New Horizons in Medicine and Medical Research Vol. 1
This book covers key areas of Medicine and Medical Research. The contributions by the authors include neutrophil to lymphocyte ratio, breast malignancy, biomarkers, breast cancer, anesthesia, gonadal dysgenesis, ultrasonography, vas deferens, neoplastic transformation, magnetic resonance Imaging, rosai dorfman’s histiocytosis, lymphadenopathy, hemoptysis, bronchial artery embolization, type II diabetes, bilateral oophorectomy, lower third facial fracture, mid facial fracture, open reduction and internal fixation, pan-facial trauma, superolateral dislocation of the intact mandibular condyle, female genital mutilation, female circumcision, sinonasal masses, nasal cavity, nasal discharge, doppler ultrasound, pseudoaneurysm, radial artery, blood gas analysis, cervical vertebra, dislocation injuries, neurological disorder, caesarean section, foetal distress, cephalopelvic disproportion, dental hygienist, osteoporosis, bone mineral density, pleomorphic lipoma, benign tumor, parotidectomy for benign neoplasms, complication after parotidectomy, facial palsy, frey's syndrome, extracapsular dissection, vascular necrosis, intracapsular fracture neck femur, accelerated fracture healing, anabolic therapy, meningitis, adrenocortical carcinoma, endoscopic stapedotomy, gastroenteroanastomosis, enteroanastomosis, Non-Wilms’ tumours, radical nephrectomy. This book contains various materials suitable for students, researchers and academicians in the field of Medicine and Medical Research.
Determining the Association of Neutrophil to Lymphocyte Ratio with Clinicopathological Features in Breast Cancer
Background: Breast cancer heterogeneity is caused by several factors, including patient characteristics, co-morbidities, histology, immunochemistry, and molecular type of the disease, resulting in a diverse set of therapeutic options. Despite breakthroughs in the diagnosis and treatment of breast cancer, breast cancer remains the leading cause of death in women in Pakistan. Several studies have shown that chronic inflammatory conditions have a role in the evolution of malignancy; these factors also stimulate growth, resulting in a bad prognosis. Aim: The purpose of this study is to examine the peripheral blood neutrophil to lymphocyte ratio (NLR) in breast cancer and its relationship to disease features. Methods: The cross-sectional study was carried out at Liaquat National Hospital and Medical College in Karachi, Pakistan. The criteria were met by a total of 2059 female breast cancer patients. Preoperatively, the patients were advised to have a full blood count with leukocyte differential. Preoperatively, complete patient data, including specimen-related histopathology reports, were gathered. Patients with clinical evidence of active infection/sepsis, any blood problems, any past or continuing inflammatory or autoimmune diseases, or steroid medication were excluded. Results: There was no correlation between the NLR and age, grade, or luminal subtypes. NLR, on the other hand, demonstrated a substantial relationship with the size and stage of the disease. The stage progressed as NLR rose. Conclusion: The study indicates the use of the NLR ratio, which could be employed as a diagnostic adjunct in the preoperative workup of patients with breast cancer in the future.
Copyright (c) 2022 Author(s). The licensee is the publisher (B P International).
Determining the Effect of Injection Dexmedetomidine for Prevention of Pain due to Propofol Injection and Comparing it with Injection Lignocaine
Background: Local pain following the injection Propofol is a common problem. Different methods are used to decrease the pain, but with limited success. The goal of this study was toassess the effect of injection Dexmedetomidine 0.2 mcg/kg for prevention of pain due to Propofol injection and compare the effect with injection Lignocaine 0.2 mg/kg. Method: After taking permission of Institutional Ethics Committee, study was initiated with written informed consent from the participating subjects. In a randomized prospective study, 60 ASA I & II patients of age range 20-60 years, of either sex, posted for elective surgeries under general anesthesia were randomly allocated in two groups. Group I (Dexmedetomidine group): Injection Dexmedetomidine 0.2mcg/kg, and Group II (Lignocaine group): Injection Lignocaine 0.2mg/kg. Both were diluted in 5 ml normal saline. IV line was secured with 20 G cannula and venous occlusion was applied to forearm using a pneumatic tourniquet and inflated to 70mm Hg for 1 minute. After injection of study drug, tourniquet was released and 25% of the calculated dose of Injection Propofol was given IV over 10 seconds. Severity of pain was evaluated using McCrirrick and Hunter scale and then remaining Propofol & neuromuscular blocking agent were given. Endotracheal intubation was done and anesthesia was maintained with Oxygen, Nitrous oxide and Isoflurane on intermittent positive pressure ventilation with Bain’s circuit. Injection Vecuronium was used as muscle relaxant. Results: Demographic data revealed that the two groups had no statistically significant differences. There was no statistically significant difference between 2 groups in respect to reduction of pain due to injection Propofol. No adverse effects like oedema, pain, wheal response at the site of injection were observed in both groups.
