Journal of Evolution of Medical and Dental Sciences

Permanent URI for this collection

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

Browse

Now showing 1 - 20 of 880

Unilateral Absence of Musculocutaneous Nerve with Variation in Distribution of Median Nerve - A Case Report
(Akshantala Enterprises Private Limited, 2025-06) Kommanda, Radhakrishna Shetty; Mani, Muthuvel; Gandrakota, Ravindranadh; Jagadeesan, Saravanan; Janakiram, Madhan Kumar Soutallu; Monteiro, Francis Nanda Prakash
The brachial plexus innervates the upper limb. It is mainly formed by the anterior primary rami of C5 through T1 and provides sensory and motor innervation of the upper extremity. The brachial plexus is divided proximo-distally into rami/roots, trunks, divisions, cords, and terminal branches.[1] The MN (Median Nerve) is the main nerve of the anterior compartment of the forearm. The formation of the trunk of the MN takes place in front of the third part of the axillary artery by the union of lateral and medial roots, which arise from the respective cords of the brachial plexus and pass towards the forearm without supplying any muscles of the arm.[1] In the forearm, it supplies the muscles of the anterior compartment of the forearm through its direct and anterior interosseous branches, except for the flexor carpi ulnaris and the medial side of the flexor digitorum profundus. In the hand it supplies the thenar and the first two lumbricals. It also gives cutaneous branches to the lateral part of the palm and lateral three and a half digits. The MCN (Musculocutaneous Nerve) arises from the lateral cord of the brachial plexus and has root values of C5, C6, and C7. The MCN pierces and passes through the coracobrachialis muscle, supplying the muscle in the process. The MCN in the lower part of the arm pierces the deep fascia below the elbow on its lateral side and becomes subcutaneous, where it continues as the lateral cutaneous nerve of the forearm.[2,3] In 3.57–6.6% of cases, there will be an absence of MCN with several unforeseen clinical implications regarding the atypical innervation of the musculature otherwise supplied by the musculocutaneous nerve.[4] Here we present a case report in which there was an absence of MCN in one arm, low fusion of roots of MN below the level of midarm, and the anterior compartment muscles being supplied by the separate branches from the lateral root of MN.
An Interesting Case of Long-Standing Renal Calculi Associated Squamous Cell Carcinom
(Akshantala Enterprises Private Limited, 2025-03) Swamy, Shivakumar S.; Revanth, R.B.; Mahesh, A; Gowda, Thasmai B.R.
A 55-year-old male patient presenting with an episode of seizure and a history of on-and-off abdominal pain since the past few years came for radiological evaluation. Initial ultrasound showed a grossly enlarged hydronephrotic right kidney with multiple large calculi and retroperitoneal lymphadenopathy. The patient underwent FAPI PET-CT to rule out malignancy and was diagnosed with long-standing renal calculi associated squamous cell carcinoma with brain, lung, and retroperitoneal lymph node metastases. Histopathology and immunohistochemistry confirmed the diagnosis of squamous cell carcinoma. The patient later underwent radical nephrectomy with retroperitoneal lymph node clearance. Adjuvant chemotherapy and radiotherapy were also administered to the patient, and he is currently on follow-up. Nonetheless, the prognosis for individuals suffering from renal pelvic squamous cell carcinoma is extremely dismal, with a median survival of barely 7 months following surgery and a mere 7.7% of patients surviving for more than 5 years.[1] It is acknowledged that one of the primary carcinogenic factors for SCC is urinary calculi, which causes persistent irritation of the renal pelvis, resulting in squamous metaplasia and then finally neoplasia.[2] Patients with renal SCC have explored a variety of therapies. The patient's age, overall health, cancer staging, and patient compliance should all be taken into consideration while choosing a treatment plan. The primary treatment options for renal SCC are radical nephrectomy combined with total ureterectomy.[3] The goal of this article is to make the physicians aware of the possibility of renal squamous cell carcinoma in patients who have long-standing hydronephrosis or nephrolithiasis.
