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   2017| July-September  | Volume 6 | Issue 3  
    Online since August 9, 2017

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A case report on chronic osteomyelitis of the right tibia in a pediatric male patient and its management
C Keerthana, TH Indu, Jaya Ganeshamoorthy, Ponnusankar Sivasankaran
July-September 2017, 6(3):184-186
The present case explains the treatment strategies followed for a chronic osteomyelitis case of a pediatric patient in a secondary care public hospital, Ooty, Tamil Nadu, India. He was presented with the complaints of pain and swelling on the right leg, which was treated with nonsteroidal anti-inflammatory drugs such as diclofenac and ibuprofen. Similarly, the tissue abscess observed was managed with parenteral antibiotics such as cefotaxime and amikacin. Surgery was done to remove the devascularized tissue and postoperative care was given with chymoral forte and vitamin supplements (Vitamin B complex, calcium and Vitamin C). In this patient, the reason for the occurrence of chronic osteomyelitis may be a complication of the previous surgery due to the accidental fall. Therefore, proper care should be given in the management of traumatic injuries in children and early diagnosis of osteomyelitis is essential to prevent the complications.
  5,539 351 2
Clinical analysis of proptosis in a tertiary care hospital of South India
Soujanya Kaup, HT Venkategowda
July-September 2017, 6(3):149-154
Context: Comprehensive data on various etiologies of proptosis is a necessity in guiding the ophthalmologists and physicians for early diagnosis and treatment. AIMS: This study aimed to describe the clinical presentation, spectrum of etiology, treatment modality, and outcome among patients with proptosis. Settings And Design: A longitudinal study was conducted in the department of ophthalmology of a tertiary care hospital, Karnataka, from December 2010 to December 2011. Participants And Methods: All the study participants who satisfied inclusion and exclusion criteria were interviewed with a pretested and validated schedule. Detailed clinical evaluation of proptosis was done after obtaining informed consent. Every case was followed up till the end of treatment. Statistical Analysis Used: Data were analyzed using Statistical Package for Social Sciences for Windows, Version 16.0. (SPSS Inc., Chicago, IL, USA). Results were expressed as frequencies and proportions for categorical variables and mean and standard deviations for continuous variables. Results: Fifty patients completed the study and nearly half were in the age group of 41–60 years. Axial proptosis was the most common type. Nearly one-third required surgical treatment and was significantly high (P < 0.01) in neoplastic proptosis. More than one-third resolved completely. Conclusions: Thyroid eye disease and other inflammatory disorders were the major etiology of proptosis. Extremes of age and unilaterality and eccentricity of proptosis clearly distinguish neoplastic causes from that of inflammatory. Considering the diverse etiology of the diseases causing proptosis, definitive management varies accordingly. The site of lesion causing proptosis is of prognostic value during orbitotomies with higher complications occurring with intraconal lesions.
  3,900 382 2
Normative values of handgrip strength in children using a perineometer
Vaishali Pornak, Suvarna Ganvir
July-September 2017, 6(3):155-157
Context: The device used in this study is a perineometer. This study comprises 100 children (50 boys and 50 girls) in the age group of 6–12 years. Children with any musculoskeletal and neurological disorder were excluded from the study. Aims: The aim of this study is to measure hand grip strength in children. Settings And Design: The observational study was conducted in Dr. Vitthalrao Vikhe Patil's CBSE School, Ahmednagar. Subjects And Methods: The children were asked to sit on a chair with an armrest. The cuff was inflated till 100 mmHg. The children were told to press the transducer of the perineometer up to their maximum strength and release it. This process was repeated for three times, and the maximum strength was noted for both the right and left hand. Armrest chair, perineometer were used. Statistical Analysis Used: Unpaired t-test. Results: The mean grip strength in boys is 72.6 mmHg on the right side and 67.18 mmHg on the left and 6.92 mmHg on the right and 58 mmHg on the left in girls. Conclusions: This study has provided the normative values of grip strength which can be used as a reference measure for detecting the abnormality in handgrip strength.
  3,828 318 -
Compare, evaluate, and estimate chronological age with dental age and skeletal age in 6–14-year-old Himachali children
Ajay K Kapoor, Seema Thakur, Parul Singhal, Deepak Chauhan, Cheranjeevi Jayam
July-September 2017, 6(3):143-148
Introduction: Age estimation is of immense importance not only for personal identification but also for treatment planning in medicine and dentistry. Chronologic age conveys only a rough approximation of the maturational status of a person. Hence, dental and skeletal ages (SAs) have been explored as maturity indicators since decades. Aims And Objectives: To test the applicability of Willem's dental age (DA) assessment methods as well as Mito T SA assessment method in Himachali children. Materials and Methods: The study included 55 subjects (30 males and 25 females) ranging from 6 to 14 years age who require orthodontic intervention. DA estimation was performed from digital orthopantomogram of mandibular teeth of left quadrant using Willem's methods. SA estimation was done from lateral cephalogram using Mito T method. The differences between the chronological age (CA) and the estimated dental and SAs were statistically tested using paired t-test. The correlation between CA, dental, and SA estimation methods was confirmed statistically using Pearson's correlation. Results: Among the age estimation methods used in this study, the Willem's DA estimation method proved to be the most accurate and consistent. Conclusion: Although various age estimation methods do exist, the results are varied in different populations due to ethnic differences. However, till new tables are formulated using greater sample size, the Willem's method can be accurately applied to estimate CA for the population studied.
