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Introduction: Fungal ball is a non-invasive sinus disease and the incidence of this disease has increased in recent years and also several case reports and case series have suggested a relationship with the accidental displacement of root into maxillary sinus. We report a case where fungal ball was removed along with the dental root fragment which was accidentally displaced into the maxillary sinus following traumatic dental extraction. A 32-years-oldCase Report: female patient presented to Maxillofacial Surgery Department with complaint of pain in the left orofacial region for one month. The patient had a history of traumatic extraction of posterior maxillary teeth 4 years back. On examination, no dental cause of pain was detected. On further evaluation, a foreign body within the left maxillary sinus was seen in the panoramic radiograph. Computed tomography images revealed displaced root in the left maxillary sinus with surrounding heterogenous soft tissue opacity. Following the detection of foreign body, patient underwent Functional Endoscopic Sinus Surgery (FESS) and the root was retrieved and the adjacent soft tissue specimen was sent for histopathological examination. The presence of fungus consistent with the Aspergillus species was confirmed. Conclusion: This article emphasizes the importance of atraumatic dental extraction, the association of fungal ball with displaced root and the utility of FESS in clearing the same.
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Several randomized studies in the early 1980s have shown that performing early cholecystectomy for acute cholecystitis was better than delayed cholecystectomy in terms of operative feasibility, post-operative complications and shorter hospital stay. In the era of minimal access surgery, laparoscopic cholecystectomy is widely established as the standard in acute cholecystitis. However, in the presence of acute inflammation, higher conversion rates of up to 30 % have been reported. Several studies have reported favourable outcomes with a low conversion rate if patients are operated within 96 hours of admission. In this study we compare the safety, intra-operative difficulty, post-operative morbidity, duration of stay in hospital, and effectiveness of early lap- / open-, versus delayed (late) lap- / open- cholecystectomy in acute cholecystitis. MethodsThis is a prospective study conducted in the Department of General Surgery, Government Stanley Medical College, from October 2016 to August 2017. From cases attending our institute for treatment of acute cholecystitis, 25 patients with acute cholecystitis were subjected to early lap- /open- cholecystectomy within 7 days of onset of symptoms and another 25 patients were subjected to late cholecystectomy at least 6 weeks after symptoms have subsided. ResultsThe two groups were well matched in terms of age, sex as well as clinical and laboratory parameters. Both early and late groups were compared both in terms of intraoperative and post-operative complications. Among the early group, 17 [68%] underwent laparoscopic cholecystectomy and 8 [32%] underwent open cholecystectomy. In the late group 19 [76%] underwent laparoscopic cholecystectomy and 6 [24%] underwent open cholecystectomy. Taking bile duct injury in to account 3 patients [12%] among the early group and 6 patients in DC [24%] had bile duct injury. 4 patients [16 %] in the early group and 6 patients [24%] in the late group had wound infections. In the early group, 6 patients [24%] and 10 patients [40%] in the late group had lung infections. Duration of stay in early cholecystectomy group was shorter when compared to patients who underwent late cholecystectomy. ConclusionsEarly cholecystectomy is safe in terms of dissection of Calot’s triangle and bile duct injury. The duration of surgery, the rate of wound infection, and the hospital stay, are however significantly shorter than the delayed cholecystectomy and reduces the rate of medical treatment failure and biliary peritonitis.
