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Singh A, Basappa N, Singh J. Comparative Analysis of Hepatobiliary and Pancreatic Pathologies on Sonography and Magnetic Resonance Cholangiopancreatography. Curr Trends Diagn Treat 2019; 3 (2):45-55.
Background: The pancreaticobiliary pathologies are one of the most common routinely encountered disorders. The evaluation of a suspected pancreaticobiliary pathology is a common radiological problem and is routinely diagnosed by a variety of imaging modalities including ultrasonography (USG), computed radiography, and magnetic resonance cholangiopancreatography (MRCP). Objectives: To study and compare the radiological features in pancreatic and biliary system pathology using USG and MRCP, and to compare the findings with histopathology results wherever available. Materials and methods: The prospective study was carried out on 50 patients with suspected pancreaticobiliary pathologies who underwent both USG and MRCP. Results: In our study of 50 cases, there were 34 (68%) female cases and 16 (32%) male cases with hepatobiliary pathologies. The female to male ratio was 2.1:1. The maximum number of 15 (30%) cases were between the age range of 41 years and 50 years. The dilatation of the biliary system was seen in 40 (80%) cases, cholelithiasis in 22 (44%), isolated choledocholithiasis in 16 (32%), cholecystitis in 3 (6%), pancreatic divisum in 3 (6%), choledochal cyst in 3 (6%), acute pancreatitis in 2 (4%) chronic pancreatitis in 4 (8%), and common bile duct (CBD) stricture in 2 (4%) cases; these are the most common pancreaticobiliary pathologies identified on MRCP. Ultrasonography was equally good in comparison to MRCP in identifying intrahepatic biliary radical dilatation, gallbladder distension, and cholelithiasis in 100% cases. However, the sensitivity and specificity of USG in detecting choledocholithiasis was low. Conclusion: Though USG provides a good information about the presence of biliary obstruction, it does not suggest the possible cause in many cases. Hence, USG is regarded as an initial guide to select the patients for MRI examination. Magnetic resonance cholangiopancreatography is a highly sensitive noninvasive modality in the detection of the level and cause of the biliary obstruction.
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Bajwa AK, Kaur R, Kaur S, S, Sharma S, Kaur S, Kaur S, Kaur S. Descriptive Study to Assess the Knowledge of Staff Nurses Regarding Forensic Psychiatry at Selected Hospitals, Amritsar. Curr Trends Diagn Treat 2019; 3 (2):56-58.
Introduction: Forensic psychiatry is a subspecialty of psychiatry that focuses on the interface between psychiatry and the law. Nurse practising in this unique specialty may apply their skills to the care of both victims and perpetrators of crime and in a variety of settings including primary care facilities, hospitals, and correctional institutions. Material and methods: The descriptive study design was applied to assess the level of knowledge on forensic psychiatry among staff nurses at selected hospitals, Amritsar. Sixty staff nurses were selected using convenient sampling technique. The tool contained demographic and clinical variables and a self-structured knowledge questionnaire regarding forensic psychiatry, which was distributed to collect the data. Results: The results of the study show the level of knowledge of staff nurses regarding forensic psychiatry, revealing that 39(65%) had excellent knowledge and 21(35%) had good knowledge with an average mean and standard deviation (SD) of 21.38 ± 3.23. The findings of the study conclude that staff nurses working in psychiatry and critical care units have less knowledge regarding forensic psychiatry. Conclusion: There is a need to arrange in-service education regarding forensic psychiatry and also a need for continued and intensified efforts to ensure that staff nurses who are involved in providing quality healthcare services must acquire knowledge and skills necessary about legal and ethical issues and the effects of misuse of law and negligence of nursing practice.
