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ORIGINAL ARTICLE
Madhuresh Kumar, Santosh Kumar, Tulika Chandra, Vineet Sharma

Clinical Outcome of Intra-articular Injection of Platelet-rich Plasma in Early-stage Knee Osteoarthritis in North Indian Patients

[Year:2018] [Month:April-June] [Volumn:52 ] [Number:2] [Pages:51] [Pages No:56-61][No of Hits : 717]


ABSTRACT

Introduction: With increasing frequency, platelet-rich plasma (PRP) preparations have been used to treat cartilage lesions to regenerate tissue homeostasis and retard the progression of knee osteoarthritis (OA).

Purpose: To determine the effectiveness of intra-articular PRP injections in early-stage OA patients and to evaluate the clinical outcome.

Materials and methods: This prospective study was conducted in the Department of Orthopaedic Surgery, King George’s Medical University, Lucknow, Uttar Pradesh, India. The study was conducted on patients with early-stage OA knee enrolled on outpatient department basis during the year 2014 to 2015. The effective sample size was 40 patients with bilateral OA knee in which intra-articular injection was given. And the clinical outcomes and effectiveness were measured in terms of visual analog scale and Western Ontario and McMaster Universities Osteoarthritis Index scores at the end of 6, 12, and 24 weeks. A p-value <0.05 was considered statistically significant.

Results: There was significant improvement in all scores at the end of 6, 12, and 24 weeks.

Conclusions: The PRP treatment showed positive effects in patients with knee OA.

Clinical relevance: There are only a few studies of PRP treatment for cartilage on OA knees. Different PRP products might be more or less appropriate to treat different types of tissues and pathologies. The clinical efficacy of PRP remains under debate, and a standardized protocol has not yet been established.

Keywords: Intra-articular injection, Osteoarthritic knee, Plateletrich plasma.

How to cite this article: Kumar M, Kumar S, Chandra T, Sharma V. Clinical Outcome of Intra-articular Injection of Platelet-rich Plasma in Early-stage Knee Osteoarthritis in North Indian Patients. J Postgrad Med Edu Res 2018;52(2):56-61.

Source of support: Nil

Conflict of interest: None


 
Case Report
Aditya Choudhary, Manoj K Goyal, Manish Modi, Kanchan K Mukherjee, Chirag K Ahuja, Vivek Lal

Froin Syndrome

[Year:2018] [Month:January-March] [Volumn:52 ] [Number:1] [Pages:51] [Pages No:34-35][No of Hits : 684]


ABSTRACT

Introduction: Yellow-colored cerebrospinal fluid (CSF) suggestive of xanthochromia can be due to elevated CSF protein and can be one of the causes of papilledema.

Observation: We observed a 55-year-old lady with papilledema with yellow-colored CSF which was hypercoagulable along with elevated CSF protein and no cells. Her systemic and nervous system examination was unremarkable except for the eye findings. Her contrast-enhanced brain magnetic resonance imaging (MRI) showed multiple meningiomas, and on imaging of the spine, she had multiple contrast-enchancing intradural, extramedullary lesions. Her eye findings were attributed to Froin syndrome found in patients with spinal tumors.

Conclusion: Our case stresses the need to keep the possibility of Froin syndrome in mind while evaluating patients with papilledema and it may be pertinent to perform a spinal imaging, especially when no apparent cause for papilledema is found.

Keywords: Froin, Papilledema, Spinal tumors, Xanthochromia.

How to cite this article: Choudhary A, Goyal MK, Modi M, Mukherjee KK, Ahuja CK, Lal V. Froin Syndrome. J Postgrad Med Edu Res 2018;52(1):34-35.

Source of support: Nil

Conflict of interest: None


 
BIOSKETCH
Ajit Avasthi, Subho Chakrabarti

Prof. NN Wig... The Living Legend of Indian Psychiatry

[Year:2018] [Month:July-September] [Volumn:52 ] [Number:3] [Pages:60] [Pages No:164-165][No of Hits : 504]


ABSTRACT

Professor NN Wig is, in the true sense of the word, a living legend of Indian psychiatry. The Department of Psychiatry at the Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, owes its existence to him and his vision continues to guide the staff and students. He single-handedly brought the department into being in 1963 and he continues to be intimately associated with the department and the PGIMER as one of its emeritus professors.


