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1.
Article | IMSEAR | ID: sea-228122

ABSTRACT

Background: Total knee replacement is one of the common orthopaedic procedures performed worldwide. Blood transfusion is one of the major requirements in TKR procedure due to the amount of blood loss during and after the procedure. We carried out a prospective study to determine the efficacy of tranexamic acid in controlling blood loss during TKR procedure. Methods: Study was conducted at a tertiary care centre, involving cases operated by a single surgeon. Study included 140 patients undergoing primary TKR for advance degenerative disease of knee and were divided into two groups of 70 each, one group that received tranexamic acid before surgery and another group that did not receive tranexamic acid before surgery. Patient with allergy to the drug, hepato/renal dysfunction, DVT, abnormal PT and INR were not included. Tranexamic acid was given intravenously as well as intra-articular. Results: Pre-operative haemoglobin ranged from 10.2 gm% to 14.4 gm% in the group getting tranexamic acid and from 10% to 14 % in the group not getting tranexamic acid. Post operatively haemoglobin varied from 8.4 gm% to 12.8 gm% in Group 1 and from 7.8 gm% to 12 gm% in Group 2. Difference of mean post-operative Hb (p=0.0045) and PCV (p=0.0024) in two groups was statistically significant. Conclusions: We concluded that administration of tranexamic acid reduces the blood loss as well as need of blood transfusion in a patient undergoing total knee replacement.

2.
Article | IMSEAR | ID: sea-234442

ABSTRACT

Anorectal melanoma is a rare and highly aggressive malignancy accounting for 0.4% to 1.6% of all melanoma and 0.5% of all anorectal cancer. About 80% cases are confused with haemorrhoids, rectal polyp, rectal ulcer or adenocarcinoma as they commonly present with rectal bleed. We herein reported a case of a 55-year male presenting with a 6-months history of vague abdominal pain, constipation, tenesmus, weight loss, and passage of blood in stool. Clinical examination and proctoscopy revealed a fungating mass. CT scan showed a mass involving lower rectum with periserosal infiltration. The patient underwent total abdominoperineal resection and specimen was sent for histopathological examination. Gross examination showed a fungating growth measuring 3.5×2.5×2 cm along with 8 lymph nodes. On microscopy rectal mucosa was normal, submucosa showed spindle shape tumor cells arranged in sheets & fascicles having pleomorphic nuclei, high N:C ratio with moderate amount of eosinophilic cytoplasm along with areas of necrosis and no evidence of lymphovascular emboli. 6/8 lymph nodes showed metastatic deposits along with large number of atypical mitotic figures. H and E examination suggested diagnosis of gastrointestinal stromal tumor (T2N1Mx). A panel of IHC markers was advised for definite diagnosis. The tumor cells were reactive for HMB45, S-100, Ki67 thus rendering a diagnosis of amelanotic melanoma. Due to absence/small numbers of melanin granules in H and E and diversity in morphology of neoplastic cells, misdiagnosis as lymphoma, gastrointestinal stromal tumor and sarcoma is very common. Hence IHC plays an indispensable role in the diagnosis of amelanotic melanoma of rectum.

3.
Indian J Pathol Microbiol ; 2023 Jun; 66(2): 366-368
Article | IMSEAR | ID: sea-223452

ABSTRACT

Intravascular papillary endothelial hyperplasia (Masson's tumor) is a reactive vascular lesion of obscure etiopathogenesis, often seen in the head and neck. Its presentation as a scalp swelling, however, is extremely uncommon. We describe the first report in an adult, being treated for bipolar illness. A young male presented with a right frontotemporal scalp swelling since 3 weeks. He was also being treated for bipolar illness with olanzapine. Examination revealed a soft, non-pulsatile swelling. After inconclusive aspiration results, a complete excision was performed. Histopathology revealed proliferating endothelial cells arranged as papillary fronds confined to vessel lumina, devoid of atypia, accompanied by thrombosed vessels facilitating a diagnosis of Masson's tumor. The patient is free of recurrence five months after surgery. Further studies on a possible effect of olanzapine on vascular proliferation in experimental in vivo and in vitro models would definitely aid in elucidating clinical relevance, if any.

