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  Most popular articles (Since September 05, 2017)

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Nasal myiasis in clinical practice
Santosh Kumar Swain, Mahesh Chandra Sahu, Manash Ranjan Baisakh,
July-September 2018, 15(3):128-131
Nasal myiasis is an opportunistic parasitic infestation of human as well as animals. Infestation of the nasal cavity by dipterous larvae is called nasal myiasis which is commonly seen in developing countries where health and sanitation are poor. Different predisposing factors associated with nasal myiasis are atrophic rhinitis, diabetes with purulent nasal discharge, midline granulomatous lesions or malignancy, and poorly nourished patients with poor hygiene. Other possible predisposing factors causing nasal myiasis include neglected children, mental retardation, and elderly age. Nasal endoscopy is a better method for removal of maggots under direct vision. Nasal endoscopic method is a better technique for the removal of maggots than conventional manual method. The maggots which are often located in deep and inaccessible areas are easily identified and removed.
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Primary fungal laryngitis: An overlooked clinical entity
Santosh Kumar Swain, Mahesh Chandra Sahu, Priyanka Debdta, Manas Ranjan Baisakh
January-March 2019, 16(1):11-15
Primary fungal laryngitis is a fungal infection of the larynx without affecting the other body parts such as lungs, pharynx, and oral cavity. It is an extremely rare clinical entity, especially in immunocompetent patients. Aspergillus fumigatus and Candida albicans are common fungi associated with primary fungal laryngitis. Hoarseness of the voice is common clinical presentations. The diagnosis of the primary fungal laryngitis is often overlooked and delayed among patients as it is usually evident among immunocompromised patients. It is often confused with certain laryngeal diseases such as granulomatous diseases, leukoplakia, and malignancy. Misdiagnosis or delayed diagnosis or inadequate treatment may lead to impaired functioning of the larynx and sometimes suffered from permanent disability. It is always important to identify the lesion earliest for avoiding morbid or life-threatening consequences. The purpose of this review article is to discuss the etiopathology, clinical presentations, diagnosis, and treatment of primary fungal laryngitis.
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An uncommon knee pain: Ganglion cyst in the gastrocnemius medialis
Sandesh Madi, Vivek Pandey, Naufal Nahas, Kiran Acharya
January-March 2018, 15(1):26-28
A large symptomatic ganglion cyst occurring in the gastrocnemius has been infrequently described in the literature. Clinical presentation and management of such a symptomatic ganglion are briefly outlined here. This is perhaps the first case that describes the surgical management of symptomatic ganglion and associated internal derangement of the knee with favorable outcomes.
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Recurrent aphthous ulcers — Still a challenging clinical entity
Santosh Kumar Swain, Sanjeev Gupta, Mahesh Chandra Sahu
October-December 2017, 14(4):202-206
Recurrent aphthous ulcer (RAU) is a clinical condition characterized by painful ulcer with different size affecting the mucosa of the oral cavity. Its etiology and pathogenesis are not clearly known and the diagnosis is based on the clinical picture. These lesions may be classified into minor, major, and herpetiformis. The aphthous ulcers in the oral cavity affect speech and feeding, leading to poor quality of life. Relevant literature was searched from PubMed, Science Direct, Cochrane Central Register of Controlled Trials, and Scopus last 20 years using the keywords “RAU.” The RAU is a common clinical entity. The diagnosis of RAU is mainly based on clinical ground and must be differentiated from other causes of oral ulceration. The treatment is often unsatisfactory as topical application of corticosteroids and other treatment modalities minimizes the severity of the ulceration but not stop chance of recurrence.