 
PROCEEDINGS OF CONGRESS IBOSCON 2018
Sandeep Patel, Tungish Bansal, Mandeep S Dhillon, Devendra K Chouhan, Himanshu Kanwat, Alka Bhatia

Multiple PRP Injection vs Single PRP Injection in Early OA Knee: An Experimental Study in a Guinea Pig Early Knee OA Model

[Year:2018] [Month:April-June] [Volumn:52 ] [Number:2] [Pages:51] [Pages No:90-103][No of Hits : 504]


ABSTRACT

Platelet-rich plasma (PRP) has emerged as the forerunner among disease-modifying treatment options of early osteoarthritis (OA) of knee.1 However, there is currently no consensus on the number and frequency of PRP injections, and their dosing schedules are widely debated. A few clinical studies2,3 have shown that multiple injections of PRP are better than single injection; however, the biological basis of this effect is not yet clear.


 
Review Article
Smit Singla, Akhilesh Verma, Snehil Goyal, Itika Singla, Anjali Shetty

Conventional and Advanced Diagnostic Tools in Oral Cancer with Emphasis on Role of Dentist and Early Detection

[Year:2017] [Month:July-September] [Volumn:51 ] [Number:3] [Pages:40] [Pages No:128-133][No of Hits : 5007]


ABSTRACT

The prevalence of oral cancer is increasing worldwide day by day. Those who suffer from oral cancer have low survival rate compared with other cancer, mainly due to delay in the diagnosis, metastases, and presence of secondary tumors. For the dental profession, it is really challenging to diagnose oral precancer or oral cancer, particularly in its early stage of the disease. Early screening and advanced diagnostic tools play an important role in the early diagnosis and treatment planning of patients suffering from oral cancer. The diagnosis method usually includes histopathology and visualization adjuncts, such as toluidine blue, vizilite, etc. This study reviews the development of new upcoming tools for early detection, emphasis on the importance of role of dentist, and early detection of oral cancer.

Keywords: Early detection, Oral cancer, Screening.

How to cite this article: Singla S, Verma A, Goyal S, Singla I, Shetty A. Conventional and Advanced Diagnostic Tools in Oral Cancer with Emphasis on Role of Dentist and Early Detection. J Postgrad Med Edu Res 2017;51(3):128-133.

Source of support: Nil

Conflict of interest: None


 
Original Article
Tvisha Ketan Parikh, S Arumugam

Are Indian Habits of Cross-legged Sitting and Squatting associated with Anterior Knee Pain?

[Year:2017] [Month:January-March] [Volumn:51 ] [Number:1] [Pages:51] [Pages No:1-6][No of Hits : 1920]


ABSTRACT

Aim: To evaluate the association between anterior knee pain (AKP) and traditional Indian habits of cross-legged sitting and squatting which involve deep knee flexion.

Materials and methods: A case control study was carried out in 225 patients and 225 age and sex matched controls at a tertiary care university hospital in South India over 3 years. Males and females between 18 and 55 years were evaluated using a clinical proforma of history and musculoskeletal examination. The details of deep knee flexion habits with quantification of duration were noted and participants were categorized into those who sat and did not sit cross legged, and squatters and nonsquatters. Odds ratios and chi-square tests were calculated for both these categorical variables. A subgroup analysis and stratified analysis were also performed.

Results: The Odds ratios for cross-legged sitting and squatting were not significant at 0.88 and 0.92 respectively. Sixty-nine point three percentage of the AKP cases and 72% of the controls sat cross legged (p = 0.534) and 67.6% of the AKP cases and 69.3% of controls habitually squatted (p = 0.685). Stratified analysis revealed a protective effect of cross legged sitting in AKP cases with quadriceps muscle tightness.

Conclusion: This study did not find an association between AKP and Indian habits of deep knee flexion. More than 65% of all the participants regularly engaged in these habits. Laboratory biomechanical analysis of these positions is suggested in future to understand their effect on knee joint.