Background: Polyorchidism is a rare congenital condition characterised by the presence of an additional testis. Globally, less than 200 cases have been reported. It carries a risk of malignancy, necessitating prompt diagnosis and follow-up. The management protocol of polyorchidism is ambiguous with factors such as age of the patient, location, size and anatomical organization of the testicular system playing an important role. Case Presentation: A 28-year-old man presented with a non-tender scrotal swelling that was diagnosed as triorchidism on clinical and sonographic examination (the most common type of polyorchidism). There was type 2 polyorchidism with normal epididymis and vas deference. The case was managed conservatively, and regular follow-up was advised.Conclusion: Polyorchidism is an extremely rare congenital anomaly. Polyorchidism patients can be managed conservatively. The reproductive potential, as well as potential concomitant symptoms and complications such as cryptorchidism, inguinal hernia, and torsion, will have an impact on the management strategy. However, if it is suspected that the supernumerary testis is undergoing neoplastic transformation, it should be resected.
A Case Report on Rhinoscleroma with Rosai–Dorfman Histiocytosis
Rhinoscleroma is a well-known disease. However, rhinoscleroma associated with lymphadenopathy is a rare clinical entity. Objective of Study: To present a case study of rare case of rhinoscleroma with cervical lymphadenopathy of Rosai Dorfman’s histiocytosis its management and literature review. We present the case of rhinoscleroma with cervical lymphadenopathy of Rosai Dorfman's histiocytosis in a 57-year-old female patient who presented with a one-year history of nasal obstruction and two-month neck swelling, as well as constitutional symptoms such as malaise.
A Case of Primary Racemose Hemangioma: An Approach towards Disappearance of Endobronchial Lesion
The present study report the first case in which the effect of bronchial artery embolization (BAE) on racemose hemangioma was confirmed by the findings of bronchoscopy. We experienced a case of primary racemose hemangioma in which an endobronchial lesion was successfully treated by bronchial artery embolization. The case report suggested that the confirmation of the improvement of endobronchial lesions in addition to that of vascular lesions after treatment could be important.
Determining the Effectiveness of Addition of Drug Teneligliptin to Metformin, Glimepiride, Pioglitazone Combination in Type II Diabetic Patients
Introduction: Diabetes is a common chronic disease that has reached epidemic proportions in practically every industrialised and developing country. Diabetes affects over 400 million people worldwide and is the biggest cause of death. Aims and Objectives: To study effectiveness of addition of drug Teneligliptin to Metformin , Glimepiride , Pioglitazone combination in type II Diabetic patients. Methodology: This was a cross sectional study carried out in the department of Medicine of a tertiary health care centre during the one year period i.e. January 2017 to January 2018 in the type II diabetic patients. Out of all type II diabetic patients 40 patients who were on the treatment for hypoglycemia with drugs Metformin , Glimepiride , Pioglitazone were selected out of these randomly 20 patients were continued on the previous treatment (Group B) and remaining 20 were given additional drug Teneligliptin (Group A) . The statistical analysis was done by unpaired t-test and chi-sqaure test analyzed by SPSS 19 version of software. Result: In our study we have seen that The average age in both the groups was comparable i.e. 36.78± 6.74 and 38.92 ± 5.87 (p>0.05,t=1.24,df=38), the sex ration was also similar in both the group (p>0.43, X2 =0.43,df=1) and The HbA1C was comparable at 1st Wk. 10 ± 4.56 - 9.87± 3.42 (p>0.05, t = 1.023,df=38 ) and 4th Wk. 8± 5.23 - 9.67 ± 4.52 (p>0.05 ,t = 1.0804,df=38 ) but significantly differed at 8th Wk. 7.12 ± 2.34 - 9.92± 3.56 (p<0.01, t = 3.82 ,df=38) , 12th Wk. 5.98± 1.98- 9.24 ± 2.79 (p<0.001, t = 4.26 ,df=38) respectively in Group A and B . Conclusion: It can be concluded from our study that the addiction of Teneligliptin significantly reduced the HbA1C level at the end of 4th wk. and hence superior to conventional Metformin , Glimepiride , Pioglitazone only combination treatment .
