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   2015| July-December  | Volume 17 | Issue 2  
    Online since April 7, 2017

 
 
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REVIEW ARTICLES
Projectisation of setting up of a dialysis centre at a zonal service hospital
Sambhu Dutta, Jayant Kumar Panda
July-December 2015, 17(2):185-191
DOI:10.4103/0975-3605.203716  
Dialysis is essential for patients suffering from “End Stage Renal Disease (ESRD)” and it is observed from preliminary studies that the prevalence of Chronic Kidney Disease (CKD), the precursor to ESRD is 0.8% in India. The major contributing causes to CKD are diabetes and high blood pressure among many others. These diseases are increasing at an alarming rate across the country 1. With the increasing global trend of chronic non-communicable diseases and India being the world capital for diabetes and possibly hypertension. The cost of supporting the treatment of patients undergoing dialysis and suffering from ESRD is very high in the order of Rs 10,000 to Rs 20,000 per month. Presently dialysis centres only exist at command level hospitals. Considering the anticipated delay in delivering the dialysis service to the patient in the available facility, time and distance; criticality factors involved and the hassles in availing the facility in civil hospitals, there is an inescapable need to establish haemodialysis units in service hospitals at places far away from Command hospitals where the dialysis facility is available at present. With the sparse availability of dialysis facilities for armed forces and their dependents, clientele, it was conceptualized that enhancing the availability of dialysis services at zonal service hospital level shall reduce the patient suffering and produce better health outcomes. This paper brought out the need, feasibility, process, factors involved and outcome of the proposed projectisation of dialysis facility at zonal service hospital. It is found that projectisation of establishing the dialysis setup in Build Own Operate (BOO) model in Public Private Partnership (PPP) mode has potential effectiveness and efficiency for providing comprehensive dialysis services to the dependent clientele at zonal service hospitals.
[ABSTRACT]   Full text not available  [PDF]
  1,274 148 -
CASE REPORTS
Proximal focal femoral deficiency: A case report
Shashank Sharma, Rochan Pant, Raj Singh Negi, SK Rai, Piyush Joshi, PI Hashim
July-December 2015, 17(2):151-153
DOI:10.4103/0975-3605.203706  
Proximal focal femoral deficiency (PFFD) is a rare congenital anomaly resulting in limb shortening and disability in young. The exact cause of the disease is not known and it may present as varying grades of affection involving the proximal femur and the acetabulum. Recognition of this rare abnormality on radiographs can help manage these cases better since early institution of therapy may help in achieving adequate growth of the femur.
[ABSTRACT]   Full text not available  [PDF] [CITATIONS]
  1,142 156 2
ORIGINAL ARTICLES
Changes in body composition of submarine crew during prolonged submarine deployment
Sourabh Bhutani, Chaitanya Kodange, DK Ghosh, CS Mohanty
July-December 2015, 17(2):101-104
DOI:10.4103/0975-3605.203695  
Introduction: Lack of physical activity is one of the major factor which affects crew health while onboard submarines at sea. Lack of physical activity along with increase in body weight and body fat content can lead to increase predisposition to lifestyle disorders in submarine crew. Materials and Methods: Omron Bioimpedance monitor to measure weight, body fat percentage and muscle mass of crew of a submarine while on a 26 days sortie. Pre-sailing and post-sailing measurements were compared and analysed using the student t test. Results: Mean weight of the submarine crew increased significantly by 0.5% from 70.71 kg on day 1 to 71.06 kg on day 25. BMI increased by 0.5% from 24.42 kg/m2 to 24.55 kg/m2. Mean fat percentage increased by 2.6% and muscle mass decreased by 0.7%. Discussion: Increased body fat along with lack of physical activity can lead to development of lifestyle disorders in submarine crew. These crew members need to be actively encouraged to participate in physical activity when in harbour. In addition dieting program specifically to encourage reduced fat consumption needs to be instituted in submarines during sorties at sea.
