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   Table of Contents - Current issue
Coverpage
July-September 2019
Volume 8 | Issue 3
Page Nos. 123-167

Online since Wednesday, December 4, 2019

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EDITORIAL  

The need for a change in the evaluation of research done in medical institutes! p. 123
P V.L.N Srinivasa Rao, Aparna R Bitla
DOI:10.4103/JCSR.JCSR_104_19  
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ORIGINAL ARTICLES Top

Role of susceptibility-weighted imaging in characterisation of solitary intra-axial-enhancing lesions of brain p. 126
Karthik Gupta, Bodagala Vijayalakshmi Devi, AY Lakshmi, VV Ramesh Chandra, Amit Kumar Chowhan
DOI:10.4103/JCSR.JCSR_64_19  
Background: To evaluate the role of susceptibility-weighted imaging (SWI) using intratumoural susceptibility signals (ITSSs) in characterising and grading intra-axial lesions of the brain. Methods: We prospectively studied 37 consecutive patients with solitary enhancing intra-axial brain lesions on contrast-enhanced magnetic resonance imaging (MRI) who underwent surgery followed by histopathological examination of the specimen at our tertiary care teaching hospital during the period January 2015–August 2016. Results: The mean age was 43.3 ± 15.7 years; there were 21 female. ITSS was detected in glioblastoma multiforme (GBM) (16/16), metastasis (2/6), high-grade glioma (2/2) and low-grade glioma (4/6). ITSS was not detected in granulomas. In semi-quantitative analysis, Grade 3 ITSS was able to differentiate GBM from other lesions (sensitivity = 87.5%; specificity = 86.4%; P < 0.0001). Grade 3 ITSS was able to differentiate GBM and metastasis (sensitivity = 87.5; specificity = 100; P < 0.0001). Conclusion: SWI using ITSSs is useful MRI sequence in characteristing and grading intra-axial bram lessions.
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Demographic profile, clinical features, imaging and outcomes in patients with traumatic brain injury presenting to emergency room p. 132
MR Kirankumar, Venkatesh Satri, V Satyanarayana, VV Ramesh Chandra, Mukkara Madhusudan, J Sowjanya
DOI:10.4103/JCSR.JCSR_65_19  
Background: Traumatic brain injury (TBI) accounts for one-quarter to one-third of all accidental deaths, and for two-thirds of trauma deaths in hospitals. Head trauma is the cause of death in more than 50% of trauma patients which made me undertake this study. Methods: A prospective observational study was conducted in a tertiary care teaching hospital, in South India during March 2016–July 2017. Demographic details, mode of injury, clinical features, radiological findings and outcomes were studied. Results: Of the 247 patients studied, majority of TBIs were in the age group of 21–40 years with male preponderance of 2.67:1. The most common mechanism of injury was road traffic accident (65.5%). In the present study, patients were classified by Glasgow Coma Scale (GCS) as mild TBI 129 (52.23%) patients, moderate 71 (28.74%) and severe 47 (19.03%). The common clinical presentation includes loss of consciousness (LOC) 65%, vomiting 61%, ear, nose and throat bleed 17% and seizures 8.9%. Computed tomography scan revealed contusions 42%, fractures 21%, subdural haematoma 21% and extradural haematoma 16%. Seventy-nine per cent patients were managed conservatively and 21% managed surgically. Mean hospital stay was 4.97 ± 5.4 days. The overall mortality was 19 (7.7%), and 209 patients were discharged in healthy condition. Conclusions: Young male adults presenting with LOC and vomiting were the common presenting features. Patients with low GCS (severe TBI) have very poor outcome. Patients with higher Rotterdam score and severe TBI had high mortality.
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Prevalence of depressive symptoms in medical students: A pilot study p. 137
MS Madhuri, S Natarajan, MS Sridhar
DOI:10.4103/JCSR.JCSR_82_19  