Study on Pilates and Physiotherapy during Post Total Hysterectomy
Introduction: An increased prevalence of female undergoing hysterectomy in early ages of 35 were recorded widely. With an increased life expectancy and longevity healthcare related with post hysterectomy such as obesity, MSD, urinary incontinence and diminished quality of life gets significant. Amis & Objectives The study aimed to analyse the combined effects of, Pilates and physiotherapy on obesity and evaluate the reduction in obesity on quality of life and glycemic control of this study subject who has undergone hysterectomy and oophorectomy in Chennai in 2015 December. Materials & Methodology: 40 years old aged subject post hysterectomy and bilateral oophorectomy with obesity and MSD was treated with combined Pilates and physiotherapy using Physioball during the period from December 2016 to February 2017 with weekly twice frequency. Results: of reduction in obesity P<.05 and an improved quality of life P<.01 among the study subject with statistically and functionally significant. Conclusion: findings of the study could benefit similar subjects who have undergone gynecological surgeries, there by promoting their dignity and enhanced quality of life. Longer follow up of all the hysterectomy subjects with due registry for recording of oncological, musculoskeletal and systemic illness incidents helps for better strategies in health care.
A Case Report on Unusual Severe Superolateral Dislocation of Right Condyle Associated with Sagittal Split of Articular Eminence in Pan-Facial Trauma Managed with Inverted L-Plate
Head and neck trauma is a difficult case for a maxillofacial surgeon since not only must pre-injury anatomy be restored, but also the cosmetic aspect must be improved. The management of such patients is difficult and often necessitates the involvement of a multidisciplinary team. Unprotected driving or high-velocity collisions are one of the causes of severe trauma. Pan-facial trauma not only disrupts normal facial anatomy but also hinders normal functions like vision (dystopia, diplopia, enophthalmos), respiration (airway) and olfactory senses, mastication and natural occlusion and intercuspation, deglutition, and overall asthetic of the patient. Restoring and rehabilitation of preinjury contour of facial skeleton in such patient of trauma requires artistic work of the operating maxillofacial surgeon. The treatment modality in case of trauma is open reduction and internal fixation (ORIF) under general anesthesia (GA). Various approaches have been suggested to achieve near normal anatomy. Past research suggested “top to bottom” or “bottom to top” along with “outward to inward” or “inward to outward,” The main aim being restoring horizontal and vertical facial pillars. This case was unique in terms of persistent superolateral displacement of intact mandibular condyle even after fixation of the zygomatic arch; to keep condyle in its anatomic place, the inverted “L” plate was used. Results obtained were functionally satisfactory even in dynamic motion and we propose it as an adequate alternative for treatment of superolateral dislocation of intact mandibular condyle.
Assessing the Practice of Female Genital Mutilation in the Paynesville Community, Liberia
Female Genital Mutilation (FGM), sometime referred to as female circumcision is one of the deeply rooted traditional and cultural practices which long existed in Liberia and the African continent. Various forms of the practice are still prevalent amongst a number of ethnic groups in Liberia. FGM is regarded as sensitive topic because of the high degree of secrecy surrounding its performance. In an attempt to study the practice of FGM in the Paynesville community, a standard questionnaire was administered to a sample size of 409 females in eight communities in Paynesville. The communities chosen were ELWA Community, Joe Bar, and 72nd, Jacob Town, Red Light/Gobachop, Pipeline, Soul Clinic, and Cocoa Cola Factory. Out of the 409 female interviewed, result of the study revealed that 43.03% (176) of the female interviewed practiced FGM. Ethnic groups that have the highest positive respondents included the Gbandi, Kpelle, Gio, Lorma, Vai, Mano, Bassa and Kissi. The Americo- Liberians, Kru, Sarpo and Grebo ethnic groups represented the highest negative respondents to the practice of FGM. A large proportion of the respondents was strongly against the practice of FGM for reasons ranging from painfulness of the act, difficulty during deliver, social, religious, physical and psychological trauma including fistula. Notwithstanding, some were supportive of the practice because of strong traditional influence and belief that it is part of their cultural heritage. FGM is a ritual with some health and psychological consequences and needs to be discouraged. However, the other aspects of the ceremony associated with FGM that has to do with the cultivation of virtues need to be maintained.
