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Penetrating injury to the floor of mouth in a child: Management of a challenging case 儿童口腔底穿透伤:一个具有挑战性的病例的处理
Pub Date : 2021-07-01 DOI: 10.4103/jmgims.jmgims_12_21
Manas Dash, S. Mallick, K. Mishra, P. Panigrahi
Penetrating injuries of the oro-maxillofacial region are not only rare but difficult to manage in the pediatric age group. We report a case of a six-year-old girl who was injured with a penetrating reinforcing bar (rebar) in the floor of the mouth, where both ends of the rebar protruded out. The girl fell off a partially constructed terrace and was hanging with the rebar in her neck for hours. On examination, the vital structures of the neck were not involved. The child was taken for surgery after stabilization, abiding by COVID protocols. The rebar was removed under ketamine sedation with repair of the injury in the floor of her mouth. The postoperative period was uneventful and the child was discharged on the fifth postoperative day. Managing this pediatric trauma emergency was challenging in terms of imaging, securing an airway, and assuring parents about the choices for intervention during lockdown.
口腔颌面部的穿透性损伤在儿童年龄组中不仅罕见而且难以处理。我们报告一个六岁的女孩谁是受伤与穿透钢筋(钢筋)在口腔底部,其中钢筋的两端突出。这名女孩从一个未完工的露台上摔了下来,脖子上的钢筋被吊了几个小时。经检查,颈部的重要结构未受累。在病情稳定后,该儿童被送往手术,并遵守了COVID协议。钢筋是在氯胺酮镇静下取出的同时修复了她口腔底部的伤口。术后顺利,患儿于术后第5天出院。处理这种儿科创伤紧急情况在成像、确保气道安全以及向家长保证封锁期间的干预选择方面具有挑战性。
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引用次数: 0
Disruptive change in medical education during the COVID-19 pandemic: Challenges and opportunities 2019冠状病毒病大流行期间医学教育的颠覆性变革:挑战与机遇
Pub Date : 2021-07-01 DOI: 10.4103/jmgims.jmgims_95_21
M. Joshi, M. Chandrasekar
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引用次数: 0
Audit of blood utilization in a tertiary care hospital: Our experience over a period of 2 years 三级医院血液利用审计:我们2年的经验
Pub Date : 2021-07-01 DOI: 10.4103/jmgims.jmgims_62_21
Urmi Chakravarty-Vartak, A. Neelakantan, Shailesh Vartak, R. Shewale
Context: Blood transfusion plays a vital role in saving lives. However, owing to its many side effects, it should be used judiciously. Aim: The aims of this study were: audit of blood utilization in our tertiary care set up, formulation of a maximum surgical blood ordering schedule (MSBOS) for procedures where a complete cross-match appears mandatory, and improvement in the efficiency of blood utilization in trauma care. Methods: All patients admitted to Lokmanya Tilak Municipal Medical College and General Hospital during the study period for whom cross-match requests were sent to blood bank were included in this study. They were divided into groups according to the departments under which they were admitted. Data were analyzed and cross-match to transfusion ratio (C/T ratio), transfusion index, and transfusion probability (%T) were calculated. C/T ratio was used as an index of the efficacy of blood ordering practice, and a ratio of >2.5 was considered an indication of the excess cross match. Results: The maximum C/T ratio of 34.11 was noted in the Department of Cardiology. Only three departments (Artificial Kidney Dialysis, Pediatrics, and Medical Intensive Care Unit) showed effective utilization of blood. Minimum C/T ratio of 1.34 observed in the Department of Artificial Kidney Dialysis. Conclusion: We found gross over-ordering of blood by different departments. Hence we propose the formulation of a blood ordering schedule. We drafted a MSBOS which provides guidelines for frequently performed elective surgical procedures by recommending the maximum number of units of blood to be cross-matched preoperatively, implementation of which will result in more efficient use of blood.
