bluuebunny/crossref_metadata_2025 huggingface dataset:
Postdischarge 24/7 hotline service for neurology and neurosurgery patients and 1-year impact on readmission rates, unplanned emergency department visits, and patient satisfaction
Authors: Bibi Shafqat , Mitha Rida , Bano Kiran , Datoo Farida , Karim Nadia , Shamim Muhammad
Published: July 2021

Objective: Telephone triage is a system in which trained nurses use standardized protocols to evaluate symptoms over the phone and determine the appropriate course of action. Materials and Methods: We implemented a protocol for systematic follow up phone calls and telephonic triage to families of neurology and neurosurgery patients after discharge, primarily to improve care transition and to assess its impact on the ratio of visits in the emergency department, readmissions, and overall satisfaction of patients and families. The intervention comprised the implementation of nurse led telephone triage and postdischarge follow up phone calls. After implementing hotline services in mind and brain service line, a retrospective cohort study was conducted to evaluate the impact of hotline services on patient readmissions, emergency department visits, and overall satisfaction rate. We collected data of readmission rate and emergency visits of discharge patients in three periods a prehotline period, immediate posthotline period, and late posthotline period to make comparison. Patients discharged home from the neurology and neurosurgery services from January 2017 to September 2019 were provided with hotline number to call in case of any issue or query. These patients also received postdischarge follow up calls from hotline nurses. We initiated the hotline in October 2017. Results: On analysis, we found a 25% decline in readmission rate in the immediate period of hotline followed by a further decline to 37.2% in the late period as compared to the prehotline period. Among discharge patients visiting the emergency department, we found a decline of 18.5% in the immediate posthotline period which further declined to 77.7% in the later phase as compared to the prehotline period. Conclusion: A standardized telephone system and pathway can be an effective way to improve nurse–patient communication which can further improve health outcomes for many patients.
Clinicoradiological profile and outcome of microsurgical clipping of ruptured anterior circulation aneurysms: A single-institute experience
Authors: Sobti Shivender , Singh Jagminder , Sharma Saurabh , Bansal Hanish , Chaudhary Ashwani
Published: July 2021

Introduction: Prevalence of intracranial aneurysms is estimated to be from 1% to 5% of population, most of them are small and located in the anterior circulation. The real danger is when an aneurysm ruptures, leading to a subarachnoid hemorrhage (SAH). SAH is a catastrophic event with a mortality rate of 25% to 50%. Permanent disability occurs in nearly 50% of the survivors. Fifteen percent of patients expire before reaching the hospital and 25% die within 24 h. The purpose of our study is to report the clinicoradiological data and outcome of microsurgical clipping of ruptured anterior circulation aneurysms in our center. Materials and Methods: This study included ruptured anterior circulation aneurysms admitted to tertiary care hospital in northern India from January 2018 to June 2020. The final outcome of patients was analyzed with Glasgow Outcome Score (GOS) at the time of discharge from the hospital. Results: A total of 53 patients with ruptured anterior circulation aneurysm underwent microsurgical clipping comprising 25 (47.2%) males and 28 (52.8%) females. The mean neck size of all aneurysms was 3.43 ± 1.66 mm. The mean hospital stay was longer in patients having preoperative intraventricular hemorrhage (IVH) (35.96 ± 27.27 days) and postoperative complications (43.36 ± 29.76 days) compared to patients who did not have IVH (21.10 ± 15.47 days) and postoperative complications (18 ± 6.54 days). P value was ≤0.05. Patients with preoperative hydrocephalus had GOS 3.44 ± 1.20 at discharge compared to nonhydrocephalus who had GOS 4.32 ± 1.07 (P = 0.009). Patients with Intracerebral Hemorrhage (ICH) and non-ICH had GOS 3.31 ± 1.38 and 4.28 ± 1.01, respectively (P = 0.009). Conclusion: Poor outcome at the time of discharge after the surgical treatment of anterior circulation aneurysms was associated with poor world federation of neurological surgeons grade on admission, presence of IVH, hydrocephalus, intracerebral hemorrhage, and postoperative cerebral infarcts.
Conventional carotid endarterectomy with shunt versus eversion carotid endarterectomy without shunt does the technique influence the outcome in symptomatic critical carotid stenosis
Authors: Kumar Vineeth , Ramachandran Sreekumar , Sylaja P , Pitchai Shivanesan
Published: July 2021

