Pub Date : 2022-12-15DOI: 10.46347/jmsh.v8i3.22.274
S. Sarkar, D. Badyal, Ritu Sharma, Manoj B. Patki, T. Khan, L. Oberoi
Background: The one thought that has taken precedence over the conscious cognition of the cerebral cortex of Indian medical educators is how to implement the Competency Based Medical Education (CBME) program. A revolution that has occurred after 21 odd years, indeed should captivate the change leaders of health professions education. COVID -19 pandemic has posed on medical educators, who enthusiastically implemented the CBME curriculum from 2019 in India, an uphill struggle to understand, apply and eradicate the challenges in effectively implementing the newer elements of the CBME curriculum. A number of newer elements namely Foundation course, Early Clinical Exposure, Electives, Integration, and Learner Doctor Method of clinical clerkship, have been introduced into the new undergraduate medical curriculum. Health professions educators in India, being beginners in implementing these newer elements of the revolutionary 2019 CBME curriculum, it is pertinent to answer the queries that tickle the minds on how to implement and address the anticipated challenges and where to look for solutions. Aims: The authors aim to address some of these queries by giving ready to use templates, guided stepwise breakup of implementation, experience based solutions to the challenges, for various newer elements. They elaborate upon the opportunities of a positive change that medical education in India so direly needs. Conclusion: The stumbling blocks in implementing such a dynamic and thoroughgoing program needs the due contemplation to navigate successfully as directed by the National Medical Commission or erstwhile Medical Council of India. Keywords: Foundation course, Electives, Integration, Early clinical exposure, Clinical clerkship
{"title":"Navigating Through the Newer Components of the Indian Competency Based Medical Education","authors":"S. Sarkar, D. Badyal, Ritu Sharma, Manoj B. Patki, T. Khan, L. Oberoi","doi":"10.46347/jmsh.v8i3.22.274","DOIUrl":"https://doi.org/10.46347/jmsh.v8i3.22.274","url":null,"abstract":"Background: The one thought that has taken precedence over the conscious cognition of the cerebral cortex of Indian medical educators is how to implement the Competency Based Medical Education (CBME) program. A revolution that has occurred after 21 odd years, indeed should captivate the change leaders of health professions education. COVID -19 pandemic has posed on medical educators, who enthusiastically implemented the CBME curriculum from 2019 in India, an uphill struggle to understand, apply and eradicate the challenges in effectively implementing the newer elements of the CBME curriculum. A number of newer elements namely Foundation course, Early Clinical Exposure, Electives, Integration, and Learner Doctor Method of clinical clerkship, have been introduced into the new undergraduate medical curriculum. Health professions educators in India, being beginners in implementing these newer elements of the revolutionary 2019 CBME curriculum, it is pertinent to answer the queries that tickle the minds on how to implement and address the anticipated challenges and where to look for solutions. Aims: The authors aim to address some of these queries by giving ready to use templates, guided stepwise breakup of implementation, experience based solutions to the challenges, for various newer elements. They elaborate upon the opportunities of a positive change that medical education in India so direly needs. Conclusion: The stumbling blocks in implementing such a dynamic and thoroughgoing program needs the due contemplation to navigate successfully as directed by the National Medical Commission or erstwhile Medical Council of India. Keywords: Foundation course, Electives, Integration, Early clinical exposure, Clinical clerkship","PeriodicalId":33653,"journal":{"name":"Journal of Medical Sciences and Health","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47622436","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-12-15DOI: 10.46347/jmsh.v8i3.22.350
