Saugat Das, A. Singh, Nehar Sinam, L. Singh, N. Singh
Background: Peripheral nerve injuries cause great morbidity leaving many with long-term disabilities with high societal costs. Direct tension-free microsurgical repair and/or the transplantation of a nerve autograft to bridge the gap are the gold standard treatments. However, such treatments may not recreate the suitable cellular and molecular microenvironment and in some cases, the functional recovery of nerve injuries is incomplete. Aims and Objectives: The purpose of the study is to investigate if, and to what extent, PRP can improve the clinical condition after nerve repair. To study the effects and therapeutic potential of platelet rich plasma in traumatic nerve injury. Materials and Methods: A hospital based Non-Randomized control trial was conducted in a tertiary hospital setup in Manipur, India, for a period of 2 years. This study was done on 12 patients who underwent peripheral nerve repair. Materials and method The selected sample will be divided into two groups. Control group was treated with direct tension-free epineural microsurgical repair and the treatment group was treated with direct tension-free epineural microsurgical repair along with intraoperative infiltrating the nerve stumps perineurally and intraneurally with a single dose of autologous PRP injection. Comparison was done on the basis of subjective and objective outcomes between the groups over a period of 1 year. Statistical analysis Statistical analysis was done by using IBM SPSS Version 21 for windows. Descriptive statistics such as mean, proportion, percentage were used to present the result. Chi square test was used to see the association of proportions. Student's t- test and repeated ANOVA were used for the continuous variables. P-value <0.05 was taken as significant. Results: A total of 12 patients were included in the study, who were divided into 2 groups i.e., Case group and Control group, with 6 patients in each. The two groups were comparable with regards to patient characteristics, nerve injured and time interval to surgery. The patients in the case group, had significant improved outcome, when compare to control group, in terms of subjective (quickDASH) and objective tests (2-point discrimination, sensory recovery, motor strength and nerve conduction studies). Conclusion: In this study we found that intraoperative PRP injection can improve the clinical outcome after nerve repair in traumatic nerve injury.
背景:周围神经损伤的发病率很高，许多人长期残疾，社会成本很高。直接无张力显微外科修复和/或自体神经移植来弥合间隙是金标准治疗方法。然而，这种治疗可能无法重建合适的细胞和分子微环境，在某些情况下，神经损伤的功能恢复是不完整的。目的和目的:本研究的目的是探讨PRP是否以及在多大程度上改善神经修复后的临床状况。目的:探讨富血小板血浆在外伤性神经损伤中的作用及治疗潜力。材料和方法:在印度曼尼普尔的一家三级医院进行了为期2年的医院非随机对照试验。本研究对12例接受周围神经修复的患者进行了研究。材料和方法选择的样本将被分为两组。对照组采用直接无张力神经外膜显微外科修复术，治疗组采用直接无张力神经外膜显微外科修复术并术中单剂量自体PRP注射神经残端神经周和神经内浸润。在1年的时间里，根据两组之间的主观和客观结果进行比较。统计分析采用IBM SPSS Version 21 for windows进行统计分析。使用描述性统计，如平均值、比例、百分比来表示结果。使用卡方检验来查看比例的关联。连续变量采用学生t检验和重复方差分析。p值<0.05为显著性。结果:共纳入12例患者，分为2组，即病例组和对照组，每组6例。两组在患者特征、神经损伤和手术时间间隔方面具有可比性。与对照组相比，病例组患者在主观(quickDASH)和客观测试(两点识别、感觉恢复、运动强度和神经传导研究)方面的结果均有显著改善。结论:术中注射PRP可改善外伤性神经损伤修复后的临床疗效。
{"title":"A clinical study of single intraneural platelet-rich plasma injection in peripheral nerve repair","authors":"Saugat Das, A. Singh, Nehar Sinam, L. Singh, N. Singh","doi":"10.4103/jms.jms_26_21","DOIUrl":"https://doi.org/10.4103/jms.jms_26_21","url":null,"abstract":"Background: Peripheral nerve injuries cause great morbidity leaving many with long-term disabilities with high societal costs. Direct tension-free microsurgical repair and/or the transplantation of a nerve autograft to bridge the gap are the gold standard treatments. However, such treatments may not recreate the suitable cellular and molecular microenvironment and in some cases, the functional recovery of nerve injuries is incomplete. Aims and Objectives: The purpose of the study is to investigate if, and to what extent, PRP can improve the