GAIMS Journal of Medical Sciences <p>An official publication of Gujarat Adani Institute of Medical Sciences</p> <p> </p> <p><strong>Published by:</strong><br />Gujarat Adani Institute of Medical Sciences<br />G K General Hospital<br />Opposite Lotus Colony<br />Bhuj, Kachchh, Gujarat – 370001</p> <p> </p> <p> </p> en-US (Editor-in-Chief) (Editorial staff) Fri, 15 Mar 2024 00:00:00 +0530 OJS 60 A Study of the Renal Arterial Anatomy in 100 Potential Renal Donors by Intra Arterial Digital Subtraction Angiography <p>Introduction: Understanding the renal vascular anatomy is essential for a safe and effective donor nephrectomy, which ultimately affects the function and longevity of the renal graft in recipients of kidney transplants. The aim of this study was to study the incidence of accessory renal arteries in 100 potential renal donors.</p> <p><br />Materials and Methods: Over a period of 24 months, a prospective assessment of consecutive intra-arterial digital angiograms of 100 potential kidney donors was conducted. Anatomical variations of renal arteries, such as auxiliary arteries, were noted.</p> <p><br />Results: Out of the 100 donors, 22% were found to have accessory renal arteries.</p> <p><br />Conclusions: Donors with accessory renal vessels are avoided for renal transplant surgeries because of the post operative complications.</p> Shaguphta Tasnim Shaikh Copyright (c) 2023 Shaguphta Tasnim Shaikh Fri, 18 Aug 2023 00:00:00 +0530 An Array of Histomorphological Findings in Cardiac Autopsies: A Retrospective Study at a Tertiary Care Centre <p><strong>Background:</strong> Autopsy plays a vital role in identifying the cause and time of death. It also aids in understanding the emerging trends and pathogenesis in the course of the diseases and its consequences which leads to death. The aim of this study was to study the cardiac pathologies encountered during the histopathological examination in the autopsied heart specimens.</p> <p><br /><strong>Methodology:</strong> We did a cross sectional retrospective study on heart specimens received in the Department of Pathology, Government Royapettah Hospital, Kilpauk Medical College, Chennai for a period of 3 years from 2020 to 2022.</p> <p><br /><strong>Results:</strong> Out of 291 autopsy cases received during this period, 170 well preserved hearts obtained from medicolegal autopsies were studied. In this study 67% were males and 33% were females. In the current study we found that atherosclerosis and coronary artery disease are the most common findings. The most common coronary artery exhibiting atherosclerotic change was left anterior descending artery. An array of cases with rare cardiac pathologies such as giant cell myocarditis, hypoplastic left heart syndrome, infective endocarditis, hypertrophic cardiomyopathy, ventricular aneurysm and metastatic deposits in the heart were highlighted in the current study.</p> <p><br /><strong>Conclusions:</strong> With the help of histopathological findings, the present study has contributed to a range of rare lesions in cardiac pathology determining the cause of death which were not diagnosed antemortem. Thus, this study emphasizes on the essentiality and multidisciplinary approach of postmortem histopathological examination in determining the causative factor of the disease significant enough to change the course of the disease if recognized before death.</p> T M Vincy, S Hemalatha, S Brihadisvarar, S Nisha Copyright (c) 2023 T M Vincy, S Hemalatha, S Brihadisvarar, S Nisha Tue, 22 Aug 2023 00:00:00 +0530 Assessing the Communication Skills of Medical Students: Bridging the Gap in Patient Centred Care <p><strong>Background:</strong> Effective communication is essential for quality healthcare delivery. However, communication skills training is often overlooked in medical education, leading to inadequate skills among young doctors and compromised patient care. This study aimed to assess the communication skills of first-year medical students and analyse their attitudes towards the importance of communication skills.</p> <p><strong>Materials and Methods:</strong> A cross-sectional study was conducted among first-year medical students enrolled at Jubilee Mission Medical College in Central Kerala, India. The study employed a multi-step methodology, including a self-assessment questionnaire to evaluate participants' communication skills, an Attitude, Ethics &amp; Communication (AETCOM) session in the form of role plays, games, and narratives, to provide communication skill training, and a Communication Skills Attitude Scale (CSAS) questionnaire to assess students' attitudes towards communication skills. Statistical analysis was conducted to identify patterns and correlations among the variables.</p> <p><strong>Results:</strong> Out of the 99 participants, 74% self-assessed their communication skills as good. In spite of the majority of students having good communication skills, the CSAS scores, post AETCOM session, indicated more positive attitudes towards communication skills. Gender differences were observed, with male students reporting increased negative attitudes compared to female students.</p> <p><strong>Conclusion:</strong> While the study revealed positive attitudes and self-assessment scores, there is still room for improvement in communication skills among medical students. Continuous training throughout medical education, along with targeted interventions addressing gender differences should be implemented to create an inclusive and supportive learning environment.</p> Aruna Davis, Biju Bahuleyan Copyright (c) 2023 Aruna Davis, Biju Bahuleyan Sun, 27 Aug 2023 00:00:00 +0530 Bloodless Technique of Earlobe Repair: A Novel Technique <p><strong>Background:</strong> Earlobe repair is one of the commonest procedures done by plastic surgeons. It is often done for enlarged holes in ear lobules. Bleeding is very common in this procedure which interferes with proper visualization of operative field. Aim of our study was to know the efficacy of SAURABH GUPTA'S TECHNIQUE OF BLOODLESS EAR LOBE REPAIR<sup>©</sup>, which is done using bull dog clamps.</p> <p><br /><strong>Materials and Methods:</strong> This was a prospective study done on 50 ear lobes repaired with the above-mentioned technique over a period of one year at a tertiary care hospital of North India. Demographic and clinical data of the patients were recorded. Also, parameters like visibility of operative field, time taken for surgery, postoperative results at three visits done at 3 days, 1week and 1 month were studied.</p> <p><br /><strong>Results:</strong> In our study, bilateral ear lobe tear repair was done in 92.31 % cases, and majority were partial thickness tears. The operative field was found to be clear in 96 % cases with slight ooze not compromising visibility in 4% cases. Mean time taken for surgery on each side was 7.06 ± 0.61 minutes. Postoperatively, 2 patients developed localized edema, which subsided at follow-up visit done at 1 week. No postoperative complications were recorded in rest of the patients. The mean satisfaction score of patients on Likert scale was 4.64 ± 0.48.</p> <p><br /><strong>Conclusions:</strong> In our study we found that the SAURABH GUPTA'S TECHNIQUE OF BLOODLESS EAR LOBE REPAIR<sup>©</sup> is a safe and effective procedure of ear lobe repair. It helps to achieve good hemostasis, providing good operative field, thereby reducing surgical time. The post operative outcomes in all the cases were found to be satisfactory and the level of patient satisfaction was also high.