Clinical significance: These positions are integral to daily habits of many Indians. The advice to AKP patients to avoid them due to their probable AKP association is not supported by the current study. Clinicians can consider the impact on the patient’s quality of life before advising against these positions.

Keywords: Anterior knee pain, Cross-legged sitting, Indian habits, Squatting,

How to cite this article: Parikh TK, Arumugam S. Are Indian Habits of Cross-legged Sitting and Squatting associated with Anterior Knee Pain? J Postgrad Med Edu Res 2017;51(1):1-6.

Source of support: Nil

Conflict of interest: None


 
Case Report
Nagarajan Doraisamy, Malarvizhi Chandrasekhar, Jim Jebakumar, Sukhdev DB Singh

Tuberculous Compound Palmar Ganglion

[Year:2017] [Month:January-March] [Volumn:51 ] [Number:1] [Pages:51] [Pages No:28-29][No of Hits : 1227]


ABSTRACT

Introduction: Compound palmar ganglion of tuberculous etiology is an infrequent condition, which has an obvious clinical picture, but still overlooked and should be diagnosed earlier before the involvement of underlying bones and nerves.

Case report: We present the case of a 56-year-old male presenting with progressive swelling of the palm and forearm. He was diagnosed to have chronic flexor tenosynovitis without involvement of the underlying bones and was treated by complete excision and antitubercular therapy (ATT).

Conclusion: Tuberculous palmar ganglion is a condition that can be managed by excision and chemotherapy. However, it presents as a challenge to rural surgeons where the patients present late. Hence, early identification and treatment are the main goals of this article.

Keywords: Antitubercular therapy, Chronic flexor tenosynovitis, Compound palmar ganglion, Melon-seed bodies.

How to cite this article: Doraisamy N, Chandrasekhar M, Jebakumar J, Singh SDB. Tuberculous Compound Palmar Ganglion. J Postgrad Med Edu Res 2017;51(1):28-29.

Source of support: Nil

Conflict of interest: None


 
Original Article
Dhaval Ranjitbhai Lekhadia, Rohan Rai, Niveditha Hegde, Gautham Hegde, Abhinay Sorake, Anil Kumar

Assessment of Vertical Skeletal Patterns using a New Cephalometric Parameter: The Dhaval Rohan Angle

[Year:2017] [Month:January-March] [Volumn:51 ] [Number:1] [Pages:51] [Pages No:7-11][No of Hits : 973]


ABSTRACT

Introduction: The aim of this study was to establish a new cephalometric parameter, named the Dhaval–Rohan angle (DR), to assess the vertical skeletal patterns on a lateral cephalogram with accuracy and reproducibility.

Materials and methods: One hundred and twenty pretreatment lateral cephalograms of the patients visiting the department of orthodontics and dentofacial orthopedics for treatment were obtained and divided into three groups. i.e., horizontal growth pattern, average growth pattern, and vertical growth pattern cases based on the routinely used cephalometric parameters; FMA, SN-GoGn, Y-axis angle and Jarabak ratio. This angle uses three skeletal landmarks, the point C (center of the condyle), point M (midpoint of premaxilla), and point G (center of the largest circle that is tangent to the internal inferior, anterior, and posterior surfaces of the mandibular symphysis).

Results: The one-way analysis of variance (ANOVA) test showed that the three groups studied were not the same for DR angle and the post hoc Tukey test found the groups to be significantly different. According to the Student’s t-test, there was no statistically significant difference in mean values of DR angle between males and females.

Conclusion: Cephalometric evaluation of young adults shows that the DR angle below 28.5° indicates a horizontal growth pattern, between 28.5 and 32.5° indicate an average growth pattern and above 32.5° indicate a vertical growth pattern.

Keywords: Growth pattern, Point C, Point G, Point M.

How to cite this article: Lekhadia DR, Rai R, Hegde N, Hegde G, Sorake A, Kumar A. Assessment of Vertical Skeletal Patterns using a New Cephalometric Parameter: The Dhaval–Rohan Angle. J Postgrad Med Edu Res 2017;51(1):7-11.