  3,124 387 4
Assessment of the cardio-autonomic status by short-term heart rate variability in young football players
Kuppusamy Maheshkumar, Sundareswaran Loganathan, Arbind Kumar Choudhary
July-September 2017, 6(3):133-136
Background/Objectives: The present study was done to explain the importance of physical activity (PA) on autonomic nervous system. We have compared the short-term heart rate variability (HRV) between football players and normal controls lacking PA, fitness, and exercise. Design: Case–control study. Methods: The sample included 40 football players and 40 controls with age group between 17 and 26 years. Individuals with minimum 5 years of football practice were included and morphological variables (weight, height, and body mass index) were recorded in all of them. Five minutes lead II electrocardiography recorded in supine position in the morning and R-R intervals were analyzed in Kubios software. Results: Time domain parameters of average mean R-R interval (1014 ± 286.12 ms vs. 860.28 ± 362.4 ms), standard deviation of the NN (89.81 ± 18.14 ms vs. 63.9 ± 31.27 ms), root mean square of successive difference (76.95 ± 24.20 ms vs. 43.19 ± 29.83 ms), and pNN 50% (39.16 ± 16.87% vs. 23.46 ± 19.43%) were significantly higher in the study group than the control group. Higher frequency power band (71.23 ± 11.59 n.u vs. 54.90 ± 17.3 n.u) showed significant higher value while low-frequency (LF) power band (29.66 ± 15.13 n.u vs. 47.23 ± 13.84 n.u) and LF/high-frequency ratio (0.964 ± 0.286 vs. 2.04 ± 0.459) of frequency domain parameters showed significant reduction among the football players. Conclusion: The present study explains that regular PA in the form of football shifts the autonomic system toward parasympathetic domination. The indices of HRV can be useful to monitor the effects of football training on parasympathetic modulation and to the periods of stress and recovery.
  2,674 318 -
Coverage of mass drug administration and status of mass drug administration program in Bankura district of West Bengal, India
Dibakar Haldar, Sanjay Kumar Saha, Amiya Dwari, Daliya Biswas, Sourav Lo, Saswati Naskar, Gautam Narayan Sarkar
July-September 2017, 6(3):137-142
Background: Government of India adopted mass drug administration (MDA) since 2004 for elimination of lymphatic filariasis (LF) by 2015 AD. MDA implementation in WB has been criticized for low coverage and Government of West Bengal (WB) emphasized directly observed therapy (DOT) (swallowing of medicines under supervision) in MDA implementation. Objective: The objective of the study was to assess coverage of MDA and status of MDA program. Materials and Methods: A cross-sectional survey was conducted in three subcenters of three blocks and three wards of Bankura municipality of Bankura district, WB, selected by multistage random sampling technique. Information was collected through interviewing randomly selected inhabitants; ground level workers and block level supervisors of selected clusters with verification of records/logistics used in MDA at clusters and leftover medicines at households. Results: Around two-third of respondents knew LF among which 83.33% considered limb swelling as an important symptom and 30.34% knew about transmission. Appropriate distribution and consumption of both MDA medicines were 70.10% and 56.20% with 64.89% consumption being supervised. Information education and communication and monitoring were suboptimal including utilization of strength and opportunity of MDA program. Conclusion: Supervised medicine consumption was found marginally increased seemingly due to DOT through repeat house visits, but effective coverage fell short of target as a result of dismal low coverage in urban cluster.
  2,538 287 1
Pachyonychia congenita affecting nails only: A sporadic case or novel mutation of an uncommon genodermatoses
Yadalla Hari Kishan Kumar, Shankar Keerthi
July-September 2017, 6(3):191-193
Pachyonychia congenita (PC) is a rare genodermatoses transmitted by autosomal dominant inheritance characterized by hypertrophic nail changes and nail dystrophy, also associated with the oral mucosa, skin, hair, and teeth involvement. A 26-year-old female presented with disfigured nails of both hands and feet involving all 20 digits since birth. She gave complaints of occasional painful swelling and shedding of nails. The nails were discolored and thickened with overcurvature and subungual hyperkeratosis giving a characteristic wedge-shaped appearance. Palms, soles, and mucous membrane examination were normal. There were no other ectodermal abnormalities, and systemic examination was normal. Potassium hydroxide examination of the nail clippings did not reveal any fungi. The presence of characteristic clinical features led to a diagnosis of forme fruste of PC.
