Journal of Evolution of Medical and Dental Sciences

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https://imsear.searo.who.int/handle/123456789/163767

Executive Editor: Dr. Sridhar.A.
ISSN: 2278-4802 (Print); 2278-4748 (Online)

Frequency: Biweekly

Language: English

Open Access Peer-reviewed journal

Web site: https://jemds.com/index.php

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An Enigmatic Discovery - Accidental Insertion of Internal Jugular Haemodialysis Catheter into the Vertebral Vein
(Akshantala Enterprises Private Limited, 2024-02) Shah, Rishab
A 40-year-old male was admitted to the medical ward with chronic kidney disease with uremic symptoms and a decision was made to initiate the patient on haemodialysis. It was decided to catheterize the right internal jugular vein directly as the patient would require an A-V fistula in the near future which would be created in the left arm subsequently. Procedure During the time of right internal jugular vein catheterization using the anterior landmark technique, the right carotid artery was punctured leading to hematoma formation on the right side of the neck, despite adequate haemostatic measures. It was decided to catheterize the left internal jugular vein subsequently. Using the anterior landmark technique again, venipuncture was performed on the left side of the neck and in the first attempt itself the guide wire was inserted without any difficulty or resistance. Safe back-flow of venous blood was achieved through all ports of the catheter; that is, the catheter tip was presumed to be well positioned in the left internal jugular vein (IJV), as seen on the chest X-ray taken following the procedure. Clinical Course The patient complained of numbness over the left shoulder and weakness of the left upper limb following the procedure and was evaluated for the same. Under the clinical suspicion of left vertebral artery catheterization, a vascular surgeon opinion was sought and a CT angiogram of the neck was advised. The CT angiogram revealed the catheter entering the left vertebral vein at the level of C6 vertebra, coursing anteroinferiorly reaching the left brachiocephalic vein with its tip noted at the confluence of subclavian vein with internal jugular vein. After the CT angiogram, the misplaced catheter was promptly extracted to prevent the onset of additional complications. No excessive resistance was encountered during the catheter removal, and there were no signs of hematoma formation. Over the next few days, the patient’s symptoms of numbness and weakness resolved spontaneously. The patient had no neurological complaints and deficits on examination during follow-up in the outpatient department.
Myriad Presentation of Adenocarcinoma Lung
(Akshantala Enterprises Private Limited, 2024-02) P., Keerthana Priya; Verma, Ghanshyam; Ravichandar, Sabarinath; Abraham, Elen Ann; Sampath, Santhosh
Lung adenocarcinoma is the leading cause of cancer related deaths worldwide. The causes for adenocarcinoma include smoking, air pollution, family history, occupational exposure, silica, asbestos, diesel fumes, and heavy metals. Smoking increases lung cancer risk by 5- to 10 fold with a clear dose–response relationship and environmental tobacco smoke among non-smokers increases lung cancer risk by about 20 %.[1] Lung cancers can be classified into two types based on histology as small cell carcinoma and non-small cell carcinoma. Adenocarcinoma falls under non-small cell carcinoma. Non-small cell carcinoma is further classified into adenocarcinoma, squamous cell carcinoma, and large cell carcinoma. Polyserositis is a condition where there is an inflammation of serous membranes with effusion. Most common sites are pleura and pericardium presenting with symptoms like chest pain, and shortness of breath.[2] The causes include idiopathic, infectious disease like tuberculosis, autoimmune conditions like SLE, and neoplasm. Neoplasm is the most common cause (nearly one-third of cases). Autoimmune disease like Adult-onset Still's disease presents with cardiac and pulmonary involvement pleural effusion, pericarditis and serositis.[3] A possible manifestation of systemic lupus erythematosus is extensive serous involvement like pericardial effusion and pleural effusion.[4] In this case report, we discuss the presentation of adenocarcinoma and pericardial effusion with liver metastasis in a 74-year-old female.