</p> Saurabh Gupta, Priyanka Gupta Copyright (c) 2023 Saurabh Gupta, Priyanka Gupta Wed, 06 Sep 2023 00:00:00 +0530 Community & Facility-based Study on Estimation of Out-of-Pocket Expenditure (OOPE): A Cross-sectional Analytical Study from Western India <p><strong>Introduction:</strong> Janani Shishu Suraksha Karyakram (JSSK) is a key program for increasing the institutional delivery. This program is a boon for pregnant women who still deliver at home as well as for sick neonates who die on account of poor access to health facilities. Thus, current cross sectional analytical study was conducted to assess any Out-of-pocket expenditure (OOPE) by beneficiaries of JSSK.</p> <p><br /><strong>Methodology:</strong> 400 rural &amp; urban beneficiaries of JSSK were enrolled from western part of India. Informed consent was sought &amp; data about demographic profile, JSSK utilization &amp; OOPE was collected in pre tested semi structured proforma.</p> <p><br /><strong>Results:</strong> Mean age of the beneficiaries was 24.87 years. 29.25% had to pay money availing the services. Most of the OOPE was for drugs &amp; consumables. Age, age at marriage, religion, place of delivery, family size, having RSBY card, type of delivery, parity were predictors of OOPE among JSSK beneficiaries.</p> <p><br /><strong>Conclusions:</strong> Approximately 70% of beneficiaries received support through JSSK, yet around 30% still incurred expenses for healthcare services, highlighting the financial challenges faced.</p> Billav Rojasara, Mittal Rathod, Vishakha Dabhi, Mehul Kaliya, Bela Patel, Harsh Patel , Dipesh Parmar Copyright (c) 2023 Billav Rojasara, Mittal Rathod, Vishakha Dabhi, Mehul Kaliya, Bela Patel, Harsh Patel , Dipesh Parmar Sat, 07 Oct 2023 00:00:00 +0530 A Study to Assess Morbidity Patterns among the Solid Waste Workers in Municipal Corporation of a Metropolitan City <p><strong>Background:</strong> The International Labour Organization (ILO) has projected that over 125 million workers face occupational accidents and illnesses within a single year, leading to roughly 220,000 fatalities and impacting about 10 million individuals who suffer significant disabilities. This alarming scenario is compounded by the fact that municipal workers handling solid waste, often hindered by limited education, knowledge, and awareness, find themselves at an elevated vulnerability to occupational hazards. Their line of work exposes them to a diverse range of risk factors including dust, bio-aerosols, volatile organic compounds, and mechanical strain, all of which contribute to their heightened susceptibility to various occupational diseases. This study was conducted to assess the morbidity pattern among the solid waste workers and to study epidemiological correlates affecting health of solid waste workers.</p> <p><strong>Material and methods:</strong> Study Area was ‘M’ ward of the metropolitan city Mumbai. Study was carried out from June 2012 to July 2013. 160 Permanent male workers who were handling the solid waste and who agreed to participate were included in the study. Employees were contacted at their work place. According to their convenient timing interviews were taken &amp; examination was carried out.</p> <p><strong>Results:</strong> Out of 160 employees, 49.4% employees were in 20-29 year age group and 11.9% employees were above 40 years age group. Most of the employees were belonging to Lower Upper Class (IV). Out of 160 participants, 58 were obese and hypertension was found in 37 participants.</p> <p><strong>Conclusion:</strong> The study unveils a comprehensive overview of the morbidities prevalent among municipal waste workers, highlighting the diverse range of health challenges they encounter in their daily activities.</p> Sandeep Kasbe, Sumit Wasnik, Mandar Sadawarte, Ramesh Singh Copyright (c) 2023 Sandeep Kasbe, Sumit Wasnik, Mandar Sadawarte, Ramesh Singh Tue, 10 Oct 2023 00:00:00 +0530 A Study of Mucormycosis as an Extended Clinicopathological Spectrum of COVID-19 at a Tertiary Care Centre <p><strong>Background</strong><br />Mucor mycosis is an emerging dreadful opportunistic angio-invasive fungal infection occurring predominantly in immunocompromised individuals. Popularly known as “Black fungus”, it gained popularity due to its association with SARS-COVID-19. The aim of this study was to analyse various predisposing factors and histopathological features of COVID associated Mucor mycosis.</p> <p><br /><strong>Methodology</strong><br />This was a cross sectional retrospective study conducted at Department of Pathology, Government Kilpauk Medical College and Hospital, Chennai, over a period of six months, from April 2021 to September 2021. Maxillectomy and functional endoscopic sinus surgery (FESS) samples from 123 post COVID-19 patients were included in the study. Clinical details of systemic hypertension, diabetes, steroid and oxygen therapy were retrieved from case records.</p> <p><br /><strong>Results</strong><br />Our study comprised of 82 males and 41 females with male to female ratio of 2:1. Maximum number of cases were observed in the age group of 40 to 50 years (39%). Youngest patient was of 27 years and oldest age was 80 years. Facial pain was the most common symptom noted. In our study, 112 cases (91%) were diabetic, 71 cases (57.7%) were hypertensive and 116 cases (94.3%) had received systemic steroid therapy. Histopathological examination revealed increased fungal load with neutrophilic inflammation in 105 cases (85.36%), granulomatous inflammation in 18 cases (14.63%), mucosal invasion in 90 cases (73.17%), angioinvasion in 71 cases (57.7%), necrosis in 73 cases (59.3%) and infarct in 19 cases (15.6%).</p> <p><br /><strong>Conclusions</strong><br />Histopathological features such as high fungal load, angioinvasion and extensive areas of necrosis plays an important role in accurate diagnosis, assessing the prognosis and thereby reducing mortality and morbidity. We also conclude that high clinical suspicion in individuals with diabetes and steroid use is essential to facilitate early diagnosis and optimizing prompt treatment.</p> T M Vincy, V Ramya, V Dhamodharan, R Nisha Copyright (c) 2023 TM Vincy, V Ramya, V Dhamodharan, R Nisha Wed, 11 Oct 2023 00:00:00 +0530 Perceptions about National Health Schemes among Patients Attending a Rural Health Training Centre of a Medical College: A Cross Sectional Study <p><strong>Background: </strong>Around 70% of the Indian population are from rural areas and around 28 percent of the population live in below poverty line; the out of pocket expenditure on health is quite a burden to the household. A report found that the coverage falls short of the desirable coverage of 25% according to the National Health Policy. Studies regarding government health schemes in the rural population are scarce. Hence, this study was conducted with objectives to assess the perception about national health schemes and to determine association between perceptions with various socio-demographic variables among patients attending Rural Health Training Centre (RHTC) of a medical college.</p> <p><strong>Methods:</strong> A cross sectional study was carried out among 107 patients attending OPD at RHTC. Data was collected with convenience sampling technique using pretested, semi-structured questionnaire. The responses were entered and statistically analysed by using SPSS v.20. Chi square test was applied to know the association between demographic variables and perception.