BACKGROUND Spongiotic dermatitis is a common diagnosis in routine dermatopathology practice. Clinically it includes eczema and its clinicopathological variants. The main purpose of a biopsy in such cases is to come to a precise diagnosis. We wanted to study the different histopathological features commonly seen in spongiotic dermatitis. METHODS This is a cross sectional study conducted at a Government Medical College in Kerala, South India. All lesions reported as cases belonging to the category of spongiotic dermatitis during the one-year period were included in the study. Patients who presented with an established diagnosis of spongiotic dermatitis were excluded from the study. The study included 41 skin biopsies. RESULTS The age distribution pattern revealed that the highest percentage was in the 10 - 20 years age group (21.95 %) with a male preponderance (68.29 %). Small plaque parapsoriasis was the most common lesion (24 %) encountered in the study. CONCLUSIONS Some of the histopathological features are specific and characteristic for each entity like small plaque parapsoriasis, pityriasis rosea and erythema annulare centrifugum whereas some features overlap in lesions like irritant contact dermatitis and photoallergic contact dermatitis. Therefore, clinical history combined with microscopic features will help us render a precise diagnosis. KEYWORDS Spongiotic, Dermatitis, Inflammatory, Histopathological
BACKGROUND Covid-19 has caused significant distress worldwide. It not only causes physical symptoms but also takes a toll on the mental well-being of an individual. A plethora of people develop the psychological disorders due to the pandemic. This study was an attempt to explore the occurrence of anxiety and its severity levels among the people working from home during the pandemic period. METHODS A cross sectional online survey was conducted by sharing Zung self-administered anxiety questionnaire using Google form. Informed consent was obtained from 105 participants and snowball sampling method was used in the study. The chi square and P-value were also calculated to determine the level of significance and association between different variables. RESULTS Out of 105 participants, 15 (14.28 %) were found to have anxiety disorder. Males were found to have higher anxiety levels than females. Higher numbers came from those living in a joint family and who were married. CONCLUSIONS Early identification of psychological distress and timely intervention will improve quality of life of an individual and will also reduce the severity of the psychological sequalae. KEYWORDS Pandemic, Anxiety, Covid-19, Mental Health
BACKGROUND Supracondylar fracture of humerus is a common fracture in children. Closed manipulative reduction and percutaneous K-wire fixation is the most widely recognized treatment method for displaced supracondylar humerus fracture in children but controversy persists regarding the ideal pin fixation technique. The purpose of this study was to compare the radiological and functional outcome of lateral entry pinning with that of crossed pinning fixation for Gartland type III supracondylar humerus fractures in children. METHODS This prospective cohort study was conducted in Govt. Medical College Hospital, Thiruvananthapuram from February, 2015 to September, 2016. A total of 54 patients who satisfied the inclusion and exclusion criteria were enrolled in the study. They were allocated to Group A (crossed pin fixation) and Group B (lateral pin) fixation with 27 patients in each. All the cases of percutaneous pinning were done according to a uniform standardized technique. The patients were reevaluated at post-operative day, three weeks, and three months after the surgery. Following information were recorded as outcome measures: (i) carrying angle (ii) range of motion (iii) modified Flynn’s criteria. (v) Baumann’s angle (vi) neurovascular injury. RESULTS There was no statistically significant difference between crossed and lateral pinning with regard to mean Baumann's angle, carrying angle, complication rate, stability and functional outcome, but there was evidence of iatrogenic ulnar nerve injury (3.7 %) in crossed pinning group. There was one case of pin tract infection. CONCLUSIONS There is no statistically significant difference between the radiological and functional outcome provided by crossed pin fixation method and lateral pin fixation methods. Closed reduction and percutaneous pin fixation are safe and efficient methods for fixation of displaced supracondylar fractures of the humerus. Closed reduction and percutaneous pin fixation for displaced supracondylar factures of the humerus in children gives good functional and cosmetic results. KEYWORDS Humerus, Percutaneous Pinning, Supracondylar Fracture