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Nanomaterials are finding the diversity of application at the leading edge in emerging field of nanotechnology. Coppernanoparticles (CuNPs) were in situ generated on the surface of cotton fabrics, using Achyranthes aspera leaf extract byenvironmentally benign green synthesis. The structural and morphological properties of synthesized nanocompositecotton fabrics (NCFs) were characterized by different spectral studies such as Fourier-transformation infrared (FTIR),scanning electron microscopy (SEM) coupled with energy-dispersive X-ray primary and derivative thermogravimetric(TG-DTG), differential scanning calorimetry (DSC), and X-ray diffractometer (XRD). The molecular functionalitiesof hydroxyl groups in polyphenols of A. aspera leaf extract were identified from FTIR absorption spectrum, and theyare responsible for the bioreduction of Cu+2 into Cu0 for the formation of CuNPs. The average size of the formedCuNPs from SEM studies was found to be 95 nm. The formed CuNPs were exhibited Face centered cubic (FCC)crystalline structure, and it was confirmed by XRD studies. TG-DTG analysis publicized the thermal stability ofNCFs. The tensile strength of NCFs was higher than normal cotton fabrics. These NCFs exhibited good antibacterialproperties which considered for making aprons and wound dressing materials in medicine and for packing materials
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Background: The study was aimed to study the practices related to breastfeeding among newborns in Aligarh and to assess the determinants of breastfeeding practices.Methods: A cross sectional study was carried out in the field practice areas of Department of Community medicine, AMU, Aligarh. All the live births in one-year study duration were included in the study. Verbal consent was obtained prior to the interview. Data was collected by interview technique using semi structured questionnaire and analysed in SPSS 20.Results: A total of 705 newborns were enrolled in the study. 5.3% of the mothers in our study didn't breastfeed their newborns even after 24 hours after the delivery. 6% of the mothers discarded their colostrum and 36.9% of mothers gave prelacteals to their newborns. Almost half of the newborns were exclusively breastfed. There is a significant association between being primiparous and not practicing exclusive breastfeeding (p=0.003). However, no significant association was found between breastfeeding practices and gender, birth order of newborn, age and education of mother.Conclusions: Present study shows that 64.2% of newborns received the right breastfeeding practices which is quite good as per the national average. This study emphasizes the need to address the practices like discarding the colostrum and use of prelacteal feed which are still widely prevalent.
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Purpose: The purpose of this study was to evaluate the doses delivered to the brachytherapy (BT) target volume and organs at risk from two-dimensional X-ray-based plans on magnetic resonance imaging (MRI) and to compare these doses with the corresponding doses from the image-based optimized plans. Materials and Methods: Twenty patients with cervical cancer treated with chemoradiation and BT were included in this study. All patients had two sets of treatment plans generated for the first fraction of BT. Volume doses resulting from MRI-based optimized plans were compared with the corresponding doses from standard “Point A” prescription plans. Results: There was statistically significant difference between the two planning modalities for the mean high-risk clinical target volume (HRCTV) D90 doses (P = 0.0014) although mean D2cc of bladder (P = 0.1667) and rectum (P = 0.051) was not different. Standard plans with a prescription dose of 7 Gy to Point A delivered a mean HRCTV D90 of 10.07 Gy in patients with no gross residual disease at the time of BT, which was very similar to the mean dose from MR-based plans (MRI 10.02 Gy and standard 10.07 Gy). The only factor seen affecting dose distribution in this group was the applicator geometry. Standard plans failed to deliver HRCTV D90 doses of >8.5 Gy in all patients with gross residual disease. The doses were <7.00 Gy to the HRCTV in three patients who had maximum residual diseases at the time of BT. Conclusion: Conventional X-ray-based plans with moderate Point A doses deliver HRCTV D90 comparable to MRI-based plans in patients with no residual disease, and centrally placed residual disease, provided proper applicator placement and ideal geometry can be ensured. Soft-tissue image-based BT dose optimization ought to be considered in all patients with gross residual disease at the time of brachytherapy.