背景:输血在挽救生命方面起着至关重要的作用。然而,由于它的许多副作用,应该谨慎使用。目的:本研究的目的是:审计我们三级医疗机构的血液使用情况,制定外科最大订血时间表(MSBOS),以确保完全交叉配型是强制性的,并提高创伤护理中血液利用的效率。方法:选取研究期间在洛克马尼亚蒂拉克市立医学院及总医院住院并向血库发送交叉配型请求的患者作为研究对象。他们根据被录取的院系被分成几组。对数据进行分析,计算输血比(C/T ratio)、输血指数、输血概率(%T)交叉匹配。C/T比值被用作血液排序实践效果的指标,比值>2.5被认为是过度交叉匹配的指标。结果:心内科C/T比值最高,为34.11。只有3个科室(人工肾透析、儿科和医学重症监护室)的血液利用有效。人工肾透析科最低C/T比值为1.34。结论:不同科室存在严重的超额订血现象。因此,我们建议制定血液订购时间表。我们起草了一份MSBOS,通过推荐术前交叉配血的最大单位数,为经常进行的选择性外科手术提供指南,该指南的实施将导致更有效的血液利用。
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引用次数: 0
Mild cognitive impairment and its lifestyle-related risk factors in the elderly: A community-based cross-sectional study 老年人轻度认知障碍及其生活方式相关危险因素:一项基于社区的横断面研究
Pub Date : 2021-07-01 DOI: 10.4103/jmgims.jmgims_16_21
A. Saikia, V. Rajendran
Context: Alzheimer's dementia (AD), an irreversible condition is an important cause of disability in old age. Mild cognitive impairment (MCI) is an intermediate state between normal cognition and dementia. Amnestic MCI (aMCI) is the precursor of AD. Identification of modifiable lifestyle risk factors help in the prevention of aMCI, and thereby in the prevention of AD. Aim: The purpose of this study was to determine the prevalence of aMCI and different lifestyle factors associated with types of MCI. Methods: This cross-sectional study was conducted amongst the elderly (≥60 years). A sample of 576 persons was selected using a multistage sampling technique. Vernacular adaptation of Hindi Mini-Mental State Examination tool was used to screen dementia and MCI. Geriatric Depression Scale-15 was used for screening depression. Data were collected using a pre-designed and pretested schedule and SPSS was used for data entry and analysis. Results: The prevalence of MCI was found to be 22.4% among the elderly. Out of all MCI cases, the prevalence of aMCI was 38.8% in this study. The lack of social and leisure engagement was found to be significantly associated with the type of MCI. Conclusion: The comparatively higher prevalence of aMCI is just the tip of the iceberg. Lack of social and leisure engagement is a highly predictive risk factor.
背景:阿尔茨海默氏症(AD)是一种不可逆的疾病,是导致老年残疾的重要原因。轻度认知障碍(MCI)是介于正常认知和痴呆之间的一种中间状态。AmnesticMCI(aMCI)是AD的前兆。识别可改变的生活方式风险因素有助于预防aMCI,从而预防AD。目的:本研究的目的是确定aMCI的患病率以及与MCI类型相关的不同生活方式因素。方法:这项横断面研究是在老年人(≥60岁)中进行的。采用多阶段抽样技术选择了576人的样本。印地语迷你精神状态检查工具的白话改编用于筛查痴呆症和MCI。老年抑郁症量表-15用于抑郁症筛查。使用预先设计和测试的时间表收集数据,并使用SPSS进行数据输入和分析。结果:老年人MCI患病率为22.4%。在所有MCI病例中,aMCI的患病率为38.8%。研究发现,缺乏社交和休闲参与与MCI类型显著相关。结论:aMCI相对较高的患病率只是冰山一角。缺乏社交和休闲参与是一个具有高度预测性的风险因素。
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引用次数: 0
Evaluation of human epidermal growth factor receptor 2 expression in colorectal cancer and its correlation with clinicopathological variables 人表皮生长因子受体2在结直肠癌中的表达及其与临床病理变量的关系
Pub Date : 2021-07-01 DOI: 10.4103/jmgims.jmgims_20_21
S. Ahuja, V. Arora
Context: Colorectal cancer is the third most common cancer in men and the second most common cancer in women worldwide. Overexpression of human epidermal growth factor receptor 2 (HER2) in breast and gastric cancer is associated with poor prognosis. However, in colorectal cancer, there are no specific guidelines for immunohistochemical interpretation of HER2. Furthermore, there are conflicting reports regarding correlation of clinicopathological parameters with HER2 expression. Aim: The present study was conducted