Clinico-Epidemiological Evaluation of Patients with Sinonasal Masses Attending a Tertiary Care Hospital in Jharkhand, India
Background: The nasal cavity may contain a wide range of masses that distinguish this organ from the rest of the body. In clinical practise, benign nasal and paranasal sinus masses are common. Aims: The study's objectives were to assess the clinico-epidemiological profile of nasal masses in patients attending ear, nose, throat and head and neck surgery (ENT & HNS) OPD of Rajendra Institute of Medical Sciences (RIMS), Ranchi from January 2013 to December 2015) and to categorise the nasal masses based on their percentage of occurrence. Methods: This retrospective study was designed to evaluate clinico-epidemiological data collected from the admission register of the ENT Department at RIMS, Ranchi from 2013 to 2015. For this time period, the total sample size was 240. MS Excel sheets were used to create templates, and SSPS software was used for analysis. Results: With the three year data analysis of 240 patients, we came up with the result that nasal masses were more common in age group of <20 years (52%), occurred more in males (68.4%), most of the patients were tribals (72.9%), mostly from rural areas (60%), and maximum of them were diagnosed as antrochoanal polyps (37.9%). Nasal obstruction was the most common presenting complaint (85.8 %), followed by nasal discharge (52.9 % ). Conclusions: Antrochoanal polyps are the most common type of nasal masses, primarily affecting tribal males from rural Jharkhand and causing nasal obstruction. Surgery is the treatment of choice for benign lesions. Certain benign tumors have high potential for malignant transformation while others can present with locally destructive features and deformities.
A Single Arterial Puncture for Blood-Gas Analysis Cause a Rare Complication: Radial Artery Pseudoaneurysm
The radial artery has largely replaced the femoral artery as the first choice for access because of its superior safety profile. Radial artery pseudoaneurysm from arterial wall disruption is an extremely rare complication of arterial cannulation, with a reported incidence of 0.048 percent. The development of PA after radial artery puncture for continuous blood pressure monitoring and serial blood-gas analysis has previously been reported; however, to the best of our knowledge, only one case report of PA development after a single arterial puncture for blood-gas analysis has previously been reported. Identifying potential high-risk patients, ensuring a more prolonged compression in these patients, and close monitoring even after removing the compression bandage/hemostatic device are crucial for the prevention and early identification of this complication.This chapter will give proper information regarding it.
Low Friction Traction for Cervical Spine Dislocation: A Clinical Approach
To reduce the magnitude of the force applied to the skull for treating acute cervical spine dislocation, we developed a method of skeletal traction based on reducing friction forces under the patient's head. The objective is to lower the complications related to skull traction for cervical dislocation. Traction force was applied to the skulls of five patients with cervical fracture dislocations. A difference in friction interface between the patient's head and shoulder girdle was created. The traction weight required to reduce the vertebral dislocation was significantly lower than an expected minimal traction weight in the commonly used techniques (p= 0.013). The presented method permits an effective and safe reduction of the dislocated cervical vertebra by a relatively low traction force.
