Indian Journal of Medical Sciences

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Cerebellar ataxia after a single day of metronidazole use: Case report
(Scientific Scholar, 2023-04) Parekh, SV; Dsouza, ME; Bhaisare, SD; Abdulla, A.
Cerebellar ataxic syndromes, although uncommon, have been reported previously in patients taking metronidazole. However, almost all cases describe instances where patients were taking prolonged or high doses of the drug. We report a 65-year-old man who consumed 400 mg of metronidazole 3 times over 1 day and presented with slurring of speech, imbalance while walking and diplopia. The symptoms developed the day after consumption of metronidazole. Examination showed slurring of speech, gaze-evoked nystagmus, and dysmetria in all limbs. MRI brain revealed symmetric hyperintense lesions in the dentate nucleus and pons on T2-weighted imaging and FLAIR, which have a well-established association with metronidazole-induced central nervous system (CNS) toxicity. On discontinuation of the drug, symptoms improved, and complete recovery was noted at follow-up 2 weeks later. This case indicates that CNS side effects of metronidazole may not necessarily occur only at high doses or after prolonged courses of metronidazole, but may occur as an idiosyncratic reaction to the drug. Reasons for variable susceptibility require further investigation.
“MaRhyThe© and cupping” – A novel multimodal approach for radiation-induced trismus
(Scientific Scholar, 2023-04) Pattanshetty, R; Rao, MS; Pawar, NN.
Head-and-neck cancer is the fifth most frequently occurring cancer in India. Among the various treatment options, side effects such as trismus are mostly caused due to radiation therapy. Physical therapy is known to be beneficial in treating post-cancer treatment side effects. To the best of our knowledge, this is the first study report highlighting the efficacy of MaRhyThe© in treating radiation induced trismus. A multimodal approach (MaRhyThe©, Cupping therapy, Myofascial Release, and exercises) has shown to be beneficial in treating trismus, shoulder disability, pain, muscle spasm, and improving the quality of life in the head-and-neck cancer patient.
Safe radiological spinal intervention: A multicenter snapshot survey of musculoskeletal radiologists in the UK and India
(Scientific Scholar, 2023-04) Aslam, A; Iyengar, KP; Sharma, GK; Botchu, R.
Objectives: Research, knowledge, and technological advances have promoted minimally invasive image-guided diagnostic and therapeutic intervention. Such interventions are increasingly performed for musculoskeletal diseases by radiologists within outpatient settings. The objective of this study was to ascertain levels of safe practice among musculoskeletal radiologists in the United Kingdom and the Indian public health-care system, as defined by access to spinal surgeons and anesthetists during radiological spinal procedures. Material and Methods: An online cross-sectional survey of eight questions (multiple choice and free text) was circulated among musculoskeletal radiologists in the UK and India, to evaluate: (i) Image-guided practice among musculoskeletal radiologists. (ii) Types of interventions undertaken. (iii) Practice setting. (iv) Availability of supportive, backup access to spinal surgery services. Results: A total of 53 replies were received of which 43 (81.1%) were from musculoskeletal radiologists who perform spinal interventional procedures. Spinal biopsies and injections were the most common procedures performed by the 43 eligible radiologists (79.1% and 74.4%, respectively), with vertebroplasty and sacroplasty performed by only 16.3% and 11.6%, respectively. Less than half (46.5%) of musculoskeletal radiologists performing interventional procedures did so within a hospital setting with both a spinal surgeon and an anesthetist on site, 20.9% had an anesthetist on site but no spinal surgeon and 16.3% had neither on-site. Conclusion: Minimally invasive image-guided diagnostic and therapeutic intervention is a niche sub-specialty practiced by a few musculoskeletal radiologists. Enhanced resource allocation, skills training, and multidisciplinary service provision will ultimately minimize existing deficiencies, improving patient-related clinical outcomes, and quality of care.
A pilot study on effect of intravenous iron sucrose on oxidative stress and antioxidant status of pregnant women with iron deficiency anemia
(Scientific Scholar, 2023-04) Rameshkumar, S; Viswanathan, S; Jagadeesan, AR; Dhanunjaya, Y.