Introduction: Carotid endarterectomy (CEA) is a surgical procedure done to prevent future embolic stroke in patients with internal carotid artery (ICA) stenosis. Conventional CEA (c-CEA) and eversion CEA (e-CEA) are two surgical techniques used for the above. As carotid shunt is rarely used in e-CEA, a certain amount of cerebral ischemia occurs in patients who were already having carotid stenosis. In this study, we have evaluated the outcome of two surgical techniques in severe carotid stenosis and impact of carotid shunting on the postoperative outcome. Materials and Methods: In this single-center prospective nonrandomized trial, a total of 62 patients who underwent CEA (c-CEA, n = 31; e-CEA, n = 31) for symptomatic ipsilateral ICA stenosis ≥50% between January 2018 and December 2019 were included. Results: A total of 62 patients who underwent CEA (c-CEA, n = 31; e-CEA, n = 31) for symptomatic ipsilateral ICA stenosis ≥50% were included in the study. There was no major stroke or stroke related death in both the study groups. One patient in e-CEA had carotid occlusion and minor stroke. There was no statistically significant difference in minor stroke (e-CEA [3.2%], c-CEA [3.2%], P = 1), transient ischemic attack (e-CEA [3.2%], c-CEA n = 0, P = 0.3), postoperative MI (e-CEA (3.2%), c-CEA (3.2%), P = 1), hematoma (e-CEA [3.2%], c-CEA n = 0, P = 0.3), and re-exploration (e-CEA [3.2%], c-CEA n = 0, P = 0.3). The incidence of cranial nerve (CN) dysfunction was significantly higher in eversion group as compared to c-CEA (e-CEA n = 6 [19.4%], c-CEA n = 1, [3.2%] P = 0.045). Conclusion: Our study showed that the early outcomes of both c-CEA and e-CEA techniques are comparable. The routine insertion of carotid shunt even though decreases the cerebral ischemic time, it does not offer any additional advantage of decreasing perioperative stroke. The choice of the CEA technique depends on the experience and familiarity of the individual surgeon as both the techniques have their own advantages and disadvantages.
Analysis of giant intraventricular and extraventricular epidermoids, defining risk factors for recurrence, an institutional experience
Authors: Jha Vikas , Shrivastava Adesh , Jha Neeraj , Rewatkar Sudhanshu , Singh Saraj
Published: July 2021

Background: Multicompartmental intraventricular epidermoids behave differently from multicompartmental extraventricular lesions and localized lesions during its management. Few studies are available which have analyzed risk factors separately in these groups of cases for recurrence of these lesions and time to recur. Materials and Methods: In this retrospective observational study, 72 cases of intracranial epidermoid were treated over a span of 7 years. Cases were categorized into three groups. Group 1 comprised 15% (11/72) of cases with intraventricular multicompartmental, Group 2 with 22% (16/72) extraventricular giant tumors with multicompartmental involvement and size >4.5 cm, and Group 3 comprised 63% (45/72) of patients with lesions <4.5 cm and localized. Data pertaining to demography, clinical and radiological features, surgery performed, postoperative complication, histology, and follow-up were obtained from medical records available in the institute. Results: The average duration to treat was 1.86 ± 0.52 (standard deviation [SD]) years, with headache as a major complaint in all the groups. Combined endoscope-assisted microsurgery was performed in 38.8% (28/72), microsurgery in 54.1% (39/72), and endoscopic excision in 6.9% (5/72) of cases. Tumor calcification was found in 23.6% (17/72) and preoperative capsular enhancement was seen in 19.4% (14/72) which persisted in 79% (11/14) of cases postoperatively on subsequent follow-up suggesting recurrence. On stepwise logistic regression analysis, preoperative capsular enhancement was a strong predictor of recurrence of tumor (P = 0.001). The average follow-up was 46 ± 14.92 (SD) months in Group 1, 52.34 ± 11.45 (SD) months in Group 2, and 63.36 ± 18.42 (SD) months in Group 3. Conclusion: Although the intracranial epidermoid is known to recur after long interval, tumor with specific characteristics can recur in short span of 5–6 years. Tumor characteristics such as preoperative capsular enhancement, multicompartmental distribution in vertebrobasilar territory, large size, and presence of calcification are strong predictors for recurrence. Performing endoscope-assisted microsurgery can decrease the postoperative morbidities but does not reduce the recurrence risk.
Filum terminale arteriovenous fistula coexisting with a large L2–L3 disc sequestration and associated diffuse lumbar arachnoiditis
Authors: Iampreechakul Prasert , Jitpun Ekkapot , Wangtanaphat Korrapakc , Lertbutsayanukul Punjama , Khunvutthidee Sirirat , Siriwimonmas Somkiet
Published: July 2021

The authors describe a case of filum terminale arteriovenous fistula (FTAVF) in association with a large L2–L3 disc sequestration and diffuse lumbar arachnoiditis. A 64-year-old male manifested with chronic back pain and gait difficulty. Magnetic resonance imaging (MRI) of the thoracic and lumbosacral spine revealed spinal cord congestion extending from the conus medullaris to the level of T9. There was a large disc sequestration came from L2–L3 disc herniation. In addition, thickening, clumping, and enhancement of the entire cauda equina were noted, probably representing arachnoiditis. MR angiography (MRA) and spinal angiography confirmed FTAVF at the level of L5. The patient underwent laminectomy with lysis adhesions and obliteration of the fistula. His postoperative course was uneventful. MRI and MRA of the thoracolumbar spine obtained 4 months after surgery revealed complete obliteration of the fistula and significant resolution of spinal cord congestion. Enhancement of the cauda equina roots was no longer visible. Interestingly, the significant resorption of the sequestrated disc was documented on MRI. The formation of the FTAVF in the present study may result from severe spinal canal stenosis caused by a large disc sequestration blocking the rostral venous drainage of the fistula, or chronic inflammation, and adhesions of the caudal nerve roots from lumbar arachnoiditis. It seems that FTAVF may be of acquired origin by this evidence.
Mixed pial-dural arteriovenous malformation in the anterior cranial fossa mimicking dural arteriovenous fistula
Authors: Maki Yoshinori , Komuro Taro , Satow Takeshi , Ishibashi Ryota , Miyamoto Susumu
Published: July 2021