Shwetha Basavaraj, P. B. Saniha, U. Geethalakshmi, R. Babu, R. P. Vinayaka
Colorectal cancers (CRC) are on the rise globally with increased incidence rate 5.7/100000 cases in developing countries like India. 1 Majority (90%) of CRC are adenocarcinoma. The primary adenosquamous carcinoma (ASC) of the colon is exceedingly rare variant of adenocarcinoma with incidence of 0.025% and accounts for 0.1% of colonic epithelial malignancies. 2 The squamous differentiation accounts for its aggressiveness and poor prognosis. Here we report a rare case of primary ASC in 80year old male who presented with large bowel obstruction and peritonitis. A 80-year-old male brought to causality with history of fever, vomiting, pain in abdomen, altered sensorium since three days. The clinical examination revealed intestinal obstruction and peritonitis. Patient was immediately subjected for radiological and hematology investigations which showed signs of bowel obstruction and perforation. On emergency exploratory laparotomy, colonic perforation was identified along with an ulcer proliferative mass in ascending colon. Gross examination of right hemicolectomy revealed 9x6x3cm ulcero proliferative mass in ascending colon. The microscopic examination showed an infiltrating tumor composed of adenocarcinoma component and areas of squamous differentiation (60%) noted. Tumor was invading through muscularis propria and serosa. Final diagnosis of primary ASC was made. Colonic ASC is rare and associated with poorer prognosis. The squamous cell differentiation has greater metastatic potential than adenocarcinoma. Compared to adenocarcinoma, ASC is more likely to manifest with advanced disease and complications. Keywords: Adenosquamous, Carcinoma, Colon
{"title":"Primary Adenosquamous Carcinoma of Ascending Colon – A Rare Entity","authors":"Shwetha Basavaraj, P. B. Saniha, U. Geethalakshmi, R. Babu, R. P. Vinayaka","doi":"10.46347/jmsh.v8i3.22.350","DOIUrl":"https://doi.org/10.46347/jmsh.v8i3.22.350","url":null,"abstract":"Colorectal cancers (CRC) are on the rise globally with increased incidence rate 5.7/100000 cases in developing countries like India. 1 Majority (90%) of CRC are adenocarcinoma. The primary adenosquamous carcinoma (ASC) of the colon is exceedingly rare variant of adenocarcinoma with incidence of 0.025% and accounts for 0.1% of colonic epithelial malignancies. 2 The squamous differentiation accounts for its aggressiveness and poor prognosis. Here we report a rare case of primary ASC in 80year old male who presented with large bowel obstruction and peritonitis. A 80-year-old male brought to causality with history of fever, vomiting, pain in abdomen, altered sensorium since three days. The clinical examination revealed intestinal obstruction and peritonitis. Patient was immediately subjected for radiological and hematology investigations which showed signs of bowel obstruction and perforation. On emergency exploratory laparotomy, colonic perforation was identified along with an ulcer proliferative mass in ascending colon. Gross examination of right hemicolectomy revealed 9x6x3cm ulcero proliferative mass in ascending colon. The microscopic examination showed an infiltrating tumor composed of adenocarcinoma component and areas of squamous differentiation (60%) noted. Tumor was invading through muscularis propria and serosa. Final diagnosis of primary ASC was made. Colonic ASC is rare and associated with poorer prognosis. The squamous cell differentiation has greater metastatic potential than adenocarcinoma. Compared to adenocarcinoma, ASC is more likely to manifest with advanced disease and complications. Keywords: Adenosquamous, Carcinoma, Colon","PeriodicalId":33653,"journal":{"name":"Journal of Medical Sciences and Health","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48399523","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-12-15DOI: 10.46347/jmsh.v8i3.22.275
Animesh Gupta, Diwakar Singh, P. M. Naik, S. Hameed, Nanjesh Kumar