4.
Article | IMSEAR | ID: sea-232992

ABSTRACT

Background: Chronic liver disease (CLD) is a continuous process of inflammation, destruction, and regeneration of liver parenchyma, which leads to fibrosis and cirrhosis. Liver plays an essential physiological role in thyroid hormone activation and inactivation, transport, and metabolism, as well as the synthesis of thyroid binding globulin. A complex relationship exists between thyroid and liver in health and disease. Methods: 103 patients of CLD were included in this study from December 2020 to September 2022. They were classified as per child Pugh scoring after clinical assessment and investigations. Thyroid function profile was measured for all the patients. Results: Among 103 patients, 8 (7.76%) patients were having overt hypothyroidism and 28 (27.18%) patients had subclinical hypothyroidism, while 67 (65.04%) patients had normal thyroid profile levels. There was significant correlation between CTP class and hypothyroidism status of patient (p value <0.001) with 25 (56.81%) patients of CTP class C having subclinical hypothyroidism, while 3 (7.5%) patients of CTP class B had subclinical hypothyroidism and none patient of CTP class A had subclinical hypothyroidism. Conclusions: Our study found that there was increased prevalence of subclinical hypothyroidism in CLD patients which increased with severity of CLD as assessed with CTP class.

5.
Article | IMSEAR | ID: sea-221857

ABSTRACT

Background and objective: Silicosis is one of the oldest occupational lung diseases. However, there are very few studies identifying the anthropometric variables associated with silicosis. The present study aimed at studying the association between body surface area (BSA), pulmonary function indices, and 6-minute walk distance (6MWD) in patients with silicosis. Materials and methods: The study was conducted on 102 male patients of silicosis. Height and weight were measured to calculate BSA. Spirometry and 6 minute-walk tests were performed. Data were analyzed using EPI info V 7 software. Student's t-test of significance (ANOVA) was applied to test the difference between means. Results: There are no significant changes found in the 6-minute walk distance with years of exposure and BSA. Statistically significant lower values of pulmonary function indices were observed in patients with BSA <1.6 sq m. Statistically significant higher values of forced expiratory volume in the first second and forced vital capacity were observed in patients with BSA >1.9 sq m in all categories of exposure. Conclusion: In conclusion, patients of silicosis with >1.9 sq m BSA had higher values of pulmonary function indices. Large body size may be of value in protection from developing occupational lung disease.

6.
Indian J Pathol Microbiol ; 2022 Dec; 65(4): 918-920
Article | IMSEAR | ID: sea-223373

ABSTRACT

Mixed neuroendocrine non-neuroendocrine neoplasm (MiNeN) is a recently described entity of the esophagus in the latest (fifth) edition of WHO Classification of Digestive System Tumors. It is often a difficult pathological diagnosis, especially in small preoperative biopsies. We herein report a case of high-grade MiNeN of gastroesophageal junction diagnosed as a squamous cell carcinoma in preoperative biopsy and subsequently as a high-grade MiNeN in esophagogastrectomy specimen comprising areas of mucoepidermoid carcinoma and large-cell neuroendocrine carcinoma (NEC). This report accentuates the importance of deeper multisite preoperative biopsies as the management is completely different in a MiNeN from esophageal squamous cell carcinoma.

7.
Indian J Med Ethics ; 2022 Jun; 7(2): 114-118
Article | IMSEAR | ID: sea-222656

ABSTRACT

The paper looks at the exploration in three Indian novels in English, of the hitherto glorified Indian family through the paradigm of dementia, examines the strained space called “home” in the shadow of dementia, and its transformation into a recuperative space with the help of support systems other than immediate family members. These three recent texts in Indian writing in English have discussed this crippling condition; which earlier authors shied away from. Anuradha Roy’s The Folded Earth (2012), Ranjit Lal’s Our Nana was a Nutcase (2015), and Pankaj Varma’s Silver Haze (2014), focus on the life-changing effects of the deadly disease dementia. These literary texts opt for a non-medical approach through which the person suffering dementia is depicted, rather than dementia itself. The family becomes a narrative prism through which to view the changing equations in relationships, the erosion of the family structure, instead of the specific medical condition. In conclusion, one could say that families become the recuperative space for patients rather than medical facilities for long term care. These Indian writers in English do not focus much on the medicalisation of dementia or geriatric health issues. They do mention medical treatments, but the spotlight is on the family, not on clinical viewpoints or medical approaches. Key words: Dementia, disorientation, trauma, deterioration, family space, caregivers.