Small Bowel Perforation Due to an Unusual Foreign Body
(Akshantala Enterprises Private Limited, 2024-02) Kamalam, Anand; Peruka, Sugatri; M., Prathap Chouhan; Seelam, Pratyusha; Taher, Madiha
Gastrointestinal perforation is one of the most common causes of acute abdomen presenting to the casualty. However, gastrointestinal perforation due to ingestion of foreign body is rare and is usually encountered in children, psychiatric patients and in alcoholics. Most of the foreign bodies pass through the GI tract without any complications. Only about 1% are known to cause complications such as perforation. Fish or chicken bones, dentures, toy parts, coins, toothpicks are the most commonly encountered foreign bodies. In this report, we present a case of a 60-year-old male who presented to the emergency department with acute abdomen secondary to ingestion of an unusual foreign body that lead to perforation and underwent exploratory laparotomy for removal of the foreign body. Gastrointestinal perforation is one of the most common causes of acute abdomen presenting to the casualty that needs a timely surgical intervention.[1] Important sites of gastrointestinal perforation are stomach, duodenum, small bowel (jejunum, small intestine), appendix, colon and rectum. The most common causes of gastrointestinal perforation include peptic ulcer disease, diverticulitis, carcinomas, IBD, ischemia of bowel wall and infrequently foreign bodies.[2] Foreign body ingestion as seen in children is unintentional and can be deliberate in psychiatric patients.[3] In general, many of these foreign bodies travel through the gastrointestinal tract without causing complications. Only about 1% cases of ingested foreign bodies cause complications such as hollow viscus obstruction and/ or perforation which are usually life threatening and have poorer outcomes if diagnosis is delayed.[4,5] CT is the imaging tool of choice. Such conditions require immediate surgical intervention such as exploratory laparotomy or laparoscopic or endoscopic removal can be attempted in case of stomach or duodenal foreign bodies. Here in the following case report, we present an atypical case who arrived at the emergency room with acute abdomen following a foreign body consumption and underwent exploratory laparotomy for retrieval of foreign body.
Computer Vision Syndrome in Medical Students-Knowledge, Attitude, Practice (KAP) Study
(Akshantala Enterprises Private Limited, 2024-03) Patil, Aishwarya; Shetty, Niharika
BACKGROUND The use of computers and visual display devices has become an integral part of our lives. As a result, a large number of people around the world are suffering from various ocular symptoms, including dry eyes, ocular strain, eye irritation, and ocular redness. All of these ocular symptoms are commonly called computer vision syndrome. The purpose of this study was to determine the prevalence, community knowledge, and pathophysiology of computer vision syndrome, as well as the factors associated with and preventing CVS. METHODS A cross-sectional study was conducted among 150 medical students and the data was collected through a structured, web-based, and self-administered questionnaire, which was pre tested and pre-validated. RESULTS In this study, 38.7% had a pre-existing knowledge on CVS. 94.67% of the respondents reported having mild to moderate symptoms of dry eyes. It is found that people use screens mostly for social media and entertainment. Long hours spent on the small screen led to sleep disturbances in about 56% of the students. According to our survey, 54% of the students used spectacles and frequent change of spectacles was present. About 40% of the students used topical eye drops prescribed by ophthalmologist. CONCLUSIONS The increasing use of digital screen and prevalence of computer vision syndrome. When combined with increased screen time, dry eyes and good quality sleep can lead to serious health problems like learning difficulties and operative errors, which may pose a challenge in the modern era. Right education, attitude and practice regarding CVS are required to all the medical students due to their increased dependency on digital devices. Proper practice and preventive measures are necessary for a doctor /surgeon for health benefit of the patients and community.