BACKGROUND Stenotrophomonas maltophilia is a gram-negative bacillus, multidrug resistant (MDR) opportunistic pathogen, which is normally present in hospital surroundings. It has been one of the leading causes of nosocomial infections due to risk factors such as extended intensive care unit (ICU) stays and multiple invasive procedures. In this study we wanted to assess the antibiotic sensitivity pattern with various antimicrobial agents i.e. levofloxacin, minocycline, ceftazidime, chloramphenicol, & ticarcillin-clavulanic acid with special focus on trimethoprim-sulfamethoxazole (TMP-SMX). METHODS In vitro analysis was conducted on 164 Stenotrophomonas maltophilia strains isolated from blood and respiratory tract from January 2016 to November 2020. Antibiotic susceptibility and minimum inhibitory concentration (MIC) testing for trimethoprim-sulfamethoxazole (TMP-SMX), levofloxacin (LVX), ticarcillin - clavulanic acid (TIM), and minocycline (MIN) were performed using Vitek 2, as per clinical and laboratory standards institute (CLSI) guideline. RESULTS A total of 164 S. maltophilia were isolated. Out of the 164 S. maltophilia isolates, 26 (16 %) were isolated from blood, 114 (70 %) were isolated from respiratory samples, 20 (12 %) from pus & tissue, and 4 (2 %) from urine. Out of the 164 patients, 130 (80 %) were males and 32 (20 %) were females. Maximum patients were above 50 years of age 93 (56 %) followed by 20 - 50 years 55 (34 %). Out of the 164 patients, 67 (40 %) were admitted to wards, 92 (56 %) were in ICU and 5 (3 %) were seen in out-patient department (OPD). A total of 90 % strains were sensitive to trimethoprim-sulfamethoxazole (TMP-SMX). Total 91 % strains were sensitive to levofloxacin. CONCLUSIONS S. maltophilia is emerging as a significant nosocomial pathogen, with a growing rate of isolation. Trimethoprim- sulfamethoxazole (TMP-SMX) is still the drug of choice, but resistance to it has been reported. KEYWORDS Minimum Inhibitory Concentration, Trimethoprim-Sulfamethoxazole (TMP-SMX), Levofloxacin
BACKGROUND Combined oral contraceptive pills are the most effective temporary contraception methods and are used by approximately 60 - 80 million eligible women throughout the world. It is the oestrogen component of the combined oral contraceptive (COC) which is responsible for the undesirable and serious side effects such as deep vein thrombosis (DVT) and pulmonary embolism (PE). So, there has been a constant effort to reduce the amount of ethinyl estradiol (EE) while maintaining its contraceptive efficacy. This study was aimed at studying the safety and efficacy of ultralow dose combined oral contraceptive (containing 15 mcg EE + 60 mcg gestodene) in rural Indian women. METHODS The study was done at Rama Medical College, Mandhana, Kanpur, among 70 patients who fulfilled the inclusion criteria. The patients were given ULDOCP and followed up for 6 months. The patients followed the regime of one tablet of ULDOCP daily from day 1 to day 24 of the menstrual cycle with 4 days pill free period before starting the next pack. RESULTS Seventy patients completed the study till 3 months and fifty patients completed the study till 6 months. Break through bleeding (BTB) was the only prominent side effect which was reduced in subsequent cycles and our patients tolerated this well. No pregnancy resulted. The ULDCOP was very well accepted by those women who were counselled about possible side effects and their harmless nature before starting the study. It was found that the users were satisfied with the use of ULDOCP. All side effects were significantly lower after 2 months of use and there were no serious side effects. CONCLUSIONS The 24 / 4 ULDOCP regimen seems to be a safe and effective contraceptive method for use in rural population after properly counselling them. The reduced pill free interval of 4 days offered additional advantages. KEYWORDS Ultra-Low Dose Oral Contraceptive Pills (ULDOCP), Ethinyl Estradiol (EE), Safe Contraception, Gestodene, BTB (Break Through Bleeding)
BACKGROUND The computerised tomography (CT) characteristics of COVID-19 are reported and compared with the CT characteristics of other viruses to familiarise radiologists with potential CT trends and to determine the effectiveness of chest CT in the diagnosis and treatment of COVID-19. METHODS This was a hospital based descriptive study which involved the first 324 patients with a finding of severe acute respiratory syndrome (SARS-CoV-2) infection validated by real-time reverse transcription-polymerase chain reaction (RT – PCR). Monitoring patients (198 males, 126 females with a mean age of 46.50 years ± 8.96 [SD] and age range of 21 - 76 years) from April 2020 to July 2020. We correlated the image reports from the initial