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   2017| October-December  | Volume 6 | Issue 4  
    Online since December 26, 2017

 
 
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ORIGINAL ARTICLES
Sickle cell disease complicating pregnancy: A retrospective study
B Kavitha, Basanta H Hota
October-December 2017, 6(4):242-246
DOI:10.4103/JDRNTRUHS.JDRNTRUHS_3_17  
Introduction: Sickle cell disease is an uncommon cause of anemia and jaundice during pregnancy. Sickle cell crisis may lead to several maternal and fetal complications. Aims: To study maternal and fetal complications in pregnant patients with sickle cell disease. Settings and Design: Retrospective study was carried out from case records at Mamata Medical College over a period of five years from July 2011 to June 2016. Patients and Methods: Among 17 pregnancies in 12 cases, we studied the baseline characteristics of study population, frequency of sickle hemoglobin variants, and complications to mother and baby. Statistical Analysis Used: Compiled data was analyzed by simple descriptive statistics and frequency tables. Results: Most cases were primigravida (58.3%). Most common presenting features were anemia and jaundice (hemolytic crisis, 70.58%) and bone and joint pains (painful crises, 41.17%). Acute chest syndrome was seen in 5.88% of the patients. Pregnancies were complicated by severe anemia (Hb <7 gm%) in 29.41% of patients, by jaundice - 76.47%, urinary tract infection - 47.05%, pre-eclampsia - 11.76%, and hepatosplenomegaly - 17.64%. Fetal/neonatal complications were intra-uterine growth restriction (IUGR, 35.29%), perinatal death (17.64%), preterm delivery (35.3%), fetal distress (41.17%), meconium stained liquor (29.41%), meconium aspiration syndrome (11.76%), and low birth weight (58.82%). Sickling test was positive in all cases. Hemoglobin electrophoresis showed HbS. HbSS was the commonest form of sickle cell disease. Discussion: Because of hematological changes, extra demands, and sickle crisis, complications to both mother and fetus are more common in sickle cell anemia during pregnancy than in non-pregnant state. Conclusions: Although sickle cell anemia during pregnancy is usually associated with complications, prompt recognition and careful management reduces morbidity and mortality associated with them.
  2,514 259 -
Quality of life in schizophrenic patients: Comparative study from South India
Anusa Arunachalam Mohandoss
October-December 2017, 6(4):224-231
DOI:10.4103/2277-8632.221523  
Objective: To assess and compare the quality of life (QoL) in patients with schizophrenia with apparently normal controls. Materials and Methods: A secondary data analysis of a cross-sectional study that was carried out in the outpatient psychiatry clinics at a South Indian referral center. Thirty consecutive patients and 30 apparently normal individuals fulfilling the inclusion and exclusion criteria formed the study group. Demographic data for the study population were collected. Schizophrenia was diagnosed as per criteria of the ICD-10th revision and measured using the positive and negative syndrome scale (PANSS) and general psychopathology scale. Outcome measures were measured using the World Health Organization (WHO)-QoL-brief version (BREF) instrument. The collected data were analyzed using descriptive and appropriate inferential statistics using Statistical Package for the Social Sciences (SPSS) version 17.0. P ≤ 0.05 was considered to be significant. Results: There was no significant difference in terms of demographic factors between the schizophrenic patients and controls. The QoL-WHO-BREF score of schizophrenic patients was 82.33 ± 12.34 and for controls it was 90.9 ± 8.41 (P = 0.003). The individual domains of physical and psychological spheres differed significantly between the schizophrenic patients and controls. Individual domain scores varied significantly in occupation. The PANSS positive subscore was correlated with QoL score and there was a statistical significance. Discussion: The deleterious effects of schizophrenia on QoL occur significantly. Management should be planned with this consideration to yield better outcomes.
