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   Table of Contents - Current issue
January-March 2018
Volume 7 | Issue 1
Page Nos. 1-50

Online since Tuesday, January 8, 2019

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The Journal of Clinical and Scientific Research: The leap forwards! p. 1
TS Ravi Kumar, P. V L. N Srinivasa Rao
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A prospective study on the common infectious causes of thrombocytopenia (dengue fever, leptospirosis, scrub typhus and malaria) in a tertiary care teaching hospital p. 2
G Nibandhana, Usha Kalawat, KK Sharma, Rashmi Patnayak, DT Katyarmal, Abhijit Chaudhury
Background: The present study was undertaken to know the contribution of four infectious causes of fever namely dengue, chikungunya, scrub typhus and malaria in patients presenting with fever of more than one week duration with thrombocytopenia in a tertiary care teaching hospital, Tirupati, Andhra Pradesh. Methods: In this prospective study, 1014 samples from different patients who presented with fever and of more than one week duration and thrombocytopenia were collected over a period of six months and were processed for the detection of non-structural 1 (NS1) glycoprotein antigen for dengue, immunoglobulin M (IgM) antibodies for leptospirosis and scrub typhus by ELISA and malaria parasite by quantitative buffy coat (QBC). Results: Among 1014 samples obtained from patients with fever with thrombocytopenia, 111 (10.94%) were due to thrombocytopenia due to infectious causes. Ninety (81.08%) were due to single infection and twenty one (18.92%) due to co-infections. Males were more affected. Peak incidence was in 40-49 years of age with scrub typhus as the predominant infection. Grade-3 thrombocytopenia was more common in all the four infections. Conclusions: Our observations suggest that scrub typhus was the predominant cause of fever with thrombocytopenia, along with dengue, leptospira and malaria. Diagnostic evaluation should include search for these causes in patients presenting with fever with thrombocytopenia. This can be helpful as both are easily treatable infections with commonly available oral antibiotics.
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Stroke in patients with and without diabetes mellitus p. 7
Avin Subhash, Chinta Raj Kumar, Neelam Kumari Singh, Suresh Krishnamurthy, MV Nagabushana, YJ Visweswara Reddy
Background: Diabetes mellitus (DM) is a well-recognized risk factor for stroke. Stroke in diabetic patients is different from stroke in non-diabetics from several perspectives. This study was carried out with the aim to identify and compare distinctive patterns between diabetic and non-diabetic stroke cases. Methods: It is a hospital based cross-sectional study, carried out at PESIMSR Hospital, Kuppam, Andhra Pradesh, in which 80 consecutive patients with stroke (40 patients with and 40 without DM) were studied. Clinical features, risk factors, stroke patterns and outcome were studied. Results: The mean age (years) in stroke patients 57.5 ± 12.7 and 61.3 ± 12.9 (p=NS) stroke in patients with and without DM respectively. Males outnumbered females in both the groups (p=NS). Stroke patients with DM known to have hypertension were 75% and that of non-DM group was 42.5%. Diabetic stroke patients with history of coronary artery disease formed 32.5% and that of non-diabetic group was 27.5%. The mean high density lipoprotein (HDL) cholesterol (mg/dL) was lower in the diabetic group (38.8 ± 12.6) compared to that in the non-diabetic group (50.1 ± 6.9). The mean triglycerides (TG) (mg/dL) was significantly higher in the diabetic (216.9 ± 67.6) than in the non- diabetic group (150.05 ± 60.58). Both diabetic and non-diabetic patients had greater incidence of ischemic stroke (about 75%) than hemorrhagic stroke. In the present study, 37.5% of stroke patients with diabetes had a poor outcome compared to 22.5% of stroke patients without diabetes. Conclusions: DM is an independent risk factor for stroke. Stroke in patients with DM differs from that of stroke in persons without DM with respect to age, gender, stroke severity, prevalence of risk factors and outcome. Hypertension, HDL level and TG were significantly associated with DM. Diabetics stroke patients were having significantly higher levels of mean TG level, lower mean HDL level.
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A prospective randomised study on comparison of weekly versus 3 weekly cisplatin chemotherapy as an adjunct to radiotherapy in treatment of carcinoma of the uterine cervix p. 12
VL Anusha Konakalla, Pranabandhu Das, Jilla Swapna, Amitabh Jena, K Radhika, B Sreenivasa Rao, Jayasree Kuna, KV Jagannathrao Naidu, BV Subramanian