</p> <p><strong>Results:</strong> About 60 (56.07%) participants perceived the health schemes to be beneficial to common man. While, 45 (42.05%) participants disagreed that they had adequate knowledge of scheme. Perception of agreement regarding its benefits was proportionately higher in males-46 (60.52%), in ≤50,000 income- 47 (69.11%) and with card availability 55 (80.88%). Perception of agreement with respect to ‘Protection from unexpected cost’ by various schemes is proportionately higher in males- 32 (58.18%) and with card availability- 34 (61.81%). Perception of agreement regarding its willingness to utilize schemes was proportionately higher in ≤30 years of age- 39 (55.71%).</p> <p><strong>Conclusions:</strong> Majority of the participants agree that these schemes are beneficial and provide quality and affordable treatment and protects from unexpected costs. Majority of participants are willing to utilise these schemes. Therefore, it is the need of the hour to increase awareness of schemes among people.</p> Ruchita Lunagariya, Ravi Patel, Dixit Chauhan, Hrishita Bhatt Copyright (c) 2023 Ruchita Lunagariya, Ravi Patel, Dixit Chauhan, Hrishita Bhatt Wed, 18 Oct 2023 00:00:00 +0530 A Study of Correlation Between Apgar Score and Urinary Uric Acid to Creatinine Ratio in Perinatal Asphyxia <p><strong>Background:</strong> Perinatal asphyxia refers to an impairment of the normal oxygenation during birth and the ensuing adverse effects on the neonate. Low Apgar score is commonly used to as an indicator of asphyxia, but it may not be available in all newborns, especially in extramural babies. Also, Apgar score alone does not predict neurologic outcome as it is influenced by various factors. So, the present study was conducted to find correlation between Apgar score and urinary uric acid to creatinine ratio in babies with perinatal asphyxia.</p> <p><br /><strong>Methodology:</strong> The present study was an observational case control study conducted in tertiary care hospital in southern part of Gujarat state. We recruited 56 babies with moderate to severe asphyxia and compared them with 56 babies without asphyxia. Uric acid (UA) to creatinine (Cr) ratio was calculated on spot urine samples within 24 hours of birth and a Receiver Operator Curve (ROC) was plotted.</p> <p><br /><strong>Results:</strong> Mean UA/Cr ratio among cases was 2.58±1.15 as compared to control group where the ratio was 0.71±0.21 (p &lt; 0.00001). Using the ROC curves, cut off of UA/Cr of 1.24 was found to have a sensitivity of 94.6% and specificity of 98.2%. Area under the curve was 98.8%. A significant negative linear correlation was found between urinary UA/Cr ratio and the Apgar score (r = -0.7188, p &lt; 0.001) among cases.</p> <p><br /><strong>Conclusions:</strong> Urinary uric acid to creatinine ratio is a useful marker to diagnose perinatal asphyxia when Apgar scores are unavailable and also to judge the severity of asphyxia.</p> Rajnikant Patel, Kalpesh Dhangar, Sandeep A Tilwani Copyright (c) 2023 Rajnikant Patel, Kalpesh Dhangar, Sandeep A Tilwani Wed, 18 Oct 2023 00:00:00 +0530 Preventing Mosquito Bite: Perceptions & Practices among Medical Students <p><strong>Background: </strong>Mosquito borne diseases remain a major public health challenge and contribute to annual outbreaks in India and in the world. Individual awareness and involvement is an important aspect of disease prevention and control. The aim of our study was to assess mosquito bite perceptions and preventive practices among medical students.</p> <p><strong>Methods: </strong>A cross sectional study was conducted among undergraduate medical students using convenient sampling method. Data was collected using semi-structured questionnaire and analyzed with SPSS software version 20.</p> <p><strong>Results: </strong>Among 258 study participants majority perceived that they are at risk of mosquito borne diseases which can be prevented. Mosquito repellant creams and full sleeve clothes were the most commonly resorted measures against mosquito bite. No significant association was observed between gender, history of disease and hospitalization with frequency of using the protective measures against mosquito bite.</p> <p><strong>Conclusions: </strong>Behavior change at individual level is essential for preventing mosquito bite; adoption of proper preventive practices needs to be emphasized among medical students and all concerned. The health campaigns should ensure that the knowledge acquired is put into practice.</p> Mandar Chandrachood, Shreyash Mehta, Adwait Godse, Nirav Nimavat Copyright (c) 2023 Mandar Chandrachood, Shreyash Mehta, Adwait Godse, Nirav Nimavat Sun, 29 Oct 2023 00:00:00 +0530 The Association of Meningitis with Altered Sensorium and CSF Inflammation in HIV-Positive Patients <p><strong>Background: </strong>Meningitis is a serious infection in HIV patients claiming millions of lives across the world. Comparative studies of meningitis in HIV positive and negative patients are scarce.</p> <p><strong>Methods: </strong>We studied the comparative clinical profile of a 116 HIV seropositive and 218 HIV seronegative patients with meningitis at a tertiary care hospital in India.</p> <p><strong>Results: </strong>High proportion of altered sensorium [84.7% vs. 70.5%], relatively higher median CSF white blood cell count [100 cells/mm3 vs. 35 cells/mm3] and higher median CSF protein content [170 mg/dl vs. 90 mg/dl] were seen in HIV positive patients.</p> <p><strong>Conclusions: </strong>Our study shows that meningitis in HIV positive individuals is clinically more severe with more inflammation in the CNS. This can partly explain the high case fatality rates of meningitis in HIV positive patients.</p> Sridhar Amalakanti, Jyothi Priya Jillella, Krishna Sagar Gajula Copyright (c) 2023 Sridhar Amalakanti, Jyothi Priya Jillella, Krishna Sagar Gajula Mon, 20 Nov 2023 00:00:00 +0530 Functional and Radiological Outcome in Lower End Radius Fractures – Our Experience <p><strong>Background: </strong>Distal radius fractures are among the most common upper extremity fractures and the second most common overall fracture in Orthopaedics and trauma. Deciding between non-operative or operative management depends on the patient factors, fracture pattern, displacement and the treating orthopaedic surgeon. The objective of our study was to assess the functional and radiological outcome in lower end radius fractures, treated or untreated at the end of 1 year follow up.</p> <p><strong>Material and methods: </strong>Our study was a prospective hospital-based study during the period January 2021 and December 2022. All closed lower end radius fractures meeting the inclusion/exclusion criteria and willing for follow up assessments were included in the study. Study subjects were divided into 2 groups- Treated/Operated group &amp; Untreated/Non-operated group of patients. All patients were followed up at 6 weeks, 3 months and 1 year post injury and their functional and radiological outcomes were assessed and compared between the 2 groups. </p> <p><strong>Results: </strong>A total of 100 patients were included in the study who met the required inclusion/exclusion criteria. There was 3 times more incidence among males as compared to females. Mean age was 45.1 yrs. High energy injuries were more frequent in younger patients. Frykman type I&gt;II&gt;VIII were the common type of fracture pattern noted in our study. In our study of 100 patients, 41 patients did not undergo operative intervention and 59 patients underwent some form of operative procedure. We observed that the acceptance of operative intervention was more in younger patients. Based on radiological criteria, 72 patients had excellent radiological outcome overall, out of which 49 patients belonged to operative group and only 23 patients belonged to non-operative group. There was only marginally better PRWE – Patient Rated Wrist Evaluation scores in operated group of patients as compared to non-operated group.