  2,205 272 1
REVIEW ARTICLE
Assorted archetypal tissue analysis: A breakthrough in oncopathology
Sushmita Swain, Harish Kumar, Sujatha Ramachandra, Shyam S Behura
October-December 2017, 6(4):203-209
DOI:10.4103/JDRNTRUHS.JDRNTRUHS_2_17  
Assorted Archetypal Tissue Analysis, commonly known as Tissue Microarray (TMA) technology is a highly throughput research tool that has greatly facilitated and accelerated tissue analysis by in-situ technologies. It involves core needle biopsies of multiple tissues constructed in the same block and is an innovative method where dozens of biomarkers can be applied to hundreds of samples simultaneously sparing costs, resources, and tissues.TMA provides a judicious use of precious tissue and gives experimental uniformity. Analyzing a large number of samples improves statistical precision in addition to enhanced speed and quality of analysis making it extremely useful in pathology research and practice. This article reviews the sequential development, modification. and applications of TMA and also comments on how TMA facilitates translation research at different levels.
  1,426 1,036 -
ORIGINAL ARTICLES
Comparative study between open and laparoscopic ventral hernia repair: A prospective non-randomized single institutional study
Anuroop Thota, KS Ravishankar, Krishna V Rao, BS Ramesh, BB Ananda
October-December 2017, 6(4):217-223
DOI:10.4103/JDRNTRUHS.JDRNTRUHS_115_16  
Introduction: In this modern era of surgery, laparoscopic surgery has gained paramount importance. There is continued debate on the role of laparoscopy in ventral hernia repair. Although laparoscopic repair has become increasingly popular, its outcomes need further evaluation. This is a prospective study designed to compare open ventral hernia repair with laparoscopic repair. Materials and Methods: This study included patients who consented for midline ventral hernia operation at our institution from October 2013 to April 2015; data on relevant history, clinical examination, and appropriate investigations were collected. A total of 81 patients were operated after obtaining written consent. A total of 51 patients underwent open mesh repair whereas 31 underwent laparoscopic intra peritoneal mesh repair. The statistical software namely SPSS 15.0, MedCalc 9.0.1 were used. Results: In the open group, majority were incisional hernias; in the laparoscopy group, majority were umbilical hernia. Age distribution and mean duration of surgery was comparable in both the groups. Significant decrease in postoperative pain, overall complication rate, length of hospital stay, and return to normal activity was noted in the laparoscopy group (P < 0.001). There were no cases of mesh infection or recurrence with a mean follow-up of 12 months. Conclusion: Laparoscopic ventral hernia repair holds a promising alternative to novel repair and the short-term results are encouraging. The technique is a little sophisticated and needs experience when compared to open repair.
  2,113 227 -
Newborn birth weight in normal pregnancy in rural Telangana
Basanta M Hota, Naimisha Movva
October-December 2017, 6(4):232-235
DOI:10.4103/2277-8632.221533  
Introduction: Newborn birth weight is a major indicator of health. Although it is influenced by many conditions that affect maternal and feto-placental units, several sociocultural, religious, and geographical factors cannot be ignored. Considering this, the present study was conducted in a tertiary hospital in Khammam, Telangana to determine the average birth weight in normal pregnancy at term. Materials and Methods: All the babies, born following normal pregnancy from January 2013 to June 2015, were included in this study to establish their birth weight. Babies born without being affected by any factor influencing fetal weight were considered for the study. Some exclusion criteria such as short maternal height and teenage pregnancy were considered in this study. Results: There were 633 cases in the study group, out of which 226 were primipara and 407 were multipara. Average birth weight for all cases was 2790 g. Average birth weight for the first born babies was 2770 g, whereas in later born, it was 2800 g. Average birth weight of male newborn babies was 2860 g, whereas it was 2710 g for female newborn babies. Conclusion: Abnormal birth weight leads to many complications, both immediate and remote. However, to predict and manage such complications, one must know the average newborn birth weight. This study is the first of its kind in rural Telangana.