clinical condition after nerve repair. To study the effects and therapeutic potential of platelet rich plasma in traumatic nerve injury. Materials and Methods: A hospital based Non-Randomized control trial was conducted in a tertiary hospital setup in Manipur, India, for a period of 2 years. This study was done on 12 patients who underwent peripheral nerve repair. Materials and method The selected sample will be divided into two groups. Control group was treated with direct tension-free epineural microsurgical repair and the treatment group was treated with direct tension-free epineural microsurgical repair along with intraoperative infiltrating the nerve stumps perineurally and intraneurally with a single dose of autologous PRP injection. Comparison was done on the basis of subjective and objective outcomes between the groups over a period of 1 year. Statistical analysis Statistical analysis was done by using IBM SPSS Version 21 for windows. Descriptive statistics such as mean, proportion, percentage were used to present the result. Chi square test was used to see the association of proportions. Student's t- test and repeated ANOVA were used for the continuous variables. P-value <0.05 was taken as significant. Results: A total of 12 patients were included in the study, who were divided into 2 groups i.e., Case group and Control group, with 6 patients in each. The two groups were comparable with regards to patient characteristics, nerve injured and time interval to surgery. The patients in the case group, had significant improved outcome, when compare to control group, in terms of subjective (quickDASH) and objective tests (2-point discrimination, sensory recovery, motor strength and nerve conduction studies). Conclusion: In this study we found that intraoperative PRP injection can improve the clinical outcome after nerve repair in traumatic nerve injury.","PeriodicalId":39636,"journal":{"name":"JMS - Journal of Medical Society","volume":"34 1","pages":"167 - 171"},"PeriodicalIF":0.0,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44246448","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}
M. Singh, P. Geetha Devi, M. Hussain, G. Pukhrambam
Background: HCV infection is widespread among HIV infected populations because of their increased life expectancy with the advent of HAART. Hepatic fibrosis is one of the most robust prognostic factors used to predict HCV disease progression and clinical outcomes. This study's objective was to evaluate hepatic fibrosis using APRI in HIV-HCV co-infected individuals compared to HIV monoinfected. Methods: A total of 120 HIV infected patients (mean age 41.7±10.0 years) was enrolled in a study conducted in JNIMS, Manipur from August 2017 to August 2019. Liver fibrosis was assessed by the APRI which signifies the presence and absence of significant fibrosis if APRI > 1.5 and APRI < 0.5 respectively. Correlation between hepatic fibrosis and immunological status was established. Statistical analysis was done using SPSS version 21. Results: HIV-HCV co-infected patients had a higher abnormal mean AST level (114.18±150.19 IU/L) than HIV monoinfected (65.03±47.71 IU/L). The mean platelet count in HIV-HCV co-infected patients (106±38×103 cells/mm3) was lower than that of HIV monoinfected (207±80×103 cells/mm3). The mean APRI score in HIV-HCV co-infected patients (3.05±3.89) was higher than that in HIV monoinfected (1.02±1.38) indicating the presence of significant hepatic fibrosis in the co-infected group (p<.001). Conclusion: A high AST level combined with thrombocytopenia (APRI score>1.5) is an indicator of hepatic fibrosis in HIV-HCV co-infected individuals. Our study demonstrates that HIV-HCV co-infected patients and HIV related advanced immunosuppression is associated with higher APRI. Because of its simple, non-invasive and less costly nature, APRI may be utilised for assessing hepatic fibrosis in resource-limited settings.