[ABSTRACT]   Full text not available  [PDF]
  999 157 -
REVIEW ARTICLES
Smart hospitals and m health-future ahead
Dev Prakash Sharma
July-December 2015, 17(2):181-184
DOI:10.4103/0975-3605.203715  
Electronic gadgets along with mobile devices & Apps are becoming integral part of the modern healthcare industry. PACS and RIS were just the building blocks in the era of m Health, which now thrives on enterprise viewers and technologies like mobile e- visit technology to name a few. With gradual increase in quality and availability ofthe technology the concept of traditional health center is getting outdated. Today in the technology driven society the patient wants at door health services with mobile key boards as means of communication with his healthcare providers.
[ABSTRACT]   Full text not available  [PDF]
  927 153 -
CASE REPORTS
Unusual occurrence of diving accidents : Case reports from andaman & nicobar islands
SS Mohapatra, AK Anand, CS Mohanty, Swaroop Pathnaik, Bhavni Oberoi, Sargundeep Singh
July-December 2015, 17(2):131-136
DOI:10.4103/0975-3605.203701  
Introduction: Andaman and Nicobar islands due to their unique location offer several exclusive diving sites and form a hub of recreational SCUBA diving and commercial diving. This in turn increases the possibility of diving accidents in these areas. Seven cases with a wide spectrum of presentations and rare symptoms has been compiled in this article. Observations : Six cases of “Decompression Sickness” which is rare type of diving accidents in the recent times, were reported with rare and varied symptoms. Out of six cases of DCS, four were type 2 with varied presentations due to neurological, cerebellar, pulmonary etc. involvement and only one case was type 1 with skin involvement. Joint manifestation which is the common form of DCS (popularly known as “Bends”) was not reported. A thorough history, good clinical examinations, advice from Marine Medicine Specialists and prompt administration of Recompression therapy were the key factors for successful recovery of such cases. Conclusions: Management of Decompression Sickness (DCS) can be extremely challenging both in the pre-hospital and hospital care setup. This could be convoluted further by lack of hyperbaric chamber and trained staff. Availability of a Recompression chamber (RCC) has been a boon in remote areas where such cases are common.
[ABSTRACT]   Full text not available  [PDF]
  956 111 -
Management of Alkaline Button Battery Foreign Body in The Nasal Cavity At A Peripheral Centre
Vishal Gaurav, Prasant Panda, D Raghavan
July-December 2015, 17(2):137-140
DOI:10.4103/0975-3605.203702  
Foreign body in nose is one of the most common Ear Nose& Throat emergencies. Button batteries are one ofthe most dangerous foreign bodies as it can cause extensive tissue damage by chemical or thermal burns. We present a 5 years old boy with nasal mucosal necrosis against a button battery foreign body managed at a peripheral centre in the light of literature available.
[ABSTRACT]   Full text not available  [PDF] [CITATIONS]
  928 125 2
ORIGINAL ARTICLES
Metabolic syndrome in urban DRDO population
Prakash P Bellubbi
July-December 2015, 17(2):105-115
DOI:10.4103/0975-3605.203696  
Metabolic syndrome is a common condition occurring all over the world which is also known by other terminology such as Dysmetabolic syndrome, Syndrome X, Insulin Resistance syndrome, Obesity syndrome, or Reaven's syndrome. Metabolic syndrome is constituted by a group of Risk Factors such as Trunkal Obesity, Impaired or Altered Glucose Tolerance, Dyslipidemia and Hypertension. Individuals with these risk factors are at a greater risk of developing a cardiovascular disease or Type 2 Diabetes. NCEP, National Heart, lung and Blood Institute, National Institutes of Health periodically publishes ATP clinical updates as warranted by advances in the cholesterol management. Each of the guideline reports -ATP I, II and III - has a major thrust in Cardiovascular Risk Management. While some of the features of ATP I and ATP II are shared by ATP III guidelines, there are some salient differences. ATP III focuses on Multiple risk factors and recommends the use ofFramingham projections of 10 year absolute risk, modifies lipid and lipoprotein classification and supports for implementation of a revised schedule for screening and Therapeutic Life-style Changes. DRDO has embarked upon a program to assess the occupational health risk and the coronary risk status of the DRDO and defence employees. The present paper describes incidence of Metabolic Syndrome amongst the DRDO and Defence employees, using the ATP III guidelines and importance of calculating the absolute coronary risk status of these personnel.
