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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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.
Correlation between Potential Risk Factors for Subacromial Impingement Syndrome and Subcoracoid Impingement - A Retrospective Radiological Study
(Akshantala Enterprises Private Limited, 2024-12) Ahmad, RG.
BACKGROUND Shoulder discomfort ranks third among musculoskeletal complaints that might cause disability. The pathogenesis and associated risk factors of impingement remain poorly understood. This study seeks to identify a potential correlation between structural risk factors for developing SAIS and subcoracoid impingement. METHODS This radiological study collected data retrospectively for patients with clinical signs and symptoms of shoulder impingement. The MRI (Magnetic Resonance Imaging) included for initial screening were symptomatic patients with suspected impingement syndrome, living in Jeddah, Saudi Arabia. Six hundred eighty-six patients with MRI were included in the study that met the inclusion criteria. Pearson correlation coefficient was used to analyze the correlation between acromiohumeral and coracohumeral distance. RESULTS Out of 686 screened MRIs, a total of 391 had SAIS (Subacromial Impingement Syndrome), whereas subcoracoid impingement was found in 238 cases. There was a significant association in the presence of these two syndromes (P = 0.000, X2 = 35.209, df = 1). A total of 176 patients (72.7%) with subcoracoid impingement also had signs of SAIS, suggesting a very strong association. However, 66 patients (27.2%) with subcoracoid impingement did not exhibit radiological features of SAIS. CONCLUSIONS No correlation was found between the decrease in coracohumeral and acromiohumeral distance. The factors associated with isolated SAIS were female gender, downsloping of the acromion, complete supraspinatus tendon tear, and supraspinatus and subscapularis tendinopathy.
VP Shunt Overdrainage Linked Myelopathy - A Rare Complication
(Akshantala Enterprises Private Limited, 2024-12) Narula, H; Mann, S; Shrivastava, A; Jindal, G; Garg, P.
Cerebrospinal fluid over drainage after placement of a VP shunt is a common but poorly recognized problem. This excess leak can lead to cervical myelopathy, a very late complication, the pathogenesis of which is linked to the compensatory engorgement of the venous plexus secondary to the fluid over drainage. We present a case of a 32-year-old male who was diagnosed with tubercular meningitis and obstructed hydrocephalus, for which he was treated with ventriculoperitoneal shunting in 2009, and now in 2022 he presented with complaints of weakness and stiffness in both the legs. The diagnosis of CSF over drainage due to VP shunt was made radiologically. The VP shunt was subsequently removed, and the patient gradually improved in 6 months. VPS (Ventriculoperitoneal Shunt) is a neurosurgical procedure that is commonly done for the treatment of hydrocephalus. Despite being one of the commonest interventions performed, it can lead to various complications, and their rates are yet undetermined.[1] These include shunt obstruction, infection, abdominal pseudocyst, bowel perforation, subdural collection, and over-draining of cerebrospinal fluid.[2] Out of all, cerebrospinal fluid over drainage after the surgery is a common but poorly recognized problem.[3] This excess leak can lead to cervical myelopathy, a very late complication, the pathogenesis of which is linked to the compensatory engorgement of the venous plexus secondary to the fluid over drainage.[4] The medical literature dates back to 1988, when chronic over-shunting of CSF was first described by the Miyazaki, and therefore it is sometimes referred to as Miyazaki syndrome.[4] Here, we describe a case of a young patient who developed a delayed constellation of neurological symptoms after the VPS, which were associated with the radiologically identified shunt malfunctioning and cord pathology.
Challenging PPIUCD Removal: A Case of Hysteroscopic Extraction from the Uterine Fundus
(Akshantala Enterprises Private Limited, 2024-12) Divakar, H; Singh, R; Narayanan, P; Rajanna, P; Joshi, S; Pushpa, PS; Divakar, GV; Girish, B.