A Rare Case of Giant Parathyroid Adenoma in a Rural Tertiary Hospital of North Bengal
(Akshantala Enterprises Private Limited, 2025-03) Bhaumik, Soumendu; Mahato, Radheshyam; Sarkar, Monideepa; Das, Saumik; Gupta, Shuvam
A 30-year-old euthyroid male patient presented with a gradually progressive, painless mass in the neck that moved with deglutition, associated with generalized weakness, needing assistance for activities of daily life, and a pathological fracture. Biochemical reports revealed hyperparathyroidism and hypercalcemia. Radiological investigations revealed a complex mass in the postero-medial aspect of the left thyroid lobe, generalized bone resorption with healed pathological fracture, and nephrolithiasis. FNAC was unable to rule out parathyroid neoplasm. The patient underwent a left hemithyroidectomy and a parathyroidectomy. Aggressive IV calcium therapy managed the post-operative hungry bone syndrome. Post-operative histopathology suggested giant parathyroid adenoma of the left superior parathyroid gland. Parathormone, secreted from the parathyroid glands, is responsible for the maintenance of calcium homeostasis in the body.[1] Increased secretion of parathyroid hormone results in primary hyperparathyroidism (or PHPT), causing symptoms characterized by the mnemonic “stones, bones, groans, thrones, and psychiatric overtones’’.[2,3] Osteoporosis and bone fractures are the most common symptoms of primary hyperparathyroidism. Calcium deposits in the renal parenchyma and recurrent nephrolithiasis lead to decreased kidney function and phosphate retention.[4,5] PHPT has been reported in 1% of the adult population and in 2% after the age of 55 years in Western series.[6] In an Indian series, the male: female ratio was 1.7: 1. Almost three quarters (71.5%) of cases were less than 40 years of age, lower than the fifth and sixth decades reported from developed nations.[7] The common causes of primary hyperparathyroidism are sporadic, solitary adenomas (80-85%), parathyroid hyperplasia (10%), and parathyroid carcinoma (2-5%).[8,9] Parathyroid adenomas (PTAs) are usually small, measuring < 2 cm and weighing < 1 gm. GPTAs (Giant PTAs) are adenomas that weigh more than 3.5 gm and are usually rare. Both PTA and GPTA present with the syndrome of primary hyperparathyroidism.[10] Most hyperparathyroidism patients are asymptomatic or have nonspecific symptoms such as fatigue, pain, and weakness that are generally missed in the initial phases. Most patients with hypercalcemia are discovered incidentally on routine laboratory screening. The present case report shows a delay in the diagnosis of a symptomatic case of hyperparathyroidism, caused by parathyroid adenoma, due to the difficulty in the diagnosis of such cases in rural areas.
Resistant Hypertension Due to Primary Aldosteronism - A Case Report
(Akshantala Enterprises Private Limited, 2025-06) Ray, Aniket Awadhesh; Puthalath, Rajeev Thekke; Hegde, Suraj; Pai, Narendra
By definition, resistant hypertension means blood pressure that remains above the goal inspite of concurrent use of three antihypertensive drugs of different classes, of which one should be a diuretic. One of the causes of resistant hypertension is primary aldosteronism, or Conn’s disease. These adrenal adenomas are often missed on ultrasound abdomen examination and may remain undiagnosed. Such patients have episodes of hypokalemia, and often they only receive potassium supplementation without a definitive diagnosis. It is estimated that less than 1.5% of hypertensive patients and less than 0.3% of the general adult population have primary aldosteronism. A high level of suspicion is required to diagnose primary aldosteronism when the patient presents with resistant hypertension, hypokalemia, and a normal USG abdomen. We present a case of a female who presented to us with hypertension refractory to 3 antihypertensives who had repeated episodes of hypokalemia which was conservatively managed at different hospitals, who came to our hospital with the same complaints and was diagnosed to have a left-sided aldosterone-producing adenoma on CECT abdomen. Laparoscopic left adrenalectomy succeeded in normalizing her potassium levels and keeping her BP under control on 1 antihypertensive medication. Blood pressure that remains above the target level in spite of simultaneous use of 3 anti-hypertensive medications of different classes, of which one is a diuretic, is called resistant hypertension. One of the causes of this condition is an aldosterone-secreting adrenal adenoma/Conn’s disease. The causes of unilateral aldosterone hypersecretion include Conn’s adenoma, primary unilateral adrenal hyperplasia and rarely, aldosterone-producing adrenocortical carcinoma. It is estimated that primary aldosteronism is seen in 1.5% of the hypertensive population and around 0.3% of the general adult population, but it may be 23% or more in patients diagnosed as having resistant hypertension. These patients have hypokalemia, which can result in serious cardiac complications. It is a surgically correctable cause of hypertension and a high level of suspicion is required when a patient presents with hypertension with hypokalemia, or a patient with resistant hypertension. We present a case of a female who presented to us with hypertension refractory to 3 anti hypertensives with repeated episodes of hypokalemia, which was then investigated to be diagnosed as left-sided aldosterone-producing adenoma.
