iosr-JDMS   Volume-19 ~ Issue-7 ~ JuLy 2020

Abstract: A pontine stroke could be missed on the initial brain imaging and Hoover's sign often fails to differentiate between organic and functional limb weakness. We present a case of a 58-years-old lady who initially was thought to have a functional weakness which later turned out to be left hemi pontine infarct. She presented to the emergency department with right hemiplegia. On physical examination, she had muscle power of MRC grade 0/5 on her right upper and lower limb. Although brain imaging on admission to the hospital was normal with positive Hoover's sign and hand on face drop test, repeat imaging revealed a subtle left hemi pontine ischemia which 6 days later turned into an established infarct due to fusiform aneurysmal dilatation of the basilar artery. The final diagnosis was left hemi pontine infarct. Perseverance with repeat brain imaging saved a near-miss for the medical team.......

[1]. Ourania V, Michael S. S., Catarina D.F., et al. Stroke recovery and reduction following acute isolated bilateral ischaemic pontine infarction: a case report. BMC Research Notes 7; Article number: 728 (2014)
[2]. H Ay, F S Buonanno, P W Schaefer, et al. Normal diffusion-weighted MRI during stroke-like deficits. PMID: 10371524; DOI: 10.1212/wnl.52.9.1784
[3]. P.N. Sylaja, Shelagh B. C., Andrea K., et al. When to expect negative diffusion-weighted images in stroke and transient ischemic attack. PMID: 18420957; DOI: 10.1161/STROKEAHA.107.497453
[4]. Gargya M, Dinesh V. J. Pontine infarction. Ncbi.nlm.nih.gov/books/NBK554418/
[5]. Cheng X., Hui-Sheng C., Shi-Wen W., et al. Etiology of isolated pontine infarctions: a study based on high-resolution MRI and brain small vessel disease scores. BMC Neurology 17; Article number: 216 (2017)

Abstract: The number of patients with heart failure presenting for surgery continues to rise, and anesthesiologists are increasingly being called upon to provide quality, safe care in the operating room for patients with low ejection fraction (EF). Perioperative goals in the management of these patients include maintaining forward flow, promoting inotropy without inducing or exacerbating ischemia, and returning patients to their preoperative level of function after surgery. In this paper we present a report of 58 Year old covid suspect patient who underwent surgery twice, once under general anesthesia and secondly,under a low dose spinal anesthesia....

Key words: low ejection fraction (EF), Covid suspect, Low dose spinal

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Abstract: Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory lung disease that causes obstructed airflow from the lungs caused by long term exposure to irritants like smoking etc. Emphysema and chronic bronchitis are the two most common conditions that contribute to COPD(1). Symptoms begin with intermittent coughing and shortness of breath. In the later stage, fatigue, weight loss and pedal edema may occur. Now a days, COPD is well-established term for obstructive lung function impairment and has become the third most common cause of death year 2020. Burden of COPD is great for both for those directly affected and for society. The majority of the COPD patients dependent on home oxygen treatment are former smokers and resembles just the top of an iceberg, since predominantly advanced cases of COPD get hospital care(1,2). Several epidemiological studies......

[1]. Lopez AD, Shibuya K, Rao C, Mathers CD, Hansell AL, Held LS, et al. Chronic obstructive airway disease: Current burden and future projections. Eur Resp J 2006;27:397‑412.
[2]. Salvi S, Agarwal A. India needs a national COPD prevention and Control program. J Assoc Physicians India 2012;60 Suppl: 5‑7.
[3]. Jindal SK, Aggarwal AN, Gupta D. A review of the population studies from India to estimate national burden of chronic obstructive pulmonary disease and its association with smoking. Indian J Chest Dis Allied Sci 2001;43:139‑47.
[4]. Hardie JA, Buist AS, Vollmer WM, Ellingsen I, Bakke PS, Morkve O. Risk of over- diagnosis of COPD in asymptomatic elderly never-smokers. Eur Respir J 2002; 20(5):1117-1122
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Abstract: Background: The computed tomographic evaluation of a clinically obvious mass in the oral cavity is difficult due to the close apposition of mucosa of the oral cavity. For the detection of "hidden" masses in radiology, contrast distension techniques have been attempted. Materials and Methods This hospital based observational study was carried out in a tertiary care teaching hospital of Karnataka. A total of 10 patients with a histological diagnosis of primary squamous cell carcinoma of the oral cavity were included in the study. Serial contiguous 3-mm axial and coronal computed tomographic scan images were obtained before and after distending the oral cavity using air and water. For achieving air distension, the subjects were asked to perform a modified Valsalva manoeuvre during the scan image acquisitions. Approximately 40 mL of water.......