8.
Article | IMSEAR | ID: sea-222199

ABSTRACT

Thrombocytopenia may be associated with a variety of conditions and risks depending on its severity, ranging from mild epistaxis to life-threatening bleeding. Many drugs or herbal remedies can cause thrombocytopenia by either inhibiting platelet production and/or enhancing their destruction from the peripheral blood-mediated through an immunological mechanism implicating drug-dependent antibodies. Drugs are a common cause of acute immune-mediated thrombocytopenia in adults, the drug etiology is often initially unrecognized. Most cases of drug-induced thrombocytopenia are caused by drug-dependent antibodies that are specific for the drug structure and bind tightly to platelets by their Fab regions but only in the presence of the drug. Thrombocytopenia is an uncommon but life-threatening complication of certain antitubercular drugs. The discovery of isolated thrombocytopenia in a patient taking several medications presents a challenging clinical problem. We report a case of a young immunocompetent female who presented with disseminated tuberculosis and was found to have rifampicin-induced thrombocytopenia

9.
Article in English | WPRIM | ID: wpr-920837

ABSTRACT

@#Introduction: Fractures around the hip in the geriatric population not only lead to functional but also psychological impairment. Psychiatric disturbances can be associated with poor participation in rehabilitation, increased risk of falling again, and higher rates of mortality. The present study was undertaken to assess the association between the psychological status and functional outcome of surgically managed elderly Indian patients who had sustained fractures around the hip. Materials and methods: The present study was a hospital based prospective, single centre study. One hundred and two geriatric patients who had sustained hip fracture and had been managed surgically, having no cognitive dysfunction, living independently, having unhindered walking capability before the fracture, were included in the study. They were called for follow-up at 3rd, 6th, and 12th month after the hip surgery. Psychological assessment was done by the Hospital Anxiety and Depression Scale (HADS) and functional outcome by using the Harris hip score (HHS). Results: Our study did not show association between psychological status and functional outcome except in one sub-group. Significant correlation was observed between the psychological status and functional outcome in most of the patients in the extra-capsular group. We have identified improvement in the depression, anxiety and functional scores during the follow-up. Conclusion: We conclude that psychiatric disturbances in a geriatric patient after undergoing a surgery for hip fracture may lead to poor recovery. We recommend that all such geriatric patients should undergo a psychological assessment and proper therapy should be instituted to achieve good functional recovery

11.
Article in English | WPRIM | ID: wpr-837705

ABSTRACT

@#Introduction: With a higher proportion of young individuals undergoing uncemented hip arthroplasty, a close match in the dimension of the proximal femur and the implanted prosthesis is paramount. This is a study to gain insight into geographical variation in proximal femur morphology to determine the reference values to design uncemented femoral stems for a south Indian population, and also the effect of ageing and gender on the proximal femur morphology. Materials and Methods: The study comprised of two groups. For the first group, 50 unpaired dry femur bones were obtained from adult human cadavers; and the second group was a clinical group of 50 adult patients. Standardised radiographic techniques were used to measure the extracortical and intra-cortical morphometric parameters. Based on these, dimensionless ratios were calculated to express the shape of the proximal femur. The data were expressed in terms of mean and standard deviation and a comparison made with other studies. Results: A significant difference was noted across various population subsets within the Indian subcontinent and also in comparison to the Western population, suggestive of regional variation. The measurements made in cadaveric bone differed significantly from those in live patients, especially the femoral head diameter and extra-cortical and intracortical width. Femoral offset, head height and diameter were significantly less in females. Conclusion: The south Indian population needs customised implants with an increase in neck shaft angle and a decrease in intra-cortical and extra-cortical width for press fit in hip arthroplasty. The variation between the two sexes must also be accounted for during prosthesis design.

12.
Article | IMSEAR | ID: sea-211942

ABSTRACT

Background: Outcome of various treatment regimen are dismal in non-small cell lung cancer. This analysis is done to find possible care in authors institutional set up and to see how these protocols have effect in Indian patients in term of toxicity.Methods: Medical records and data on patients who had been diagnosed with non-small cell lung cancer histologically or cytologically, and who had been treated with sequential chemoradiation and concurrent chemoradiation at the hospital from January 2007 to March 2015 was retrospectively reviewed and analyzed. Two groups of sequential chemoradiotherapy and concurrent chemoradiotherapy were formed and compared for outcomes.Results: Of the 114 evaluable patients in sequential chemoradiotherapy group, the median survival time was 16.0 months and the 1, 3- and 5-years overall survival were 57.0, 26.9 and 21.2%, respectively. Median progression free survival (PFS was 13.0 months and the 1, 3 and 5 years PFS were 52.6, 14.6 and 7.8%, respectively. In concurrent chemoradiotherapy group (105 patients), the overall median survival time was 15 months and the 1, 3- and 5-year overall survival were 56.2, 20.6 and 14.7%, respectively. Median PFS was 13 months and the 1, 3 and 5-year PFS were 48.8, 19.7 and 10.3%, respectively. Grade 3 and 4 toxicity in both regimen groups are same and statistically not significant.Conclusions: Analysis confirm dismal outcome with standard treatment and signifies to search for care beyond conventional chemoradiotherapy.

