Abstract Introduction Osteoporosis is one of the most common and rampant metabolic bone disorders among the geriatric, particularly affecting postmenopausal women. Even though resorption tends to occur more rapidly in bones with a higher proportion of trabecular bone (e.g., vertebrae, pelvis, calcaneus), bones with significant cortical bone content also do undergo resorption, for example, mandible. The dental manifestations that may indicate low-bone density include loose teeth, receding gums, and ill-fitting or loose dentures. Objective To validate the efficacy of orthopantomograms (OPGs) in recognizing bone mineral density (BMD) changes of the mandible using mandibular cortical index (MCI) and substantiate the same with dual energy X-ray absorptiometry (DEXA) scan on femoral neck and spine. Materials and Methods This cross-sectional study comprised 60 geriatric patients of both genders. All the patients were subjected to panoramic radiographs wherever clinically indicated. The visual analysis was done based on the radiographic appearance of the mandibular cortical border and results were compared with DEXA scan reports, followed by an analysis of three grades of MCI and BMD statistically. Results In our study, out of 40 patients in C2 and C3 subgroups, 67% and 20% were normal, respectively. The incidence of osteopenia was 33% in the C2 group and 70% in the C3 group, whereas Osteoporosis was present only among 10% of the population in the C3 group. The difference between the groups are statistically significant (p = 0.01). These findings imply that a progressive link exists between BMD and deteriorating cortical morphology. Conclusion The purpose of this study is that dentists will be able to refer patients to physicians of suspected low BMD, based on incidental findings on panoramic radiographs for further examination. There is a statistically significant correlation present between DEXA and MCI, so the latter can also be used for screening BMD changes.
{"title":"Diagnostic Validity of Orthopantomogram Compared to Dual Energy X-ray Absorptiometry Scan in Detecting Osteoporosis","authors":"D. Kumar, S. Jayachandran, N. Thilagavathy","doi":"10.1055/s-0041-1724462","DOIUrl":"https://doi.org/10.1055/s-0041-1724462","url":null,"abstract":"Abstract Introduction Osteoporosis is one of the most common and rampant metabolic bone disorders among the geriatric, particularly affecting postmenopausal women. Even though resorption tends to occur more rapidly in bones with a higher proportion of trabecular bone (e.g., vertebrae, pelvis, calcaneus), bones with significant cortical bone content also do undergo resorption, for example, mandible. The dental manifestations that may indicate low-bone density include loose teeth, receding gums, and ill-fitting or loose dentures. Objective To validate the efficacy of orthopantomograms (OPGs) in recognizing bone mineral density (BMD) changes of the mandible using mandibular cortical index (MCI) and substantiate the same with dual energy X-ray absorptiometry (DEXA) scan on femoral neck and spine. Materials and Methods This cross-sectional study comprised 60 geriatric patients of both genders. All the patients were subjected to panoramic radiographs wherever clinically indicated. The visual analysis was done based on the radiographic appearance of the mandibular cortical border and results were compared with DEXA scan reports, followed by an analysis of three grades of MCI and BMD statistically. Results In our study, out of 40 patients in C2 and C3 subgroups, 67% and 20% were normal, respectively. The incidence of osteopenia was 33% in the C2 group and 70% in the C3 group, whereas Osteoporosis was present only among 10% of the population in the C3 group. The difference between the groups are statistically significant (p = 0.01). These findings imply that a progressive link exists between BMD and deteriorating cortical morphology. Conclusion The purpose of this study is that dentists will be able to refer patients to physicians of suspected low BMD, based on incidental findings on panoramic radiographs for further examination. There is a statistically significant correlation present between DEXA and MCI, so the latter can also be used for screening BMD changes.","PeriodicalId":53332,"journal":{"name":"Annals of the National Academy of Medical Sciences India","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0041-1724462","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42213943","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}
Abstract We report a case of successful management of a rare incidence and avoidance of complication of Ryle’s tube knotting around endotracheal tube. A vigilant anesthesia team prevented fatal complications of intraoperative accidental extubation and ventilation impairment which could have resulted into respiratory distress.