Key Words: Computed tomography, Oral cavity distension, Squamous cell carcinoma

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Abstract: Aim: The study was conducted to investigate the incidence, causes and delivery methods of iatrogenic preterm births. Material & Methods: It was a one year retrospective study conducted in the Department of obstetrics and gynecology, IGMC Shimla, Himachal Pradesh from 1st August 2017 to 31st July 2018. All mothers who had iatrogenic preterm deliveries between 24 to 37 weeks were included in the study. The data was collected from the motherscase sheet. Parametric and non-parametric test of significance were used to find the association between different quantitative and......

Key words: cause, delivery method, iatrogenic preterm birth, incidence, preterm birth

[1]. RussellRB,GreenNS,SteinerCAet al.Costofhospitalization forpretermandlowbirthweightinfantsintheUnitedStates. Pediatrics 2007; 120: 1–9.
[2]. Wen SW, Smith G, Yang Q, Walker M. Epidemiology of pretermbirthandneonataloutcome.Semin Fetal Neonatal Med 2004; 9: 429–35.
[3]. Institute of Medicine. Preterm Birth Causes, Consequences and Prevention. Washington DC: National Academies Press, 2007.
[4]. Mathews TJ, Menacker F, MacDorman MF. Infant mortality statisticsfromthe2002period:Linkedbirth/infantdeathdata set. Natl Vital Stat Rep 2004; 53: 1–29.
[5]. Hack M, Flannery DJ, Schluchter M, Cartar L, Borawski E, Klein N. Outcomes in young adulthood for very-low birthweight infants. N Engl J Med 2002; 346: 149–57.

Abstract: Background: Intramedullary nailing is gold standard for femoral shaft fractures fixation with good apposition with minimal tissue damage. Patients can start with immediate rehabilitation and with fewer complications. The optimal entry point for antegrade intramedullary nailing of femoral shaft fractures has been the topic of debate. Since the study by Ricci et al, there have been a number of randomized, controlled trials (RCTs) and cohort studies comparing the efficacy of the 2 entry points on various patient-and procedure-related outcomes. The piriformis fossa and greater trochanter has been commonly described as starting points for antegrade femoral nailing. Materials and Method......

Key Word: Fracture shaft femur,Antegrade Nailing, GT entry, Piriformis entry

[1]. Winquist RA, Hansen ST, Clawson DK. Closed intramedullary nailing of femoral fractures. A report of five hundred and twenty cases. J Bone Joint Surg Am. 1984;66:529–539.
[2]. Christie J, Court-Brown CM, Kinninmonth AWG, et al. Intramedullary locking nails in the management of femoral shaft fractures. J Bone Joint Surg Br. 1998;70:206–210.
[3]. Starr AJ, Hay MT, Reinert CM, et al. Cephalomedullary nails in the treatment of high-energy proximal femur fractures in young patients: a prospective, randomized comparison of trochanteric versus piriformis fossa entry portal. J Orthop Trauma. 2006;20:240–246.
[4]. Grechenig W, Pichler W, Clement H, et al. Anatomy of the greater femoral trochanter: clinical importance for intramedullary femoral nailing. Anatomic study of 100 cadaver specimens. Acta Orthop. 2006;77: 899–901.
[5]. Simonian PT, Chapman JR, Selznick HS, et al. Iatrogenic fractures of the femoral neck during closed nailing of the femoral shaft. J Bone Joint Surg Br. 1994;76:293–296.