{"title":"The aspartate aminotransferase to platelet ratio index for assessing hepatic fibrosis in human immunodeficiency virus-hepatitis C virus coinfected patients: A local experience","authors":"M. Singh, P. Geetha Devi, M. Hussain, G. Pukhrambam","doi":"10.4103/jms.jms_17_21","DOIUrl":"https://doi.org/10.4103/jms.jms_17_21","url":null,"abstract":"Background: HCV infection is widespread among HIV infected populations because of their increased life expectancy with the advent of HAART. Hepatic fibrosis is one of the most robust prognostic factors used to predict HCV disease progression and clinical outcomes. This study's objective was to evaluate hepatic fibrosis using APRI in HIV-HCV co-infected individuals compared to HIV monoinfected. Methods: A total of 120 HIV infected patients (mean age 41.7±10.0 years) was enrolled in a study conducted in JNIMS, Manipur from August 2017 to August 2019. Liver fibrosis was assessed by the APRI which signifies the presence and absence of significant fibrosis if APRI > 1.5 and APRI < 0.5 respectively. Correlation between hepatic fibrosis and immunological status was established. Statistical analysis was done using SPSS version 21. Results: HIV-HCV co-infected patients had a higher abnormal mean AST level (114.18±150.19 IU/L) than HIV monoinfected (65.03±47.71 IU/L). The mean platelet count in HIV-HCV co-infected patients (106±38×103 cells/mm3) was lower than that of HIV monoinfected (207±80×103 cells/mm3). The mean APRI score in HIV-HCV co-infected patients (3.05±3.89) was higher than that in HIV monoinfected (1.02±1.38) indicating the presence of significant hepatic fibrosis in the co-infected group (p<.001). Conclusion: A high AST level combined with thrombocytopenia (APRI score>1.5) is an indicator of hepatic fibrosis in HIV-HCV co-infected individuals. Our study demonstrates that HIV-HCV co-infected patients and HIV related advanced immunosuppression is associated with higher APRI. Because of its simple, non-invasive and less costly nature, APRI may be utilised for assessing hepatic fibrosis in resource-limited settings.","PeriodicalId":39636,"journal":{"name":"JMS - Journal of Medical Society","volume":"34 1","pages":"154 - 161"},"PeriodicalIF":0.0,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47845138","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}
Moirangthem Singh, L. Simon, Angelica Laiphrakpam, L. Devi
Nevus sebaceous of Jadassohn is a congenital, uncommon hamartomatous lesion of the epidermis, dermis, and appendages with the predominance of sebaceous elements. This hamartoma has the capacity to develop benign as well as malignant neoplasms, but the malignant transformation is rare. Herein, we report a case of basal cell carcinoma in the background of nevus sebaceous in a 53-year-old female highlighting the importance of prophylactic excision of this lesion.
{"title":"Nevus sebaceous associated with basal cell carcinoma","authors":"Moirangthem Singh, L. Simon, Angelica Laiphrakpam, L. Devi","doi":"10.4103/jms.jms_7_21","DOIUrl":"https://doi.org/10.4103/jms.jms_7_21","url":null,"abstract":"Nevus sebaceous of Jadassohn is a congenital, uncommon hamartomatous lesion of the epidermis, dermis, and appendages with the predominance of sebaceous elements. This hamartoma has the capacity to develop benign as well as malignant neoplasms, but the malignant transformation is rare. Herein, we report a case of basal cell carcinoma in the background of nevus sebaceous in a 53-year-old female highlighting the importance of prophylactic excision of this lesion.","PeriodicalId":39636,"journal":{"name":"JMS - Journal of Medical Society","volume":"34 1","pages":"172 - 174"},"PeriodicalIF":0.0,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45634651","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}
Aims and Objectives: To study the spectrum of lesions of nose and paranasal sinuses over a period of 5 years in a tertiary care hospital. To find the incidence and age and sex distribution along with their clinical presentation and various histopathological patterns. Materials and Methods: The study included biopsies and resection specimens. The clinical details such as age and sex of the patient, clinical presentation, and radiological findings were retrieved from the records. The tissue specimens were processed after fixing in 10% formalin and stained with hematoxylin and eosin stains. Various special stains were performed as per the need such as Gomori methenamine silver stain and periodic acid–Schiff for fungus. The neoplastic lesions were classified as per the World Health Organization 2017 classification. Results: The incidence of nose and paranasal sinus lesions was 0.71% (310 cases). Nonneoplastic cases (156) constituted 50.32%, whereas neoplastic lesions (154) constituted 49.67%. Benign neoplasms (126) were 40.64% and malignant neoplasms (28) formed 9.03% of total neoplasms. A wide age ranging between the 1st and 9th decades was observed. Male predominance in neoplastic as well as nonneoplastic lesions was noted. Nasal obstruction (90.96%) was the most common symptom seen. Radiology was available in 30 cases and accurate diagnoses were made in 28 cases (93.33%). Among nonneoplastic lesions, inflammatory cases (128) formed the largest group (82.05%). Nasopharyngeal angiofibroma (NPA) was the dominant benign neoplasm (67.46%) exclusively seen in males of the second decade (76.47%). Among malignant lesions (9.03%), squamous cell carcinoma was the most common (28.57%) malignancy. Lesions with round cell morphology could not be typified on histopathology; hence, immunohistochemistry (IHC) was done for the exact diagnosis. Conclusion: This study elaborates wide spectrum of lesions encountered in nose and paranasal sinuses with their relative frequencies in the population. Nonneoplastic lesions are more common than neoplastic lesions. Histopathological examination is essential for the diagnosis as clinical and radiological features may be overlapping. Round cell tumors could not be typified on the basis of histopathology; hence, use of ancillary techniques such as IHC plays a vital role in diagnosis.