Single Umbilical Artery with Symmetrical IUGR and Multiple Fetal Anomalies - An Interesting Case Report
(Akshantala Enterprises Private Limited, 2025-03) Kotapati, Amulya Choudary; Khandru, Bhargavi; Vijayasree, M.
In the present-day scenario, congenital abnormalities and genetic syndromes are increasing due to conceptions in extremes of age groups (teenage pregnancy and elderly primi gravidas), which is about 0.8 to 2.9%. Since our hospital is situated in the periphery, consanguinity persists. In our tertiary care center, we terminate many cases of abnormal fetuses. Here we are presenting one such interesting case scenario. In today's world, where women's access to education is continuously improving, societal trends are shifting, and one notable change has been a decline in consanguineous marriages. Consanguineous marriages, or marriages between closely related individuals, have historically been more common in certain cultures, but the increasing level of female education and awareness of the potential genetic risks associated with these unions has led to a noticeable reduction in their occurrence. This is a positive shift, as consanguineous marriages have been linked to a higher risk of genetic disorders in offspring due to the increased likelihood of inheriting recessive genetic conditions. In tandem with these social changes, advancements in medical technology have significantly improved prenatal care. Fetal medicine specialists now employ a variety of cutting-edge diagnostic tools to identify potential genetic and structural abnormalities in a fetus as early as possible. Among the most notable of these technologies are NIPT (Non-Invasive Prenatal Testing) and the TIFFA (Targeted Imaging for Fetal Anomalies) scan. NIPT is a blood test that analyzes small fragments of fetal DNA circulating in the mother's blood, providing a safe and highly accurate method for detecting chromosomal abnormalities, such as Down syndrome, as early as 10 weeks of pregnancy. Meanwhile, the TIFFA scan is a more advanced ultrasound technique used to identify gross anatomical abnormalities in the fetus, offering detailed insights into the fetal development during the second trimester. These technologies, along with others, have revolutionized prenatal care by enabling early intervention, counselling, and decision-making based on a more accurate understanding of potential risks. Despite the tremendous progress made in the field of fetal medicine, the detection and prevention of genetic abnormalities are not flawless, and cases of genetic disorders continue to emerge. The present case we are discussing serves as a poignant reminder that, even with the most advanced screening methods available, some conditions may still go undetected or may not be entirely preventable. The case highlights the complexity of genetic inheritance and the limitations of current diagnostic tools, underlining the importance of continued research and development in prenatal care.
Unusual Neonatal Presentation of Type I Leukocyte Adhesion Deficiency (LAD 1)
(Akshantala Enterprises Private Limited, 2025-03) Rathour, JS; Muthukumaran, N.
Leukocyte adhesion deficiency is a type of primary immunodeficiency syndrome with fatal forms of recurrent episodes of infection since the neonatal period. This is a very rare disease. Diagnosis is usually made in childhood but can be diagnosed in the early days of the neonatal period, which helps in starting early treatment with excellent results. Neonatologists should have a very high index of suspicion to diagnose this condition in neonates. The condition may mimic serious bacterial infections with a leukemoid reaction. About 1 in 1 million people are affected worldwide, which shows it’s a rare occurrence. There are few reported cases of LAD-I in newborns’. In LAD 1 (Leukocyte Adhesion Deficiency Type 1), steady adhesion of leukocytes to endothelial surfaces is defective with the following major immunological features.[1] 1. Inability to form pus 2. Deficiency of various glycoproteins like LFA-1/Mac-1, involved in cellular adhesion 3. Inability of leukocytes to migrate to the site of infection to kill offending microbes. The main adhesion glycoprotein involved is CD18. 4. Due to the absence of these adhesion molecules, inflammatory response is not sufficient to restrict or kill microorganisms, which eventually leads to recurrent bacterial infections. • Inheritance pattern of LAD 1 is autosomal recessive.[2] • Both B-cells and T-cells are affected. • Worldwide very few cases in neonates are reported. Main striking characteristics of LAD 1 are “delayed separation of umbilical cord at birth, persistent leukocytosis, and recurrent bacterial and fungal infections involving skin and mucosa and poor wound healing.” In our case of LAD-1 in a neonate, there was normal separation of the umbilical cord with no clinical signs of omphalitis.
Section Case Report Congenital Chylous Ascites - A Rare Case Report
(Akshantala Enterprises Private Limited, 2025-03) Agarwalla, Sunil Kumar; Priyadarshini, Pallavi; Das, Jigeesha; Mallick, Bijayalaxmi; Mahar, Jatadhari
A 42-day-old female infant presented with persisting pedal edema of the dorsum of both feet since birth, which gradually progressed to tense distended abdomen and peri-orbital edema. On further examination, the bilateral pedal edema was pitting type, and per abdomen examination revealed tense distended abdomen with slit-like abdomen and fluid thrill positive.