{"title":"Rare Complication of Nasogastric Tube Knotting around Endotracheal Tube in an Anesthetized Patient Undergoing Surgery","authors":"S. Sood, Yeesha Aggarwal, Anoj Kumar","doi":"10.1055/S-0041-1726153","DOIUrl":"https://doi.org/10.1055/S-0041-1726153","url":null,"abstract":"Abstract We report a case of successful management of a rare incidence and avoidance of complication of Ryle’s tube knotting around endotracheal tube. A vigilant anesthesia team prevented fatal complications of intraoperative accidental extubation and ventilation impairment which could have resulted into respiratory distress.","PeriodicalId":53332,"journal":{"name":"Annals of the National Academy of Medical Sciences India","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/S-0041-1726153","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41291132","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}
Abstract Cryptosporidiosis is one of the major causes of diarrhea in immune-compromised individuals and children besides causing sporadic water-borne, food-borne, and zoonotic outbreaks. In 2016, Cryptosporidium species infection was the fifth leading cause of diarrhea and acute infection causing more than 4.2 million disability-adjusted life years lost besides a decrease in childhood growth. Human cryptosporidiosis is primarily caused by two species/genotype: Cryptosporidium hominis (anthroponotic) and Cryptosporidium parvum (zoonotic) besides other six rare species/genotypes. Transmission intensity, genetic diversity, and occurrence of genetic recombination have shaped the genus Cryptosporidium population structures into palmitic, clonal, and epidemic. Genetic recombination is more in C. parvum compared with C. hominis. Furthermore, parasite–host co-evolution, host adaptation, and geographic segregation have led to the formation of “subtype- families.” Host-adapted subtype-families have distinct geographical distribution and host preferences. Genetic exchanges between subtypes played an important role throughout the evolution of the genus leading to “adaptation introgression” that led to emergence of virulent and hyper-transmissible subtypes. The population structure of C. hominis in India appears to be more complex where both transmission intensity and genetic diversity are much higher. Further, study based on “molecular strain surveillance” has resulted newer insights into the epidemiology and transmission of cryptosporidiosis in India. The identification at the species and genotype levels is essential for the assessment of infection sources in humans and the public health potential of the parasite at large. The results of the study over three decades on cryptosporidiosis in India, in the absence of a national surveillance data, were analyzed highlighting current situation on epidemiology, genetic diversity, and distribution particularly among vulnerable population. Despite creditable efforts, there are still many areas need to be explored; therefore, the intent of this article is to facilitate future research approaches for mitigating the burden associated with this disease.
{"title":"Evolving Patterns of Cryptosporidiosis: Issues and Implications in the Context of Public Health in India","authors":"B. Mirdha","doi":"10.1055/s-0041-1726149","DOIUrl":"https://doi.org/10.1055/s-0041-1726149","url":null,"abstract":"Abstract Cryptosporidiosis is one of the major causes of diarrhea in immune-compromised individuals and children besides causing sporadic water-borne, food-borne, and zoonotic outbreaks. In 2016, Cryptosporidium species infection was the fifth leading cause of diarrhea and acute infection causing more than 4.2 million disability-adjusted life years lost besides a decrease in childhood growth. Human cryptosporidiosis is primarily caused by two species/genotype: Cryptosporidium hominis (anthroponotic) and Cryptosporidium parvum (zoonotic) besides other six rare species/genotypes. Transmission intensity, genetic diversity, and occurrence of genetic recombination have shaped the genus Cryptosporidium population structures into palmitic, clonal, and epidemic. Genetic recombination is more in C. parvum compared with C. hominis. Furthermore, parasite–host co-evolution, host adaptation, and geographic segregation have led to the formation of “subtype- families.” Host-adapted subtype-families have distinct geographical distribution and host preferences. Genetic exchanges between subtypes played an important role throughout the evolution of the genus leading to “adaptation introgression” that led to emergence of virulent and hyper-transmissible subtypes. The population structure of C. hominis in India appears to be more complex where both transmission intensity and genetic diversity are much higher. Further, study based on “molecular strain surveillance” has resulted newer insights into the epidemiology and transmission of cryptosporidiosis in India. The identification at the species and genotype levels is essential for the assessment of infection sources in humans and the public health potential of the parasite at large. The results of the study over three decades on cryptosporidiosis in India, in the absence of a national surveillance data, were analyzed highlighting current situation on epidemiology, genetic diversity, and distribution particularly among vulnerable population. Despite creditable efforts, there are still many areas need to be explored; therefore, the intent of this article is to facilitate future research approaches for mitigating the burden associated with this disease.","PeriodicalId":53332,"journal":{"name":"Annals of the National Academy of Medical Sciences India","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0041-1726149","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48639452","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}
