Medical Journal Armed Forces India最新文献

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Puerperal uterine inversion- mismanaged third stage of labour: A diagnostic challenge 产后子宫内翻-处理不当的第三阶段劳动:诊断的挑战

Q2 Medicine

Medical Journal Armed Forces India

Pub Date : 2024-12-01 DOI: 10.1016/j.mjafi.2023.02.006

Sirisha Anne , Neera Singh , Arpit Garg , E. Sibi

Puerperal inversion of uterus is a catastrophic and a rare complication, which occurs during the third stage of labour. It can lead to severe haemorrhage and shock which results in maternal morbidity and mortality. When diagnosed correctly, early cases can be managed by manual reposition, but neglected and late cases need surgery. With advancement in management of the third stage of labour by oxytocics, the incidence of this entity is decreasing. But in developing countries, delivery by untrained birth attendants with inadequate knowledge in management of delivery and delay in referral to higher centres are leading to a relative increase in uterine inversion cases, which leads to an increase in maternal morbidity and mortality. We are presenting a neglected case of subacute uterine inversion in a home delivered female patient bought with clinical presentation of postpartum haemorrhage, shock with acute kidney injury, and sepsis. Diagnosis was a challenge to the treating gynaecologist because of the dramatic presentation in which she was bought with history of normal delivery 2 days back. This case report is to re-emphasis the need for safe motherhood and delivery, which is still a far cry for many patients. She was resuscitated initially and diagnosed as uterine inversion, and surgical management was required for repositioning of the uterus.

产后子宫内翻是一种灾难性的罕见并发症，发生在分娩的第三阶段。它可导致严重出血和休克，从而导致产妇发病率和死亡率。当诊断正确时，早期病例可通过手动复位处理，但忽视和晚期病例需要手术。随着使用催产素管理第三产程的进展，这种情况的发生率正在下降。但在发展中国家，未经培训的助产士接生，缺乏分娩管理知识，转诊到高级中心的时间较晚，导致子宫内翻病例相对增加，从而导致产妇发病率和死亡率增加。我们报告了一个被忽视的亚急性子宫内翻病例，在家中分娩的女性患者，临床表现为产后出血，急性肾损伤休克和败血症。诊断对妇科医生来说是一个挑战，因为她在2天前就有正常分娩的病史。本病例报告是为了再次强调安全孕产和分娩的必要性，这对许多患者来说仍然相去甚远。她最初被复苏，诊断为子宫内翻，需要手术处理子宫重新定位。

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引用次数: 0

Importance of interprofessional collaboration in teaching diabetic foot self-management: Perceptions of health care professionals 跨专业合作在糖尿病足自我管理教学中的重要性:卫生保健专业人员的看法

Q2 Medicine

Medical Journal Armed Forces India

Pub Date : 2024-12-01 DOI: 10.1016/j.mjafi.2023.01.003

Sushma Prabhath , Ganesh Handady , Gagana Herle , M Ganesh Kamath , Harihara Prakash Ramanathan

Background

Diabetes and associated diabetic foot ulcers require coordinated management, including several health care professional (HCPs). Therefore, an interprofessional (IP) team-based approach is essential for effectively managing and educating the population on diabetic foot self-management strategies. However, the perceptions of the HCPs related to the importance of IP teamwork in diabetic foot care and their readiness to work in an IP team are less explored.

Methods

This qualitative study aimed to investigate the HCPs' perception on the importance of IP collaboration in diabetic foot care and their readiness to work as part of an IP team in teaching patients’ effective diabetic foot self-management techniques. The study includes seven HCPs involved in diabetic foot management patient education and treatment. In-depth interviews using an interview guide and a thematic analysis of the interview transcripts were undertaken.

Results

Every participant was strongly motivated to be an IP team member. The following themes were identified that supported IP team-based approach in diabetic foot care: ‘patient-centric practices,’ ‘comprehensive care,’ ‘teamwork and coordination for improved patient outcome,’ ‘integrated approach,’ ‘professional knowledge amalgamation,’ ‘time-management,’ ‘education in a favorable environment,’ ‘constant motivation and support through educational modules,’ and ‘commitment and policy reforms.’

Conclusions

The HCPs' were aware about the benefits of IP team-based approach in diabetic foot care. They further expressed their willingness to work as part of an IP team and suggested appropriate teaching methods for diabetic foot self-management. This manuscript thus attempts to create an awareness about the importance of IP approach in teaching the proper practices of diabetic foot care. The problems faced in implementing an IP approach in diabetic foot care and the possible solutions are also discussed.