CT analysis with the findings of the laboratory studies and established possible CT patterns for viral infection. RESULTS The initial chest CT studies of the 324 SARS-CoV-2 patients showed that the disease affected all 'five lobes' in 248 (76.54 percent) patients, both 'lower lobes' in 49 (15.12 percent) patients, the right lower lobe in 23 patients (7.10 percent), and the left lower lobe and right middle lobe in 2 patients (0.62 percent). In 303 (93.52 percent) patients, the lesions were primarily peripheral and subpleural; and there were fewer lesions along the bronchovascular bundles. Two major patterns of SARS-CoV-2 lesions on CT images are GGO (ground - glass opacity) and consolidation. In 303 of the 324 patients (93.52 percent), CT showed single or multiple abnormal GGO or consolidation, or both. In the remaining 21 (6.48 percent) cases, neither GGO nor consolidation was observed on CT. Follow-up CT showed moderate or pronounced disease worsening in 12 out of 58 (20.69 percent) cases and follow-up CT showed improvement with the appearance of fibrosis and GGO resolution. CONCLUSIONS In conclusion, the use of a chest CT system in SARS-CoV-2 patients can accurately evaluate pneumonia. Most notably follow-up CT scans may help assess patients with SARS-CoV-2 pneumonia in their response to treatment. KEYWORDS SARS-CoV-2, Pneumonia, Chest Computed Tomography, Ground-Glass Opacities
BACKGROUND Perinatal asphyxia (PA) is an important cause of neonatal morbidity, mortality, and neurologic handicap in children. Dysfunction of organs other than central nervous system is often recognised after perinatal asphyxia and manifests as hypoxic ischaemic insults to heart, lungs, kidneys and bowel. The purpose of this study was to assess the spectrum of multi-organ system involvement in perinatal asphyxia. METHODS This observational, descriptive study was conducted at SVRRGGH (Sri Venkateswara Ramnarayan Ruia Government General Hospital) - Tirupati from October 2010 to September 2011 and has Institutional Ethics Committee approval (Regd. No: 58647, Dt: 20 / 11 / 2010). After considering the inclusion and exclusion criteria, 204 neonates diagnosed with perinatal asphyxia who got admitted in our newborn intensive care unit (NICU) were included in this study. RESULTS In the present study, we had 118 (57.89 %) male babies and 86 (42.11 %) female babies. The mean birth weight was 2640 +/- 460 grams. Infants of birth weight 2500 - 4000 grams (appropriate for gestational age - AGA) accounted for 202 (98.96 %). Major maternal risk factors in this study were MSAF (meconium-stained amniotic fluid (66/204, 32.4 %), PIH (pregnancy induced hypertension) and Eclampsia (26/204, 12.7 %) and PROM (premature rupture of membranes) (26/204, 12.7 %). In the present study, we found higher mortality (19/117, 16.2 %) in babies born to multiparous mothers. Respiratory system involvement was seen in 80 (39.2 %) infants. Renal involvement was observed in 58 (27.5 %) infants. Acute renal failure was diagnosed in 22 (10.8 %) cases. CVS (cardiovascular system) involvement was seen in 56 (27.5 %) cases where as GIT (gastrointestinal tract) involvement was found in 32 (15.68 %) cases. CONCLUSIONS Epidemiological research is needed to accurately estimate the contribution of birth asphyxia to perinatal morbidity and mortality, especially in community settings where the burden of disease, due to high proportion of unattended deliveries, is likely to be larger than the hospital setting. KEYWORDS Perinatal Asphyxia, Neonatal Intensive Care Unit, Hypoxic Ischaemic Encephalopathy, Multi Organ Dysfunction, Cardiovascular System
A dermoid cyst is a teratoma of a cystic nature which can occur wherever a teratoma can occur. Intra mesenteric dermoid cyst is rarest of rare case and even its incidence is not known. Here, we report a case of intra mesenteric dermoid cyst in 21 yr. old female patient who presented to us with complain of on & off mild pain in abdomen for last 2 years. Intra mesenteric dermoid cyst is a rare condition and when presented with symptoms, it should be operated upon for improving patient’s overall wellbeing. Dermoids belong to the group of congenital cystic tumours developing from an embryonic rest. Such tumours vary from those which contain only epidermal cells to those containing various dermal derivatives, such as glandular cells (sebaceous), and even hair and teeth. So, they vary from pure epidermoids to dermoids and then through the teratoid tumours to the teratomas. These tumours can arise wherever two ectodermal surfaces fuse together in the developing embryo when an ectodermal implant is retained deep in the surface.”1 Intra mesenteric dermoid is very rare and no previous case report regarding intra mesenteric dermoid was found.