Mixed pial-dural arteriovenous malformation (MpdAVM) and dural arteriovenous fistula (dAVF) are rare entities in the anterior cranial fossa (ACF). As dural-pial vascular anastomosis can exist near the cribriform plate, MpdAVM with a small nidus, which cannot be apparently identified, can be logically indistinguishable from dAVF in ACF. A 71-year-old man was referred for evaluation of possible intracranial vascular malformation. Cerebral angiography revealed an arteriovenous shunt in the ACF. The lesion was fed by the bilateral ethmoidal arteries and right orbitofrontal artery, draining through the bilateral cortical veins to the superior sagittal sinus. As a nidus was not detected, dAVF was suspected. Venous interruption was planned with direct surgery. Intraoperatively, an arterial aggregation was observed in the right frontal lobe. The arterial aggregation seemed to be connected to the interrupted drainer in the right ACF. The arterial aggregation was removed and pathologically diagnosed as arteriovenous malformation. Postoperatively, intracerebral hemorrhage was confirmed, and postoperative cerebral angiography confirmed the resolved arteriovenous shunt. The intracranial hemorrhage was possibly due to the timing gap between drainer interruption and removal of the nidus. MpdAVM with a small nidus in the ACF can mimic dAVF. Clinicians must be aware that an unremoved nidus of MpdAVM may postoperatively result in fatal intracranial hemorrhage.
Clinical and morphological characteristics of ruptured small (<5 mm) posterior communicating artery aneurysms
Authors: Shibata Aoto , Kamide Tomoya , Ikeda Shunsuke , Yoshikawa Shinichiro , Tsukagoshi Eisuke , Yonezawa Azusa , Takeda Ririko , Kikkawa Yuichiro , Kohyama Shinya , Kurita Hiroki
Published: July 2021

Context: Small intracranial aneurysms (IAs) are considered to have a low risk of rupture; however, in clinical practice, we often encounter patients with subarachnoid hemorrhage (SAH) due to rupture of small IAs. Aims: This study aims to clarify the clinical and morphological characteristics of ruptured small IA, focusing on posterior communicating artery (PCoA) aneurysms as a prone site. Settings and Design: We retrospectively reviewed 102 consecutive patients with SAH due to ruptured PCoA aneurysm who underwent microsurgical or endovascular aneurysm repair between April 2013 and March 2018. Subjects and Methods: All PCoA aneurysms were diagnosed using three-dimensional rotation angiography or three-dimensional computed tomography angiography. Information regarding the following clinical characteristics was collected: age, sex, past medical history, current smoking, antithrombotic therapy, multiplicity, hydrocephalus, intracerebral hemorrhage, intraventricular hemorrhage, and World Federation of Neurosurgical Societies (WFNS) Grade on admission. Statistical Analysis Used: We analyzed factors of ruptured small IA, focusing on PCoA aneurysms using univariate and multivariate regression analyses. Results: Univariate and multivariate analyses revealed that low aspect ratio (AR) (odds ratio [OR] = 0.33, P = 0.01) and nonfetal type of PCoA (OR = 0.31, P = 0.02) might be independent characteristics of ruptured small PCoA aneurysms. However, age, sex, past medical history, WFNS grade, and treatment outcome were not different between the small and nonsmall PCoA aneurysms. The aneurysm size was not associated to the selection of treatment, proportion of complications, and treatment outcome. Conclusions: In cases of ruptured PCoA aneurysms, low AR and nonfetal type of PCoA might be associated with rupture of small aneurysms.
Getting Neurosurgery Services Back on Its Feet: “Learning to Live” with COVID-19
Authors: Goyal Nishant , Gupta Kanav , Chaturvedi Jitender , Swain Srikant , Tomy Akhil
Published: July 2021

Background: Cancellation/postponement of ”non-emergent” surgeries during coronavirus disease of 2019 (COVID-19) pandemic has created a huge backlog of patients waiting for surgery and has put them at risk of disease progression. We share our institute's policy and our department's attempt to resume ”non-emergent” surgeries. Materials and Methods: We collected details of all patients operated under department of neurosurgery since the onset of COVID-19 pandemic in India and categorized them into ”lockdown” and ”unlock” groups for comparison. COVID-19 tests done in these patients were also analyzed. We also compared our surgical volume with the number of COVID-19 cases in the state. Results: One hundred and forty-eight patients (97 males, 51 females) with mean age of 37.8 years (range-2 months-82 years) underwent surgery in our department during the study period. The operative volume per week increased by 37% during the ”unlock” period as compared to ”lockdown” period. The proportion of elective/”non-emergent” surgeries increased from 11.3% during ”lockdown” to 34.7% during the ”unlock” period (P = 0.0037). During ”lockdown” period, number of surgeries declined steadily as the number of COVID-19 cases rose in the state (rs(8) = −0.914, P = 0.000). Whereas there was a trend toward increased number of cases done per week despite increase in the number of cases in the state during the “unlock” period. During the ”unlocking” process, in-patient department admissions and surgeries performed per month increased (P = 0.0000) and this increase was uniform across all specialties. COVID-19 test was done (preoperatively or postoperatively) for all surgeries during ”unlock” period compared to 12 (22.6%) surgeries during ”lockdown” period. Three neurosurgery patients who underwent surgery during the ”unlock” period tested positive for COVID-19. Conclusions: Our experience shows that proper evidence-based protocols, setting up of adequate COVID-19 testing facilities and provision of ample personal protective equipments are instrumental in re-starting “nonemergent” surgeries.
Morphology and morphometry of human paracentral lobule: An anatomical study with its application in neurosurgery
Authors: Patra Apurba , Kaur Harsimarjit , Chaudhary Priti , Asghar Adil , Singal Anjali
Published: July 2021