Source of support: Nil

Conflict of interest: None


 
Review Article
Vinay Jasani

Congenital Scoliosis

[Year:2017] [Month:April-June] [Volumn:51 ] [Number:2] [Pages:61] [Pages No:95-102][No of Hits : 904]


ABSTRACT

Congenital scoliosis is a scoliosis that occurs as a result of bony abnormalities that arise between 4 to 16 weeks of gestation. There are genetic and environmental factors involved in etiology. The majority of congenital vertebral anomalies are in the thoracic spine (64%).
The patients often have associated skeletal anomalies and can also be part of a syndrome. Skeletal, cardiac, genitourinary intraspinal abnormalities are most commonly found in association with congenital scoliosis.
The natural history seems to be related to the morphology of the bony the site in the spine, and the patient’s age. Congenital scoliosis usually progresses and often requires intervention. The aim of intervention is to achieve a flexible and balanced spine with normal truncal height and space available for lung ratio. Early intervention for scoliosis seems to be instrumental in trying to achieve these goals.

Keywords: Congenital, Hemivertebra, Scoliosis, Segmentation.

How to cite this article: Jasani V. Congenital Scoliosis. J Postgrad Med Edu Res 2017;51(2):95-102.

Source of support: Nil

Conflict of interest: None


 
Review Article
Mushtaq A Shaikh

Intraoperative Neurophysiological Monitoring in Spine Surgery

[Year:2017] [Month:April-June] [Volumn:51 ] [Number:2] [Pages:61] [Pages No:89-94][No of Hits : 893]


ABSTRACT

Intraoperative neurophysiological monitoring (IONM) encompasses a variety of neurological testing modalities used during surgery to monitor, identify, and potentially prevent iatrogenic complications to the nervous system and the blood supply to it or adjacent tissue. It has been used to monitor integrity of the neural pathway during spinal, neurological, cranial, and vascular procedures. Specific tests are designed to the clinical need of the surgery. Modalities may include: Somatosensory evoked potentials, motor evoked potentials, spontaneous or triggered electromyography, brainstem auditory evoked potentials, visual evoked potentials, electroencephalogram, and electrocorticography. During spinal surgery, a wide variety of procedures are utilized in which the spinal cord, nerve roots, and key blood vessels are frequently placed at risk from iatrogenic injury. Multimodal IONM relies on the strengths of different types of neurophysiological modalities to maximize the diagnostic efficacy in regard to sensitivity and specificity in the detection of impending neural injury. Thorough knowledge of the benefits and limitations of each modality helps in optimizing the diagnostic value of IONM during spinal procedures. As spinal surgeries continue to evolve, the value of neuromonitoring will also continue to become more prominent.

Keywords: Electroencephalography, Electromyography, Motor evoked potentials, Sensory evoked potentials.

How to cite this article: Shaikh MA. Intraoperative Neurophysiological Monitoring in Spine Surgery. J Postgrad Med Edu Res 2017;51(2):89-94.

Source of support: Nil

Conflict of interest: None


 
Review Article
Amrut U Borade, Filippo Familiari, Kyubo Choi, Jacob Joseph, Edward G McFarland

Comparison of Reverse Total Shoulder Arthroplasty vs Hemiarthroplasty for Acute Fractures of the Proximal Humerus: Systematic Review

[Year:2017] [Month:October-December] [Volumn:51 ] [Number:4] [Pages:51] [Pages No:182-187][No of Hits : 800]


ABSTRACT

The optimal treatment of proximal humerus fractures is debated; however, reverse total shoulder arthroplasty (RTSA) has become increasingly popular as the primary treatment. We systematically reviewed the PubMed, EMBASE, and Scopus databases to identify English-language clinical studies (evidence levels I through IV) comparing the results of RTSA with those of hemiarthroplasty (HA) for the treatment of acute proximal humerus fractures. We evaluated the following outcomes: Range of motion, patient-reported outcome measures (including pain relief), and complications. We identified eight published studies comparing RTSA with HA for treatment of acute proximal humerus fractures. The RTSA group (180 patients) showed significantly better postoperative pain relief, active anterior elevation, Constant-Murley scores, and American Shoulder and Elbow Surgeons (ASES) scores compared with the HA group (439 patients; all p < 0.05). There were no significant differences between the two groups for overall complications (RTSA, 11.8% vs HA, 20.8%), infections (2% for both groups), dislocations (RTSA, 0% vs HA, 2.5%), or nerve injury (RTSA, 1% vs HA, 2.8%). Scapular notching occurred in 15.8% of RTSA cases (grade I, 53%; grade II, 32%; grade III, 16%; and grade IV, 0%). In the treatment of acute proximal humerus fractures, RTSA provided better pain relief, postoperative anterior elevation, and outcome scores after surgery compared with HA and had similar complication rates.