Placental Mesenchymal Dysplasia – A Diagnostic Dilemma
(Akshantala Enterprises Private Limited, 2025-03) Vijayakumar, Meghana D; V, Madhushree; Honne, Deepthi; Ganguli, Aparna
PMD (Placental Mesenchymal Dysplasia) is a rare, benign cystic lesion of the placental stroma generally categorized by placentomegaly and enlargement of chorionic villi. It is significantly associated with severe intrauterine growth restriction and intrauterine fetal demise. We present a case of a 31-year-old gravida 2 para 1 with previous intrauterine fetal death at 28 weeks with no fetal movements. Post-fetal expulsion, the placenta was sent for histopathology, which reported placental mesenchymal dysplasia. It is imperative to do a careful examination of the placenta and exclude rare cases of placental pathologies. PMD is associated with severe IUGR with fetal demise. PMD is a rare, benign, cystic disorder of the placenta. It is often misdiagnosed as a partial hydatidiform mole.[1] However, placental mesenchymal dysplasia is diploid in nature with normal trophoblast, while partial hydatidiform mole is triploid in nature with trophoblastic hyperplasia. The incidence of PMD is 0.02% in pregnancies.[2] PMD is associated with severe fetal growth restriction or fetal demise.[3] In few reported cases of PMD, there is a correlation to a pathogenic heterozygous variant in one of the genes. Hence, genetic counselling is important for future pregnancy care.
A Rare Case of Right Internal Carotid Artery Agenesis Complicated by Fusiform Basilar Aneurysm Leading to Subarachnoid and Parenchymal Haemorrhage with Intra-Ventricular Extension
(Akshantala Enterprises Private Limited, 2025-03) Borah, Pronami; Dharavath, Venkatesh; Deka, Angshumi; Majumdar, Debarati; LS, Muhammed Shameem
ICA (Internal Carotid Artery) agenesis is a rare vascular anomaly, often associated with compensatory collateral circulation and predisposition to aneurysm formation. We report the case of a 60-year-old female presenting with acute SAH (Subarachnoid Haemorrhage), intraparenchymal haemorrhage, and intraventricular extension, secondary to ruptured aneurysms. Imaging revealed right ICA agenesis, a fusiform basilar aneurysm, and a saccular aneurysm in the left anterior cerebral artery. Endovascular coiling successfully stabilized the patient. This case highlights the importance of multimodal imaging and early intervention in managing rare cerebrovascular anomalies. ICA agenesis is an exceedingly rare congenital vascular anomaly with a prevalence of <0.01%.[1] It is often asymptomatic but can lead to significant cerebrovascular complications due to altered hemodynamics and compensatory collateral circulation. We report a rare case of right ICA agenesis complicated by ruptured aneurysms, emphasizing the role of advanced imaging modalities in diagnosis and management.
Subhepatic Caecum and Appendix - A Case Report
(Akshantala Enterprises Private Limited, 2025-03) Kommanda, Radhakrishna Shetty; Shetty, Prakash Chandra; Hegde, Shruthi; Mani, Muthuvel; Zulkaflee, Hazim; Monteiro, Francis Nanda Prakash
Sub hepatic cecum and appendix is a rare anatomical condition with a reported incidence of 0.08%. This results from the developmental incomplete rotation or malrotation of the midgut and arrested descent of the caecum. In this position, if there occurs an inflammation, the resulting right upper abdominal pain is mistaken for acute cholecystitis, liver abscess, or perforated duodenal ulcer. Moreover, this may be missed on imaging modalities. This necessitates clinical suspicion of subhepatic appendicitis in case of undiagnosed right upper abdominal pain. Herein we report a case of caecum and appendix encountered in the right hypochondrium beneath the liver during routine anatomical dissection of a cadaver. Caecum and appendix are the early parts of the large intestine and are situated in the lower part of the abdomen on the right side, corresponding to the iliac fossa. The appendix is a narrow muscular tube varying in length between 3 inches and 5 inches, the base of which is attached to the posterior wall of caecum just below the ileo-caecal junction.[1] The most common position of the appendix is retrocecal in position in the right iliac fossa. Acute appendicitis is not uncommon during life, normally diagnosed with a high index of clinical suspicion followed by laboratory and imaging modalities. But, when the caecum and appendix are situated in a location other than the usual right iliac fossa, the diagnosis of acute appendicitis becomes challenging and erroneous.[2] Delay in diagnosis or wrong diagnosis because of an abnormally located appendix when inflamed may lead to delay in recognizing the appendicitis, which may result in the perforation of the appendix, a surgical emergency.[3] King in 1975 was the first one to report a case of abnormally located appendicitis.[4] Ideally, the right iliac fossa is the place where the terminal segment of the ileum joins the caecum.[5] However, when the caecum is in subhepatic region, the terminal part of the ileum passes through the right iliac fossa and joins the caecum. Herein we report a case of a subhepatic caecum with an appendix encountered during routine anatomical dissection and discuss the complication resulting from such anomaly.