Fetal Warfarin Syndrome - A Case Report
(Akshantala Enterprises Private Limited, 2024-02) K. V., Laila; P., Noufira; K., Shilpa; Santhosh, Smitha
Fetal warfarin syndrome (FWS) or warfarin embryopathy also known as “Di Sala syndrome” is a rare fetal anomaly which occurs as a result of fetal exposure to warfarin during the early stages of pregnancy. FWS is characterised by nasal hypoplasia and skeletal abnormalities, including short limbs and digits and stippled epiphyses. Here we present a case of foetal embryopathy due to warfarin use in a female with an unplanned pregnancy while taking warfarin for cerebral venous thrombosis. The case was reported in Adverse Drug Reaction (ADR) Monitoring centre in August 2023. The purpose of this case report is to caution all the clinicians particularly obstetricians regarding the fetal abnormalities of warfarin. If the mother had history of warfarin usage, paediatricians should also be vigilant regarding the possibility of congenital warfarin syndrome in the newborn. Warfarin is an oral anticoagulant drug that decreases the production of clotting factors (II, VII, IX, X) which are vitamin K-dependent. Warfarin is used in the treatment of patients with thromboembolic disorders and in patients who are predisposed to the development of thrombus. Especially those people with prosthetic heart valves, those who have had ischemic stroke and atrial fibrillation. Warfarin is a teratogen which can cross the placental barrier and cause harm to the developing foetus.[1] Warfarin causes inhibition of clotting factors leading to internal bleeding of the fetus, while inhibition of osteocalcin retards bone growth. In addition to birth defects, warfarin can induce spontaneous abortion, premature delivery, neonatal death and even congenital anomalies known as fetal warfarin syndrome.[2] The risk of teratogenicity is not predictable with any dose of warfarin. The first case of embryopathy due to warfarin was reported by Di Sala in 1966 hence, it is also known as Di Sala syndrome.[3,4] Warfarin leads to embryopathy which is characterized by the abnormalities of cartilages and bones known as chondrodysplasia punctata.[5] Almost 6% of babies born to mothers treated with warfarin during the first trimester have a pattern of congenital anomalies like nasal hypoplasia and stippling of vertebrae or bony epiphyses.[6] So, warfarin is contraindicated during pregnancy. Here we present a case of foetal embryopathy due to warfarin use in a female with an unplanned pregnancy while taking warfarin for cerebral venous thrombosis. This form of stroke is relatively rare and underdiagnosed which accounts for 0.5%-1% of all strokes mostly occurring in young adults, especially in women. Pregnancy, use of oral contraceptive pills (OCPs), puerperium, malignancies and other conditions with hypercoagulable states have been recognised as predisposing risk factors.[7] The conventional therapy for venous thromboembolism includes treatment with parenteral low-molecular-weight heparin (LMWH) and the vitamin K antagonist warfarin.[7]
Lemmel Syndrome - Early Diagnosis of Rare Disease Presenting with Commonest Symptom
(Akshantala Enterprises Private Limited, 2024-01) Shrivastava, Amit; Aggarwal, Aakash; Mann, Srishti; Jindal, Gunjan
One of the most frequent causes of visits to the emergency room is abdominal pain and approximately 10-12% of cases occur globally.[1] From generalized mild pain to major life-threatening disorders, there are a number of considerations to be identified. The causes of pain with signs of biliary obstruction range from most common diagnosis of choledocholithiasis to complex worrisome diagnosis of carcinoma.[2] Up to 27% of individuals undergoing upper gastrointestinal tract assessment have duodenal diverticula, with periampullary diverticula (PAD) being the most prevalent kind. Periampullary diverticula (PAD) are extraluminal duodenal mucosal outpouchings that often form in the medial side of the second and third parts of the duodenum within a radius of 2 to 3 cm from the ampulla of vater.[3,4] Periampullary duodenal diverticulum (PAD) in the absence of choledocholithiasis or neoplasm causing biliary obstruction is diagnosed as Lemmel syndome.[5]
Morphologic and Topographic Anatomy of the Nutrient Foramen in Human Long Bones and Its Clinical Significance
(Akshantala Enterprises Private Limited, 2023-02) ?enol, Gamze Ta?kin; Kürtül, Ibrahim
BACKGROUND The aim of the study was to evaluate the number and position of the nutrient foramina in tibia, fibula, femur, humerus, ulna, and radius bones of dry human bones and correlate the results clinically. METHODS For this purpose, 214 long bones were examined. Of the 214 bones studied, 31 were radial, 28 ulnar, 46 humeral, 33 tibial, 22 fibular and 54 femoral. The size, location and the number of nutrient foramina were analysed, and the length of the bone, and the distance of the nutrient foramina from the proximal end of the bone were measured. And the foraminal index was calculated. RESULTS The numbers of primary nutrient foramen (PF) and secondary nutrient foramen (SF) were 183 (85.5 %) and 16 (7.47 %), respectively, and distributed 80.64 % at radius, 92.85 % at ulna, 80.43 % at humerus, 93.93 % at tibia, 86.36 % at fibula, and 83.33 % at femur. The greatest number of SF was on the femur, but not on the tibia and fibula. A statistically significant correlation was seen among; TL-DPF (radius, tibia and femur), DPF-FI (radius, ulna, humerus, tibia, fibula and femur). CONCLUSIONS This study provides important information about the morphology of nutrient foramina in human long bones, knowledge of which will be useful to surgeons in planning orthopaedic procedures and useful to anthropologists in segmental analysis.