BACKGROUND Thyroid carcinoma is the most common endocrine malignancy. Galectin-3 has been implicated in malignant transformation and metastasis of cancer cells and it has received notable recognition for its usefulness as a diagnostic marker for thyroid cancer. We wanted to evaluate the expression of Galectin-3 on thyroid neoplasms, establish its diagnostic accuracy and also differentiate between benign and malignant thyroid lesions. METHODS A total of 54 thyroidectomy specimens were studied over a period of 3 years (2016 - 2019) which included 20 benign and 34 malignant thyroid neoplasms. Histopathologic evaluation of H & E stained sections was done and immunohistochemistry (IHC) staining for Galectin-3 was performed for all neoplasms with the polymeric method using lyophilized mouse monoclonal antibody. (Path n Situ) and grading based on intensity of Galectin-3 expression were noted. RESULTS Galectin-3 expression was significantly higher (P < 0.001) in malignant thyroid neoplasms in comparison to the benign neoplasms. Galectin-3 expression for malignant neoplasms showed sensitivity of 88.23 %, specificity of 95.0 %, positive predictive value (PPV) of 96.8 % and negative predictive value (NPV) of 82.6 %. Galectin-3 expression in Papillary thyroid carcinoma showed a sensitivity of 95.83 % and PPV of 88.2 %. While comparing the neoplasms showing follicular pattern, Galectin-3 expression was more in the malignant neoplasms (follicular carcinoma and follicular variant of papillary carcinoma thyroid) than benign neoplasms (follicular adenoma). CONCLUSIONS Galectin-3 is a useful marker in differentiating benign and malignant thyroid neoplasms. Galectin-3 is sensitive for Papillary thyroid carcinoma (PTC) and among the follicular patterned lesions, Galectin-3 is sensitive for follicular variant of papillary carcinoma and follicular carcinoma. Thus Galectin-3 protein expression evaluated using immunohistochemistry technique acts as an adjunctive ancillary technique in thyroid cancer diagnosis. KEYWORDS Galectin-3, Immunohistochemistry, Thyroid Carcinoma, Papillary Thyroid Carcinoma
BACKGROUND Gamma glutamyl transferase (GGT) is a biomarker elevated in various cardiovascular diseases due to oxidation mediated free radical damage. It has been recently used in patients presenting with acute coronary syndromes (ACS) for predicting major adverse cardiovascular events and in hospital adverse outcomes. The application of gamma glutamyl transferase to the traditional set of biomarkers like troponin I and T, creatinine kinase-MB (CKMB) adds to the value that it helps in reclassifying the patients into high and low risk and plan the appropriate treatment strategy. METHODS Patients presenting with acute coronary syndromes were classified into STEMI (ST elevation myocardial infarction), NSTEMI (Non-ST elevation myocardial infarction) and unstable angina based on cardiac biomarkers and electrocardiographic changes. Serum gamma glutamyl transferase of these patients were measured by photo spectrometry and were monitored for 5 days for major adverse cardiovascular events. RESULTS Of the study population (N = 210), 41 % presented with STEMI, 24 % unstable angina, 25 % NSTEMI. The normal range of GGT in our study population was 15 - 70 U/l. values more than 70 U/l was considered raised GGT major adverse cardiac events (MACE) was present in 35 % of the study population. 58 % of the patients with MACE had raised GGT (> 70 U/l) which was statistically significant (P < 0.001). The ROC (receiver operator characteristic curve) for GGT to predict MACE was to the left of the reference line and the area under the curve (AUC) was 0.915. The optimal cut-off for GGT to predict MACE from our study was 50.5 with a sensitivity and specificity of 0.813 and 0.868 respectively. CONCLUSIONS Raised GGT was significantly associated with MACE and in hospital adverse outcomes (ventricular arrythmias, heart failure, recurrent angina). GGT can be used as a prognostic marker in patients presenting with ACS. KEYWORDS Gamma Glutamyl Transferase, Acute Coronary Syndromes, St Elevation Myocardial Infarction, Non-ST Elevation Myocardial Infarction, Unstable Angina
