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2018 | July-December | Volume 2 | Issue 2

EDITORIAL

Richa Thaman

Editorial

[Year:2018] [Month:July-December] [Volume:2] [Number:2] [Pages:1] [Pages No:0 - 0]

PDF  |  DOI: 10.5005/ctdt-2-2-v  |  Open Access |  How to cite  | 

ORIGINAL RESEARCH ARTICLE

Rahat Kumar, Jaswinder Singh, Narinder Singh, Meenakshi Gupta, Deepika Tikko, Vikram Bhandari, Preet Sood

Dermatological Adverse Drug Reactions in a Tertiary Care Teaching Hospital of Punjab-A Pharmacovigilance Study

[Year:2018] [Month:July-December] [Volume:2] [Number:2] [Pages:6] [Pages No:71 - 76]

Keywords: Adverse drug reactions, Dermatology, Pharmacovigilance, Urticaria

PDF  |  DOI: 10.5005/jp-journals-10055-0042  |  Open Access |  How to cite  | 

Abstract

Introduction: Adverse drug reactions (ADRs) constitute a significant economic burden on society. ADRs to skin are common; however, information about their incidence, severity, and ultimate health effects is scanty. The aim of the present study was to detect, document, assess, and report the suspected ADRs in the Department of Dermatology at a tertiary care teaching hospital, Amritsar, so as to treat ADRs and also stop the indiscriminate use of drugs in clinical practice. Material and methods: A prospective study was undertaken in patients presenting with ADRs in the outpatient Department of Dermatology in the tertiary care teaching hospital, Amritsar, Punjab, from June 2015 to May 2018. The data obtained were collected, compared, and reviewed, calculating the percentage to assess their significance and evaluation. A total of 152 ADRs were detected during the study period. Results: The most common age group presenting with adverse cutaneous drug reactions (ACDRs) was 18 to 35 years (54%) and the most common ADR was urticaria (30.2%) followed by fixed drug eruptions (16.4%). The most common drugs responsible for ACDRs were non-steroidal antiinflammatory drugs (NSAIDs) and fluoroquinolones followed by systemic steroids, oral contraceptive pills, ampicillin, angiotensin converting enzyme (ACE) inhibitors, antimalarial, clofazimine, and so on. According to the WHO causality assessment, 13.0% cases were certain, 56.1% were probable, and 30.7% were possible in nature. On severity assessment by the modified Hartwig and Siegel scale, 72.3% ACDRs were mild, 25% were moderate, and 2.05% cases were of severe category. Preventability assessment by the modified Schumock and Thornton scale revealed that 69.1% ACDRs were definitely probable, 20.51% were probably preventable, and 13.8% were not preventable. Conclusion: The study findings indicate that ADR reporting helps in identifying the most common drugs associated with dermatological reactions. Thus it helps us to provide better patient treatment by the early identification and management of dermatological reactions.

ORIGINAL RESEARCH ARTICLE

Mandeep Singh, Gurinder Bir Mahal, Ramesh Chander

A Prospective Evaluation of Acute Cerebral Ischemic Stroke by Conventional and Diffusion-Weighted MR Imaging Sequences

[Year:2018] [Month:July-December] [Volume:2] [Number:2] [Pages:5] [Pages No:77 - 81]

Keywords: Acute ischemic stroke, Diffusion-weighted image, T1 weighted (T1W), T2 weighted (T2W)

