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Tuberculosis of the lymph nodes: Many facets, many hues
Avinash Gandhare, Ashok Mahashur
July-September 2017, 4(2):80-86
Lymph node tuberculosis (LNTB) is one of the most common extrapulmonary manifestations of tuberculosis. A high index of suspicion is needed for diagnosis of tuberculous lymphadenitis, which is known to mimic numerous pathological conditions. Availability of molecular technology has improved the ease of diagnosis. Molecular techniques are also useful for the early detection of drug resistance. With the advent of endobronchial ultrasound in the last decade, the diagnosis of mediastinal tuberculosis has also improved. Management of LNTB often has difficulties. However, most cases can be managed medically and surgical intervention is rarely required. The treatment is similar to pulmonary tuberculosis. However, paradoxical reaction, which is observed in 10–15% of immunocompetent and about 50% of human immunodeficiency virus positive patients needs a special mention for an appropriate management of LNTB.
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Radiology of ventilatory, feeding, and circulatory lines and tubes in the critically sick
Narainder K Gupta
July-September 2014, 1(2):104-123
A variety of supportive ventilatory, feeding and circulatory devices are employed in the management of critically sick patients. The hardware ranges from endotracheal, tracheostomy and chest tubes, nasogastric and nasoenteric feeding tubes, to central venous lines, umbilical venous and arterial catheters, pacers and automatic implantable cardioverter defibrillators, intraaortic balloon pumps and ventricular assist devices. The accurate positioning of this hardware is critical to the well being of a patient. However, these devices may not be positioned appropriately. Faults may occur at the time of their insertion, or the hardware may get dislodged while in use. A portable chest radiograph can be extremely useful in identifying such mishaps. This pictorial review captures some of the critical scenarios which must be known to radiologists and the treating intensivists.
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Textbook of prosthodontics
SP Aggarwal
July-September 2014, 1(2):161-161
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Development of post graduate program in emergency medicine in India: Current status, scope and career pathways
Manish Jain, Bipin Batra, Elizabeth G Clark, Tamorish Kole
October-December 2014, 1(3):218-221
Recent epidemiologic and demographic public health data highlight the growing need for emergency medicine (EM) services in India and highlight its importance as a recognized medical specialty. Developing a comprehensive and recognized EM program for training physicians in India is of utmost priority and should not be neglected at any point of time. This review article attempts to highlight the development of a post-graduate program in EM in the country.
  5,952 329 1
Diagnostic approach to histopathology of central nervous system papillary tumors
Ishita Pant, Sujata Chaturvedi
July-September 2014, 1(2):124-131
Tumors of the central nervous system (CNS) exhibiting a papillary pattern constitute a remarkably diverse group of neoplasms that can occur at virtually any site and in patients of any age. Since the first classification of nervous system tumors in 1926, formulated by Percival Bailey and Harvey Cushing based on the presumed parallels between embryologic and neoplastic cells to the World Health Organization (WHO) classification of tumors of the CNS 2007, CNS tumors have come a long way. WHO classification of tumors of the CNS 2007, lists several new entities. However, despite the advancements and the rapid progress with various classification systems in place, as a first step, brain tumors are still characterized largely by the typical patterns and their histopathological features. This pictorial essay represents the histopathology of one of these patterns comprised of various papillary tumors of the CNS, highlighting the diagnostic approach.
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Types of observational studies in medical research
Rajeev Kumar, Amir Maroof Khan, Pranab Chatterjee
July-September 2014, 1(2):154-159
Study design forms a core component of research, mainly determined by the study objectives, and it in turn further decides the type of statistical analyses to be carried out. Observational studies are devoid of the investigator's control over assignment of a subject to the treated or control group, in contrast to interventional studies Even though randomized controlled trials are seen as the best study design, evidence shows that properly conducted observational studies give similar results, and is relevant in medical research where ethics and feasibility concerns assume great significance. Observational studies point out towards possible causal associations, are less resource intensive than trials and have a better external validity. This review article discusses various types of observational study designs such as case reports, cross sectional, cohort, case-control and nested case-control studies with real literature examples.
