JK Science Journal of Medical Education and Research
Permanent URI for this collection
Editor in chief: Vishal R. Tandon
Frequency: Quarterly
Language: English
Open Access Peer-reviewed journal
Web site: https://www.jkscience.org/index.php
Browse
Recent Submissions
Item Adenoid Cystic Carcinoma (ACC) Cervix in a Young Female- A Rare Occurrence(Dr. Annil Mahajan, 2023-01) Mahajan, S; Jandial, A; Bhardwaj, S.Adenoid cystic carcinoma cervix (ACC) is an extremely rare (representing <1% of cervical carcinomas), highly aggressive cancer of old, macroscopically appearing as an irregular, friable mass and histologically showing a pseudo glandular or cribriform growth pattern. The tumor is highly infiltrative, often associated with vascular, lymphatic as well as perineural invasion and early recurrence. We report a case of ACC Cervix in a 20-year-old female who presented with vaginal bleeding and cervical biopsy suggested ACC. The patient underwent total abdominal hysterectomy with bilateral adnexectomy and the histopathological examination revealed adenoid cystic carcinoma cervix extending and inolving endometrium and greater than 2/3rd of the myometrium with uninvolved adnexa. We report this case because of its rarity and particularly unusual occurrence in young females.Item Revolutionizing Diabetes and Obesity Management: A Comprehensive Review of Tirzepatide’s Dual Agonist Approach(Dr. Annil Mahajan, 2024-04) Samal, S; Maiti, S; Vihari, J.Tirzepatide, an innovative glucagon-like peptide-1 (GLP-1) and glucagon receptor dual agonist, has emerged as a promising therapeutic avenue for type 2 diabetes and obesity management. This review encompasses a comprehensive evaluation of Tirzepatide’s mechanism of action, clinical efficacy, safety profile, and comparative effectiveness against existing treatments. By targeting multiple pathways related to glucose and weight regulation, Tirzepatide exhibits superior glycemic control and substantial weight loss, presenting a novel approach to address the intertwined challenges of diabetes and obesity. An analysis of pivotal clinical trials, potential adverse effects, and future directions in Tirzepatide research further underscores its potential as a transformative treatment strategy.Item Assessment of High-resolution Computed Tomography Thorax Volumetric Indices in Covid-19 Patients and Correlation with Biochemical Markers(Dr. Annil Mahajan, 2024-04) Parida, B; Mohapatra, SSG; Swain, S; Juvvadi, KR; Das, S.Background: Years after SARS recovery, residual pulmonary abnormalities may still exist. This raises the question of whether or not Covid-19 could have comparable late consequences. Structural changes in the Lungs after recovery can be better visualized using CT-Thorax. Objectives: To study the Covid CT changes during hospitalization and after four months follow-up of infection, and to correlate with the volumetric HRCT thorax indices and Biochemical parameters. Materials and Methods: This is a hospital- based Cross-sectional study, with a follow-up among 100 Hospitalized clinically moderate to severe Covid- 19 patients who recovered after four months. Results:The biochemical markers such as d-Dimer and C- Reactive Protein (CRP) were significantly reduced. The values of NL (L) and NL (%) had a significant negative correlation with d-Dimer and C-Reactive Protein (CRP). The individuals’ average ages in years, which ranged from 24 to 80, were 48.56 ± 13.87. Conclusion: Biochemical indicators, including d-Dimer and CRP, were greatly decreased. The NL (L) and NL% values exhibited a strong negative connection with d-Dimer and C-reactive protein (CRP) both during and after Covid. Hence the different CT indices (NL, NL%) can be used along with Biochemical parameters (CRP and d-Dimer) for structural and functional recovery in Covid-19 patients.Item Cutaneous Rosai-Dorfman Disease - A Rare Non-Langerhans Cell Histiocytosis(Dr. Annil Mahajan, 2024-04) Wahab, AJ; Athilakshmi, S; Nivvedhetha, S.Cutaneous Rosai-Dorfman disease is classified as non-Langerhans cell histiocytosis. It is a benign lymphoproliferative disorder involving only skin and subcutaneous tissue, which is rare and not well documented. It manifests as erythematous to brown papules, plaques, or nodules with histiocyte-rich inflammatory infiltrate which constantly exhibit emperipolesis i.e., uptake of intact lymphocytes and plasma cells; they express both Langerhans cell and