Background: Cardiovascular disease (CVD), one of the non-communicable diseases, has become a major public health problem and it is a leading cause of morbidity and mortality in both developing and developed countries. The important CVD risk factors are obesity, hypertension, diabetes, hyperlipidaemia, unhealthy diet, physical inactivity and tobacco use. Cardiovascular risk approach is feasible and cost-effective tool, which helps to identify those at high risk for developing CVDs, so that immediate preventive measures or action can be taken to reduce the risk. Objectives: estimate the ten-year risk of developing cardiovascular disease using Framingham heart risk assessment score. Materials and Methods: A community-based, cross-sectional study was conducted among adults residing in a rural area of Dakshina Kannada District for a period of 6 months from July 2013 to December 2013. The data was collected using pretested semi structured questionnaire through interview methods. Anthropometric measurement and blood investigation (fasting blood sugar and lipid profile) was done. The Framingham Risk Score is a gender-specific algorithm used to estimate the 10-year cardiovascular risk of an individual Results: Among 712 study participants, 95 (13.3%) and 20 (2.8%) participants had intermediate and high risk of developing cardiovascular disease in 10 years respectively. The proportion of intermediate CVD risk prediction and high-risk predication was more in males as compared to females. Conclusion: The cardiovascular risk factors like obesity, physical inactivity, diabetes and hypertension are widely prevalent among adults in rural areas. The high-risk prediction for developing CVD among study participants in next 10 years was 2.8%. Keywords: Cardiovascular risk factors, Framingham risk score, 10 years CVD risk prediction, Prevalence
{"title":"Ten Years Risk Prediction of Cardiovascular Disease among Adults in Rural Area of Dakshina Kannada, Karnataka","authors":"Animesh Gupta, Diwakar Singh, P. M. Naik, S. Hameed, Nanjesh Kumar","doi":"10.46347/jmsh.v8i3.22.275","DOIUrl":"https://doi.org/10.46347/jmsh.v8i3.22.275","url":null,"abstract":"Background: Cardiovascular disease (CVD), one of the non-communicable diseases, has become a major public health problem and it is a leading cause of morbidity and mortality in both developing and developed countries. The important CVD risk factors are obesity, hypertension, diabetes, hyperlipidaemia, unhealthy diet, physical inactivity and tobacco use. Cardiovascular risk approach is feasible and cost-effective tool, which helps to identify those at high risk for developing CVDs, so that immediate preventive measures or action can be taken to reduce the risk. Objectives: estimate the ten-year risk of developing cardiovascular disease using Framingham heart risk assessment score. Materials and Methods: A community-based, cross-sectional study was conducted among adults residing in a rural area of Dakshina Kannada District for a period of 6 months from July 2013 to December 2013. The data was collected using pretested semi structured questionnaire through interview methods. Anthropometric measurement and blood investigation (fasting blood sugar and lipid profile) was done. The Framingham Risk Score is a gender-specific algorithm used to estimate the 10-year cardiovascular risk of an individual Results: Among 712 study participants, 95 (13.3%) and 20 (2.8%) participants had intermediate and high risk of developing cardiovascular disease in 10 years respectively. The proportion of intermediate CVD risk prediction and high-risk predication was more in males as compared to females. Conclusion: The cardiovascular risk factors like obesity, physical inactivity, diabetes and hypertension are widely prevalent among adults in rural areas. The high-risk prediction for developing CVD among study participants in next 10 years was 2.8%. Keywords: Cardiovascular risk factors, Framingham risk score, 10 years CVD risk prediction, Prevalence","PeriodicalId":33653,"journal":{"name":"Journal of Medical Sciences and Health","volume":"115 15","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41251184","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-12-15DOI: 10.46347/jmsh.v8i3.22.168
Mudit Maheshwari, P. Yadav, S. Jain, Indra Kumar Batham, Akshara Gupta, Sweta Swaika