{"title":"Spectrum of histopathological lesions of nose and paranasal sinuses: A 5-year study","authors":"U. Vartak, A. Sarnaik, Shailesh Vartak, F. Pathan","doi":"10.4103/jms.jms_100_20","DOIUrl":"https://doi.org/10.4103/jms.jms_100_20","url":null,"abstract":"Aims and Objectives: To study the spectrum of lesions of nose and paranasal sinuses over a period of 5 years in a tertiary care hospital. To find the incidence and age and sex distribution along with their clinical presentation and various histopathological patterns. Materials and Methods: The study included biopsies and resection specimens. The clinical details such as age and sex of the patient, clinical presentation, and radiological findings were retrieved from the records. The tissue specimens were processed after fixing in 10% formalin and stained with hematoxylin and eosin stains. Various special stains were performed as per the need such as Gomori methenamine silver stain and periodic acid–Schiff for fungus. The neoplastic lesions were classified as per the World Health Organization 2017 classification. Results: The incidence of nose and paranasal sinus lesions was 0.71% (310 cases). Nonneoplastic cases (156) constituted 50.32%, whereas neoplastic lesions (154) constituted 49.67%. Benign neoplasms (126) were 40.64% and malignant neoplasms (28) formed 9.03% of total neoplasms. A wide age ranging between the 1st and 9th decades was observed. Male predominance in neoplastic as well as nonneoplastic lesions was noted. Nasal obstruction (90.96%) was the most common symptom seen. Radiology was available in 30 cases and accurate diagnoses were made in 28 cases (93.33%). Among nonneoplastic lesions, inflammatory cases (128) formed the largest group (82.05%). Nasopharyngeal angiofibroma (NPA) was the dominant benign neoplasm (67.46%) exclusively seen in males of the second decade (76.47%). Among malignant lesions (9.03%), squamous cell carcinoma was the most common (28.57%) malignancy. Lesions with round cell morphology could not be typified on histopathology; hence, immunohistochemistry (IHC) was done for the exact diagnosis. Conclusion: This study elaborates wide spectrum of lesions encountered in nose and paranasal sinuses with their relative frequencies in the population. Nonneoplastic lesions are more common than neoplastic lesions. Histopathological examination is essential for the diagnosis as clinical and radiological features may be overlapping. Round cell tumors could not be typified on the basis of histopathology; hence, use of ancillary techniques such as IHC plays a vital role in diagnosis.","PeriodicalId":39636,"journal":{"name":"JMS - Journal of Medical Society","volume":"34 1","pages":"128 - 138"},"PeriodicalIF":0.0,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41421487","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}
R. Shimray, Paramita Pal, S. Laishram, G. Pukhrambam
Background: Ectopic pregnancy remains the leading cause of maternal death in early pregnancy. It is assuming greater importance because of its increasing incidence and its impact on woman's fertility. Objectives: To study the histomorphological changes of ectopic pregnancy and its correlation with relevant parameters such as age, site, parity, and gestational age. Materials and Methods: This study was conducted in the Department of Pathology, Regional Institute of Medical Sciences, Imphal, for a period of 5 years (January 2015–December 2019). All the specimens with a clinical diagnosis of ectopic pregnancy were included in the study. Histomorphological changes and other relevant parameters such as age, site, parity, and gestational age were analyzed. Results: A total of 160 ectopic pregnancies were diagnosed during the study period. A total number of pregnant women attending antenatal outpatient department during the study period was found to be 121,1941 giving an overall rate of occurrence of 0.13% or 1.31/1000 pregnancies. The most common site of involvement was fallopian tube (95%), mostly on the right side (64.37%). The most common age group was 30–39 years (mean age 30.8 years). Nearly 91.25% of cases were multiparous presenting mostly in their first trimester. Predominant-associated histopathological findings were chronic salpingitis (43.12%), acute salpingitis (20.62%), and salpingitis isthmica nodosa (7.5%). One case was found to be associated with paratubal cyst. Conclusion: Histopathological examination of resected ectopic pregnancy specimens can give an insight into the etiopathogenesis of ectopic pregnancy, thereby helping in early treatment and preventing recurrence.