macrophage markers (S100 and CD68 respectively). We report a case of a 45-year-old female presenting with a plaque on right cheek since 10 months without systemic symptoms. The lesion was excised in-toto and defect covered with rhomboid flap repair.Item Malignant Mixed Germ Cell Tumor in a Patient with Swyer Syndrome: A Case Report(Dr. Annil Mahajan, 2024-04) Raina, K; Anuradha; Thakur, R; Thaker, B; Suri, J.Mixed germ cell tumors are extremely rare tumors, usually malignant with a poor prognosis and made up of at least two different germ cell tumors. These tumors occur most often in the gonads but may also occur at other sites in body. In this case, a 24 year female presented to SMGSH, GMC Jammu with an abdominal lump associated with pain and primary amenorrhea. On examination, a firm mass reaching upto epigastrium was present. Upon investigation, all the tumor markers were raised. Her radiological evaluation showed a complex solid-cystic adnexal mass suggestive of neoplastic etiology. Simultaneously, patient was also evaluated for primary amenorrhea and upon karyotyping, she had an XY chromosome suggestive of Swyer syndrome. Patient underwent laparotomy with bilateral salpingo-gonadectomy and pelvic lymphadenectomy with preservation of the uterus. Histopathology confirmed mass to be a malignant mixed germ cell tumor with elements of teratoma, yolk sac tumor, and embryonal carcinoma.Item From Silence to Sound - A Case of Autoimmune Ear Disease(Dr. Annil Mahajan, 2024-04) Mamadapur, M; Pragya, V; Priya, N; Subramanian, R; Pinnam, HS.Autoimmune inner ear disease (AIED) is a rare rheumatological cause of sensorineural hearing loss, accounting for less than 1% of worldwide hearing loss. It presents with rapidly progressive, unilateral or bilateral SNHL, often fluctuating. The progression is over weeks to months, along with vestibular symptoms. Diagnosing the condition is challenging because no adopted standardized tests are available. Hence, AIED is a challenging diagnosis based on exclusion. Clinical characteristics and how the patients respond to immunosuppressive agents are used for the diagnoses of AIED. Only a few cases have been reported in India till now. Here, we present a rare case of Autoimmune Ear Disease without any underlying systemic autoimmune disease.Item Pre-Emptive Dexamethasone for Managing Post Operative Pain in Patients Undergoing Laparoscopic Cholecystectomy Under General Anaesthesia: A Prospective Randomized Study(Dr. Annil Mahajan, 2024-04) Sasan, S; Gupta, S; Manhas, RD; Mehta, KS; Mustafa, A.Background: Pain after laparoscopic cholecystectomy arise from multiple sources and so require multimodal approaches to manage it. Dexamethasone is a corticosteroid drug with excellent anti-inflammatory properties. Present study was designed to study the effect of administering an intermediate dose of dexamethas one (8 mg), one hour before the induction of anaesthesia, on post-operative analgesia, time to first analgesia and total number of analgesics used in twenty four hours. Material and Methods: A total of 80 patients were randomly allocated into two study groups by computer generated randomization. Group 1 received 8 mg/2 ml of Inj. Dexamethasone intravenously 1 hour prior to induction of General Anaesthesia slowly over a period of 5 minutes. Group 2 received 2 ml of Normal Saline (NS) intravenously 1 hour prior to induction of General Anaesthesia slowly over a period of 5 minutes. Results: The mean Visual analogue score of group 1 was lower than that of group 2 and the difference was statistically significant at 0, 2, 6 and 12 hours postoperatively (p<0.05). The mean time taken by the patients in group 1 for the first rescue analgesic was (11.65±4.59) hours, which was statistically significant as compared to group 2 (4.01±2.03) hours(p=0.0001). Mean total number of analgesic used in Group I was significantly less as compared to Group 2 (p=0.0001) Conclusion: Use of dexamethasone 8 mg intravenously one hour before induction of general anaesthesia for post-operative analgesia causes a significant decrease in overall VAS scoreat 0, 2, 6 and 12 hours post-operatively, increases the duration between the surgery and the need for first rescue analgesia and decreases the total number of analgesics used with minimal adverse effects after laparoscopic cholecystectomy.Item Uncommon skin and soft tissue infections encountered in adults and children caused