Δημοφιλείς αναρτήσεις

! # Ola via Alexandros G.Sfakianakis on Inoreader

Τετάρτη, 23 Νοεμβρίου 2016

False non-reactive VDRL in a patient with later syphilis and underlying HIV infection: A case report

Source: Case Study and Case Report
Sonnes Fredson.
Sexually transmitted disease (STD) is still important public health problem around the world. Syphilis is an old disease that is still detectable in the present day. VDRL serological test is the classical laboratory investigation for syphilis. The problem of false reactive and false non-reactive VDRL is interesting finding. Here, the author reports a case of false non-reactive VRDL in a patient with later syphilis and underlying HIV infection.


Effect of silver nanoparticle on renal cell: a preliminary study

Source: Advance Laboratory Medicine International
Alendra Alama, Corrosa Ponteno.
This is a report on in vitro testing on effect of silver nanoparticle on renal cell. According to this work, it revealed that after mixing the renal cell sediment with silver nanoparticle solution, the silver nanoparticle can be seen within the renal cells. In conclusion, the silver nanoparticle contains penetrating property into renal cell and this is the laboratory report on this observation implying for the possibility of nephrotoxicity due to the use of nanoparticle in the present nanomaterial era.


Tissue Correlation of Nitrite in Plant Parts of Cassava (Manihot esculenta Crantz) and Nitrosamine Toxicity in Wistar Rat

Source: Journal of Investigational Biochemistry
John Uyinmwen Bazuaye, Emmanuel Ndubisi Maduagwu, Babatunji Emmanuel Oyinloye.
Aim: This study was designed to determine the correlation in nitrite content of cassava (Manihot esculenta Crantz) as present in the various parts (roots, stems and leaves) and the possible hepatotoxicity when Wistar rats are exposed to N-nitosamine precursors. Methods: Cassava cultivar used for this experiment was collected from International Institute of Tropical Agriculture, Ibadan, Nigeria (IITA). Various parts (Roots, Stems and Leaves) was weighed and homogenized. The homogenate was filtered to get clear solution and nitrite content therein was analyzed. Thirty Wistar rats divided into three groups, classified into; Group 1, Group 2 and Group 3 were used for the in-vivo experiment. The urine nitrite content and serum biomarkers of toxicity namely; Serum alanine transaminase (ALT), aspartate transaminase (AST), alkalin phosphatase (ALP) and gamma-glutamyl transferase (GGT) was estimated and the histopathological changes in the liver was examined in order to evaluate the extent of toxicity. Results: The nitrite levels in the roots, stems and leaves of these cassava cultivars were estimated as follows: roots; 118±23.0 µg/50 g, stems; 14.4±17.7 µg/30 g and leaves; 112±30.4 µg/5 g. The nitrite correlations between the roots and leaves is r = 0.97, correlations between the roots and stems is r = 0.65 while the correlations between the stems and leaves is r = 0.63. Urinalysis test carried out shows urine is the major sources of excretion of N-nitrosamines from the system. Both Group 2 and Group 3 animals had a significant increase in ALT, AST, ALP and GGT levels in the serum. Histopathology study of liver is in agreement with these results. Conclusion: This study shows that there was a correlation in nitrite levels between the roots and leaves of cassava and the level of toxicity found in the liver of rat administer with N-nitrosamine precursors (DMA.HCL and NaNO₂).


Association of H. Pylori Infection with Gastroduodenal Disease: A Cross Sectional Study from Mysuru, India

Source: National Journal of Medical Research
Chandrababu D, Nandeesh HP, Deepak Suvarna, Aradya HV, Vijaykumar T R, Indrajit Suresh, Surya prakash R Kothe.
Introduction: In developing countries like India, Helicobacter pylori related gastritis is a major health ailment. This study was aimed to explore the prevalence of H. pylori infection in patients undergoing upper gastrointestinal endoscopy and its association with the various gastroduodenal diseases. Methods: This study cross sectional includes 158 patients both male and females patients attending Gastroenterology OPD at JSS Hospital, Mysuru with symptoms suggestive of gastro duodenal diseases. They were subjected to upper gastrointestinal endoscopy and investigated for H. pylori infection through histopathological examination. Data analysis was carried out using SPSS for Windows version 16.0. Results: Prevalence of H. pylori was more in male (78%) population compared to females (66%). Majority of the patients 97 (61.6%) out of 158 were in the age group of 31-60 yrs. Majority of H-pylori positive patients were found to be having H-pylori density 1+ (44.9%). Majority of patients was diagnosed to have duodenal ulcer (25.3%), gastric ulcer (21.5%) and gastric erosions (17.7%). Conclusion: From this study, we concluded that age related prevalence is more in relatively younger age group than elderly and prevalence is more in males. We also noticed that associations of H-pylori infection with gastric erosions and duodenal ulcers were statistically significant.