Section Case Report Congenital Chylous Ascites - A Rare Case Report
(Akshantala Enterprises Private Limited, 2025-02) Agarwalla, Sunil Kumar; Priyadarshini, Pallavi; Das, Jigeesha; Mallick, Bijayalaxmi; Mahar, Jatadhari
A 42-day-old female infant presented with persisting pedal edema of the dorsum of both feet since birth, which gradually progressed to tense distended abdomen and peri-orbital edema. On further examination, the bilateral pedal edema was pitting type, and per abdomen examination revealed tense distended abdomen with slit-like abdomen and fluid thrill positive.
A Rare Case of Giant Parathyroid Adenoma in a Rural Tertiary Hospital of North Bengal
(Akshantala Enterprises Private Limited, 2025-02) Bhaumik, Soumendu; Mahato, Radheshyam; Sarkar, Monideepa; Das, Saumik; Gupta, Shuvam
A 30-year-old euthyroid male patient presented with a gradually progressive, painless mass in the neck that moved with deglutition, associated with generalized weakness, needing assistance for activities of daily life, and a pathological fracture. Biochemical reports revealed hyperparathyroidism and hypercalcemia. Radiological investigations revealed a complex mass in the postero-medial aspect of the left thyroid lobe, generalized bone resorption with healed pathological fracture, and nephrolithiasis. FNAC was unable to rule out parathyroid neoplasm. The patient underwent a left hemithyroidectomy and a parathyroidectomy. Aggressive IV calcium therapy managed the post-operative hungry bone syndrome. Post-operative histopathology suggested giant parathyroid adenoma of the left superior parathyroid gland. Parathormone, secreted from the parathyroid glands, is responsible for the maintenance of calcium homeostasis in the body.[1] Increased secretion of parathyroid hormone results in primary hyperparathyroidism (or PHPT), causing symptoms characterized by the mnemonic “stones, bones, groans, thrones, and psychiatric overtones’’.[2,3] Osteoporosis and bone fractures are the most common symptoms of primary hyperparathyroidism. Calcium deposits in the renal parenchyma and recurrent nephrolithiasis lead to decreased kidney function and phosphate retention.[4,5] PHPT has been reported in 1% of the adult population and in 2% after the age of 55 years in Western series.[6] In an Indian series, the male: female ratio was 1.7: 1. Almost three quarters (71.5%) of cases were less than 40 years of age, lower than the fifth and sixth decades reported from developed nations.[7] The common causes of primary hyperparathyroidism are sporadic, solitary adenomas (80-85%), parathyroid hyperplasia (10%), and parathyroid carcinoma (2-5%).[8,9] Parathyroid adenomas (PTAs) are usually small, measuring < 2 cm and weighing < 1 gm. GPTAs (Giant PTAs) are adenomas that weigh more than 3.5 gm and are usually rare. Both PTA and GPTA present with the syndrome of primary hyperparathyroidism.[10] Most hyperparathyroidism patients are asymptomatic or have nonspecific symptoms such as fatigue, pain, and weakness that are generally missed in the initial phases. Most patients with hypercalcemia are discovered incidentally on routine laboratory screening. The present case report shows a delay in the diagnosis of a symptomatic case of hyperparathyroidism, caused by parathyroid adenoma, due to the difficulty in the diagnosis of such cases in rural areas.
An Interesting Case of Long-Standing Renal Calculi Associated Squamous Cell Carcinom
(Akshantala Enterprises Private Limited, 2025-02) Swamy, Shivakumar S.; Revanth, R.B.; Mahesh, A; Gowda, Thasmai B.R.