Keywords: Complications, Outcomes, Pain, Reverse total shoulder, Shoulder hemiarthroplasty, Surgery, Systematic review.

How to cite this article: Borade AU, Familiari F, Choi K, Joseph J, McFarland EG. Comparison of Reverse Total Shoulder Arthroplasty vs Hemiarthroplasty for Acute Fractures of the Proximal Humerus: Systematic Review. J Postgrad Med Edu Res 2017;51(4):182-187.

Source of support: Nil

Conflict of interest: None


 
Invited Article
Jayesh Trivedi

Adolescent Idiopathic Scoliosis

[Year:2017] [Month:April-June] [Volumn:51 ] [Number:2] [Pages:61] [Pages No:58-67][No of Hits : 718]


ABSTRACT

Traditionally idiopathic scoliosis is divided into three categories according to the age of onset: Infantile (0-3 years), juvenile (4-9 years), and adolescent (10 years to skeletal maturity).

How to cite this article: Trivedi J. Adolescent Idiopathic Scoliosis. J Postgrad Med Edu Res 2017;51(2):58-67.

Source of support: Nil

Conflict of interest: None


 
Invited Article
Rajat Verma

Blood Conservation in Scoliosis Surgery

[Year:2017] [Month:April-June] [Volumn:51 ] [Number:2] [Pages:61] [Pages No:68-73][No of Hits : 695]


ABSTRACT

Spinal deformity correction surgery can result in significant blood loss. Historically, large volumes of allogeneic blood transfusion were used in these patients. There is now an increasing awareness of the need to reduce allogeneic transfusion as there are reported adverse effects. Reducing blood loss during scoliosis surgery is a multipronged approach. This study reviews current strategies to reduce requirements for allogeneic blood transfusion for scoliosis corrective surgery.

Keywords: Blood loss, Blood salvage, Blood transfusion, Scoliosis, Spine surgery.

How to cite this article: Verma R. Blood Conservation in Scoliosis Surgery. J Postgrad Med Edu Res 2017;51(2):68-73.

Source of support: Nil

Conflict of interest: None


 
Research Article
Georgy J Eralil

Role of Structured Feedback of Direct Observation of Procedural Skills in improving Clinical Skill of Interns

[Year:2017] [Month:January-March] [Volumn:51 ] [Number:1] [Pages:51] [Pages No:22-27][No of Hits : 679]


ABSTRACT

Objectives:

• To assess clinical skills of interns in selected procedures using direct observation of procedural skills (DOPS)
• To assess the change in procedural skills among students who received a structured feedback on DOPS.

Materials and methods: The study was interventional and conducted between December 2015 and February 2016 at the Department of Obstetrics and Gynaecology of Sree Narayana Institute of Medical Sciences, Ernakulam, Kerala, India. In the study, investigator observed the trainee performing a practical procedure within the workplace and recorded a rating for each competency on the assessment form. Feedback was given expanding on the reasons for any ratings of development required and makes practical suggestions for any remedial steps. The intern is reassessed for the same procedure at a later stage and the impact on skills is scored. Then the structured feedback is provided, and later on again the score on skills obtained by DOPS are compared between pre- and post-values by Wilcoxon-signed rank test.

Results: The average of pre- and post-feedback values were compared by Wilcoxon signed rank test. The p-value calculated was <0.001, which is significant. None of the interns were competent to perform the procedure before feedback; 80% of them needed more practice and 20% needed supervision. After feedback, 53.3% achieved competency and 46.7% achieved competency needing supervision; 93.3% of interns regarded feedback as superior quality, while 6.7% regarded as satisfactory.