背景：糖尿病和相关的糖尿病足溃疡需要协调管理，包括几个卫生保健专业人员（HCPs）。因此，一个基于跨专业（IP）团队的方法对于有效管理和教育人群糖尿病足自我管理策略至关重要。然而，HCPs对糖尿病足护理中IP团队合作的重要性的看法以及他们在IP团队中工作的意愿却很少被探索。方法本定性研究旨在调查医护人员对知识产权合作在糖尿病足护理中的重要性的看法，以及他们是否愿意作为知识产权团队的一部分，教授患者有效的糖尿病足自我管理技术。该研究包括7名参与糖尿病足管理、患者教育和治疗的医护人员。利用访谈指南进行了深入访谈，并对访谈记录进行了专题分析。结果每位参与者都有成为IP团队成员的强烈动机。以下主题被确定为支持以知识产权团队为基础的糖尿病足护理方法：“以患者为中心的实践”、“全面护理”、“改善患者预后的团队合作和协调”、“综合方法”、“专业知识融合”、“时间管理”、“有利环境中的教育”、“通过教育模块持续激励和支持”以及“承诺和政策改革”。结论：HCPs意识到以IP团队为基础的糖尿病足护理方法的益处。他们进一步表示愿意作为IP团队的一部分工作，并提出了适当的糖尿病足自我管理教学方法。因此，这篇手稿试图创建一个关于知识产权的重要性认识方法在教学糖尿病足护理的适当做法。在糖尿病足护理中实施IP方法所面临的问题和可能的解决方案也进行了讨论。

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引用次数: 0

Precision therapy for Developmental delay, Epilepsy and Neonatal Diabetes syndrome in the era of genomics 基因组学时代的 DEND（发育迟缓、癫痫和新生儿糖尿病）综合征精准疗法

Q2 Medicine

Medical Journal Armed Forces India

Pub Date : 2024-12-01 DOI: 10.1016/j.mjafi.2024.01.007

Sachendra Badal , Vishal Sondhi , Kiran Sannalli , Karthik Ram Mohan , Shuvendu Roy , Ashok K. Yadav , Narendra Kotwal

Neonatal diabetes mellitus is a rare disorder with prevalence of one in 400,000 live births that's defined by persistent hyperglycaemia within the first six months of life. Neonatal diabetes is heterogeneous and can be transient or permanent.

Developmental delay, Epilepsy and Neonatal Diabetes (DEND) syndrome is characterised by developmental delay, epilepsy, and neonatal diabetes. The most common cause is activating mutations of KCNJ11 or ABCC8 genes, which encode Kir6.2 and SUR1 respectively. KATP channels are expressed in the brain, nerves, muscles, and pancreatic b-cells, implying an association with the neurological features observed in patients.

Neonate patients with early onset/neonatal onset diabetes are often misdiagnosed as type 1 DM and do not require lifelong insulin therapy. Whenever associated with neurological features DEND syndrome should be suspected which is a channelopathy affecting pancreas and brain and is amenable to precision therapy. Oral sulfonylureas show promising results in not only attaining euglycemia, but also in controlling seizures and ameliorating developmental delay.

新生儿糖尿病是一种罕见的疾病，其患病率为40万分之一，其定义是在生命的前六个月内持续出现高血糖。新生儿糖尿病是异质性的，可以是短暂的，也可以是永久性的。发育迟缓、癫痫和新生儿糖尿病（DEND）综合征以发育迟缓、癫痫和新生儿糖尿病为特征。最常见的原因是KCNJ11或ABCC8基因激活突变，这两个基因分别编码Kir6.2和SUR1。KATP通道在脑、神经、肌肉和胰腺b细胞中表达，暗示与患者观察到的神经学特征有关。早发/新生儿型糖尿病的新生儿患者经常被误诊为1型糖尿病，不需要终身胰岛素治疗。只要与神经系统特征相关，就应怀疑DEND综合征，这是一种影响胰腺和脑的通道病变，可以进行精确治疗。口服磺脲类药物不仅在实现血糖正常，而且在控制癫痫发作和改善发育迟缓方面显示出良好的效果。

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引用次数: 0

A rare case of progressive cribriform and zosteriform hyperpigmentation 一例罕见的进行性筛状和带状色素沉着