Abstract: Background: The use of triple therapy regimen for Helicobacter pylori (H. pylori) eradication is a highly efficacious, gold standard regimen. In the current study we have evaluated the H. pylori eradication rate following a triple therapy regimen that include pantoprazole, clarithromycin, amoxycillin. Objectives: To evaluate the efficacy, safety and compliance of a triple therapy regimen with a PPI, amoxicillin and clarithromycin for the eradication of H. pylori . Materials and methods: A total of 140 patients diagnosed with dyspepsia and H. pylori infection as documented by the rapid urease test (RUT) were treated with the following triple therapy regimen: pantoprazole (40mg ,12h), amoxycillin (1000 mg/12h),clarithromycin.......

Key words: Helicobacter pylori, eradication, rapid urease test , triple therapy regimen

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[5]. Bigard MA, Delchier JC, Riachi G, Thibault P, Barthelemy P. One-week triple therapy using omeprazole, amoxycillin and clarithromycin for the eradication of Helicobacter py- lori in patients with non-ulcer dyspepsia: influence of dos- age of omeprazole and clarithromycin. Aliment Pharmacol Ther 1998;12:383-8..

Abstract: Background- To identify the relationship between hemoglobin (Hgb) or hematocrit (Hct) level and dural sinus density using unenhanced computed tomography (UECT). Methods-100 Patients who were performed UECT and had records of a complete blood count within 24 hours from UECT were included. We measured the Hounsfield unit (HU) of the dural sinus at the right sigmoid sinus, left sigmoid sinus and 2 points of the superior sagittal sinus. Results-The mean densities of the dural sinuses ranged from 26.00 to 58.75 HU (mean= 48.13 HU). There was a strong correlation between mean density and Hgb level (r=0.52) and between mean density and Hct level (r=0.84)......

Keywords- Dural sinus, density, CT, hemoglobin, hematocrit

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Abstract: Background: Diabetic Foot Infections (DFI) are a major cause of significant morbidity and put a high economic burden on patients and health care facilities. The mortality rate due to diabetes and its related complications increased by 131% from 1990 to 2016.Neutrophil to lymphocyte ratio(NLR) is an indicator of physiological stress, immune response and systemic inflammation. Studies showed that NLR can predict the prognosis of various inflammatory conditions. In this study, we evaluated the value of NLR as a prognostic marker in DFI. Materials and Methods: This prospective study was conducted on 265 patients admitted to S.V.R.R.G.G. Hospital, Tirupati, with the diagnosis....

Keywords: neutrophil to lymphocyte ratio, diabetic foot infections, prognosis amputation, mortality.

[1]. International Diabetes Federation. IDF Diabetes Atlas, 8th edn. Brussels, Belgium:International Diabetes Federation,2017. http://www.diabetesatlas.org
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[3]. Lavery, L. et al. Risk Factors for Foot Infections in Individuals With Diabetes. Diabetes Care (2006).
[4]. Infectious Diseases Society of America. Clinical practice guideline for the diagnosis and treatment of diabetic foot infections. Clin Infect Dis 2012;54: e132-73.
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Abstract: Aim: To compare traditional method of demonstration of teaching knee joint examination with a video assisted method on medical students. Methods: The study was conducted on 120 medical students on Phase 2 of their curriculum at Travancore Medical College, Kollam. The students were divided into 6 subgroups of 20 each. Then 10 of each groups were taught knee joint examination in direct clinical demonstration way and the latter half by video assisted demonstration. Post evaluation OSCE was conducted. Then cross over done. Also student perceptions were collected using a validated feedback questionnaire. Results: The students were able to understand the examination of knee joint better when demonstrated along with visual aided method. The students identified video assisted method as the more interesting one.....

Keywords: knee joint examination, video assisted learning, teaching-learning technology

[1]. Sood R. Medical education in India. Med Teach [Internet]. 2008 Jan 3 [cited 2019 May 9];30(6):585–91.
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[3]. Smith TL, Ruocco A, Jansen BJ. Digital video in education. Proceedings of the ACM Computer Science Education Conference, New Orleans. 1999:122–126.
[4]. Paalman J. New frontiers in Anatomy education. Anat Rec (New Anat) 2000;261:47.
[5]. Galvan SM, Visciglio S, Andreotti C. The effects of the use of image technologies in the learning of factic subjects upon students of vetinary anatomy. Rev Chil Anat. 1999;17:1–15..