</p> <p><strong>Conclusion: </strong>Lower end radius fractures have a bimodal age of incidence with a peak in younger patients usually associated with high velocity injuries, and in elderly patients usually secondary to low velocity injuries mostly due to falls. Based on Frykman classification, the more severe the injury there is more acceptance of operative intervention. Operative intervention results in better radiological outcome at 1 year.</p> <p> </p> Naveenkumar Patil, Mohammed Nizam AK Copyright (c) 2023 Naveenkumar Patil, Mohammed Nizam AK Mon, 27 Nov 2023 00:00:00 +0530 Evaluation of Epidemiological and Genetic Risk Factors Associated with Idiopathic Congenital Talipes Equinovarus in the South Indian Population <p><strong>Background: </strong>The heterogeneity between studies in reported risk factors for Congenital Talipes Equinovarus (CTEV) may be due to many factors including definitions of CTEV, whether non-idiopathic cases are included, differences in study design, and chance as some series are relatively small. This study was aimed to evaluate epidemiological and genetic risk factors associated with Idiopathic Congenital Talipes Equinovarus (ICTEV) in a south Indian Population.</p> <p><strong>Methods: </strong>A prospective case parental control design - epidemiological data was collected in the form of factors associated with mother like age at index pregnancy, education, reproductive history, smoking history. Similarly for father we studied factors like age, education, alcohol intake and genetic risk factors mainly <em>MTHFR C677C&gt;T</em> Gene polymorphism. Clinically severity graded by dimeglio scoring system and classified accordingly.</p> <p><strong>Results: </strong>Total 145 Case Parent triads were evaluated over a period of three years duration. Around 74 percent of ICTEV cases were males with positive family history. Positive association is found with first pregnancy, C – section, bilaterality, mother’s education, father’s alcohol intake during index pregnancy. There was negative association with increasing number of mutant T allele and severity of disease.</p> <p><strong>Conclusions: </strong>Our study is first study to show MTHFR C677C&gt;T gene polymorphism and its protective role in ICTEV in an Indian population and also given an epidemiological picture of a large series of children in south India. There is a need of increasing awareness of folic acid use during index pregnancy and fortification of food with folic acid in national level programmes.</p> Naveenkumar Patil Copyright (c) 2023 Naveenkumar Patil Tue, 12 Dec 2023 00:00:00 +0530 Study of Clinical Profile of Patients with Malarial Fever admitted in a Tertiary Care Centre <p><strong>Background:</strong> Malaria remains a leading cause of human morbidity and mortality due to inability of the insecticide and <br />chemotherapeutic agents to eliminate the vector and the agent of the disease. The present study is aimed to study the clinical profile, laboratory profile, species identification and line of treatment of the patients as per the species.</p> <p><br /><strong>Material &amp; Methods:</strong> Present study was conducted on 100 confirmed cases of Malaria admitted in Medicine department of Sanjeevan super-specialty hospital, Satara, Maharashtra. All patients were interviewed followed by clinical examination and relevant investigations. Data was entered in MS Excel and statistical analysis was done using EPI-5.</p> <p><br /><strong>Results:</strong> There was male preponderance in my study and incidence was more (84%) in middle age 16-50 years. 100% cases <br />showed fever as the major symptom followed by nausea (36%), vomiting (36%), headache (22%). Anaemia is common (56%) <br />followed by thrombocytopaenia (30%). Spleen was palpable in 50% patients. Hyperbilirubinemia was 28% in my study <br />predominantly of conjugated variety. 72% cases were P. falciparum, 22 % were p. vivax and 6 % were mixed. In the diagnosis, QBC was found to be more sensitive 98% than PBS 78%. for uncomplicated vivax malaria Tab chloroquine showed 60% sensitivity, tab artemether + lumefantrine showed 75% sensitivity, those who were not responding were added with quinine, doxycycline. In falciparum inj. artesunate76 % was more sensitive than quinine 69%. Artemether showed 57% response in falciparum in my study.</p> <p><br /><strong>Conclusion:</strong> Incidence of malaria was more in males than females due to their outdoor stay, travelling and more expose part of the body. Splenomegaly is the most common elicitable sign. Anaemia, thrombocytopaenia are found in falciparum malaria. Multidrug therapy like artemisinin combination therapy has more response in complicated and non-responding cases.</p> Gaurav Uday Ghurye, Nirmala Umesh Sawant, Vijaykumar Bhagwan Barge Copyright (c) 2023 Gaurav Uday Ghurye, Nirmala Umesh Sawant, Vijaykumar Bhagwan Barge Tue, 19 Dec 2023 00:00:00 +0530 Correlation between Intraoperative Imprint Cytology and Histopathological Diagnosis of Sentinel Lymph Nodes in Clinically Node Negative Breast Carcinomas <p><strong>Introduction: </strong>Sentinel lymph node imprint cytology is a reliable method of assessment of axillary lymph node status in clinically node-negative breast cancers.This technique is advantageous in resource-poor settings where cryostats are not available. The results are obtained in a short time, and hence they can be used intra operatively to arrive at a conclusive evidence of metastatic disease in axillary lymph nodes, thereby guiding further treatment. The objective of this study was to compare imprint cytology and histopathological diagnosis of sentinel lymph node in clinically node-negative breast cancers.</p> <p><strong>Methods: </strong>This was a cross-sectional study conducted among 53 female patients with clinically node- negative breast cancer who had undergone mastectomy with sentinel lymph node sampling. Imprint smears of the sentinel node were prepared and interpreted either as positive or negative based on the presence of metastasis. The results were compared with histopathological diagnosis, and the sensitivity and specificity of the procedure were determined.</p> <p><strong>Results: </strong>Out of the 53 cases, 6 cases were diagnosed with metastatic carcinomatous deposit in the axillary nodes, both by imprint cytology and histopathology. Only one case which was reported as negative for metastatic deposit in the lymph node by imprint cytology was diagnosed later by histopathology to have metastatic carcinomatous deposit. 46 cases were negative for metastatic carcinoma, both by imprint cytology and histopathology of axillary lymph node. Based on the above results, the sensitivity of Sentinel lymph node imprint cytology was 85.71% and specificity was 100%.</p> <p><strong>Conclusion: </strong>Intraoperative imprint cytology of axillary lymph nodes was found to have high sensitivity and specificity in diagnosing metastatic disease in resource-poor settings.