There were a total of 61 study participants, who consented to participate, of which more than half were females (52.5%). The mean age of the study participants was 28.6±0.63 years. Regarding the source of knowledge about medical ethics most of the study participants had acquired the information during their experience at their workplace (42.6%). A majority of the male participants disagreed that confidentiality while providing the health care services should be abandoned (54.3%). More than 90% of the study participants agreed that incorporation of medical ethics is necessary in undergraduate curriculum.Conclusions: Incorporation of a formal structured teaching on medical ethics in the undergraduate curriculum is the need of the hour. Besides research work, the medical ethics committee in the institution should also act as the guiding hands to address the grievances faced by the doctors during medical practice.
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Background: Suicide is the result of an act deliberately initiated and performed by a person in the full knowledge or expectation of its fatal outcome. Suicide attempts are a significant public health problem. The present study aimed to explore the variousclinical characteristics of suicideattempters in a tertiary care hospital of Shimla, Himachal Pradesh, a northern state of India.Methods: We conducted a descriptive study among patients with attempted suicide to the department of Psychiatry, Indira Gandhi Medical College (IGMC) Shimla. A structured, self-designed interview schedule and short-form revised Eyseneck personality questionnaire-Hindi (EPQRS-H) was used for data collection. Data was analyzed using Epi info software v 7.2.0.Results: There were total 77 participants in the study out of which 44 (57.1%) were females. Mean age (Standard deviation) of participants was 30.8 years (9.9 years). Relationship problems were the most common (48.1%) recent life event followed by health events (28.6%). Depression was found to be the most common diagnosis (62.3%). Pesticide consumption was the method of attempting suicide in 72.7% of females compared to 66.7% of males.Conclusions: Recent major life events especially relationship problems may lead to majority of suicide attempts. There is urgent need to focus on patients suffering from depression by health personnel as well as family members. The sale of the pesticides should be regulated to keep in check the misuse of the same.
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Xanthogranulomatous cystitis (XC) is a rare benign chronic granulomatous inflammation of the urinary bladder of unknown etiology. Here, we report a rare case of XC in a 54-year-old man who presented with painless hematuria and frequent urination for the past 3 years. His urine culture and sensitivity were positive for Escherichia coli with significant colony count. Contrast-enhanced computed tomography showed diffusely thickened urinary bladder with no definitive mass. The patient was subjected to other investigations including cystoscopy and biopsy. All the above investigations confirmed the entity to be XC. An endoscopic resection was performed and he was started on a sulfamethoxazole-trimethoprim combination. The patient was asymptomatic at 3-month follow-up.
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Background and Objectives: The aim of this paper is to describe the application of a newly developed three-dimensional imaging system, Cone-Beam Computed Tomography in the diagnosis and evaluation of supernumerary teeth.Material and Methods: One hundred and eighty-five patients with supernumerary teeth (134 males and 51 females) were included in this study. Patients ranged in age from 6 to 38 years. Supernumerary teeth were detected by clinical examination and conventional radiographs. Moreover, careful investigation for more details was made with the cone beam computed tomography. Supernumerary teeth which were detected with the examinations of the cone beam computed tomography images were analyzed according to the number, location, shape and position.Results: Males were affected more than females in a ratio of 2.6:1. 95 % supernumerary teeth were located in maxilla and 5 % in the mandible. 71.6% of supernumerary teeth were conical in shape. 93.6% supernumerary teeth were impacted and 6.4% were erupted. A total of 198 supernumerary teeth were found to be present in palatal/lingual side and 24 were found on the buccal side. 80.5 % of the patients had one, 18.9 % had two, and 0.5 % had three supernumeraries.Conclusion: Detailed examinations and evaluations of these teeth with Cone-Beam Computed tomography (CBCT) yields accurate 3-dimensional pictures of supernumerary teeth, local dental and bony structures which are very beneficial in terms of proper diagnosis and treatment planning and preventing complications which may occur.
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Abstract: Background & Objective: To assess Clinical Presentations and Surgical Outcomes of various parotid gland tumors which required Parotidectomy. Methodology: The present retrospective study was carried out at the Department of E.N.T. & Head Neck Surgery, Medical College Vadodara from January 2010 to December 2014 and included 34 patients who underwent parotidectomy. Data were collected regarding clinical presentations, benign versus malignant nature of the disease on FNAC reports, radiological findings, type of surgery instituted, complications encountered and histology reports of the surgical specimens and subjected to statistical analysis. Results: All patients had presented with a lump usually painless. Thirty (88%) patients had benign pathology while four (12%) had malignancies. Most common surgical procedure instituted was superficial parotidectomy, performed in 90% (n = 31). The most common complication was Sialocele (n=5; 15%) followed by facial nerve palsy (n= 2; 6%).The value of FNAC as a diagnostic tool was with 96.66% specificity and 75% sensitivity. Conclusion: Pleomorphic adenoma is most common benign pathology. Superficial parotidectomy is the most commonly offered surgical procedure. Parotid surgeries are safely performed with low morbidity and no mortality.