A Retrospective Study on Rising Trends of Caesarean Section
Background: The indications for Caesarean Section (CS) have changed over time, along with a visible, much-discussed increase in the rate. When performed for a medical reason, C-sections can without a doubt effectively prevent maternal and perinatal mortality. However, there has been little research into the extent of maternal indications and the foetal outcomes of C-sections. Methods: Data from January to March 2012 and January to March 2017 were obtained through a thorough examination of patient files at the hospital's Medical Records Department. To record the relevant information, a pre-designed proforma was used. Standard statistical methods were used to analyse the data. Results: Cephalopelvic disproportion (CPD) and foetal distress (FD) remained the leading causes of CS in both groups, accounting for 50.4 percent in the 2012 group and 60.5 percent in the 2017 group. Trends in CS are emerging as a result of maternal demand and tubal ligations. Though the increase in CS was not significant over the 5-year period, rising from 45.41 percent to 48.81 percent, there was a significant increase in deliveries without complications, rising from 74.8 percent to 88.3 percent. Conclusions: According to the study, there was a non-significant increase in the incidence of C-sections during the study period. Major contributory factors observed were CPD and FD, in which it is imperative to perform C-sections. An emerging trend of patient’s desire/demand emerged as a new indication.
Implant Surgery and Assistant Guide: An Approach towards Surgery and Assistant’s Understanding
Objectives: This study introduces the assistance process of dental hygienists during an implant surgery. The purpose of the study is to promote high-quality implant surgery assistance in order to increase the success rate of implant surgeries. Background: Dental hygienists are service providers with experience, abilities, and a service-oriented mindset. Dental hygienists analyse and confirm the medical history of patients who attend the dental clinic, observe these patients' overall health, and take quick measures when an infectious condition is found in order to cut off the infection path and avoid infection within the dental office. Materials and Method: The authors introduce the implant surgery procedures during the treatment of patient K, who visited Y Dental Department in City G in January of 2020. Surgical procedures and cautions with a focus on the assistance of dental hygienists during a surgery are listed. The roles of a surgical assistant; patient management during surgery; assistive roles in soft tissue incision, retraction, bond preparation, and implant placement; cases that give special attention to suctioning; and medical assistance including sutures are introduced with pictures and explanations. Results: Dental hygienists must maintain accuracy, agility, and composure along with the practitioner when providing assistance. In addition, dental hygienists’ medical assistance affects the amount of time required for surgery; occurrence of trauma during surgery, post-surgery edema and pain, and post-surgery infection; and surgery failure rate. The role of a dental hygienist in assisting implant surgeries is essential. A patient-centered assistance is important, and a dental hygienist must maintain the patient's comfort level and psychological stability through communication with the patient. Conclusion: Dental hygienists’ medical assistance affects the amount of time required for surgery; occurrence of trauma during surgery, post-surgery edema and pain, and post-surgery infection; and surgery failure rate. Clinical Relevance: Introducing dental hygienist assistance and protocols for implant surgery.
Bone Mineral Density and Serum Minerals in Pre and Post-Menopausal Women: A Comparative Study
Background: Osteoporosis is a bone condition that weakens bones and increases the risk of fractures. It literally means "porous bone," and it causes a loss of bone mass and strength. Symptoms and pain are rarely present as the condition advances. The specific reason is unknown, but it can be avoided. Bone breakdown outpaces bone formation after the age of 35, leading in a steady loss of bone mass. Osteoporosis is diagnosed when bone loss exceeds a particular threshold. Bone resorption (breakdown) outpaces bone formation after menopause. Osteoporosis is a silent disease, reflected only in a low bone density, till a fracture occurs. One of the most rapidly emerging health problems in the postmenopausal women is osteoporosis. It is now realized that, osteoporotic fractures are a major cause of morbidity and mortality in India in the elderly women population. Aim: To study the correlation between serum minerals and Bone Mineral Density (BMD) in pre and postmenopausal women. Methods: This study was designed to find out the serum mineral levels and its correlation with bone mineral density in pre and post-menopausal women. The present study was a cross-sectional study. 40 women from each group i.e. premenopausal and postmenopausal women were selected for the study with no medical, surgical or gynaecological abnormalities. The Bone Mineral Density (BMD) was measured by Bone Densitometer and classified as normal, osteopenia and osteoporosis according to T-score. Serum minerals were measured in autoanalyser. The data was analyzed using Microsoft excel 2007. For the comparison of values between the groups, students ,,t" test was used, for the correlation, Pearson"s correlation coefficient was used. Results: Around 80% of the post-menopausal women are osteoporotic. BMD scores were significantly low in postmenopausal women according to T-score along with significantly decreased Serum mineral levels when compared to premenopausal women. There was significant positive correlation between T-score and serum calcium and magnesium levels in postmenopausal women. Conclusions: The present study suggests that peri and postmenopausal women should take magnesium rich foods also like whole grains, legumes, fruits and vegetables (especially dark-green, leafy vegetables) every day which will help to provide recommended intakes of magnesium and maintain normal storage levels of this mineral. If these foods are not available or serum levels are too low supplementation can be given in the form of tablets.