A Case of Lipoid Pneumonia - Hydrocarbon Pneumonitis
(Akshantala Enterprises Private Limited, 2023-12) K., Roopesh Kishan; Ravichandar, Sabarinath; Riaz, Mohammed; Arasu, Thanigai; R., Prasana
Lipoid pneumonia is a rare lung disease that occurs when lipid-containing products are aspirated or inhaled.[1] Exogenous lipoid pneumonia is typically caused by the inhalation or aspiration of animal fats, mineral oils, or vegetable oils, while endogenous lipoid pneumonia occurs due to lipid accumulation within intra-alveolar macrophages in the presence of bronchial obstruction, chronic pulmonary infection, pulmonary alveolar proteinosis, or fat storage diseases.[2] The clinical and radiological features of this condition are non-specific, and a careful history is crucial for accurate diagnosis. Organizing pneumonia can also be observed as a non-specific consequence of interstitial inflammatory diseases such as nonspecific interstitial pneumonia, usual interstitial pneumonia, organizing diffuse alveolar damage, vasculitis, or aspiration pneumonia. In this case report, we discuss the presentation of lipoid pneumonia in a 23-year-old male with a history of petroleum ingestion.
Xanthogranulomatous Cholecystitis - An Intimidating Diagnostic Dilemma - A Case Report
(Akshantala Enterprises Private Limited, 2024-01) Shrivastava, Amit; Bali, Irbinder Kour; Mann, Srishti; Jindal, Gunjan
Xanthogranulomatous cholecystitis (XGC) is an uncommon form of chronic cholecystitis[1] characterized by inflammation and infiltration of gall bladder (GB) wall by lymphocytes and multinucleated histiocytic giant cells. There is transudation of bile into gall bladder wall and involvement of the Rokitansky-Aschoff sinuses leading to formation of submucosal abscess and xanthogranulomas.[2] On CECT, they appear as submucosal hypoattenuating nodules and circumferential wall thickening of gallbladder wall, a sign highly specific of XGC.[3]
Rubber Band Syndrome - An Invisible Syndrome
(Akshantala Enterprises Private Limited, 2024-01) Sanjeevappa, Pavan Banavathi; Suresh, Anugrah
Rubber band Syndrome or Dhaga syndrome is a clinical entity still prevalent in developing countries with strong religious practices which involves the use of elastic bands or threads tied commonly around the arms or legs especially in children as part of religious previews. Here we wanted to diagnose and describe the imaging findings in a case of Rubber Band Syndrome. A three-year-old female patient presented to the surgical out-patient department with complaints of pain, swelling and discoloration of the left wrist. Her mother gave a history of religious thread being tied to the left wrist of the patient two years back. The patient was referred to the Department of Radio-diagnosis for Imaging. Plain radiograph of the left wrist with forearm (AP and Lateral views) revealed a smooth bony defect over the outer aspect of the distal radius and ulna. This syndrome is an invisible syndrome as the patients themselves would not remember tying a religious thread or rubber band over the arm or leg as it is worn for years together due to religious beliefs. Hence, it is important to have knowledge of the condition and the imaging features to make an accurate diagnosis. Rubber Band Syndrome (A.K.A Dhaga Syndrome) is a rare disorder which is caused by elastic bracelets or rubber bands or ceremonial threads worn for decorative or religious reasons and constricting mainly the wrist.[1] All the cases were reported in children especially chubby children.[2] The rubber band/ thread remains unnoticed on the child’s arm which slowly burrows through the skin progressing deeper and becomes invisible during physical examination. In severe cases, the constriction worsens and results in neurovascular deficits. Timely diagnosis by imaging is required in such cases as the physical examination may not reveal any foreign body and prevent lifelong morbidity to the child.
