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  Most popular articles (Since June 14, 2013)

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Are our intramuscular injections nerve-friendly? What are we missing? Simple techniques to prevent, recognize and manage nerve injection injuries
James M Barry, Viraat Harsh, Shashikant Patil
July-December 2014, 4(2):25-28
  33,186 1,010 2
Acute monoblastic leukemia (aleukemic leukemia) presenting as gingival enlargement
Manasi M Kajale, Hemant R Umarji, Sonali Kadam, Vinisha Ranna
January-June 2014, 4(1):18-20
Acute myeloid leukemia (AML) is a malignant disease of the bone marrow in which hematopoietic stem cells fail to differentiate. Overproliferation of these abnormal cells results in suppression of the normal components of the bone marrow. Aleukemic leukemia is a type of leukemia in which abnormal (or leukemic) cells are absent in the peripheral blood. We put forth a unique case of aleukemic leukemia presenting as gingival enlargement, that was diagnosed by immunophenotyping and flow cytometery as acute monoblastic leukemia (AML FAB 5a).
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Neurogastroenterology: Gastrointestinal dysfunctions from the window of acute brain injury
Surya P Singh
January-June 2013, 3(1):1-4
  7,256 587 2
Traumatic pneumomediastinum: A risk factor for the development of pneumopericardium
Farooq Ahmad Ganie, Hafeez Ulla Lone, Gh Nabi Lone, Shyam Singh, Abdual Majeed Dar, Mohd Akbar Bhat, Mohd Lateef Wanie, Syeed Wahid, Masaratul Gani
January-June 2013, 3(1):7-10
Objective: Patients of polytrauma due to road traffic accident, fall from height, sports injury with blunt chest trauma, as well as penetrating injury to chest were investigated for pneumomediastinum and pneumopericardium, which may prove life threatening. Material and Methods: This study was retrospective for three years and prospective for three years and was conducted in the department of cardiovascular and thoracic surgery at the Sher-i-Kashmir Institute of Medical Sciences, Soura, Srinagar, Jammu and Kashmir for six years. All patients who reported to the hospital as polytrauma were investigated by noncontrast computed tomography (CT) scan of the chest. We did 1,350 CT scans of the chest for blunt and/or penetrating chest trauma in the last six years as a part of emergency investigations. All chest CT scans were investigated for pneumopericardium, simultaneous with other traumatic pathologies. Results: Of the 1,350 chest CT scans, 930 were normal. Twenty-one patients had pneumomediastinum in addition to other primary surgical pathology. Of these 21 patients with simultaneous pneumomediastinum, eight patients had associated pneumopericardium; five patients with pneumopericardium had blunt chest trauma as etiology and three patients had penetrating trauma as etiology for pneumopericardium. Conclusion: To overcome the fatality of pneumopericardium, two important approaches need to be followed. The first is continuous monitoring of blood pressure and the second is the availability of an immediate facility for drainage of pneumopericardium. Pneumomediastinum is obligatory for pneumopericardium to occur.
  6,955 480 2
Surgical technique for cisternostomy: A review
Iype Cherian, Sunil Munakomi
January-June 2013, 3(1):5-6
The evolution of modern neurosurgical techniques in traumatic brain injury has been ongoing for the last two centuries. However, it has always been a challenge to obtain an effective clinical outcome, especially in those following severe traumatic brain injuries. Other than the well-established procedures for acute and/or chronic subdural hematomas and depressed skull fractures, newer avenues for the development of surgical techniques, where indicated, have been minimal. The study proposes to apply the principles of microvascular surgery and skull base surgery in selected cases of severe traumatic brain injuries.
  6,604 689 1
Factors predicting difficult laparoscopic cholecystectomy: A single-institution experience
Prashant S Dhanke, Subodh P Ugane
January-June 2014, 4(1):3-7
Introduction: Cholelithiasis is the most common biliary pathology, with prevalence of 10-15%. In 1992, National Institute of Health consensus development stated that laparoscopic cholecystectomy "provides a safe and effective treatment for most patients with symptomatic gallstones" and it is the treatment of choice for cholelithiasis. This study is undertaken to determine the predictive factors for difficult laparoscopic cholecystectomy. Methodology: A prospective open-labeled study was carried out at Padmashree Vasant Dada Patil, Government Hospital Sangli, a tertiary center and teaching hospital in Western Maharashtra that is attached to Government Medical College, Miraj. All patients presenting with upper abdominal pain, or vomiting or dyspepsia or jaundice from January 1, 2011 to December 31, 2013 were screened for cholelithiasis. Ninety-nine cases diagnosed with cholecystitis following exclusion criteria and undergoing laparoscopic cholecystectomy were considered for the study. They were evaluated with following risk factors: age >50 years, male gender, body mass index (BMI) 25.1-27.5 and >27.5, previous surgery, prior hospitalization, palpable gall bladder, gallbladder wall thickening, impacted stone, and pericholecystic collection. Each risk factor was given a score preoperatively. The total score up to five predicted easy, 6-10 difficult and >10 very difficult. Statistical analysis was performed using Fischer's Test for qualitative data and unpaired t-test for quantitative data. Results: BMI >27.5 history of prior hospitalization, palpable gallbladder, impacted stone and pericholecystic collection are significant predictors of difficult laparoscopic cholecystectomy. Conclusion: The proposed scoring system had a positive prediction value for easy prediction of 94.05% and for difficult prediction of 100%.
