bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of traditional and online education in airway management
Authors: Yazıcı Mümin Murat , Ataş İsmail , Güler Enes , Bilir Özlem
Published: April 2023

Background: Endotracheal intubation is commonly used to maintain the airway during airway management, but it requires skill and experience, so standard endotracheal intubation performed by beginner managers carries a high risk of failure. This study was conducted based on the hypothesis that there are differences between the traditional and online education models in terms of learning and skill development in situations requiring basic skills, and it aimed to compare the traditional and online education models to evaluate endotracheal intubation learning and skills.
Methods: This single-centre, prospective study aimed to evaluate the endotracheal intubation performance of volunteers. The research involved examining the endotracheal intubation experience of fourth-year medical school students who completed their education either traditionally or online at the Recep Tayyip Erdogan university simulation-based learning centre (RSIM). Approval was obtained before commencement from the local ethical committee (decision no. 2023/03, E-40465587-050.01.04-572).
Results: Mean time for successful intubation in the traditional and online education models evaluated was statistically significant at the non-difficult (p=0.005), moderately difficult (p=0.007) and difficult airway (p=0.014) levels.
Conclusions: Traditional and online education models affect endotracheal intubation ability. In endotracheal intubation with either a direct or a video laryngoscope, the traditional education model offered a more successful experience than the online education model. In addition, skills with the video laryngoscope were stronger in novice users than with the direct laryngoscope.
Relationship between the duration of diabetes and severity of neuropathy in patients of peripheral neuropathic diabetic foot ulcers
Authors: Kumar Utkarsh , Singh Anjali , Singla Deepak , Agrawal Nivesh
Published: April 2023

Background: Diabetic foot ulcer (DFU) has devastating impact on the social, personal as well as economic life of a diabetic patient. In US, prevalence of peripheral neuropathy in adult diabetics is approximately 28%. The aim of this study is to establish relationship between the duration of diabetes and severity of neuropathy in patients with peripheral neuropathic DFU.
Methods: This is a prospective observational study, including 30 patients, who underwent history, examination and Toronto clinical scoring system (TCSS) was used for diagnosing severity of diabetic peripheral neuropathy (mild, moderate, severe) from a period of October 2015 to June 2017.
Results: In this study, we observed that the mean age of the diabetic foot patients was 53.50±12.03 years ranging from 30 to 75 years. Male-to-female ratio was 1.5:1. The mean duration of diabetes was 6.38±4.57 years. The patients with mild neuropathy had a mean duration of diabetes of 4.77±2.61 years, while, those with moderate and severe neuropathy had mean duration of 7.17±1.48years and 8.48±4.59 years, respectively.
Conclusions: The study concluded that there is a significant association between duration of diabetes and severity of neuropathy, i.e., patients with longer duration of diabetes had severe peripheral neuropathy.
A retrospective observational study on changes in macular thickness with age in normal population using spectral-domain optical coherence tomography
Authors: Edwin Megha , Raghavan Remya , K. Mahadevan
Published: April 2023

Background: The aim of this study was to determine the changes in macular thickness with age, by SD-OCT and to estimate the inner and outer retinal layer thickness of outer and inner macula based on different zones and to assess their relationship with age.
Methods: A retrospective observational study of 50 subjects with age ranging from 21 to 60 years was studied with SD-OCT (10 mm scan). The study was done in the month of April 2021 at Department of Ophthalmology, Sree Gokulam Medical College and Research Foundation.
Results: Total macular thickness ranged from 180 to 225 micrometer with no significant change with age. It was found that the thickness of inner retinal layer showed a significant decrease with age in 72% of subjects (p<0.05) and changes in outer layer was not significant. The inner retinal nerve fibre layer thickness in all quadrants was more than outer retinal layer thickness. The nerve fibre layer thickness of outer macula was more than the inner macula followed by the fovea. The RNFL was thickest at the inferior quadrant and thinnest at the temporal quadrants, followed by the nasal quadrant and the superior quadrant.
Conclusions: The total macular layer thickness didn’t show any significant change with age. It was found that the inner retinal layer thickness showed a significant decrease with age but outer retinal layer didn’t. This information can be used for clinical studies evaluating the association between macular thickness and various retinal diseases.
Comparative study of pre-operative high-resolution computed tomography in middle ear cholesteatoma with per-operative findings
Authors: Ram Birma , Gujral Giriraj Singh , Sarkar Krishnendu , Sharma Pankaj
Published: April 2023

Background: Imaging plays an important role in the management of middle ear pathology. Temporal bone imaging is challenging and involves deep understanding of the anatomy, especially in relation to high resolution computed tomography (HRCT) imaging. An HRCT scan can precisely determine the site and extension of cholesteatoma and its sac, assessing the erosion of ossicles, evaluating the facial nerve in its entire course, tegmen and sinus plate, and determining Dural, sigmoid sinus, and jugular bulb positions.
Methods: This prospective descriptive study was performed from January 2018 to May 2019 in 60 patients with cholesteatoma who were referred to the Otolaryngology department of the Command Hospital Kolkata. Preoperative high-resolution temporal bone CT scans were carried out and compared with intraoperative findings.
Results: Evaluation of 60 patients and their CT scans revealed excellent correlation for presence of soft tissue mass and its extent into the middle ear and mastoid, erosion of scutum, erosion of ossicular chain and tegmen plate, good correlation for facial canal dehiscence, labyrinthine fistula and sinus plate erosions.
Conclusions: HRCT temporal bone is essential for anatomical determination of cholesteatoma and its complication. Careful and thorough evaluation is needed for the early diagnosis and treatment of the disease, to prevent complications and preserve hearing. The extent of disease and associated complications like facial nerve paralysis, labyrinthine fistula, and intracranial complications often will determine the aggressiveness of the surgical approach.
Expression of Ki-67 in premalignant and malignant lesion of cervix in tertiary care hospital in Uttar Pradesh
Authors: Singh Pratima , Garg Kanchan , Singh Ankita , Tripathi Shambhavi
Published: April 2023

