ABSTRACT
Vitamin K deficiency bleeding (VKDB) is closely associated with the hemorrhagic disease of the newborn (HDN) and can have a late onset, after one week of birth up to six months of age. It is a major concern in developing countries where vitamin K prophylaxis is not often given to newborns and can lead to significant mortality and morbidity. We report a case of a three-month-old child who was exclusively breastfed. He presented with repeated vomiting and was eventually diagnosed as a case of acute-on-chronic subdural hemorrhage. Timely diagnosis and surgical intervention played a key role in ensuring a favorable outcome for the child.
ABSTRACT
Meningiomas are one of the most common primary intracranial tumors known to exist since pre-historic times. Most of these tumors are benign, sporadic, and solitary. Multiple meningiomas are rare and have mostly been described in patients with neurofibromatosis type 2 (NF2). The presence of multiple lesions poses a unique challenge in strategizing the treatment. We present a rare case of multiple intracranial meningiomas in the absence of NF2, which we treated at Tata Main Hospital, Jamshedpur. The relevant literature has also been discussed.
ABSTRACT
Tuberculosis is one of the most common infectious diseases that has a varied presentation and can affect most of the organs of the body. Differentiating disseminated tuberculosis with minimal symptoms from malignancy is difficult and makes the diagnosis challenging. No single test can be earmarked to diagnose tuberculosis and multiple investigations are mostly required. Here, we would like to discuss a rare case of a young male with mild symptoms who, on initial investigations, was provisionally diagnosed as having a metastatic disease, but detailed investigations proved it to be a case of disseminated tuberculosis. Through this case, we learn that radiological images alone cannot help in diagnosing even a common disease like tuberculosis. A complete workup helped in differentiating malignancy from tuberculosis in this mildly symptomatic patient.
ABSTRACT
CONTEXT: High intracranial pressure is the most frequent cause of mortality and disability after severe traumatic brain injury (TBI) which is treated by first-line therapeutic measures. When these measures fail, second-line therapies are started. Among second-line therapies, decompressive craniectomy (DC) has been used. It improves the functional outcome in these patients. AIM: This study aims to analyze the clinicoradiological factors associated with the prognosis of severe TBI in patients undergoing DC. SETTINGS AND DESIGN: It was a retrospective case series study from April 2014 to March 2016. SUBJECTS AND METHODS: A total of 85 patients (admitted at Tata Main Hospital, Jamshedpur) with severe diffuse TBI with clinical and radiological evidence of intracranial hypertension who were refractory to first-tier therapies and required DC were included in our study. Cases excluded were patients with age <10 years and polytrauma patients. RESULTS: Out of 85 cases, 55 were males, and thirty were females (male:female = 1.8:1) with the age ranging from 17 to 68 years. Road traffic accident was the leading cause of injury in 69.5% cases. A total of 49 (58%) patients were of Glasgow coma scale (GCS) 4-6 whereas 36 (42%) patients had GCS 7-8. Computed tomography (CT) scan brain was classified as per Marshall CT classification. Bifrontotemporal DC was done in 29% cases, and unilateral frontotemporoparietal craniectomy was done in 71%. CONCLUSIONS: Patients with younger age, early surgical intervention, better preoperative GCS score, and with low Marshall CT score have better prognosis.
ABSTRACT
BACKGROUND: Predicting future coronary heart disease (CHD) risk with the help of a validated risk prediction function helps clinicians identify diabetic patients at high risk and provide them with appropriate preventive medicine. AIM: The aim of this study is to estimate and compare 10-year CHD risks of Nepalese diabetic patients using two most common risk prediction functions: The Framingham risk equation and United Kingdom Prospective Diabetes Study (UKPDS) risk engine that are yet to be validated for Nepalese population. PATIENTS AND METHODS: We conducted a hospital-based, cross-sectional study on 524 patients with type 2 diabetes. Baseline and biochemical variables of individual patients were recorded and CHD risks were estimated by the Framingham and UKPDS risk prediction functions. Estimated risks were categorized as low, medium, and high. The estimated CHD risks were compared using kappa statistics, Pearson's bivariate correlation, Bland-Altman plots, and multiple regression analysis. RESULTS: The mean 10-year CHD risks estimated by the Framingham and UKPDS risk functions were 17.7 ± 12.1 and 16.8 ± 15 (bias: 0.88, P > 0.05), respectively, and were always higher in males and older age groups (P < 0.001). The two risk functions showed moderate convergent validity in predicting CHD risks, but differed in stratifying them and explaining the patients' risk profile. The Framingham equation predicted higher risk for patients usually below 70 years and showed better association with their current risk profile than the UKPDS risk engine. CONCLUSIONS: Based on the predicted risk, Nepalese diabetic patients, particularly those associated with increased numbers of risk factors, bear higher risk of future CHDs. Since this study is a cross-sectional one and uses externally validated risk functions, Nepalese clinicians should use them with caution, and preferably in combination with other guidelines, while making important medical decisions in preventive therapy of CHD.