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Isolation and identification of fungus associated with skin and nail scalps of patients in a tertiary care teaching hospital
Kaniska Uthansingh, Manoj Kumar Sahu, Nagen Kumar Debata, Debasmita Behera, Kirtika Panda, Mahesh Chandra Sahu
January-March 2019, 16(1):16-21
Background and Objectives: Ringworm of the scalp is starting at now a disease of overall criticalness and a general prosperity teaching care hospitals. It is otherwise known as dermatophytes, which attack and create on dead animal keratin. This assessment was intended to recognize the regular dermatophyte causing parasitic infection with both minute just as social strategies. Materials and Methods: This is a Prospective study which was carried out for the period 1 year and included the patients with tinea cruris and tinea corporis, tinea unguium, tinea pedis, and tinea barbae which are seen in the patients between 6 to 70 years of age. Dermatophytes were confirmed with microscopic examination of skin and nail tests taken from the influenced lesion of the body. Both cotton blue and potassium hydroxide grouping of 10%– 30% were utilized to see under magnifying micrioscope. All information were broken down with SPPS 20 programming. Results: Out of 78 patients, the recurrence of ringworm infection among those patients attending in the department of Skin and VD, IMS and SUM Hospital was Trichophyton rubrum (73%), Trichophyton mentagrophytes (53%), Epidermophyton floccosum (26.82%), and Trichophyton verrucosum (7.31%). T. rubrum was the most widely recognized etiological fungus in tinea corporis, and this positioned first in the other type of ringworm infection. Recurrence of dermatophytes infection partner with various clinical examples; for example, nail pieces and skin swabs from the infected area. Conclusions: The greater part of the tinea corporis patients were infected with T. rubrum then comes the disease of Trichophyton violaceum, Trichophyton tonsurans, and T. mentagrophytes. The most astounding recurrence of disease was among the patients matured 20– 30 years. It is additionally essentially noticed that this infection takes a somewhat serious turn in patients of cutting edge in older age (60– 80 years).
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The impact of loneliness on physical and mental health among older adults in the era of coronavirus disease 2019 pandemic
Chidiebere Emmanuel Okechukwu
January-March 2021, 18(1):29-32
Coronavirus disease 2019 (COVID-19) pandemic has a significant negative impact on emotions and feelings of loneliness in terms of lack of companionship, social isolation, and connections in older adults. Compulsive loneliness can negatively alter cognition, mental, and physical health and lifespan in the elderly. Isolation and restricted social interaction in the time of COVID-19 pandemic was clearly connected with the symptoms of mood and behavioral disorders in older adults. The aim of this narrative review was to evaluate the impact of loneliness caused by the public health social isolation measures aimed to curtail the prevalence of COVID-19 on the physical and mental health in older adults. Articles regarding the effect of loneliness caused by the public health social isolation measures aimed to curtail the prevalence of COVID-19 on the physical and mental health of older adults were searched on PubMed electronic database. Relevant articles were selected; full-text articles were assessed; and significant evidence were extracted. To avoid the negative impact of social isolation on older adults during the era of COVID-19, it is essential to involve older adults in the activities such as physical activity, playing games with their peers, and sightseeing.
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Pediatric humeral fracture fixed by a single retrograde titanium elastic nail
Kapil Mani K C, Parimal Acharya, Bandhu Ram Pangeni, Suman Babu Marahatta
October-December 2017, 14(4):212-217
Introduction: Almost all pediatric humerus fractures are well managed with conservative treatment with higher percentage of union rate. However there are certain conditions where surgical intervention will be inevitable like humerus fracture associated with polytrauma compound fractures, those with head and unacceptable alignment. It is not only the stable fixation but also the alignment which is important and can be maintained even by a single pre-bent elastic or flexible intramedullary nailing. Methods: This was a retrospective study of 28 pediatric humeral fractures fixed with a single retrograde titanium elastic nail from 2012 to 2016. Time to unite the fracture along with other complications was noted. The functional outcomes were assessed according to Broberg and Morrey for elbow function and Disabilities of the Arm, Shoulder and Hand (DASH) score for shoulder function. Results: Average age of patients was 8.85 1.84 (range 6 to 12 years). Time to unite the fracture was 8.28 2.43 weeks (range 6 to 12 weeks). There were 1 case of malunion around 10 degrees, 1 case of nail migration, one case of superficial infection at the site of nail entry, one case of transient radial nerve palsy and one case of nail protrusion in our study. There were 24 (85.71%) cases of excellent and 4 (14.29%) cases of good results according to Broberg and Morrey functional scores. Conclusion: Fixation of pediatric humerus fractures with a single flexible nail reduces operative time, radiation exposure, cost of treatment, chances of iatrogenic supracondylar fracture and ulnar nerve injury without compromising the final outcomes.