Background: cancer is fast emerging as one of the most common causes of death related morbidities throughout the world. As far as India is concerned. Ki-67 is an ideal marker to assess the cellular proliferation. The study aimed to evaluate the proliferative activity by using Ki-67 in premalignant and malignant lesion of cervix. To study the various histomorphology features of cervical lesion and grading it into cervical intraepithelial neoplasia and malignant lesion. To access the expression of Ki 67 in different grade of lesions.
Methods: The study was carried in 60 cases of cervical biopsy that included 30 cases of CIN 1, CIN2 and 30 cases of CIN 3, SCC. Ki-67 staining was done on all cases which were diagnosed histologically as CIN or cervical carcinoma. The result was categorized in grading 1,2,3.
Results: Ki-67 expression was studied in all cases. There was an increase in the intensity of Ki-67 from CIN to carcinoma. The focal positivity in low grade lesion to diffuse positivity in higher grade lesion was seen in our study.
Conclusions: In this study, Ki-67 expression was helpful in differentiating dysplastic lesion from carcinoma and helps in confirming the histopathological diagnosis. Therefore Ki-67 marker could be used as biomarker in the evaluation of the proliferative activity and progressive potential of dysplastic and neoplastic changes.
Platelet indices and their correlation with HbA1c and association with microvascular complications in type-2 diabetes mellitus
Authors: Sangapur Shivakanth M. , R. S. Darshan , Sharanabasappa  , Meena Baldev
Published: April 2023

Background: Depending on the aetiology of the DM, factors contributing to hyperglycaemia include reduced insulin secretion, decreased glucose utilization, and increased glucose production. Mean platelet volume (MPV) and platelet distribution width (PDW) are important, simple, effortless, and cost-effective tools measured by hematology analyser which assess the volume and function of platelets. Analysing the platelet parameters can act as an alarm for progression of complications of DM. Hence, we studied the platelet parameters in diabetic patients with good and poor glycaemic control and their association in microvascular complications.
Methods: This study was conducted on 100 patients having diabetes mellitus. All the patients were subjected to detailed history regarding age, sex, occupation, socioeconomic status, GPE and systemic examination.
Results: Out of 100 cases, 29 patients had a good glycemic control (HbA1c<7%) and 71 had poor glycemic control (HbA1c>7%). Mean FBS was 118.59±19.36 mg/dl in good control group and 158.79±29.21 mg/dl in poor control (p<0.001). Mean PPBS was 159.86±37.78 mg/dl in good control group and 235.80±53.28 mg/dl in poor control group (p<0.001). Good glycemic control group had mean MPV of 7.89±0.63 fl and poor glycemic control group had mean MPV 10.06 fl (p<0.001). Mean PDW was 12.32±1.94 in good control group and 13.81±2.25 in poor control group.
Conclusions: Our study indicates that MPV and PDW are increased in diabetic patients, more so in patients with microvascular complications than in those without complications. Hence, they can be used as markers in predicting the microvascular complications in diabetes mellitus.
Prevalence of computer vision syndrome and associated ocular morbidity in a tertiary care hospital
Authors: Chaudhary Aparajita , Rai Arpita , Singh S. P. , Singh Vibha
Published: April 2023

Background: This study was done to determine the prevalence of computer vision syndrome and associated ocular morbidity in a tertiary care hospital.
Methods: A cross sectional observational study was conducted on  673 patients based on the inclusion criteria. The patients were asked to fulfil the computer vision syndrome survey form 3 and OSDI questionnaire. Spontaneous eye blink rate, Schirmer’s test 1, tear break up time, refraction were performed for these patients. Data was collected and analysed by SPSS software.
Results: The prevalence of computer vision syndrome was 73% with 294 males and 206 females. The mean age of the patients was 30.29 years. Most of the participants were between 21-30 years. The screen time for most of the study participants (59.80%) came out to be >6 hours/day on average. The chief complaint of majority patients was blurred vision and asthenopia whereas the secondary complaint was watering and headache. Maximum patients (38.20%) from our study were students and competitive exam aspirants followed by teachers and software engineers. The screen modality used by 34.20 % patients was mobile phones > laptops. The mean SEBR was 13.50 minutes. The mean OSDI was 17.44. The screen time was significantly correlated to SEBR (p<0.0001). Also the screen time and OSDI correlation came out to be significant (p<0.0001).
Conclusions: The present study revealed a significantly high prevalence of CVS among our patients. The ocular symptoms are predominantly affecting the convergence power of eyes and tear film instability causing blurred vision and dryness.
Correlation between bullying involvement and behavioral problems among adolescents
Authors: Panwar Neha
Published: April 2023