A Cross-Sectional Study Examining the Behavioral Patterns and Attitudes of First - and Second-Year Medical College Students in West Bengal, India, Regarding Self-Medication
(Akshantala Enterprises Private Limited, 2024-02) Kundu, Rupayan; Sarkar, Nivedita; Pal, Tuhin Subhra
BACKGROUND Self-medication is a pervasive habit, and drug abuse is a severe problem. Since medical students are future doctors, they give it a unique significance. The study's objectives were to assess the practice, knowledge, and attitudes of first- and second-year medical students at a medical college in West Bengal, India, about self-medication. METHODS The study was conducted in Nilratan Sircar Medical College and Hospital, Kolkata, West Bengal. In 2021, medical students across the colleges of West Bengal conducted cross-sectional research using questionnaires. Upon being informed of the objectives and design of the study, first- and second-year MBBS students willingly agreed to participate. RESULTS In this study, 91.50% of medical students practiced self-medication. The common indication for self-medication was fever (89.2%) and headache (69.6%). Previous prescriptions for the same illness (68.87%) were the main source of information for self-medication. Common reasons for self-medication were urgency (53.33%) and quick relief (50%). Over-the-counter (88.14%) drugs were the most common sources of medications. The common preferred system of self-medication was allopathic (92.5%). The percentage of discontinuation (58.1%) of self-medication was more. The majority of them favoured oral (96.67%) media. CONCLUSIONS It was determined that more than half of the student population self-medicated for a wide range of ailments; the cause may be the increased public awareness of drugs brought on by the availability of information via books, the internet, and over-the-counter medications from pharmacists. Therefore, it is crucial to stop students from self-medicating to prevent the emergence of drug habits, resistance, and drug interactions.
Chronic Cholecystitis with Cholelithiasis with Gall Bladder Adenomyomatous Hyperplasia in a Young Female - A Case Report
(Akshantala Enterprises Private Limited, 2023-12) Soni, Amit; Barpande, Chitrangi P.; Soni, Nitasha; Barpande, Prashant S.
A thirty-year-old female presented to the Surgery outpatient department of Shri Ram Care Hospital, Bilaspur, Chhattisgarh, with complains of pain in whole abdomen with abdominal distention, nausea, anorexia, dyspepsia and constipation off and on for the last twenty days. There was no history of jaundice in the past. There were no bowel / bladder complaints. On examination, pallor was present. Per abdomen palpation revealed splenomegaly. She was evaluated completely; clinically, radiologically and by routine investigations. She was found to be anaemic (her haemoglobin level was 5.8 gm/dl) and her ultrasound abdomen revealed multiple gall bladder calculi with splenomegaly. She was admitted and a laparoscopic or if needed, an open cholecystectomy was planned after three units of blood transfusion. She underwent the procedure well at Shri Ram Care Hospital and her cholecystectomy specimen was sent to Anushka Diagnostics, Bilaspur, for histopathological evaluation.
A Study of Serial Shearwave Sonoelastography (SWE) Using Supersonic Imaging in Early Renal Post - Transplant Period
(Akshantala Enterprises Private Limited, 2024-01) K., Ashbina; Ramakrishnan, K. G.; Janardhanan, Sujith; Narayanan, Sajith; Aziz, Feroz
BACKGROUND Ultrasound elastography is a novel technique in ultrasound that quantifies the tissue stiffness in organs and recently has emerged as a tool in complementing the evaluation of renal allograft function. The pathological processes underlying the graft dysfunction cause the changes in elasticity of the graft tissue. This change in elasticity is detected and imaged using elastography. US-based elastography is now a noninvasive complementary tool in addition to the existing laboratory and Doppler-based parameters in the evaluation of renal allograft dysfunction. METHODS The present prospective cohort study was conducted in the Department of Radiology, Malabar Institute of Medical sciences, Kerala, India from January 2019 to June 2020. RESULTS Renal allograft parenchymal stiffness by shearwave sonoelastography correlated positively with S. creatinine (p <0.001) and RI (p <0.001) and inversely correlated with eGFR (p<0.001). There was no correlation between the SWE values and BMI of the recipient. There was no correlation between the SWE values and age of the donor and between the SWE values and age of the patient. CONCLUSIONS The renal parenchymal stiffness by shearwave elastography showed positive correlation with serum creatinine and RI values and inverse correlation with eGFR which reflected the functional status of the renal allograft. The renal allografts with graft dysfunction were found to have higher SWE values than the stable renal allografts. The renal parenchymal stiffness can help to differentiate stable allografts and graft with allograft dysfunction, hence may be used as a reliable tool in addition to the existing laboratorical and Doppler based parameters in predicting allograft dysfunction. The cut-off value for differentiating stable renal allografts and renal allografts with dysfunction was found to be 14.32 kpa. There was no correlation between shear wave elastography values with the BMI of the recipient and age of the donor.