Background: The human paracentral lobule (PCL) is the medial continuation of the precentral and postcentral gyri. It has important functional area related to the lower limb and perineum. Its visible surface that corresponds to magnetic resonance imaging scout images varies in morphology, so it requires exact data. Studies related to such data are rare. With such a facile, we studied the morphology and morphometry of PCL. Materials and Methods: Fifty formalin-fixed adult human brains dissected in the midsagittal plane were used in this study. First, the morphological types of PCL and its boundary were determined, followed by morphometry of its extrasulcal surface using digital vernier calipers. Measurements were done along the anteroposterior axis (length) and vertical axis (height). In addition to that, the extent of motor and sensory area into PCL was also measured. Results: Three distinct morphological types of PCL were found: continuous (2%), partially segmented (91%), and completely segmented type (7%). In completely segmented type, a short transitional lobulolimbic gyrus was also found in three cases. The mean extrasulcal surface of the left PCL was significantly larger, both in males (left 10.67 cm2 vs. right 8.80 cm2) and in females (left 8.80 cm2 vs. right 6.99 cm2). Irrespective of gender and sidedness, motor area was significantly larger than the sensory area. Conclusion: Reported data will be useful in diagnosis and treatment of diseases affecting the human PCL. Variations in the distribution of sensorimotor cortex over PCL may help further assessment of hemispheric lateralization and the location of central sulcus as a reliable indicator of cytoarchitectonic borders.
Retrospective study and outcome predictor after microsurgical resection of cerebral arteriovenous malformations in Nepal
Authors: Karki Prasanna , Sharma Gopal , Joshi Sumit , Paudel Prakash , Shah Damber
Published: July 2021

Objective: The purpose of this study is to assess demographic, clinical, and morphological characteristics of patients with brain arteriovenous malformations (bAVMs). The relation of outcome using modified Ranklin Scale (mRS) at time of discharge, early and last follow ups with respect to various factors. Materials and Methods: Demographic data, arteriovenous malformation characteristics, and treatment outcomes were evaluated in 43 bAVMs treated with microsurgery between 2009 and 2019. For this series, 43 patients were retrospectively reviewed. A subgroup analysis for Spetzler-Martin grades (SMG) I/II, III, IV/V and III–V were performed. The mRS was used to assess functional outcomes. Results: Overall, mean age at diagnosis was 33 years (standard deviation = 19). Transient deficit, mRS deterioration and impaired functional outcome occurred less frequently in SMG I–II patients compared with Grade III–V patients combined (29% vs. 32% respectively, P = 0.00). All patients with SMG Grade I, Supplemented SMG Grade 2, 3, 4 and 6 had a mRS score of 2 or less at the last follow-up. Age was the only significant predictor of overall outcome after bAVM surgery on Chi-square test (P = 0.046), i.e: all patients <20 years had mRS score of 2 or less on last follow-up. Unfavorable outcome (mRS score of 3 or more than 3) level increased with higher grades in SMG on long term follow-up. Conclusion: The results of our case series of bAVM with SMG Grade I and Suplemented Grade 2, 3, 4 and even higher grade i.e., 6 can have excellent overall outcome after microsurgical resection. Association of factors which increases the grading system of bAVM like eloquence, deep venous drainage and increasing sizes did not correlate with the predicted unfavorable outcomes, whereas age of patients was a predictor of overall outcome. Although the small sample size of this study is a limitation, age of patient plays important role on the overall outcome.
Filum terminale arteriovenous fistula with additional arterial supply by the posterior spinal artery: A report of two cases
Authors: Iampreechakul Prasert , Yaisarn Naruedol , Wangtanaphat Korrapakc , Lertbutsayanukul Punjama , Siriwimonmas Somkiet , Techataweewan Nawaporn
Published: July 2021

Filum terminale arteriovenous fistulas (FTAVFs) are rare and usually supplied by the artery of the filum terminale, distal termination of the anterior spinal artery (ASA). These fistulas may also supply from the lateral sacral artery (LSA) arising from the internal iliac artery and/or middle sacral artery. Additional supply by the posterior spinal artery (PSA) has never been mentioned before. The authors describe two middle-aged men harboring FTAVFs manifested with progressive myelopathy and bowel/bladder dysfunction. The first fistula was supplied by the ASA with additional supply by the dilated PSA connecting with the ASA. Another fistula was supplied by the LSA and the PSA communicating with the ASA. The first case was successfully treated by endovascular treatment with N-butyl cyanoacrylate through the enlarged PSA, whereas the second case was surgically treated by direct obliteration of the fistula. Both patients had good neurological outcome.
Glioblastoma shortly after a normal conventional brain magnetic resonance imaging: A report of two cases and review of the literature
Authors: Hakan Tayfun , Çelikoglu Erhan
Published: July 2021

Glioblastoma (GB) is the most common malignant tumor of the brain. Most of these tumors are primary or de novo GBs that manifest rapidly with initial presentations such as headache, new-onset epileptic seizure, focal neurological deficits, and altered mental status. The typical radiological features of GB include strong contrast enhancement, central necrosis, and edema with mass effect. Herein, we describe two cases of primary GB – two women aged 60 and 51 years who were diagnosed with GB 3.5 and 4 months, respectively, after their initial admission. These patients presented with right-sided headaches, and their neurological examination was within the normal limits. Their initial radiological investigations revealed no suspicious lesions, either on T1-weighted or T2-weighted magnetic resonance (MR) images. The 60-year-old patient was readmitted with persistent headache, and her T1-weighted MR images revealed a well-demarcated mass lesion in the right temporal lobe with strong contrast enhancement. Moreover, the T2-weighted MR images revealed closed sulci and swollen midline structures because of edema. The 51-year-old patient was readmitted with persistent headache, and her MR image revealed a mass lesion with heterogeneous contrast enhancement and necrosis on T1-weighted images and hyperintense areas with severe edema on T2-weighted images. The patients underwent craniotomy and gross total tumor resection. Notably, in both cases, the lesions were pathologically diagnosed as GB. Therefore, it should be borne in mind that only persistent headache could be a sentinel sign of GB before it becomes radiologically visible, thereby emphasizing the need for follow-up imaging studies at short intervals.
Temporalis muscle cysticercosis: Common parasite at uncommon location
Authors: Wankhede Lomesh , Sahoo Sushanta , Hosur Bharat
Published: July 2021