A 55-year-old male patient presenting with an episode of seizure and a history of on-and-off abdominal pain since the past few years came for radiological evaluation. Initial ultrasound showed a grossly enlarged hydronephrotic right kidney with multiple large calculi and retroperitoneal lymphadenopathy. The patient underwent FAPI PET-CT to rule out malignancy and was diagnosed with long-standing renal calculi associated squamous cell carcinoma with brain, lung, and retroperitoneal lymph node metastases. Histopathology and immunohistochemistry confirmed the diagnosis of squamous cell carcinoma. The patient later underwent radical nephrectomy with retroperitoneal lymph node clearance. Adjuvant chemotherapy and radiotherapy were also administered to the patient, and he is currently on follow-up. Nonetheless, the prognosis for individuals suffering from renal pelvic squamous cell carcinoma is extremely dismal, with a median survival of barely 7 months following surgery and a mere 7.7% of patients surviving for more than 5 years.[1] It is acknowledged that one of the primary carcinogenic factors for SCC is urinary calculi, which causes persistent irritation of the renal pelvis, resulting in squamous metaplasia and then finally neoplasia.[2] Patients with renal SCC have explored a variety of therapies. The patient's age, overall health, cancer staging, and patient compliance should all be taken into consideration while choosing a treatment plan. The primary treatment options for renal SCC are radical nephrectomy combined with total ureterectomy.[3] The goal of this article is to make the physicians aware of the possibility of renal squamous cell carcinoma in patients who have long-standing hydronephrosis or nephrolithiasis.
Unusual Neonatal Presentation of Type I Leukocyte Adhesion Deficiency (LAD 1)
(Akshantala Enterprises Private Limited, 2025-02) Rathour, JS; Muthukumaran, N.
Leukocyte adhesion deficiency is a type of primary immunodeficiency syndrome with fatal forms of recurrent episodes of infection since the neonatal period. This is a very rare disease. Diagnosis is usually made in childhood but can be diagnosed in the early days of the neonatal period, which helps in starting early treatment with excellent results. Neonatologists should have a very high index of suspicion to diagnose this condition in neonates. The condition may mimic serious bacterial infections with a leukemoid reaction. About 1 in 1 million people are affected worldwide, which shows it’s a rare occurrence. There are few reported cases of LAD-I in newborns’. In LAD 1 (Leukocyte Adhesion Deficiency Type 1), steady adhesion of leukocytes to endothelial surfaces is defective with the following major immunological features.[1] 1. Inability to form pus 2. Deficiency of various glycoproteins like LFA-1/Mac-1, involved in cellular adhesion 3. Inability of leukocytes to migrate to the site of infection to kill offending microbes. The main adhesion glycoprotein involved is CD18. 4. Due to the absence of these adhesion molecules, inflammatory response is not sufficient to restrict or kill microorganisms, which eventually leads to recurrent bacterial infections. • Inheritance pattern of LAD 1 is autosomal recessive.[2] • Both B-cells and T-cells are affected. • Worldwide very few cases in neonates are reported. Main striking characteristics of LAD 1 are “delayed separation of umbilical cord at birth, persistent leukocytosis, and recurrent bacterial and fungal infections involving skin and mucosa and poor wound healing.” In our case of LAD-1 in a neonate, there was normal separation of the umbilical cord with no clinical signs of omphalitis.
A Rare Case of Right Internal Carotid Artery Agenesis Complicated by Fusiform Basilar Aneurysm Leading to Subarachnoid and Parenchymal Haemorrhage with Intra-Ventricular Extension
(Akshantala Enterprises Private Limited, 2025-02) Borah, Pronami; Dharavath, Venkatesh; Deka, Angshumi; Majumdar, Debarati; LS, Muhammed Shameem
ICA (Internal Carotid Artery) agenesis is a rare vascular anomaly, often associated with compensatory collateral circulation and predisposition to aneurysm formation. We report the case of a 60-year-old female presenting with acute SAH (Subarachnoid Haemorrhage), intraparenchymal haemorrhage, and intraventricular extension, secondary to ruptured aneurysms. Imaging revealed right ICA agenesis, a fusiform basilar aneurysm, and a saccular aneurysm in the left anterior cerebral artery. Endovascular coiling successfully stabilized the patient. This case highlights the importance of multimodal imaging and early intervention in managing rare cerebrovascular anomalies. ICA agenesis is an exceedingly rare congenital vascular anomaly with a prevalence of <0.01%.[1] It is often asymptomatic but can lead to significant cerebrovascular complications due to altered hemodynamics and compensatory collateral circulation. We report a rare case of right ICA agenesis complicated by ruptured aneurysms, emphasizing the role of advanced imaging modalities in diagnosis and management.