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Neurological benefits of mindfulness meditation
Pushpendra Nath Renjen, Dinesh Mohan Chaudhari
October-December 2017, 14(4):198-201
Meditation can be defined as a form of mental training that aims to improve an individual's core psychological capacities, such as attentional and emotional self-regulation. Research on the biological concomitants of meditation practice is sparse and has mostly focused on changes that occur during meditation compared with a resting control condition in a single experimental session. Over 2000 scientific publications on the term “meditation” have been published till date, mainly in the scientific fields such of psychology and neuroscience. If supported by rigorous research studies, the practice of mindfulness meditation might be promising for the treatment of clinical disorders and might facilitate the cultivation of a healthy mind and increased well-being.
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Chondrocalcinosis: A common but poorly understood joint disease
Siddhartha Gupta, Abhishek Vaish, Raju Vaishya
October-December 2018, 15(4):201-203
Calcium pyrophosphate crystal deposition is a spectrum of diseases, involving the musculoskeletal system. It may be asymptomatic or may manifest with pain, swelling, stiffness, and deformity of the joints. It may lead to secondary osteoarthritis of the joint. Awareness about these conditions is necessary to diagnose it and to differentiate it with other mimicking disorders. The diagnosis is often achieved by clinical manifestations, plain radiographs, and synovial fluid examination. The treatment is often symptomatic by conservative means, but in advanced arthritis, joint replacement may be needed.
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Hydrops fetalis with septated cystic hygroma
Reddy Ravikanth, Rajalakshmy Prasannan
January-March 2019, 16(1):47-49
Hydrops fetalis is excess accumulation of fluid in the fetus, and fetal cystic hygroma is a manifestation of early lymphatic obstruction. Depending on the severity and cause of hydrops, there may be anasarca of fetus, placentomegaly, ascites, pleural effusions, and/or pericardial effusions. Fetal hydrops and cystic hygroma can be diagnosed in the second trimester of gestation and is associated with a higher incidence of aneuploidy and high mortality. Previously, most cases of hydrops were caused by severe erythroblastosis fetalis secondary to Rh isoimmunization. At present, hydrops fetalis is caused by other conditions and is known as nonimmune hydrops. Here, we present a case of an 18-week pregnancy with fetal cystic hygroma and nonimmune hydrops fetalis.
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Stroke chameleons: Uncommon presentations of a common disease
Pushpendra Nath Renjen, Dinesh Chaudhari
July-September 2017, 14(3):148-149
Stroke is one of the major causes of death and morbidity worldwide and carries an important economic impact. The diagnosis is still a clinical one, supported by brain imaging. However, up to 30% of suspected stroke presentations have a different diagnosis. In these cases, two scenarios must be considered: a false positive diagnosis, or “stroke mimic”, and a false negative or “stroke chameleon”. The diagnosis of acute ischemic stroke is often straightforward. The sudden onset of a focal neurologic deficit in a recognizable vascular distribution with a common presentation - such as hemiparesis, facial weakness and aphasia - identifies a common syndrome of acute stroke. But differential diagnostic problems remain because there are several subtypes of stroke and also because some non-vascular disorders may have clinical pictures that appear identical to strokes. Acute ischemic stroke (AIS) with neurological deficit is a very debilitating condition, especially in younger patients and the rate of false positive diagnosis of ischemic stroke labeled ''stroke mimics'' ranges from 1.3% to 25%.
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Biosensors applications in fighting COVID-19 pandemic
Shashi Bahl, Mohd Javaid, Ashok Kumar Bagha, Ravi Pratap Singh, Abid Haleem, Raju Vaishya, Rajiv Suman
July-September 2020, 17(3):221-223
Biosensors can measure nonpolar molecules, which is not possible by other conventional devices. These sensors provide high specificity and fast response time. During COVID-19, this technology has helped to identify the symptoms of the viral infection. It measures the respiration rate, heart rate, temperature, and any movement in the real time for COVID-19 patients. During any changes in the symptoms of the patient, this technology rapidly contacts and advice to the health-care service provider. It helps to monitor infected patients without any risk of contamination easily. We have identified seven significant applications of the biosensors for the COVID-19 pandemic. Tests of the COVID-19 virus can be carried out effectively by employing these biosensors more appropriately and productively. This technology has completely changed and revolted the health-care world to perform its intended functions in an ongoing situation. In the future, biosensors can offer better treatment of the patients in an epidemic and pandemic, more productively and effectively.