PDF  |  DOI: 10.5005/jp-journals-10055-0043  |  Open Access |  How to cite  | 

Abstract

Aim: The aim of this study is to compare the diffusion-weighted magnetic resonance imaging (DW-MRI) with conventional MRI in the evaluation of acute cerebral ischemic stroke. Materials and methods: In this prospective study, for 2 years, 50 patients who were clinically suspected cases of acute ischemic stroke (AIS) underwent MRI using a 1.5 tesla scanner (SIEMEN MAGNETOM Aera) in the Department of Radiodiagnosis, Guru Nanak Dev Medical College, Amritsar, Punjab. The patients from all age groups and both sexes were included in this study. Results: In our study of 50 cases, the age range of patients was from 2 years to 80 years with a majority of 40 (90%) patients above 40 years age with 32 (64%) males and 18 (36%) females. About 20 (40%) patients presented with weakness/numbness on either side. The conventional MRI had a sensitivity of 50% in detecting stroke in patients presented within 3 hours of the onset of symptoms, while DW-MRI had a sensitivity of 100%. For the patients presented within 3 to 6 hours, conventional MRI and DWI had a sensitivity of 66% and 100%; for the patients presented within 6 to 12 hours, conventional MRI and DWI had a sensitivity of 85% and 100%, and for patients presented within 12 to 24 hours, conventional MRI and DWI had a sensitivity of 92.3% and 100%, respectively. The middle cerebral artery (MCA) was the most commonly involved territory. Conclusion: The DW sequence is the sensitive modality in the diagnostic evaluation of acute stroke as compared to conventional MRI sequences. It plays a pivotal role in the localization and characterization of acute ischemic lesions and, hence, effective and early treatment with thrombolytic therapy is needed.

ORIGINAL RESEARCH ARTICLE

Ripan Bala, Simran J Kaur, Madhu Nagpal

To Improvise Risk Reduction Strategies in Obstetrical ICU Admissions

[Year:2018] [Month:July-December] [Volume:2] [Number:2] [Pages:6] [Pages No:82 - 87]

Keywords: ICU interventions, Review of mortality, Risk reduction strategies

PDF  |  DOI: 10.5005/jp-journals-10055-0044  |  Open Access |  How to cite  | 

Abstract

Background: The goals of management of critically ill obstetric patients involve intensive monitoring and physiological support for patients with life threatening but potentially reversible conditions. Intensive care unit (ICU) is highly specified and sophisticated area of a hospital which is specifically designed, staffed, located, furnished, and equipped, dedicated to the management of critically sick patient, injuries, or complications. The aim of this study is to know the frequency of ICU admissions, to analyze the disease comorbidity related to medical and obstetrical problems, to segregate cause of morbidity, and also to identify and adopt risk reduction strategies. Methods: This observational study was conducted on 35 ICU patients in our institute from 1 December 2016 to 31 May 2018. Our study was divided into two groups. In group I, the intervention was done first followed by ICU intervention and, in group II, ICU stabilization was done prior to surgical intervention. The parameters noted were age, parity, diagnosis on admission, and associated medical and surgical comorbidity; reason for ICU admission, any surgical procedure performed, antenatal, and postnatal admission; details of treatment given like ventilator support, blood and blood components\' transfusion, inotropic support, and dialysis. Neonatal outcome was also noted and the total duration was noted. Parameters noted after ICU admissions were cost, duration of stay, patient outcome, review of mortality, and area of improvement. Results: There were 17.1% of mortalities observed in our study. The commonest cause for maternal mortality was multi-organ dysfunction (33.3%) followed by hypertensive disorder of pregnancy (16.7%), peripartum cardiomyopathy (16.7%), acute fatty liver of pregnancy (16.7%), and septic shock (16.7%). Severe anemia, cardiac diseases, sepsis, need for a caesarean delivery, and more than one diagnosis on admission are the other risk factors for ICU admission. Conclusion: The majority of the survivors (69%) were discharged satisfactorily from the hospital. There is a need for training in emergency obstetrics so that the complication can be managed right at the time of occurrence. There is a need to train obstetricians in obstetric medicine and critical care to do justice to these critically ill pregnant women.

ORIGINAL RESEARCH ARTICLE

Harmanpreet Singh, Gurinder Mohan

To Study the Incidence of Lacunar Infarcts in Patients with Acute Ischemic Stroke and its Correlation with Carotid Artery Stenosis

[Year:2018] [Month:July-December] [Volume:2] [Number:2] [Pages:4] [Pages No:88 - 91]