Placental Mesenchymal Dysplasia – A Diagnostic Dilemma
(Akshantala Enterprises Private Limited, 2025-02) Vijayakumar, Meghana D; V, Madhushree; Honne, Deepthi; Ganguli, Aparna
PMD (Placental Mesenchymal Dysplasia) is a rare, benign cystic lesion of the placental stroma generally categorized by placentomegaly and enlargement of chorionic villi. It is significantly associated with severe intrauterine growth restriction and intrauterine fetal demise. We present a case of a 31-year-old gravida 2 para 1 with previous intrauterine fetal death at 28 weeks with no fetal movements. Post-fetal expulsion, the placenta was sent for histopathology, which reported placental mesenchymal dysplasia. It is imperative to do a careful examination of the placenta and exclude rare cases of placental pathologies. PMD is associated with severe IUGR with fetal demise. PMD is a rare, benign, cystic disorder of the placenta. It is often misdiagnosed as a partial hydatidiform mole.[1] However, placental mesenchymal dysplasia is diploid in nature with normal trophoblast, while partial hydatidiform mole is triploid in nature with trophoblastic hyperplasia. The incidence of PMD is 0.02% in pregnancies.[2] PMD is associated with severe fetal growth restriction or fetal demise.[3] In few reported cases of PMD, there is a correlation to a pathogenic heterozygous variant in one of the genes. Hence, genetic counselling is important for future pregnancy care.
Single Umbilical Artery with Symmetrical IUGR and Multiple Fetal Anomalies - An Interesting Case Report
(Akshantala Enterprises Private Limited, 2025-02) Kotapati, Amulya Choudary; Khandru, Bhargavi; Vijayasree, M.
In the present-day scenario, congenital abnormalities and genetic syndromes are increasing due to conceptions in extremes of age groups (teenage pregnancy and elderly primi gravidas), which is about 0.8 to 2.9%. Since our hospital is situated in the periphery, consanguinity persists. In our tertiary care center, we terminate many cases of abnormal fetuses. Here we are presenting one such interesting case scenario. In today's world, where women's access to education is continuously improving, societal trends are shifting, and one notable change has been a decline in consanguineous marriages. Consanguineous marriages, or marriages between closely related individuals, have historically been more common in certain cultures, but the increasing level of female education and awareness of the potential genetic risks associated with these unions has led to a noticeable reduction in their occurrence. This is a positive shift, as consanguineous marriages have been linked to a higher risk of genetic disorders in offspring due to the increased likelihood of inheriting recessive genetic conditions. In tandem with these social changes, advancements in medical technology have significantly improved prenatal care. Fetal medicine specialists now employ a variety of cutting-edge diagnostic tools to identify potential genetic and structural abnormalities in a fetus as early as possible. Among the most notable of these technologies are NIPT (Non-Invasive Prenatal Testing) and the TIFFA (Targeted Imaging for Fetal Anomalies) scan. NIPT is a blood test that analyzes small fragments of fetal DNA circulating in the mother's blood, providing a safe and highly accurate method for detecting chromosomal abnormalities, such as Down syndrome, as early as 10 weeks of pregnancy. Meanwhile, the TIFFA scan is a more advanced ultrasound technique used to identify gross anatomical abnormalities in the fetus, offering detailed insights into the fetal development during the second trimester. These technologies, along with others, have revolutionized prenatal care by enabling early intervention, counselling, and decision-making based on a more accurate understanding of potential risks. Despite the tremendous progress made in the field of fetal medicine, the detection and prevention of genetic abnormalities are not flawless, and cases of genetic disorders continue to emerge. The present case we are discussing serves as a poignant reminder that, even with the most advanced screening methods available, some conditions may still go undetected or may not be entirely preventable. The case highlights the complexity of genetic inheritance and the limitations of current diagnostic tools, underlining the importance of continued research and development in prenatal care.