  1,925 152 -
CASE REPORTS
Implant retained auricular prosthesis: A clinical report
Angadi Kalyan Chakravarthy, Khaja Yousuf Sharif, Molugu Mallikarjun, Kethireddy Mahesh Babu, Pothula Gautham, Budige Veerendra Prasad
October-December 2017, 6(4):262-266
DOI:10.4103/2277-8632.221526  
Prosthetic ears are created for patients with microtia, a congenital defect that affects 1 in 10,000 births, as well as patients that have ears removed due to cancer and trauma. The current standard for ear prostheses is osseointegrated abutments and either magnets or bar clip prosthetic attachments. Osseointegration is a technology that grew out of the dental industry and was effectively translated to other prosthetic applications. Defects of the external ear could be corrected using prosthetic reconstructions retained by implants. Implant retained auricular prosthesis eliminates the need for the adhesives and provides better retention compared to the conventional prosthesis. Bar and clip design is currently followed for retaining the ear prosthesis. Bars are fixed onto osseointegrated craniofacial implants through a surgery. Clips embedded in an acrylic housing are used to retain the prosthesis on the bars. The major problems in this method are the bulk of prosthesis that compromises the final cosmetic outcome and the loosening of the clips. Although several reconstructive techniques exist for the auricular defect, the use of implants to anchor auricular prosthesis presents a suitable alternative. This article presents a case of a right auricular defect, which was congenital for which two bone-anchored implants were placed. Hader bar with ERA attachments was used for retention of the silicone auricular prosthesis.
  1,400 164 -
ORIGINAL ARTICLES
Treating multiple and recalcitrant wart with autoimplantation technique
Swapna Subhash Khatu, Yuvraj Eknath More, Divyank Vankawala, Sai S Pawar, Neeta Rajendra Gokhale, Dipali Chetan Chavan
October-December 2017, 6(4):247-250
DOI:10.4103/2277-8632.221528  
Background: Warts are benign tumors involving skin and mucous membrane that are caused by human papillomavirus (HPV). Several treatment modalities are available for treating multiple warts, but without any significant response or cost-effectiveness. Aims: This study aimed to evaluate the safety and efficacy of autoimplantation therapy in the treatment of recalcitrant and multiple warts. Materials and Methods: A total of 40 patients of multiple warts (more than five warts per patient), palmoplantar warts, recurrent warts, and resistant warts were enrolled in this study. A small piece of warty tissue was introduced in the wound with the help of 26 no. needle. Patients were assessed monthly and resolution after 3 months was considered complete clearance. Result: Out of 40 patients, 21 patients of verruca vulgaris (75%) and 10 patients of palmoplantar warts (83.3%) showed resolution within 3 months, accounting for a total clearance rate of 77.5%. Conclusion: Autoimplantation of wart using the pared stratum corneum of wart is a safe, efficacious, less painful, and in-office procedure for the treatment of multiple, recurrent, and palmoplantar warts.
  1,377 122 -
Uterine rupture: A catastrophic obstetric emergency
B Kavitha, GC Prabhakar, K Shaivalini
October-December 2017, 6(4):251-254
DOI:10.4103/JDRNTRUHS.JDRNTRUHS_16_14  
Background: Uterine rupture can be a catastrophic obstetrical emergency with high incidence of fetal and maternal morbidity and mortality, varying from 1 in 2000 to1 in 200 deliveries. Aims and objective: To investigate the incidence, etiology, diagnosis, treatment and outcome of uterine rupture. Material and Methods: Thirteen cases of major rupture of the pregnant uterus in which life of the mother and fetus were endangered are presented. This study examined all cases of ruptured uterus managed in the Department of Obstetrics and Gynaecology at Mamata General Hospital, Khammam over a 3 year period. Details were obtained from medical records retrospectively and analyzed manually. Results: All 13 cases had varied etiologies and presentations such as poor antenatal care, previous cesarean section scar was present in 8, uterine anomalies were noted in 3, history of trauma was present in 1 case, and 1 case was grand multipara who set into spontaneous labour. Sonography findings in all cases showed an empty uterus surrounded by echogenic intra-abdominal fluid (haemoperitoneum) with dead fetus and placenta in maternal abdomen. Most patients were in shock and required basic life support, IV fluids, blood transfusion and emergency laparotomy. Few required intensive care and ventilator support. There were no maternal deaths and 100% perinatal deaths were seen. Conclusion: This study confirms previous cesarean section scar as the predominant cause of uterine rupture which can be prevented by regular antenatal care and mandatory institutional delivery.