[ABSTRACT]   Full text not available  [PDF]
  898 103 -
CASE REPORTS
Clinical profile of a patient with post traumatic stress disorder
HS Dhillon, Nikhil A Singh, KJ Divinakumar, PS Bhat
July-December 2015, 17(2):160-162
DOI:10.4103/0975-3605.203708  
PTSD is a common psychiatric disorder that appears in a genetically predisposed individual after being exposed to a catastrophic life threatening event characterized by reliving of the memories, marked avoidance, hyperarousal and emotional numbing. This is a case report of a 35 years old serving soldier with who presented with classical symptoms of PTSD.
[ABSTRACT]   Full text not available  [PDF]
  860 137 -
ORIGINAL ARTICLES
Effects of comorbidities on auditory perception outcomes in cochler implant recipient children
Vishal Gaurav
July-December 2015, 17(2):116-120
DOI:10.4103/0975-3605.203697  
Background: Cochlear implant (CI) for rehabilitation of children with bilateral severe to profound sensorineural hearing loss represents the initial use of electrical fields to provide auditory perception in cases where sound amplification does not provide satisfactory results. Aims: To study effect individual factor of “Presence or absence of an associated comorbidity” on auditory perception outcomes on CI recipient children. Study design: Prospective study Setting: Tertiary care centre Methods: During the period from October 2011 to March 2013 cochlear implantation was performed on 50 children with bilateral severe to profound sensorineural hearing loss under 10 yrs of age. History in terms of any other comorbidities in the child was noted. Auditory perception outcomes (CAP & MAIS) was measuredpreoperatively, and 3, 6, 9 & 12 months after CI surgery. Auditory perception in these children was studied in relation to the patient variable of comorbidities (whether Present/Absent). Chi square test was used for statistical analysis. Results: There were improved mean auditory perception outcomes (increased 9.15% CAP, 14.14% MAIS) in cochlear implant recipients who had no comorbidities, in comparison to those who had an associated comorbidity. Conclusion: In this study of auditory perception assessment of 50 children with Profound hearing losses, presence of comorbidities was found to have a deleterious effect on auditory perception outcome and this result has been found to be statistically significant for MAIS and not significant for CAP scores. Hence it is safe to conclude that knowledge of “Presence or absence of an associated comorbidity” can provide reasonable help in predicting the auditory perception and hence spoken language outcomes for individual CI candidates.
[ABSTRACT]   Full text not available  [PDF]
  886 110 -
CASE REPORTS
Tracheal diverticulum - A case report
Rahul Tyagi, RS Negi
July-December 2015, 17(2):163-164
DOI:10.4103/0975-3605.203709  
Tracheal diverticulum is a rare entity usually detected post-mortem. It may be congenital or acquired. Clinically the patient may be asymptomatic or present with chronic cough, dyspnea, stridor, repeated tracheobronchitis. We report a case of this rare entity in an elderly women detected during evaluation of chronic cough.
[ABSTRACT]   Full text not available  [PDF]
  888 107 -
PRESIDENT DESK
Frontiers in medicine : Looking beyond organ transplant
Tapan Sinha
July-December 2015, 17(2):99-100
DOI:10.4103/0975-3605.203718  
The introduction of organ transplantation has revolutionized outcomes in end stage organ failure. Concepts of Brain death & beating heart donors make organs more available. Yet wait lists for organs are long and the techniques of immuno suppression still evolving .3 D Tissue culture techniques may one day archive cadaveric & living donations with their attendant ethical quagmires.
[ABSTRACT]   Full text not available  [PDF]
  875 119 -
REVIEW ARTICLES
Weight issues during submarine deployments
Sourabh Bhutani, DK Ghosh, CS Mohanty, Chaitanya Kodange
July-December 2015, 17(2):178-180
DOI:10.4103/0975-3605.203714  
Physical activity onboard the diesel-electric submarines is as it is restricted due to lack of space onboard. In the absence of physical activity, one would expect the weight of the submarine crew to increase during the period of deployment at sea. Submarine crew were seen to be consuming 3168±282 kCal/day while doing hard physical work but DIPAS, New Delhi designed ration scales for the submarine crew which were to provide 3640 kCal/day. In such a scenario, a high calorie intake with low physical activity at sea would be of grave concern for long term health status of the crew. Data from an Indian submarines during a 26 day sortie involving 42 crew members revealed that weight gain occurred in 29 crew members. When food remains an important motivator at sea to break the monotony, restriction of intake is important and that can be brought about only by motivation and individual awareness. Data from a US Navy study have shown that this is possible and implementable and the solution seems quite simple.