  5,070 771 5
Rapid spontaneous resolution of acute subdural hematoma associated with a contralateral arachnoid cyst: A case report and review of the literature
Aslam Perwez, Waleed Abdelfattah Azab, Suryapratap Singh
January-June 2013, 3(1):26-28
Rapid resolution of post-traumatic acute subdural hematoma is infrequently reported. We report a case of rapid spontaneous disappearance of post-traumatic acute subdural hematoma in one patient who was discovered to have a contralateral middle cranial fossa arachnoid cyst. The previously reported mechanisms responsible for the rapid spontaneous disappearance of post-traumatic acute subdural hematoma are reviewed and the contribution of the middle cranial fossa arachnoid cyst to the disappearance of the pos-traumatic acute subdural hematoma that has taken place in our case is discussed. To the best of our knowledge the association between spontaneous disappearance of post-traumatic acute subdural hematoma and arachnoid cysts has not been previously reported.
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Spleen with multiple notches: A rare anatomical variant with its clinical significance
Kusum R Gandhi, Sushama K Chavan, Sneha A Oommen
January-June 2013, 3(1):24-25
Two or three notches on the superior border of spleen are not an uncommon presentation. As many as seven notches were observed in a spleen of 32 year old female in Rural Medical College, PIMS, Loni, Maharashtra, India, during autopsy. Along the superior border of spleen six notches were present and one notch was observed on the broad anterior pole. A 2.8 cm long fissure was also seen on the renal visceral surface of the specimen. This unusual anatomical variation may lead to difficulty while distinguishing the spleen from adjoining organs in patients of splenomegaly. The variation is explained on the basis of embryological development. A sound knowledge of such variation is essential for physicians, surgeons, radiologists, and of course the anatomists.
  5,147 350 -
Idiopathic intracranial hypertension: diagnosis and management
Prem S Subramanian
July-December 2014, 4(2):29-35
Idiopathic intracranial hypertension (IIH), also known as pseudotumor cerebri, may occur at any age but is primarily a disease of obese women between the ages of 15 and 40. Diagnosis is made based on modified Dandy criteria, which include normal neuroimaging studies, elevated intracranial pressure (ICP) on lumbar puncture, signs and symptoms of elevated ICP, and a non-focal neurologic examination aside from sixth nerve paresis. Presenting symptoms include headache, pulsatile tinnitus, transient visual obscurations, diplopia, and visual field constriction. Diagnosis may be delayed because headache from other causes such as migraine is much more common, and patients may be treated for this condition without improvement before the actual diagnosis is recognized. Ophthalmologic signs may include papilledema and esotropia (from the sixth nerve palsy) as well as visual field and even visual acuity loss; the latter two signs are very ominous, as they indicate severe and potentially permanent visual damage. Medical and surgical options vary depending on the severity of the disease and are used to control headache as well as to prevent vision loss. Because most IIH is associated with obesity, weight loss is an essential element of any treatment regimen, as retrospective as well as prospective studies have shown disease resolution with as little as 6% weight reduction. Secondary causes of high ICP are being recognized in a greater number of IIH patients, and the term "idiopathic" likely applies to fewer patients than in the past. The underlying pathogenesis of the disorder remains elusive.
  4,847 463 1
Oral health status of special health care needs children attending a day care centre in Chennai
MS Saravanakumar, A Vasanthakumari, R Bharathan
January-June 2013, 3(1):12-15
Introduction: Oral health is an important aspect of health for all children and is all the more important for children with special needs. Aim: To evaluate the oral health status of special health need children at Vidya Sudha, a day care centre in Chennai. Materials and Method: A modified WHO oral health assessment form was used to assess the caries experience, gingival, and oral hygiene status. Result: Data were analyzed using ANOVA and chi-square test. No statistical significant differences were found between the evaluated groups regarding age or gender, and medical conditions. Conclusion: Majority of the children had poor oral hygiene, showing high caries prevalence as well as moderate gingivitis.