Objectives: Iron deficiency anemia (IDA) is the most common nutritional deficiency among pregnant women in India. Iron can be supplemented orally or intravenously to treat IDA. Intravenous supplementation of iron can be risky as there is more possibility for the production of free iron in circulation. The role of free iron in the generation of free radicals and thereby oxidative stress is well known. The present study tends to evaluate oxidative stress and antioxidant status of intravenous iron sucrose treated pregnant women. Materials and Methods: This prospective study was conducted in ACS Medical College and Hospital, Chennai. Twenty pregnant women with moderate IDA (Hb: 7–9.9 g/dl) were included in the present study. Blood samples were collected before and after the treatment with intravenous iron sucrose to measure antioxidants such as reduced glutathione, catalase and superoxide dismutase, and lipid peroxidation marker such as malondialdehyde. Results: In the present study, plasma malondialdehyde levels were increased significantly after the treatment with intravenous iron sucrose. No significant alterations were observed in the levels of reduced glutathione and activities of catalase and superoxide dismutase. Conclusion: In the present study, intravenous iron sucrose infusion was associated with oxidative stress as evidenced by increased lipid peroxidation in antenatal women with IDA. Hence, treatment with antioxidants during iron infusions can be considered
Parenteral testosterone therapy’s effect on penile size before hypospadias surgery
(Scientific Scholar, 2023-04) Godse, S; Kumar, A; Singh, H; Choudhary, G; Chhabra, MK.
Objectives: The purpose of this study was to see the effect of parenteral testosterone injection on penile length, glans diameter, and diameter at the base of the penis in hypospadias patients before surgery. Material and Methods: The study was conducted from September 2019 to March 2021. This study comprised a total of 20 hypospadias patients. At a dose of 2 mg/kg body weight, an injection testosterone propionate was administered deep intramuscularly in three doses with a 3-week gap before reconstructive surgery. Before surgery, the penile length, glans diameter, and penile diameter at the base of the penis were all measured. Results: The mean increase in penile length, glans diameter, and diameter at the base of penis following parenteral testosterone therapy was 1.07 ± 0.23 cm (P < 0.001), 1.01 ± 0.46 cm (P < 0.001), and 0.92 ± 0.12 cm (P < 0.001), respectively. All three measurements were statistically significant. Conclusion: Intramuscular testosterone increased penis size, glans diameter, and penile diameter without causing any notable side effects. Development of fine pubic hair, acne, and aggressiveness is minor adverse effects.
Prevalence and determinants of chronic illness and quality of life among rural residents of Pondicherry – A descriptive cross-sectional study
(Scientific Scholar, 2023-04) Jafrin, MM.
Objectives: The lifestyle diseases which are becoming chronic noncommunicable disorders contribute to about 53% of death rate in India affecting the DALY to a greater extent. These lifestyle illnesses are proving to be a great challenge in public health as they are necessitating for the advanced modalities of screening techniques that have to be in place for early detection. The objectives of the study were to assess the prevalence and determinants of chronic illness and quality of life among rural residents of Pondicherry. Materials and Methods: The study is a descriptive observational study using a validated structured questionnaire among rural residents who have crossed the adolescent period. Results: The subjects included people aged above 18 years. It is observed that about 45.5% of the study population are between 38 and 58 years and about 24% of the study population were skilled, 10.6% are illiterate and 59.8% of the study population are not regular visitors to any health center, about 72% of them attend a health facility once in 3- 5–7 months/year. It is observed that about 24.6% have had the disease for 6–10 years. Among them, 25.9% are diabetic, 7.3% are hypertensive, 8% have both, 3.7% had asthma, 0.3% are CAD, and 0.7% had a stroke. According to physical (median = 26), psychological (median = 21), social (median = 11), and environmental (median = 29) domains, quality of life was moderately good. Conclusion: This study revealed that all the domains are affected in the quality of life even in a rural area where urbanisation and industrialisation is not establihed.
Unusual presentation of intranasal myxoma – A case report
(Scientific Scholar, 2023-04) Kuniyil, R; Ogra, S; Achaparambil, AS; Bhageeratha, M
Myxomas are benign and locally invasive neoplasms of primitive mesenchymal origin. They are most commonly found in the atria of the heart. They have also been reported in bones, muscles, and other connective tissues. Myxomas are rarely found in the nose and paranasal sinuses. Myxomas are notorious for their recurrence after excision and local invasion. We report a case of intranasal myxoma in a 30-year-old male who presented with blocked ear sensation and progressive nasal block. With this report, we intend to increase awareness about the clinical presentation, histologic characteristics, and management options of myxoma
Judge Juan Manuel Padilla Garcia, ChatGPT, and a controversial medicolegal milestone
(Scientific Scholar, 2023-04) Parikh, PM; Shah, DM; Parikh, KP.