</p> R Thangam, Venu Anand, T Vincy Copyright (c) 2023 R Thangam, T Vincy, Venu Anand Thu, 28 Dec 2023 00:00:00 +0530 Yogic Breathing as a Tool to Improve Working Memory among Rural School Children <p><strong>Background:</strong> Literature supports that for overall development of mental as well as physical health and academic success, working memory is an important necessity. Low childhood Socioeconomic status (SES) negatively affects the development of cognitive functions. Right nostril yoga breathing (RNB) and alternate nose breathing (ANB) are fairly simple and children can be taught to do this with practice easily.</p> <p><strong>Material and Methods:</strong> It was a randomized pre -post study with a total of 48 students (25 boys &amp; 23 girls) in an age group between 10 to 14 years. Each group comprising of 24 students were assigned to do RNB and ANB for 30 days. Model based on The Wechsler Intelligence scale for children in native language was used to test the working memory of the students before and after 30 days intervention.</p> <p><strong>Results:</strong> Average age of the students was 13.10 years. Modified B. G. Prasad was used to define socioeconomic status and all fitted into the Lower Socioeconomic class. There was an improvement in all the three subsets of working memory in the post test score of both the group. Using Cohen's D analysis, the effect size was large for Digi Span Forward with both RNB and ANB intervention (1.12 vs 1.16) Both practices showed a medium effect size on Digi Span Backward assessment (1.41 vs 1.20). In the more complex Letter Number Sequencing assessment , the effect size was larger after practicing ANB and medium after practicing RNB (1.16 vs 0.91).</p> <p><strong>Conclusions:</strong> Support in the form of this inexpensive, simple intervention like yogic breathing techniques might help to improve the working memory skills among these impoverished children who have too many environmental and social stressors hampering their cognition.</p> Bindu Krishnan, Balasaheb B Vikhe, Rahul B Vikhe Copyright (c) 2024 Bindu Krishnan, Balasaheb B Vikhe, Rahul B Vikhe Fri, 05 Jan 2024 00:00:00 +0530 Designing, Implementation and Assessment of Effectiveness of Physiology Electives in CBME Curriculum <p><strong>ABSTRACT</strong></p> <p><strong>Background: </strong>Elective courses, a significant addition to the competency based medical education curriculum, were implemented for the first time in the MBBS 2019 batch nationwide. This study was formulated to assess whether the design and manner of implementation of elective modules in Physiology could provide the students with diverse learning experiences.</p> <p><strong>Materials and Methods:</strong> A cross-sectional study was conducted among 19 undergraduate students who completed electives in physiology at a private medical college in South India. The students enrolled in three electives in Exercise, Cardiovascular, and Sleep Physiology, each of which had a research component. Pre- and post-tests were used to assess knowledge levels in their selected topics and basics of biomedical research and a Likert scale survey was used to evaluate student perception of the electives. Pre-test and post-test scores were compared using a paired t test, and responses to survey questions were expressed in percentages using a diverging stacked bar chart.</p> <p><strong>Results:</strong> Mean knowledge scores were significantly improved after the electives (p&lt;0.05). Overall, students had a positive perception of the design, implementation, and faculty knowledge of the electives. However, some of the students reflected that data collection procedures were hectic and the daily entries of log book activities were time consuming.</p> <p><strong>Conclusions:</strong> Well-designed and effectively implemented electives in physiology can provide students with valuable learning experiences, expand their knowledge, and equip them with relevant skills for their future careers. Incorporating ongoing student feedback and continuous evaluation can contribute to the refinement and improvement of future elective modules in physiology.</p> Neenu Elsin Thomas, Biju Bahuleyan, Shilpa A.V., Rose Babu, Aruna Davis, Archana S Copyright (c) 2024 Dr.Neenu Elsin Thomas, Dr.Biju Bahuleyan, Dr.Shilpa A.V, Dr.Rose Babu, Dr.Aruna Davis, Dr.Archana S. Tue, 16 Jan 2024 00:00:00 +0530 Psychiatric Morbidities among Patients with Lichen Simplex Chronicus: A Cross-Sectional Study in a Tertiary Care Hospital of South India <p><strong>Background:</strong> Lichen simplex chronicus (LSC) is one of the chronic and debilitating neuro-dermatological condition which results in lichenified skin plaques. Psychological stress being one of the main reasons behind intense itching which again leads to repeated cycle of itching and temporary relief. Chronic nature of the disease with intense itching is the of the important factor for the development of psychiatric morbidities. Due the scarcity of Indian literature this study was undertaken. Aim is to study the psychiatric morbidities in patients of Lichen simplex chronicus.</p> <p> </p> <p><strong>Materials and methods:</strong> This is a cross sectional study conducted in a tertiary care hospital after ethical committee approval. Total of consenting 150 diagnosed LSC patients were interviewed for psychiatric morbidities using MINI-Plus scale.</p> <p> </p> <p><strong>Results:</strong> Major Depressive Disorder was found in 8%, Generalized anxiety disorder (GAD) was present among 13.3.%, social phobia in 15.3% in our study group. One of the females had somatization disorder and other one had obsessive compulsive disorder.</p> <p> </p> <p><strong>Conclusion:</strong> Comparatively higher prevalence of psychiatric morbidities was found in our study group which further warrants adequate consultation liaison between dermatology and psychiatry department.</p> Niranjan Hebbar YR, Soumya G Hegde Copyright (c) 2024 Niranjan Hebbar YR, Soumya G Hegde Wed, 31 Jan 2024 00:00:00 +0530 Breaking Barriers and Nurturing Acceptance: Exploring School Teachers' Knowledge and Awareness About LGBTQ+ Communities <p><strong>Background:</strong> LGBTQ+ communities are constantly facing disparities related to social stigma and denial of human rights. Among youth, the formative years of upper primary and high school are pivotal for self-discovery. School teachers have a key role in creating a supportive environment for LGBTQ+ students. This study aims to explore the level of knowledge and awareness among school teachers regarding LGBTQ+ communities and their rights, with the ultimate goal of developing strategies to improve teacher education and support for LGBTQ+ students.</p> <p><br /><strong>Materials and Methods:</strong> A cross-sectional study was conducted among 255 school teachers aged 23 to 60 years from 17 schools in Thrissur district in Kerala, India, based on convenient sampling techniques. A semi-validated questionnaire was distributed among school teachers of high school and upper primary classes. Based on the scores obtained they were categorized as good, average and poor. Chi-square test was used for the analysis.</p> <p><br /><strong>Results:</strong> Out of the total respondents, 56.5% exhibited average knowledge, while 53.7% showed poor awareness. Notably, a statistically significant finding emerged, indicating a paradoxical scenario where a majority possessed commendable knowledge, yet concurrently showcased a significantly poor level of awareness (p value= 0.002). Specifically, as age increased, there was a<br />concurrent decrease in both knowledge and awareness levels. Subgroup analysis delineated a statistically significant distinction, with the younger age groups (&lt; 40 years) manifesting higher levels of knowledge compared to their older counterparts (&gt; 51 years) (p value= 0.013).