Study about Pleomorphic Lipoma- A Rare Pseudosarcomatous Lesion
Pleomorphic lipoma is a rare benign tumour that can resemble a number of malignant tumours, the most common of which is liposarcoma. This pseudosarcomatous lesion is a rare type of lipoma with benign behaviour. This paper presents two cases of this lesion, one on the thigh and one on the posterior aspect of the neck, as well as a summary of the main clinical and morphological characteristics of this rare tumour. FNAC is the initial investigation for diagnosis, followed by confirmation by histology. Objectives- To highlight importance of different pseudo-sarcomatous lesion in routine cytology.
Determination of Complications using Different Techniques for Parotidectomy for Benign Tumors
Objectives: There are few long-term prospective studies on procedure-related complications following parotid surgery for benign neoplasms (BNs). This is the first prospective study on the use of extracapsular dissection (ECD) for BNs, and its goal was to look at the incidence of postoperative complications following parotid surgery for BN. Methods: We analysed transient and long-term complications from a prospective study of parotidectomy for BN at a university hospital. Results: The rates of transient facial palsy immediately after surgery and 18 months later were 15.0 percent and 3.7 percent, respectively. The rates of immediate postoperative facial palsy in patients who underwent ECD, partial superficial, superficial, and total parotidectomy were 5.8%, 29.3%, 20.0%, and 44.1%, respectively. Multiple and larger lesions, as well as surgery duration and extension, were significant risk factors for facial palsy. Conclusions: Postoperative facial palsy is still a common complication after parotidectomy for BN, and it is related to the extent of the parotidectomy, the presence of multiple neoplasms, and the length of the operation. The findings of this study suggested that ECD could be a safe method of avoiding facial palsy.
Assessing the Treatment of Nonuniting Fracture ICNF with Teriparatide in Young Adult Osteopenic Male
We present a case of fracture intra capsular neck of femur in a young adult osteopenic patient, who had a nonunion and early signs of avascular necrosis even after the initial surgical intervention. Teriparatide was administered for two monthly doses after diagnosis of nonunion and avascular necrosis of femoral neck. 90% successful union was achieved in 2 months without further surgical intervention, and no adverse events related to the use of teriparatide were observed. Our case report shows that teriparatide can be an alternative to surgical intervention in nonunion of ICNF with early signs of avascular necrosis.
A Case Report on Teriparatide Treatment in Non-Uniting Fracture
The purpose of this case report is to elucidate the Indian experience of 5 cases of use of Teriparatide for fracture healing - delayed unions and non-unions and in the setting of osteoporotic fracture. Impaired healing of fractures delays the rehabilitation process, which in turn impacts quality of life. The associated costs cause an economic burden to both the society and the patients. Till date, no systemic treatment is approved for fracture healing. Teriparatide is a synthetic polypeptide hormone consisting of the 1–34 fragment of human parathyroid hormone. Apart from its recognized indication of osteoporosis, there is a growing body of evidence suggesting its ability to accelerate fracture healing and heal non-unions. The primary observation of our case report depicts that teriparatide is a viable therapy not only to treat osteoporosis but also to accelerate fracture healing. Teriparatide therapy accelerates healing, which allows patients to return to normal life and work faster, optimizes medical resource utilization, reduces chances for future second surgery, requirement of bone graft and overall chronic morbidity associated with long-term treatment. Teriparatide therapy has several advantages: it can be recommended for any type of fracture, including those that will be treated non-surgically; it can be started at any time; and it can be used throughout the healing process. Our findings are consistent with those of earlier research that have looked at the impact of Teriparatide on delayed and non-unions in humans.