Hepatitis E virus: Seroprevalence and associated factors in acute viral hepatitis during pregnancy

Source: International Journal of Medical Science and Public Health
Mitalkumari R Gamit, Kanaiyalal Patel, Alpesh Rathod, Mamtakumari Shrivastav, Bhavika Patel, Mahendra Vegad.
Background: Acute viral hepatitis (AVH) is defined as those cases which have acute self-limited disease and a serum aspartate aminotransferase elevation of at least 5-fold or clinical jaundice or both. Hepatitis E virus (HEV) is the most common cause of acute hepatitis and common cause of jaundice in pregnant women. Objective: To study the seroprevalence and maternal mortality of HEV in AVH during pregnancy. Materials and Methods: 220 patients admitted in Tertiary Care Teaching Hospital, Ahmedabad, during August 2014 to July 2015 that presented with symptoms of AVH and satisfied the clinical, biochemical criteria for participation were included in this study and tested for anti-HEV immunoglobulin M (IgM) antibodies using enzyme-linked immunosorbent assay. Results: Out of the total 220 patients 63 (28.64%) were positive for anti-HEV IgM antibodies where patients 37 (58%) are belongs to age group 21-25 years and mean age was 23.80 ± 3.13 years. Majority of the patients were from lower socioeconomical class 130 (59.1%) and positivity in them 51 (81%). The maternal mortality was 22% and showed in the third trimester 31.03%, followed by second trimester 21.05% and first trimester 6.66%. Conclusion: Infection with HEV is an important cause of morbidity and mortality and representing a significance risk for pregnant women and indicates the need of appropriate strategies to reduce it.


Mushrooming of urban slums - A challenge toward population stabilization: A cross-sectional study in urban slums of Ahmedabad city

Source: International Journal of Medical Science and Public Health
Samarth Govil, Shalu R Chaudhary, Geeta Kedia.
Background: Being first in the world to launch nationwide family planning program, population stabilization is still a major concern for India and now with rapid expansion of urban slums with poor service delivery and limited research, it could transform into a formidable public health challenge. Objectives: (1) To find out unmet need for family planning in urban slum community. (2) To study birth spacing practices in urban slums. Materials and Methods: The crosssectional study was conducted during October-November 2015 in urban slum pockets of Ahmedabad city. A total of 195 women and child pair were interviewed using a pretested questionnaire. Data collected was entered in Microsoft Office 2007, and Epi info 7 was utilized for applying statistical tests. P 36 months while only 16.9% of illiterate couples follow the same (Chi-square value 16.16 at P


Can the early symptoms of attenuated psychosis syndrome be recognized: Caregivers’ perspective

Source: International Journal of Medical Science and Public Health
Sarada Prasanna Swain, Sushree Sangita Behura, Saumya Swaroop Sahoo.
Background: Identification of symptoms of early-onset psychosis is one of the longstanding researches in mental health. As these early symptoms cause functional impairment, it necessitates early management of psychosis. Objectives: To identify various symptom clusters recognized by caregivers in Attenuated Psychosis Syndrome (APS). It was also intended to assess the functioning level of patients and pathway of help seeking clinically. Materials and Methods: In a hospital-based cross-sectional study, 36 key relatives of patients of APS were chosen from the outpatient department of a tertiary center in psychiatry. Care givers reported the symptoms using a semi-structured 44 items symptom schedule, which was divided into four groups (positive, negative, vegetative, and depressive/anxious symptoms). Data were analyzed for percentages of responses and principal component analysis. Results: There was equal representation of the genders in the sample. The mean age of the study population is 27.1 ± 8.9 years. The caregivers could recognize the depressive/anxious, negative symptoms, and vegetative symptoms more easily. Principal component analysis suggested four cluster symptoms (Eigenvalue >0.3). The mean GAF score was 57.5 ± 8.67 suggesting a considerable functional decline in these patients. Conclusion: It appears that APS has more depressive/anxious, negative and vegetative symptoms which can be easily identified by the caregivers and grouped into four clusters. Considering the functional impairment and variations in the help-seeking, there is a need to highlight the treatment needs and psycho-education.