Isolated involvement of the temporalis muscle by cysticercosis is uncommon. The clinical features may mimic other inflammatory conditions of maxilofacial region or that of temporal headache. We describe here a case of right temporalis muscle cysticercosis that was initially misdiagnosed as dental caries. She clinically improved with albendazole and steroid. The radiology done after 6 months of therapy showed a complete resolution of the intramuscular lesion. Although rare, cysticercosis should be kept as one differential in patients present with unilateral temporal headache in endemic areas. Intramuscular cysticercosis can be diagnosed on the basis of radiological findings and respond well to pharmacological therapy.
Remote surgery using a neuroendovascular intervention support robot equipped with a sensing function: Experimental verification
Authors: Miyachi Shigeru , Nagano Yoshitaka , Kawaguchi Reo , Ohshima Tomotaka , Tadauchi Hiroki
Published: July 2021

Purpose: Expectations for remote surgery in endovascular treatments are increasing. We conducted the world's first remote catheter surgery experiment using an endovascular treatment-supported robot. We considered the results, examined the issues, and suggested countermeasures for practical use. Methods: The slave robot in the angiography room is an original machine that enables sensing feedback by using an originally developed insertion force-measuring device, which detects the pressure stress on the vessel wall and alerts the operator using an audible scale. The master side was set in a separate room. They were connected via HTTP communication using local area network system. The surgeon operated by looking at a personal computer monitor that shared an angiography monitor. The slave robot catheterized and inserted a coil for an aneurysm in the silicon blood vessel model in the angiography room. Results: Our robot responded to the surgeon's operations promptly and to the joystick's swift movements quite accurately. The surgeon could control the stress to the model vessels using various actions, because the operator could hear the sound from the insertion force. However, the robot required a time gradient to reach a stable advanced speed at the time of the initial movement, and experienced a slight time lag. Conclusion: Our remote operation appeared to be sufficiently feasible to perform the surgery safely. This system seems extremely promising for preventing viral infection and radiation exposure to medical staff. It will also enable medical professionals to operate in remote areas and create a ubiquitous medical environment.
Recurrent DHA nephropathy in renal allograft—revisiting clinicopathological aspects of a rare entity
Authors: Yesodharan Jyotsna , Seethalekshmy NV , Nair Rajesh R.
Published: July 2021

Background:

Adenine phosphoribosyltransferase (APRT) enzyme deficiency is a rare autosomal recessive disorder of purine metabolism affecting mainly the kidneys. It can present at any age with varying degrees of acute and chronic renal damage. Though xanthine dehydrogenase inhibitors offer effective control over the disease process, delay in diagnosis and treatment often lead to compromised function of native and even graft kidneys.

Methods:

We have done a retrospective search of records of renal biopsies reported at our center during the 5-year period from 2014 to 2018 to identify biopsies with 2,8-dihydroxyadenine crystal deposits. The demographic, clinical, and histopathological findings in these cases were studied and reviewed in the light of available literature.

Results:

Of 9059 renal biopsies received during the study period, 3 cases had the rare 2,8- dihydroxyadenine (DHA) crystals. All of them were diagnosed for the first time on allograft biopsies.

Conclusion:

A high index of clinical suspicion together with the characteristic microscopic appearance of crystals on renal biopsy and urine microscopy can clinch the diagnosis of this rare disease. Hence, improving awareness about this entity among clinicians and pathologists is extremely important.
Intravascular papillary endothelial hyperplasia of the cavernous sinus—A rare occurrence
Authors: Gajaria Pooja K. , Shenoy Asha S. , Baste Balaji D. , Goel Naina A.
Published: July 2021

Intravascular papillary endothelial hyperplasia (IPEH) is a benign, reactive proliferation of endothelial cells within areas of thrombus. It most commonly occurs in the skin and subcutaneous tissue, with less than 40 cases reported in intracranial location. Ours is the first case report from India of IPEH in the cavernous sinus. A 45-year-old male presented with headache and decreased visual acuity. Magnetic resonance imaging (MRI) revealed a well-defined, homogeneously contrast-enhancing mass in the cavernous sinus. Postoperatively, examination of tissue showed organizing thrombus within the vessel wall along with delicate, acellular, pseudopapillary cores. The fibrin-rich connective tissue of these showed blue staining with Masson's trichrome stain. These were lined by a single layer of endothelial cells without evidence of atypia; no nuclear pleomorphism, hyperchromasia, atypical mitosis, or areas of necrosis were seen. Hence, it was diagnosed to be IPEH. Follow-up MRI revealed no residual disease and the patient is disease-free at 8 months. Recognition of this entity by pathologic examination is important to rule out angiosarcoma. Gross total resection is curative. Residual lesions have the potential for recurrence, requiring adjuvant therapy.
Composite phaeochromocytoma with malignant peripheral nerve sheath tumour
Authors: Mukherjee Sriranjan , Mondal Akash , Sengupta Moumita , Chatterjee Uttara , Sarkar Debansu , Mukhopadhyay Satinath
Published: July 2021