by different aerobic, anaerobic bacteria and protistan organism: A series of cases from Kolkata, India(Dr. Annil Mahajan, 2024-04) Manda, AS; Paul, D; Banu, HN; Ghosh, AK; Raj, HJ; Banu, H.Skin and soft tissue infections (SSTIs) result from microbial invasion and may be mono or polymicrobial in etiology. The present retrospective record based study described five uncommon SSTIs from a medical college hospital of West Bengal. Clinical samples were collected and processed following standard microbiological procedures and guidelines. Identification and antimicrobial susceptibility testing of etiological agents, wherever applicable, were done by conventional and automated (Vitek-2 Compact) system. We found a case of spontaneous gas gangrene caused by Clostridium septicum, Group-A â-hemolytic Streptococcus mediated necrotizing fasciitis; lesions of Burkholderia pseudomallei and Burkholderia cepacia complex and that of disseminated rhinosporidiosis caused by Rhinosporidium seeberi. We infer that strong clinical suspicion may surface uncommon etiology from unusual presentations of SSTIs making their diagnosis, treatment and relief rapid and uneventful.Item Role of Wet Laboratory Training for Residents of Ophthalmology(Dr. Annil Mahajan, 2024-04) Sharma, AK; Sharma, HR; Sharma, T.Background: In current residency programs, surgical skill acquisition relies on observation and incremental practice, often due to limited surgical opportunities, potentially lowering learner confidence and impacting patient outcomes. To counter this, mandatory wet lab training has been introduced to enhance surgical exposure. Aim: To evaluate the role of wet laboratory training for residents of Ophthalmology. Material and Methods: Thirty-two postgraduate residents participated in three supervised sessions, practicing small incision cataract surgery (SICS) on goat eyes. Faculty evaluated their performance using the SICS Ophthalmic Simulated Surgical Competency Assessment Rubric (Sim-OSSCAR:SICS) scale. Residents provided feedback through a pretested questionnaire. Results: Significant improvement in mean scores across sessions (16.094 ± 5.449 after exposure 1, 22.188 ± 4.948 after exposure 2, and 29.094 ± 5.384 after exposure 3, p < 0.001) was seen. Qualitative analysis indicated high relevance of wet lab training (71.9%), with residents acknowledging its usefulness (68.7% strongly agreed, 31.3% agreed) and confidence boost (75% strongly agreed, 25% agreed). Most residents found ease in performing different (93.7%) and subsequent (96.9%) steps during wet lab training. Conclusion: This study emphasized the importance of wet lab training is crucial, as it significantly contributes to enhancing patient care quality by allowing residents to refine surgical skills in a safe environment.Item Congenital Perisylvian Syndrome: Magnetic Resonance Imaging Findings in Six Cases(Dr. Annil Mahajan, 2024-04) Malgotra, S; Mahajan, M; Nathyal, S; Gupta, S; Gupta, V.Background: Congenital perisylvian syndrome is an extremely rare congenital neurological disorder associated with distinctive imaging findings. Herein we describe the clinical features and imaging appearance of congenital perisylvian syndrome on Magnetic Resonance Imaging (MRI). Material and Methods: Six patients with clinical history, neurological examination and MRI findings suggestive of perisylvian syndrome were included in this review. Results: Six patients were found to have perisylvian syndrome on MRI findings. Five patients presented with pseudobulbar palsy while seizures were present in 3 patients. The most common MRI findings were vertically oriented sylvian fissures that were continuous with the central or post-central gyrus and perisylvian polymicrogyria.The findings were bilateral in 4 cases and unilateral in 2 cases. Conclusion: Perisylvian syndrome is a rare neurological disorder which can be diagnosed with certainty on MRI findings along with relevant clinical history.Item Congenital Medial Clavicular Pseudoarthrosis - A Rare Presentation in an Adult(Dr. Annil Mahajan, 2024-04) Ilyas, M; Valsalan, BP.We are presenting a rare case of a 29-year-old male patient with congenital pseudoarthrosis of the clavicle who presented in adulthood with a progressively growing lump on medial end of clavicle which after investigations tuned out to be pseudoarthrosis of the medial clavicle.Item A Rare Case of Pseudoglucagonoma Syndrome Masquerading