A study of antibiotic sensitivity pattern of Pseudomonas aeruginosa isolated from a tertiary care hospital in South Chhattisgarh

Source: International Journal of Medical Science and Public Health
Vikas Chandra Yadav, Vepada Ravi Kiran, Mahendra Kumar Jaiswal, Khileshwar Singh.
Background: Pseudomonas aeruginosa is one of the leading causes of hospital-acquired as well as community-acquired infections due to significant changes in microbial genetic ecology; as a result of indiscriminate use of antibiotics, the spread of multidrug resistance (MDR) is now a global problem. Its general resistance is due to a combination of factor. Several different epidemiological studies indicate that antibiotic resistance is increasing in clinical isolates. Objectives: The present study was conducted to find out the current antimicrobial susceptibility pattern of P. aeruginosa isolates obtained from various clinical samples at our tertiary care hospital. Materials and Methods: The present study was conducted in a tertiary care hospital in South Chhattisgarh, India, from June 2014 to May 2016. One hundred and ninety-eight clinical isolates of P. aeruginosa obtained from various clinical samples were studied. They were identified by routine standards and operative procedures, antimicrobial susceptibility testing was done using Kirby-Bauer disc diffusion method, and the results were interpreted according to the CLSI guidelines. Quality control of the test was done by standards ATCC strain P. aeruginosa 27853. Data obtained were analyzed and presented in counts and percentage. Results: Piperacillin tazobactam was the most sensitive chemotherapeutic agent with 93% susceptibility rate, followed by imipenem 91% and levofloxacin 83.5%. Amikacin showed better susceptibility rate 78% when compared to that of gentamicin 53%; the susceptibility rate to cephalosporin and aztreonam was relative very low. Most of the P. aeruginosa strains were isolated from clinical samples such as pus 73, urine 42, and respiratory secretion 16, and sputum 26. Out of 198 clinical isolates, 34 (17%) clinical isolates of P. aeruginosa were found to be MDR. Most of the MDR P. aeruginosa strains were isolates from pus, urine, and respiratory sample. Conclusions: To prevent the spread of the resistant bacteria, it is critically important to have strict antibiotic policies in our country. There should be surveillance programs for the detection of MDR organisms in every locality. Infection control programs need to be implemented with quality control in every hospital.


Acute ischemic stroke in a patient of Takayasu’s arteritis

Source: International Journal of Medical Science and Public Health
Synrang Batngen Warjri, Tony Ete, Gaurav Kavi, Rinchin Dorjee Megeji, Bhupen Barman, Swapan Saha, Manish Kapoor, Animesh Mishra.
Takayasu arteritis (TA) is a chronic inflammatory condition usually seen in females mainly affecting aorta and its branches resulting in clinical manifestations such as malaise, claudication, and pulselessness. Raised erythrocyte sedimentation rate and C-reactive protein are important markers of active inflammation other than clinical features associated. Rarely TA may involve coronary and cerebral arteries resulting in myocardial infarctions and cerebrovascular accidents.


Seroprevalence of Hepatitis A Virus in Inonu University Medical Faculty Hospital, 2015

Source: Medicine Science | International Medical Journal
Yucel Duman, Mehmet Sait Tekerekoglu, Selma Ay, Ayfer Serindag.
Hepatitis A is the most common pathogen that causes acute viral hepatitis in humans. HAV infection is considered as an important public health concern. The aim of this study was to assess the seroprevalence of anti-HAV IgG and IgM antibodies in our hospital. The presence of anti-HAV IgG and IgM antibodies were evaluated retrospectively from 7275 serum samples which sent to our hospitals microbiology laboratory in 2015. The presence of anti-HAV IgG and IgM antibodies in serum samples were studied by using macro ELISA Abbott - Architect i2000 system test kits. The 7275 patients serum samples were analyzed. The 74.4% of analyzed samples were positive for anti-HAV IgG antibodies. Anti-HAV IgM antibody positivity rate was found as 1.3%. The 87.4% of anti-HAV IgM positive cases were under the age of 16 and 12.6% were at adulthood stage. The incidence of acute viral hepatitis disease could be reduced by improving hygiene conditions, personal hygiene education, routine vaccination activities, correcting infrastructure and informing people about HAV. We believe that; the data contributes to evaluate the preventive measures, immunization program studies and determination of vaccine efficacy studies.