  2,371 131 1
Blunt abdominal trauma presenting as an isolated intraperitoneal bladder rupture: A diagnostic and therapeutic dilemma
Money Gupta, Sukhminder Jit Singh Bajwa, Arvinder Pal Singh, Meenal Khanna, Lehar Khanna
July-September 2017, 6(3):177-179
Bladder rupture is very rare clinical finding in pediatric age group. This should be suspected in any child who does not pass urine, develops abdominal distension, pain, and tenderness in the lower abdomen after sustaining blunt trauma to the abdomen. Delay in presentation and diagnosis further increases the morbidity and mortality. Isolated bladder rupture is a rare consequence of blunt trauma in the absence of pelvic fracture. We are reporting a rare case with an isolated bladder rupture in which no any other associated injury was present. The patient had presented 24 h after sustaining the injury with clinical features of anuria and peritonitis. Emergency surgery was undertaken to save the child.
  2,042 155 -
A rare case of subungual exostosis of the hallux in an adolescent: A clinico-pathological review of literature
Supreeth Nekkanti, Arunodhaya Siddartha, Sujana Theja, Purushotham Sastry, Abhilash Gowd
July-September 2017, 6(3):187-190
Osteochondromas and subungual exostosis (SE) are commonly misunderstood conditions. They are widely used synonymously. However, a detailed review of literature tells us that SE is in fact a rare variant of osteochondroma. This peculiar tumor is relatively uncommon; it has not been much remarked in the recent years. We report a case of SE of the hallux in an 18-year-old girl who presented to us with a swelling on her great toe which ulcerated the skin and caused lifting of the nail. We surgically excised the mass and reconstructed the nail and confirmed the diagnosis by histopathological studies. We present this case for its rarity and also because it is often misunderstood and misdiagnosed.
  2,020 155 -
Recurrent pulmonary embolism associated with oral hormonal contraceptive use
Bhanukumar Muthaiah, Vineetha Bharathan Menon
July-September 2017, 6(3):180-183
Pulmonary embolism (PE) is a dramatic and life-threatening complication of deep vein thrombosis, and thus, its prevention, diagnosis, and treatment are of special importance. One of the more common acquired risk factor of PE is the use of oral contraceptive (OCP) medications. We report a case of PE secondary to OCP use. A 30-year-old female patient presented with PE following OCP use. Diagnosis was confirmed with computed tomography angiography and treatment was started with thrombolytics. Although appropriate treatment was initiated and offending drug was withdrawn, patient succumbed to her illness. Thus, treatment with OCPs requires careful and thorough evaluation of patient history and regular follow-up, focusing on likely complications.
  1,941 189 -
Tuberculosis of patella: Nonspecific presentation, treated conservatively
Pankaj Kumar Sharma, Arkesh Madegowda, Ravi Mittal
July-September 2017, 6(3):194-196
Skeletal tuberculosis (TB) accounts for 8% of extrapulmonary TB, and patella accounts for 0.1% of all skeletal TB. Patella TB in early stages is very difficult to diagnose because of no constitutional signs and symptoms. It may be found in immunocompromised states, endemic areas, and in chronic debilitated patients. Isolated TB of patella is very rare, so early diagnosis and management is quite difficult without clinical and histopathological examination. There is a significant improvement in clinical outcome after taking antitubercular multidrug therapy and surgery is rarely required.
  1,902 164 -
Impact of diabetes on the risk of geriatric conditions among patients seen in a tertiary care hospital in India
Ancy Varghese, Krishna Undela, Parthasarathi Gurumurthy, Narahari Moda Gopalakrishna
July-September 2017, 6(3):169-176
Context: Geriatric conditions (GCs) are associated with poor quality of life, higher morbidity and mortality among the elderly. AIMS: To assess the risk of diabetes mellitus (DM) on GCs and the effect of gender differences on this association. Materials And Methods: A cross-sectional, observational study was conducted in a tertiary care teaching hospital for eight months. Patients with ≥60 years of age were included. Selected GCs included cognitive impairment (CoI), falls, depression, urinary incontinence (UI), dizziness, lower body mass index (BMI), visual impairment (VI), and hearing impairment. The Short Portable Mental Status Questionnaire and Geriatric Depression Scale were used to assess CoI and depression, respectively. Other GCs, DM, and comorbidities were self-reported. Binary logistic regression analysis was used to identify the risk of GCs among DM patients. Results: A total of 1150 patients were included; more than half (65%) were males and 60% aged between 60 and 69 years. After adjustment for basic demographics and comorbid conditions, DM was associated with increased risk of overall GCs (risk ratio [RR]: 1.41; 95% confidence interval [CI]: 1.01–1.96; P = 0.04) and specifically for UI (RR: 2.91; 95% CI: 2.09–4.04; P< 0.001) and VI (RR: 1.59; 95% CI: 1.16–2.18; P< 0.001). We found less risk of lower BMI among patients with diabetes (RR: 0.49; 95% CI: 0.32–0.77; P< 0.001). In the subgroup analysis, males were found to have significant increased risk to get GCs (RR: 1.60; 95% CI: 1.05–2.44; P = 0.02) than females (RR: 1.28; 95% CI: 0.71–2.30; P = 0.08). Conclusions: DM was associated with excessive risk for GCs, especially for UI and VI.