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Background: Autoimmune disorders are chronic multisystem disorders affecting women of their reproductive age. Pregnancy among these women is complicated by the disease itself. Flaring up of disease, uteroplacental insufficiency due to vasculitis and drugs used for treatment are main reason for unfavourable pregnancy outcomes. The objective of this study was to analyze the pregnancy complications and outcome among 113 cases of autoimmune disorders.Methods: This study is a retrospective analysis of case records of pregnant women with autoimmune disorders. This study was conducted at PSG IMSR and Hospital, Coimbatore, and Tamil Nadu from July 2012 to June 2018. The case sheets were retrieved from medical record department and the details such as type of disease, maternal age, parity, status of disease at conception, treatment taken during pregnancy, maternal complications and fetal complications were collected and analyzed.Results: During 6-year period there were 113 pregnant women with autoimmune disorders, and they were studied of their previous and present pregnancy outcome. The disease incidence was 7.01% per 1000 deliveries. 40.7% were less than 25 years age group and 71.6% were multigravidae. We had forty-one patients (36%) who were positive for APLA syndrome which were the maximum number of patients with auto immune disorder in pregnancy and 37 patients (32.7) with SLE. We had significant numbers of maternal and fetal complications for common disorders. Most of the rare auto immune disorders were diagnosed before pregnancy and these pregnancies were managed by multi-disciplinary approach, and continued on immunomodulators throughout pregnancy, hence maternal and fetal complications were less for them.Conclusions: Adequate pre-conceptional counseling, vigilant monitoring during pregnancy and post-partum will avoid pregnancy related complications and have favorable outcomes.
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Background: Thyroid diseases are one of the commonest endocrine disorders affecting women of reproductive age group, and hence constitute one important disorders complicating pregnancy. The objective of this study was to determine the importance of universal screening for hypothyroidism in pregnancy at the first antenatal visit and to formulate whether this routine screening is mandatory in our country.Methods: This retrospective study was conducted in the year 2018 at PSG IMSR Hospital for all pregnant women who attended the first antenatal visit between Jan 2012 to Dec 2012 after obtaining ethical clearance. Pregnant women who were already taking treatment for hypothyroidism, diabetes mellitus, hypertension and those pregnant women who lost their follow up were excluded from the study.Results: The incidence of subclinical hypothyroidism among antenatal women were 7.06%. In our study the maternal complications like anemia 12 (8%), preeclampsia 26 (17.3%), gestational diabetes 25 (16.7%), fetal growth restriction 8 (5.3%), Oligohydramnios 13 (8.7%), pre mature rupture of membranes 25 (16.7%), placental abruption in 2 (1.33%), APLA syndrome 2 (1.33%), low birth weight 26 (17.3%) were observed.Conclusions: Universal screening for hypothyroidism is recommended for all antenatal women especially in iodine depleted country like India.
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Introduction: CT guided lung FNAC/Biopsy is beingincreasingly used for the tissue diagnosis of lung lesions. CTis the safest and most accurate method of biopsying centrallesions and lesions adjacent to or involving the hila andmediastinal structures. This study was aimed at evaluatingthe frequency of complications following CT – guided lungBiopsy/FNACMaterial and methods: This was a retrospective study. 53CT guided procedures performed during the year 2016 wereincluded in the study. All the patients had a CT examination ofthe chest (plain and contrast) done before the guided procedurewhich was used as a road map. CT examination was doneon a Siemens somatom 148 slice scanner. In some patientstable dose oral contrast was also given done to delineate theoesophagus.Results: The incidence of pneumothorax was 1.06% i.e. only1 patient out of 53 had minimal pneumothorax which wastreated conservatively.Conclusion: CT guided lung FNAC/Biopsy is a safeprocedure if done in expert hands with a multi-disciplinaryteam approach. Complications can be minimised by carefulselection of the patient... considering the site and size oflesion; associated lung conditions etc
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Background: Atherosclerosis is caused by the combination of type 2 diabetes mellitus and dyslipidemia. Combination of DM and dyslipidemia is associated with increased mortality and morbidity. Hence, it is of utmost importance to know the nature of dyslipidemia in DM for its effective management. The major lipid abnormalities seen in DM are elevated triglyceride levels and lowered HDL-C levels.Methods: A case-controlled study was initiated in Vinayaka Missions Medical college and hospital for a period of 2 year. Pre-prandial and post-prandial lipid profile was assessed in 50 cases of type 2 DM and was compared with age and sex matched healthy controls satisfying the inclusion and exclusion criteria.Results: At the end of the study, the mean age±SD was 48.5±5.68 years. The mean HbA1c±SD of the study population was found to be 7.48±1.517. Looking at the lipid profile all cases in fasting state had elevated VLDL-C levels (mean 50.39±60.27), elevated TC (mean 169.70±39.917), elevated TGL (mean 146.04±60.140) and low LDL-C (mean 92.3±27.699) when compared to control group. In the postprandial state, there was a significant raise in TGL level (mean 188±68.59), raised TC (mean 180.74±38.46), decreased HDL-C (mean 38.761±9.028) compared to the fasting state.Conclusions: Lipid profile of type 2 DM in pre-prandial 12 hour fasting state showed elevated TC, VLDL-C levels and low LDL-C and HDL-C levels. Where as in post prandial state TGL levels were markedly elevated with elevated TC and low HDL-C levels.