to determine the frequency of HER2 expression in colorectal cancer and its correlation with clinicopathological variables, if any. Methods: Resection specimens for colorectal cancer over a 2-year period were included in this retrospective study. HER2 immunostaining was done using a monoclonal antibody followed by evaluation of pattern and intensity of staining along with correlation of cells with membranous positivity. Clinicopathological parameters such as age, gender, tumor location, histological subtype of tumor along with tumor stage and grade were analyzed using Fisher's exact test for significance. Results: Of the 50 cases analyzed, 70%, 28%, and 2% were conventional, mucinous, and signet cell ring adenocarcinomas, respectively. The majority were moderately differentiated (56%) and most of the cases presented at Stage III. Weak-to-moderate cytoplasmic positivity was seen in 18% cases, while one case each (2%) showed combined cytoplasmic-membranous and complete membranous positivity, respectively. No significant correlation could be established between HER2 immunostaining and histological subtype or tumor stage/grade. Conclusions: Colorectal cancer demonstrates a very low membranous positivity to HER2 immunostaining. HER2 expression in colorectal cancer has no correlation with clinicopathological variables such as tumor grade, stage, and histological subtype. HER2 does not appear to have any prognostic role to play in colorectal cancer in the context of Indian population.
背景:结直肠癌癌症是世界上男性第三常见的癌症,女性第二常见的癌症。人表皮生长因子受体2(HER2)在癌症和乳腺癌中的过度表达与预后不良有关。然而,在结直肠癌癌症中,没有关于HER2免疫组化解释的具体指南。此外,关于临床病理参数与HER2表达的相关性,也有相互矛盾的报道。目的:本研究旨在确定HER2在癌症中的表达频率及其与临床病理变量(如果有的话)的相关性。方法:对癌症切除标本进行为期2年的回顾性研究。使用单克隆抗体进行HER2免疫染色,然后评估染色的模式和强度以及细胞与膜阳性的相关性。临床病理参数,如年龄、性别、肿瘤位置、肿瘤组织学亚型以及肿瘤分期和分级,使用Fisher精确检验进行显著性分析。结果:在分析的50例病例中,常规腺癌、粘液腺癌和印戒细胞环腺癌分别占70%、28%和2%。大多数为中度分化(56%),大多数病例出现在III期。18%的病例出现弱至中度细胞质阳性,而各有一例(2%)分别显示细胞质膜性和完全膜性联合阳性。HER2免疫染色与组织学亚型或肿瘤分期/分级之间没有显著相关性。结论:癌症大肠癌HER2免疫染色膜阳性率非常低。癌症中HER2的表达与肿瘤分级、分期和组织学亚型等临床病理变量无关。在印度人群中,HER2在癌症中似乎没有任何预后作用。
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引用次数: 0
Glandular odontogenic cyst mimickers: A review and report of two cases 腺源性牙源性囊肿模拟物:2例回顾报告
Pub Date : 2021-07-01 DOI: 10.4103/jmgims.jmgims_14_21
Shruti N. Vichare, S. Natarajan, Padmakar S. Baviskar, S. Ahuja, Pradeep Vathare
Glandular odontogenic cyst (GOC) is a rare odontogenic cyst with a high recurrence rate. It is also associated with other odontogenic cysts and tumours. Odontogenic cysts with some histopathological features of GOC are termed as GOC mimickers (GOC-M). The diagnosis of a mimicker is challenging due to the lack of distinctive clinical and radiological features. Diagnosis is confirmed exclusively on histopathology. Specific guidelines based on histopathological features exist to recognize and delineate these mimickers from GOC. These features may be evident on incisional biopsy presenting an incorrect diagnosis of GOC leading to an erroneous overtreatment. On the contrary, overlooking these features in an incisional biopsy may result in misdiagnosis and under-treatment which increases the patient susceptibility to recurrence. This article reviews the enigmatic nature of GOC-M and presents two rare cases of the same in dentigerous cysts of the impacted supernumerary teeth in the anterior maxilla.