Intrauterine contraceptive devices offer reliable and reversible contraception. However, there are still challenges that persist in their management, particularly regarding deeply embedded PPIUCDs (Post-Partum Intrauterine Contraceptive Devices). We present a case study of a 30-year-old woman who had two caesareandeliveries and sought PPIUCD removal to plan a future pregnancy. On speculum evaluation, the threads of the device were undetectable with no abnormal health symptoms. Subsequent ultrasoundanalysis confirmed the presence of PPIUCD, positioned obliquely within the uterine cavity. The first removal attempt under aseptic precautions with an IUCD hook was unsuccessful. The second attempt was guided by ultrasound and hysteroscopy, which successfully eliminated the IUCD. The case highlights the intricate challenges in managing PPIUCDs and emphasizes the importance of proactive management strategies. By integrating advanced techniques like hysteroscopy, healthcare providers can navigate these challenges effectively, enhancing patient care and satisfaction.Intrauterine contraceptive devices have become a reliable and convenient method of birth control due to their high effectiveness and reversibility. Long-acting contraceptives provide reliable and lasting protection against unintended pregnancy, making them a popular choice for individuals looking for a hassle-free contraception method. The PPIUCD technique involves implanting an IUCD within 48 hours following either vaginal delivery or caesareansurgery to block sperm survival and prevent endometrial foreign body reactions.[1]The acceptability rate for PPIUCD implantation is 36.25%.[2]The placement of the PPIUCD is preferable since it does not interfere with breastfeeding.[3]The prevalence of modern contraceptives among married women who have reached reproductive age has gradually increased globally, rising from 55.0% in 2000 to 57.1% in 2019.[4]According to the recent India National Family Health Survey, the contraception prevalence rate among currently married women under 15 to 49 increased from 54% in 2015-16 to 67% in 2019-21. Intrauterine devices comprise only 2.1% of all contraceptive techniques used in family planning. However, all government facilities offer free IUCD services.[5]Complications like bleeding, pain, infection, perforation, and expulsion contribute to 20–40% discontinuation rates.[6]Younger women using IUDs are more likely to experience adverse effects than older women.[7]The limited progress was attributed to factors such as the low quality of services offered, restricted access, and misconceptions about techniques held by providers and users.Despite their effectiveness, IUDs can lead to potential complications. One such issue is the occurrence of lost or embedded IUDs,which are rarely observed, with approximately 1-2 cases per 1000 insertions.[8]This case report illustrates the difficulties encountered in removing embedded IUDs and underscores the significance of exploring alternative techniques to manage challenging cases safely and effectively.
Rickets Secondary to Renal Tubular Acidosis - A Case Report
(Akshantala Enterprises Private Limited, 2024-12) Borah, P; Gorlosa, S; Dharavath, V.
This case study presents a 2-year-old female patient admitted to the paediatric High Dependency Unit (HDU) with symptoms including fever, cough, breathing difficulty, and recent loose stool. Clinical examination revealed severe dehydration and signs of metabolic acidosis characterized by hyperglycaemia and acidotic breathing. Initial management involved fluid resuscitation, mechanical ventilation in Synchronized intermittent mandatory ventilation (SIMV) mode, and insulin therapy. Arterial blood gas analysis indicated hyperchloremic normal anion gap metabolic acidosis, while urine ketone testing was negative. Laboratory investigations revealed severe hypokalaemia, alkaline urine pH, and hypercalciuria. Imaging studies, including X-ray and ultrasonography (USG KUB), showed bilateral nephrocalcinosis and features suggestive of rickets in the long bones. Treatment included conservative measures such as oral potassium chloride syrup, oral sodium bicarbonate, and intravenous amikacin. Continuous monitoring of renal function tests, electrolytes, and arterial blood gases was conducted, leading to clinical improvement and eventual discharge. Renal tubular acidosis (RTA) is a group of disorders characterized by impaired renal acid-base regulation, leading to metabolic acidosis. Common presentations of RTA in children are growth failure, failure to thrive, and refractory rickets. All of these are evident in the index case. Rickets in RTA is mainly caused by bone acting as a buffer for acidosis, leading to leaching of the mineral matrix from the bone and growth plate. Renal loss of phosphate and impaired synthesis of 1, 25 dihydroxy D3 are also contributors. The risk of nephrocalcinosis or nephrolithiasis is much more common in dRTA compared to other forms of RTA and is almost diagnostic of dRTA in the appropriate clinical setting.[1] There are several types of RTA, each with distinct underlying mechanisms
Adnexal Torsion - Diagnosis Features and the Case Showing Perils of Delay in Diagnosis
(Akshantala Enterprises Private Limited, 2024-12) Shrivastava, A; Barhate, SP; Jindal, G; Kalpdev, A; Dod, SG; Garg, P.