13.
Article | IMSEAR | ID: sea-205314

ABSTRACT

Introduction: With sectional imaging, wide variations are reported in pelvic anatomy of individual patients raising concerns over adequate coverage of target volume with conventional radiotherapy based on standard bony landmarks. Three-dimensional conformal radiotherapy (3DCRT) is reported to decrease normal tissue toxicity, along with decrease in chances of geographic miss. Present study is done for dosimetric comparison of Planning Target Volume (PTV) and Organs at Risk (OAR) in cancer cervix patients treated with conventional and conformal radiotherapy along with clinical correlation in terms of side effects and tumor response. Materials and Methods: Fifty patients of cancer cervix underwent planning contrast enhanced CT scan. Target volumes & OAR were contoured. Patients were randomized into conventional & conformal arms. Conventional fields were planned using standard bony landmarks. CT based radiotherapy planning was done for 3DCRT arm. Field sizes &dose volume histogram (DVH) were recorded & compared for target coverage & OAR sparing in both arms. All patients received concurrent chemotherapy followed by brachytherapy. Results: Field sizes used for the 3DCRT plans were significantly larger than those used for the conventional plans (p= 0.000). Optimal PTV coverage was significantly improved using 3DCRT as compared to conventional radiotherapy (p= 0.0001). Dose homogeneity in both arms were almost similar (p= 0.292), while conformity index was better in 3DCRT which was statistically significant between the groups (p= 0.000). Mean dose to the Planning Target Volume was increased significantly in the CT based plan when compared with the standard four field plan (p= 0.0001).Difference in doses to the organs at risk (urinary bladder, and small bowel)and their side effects were statistically significant across both groups. There was no difference in tumor response. Conclusion: The present study showed significantly better target volume coverage & dose homogeneity with 3DCRT which may translate into better local control & survival but longer follow up is required to validate it.

14.
Indian J Ophthalmol ; 2019 Dec; 67(12): 2029-2034
Article | IMSEAR | ID: sea-197653

ABSTRACT

Purpose: Retinal hemangioblastomas (RHs) are characteristic of von Hippel-Lindau (VHL) disease. Early diagnosis of retinal lesions may aid in systemic diagnosis. Early identification of VHL is life-saving and also prevents vision loss. Fundus fluorescein angiography (FFA) is a useful tool in the diagnosis and management of RHs. The aim of this study is to report FFA features of RH using ultra-widefield (UWF) imaging. Methods: A retrospective cross-sectional study of consecutive patients of RH who underwent UWF FFA at a tertiary eye care center. Images were analyzed and assessed by authors. The main outcome measures were (a) the number and size of RH in each eye and (b) vascular characteristics of the retina. UWF-FFA characteristics in each eye were tabulated. The number of clock hours involved by these characteristics and their correlation with the number and size of RH were analyzed. Results: The study evaluated 24 eyes of 13 patients. The mean age was 28.4 years. The median number of RHs in an eye was 3.5 (range 1�16), and the size of RHs varied from 0.1 to 4 disc diameters. Novel UWF-FFA findings noted in this study were the presence of abnormal capillary network in 22 of 24 eyes (91.7%), capillary leakage in 15 of 24 eyes (62.5%), and capillary telangiectasia in 7 of 24 eyes (29.2%). In addition, feeder arterioles and venules showed bulbous projections in 8 of 24 eyes (33.3%). Conclusion: The UWF-FFA characteristics of RH, which have not been described before, were identified. These add to our understanding of the pathogenesis of the disease and may pave the way for future therapeutic targets.

15.
Int J Pharm Pharm Sci ; 2019 Sep; 11(9): 1-7
Article | IMSEAR | ID: sea-205942

ABSTRACT

This review is generally focussed on lipid-based excipients in solid oral formulations which increase its bioavailability. Several approaches have been used to deliver the drug efficiently in the body, and lipid excipients are one of the promising drug delivery systems which address challenges like solubility and bioavailability of water-soluble drugs. Lipids excipients can be tailored to meet a wide range of product requirements like disease indication, route of administration, stability, toxicity, and efficacy. This review discusses novel lipids like Compritol 888 ATO, Dynasan 114, and Precirol ATO 5 and how these can be employed for devicing efficient drug delivery models and thereby have used in cosmetic and pharmaceutical industries.