Background: Bullying is one of the common problems among adolescents. This study assessed the correlation between bullying involvement and behavioral problems among adolescents at selected schools of Dehradun, Uttarakhand.
Methods: A quantitative correlational study was undertaken at selected school of Dehradun, Uttarakhand to assess the correlation between prevalence of bullying involvement and behavioral problems among 228 adolescents aged 12 to 17 years. The participants completed a self-report PRQ (peer relation questionnaire) to assess bullying involvement and SDQ (self report questionnaire) to assess behavioral problem.
Results: The mean age of participants was 14.86. The prevalence of bullying involvement was 30.2%, from those 28 (9.7%) as bully, 59 (20.5%) as victim and 13 (4.5%) as bully-victim. There was significant correlation between bullying score and total difficulties problem (r=0.247); conduct problem (r=0.398); hyperactivity problem (r=0.143); peer problem (r=0.204) and pro-social problem (r=-0.215). There was significant correlation between victim score and total difficulties problem (r=0.309); emotional problem (r=0.328); conduct problem (r=0.289); peer problem (r=0.267) and pro social problem (r= -0.197). There was significant correlation between bully-victim score and total difficulties problem (r=0.341); emotional problem (r=0.258); conduct problem (r=0.420); hyperactivity problem (r=0.135); peer problem (r=0.288) and pro social problem (r=-0.250).
Conclusions: Study showed that there is substantial prevalence of bullying involvement among adolescents. Bullying involvement is correlated to behavioral problem. Our findings can be used to construct school intervention directed toward bullying and behavioral problems.
Prevalence of hypothyroidism in type 2 diabetic adult Indian females and its correlation with age, HbA1c, BMI and duration of diabetes
Authors: Chauhan Devendra S. , Kushwaha J. S. , Giri Richa , Kushwaha Prakhar
Published: April 2023

Background: Patients with type 2 diabetes mellitus are more prone to thyroid disorders. Hypothyroidism in them leads to an aggravation of microvascular complications. Screening for thyroid dysfunction in diabetic patients will allow early treatment of hypothyroidism. The aim of this study was to assess the prevalence of hypothyroidism in patients with type 2 diabetes mellitus and its correlation with age, HbA1c, BMI and duration of diabetes.
Methods: This was a cross sectional study that was conducted at department of medicine GSVM medical college, Kanpur. 200 female patients with type 2 diabetes mellitus attending the outpatient department without any prior history of thyroid disease, chronic liver disease or acute illness were recruited for the study.
Results: Our study describes 14% prevalence of hypothyroidism (subclinical hypothyroidism 13.5%) among 200 diabetic subjects. Hypothyroidism was more common in older age group maximum seen in age group 70-79 years (66.7%). Hypothyroidism was more common in subjects having diabetes for a longer duration; maximum seen in 25-30 years group (40%). No correlation was found between BMI and hypothyroidism.
Conclusions: The prevalence of hypothyroidism was 14% among female patients with type 2 diabetes mellitus in this study. Overt hypothyroidism was 0.5 % and subclinical hypothyroidism was more common (13.5%) among the study subjects. Hypothyroidism was more common in older age group. and in subjects having diabetes for longer duration. No corelation was found between prevalence of hypothyroidism and body mass index (BMI).
Fetomaternal outcomes in eclamptic primigravida in a tertiary care centre
Authors: Nazida Arham , Barman Karabi , Das Rajesh
Published: April 2023

Background: As a tertiary care facility, our institute sees a high volume of complex pregnancy cases. The purpose of this study is to examine the foetal and maternal outcomes in primigravida cases with eclampsia, as they represent a high-risk but not uncommon patient subset in obstetric practice.
Methods: This study was a prospective observational study of 80 primigravida patients admitted to the department of obstetrics and gynaecology, FAAMCH, Barpeta during the period of 4th September 2021 to 3rd September 2022. Maternal outcomes were studied in the mother and fetus, including pulmonary oooedema, placental abruption, HELLP syndrome, PPH, cerebral infarction, ICU admission, MODS, and stillbirth.
Results: Pulmonary oedoema was the most common problem among the 80 subjects, with AKI, aspiration Pneumonitis, CVA, MODS, placental abruption, PPH, and HELLP syndrome. Only 14 subjects had to be admitted to the ICU, and 54 (67.50%) had no problems while they were still in the womb.
Conclusions: This study found that most primigravida patients with eclampsia eventually underwent spontaneous vaginal delivery, with pulmonary oooedema being the most common maternal complication. Early intervention, such as blood pressure monitoring, and urine dipsticks, can influence the path of illness care for a patient. To reduce maternal and perinatal morbidity and mortality, good antenatal care is essential.
An observational study to correlate arterial lactate level and peripheral perfusion index in context of tissue perfusion in sepsis
Authors: Singla Priyanka R. , Mahajan Sanket K.
Published: April 2023