Introduction: Hepatic encephalopathy is defined as a spectrum of neuropsychiatric abnormalities in patients with liver dysfunction after exclusion of brain disease. To compare arterial vs venous ammonia levels in hepatic encephalopathy and to correlate the severity of hepatic encephalopathy with arterial as well as venous ammonia levels. Materials and methods: This study was an observational study conducted on 60 patients of hepatic encephalopathy admitted to a tertiary care hospital and medical institute. For ammonia estimation, arterial and venous samples were collected on first, third, and fifth days of admission. The samples were then centrifuged immediately and analyzed with in 30 minutes of centrifugation on fully automated analyzer by Siemens RxL Dimensions. Patients were thoroughly examined to know the grade of hepatic encephalopathy. Then, arterial and venous ammonia levels were correlated with the severity of hepatic encephalopathy. Results: Arterial ammonia level measurement is considered better while assessing hepatic encephalopathy when compared with venous ammonia levels. Results of this study also indicated that arterial total ammonia level measurement is a better indicator in assessing the grade of hepatic encephalopathy when compared with venous total ammonia levels. Of all patients, most were in grade I, and the highest level of ammonia was seen in grades III and IV. Conclusion: Arterial ammonia levels correlated better with the presence and severity of hepatic encephalopathy when compared with venous ammonia levels.
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Kaur A, Chawla A, Manjari M. Incidence and Clinicopathological Correlation of Cervical Cancer in a Tertiary Care Center: A 5-year Retrospective Study. Curr Trends Diagn Treat 2019; 3 (2):64-67.
Introduction: Cervical carcinoma is the second most common cancer of women in India, with the first being breast carcinoma. In 2018, the age standardized incidence rate in the world was 13.1% and in India was14.7%, with 569,847 new cases and 311,365 deaths in 2018 in the world. Infection by human papillomavirus (HPV) is the most common risk factor for cervical cancer, with more than 99% cases expressing viral sequence. The present study was undertaken to study the incidence, various clinical presentations, and the histological types of cervical carcinoma. Materials and methods: The study was carried out in a tertiary care center for a period of 5 years (January 2015 to December 2019) on histopathologically diagnosed cases of cervical cancer. A total of 308 cases of cervical carcinoma were studied in this period. Results: Incidence of cervical cancer in the present study was 2.9%. Maximum number of cases was seen in fifth and sixth decades. The most common clinical presentation was postmenopausal bleeding (78.6%) followed by discharge per vaginam (66.6%). On microscopy, squamous cell carcinoma (SCC)-large-cell nonkeratinizing type was most common (89%) followed by adenocarcinoma (5.5%). Other types were adenosquamous (1.9%) and small cell carcinoma (1.9%), and the least common was SCC-large-cell keratinizing type (1.6%). Of the 308 cases, 164 (53.2%) were in stage II followed by 95 cases (30.2%) in stage I. Conclusion: In conclusion, the current study stressed the fact that as a majority of Indian women are diagnosed at later stages of cervical cancer rather than in its early treatable stages, so there is a need for strengthening and proper implementation of screening programs. Keeping in mind the incidence, the knowledge of vaccination against HPV for prevention of carcinoma cervix should also be followed.
Background: Although repeated efforts are being made from time to time to enhance the knowledge of pediatricians regarding the oral health of children, yet there is a huge gap to bridge. This study is yet another effort to find the loopholes where improvements can be made, as establishing a good rapport and communication between both the fraternities is the need of the hour to decrease the load of a major public health problem, i.e., dental caries in children. Aim: This study was aimed to appraise pediatricians’ knowledge and awareness toward oral health and treatment needs. Materials and methods: Pediatricians in the Amritsar district were requested to fill up the questionnaire concerning their knowledge level and approach toward pediatric dentistry. Results: Although 80% of pediatricians were aware about dental caries, only 60% of the pediatricians surveyed had ample knowledge of the importance of various aspects of pediatric dentistry. Conclusion: Every pediatrician should be associated with a pediatric dentist to minimize the load of oral diseases and brace the positive dental attitude in developing years of life.
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Sandhu IM, Singh NR. Absence of Nocturnal Penile Tumescence: An Earlier Sign of Erectile Dysfunction and Its Linked Comorbid Conditions. Curr Trends Diagn Treat 2019; 3 (2):72-76.