Bite Force Measurement in Children with Primary Dentition
(Akshantala Enterprises Private Limited, 2024-01) Karunakaran, Rajika; Sargod, Sharan S.; Suvarna, Reshma; Bhat, Sham S.; Hedge, Sundeep; Salman, Afreen; Shenoy, Shailesh Ramdas
BACKGROUND This study intended to compute the maximum bite force in the primary dentition of the young children (3-6 years old) and examine the possible influences of caries, malocclusions (such as crossbite and bruxism), and other factors on maximum bite force. We wanted to ascertain the extent of biting forces in young children's primary dentition, aged three to six, and examine the impact of several factors, including the subjects' gender, caries, crossbite, and bruxism, on the maximum bite force in this study. METHODS Children within the age group of 3-6 years were selected from nearby schools. A dental examination was done for caries and malocclusion. The subjects were asked to bite on the unit consisting of a force sensor wedged between wooden sticks wrapped in a polyethylene sheet, 3 times on each side (posteriors) and on anterior teeth with maximum bite force and then the mean value was taken. RESULTS 502 subjects between the age group of 3-6 years were included in the study. The levels of bite force recorded showed that there was a significant difference in all three teeth standardized for the bite force measurement in the four groups included (p<0.001). The maximum bite force of the posterior teeth was 351.5N seen in the control group, in the caries group (281.7N), crossbite (181.1N), and bruxism (250.2N). CONCLUSIONS Bite forces in primary dentition showed comparatively wide intra- and interindividual variation. For both boys and girls, there was no discernible variation in the maximal bite force, however maximum bite force in children with caries and bruxism had significant differences compared to the control group. No significant difference in bite forces was seen in children having crossbite and non-crossbite sides.
Level of Stress and its Causes in Indian Engineering Colleges and in Different Professional Colleges Belongingto One of the Universities in the Kingdom of Saudi Arabia, Compared to Control
(Akshantala Enterprises Private Limited, 2024-02) Kumar, Shrenik Shiroorkar Pradeep; Mannil, Aman; Gangadhar, Shreya; Shiroorkar, Pradeep Kumar Narayanappa
BACKGROUND Stress in life can deteriorate the physical and mental health of a person. Stress is higher among medical college students. The present study was undertaken to estimate the prevalence and causes of stress in different professions, in different countries, and different sexes to compare with the control and suggest possible solutions for the same in the future. METHODS A cross-sectional study was undertaken among different professional college students (PCS) (Medical, Engineering, Dental, Pharmacy, and Nursing) at a randomly selected King Faisal University in Saudi Arabia with control from the same university. A similar study was conducted at one rural engineering college and one urban engineering college in India. The level of stress was assessed using the perceived stress scale (1983). Data was collected, tabulated, and analyzed using Excel and SPSS software. Complete data was available from 426 PCS at KFU, including 120 students from rural engineering colleges in India and 31 students from urban engineering colleges in India. A total of 60 controls were taken from non-professional colleges in SA. RESULTS The overall prevalence of stress was high in all PCS, and it varied from 65.33% to 87.10% in different PCS. The causes of stress were a vast and difficult syllabus, pattern of exams, lack of counselling and guidance, fewer co-curricular activities, etc. Stress in nonprofessional control was 30.00%. CONCLUSIONS The incidence of stress is more in different professional college students irrespective of colleges, countries and sex compared to control. The causes of stress among all these students are similar. So the planning and managements for professional colleges must take it seriously. These issues can be solved by providing more teaching and learning facilities, creating a relaxing atmosphere within the college, changing the patterns of examinations, regular counselling, inclusion of recreations like cultural activities, educational tours, music, sports, etc. along with the curriculum. All these things might create more and more healthy and educated professionals to serve our society.