腺牙源性囊肿(GOC)是一种罕见的牙源性囊肿,复发率高。它也与其他牙源性囊肿和肿瘤有关。具有某些GOC组织病理学特征的牙源性囊肿被称为GOC拟态细胞(GOC-M)。由于缺乏独特的临床和放射学特征,模仿者的诊断具有挑战性。诊断仅通过组织病理学确认。存在基于组织病理学特征的特定指南来识别和描述GOC中的这些拟态者。这些特征在切口活检中可能很明显,表现为GOC的错误诊断,导致错误的过度治疗。相反,在切口活检中忽视这些特征可能会导致误诊和治疗不足,从而增加患者复发的易感性。本文综述了GOC-M的神秘性质,并介绍了两例罕见的前上颌骨阻生多生牙的含牙囊肿。
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引用次数: 0
Evaluation of ureterorenoscopy with semirigid ureteroscope and laser lithotripsy as a treatment modality for upper ureteric stones less than 20 mm 输尿管镜下半硬输尿管镜联合激光碎石治疗输尿管上段小于20mm结石的疗效评价
Pub Date : 2021-07-01 DOI: 10.4103/jmgims.jmgims_80_21
R. Batra, P. Batra, Shreyak Garg, S. Yadav
Context: Technological developments over the past two decades have revolutionized the treatment of ureteric stones. With the emergence of flexible, small-diameter ureteroscopy, the paradigm of ureteral stone treatment has shifted to ureteroscopy. The success rate is close to 95%, but it has its own complications. Objective: The objective of this study is to assess the effectiveness of ureterorenoscopy (URS) with semirigid ureteroscope and laser lithotripsy in the treatment of upper ureteric stones of size less than 20 mm and its associated complications. Methods: This is a prospective cohort study designed to assess the effectiveness of URS for the treatment of upper ureteric calculi. We present data from 57 patients who received URS as their primary treatment at our center and were followed up for at least 3 months. Results: We found that when stone size was less than 10 mm, the stone-free rate was 80% (28/35), while when stone size was in the 10.1–20 mm range, the stone-free rate increased to 90.9% (20/22). Stones were found in 41/48 patients (85.41%) with symptoms lasting less than a month. Only 7/9 patients (77.77%) were stone-free in the group with symptoms lasting more than a month. A total of 28.1% of patients encountered complications among which proximal migration of the stone was the most common (12.3%). Mean procedure time was 40.37 min. Conclusion: This study shows that URS had a higher stone-free rate when treating stones of size ranging from 10.1 to 20 mm. In upper ureteric stones ranging in size from 10.1 to 20 mm, we strongly advise using URS as the primary treatment option.