{"title":"Study of resected specimens of ectopic pregnancy: A-5 year experience in Regional Institute of Medical Sciences Hospital, Imphal","authors":"R. Shimray, Paramita Pal, S. Laishram, G. Pukhrambam","doi":"10.4103/jms.jms_4_21","DOIUrl":"https://doi.org/10.4103/jms.jms_4_21","url":null,"abstract":"Background: Ectopic pregnancy remains the leading cause of maternal death in early pregnancy. It is assuming greater importance because of its increasing incidence and its impact on woman's fertility. Objectives: To study the histomorphological changes of ectopic pregnancy and its correlation with relevant parameters such as age, site, parity, and gestational age. Materials and Methods: This study was conducted in the Department of Pathology, Regional Institute of Medical Sciences, Imphal, for a period of 5 years (January 2015–December 2019). All the specimens with a clinical diagnosis of ectopic pregnancy were included in the study. Histomorphological changes and other relevant parameters such as age, site, parity, and gestational age were analyzed. Results: A total of 160 ectopic pregnancies were diagnosed during the study period. A total number of pregnant women attending antenatal outpatient department during the study period was found to be 121,1941 giving an overall rate of occurrence of 0.13% or 1.31/1000 pregnancies. The most common site of involvement was fallopian tube (95%), mostly on the right side (64.37%). The most common age group was 30–39 years (mean age 30.8 years). Nearly 91.25% of cases were multiparous presenting mostly in their first trimester. Predominant-associated histopathological findings were chronic salpingitis (43.12%), acute salpingitis (20.62%), and salpingitis isthmica nodosa (7.5%). One case was found to be associated with paratubal cyst. Conclusion: Histopathological examination of resected ectopic pregnancy specimens can give an insight into the etiopathogenesis of ectopic pregnancy, thereby helping in early treatment and preventing recurrence.","PeriodicalId":39636,"journal":{"name":"JMS - Journal of Medical Society","volume":"34 1","pages":"149 - 153"},"PeriodicalIF":0.0,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43043250","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}
Shweta Bhalothia, Veeraraghavan Gunasekaran, S. Singh
Background: Small bowel imaging is technically challenging due to the difficulty in displaying the long and serpentine small bowel in entirety and intrinsic motion peristalsis and positional changes caused by breathing. Multidetector computed tomography (MDCT) enterography with the use of neutral enteric contrast permits an excellent assessment of the small bowel pathologies. Objective: The objective of this study is to determine the radiological features of small bowel diseases with respect to the presence, localization, causes, and associated complications with MDCT enterography. Materials and Methods: This is a single-center, cross-sectional, analytical study, which was carried over a period of 2 years on 43 patients, in a medical institute at department of radiodiagnosis. The study was conducted with Philips Brilliance 64-Slice computed tomography machine with neutral enteric contrast and intravenous contrast agents with arterial and enteric or portal phases. Imaging findings were correlated clinically, surgically, and histopathologically. Results: Out of the 43 cases, nine cases (20.93%) were of malignant pathologies, 20 cases were of nonmalignant mural pathologies (46.51%), and 14 cases were other intraluminal or extraluminal pathologies. The common bowel wall patterns found in nonneoplastic pathologies were segmental (50%), symmetrical (70%), mild-to-moderate wall thickening (70%), homogeneous and stratified attenuation patterns (95%), whereas segmental (80%), asymmetrical (80%), marked wall thickening (100%), and heterogeneous enhancement patterns (60%) with distal bowel involvement in primary malignancy cases. Mean wall thickness in malignant pathologies (21.56 ± 15.68 mm) was statistically significantly higher than mean wall thickness of nonmalignant pathologies (7.85 ± 3.69 mm) with P value of 0.031 (<0.05). Conclusion: MDCT enterography is a powerful diagnostic tool for the study of small bowel disorders, including inflammatory disease, small bowel neoplasms, and mechanical obstruction.