Most of the patients with vascular and metabolic disorders such as cardiovascular diseases (CVDs), hypertension, diabetes, obesity, or stroke show some kind of abnormal erectile function (EF) significantly affecting the quality of life (QoL). There is a direct link between person\'s sexual health and physical health. Nocturnal penile tumescence (NPT), the involuntary erections occur during sleep, are the normal physiological and spontaneous phenomenon in all healthy men. Nocturnal penile tumescence measurement expedites the procedure of differentiating organic causes of erectile dysfunction (ED) in men from psychological causes. Absence of NPT can precede ED and its related comorbid conditions and should be given importance during early clinical diagnoses of such disorders.
Pancreatic cutaneous fistulas are rare but a possible complication of a kidney surgery. The anatomical proximity of the tail of the pancreas to the left kidney plays a key role in this matter. The relevant factors are also the size of the kidney tumor and the coexisting inflammatory infiltration as well. The reason of fistula formation is the imperceptible intraoperative damage to the pancreatic tissue and opening of pancreatic ducts. We are reporting a case of a 40-year-old patient who developed pancreatic cutaneous fistula after 10 years of left nephrectomy leading to skin excoriation. He was treated conservatively with octreotide and the fistula healed spontaneously. In conclusion, the pancreatic fistula is a rare complication of left nephrectomy.
Background: Morel-Lavallée lesion is a rare clinical presentation which involves detachment of skin and subcutaneous fat from underlying fixed fascia which mainly occurs after traumatic injury. Morel-Lavallée lesions require immediate attention because it may lead to superinfection and poor patient outcomes, if treatment is delayed. Materials and methods: A detailed case study was done of three patients who were diagnosed with Morel-Lavallée lesion at the outpatient surgery department of tertiary care center at Amritsar. Results and conclusion: Patients were treated either surgically or conservatively and they responded to treatment. It can be concluded that the initial treatment is critical to shortening the clinical course and preventing the recurrence. Early diagnosis and management are essential. The Morel-Lavallée lesion is usually missed during the initial assessment, so a thorough clinical examination of roadside accident should be done to rule out such lesions. Neglected lesions can become infected and progression of lesion may lead to extensive skin necrosis.
Background: Prostatic cyst is a rare disease of prostate, with 0.5–7.9% prevalence. It is often asymptomatic and found accidentally using abdominal ultrasound, computed tomography (CT), or magnetic resonance imaging (MRI). It is a rare pathology which can be confused with diseases of prostate like benign hyperplasia of prostate or carcinoma prostate which are much more common in old age. Case description: A 70-year-old male presented to emergency department with complaints of acute urinary retention and constipation. Abdomen was opened via a lower midline incision revealing a large cystic lesion of prostate which was aspirated (550 mL approximately, brownish in color) and deroofing of cyst wall was done. Complete excision could not be done due to the presence of adhesion with rectal wall. Histopathology report confirmed it to be a benign cyst of prostate. Discussion: Existing literature of prostatic cysts are highlighting its infrequent occurrence. The etiological factors of prostatic cyst include inflammatory disease, benign prostatic hyperplasia, ejaculatory duct obstruction, atrophy of prostate gland, and tumor. In our case, the patient had urinary retention and constipation which was related to large size of the cyst. The differential diagnosis includes bladder diverticulum, teratoma, seminal vesicle cyst, epididymal cyst, and Wolffian duct cyst.
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Abbi P, Kullar KK, Arora D, Badhan C, Gupta R. Anesthetic Management for Emergency Lower Segment Cesarean Section in a Septicemia Patient with Systemic Lupus Erythematosus. Curr Trends Diagn Treat 2019; 3 (2):84-85.