A Case Report of Giant Splenic Artery Pseudoaneurysm with Splenic Infarctions
(Akshantala Enterprises Private Limited, 2024-02) Lokesh, Yashas Ullas; Dudekula, Anees; Bhat, Revanth Ravindra; Muthyala, Guru Yogendra; Shankar, Suprith Jaya
The splenic artery is a frequently affected site for pseudoaneurysms, abnormal bulges in the artery wall. Pseudoaneurysms of the splenic artery are typically linked to pancreatic issues, including acute pancreatitis, chronic pancreatitis, and the formation of pancreatic pseudocysts.[1,2,3,4] These pseudoaneurysms can rupture into nearby organs, leading to gastrointestinal bleeding.[5] Common symptoms associated with splenic artery pseudoaneurysms include the passage of bloody stools (hematochezia) or dark, tarry stools (melena), vomiting blood (hematemesis), abdominal pain, and a condition known as hemosuccus pancreaticus.[6] In the instance of our patient, hematemesis, anaemia, and stomach pain were observed.[6] The preferred imaging method for diagnosing splenic artery pseudoaneurysm is CT angiography.[7] Diagnosing a pseudoaneurysm of the splenic artery can be challenging due to its rarity. Still, splenic infarct can provide a valuable diagnostic clue, as was the case similar to our patient.[6] Pseudoaneurysm of the splenic artery is a relatively rare complication with associated pancreatitis.[1] While pseudoaneurysms can develop in any blood vessel near the pancreas, the splenic artery is most frequently affected, accounting for about 60% of cases due to its proximity to the pancreas.[8] In autopsy studies, the reported incidence of splenic artery pseudoaneurysms ranges from approximately 0.098% to 10.4%.[9] Identifying this less common vascular complication is crucial because it has the potential to rupture and lead to gastrointestinal bleeding.[5]
A Rare Case of Cornelia De Lange Syndrome
(Akshantala Enterprises Private Limited, 2024-01) Mahipathy, Surya Rao Rao Venkata; Ananthappan, Manoj; Natarajan, Praveen Ganesh; Singaram, Mamta; Durairaj, Alagar Raja
An 8-year-old female child was referred to our Cleft and Craniofacial centre, Department of Plastic & Reconstructive Surgery, Saveetha Medical College & Hospital, after being diagnosed with cleft palate and hyper nasal speech. She is the first child born from a non- consanguineous marriage with a birth weight of 2.6 kg. Following her, a girl and a boy were born and exhibited no apparent abnormalities. Both parents maintain a normal status, and there is no history of deformities in their family lineage. The patient underwent a typical vaginal delivery and was born at full term. At the time of birth, the child was differentially diagnosed with a neurogenic tumour in the occipital region of the skull. The child was not treated for the growth in the occiput. Patient had growth retardation, global developmental delays and features of facial dysmorphism like microcephaly, bushy and uni eyebrow, long eyelashes, low set ears, small nose, concave nasal bridge, and hirsutism. The child was subjected to an MRI brain scan in our unit and it suggested a hyperechoic lesion in the midline at C3, C4 level with an impression of Arnold Chiari malformation. Clinically, on palpation of the lesion, it approximately measured 4x3 cm, soft in consistency and the lesion hardened while coughing or sneezing and regressed back to normalcy within a few minutes. USG abdomen was done and a well-defined hypoechoic dumbbell shaped bilobed solid lesion with smooth margins with no significant vascularity was noted in the gastrohepatic region. Echocardiogram was done and it ruled out cardiac anomalies like patent ductus arteriosus or coarctation of aorta. Inspection of the oral cavity was done to diagnose the cleft of the secondary palate. (Fig. 1) Based on all features in examination and investigation, a diagnosis of Cornelia de Lange syndrome was made. The surgery was planned after a routine blood workup. The child was advised for CECT of abdomen to confirm the USG findings of abdominal anomalies, however, the report suggested cystic lymphangioma. (Fig. 2) Fitness for palatoplasty surgery was obtained from paediatrician, paediatric surgeon, neurosurgeon, cardiologist and anaesthesiologist. Under antibiotic cover, the child was operated under general anaesthesia for palatoplasty by Sommerlad’s technique. (Fig. 3 & 4) The post-operative period was uneventful.
Can We Use Our Dental Curing Lights to Polymerize Objects Produced with 3D Resin Printer?