[ABSTRACT]   Full text not available  [PDF]
  873 117 -
CASE REPORTS
A case of primary lid tuberculosis - an unusual finding
Amit Sethi, Vani Puri Sethi, Prasant Panda, H Trehan
July-December 2015, 17(2):168-170
DOI:10.4103/0975-3605.203711  
We report a case ofprimary lid tuberculosis left eye occurring in a 46 year old female. She had a white creamy discharge from the upper lid close to the lateral canthus since 9 months. She was managed with systemic antibiotics many times during this period but with no response. Complete systemic examination revealed no signs of tuberculosis. All haematological investigations were WNL Montoux was positive. Pus culture did not show any growth. USG and CECT orbit revealed a subcutaneous collection in left upper lid An incision biopsy of the involved area of the lid was done. Histopathology did not reveal any signs of tuberculosis. However the PCR test of the pus confirmed the diagnosis of tuberculosis. The patient was given anti tubercular treatment and is responding well with no discharge from the upper lid.
[ABSTRACT]   Full text not available  [PDF]
  880 107 -
Maxillary sinus fungal ball due to aspergillus managed at a peripheral centre
Vishal Gaurav, Natasha , Prasant Panda, Dilip Raghavan
July-December 2015, 17(2):141-143
DOI:10.4103/0975-3605.203703  
Fungal infections of the paranasal sinuses are uncommon but are on the rise globally and usually occur in immunocompromised individuals. We report a case of a 69-year-old immunocompetent man with a maxillary sinus fungal ball caused by Aspergillus.
[ABSTRACT]   Full text not available  [PDF]
  875 111 -
ORIGINAL ARTICLES
To study the outcome of psoriatic arthritis in tertiary care hospital
A Singhal, R Ray, SR Gote
July-December 2015, 17(2):124-126
DOI:10.4103/0975-3605.203699  
Aim: To study the outcome of psoriatic arthritis in a tertiary care hospital. Methodology: A Prospective observational study conducted at Department of Rheumatology and Department of Dermatology from 01 May 2014 - 30 June 2015. Data was collected from OPD register, admission and referral forms. All patients aged between 20-70years, who had reported to these Departments and were willing in this study were enrolled. Inclusion criteria are the confirmed cases of Psoriasis with evidence of at least one joint involvement on clinical or radiological examination. Exclusion Criteria considered were Age < 20 years and >70 years, Rheumatoid factor, ANA positivity, HIV/HBsAg/HCVpositivity, or any other evidence of Rheumatoid Arthritis. Patient suffering from Psoriatic arthritis who were meeting CASPER criteria were enrolled. They were screened by (Mantoux, Chest X ray, Serum Uric acid, VDRL, HBsAg, HIV, anti HCVantibody, Rheumatoid factor, and antinuclear antibody) for absence of other joint disease or evidence of connective tissue diseases that can affect joints or treatment. PASI score was calculated and they were started on NSAIDs. Except in Enthesitis Related Arthritis, all patients were started on Methotrexate and followed up on 3 monthly basis with clinical evaluation, Visual Analogue Scale and acute phase reactants. Cases who had failed to Methotrexate / NSAIDs after 3 months were started on BRM's and followed up. Results: Total psoriasis patient screened for athropathy were 120 patients in this study. Out of which 30 were detected to have psoriatic arthritis (PsA). Of these 30 PsA, 03 were treated with NSAID and 27 were exhibited MTx. 06 patients who had failed on MTx and were treated with Biological Response Modifiers (02 with infliximab and 4 with Etanercept). Two patients from enthesitis group who had refractory disease were treated with BRM (infliximab). Conclusion: Prevalence of Psoriatic arthritis in psoriasis in this study was 25%. Psoriasis being a common disease in general population, a high index of suspicion is kept in screening arthritis patients. Since the treatment for PsA is different from other joint diseases and reasonably well established, it should be started early for better patient satisfaction and to delay long term joint failure.