Background: The present study attempted to compare concurrent weekly and three weekly cisplatin with radiotherapy in locally advanced cervical cancer. Methods: This prospective randomised study was conducted in 40 patients with locally advanced cervical cancer randomised into 2 arms. Arm A patients received external beam Radiotherapy (EBRT) to pelvis with concurrent weekly cisplatin at dose of 40 mg/m2 and arm B patients received EBRT to pelvis with concurrent cisplatin at dose of 75 mg/m2 three weekly followed by brachytherapy. Acute haematological, gastrointestinal (GI) and genitourinary toxicities and response rates were assessed. Results: All the patient and disease characters were comparable in both arms. There was no significant difference in both arms in terms of upper GI toxicity (75% Vs 80%; P = 0.208), haematological (25% Vs 10%; P = 0.195) and nephrotoxicity (10% Vs 25%; P = 0.212). Compliance to chemoradiation was better in three weekly cisplatin arm but not statistically significant. After a median follow up of 12 months, tumor response rates in both arms were almost similar (85% Vs 90%; P = 0.128). Conclusions: Our observations suggest that either concurrent weekly or three weekly cisplatin chemoradiation is equally effective in treatment of cervical cancer. However randomised trials with larger sample sizes and longer duration of follow up are required.
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Clinico-epidemiological study of melasma in men p. 19
Keerthi Charupalli, TS Rajasekhar, Madhusudan Mukkara
Background: Melasma is one of the most common and distressing pigmentary disorders presenting to dermatology clinics. There is paucity of data regarding the aetiological factors and clinical presentation of melasma in men. The present study was taken up to fill this lacuna and to understand the unique aspects of melasma in this group. Methods: Study was conducted in the Department of Dermatology at University teaching hospital from January 2015 to July 2016. A total of 72 male patients with melasma were studied. A detailed history including occupation, onset, duration and evolution of melasma, predisposing factors like sun exposure and genetic factors, were taken followed by general physical examination, cutaneous examination and Woods lamp examination and recorded in a proforma. Laboratory investigations like complete haemogram, hormonal profile, liver function tests were done whenever necessary depending on the presenting condition. Results: The mean age of onset was 31.5 years. The duration of melasma varied from 3 months to 6.5 years. The aetiological factors identified were, sun exposure in 42 patients (58.3%) and family history in 29 (40.3%). Laboratory investigations revealed hepatic disorders in 5 patients(6.9%), increased luteinizing hormone (LH) and low testosterone in 2 (2.8%) and hypothyroidism in 4 patients (5.6%). According to clinical patterns, malar pattern was seen in 65.3% of patients, centro-facial in 31.9% and mandibular in 2.8% of patients. The most common skin type found to be type IV. Conclusion: Melasma was evident in men in their fourth decade of life; malar pattern, type IV skin type were most commonly seen.
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Transfusion-related acute lung injury Highly accessed article p. 24
V Arun Raja, C Rahul, M Krishna Kumar, V Pradeep, KV Sreedhar Babu, J Harikrishna
Transfusion-related acute lung injury (TRALI), an important non-infectious risk of blood transfusion is a leading cause of morbidity and mortality. Activation of polymorphonuclear (PMN) leucocytes by the mediators released due to the interaction of donor antibodies against the recipient monocytes is thought to trigger TRALI. Major histocompatibility complex Class II antibodies have been implicated in the direct causation of TRALI by direct activation of PMN leucocytes. TRALI has been reported in patients receiving all blood components that contain plasma. Awareness regarding TRALI among clinicians and a high index of suspicion will facilitate early diagnosis of the condition. TRALI is a clinical diagnosis that is suspected when new acute lung injury (ALI) develops within six hours of a transfusion. Diagnostic work-up should focus on ruling out other risk factors for ALI like sepsis, aspiration, among others. TRALI mitigation strategies are helpful to ensure blood safety and facilitate lessening of other transfusion reactions transfusion associated circulatory overload as well. The treatment for TRALI is symptomatic and supportive and is similar to that administered for ALI.
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Plummer–Vinson syndrome p. 30
P Gopalakrishna, M Rajendra Prasad, PT Joyes, MS Sridhar
The clinical findings of a 36-year-old female who presented to Medicine out-patient service with the triad of dysphagia, iron deficiency anaemia, splenomegaly and oesophageal web are reported. Clinical pathology of anaemia is diagnostic of iron deficiency anaemia. Dysphagia was treated with endoscopic dilation of the web and was prescribed iron therapy. This relatively rare condition is reported as the physician should be alert to its possibility because of its association with increased risk of hypopharyngeal carcinoma.
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A 41-year-old man with end-stage renal disease on maintenance haemodialysis with pericardial effusion p. 33
B Sangeetha Lakshmi, D Neeharika, CV Anil Kumar, M Harikrishna Reddy, V Sarat Chandra, RD Nagaraj, S Sarala, R Ram, V Siva Kumar
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Multidisciplinary approach in modern science p. 44
P Kunhikrishnan
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High-flow nasal cannula oxygen therapy: An alternative means of respiratory support for critically ill patients p. 47
Hemanth Natham, Madhusudan Mukkara
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Journal Scan p. 49

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