Abstract Objectives This study was undertaken to investigate and review the clinical presentation, surgical procedures executed, and the final outcome of infants managed for the patent vitellointestinal duct. Materials and Methods This is a single-institution, retrospective study and included infants who were operated for the patent vitellointestinal duct. This study was conducted at author’s Department of Paediatric Surgery during the last 20 years; from January 1, 2000 to December 31, 2019. Results A total of 24 infants were operated for the patent vitellointestinal duct during the study period and comprised 20 (83.3%) boys and 4 (16.6%) girls. The age of infants ranged from 7 days to 10 months, with a mean of 88.41 ± 64.9 days. Twenty-three (95.8%) infants were operated within 6 months of the age, 17 (70.8%) of them were operated within 3 months of the age. Only one (4.1%) infant was operated at the age of 10 months. Among 24 infants, 13 (54.1%) were presented with features suggestive of acute intestinal obstruction and remaining 11 (45.8%) were presented with fecal discharges through the umbilicus without intestinal obstruction. Among 13 infants who presented with acute intestinal obstruction, 12 had prolapsed bowel and 6 of them also had gangrenous bowel. Operative procedures were executed (n = 24) in the following order of frequency: (1) resection of patent vitellointestinal duct, wide wedge resection of ileum,and ileal repair (n = 13, 54.1%); (2) resection of patent vitellointestinal duct, small segment of ileum, and ileoileal anastomosis (n = 9, 37.5%); and (3) resection of patent vitellointestinal duct, segment of ileum, and an ileostomy (n = 2, 8.33%). Postoperatively, two (8.3%) infants developed anastomotic leak and peritonitis one each, later on, both of them died. Conclusion Patent vitellointestinal duct not only present with fecal discharges through the umbilicus but half of the infants presented with prolapsed bowel and with features of acute small bowel obstruction. Delay in seeking treatment for such cases was associated with considerable morbidity and mortality and therefore the patent vitellointestinal duct should be excised at the earliest.
{"title":"Management of Patent Vitellointestinal Duct in Infants","authors":"R. Ghritlaharey","doi":"10.1055/s-0041-1722836","DOIUrl":"https://doi.org/10.1055/s-0041-1722836","url":null,"abstract":"Abstract Objectives This study was undertaken to investigate and review the clinical presentation, surgical procedures executed, and the final outcome of infants managed for the patent vitellointestinal duct. Materials and Methods This is a single-institution, retrospective study and included infants who were operated for the patent vitellointestinal duct. This study was conducted at author’s Department of Paediatric Surgery during the last 20 years; from January 1, 2000 to December 31, 2019. Results A total of 24 infants were operated for the patent vitellointestinal duct during the study period and comprised 20 (83.3%) boys and 4 (16.6%) girls. The age of infants ranged from 7 days to 10 months, with a mean of 88.41 ± 64.9 days. Twenty-three (95.8%) infants were operated within 6 months of the age, 17 (70.8%) of them were operated within 3 months of the age. Only one (4.1%) infant was operated at the age of 10 months. Among 24 infants, 13 (54.1%) were presented with features suggestive of acute intestinal obstruction and remaining 11 (45.8%) were presented with fecal discharges through the umbilicus without intestinal obstruction. Among 13 infants who presented with acute intestinal obstruction, 12 had prolapsed bowel and 6 of them also had gangrenous bowel. Operative procedures were executed (n = 24) in the following order of frequency: (1) resection of patent vitellointestinal duct, wide wedge resection of ileum,and ileal repair (n = 13, 54.1%); (2) resection of patent vitellointestinal duct, small segment of ileum, and ileoileal anastomosis (n = 9, 37.5%); and (3) resection of patent vitellointestinal duct, segment of ileum, and an ileostomy (n = 2, 8.33%). Postoperatively, two (8.3%) infants developed anastomotic leak and peritonitis one each, later on, both of them died. Conclusion Patent vitellointestinal duct not only present with fecal discharges through the umbilicus but half of the infants presented with prolapsed bowel and with features of acute small bowel obstruction. Delay in seeking treatment for such cases was associated with considerable morbidity and mortality and therefore the patent vitellointestinal duct should be excised at the earliest.","PeriodicalId":53332,"journal":{"name":"Annals of the National Academy of Medical Sciences India","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0041-1722836","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45479444","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}