Composite phaeochromocytomas (CP) are extremely uncommon adrenal medullary tumours where phaeochromocytoma coexists with another adrenal medullary tumour also of neural crest origin. CP includes combination of phaeochromocytoma along with a component of neuroblastoma, ganglioneuroblastoma, ganglioneuroma, benign nerve sheath tumour or a malignant peripheral nerve sheath tumour (MPNST). Here we describe the morphological and immunohistochemical details of a case of CP with MPNST in a 30 years old lady, without history of neurofibromatosis. Only 6 cases of CP with MPNST have been reported so far. We have tabulated a summary of these prior published cases of phaeochromocytoma with MPNST. To our knowledge, this is the first literature review describing the clinico-pathological characteristics of these rare tumours.
Moderately differentiated Sertoli-Leydig cell tumor of ovary with associated mucinous carcinoma and carcinoid—A case report and review of literature
Authors: Ravichandaran Aarthiprabha , Lakshmanan Archana , Kurian Ann , Prasad Srikala
Published: July 2021

Sertoli-Leydig Cell Tumors (SLCT) are very rare neoplasms of the ovary (0.2%) and they belong to the group of sex cord-stromal tumors. Of these, 20% of the cases show heterologous elements. We report a case of a 22-year-old woman who presented with complaints of lower abdominal pain and secondary amenorrhea for 10 months. Physical examination revealed right lower abdominal tenderness and fullness. Imaging showed a right ovarian mass. She underwent right salpingo-oophorectomy with bilateral pelvic lymphadenectomy and omentectomy. Microscopic examination revealed a neoplasm with varied histomorphological patterns. The predominant pattern was an atypical proliferative mucinous tumor with foci of microinvasion. The other component was that of moderately differentiated Sertoli-Leydig Cell Tumor. Focal areas resembling carcinoid were also noted. Immunohistochemistry was performed and the Sertoli-Leydig Cells were positive for CD56, calretinin, inhibin, vimentin, and ER. The glandular component was positive for CK20, EMA, CEA, and CDX2. Synaptophysin and chromogranin were positive within nests resembling carcinoid. With the given histomorphological features and immunohistochemistry findings, a diagnosis of moderately differentiated Sertoli-Leydig Cell Tumor of the ovary with associated mucinous carcinoma and carcinoid was rendered. The presence of heterologous elements in SLCTs has been reported to be associated with poor prognosis.
Desmoplastic fibroma of the Mandible with unusual histopathological features
Authors: Nisha Shetty , Chetana Chandrashekar , Ranjini Kudva , Adarsh Kudva
Published: July 2021

Desmoplastic fibroma (DF) is a rare myofibroblastic primary tumor of bone that histologically and biologically mimics the extra-abdominal desmoid tumor of soft tissue. The surgical management of this tumor has been a matter of controversy and its recurrence has been a matter of clinical relevance. In this case report, we describe an unusual case of DF in a 15-year-old male patient who presented with a slow-growing mass in the right posterior mandibular region of 2 years duration. The presence of areas mimicking Giant cell angiofibroma (GCA) is the highlight of the case. The possibility of misdiagnoses is more in early lesions since the available literature shows that immunohistochemistry (IHC) is not of much benefit while differentiating DFs from other spindle cell lesions.
IgG4 producing POEMS syndrome
Authors: Hindilerden Fehmi , Yonal-Hindilerden Ipek , Gulturk Emine , Yuksel Mahmut , Ozturkmen Asli Yuksel , Sakız Damlanur
Published: July 2021

Serum IgG4 is typically measured for Immunoglobulin G4-related Disease (IgG4-RD), a fibroinflammatory condition associated with polyclonal increase in serum IgG4. Yet, increased IgG4 may still be monoclonal, and little is known about IgG4 POEMS syndrome. We present a case of 40-year-old male with a mass lesion in the left sacral ala. The mass was composed of non-neoplastic fibrous tissue and dense infiltrate of mature plasmacytes with dense eosinophilic cytoplasm and eccentrically placed nuclei that express monoclonal Lambda free light chains and show diffuse positivity for IgG and IgG4. We discuss clinical manifestations and challenges encountered in the diagnosis and treatment of this rare coexistence.
Prevalence of contraceptive use and its association with depression among women in the Jazan province of Saudi Arabia
Authors: Alfaifi Mashael , Najmi Ali H. , Swadi Khadija H. , Almushtawi Abdullah A. , Jaddoh Sattam A.
Published: July 2021

Background:

Hormonal contraceptives (HC) are used for birth control and the treatment of premenopausal syndrome. Mood changes represent the leading reported cause of discontinuation of HC. Changes in mood vary from mild disturbances to severe clinical depression.

Objectives:

This study aims to estimate the prevalence of depression among HC users who visit primary health care centers in the Jazan Province of Saudi Arabia and to identify psycho-social factors that may predispose HC users to depression.

Methods:

A self-administered questionnaire was distributed among women who visited five primary health care centers in the Jazan Province. The survey included questions about socio-demographic information and an Arabic adaptation of the Beck Depression Inventory.