  1,556 181 -
Adansonia digitata ameliorates carbon tetrachloride-induced cerebello-pituitary dysfunction in adult male Wistar rats
Oyetunji Adeoye Oyewopo, Kehinde Samuel Olaniyi, Christianah I Oyewopo, AO Morakinyo
July-September 2017, 6(3):158-162
Background: The use of Adansonia digitata (AD) as a multipurpose tree is gaining worldwide acceptance, and it is readily available in many parts of Africa and other parts of the world. Several functions of AD are well documented, but little is known on the neuroprotective effect of AD. We hereby hypothesize that administration of AD would ameliorate carbon tetrachloride (CCl4)-induced cerebellar and pituitary gland dysfunction. Methods: Adult male Wistar rats were randomly allotted into groups; control (vehicle; received 1 ml of distilled water), AD- treated (received 500 mg/kg b.w.), CCl4-treated (received 2.5 mg/kg b.w. and AD + CCl4-treated. CCl4was administered for 2 days p.o., thereafter AD fruit pulp was given to the AD-and AD + CCl4-treated groups p.o. for 17 days. The body weight change was monitored using animal weighing balance (Olympia SCL66110 Model, Kent Scientific Corporation, Torrington, CT06790, USA), biochemical assay, histology of cerebellum, and pituitary glands were performed. Results: The results show a significant decrease in body weight gain and distortion in the cytoarchitecture of the cerebellum and pituitary gland of the group treated with CCl4when compared to the control group. These alterations were associated with increased oxidative stress (malondialdehyde) and decreased gonadotropic hormones. Administration of AD fruit pulp significantly restored the effect of CCl4in the AD + CCl4-treated group. Conclusion: This study demonstrates that administration of AD ameliorates CCl4-induced cerebellum and pituitary gland dysfunction. This might be due to its antioxidative effect and enhancement of gonadotropic hormone secretion.
  1,466 155 -
A study on implementation and factors affecting functioning of Chiranjeevi Yojna in Ahmedabad district of Gujarat
Rajendrasinh Bhikhuji Chauhan, Rohit Vasabhai Ram, Bhagyalaxmi B Aroor
July-September 2017, 6(3):163-168
Aim: The aim is to study the bottlenecks and factors affecting the implementation of Chiranjeevi Yojna (CY) in Ahmedabad district. Setting And Design: A cross-sectional study was conducted in six blocks of Ahmedabad district from April 2010 to June 2010. Materials And Methods: We conducted detail interview of 50 beneficiaries of CY, 50 nonbeneficiaries of CY, 24 health workers and 13 doctors with pretested questionnaires after taking informed verbal consent. Data entry and analysis was performed using Microsoft Excel 2007 and Epi Info 3.5.1 software package. Statistical Analysis: Percentages, Chi-square test, Wilcoxon matched – pair test were used. Results: In more than 80% of the cases, place of delivery was decided by mother in law and husband, in both groups. It was seen that main motivator to join the scheme were Auxiliary Nurse Midwife (ANM) and Accredited Social Health Activist (ASHA) workers in 86% of the beneficiaries. In this study, beneficiaries were started antenatal visit early and taken more antenatal visits as compared to nonbeneficiaries and the difference is statistically significant. In this study, most of the beneficiaries were satisfied with the service but unsatisfied with the payment modalities. Very few beneficiaries have received cash assistance, and full payment (Rs. 200 + Rs. 50) was only given in around 10.53% of cases. Conclusion: ANMs and ASHAs have been found effective in building awareness and guiding the clients to utilize the services. The level of education and awareness about CY was very low among the beneficiaries and nonbeneficiaries. Satisfaction with the service among client was quite good.
  1,477 142 -
Acute hemodynamic disturbances during pituitary surgery
Surya Kumar Dube, Rupali Pattanaik, Devika Agarwal, Gyaninder P Singh
July-September 2017, 6(3):197-198
  1,156 128 -