[ABSTRACT]   Full text not available  [PDF]
  877 105 -
CASE REPORTS
Pilocytic astrocytoma masquerading as cerebeller abscess in a case of VSD with eisenmenger's syndrome : A rare case report
KI Mathai, V Vibhakar, Ananthkrishnan , Kushal Bhatia
July-December 2015, 17(2):148-150
DOI:10.4103/0975-3605.203705  
Congenital cyanotic heart disease patients have increased risk of brain abscess via haematogenous spread. We report the case of a middle aged Lady with Eisenmenger's complex suspected of having a cerebellar abscess clinically and radiologically. But intraoperatively found to have a Pilocytic astrocytoma. This case highlights the difficulty in differentiating between an abscess and tumour at times on imaging. To the best of our knowledge, no association between VSD and Pilocytic astrocytoma has been described in literature.
[ABSTRACT]   Full text not available  [PDF]
  862 119 -
EXPERT OPINION
Marine Medicine : “Quo Vadis?”
VS Dixit
July-December 2015, 17(2):192-196
DOI:10.4103/0975-3605.203717  
Electronic gadgets along with mobile devices & Apps are becoming integral part of the modern healthcare industry. PACS and RIS were just the building blocks in the era of m Health, which now thrives on enterprise viewers and technologies like mobile e- visit technology to name a few. With gradual increase in quality and availability ofthe technology the concept of traditional health center is getting outdated. Today in the technology driven society the patient wants at door health services with mobile key boards as means of communication with his healthcare providers.
[ABSTRACT]   Full text not available  [PDF]
  866 109 -
ORIGINAL ARTICLES
Management of Third Stage of Labour with Per Rectal Administration of 400 MCG of Tablet Misoprostol Before Delivery of Placenta - Protocol for 3rd Stage of Labour - A Pilot Study
Pragati Tugnait, Kaushik Roy, BG Pawar, V Pion, Seema Patel
July-December 2015, 17(2):127-130
DOI:10.4103/0975-3605.203700  
Post partum haemorrhage (PPH) is the single most significant and preventable cause of maternal death worldwide. More than half of all maternal deaths occur within 24 hours of delivery, mostly due to excessive bleeding. Aims: The aim of the study was to evaluate the efficiency of tablet misoprostol 400 mcg administered per rectum within one minute of delivery of the baby in preventing postpartum haemorrhage and to study any side effect due to this. Materials and Methods: A prospective pilot study was carried out in a peripheral hospital from 01 Jun 2014 to 10 Oct 2015 110 patients were included in the study. Results: 110 patients of term pregnancy with singleton foetus were evaluated. 24 were primiparas and 86 were multiparas. The mean blood loss of all the patients evaluated was 163.41 ml with SD of 59.97 ml. That of primiparas 163.83 ml with SD of42.78 ml and that of multiparas was 166.93 ml with SD of 63.35 ml. Conclusion: The third stage of labour poses potentially life threatening risks and several severe complications to a mother who has just delivered. The patients in rural and peripheral setups are more vulnerable given their poor nutritional status, rare health care facilities, non availability of trained birth attendants and distance to a tertiary care centre. In larger centres also ,avoidance of post partum haemorrhage adds to maternal well being and saves on hospital resources in terms of man and material. The mean blood loss of 163.41 ml during third stage of labour is an encouraging result especially when no significant side effects were noted.
[ABSTRACT]   Full text not available  [PDF]
  862 108 -
CASE REPORTS
Foreign body esophagus : An unusual presentation
Anil Kaul, Marshalla Nalawade, Meet Sheth
July-December 2015, 17(2):175-178
DOI:10.4103/0975-3605.203713  
The paediatric age group presents the otolaryngologist with varied emergencies, foreign bodies in the aerodigestive tract forming the vast majority of them. Peculiar presentation with an upfront history usually make the diagnoses straightforward in all but a few cases. We describe an unusually silent case of an infant with a foreign body in the oesophagus for over 48 hrs.