Results:

Among the 904 women surveyed, the prevalence of HC use was 57.3%. Mood disturbances were observed in approximately one-third of these women. There is was a significant correlation between higher depression scores and a history of depression therapy (P-value < 0.001), as moderate, severe, and extreme depression was more common in those with a history of taking depression therapy. The type of contraception used was also found to be a significant factor (P-value = 0.01) in the degree of depression.

Conclusion:

Approximately one-third of women using HC were shown to exhibit symptoms of mood disturbance. Working, limited social support, asked whether or not they experienced living problems in the past 2 months, and having an uncomfortable or somewhat comfortable marital relationship increased the likelihood of mood disturbances. Primary health care physicians should be aware of the relatively high prevalence of mood disturbances in women using HC, to provide support and care to patients.
Repercussions of lockdown on primary health care in India during COVID 19
Authors: Vyas Shaili , Sharma Neha , Archisman  , Roy Pritam , Kumar Raman
Published: July 2021

Primary health care is a comprehensive care with a wide range of essential services for people living in the rural and hard-to-reach areas. However, the primary healthcare delivery system in India is still in its initial stages and lacks human resources. With the COVID-19 pandemic around the corner, there has been a diversion of resources for controlling corona pandemic leading to undermining availability and accessibility of health services. This article highlights a few case scenarios and the multidimensional impact of lockdown on primary healthcare services. The article suggests certain appropriate measures that can be implemented as the lockdown simply cannot stop the transmission with no definite treatment and vaccine. There should be a multipronged strategy for breaking the chain of transmission and for future preparedness in case of such situations and to strengthen our primary healthcare system.
Knowledge, attitude, and practice of travel medicine among primary health care physicians in the Cluster-1, Riyadh City, Saudi Arabia
Authors: Sharahili Abeer Ahmed , AL-Eanzi Fayiz , Ghzwany Amal Ahmed , Alazmi Alhanouf Mamluh , Alhwsawi Esra Ali
Published: July 2021

Introduction:

Travel medicine deals with prevention and management of health problems of travelers to avoid or reduce the risk of avoidable illnesses. Primary healthcare physicians are the key individuals to provide the same. The objective of current study was to explore the level of knowledge, attitude, and current practical application of travel medicine among primary health care physicians serving in the Riyadh Health Cluster, Saudi Arabia.

Methodology:

A descriptive cross-sectional study among 210 primary healthcare physicians serving in Riyadh Health Cluster was conducted using a paper-based self-administered questionnaire collecting information on socio-demographic characteristics and knowledge, attitude as well as practice of travel medicine.

Results:

The majority of study participants were females (117, 55.7%) and 63% (n = 133) were non-Saudi physicians. More than 30% that is 66 participants had clinical experience of less than 5 years and around 67% (i.e., 141) participants were serving at the designation of registrar/senior registrar. One hundred sixty-seven participants (79.5%) had ever provided health advice to the travelers. Majority of the study participants had gained information on the travel medicine through Ministry of Health guidelines (66%). Nearly 11.4% participants were not sure about the cause of occurrence of typhoid infection. As reported by 30.5%, travelers never really sought advice on the travel insurance. Nearly 79.5% participants reported to have provided post-travel consultation for diarrhea, followed by respiratory infection (45.2%), fever (42%), and skin problems (21%).

Conclusion:

The knowledge, attitude, and practice of travel medicine among primary healthcare physicians was found to be sub-optimal in Riyadh.
Preventability, predictability, severity and causality assessment of adverse drug reactions reported from a teaching hospital in chhattisgarh
Authors: Keche Yogendra , Gaikwad Nitin , Dhaneria Suryaprakash
Published: July 2021

Background and Objectives:

Adverse Drug Reactions (ADRs) can lead to significant morbidity, rarely mortality and financial burden over the patient. ADRs that can be prevented can be considered as form of medication error sometimes. This study assessed the preventability, predictability and severity of ADRs using different assessment scales.

Methods:

ADR Monitoring Centre under newly established teaching hospital in Chhattisgarh collected ADR reports from different healthcare professionals during the period from November 2016 to November 2018. Analysis of the reported ADRs was done for their causality assessment, demographic details of patients, most common drug class responsible for the ADR. Seriousness and preventability of ADRs were analysed by using WHO Causality Scale and Modified Schumock and Thornton Scale respectively. Severity of ADRs was assessed by Modified Hartwig and Siegel Scale.

Results:

Totally 288 ADRs were reported in a 2-year period. 92.01% ADRs were non serious. 44.8% were mild, 53.81% moderate and 1.39% were severe ADRs. Causality assessment showed: 5.21% certain, 54.86% probable, 39.24% possible and 0.69% unlikely ADRs. Around 26% ADRs were definitely and probably preventable and 27.78% ADRs were predictable. The highest number (32.29%) of ADRs were reported to antimicrobials. 11.15% ADRs were reported to NSAIDs, in that 37.5% ADRs were due to NSAIDs combination.

Conclusion:

Many ADRs in this study are non-serious, preventable and predictable. Management of such ADRs through therapeutic interventions would be beneficial in a better patient outcome. Multidisciplinary strategies involving physicians, pharmacists, other healthcare professionals and patient education and awareness about ADRs are needed for prevention of ADRs.
The prevalence of stress, stressors and coping mechanisms and the socio-demographic factors associated among the auto-rickshaw drivers in Bengaluru city, India
Authors: Joshi Amey , Reddy Raveendra H. R. , Agarwal Anurag
Published: July 2021

Context:

Socio-demographic and environmental factors attribute to stress for auto-rickshaw driver leading to compromise of driver and passenger safety.