Incidence of Scrub Typhus in a Tertiary Care Hospital in Kolkata, India: A Cross-sectional Study Approach
Background: Scrub typhus is an endemic disease in India caused by Orientia tsutsugamushi, transmitted by trombiculid mites. It is an important cause of acute febrile illness in India. Signs and symptoms include fever, headache, myalgia and GI symptoms and is generally associated with morbilliform rash (<40%), eschar (<50%) which is due to bite of the mite. Abnormal LFTs and lymphocytosis are commonly seen in early phase of illness. It’s often labelled as PUO. Early diagnosis and prompt administration of therapy mostly leads to complete recovery. Aims: The present study aimed to highlights the incidence of scrub typhus in a tertiary care hospital in Kolkata, India. Methods: Authors screened 100 patients presenting with fever, malaise, headache, with or without rash for more than a week from the month of May to December 2019. Routine blood investigations with fever profile (Dengue NS1 antigen, MP, MPDA, TyphidotM) and cultures were done. Patients in whom no cause of fever could be established, having lymphocytosis, hyponatremia and transaminitis, they were tested for Scrub typhus by using Indirect immunofluorescence & detection of IgM antibody. Results: Total 22 patients were found positive for scrub typhus by using the aforementioned method (22%). Male: Female ratio was 3:4 (9 vs 12). Patients were in the age group of 16-76 years. Lymphocytosis, hyponatremia and transaminitis were cardinal features seen in almost all patients diagnosed with Scrub Typhus. Conclusions: This study will help clinicians to have a stronger suspicion of scrub typhus in undiagnosed febrile patients. Clinically, younger patient population, rapid diagnosis, and prompt treatment may be associated with a shortened disease course and a better outcome.
An Unusual Case Presentation on Giant Non-Functioning Adrenocortical Carcinoma
We herein present a case of giant non-functioning adrenocortical carcinoma without any pressure effects which is a rare entity. Adrenocortical carcinoma is a rare tumour with incidence of 1 per million all over the world. Age distribution is bimodal with peaks occurring at 5-20 years and 40-50 years. Tumours greater than 9 cm commonly involve inferior vena cava (IVC) or right side of heart. 80 percent of the carcinomas are functional. We describe a case report of a rare tumour of a non-functioning adrenocortical carcinoma in a 40 year old female having incidence of 0.5/million world over with no extra-adrenal spread at presentation without IVC or right heart involvement in spite of having a large size of 12 cm. Patient underwent successful surgical extirpation with adjuvant radiotherapy with regular follow ups and disease free survival since the surgery. It is imperative to determine hormone levels in symptomatic and asymptomatic patients with adrenal masses. In a functioning or non-functioning tumour, the likelihood of adrenocortical cancer should not be discounted. All solid incidentalomas more than 5 cm in size on computed tomography (CT)/magnetic resonance imaging (MRI) should be surgically removed, with adjuvant therapy considered following histological evaluation.
Determination of Endoscopic Stapedotomy Technique and Its Audiological Outcome
Background: Since 2011, endoscopic stapedotomy for otosclerosis has been performed in Sudan, with a growing number of patients. The clinic-demographic aspects of otosclerosis are described, as well as the surgical approach and hearing outcome following endoscopic stapedotomy, in this prospective hospital-based study that runs from November 2016 to November 2020. Results: Total number included in the study was 91 patients. Females were 48, and males were 43 with a female to male ratio of 1.1:1. Age ranged from 19 years to 52 with a mean age of 30.6± 7 SD years. The main symptom was decreased hearing in all patients (100%); in 82 patients (90%), it was bilateral, followed by tinnitus in 80 patients (88%) while two patients (2.2%) had vertigo. Family history was stated by 2 patients (2.2%) only. Audiological assessment by pure tone audiogram (PTA) for each ear (total of 182) revealed that conductive hearing loss (CHL) is the commonest type of hearing loss in 148 ears (81.3%), mixed type in 30 ears (16.5%), while 4 ears (2.2%) were normal. Endoscopic stapedotomy was performed for 74 patients; this technique was safe; few complications were managed successfully: one gusher and one revision, with no facial nerve injury. Majority of complications happened during the first year. Mean air bone gap (ABG) gain was 23.3± 7.2 dB, air conduction (AC) gain was 18.3 ± 8 dB, and Carhart notch disappeared in 79.5%. Conclusions: Endoscopic stapedotomy is a safe and effective procedure with a steep learning curve and a satisfactory hearing outcome. The air bone gap (ABG) gain was comparable to international studies.