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Refractory hypokalemia – An exigent concern: Case series and review of literature
Gunadhar Padhi, Masood Ahmed Chandsha
April-June 2020, 17(2):108-110
Potassium is a major intracellular cation affecting tonicity and regulating intracellular processes such as protein/glycogen synthesis and carbohydrate metabolism and partially responsible for maintaining the potential difference across the membrane, particularly in excitable tissues such as nerve and muscle. Of all the electrolytes, a rapid change in potassium concentration is life-threatening. Hypokalemia is a common electrolyte disturbance, especially in hospitalized patients. Severe hypokalemia is life-threatening and requires urgent medical attention. It may trigger dangerous arrhythmias such as ventricular fibrillation and tachycardia, leading to cardiac arrest. It leads to neuromuscular weakness prolonging weaning in mechanically ventilated patients and also contributes to paralytic ileus. The body maintains serum potassium concentration within very narrow limits through tightly regulated feedback and feedforward systems. Understanding the physiology of potassium homeostasis and diverse etiologies of hypokalemia spanning from error in sample collection, endocrine abnormalities, renal tubular acidosis, and many more may guide toward the appropriate treatment of hypokalemia.
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Diagnosis, pathophysiology, and treatment of normal pressure hydrocephalus: A review of current perspectives
Charchit Gupta, Pushpendra Nath Renjen, Dinesh Chaudhari, Anjali Mishra
January-March 2020, 17(1):10-15
Normal pressure hydrocephalus (NPH) is a potentially reversible syndrome characterized by enlarged cerebral ventricles (ventriculomegaly), cognitive impairment, gait apraxia, and urinary incontinence. A critical review of the current prospectives in the diagnosis and treatment of both idiopathic and secondary NPH has been done in our article. NPH is an important cause of potentially reversible dementia, frequent falls, and recurrent urinary infections in the elderly. The clinical and imaging features of NPH may be incomplete or nonspecific, posing a diagnostic challenge for medical doctors, and often requiring expert assessment to minimize unsuccessful surgical treatments. Recent advances resulting from the use of noninvasive magnetic resonance imaging methods for quantifying cerebral blood flow, in particular arterial spin-labeling, and the frequent association of NPH and obstructive sleep apnea, offer new avenues to understand and treat NPH.
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Effect of risk factors on grades of gastroesophageal reflux disease
Batool Mutar Mahdi, Riyadh Mohamad Hasan, Wafaa Hazim
July-September 2017, 14(3):154-159
Background: There are many risk factors associated with degree of development erosive esophagitis and its complications. Aim of the Study: To evaluate the effect of risk factors on severity of esophagitis and identify the most important risk factors among patients presenting to gastroscopy unit. Patients and Methods: Patients with upper gastrointestinal tract (GIT) symptoms were enrolled in gastroscope examination. For each participant, the body mass index (BMI), waist circumference, and immunoglobulin G Helicobacter pylori were done. Results: A total of 195 patients with upper GIT symptoms were examined by gastroscope. One hundred and twenty patients had erosive esophagitis (Grade II and III) (Group A): 75 of them were men (62.5%) and 45 (37.5%) were women. The rest 75 had gastroesophageal reflux disease Grade I (Group B), 52% of them were males, and the rest were females. Group A patients were more likely to be non-steroidal anti-inflammatory (NSAID) users (42.5%) than Group B (P = 0.0002). Group A was more likely to be obese (body mass index >30) (37.5%) (P = 0.015). Men have waist circumference >102 cm and women have a waist circumference >88 cm constitute 92.5% (P = 0.0001) of Group A. Patient with Group A who had hiatus hernia (HH) were (20%) (P = 0.0001) and those with H. pylori (35%) (P = 0.001). Conclusions: Obesity, abdominal obesity, NSAID, HH, and H. pylori infection are strong risk factors for gastroesophageal reflux grades.
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Multi-agent system applications to fight COVID-19 pandemic
Abhishek Sharma, Shashi Bahl, Ashok Kumar Bagha, Mohd Javaid, Dinesh Kumar Shukla, Abid Haleem
September 2020, 17(5):41-43
A multi-agent system (MAS) uses multiple interacting intelligent agents with the support of the computerized system. During this COVID-19 pandemic, there is a requirement to improve service for patients to fulfill the ongoing challenges. This technology provides a digital service continuously for the patients. An MAS-based platform is helpful for different scenarios during this pandemic. This article discusses significant components, as used for developing an MAS to handle COVID-19 situations. Finally, it discusses various significance applications of an MAS for COVID-19 pandemic patients. The knowledge and data required to solve the COVID-19 pandemic are distributed spatially in different locations, which add constraints, toward proper planning of the treatment of patients to combat this pandemic. Governments accept that their systems cannot stop the widespread transmission of this virus. However, by flattening the curve, the mortality rate can be reduced. MAS consist of autonomous entities, also known as agents, who work collaboratively. By using MAS, lots of real-world data of the emerging situation such as an outbreak can be processed gainfully. It will allow doctors and organizations to create flexible models of potential scenarios.