Abstract The world is in the midst of the COVID-19 pandemic. In addition to quarantine, public health interventions which can reduce the risk of infection and death are urgently required. This article discusses the roles of vitamin D in reducing the risk of COVID-19, and how vitamin D supplementation may be a useful risk reduction measure. Vitamin D can reduce the risk of infections through a variety of mechanisms: induction of cathelicidins and defensins that can lower the rate of viral replication and decrease the concentrations of pro-inflammatory cytokines, which are responsible for induction of inflammation, injuring lining of lungs and contributing to developing pneumonia. Evidence supporting the role of vitamin D in reducing the incidence of COVID-19 includes a) winter outbreak; b) a timeframe when concentrations of 25-hydroxyvitamin D (25(OH)D) are lowest; c) a small number of cases in the southern hemisphere toward the end of summer; d) a vitamin D deficiency found to lead to acute respiratory distress syndrome (ARDS); e) and a rise in case-fatality rates with increasing age and comorbid chronic diseases, both of which are associated with lower concentrations of 25(OH)D. It is recommended that people at risk of COVID-19 consider taking 10,000 IU/d of vitamin D3 for a few weeks to rapidly increase 25(OH)D concentrations, followed by 5,000 IU/d to reduce the risk of infection. Higher doses of vitamin D3 may be useful for treating people who are infected with COVID-19. To test these guidelines, randomized controlled trials and comprehensive population studies should be performed.
{"title":"Role of Vitamin D in Risk Reduction of COVID-19: A Narrative Review","authors":"P. Mishra, R. Parveen, N. Agarwal","doi":"10.1055/s-0041-1724460","DOIUrl":"https://doi.org/10.1055/s-0041-1724460","url":null,"abstract":"Abstract The world is in the midst of the COVID-19 pandemic. In addition to quarantine, public health interventions which can reduce the risk of infection and death are urgently required. This article discusses the roles of vitamin D in reducing the risk of COVID-19, and how vitamin D supplementation may be a useful risk reduction measure. Vitamin D can reduce the risk of infections through a variety of mechanisms: induction of cathelicidins and defensins that can lower the rate of viral replication and decrease the concentrations of pro-inflammatory cytokines, which are responsible for induction of inflammation, injuring lining of lungs and contributing to developing pneumonia. Evidence supporting the role of vitamin D in reducing the incidence of COVID-19 includes a) winter outbreak; b) a timeframe when concentrations of 25-hydroxyvitamin D (25(OH)D) are lowest; c) a small number of cases in the southern hemisphere toward the end of summer; d) a vitamin D deficiency found to lead to acute respiratory distress syndrome (ARDS); e) and a rise in case-fatality rates with increasing age and comorbid chronic diseases, both of which are associated with lower concentrations of 25(OH)D. It is recommended that people at risk of COVID-19 consider taking 10,000 IU/d of vitamin D3 for a few weeks to rapidly increase 25(OH)D concentrations, followed by 5,000 IU/d to reduce the risk of infection. Higher doses of vitamin D3 may be useful for treating people who are infected with COVID-19. To test these guidelines, randomized controlled trials and comprehensive population studies should be performed.","PeriodicalId":53332,"journal":{"name":"Annals of the National Academy of Medical Sciences India","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0041-1724460","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42294159","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}
Abstract Drug-susceptible tuberculosis (DS-TB) requires treatment with first-line drugs (FLDs) whereas drug-resistant TB (DR-TB) are treated with combination of second-line drugs (SLDs) and fewer FLDs. Adverse drug reactions (ADRs) to these drugs are quite evident as they are being used for longer duration. The overall prevalence of ADRs with FLDs and SLDs are estimated to vary from 8.0 to 85 and 69 to 96%, respectively. Most ADRs are observed in the intensive phase as compared to continuation phase. Major concerns exist regarding treatment of DR-TB patients, especially with SLDs having lower efficacy more toxicity and high cost as compared to FLDs. A variety of ADRs may be produced by anti-TB drugs ranging from mild or minor to severe or major like gastrointestinal toxicity (nausea/vomiting, diarrhoea, and hepatotoxicity), ototoxicity, neurotoxicity (peripheral neuropathy and seizures), nephrotoxicity, cutaneous toxicity, and cardiotoxicity. Most of ADRs are minor and can be managed without discontinuation of treatment. Few ADRs’ can be major causing life-threatening experience leading to either modification or discontinuation of regimen and even mortality. A careful monitoring of ADRs during the treatment with anti-TB drugs and early recognition and appropriate management of these ADRs might improve adherence leading to favorable outcome.