Conclusion: Direct observation of procedural skills can be used to assess clinical skills of interns in selected procedures and it brings changes in procedural skills among students who received a structured feedback on DOPS.

Keywords: Direct observation of procedural skills, Feedback, Internship, Medical education, Skill assessment, Workplacebased assessment.

How to cite this article: Eralil GJ. Role of Structured Feedback of Direct Observation of Procedural Skills in improving Clinical Skill of Interns. J Postgrad Med Edu Res 2017;51(1):22-27.

Source of support: Harsha CH, Statistician, Sree Narayana Institute of Medical Sciences, Ernakulam, Kerala, India

Conflict of interest: None


 
Review Article
Nusrat Shafiq, M Praveen Kumar, Gautam Kumar, Rachna Rohilla, Shruti Saha, Vikas Gautam, Ritesh Agarwal, Pallab Ray, Gurpreet Singh, Jayashree Muralidharan, Pankaj Arora

Antimicrobial Stewardship Program of Postgraduate Institute of Medical Education and Research, Chandigarh: Running Fast to catch the Missed Bus

[Year:2017] [Month:July-September] [Volumn:51 ] [Number:3] [Pages:40] [Pages No:123-127][No of Hits : 629]


ABSTRACT

Antimicrobial stewardship is a coordinated multidisciplinary effort directed at judicious use of antimicrobials. While antimicrobial stewardship is a routine activity in the developed world, the concept has evolved only of late in the developing countries including India. Started initially as a research project, a formal antimicrobial stewardship committee was constituted in the institute. The present article highlights the work done so far, problems faced, and the future of antimicrobial stewardship related activities in the institute.

Keywords: Antimicrobial stewardship, Rationale, Tertiary care hospital.

How to cite this article: Shafiq N, Kumar MP, Kumar G, Rohilla R, Saha S, Gautam V, Agarwal R, Ray P, Singh G, Muralidharan J, Arora P. Antimicrobial Stewardship Program of Postgraduate Institute of Medical Education and Research, Chandigarh: Running Fast to catch the Missed Bus. J Postgrad Med Edu Res 2017;51(3):123-127.

Source of support: Nil

Conflict of interest: None


 
Review Article
Vibhu K Viswanathan, Nirmal R Gopinathan

Resurgence of Serial Casting in Early-onset Scoliosis: Is It “Old Wine served in a New Bottle”?

[Year:2017] [Month:April-June] [Volumn:51 ] [Number:2] [Pages:61] [Pages No:79-83][No of Hits : 625]


ABSTRACT

Casting as a treatment of scoliosis has been practiced since 1800s. However, the practice fell into disfavor following the serious chest deformities and thoracic constrictions secondary to casting, as well as tremendous improvements in the surgical modalities. Recently, there has been a resurgence of this technique in early-onset scoliosis (EOS) and it has been considered to be a definitive treatment modality and a delaying tactic prior to the inevitable surgery. It carries the triple advantages including correction of the spinal deformity, allowing spinal growth uninterruptedly as well as low complication rates. The current article elaborately discusses the role of serial casting in EOS.

Keywords: Early-onset scoliosis, Nonsurgical treatment, Serial casting.

How to cite this article: Viswanathan VK, Gopinathan NR. Resurgence of Serial Casting in Early-onset Scoliosis: Is It “Old Wine served in a New Bottle”? J Postgrad Med Edu Res 2017;51(2):79-83.

Source of support: Nil

Conflict of interest: None


 
Clinicopathological Conference Report (CPC)
Ritambhra Nada

Looking beyond Allergic Bronchopulmonary Aspergillosis in a 10-year-old Boy

[Year:2017] [Month:April-June] [Volumn:51 ] [Number:2] [Pages:61] [Pages No:103-113][No of Hits : 544]


ABSTRACT

A 10-year-old male child presented with chief complaints of cough, breathing difficulty, and fever for 15 days.