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Factors influencing outcome in head injury patients with glasgow coma scale <8
Kodeeswaran Marappan, M Prabhu, Balasubramani K, Sherina Paul Raj
October-December 2017, 14(4):207-211
Background: Over the years in the emergency department, it has been generally observed that the overall outcome in severe head injury patients is very poor. Hence, a study was conducted in traumatic brain injury patients with a Glasgow Coma Scale (GCS) <8, in which various factors that affect outcome in severe head injury patients were analyzed. Objective: The objective of the study was to understand the various factors influencing outcome in patients with severe head injury (GCS ≤8). Subjects and Methods: This was a prospective study, conducted on 350 consecutive acute severe head injury patients with a GCS ≤8. Thirteen independent factors expected to affect prognosis of severe head injury patients were analyzed and studied. Multivariate analysis was used to include adjustment for prognostic variables. Positive predictive value and strong association of the data were analyzed using cumulative percentage, Chi-square test, and cross-tabulation. Results: From the study, it was observed that male population, older age group patients, low GCS on arrival, train accidents, increased time interval, poor motor response, sluggish or absent pupillary reaction to light, absence of dolls eye movement, presence of comorbidities and other severe traumatic injury of major organs, poor glycemic status, and altered coagulation profile were associated with poor outcome in patients. Conclusions: A keen evaluation of patient profile before taking definitive management decisions is recommended, so as to improve the outcome in severe head injury patients. This is because, there are certain factors such as glycemic statuses of the patient, hemoglobin level, and coagulation profile that are modifiable, and if identified and corrected early, could improve the prognosis of the patients to a large extent.
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Boron: A dietary mineral for human health
Roopesh Jain, Archana Tiwari
January-March 2019, 16(1):66-67
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Chemical thromboprophylaxis in total knee replacement: A critical review
Raju Vaishya, Amit Kumar Agarwal, Pratik Desai, Vipul Vijay
April-June 2018, 15(2):59-68
Venous thromboembolism (VTE) remains a devastating and potentially lethal complication following total knee replacement (TKR) surgery. Studies have shown that 40%–85% of patients develop venographically confirmed deep vein thrombosis after TKA if they do not receive any form of thromboprophylaxis (TP), and approximately 0.1%–1.7% also suffer from fatal complication such as pulmonary embolism (PE). There are various chemical-TP (CTP) recommendations in the literature for patients having TKR surgery. The present review provides the current evidence for CTP in post-TKR surgery. All guidelines provided by the American Academy of Orthopedic Surgeons, American College of Chest Physicians, and National Institute for Health and Clinical Excellence are reviewed and analyzed in detail. Newer oral anticoagulants results are also studied as well, in the quest for an effective and safe VTE prophylaxis after TKR surgery.
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A review of sports-related injuries: Head to toe spectrum
Reddy Ravikanth, Jyotin Kshitiz Singh, Anegh Pavithran, Anoop Pilar, Anush Nagotu, Parthasarathi Sarkar, S Sandeep, Denver Steven Pinto, Mathew David, John Joshy, Manu Jacob Abraham, Ashok Alapati, Robert Patrick Selvam, Sunil Mathew
April-June 2018, 15(2):79-87
All sports come with a risk of injury, and in general, the more contact involved in the sports, the higher the risk of a more significant or traumatic injury. The most frequent types of sports injuries are sprains (ligament injuries), strains (muscle injuries), and stress fractures (bone injuries). In sports medicine, a catastrophic injury is defined as severe trauma to the human head, spine, or brain. Concussions in sports became a major issue in the 2000s as evidence connected repeated concussions and subconcussive hits with chronic traumatic encephalopathy and increased suicide risk. Overuse and repetitive stress injury problems associated with sports include jumper's knee, tennis elbow, and tendinosis. In this review article, we have made an attempt to describe the head to toe spectrum of sports-related injuries including traumatic injuries of the head and face, extremity injuries, soft-tissue injuries, and contact sports-related injuries.