  4,838 682 1
Drug-induced diffuse hair loss in females: An observational study
Taru Garg, Pravesh Yadav, Soumya Agarwal, Vibhu Mendiratta
July-September 2014, 1(2):80-83
Introduction: A large number of drugs may interfere with hair cycle and produce diffuse hair loss (DHL). This needs to be identified, as it may lead to poor compliance with the drug regimen. Material and Methods: History of drug intake in the recent past was taken from 255 females presenting with DHL. Sixty-seven patients (26.2%) revealed a history of drug intake. Out of these, a detailed history about nature and duration of drugs was taken from 57 patients (22.3%) who had a history of drug intake preceding the onset of DHL or had a history of aggravation in preexisting hair loss following drug intake. Results: Duration of DHL ranged from 1 month to 5 years with a mean duration of 9.8±13.1 months. The mean duration of drug intake was 49.1±80.8 months. History of intake of 100 suspected drugs was available, most common group being antihypertensives (23%), followed by hormones (12%), nonsteroidal antiinflammatory drugs (11%), antidiabetic (8%), oral contraceptive pills (6%), antitubercular treatment (5%), tricyclic antidepressants (4%), and vitamin supplements (4%). Among individual drugs, thyroxine (10%) was the most commonly implicated agent followed by amlodipine (5%), Amitriptyline (4%), atorvastatin, aspirin, metformin, ibuprofen, and vitamin B complex (3% each). Conclusions: Drugs should be suspected as a cause of DHL in females and a detailed history about the nature and duration of drug intake should be taken in such patients.
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Combating corruption in health care organizations: Methods, tools, and good practices
Sujata Chaturvedi
July-September 2014, 1(2):150-153
Although corruption in health care reflects the ills of the society in general, some key areas to be focused upon are as follows: procurement processes; the so-called 'speed money'; theft, pilferage and malpractices; and staff recruitment. Each organization needs to devise its own mechanisms for transparency and accountability in procurements. A two-bid system of technical and price bid, asking for users' list, demonstration, or onsite visits to ascertain the functioning of equipments, 'Publish What You Pay' type of initiative, participation of users as in Rogi Kalyan Samitis, anticorruption networks are some of the tools to address corruption in hospital procurement. The menace of informal payments or speed money can be addressed by encouraging and facilitating users' feedback, involving hospital neighborhoods in anticorruption squads and having CCTV surveillance in key areas. Theft, pilferage, and malpractice siphons off goods and services meant for the ailing. Administrative vigilance and strict handling of the instances reported may serve as a deterrent. Having a labor law professional or a trustworthy NGO on the panel may help reduce corruption, especially seen in the case of contractual jobs. Phenomenon of corruption is difficult to capture in a single definition or measure. Sincere, intense, and sustained anticorruption measures have to be adopted and pursued by health care facilities top-down as well as bottom-up, providers as well as users, ex ante as well as post facto. All anticorruption measures have a use-by-date to them. Innovations would be required. Key ingredient would be sincerity of the management.
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Foreign bodies in maxillary sinus: Causes and management
Shilpi Agarwal, Sanjeev Kumar
July-September 2014, 1(2):89-92
Foreign bodies in maxillary sinus, whatever their origin or nature, are unusual. However unilateral unexplained chronic rhinosinusitis should arouse clinical suscipicion. The diagnosis is based on radiological findings. The range of such foreign bodies is wide; those of dental origin such as tooth roots, burs, dental impression material, root-filling materials, dental implants, and needles take precedence over all others, but rarely, they may relate to blast injuries and penetrating objects. This special report highlights the unusual case of a pressure cooker nozzle lodged in maxillary sinus of a 28-year-old female who suffered a facial injury caused by explosion of a pressure cooker at home. The acuteness of the event and the flight of the foreign body were such that neither the casualty felt the ingress of foreign body nor was the diagnosis entertained by the surgeon who first examined her. Each blast injury therefore must be thoroughly evaluated for such possibility. While a radiological examination can clinch the diagnosis, treatment lies in endoscopic or surgical foreign body removal, with Caldwell luc procedure being a preferred technique.
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The uncommon syndrome of pancreatic encephalopathy
Saumya H Mittal, Salony Mittal, Tuhina Govil
January-March 2016, 2(4):185-186
Even though first described in 1923, the syndrome of pancreatic encephalopathy is an uncommon complication of acute pancreatitis. A multiple organ dysfunction syndrome, it generally occurs in early stage of severe acute pancreatitis and carries a high mortality of up to 57% and more. The syndrome must be distinguished from Wernicke encephalopathy, which may follow as a part of neurological complications in the last or restoration stage of acute pancreatitis, and occurs as a result of long fasting, hyperemesis and total parenteral nutrition without thiamine. Poorly recognized by clinicians, a large dose of Vitamin B1 is effective in the management of Wernicke encephalopathy. The present article draws attention to the two lesser recognized complications of acute pancreatitis and briefly dwells on their pathogenesis and management.