as Necrolytic Migratory Erythema(Dr. Annil Mahajan, 2024-04) Nikita; Dalai, SP; Sahu, S; Sahoo, AK.Necrolytic migratory erythema (NME) is pathognomonic of glucagonoma syndrome associated with pancreatic neoplasm. Pseudoglucagonoma syndrome, which is extremely rare, refers to NME without a glucagon-secreting tumor. We describe a rare case of NME in a 45-year-old female who presented with a skin rash associated with scaling, cheilitis, glossitis, hair loss, and weight loss. Serum glucagon and serum zinc levels were normal. Skin biopsy was suggestive of necrolytic erythema migrans. Ultrasonography (USG) and computed tomography (CT) of the abdomen showed chronic pancreatitis. Resolution of lesions was observed with topical steroids, emollients, intravenous (IV) protein infusions, and other supplements.Item Serum Cortisol Level as a Biomarker in Predicting the Severity of Stroke(Dr. Annil Mahajan, 2024-04) Konduru, A; Tripathy, D; Sahu, S; Padhi, R; Maiti, S; Samal, S; Ghosh, A.Background: A number of clinical and radiological indicators can reliably detect the prognosis of a stroke. Improved biomarkers for predicting prognosis in acute ischemic and hemorrhagic stroke are still elusive. Aims and Objective: The present study was aimed to observe whether serum cortisol acts a biomarker in predicting the severity of stroke. Materials and Methods: A prospective study performed among 50 patients with ischemic in Group A and 50 patients with hemorrhagic stroke in Group B. The random serum cortisol of these patients was compared with the NIHHS score. Results: Incidence of hypertension was significantly higher in group Bthan group A (72% vs. 38%; P<0.0001). Both systolic and diastolic BP were significantly higher in group B in comparison to group A (P<0.001). Severity of stroke was significantly higher in group B in comparison to group A (P<0.001). Mean cortisol levels were significantly more in group B in comparison to group A (P<0.001). Also, a statistically significant correlation with raised serum cortisol levels and the severity of stroke irrespective of type of stroke was observed. Conclusion: The study revealed that serum cortisol can be used as a biomarker for the prediction of severity of stroke.Item Analysis of Two Different Suturing Methods in Laparoscopic Pyeloplasty(Dr. Annil Mahajan, 2023-01) Ahmed, MM; Ahmad, BT; Ahmad, KI.Background: Ureteropelvic junction (UPJ) obstruction is the most common congenital anomaly of the urinary tract (1 in 20,00 live births). Laparoscopic pyeloplasty has equivalent success rates with open pyeloplasty. We prospectively analysed techniques of transperitoneal laparoscopic dismembered pyeloplasty and compared clinical outcome between two groups using two different suturing methods (continuous and interrupted). Material and Methods: - After obtaining ethical clearance from Institutional Ethical Committee, the present prospective study was conducted on 33 patients over the period of two years in the Post-Graduate Department of General Surgery in a tertiary care hospital. Results: - In our study the commonly involved age group was 20-29 years. (57.58%) in both interrupted as well as in continuous group and mean age for continuous and interrupted suturing was 26.23±6.961 and 27.50±6.619 respectively with male predominance. The mean duration of suturing, mean duration of surgery, mean duration of drain, mean drain output, and Hospital stay in continuous group are 72.74±3.194min, 203.75±12.457min, 2.26±0.452days, 13.42±4.730ml, and 3.26±0.452days respectively and in interrupted group are 94.14±3.505min, 234.50±10.761min, 4.43±0.646days, 40.93±7.043ml and 5.43±0.646days respectively. Urine leak was the only postoperative complication occurring in (3.03%) in interrupted group. The total success rate in our study was 100% with no postoperative anastomotic re-stricture during the follow-up. Conclusion: - Continuous suturing may be preferred to interrupted suturing for ureteropelvic anastomosis in patients undergoing laparoscopic pyeloplasty with comparable results and good intraoperative and postoperative parameters.Item Profile of Animal Inflicted Injuries to Head, Face and Neck: An Experience in Tertiary Care Hospital(Dr. Annil Mahajan, 2024-01) Bhat, S; Koushal, P; Bhardwaj, V; Sharma, H; UlRehman, A; Sharma, R.Background and Aims: Animal-related injuries are a significant public health concern. Animals bite injuries are caused by