Q2 Medicine

Medical Journal Armed Forces India

Pub Date : 2024-12-01 DOI: 10.1016/j.mjafi.2022.11.007

Veena Kharayat, K.V. Vinu Balraam, Preema Sinha

引用次数: 0

Co-circulation of dengue serotypes in East Delhi: A new threat 东德里登革热血清型共流行:一种新的威胁

Q2 Medicine

Medical Journal Armed Forces India

Pub Date : 2024-12-01 DOI: 10.1016/j.mjafi.2023.05.002

Charu Jain , Swati Sinha , Anshdha Shah, Nikita Birhman, N.P. Singh, Shukla Das

引用次数: 0

Tolosa Hunt syndrome: A rare cause of headache Tolosa-Hunty综合征：一种罕见的头痛原因

Q2 Medicine

Medical Journal Armed Forces India

Pub Date : 2024-12-01 DOI: 10.1016/j.mjafi.2023.01.009

Harish Kasarabada , Deependra Singh , Sreenivasa Iyenger , K. Praveena

Tolosa Hunt syndrome (THS) is characterized by painful ophthalmoplegia preceded by retro orbital headache. First described in year 1952, it is a diagnosis of exclusion and is extremely rare entity^. Here we present a case report of syndrome in a female patient who presented with 03 weeks of progressive unilateral retro orbital headache followed by acute onset ptosis and complete ophthalmoplegia in right eye. On evaluation (brain imaging) and after ruling out all the other differentials, she was diagnosed as a case of THS. She was managed with parenteral corticosteroids followed by oral therapy. Patient showed remarkable response and complete recovery following 10 days of treatment. The follow-up brain imaging confirmed resolution of inflammation.

托洛萨亨特综合征（THS）的特征是疼痛性眼麻痹，并伴有眼眶头痛。首次描述于1952年，它是一种排斥性诊断，是一种极其罕见的实体。我们在此报告一位女性病患，表现为3周的进行性单侧眶内头痛，并伴有急性上睑下垂及右眼完全麻痹。经评估（脑成像）和排除所有其他鉴别后，她被诊断为三叉烧病例。她在口服治疗后接受肠外皮质类固醇治疗。经过10天的治疗，患者疗效显著，完全康复。随后的脑成像证实炎症消退。

引用次数: 0

Impact of the timing of surgery on the recovery of sexual functions after fracture penis 手术时机对阴茎骨折后性功能恢复的影响

Q2 Medicine

Medical Journal Armed Forces India

Pub Date : 2024-12-01 DOI: 10.1016/j.mjafi.2022.04.002

Amit Agrawal , Rankeen Raj

Background

Fracture penis is an uncommon urological emergency, which often results from sexual trauma. Diagnosis remains clinical, and early surgical management is advocated. However, the timing of the repair may have a bearing on the outcomes. Herein, we share our experience of 17 such cases and compare the complications and the sexual function in relation to the timing of the surgery.

Methods

The records of all patients with a penile fracture who had presented to our hospital between 1st Mar 2015 and 28th Feb 2021 were reviewed. All patients were managed surgically. The patients were divided into three groups based on the time elapsed between the injury and the surgery. All patients were followed up for 6 months and the development of complications was recorded. The sexual function was assessed with International Index of Erectile Function (IIEF) at the end of 6 months.

Results

A total of 17 patients were included in the study. Coital trauma was the most common cause, followed by masturbation. 15 out of the 17 patients were operated on within 48 h of the injury. There were no long-term complications except for one patient having a palpable painless nodule at the site of the repair. At 6 months follow-up all patients who had an immediate surgical repair on presentation, had a normal sexual function, and there was no difference between those who presented early or after 48 h of injury.

Conclusion

Immediate surgical intervention should be the treatment of choice for all patients with a penile fracture, even if they present late, to prevent complications and erectile dysfunction.

背景：阴茎骨折是一种罕见的泌尿外科急症，通常由性创伤引起。临床诊断，提倡早期手术治疗。然而，修复的时机可能会对结果产生影响。在此，我们分享了17例此类病例的经验，并比较了手术时机与并发症和性功能的关系。方法回顾性分析2015年3月1日至2021年2月28日我院收治的所有阴茎骨折患者的临床资料。所有患者均行手术治疗。根据受伤和手术之间的时间将患者分为三组。随访6个月，记录并发症发生情况。6个月后用国际勃起功能指数（IIEF）评估性功能。结果共纳入17例患者。性交创伤是最常见的原因，其次是手淫。17例患者中有15例在伤后48小时内手术。除了一名患者在修复部位有可触及的无痛结节外，没有长期并发症。在6个月的随访中，所有在出现后立即进行手术修复的患者性功能正常，并且在损伤早期和48小时后出现的患者之间没有差异。结论对于阴茎骨折患者，即使出现较晚，也应立即进行手术治疗，以预防并发症和勃起功能障碍。