Umbilical cord blood culture versus peripheral venous blood culture in early onset neonatal sepsis

Source: International Journal of Contemporary Pediatrics
Sanjay Mandot, Jeetendra S. Gandhi.
Background: Neonatal sepsis is a major cause of neonatal morbidity and mortality. Blood culture and sensitivity is gold standard for the diagnosis of neonatal sepsis. Low sensitivity of blood culture especially in newborn is due to small volume of blood sample collected from neonates and antibiotics given before sampling. The aim was to evaluate the use of umbilical cord blood culture in the diagnosis of early onset neonatal sepsis as compared to Peripheral vein blood culture. Methods: Eighty neonates with two or more risk factors for early onset neonatal sepsis were included in the study. Blood samples were collected from umbilical cord and peripheral vein for culture. Sepsis screen was done to corroborate the diagnosis of neonatal sepsis. Results: Sepsis screen was positive in twenty three babies. Among these four had grown organism on Umbilical cord blood culture only. While two babies had both positive, Umbilical cord bloods culture and peripheral vein blood culture. Organisms grown on culture were E.Coli, Pseudomonas, Klebsiella and Acinetobacter. Conclusions: Umbilical cord blood culture is simple and convenient method for the diagnosis of early onset neonatal sepsis compared to peripheral venous blood culture. Organisms grown are comparable to peripheral venous blood culture sample.


Left ventricular mass - a facade for left ventricular calcification

Source: International Journal of Research in Medical Sciences
Prabhu Halkati, Suresh Patted, Ranjan Modi.
Calcification overlying the left side of the heart on a chest radiograph may involve either the pericardium or, alternatively, the myocardium in association with a left ventricular aneurysm. Pericardial calcification was found primarily over the right-sided cardiac chambers and in the atrioventricular grooves, infrequently over the base of the left ventricle, and rarely over the apex of the left ventricle. When the left ventricle was involved, there was always more extensive calcification elsewhere in the pericardium. Myocardial calcification occurred predominantly in the apex of the left ventricle, although it was rarely confined to the posterior wall of the left ventricle. Isolated calcification in the region of the left ventricular apex, therefore, strongly suggests left ventricular aneurysm. Isolated idiopathic left ventricular calcification without any detectable abnormality is a rare phenomenon and found to be worth reporting.


Left ventricular pseudoaneurysm due to patch dehiscence after ventricular septal rupture repair

Source: International Journal of Research in Medical Sciences
Sanjeev Sanghvi, Anil Baroopal, Rohit Mathur.
Ventricular septal rupture is a rare complication of acute myocardial infarction and has a high mortality. We present a case of 52-year-old male patient with left ventricular pseudoaneurysm due to patch dehiscence after surgical repair of post-myocardial infarction ventricular septal rupture.


Borderline mucinous ovarian tumour – a rare bilateral presentation

Source: International Journal of Research in Medical Sciences
Jayawant W. Mahadani, Surabhi S. Kulkarni, Nilima D. Lodha, Nigar Fatema M. Khan.
Surface epithelial tumours are the most common ovarian tumours. According to the cell type, surface epithelial tumours can be serous, mucinous, endometrioid etc. Mucinous tumours of ovary are the neoplasms characterized by glandular, cystic architecture and are lined to variable extents by mucin-containing epithelium. Further these tumours are sub-classified into benign, borderline and malignant category. Typically, borderline tumours are non-invasive neoplasms that have nuclear abnormalities and mitotic activity intermediate between benign and malignant tumours of similar cell type. Borderline ovarian tumours are clinical entities less frequently encountered by pathologists and gynaecologists. Mucinous borderline ovarian tumours are among the most difficult ovarian neoplasms for surgical pathologists to interpret. They occur in younger women and present at an early stage. However, borderline tumours are difficult to diagnose correctly preoperatively using imaging methods because their macroscopic features overlap with invasive and benign ovarian tumours. Most importantly, these tumours have a superior prognosis when compared with ovarian carcinomas stage for stage. The borderline tumours may be of intestinal type or mullerian (endocervical like) type. The intestinal type tumours are by far the most common. Approximately 5% of the borderline mucinous tumours are bilateral. We here report a rare case of bilateral borderline mucinous tumours diagnosed on histopathology.