Keywords: Carotid artery stenosis, Ischemic stroke, Lacunar infarct

PDF  |  DOI: 10.5005/jp-journals-10055-0045  |  Open Access |  How to cite  | 

Abstract

Introduction: Stroke remains the second leading cause of death worldwide, after ischemic heart disease. Lacunar infarcts are small deep infarcts ranging from 2 to 20 mm in size resulting from occlusion of a penetrating artery which accounts for approximately 25% of all ischemic strokes. The present study was undertaken to study the incidence of lacunar infarcts in patients with acute ischemic stroke and its correlation with carotid stenosis. Methods: This study was performed at the Department of Medicine at a tertiary-care hospital in Amritsar, Punjab, in 50 patients presenting with acute ischemic stroke with or without lacunar syndrome. All patients were diagnosed using diffusionweighted imaging (DWI) on magnetic resonance imaging (MRI) of the brain. Carotid artery stenosis was measured with duplex ultrasound. Results: Patients with acute ischemic stroke had a mean age of 61.36 ± 11.36 years. About 40% of the patients had lacunar infarcts with a higher frequency in male patients (64% vs 36%). There was no significant difference found in the incidence of hypertension (85% vs 70%), diabetes (20% vs 13.3%, p value = 0.529), alcohol drinking (20% vs 16.67.0%, p value = 0.764), smoking (23% vs 10% p value = 0.318), and carotid artery stenosis (35% vs 43.3%, p value = 0.828) between lacunar and non-lacunar infarct patients. Conclusion: The difference in the incidence of potential risk factors such as hypertension, diabetes mellitus, alcoholism, smoking, and dyslipidemia was found to be statistically insignificant between lacunar and non-lacunar infarct groups. Carotid stenosis did not show any significant difference in the lacunar and non-lacunar infarct groups. The findings in our study are consistent with the hypothesis that severe carotid artery stenosis in lacunar infarction is an incidental finding.

ORIGINAL RESEARCH ARTICLE

Preneet Kaur, Muskan Behl

Comparative Evaluation of Marginal Integrity of Mineral Trioxide Aggregate and Biodentine as Retrograde Filling Materials-An In Vitro Study

[Year:2018] [Month:July-December] [Volume:2] [Number:2] [Pages:6] [Pages No:92 - 97]

Keywords: Biodentine, Marginal integrity, Microbial leakage, MTA Angelus, Root-end filling materials

PDF  |  DOI: 10.5005/jp-journals-10055-0046  |  Open Access |  How to cite  | 

Abstract

Aim: The purpose of this research was to compare the microleakage of different root-end filling materials. Materials and methods: Thirty human single-rooted teeth were decoronated at the cementoenamel junction, shaped with protaper rotary files, and obturated. About 3 mm apical resection of the roots was carried out and 3-mm deep rootend cavities were prepared using an ultrasonic retro-tip. The root-end cavities were then retrofilled with mineral trioxide aggregate (MTA Angelus) and biodentine, respectively, and submerged in 2% methylene blue dye for 24 hours. The depth of dye penetration and microleakage in each sample were recorded using a stereomicroscope. Results: Higher mean microleakage (mm) was recorded in MTA (2.40 ± 0.63) when compared to biodentine (1.60 ± 0.63) and the difference between them was statistically significant. Conclusion: Both the tested materials showed microbial leakage. Root-end fillings with biodentine had the lowest microleakage and better marginal adaptation as compared to MTA. Clinical significance: Biodentine showed better marginal adaptation and sealing ability when compared to MTA and can be considered as an alternative to MTA as a root-end filling material.

ORIGINAL RESEARCH ARTICLE

Rajiv Sharma, Neeti Rajan Singh, Rachhpal Singh

Comparative Study of Complications Following Electrocautery Dissection vs Conventional Scalpel/Scissor Dissection in Modified Radical Mastectomy

[Year:2018] [Month:July-December] [Volume:2] [Number:2] [Pages:4] [Pages No:98 - 101]

Keywords: Electrocautery, Modified radical mastectomy (MRM), Seroma

PDF  |  DOI: 10.5005/jp-journals-10055-0047  |  Open Access |  How to cite  | 

Abstract

Background: Early breast carcinoma is amenable to modified radical mastectomy (MRM) done either with electrocautery or scalpel dissection, following which seroma and other complications can arise. Methods: We performed a comparative study on the complications following dissection in MRM by electrocautery and scalpel dissection in a total of 70 patients in Sri Guru Ram Das Institute of Medical Sciences & Research (SGRDIMSR) over a period of 2 years. Results: The complications of seroma and flap necrosis were comparable in both the study groups, but the operative time period for electrocautery was shorter than that for scalpel dissection. Complications of seroma formation after 4 weeks of surgery as well as flap infection were comparable too. Conclusion: MRM done with the help of electrocautery takes shorter time and the patient has a shorter hospital stay.