16.
Article | IMSEAR | ID: sea-195807

ABSTRACT

Background & objectives: The growing incidence and the wide diversity of carbapenemase-producing bacterial strains is a major concern as only a few antimicrobial agents are active on carbapenem-resistant bacteria. This study was designed to study molecular epidemiology of carbapenem-resistant Gram-negative bacterial (GNB) isolates from the community and hospital settings. Methods: In this study, non-duplicate GNB were isolated from clinical specimens, and phenotypic test such as modified Hodge test, metallo ?-lactamase E-strip test, etc. were performed on carbapenem-resistant bacteria. Multiplex PCR was performed to identify the presence of blaIMP, blaVIM, blaKPC, blaOXA48, blaOXA23, blaSPM, blaGIM, blaSIM and blaNDM. Minimum inhibitory concentration (MIC) of colistin, fosfomycin, minocycline, chloramphenicol and tigecycline was also determined. Results: Of the 3414 GNB studied, carbapenem resistance was 9.20 per cent and maximum resistance (11.2%) was present at tertiary care centre, followed by secondary care (4%) and primary centre (2.1%). Among the carbapenem-resistant bacteria, overall, the most common isolate was Pseudomonas aeruginosa (24%). On multiplex PCR 90.3 per cent carbapenem-resistant isolates were positive for carbapenemase gene. The blaNDM(63%) was the most prevalent gene followed by blaVIM(18.4%). MIC results showed that 88 per cent carbapenem-resistant Enterobacteriaceae were sensitive to fosfomycin, whereas 78 per cent of P. aeruginosa and 85 per cent Acinetobacter spp. were sensitive to colistin. Interpretation & conclusions: Carbapenem resistance in GNB isolates from the community and hospital settings was found to be on the rise and should be closely monitored. In the absence of new antibiotics in pipeline and limited therapeutic options, prudent use of antibiotics and strict infection control practices should be followed in hospital to limit the emergence and spread of multidrug-resistant bacteria.

17.
Indian J Ophthalmol ; 2018 Aug; 66(8): 1084-1087
Article | IMSEAR | ID: sea-196858

ABSTRACT

Purpose: The aim of the study was to report the occurrence of contamination/replacement of ophthalmic eye drops with liquids of acidic nature in patients treated for nonresponding scleritis. Methods: This was a retrospective interventional case series study. Results: Of the three patients (4 eyes) referred as necrotizing scleritis, two were found to have acid as the content in the bottle/s being used as eye drops, confirmed using biochemical tests. All four eyes had tarsal ischemia and tarsal conjunctival defect in addition to severe scleral ischemia involving the inferior bulbar area. All four eyes required tenonplasty with amniotic membrane transplant more than once for the ocular surface to heal. Two of the three patients were on systemic immunosuppressives including pulse cyclophosphamide for refractory necrotizing scleritis. Sulfuric and hydrochloric acid was isolated from the bottles of 2nd and 3rd patient using confirmatory biochemical tests. Conclusion: It is important to be aware of the possibility of contaminating or replacing contents of eye drops with harmful agents of acidic nature and should be considered in situations that resemble the clinical picture described herein.

18.
Article | IMSEAR | ID: sea-192711

ABSTRACT

Background: Aim: The aim of this study was to analyze the branching pattern of hepatic arterial system with Multi Detector Computed Tomography (MDCT). Methods: 100 patients who underwent Contrast Computed Tomography of abdomen for any medical reasons were evaluated retrospectively. Results: Out of 100 patients analyzed 38% shown variations in hepatic artery branching pattern. Conclusion: Knowledge about hepatic artery variations using MDCT provides valuable guidance particularly for hepatobiliary and liver transplant surgeons and radiologist to make appropriate diagnosis and treatment.

19.
Indian J Ophthalmol ; 2018 Jul; 66(7): 1004-1006
Article | IMSEAR | ID: sea-196789

ABSTRACT

Human immunodeficiency virus infection (HIV) is associated with a reduced T-helper (Th) 1 response, and vernal keratoconjunctivitis (VKC) occurs secondary to a heightened Th2 response. VKC has been reported to occur in patients with HIV. In all probability, a Th1–Th2 shift occurs in the immune response in progressive HIV patients with a decreasing CD4 count. This shift could be the probable cause for the initiation and gradual worsening of the VKC in our patient that corresponded to the dropping CD4 counts. VKC resolved only after a change in antiretroviral therapy for HIV that caused a demonstrable increase in the CD4 counts possibly by reversing the shift.

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