Abstract: This paper aims at developing a Level of Service (LOS) model for unsignalized intersection crosswalks for pedestrians from the perspective of the pedestrian's perception of comfort and safety in unsignalized intersection environment. Firstly, the potential primary factors influencing pedestrian LOS at crosswalk were summarized from three respects: traffic conflicts, crossing facilities and delay. Secondly, data for the model were collected, including 124 participants real-time sense of comfort and safety when they crossing the selected intersection crosswalks and the design and operational characteristics of the selected intersection. The above mentioned data's are obtained by conducting questionnaire and videographic survey in the selected intersection. The study area for research work is taken at Ernakulam district of Kerala, India which includes a two three legged intersection (Angamaly LF intersection.....

Keywords: Pedestrian, Level of Service, Crosswalks, Unsignalized Intersection, Junction Improvement

[1]. Archana.G and Reshma.E.K, Analysis of pedestrian level of service for crosswalk at intersection for urban condition,2013.
[2]. YiangBian, Jian Lu, Method to determine pedestrian level of service for unsignalised intersection,2013.
[3]. RakeshWahane, ME student, Pedestrian level of service at intersection in Bhopal city,2017.
[4]. Muraleetharan, Method to determine pedestrian level of service for crosswalk at urban intersection,2015.
[5]. B.RaghuramKadali, P Vedagiri, Evaluation of pedestrian crosswalk level of service in perspective of type of landuse,pert A73.

Abstract: Background: Pituitary adenomas are a group of tumors that arise from the pituitary gland, these comprise 12 - 15 % of intracranial tumours and are mostly benign. These are the commonest cause of optic chiasm compression in adults. Pituitary adenomas are described by their size radiologically with CT or MRI as macroadenoma ≥10mm and microadenoma <10 mm. Suprasellar extension causes impairment of vision in one or both eyes with a visual field loss involving the upper temporal quadrants, bitemporal hemianopia. Materials and methods: 40 patients who were diagnosed to have pituitary macroadenoma by CT or MRI were included in the study. All patients.....

Keywords: Pituitary adenoma, Bitemporal hemianopia, Bilateral superotemporal quadrantanopia, temporal hemianopia.

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Abstract: Arteriovenous malformations (AVMs) are developmental vascular anomalies that occur when the embryonic vascular network fails to differentiate. It is composed of abnormal communications between arteries and veins without a normal intervening capillary bed. Lymphatic, capillary, venous and AV malformations make up a majority of vascular malformations. Diagnosis of these lesions is essential and management of maxillofacial AVMs remains challenging. In this article, we report a case of 21-year-old female patient with arteriovenous malformation involving the right side of the face and oral cavity.

Keywords: Arteriovenous malformations,hemangioma, vascular lesion

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Abstract: Background:-Supracondylar fractures of the humerus are common in paediatric ageand needs adequate treatment to prevent complications like cubitusvarus/ valgus, elbow stiffness, neurovascular damages, compartment syndromeand Volkmann's ischaemic contracture.This study aimed to evaluate the clinical and radiologicaloutcomes and complications following close reduction and crossed percutaneous pinningoftype II & III (modified Gartland classification) supracondylar fractures of humerus in children (5-15 years age). Methods:- :-This prospective interventional study was conducted in Department of Orthopaedics at a tertiary referral hospital of western Rajasthan from June 2018 to November 2019. Study was done on 50children aged 5-15 years with supracondylar fracture of the humerus selected, who were managed byclosed reduction and percutaneous pinning (crossed).The minimum duration of follow up was 6 month. After assessing fracture union with serial radiographs, range of motion, carrying angle,final outcomes were evaluated by Modified Flynn's criteria....

Keywords: Supracondylar fracture, closed reduction, percutaneous pinning, humerus

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