</p> <p><br /><strong>Conclusions:</strong> This study highlights the lack of LGBTQ+ knowledge and awareness among teachers. Introducing Comprehensive Sexuality Education in schools is crucial for a safe environment enhancing LGBTQ+ youth's well-being and academic outcomes. It is our collective responsibility to ensure all students feel seen, heard, and valued, irrespective of sexual orientation or gender identity.</p> Jassal Mathew, Stephina Lizette Sebastian, Biju Bahuleyan Copyright (c) 2024 Jassal Mathew, Stephina Lizette Sebastian, Biju Bahuleyan Wed, 07 Feb 2024 00:00:00 +0530 Biofilm Formation among Bacteria Isolated from Different Types of Human Infections <p><strong>Background:</strong> Biofilms are the assembly of bacterial species embedded in an extra-polymer matrix. Literature suggests biofilms can be formed on various biotic and abiotic surfaces. This may contribute to diseases by inducing chronic inflammation by underlying bacterial species. A prospective observational study was planned to isolate and identify bacterial pathogens among heterogenous clinical samples along with their antimicrobial resistance pattern and to study their tendency to form biofilm.</p> <p><br /><strong>Materials and Methods:</strong> Samples were processed and identified according to standard microbiological protocol. Further Tissue Culture Plate (TCP) method was employed for detection of biofilm formation. Data analysis was done using descriptive statistics, Chi-square test &amp; Fisher test.</p> <p><br /><strong>Results:</strong> Among 329 positive bacterial isolates, 295 isolates were gram negative while only 35 isolates were gram positive. 138 (41.95%) bacterial isolates produced biofilm while 191 (58.05%) isolates were non-biofilm producers. Antibacterial resistance was higher in biofilm producing isolates as compared to non-biofilm producing isolates.</p> <p><br /><strong>Conclusions:</strong> Timely information about biofilm producing bacterial species causing infection can help clinicians for appropriate treatment measures in addition to antibiotic therapy. Knowledge regarding these organisms could help us in formulating hospital antibiotic policy which will lead to better patient outcome.</p> Riti Jain Seth, Shruti Asati, Bhavya Chiti Copyright (c) 2024 Riti Jain Seth, Shruti Asati, Bhavya Chiti Tue, 13 Feb 2024 00:00:00 +0530 A Study of Postictal Complications and Co-Morbidities of Status Epilepticus in Emergency Department of Tertiary Hospital of Bundelkhand Region, Central India <p><strong>Introduction:</strong> The postictal state is a temporary condition that occurs after seizures, often characterized by EEG slowing or suppression, and can last from minutes to days. Seizures can be accompanied by various postictal complications, including headache, automatism, delirium, psychosis, functional deficits, neuropsychological deficits, and abnormal behavioral manifestations. Effective management of postictal states requires identification of associated comorbidities and underlying neurological and systemic disorders. However, there is limited information regarding the causes, prevalence, and optimal treatment of postictal complications following status epilepticus. This study aimed to determine the different types of postictal complications and comorbidities.</p> <p><br /><strong>Materials and Methods:</strong> Patients with status epilepticus were observed after their seizure episode subsided, and their medical history and comorbidities were recorded. It was a cross sectional observation study. 100 participants were selected for the study at MLB Medical College, Jhansi, between March 2020 and November 2021. Written informed consent was obtained from all<br />participants after explaining the study's objectives and procedures.</p> <p><br /><strong>Results:</strong> The most common postictal complication observed in our study was headache, experienced by 51% of patients after the seizure subsided. Delirium was observed in approximately 28% of patients, while psychosis and automatism were reported by 9% and 8% of patients, respectively.</p> <p><br /><strong>Conclusions:</strong> The results of our study indicate that individuals with seizures have significantly higher odds of experiencing various comorbid conditions compared to those without seizures. The strongest association was found between seizures and stroke.</p> Kuldeep Kumar, Jeetam Singh Rajput, Virendra Gupta, Ravindra Singh Copyright (c) 2024 Kuldeep Kumar, Jeetam Singh Rajput, Virendra Gupta, Ravindra Singh Wed, 14 Feb 2024 00:00:00 +0530 A Study of Cytomorphological Spectrum of 300 Cases of Superficial Lymphadenopathy in a Tertiary Care Center in Garhwal Region of Uttarakhand <p><strong>Background</strong><br />India continues to be a country with a high burden of tuberculosis. Tuberculous lymphadenitis is one of the commonest manifestations of extra pulmonary tuberculosis. The aim of this study was to find the commonest cause of superficial lymphadenopathy and to describe the various cytological patterns of tuberculous lymphadenitis.</p> <p><br /><strong>Materials and Methods</strong><br />This was a cross sectional study conducted between June 2022 and September 2023. All patients with superficial lymphadenopathy were included in the study. All slides were stained with H &amp; E, PAP and MGG. Acid fast staining for tubercular bacilli was done on smears with cytological features of tuberculosis and in all cases where pus was aspirated.</p> <p><br /><strong>Results</strong><br />A total of 300 aspirations were done. Maximum aspirates were blood mixed material (81.6%). 144 cases were of tubercular lymphadenitis with cervical group of lymph nodes (75.6%) being the commonest location. Maximum cases of tubercular lymphadenitis were in the age group of 21-30 years (36) and showed a female preponderance (75). Out of the 144 cases 43.75% showed AFB positivity on ZN stain. Epithelioid cell granuloma with necrosis was the commonest cytological pattern seen (41.7%) and showed maximum AFB positivity. Minimum AFB positivity was seen with smears showing caseous necrosis only.</p> <p><br /><strong>Conclusions</strong><br />Superficial lymphadenopathy is one of the commonest indications for FNAC and tuberculosis is the commonest etiology in our region. Coupled with ZN staining a reliable and early diagnosis of tuberculous lymphadenitis can be given avoiding a biopsy. In patients where AFB is not demonstrated on ZN staining, a microbiological confirmation could be sought for diagnosis.</p> Ghazala Rizvi, Swati Pundir Copyright (c) 2024 Ghazala Rizvi, Swati Pundir Mon, 26 Feb 2024 00:00:00 +0530 Comparison between Automated Hematology Analyzer and Peripheral Blood Smear Examination for Assessment of Morphological Types of Anemia <p><strong>Background</strong><br />Anemia represents a major healthcare burden in developing country like India. Since decades peripheral blood smear has been used for diagnosis of anemia. Cell counter has been introduced with increasing efficacy and a decreasing cost all over the world. Aim of this study was to correlate morphological typing of anemia based on RBC indices and RDW obtained from automated hematology analyzer with PBS (Peripheral Blood Smear) and to give better approach in diagnosis of anemia and analyze their limitations.