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Unilateral renal cystic disease (URCD) of kidney is a non-familial, extremely rare condition, characterized by replacement of the renal parenchyma of one kidney by a cluster of multiple cysts of varying size with a normal contralateral kidney. It is morphologically indistinguishable from autosomal dominant polycystic kidney disease (ADPKD); as such, hepatic and pancreatic cysts is not seen and shows no progressive deterioration in renal function; thus, differentiating ADPKD from URCD becomes important. We report a case of URCD documented by clinical and radiological imaging. A 21 year-old female, presented with history of mild lancinating pain in the left flank for 6 years which aggravated in the past 3 days, with no history of lower urinary tract symptoms. No significant family illnesses reported. Examination showed normal vitals and ballotability present and associated tenderness on deep palpation in left lumbar region. Laboratory findings were within normal limits. Ultrasonography of abdomen and pelvis showed left hydronephrosis with multiple cysts. CECT Abdomen revealed an enlarged left kidney (∼15×16×10 cm) filled with variable sized round, well-marginated multiple cysts. Renal ultrasound was performed on patient’s parents and her siblings and ruled out cystic renal disease. Hence, authors considered the diagnosis of URCD in this patient. In conclusion, treatment and managing guidelines of URCD have not been mentioned in any of the medical literatures. There is little information regarding the progression of URCD. Hence there is a need for further understanding of pathogenesis, progression and management of these patients.
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Background: Acid base disorders are common in the ICU patients and pose a great burden in the management of the underlying condition.Methods: Identifying the type of acid-base disorders in ICU patients using arterial blood gas analysis This was a retrospective case-controlled comparative study. 46 patients in intensive care unit of a reputed institution and comparing the type of acid-base disorder amongst infectious (10) and non-infectious (36) diseases.Results: Of the study population, 70% had mixed acid base disorders and 30% had simple type of acid base disorders. It was found that sepsis is associated with mixed type of acid-base disorders with most common being metabolic acidosis with respiratory alkalosis. Non-infectious diseases were mostly associated with metabolic alkalosis with respiratory acidosis. Analysis of individual acid base disorders revealed metabolic acidosis as the most common disturbance.Conclusions: These results projected the probability of acid bases disorders in various conditions and help in the efficient management. Mixed acid base disorders are the most common disturbances in the intensive care setup which is metabolic acidosis with respiratory alkalosis in infectious diseases and metabolic acidosis is the most common simple type of acid base disorder.