Chat Generative Pre-Trained Transformer (ChatGPT) has revolutionized how we perceive artificial intelligence (AI).: Judge Juan Manuel Padilla Garcia created history by mentioning its use while passing judgment about an autistic child and payment for his medical treatment by his insurance company. The use of AI is not new and is helping the judiciary system in many ways. However, this judgment given on January 30, 2023, has ignited controversy among Judge Garcia’s peers and the global community (a Google search produced more than 70 million hits on February 5, 2023). EU has established guidelines that are to be followed before calling any AI tool trustworthy. This requires stringent compliance with the verification and due diligence process. In this instance, ChatGPT was used within 2 months of its launch, even when it has been shown to give incomplete, incorrect, and misleading answers in many instances. Hasty adaption of unproven technology, however good it may be, should not be our path. This might fuel the misguided fear amongst people about robots taking over from human judges.
Brain stem auditory evoked potential response in neonates after recovery from hyperbilirubinemia: A neurophysiological approach to screening neuronal hearing loss
(Scientific Scholar, 2022-04) Yadav, RL; Yadav, LK; Bhusal, P; Timilsina, S; Sapkota, NK; Islam, MN.
Objectives: Neonatal hyperbilirubinemia leads to neurological damages including encephalopathy and hearing loss. This study aimed to screen and evaluate the hearing loss in neonates after recovery from hyperbilirubinemia using the Brainstem evoked response audiometry (BERA) test. Materials and Methods: This cross-sectional comparative study was conducted in Physiology Department at Chitwan Medical College, Nepal. It included 20 age and sex-matched neonates recently recovered from hyperbilirubinemia and 20 normal healthy controls. The external acoustic canals of subjects were checked for any blockage or collapse before BERA testing. The BERA recordings were performed after the neonate’s natural sleep following a standard lab protocol explained by Taylor’s Evoked Potential in Clinical Testing. Results: The BERA wave latencies were delayed with a higher number of case group neonates I (IL-75%, IR-80%), III (IIIL-70%, III R-80%), and V (VL- 80%, VR-85%) than those of controls. The percentage of neonates with delayed interwave latencies was comparable between groups. The neonate’s hearing sensitivity assessed using the grades of hearing impairment by WHO revealed slight (threshold of hearing left ear [THL]-25% and threshold of hearing right ear [THR]-30%) and moderate (THL-40% and THR-35%) grades among cases whereas no impairment (THL-60% and THR-55%) in controls. The hearing thresholds were more in cases. Conclusion: The auditory pathway is highly sensitive to elevated serum bilirubin. BERA detects even a minute degree of hearing damage seen after complete treatment of hyperbilirubinemia. Therefore, BERA is a helpful tool in the early screening of hearing impairment in neonates. This improves prognosis by early management so that the neurosensory systems develop to their full extent and one can enjoy a normal social life.
Determinants of quality of life among COVID-19 patients in Southwestern region of Bangladesh
(Scientific Scholar, 2022-04) Methun, MH; Uddin, MSG; Haq, I; Noor, A; Habib, MJ; Hossain, MI; Saleheen, Ahmed Abdus Saleh; Roy, Sutopa; Ume, Shatabdi Shamrita; Rukon, Md. Rukonozzaman; Hasan, Md. Amit; Alam, Md. Jahangir
Objectives: The outbreak of COVID-19 has caused an unprecedented health crisis and dramatically changed human lives. This study aims to identify risk factors related to health-related quality of life (HRQoL) among COVID-19 patients who were discharged from the hospital. Material and Methods: A total of 557 COVID-19 patients of Jhenaidah district of Bangladesh who had tested positive before February 1 of 2021 were selected for this cross-sectional study. The EuroQol 5-dimensional-5 level questionnaire was used to measure the HRQoL. Thai value set was used to assess the full health status. Chi-square test was used to find out the association of HRQoL with sociodemographic and clinical factors. Finally, logistic regression was used to find out the predictors of the dimensions of HRQoL. Results: Using the Thai value set, it is observed that 57.27% of participants had reported that they had experienced moderate or severe health problems. About 40.57% of the respondent reported anxiety or depression, whereas 39.14% of the participants had experienced moderate or severe pain or discomfort. The result of the logistic regression showed that age, gender, occupation, place of care, heart problems, and diabetes significantly affect various dimensions of the HRQoL. Conclusion: The COVID-19 significantly depletes the health condition of the patients in both mental and physical aspects. Therefore, the policy-makers and government should need to come with comprehensive strategies to reduce the psychological and physical health woe of COVID-19 patients.