{"title":"Role of multidetector computed tomography enterography in the evaluation of small bowel diseases","authors":"Shweta Bhalothia, Veeraraghavan Gunasekaran, S. Singh","doi":"10.4103/jms.jms_100_17","DOIUrl":"https://doi.org/10.4103/jms.jms_100_17","url":null,"abstract":"Background: Small bowel imaging is technically challenging due to the difficulty in displaying the long and serpentine small bowel in entirety and intrinsic motion peristalsis and positional changes caused by breathing. Multidetector computed tomography (MDCT) enterography with the use of neutral enteric contrast permits an excellent assessment of the small bowel pathologies. Objective: The objective of this study is to determine the radiological features of small bowel diseases with respect to the presence, localization, causes, and associated complications with MDCT enterography. Materials and Methods: This is a single-center, cross-sectional, analytical study, which was carried over a period of 2 years on 43 patients, in a medical institute at department of radiodiagnosis. The study was conducted with Philips Brilliance 64-Slice computed tomography machine with neutral enteric contrast and intravenous contrast agents with arterial and enteric or portal phases. Imaging findings were correlated clinically, surgically, and histopathologically. Results: Out of the 43 cases, nine cases (20.93%) were of malignant pathologies, 20 cases were of nonmalignant mural pathologies (46.51%), and 14 cases were other intraluminal or extraluminal pathologies. The common bowel wall patterns found in nonneoplastic pathologies were segmental (50%), symmetrical (70%), mild-to-moderate wall thickening (70%), homogeneous and stratified attenuation patterns (95%), whereas segmental (80%), asymmetrical (80%), marked wall thickening (100%), and heterogeneous enhancement patterns (60%) with distal bowel involvement in primary malignancy cases. Mean wall thickness in malignant pathologies (21.56 ± 15.68 mm) was statistically significantly higher than mean wall thickness of nonmalignant pathologies (7.85 ± 3.69 mm) with P value of 0.031 (<0.05). Conclusion: MDCT enterography is a powerful diagnostic tool for the study of small bowel disorders, including inflammatory disease, small bowel neoplasms, and mechanical obstruction.","PeriodicalId":39636,"journal":{"name":"JMS - Journal of Medical Society","volume":"34 1","pages":"69 - 75"},"PeriodicalIF":0.0,"publicationDate":"2020-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48957345","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}
{"title":"Letter to the editor - Reducing medication errors in telemedicine during the COVID era - need of the hour!","authors":"V. Kalidoss, S. Bakshi","doi":"10.4103/jms.jms_40_20","DOIUrl":"https://doi.org/10.4103/jms.jms_40_20","url":null,"abstract":"","PeriodicalId":39636,"journal":{"name":"JMS - Journal of Medical Society","volume":"34 1","pages":"119 - 120"},"PeriodicalIF":0.0,"publicationDate":"2020-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42584828","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}
Gallstone ileus is an uncommon complication of calculus cholecystitis and often presents as a life-threatening emergency. It is more common in the elderly and especially among females. It is a rare cause of intestinal obstruction and accounting for 1%–4% of cases. Patients present with symptoms of intestinal obstruction such as abdominal pain, vomiting, and abdominal distension. Diagnosis can be confirmed by computerized tomography (CT) of the abdomen. Enterolithotomy is the most accepted treatment of choice. We report a case of 55-year-old female who presented with epigastric pain for 8 days duration with multiple episodes of vomiting and progressive abdominal distension. Classical Rigler's triad was observed. CT of the abdomen was suggestive of a gallstone obstructing the small bowel. Enterolithotomy with primary bowel repair was done. A large gallstone of size 5 cm × 3 cm was extracted from the terminal ileum. Postoperative period was uneventful. This case is being reported to highlight the rare incidence of gallstone ileus and its life-threatening surgical emergency, particularly large gallstone causing obstruction, and impending bowel gangrene.
胆结石性肠梗阻是一种罕见的结石性胆囊炎并发症，经常表现为危及生命的紧急情况。它在老年人中更为常见，尤其是在女性中。它是一种罕见的肠梗阻的原因，占1%-4%的病例。患者表现为腹痛、呕吐和腹胀等肠梗阻症状。诊断可通过腹部计算机断层扫描(CT)进行确认。肠内取石术是最被接受的治疗选择。我们报告一例55岁的女性，她表现为上腹疼痛8天，并伴有多次呕吐和进行性腹胀。观察经典里格勒三和弦。腹部CT显示胆囊结石阻塞了小肠。行肠内取石术并进行一期肠修复。从回肠末端取出一颗5 cm × 3 cm的大胆结石。术后无意外。报道此病例是为了强调胆石性肠梗阻的罕见发生率及其危及生命的外科急诊，特别是引起梗阻的大胆结石和即将发生的肠坏疽。
{"title":"Gallstone ileus: Rare life-threatening disease","authors":"Pranjal Dhekiyal Phukan, A. Roy","doi":"10.4103/jms.jms_86_18","DOIUrl":"https://doi.org/10.4103/jms.jms_86_18","url":null,"abstract":"Gallstone ileus is an uncommon complication of calculus cholecystitis and often presents as a life-threatening emergency. It is more common in the elderly and especially among females. It is a rare cause of intestinal obstruction and accounting for 1%–4% of cases. Patients present with symptoms of intestinal obstruction such as abdominal pain, vomiting, and abdominal distension. Diagnosis can be confirmed by computerized tomography (CT) of the abdomen. Enterolithotomy is the most accepted treatment of choice. We report a case of 55-year-old female who presented with epigastric pain for 8 days duration with multiple episodes of vomiting and progressive abdominal distension. Classical Rigler's triad was observed. CT of the abdomen was suggestive of a gallstone obstructing the small bowel. Enterolithotomy with primary bowel repair was done. A large gallstone of size 5 cm × 3 cm was extracted from the terminal ileum. Postoperative period was uneventful. This case is being reported to highlight the rare incidence of gallstone ileus and its life-threatening surgical emergency, particularly large gallstone causing obstruction, and impending bowel gangrene.","PeriodicalId":39636,"journal":{"name":"JMS - Journal of Medical Society","volume":"34 1","pages":"111 - 114"},"PeriodicalIF":0.0,"publicationDate":"2020-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45877193","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}