{"title":"Adverse Drug Reactions with First-Line and Second-Line Drugs in Treatment of Tuberculosis","authors":"R. Prasad, Abhijeet Singh, N. Gupta","doi":"10.1055/s-0040-1722535","DOIUrl":"https://doi.org/10.1055/s-0040-1722535","url":null,"abstract":"Abstract Drug-susceptible tuberculosis (DS-TB) requires treatment with first-line drugs (FLDs) whereas drug-resistant TB (DR-TB) are treated with combination of second-line drugs (SLDs) and fewer FLDs. Adverse drug reactions (ADRs) to these drugs are quite evident as they are being used for longer duration. The overall prevalence of ADRs with FLDs and SLDs are estimated to vary from 8.0 to 85 and 69 to 96%, respectively. Most ADRs are observed in the intensive phase as compared to continuation phase. Major concerns exist regarding treatment of DR-TB patients, especially with SLDs having lower efficacy more toxicity and high cost as compared to FLDs. A variety of ADRs may be produced by anti-TB drugs ranging from mild or minor to severe or major like gastrointestinal toxicity (nausea/vomiting, diarrhoea, and hepatotoxicity), ototoxicity, neurotoxicity (peripheral neuropathy and seizures), nephrotoxicity, cutaneous toxicity, and cardiotoxicity. Most of ADRs are minor and can be managed without discontinuation of treatment. Few ADRs’ can be major causing life-threatening experience leading to either modification or discontinuation of regimen and even mortality. A careful monitoring of ADRs during the treatment with anti-TB drugs and early recognition and appropriate management of these ADRs might improve adherence leading to favorable outcome.","PeriodicalId":53332,"journal":{"name":"Annals of the National Academy of Medical Sciences India","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0040-1722535","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46795589","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":"Can We Consider Scholarship of Teaching Learning Rather than Focusing Only on Publications for Recognition of Medical Teachers by National Medical Commission?","authors":"T. Singh, Piyush Gupta","doi":"10.1055/S-0041-1728179","DOIUrl":"https://doi.org/10.1055/S-0041-1728179","url":null,"abstract":"","PeriodicalId":53332,"journal":{"name":"Annals of the National Academy of Medical Sciences India","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/S-0041-1728179","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49420988","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}
Abstract Objectives This study was undertaken to investigate and review the age, sex, clinical presentation, surgical procedures done, major postoperative complications, and the final outcome of infants and children operated for intussusceptions secondary to pathological lead points (PLPs). Materials and Methods This is a single-institution, retrospective study and included infants and children below the age of 12 years who were operated for the secondary intussusceptions. This study was conducted at author’s Department of Paediatric Surgery during the last 20 years; from January 1, 2000 to December 31, 2019. Results During the study period, 200 infants and children were operated for the intussusceptions, and 23 (11.5%) of them were operated for the intussusceptions secondary to PLPs. This review comprised 18 (78.26%) boys and 5 (21.73%) girls, and consisted of infants (n = 9, 39.13%) and children of 1 to 5 years of age (n = 7, 30.43%) and 6 to 12 years of age (n = 7, 30.43%). The age at presentation ranged from 3 months to 10 years, with the mean age of 41.47 ± 40.06 months. Clinically, all the children presented with features of acute intestinal obstruction. Ultrasonography (USG) examination of the abdomen revealed the diagnosis of intussusception in all of them but not able to document the PLPs as a cause for it. During the exploratory laparotomies, gangrenous bowel was detected in 15 (65.21%) cases. PLPs causing intussusceptions were Meckel’s diverticulum (n = 17, 73.91%), begin ileal growth (n = 4, 17.39%), benign ileal polyp (n = 1, 4.34%), and caecal lymphoma (n = 1, 4.34%). Surgical procedures were executed in the following order of frequency: (1) resection of segment of ileum including PLP, and ileoileal anastomosis (n = 13, 56.52%); (2) resection of segment of ileum including PLP, caecum and part of ascending colon, and ileoascending anastomosis (n = 5, 21.73%); (3) Meckel’s diverticulectomy (n = 3, 13.04%); and (4) resection of segment of ileum including PLP and terminal ileostomy (n = 2, 8.69%). This study documented two (8.69%) deaths in postoperative period. Conclusion Meckel’s’ diverticulum was the commonest pathology for the secondary intussusceptions in infants and children and documented most frequently during infancy. Half of the secondary intussusceptions occurred within 24 months of age. Bowel resection was required in more than 85% of the cases during the surgical procedures.