  1,354 131 -
Comparison of nitroglycerine and sodium nitroprusside on serum lactate, mixed venous oxygen saturation and mixed venous and arterial PCO2difference during cardiopulmonary bypass
Indira Gurajala, Padmaja Durga, R Gopinath
October-December 2017, 6(4):210-216
DOI:10.4103/JDRNTRUHS.JDRNTRUHS_43_17  
Background: The primary objective of the study was to evaluate the effect of nitoglycerine (NTG) and sodium nitroprusside (SNP) on serum lactate (S. lactate), mixed venous oxygen saturation (SvO2), and mixed venous arterial carbon dioxide difference (V-ACO2) during cardiopulmonary bypass (CPB). The secondary objectives included the effect on mortality, end organ dysfunction, requirement of vasopressors, duration of mechanical ventilation (MV), intensive care unit (ICU) stay and hospital stay. Materials and Methods: A prospective randomized single blinded study was conducted in 40 patients aged between 20 years and 70 years who underwent cardiac surgery on CPB. The patients were randomly divided into Group N (n = 20) receiving NTG (0.5–2 mic/kg/min) and group S (n = 20) receiving SNP (0.5–2 mic/kg/min) from the commencement of total CPB up to complete rewarming (nasopharyngeal temperature >36.5°C). Arterial blood gases and S. lactate were measured at baseline, after institution of total bypass, after completion of cooling and rewarming, at weaning off CPB and admission to ICU. Venous blood gas (VBG) was sampled from the venous reservoir immediately after institution of total bypass and completion of rewarming. Urine output, dose of rescue vasodilator, use of inotropes and vasopressor after CPB, end organ dysfunction, duration of MV, ICU, and hospital stay were noted. Results: Though the SvO2at the end of CPB decreased significantly from the baseline (P < 0.05), it was similar between the groups. There was no difference in V-ACO2too. The S. lactate markedly increased (P = 0.00) from the baseline; however, only the S. lactate at admission to ICU was significantly lower in Group S (P = 0.034). There was no difference in mortality, end organ dysfunction, requirement of vasopressors, duration of MV, ICU, and hospital stay. Conclusion: The authors showed that S. lactate increased with CPB and this increase did not correlate with SvO2and V-ACO2. NTG and SNP were comparable in their effect on indices of tissue perfusion.
  1,289 137 -
Study of respiratory status in young male automobile painters: A cross sectional study
Vitthal Khode, Ruikar Komal
October-December 2017, 6(4):236-241
DOI:10.4103/2277-8632.221530  
Background: Painters are exposed to solvent fumes and aerosols containing various concentrations of pigments, binders, fillers (talc), and chemically reactive monomers. Specific components in paint, such as isocyanates and dimethyl ethanolamine, are capable of inducing acute and chronic forms of airflow obstruction. Our study aims to establish the hypothesis that even young male painters may be at an increased risk of developing respiratory impairment. We studied the respiratory status of young male painters exposed to paints for more than 5 years and compared their pulmonary functions to a group of age- and sex-matched controls. Aims: To compare various parameters of lung functions in young male automobile spray painters with age- and sex-matched controls. Materials and Methods: This cross sectional study was conducted in the department of physiology and medicine. Fifty-eight young male spray painters who attended the medical outpatient department of our college were selected. Fifty-two age- and sex-matched controls were also selected from subjects who attended the medical outpatient department for routine medical checkup for recruitment in the same automobile company. After history and routine examinations, the patients were subjected to pulmonary function tests. Schiller's spirovit SP-1 was used. The data were analysed using Student's t test. Results: Significantly reduced forced expiratory volume in 1 s (FEV1)/slow vital capacity (SVC) (P < 0.001) and maximal voluntary ventilation (MVV) (P < 0.05) were observed among painters as compared to the controls. There was significant differences in SVC (P < 0.001) and FEV1 (P < 0.05) in grade 1, grade 2, and grade 3 exposed groups. There was no significant correlation between numbers of hours of exposure to SVC (P = 0.420) and FEV1 (P = 0.377) in painters. Conclusions: Potential respiratory health hazard exists in automobile painters and exposure to organic solvents should be prevented in order to improve their health status.