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Meningioma is the most common intracranial benign neoplasm. The malignant transformation of this neoplasm is less frequent. Here, we report the case of a 77-year-old male patient who came to our department with a visible mass in the scalp for 1½ years. The mass was gradually increasing in size, soft in nature, not painful, and associated with the left-sided weakness. His multidetector computed tomography showed lesion which is having an intracranial component with the destruction of a vault with extracranial extension. This imaging modality gives a clear-cut picture of the extent of the lesion, nearby structures, and vascularity to give the surgeon proper guidance in two, three, and four dimensions
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Diverticula of the esophagus are rare, accounting for <1% of all barium gastrointestinal radiographs and <5% of all cases of dysphagia. Here, we report a case of an 80-year-old male presented with the chief complaint of dysphagia for 8 months. Contrast studies with barium swallow and computed tomography (CT) scan were performed to diagnose the etiology behind dysphagia, and it turned out to be a case of esophageal diverticulum which demonstrates outpouching from the wall of the esophagus in barium swallow and CT scan. These investigating modalities also aid in eliminating other causes of dysphagia.Key words: Barium swallow, Contrast computed tomography, Diverticulum, Dysphagia, Esophagus
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Context: Neonatal sepsis is an early infection occurring within 28 days of the postnatal life. It has nonspecific signs and symptoms which make the diagnosis cumbersome. It inflicts an increase in morbidity and mortality among neonates. Procalcitonin (PCT) is yet another acute phase reactant, which is synthesized by the C-cells of thyroid gland. Aims: The aim of our study is to evaluate PCT as a diagnostic marker of neonatal sepsis in comparison with C-reactive protein (CRP). Subjects and Methods: A prospective cross-sectional study was conducted at our tertiary care hospital in Puducherry. The study was conducted over a period of 5 months from November 2015 to 2016. The study included all neonates with clinical signs of sepsis. The neonates were assigned into three groups as proven sepsis, suspected sepsis, and no sepsis group. The CRP level and PCT level were compared between the three groups, and their sensitivity and specificity were calculated. Statistical Analysis Used: The mean, standard deviation, and standard error of mean were calculated. The groups were compared using one-way ANOVA. The diagnostic test efficiency was evaluated by receiver operating characteristic curve analysis. Results: A total of 75 neonates were included in our study. There were 9 (12%) neonates with proven clinical sepsis, 47 (62.6%) neonates with suspected clinical sepsis, and 19 (25.3%) neonates with no sepsis. The mean and standard error of mean were calculated for CRP and PCT in all the three groups. The results showed a sensitivity of 88.90% for both CRP and PCT and specificity of 89.40% for CRP and 80.30% for PCT. The common organisms isolated from culture-positive group were Escherichia coli (22.2%), Pseudomonas aeruginosa (22.2%), and Candida albicans (22.2%), followed by Klebsiella pneumoniae, Acinetobacter baumannii, and methicillin-resistant Staphylococcus aureus. Conclusions: PCT may not be sufficiently used as a sole marker of sepsis in neonates compared to CRP. PCT in conjunction with CRP and other tests for septic screen can aid in better diagnosis of neonatal sepsis.
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Neurofibromatosis (NF) with sphenoid wing dysplasia is a rare clinical entity. Herewith, we present a case of NF with sphenoid wing dysplasia which presented with pulsatile progressive proptosis. Other ocular symptoms or visual disturbances were absent. Diagnosis of the condition was not easy and the management was a challenging task which needed multidisciplinary approach as there were ocular, neurological, orthopedic, and dermatological manifestations. With neurosurgical intervention, reconstruction of the sphenoid wing was possible. Proptosis was corrected without any disturbance of vision.
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Neonatal meningitis is a lethal infection occurring in the 1st month of life. The risk of developing permanent neurological sequels is high among the neonates who survive. Bacterial pathogens are commonly associated with this condition. Aeromonas is a Gram‑negative bacteria of aquatic habitat. Although isolation of Aeromonas species from neonates with blood stream infection is infrequently reported, neonatal meningitis caused by Aeromonas is exceedingly rare. We present a case of fulminant sepsis and meningitis caused by Aeromonas hydrophila in a preterm newborn male. The bacteria was isolated in culture from blood and cerebrospinal fluid. In spite of targeted antibiotics and supportive therapy, the baby failed to respond and died on the 12th day of life.