Subhepatic Caecum and Appendix - A Case Report
(Akshantala Enterprises Private Limited, 2025-02) Kommanda, Radhakrishna Shetty; Shetty, Prakash Chandra; Hegde, Shruthi; Mani, Muthuvel; Zulkaflee, Hazim; Monteiro, Francis Nanda Prakash
Sub hepatic cecum and appendix is a rare anatomical condition with a reported incidence of 0.08%. This results from the developmental incomplete rotation or malrotation of the midgut and arrested descent of the caecum. In this position, if there occurs an inflammation, the resulting right upper abdominal pain is mistaken for acute cholecystitis, liver abscess, or perforated duodenal ulcer. Moreover, this may be missed on imaging modalities. This necessitates clinical suspicion of subhepatic appendicitis in case of undiagnosed right upper abdominal pain. Herein we report a case of caecum and appendix encountered in the right hypochondrium beneath the liver during routine anatomical dissection of a cadaver. Caecum and appendix are the early parts of the large intestine and are situated in the lower part of the abdomen on the right side, corresponding to the iliac fossa. The appendix is a narrow muscular tube varying in length between 3 inches and 5 inches, the base of which is attached to the posterior wall of caecum just below the ileo-caecal junction.[1] The most common position of the appendix is retrocecal in position in the right iliac fossa. Acute appendicitis is not uncommon during life, normally diagnosed with a high index of clinical suspicion followed by laboratory and imaging modalities. But, when the caecum and appendix are situated in a location other than the usual right iliac fossa, the diagnosis of acute appendicitis becomes challenging and erroneous.[2] Delay in diagnosis or wrong diagnosis because of an abnormally located appendix when inflamed may lead to delay in recognizing the appendicitis, which may result in the perforation of the appendix, a surgical emergency.[3] King in 1975 was the first one to report a case of abnormally located appendicitis.[4] Ideally, the right iliac fossa is the place where the terminal segment of the ileum joins the caecum.[5] However, when the caecum is in subhepatic region, the terminal part of the ileum passes through the right iliac fossa and joins the caecum. Herein we report a case of a subhepatic caecum with an appendix encountered during routine anatomical dissection and discuss the complication resulting from such anomaly.
Comparative Evaluation of Antimicrobial Effect of Different Irrigating Solution Against Enterococcus Faecalis - An In-Vitro Study
(Akshantala Enterprises Private Limited, 2024-12) Shah, RJ; Panda, A; Virda, MG.
BACKGROUND The invasion of microorganisms into the root canal system poses a significant challenge in endodontic infections, especially in primary teeth. Enterococcus faecalis is a common culprit in such infections, necessitating effective antimicrobial strategies. This study aims to assess various irrigating solutions' antimicrobial efficacy against E. faecalis. Aim: The aim of this study was to evaluate the antimicrobial efficacy of different irrigating solutions against E. faecalis. METHODS Six experimental groups, including lemon extract, chlorine dioxide solution, apple cider vinegar, Echinacea angustifolia, sodium hypochlorite, and a control group (normal saline), were evaluated. The antimicrobial activity was assessed using the agar-well diffusion method, and MIC (Minimum Inhibitory Concentration) and MBC (Minimum Bactericidal Concentration) were determined. RESULTS Lemon extract and apple cider vinegar exhibited higher zones of inhibition compared to sodium hypochlorite, chlorine dioxide, and Echinacea angustifolia. Statistical analysis confirmed significant differences in antimicrobial efficacy between various groups. Lemon extract and apple cider vinegar demonstrated the lowest MIC and MBC values, indicating potent antimicrobial activity against E. faecalis. CONCLUSIONS This study highlights the antimicrobial efficacy of lemon extract and apple cider vinegar against E. faecalis, suggesting their potential as alternative irrigating solutions in endodontic practice. Further research is warranted to explore their clinical applicability and long-term effects on treatment outcomes.
Charting the Fight Against Childhood Obesity - A Comprehensive Bibliometric and Visual Analysis
(Akshantala Enterprises Private Limited, 2024-12) Azees, AHI; Meeral, PR; Kadiyala, P; G, Merlin.
BACKGROUND Childhood obesity is a critical public health challenge marked by a rapid rise in prevalence over recent decades. The multifactorial nature of obesity, driven by dietary changes, sedentary lifestyles, and environmental factors, has prompted an increase in global research efforts. Bibliometric and visual analysis provide insights into research trends, influential publications, and collaborative networks, helping shape future directions for addressing this issue. METHODS A comprehensive bibliometric analysis of 369 relevant publications on childhood obesity was conducted using SCOPUS data from 2007 to 2024. Initial search terms focused on variations of “Childhood” and “Obesity” combined with “Prevention” and “Intervention.” Biblioshiny and VOSviewer software were utilized for visual and network analyses, mapping research trends, identifying key contributors, and analysing collaborative networks among authors, institutions, and countries. RESULTS The study identified key research trends, revealing a significant growth in publication output from 1999 to 2017, followed by a decline in recent years. The USA, Australia, and the UK were the leading contributors, with strong collaborative networks across countries. BMC Public Health and Obesity Reviews emerged as the most prolific journals, while Messiah SE, Ward DS, and Story M were the most influential authors. Thematic analysis highlighted shifts from traditional prevention strategies to multifaceted approaches, including behavioral and policy interventions. CONCLUSIONS The bibliometric and visual analysis of childhood obesity research underscores the need for continued focus on prevention, collaboration, and integrated strategies. The findings suggest that although progress has been made, future research should prioritize interdisciplinary and international efforts to address the complex determinants of childhood obesity.

Browse

Recent Submissions