REVIEW ARTICLE

Gurinder Mohan, Arvinderpal Singh, Trimaan Singh

Guidelines for the Management of Snakebites

[Year:2018] [Month:July-December] [Volume:2] [Number:2] [Pages:7] [Pages No:102 - 108]

Keywords: Anti-snake venom, First aid, Snakebite

PDF  |  DOI: 10.5005/jp-journals-10055-0048  |  Open Access |  How to cite  | 

Abstract

India is estimated to have the highest snakebite mortality in the world. World Health Organization (WHO) places the number of bites to be 83,000 per annum with 11,000 deaths.1 Most of the fatalities are due to the victim not reaching the hospital in time where definite treatment can be administered. In addition, community is also not well informed about the occupational risks and simple measures which can prevent the bite. It continues to adopt harmful first-aid practices, such as tourniquets, cutting, and suction. Studies reveal that primary care doctors do not treat snakebite patients mainly due to lack of confidence.2 At the secondary and the tertiary care level, multiple protocols are being followed for polyvalent anti-snake venom (ASV) administration, predominantly based on western textbooks.

CASE REPORT

Sangeeta Pahwa, Sheena Chopra

Ovarian Hyperstimulation Syndrome in Natural Conception

[Year:2018] [Month:July-December] [Volume:2] [Number:2] [Pages:3] [Pages No:109 - 111]

Keywords: Human chorionic gonadotropin, Ovarian hyperstimulation, Ovarian hyperstimulation syndrome, Spontaneous

PDF  |  DOI: 10.5005/jp-journals-10055-0049  |  Open Access |  How to cite  | 

Abstract

Background: Ovarian hyperstimulation syndrome (OHSS) generally results due to exogenous administration of gonadotropins for ovulation induction in females seeking treatment for infertility. OHSS can lead to life-threatening complications, therefore, its early diagnosis and management are very important. Case report: We hereby report a rare case of OHSS in a spontaneously and naturally conceived pregnancy. Our patient is a 28-year old gravida 3 para 2 live 2 female with a period of gestation of 14 weeks, who presented to us with complaints of abdominal pain, mild distension, nausea, vomiting, and mild degree of breathlessness. All the possibilities that would have caused OHSS in a pregnancy were ruled out with adequate investigations. Ultrasound (USG)-guided aspiration of cyst was done and the cytology was negative for malignancy. The patient and her attendants voluntarily demanded termination of pregnancy for the health interest of the mother. Termination of pregnancy was done. The postabortal period was uneventful. The follow-up scan after 4 weeks revealed bilateral ovaries near normal in size, shape, and volume. No ascites was found this time. Conclusion: As after the termination of pregnancy B-human chorionic gonadotropin (HCG) levels dropped down and ovaries were found to be normal in the follow-up scan, our diagnosis goes more in favor of OHSS. Thus, although OHSS is a characteristic outcome of women who underwent some sort of ovarian induction or assisted reproductive technologies, one must be aware of its occurrence in a spontaneous conception too.