Background: Magnetic resonance imaging (MRI) has been accepted as the best non-invasive imaging modality for the evaluation of knee joint pathology but the advantages of ultrasound (US) over magnetic resonance imaging (MRI) are that the ultrasound is readily available, cheap and offers real-time imaging. Aim: To assess the accuracy of ultrasound in diagnosing knee joint pathologies using MRI as a reference. Materials And Methods: 50 patients were evaluated prospectively over a period of 1.5 years by USG followed by MRI of the affected knee. Accuracy of USG was calculated with MRI as reference. Results: In our study, the majority of patients were in age group 21-30 years. Perfect agreement was noted between ultrasound and MRI for detecting Baker’s cyst. Near perfect agreement was noted between ultrasound and MRI for detecting joint effusion, soft tissue edema and osteophytes. Substantial agreement was noted between ultrasound and MRI for Collateral ligaments tear and Meniscal injuries. Moderate agreement was noted between ultrasound and MRI for PCL tear. Fair agreement was noted between ultrasound and MRI for ACL tear. Conclusion: Knee USG has high accuracy in diagnosing pathologies like knee joint effusion, synovitis, popliteal/baker’s cysts, soft tissue edema/cellulitis, arthritic changes, collateral ligament and meniscal tears. Keywords: Knee joint pathologies, Ultrasound, MRI, Ligaments
{"title":"Imaging of Knee Joint Pathologies: A Comparative Study of Ultrasound and Magnetic Resonance Imaging","authors":"Mudit Maheshwari, P. Yadav, S. Jain, Indra Kumar Batham, Akshara Gupta, Sweta Swaika","doi":"10.46347/jmsh.v8i3.22.168","DOIUrl":"https://doi.org/10.46347/jmsh.v8i3.22.168","url":null,"abstract":"Background: Magnetic resonance imaging (MRI) has been accepted as the best non-invasive imaging modality for the evaluation of knee joint pathology but the advantages of ultrasound (US) over magnetic resonance imaging (MRI) are that the ultrasound is readily available, cheap and offers real-time imaging. Aim: To assess the accuracy of ultrasound in diagnosing knee joint pathologies using MRI as a reference. Materials And Methods: 50 patients were evaluated prospectively over a period of 1.5 years by USG followed by MRI of the affected knee. Accuracy of USG was calculated with MRI as reference. Results: In our study, the majority of patients were in age group 21-30 years. Perfect agreement was noted between ultrasound and MRI for detecting Baker’s cyst. Near perfect agreement was noted between ultrasound and MRI for detecting joint effusion, soft tissue edema and osteophytes. Substantial agreement was noted between ultrasound and MRI for Collateral ligaments tear and Meniscal injuries. Moderate agreement was noted between ultrasound and MRI for PCL tear. Fair agreement was noted between ultrasound and MRI for ACL tear. Conclusion: Knee USG has high accuracy in diagnosing pathologies like knee joint effusion, synovitis, popliteal/baker’s cysts, soft tissue edema/cellulitis, arthritic changes, collateral ligament and meniscal tears. Keywords: Knee joint pathologies, Ultrasound, MRI, Ligaments","PeriodicalId":33653,"journal":{"name":"Journal of Medical Sciences and Health","volume":" 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41254055","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-12-15DOI: 10.46347/jmsh.v8i3.22.156
Sajjan Prashant Shivaraj, K. Sharashchandra
Gullain Barre Syndrome (GBS) is an acute inflammatory demyelinating polyradiculopathy of rare occurrence in pregnancy. We report a case of a 36 weeks pregnant patient posted for emergency Caesarean section for foetal distress. At 28weeks of pregnancy the patient was diagnosed with GBS for which she was intubated and was on mechanical ventilation for 19 days. Subsequently she was extubated and discharged after 36 days. During this period, she received treatment with intravenous immunoglobulins and plasmapheresis. The patient continued to have weakness of both lower limbs and bladder incontinence prior to surgery. General anaesthesia was administered to the patient keeping in view the autonomic system involvement in the disease and presence of foetal distress. The intraoperative course was smooth and patient was extubated uneventfully. Keywords: Gullain Barre Syndrome, Pregnancy, Autonomic dysfunction, General anaesthesia, Emergency caesarean section