a wide variety of domestic and wild animals. Key to successful management of such wounds are meticulous cleansing of wounds, careful debridement, primary repair, appropriate antibiotic therapy and rabies and tetanus immunization where indicated. The present study was undertaken with an objective to study the epidemiology treatment of animal inflicted injuries to head, face and neck. Material and Methods: The study was an observational cross sectional study carried out on 40 patients having animal inflicted injuries over head, face and neck requiring treatment by suitable modalities admitted to Government Medical College and hospital Jammu over a period of 1-year w.e.f. 1st October 2020 to 31st September 2021.All the patients were treated as inpatients. Results: Most common type of animal involved was dog accounting for 27 cases (67.5%). Maximum number of patients were in the age group of < 10 years which accounted for 47.5% of patients. Face was the most common site of defect due to animal induced injuries accounting for 20 cases (50%). Out of total 40 cases of animal inflicted injuries, most common treatment modality used were anti-septic dressings (65%), followed by primary closure of defects in 12 cases (30%); whereas nasolabial flap coverage, and wedge resection with lip advancement was done in one case each (2.5% each). 5% of wounds were infected and were managed by antibiotics and antiseptic dressings. Conclusion: The most common animal injury in our study was dog bite and young children are especially vulnerable. A variety of treatment modalities in form of various procedures such antiseptic dressings, primary closure, split thickness skin grafting, nasolabial flap flap and wedge resection with lip advancement were employed for treatment of the various injuries.Item Burned-out Metastatic Yolk Sac Tumour: A Rare Case Report(Dr. Annil Mahajan, 2024-01) Mishra, J; Trisal, M; Gupta, A.Burned-out testicular tumor is a very rare clinical entity. There are no clinical findings in the testicle because it regresses spontaneously without any treatment and generally presents with metastases. Burnt out testicle is often seen with Yolk sac tumour. The diagnosis of yolk sac tumours is usually a multimodality diagnosis including a biopsy of the lesion. We describe a case of metastatic yolk sac tumours that presented with deposits in inguinal lymph nodes. No testicular tumour was identified in our case.Item Intellectual Disability Among Disabled Children: Prevalence and Risk Factors in a Rural Area of Jammu, India(Dr. Annil Mahajan, 2024-04) Kumari, P; Langer, B; Rivees, S; Gupta, RK; Mahajan, R; Kumari, R.Background: Disabled Children suffer Intellectual Disability/ies (ID) to a varying extent. Role of environmental and non-genetic factors in Intellectual Disability remains largely unexplored in developing nations. The study aimed to determine Intellectual Disability among disabled rural children and its association of various demographic variables. Methods: A cross sectional study was conducted in a randomly selected rural health zone. 52 children of ages 1-18 years with various disabilities were assessed for IQ by a clinical psychologist using Developmental Screening Test, Sequin Form Board test, CM Bhatia test and Vineland Social Maturity Scale. Chi-square test was used to find associations, if any. Results: 16 children out of 52 were suffering from Intellectual Disability thus resulting in a prevalence of 30.7%. Male: Female ratio for Intellectual Disability was 1.3:1. Among the demographic variables, sex of the child and maternal age at child birth were significantly associated with Intellectual Disability (p<0.05). Conclusions: High prevalence of Intellectual Disability among disabled children is a cause of concern. Healthcare team needs to raise awareness among females of reproductive age about various risk factors and screen children with disabilities for Intelligence Quotient (IQ) for early interventions.Item Potential Link Between Janus Kinase 2 Mutation and Renal Artery Stenosis Leading to Refractory Secondary Hypertension - A Case Report(Dr. Annil Mahajan, 2024-01) Lakshmipriya, V; Murugavel, V; Jayaganesh.Polycythaemia vera (PV) is a rare BCR/ABL negative chronic myeloproliferative neoplasm characterized by increased red cell mass, splenomegaly and JAK2 V617 mutation in nearly all patients. The frequency of acquired Janus kinase 2 (JAK 2) V617 mutation