CASE REPORT

Nilanshu Kataria, Vijinder Arora

Radiological and Imaging Findings in Gastrointestinal Stromal Tumor: A Case Report

[Year:2018] [Month:July-December] [Volume:2] [Number:2] [Pages:3] [Pages No:112 - 114]

Keywords: Contrast-enhanced CT, Gastrointestinal stromal tumor, Histopathology, Ultrasonography

PDF  |  DOI: 10.5005/jp-journals-10055-0050  |  Open Access |  How to cite  | 

Abstract

Introduction: Gastrointestinal stromal tumors (GISTs) are nonepithelial tumors arising from the interstitial cells of Cajal, which express KIT protein-CD117 on immunohistochemistry. It represents a wide clinical spectrum of tumors with different clinical presentations, locations, histology, and prognosis. Gastro intestinal stromal tumours (GISTs) can arise anywhere in the GIT, including the mesentery, omentum, and retroperitoneum. Because most of these tumors are submucosal in location, they usually attain a large size without causing bowel obstruction at the time of diagnosis. This report presents a case of GIST in a 30-year-old male. The patient presented with acute abdomen without any symptoms of obstruction or perforation. He underwent ultrasonography in the radiology department which revealed a large mass along the small bowel with deposits along the mesentery and space occupying lesions (SOLs) in the liver. On contrast-enhanced computerised tomography (CECT), a possibility of GIST with deposits along the mesentery and liver was given, which was confirmed by histopathology. Conclusion: Recognition and acquaintance with GISTs is primarily important for early detection which allows for more treatment options. These tumors are rare in people younger than 40 years of age, but can occur in people of any age.

CASE REPORT

Seema Sehmi

Accessory Cusp of Tricuspid Valve-Anatomical, Clinical, and Embryological Aspects

[Year:2018] [Month:July-December] [Volume:2] [Number:2] [Pages:3] [Pages No:115 - 117]

Keywords: Accessory, Anterolateral, Septal, Tricuspid

PDF  |  DOI: 10.5005/jp-journals-10055-0051  |  Open Access |  How to cite  | 

Abstract

Aim: The aim of this study is to report the rare anomaly of accessory cusp present in the tricuspid valve. Background: The right atrioventricular valve also known as the tricuspid valve allows the blood to flow from the right atrium to the right ventricle. Tricuspid diseases although rare but tricuspid valve regurgitation, stenosis, and Ebstein\'s anomaly are included. Case description: During routine dissection of normal adult formalized heart for undergraduate medical students at the Department of Anatomy, SGRD Medical College, Amritsar, we noticed four cusps of the right atrioventricular valve. They were anterior, septal, posterior, and accessory valves which were anterolateral in position. The septal cusp was the largest of all. The papillary muscles were anterior, posterior, and septal and one for the accessory cusp. Conclusion: This anomaly is important for the cardiothoracic surgeon for correcting their defects.

CASE REPORT

Karuna Thapar, Angie Garg

Congenital Tuberculosis: A Challenging Diagnosis

[Year:2018] [Month:July-December] [Volume:2] [Number:2] [Pages:3] [Pages No:118 - 120]

Keywords: Anti tubercular therapy, Bacillus Calmette-Geurin, Cartridge-based nucleic acid amplification test, Tuberculosis

PDF  |  DOI: 10.5005/jp-journals-10055-0052  |  Open Access |  How to cite  | 

Abstract

Introduction: Congenital tuberculosis though rare is of paramount importance to outline early management. Symptoms of congenital tuberculosis may be present at birth but more commonly begin by second or third week of life. The clinical presentation of tuberculosis in newborns is similar to that caused by sepsis and other congenital infections. Purpose: Nonspecific nature of the disease in the newborn infant and less knowledge of the maternal disease prior to delivery makes the diagnosis a clinical challenge. Case report: A rare case of one and a half month F baby who had fever since 3 weeks of age, after a month baby landed into neonatal intensive care unit because of missed diagnosis and reported to us with clinical signs of sepsis. Investigations and results: X-Ray chest was suggestive of tuberculosis, presumptive diagnosis of tuberculosis made & baby started on anti tubercular therapy. Cartridge based nucleic acid amplification test was found positive in gastric aspirate. The baby started recovering and during that period mother developed symptoms of low grade fever, lethargy, headache and seizures. She was diagnosed as neurotuberculosis with evidence of multiple tuberculomas in MRI-Brain. This led to confirmation of diagnosis of congenital tuberculosis. Conclusion: Most important clue for rapid diagnosis of congenital tuberculosis is maternal history of tuberculosis. Often, the mother\'s disease is discovered after the neonatal diagnosis is suspected. In summary, there is need to improve screening to identify and treat active tuberculosis in prenatal period, which decreases perinatal mortality and prevents occurrence of this serious disease in neonate. This case remarks difficulties on diagnosis and therapeutic management about this important severe disease in public health, and alert for development of protocols that foresee these difficulties.