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Objective: To analyze the outcomes of Prevention of Parent to Child Transmission (PPTCT) of HIV program in an urban Southern Indian setting. Design: Observational study. Setting: Anti-retroviral Therapy (ART) Centers/ Integrated Counseling and Testing Centers (ICTC) at four government Obstetrics Institutes in an urban area. Participants: 100 HIV-positive pregnant women and their infants delivered in the study centers. Methods: Triple drug ART to HIV-positive pregnant women was started for maternal indications only. Rest of the pregnant women were given single dose Nevirapine (200 mg) at the onset of labor. All infants were given single dose Nevirapine (2 mg/kg) prophylaxis, according to National AIDS Control Organization guidelines. Mothers were counseled regarding breastfeeding and artificial feeding, and the choice was left to them. Whole blood HIV 1 DNA PCR was done for all infants at 6 weeks of life. A second PCR was done at 6 months or 6 weeks after stopping breastfeeds. PCR-positive infants were started on ART, and were followed-up till18 months of life. Results: Four infants were PCR-positive for HIV. All of them were breastfed. They were born to mothers of HIV stage 1 or 2 who were not on ART as CD4 counts were >350 cells/mm3. Among the mothers in Stage 3 or 4 or CD4 count <200 cells/mm3 and on ART, none of the infants was HIV-positive. The cumulative HIV-free survival at 18 months was 94%. Conclusion: Parent-to-child transmission rate in HIV was low with the currently used strategies . Triple drug ART to mother reduces mother-to-child transmission despite advanced maternal stage or low CD4 counts.
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Background: The objective was to evaluate the outcome of late second trimester emergency cerclage in patients with advanced cervical dilatation with bulging membranes. Methods: Setting: department of obstetrics and gynaecology, PSG Institute of medical sciences & research, Coimbatore, Tamil Nadu, India. This is a retrospective study of case files of patients who underwent emergency late second trimester cerclage for advanced cervical dilatation with bulging membranes between January 2009 to January 2014. McDonald’s technique was used in all the cases. Results: Altogether, 7 patients (100%) underwent late second trimester emergency cerclage between 20-28 weeks of gestational age, out of which three patients (42.86%) had term deliveries (>37w), and 3 patients (42.86 %) carried on their pregnancies to more than 32 weeks resulting in healthy live born babies. Two of them delivered by normal vaginal delivery, 4 underwent LSCS, and one patient had severe abdominal pain with bleeding and draining per vaginum after 3 days of cerclage, in view of which the stitch was removed. Subsequently, the patient expelled a live foetus weighing 620gms, which died in the Neonatal Intensive Care Unit (NICU) after 3 hours. This procedure prolonged the duration of pregnancy in all patients with a mean duration of 70.4 days. The mean gestational age at the time of delivery was 34.33 weeks. The mean birth weight was 2.18 kg and ranged between 1.97 to 2.64 kg. The mean APGAR at one minute was 8/10 and the mean duration of stay in NICU was 1.66 days. All the new-born babies were healthy at the time of discharge. The live birth rate following emergency late second trimester cerclage in this series was 85.75%. Conclusion: Favourable neonatal outcome can be accomplished in patients with cervical incompetence in the second trimester of pregnancy following emergency cervical suturing, even if performed when the membranes are bulging through the cervix.
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Perioperative hyperglycemia is common and associated with increased rates of surgical wound infections, length of hospital stay, morbidity, and mortality. Improved perioperative glycemic control has the potential to improve patient outcome. Surgery and anesthesia induce a stress response with hormonal cascades that influences glucose control. In patients with diabetes and prediabetes, a focused history is necessary to create a plan that optimizes glycemic control in the perioperative setting. The goal of perioperative glycemic control is to keep glucose levels as normal as possible, while avoiding complications associated with hypoglycemia. Metabolic consequences of surgery and preoperative considerations of an inpatient with diabetes are discussed in this paper.
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Duane retraction syndrome (DRS) is a rare cause of strabismus in children. It has a characteristic ocular motility disorder and constitutes approximately 1% of all cases of strabismus. We describe a 9-year-old girl with absent or restricted horizontal eye movement, globe retraction and narrowing of the palpebral fissure on attempted adduction. DRS is classified into three types based on the different restrictions of ocular motility and can be associated with various ocular and systemic anomalies.