Aim: The aim of this study is to describe the successful anesthetic management of a diagnosed systemic lupus erythematosus (SLE) parturient with bad obstetric history and septicemia, posted for emergency cesarean section. Background: Systemic lupus erythematosus is an autoimmune disease which may occur in pregnancy resulting in obstetrical complications. Disease exacerbation, increased fetal loss, neonatal, and an increased incidence of preeclampsia are the major challenges. Case description: A 33-year-old female patient (G7A6L0) with 32 weeks of amenorrhea presented with fetal distress planned for cesarean section, in Sri Guru Ram Das Medical College and Hospital, Amritsar. Patient had a history of multiple abortions and no live issues. Conclusion: Regional anesthesia is a preferred choice for pregnant patient with SLE who presents for cesarean section.
Benign cementoblastoma was acknowledged by World Health Organization as an odontogenic tumor originating from cementum. Nowadays, it has been included into tumors of mesenchyme and/or odontogenic ectomesenchyme origin, with or without odontogenic epithelium. This article reports an unusual case of cementoblastoma in a 16-year-old male patient, which involved right mandibular first and second molars causing sharp spontaneous pain radiating to temporal region along with local swelling, which was progressive in nature since 3 months. The lesion showed slow growth and was usually asymptomatic; however, pain and swelling were also been reported in a plethora of cases including the one in this article. Radiographically, the lesion commonly highlights a radiopaque mass often merged with the roots of a tooth, which was enveloped and limited peripherally by a radiolucent halo. The treatment involves surgical excision of the mass along with extraction of involved teeth.
Neeti R Singh
Aim: Retroperitoneal soft-tissue sarcomas are relatively uncommon diseases, and the most frequent histotype, ranging from 20 to 45% of all cases, is represented by liposarcoma, which is a hard-to-treat condition for its local aggressiveness and clinical aspecificity. Presentation of case: We report a case of a 69-year-old woman who underwent surgical resection for a giant pleomorphic retroperitoneal liposarcoma. Discussion: Currently, chemotherapy for retroperitoneal soft-tissue sarcomas is not effective, and radiotherapy has limited efficacy due to the toxicity affecting adjacent intra-abdominal structures and showed validity only in case of high-grade malignancy by reducing local recurrence but with no advantage in overall survival. Nowadays, complete surgical resection remains the most important predictor of local recurrence and overall survival. Conclusion: The removal of a retroperitoneal sarcoma of remarkable size is a challenge for the surgeon owing to the anatomical site, the absence of an anatomically evident vascular-lymphatic peduncle, and the adhesions contracted with the contiguous organs and great vessels. Therefore, we believe that, particularly for large-sized diseases associated with high-grade malignancy, a complete surgical resection with the removal of the contiguous intra- and retroperitoneal organs when infiltrated represents the only therapeutic option to obtain a negative margin and therefore an oncological radicality.
MEDICAL ETHICS, LAW AND SOCIETY
Jatinder P Singh,
Jaspinder P Singh
In September 2017, a communication from the Ministry of External Affairs of India in connection with 39 Indian nationals held captive in Iraq was received. Out of 39 persons, 25 belonged to Punjab state of India. As per this communication, mass graves had been found in Mosul and Badish areas of Iraq. In order to establish the identity of mortal remains found in mass graves, blood samples of close blood relative of these missing persons were needed, which will enable the Iraqi authorities to match the deoxyribonucleic acid (DNA) samples with those found in mass graves. The Government of Iraq suspected these mass killings of Indians alleged to have been done by Islamic terrorists. The blood samples of the close relatives of 16 missing persons and blood samples of rest of persons were taken by experts of district headquarters of Punjab after guidance from this department. As per the requirements of the Iraq government, the blood samples of the close relatives of the deceased were taken on FTA cards that were sent through district administration of Amritsar to Ministry of External Affairs, Government of India, for onward transmission to Iraq embassy. Later on, the samples were sent to Iraq. After confirming their identity by the Iraq government, cadaveric remains of deceased in coffins were airlifted to India for their final rites. The collection of blood samples in these cases was done as per the standard guidelines issued by Centre for DNA Fingerprinting and Diagnostics (CDFD) Hyderabad on Flinders Technology Associates (FTA) cards. The role of this advanced technology proved to be a boon for the distressed relatives of the deceased by establishing the confirmed identity of deceased and providing solace.