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Abstract: Background & Objective: To assess Clinical Presentations and Surgical Outcomes of various parotid gland tumors which required Parotidectomy. Methodology: The present retrospective study was carried out at the Department of E.N.T. & Head Neck Surgery, Medical College Vadodara from January 2010 to December 2014 and included 34 patients who underwent parotidectomy. Data were collected regarding clinical presentations, benign versus malignant nature of the disease on FNAC reports, radiological findings, type of surgery instituted, complications encountered and histology reports of the surgical specimens and subjected to statistical analysis. Results: All patients had presented with a lump usually painless. Thirty (88%) patients had benign pathology while four (12%) had malignancies. Most common surgical procedure instituted was superficial parotidectomy, performed in 90% (n = 31). The most common complication was Sialocele (n=5; 15%) followed by facial nerve palsy (n= 2; 6%).The value of FNAC as a diagnostic tool was with 96.66% specificity and 75% sensitivity. Conclusion: Pleomorphic adenoma is most common benign pathology. Superficial parotidectomy is the most commonly offered surgical procedure. Parotid surgeries are safely performed with low morbidity and no mortality.
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Background: Tympanoplasty is one of the commonest operations performed on the middle ear. Endoscopes are increasingly used for various middle ear surgeries. The objective was to determine merits and demerits of the endoscope as compared to the microscope in myringoplasty surgery and to compare the results of both group. Methods: Between the time period of January 2014 to September 2014, 44 patients underwent myringoplasty, 22 were endoscope assisted and 22 were microscope assisted. Results of surgery were compared at the end of 3 months post surgery. Results: In both groups, equal number of patients i.e. 15 (68.18%) had a successful outcome. Conclusion: Panoramic, wide angle, and magnified view provided by endoscope as well as ability to easily negotiate through EAC and provide uninterrupted image overcomes most of the disadvantage of microscope. In our study success rate was equal between endoscopic and microscopic technique. In terms of morbidity and postoperative recovery endoscope produced better results. Loss of depth perception and one handed technique are some of the disadvantage of endoscope that can be overcome with practice. Thus, Endoscopic tympanoplasty can be a good alternative of microscopic tympanoplasty.
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Intestinal perforation induced by chemotherapy in a patient of Burkitt lymphoma is a known potential complication which carries high mortality. Perforation may also occur as a result of the transmural nature of the tumour. Patients on chemotherapy are prone to contract infectious diseases due to a compromised immune system. Pulmonary tuberculosis has been reported in these patients, but abdominal tuberculosis has not. We report the case of a five year old boy on chemotherapy for Burkitt lymphoma, and who developed a tuberculous jejunal perforation. The patient underwent drain insertion and stabilization followed by exploratory laparotomy with resection of the pathological segment and closure of the duodenal stump at the fourth part. Bowel continuity was re-established by gastrojejunostomy. Histopathologic examination of the resected segment revealed intestinal tuberculosis. Anti -tubercular therapy was started and continued for nine months. The last cycle of chemotherapy was administered 1 month after surgery. At 1 year of follow up the patient is asymptomatic and thriving well.
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The present prospective study was conducted on 170 patients of lung carcinoma, over a period of two years, to study the clinical features, radiological manifestations and histological types of primary lung carcinoma. These were investigated according to a study protocol which included a detailed history regarding the onset and progress of the disease, smoking habits, detailed examination of the respiratory system, routine laboratory investigations, chest roentgenogram, computed tomography of thorax, fibreoptic bronchoscopy and others. The mean age of the patients was 55.94 years (range 29 to 85 years). Eighty seven percent were males. The smoker to non-smoker ratio was 3.9:1. The average duration of symptoms was three months. Cough was the most common presenting symptom (90%). A history of anti-tubercular treatment was present in 42.5% patients. A mass lesion was the most common radiological finding (30.6%), followed by collapse consolidation in 13.5%. Combination presentation was observed in 43.5% patients. Squamous cell carcinoma presented more commonly as a central mass (75%), while adenocarcinoma as peripheral mass lesion (64.5%). Squamous cell carcinoma was the most common histological type diagnosed (45.3%) although adenocarcinoma was the more common in females (39.1%) and non-smokers (51.4%). In India Squamous cell carcinoma is still the most common cell type. Carcinoma lung is still being misdiagnosed as tuberculosis and many patients are wrongly put on antitubercular treatment. Thus there is a need to create awareness about carcinoma lung among the general practitioners.
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A 10 days old male baby brought with abdominal distension and cystic swelling in the left buttock. Radiological investigations suggested para-rectal abscess or rectal duplication cyst. Patient underwent transverse loop colostomy and later definitive surgery by posterior sagittal approach. Intra-operative findings were suggestive of small atretic rectal segment with duplication cyst of the rectum. To the best of our knowledge, neonatal rectal atresia with rectal duplication cyst has not been reported in English literature.