</p> <p><strong>Materials and Methods</strong><br />This prospective study was undertaken at Sir T hospital, Bhavnagar comprising of total 300 cases of anemia over a period of 4 months between July to October, 2021. Anemia typing was done by NIHONKODEN 9100 hematology analyzer and peripheral blood smear.</p> <p><strong>Results</strong><br />Out of 300 cases, 265 cases of anemia typed by RBC indices and RDW obtained from hematology analyzer were correct. 35 cases needed blood smear examination for correct typing of anemia. Microcytic hypochromic anemia was the most common morphological type of anemia followed by normocytic normochromic anemia. Anemia was found to be more common in females. Microcytic hypochromic anemia and normocytic normochromic anemia was the most common type in females and males respectively.</p> <p><strong>Conclusions</strong><br />PBS examination remains the gold standard test for morphological typing of anemia. With new advances in hematology analyzer typing of anemia can be done with indices and RDW but PBS confirmation is must. Both the methods should be used complementary to each other for better diagnostic accuracy.</p> Raina Goti, Pragnesh H Shah, Jay Raval Copyright (c) 2024 Raina Goti, Pragnesh H Shah, Jay Raval Sun, 03 Mar 2024 00:00:00 +0530 Role of Duodenal Biopsy in the Diagnosis of Giardiasis with Negative Stool Tests: A Case Report and Literature Review <p>Giardia lamblia (also known as Giardia intestinalis and Giardia duodenalis) is the most frequent intestinal parasite responsible for chronic diarrhea and malnutrition. Giardia infections commonly cause nausea, abdominal cramping, bloating, and foul-smelling diarrhea in patients. Usually, Giardiasis causes a self-limiting illness, but it can progress to a severe disease in immunocompromised individuals and cause dehydration, malnutrition, and failure to thrive. As a result, early diagnosis and treatment are required to control the infection and prevent complications. Infectious Disease Society of America diagnostic guidelines recommend obtaining stool studies to diagnose Giardiasis. When stool tests are negative, but suspicion persists, a duodenal biopsy is a gold standard for diagnosis. We present the case of a patient diagnosed with Giardia by an incidental duodenal biopsy specimen obtained during a workup for malnutrition and chronic diarrhea, despite a normal stool examination. A few cases of Giardiasis have been diagnosed and reported in the literature using a duodenal biopsy. Some studies addressed the same issue, and we believe that duodenal biopsy can be a good strategy for diagnosing Giardiasis with high sensitivity and specificity.</p> Milan R Akbari, Nirali V Vagadiya, Rajeshkumar R Akbari, Roshani B Sanghani, Manali Chodvadiya, Keval A Patel Copyright (c) 2023 Milan R Akbari, Nirali V Vagadiya, Rajeshkumar R Akbari, Roshani B Sanghani, Manali Chodvadiya, Keval A Patel Wed, 30 Aug 2023 00:00:00 +0530 Metastatic Squamous Cell Carcinoma of Lung: An Atypical Presentation in a 65 Years Old Man <p>Lung cancer stands as one of the most prevalent and fatal malignancies worldwide. It can originate primarily in the lung or manifest as metastases from various organs within the body. Squamous cell carcinoma (SCC) metastases to the lungs account for the majority, constituting 66% of all distant metastases. Distinguishing primary lung cancers from metastatic lung tumors often relies on immuno-histochemical markers such as Napsin A and TTF-1. In this case study, we present the medical history of a 65-year-old male with a history of smoking and occupation as a farmer. He experienced a persistent cough for one year and had been grappling with breathing difficulties for the past three days. Notably, the patient had a previous diagnosis of posterior pharyngeal wall SCC and had undergone chemo-radiotherapy treatment in 2021. Regular follow-up assessments were conducted through annual PET-CT scans, with the latest revealing nodular opacities and cavitations in the left lower lobe of the lung. This article provides a comprehensive account of the histopathological findings obtained from a tiny CT-guided lung biopsy extracted from the left lower lobe mass, alongside its radiological correlation.</p> Shweta Joshi, Bhushan Warpe, Priyal Patel, Jinal Patel, Kalpesh Patel Copyright (c) 2023 Shweta Joshi, Bhushan Warpe, Priyal Patel, Jinal Patel, Kalpesh Patel Tue, 03 Oct 2023 00:00:00 +0530 A Case of Pancreaticopleural Fistula Causing Gross Right Hydrothorax <p>Hydrothorax due to a pancreaticopleural fistula (PPF) is an uncommon complication of acute pancreatitis. In patients with a history of pancreatitis, diagnosis is based on detection of amylase in the pleural exudate. For detection of pancreaticopleural disruption imaging, particularly magnetic resonance cholangiopancreatography (MRCP)is helpful. For management purpose invasive methods such as thoracocentesis and pancreatic duct drainage or pancreatic resection procedures are preferred. Here we are presenting a case of 40 years old male with pancreaticopleural fistula having right sided gross hydrothorax. Patient was managed conservatively.</p> Foram Ruparel, Chandrahas Padvi, Kamal Kava, Kalpesh Patel Copyright (c) 2023 Foram Ruparel, Chandrahas Padvi, Kamal Kava, Kalpesh Patel Thu, 26 Oct 2023 00:00:00 +0530 Anaesthetic Management of Disseminated Intravascular Coagulation (DIC) in Pregnancy at a Tertiary Care Hospital <p>Abruptio placenta can lead to rapid separation of the placenta and result in fetal demise. Secondary to abruption, Disseminated Intravascular Coagulation (DIC) can occur due to inappropriate activation of the coagulation and fibrinolytic system. Once DIC develops, early recognition, specific treatment and repeated tests with aggressive correction of coagulation and electrolyte imbalance along with avoidance of hypothermia and metabolic acidosis help in preventing multi organ failure and mortality.</p> Pooja Fumakiya, Mandakinee Thacker, Yashvi Shah, Risheta Awasthi Copyright (c) 2023 Pooja Fumakiya, Mandakinee Thacker, Yashvi Shah, Risheta Awasthi Sun, 29 Oct 2023 00:00:00 +0530 A Rare Case of Compressive Cervical Myelopathy Presenting with Reversible Complete Heart Block <p>We present here a rare case of an elderly male who presented with the complaints of progressively worsening gait imbalance, associated with acute onset giddiness. On evaluation, the patient had bradycardia with exaggerated upper and lower limb deep tendon reflexes and pain on neck movements. A Magnetic Resonance Imaging (MRI) showed posterior disc herniations at C6-C7 level with neural foraminal narrowing, and 12 lead Electrocardiogram showed Complete Heart Block (CHB). Decompressive surgery with temporary pacing was done, following which, the patient recovered well. Although Permanent Pacemaker (PPM) was initially planned, it was not required due to reversion to normal sinus rhythm on ECG, post-surgery. Hence, rare reversible causes of CHB should be ruled out, before opting for a long term permanent invasive treatment modality.