[ABSTRACT]   Full text not available  [PDF]
  822 111 -
Combined anterior cerebral and posterior inferior cerebellar artery embolism in a diver; A case report
AC Kulkarni
July-December 2015, 17(2):154-159
DOI:10.4103/0975-3605.203707  
Onshore diving operations are often carried out in remote areas with poor or nil medical assistance available at site. Diving crew also tends to be poorly trained and inexperienced. As a result, initially, diving accident cases get treated symptomatically, till proper diagnosis is established and therapeutic recompression carried out after a considerable delay. Pulmonary barotrauma, lung burst, leading to Arterial Gas Embolism ( AGE) and its dreadful effects is a known complication of diving especially amongst novice divers. A case report of embolism in both Anterior Cerebral Artery and Posterior Inferior Cerebellar Artery (ACA and PICA) distribution with successful delayed hyperbaric oxygen treatment ( HBOT)
[ABSTRACT]   Full text not available  [PDF]
  822 106 -
Colonic stricture : An unusual delayed complication of abdominal blunt trauma a case report and review of literature
Shams Alam, Vimal Vibhakar, Kunal Ghosh
July-December 2015, 17(2):144-147
DOI:10.4103/0975-3605.203704  
The increase in road traffic accident had been cited as increase in blunt injury to the abdomen. Patients usually present immediately after injury and require urgent laparotomy. An unusual case of delayed large-bowel stricture after conservative management of an injury resulting from blunt trauma is reported. A 65-year-old man involved in a high-speed motor vehicle accident was managed in hospital by observation. He was discharged from hospital but returned 04 weeks after injury with pain, abdominal distension, vomiting and obstipation. Stricture of a 6-cm segment of sigmoid colon was found. Resection of the involved segment with primary anastomosis was curative.
[ABSTRACT]   Full text not available  [PDF]
  821 101 -
ORIGINAL ARTICLES
Glioblastoma multiforme : A study of 22 patients and an analysis of the effect of gross total resection on quality of life and recurrence free survival
KI Mathai, Vidhu Bhatnagar, Kushal Bhatia, Gayetri Subba, Gunjan Bansal
July-December 2015, 17(2):121-123
DOI:10.4103/0975-3605.203698  
We present a series of 22 cases of Glioblastoma Multiforme (GBM) managed at our centre. Patients underwent surgical decompression followed by radio chemotherapy. Intraoperative ultrasound was used as an aid to surgery. Ultrasonic and later CT confirmation of extent of tumor resection was obtained. Outcomeswere evaluated with respect to tumor progression. In our study patients in whom a gross total resection was achieved had better outcomes.
[ABSTRACT]   Full text not available  [PDF]
  792 118 -
CASE REPORTS
Intra osseous ganglion of scaphoid - Case report
Dev Prakash Sharma
July-December 2015, 17(2):171-174
DOI:10.4103/0975-3605.203712  
Though wrist pain has many musculoskeletal causes, the intraosseous non traumatic causes are very few. Intraosseous ganglion is an uncommon cause of chronic dull pain in the region of the wrist without any history of past or recent trauma. The case report highlights the main imaging findings of this uncommon condition. Intraosseous ganglion invariably shows communication with the parent bone and is unlikely to heal without intervention. Cross sectional imaging studies like CT and MRI are essential to make a diagnosis and help in planning for the treatment.
[ABSTRACT]   Full text not available  [PDF]
  806 102 -
Laproscopic partial splenectomy : A rare surgery for unusual diagnosis
Aditya Gupta, Renu Madan, Kunal Ghosh
July-December 2015, 17(2):165-167
DOI:10.4103/0975-3605.203710  
Laproscopic partial splenectomy is a safe, minimally invasive technique for the treatment of solitary space occupying lesion (SOL) in splenic pole. Sclerosing angiomatoid nodular transformation (SANT) of the spleen is a rare benign vascular lesion, first described in the literature under this name in 2004. We report a case of upper pole splenic SOL diagnosed as SANT on HPE successfully managed by Laparoscopic partial splenectomy for the first time at INHS Asvini. The patient presented with pain left hypochondrium of 02 year duration. Ultrasonography (USG) and Contrast enhanced Computerized tomography (CECT) abdomen revealed a splenic mass in upper pole. The laproscopic partial splenectomy has proved to be both diagnostic and therapeutic.
[ABSTRACT]   Full text not available  [PDF]
  794 103 -