  1,105 93 -
CASE REPORTS
Primary B cell lymphoma of skull mimicking meningioma: A case report
A S. K Ahamed Sharief, Rajesh Alugolu, M Vijaya Saradhi
October-December 2017, 6(4):267-269
DOI:10.4103/JDRNTRUHS.JDRNTRUHS_84_17  
Primary presentation of a central nervous system (CNS) lymphoma is rare. Primary non-Hodgkin's lymphoma of the skull with extra and intracranial extensions without systemic or skeletal manifestations is extremely rare. This type of lesion often causes dilemma in diagnosis as they mimic other conditions. We herein report a case of primary lymphoma of the skull involving the scalp, skull vault, and meninges and invading the brain parenchyma, which mimicked meningioma radiologically as well as intraoperatively.
  1,085 91 -
A rare case report of an aggressive malignant spiradenoma chest wall masquerading as carcinoma of unknown origin - Course of events and review of literature
Ramana Reddy Naru, Mohammed B Inamdar, Pranabandhu Das, Radhika Kottu
October-December 2017, 6(4):255-258
DOI:10.4103/JDRNTRUHS.JDRNTRUHS_76_17  
Malignant eccrine spiradenomas are exceedingly rare and aggressive tumours normally arising in long-standing benign eccrine spiradenomas. We present a case of malignant eccrine spiradenoma (MES) that was initially misdiagnosed as carcinoma of unknown origin in spite of extensive workup to look for primary and presented with a large exophytic tumour on the right side of his chest wall, which had fungated. Radiological imaging of the chest region revealed extensive involvement of the local tissues. Patient underwent wide local excision with a 1 cm margin along with right-sided axillary lymph node dissection. Histopathological findings were consistent with MES with tumour deposits in multiple lymph nodes in the axilla. Our case report shows MES is a rare and aggressive cancer, which is difficult to diagnose, highly aggressive with propensity to involve the lymph nodes. May present with local recurrence and also develop distant metastases significantly compromise the quality of life of the patient. It requires the surgeons to have a high index of suspicion for its initial diagnosis, and a multidisciplinary management with surgery, radiotherapy, and chemotherapy is required for complete treatment and needs close follow up.
  1,085 90 -
LETTERS TO THE EDITOR
Under-five malnutrition in Indian slums
Manas P Roy
October-December 2017, 6(4):270-271
DOI:10.4103/JDRNTRUHS.JDRNTRUHS_60_17  
  1,029 101 -
CASE REPORTS
An unusual case of posterior circulation stroke
V Rama Tharaknath, A Haritha Chowdary, K Suseel Kumar, Lakshmi Navya
October-December 2017, 6(4):259-261
DOI:10.4103/JDRNTRUHS.JDRNTRUHS_8_17  
Anterior circulation strokes are far more common than posterior circulation strokes. Approximately 80–85% of all strokes are ischemic, and 20% of lesions occur in the vertebrobasilar territory. Most common cause of lateral medullary syndrome is vertebral artery occlusion. Although vertebral artery also supplies the spinal cord, involvement of the spinal cord in a case of lateral medullary syndrome has not been reported before. Pyramidal tract involvement in lateral medullary syndrome can occur due to medial extension of infarct in the medulla or caudal extension into the spinal cord. Here, we report an interesting case of lateral medullary syndrome caused by vertebral artery occlusion with cervical cord infarct presenting as quadriparesis.
  1,014 79 -
LETTERS TO THE EDITOR
Small intestinal adenocarcinoma in crohn's disease: Report of a case
Rashmi Patnayak, Sujata Singh, Salil Parida, Amitabh Jena
October-December 2017, 6(4):273-274
DOI:10.4103/JDRNTRUHS.JDRNTRUHS_16_17  
  722 67 -
Patients with coronary slow-flow are more likely to be young men and active smokers
Yousef Rasmi
October-December 2017, 6(4):272-272
DOI:10.4103/JDRNTRUHS.JDRNTRUHS_80_16  
  694 53 -
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