BACKGROUND Treatment of fungal ulcers is one of the most challenging tasks. Various topical antifungal drugs have poor corneal stromal penetration. Voriconazole is a broad spectrum drug and is an effective agent for the treatment of fungal keratitis as a topical preparation. It is potent against a broad range of clinically significant fungal infections both in the eye as well systemically. In tropical climatic conditions filamentous fungi commonly cause eye infections and are associated with poor visual outcomes. The treatment options for mycotic ulcers are limited, therefore direct intrastromal injections are helpful in the management of these deep mycotic keratitis. We wanted to evaluate the role of intrastromal injection of voriconazole in the management of deep fungal keratitis not responding to conventional therapy. METHODS This an interventional case series study done at a tertiary care centre in south India from the year April 2019 to August 2020. Eight eyes of eight patients with microbiologically proven deep stromal recalcitrant mycotic keratitis not responding to topical antifungal medications were evaluated. Voriconazole 50 microgram / 0.1 ml was injected around the infiltrate in the corneal stroma as an adjunctive to the topical antifungal treatment. Main outcome measure was a reduction of the size of the infiltrate and ulcer and decrease in infection on regular follow ups. RESULTS Before injecting voriconazole, all the cases were of either gradually worsening of lesions on topical treatment, or not responding to topical treatment. After the injection a rapid decrease in the size of corneal ulcer, hypopyon, and infiltration was seen within 3 weeks. CONCLUSIONS Targeted delivery of intrastromal voriconazole may be a safe and effective way in the management of deep seated fungal ulcers which respond poorly to conventional treatment procedures, thus reducing the need for further surgical treatment. KEYWORDS Intrastromal Injection, Voriconazole, Fungal Keratitis, Deep Mycotic Keratitis
BACKGROUND Solid pseudopapillary neoplasm (SPN) of pancreas is a rare epithelial tumour of low malignant potential. SPN accounts for less than 1 to 2 % of exocrine pancreatic tumours. It mainly affects women between the second and third decade of life, and its management is not well defined. The aim of this study was to report clinicopathological characteristics of SPN and its outcome. METHODS A retrospective study was conducted in a tertiary care centre from January 2015 to December 2019. All patients who were diagnosed and treated as SPN of pancreas in our institute were retrospectively reviewed. A data of the characteristics of these patients was developed, including age, gender, size, location of tumour, treatment, histopathological and immunohistochemical features. RESULTS Six patients were diagnosed as having SPN of pancreas, during the 5-year period. All 6 patients were female. Youngest age of occurrence was 15 years. Maximum age was 41 years. Average age was 25 years. All patients were symptomatic and the most common symptom was dull aching upper abdominal pain. Contrast enhanced computed tomography (CECT) was done for all patients. 