背景:过去二十年的技术发展已经彻底改变了输尿管结石的治疗。随着柔性、小直径输尿管镜的出现,输尿管结石的治疗模式已转向输尿管镜。成功率接近95%,但它也有自己的并发症。目的:探讨输尿管镜联合半硬输尿管镜联合激光碎石术治疗输尿管上段小于20mm结石及其并发症的疗效。方法:这是一项前瞻性队列研究,旨在评估URS治疗输尿管上段结石的有效性。我们提供了来自57名在我们中心接受URS作为主要治疗的患者的数据,并随访了至少3个月。结果:我们发现,当石材尺寸小于10 mm时,石材的游离率为80%(28/35),而当石材尺寸在10.1-20 mm范围内时,石材的游离率增加到90.9%(20/22)。48例患者中有41例(85.41%)出现结石,症状持续时间小于1个月。在症状持续1个月以上的患者中,仅有7/9(77.77%)无结石。共有28.1%的患者出现并发症,其中结石近端移位最为常见(12.3%)。平均手术时间为40.37分钟。结论:本研究表明,在治疗10.1 - 20 mm的结石时,URS的结石清除率更高。对于输尿管上部结石,大小从10.1到20毫米,我们强烈建议使用尿路作为主要治疗选择。
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引用次数: 0
Physiotherapy for simple mastectomy following phyllodes tumor: A case report 物理疗法治疗叶状肿瘤后单纯乳房切除术1例
Pub Date : 2021-07-01 DOI: 10.4103/jmgims.jmgims_55_21
Zoha Alvi, M. Shukla, A. Mishra
Phyllodes tumors are relatively rare breast tumors. Management of these tumors with surgical resection may cause postoperative complications. The purpose of this case study was to define the role of early postoperative physiotherapy in a patient with phyllodes tumor of the breast following simple mastectomy. A 50-year-old woman was brought to the outpatient department following a 1-year history of the lump in the right breast, worsening gradually in the preceding 2 months, and subsequently diagnosed to be a phyllodes tumor. She was treated with simple mastectomy followed by a drain insertion. Postoperatively, she presented with reduced chest expansion and functional mobility and postural impairments. Treatment protocol was set and follow-up was made on the 8th postoperative day. We conclude that early physiotherapy intervention can help in improving the functional mobility and preventing further postoperative complications.
叶状肿瘤是相对罕见的乳腺肿瘤。手术切除这些肿瘤可能会引起术后并发症。本病例研究的目的是确定术后早期物理治疗在乳腺叶状肿瘤患者单纯乳房切除术后的作用。一名50岁的女性在右乳房肿块病史为1年后被带到门诊部,在前2个月逐渐恶化,随后被诊断为叶状肿瘤。她接受了简单的乳房切除术,然后插入引流管。术后,她出现胸部扩张减少、功能活动和姿势障碍。制定治疗方案,并在术后第8天进行随访。我们的结论是,早期物理治疗干预有助于改善功能活动能力,防止进一步的术后并发症。
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引用次数: 0
Animal bites presenting to the emergency department: Spectrum, seasonal variation, and outcome 动物咬伤呈现到急诊科:频谱,季节变化,和结果
Pub Date : 2021-07-01 DOI: 10.4103/jmgims.jmgims_22_21
K. Abhilash, Rayshna Rao
Context: Animal bites including insect, reptile, and mammalian bites are common presentations to the emergency department (ED). Although profile and outcome of individual bites are described in detail, the literature on comprehensive overall clinical spectrum and seasonal variation of all animal bites is scant. Aims: To describe the spectrum, seasonal variation, clinical features, and outcomes of all patients presenting as emergencies due to animal bites. Methods: All the patients who presented to the ED of a large tertiary care hospital in South India with bites from January 2017 to December 2018 were retrospectively included in the analysis. Results: During the 2-year study period, animal bites constituted 0.83% of all ED admissions with 1145 incidents included in our analysis. The various animal bites/stings were classified as follows: mammal bites (480: 41.9%), arthropod bites (275: 24%), reptile bites (290: 25.3%), and unknown bites (100: 8.6%). We found an increase in the incidence of bites during the monsoon months of July to September (average: 58 cases per month) in our geographical locality. More than half (46: 58%) of scorpion stings had features of envenomation while a quarter (19: 24%) had the signs of autonomic storm. Snake bites constituted a quarter (25.2%: 289/1145) of all animal bites with 66% (191/289) showing features of envenomation. Dog bites constituted the majority of mammalian bites with 73% (352/480), followed by rat bites (14%: 68/480), cat bites (7.5%: 37/480), human bites (2.5%: 12/480), and monkey bites (1.9%: 9/480). The World Health Organization rabies exposure Category 3 bites were seen in 48%, 12%, and 27% of dog, rat, and cat bites, respectively. Conclusion: Snake and dog bites comprised the majority of all animal bites. There was a clear seasonal pattern with increased prevalence of bites during the rainy season.