Unilateral high division of brachial artery and its clinical significance

Source: International Journal of Research in Medical Sciences
Aarti Rohilla, Priyanka Parmar, Kamal Singh, Jyoti Rohilla.
Upper limb arterial variations are commonly encountered and have been reported in many articles. The present study showed a high division of brachial artery in the middle third of arm into its terminal branches, the radial artery laterally and the ulnar artery medially. This study is an attempt to discuss the anatomy, embryological basis and clinical implications of such variations. Knowledge of such anomalous vessels is significant from clinical point of view.


Heterotopic ossification or unusual foramen in radius?

Source: International Journal of Research in Medical Sciences
Gitanjali Khorwal, Sunita Kalra.
The interosseous membrane (IOM) runs obliquely from radius to ulna attached to their respective interosseous borders. The membrane provides surface for attachment for muscles; stabilizes the radius and ulna during forearm rotation and actively transmits forces from the radius to the ulna. IOM is an occasional site for heterotopic ossification (HO) that involves development of mature lamellar bone, in a variety of soft tissues such as muscles, ligaments and other soft tissues causing significant functional limitation of upper limb. We describe unusual findings equivocal of congenital or acquired features in a dry adult radius where two thick bony spurs/processes emerging from the middle third of interosseus border approach towards each other joined by a thin bony fragment to form a huge foramen 2.4 cm in length and 6 mm in width abutting an uneven rough area of about 3.6mm x 1.6 mm on anterior surface. A prominent groove leading to a foramen at its junction with the shaft was present on the posterior surface of the bone. Knowledge of such HO as anatomical variants or possible sequel of trauma or neurological insult is indispensible and call for further research and trials to obviate such complications.


Cystic thymoma presenting with urticaria: a case report

Source: International Journal of Research in Medical Sciences
Manoj Gopinath, Deepika Gulati.
Thymomas are epithelial neoplasms of the thymus and are the most common primary tumors of the anterior superior mediastinum, although it can also arise in other locations like the neck, the middle or posterior mediastinum, the lung and the pleural cavity. Ectopic thymomas are said to arise from scattered thymic elements as a result of failure of migration into the anterosuperior mediastinum. The neoplasm may be well encapsulated or may display varying degrees of invasion of the tumor capsule and the adjacent structures. We report a case of non-invasive cystic thymoma in a young individual with unusual clinical presentation and imaging findings.


Ruptured ileal mesenteric dermoid mimicking acute abdomen: a clinical report

Source: International Journal of Research in Medical Sciences
Mayukh Chakraborty, Sanghamitra Chakraborty.
Mature cystic teratoma is the uncommon variety of rare mesenteric cysts. Dermoid cysts of the intestine are mostly asymptomatic. Till date incidence of symptomatic mesenteric cyst (only 21 cases) is rare and most of them are asymptomatic. Here we report a case of ruptured mesenteric dermoid cyst in a 15 year old male child who presented with acute abdomen. This case shows ruptured dermoid cyst may mimic appendicitis and a high degree of clinical suspicion and radiological back up may clinch the diagnosis.


Oncocytic carcinoma of minor salivary gland: a case report

Source: International Journal of Research in Medical Sciences
Sagarika Samantaray, Sasmita Panda, Sashibhusan Dash, Niranjan Rout.
Oncocytic carcinoma is an extremely rare malignancy of minor salivary gland. The biological behaviour, management and prognosis are not well established due to its rarity and paucity of published literature. We report a case of 32 year old man presented an ulcerated growth measuring 1cm in size in right buccal mucosa along with enlarged left submandibular lymphadenopathy. The diagnosis was suggestive of oncocytic carcinoma of minor salivary gland by cytology and subsequently confirmed by excisional biopsy.