{"title":"Management of Intussusceptions Secondary to Pathological Lead Points in Infants and Children","authors":"R. Ghritlaharey","doi":"10.1055/s-0040-1722536","DOIUrl":"https://doi.org/10.1055/s-0040-1722536","url":null,"abstract":"Abstract Objectives This study was undertaken to investigate and review the age, sex, clinical presentation, surgical procedures done, major postoperative complications, and the final outcome of infants and children operated for intussusceptions secondary to pathological lead points (PLPs). Materials and Methods This is a single-institution, retrospective study and included infants and children below the age of 12 years who were operated for the secondary intussusceptions. This study was conducted at author’s Department of Paediatric Surgery during the last 20 years; from January 1, 2000 to December 31, 2019. Results During the study period, 200 infants and children were operated for the intussusceptions, and 23 (11.5%) of them were operated for the intussusceptions secondary to PLPs. This review comprised 18 (78.26%) boys and 5 (21.73%) girls, and consisted of infants (n = 9, 39.13%) and children of 1 to 5 years of age (n = 7, 30.43%) and 6 to 12 years of age (n = 7, 30.43%). The age at presentation ranged from 3 months to 10 years, with the mean age of 41.47 ± 40.06 months. Clinically, all the children presented with features of acute intestinal obstruction. Ultrasonography (USG) examination of the abdomen revealed the diagnosis of intussusception in all of them but not able to document the PLPs as a cause for it. During the exploratory laparotomies, gangrenous bowel was detected in 15 (65.21%) cases. PLPs causing intussusceptions were Meckel’s diverticulum (n = 17, 73.91%), begin ileal growth (n = 4, 17.39%), benign ileal polyp (n = 1, 4.34%), and caecal lymphoma (n = 1, 4.34%). Surgical procedures were executed in the following order of frequency: (1) resection of segment of ileum including PLP, and ileoileal anastomosis (n = 13, 56.52%); (2) resection of segment of ileum including PLP, caecum and part of ascending colon, and ileoascending anastomosis (n = 5, 21.73%); (3) Meckel’s diverticulectomy (n = 3, 13.04%); and (4) resection of segment of ileum including PLP and terminal ileostomy (n = 2, 8.69%). This study documented two (8.69%) deaths in postoperative period. Conclusion Meckel’s’ diverticulum was the commonest pathology for the secondary intussusceptions in infants and children and documented most frequently during infancy. Half of the secondary intussusceptions occurred within 24 months of age. Bowel resection was required in more than 85% of the cases during the surgical procedures.","PeriodicalId":53332,"journal":{"name":"Annals of the National Academy of Medical Sciences India","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0040-1722536","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42720514","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}
Anurima Patra, S. Gibikote, P. Khera, N. Kalra, S. Keshava
Abstract Objective The aim of this study was to gather the opinion of medical practitioners in India regarding the modifications in the recently released MCI (Medical Council of India) circular for faculty promotion criteria across medical colleges in the country and their suggestions for further changes. Materials and Methods An 11-set validated online questionnaire was circulated among medical practitioners across various medical colleges in the country, open for a period of 8 days between 5 to 12 June, 2020. The participants in this online survey were asked to rank the order of authors and types of manuscripts on a scale of 0 to 1 with increments of 0.1 and were also asked for an opinion regarding indexing, inclusion of impact factor of the journal, and citation indices. Results There were 182 respondents included in the survey, belonging to 12 different states. Majority of the doctors participating in the survey were professors (37.3%, 68/182). About 81.3% (148/182) doctors were aware of the latest MCI guidelines. Opinion for adding citations to the promotion criteria was expressed by 59.3% (108/182). There was a general suggestion to include number of citations, and Google Scholar as citation service. A scoring table was proposed based on the responses, to rank various publications. Conclusion As per the survey, more than 80% of the medical practitioners were aware of the recent update by MCI for faculty promotion. The participants expressed that the exiting guidelines may be further modified by the inclusion of all authors and all types of manuscripts into the criteria, based on a graded score system.