Study on Randomized Clinical Trial Comparing Manual Suture and Different Models of Mechanical Suture in the Mimicking of Bariatric Surgery in Swine
Background: Variations in surgeon ability provided as impetus for the invention of technologies that, by overcoming individual disparities, allow for proper execution of methods and the best potential end result. For a procedure to be adopted and recognised as effective, it must be reproduced consistently by the majority of surgeons. Aims: The aim of this study was to compare the results, from the point of view of anatomic pathology, of manual sutures versus mechanical sutures using different models of linear mechanical staplers, in the procedure of gastroenteroanastomosis and enteroanastomosis in swine. Methods: Thirty-six healthy, adult, male Sus scrofa domesticus pigs, weighing between 20.7 and 25.5 kg, were used. The swine were randomly divided into four groups of nine pigs, according to the type of suture employed: group A, manual suture with Polysorb® 3-0 wire; group B, 80-shear linear stapler (Covidien® Gia 8038-S); group C, 75-shear linear stapler (Ethicon® Tlc 75); and group D, 75-shear linear stapler (Resource® Yq 75-3). Results: Observations during the histopathological analysis included the formation of foreign body granuloma in the gastroenteroanastomosis and enteroanastomosis in 88.9% of the swine that underwent manual suture and in none of the swine that underwent stapling. There was also a significant statistical difference among swine from Group A, and those from groups B, C and D regarding the degree of inflammation, being more intense in those swine that underwent manual suture. Although the results were not statistically significant, closing anastomoses in swine with mechanical sutures has the advantage of avoiding the need to breach the intestinal wall within the cavity, minimising the risk of peritoneal cavity contamination. Conclusion: This study shows that both types of suture promoted proper healing of gastroenteroanastomosis and enteroanastomosis, although there was a higher degree of inflammation and an increased occurrence of foreign body granuloma in swine subjected to manual suture, although there have been similarities in safety, efficiency, and effectiveness between the models of linear mechanical staplers tested during the performance of these anastomoses on swine.
A Rare Entity on Paediatric RCC with Sarcomatoid Variation
Background: Malignant renal masses in paediatric age group are mostly Wilms’ tumour. RCC is very rare in this age group, papillary variant being the most common. Sarcomatoid variation occurs in 5% of adult RCC, while it is extremely rare in children. No treatment protocol exists in the management of paediatric RCC. Aims: We present a case of 10-year-old child presenting with an asymptomatic left flank mass. Case Presentation: Here, we present a case of 10-year-old female who presented with left flank mass. Radi- cal nephrectomy was done which showed clear cell carcinoma with sarcomatoid variant on histopathological examination. Conclusion: Children can develop RCC with sarcomatoid variant. However, more research and long-term follow-up are required before a therapy strategy and prognostication criteria can be developed.
Histopathology of Nephrectomy Specimens in a Tertiary Care Hospital, India: A Review
This study was undertaken retrospectively in the Department of Pathology, GMC Jammu, over a two-year period to determine the Histopathological spectrum of illnesses observed in these obtained nephrectomy specimens and compare it to other studies. 70 nephrectomy specimens were obtained in total. Males accounted for 40 (57%) of the cases, while females accounted for 30 (43 %). The cases ranged in age from 3 to 70 years old. The age range 41-50 years had the highest percentage of patients. Non-neoplastic tumours were the most common (62 instances), followed by malignant tumours, and benign tumours were the least common. The most prevalent inflammatory illness for which nephrectomy was performed was chronic pyelonephritis (30 instances). The most common malignant tumour was clear cell renal carcinoma, which had three occurrences. The most prevalent clinical complaint was pain in the flanks. There were more non-neoplastic lesions than neoplastic ones. The most common histological diagnosis was chronic pyelonephritis. Among the malignant tumours, renal cell carcinoma was the most common.