3 patients had typical features of SPN. Endoscopic ultrasound (EUS) was done for 4 patients and EUS fine needle aspiration cytology (FNAC) was done for 3 patients. Patients were provided with procedure details and informed consent was taken. All patients were subjected to surgical treatment. Out of six patients, two underwent laparoscopic spleen preserving distal pancreatectomy, two patients underwent classical Whipple’s procedure and two patients had undergone median pancreatectomy. CONCLUSIONS SPN are rare neoplasms, typically affecting young females without clear histogenesis and with a malignant potential. Appearance from imaging studies can be adequate to guide surgical resection without pre-operative pathological assessment. But in unclear cases, EUS-FNAC with immunohistochemistry helps in establishing a pre-operative diagnosis. Surgical resection should be offered when feasible. Prognosis of SPN of the pancreas is good due to its favourable biological features, even in the presence of distal metastasis. KEYWORDS Solid Pseudopapillary Neoplasm (SPN)
BACKGROUND State Initiative on Disabilities [SID] survey (2015) states that 2.32 % of Kerala population are affected with one or the other form of disabilities; the Sruthitharangam scheme of Kerala Government since 2012 provides free cochlear implant surgery and rehabilitation to children with bilateral profound sensorineural hearing loss among children of 0 - 5 years age group. We wanted to measure the expectations of the parents and their perspectives before cochlear implant surgery which depends upon their understanding of the whole process of surgery and the rehabilitation after surgery and its final outcomes. METHODS 67 parents of pre-implant children were interviewed with an open-ended questionnaire to know their perspective of government aided pre-implant programme in the state of Kerala. Children were using Hearing aids of Behind the Ear (BTE) TBE 110 HT model supplied by the government, free of cost. Children were attending pre-implant Auditory Verbal Therapy (AVT) with hearing aids at Centre for Audiology and Speech Pathology [CASP] Govt. Medical College, Kozhikode, for a minimum of 3 months. All the data was analysed using mean and percentage calculations. RESULTS 67 pre-implant children used their hearing aids for a minimum of 3 - month period and the age range was between 12 months to 36 months. The mean age of children was 2.1 ± 0.43 years. 41 male and 26 female children, with a male to female ratio of 1.53: 1 were included in the study. Analysis of the questionnaire showed 8 benefits, 11 shortcomings, 5 expectations and 8 suggestions. CONCLUSIONS The parentally reported expectations, short comings, and outcomes of the use of hearing aids could be related to many factors like health care services provided by the government, and the after services of hearing aids involved. These findings help us to understand the parental perspectives of the success of cochlear implantation which can be useful during parental counselling sessions. Study is also useful to the implant centres to revise their practices accordingly and improve the information given to candidate families. KEYWORDS Hearing Impairment, Cochlear Implant, Pre-Implant Children and Hearing Aid
The incidence of ischemic heart disease (IHD) is increasing and it is the leading cause of morbidity and mortality worldwide.1 These patients have increased risk of myocardial ischemia, myocardial infarction (MI), conduction disturbances and cardiac arrest perioperatively. Preoperative cardiovascular assessment and prediction of short- and long-term risks affects the perioperative anaesthetic management and also surgical decision making. Risk factors include recent MI, congestive cardiac failure, peripheral vascular disease, angina pectoris, diabetes mellitus (DM), hypertension, renal dysfunction, age, obesity and sedentary lifestyle.2 The choice of anaesthesia is general anaesthesia so that myocardial oxygen supply can be kept greater than demand by preventing tachycardia and high blood pressures, which can lead to ischemia.3 Few studies have shown that Epidural anaesthesia can decrease cardiac morbidity and mortality in IHD patients. We report a successful anaesthetic management of IHD with ejection fraction of 30 % posted for fracture femur surgery under Combined Spinal Epidural (CSE) anaesthesia.