Background: In view of goal directed therapies, the predictive value of the course of peripheral perfusion parameters over time has not been studied. Moreover serial assessment of peripheral perfusion index (PI) can be more predictive for mortality when compared to a single assessment of peripheral perfusion. Successfully normalized PI (≥1.4) during treatment might be an indication to stop the resuscitation, whereas pursuing normalized PI (≥1.4) might not result in better outcomes compared with mild-to moderate PI impairment after a normalized arterial lactate level. Complementing arterial lactate assessment with PI during resuscitation can better identify the endpoint of resuscitation and patients at higher risk of adverse outcomes. By simple clinical assessment of peripheral perfusion immediately during and after resuscitation, clinicians will be able to discriminate patients at high risk for developing severe complications even in the rural setups.
Methods: This prospective study was conducted on 100 patients admitted at Dr. Kiran C. Patel Medical College and Research Institute, over a period of 12months (Janury 2022 to December 2022). Patients of sepsis were selected on the basis of criteria for tissue hypoperfusion and classification of sepsis.
Results: On statistical analysis, PI was found to have significant correlation with arterial lactate levels (P<0.001) in PI <1.4 sub-measurement and not in PI >1.4. SOFA score & metabolic parameters were also found to have statistical significance.
Conclusions: We inferred that peripheral perfusion index monitoring could provide useful information to determine the possibility of hyperlactatemia in critically ill patients thus providing a noninvasive source of tissue-bed perfusion monitoring even in the absence of facilities and infrastructure to measure the lactate levels thereby providing a gross insight in the perfusion haemodynamics of the patients of sepsis even in the primary healthcare setups too.
Evaluation of the immunohistochemical expression of HER2/NEU in urinary bladder neoplasms in a tertiary care hospital
Authors: Samra Sukhmani , Nibhoria Sarita , Sandhu Vaneet Kaur , Singh Amandeep
Published: April 2023

Background: HER2/NEU expression in urothelial neoplasms has been reported to range from 9% to 80% on immunohistochemistry. We studied the expression of HER2/NEU in urothelial neoplasms and its variability according to histological grade along with the prognostic value.
Methods: The present study was conducted on 60 formalin-fixed, paraffin-embedded specimens of urinary bladder neoplasms, which comprised 45 cases of high-grade urothelial carcinoma followed by 13 cases of low-grade and 2 cases of PUNLMP. These were then subjected to IHC by HER2/NEU. Membrane positivity for HER2/NEU was noted.
Results: A total of 65% of cases showed positive membranous HER2/NEU expression. HER2/NEU expression was noted in 82.6% of cases of high grade while 8.4% of cases of low grade were positive for HER2/NEU expression.
Conclusions: The majority of high grade invasive urothelial carcinomas showed positive HER2/NEU expression with a significant p-value <0.001. Thus patients with high grade urothelial carcinoma may benefit from HER2/NEU targeted therapy.
Comparison of transvaginal versus transumbilical retrieval technique of laparoscopically removed surgical specimens
Authors: Puri Suman , Kaur Manpreet , Aneja Rashim , Ladher Heena , Puri Aneesha
Published: April 2023

Background: Laparoscopy is a minimally invasive, safe, and acceptable technique for the removal of adnexal masses whereas specimen removal remains a big challenge due to the size and type of specimens. In this study, we have discussed the two different routes of specimen retrieval, transumbilical and transvaginal route.
Methods: A prospective study was conducted on 34 women with adnexal mass who were admitted for laparoscopic removal of adnexal mass. Patients were randomized into two groups, Group A included 17 women who underwent transumbilical retrieval of specimens, and Group B included 17 patients who underwent transvaginal retrieval of specimens.
Results: Basic demographic data were similar in both groups. None of our patients had intraoperative & postoperative complications. There was no significant difference in Specimen retrieval time, operative time, and blood loss. Two patients (N=2) in group A had spillage. Postoperative pain was significantly higher in group A and the cosmetic response was significantly higher in group B.
Conclusions: Both transumbilical and transvaginal techniques of specimen retrieval in the laparoscopically resected specimen are safe, feasible, and easy, but the Transvaginal route has advantages over the transumbilical route because of better cosmesis and less postoperative pain.
The study of musculoskeletal symptoms in diabetic patients with Nordic questionnaire
Authors: D. S. Ashwini , A. N. Ravichethan Kumar , L. Harshvardhan
Published: April 2023

Background: A variety of musculoskeletal conditions have been associated with diabetes mellitus which involves multiple joints affecting activities of daily living. It warrants screening of such symptoms in patients with diabetes mellitus in routine health checkup and to address such complaints. Using a simple questionnaire such as Nordic questionnaire which can aid in studying presence or absence of musculoskeletal symptoms in diabetic patients and to know the frequently involved joint.
Methods: Cross sectional data of 156 adults with type 2 diabetes mellitus attending tertiary hospital were examined. The patient’s demographic details were collected. Musculoskeletal pain was assessed using Nordic questionnaire. Multiple logistic regressions were used to examine risk associated with musculoskeletal pain.
Results: The study showed that prevalence of musculoskeletal pain was 64.1%. The participants mean age was 50.57 years. The study group contained 48.7 % females and 51.3% males. The mean BMI was 27.56kg/m2 with mean HBA1c of 9.29%. 26% of the study population had significant discomfort in last 7 days which was interfering with their work. Majority of them (73%) had suffered shoulder pain. Presence Of musculoskeletal symptoms showed association with HbA1c, BMI, and waist circumference. There was no association between joint pains with respect to years of job
Conclusions: Musculoskeletal symptoms are frequent in diabetic patients. Addressing such complaints is important to screen pathology related to joint and surrounding soft tissue on routine check-up, thus preventing future complication which may result in disability by using simple Nordic questionnaire.
Histopathological evaluation of abnormal uterine bleeding with immunohistochemical study of significant estrogen receptor expression in endometrium of women with different age groups
Authors: Singh Ankita , Tripathi Dipti , Singh Pratima , Agrawal Sanjay
Published: April 2023