Background: Globally, depression and depressive disorder are common amongst people of all ages, especially amongst 15–29 years old. The prevalence of depression amongst medical students was studied on the World Health Day 2017 using the Brief Patient Health Questionnaire. Objective: The objective was to study the prevalence of depression and depressive symptoms amongst students of a class of MBBS based on responses collected anonymously in the year 2017. Materials and Methods: A class of students in a medical college was administered the questionnaire consisting of nine items, and 81 students participated in this study. Each item was explained, and the students were given time to think and mark their respective responses. The results of responses of 79 students who answered all questions are reported. Based on the cumulative score of their responses, depression was graded as minimal, mild, moderate, moderately severe and severe depression. Results and Discussion: Twenty-four male students and 55 female students constituted the study population. Overall, 91% of the students reported some degree of depression in the previous 2 weeks. Nearly 8.9% of the students did not have any depressive symptoms over the previous 2-week period. Almost 12.7% and 5.1% of the students reported moderately severe and severe depression, respectively. Minimal, mild and moderate depression were reported by 21.5%, 32.9% and 22.8% of the students, respectively. Students with depression were informed to consult with a psychiatrist for formal evaluation. Conclusion: The prevalence of depressive symptoms is very high amongst medical students, and a formal study with intervention is the need of the hour.
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A study on clinical features, complications and management of scorpion sting envenomation at a tertiary care hospital, in rural South India p. 140
Karuppan Yuvaraja, Natesan Chidambaram, Ravichandran Umarani, Kanchi Mitra Bhargav, S Pratheep Kumar, T Prabhu, E Balasubramaian
DOI:10.4103/JCSR.JCSR_71_19  
Background: Scorpion sting is a common medical emergency in rural India. Sparse published data are available regarding scorpion sting envenomation in adults from South India. Methods: We prospectively studied the clinical manifestations and two-dimensional echocardiography findings in fifty adult patients admitted with scorpion sting at a tertiary care teaching hospital in South India. Results: Their mean age was 34.8 ± 13.6 years; there were 28 (56%) males. Forty-one (82%) patients were stung over the limbs and the remaining over the rest of the body. Seventeen (34%) patients received prazosin within 5 h of sting; the remaining 33 (66%) received prazosin thereafter. Salient symptoms were pain over the sting area (n = 18, 36%), dyspnoea (n = 13, 26%), chest pain (n = 9, 18%), vomiting (n = 6, 12%), sweating (n = 5, 10%), nausea (n = 3, 6%), priapism (n = 7, 14%) and piloerection (n = 6, 12%). Common complications were accelerated hypertension (n = 12, 24%), pulmonary oedema (n = 10, 20%), myocarditis (n = 8, 16%), congestive heart failure (n = 6, 12%) and peripheral circulatory failure (n = 3.6%). Common electrocardiogram abnormalities were tachycardia (20%), T-wave inversion (10%), tall T-waves (10%), ST-depression (4%) and atrial fibrillation (2%). Mitral regurgitation was mild (Grade I) in 4 (8%) and moderate (Grade II) in 3 (6%) patients. Decline in left ventricular ejection fraction was noted (n = 14, 28%). Conclusion: Scorpion sting patients present with complaints of pain, palpitation, dyspnoea and paraesthesia. Complications such as hypertension, pulmonary oedema and sinus tachycardia are common. Early administration of prazosin is advocated for better outcome. Therefore, prudent knowledge on cardiovascular manifestations of the disease and timely management is pivotal for physicians.
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REVIEW ARTICLE Top