Introduction: Manipur, the easternmost state of India, suffer from lack of specialist doctors at peripheral public health service points. Among MBBS doctors, many lack knowledge on maternal and child health, resulting in delay identifying high-risk cases, which contribute to increased morbidity and mortality. Under RMNCH + A strategy as a continuum to the previous program, to overcome the shortage of specialist doctors, multi-skilling of doctors in the public health system is being undertaken. Training need assessment, proper conduct of training, mentoring should be ensured so that these service providers gain confidence and are thus able to practice newly acquired skills. Objectives: The aim is to determine the type and pattern of training among Medical Officers and to assess the level of translation of Basic Emergency Obstetric Care (BEmOC) training (knowledge and skills) into practice. Materials and Methods: A cross-sectional study was done from June 2015 to October 2017. A questionnaire-guided interview was done among BEmOC trained in-service doctors. Data collected were analyzed using SPSS-version-21. Descriptive statistics such as percentage, mean, median, and standard deviation were used. Chi-square test and Fisher's exact test were used for testing the significance between the proportions. ANOVA and independent t-test were used for comparing means. A value of P < 0.05 was taken as significant. Results: Out of 49 respondents, 82% responded and 61% were male. The mean knowledge score was 21 ± 2.8 with a range of 16–27 and the mean age was 33.2 ± 4.1. Gender, year of training, and performed manual removal of placenta were seen significantly associated with knowledge score. About 81.6% of the doctors conducted normal delivery in the past 6 months. Around 45% of the doctors reported performing manual vacuum aspiration (MVA) procedures in the past 6 months and were confident about it. Conclusion: The mean knowledge score about BEmOC was more than two-third of the total score. After training, the knowledge score seems to decrease as time passes. Males had better knowledge than females. There was no association between age, place of posting, and years of experience with knowledge. Almost half of the participants performed the induction of labor and MVA procedure in the last 6 months.
{"title":"Training among in-service doctors in Manipur and their translation into practice","authors":"Mutum Vivekson, B. Akoijam","doi":"10.4103/jms.jms_82_17","DOIUrl":"https://doi.org/10.4103/jms.jms_82_17","url":null,"abstract":"Introduction: Manipur, the easternmost state of India, suffer from lack of specialist doctors at peripheral public health service points. Among MBBS doctors, many lack knowledge on maternal and child health, resulting in delay identifying high-risk cases, which contribute to increased morbidity and mortality. Under RMNCH + A strategy as a continuum to the previous program, to overcome the shortage of specialist doctors, multi-skilling of doctors in the public health system is being undertaken. Training need assessment, proper conduct of training, mentoring should be ensured so that these service providers gain confidence and are thus able to practice newly acquired skills. Objectives: The aim is to determine the type and pattern of training among Medical Officers and to assess the level of translation of Basic Emergency Obstetric Care (BEmOC) training (knowledge and skills) into practice. Materials and Methods: A cross-sectional study was done from June 2015 to October 2017. A questionnaire-guided interview was done among BEmOC trained in-service doctors. Data collected were analyzed using SPSS-version-21. Descriptive statistics such as percentage, mean, median, and standard deviation were used. Chi-square test and Fisher's exact test were used for testing the significance between the proportions. ANOVA and independent t-test were used for comparing means. A value of P < 0.05 was taken as significant. Results: Out of 49 respondents, 82% responded and 61% were male. The mean knowledge score was 21 ± 2.8 with a range of 16–27 and the mean age was 33.2 ± 4.1. Gender, year of training, and performed manual removal of placenta were seen significantly associated with knowledge score. About 81.6% of the doctors conducted normal delivery in the past 6 months. Around 45% of the doctors reported performing manual vacuum aspiration (MVA) procedures in the past 6 months and were confident about it. Conclusion: The mean knowledge score about BEmOC was more than two-third of the total score. After training, the knowledge score seems to decrease as time passes. Males had better knowledge than females. There was no association between age, place of posting, and years of experience with knowledge. Almost half of the participants performed the induction of labor and MVA procedure in the last 6 months.","PeriodicalId":39636,"journal":{"name":"JMS - Journal of Medical Society","volume":"34 1","pages":"61 - 68"},"PeriodicalIF":0.0,"publicationDate":"2020-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47130320","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}