The effect of hemodialysis on hearing in chronic kidney disease patients – A systematic review
(Scientific Scholar, 2022-04) Kumar, KA; Hishamudin, AD; Krishnan, DA; Lingam, H; Manogaran, JA; Yahya, NA; Jeppu, Ashok Kumar
Hemodialysis as a treatment modality for Stage V chronic kidney disease (CKD) has significantly decreased mortality. However, there have been several studies reporting sensorineural hearing loss (SNHL) in these patients which affects their quality of life. The role of hemodialysis in its etiology has been widely debated and the strength of available evidence has not yet been evaluated. A systematic literature review was conducted to identify a possible association of hemodialysis to hearing loss and guide in making informed decisions in the management of CKD patients. Relevant articles from PubMed, ScienceDirect, EBSCO Medline, SCOPUS, Google Scholar, and Clinical Key were identified using Preferred Reporting Items for Systematic Review and Meta-Analyses framework. Studies that were published since the inception of the database to May 2020 and written in the English language were analyzed. A total of 36 articles on hemodialysis and sudden or SNHL were retrieved. Many were observational (13 cohorts, 10 case-control, seven case series, and six cross-sectional) studies involving 99,020 participants with ages ranging from 1 to 80 years. This review elucidates the occurrence of SNHL in CKD patients on hemodialysis. Yet, the available literature fails to provide conclusive evidence on hemodialysis as a causative agent for SNHL. Audiological assessment of all CKD patients before hemodialysis and regular follow-up may help in early diagnosis and better management of hearing loss
Knowledge, attitude, and prevention of self-medication practices among the general population of Gujarat
(Scientific Scholar, 2022-04) Shah, H; Arora, B.
Objectives: The practice of self-medication (SM) without consulting a health-care professional among the populace of both developed and developing countries like India may lead to a delay in therapeutic effectiveness. The present study was conducted to assess the knowledge, attitude, and practice of SM among the general population of Gujarat. Material and Methods: An observational, cross-sectional questionnaire-based study was conducted among 488 participants between April 2021 and May 2021 to evaluate the several aspects of SM. In April 2021, this study was conducted on both the genders of 18–80 years of urban and rural areas of Gujarat. Data were analyzed for descriptive statistics. The data presented in the form of percentages using tables and figures. The responses were collected and analyzed using GraphPad v.8 and Microsoft Excel for percentage and statistical significance. Results: Prevalence of SM was 78.3%. It was found to be practiced more among the younger age group (55.32%) than the older. Graduates practiced SM more than the others (P < 0.004). Significant association was found between its practice and residency (P < 0.03), marital status (P < 0.003), education (P < 0.004), and occupation (P < 0.0007). Fever, cough, and cold were the most common conditions noted for SM practice followed by headache. It was noticed that 63.5% participants were procured medications from pharmacy. Multivitamins, nonsteroidal anti-inflammatory drugs, and antibiotics were the most frequent medications used by participants. Conclusion: The prevalence of SM is alarming which causes serious health issues and needs an intervention. Planning of health awareness programs, educating people, and pharmacists are necessary for promoting rational use of medication.
Primary vesical actinomycosis with changes of cystitis cystica presenting as bladder mass
(Scientific Scholar, 2022-04) Mishra, N; Upadhyay, H; Parikh, C.