{"title":"Anaesthetic Management of a Patient with Gullain Barre Syndrome Posted for Emergency Caesarean Section: A Case Report","authors":"Sajjan Prashant Shivaraj, K. Sharashchandra","doi":"10.46347/jmsh.v8i3.22.156","DOIUrl":"https://doi.org/10.46347/jmsh.v8i3.22.156","url":null,"abstract":"Gullain Barre Syndrome (GBS) is an acute inflammatory demyelinating polyradiculopathy of rare occurrence in pregnancy. We report a case of a 36 weeks pregnant patient posted for emergency Caesarean section for foetal distress. At 28weeks of pregnancy the patient was diagnosed with GBS for which she was intubated and was on mechanical ventilation for 19 days. Subsequently she was extubated and discharged after 36 days. During this period, she received treatment with intravenous immunoglobulins and plasmapheresis. The patient continued to have weakness of both lower limbs and bladder incontinence prior to surgery. General anaesthesia was administered to the patient keeping in view the autonomic system involvement in the disease and presence of foetal distress. The intraoperative course was smooth and patient was extubated uneventfully. Keywords: Gullain Barre Syndrome, Pregnancy, Autonomic dysfunction, General anaesthesia, Emergency caesarean section","PeriodicalId":33653,"journal":{"name":"Journal of Medical Sciences and Health","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46398988","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-12-15DOI: 10.46347/jmsh.v8i3.22.219
George Nkansah Rost Fordjour
Treatment of sickle cell disease remains largely palliative. While it may improve the quality of life, persons with sickle cell disease still suffer from extreme sickling crises, end-organ damage, and reduced life expectancy. Increasing studies have led to the identification and advancement of stem cell transplant and gene therapy as potential curative strategies for sickle cell disease. However, there have been various factors that have hindered their clinical application. Stem cell transplantation, the more propitious of the two, is limited by restricted transplant donor pool, transplant complications, and selection criteria. The current paper reviewed the literature on sickle cell disease, current treatment options, and more particularly on the progress of stem cell transplants. It outlined various challenges of stem cell transplant and proposed ways to increase the donor pool using alternative strategies and modifications of regimen conditioning with minimal transplant-related toxicities and associated complications. Keywords: Cord blood, Haploidentical, Sickle cell disease, Stem cell transplantation
{"title":"The Current State of Sickle Cell Disease Management: A Concise Review on Stem Cell Transplant as a Cure","authors":"George Nkansah Rost Fordjour","doi":"10.46347/jmsh.v8i3.22.219","DOIUrl":"https://doi.org/10.46347/jmsh.v8i3.22.219","url":null,"abstract":"Treatment of sickle cell disease remains largely palliative. While it may improve the quality of life, persons with sickle cell disease still suffer from extreme sickling crises, end-organ damage, and reduced life expectancy. Increasing studies have led to the identification and advancement of stem cell transplant and gene therapy as potential curative strategies for sickle cell disease. However, there have been various factors that have hindered their clinical application. Stem cell transplantation, the more propitious of the two, is limited by restricted transplant donor pool, transplant complications, and selection criteria. The current paper reviewed the literature on sickle cell disease, current treatment options, and more particularly on the progress of stem cell transplants. It outlined various challenges of stem cell transplant and proposed ways to increase the donor pool using alternative strategies and modifications of regimen conditioning with minimal transplant-related toxicities and associated complications. Keywords: Cord blood, Haploidentical, Sickle cell disease, Stem cell transplantation","PeriodicalId":33653,"journal":{"name":"Journal of Medical Sciences and Health","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41774074","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-12-15DOI: 10.46347/jmsh.v8i3.22.70