Aims:

This study assesses the prevalence and socio-demographic factors associated with stress and identifies the stressors and coping mechanisms in auto-rickshaw drivers.

Settings and Design:

A cross-sectional study was conducted amongst 140 randomly selected auto-rickshaw drivers in Bengaluru city, India.

Methods and Material:

Data was collected at a place and time convenient to the study participants using semi-structured pre-tested tool. Stress was assessed using Cohen's Perceived Stress Scale.

Statistical Analysis:

Data was entered and analyzed using Epi Info™ software. Two sample t/ANOVA tests were used to compare the difference in means and standard deviations (SD) between the sub-groups. P <0.05 was considered statistically significant.

Results:

Mean age of the auto-rickshaw drivers was 32.8 ± 8.3 years, majority belonged to the 25-30 years age-group. About 55.7%, 40.7% and 28.7% were consuming tobacco products, alcohol and some both, respectively. While the prevalence of self-reported stress was 76.4% (n = 107), 78.6% (n = 110) had stress based on Perceived Stress Scale (PSS) assessment. Mean PSS for participants self-reporting stress was 20.51 ± 5.25 as against 12.36 ± 4.98 who did not (P < 0.001). The mean PSS was 17.55 ± 4.13, 20.65 ± 5.23 and 23 ± 5.12 among those who self-reported having mild-, moderate- and severe-degree stress, respectively (P < 0.001). There was no significant association of any socio-demographic factors with the PSS score. Financial problems (n = 51; 47.7%) was the leading stressor, followed by road traffic (n = 49; 45.8%). Conclusions: Appropriate strategies are needed to address the high level of stress among auto-rickshaw drivers.
Risk of non-resumption of vaginal sex and dyspareunia among cesarean-delivered women
Authors: Doke Prakash Prabhakarrao , Vaidya Varsha Mahesh , Narula Arvinder Pal Singh , Patil Archana Vasantrao , Panchanadikar Tushar Madhavrao , Wagh Girija Narendra
Published: July 2021

Context:

Many women have postpartum sexual dysfunction. The mode of delivery is an important determinant.

Aims:

To calculate the risk ratio of non-resumption of vaginal sex and dyspareunia during the postpartum period among cesarean-delivered women.

Settings and Design:

This large multisite study was conducted in 13 selected hospitals in Pune District during 2017–19.

Methods and Material:

A total of 3,112 women (half cesarean delivered and half vaginally) were interviewed by trained health workers using a structured questionnaire. Women were interviewed at 4 weeks, 6 weeks, and 6 months.

Statistical analysis used:

Chi-square test was applied. A risk ratio with a 95% confidence interval was calculated.

Results:

At 6 weeks, the risk ratio of non-resumption of vaginal sex was significantly high among cesarean-delivered participants (1.14). Cesarean-delivered women had a lesser risk ratio of dyspareunia at both follow-ups (0.59, 0.49). Even at 6 months, about one-third vaginally delivered women had dyspareunia. The proportion of women non-resuming vaginal sex gradually decreased from 6 weeks to 6 months. The proportion of women having dyspareunia also decreased from 6 weeks to 6 months following childbirth. Residence in the rural area and cesarean delivery were the significant determinants of an early resumption of vaginal sex. Dyspareunia was significantly high among vaginal delivered than cesarean. About 25% of women continued to have dyspareunia up to 6 months.

Conclusions:

A large number of women suffer from dyspareunia; hence antenatal and postnatal care should include some counseling and management about the resumption of sex and dyspareunia.
Sternal Tuberculous Osteomyelitis in a Young Adult Presenting as Atypical Chest Pain
Authors: Sunil P. P. , Renjith K. R. , Ajayakumar T. , Vijayan Arvind P.
Published: July 2021

Sternal tuberculosis (TB) is an uncommon involvement of osteoarticular tissues where the diagnosis is most often delayed due to an insidious presentation. We present an unusual case of a young female with TB osteomyelitis of the sternum presenting as atypical chest pain in which a timely diagnosis could result in successful management by conservative means.
Denosumab in Giant Cell Tumor of Bone – Science Wins Over Evidence
Authors: Puthoor Dominic
Published: July 2021

Denosumab is a relatively new drug and is used in the treatment of giant cell tumor (GCT) of bone. There are hardly any drugs such as denosumab, indication of which changed in a short period of 10 years. The author analyses the cause of this transformation of indication of that drug in the treatment of GCT of bone, based on the scientific ground, review of the literature, and personal experience.
Charcot Foot – Current Concepts
Authors: Kumar Gautam , Simon Rajesh , Jose Dennis P.
Published: July 2021

Charcot neuropathic osteoarthropathy (CNO) is painless, progressive, noninfectious, degenerative arthropathy affecting single or multiple joints and soft tissues of foot and ankle caused by an underlying neurological deficit. The primary indication for surgical correction is a nonbraceble, nonplantigrade foot, instability, and impending or established ulceration. The goal of surgical management is to provide a stable, ulcer-free, plantigrade foot that can accommodate therapeutic footwear for self-ambulation. The choice of implants in midfoot CNO can be a combination of plate and screws well beyond the area of deformity to achieve rigid stability and good alignment following the principle of a super construct. The deformities involving the talus and ankle joint require a Total contact casting (TCC) arthrodesis, preferably with an intramedullary nail. The choices for soft tissue coverage as an additional procedure for ulcer management are guided by anatomic location, size, depth of ulcer, condition of surrounding soft tissue, and underlying deformity.