Pathophysiology of matrix metalloproteinases in breast cancer progression p. 145
Sudheer Kumar Katari, Chiranjeevi Pasala, Ravina Madhulitha Nalamolu, Umakanth Naik Vankadoth, Sharon Priya Alexander, Siva Ranjani Pakala, Aparna R Bitla, Amineni Umamaheswari
DOI:10.4103/JCSR.JCSR_67_19  
Matrix metalloproteinases (MMPs) are secretary or membrane type proteolytic enzymes that act on extracellular matrix protein components such as collagens, gelatins, elastins, laminins, fibronectins, and integrins. MMPs are synthesized as zymogens and are activated to functional forms on autoproteolysis or by other proteases. Naturally, the activity of MMPs was regulated by specific tissue inhibitors of metalloproteinases and transcriptionally regulated by miRNAs. MMPs have an important role in tissue remodeling by regulating cell death, morphogenesis, and wound healing activity. Overexpression of MMPs leads to various pathologies predominantly cancer, cardiovascular, and neurological diseases. Impact of MMPs on breast cancer progressions such as proliferation, angiogenesis, invasion, and metastasis are focused in this review.
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CASE REPORTS Top

A rare case of pelvic actinomycosis mimicking an ovarian malignancy p. 151
Prabhu Kiran Vanka, MV S Subbalaxmi, S Radhika, Sujata Patnaik
DOI:10.4103/JCSR.JCSR_24_18  
Actinomycosis is a rare chronic infectious disease caused by Actinomyces species. Orocervicofacial actinomycosis is the most common presentation (50%), followed by thoracic disease (15%–20%) and abdominopelvic disease (20%). It poses great diagnostic dilemma due to its variable presentations. We present a case of a 45-year-old female who presented with complaints of abdominal pain, abdominal fullness, constipation, weight loss and loss of appetite for the past 1 year. On examination, the patient was found to have palpable mass in lower abdominal region measuring about 10 cm × 12 cm, nontender, immobile mass. Patient was seen initially at another hospital, where ovarian malignancy was suspected in view of large size and radiological findings. Laparotomy was done but in view of adhesions and vascularity, multiple biopsies were taken and abdomen was closed. The patient was diagnosed to have actinomycosis based on histopathology and was treated accordingly. This case stresses on the diagnostic importance of clinical suspicion of actinomycosis in patients presenting with long-standing abdominal complaints, especially with history of previous surgeries.
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Stevens–Johnson syndrome/toxic epidermal necrolysis overlap syndrome due to oral cefuroxime p. 155
D Prabath Kumar, G Niveditha, B Siddhartha Kumar, J Indirakshi, Pilla S.Surya Durga Devi, Alladi Mohan
DOI:10.4103/JCSR.JCSR_23_18  
Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are life-threatening and severe cutaneous adverse drug reactions characterised by epidermal detachment presenting as blisters and differ only by their extent of skin detachment. A 22-year-old male presented to our tertiary care teaching institute with fever for the preceding 5 days and macular rash over the back for the past 1 day. Before this, he had consulted a local physician for fever and was using oral cefuroxime (250 mg bid) for the past 5 days. General physical examination revealed fever (103oF), conjunctival congestion, generalised maculopapular rash and ulcers over the lips. He was admitted to medical intensive care unit. On the next day, fever persisted; rash had worsened, conjunctivitis developed and skin peeling became evident, involving >10% but <30% of body surface area. At this point in time, a diagnostic possibility of an adverse drug reaction was considered and the patient's history was thoroughly reviewed again. Oral cefuroxime was stopped. Dermatology consultation was sought. Based on clinical presentation, the patient was diagnosed to have SJS/TEN overlap syndrome. He was treated with intravenous linezolid 600 mg twice daily, topical antibiotics and symptomatic management. The patient recovered, skin lesions subsided and he was discharged from the hospital in a stable condition after 2 weeks of in-hospital stay. The present case documents the rare occurrence of SJS/TEN overlap syndrome as an adverse drug reaction with cefuroxime treatment.
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Methaemoglobinaemia due to nitrobenzene poisoning p. 159
V Manolasya, M Soumya, G Harshavardhan Reddy, T Sowjanyalakshmi, B Sreevidya, DT Katyarmal
DOI:10.4103/JCSR.JCSR_63_19  
An acute poisoning with nitrobenzene presenting as methaemoglobinaemia is an uncommon medical emergency. Here, we report the case of a 33-year-old male presenting with an alleged history of consumption of an unknown substance 24 h ago. On admission, he was unconscious (Glasgow Coma Scale score 3) and gasping. General physical examination revealed cyanosis of the fingers, lips and tongue, pulse: 128/min, blood pressure: 98/70 mmHg and arterial oxygen saturation by pulse oximeter (SpO2): 70%. Pupils on both sides were dilated and sluggishly reacting to light. Respiratory system examination revealed bilateral basal crepitations. Rest of the physical examination was normal. Tracheal intubation was done, and he was initiated on mechanical ventilator support. Arterial blood gas analysis showed pH: 7.28; arterial carbon dioxide tension (PaCO2): 29.9 mmHg, arterial oxygen tension (PaO2): 45 mmHg, arterial oxygen saturation (SaO2): 83.8% and bicarbonate: 13.4 mEq/L. In spite of mechanical ventilator support, he continued to have hypoxia and cyanosis. Saturation gap was calculated to be 13%. In view of which methaemoglobinaemia was considered and blood sample has been sent for methaemoglobin levels and started him on injectable methylene blue and ascorbic acid. After a week, hypoxia and cyanosis improved and he was discharged in a haemodynamically stable condition.
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SPECIAL FEATURE Top

Transcranial Doppler ultrasound for the brain p. 162
Hemanth Natham, Mukkara Madhusudan, Hemalatha Pasupuleti, Aloka Samantaray
DOI:10.4103/JCSR.JCSR_70_19  
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CORRESPONDENCE Top

Emphysematous pyelonephritis with acute kidney injury in the postpartum period p. 164
B Sangeetha, G Aparna, R Ram, AY Lakshmi, V Siva Kumar
DOI:10.4103/JCSR.JCSR_68_19  
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JOURNAL SCAN Top

Journal scan p. 166
V Suresh, AR Bitla
DOI:10.4103/JCSR.JCSR_69_19  
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