A case report on bilateral neuromyelitis optica

Source: International Journal of Research in Medical Sciences
Abhishek Mansinh Patel, Khushnood M. Sheikh, Manisha B. Shastri.
Neuromyelitis optica (NMO, Devic disease) is an autoimmune inflammatory disorder of the central nervous system (CNS) in which the autoimmune system attacks myelin of the neurons located at the optic nerve and spinal cord, thus producing a simultaneously or sequential longitudinally extensive inflammation of the optic nerve (optic Neuritis) and spinal cord (myelitis). Early discrimination between NMO and multiple sclerosis is important because the two diseases have different natural histories and treatment regimens. Seropositivity for NMO-IgG and longitudinally extensive spinal cord lesions are characteristic of NMO. Despite the absence of a definitive therapeutic strategy for NMO syndrome, methylprednisolone pulse therapy is recommended in the acute phase. Treatment strategies in relapse phases are aimed at preventing relapses, and increasing evidence shows a better clinical response of immunosuppressive therapy than immuno-modulating therapy (a standard multiple sclerosis-modulating therapy). We have described a 32 years old girl who had visual loss due to acute optic neuritis before 15 days in right eye and followed by complete visual loss in left eye. NMO was diagnosed because of its characteristic longitudinal myelitis and positive NMO-IgG. After combine therapy with prednisolone and an immunosuppressant, the patients medical condition was stable and no relapse symptoms were observed.


Tropical diabetic hand syndrome- a case report with a short review

Source: International Journal of Research in Medical Sciences
Mohd Mubarik Naqash, Feroze Ahmad, Arif Nabi Bhat, Umar Jalalie, Rameez Raja Najar.
Tropical diabetic hand syndrome (TDHS) encompasses an acute symptom complex found in patients of diabetes mellitus primarily in the tropical regions. The syndrome usually follows a minor trauma to the hand, may rapidly progress to gangrene, fulminant sepsis and may even be life threatening. The syndrome is less recognized and thus reported less often. The authors present here a case of Tropical diabetic hand syndrome (TDHS) in a middle aged female with a poor glycemic control. The patient was managed meticulously both by surgical debridement and proper, culture evidenced antibiotic therapy apart from routine diabetic management.


Extreme complication of somnambulism: death due to accidental fall from height

Source: International Journal of Research in Medical Sciences
Shivkumar Rajshekhar Kolle, Vinod Ashok Chaudhari.
Somnambulism is NREM sleep disorder which associated with severe injuries and violence and even death. We reported an extreme complication of somnambulism i.e. death due accidental fall from height leading to head injury. Twenty-one-year-old male fell from a terrace of a three-storey residential building (13-14 meters) in the early morning. Police and relatives thought it to be suicidal or homicidal death. On inquiry, he had a history of somnambulism (SA) and sleep talking [somniloquy (SL)] since childhood. He never had severe injuries due to somnambulism except for minor injuries. Autopsy findings showed multiple comminuted fractures of the skull, but no evidence of long bone and spine fractures. Multiple graze abrasions on both the sheens, right knee, and toes; these were suggestive of brushing or hitting with enclosure wall of a terrace. Other injuries were suggestive of impact with the hard surface of ground. He died due to a complication of somnambulism, which was accidental in nature. We suggest safety practices, regular psychiatric and psychological assessment for a person suffering from somnambulism.


Acute myocardial infarction in a resource-poor setting: a case report in Awka, Nigeria

Source: International Journal of Research in Medical Sciences
Innocent C. Okoye, Ernest N. Anyabolu.
The incidence of acute coronary syndrome (ACS) is increasing in Sub-Saharan Africa. Predisposing factors to ACS in Nigeria are not completely known. The management of ACS is influenced by its timely detection and availability of medical and reperfusion intervention facilities. We thus document a case of acute myocardial infarction (AMI) in 3 years that was successfully managed medically in Awka, Nigeria, albeit a debacle of resource-poor setting. The patient was a 42 year-old man who presented with retrosternal, stabbing chest pain of 4 hours duration. He has obesity, hypertension and a sedentary life style. He was in painful and respiratory distress; blood pressure was 140/80mmHg. Oxygen therapy, intravenous morphine 10mg was given. Oral Isosorbide dinitrate 20mg bd, oral Clopidogrel 300mg bd initially then 75mg daily, oral Aspirin 150mg bd, oral Simvastatin 20mg daily and oral Lisinopril 2.5mg were instituted. Resting electrocardiography showed evidence of ST elevations in the inferior leads. Cardiac enzyme markers were elevated. Following medical therapy, his condition improved. On the 3rd day he was discharged and subsequently followed up in the clinic. This case of AMI in a man who, has risk factors for AMI and, presented as the first case in three years in a Cardiology Unit in a tertiary hospital in Awka suggests that AMI is rare in this area. A resource-poor setting such as ours might still provide valuable medical therapy to ACS patients especially with prompt referrals from peripheral hospitals.