MEDICAL EDUCATION

Monika Lalit, Anupama Mahajan, Anterpreet K Arora, Sanjay Piplani

Attitude and Response of First-Year Medical Students Toward Cadaver, Dissection, and Subject of Anatomy: A Qualitative Study

[Year:2018] [Month:July-December] [Volume:2] [Number:2] [Pages:9] [Pages No:121 - 129]

Keywords: Anatomy education, Attitudes, Cadaver dissection, Psychology reactions

PDF  |  DOI: 10.5005/jp-journals-10055-0053  |  Open Access |  How to cite  | 

Abstract

Background: The first-year medical students go through the anatomy curriculum which involves extensive anatomy teaching by dissection and experience a variety of emotional reactions and mixed feelings when they encounter the human cadavers for the first time. Therefore, the present study was designed to explore the attitude and views of first-year medical students toward cadaver dissection. Materials and methods: This observational study was performed on newly admitted 150 first-year medical students, at the Department of Anatomy at a tertiary care teaching hospital and medical college in Amritsar, Punjab. A performa was designed with a structured questionnaire having 22 items requiring “yes, no, or undecided” responses and 6 items with Likert-type questions ranging from strongly agree to strongly disagree. One hundred thirty-eight students participated in the study and answered the questionnaires. The data were compiled and analyzed. Result: The impact of cadaveric dissection on the students that sway on routine activity was observed like nausea (20.28%), dizziness (2.89%), weakness (3.62%), fear (9.42%), tremor (1.45%), sweating (4.35%), restlessness (10.14%), lack of concentration (13.77%), sleep disturbance (3.62%), etc. The results showed that 94.2% of the students found their first visit to the dissection room exciting. About 9.42% of the students were upset at the beginning of the dissection. About 84.78% of the students did not show any anxiety and stress immediately before and during dissection. About 47.83% of the students were found mentally prepared for the dissection and 86.96% agreed that dissection enhanced there thinking skills. About 96.37% of the students agreed that dissection provided the best method for learning anatomy. Conclusion: Most of the students in the present study reported their first exposure to dissection hall thrilling. It was also inferred that cadaveric dissection for learning anatomy is still considered important and indispensable and cannot be substituted by any other tool and technique.

MEDICAL ETHICS, LAW AND SOCIETY

Simranpreet Kaur, Madhu Nagpal

The Rise of Designer Babies: In Defiance with Nature! CRISPR-Cas9-A New Gene Editing Tool

[Year:2018] [Month:July-December] [Volume:2] [Number:2] [Pages:3] [Pages No:130 - 132]

Keywords: CRISPR babies, CRISPR-Cas9, Ethical considerations, Gene editing, Genetic manipulation

PDF  |  DOI: 10.5005/jp-journals-10055-0054  |  Open Access |  How to cite  | 

Abstract

A new genome-editing tool, clustered regularly interspaced short palindromic repeat (CRISPR)-Cas9, could transform the field of biology, and a recent news on the birth of a first gene-edited baby has created a lot of media hype. But, why such a big hype for CRISPR-Cas9, as scientists have already been tinkering with genomes for decades. The answer is in the technology of CRISPR, which is far better than older techniques for gene splicing and editing, doing the work with unprecedented precision, efficiency, and flexibility and just raising the fear of the development of designer babies. Germline editing means editing sperm, eggs, or embryos, i.e., altering the DNA of future generations even before birth, putting a question mark on the line of morality and ethics.

LETTER TO THE EDITOR

Poonam Sharma

MDROs—The New Age Challenge

[Year:2018] [Month:July-December] [Volume:2] [Number:2] [Pages:3] [Pages No:133 - 135]

PDF  |  DOI: 10.5005/jp-journals-10055-0055  |  Open Access |  How to cite  | 

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