A 7-day-old new-born was referred to Department of Radiodiagnosis of North Bengal Medical College and Hospital to evaluate enlargement of head circumference. On clinical examination of this new-born we found macrocephaly and absent right thumb as well as deformed left thumb. No other clinical abnormalities were seen in this new-born apart from this. Facial structures, spine, upper and lower limbs, trunks were normal clinically. Transcranial ultrasound was done using LOGIQ P9 ultrasound machine which revealed an open lip schizencephaly involving right cerebral hemisphere with absence of corpus callosum. Trans abdominal sonography revealed non visualisation of left kidney in left renal fossa as well as in its usual ectopic position. Therefore, the new-born underwent magnetic resonance imaging (MRI) of brain and whole abdomen which confirmed ultrasound findings. MRI additionally revealed there was no ocular, anorectal and genito-urinary malformations. Infantogram was done to evaluate the skeleton of this new-born. Fetal echocardiography revealed no obvious cardiac anomalies.
BACKGROUND Breast lump is fairly a common complaint in females for which patient seeks medical advice and becomes anxious about the diagnosis. Quick diagnosis by fineneedle aspiration cytology (FNAC) relieves patient’s anxiety and assists in their preoperative management and overall treatment. This study was conducted to find out the cytomorphological patterns and distribution of breast lesions in various age groups in our institute. METHODS This is a prospective observational study of breast lesions conducted in the Mandya Institute of Medical Sciences, Mandya, for a period of 18 months from January 2016 to June 2017. About 200 cases were studied by cytology and correlated with histopathology wherever biopsy specimens were available, and were stained with haematoxylin and eosin (H & E) and May–Grunwald–Giemsa stains (MGG). Cases were grouped according to the five-tier reporting format for breast lesion (C1 – C5) laid down by National Cancer Institute. RESULTS The spectrum of breast lesions on cytomorphological interpretation was 1 % inadequate / insufficient material (C1), 80 % benign (C2), 1.5 % atypia probably benign (C3), 0.5 % suspicious of malignancy (C4) and 17 % malignant (C5). Out of 200 cases studied, 160 cases were benign lesions, and 34 cases were malignant lesions. Most of the benign lesions belonged to the age group 21 - 30 years followed by 31 - 40 years. Malignant lesions were maximum in the age group of 41 - 50 years. In benign disease, fibroadenoma was the commonest i.e. (31 %) followed by fibrocystic change (22 %), benign epithelial hyperplasia (8.7 %), acute mastitis (3 %), chronic mastitis (2 %), epidermal cyst (1.8 %), subareolar abscess, granulomatous mastitis, galactocele (1 %) and gynaecomastia (8.5 %). In the malignant group, infiltrating ductal carcinoma - not otherwise specified, was the commonest lesion (82.4 %), followed by mucinous carcinoma (8.8 %), papillary carcinoma, medullary carcinoma and metaplastic carcinoma (2.9 %). In this study, the specificity, sensitivity, positive and negative predictive value, and diagnostic accuracy of fine-needle aspiration cytology were 100 %, 90 %, 100 %, 95 %, and 96 %, respectively. CONCLUSIONS FNAC of the breast lump is an easily performed outpatient diagnostic method for determining the nature of the breast mass. KEYWORDS FNAC, Fibroadenoma, Haematoxylin and Eosin, Infiltrating Ductal Carcinoma - Not Otherwise Specified (IDC NOS), May Grunwald Giemsa
BACKGROUND Ovarian torsion occurs when the ovary twists on its fibrovascular pedicle resulting in vascular compromise. Initially, there is twisting of the ovary, fallopian tube, or both structures, causing venous, lymphatic and arterial compromise with resultant ovarian oedema and adnexal enlargement. We wanted to determine the most common ultrasonography (USG) and magnetic resonance imaging (MRI) findings in surgically proven cases of ovarian torsion. METHODS We present a series of cases obtained on retrospective review of USG and MRI findings in 10 surgically proven cases of ovarian torsion between June 2018 to June 2020 in the Department of Radiology, MVJ Medical College & Research Hospital, Hoskote. RESULTS Significant enlargement of the ovary with size ranging from 5 to 15 cms with peripherally displaced follicles and free fluid in the pelvis in noted in all the patients on USG and MRI. Other common MRI features include ‘twisted vascular pedicle’ sign seen in 7 (70 %) cases, areas of haemorrhage within the ovarian stroma in 7 (70 %) cases and abnormal ovarian enhancement in 9 (90 %) cases. CONCLUSIONS Ultrasound and MRI are the main diagnostic imaging modalities prior to treatment. Improved detection and characterisation of pelvic mass contributes to better diagnostic accuracy. The most common findings in US and MRI features of ovarian torsion include ovarian enlargement with peripherally displaced follicles and free fluid in pelvis. Other common MRI features include ovarian haemorrhage, twisted vascular pedicle, abnormal ovarian enhancement and deviation of the uterus towards the same side. KEYWORDS Ovarian torsion, USG, MRI