{"title":"Publication Parameters for Medical Faculty Promotions: A Survey on the Medical Council of India Amendment 2019 with Review of Literature","authors":"Anurima Patra, S. Gibikote, P. Khera, N. Kalra, S. Keshava","doi":"10.1055/S-0040-1722382","DOIUrl":"https://doi.org/10.1055/S-0040-1722382","url":null,"abstract":"Abstract Objective The aim of this study was to gather the opinion of medical practitioners in India regarding the modifications in the recently released MCI (Medical Council of India) circular for faculty promotion criteria across medical colleges in the country and their suggestions for further changes. Materials and Methods An 11-set validated online questionnaire was circulated among medical practitioners across various medical colleges in the country, open for a period of 8 days between 5 to 12 June, 2020. The participants in this online survey were asked to rank the order of authors and types of manuscripts on a scale of 0 to 1 with increments of 0.1 and were also asked for an opinion regarding indexing, inclusion of impact factor of the journal, and citation indices. Results There were 182 respondents included in the survey, belonging to 12 different states. Majority of the doctors participating in the survey were professors (37.3%, 68/182). About 81.3% (148/182) doctors were aware of the latest MCI guidelines. Opinion for adding citations to the promotion criteria was expressed by 59.3% (108/182). There was a general suggestion to include number of citations, and Google Scholar as citation service. A scoring table was proposed based on the responses, to rank various publications. Conclusion As per the survey, more than 80% of the medical practitioners were aware of the recent update by MCI for faculty promotion. The participants expressed that the exiting guidelines may be further modified by the inclusion of all authors and all types of manuscripts into the criteria, based on a graded score system.","PeriodicalId":53332,"journal":{"name":"Annals of the National Academy of Medical Sciences India","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/S-0040-1722382","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42818415","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}
Paras Kathuria, S. Arora, R. Karna, Naresh Kumar, Suresh Kumar, P. Kar
Abstract Autoimmune liver diseases (AILD) are part of a broad spectrum of liver diseases with autoimmune etiology, usually present individually but at times have overlapping features. We present the case of a 60-year-old lady presenting with fatigue, itching and right upper quadrant abdominal pain. Further investigation showed cholestatic pattern of liver enzymes and evidence of portal hypertension without any evidence of extrahepatic obstruction. Autoimmune markers and liver biopsy showed overlapping features of both autoimmune hepatitis (AIH) and primary biliary cirrhosis (PBC), which is a separate diagnosis known as overlap syndrome, but by applying appropriate criterion, we were able to make a definite diagnosis of PBC. Differentiating PBC from overlap syndrome was important as therapy of both are different.
{"title":"An Interesting Case of Autoimmune Liver Disease","authors":"Paras Kathuria, S. Arora, R. Karna, Naresh Kumar, Suresh Kumar, P. Kar","doi":"10.1055/s-0040-1722105","DOIUrl":"https://doi.org/10.1055/s-0040-1722105","url":null,"abstract":"Abstract\u0000 Autoimmune liver diseases (AILD) are part of a broad spectrum of liver diseases with autoimmune etiology, usually present individually but at times have overlapping features. We present the case of a 60-year-old lady presenting with fatigue, itching and right upper quadrant abdominal pain. Further investigation showed cholestatic pattern of liver enzymes and evidence of portal hypertension without any evidence of extrahepatic obstruction. Autoimmune markers and liver biopsy showed overlapping features of both autoimmune hepatitis (AIH) and primary biliary cirrhosis (PBC), which is a separate diagnosis known as overlap syndrome, but by applying appropriate criterion, we were able to make a definite diagnosis of PBC. Differentiating PBC from overlap syndrome was important as therapy of both are different.","PeriodicalId":53332,"journal":{"name":"Annals of the National Academy of Medical Sciences India","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0040-1722105","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46915143","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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