Background: Abnormal uterine bleeding is symptom, not disease. Bleeding per vaginum is labelled to be pathological when there is constant irregularity in pattern and flow of bleeding, altered duration or increased amount of menstrual blood. Histopathological examination of endometrium biopsies remains a gold standard diagnostic tool.
Methods: A prospective study was done on 150 patients presenting with AUB over the period January 2022 to December 2022 in the department of pathology, Hind institute of medical sciences, Sitapur, Uttar Pradesh, India. The sections were stained with hematoxylin and eosin and special stain estrogen receptor was used.
Results: Majority of the patients were seen in the perimenopausal age group and most common complaint was menorrhagia in 73 patients (48%). The commonest pathology observed in our study was proliferative phase endometrium in 48 patients (32%). Most of the endometrial carcinoma (4%) were presented after the age of 50 years. The association between histopathological patterns and estrogen receptor category were found to be statistically significant as the p<0.05.
Conclusions: Disease burden on a global scale is witnessed by women affected by AUB thus having a detrimental impact. Accurate diagnosis of AUB in women over the age of 35yrs is important to rule out preneoplastic lesions and malignancies so that surgical interventions can be avoided by initiating proper medical management. Comparing the hyperplastic and neoplastic endometrium to that of the proliferative phase, ER expression was lower. Endometrial carcinoma with advanced stage often lacks the expression of the receptors.
Biloma secondary to blunt liver trauma in a pediatric patient: case report
Authors: Sánchez Omar Sosa , Tovar Fernando Navarro , Montaño Mónica Heredia , Barrientos Cheryl Zilahy Diaz , Ponce Mildred Philipe , Pérez Yoselin Julisa Sarabia
Published: April 2023

Liver is the organ most frequently injured after blunt or penetrating abdominal trauma, being in pediatrics a pathology that has an increasing incidence; Non-operative management is the hallmark of treatment, however cases of secondary biliary leakage have been described, which may affect the intrahepatic or extrahepatic track. A male 8 years old, with blunt trauma in the right hypochondrium, presenting acute abdomen and hemodynamic instability, requiring exploratory laparotomy with a grade III liver injury in VI and VII hepatic segments. Four weeks after discharge, he presented as a complication a giant biloma in VII and VIII hepatic segments, performing percutaneous drainage guided by ultrasound. The incidence of biliary complications related to hepatic trauma is low, 4% in pediatric patients, dividing into bilomas or biliary fistulas; the presentation of biliary leakage is very non-specific and early diagnosis difficult; in the bilomas, the tomography allows to define precisely its size, nature, distribution and regional anatomy in relation to adjacent structures, as well as underlying cause. The approach of choice is percutaneous or endoscopic drainage, with surgical management being the last option.
Renal artery stenosis complicated by an intraoperative rupture of renal artery: a case study
Authors: Mevawala Hardik Bakulkumar , Shah Jash Kamlesh , Oza Yugam Rajeshkumar , Gondalia Shrinath Vasantbhai , Gor Nancy Mahesh
Published: April 2023

Renal artery stenosis (RAS) is a major contributor to the prevalence of secondary hypertension. Fibromuscular dysplasia and atherosclerosis are commonly responsible for the occurrence of the disease. Medical therapy is the primary means of treatment for RAS. However, surgical interventions for revascularization are also considered, in selected group of patients, which can effectively cure hypertension and chronic kidney disease. An older man presented at Venus hospital, Surat, Gujarat with the complaints of severe dyspnea, edema, uncontrolled hypertension and renal insufficiency. He was diagnosed RAS and was operatively managed with percutaneous transluminal renal angioplasty. Written consent was taken from the patient mentioned in the study. During the procedure, the renal artery got ruptured, which was managed by placing a covered stent. The patient was successfully treated for RAS, in spite of comorbidities and intraoperative complication. In the subsequent clinical follow-up, the patient was asymptomatic. There was marked reduction in serum creatinine levels and even the blood pressure improved significantly. Absence of post-operative complications and positive recovery of the patient signifies the fact that management of renal artery rupture with a covered stent is a convenient approach in acquiring effective haemostasis. This approach can be useful in managing any sort of vessel rupture, related to revascularization procedures.
A case report: management of hypernatremia in diabetic ketoacidosis patient with type II diabetes mellitus
Authors: Pratikto Bella Christie , Suryana Ketut
Published: April 2023