Adnexal torsion, characterized by the twisting of an ovary or fallopian tube, poses a critical gynaecological emergency with high morbidity. A young woman presented with sudden sharp pelvic pain, nausea, vomiting, and abdominal distention, revealing significant hemoperitoneum and a low haemoglobin level. Initial ultrasound was inconclusive in most of the cases like in this case; however, MRI demonstrated an enlarged right ovary, twisted fallopian tube, and hemoperitoneum with a ‘whirlpool sign.’ Emergency laparoscopic surgery confirmed right tubo-ovarian torsion, leading to right salpingo-oophorectomy. This case highlights the MRI findings of the adnexal torsion with critical importance of early diagnosis and timely intervention to prevent irreversible tissue damage and preserve ovarian function. Adnexal torsion is a critical gynaecological emergency characterized by the twisting of an ovary or fallopian tube around its supporting ligaments, which can lead to compromised blood flow and potential tissue necrosis.[1] Adnexal torsion is often misdiagnosed due to clinical and radiological inconsistency. Adnexal torsion typically affects women of reproductive age and can occur in the absence of underlying pathology or in conjunction with ovarian cysts or masses. It is confused with numerous gynaecological and surgical emergencies. This condition often presents with sudden, severe abdominal or pelvic pain and may be accompanied by nausea, vomiting, and fever. Prompt diagnosis and surgical intervention are crucial to restore blood flow and preserve ovarian function avoid the high morbidity associated with this condition. Delaying surgery can result in complications such as infections, adhesions, peritonitis, sepsis and even death.[2] We are presenting a case of diagnosis of adnexal torsion with delayed presentation and highlighting the consequences of missing the early diagnosis of adnexal torsion in the emergency setting.
Evaluation of Maxillofacial Silicone Implant Superstructure Material Mechanical Properties after Addition of Titanium Dioxide Nanoparticles
(Akshantala Enterprises Private Limited, 2024-12) Bunyan, SF.
BACKGROUND This study is to investigate the effects of titanium dioxide addition on maxillofacial silicone implant superstructure material mechanical properties. METHODS A total of 60 samples were prepared and divided into 6 groups; control, 1% Tio2 (nano-titanium oxides), 1.5% Tio2, 2% Tio2, 2.5% Tio2, 3% Tio2 which was added to (VST30) silicone elastomer. Samples were exposed to artificial weathering for 600 hours, then tested for tensile strength and Shore A hardness. The data were analyzed using a one-way ANOVA to determine the differences between groups. RESULTS After artificial weathering, a high increase in the mean value for tensile strength with a significant increase in hardness in samples containing 2.5% Tio2, followed by the samples with 2% Tio2 compared to the control and other groups. CONCLUSIONS The addition of Tio2 nanoparticles to maxillofacial silicone improved its mechanical properties. Tio2 nanoparticle filler reinforcement is encouraging for enhancing tensile strength and Shore A hardness properties values for the longevity of maxillofacial silicone.
Emphysematous Pancreatitis-Clinical and Radiological Insights
(Akshantala Enterprises Private Limited, 2024-12) Biswas, P; Saritha, P.
Acute pancreatitis is a prevalent emergency encountered in clinical practice, presenting with varying degrees of severity.[1,2]Emphysematous pancreatitis (EP), a rare complication of acute necrotizing pancreatitis, is characterized by the presence of gas within or surrounding the pancreas.[1,2]This condition is associated with a significantly poor prognosis, making early radiological assessment critical for influencing patient outcomes. Computed tomography (CT) is the primary modality for diagnosing emphysematous pancreatitis, revealing pancreatic parenchymal necrosis as areas of non-enhancement, along with intra-or peripancreatic fluid collections. CT findings typically include single or multiple foci of gas in the pancreatic bed, as well as an assessment of the degree of inflammatory changes and potential complications associated with this severe form of necrotizing pancreatitis.[2]The objective of this case report is to present a classic case of emphysematous pancreatitis, an uncommon manifestation of acute pancreatitis. Early diagnosis of emphysematous pancreatitis is crucial, as it represents a potentially fatal subtypeof severe necrotizing pancreatitis. Clinicians must maintain a high index of suspicion for this condition to ensure timely intervention and improve patient outcomes.[2]
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.

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