L. Gouri, Satyabrata Jena, G. Satpathy, D. Nanda
Background & Aims: The diagnosis of abdominal tuberculosis has always been a challenge to the physician. The clinical presentation is subtle with many vague symptoms and nonspecific signs. We did this study to find the various diagnostic findings in a case of chronic abdominal pain and find out the efficacy of laparoscopy in diagnosing Koch’s abdomen. Materials and Methods: A prospective observational study was conducted on patients attending surgery department from Nov-2020 to Nov-2021 having clinical and radiological diagnosis of abdominal tuberculosis. Total 59 patients of suspected abdominal tuberculosis underwent diagnostic laparoscopy and started on anti-tuberculosis treatment. Result: The most common presenting symptom was abdominal pain present in 35 patients (59.32%). In CT scan, 31 of them were suggestive of abdominal tuberculosis and seven were inconclusive. Only 37 of them had positive (62.71%) histology for tuberculosis and 22 were negative (37.28%). The PPV and NPV of CT scan was 77.42% (95% CI=60.19-88.61%) and 85.71%% respectively. Out of 27, 20 mesenteric lymph nodes had positive histology for tuberculosis. 29 patients had caseating granuloma and 12 had non-caseating granuloma. All 18 histology negative patients had nonspecific chronic inflammation with reactive lymph nodes. Peritoneal fluid was aspirated and sent for CBNAAT from 30 patients (50.84%). 10 were positive (33.33%) for tuberculosis gene and 20 (66.33%) were negative. Conclusions: Performing laparoscopy in the majority of patients with suspected abdominal tuberculosis is a clinically rewarding idea. It has a high yield to establish the diagnosis of abdominal tuberculosis (65.78%) by sampling macroscopically pathological tissues. Keywords: Koch’s abdomen, Diagnostic laparoscopy, Koch’s abdomen
{"title":"Role of Diagnostic Laparoscopy in Case of Koch’s Abdomen with Intestinal Obstruction: An Observational Study","authors":"L. Gouri, Satyabrata Jena, G. Satpathy, D. Nanda","doi":"10.46347/jmsh.v8i3.22.70","DOIUrl":"https://doi.org/10.46347/jmsh.v8i3.22.70","url":null,"abstract":"Background & Aims: The diagnosis of abdominal tuberculosis has always been a challenge to the physician. The clinical presentation is subtle with many vague symptoms and nonspecific signs. We did this study to find the various diagnostic findings in a case of chronic abdominal pain and find out the efficacy of laparoscopy in diagnosing Koch’s abdomen. Materials and Methods: A prospective observational study was conducted on patients attending surgery department from Nov-2020 to Nov-2021 having clinical and radiological diagnosis of abdominal tuberculosis. Total 59 patients of suspected abdominal tuberculosis underwent diagnostic laparoscopy and started on anti-tuberculosis treatment. Result: The most common presenting symptom was abdominal pain present in 35 patients (59.32%). In CT scan, 31 of them were suggestive of abdominal tuberculosis and seven were inconclusive. Only 37 of them had positive (62.71%) histology for tuberculosis and 22 were negative (37.28%). The PPV and NPV of CT scan was 77.42% (95% CI=60.19-88.61%) and 85.71%% respectively. Out of 27, 20 mesenteric lymph nodes had positive histology for tuberculosis. 29 patients had caseating granuloma and 12 had non-caseating granuloma. All 18 histology negative patients had nonspecific chronic inflammation with reactive lymph nodes. Peritoneal fluid was aspirated and sent for CBNAAT from 30 patients (50.84%). 10 were positive (33.33%) for tuberculosis gene and 20 (66.33%) were negative. Conclusions: Performing laparoscopy in the majority of patients with suspected abdominal tuberculosis is a clinically rewarding idea. It has a high yield to establish the diagnosis of abdominal tuberculosis (65.78%) by sampling macroscopically pathological tissues. Keywords: Koch’s abdomen, Diagnostic laparoscopy, Koch’s abdomen","PeriodicalId":33653,"journal":{"name":"Journal of Medical Sciences and Health","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43861899","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-12-15DOI: 10.46347/jmsh.v8i3.22.98