is about 95% in PV patients.Herein,we report a case of renal artery stenosis leading to uncontrolled hypertension in apatient with PV having JAK2 V617F mutation, high haematocrit levels and erythrocytosis.A syndrome of refractory secondary hypertension, renal artery stenosis and erythrocytosis could be seen in the same patient.However, renovascular hypertension may be a thrombotic complication of primary erythrocytosis seen in PV patients and may lead to secondary erythrocytosis. Thus, patients with PV having JAK2 V617 mutation must be evaluated for thrombosis and optimally managed when hypertension coexist.Item Beyond the Symptoms: Exploring the Clinical, Bacteriological, and Radiological Profiles and Outcomes of Community-Acquired, Hospital-Acquired, and Ventilator-Associated Pneumonia in a Tertiary Care Setting(Dr. Annil Mahajan, 2024-01) Kelli, SBR; Deoskar, RB; Bhoite, GM; Momin, AA.Background: The lower respiratory tract infections (LRTIs), including pneumonia, are the fourth most common cause of mortality globally and the second most frequent reason for years of life lost. India is home to one-quarter of the world’s pneumonia cases. Aims and Objectives: The present study was aimed to evaluate the clinical, bacteriological and radiological profile of CAP, HAP and VAP patients from a tertiary care teaching hospital. Material & Methods: This cross-sectional, observational study was conducted at the Department of Pulmonary Medicine, Bharati Vidyapeeth (DTU) Medical College and Hospital, Pune, India. The study included 100 clinically diagnosed patients of community-acquired pneumonia (CAP), hospital-acquired pneumonia (HAP), and ventilator-associated pneumonia (VAP). Patients were evaluated for clinical symptoms, microbiological investigations, radiological assessment, treatment given, and final outcome. Severity indices were calculated for CAP, HAP, and VAP patients to predict the severity and rate of mortality. Results: The most common symptoms are cough, fever, and shortness of breath. The most common organisms isolated in sputum cultures of patients with pneumonia are Streptococcus, Pseudomonas, and Acinetobacter. The most common site of consolidation on chest X-ray is bilateral. Mortality rates are highest in patients with ventilator-associated pneumonia (VAP), followed by hospital-acquired pneumonia (HAP) and community-acquired pneumonia (CAP). Conclusion: The most common symptoms of pneumonia are cough, fever, crepitation, and expectoration. Mortality rates are highest in patients with VAP, followed by HAP and CAP.Item Cutaneous Adverse Drug Reaction Profile in Tertiary Care Teaching institute: A Prospective Study(Dr. Annil Mahajan, 2024-04) Bashir, S; Mahajan, V; Tandon, VR; Sadiq, S; Dass, Y; Gupta, G; Sharma, N.Introduction: Cutaneous adverse drug reactions (CADRs) are the most common type of drug sensitivity reactions, with a varied and diverse range of morphologies. Therefore, it is essential to be aware of them for diagnosis and prevention. Aim: To assess the cutaneous adverse drug reaction (CADR) profile of patients from the tertiary care teaching hospital in North India. Methods: A prospective, observational study was conducted over 6 months in the Department of Pharmacology & Therapeutics, Jammu in collaboration with the Dermatology department, SMGS Hospital, Jammu after obtaining permission from the institutional ethical committee. Patients with drug rash, of either sex and all age groups were included in the study. The WHO-UMC scale and Naranjo algorithm scale were used to determine the causality assessment. Details regarding drug intake, morphology of eruption, offending drugs, drug rechallenge/ de- challenge history, and treatment given to the patients were assessed. Results: Out of 100 patients enrolled, 42% had an exanthematous drug eruption, while 21% had fixed drug eruptions. Most reactions were caused by antimicrobials 64% followed by non-steroidal anti-inflammatory drugs (NSAIDs) in 15% of patients, with 9% experiencing severe cutaneous adverse drug reactions (SCADRs), like Stevens- Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), caused by antituberculous drugs. Conclusion: The study findings show that reporting adverse drug reactions (ADR) can help identify the drugs most commonly associated with dermatological reactions. This leads to better patient treatment through early identification and management of these reactions.