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Marriott's practical electrocardiography
Anupam Goel, DM Cardiology
July-September 2014, 1(2):160-160
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Spectrum of histopathology in spinal lesions
Ishita Pant, Sujata Chaturvedi
January-March 2016, 2(4):187-199
Spinal lesions are broadly categorized as lesions encountered in the spine and epidural space, lesions of spinal meninges, lesions of spinal nerve roots, and lesions of spinal cord. These are further sub classified into congenital malformations, inflammatory disorders, degenerative and reactive processes, cystic lesions, vascular malformations, and neoplasms. This pictorial essay highlights the histopathology of these lesions along with the clinical and radiology findings, where relevant.
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Allergic contact dermatitis in children: Culpable factors, diagnosis and management
Taru Garg, Pravesh Yadav, Surekha Meena, Ram Chander
April-June 2014, 1(1):33-40
Allergic contact dermatitis (ACD) is not uncommon in children. Prevalence of ACD was previously thought to be low in children and adolescents, but of late increased prevalence has been reported. Actual increase in the prevalence could be due to increased recognition of the disease or due to other factors such as changes in lifestyle. Various factors such as age, gender, atopy, social and cultural practices, habits of parents and caregivers, and geographical changes may influence the prevalence and pattern of ACD in children. It can significantly affect the quality of life among children. ACD can affect various sites, including hands, face, neck, axillae, trunk, anogenital region, thigh, feet, and others, depending on the site of exposure to allergen. Common allergens implicated in childhood ACD include nickel, cobalt, potassium dichromate, mercury, aluminium, skin care products, fragrances, neomycin, dyes, preservatives, rubber, and so on. Identification of the implicated allergen is vital as the patient may experience recurrent episodes of dermatitis in the absence of avoidance of allergen. Patch testing is by far the commonly used method of identification of the causative allergen. The only etiologic treatment is elimination of the contact allergen. The patients/parents should be informed about the identity of the offending agent and the possible sources of the sensitizer. Topical steroids used in the acute stage and topical calcineurin inhibitors along with oral H1-antihistamines to alleviate itching are the mainstay of treatment. In widespread and severe cases, systemic corticosteroids may be indicated for a short period of time. The prognosis of ACD is dependent on its cause and the feasibility of avoiding repeated or continued exposure to the causative allergen.
  3,013 264 -
Breast pathologies: Kaleidoscope of conventional mammography, sonography, magnetic resonance mammography, and histopathology features
Seema Sud, TBS Buxi, Samarjit Ghuman, Shashi Dhawan, Ruhani Doda, M Chandra
July-September 2014, 1(2):132-143
Breast can be the seat of a number of benign and malignant pathologies. Even though digital mammography - with or without correlative ultrasonography - is still largely the mainstay of breast imaging, the newer technique of magnetic resonance mammography has come of age. Capable of capturing wide and varied morphology of diverse breast lesions, it can contribute in a major way to the diagnosis and management of some patients. Characteristic magnetic resonance mammography features can help obviate the need of a biopsy in lesions like hamartomas, and benign virginal hyperplasia, whereas in conditions like invasive lobular carcinoma and Paget's disease, it can make a significant difference to the surgical plan. This pictorial kaleidoscope presents the imaging and histopathology characteristics of many usual and unusual breast lesions.
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Containing leprosy: Current epidemiological status, detection and management strategies, and experiences at a tertiary level center
Sandeep Arora, Sukriti Baveja, Aradhana Sood, Gulhima Arora
April-June 2014, 1(1):23-27
Leprosy, an infectious disease, described since ancient times and endemic in India since then, has been eliminated (elimination defined as a prevalence of less than 1 case per 10,000 population) as a public health problem in December 2005. World Health Organization and National Leprosy Eradication Program (NLEP) have now focused on reducing the disease burden in the population. Data indicates that annual fresh case detection rate remains high with a high incidence of multibacillary cases. A review of present NLEP figures and those reported in a number of studies reflect a discordance and caution by dermatologists. A review of present policy, epidemiological status in the population, and our experience is presented. Data from Base Hospital, Delhi Cantonment, over the past 3 years, including patients treated as well as those on surveillance is presented. A higher incidence of paucibacillary cases was seen, with a high incidence of pure neuritic involvement (15%), reactions (24.7%), and deformities (28.37%). Tenosynovitis was observed with increasing frequency. Future challenges in containing the epidemic to reduce the disease burden in population will require regular assessment of treatment measures, especially the use of fixed drug therapy as well as rehabilitation of the affected. Dermatologists shall play a central role in any such endeavor in the management of this disease.