Actinomycosis is a rare chronic granulomatous suppurative infection caused by Gram-positive bacteria. The occurrence of primary vesical actinomycosis is extremely rare and only a few cases have been reported. Pre-operative diagnosis of vesical actinomycosis is challenging as the clinical and radiological features usually point towards bladder malignancy. Therefore, in most cases, definitive diagnosis is usually made after histopathological examination of the involved tissue. A 60-year-old male presented with complaints of hematuria, burning micturition, irritative, and obstructive urinary symptoms for 15 days. USG revealed a large soft-tissue mass having a polypoidal intraluminal and extraluminal component and involving the right posterolateral urinary bladder wall. CT scan showed a large irregular soft-tissue mass with multiple cystic lesions involving the right lateral wall of the urinary bladder. Transurethral resection of bladder mass biopsy was performed and the histopathological examination showed bacterial colonies of Actinomyces with changes of cystitis cystica. The patient was treated with amoxicillin and potassium clavulanate for 3 months. Actinomycosis should be kept as a rare differential diagnosis in cases presenting as bladder mass. The diagnosis is most commonly made by histopathology and may need a repeat biopsy to arrive at the correct diagnosis. The patient should be treated by penicillin group of antibiotics for 2–3 months and followed up for years to detect any recurrence
Alcohol-based hand sanitizer-induced burns: A harsh reality in current times
(Scientific Scholar, 2022-04) Gupta, D; More, A.
ue to the recent coronavirus pandemic, there is a steep rise in the use of alcohol-based hand sanitizers (ABHSs) over the past few months. For them to be effective against microorganisms, the minimum recommended concentration of alcohol is 60%. This high alcohol content makes the sanitizers easily flammable. Although, they are extremely convenient to use, they can also prove to be a hazard if used in an improper manner. Guidelines have been published for safe manufacturing and distribution of these sanitizers. There are recommendations for storage and use, which should be adhered to in a strict manner. Their use by children should always be supervised. We report four cases of burn injuries caused by injudicious use of alcohol-based sanitizers. The flammable nature of ABHSs can also be exploited as witnessed in one of our cases. With this report, we wish to emphasize that judicious and correct use of these seemingly benign products is essential.
A correlation biomarker between BMI and lipid peroxidation in type 2 diabetes mellitus with and without other complications
(Scientific Scholar, 2022-12) Premkumar, G; Bhagyalakshmi, V; Sandhya, S.
Objectives: Body mass index (BMI) is a traditional measurement practice that divides a person’s weight by their height to find out whether they have a healthy range of weight. The objective of this study is to understand the relation between BMI and prevalence of diabetes mellitus, hypertension, and dyslipidemia. Material and Methods: BMI distribution among these patients was compared with and without hypertension and dyslipidemia. The improper of secretion of insulin leads to changes in metabolism of lipids, proteins, and carbohydrates also characterized hyperglycemia generally considered as diabetes mellitus (DM). Results: The excessive formation of free radicals induces oxidative stress, and the antioxidant defense system becomes weaken and hence arises diabetic disorder and overproduction of malondialdehyde (MDA). In cells, the polyunsaturated fatty acid peroxidation is considered as the final product and marker of oxidative stress. Conclusion: In this study, significantly increased BMI is observed in diabetic victims in comparison with control group. A significant positive correlation was noticed between glycated hemoglobin, cholesterol, and MDA. In conclusion, for the prevention and management of vascular complication in type 2 diabetes mellitus, maintaining normal levels of MDA and body weight are very important. Further large-scale studies are required to confirm it
Differences in COVID-19 mortality in males and females: Is estrogen hormone attributing to sex differences?