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引用次数: 0

Zinner syndrome: A mesonephric duct anomaly with renal agenesis, ipsilateral seminal vesicle cyst, and ejaculatory duct obstruction Zinner综合征：一种中肾管异常，伴有肾脏发育不全、同侧精囊囊肿和射精管阻塞

Q2 Medicine

Medical Journal Armed Forces India

Pub Date : 2024-12-01 DOI: 10.1016/j.mjafi.2022.05.012

Varun Gupta , Rizwan K. Khan , Lanka Praveen Kumar

Anomalies of the mesonephric duct are associated with a combination of renal agenesis/dysgenesis, ejaculatory duct obstruction, and seminal vesical cyst, called Zinner syndrome. We present a case of this rare syndrome in a young male patient, who initially presented with urinary symptoms. The relevant embryology and diagnostic modalities are discussed.

中肾管异常与肾脏发育不全/发育不良、射精管阻塞和精囊囊肿相关，称为Zinner综合征。我们提出一个病例，这种罕见的综合征在一个年轻的男性患者，谁最初提出了泌尿系统的症状。讨论了相关的胚胎学和诊断方法。

引用次数: 0

Role of neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in predicting carcinoma prostate (CaP) in patients with lower urinary tract symptoms and raised serum prostate-specific antigen (sr.PSA) 中性粒细胞与淋巴细胞比率（NLR）和血小板与淋巴细胞比率在预测下尿路症状和血清前列腺特异性抗原（sr.PSA）升高患者前列腺癌（CaP）中的作用

Q2 Medicine

Medical Journal Armed Forces India

Pub Date : 2024-12-01 DOI: 10.1016/j.mjafi.2023.03.001

Sejal Mehta , Mrunal Ketkar , D.K. Jain

Background

Carcinoma prostate (CaP) is second most common cancer and sixth leading cause of cancer-related mortality among men worldwide. Prostate-specific antigen (sr. PSA) levels are prostate specific, not cancer specific. Therefore, finding non-invasive novel markers that can detect clinically significant CaP for preventing unnecessary biopsies is needed. Relation between host inflammatory responses and tumour has been increasingly recognized in various carcinomas. Many follow-up studies used neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) with sr. PSA level for CaP detection in India. The present study explored the use of these biomarkers in predicting CaP in patients with lower urinary tract symptoms (LUTS).

Methods

This prospective observational analytical study included 220 patients who underwent prostate biopsy for LUTS and suspected CaP between 2019 and 2021. Pearson's correlation (r) was used to find association between various attributes. Receiver operating characteristic curve analysis was performed to determine cut-off values and find sensitivity, specificity, positive and negative predictive value of NLR and PLR. P-value <0.05 was considered statistically significant (α = 5%).

Results

Out of 263 patients, 43 were excluded. Among remaining 220 study patients, 166 had BPH and 54 CaP. Median values of NLR and PLR were significantly higher in CaP patients. There was a strong positive correlation noted between NLR, PLR, and CaP groups. Areas under receiver operating characteristic curve of NLR (p = 0.001) and PLR (p < 0.001) for predicting CaP were statistically significant, with cut-off values of >3.44 and > 165.96, respectively.

Conclusion

In present study, we found significant increase in NLR and PLR in CaP patients. These parameters could be useful as pre-prostate biopsy predictors of CaP and help avoid unnecessary biopsies.

前列腺癌（CaP）是世界范围内男性癌症相关死亡的第二大常见癌症和第六大主要原因。前列腺特异性抗原（sr. PSA）水平是前列腺特异性的，而不是癌症特异性的。因此，需要寻找无创的新型标记物来检测具有临床意义的CaP，以防止不必要的活检。宿主炎症反应与肿瘤之间的关系在各种癌症中得到越来越多的认识。在印度，许多后续研究使用中性粒细胞与淋巴细胞比率（NLR）和血小板与淋巴细胞比率（PLR）与sr PSA水平进行CaP检测。本研究探讨了这些生物标志物在下尿路症状（LUTS）患者中预测CaP的应用。方法本前瞻性观察性分析研究纳入了2019年至2021年间因LUTS和疑似CaP接受前列腺活检的220例患者。Pearson’s correlation (r)用于发现不同属性之间的关联。进行受试者工作特征曲线分析，确定截断值，寻找NLR和PLR的敏感性、特异性、阳性预测值和阴性预测值。p值<；0.05认为有统计学意义（α = 5%）。结果263例患者中43例被排除在外。在剩余的220例研究患者中，166例BPH和54例CaP。CaP患者NLR和PLR的中位数显著高于CaP患者。NLR、PLR和CaP组间存在显著正相关。NLR （p = 0.001）和PLR (p <；0.001)预测CaP有统计学意义，临界值为>；3.44和>；165.96,分别。结论本研究发现CaP患者NLR和PLR明显增高。这些参数可以作为前列腺活检前CaP的预测指标，并有助于避免不必要的活检。