 
Book Review
Vishal Kumar

Book Review: The Textbook of Spinal Surgery

[Year:2017] [Month:April-June] [Volumn:51 ] [Number:2] [Pages:61] [Pages No:114][No of Hits : 525]


ABSTRACT

The recent edition of “The Textbook of Spinal Surgery” by Bridwell and DeWald continues its tradition of excellence in the field of spinal surgery. The book is exhaustive yet comprehensive, presents an expanded coverage of all spectrum of spinal surgery including cervical, thoracic, and lumbosacral spine; adult, pediatric, and geriatric age groups in toto; degenerative, deformity, tumors, fractures, infections, etc.


 
Case Report
Palak Bhuta, Aakash Patel, Luv Yadav, Utsav Patel, Virendra Kosamia, Arti Muley

A Fatal Case of Pyrexia of Unknown Origin: Hemophagocytic Lymphohistiocytosis?

[Year:2017] [Month:October-December] [Volumn:51 ] [Number:4] [Pages:51] [Pages No:188-191][No of Hits : 510]


ABSTRACT

Aim: To highlight the need of high suspicion of hemophagocytic lymphohistiocytosis (HLH) in pyrexia of unknown origin (PUO) and also the need of specific guidelines for the management of the disease.

Background:The HLH is a rare disease of overactive histiocytes and lymphocytes. Although seen in all age groups, it is less common in adults as compared with infants. It usually presents with fever, hepatosplenomegaly, pancytopenia, lymphadenopathy, and rash. Cutaneous involvement is seen in as many as 65% of patients.

Case report: A 25-year-old male presented with high-grade fever and cough since 4 weeks. Examination at presentation revealed only hepatosplenomegaly. During the course of the disease, he developed pancytopenia, but there was no lymphadenopathy or neurological or cutaneous manifestations. The patient was thoroughly investigated, but it remained inconclusive. He did not respond to any antibiotics, antimalarials, or antituberculars. There was an initial response to steroids, but it did not sustain. Bone marrow remained normal throughout the course of illness. Based on other features, we made a diagnosis of HLH, but the patient’s condition worsened rapidly and proved to be fatal despite all treatment.

Conclusion and clinical significance: The HLH must be suspected in a case of PUO especially in presence of pancytopenia and hepatosplenomegaly. It is important to look for other features like hyperferritinemia and hypertriglyceridemia to reach an early diagnosis as bone marrow features may present very late during the course of illness. Early diagnosis is all the more important in view of rapidly progressive fatal course of the disease.

Keywords: Hemophagocytic lymphohistiocytosis, Hepatosplenomegaly, Hyperferritinemia, Hypertriglyceridemia, Pancytopenia.

How to cite this article: Bhuta P, Patel A, Yadav L, Patel U, Kosamia V, Muley A. A Fatal Case of Pyrexia of Unknown Origin: Hemophagocytic Lymphohistiocytosis? J Postgrad Med Edu Res 2017;51(4):188-191.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
SR Challa, Jaahnavi Chinamilli, Rajeshwar Reddy Langati

A Rare Case of Gastric Diverticula on Posterior Wall associated with Cholelithiasis

[Year:2016] [Month:April-June] [Volumn:50 ] [Number:2] [Pages:72] [Pages No:100-102][No of Hits : 2131]


ABSTRACT

Gastric diverticulum is an extremely rare surgical condition. Most patients are asymptomatic, hence, the diagnosis is more often incidentally made than otherwise. They are usually congenital, solitary and are located on posterior wall and the lesser curvature. Patients presenting are usually between 20 and 50 years of age. Gastric diverticula harbor risk of the same complications as diverticula elsewhere in the gastrointestinal (GI) tract, such as bleeding, diverticulitis, obstruction, perforation, ectopic tissue and malignant transformation. We present a rare case of a 48-year-old female with gastric diverticula in the posterior wall of fundus of stomach with gallstone disease which was managed surgically and a brief review of literature.

Keywords: Diverticula, Dyspepsia, PPIs, Refractory epigastric pain.

How to cite this article: Chinamilli J, Challa SR, Langati RR. A Rare Case of Gastric Diverticula on Posterior Wall associated with Cholelithiasis. J Postgrad Med Edu Res 2016;50(2):100-102.

Source of support: Nil

Conflict of interest: None