R. Gowda, T. Krishnamurthy
Background: The nail is our most versatile tool and serves a very important function of protecting the distal phalanx. The nail unit shows specific changes that are markers for a wide range of local and systemic conditions. Objectives: The objectives of the study are to identify the spectrum of histomorphological features in various nail lesions and to highlight the role of histopathology in diagnosis of nail diseases. Methods: This is a descriptive study done over a period of 18 months. The nail biopsy specimens were received in 10 % formalin, softened with 10% nitric acid, processed and stained with routine Hematoxylin & Eosin [H&E] stains. Periodic Acid stain[PAS] stain was done wherever necessary. Histopathological examination by light microscopy was done to arrive at a precise diagnosis. Brief patient history and clinical features were also noted. Results: A total of 50 nail punch biopsies were examined. Psoriasis was the most common accounting for 38%. The combined approach of H & E and PAS stain was helpful in diagnosis of onychomycosis in 24%. Pigmentary disorders (14%) , lichen planus (10%) and alopecia areata (6%) were the other conditions observed. In 8% of cases microscopic features were nonspecific. Conclusion: The nail unit has a complex morphology with many peculiarities. Though it is quite accessible, it remains understudied. Histomorphological evaluation of nail punch biopsy is useful in understanding the involvement of nail in various dermatoses and also aids in the accurate diagnosis. Keywords: Dermatoses, Histopathology, Nail biopsy
{"title":"Histomorphological Study of Nail Changes in Various Dermatoses — An Understudied Entity in Dermatopathology","authors":"R. Gowda, T. Krishnamurthy","doi":"10.46347/jmsh.v8i3.22.98","DOIUrl":"https://doi.org/10.46347/jmsh.v8i3.22.98","url":null,"abstract":"Background: The nail is our most versatile tool and serves a very important function of protecting the distal phalanx. The nail unit shows specific changes that are markers for a wide range of local and systemic conditions. Objectives: The objectives of the study are to identify the spectrum of histomorphological features in various nail lesions and to highlight the role of histopathology in diagnosis of nail diseases. Methods: This is a descriptive study done over a period of 18 months. The nail biopsy specimens were received in 10 % formalin, softened with 10% nitric acid, processed and stained with routine Hematoxylin & Eosin [H&E] stains. Periodic Acid stain[PAS] stain was done wherever necessary. Histopathological examination by light microscopy was done to arrive at a precise diagnosis. Brief patient history and clinical features were also noted. Results: A total of 50 nail punch biopsies were examined. Psoriasis was the most common accounting for 38%. The combined approach of H & E and PAS stain was helpful in diagnosis of onychomycosis in 24%. Pigmentary disorders (14%) , lichen planus (10%) and alopecia areata (6%) were the other conditions observed. In 8% of cases microscopic features were nonspecific. Conclusion: The nail unit has a complex morphology with many peculiarities. Though it is quite accessible, it remains understudied. Histomorphological evaluation of nail punch biopsy is useful in understanding the involvement of nail in various dermatoses and also aids in the accurate diagnosis. Keywords: Dermatoses, Histopathology, Nail biopsy","PeriodicalId":33653,"journal":{"name":"Journal of Medical Sciences and Health","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44475427","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-12-15DOI: 10.46347/jmsh.v8i3.22.210
Nikhil Era, Ritika Singh, Shatavisa Mukherjee, S. Bordoloi