Diabetic ketoacidosis (DKA) is a life-threatening hyperglycemic crisis. DKA rarely presents with hypernatremia, so it is not a common case. We report an unusual case of a 47-year-old woman with type 2 diabetes mellitus (T2DM) admitted with blood glucose 654 milligrams/deciliter and serum sodium 147 millimoles/liter. Patient was transferred to ICU for further management. Patient was given initial bolus of normal saline and switched to D5-1/4 saline for correction of hypernatremia along with insulin therapy. The patient gradually recovered. This report reminds us about how we choose the right treatment to correct the hypernatremia in patient with DKA and also reminds that monitoring the electrolyte levels in hyperglycemia is relevant in the management of diabetes.
A rare case of patient with severe thrombocytopenia associated with sarcoidosis: a case study
Authors: Karpovich Yulia , Ribadiya Fenilkumar Nitinbhai , Tanna Shalini Suresh , Trada Darshi Yagnesh , Karpovich Yury , Bogdanovich Vladimir
Published: April 2023

Thrombocytopenia is a problem causing drop in platelet counts through different mechanisms. Patients typically present with petechiae to systemic bleeding, which are indications of a low platelet count. A smaller percentage of drop may be asymptomatic. The major mechanisms include increased sequestration in the spleen, underproduction from the bone marrow, and peripheral destruction. Many etiological factors can cause this. Sarcoidosis is one of the most uncommon etiologies. A careful diagnosis is required because, if the condition is not treated, it can be fatal. Steroid therapy and platelet transfusions remain the mainstay of treatment. Here, we describe a patient who presented with signs and symptoms of severe thrombocytopenia, which further led to the diagnosis of sarcoidosis. An adult male presented to the emergency department with a rash that deteriorated throughout the day. Based on complaints and laboratory testing, severe thrombocytopenia was noted. After a detailed examination and history-taking, he was found to have sarcoidosis. In association with drug administration and sarcoidosis, this could have caused severe thrombocytopenia. Written consent was taken from the patient mentioned in the study. The study was approved by the hospital and institutional ethics committee. Thrombocytopenia is a disorder where platelet counts drop below 150×109/l due to many different mechanisms. Among different etiological factors, sarcoidosis is the rarest and may present with very severe thrombocytopenia and lead to fatal complications. Such patients require close monitoring and treatment. Corticosteroids and platelet transfusions can be used as treatments. In the presented case, the patient was successfully treated, and on subsequent follow-up, the patient’s condition improved. Manifestations of severe thrombocytopenia can be present even before the diagnosis of sarcoidosis. Further, the history of amoxicillin administration due to infection could have triggered the appearance of thrombocytopenia. Confirmation of sarcoidosis was made via biopsy. Multiple etiological factors that resulted in diagnostic ambiguity in our patient's presentation include the diagnosis of sarcoidosis, a history of infection, amoxicillin, and mild splenomegaly. The patient's treatment and recovery may indicate that corticosteroids, in conjunction with platelet transfusions, are beneficial. This is a novel case report of the presentation of severe thrombocytopenia, which was present even before the diagnosis of sarcoidosis.
Early-stage intestinal-type gastric adenocarcinoma as an incidental finding: case report and review of literature
Authors: Mauricio Leonel Iturbide , Leal Hector Garza , Lòpez Jesùs Renè Tadeo Calleja , Morales Genaro Arguelles , Silva Jonathan Ricardo , Ordaz David Torres
Published: April 2023

Gastric cancer is the malignant neoplasm in which gastric resection is the only viable strategy for long-term survival. Gastric carcinoma typically does not produce symptoms, therefore presenting as either advance or metastatic disease at the time of diagnosis. The most common early symptoms tend to be abdominal pain and weight loss. Adequate surgical resection is the only curative therapeutic option in patients with resectable gastric cancer.  We present the case of a 66-year-old male patient who initially presented with abdominal pain and one episode of gastrointestinal bleeding, for which an endoscopic biopsy was conducted which reported intestinal-type gastric adenocarcinoma. Subtotal gastrectomy with Billroth II anastomosis was then performed without reported complications. Patient remains asymptomatic 3 months following the surgical intervention in surveillance with ambulatory care.
Intussusception as an unusual etiology of intestinal obstruction in adults: case report and review
Authors: Campa Kassandra Janeth Espinal , Arias Francisco de Jesús Cisneros , Campa Alondra Yaneli Espinal , Vega Hector Aurelio Diarte
Published: April 2023

Intussusception is a rare entity in adults, representing 1 to 5 percent of cases of intestinal obstruction. The clinical manifestations are non-specific, a structural lesion is identified by imaging, in more than 70% of the cases. Most cases require surgical treatment. We report the case of a 65-year-old female patient, with a history of intermittent colicky abdominal pain of two months of evolution, associated with nausea, vomiting, melena, and weight loss. Assessed in the emergency department due to worsening abdominal pain and lack of defecation. Her laboratory data reported anemia and leukocytosis. Abdominopelvic CT scan reported an image compatible with intussusception. We performed an emergency exploratory laparotomy, finding the terminal ileum invaginated into the colonic lumen., caused by a gastrointestinal stromal tumor. Intussusception in adults is uncommon but it should be considered as a diagnostic possibility in patients with intestinal obstruction, intestinal bleeding, and a palpable abdominal mass. Although these are non-specific manifestations, complementing the study with chemical and imaging analyzes significantly increases the diagnostic probability. The set of data obtained should be used to select the most appropriate treatment.
Total obstruction of small intestine due to metastatic lung adenocarcinoma
Authors: Widyanti Ni Nyoman Ayu , Putra Wayan Wahyu Semara , Yaniswari Ni Made Dwita , Novitasari . , Suhardinatha P. Kadek Agus
Published: April 2023