{"title":"Role of neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in predicting carcinoma prostate (CaP) in patients with lower urinary tract symptoms and raised serum prostate-specific antigen (sr.PSA)","authors":"Sejal Mehta , Mrunal Ketkar , D.K. Jain","doi":"10.1016/j.mjafi.2023.03.001","DOIUrl":"10.1016/j.mjafi.2023.03.001","url":null,"abstract":"<div><h3>Background</h3><div>Carcinoma prostate<span><span> (CaP) is second most common cancer and sixth leading cause of cancer-related mortality among men worldwide. Prostate-specific antigen (sr. PSA) levels are prostate specific, not cancer specific. Therefore, finding non-invasive novel markers that can detect clinically significant CaP for preventing unnecessary biopsies is needed. Relation between host inflammatory responses and tumour has been increasingly recognized in various carcinomas. Many follow-up studies used neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) with sr. PSA level for CaP detection in India. The present study explored the use of these biomarkers in predicting CaP in patients with </span>lower urinary tract symptoms (LUTS).</span></div></div><div><h3>Methods</h3><div>This prospective observational analytical study included 220 patients who underwent prostate biopsy for LUTS and suspected CaP between 2019 and 2021. Pearson's correlation (r) was used to find association between various attributes. Receiver operating characteristic curve analysis was performed to determine cut-off values and find sensitivity, specificity, positive and negative predictive value of NLR and PLR. P-value <0.05 was considered statistically significant (α = 5%).</div></div><div><h3>Results</h3><div>Out of 263 patients, 43 were excluded. Among remaining 220 study patients, 166 had BPH and 54 CaP. Median values of NLR and PLR were significantly higher in CaP patients. There was a strong positive correlation noted between NLR, PLR, and CaP groups. Areas under receiver operating characteristic curve of NLR (p = 0.001) and PLR (p < 0.001) for predicting CaP were statistically significant, with cut-off values of >3.44 and > 165.96, respectively.</div></div><div><h3>Conclusion</h3><div>In present study, we found significant increase in NLR and PLR in CaP patients. These parameters could be useful as pre-prostate biopsy predictors of CaP and help avoid unnecessary biopsies.</div></div>","PeriodicalId":39387,"journal":{"name":"Medical Journal Armed Forces India","volume":"80 ","pages":"Pages S160-S166"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46822941","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}

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High altitude pulmonary oedema: Mimicker of acute coronary syndrome 高原肺水肿：急性冠状动脉综合征的模仿者

Q2 Medicine

Medical Journal Armed Forces India

Pub Date : 2024-12-01 DOI: 10.1016/j.mjafi.2023.07.014

Rohit Jain , Sanjeev Sengupta , Amit Sharma , Yogendra Mishra

High altitude pulmonary oedema (HAPO) is a common emergency seen at high altitude. It can be associated with electrocardiogram (ECG) changes due to pulmonary arterial hypertension in the form of ST elevation and T wave inversion in the right precordial leads, which mimic acute coronary syndrome. These changes can lead to confusion in diagnosis and management. ECG changes resolve over a period of time when the patients are de-inducted to low land. So appropriate history and clinical examination, followed by monitoring of patients with cardiac enzymes and ECG, can prevent misdiagnosis and thereafter management.

高原肺水肿（HAPO）是在高海拔地区常见的紧急情况。它可能与肺动脉高压引起的心电图（ECG）改变有关，表现为右心前导联ST段抬高和T波倒置，类似急性冠状动脉综合征。这些变化可能导致诊断和治疗的混乱。心电图变化在一段时间内消失，当病人去感应到低地。因此，适当的病史和临床检查，然后监测患者的心脏酶和心电图，可以防止误诊和后续处理。

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