As a non-narcotic antitussive, benzonatate has been effective in symptomatic relief of dry cough. Cough following recovery from acute COVID-19 has widely been treated with over-the-counter cough suppressants like benzonatate, guaifenesin, dextromethorphan etc. However, despite being an effective non-narcotic cough suppressant modality, benzonatate has been constrained by its poor safety profile. The present case series describes a very rare side effect of neck stiffness reported in patients who were prescribed benzonatate for dry cough suppression post COVID 19. Keywords: Benzonatate, Neck stiffness, Post-COVID complications, Cough
{"title":"Benzonatate Induced Neck Stiffness: A Case Series","authors":"Nikhil Era, Ritika Singh, Shatavisa Mukherjee, S. Bordoloi","doi":"10.46347/jmsh.v8i3.22.210","DOIUrl":"https://doi.org/10.46347/jmsh.v8i3.22.210","url":null,"abstract":"As a non-narcotic antitussive, benzonatate has been effective in symptomatic relief of dry cough. Cough following recovery from acute COVID-19 has widely been treated with over-the-counter cough suppressants like benzonatate, guaifenesin, dextromethorphan etc. However, despite being an effective non-narcotic cough suppressant modality, benzonatate has been constrained by its poor safety profile. The present case series describes a very rare side effect of neck stiffness reported in patients who were prescribed benzonatate for dry cough suppression post COVID 19. Keywords: Benzonatate, Neck stiffness, Post-COVID complications, Cough","PeriodicalId":33653,"journal":{"name":"Journal of Medical Sciences and Health","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41800091","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-12-15DOI: 10.46347/jmsh.v8i3.22.276
D. Maiti, T. Mitra, Manisankar Nath, Swapnadeep Sengupta
Background and aims: Epidural analgesia has been considerably used for postoperative analgesia in Orthopaedic surgeries, however, combination of opioid and non-opioid medications in the perioperative period seems to provide an effective alternative. Objectives: To compare the efficacy of pre-emptive multimodal analgesia with combined spinal epidural for postoperative analgesia in lower limb arthroplasties. Materials and methods: 50 patients scheduled for elective lower limb Arthroplasties were randomly divided into two groups. Spinal anaesthesia with 2.5ml of 0.5% Bupivacaine (heavy) plus 0.5ml (25µg) Fentanyl was given in both the groups for procedure. Group I received Cap. Pregabalin 150mg and Inj Paracetamol 1000mg IV 1 hour before surgery and 75mg 12 hourly and 1000mg IV 8 hourly respectively, while Group II received epidural top up with 10 ml of 0.125% bupivacaine 8 hourly, both for 3 days postoperatively. Perioperative haemodynamics, postoperative VAS, rescue analgesics requirement, and Patient satisfaction level were monitored for 72 hours. Results: Postoperative VAS score was significantly higher in Group II from 4th hour postoperatively, and, accordingly, more patients in this group required rescue analgesia (21 and 20 in Group II vs 10 and 1 in group I in 12-24 hrs and 24-36 hrs respectively with p value <0.001). Modified Bromage score, haemodynamics and side effect profiles were comparable in the groups, however, patient satisfaction level was more in Group I (p value <0.001) after 72 hours. Conclusion: Pre-emptive multimodal analgesia can be used as an effective alternative to epidural for postoperative analgesia in patients undergoing lower limb joint replacement surgeries. Keywords: Pre-emptive multimodal analgesia, Combined spinal epidural analgesia, Lower limb arthroplasties, Postoperative analgesia
背景和目的:硬膜外镇痛在骨科手术中被广泛用于术后镇痛，然而，围手术期阿片类药物和非阿片类药物联合使用似乎是一种有效的替代方法。目的:比较先发制人式多模式镇痛与脊髓硬膜外联合镇痛在下肢关节置换术后的疗效。材料与方法:50例择期下肢关节置换术患者随机分为两组。两组均予腰麻2.5ml 0.5%布比卡因(重)加0.5ml芬太尼(25µg)。ⅰ组术前1小时给予普瑞巴林150mg，注射扑热息痛1000mg IV, 12小时75mg, 8小时1000mg IV;ⅱ组术后3天给予0.125%布比卡因8小时10ml硬膜外补液。监测围手术期血流动力学、术后VAS、抢救镇痛药需求及患者满意度72小时。结果:术后第4小时起，II组VAS评分明显增高，需要抢救性镇痛的患者较多(12 ~ 24小时，II组21例，20例;24 ~ 36小时，I组10例，1例，p值<0.001)。改良Bromage评分、血流动力学和副作用情况在两组间具有可比性，但在72小时后，I组患者满意度更高(p值<0.001)。结论:在下肢关节置换术患者中，先发制人的多模式镇痛可作为硬膜外镇痛的有效替代。关键词:先发制人式多模式镇痛，脊髓硬膜外联合镇痛，下肢关节置换术，术后镇痛
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