A. Choudhary, A. Singh, Saugat Das, L. Singh, N. Singh
Background: Flap surgery has become a reliable method of reconstruction of postsurgical and posttraumatic defects almost over any part of the body with vascularized tissue. Complications associated with flap surgeries may lead to partial or total flap failure. Scrupulous postoperative flap monitoring allows early detection of flap failure which is the only evidence-based strategy for optimizing free flap salvage. There are various methods available for flap monitoring. Classical clinical observation of the flap requires clinical expertise. Microdialysis is a method that measures certain metabolites like glucose, lactate, etc., levels in the flap blood which is objective, reliable, and reproducible method. Based on the principles of microdialysis, monitoring of capillary glucose levels in flaps using glucometer is being proposed as a cheap, rapid, and simple method for the early prediction of microvascular complications and thereby reducing flap failure. Aims: The aim was to study blood glucose levels in flaps incorporating skin in comparison to control site to correlate flap blood glucose level with clinical changes in these flaps. Settings and Design: A hospital-based observational study was conducted on twenty patients operated for reconstruction with flaps in a tertiary hospital setup in Manipur during the period of December 2017 to November 2019. Statistical Analysis: The data were analyzed with IBM SPSS statistics 21 developers. Descriptive statistics mean were used for statistical analysis and paired t-test for quantitative data. P < 0.05 will be taken as statistically significant. Results: Out of total twenty patients studied, 10 patients (50%) were in the age group of 30–50 years. Total 14 flaps (70%) were pedicled and 6 (30%) were free flaps. Total 4 flaps (20%) had complications (venous thrombosis) in the first 24 h, three flaps were pedicled and one flap was free flap. Flap capillary glucose level drops when there was venous thrombosis otherwise flap capillary glucose level fluctuates according to capillary blood glucose level of control area. Conclusions: The measurement of free flap capillary glycemia may be used as a method of diagnosis of complications which is a simple and rapid method of flap monitoring. It can help in flap salvage but it is not superior to clinical evaluation by an experienced professional for the detection of venous thrombosis.
{"title":"Role of flap blood glucose measurement in monitoring of flap incorporating skin and to detect flap congestion and flap salvage","authors":"A. Choudhary, A. Singh, Saugat Das, L. Singh, N. Singh","doi":"10.4103/jms.jms_127_20","DOIUrl":"https://doi.org/10.4103/jms.jms_127_20","url":null,"abstract":"Background: Flap surgery has become a reliable method of reconstruction of postsurgical and posttraumatic defects almost over any part of the body with vascularized tissue. Complications associated with flap surgeries may lead to partial or total flap failure. Scrupulous postoperative flap monitoring allows early detection of flap failure which is the only evidence-based strategy for optimizing free flap salvage. There are various methods available for flap monitoring. Classical clinical observation of the flap requires clinical expertise. Microdialysis is a method that measures certain metabolites like glucose, lactate, etc., levels in the flap blood which is objective, reliable, and reproducible method. Based on the principles of microdialysis, monitoring of capillary glucose levels in flaps using glucometer is being proposed as a cheap, rapid, and simple method for the early prediction of microvascular complications and thereby reducing flap failure. Aims: The aim was to study blood glucose levels in flaps incorporating skin in comparison to control site to correlate flap blood glucose level with clinical changes in these flaps. Settings and Design: A hospital-based observational study was conducted on twenty patients operated for reconstruction with flaps in a tertiary hospital setup in Manipur during the period of December 2017 to November 2019. Statistical Analysis: The data were analyzed with IBM SPSS statistics 21 developers. Descriptive statistics mean were used for statistical analysis and paired t-test for quantitative data. P < 0.05 will be taken as statistically significant. Results: Out of total twenty patients studied, 10 patients (50%) were in the age group of 30–50 years. Total 14 flaps (70%) were pedicled and 6 (30%) were free flaps. Total 4 flaps (20%) had complications (venous thrombosis) in the first 24 h, three flaps were pedicled and one flap was free flap. Flap capillary glucose level drops when there was venous thrombosis otherwise flap capillary glucose level fluctuates according to capillary blood glucose level of control area. Conclusions: The measurement of free flap capillary glycemia may be used as a method of diagnosis of complications which is a simple and rapid method of flap monitoring. It can help in flap salvage but it is not superior to clinical evaluation by an experienced professional for the detection of venous thrombosis.","PeriodicalId":39636,"journal":{"name":"JMS - Journal of Medical Society","volume":"34 1","pages":"106 - 110"},"PeriodicalIF":0.0,"publicationDate":"2020-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43917114","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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