  2,737 384 1
Recognizing ulegyria—the lesser known form of hypoxic ischemic encephalopathy
Manish Kumar, Rohini Gupta, Bhawna Kaul, Yatish Agarwal
January-March 2016, 2(4):209-210
Derived from the Latin term ule, which means scarring, ulegyria is a manifestation of hypoxic ischemic encephalopathy. Recognizable on the magnetic resonance imaging sequences because of its characteristic features, the diagnosis is critical from the standpoint of clinical management. Seizures caused by ulegyria are refractory to pharmacotherapy and often do well with surgery.
  2,749 349 1
Multihued complications in acute pancreatitis: A kaleidoscopic retrospective
Swarna Gupta Jain, Brij Bhushan Thukral, Avneet Singh Chawla, Shalabh Jain, Yatish Agarwal
April-June 2014, 1(1):50-55
Acute pancreatitis is a diffuse inflammatory process in and around the pancreas triggered by the leakage of activated pancreatic secretions. It may remain localized within the pancreatic glandular tissue or spread to involve the adjacent or remote tissue planes and organs. Since the morbidity and mortality of acute pancreatitis is closely related to the extent of intra- and extra-pancreatic complications, cross-sectional contrast-enhanced computed tomography (CECT) imaging plays a major role in assessing the complications, stratifying the severity, and thus, prognosticating the outcome. Early diagnosis of complications allows for timely institution of specific measures that can help decrease the morbidity and mortality. This kaleidoscopic retrospective presents the complications of acute pancreatitis on CECT. The essay may benefit family physicians, surgeons, gastro-intestinal (GI) surgeons and GI physicians who manage such patients in their clinical practice, besides drawing the attention of residents and fellows practicing GI radiology.
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Setting course for a global medical varsity and third generation reforms in medical education
Yatish Agarwal, Bipin Batra
October-December 2015, 2(3):107-110
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Management of maxillary anterior supernumerary teeth
IE Neena, Mebin G Mathew, P Poornima, KB Roopa
January-March 2017, 3(4):231-233
Supernumerary teeth may be defined as any teeth or tooth substance in excess of the usual configuration of 20 deciduous and 32 permanent teeth. Their prevalence in primary dentition has been recorded variously between 0.3% and 0.8%, and between 0.1% and 3.8% in relation to permanent dentition. They may be a part of number of developmental disorders such as cleft lip and palate, cleidocranial dysostosis, Gardner's syndrome, Fabry Anderson's syndrome, Ehlers–Danlos syndrome, incontinentia pigmenti, and Trico Rhino-Phalangeal syndrome. If neglected, they can be the harbinger of a number of esthetic and pathologic complications. The management is dodged with several controversies.
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Current strategies in the diagnosis and management of resectable gastric adenocarcinoma
Savio G Barreto
April-June 2014, 1(1):41-49
Gastric cancer is generally associated with a dismal outcome. One of the major reasons for this is the fact that patients often ignore the early symptoms of the disease, which masquerade benign diseases such as reflux disease and gastritis, and hence present when the cancer is advanced or metastatic. Multidisciplinary management has emerged as an important determinant of outcomes in patients with gastric cancer. Complete surgical resection remains the cornerstone if cure is to be achieved, especially in those patients with non-metastatic disease. This article provides an updated review of the multidisciplinary management of patients with resectable gastric adenocarcinoma.
  2,606 296 1
Tissue and organ transplantation: Myths, miracles, and triumphs
Avneet Singh Chawla, Ranjan Chandra, Yatish Agarwal
July-September 2014, 1(2):144-149
Notwithstanding the unfulfilled quest for immortality, man's endeavor to outdo organ failure and prolong life has been a journey bejeweled with hues of ingenuity. This exciting odyssey has been marked with chimerical events and miracles in the olden times, and, in the more recent, by triumphs of technical and cognitive advances in organ preservation, surgical skill, immunology, management of infectious diseases, and multidisciplinary innovative approaches, which have collated to fructify the realm of tissue and organ transplantation. The remarkable evolution-colored with serendipitous discoveries, tragic accidents, abandoned paths, and incidents that have produced ethical and legal predicaments-stems from a confluence of cultural, legal, and political acceptance of the need to facilitate organ donation, procurement, and allocation. This serial narrative, punctuated with historic pictures, captures some of the major milestones in the saga of transplant medicine.