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Three-dimensional printing for complex orthopedic cases and trauma: A blessing
Raju Vaishya, Vipul Vijay, Abhishek Vaish, Amit Kumar Agarwal
April-June 2018, 15(2):51-54
Three-dimensional (3D) printing technology is penetrating the health-care field at an astonishing rate. In the clinical settings, 3D printing, as a novel additive manufacturing technique, is mainly applied in orthopedics. A group of 3D printing-based patient-specific osteotomy instruments, orthopedic implants, and dental implants have been available for clinical use. The uses of 3D printing have been explored in the field of arthroplasty, sports medicine, spine, pediatric orthopedics, and trauma. The 3D printing technology may provide a chance for the Indian orthopedists and technicians to independently develop innovative medical devices to catch up with their Western counterparts. Its role in patient as well as medical education is also worth exploring. With these myriad applications, 3D printing holds great promise to improve patient as well as surgeon satisfaction in the near future. We discuss the process, applications, and advantages of 3D printing in this review article.
  5,360 455 -
Tamoxifen in recurrent thin endometrium
Abdul Basith S. Fazal, Rachita Munjal, KS Kirthika
October-December 2018, 15(4):240-241
To evaluate the effects of tamoxifen in patients with repeated unresponsive thin endometrium (<6 mm). Three women showed recurrent thin endometrium <6 mm during frozen embryo transfer endometrial preparation. Tamoxifen was added in the successive cycles as an adjunct. The endometrium was found to build up more than the target 7 mm in all the women with tamoxifen therapy. Two of the women conceived. In frozen-thawed embryo transfer cycles with recurrent thin endometrium, addition of tamoxifen helps achieve target endometrial thickness.
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An unusual vertical swelling over the back
Vinod Kumar Viswanathan
July-September 2019, 16(3):196-198
Skeletal tuberculosis (TB) accounts for 1%–2% of all types of TB. The most common form of skeletal TB is Pott's disease, a disease of the spine; this entity comprises approximately half of skeletal TB cases. Tuberculous cold abscess can present as swelling on the back usually originating from the thoracic spine. Herewith is presented a rare case presentation of a patient who presented with a vertical swelling over the paraspinal region who on evaluation was found to have a cold abscess of tuberculous etiology arising from the ribs and tracking down the paraspinal region. This case is presented here for its rarity being a primary chest wall TB with no pulmonary involvement.
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Postoperative ileus after orthopedic and spine surgery: A critical review
Vishal Kumar, Abhishek Vaish, Raju Vaishya
January-March 2020, 17(1):16-21
Constipation and abdominal discomfort are the most common complaints after orthopedic surgery. Still, there is still not much development in the knowledge about postoperative ileus (POI). It is evident due to the lack of published literature on Post Operative Ileus (POI) and its sequel. A comprehensive review of the literature was conducted to identify the risk factors, mechanism, and treatment to treat POI. The literature search was performed using search engines such as PubMed, MEDLINE, SCOPUS, and Google Scholar databases on April 1, 2019. After applying the inclusion and exclusion criteria, we selected nine publications for this review. Only six of these studies were related to POI after orthopedic (4) or spine surgery (2). These studies comprised a total of 231,773 patients of POI. The results showed that invariably, all the patients after gastrointestinal surgeries developed POI, but it was not restricted to it. POI was also seen after orthopedic surgery, with its incidence being maximum in patients undergoing spine and arthroplasty surgery. POI is multifactorial and is invariably an unavoidable cause in the postoperative period leading to increased morbidity and hospital stay. In order to deal with this, identifying the risk factors in a patient in the preoperative period, modifying the anesthesia technique, early mobilization, adequate pain management, recognizing the clinical signs and symptoms of ileus, and treating it promptly lead to achieving the optimal outcomes. The multimodal approach of management of POI is advisable.
  5,426 306 -
Mitral valve prolapse
Nekkanti Venkat Rayudu
January-March 2018, 15(1):11-14
Mitral valve prolapse, Click murmurs syndrome, Barlow's syndrome is one of the common cause of mitral valve disease with or without mitral regurgitation. Barlow gave full clinical description of the disorder in 1963. It has large clinical spectrum from asymptomatic auscultatory or Echodopler finding to frank mitral regurgitation needing valve surgery.
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