</p> Krushan Yajnik, Kishti Chhaya, Nirmit Yajnik, Kaushik Trivedi, Suresh Nayak Copyright (c) 2023 Krushan Yajnik, Kishti Chhaya, Nirmit Yajnik, Kaushik Trivedi, Suresh Nayak Thu, 02 Nov 2023 00:00:00 +0530 Jessner’s Lymphocytic Infiltration of the Skin (JLIS): A Rare Forehead Skin Involvement <p>Rare cutaneous condition of Jessner’s lymphocytic infiltration of the skin (JLIS) is a chronic, benign T-cell infiltrative disorder. It is a skin disease manifesting as red-colored papules or plaques on the face, neck and back. This lesion can be single or multiple with frequent recurrence. We report the case of a 35-year-old male, who presented with on and off multiple, well defined, discrete, erythematous plaques over forehead skin with 15 years duration, exacerbated during winters. The gold standard, ‘skin biopsy’ confirmed the diagnosis of JLIS over the forehead.</p> <p> </p> Shweta Joshi, Bhushan Warpe, Vishva Sureja, Bhumi Koradiya Copyright (c) 2023 Shweta Joshi, Bhushan Warpe, Vishva Sureja, Bhumi Koradiya Tue, 19 Dec 2023 00:00:00 +0530 Mucinous Cystic Neoplasm of Liver: A Case Report from a Center in Kachchh District <p>Mucinous cystic neoplasms of the liver (MCN-L) are rare cystic tumors that occur within the liver parenchyma, or less frequently, in the extrahepatic bile ducts. Epidemiologic data are limited due to indolent nature of the tumor and recent changes to the diagnostic criteria proposed by World Health Organization (WHO). The etiology remains unclear, however female predominance, age of onset, and hormonally responsive ovarian-type stroma, suggest ectopic organogenesis during embryologic development. MCNs are<br />typically identified on imaging. Differentiation from common cystic lesions of liver is important for proper management. Complete excision is recommended for all lesions as malignant transformation has been reported.</p> Jaydip Gorani, Panna S Rudani, Bimal Patel Copyright (c) 2024 Jaydip Gorani, Panna S Rudani, Bimal Patel Wed, 07 Feb 2024 00:00:00 +0530 Lafora Disease in a Teenage Girl with Epilepsy <p>Lafora disease is rare group of progressive myoclonic epilepsies, worldwide. It is more common in children and adolescents and is genetic, glycogen metabolism disorder. It has Autosomal recessive (AR) inheritance and characterized by presence of inclusion bodies known as Lafora bodies within cytoplasm of cells in heart, liver, muscle, skin. Disease clinically has triad of seizures, myoclonus, and dementia. Lafora disease is a neurodegenerative disorder that causes impairment in the development of cerebral cortical neurons. In the absence of laforin function, long glucose chains in specific glycogen molecules extrude water form double helices and drive precipitation of molecules which accumulate into Lafora bodies. Onset of clinically usually starts in the range of 8-19 years of age and peaks around 15 years of age. In our case, 16-year-old girl presented to emergency of tertiary care hospital with complain of episode of convulsions 40 minutes before admission. She is known case of generalized tonic-clonic seizures for past two years. Axillary skin biopsy on H&amp;E staining showed pilosebaceous glandular unit with peri-adnexal and perivascular infiltrate. PAS-D stain showed round, globular, tiny PAS positive material noted within sweat glands. MRI brain was suggestive of right vertebral artery partial occlusion.</p> Bhushan Warpe, Shweta Joshi, Vishva Sureja Copyright (c) 2024 Bhushan Warpe, Shweta Joshi, Vishva Sureja Thu, 22 Feb 2024 00:00:00 +0530 Revitalizing Classroom Attendance: Reviving Interest in Medical Education by Tackling Challenges and Embracing Solutions <p>The pursuit of medical education has always been a noble path, attracting individuals driven by a passion to heal, serve, and make a meaningful impact on society. However, in recent years, there has been a concerning decline in classroom attendance among undergraduate medical students.&nbsp;The significance of in-person learning cannot be understated, as it facilitates hands-on experience, fosters mentorship, and enables collaborative learning.&nbsp;To ensure the future of medicine remains bright, it is imperative to address the challenges leading to decreased classroom attendance and implement effective solutions that reignite interest in medical education. This editorial delves into the underlying issues and proposes measures to revitalize classroom attendance and rekindle enthusiasm in the pursuit of medical knowledge.</p> Mandar Chandrachood Copyright (c) 2023 Mandar Chandrachood Wed, 02 Aug 2023 00:00:00 +0530 Enterobiasis Masquerading as Acute Appendicitis: A Case Series from a Remote Indian Island <p>Enterobius vermicularis is a common parasitic infection and is rarely seen as an incidental finding in appendectomy specimens. Enterobius vermicularis often presents with symptoms similar to acute appendicitis. We present six cases with clinical features of acute appendicitis. Appendectomies were done for all the cases and the histopathological examination showed Enterobius vermicularis in the lumen of appendix in all six cases. Four cases showed lymphoid hyperplasia without acute inflammation, one case showed evidence of acute inflammation (acute appendicitis) and one case showed normal histology with no evidence of acute inflammation. Enterobius vermicularis infestation is quite common in India but these six cases belong to the remote Indian Islands of Andaman &amp; Nicobar. Enterobiasis may rarely present as acute appendicitis and careful histopathological examination needs to be done for initiation of post-operative antiparasitic medications. Preoperative diagnosis of these patients is important to avoid unnecessary surgery unless presenting as a surgical emergency.</p> Ashwinkumar K Barsagade, Sivaganesh Alias Porko, Chandan Chowdhuri, Avnika Jasuja Copyright (c) 2023 Ashwinkumar K Barsagade, Sivaganesh Alias Porko, Chandan Chowdhuri, Avnika Jasuja Thu, 26 Oct 2023 00:00:00 +0530 Immune Thrombocytopenic Purpura (ITP): A Comprehensive Review <p>Immune thrombocytopenic purpura (ITP) is a condition where the body's immune system mistakenly attacks and destroys platelets, resulting in a decreased platelet count. This leads to the development of purpura on the skin and may cause bleeding episodes due to the presence of antibodies that target and damage platelets. Excluding the usual suspects helps in identifying the underlying causes of thrombocytopenia. The diagnosis of immune thrombocytopenia (ITP) relies on clinical suspicion and the presence of thrombocytopenia, as indicated on a normal peripheral smear. Bone marrow examination is performed in order to eliminate the possibility of leukemia, myelodysplastic syndrome or aplastic anemia. Circulating platelets become sensitized due to the presence of IgG autoantibodies. As a result, these cells are swiftly eliminated by antigen-presenting cells, such as macrophages, which are primarily found in the spleen, and occasionally in the liver or other parts of the monocyte-macrophage system. In response, the bone marrow increases the production of platelets. ITP frequently occurs in healthy individuals, including children and young adults, following a viral infection. Certain medications can also lead to immune thrombocytopenia, which is practically indistinguishable from idiopathic thrombocytopenic purpura. Children usually recover spontaneously within a few weeks or months, and splenectomy is rarely required. However, spontaneous remissions necessitating splenectomy in young adults are uncommon in the first several months following diagnosis. This article discusses the most frequent causes of ITP and outline an interdisciplinary diagnostic and therapeutic approach based on current research.</p> Riddhi A Parmar, Keval A Patel Copyright (c) 2023 Riddhi A Parmar, Keval A Patel Mon, 04 Dec 2023 00:00:00 +0530