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Textbook of radiology for residents and technicians
Jyotindu Debnath
January-March 2016, 2(4):221-221
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Understanding the basic statistical questions that disturb a medical researcher
Amir Maroof Khan, Rajeev Kumar, Pranab Chatterjee
April-June 2014, 1(1):62-66
Medical research does not deal with only medical sciences; it is also dependent on other disciplines, and statistics is an integral part in its conduct. It is challenging for a medical researcher to grasp the importance of statistics and also to decide the types of statistical issues in the various phases of his/her medical research. There are inherent variations within and between the human/animal subjects used in medical research and these uncertainties can only be grasped using statistical tools. Initiating a medical research while taking into account the statistical aspects right at the planning stage is one of the best ways to conduct better evidence-based research. The validity of the results of a medical research depends not only on the methodology of conducting the study but also on the analysis of data collected. As opposed to the general perception, statistics not only deals with analysis of data but is also intricately interwoven with the methodology section of the research where sample sizes, inclusion/exclusion criteria, and others are mentioned. Although statistical softwares simplify the computational aspect of statistics, the confusing conceptual aspects make interpretation of the outputs difficult and incorrect. Seemingly simple terms such as population, sample, parameters, and variables have been explained keeping the medical researchers' perspective in mind. This first article in the series "Statistics in Medical Research" makes an attempt to facilitate the medical researcher to overcome the initial questions that challenge him/her with regard to statistics.
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Assessment of serum lipid profile and liver function parameters in children with epilepsy on phenytoin or valproic acid monotherapy for 6 months and beyond
Muzamil M Mugloo, Rubeena Akhtar, Seema Malik
January-March 2017, 3(4):180-183
Objectives: The highest incidence of epilepsy in children coupled with the need of long-term antiepileptic treatment could lead to development of metabolic complications at an early age. Phenytoin and valproic acid are commonly used antiepileptic drugs in children. This study aimed to assess the serum lipid profile and liver function tests in children with epilepsy on phenytoin or valproic acid monotherapy for 6 months and beyond. Materials and Methods: This prospective descriptive study recruited children from the pediatric outpatient department of a tertiary care GB Pant Children Hospital, Srinagar, Kashmir, India from August 2009 to September 2011. All consecutive children diagnosed with epilepsy as per International League Against Epilepsy definition aged 3–18 years on phenytoin or valproic acid monotherapy for 6 months or beyond were enrolled. After baseline clinical and anthropometric evaluation (including body mass index [BMI]), the fasting blood samples were analyzed for serum lipid profile and liver enzyme changes. Results: Total of 75 children were enrolled. There were 25 patients each in phenytoin, valproic acid, and control group. We observed statistically significant high mean total cholesterol and alkaline phosphatase levels in group receiving phenytoin when compared with valproic acid or control group. Conclusion: The lipid and liver enzyme abnormalities may be observed in children on phenytoin or valproic acid therapy, which warrants careful screening and monitoring.
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Correlative imaging in congenital heart disease
Anurag Yadav, TBS Buxi, Supraja Reddy, Saumya Gupta, Kishan Singh Rawat, Samarjit Singh Ghuman
October-December 2014, 1(3):195-210
For the evaluation of congenital heart diseases (CHDs), echocardiography is the initial diagnostic modality and Catheter angiography is the gold standard for delineation of the anomalies. Though echocardiography is the initial diagnostic modality in CHDs, it has its limitations and Catheter angiography is relatively invasive and should be reserved for therapeutic procedures. Multidetector computed tomography (MDCT) has emerged as an important tool for cardiac imaging owing to constant advancements in computed tomography scanners. With the judicious and innovative use of three-dimensional reconstructions, the depiction of congenital anomalies is more accurate and it is possible to perform a virtual surgery to aid the surgeon in planning the approach to the patient as a one or two step procedure, counseling the parents about the outcome and giving a fair estimate of the cost of treatment. MDCT acts as a one stop shop for a complete evaluation of the cardiac, extra-cardiac, visceral and skeletal anomalies; their combinations and subsequent effects on each other. Excellent delineation of the vascular compressions on the tracheo-bronchial tree, degree of main and branch pulmonary artery stenosis, anomalous drainage of pulmonary and systemic veins, interruptions and narrowing of the aorta, anomalies of origin and course of coronary arteries are unique to MDCT.
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