BACKGROUND Lack or relative absence of access or disinterest in the use of standardised protocols in diagnosis, treatment and management of majority of ailments is a phenomenon very often seen but rarely acknowledged in the medical fraternity. This occurrence extends to many of the higher centers of healing and teaching including tertiary care institutes. We wanted to assess the perceptions, attitudes, practices and barriers to practice of evidence-based medicine among practitioners in clinical medicine in a tertiary care institute. METHODS A structured proforma containing Evidence Based Practice Questionnaire by Upton and Upton (2006) was administered to faculty members of various clinical specialties between July to September 2019. Non probability purposive sampling technique was used to enlist 50 participants who met the inclusion criteria. The completed proformas were collected and data was analysed using SPSS v.21. After analysing the data, in depth interviews of 16 consenting faculty members was conducted to identify barriers to practice of evidence-based medicine. RESULTS The mean score for knowledge domain of evidence based medicine was 53.18, SD = 7.05, for the attitude was 16.90, SD = 2.12 and that for practice was 20.50, SD = 5.26. The Cronbach alpha for the three domains were found to be 0.57, 0.62 and 0.81. The familiarity with common bio statistical terms and measures was best with odds ratio (78 %) and relative risk (64 %) and poorest with the understanding of parametric, non-parametric tests and power of the study (2 %). Of the 50 study subjects, 26 (52 %) used MS Excel for data analysis, 32 (64 %) generic search engines like Google, Yahoo, MSN to search for relevant medical literature. The thematic analysis of the interview transcripts of 16 interviewed faculty members revealed that barriers for non-practice of EBM were lack of comfort with research process, lack of mentoring, incomplete knowledge on how to conduct literature research and lack of time. CONCLUSIONS Practice of evidence based medicine has come a long way but still has a longer way to go. KEYWORDS Evidence Based Medicine, Barriers, Clinical Practitioners
A 22-year-old woman, single, came to Radiodiagnosis Department of North Bengal Medical College and Hospital for ultrasonography examination of whole abdomen for evaluation of amenorrhoea and vague cyclical lower abdominal pain. She had been treated outside the hospital for several years for above symptoms without any fruitful outcome. There was no history of any surgical management to this patient. Careful clinical examination of pelvis revealed an imperforate hymen. No other clinical signs were found except mild lower abdomen tenderness. Routine ultrasound was done with curvilinear probe with frequency of 5 MHz in GE LOGIQ P 9 model ultrasound sonography (USG) Machine. Cervical agenesis was suspected based on sonographic findings, non-visualization of the cervix with a uterus like structure (measuring approx. 30 x 36 x 30 mm.) in right adnexal region. Mild collection seen in pouch of Douglas. Both ovaries and bilateral adnexa were normal. Vagina showed no abnormal collection. Other abdominal organs like liver, gallbladder (GB), common bile duct (CBD), portal vein (PV), pancreas, spleen, both kidneys, and bladder appeared normal. Transvaginal examination as well as transvaginal sonography could not be performed as imperforate hymen. Therefore, the patient underwent magnetic resonance imaging (MRI) examination of whole abdomen which confirmed the ultrasonographic findings and the case diagnosed as congenital atresia of uterine cervix with imperforate hymen.
Lipomas are very common benign tumours of mesenchymal origin. Lipomas occur with an estimated prevalence rate of 2.1 per 1000 amongst all tumours that can involve in the human body. There have been only 5 cases of giant lipomas published to date.1-5 This case report describes a unique giant lipoma located in the upper back with 30 x 30 cm in measurement and weighing 3800 grams.