Intra-parotid facial nerve schwannoma: case report of a rare entity

Source: International Journal of Research in Medical Sciences
Shaheen H. Kanpurwala, Nisha V. Thakare, Prashant S. Mane.
Intraparotid facial nerve schwannoma was first reported by Ibarz in 1927. The frequency of intra-parotid schwannomas range from 0.2% to 1.5%. Facial nerve schwannoma can occur at any point along its course from the cerebello-pontine angle to its peripheral branches. Its typical presentation is a slow growing, painless mass mimicking a pleomorphic adenoma. Because of its low prevalence and very few clinical and radiological signs associated with it, pre-operative diagnosis of intraparotid facial nerve schwannoma is generally difficult. There is great potential of misdiagnosis and mismanagement when detected intra-operatively with the worst consequences of facial nerve palsy. In this case a 58 years old male had a parotid mass with a prolonged history of sixteen years with sudden increase in size. Preoperative work up of imaging modalities and fine needle aspiration cytology was not conclusive. Intraoperatively mass couldnt be separated from the facial nerve, so total parotidectomy for the tumor with transection of facial nerve was done resulting in postoperative facial nerve paralysis. The diagnosis of schwannoma was offered only after histopathological examination. Parotid nerve schwannomas are extremely rare and routine investigations are not very helpful in diagnosis. Whenever a facial nerve is seen involved by a clinically benign appearing lesion, intraparotid schwannoma should be thought of as a diagnostic possibility to avoid radical surgery and prevent complications like facial nerve palsy.


Spinal intradural extramedullary mature cystic teratoma in young adult: a rare tumor with review of literature

Source: International Journal of Research in Medical Sciences
Ashuvi Kunjan Agay, Sunil Garg, Ketan Hedaoo.
Spinal intradural extramedullary teratoma is a rare condition that develops more commonly in children than in adults. We report a rare case of adult onset intradural extramedullary teratoma in the thoracolumbar spinal cord with no evidence of spinal dysraphism and without the history of prior spinal surgery. The patient was a 20 year young adult male whose chief complaint was back pain and urinary incontinence. X-ray images of the thoraco-lumbar spine showed no abnormalities. Magnetic resonance imagings of spine revealed a well marginated cystic intradural extramedullary mass at the D11 to D12 vertebral levels. The patient was operated and the mass was totally excised. It was histopathologically diagnosed as a mature cystic teratoma. The patient's symptom of back pain and urinary incontinence was improved following the surgery.


Pycnodysostosis: a distinctive brittle bone disease?

Source: International Journal of Research in Medical Sciences
Muralidhara K., Gouramma Padanad, T. S. Srinath Kumar.
Pycnodysostosis is a rare disorder that is inherited as an autosomal recessive trait usually diagnosed at an early age with an estimated incidence of 1.7 per 1 million births. It is a rare clinical entity, first described in 1962 by Maroteaux and Lamy. The disease has also been named Toulouse-Lautrec syndrome, after the French artist Henri de Toulouse-Lautrec, who suffered from the disease. Pycnodysostosis is a lysosomal storage disorder of the bone caused by a mutation in the gene that codes the enzyme Cathepsin K causing osteosclerosis. However, the diagnosis is sometimes late, made as a result of bone fracture, given the severe bone fragility resulting from increased bone density. Oral and maxillofacial manifestations of this disease are very common.


Bilateral thalamic infarcts due to occlusion of artery of percheron - a rare vascular variant

Source: International Journal of Research in Medical Sciences
Surender Kumar, Hitender Kumar.
The artery of percheron is a rare vascular variant, occlusion of which is uncommon and associated with bilateral paramedian thalamic infarcts with or without mesencephalic infarctions. We report a case of a 50 year-old male patient with acute bilateral thalamic infarcts. Patient presented with history of sudden onset of altered sensorium with episodes of restlessness, agitation and loss of consciousness. Non-contrast CT scan of head was suggestive of bilateral paramedian thalamic infarcts.