Lung cancer with symptomatic small intestinal metastasis is a rare case but potentially fatal with poor diagnosis in most advanced stages. A-82 years old male patient with chronic cough, chest pain, progressive dyspnea abdominal pain, obstipation, and distended abdomen. Chest computed tomography (CT)-scan revealed right inferior pulmonary lobe of lung tumor. Abdominal X-ray and abdominal ultrasound showed ileus obstruction features. The patient underwent emergency laparotomy under the diagnosis of total ileus obstruction. Surgical resection of two masses in the small intestinal were performed with ileo-ileal anastomosis. Histomorphology of the surgical specimen revealed poorly differentiated adenocarcinoma involving the small intestine without precursor lesions that suggested a metastasis. The patient underwent thoracentesis and pleural fluid cytology that reported seeding of non-small cell lung cancer (NSCLC) tend to adenocarcinoma type. A diagnosis of lung adenocarcinoma with small intestinal metastasis was concluded based on correlation of these anatomopathological examination. Clinicians should consider possibility of lung cancer with small intestinal metastasis in patient with abdominal symptoms.
Carotid body tumour resection using combined general anaesthesia and cervical plexus regional anaesthesia technique: a case report and review of literature
Authors: Amin Rachan , Bhandary Disha
Published: April 2023

Carotid body tumours are rare benign tumours that originate from neural non-chromaffin cells that are typically localized near bifurcation of carotid artery. Reported incidence of tumor was 1-2 per 100,000. Surgical removal of the tumor is the most definitive treatment. It has a high incidence of perioperative morbidity and mortality We combined general anaesthesia with regional anaesthesia technique for better haemodynamic stability. Basic elements of anaesthetic management are protection of hemodynamic stability and maintaining cerebral perfusion pressure. Few cases have been reported as of now. The aim of this study was to evaluate anaesthetic management of CBT surgery and present the literature knowledge.
Case report of congenital rubella syndrome with sub aortic membrane non-coronary cusp perforation and patent ductus arteriosus
Authors: Kiran Amith , Shetty Harshika S. , Gotur Chetan , Nishith .
Published: April 2023

Rubella, a common viral infection caused primarily by the rubella virus, is still a global public health concern. Every year, about 30000 instances of congenital rubella syndrome are reported in India, according to health ministry surveillance. A case study of a 6-year-old boy with congenital rubella syndrome was presented here. The child presented with classic abnormalities of congenital rubella syndrome like hearing loss, vision problems, heart defects and intellectual disabilities. Among its many manifestations, congenital heart defects are life threatening, this child was planned for surgical correction of above cardiac lesions. Treatment modalities differ in each type of congenital heart defects and its early detection and surgical intervention can reduce childhood mortality and morbidity.
Sinonasal teratocarcinosarcoma: a rare case report from a tertiary care centre of North East India
Authors: Bharadwaj Barasha S. , Suhana Asreen , Deka Muktanjalee , Sharma Jagannath D. , Beso Adahra P. , Kalita Upasana , Goswami Bibhash C.
Published: April 2023

Sinonasal teratocarcinosarcoma is an extremely rare malignant tumour arising in the sinonasal tract, that may extend intracranially to complicate the treatment and further worsen its dismal prognosis. Diagnosis is challenging because of its rarity and morphologic heterogeneity. Here, we reported a case of a 55 years old male who presented with complaints of left sided nasal blockage and facial swelling. CECT showed a large sinonasal mass with epicentre in the left nasal cavity extending to post nasal space and nasopharynx, eroding the left medial orbital wall and cranially the cribriform plate. Histopathologically, malignant epithelial component comprising of squamous cell carcinoma, mesenchymal component comprising of fibrosarcoma with focal chondroid differentiation, primitive blastemal component with extensive necrosis was noted. Immunohistochemistry demonstrated positivity for synaptophysin, chromogranin, Pan-CK, EMA, CD99, focal p63 in areas of squamous metaplasia; stromal cells showed Desmin, S100, SOX 10 expression: Ki-67 was 30-40%. Immunohistochemistry confirmed the diagnosis of sinonasal teratocarcinosarcoma. Knowledge about this tumour is important because of its heterogenous morphology which often leads to a misdiagnosis, necessitating repeated biopsies and thorough examination of the surgical specimen.
Undifferentiated necrotizing ulcerative vasculitis in a patient with pneumonia and stage 5 chronic kidney disease-a case report
Authors: Karpovich Yulia , Sadadiwala Mehul Hitesh , Mevawala Hardik Bakulkumar , Ribadiya Fenilkumar Nitinbhai , Bogdanovich Vladimir
Published: April 2023