背景:动物咬伤,包括昆虫、爬行动物和哺乳动物咬伤,是急诊科常见的表现。尽管对个体咬伤的情况和结果进行了详细描述,但关于所有动物咬伤的全面临床谱和季节变化的文献很少。目的:描述所有因动物咬伤而出现紧急情况的患者的症状谱、季节变化、临床特征和结果。方法:对2017年1月至2018年12月在南印度一家大型三级护理医院急诊科就诊的所有被咬伤患者进行回顾性分析。结果:在2年的研究期间,动物咬伤占所有ED入院人数的0.83%,我们的分析中包括1145起事件。各种动物咬伤/蜇伤分为:哺乳动物咬伤(480:41.9%)、节肢动物咬伤(275:24%)、爬行动物咬伤(290:25.3%)和未知咬伤(100:8.6%)。超过一半(46:58%)的蝎子蜇伤具有蜕皮特征,而四分之一(19.24%)的蝎子有自主风暴的迹象。蛇咬伤占所有动物咬伤的四分之一(25.2%:289/1145),其中66%(191/289)表现出环境化特征。狗咬伤占哺乳动物咬伤的大多数,占73%(352/480),其次是老鼠咬伤(14%:68/480)、猫咬伤(7.5%:37/480)、人类咬伤(2.5%:12/480)和猴子咬伤(1.9%:9/480)。世界卫生组织狂犬病暴露3类咬伤分别发生在48%、12%和27%的狗、老鼠和猫咬伤中。结论:蛇和狗咬伤占所有动物咬伤的大多数。雨季有明显的季节性模式,咬伤的发生率增加。
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引用次数: 1
Association of Down syndrome with major congenital anomalies in the North Indian population 北印度人群中唐氏综合征与主要先天性畸形的关系
Pub Date : 2021-07-01 DOI: 10.4103/jmgims.jmgims_140_20
K. Bisht, R. Verma, Navneet Kumar, S. Singh, B. Bhandari
Context: Down syndrome (DS), which usually occurs due to an extra chromosome 21 or a partial trisomy, is the most common genetic cause of intellectual disability. The affected individuals usually present with characteristic clinical manifestations and are seen to be associated with various systemic defects. Aim: The aim of our study was to determine the major congenital anomalies associated with DS in the North Indian population. Methods: Blood samples of 51 children (0–10 years) who were screened for the suspicion of DS were collected. Karyotyping was conducted. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) software version 21.0. Results: Out of the 51 suspected participants, karyotypes could be successfully obtained only for 40. Among these 40 participants, karyotypes of 35 were confirmed to be DS. Of these 35 confirmed cases, 21 (60%) were found to be associated with at least one major congenital anomaly, of which cardiac anomalies (34.2%) were most common, followed by gastrointestinal tract and genitourinary anomalies (11.4% each). Central nervous system and musculoskeletal anomalies constituted 5.7% each. Mosaic variant of DS was found to be least associated with congenital anomalies. Conclusion: The patients with DS should be carefully examined for systemic anomalies. Most cases are usually associated with at least one congenital anomaly.
背景:唐氏综合征(DS)通常是由额外的21号染色体或部分三体引起的,是智力残疾最常见的遗传原因。受影响的个体通常表现出特征性的临床表现,并被认为与各种系统性缺陷有关。目的:我们研究的目的是确定北印度人群中与DS相关的主要先天性异常。方法:收集51名0~10岁儿童的血液样本,对其进行DS疑似筛查。进行了核型分析。使用社会科学统计软件包(SPSS)软件版本21.0对数据进行分析。结果:在51名疑似参与者中,只有40人能成功获得核型。在这40名参与者中,35人的核型被证实为DS。在这35例确诊病例中,21例(60%)被发现与至少一种主要先天性异常有关,其中心脏异常(34.2%)最常见,其次是胃肠道和泌尿生殖道异常(各11.4%)。中枢神经系统和肌肉骨骼异常各占5.7%。DS的马赛克变体被发现与先天性畸形的相关性最小。结论:DS患者应仔细检查全身异常。大多数病例通常至少与一种先天性异常有关。
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引用次数: 0
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Journal of Mahatma Gandhi Institute of Medical Sciences
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