Presentation of isolated trolard vein thrombosis with subarachnoid hemorrhage: a case report and review of literature

Source: International Journal of Research in Medical Sciences
Saeed Razmeh, Farzad Sina, Maryam Zaribafian, Zahra Ghurchian.
Cortical vein thrombosis (CVT) is uncommon and life threatening condition. It is usually secondary to the propagation of the clot from dural sinus to cortical vein, but isolated thrombosis of this vein is very rare. Usual symptoms include headache, sensory and motor deficit, seizure, confusion and an increase in intracranial pressure (ICP). Presentation with subarachnoid hemorrhage (SAH) is very rare that has been reported only in the case studies. In this paper, we describe a case of isolated trolard vein thrombosis that present with SAH.


Subluxation of lens alarms to homocystinuria

Source: International Journal of Research in Medical Sciences
Abhishek Mansinh Patel, Khushnood M. Sheikh, Manisha B. Shastri.
Homocystinuria is a disorder of methionine metabolism. The term Homocystinuria refers as abnormally large amounts of homocystine are excreted in the urine. The condition was caused by impaired functioning of the cystionin B-synthetase (CBS) enzyme. Homocystinuria is an autosomal recessively inherited defect in the trans-sulfuration pathway (homocystinuria I) or methylation pathway (homocystinuria II and III). The most common form of homocystinuria is characterized by near sightedness, dislocation of the lens at the front of the eye, an increased risk of abnormal blood clotting, and brittle bones that are prone to fracture or other skeletal abnormalities. Some affected individuals also have developmental delay and learning problems. Homocystinuria has a current cumulative detection rate of 1 in 344,000. A high concentration of homocysteine makes fibrillin unstable. Fibrillin is responsible to form the structures which hold the lens of the eye in place. We report a case of 28 year old male with unilateral Subluxation of lens following trauma coincidentally diagnosed to have Homocystinuria and bilateral Subluxation of lens. On account of case we would like to emphasize homocystinuria should be considered as differential diagnosis in Subluxation of lens.


Cryptic tuberculosis: a missed diagnosis and an unusual presentation

Source: International Journal of Research in Medical Sciences
Deepika Patel, Ravi Dosi.
Cryptic tuberculosis is a rare and atypical clinical presentation of disseminated hematogenously spread tuberculosis, in which the usual diagnostic criteria for tuberculosis, especially the roentgenographic evidence, are lacking. Here we report a case of an elderly female with prolonged respiratory distress, persistent anaemia, with thrombocytopenia and hypoproteinaemia; inspite of long term treatment and normal X-ray chest. Diagnosis of cryptic tuberculosis was established only after histopathology report of a late appearing axillary lymph node during the course of treatment. The incidence of these occult forms of tuberculosis, where diagnosis is often established too late or entirely missed, is significant. This possibility must be kept in mind in severe infectious conditions and pyrexia of unknown origin without obvious aetiology.


The relationship between communication of nurses and level of anxiety of patient’s family in emergency room dr. Dradjat Prawiranegara hospital, Serang Banten, Indonesia

Source: International Journal of Research in Medical Sciences
Lukmanulhakim, Suryani, Anastasia Anna.
Background: Critical condition of patient is trigger to the increasing of anxiety of family members. This situation is vulnerable of ineffective nursing care services provide by nurses in emergency room. Communication is one of abilities which nurse have to performed, and is recognized not that simple in its implementation. This study aimed was to identify whether or not there is a relationship between communications performed by the nurses and the level of anxiety of family members of patient in Emergency Room dr. Dradjat Prawiranegara hospital, Serang Banten, Indonesia. Methods: This study was cross-sectional study with non-parametric analysis data used was Spearmans Rho. Data were collected through direct observation by 4 numerators and observational sheet of nurses communication. Level of anxiety of family members was measuring by using State Trait Anxiety Inventory Y-1. Data were collected from 47 family members and 47 nurses who were selected by using accidental sampling technique. Results: The study revealed that nurses performed eye contact, well informed consent, quick respond to the needs of patient and family members, clear voice, understandable language, introducing them self, active listening and emphatic, calm and friendly. Regarding anxiety of family members, 42.6% of them were showing moderate level of anxiety, whereas 34.0% of them were showing low level of anxiety. In bivariate analysis by using Spearmans Rho showed that p value was 0.000 and coefficient correlation -0.765. It was indicated that there was significantly relationship between communication of emergency nurses and the level of anxiety of family members. It was indicated that the more effective the communication performed by nurses, the less the anxiety level of family members. Conclusions: Nurse is required to be able to perform their therapeutic communication skill effectively so that the anxiety level of family members is decreasing. As a result, the stable emotion of family members affect to the appropriate decision making of medical treatment.