(Akshantala Enterprises Private Limited, 2023-02) Kölü?, Türkay; ?ahbaz, Mehmet; Köklü, U?ur
BACKGROUND Dental treatment objects produced with 3D resin printers barely polymerize after fabrication. They need post-curing and an extra polymerization oven is required. Present study is aimed to determine the effectiveness of dental curing lights for post-curing of objects produced with a 3D resin printer. METHODS Samples were produced with Alias Sharp & Rigid Model 3D Printing Resin in Photon Mono X 3D resin printer. The control set samples were cured with UV light for 2 min in Wash & Cure Plus device. T-20, T-40 and T-60 set samples were exposed to VALO Cordless curing light for 20, 40 and 60 seconds respectively. The hardness was measured with the Shore D Durometer. Then, the samples were subjected to compression. For statistical analysis, one way analysis of variance (ANOVA) and Tukey test was used. RESULTS The set cured with VALO Cordless for 20 seconds showed the highest strength. Compressive strength decreased with prolongation of the curing time. All experimental sets showed significantly higher hardness than the control set. Hardness increased gradually in the 20 and 40 second sets, but the difference between the 40 and 60 second sets was not significant. Also, color change was observed in the experimental sets samples. CONCLUSIONS Dental curing lights are effective in post-curing 3D printer resins
Assessment of Cardiac Dysfunctions in Patients with Liver Cirrhosis Admitted in a Tertiary Care Centre
(Akshantala Enterprises Private Limited, 2023-11) Pillai, Kasthuri Ramachandran; K. P., Selvarajan Chettiar; M. K., Suresh
BACKGROUND The presence of cardiovascular dysfunction in liver cirrhosis has been studied over the past several years. Cardiovascular dysfunctions in cirrhosis increase the risk of coronary artery disease and mortality after TIPSS insertion and liver transplantation. Cirrhotic cardiomyopathy also plays an important role in the pathogenesis of hepatorenal syndrome. All these data highlight the need for rigorous cardiovascular risk assessment in patients with liver cirrhosis. METHODS After obtaining institutional approval, we analysed 96 consenting patients with liver cirrhosis satisfying inclusion criteria. Relevant history of the cases was sought through a structured questionnaire. Appropriate clinical examinations were done. Echocardiogram, ECG and biochemical parameters of the patients were examined and recorded. Data analysis was done using SPSS software. RESULTS 51% of the patients had QTc > 0.44 seconds in ECG which was suggestive of electrophysiological abnormality. The systolic dysfunction was assessed by presence of left ventricular ejection fraction below 55%, which was detected in 4.2% of the patients. E/A ratio less than 1 and deceleration time more than 200 msec were taken as parameters suggestive of the presence of diastolic dysfunction. 34.4% had an E/A ratio < 1 and 42.7% of the patients had a deceleration time more than 200 msec. 53% were found to have cirrhotic cardiomyopathy. The prevalence of CCM was increasing with the severity of liver disease. 53.1% of the patients had left ventricular hypertrophy and there was significant association between the prevalence of LVH and severity of cirrhosis. 38.5% of the patients had coronary artery disease as per history and ECG findings. No significant association was obtained between the prevalence of CAD and severity of CLD. 4.2% patients had arrhythmia and there was a significant association with the severity of disease. Troponin I was elevated in 20.8% of the patients. CONCLUSIONS Liver cirrhosis is a risk factor for cardiovascular dysfunctions. Most of the patients with cardiac compromise were asymptomatic. 53% patients were diagnosed to have cirrhotic cardiomyopathy. The prevalence of cardiovascular dysfunctions was found to increase with the rising severity of cirrhosis as per CTP score. Diastolic dysfunction was more prevalent than systolic dysfunction. The prevalence of cardiovascular dysfunctions was lesser among patients with regular follow-up and treatment for cirrhosis liver. 38.5% of the patients had coronary artery disease. The prevalence of arrhythmias was 4.2%. Troponin levels were elevated in 20.8% patients.
Digital Technologies in Clinical Practice? Ethical and Legal Knowledge and Practice -A Questionnaire-Based Cross-Sectional Study
(Akshantala Enterprises Private Limited, 2023-11) P. M., Dhamini; Prashanth, Vaishnavi; S., U Arrvinthan
BACKGROUND Digital technologies have become indispensable tools in clinical practice, revolutionizing the way healthcare professionals deliver care, access information, and manage their daily routines. However, it also presents ethical and legal challenges that need to be carefully addressed. This study focused on the assessment of knowledge and practice among dental practitioners of using digital technologies in clinical setups. METHODS The descriptive cross-sectional survey was conducted using the well-structured, pretested, questionnaire consisting of close-ended questions and was statistically analyzed using Statistical Package for Social Sciences (SPSS version 3.1.9) for MS Windows. RESULTS Overall knowledge of participants between different years of practice (P-0.702) and between general dentists and specialties (P-0.09) had no statistically significant difference unlike in practices between the groups. CONCLUSIONS To navigate these issues effectively, healthcare organizations should establish comprehensive policies and procedures for their efficient use in clinical practice along with education programs for professionals.

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