(Scientific Scholar, 2022-12) Garg, R; Agrawal, P; Purussnani, N; Gautam, A; Agrawal, M; Singh, A; Gupta, Prashant
Objectives: Globally, the case fatality ratio is more in males versus females. Some studies have suggested estrogen hormone decreases susceptibility to SARS CoV-2. We have analyzed the observed sex differences in COVID-19 behavior in males and females and the clinical profiles of females of different age groups of COVID-19 patients and discussed their symptoms, laboratory evaluations, and associated comorbidities. Material and Methods: The patients were tested for COVID-19 through real-time RT-PCR (Reverse Transcription Polymerase Chain Reaction) assay. The data obtained were studied for the epidemiological, clinical, and laboratory characteristics from their medical records. Results: The mortality rate in females was 12.33% (36/292) whereas mortality in males was 19.63% (84/428). In between group analysis, 8.7% (14/161) of females died in the <40 years age group versus 16.8% (22/131) in more than 40 years age group whereas in males, the mortality was 13.7% (21/153) in <40 years versus 22.9%(63/275). The mortality rate in women older than 40 years was greater than mortality in younger females emphasizing the protection provided by estrogen hormone in them. The proportion of patients who expired due to COVID-19 significantly differs by age cutoff of 40 years, X2 (1, n = 428). The difference is statistically significant at P < 0.05. Males more than 40 years are more likely to expire. Conclusion: Sex-related differences in coronavirus pandemic have been found pointing toward the protective role of estrogen hormone and other differences in immunological behavior in males and females. Downregulation of ACE2 expression, thereby reducing viral entry, might also be contributory to decreasing mortality in females.
Thrombus in transit – A case series on dilemma in management
(Scientific Scholar, 2022-12) Agrawal, G; Sharma, S; Paul, B
Thrombus in transit (TIT) is a rare but potentially fatal condition. Transthoracic echocardiography is the diagnostic modality of choice. The major complications of TIT are pulmonary embolism, right ventricular dysfunction, obstructive shock, and paradoxical embolism through patent foramen ovale. We hereby present a case series of four patients with TIT and the challenges faced while managing them
COVID-19 in people living with HIV – A case series
(Scientific Scholar, 2022-08) Chadalavada, B; Rao, MR; Pandharpurkar, D.
People with chronic diseases, old age, obesity, and immunosuppression are more susceptible to infections, including COVID-19. Human immunodeficiency virus (HIV) is widely prevalent in India, yet, the number of COVID cases in people living with HIV is low. We report six cases of COVID-19 in patients with HIV who face various challenges in the intensive care unit. The severity of their COVID infection varies from patient to patient depending on their immune status and treatment with antiretroviral therapy
COVID-19 mRNA vaccine triggering dermatomyositis: A case report
(Scientific Scholar, 2022-12) Awadh, NI; Gorial, FI; Al-Laylaa, RD; Ismail, M.
The battle against SARS-COV-2 is rising and the hope in the safety and effectiveness of immunization against this virus is growing up, even though serious and severe adverse events are scarcely observed. In this article, we report a case of mRNA vaccine induced an autoimmune dermatomyositis with features of severity that are managed by immunosuppressants medications and still in regular follow-up. Inflammatory dermatomyositis can be triggered after vaccination with COVID vaccine in the same mechanism that COVID-19 infection-induced myositis.
Relationship of MTHFD1 G1958A and CBS 844ins68 polymorphism with congenital heart defects in North Indian population (Jammu and Kashmir): A case-control study
(Scientific Scholar, 2022-12) Bala, A; Raina, JK; Sudershan, A; Digra, S; Dhar, MK; Panjaliya, RK; Parvinder, Kumar
Objectives: There are many multifactorial causes for Congenital Heart Defects (CHDs) in which both genetic and non-genetic factors play role. MTHFD1 and CBS are two of the key enzymes that plays pivotal role in the metabolic pathway of homocysteine. Most of the studies revealed that genes involved in folate/homocysteine pathways are involved in the occurrence of CHDs. The present study was planned to investigate the role of common polymorphisms in MTHFD1 and CBS gene in children with CHD in Jammu region of Jammu and Kashmir UT. Material and Methods: A total of 160 (80 CHD patients and 80 controls) children were enrolled for the present case-control study. After extraction of genomic DNA genotyping of SNP MTHFD1 G1958A(rs2236225) was done by PCR-RFLP and CBS 844ins68 polymorphism was done by PCR technique. Results: Our results show that there is no significant association between MTHFD1G1958A and CBS 844ins68 polymorphism with CHD. In case of SNP MTHFD1 G1958A allele A found to be higher in both patient and control group and inCBS 844ins68 polymorphism frequency of risk allele ‘I’ found higher in cases (0.06) as compared to controls (0.04). The homozygous genotype for 844ins68 (II) was found absent in both the patients and control group. Conclusion: We conclude that both MTHFD1 G1958A and CBS 844ins68 polymorphism were not found to be genetic risk factor in the development of CHD in population of Jammu region of Jammu and Kashmir UT

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