Skin is a frequently involved and damaged organ in cutaneous necrotizing vasculitis (CNV), mainly characterized histologically by a segmental angiocentric inflammatory condition with fibrinoid necrosis of the vessel wall. Various etiological factors have been described as probable causes that trigger CNV, ranging from infectious causes to autoimmune conditions. We have described a case of a middle-aged man with chronic kidney disease (CKD) that presented to the Grodno university clinic with Staphylococcal pneumonia and high level of the IgE antibodies that probably triggered CNV. Written consent was taken from the patient mentioned in the study. The study was approved by the hospital and institutional ethics committee. Based on the provisional diagnosis of hemorrhagic necrotizing vasculitis (cutaneous form), the patient was started on a low dose of glucocorticosteroid therapy. After carrying out a skin flap biopsy, a confirmed diagnosis of ANCA-negative CNV-leukocytoclastic vasculitis (LcV) form was made. The patient was started on steroid pulse therapy followed by plasmapheresis for elevated IgE count, leading to rapid resolution of symptoms. Literature has stated that CNV-LcV form commonly involves immune complexes composed of IgG or IgM. Based on our observation, we have proposed a novel hypothesis that elevated IgE and IgE immune complexes can be an additional triggering factor for CNV-LcV form as well.
A rare ischemic ventricular tachycardia
Authors: Gudaghe Rahul , Deora Surender
Published: April 2023

Many times, physicians in emergency may get confronted with tachycardia. Some tachycardia are easily mistaken as supraventricular tachycardia (SVT) with aberrancy which is actually a ventricular tachycardia. So, here we report a case of such tachycardia which was thought to be a SVT but which, in fact, was a ventricular tachycardia instead.
A case report of primary intraabdominal rhabdomyosarcoma presenting as metastasis
Authors: Gupta Monika , Kaushik Nidhi , Prasad Sujata S. P. , Singh Sunita
Published: April 2023

Rhabdomyosarcoma (RMS) is a rare and in adult accounts for only 1-3% of all malignant soft tissue tumors. The most frequent sites of origin is within head and neck area. One of the least common sites is the retrorectal-presacral space. This case of 61 years old female is probably the fifth well-documented case of primary abdominopelvic RMS. She presented with abdominal distensions, obstipation, vomiting for 5 days. Excision of the gut wall along with soft tissue mass was done and sent to our department for histopathological examination. On microscopic examination, a diagnosis of malignant mesenchymal tumor with closest resemblance to RMS was made. It is a rare case and needs to bring in notice as there is very few information regarding intraabdominal RMS. This case initially thought to be metastasis from gynecologic malignancy.  It is important for pathologists, gynecologists and radiologists to recognize RMS as differential diagnosis of masses arising in abdomen and pelvis.
Erythema annulare centrifugum: a case report
Authors: Thokchom Nandakishore  , S. Mrudula , Linda Kongbam  , Deepa Yumnam  , Shivam Sabharwal  , Ruopfükhrietuo Tetso
Published: April 2023

Erythema annulare centrifugum (EAC) is a rare cutaneous disease characterized by polycyclic lesion simulating urticarial papules that enlarge centrifugally with central clearing and trailing scales. .  It is classified as a reactive erythema and has been associated with various underlying conditions, including malignancies. Diagnosis is established on history, clinical features, and supporting examination. No treatment seems to be effective for this disease and there is still a lack of consensus regarding the best approach. Current choices are focused on treating the underlying subjective complaints. We reported a case of erythema annulare centrifugum in a 49 year old female patient.
Pulmonary infarct as a initial presentation of acute myeloid leukemia: a diagnostic difficulty
Authors: Anandan Jeevanandham , Upadhya Pratap , Vemuri Mahesh Babu  , Basu Debdatta , Vidhyalakshmi Rangarajan
Published: April 2023

The incidence of acute myeloid leukemia (AML) is age dependent and increasing among the patient groups aged above 60 years. The overall presentations in a case of AML is due to marrow infiltration of leukemic cells which results in fever and chills due to neutropenia, bleeding due to thrombocytopenia, fatigue and weakness due to anemia. Incidence of venous thromboembolism is very rare in hematological malignancies. We describe a case of adolescent male presented with features of lung consolidation later found to be a pulmonary infarct and finally diagnosed to have acute leukemia (AL).
Sandifer syndrome: the mis-interpretable disorder
Authors: Aswathy Gopi  , A. Priya  , K. Arun Chander
Published: April 2023

Sandifer syndrome (SS), a movement disorder which is characterised by spasmodic torsional dystonia with back arching and rigid opisthotonic posturing, negatively impacting predominantly the neck, back, and upper extremities. Symptomatic gastro-esophageal reflux disease, esophagitis, or the presence of a hiatal hernia are all associated with Sandifer syndrome. The cause of Sandifer syndrome being uncertain, lifestyle adjustments and modifications highlights as the appropriate mode of treatment. To treat the condition and help relax the baby after feeding, dietary changes or medications can be administered. The case report of a patient with Sandifer Syndrome is considered for observation. Upon arrival, the child was stable, and an Electro-encephalogram (EEG) test revealed nothing abnormal. The child was taking several Anti-epileptic drugs (AED’s), which were stopped in favour of Sodium valproate and Pyridoxine.  An opinion from a Gastro-enterologist was sought in light of the epilepsy and possible Gastro-esophageal reflux disease (GERD), and they suggested a milk scan. Rantac was then started, and breastfeeds were thickened. Milk can indicate mild GERD and a reduction in episode frequency. So, sodium valproate was discontinued. Haemodynamically stable child was discharged from the hospital with Pyridoxine and Carnisure. Studies shows most cases of SS improve over time, within the first 24 months in general.