  4,343 799 1
Pulmonary hyalinizing granuloma involving the diaphragm and the pericardium
Haranahally Raghavan Vanisri, Satish Suchitha, Hungund Chandrakanth, Gubanna Vimalambika Manjunath
January-June 2014, 4(1):13-14
Pulmonary hyalinizing granuloma (PHG) is a rare disorder and is a pertinent differential for lung diseases with multiple pulmonary nodules. Natural history of this disease is not known. Although the usual course is benign, a close follow-up of these cases is necessary. We herein report a case of PHG involving the diaphragm and the heart, detected on autopsy in a 57-year-old male who suffered a road traffic accident.
  4,646 232 -
Giant fibroadenoma of the breast mimicking phyllodes tumor in an adult female: emphasizing the role of cytology in the diagnosis
Bhushan Shah, Bhavini Bhushan Shah, Kanika Sharma, Suman Sahu, Puneet Singh
July-December 2014, 4(2):44-45
Giant fibroadenoma is an uncommon variant of fibroadenoma with an overall incidence of <4%. It is common in adolescent age group and is seldom seen in elderly. Often surgeons might encounter a diagnostic dilemma between phyllodes tumor (PT) of the breast and a giant fibroadenoma. We herein report a similar case of a middle-aged woman with an unusually large fibroadenoma of the breast mimicking a PT and emphasize the role of fine-needle aspiration cytology in differentiation of these two different breast entity.
  4,264 228 1
Solitary diaphyseal exostosis of femur: case report of an uncommon presentation
Sunil Kukreja, Kanika Sharma
July-December 2014, 4(2):46-49
Osteochondroma is the most common benign bone tumor and often diagnosed as an incidental finding. Most are asymptomatic, however significant pain, and pressure symptoms warrant excision. Most common location of solitary exostosis is metaphysics around the knee. We are reporting a case of a 14-year-old boy who presented with a swelling over the anterior aspect just below the mid-thigh level on the right side. Characteristic radiological features of exostosis were documented on plain radiograph and magnetic resonance imaging. Growth was excised, and diagnosis of solitary exostosis arising from diaphyseal region was confirmed on histopathology examination. This case report documents the uncommon diaphyseal location of solitary exostosis in an adolescent. Symptomatic lesions warrant excision.
  4,141 205 -
Association of ABO blood groups with risk factors of intracranial cerebral aneurysm formation
Shyamal C Bir, Piyush Kalakoti, Sudheer Ambekar, Papireddy Bollam, Anil Nanda
July-December 2014, 4(2):36-40
Introduction: The association between ABO blood groups and intracranial aneurysms is not well-understood. Many co-morbid factors are associated with intracranial aneurysms. The prevalence of different blood groups and associations with the risk factors in patients with intracranial aneurysms are reviewed. Methodology: A retrospective analysis was conducted on patients presenting with intracranial aneurysms and undergoing active neurosurgical intervention at the Louisiana State University Health Sciences Center between 1 st January 1993 and 31 st December 2012. A total of 1248 patients were identified for the analysis. Data pertaining to demographics and clinical characteristics of these patients were extracted from the electronic patient records by two authors independently. A univariate and multivariate analysis was performed to investigate the association of ABO blood groups with risk factors in patients with intracranial aneurysms. Results: The most common ABO blood group in our study population was O (543 cases, 43.5%), followed by group A (525 cases, 42%). Blood group A (46% vs. 35.5% patients; P = 0.01) and blood group B (18% vs. 7% patients; P = 0.000) were significantly associated with the development of intracranial aneurysms in Caucasians and African Americans, respectively. We found smoking (P = 0.01) and hypercholesterolemia (P = 0.006) to be an independent risk factor for the development of intracranial aneurysms in blood group O and blood group A, respectively . Conclusion: Racial disparity in the distribution of blood groups and risk factor association with blood groups in the development of intracranial aneurysm needs to be considered. The findings from our study may be useful in identifying patients at increased risk of developing intracranial aneurysms.
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Introducing 'A-Z' algorithm for extubation
Sunil Munakomi, Karuna Tamrakar
July-December 2014, 4(2):56-57
  4,071 223 -
Evaluation of attitude, behavior, knowledge, and smoking rates among youngsters from Southern India: a survey-based study from Andhra Pradesh
Shilpa Garg, Raman Garipelly, Anantha Naik Nagappa, Uday Venkat Mateti
July-December 2013, 3(2):35-41
Introduction: India accounts for 274.9 million global tobacco users and approximately 120 million tobacco smokers. It is predicted that tobacco deaths in India may exceed 1.5 million annually by 2020. Considering the hazardous impact of smoking upon the health of an individual, we conducted this investigation to evaluate the magnitude of this increasingly distressing public health concern among youngsters enrolled in university courses at various educational institutes in the state of Andhra Pradesh, India. Methodology: A cross-sectional questionnaire based study was conducted among youngsters at various educational institutions in Andhra Pradesh, India. The structured questionnaire was developed to assess the number of youngsters habituated to smoking and to know their attitude, knowledge, and behavioral responses toward smoking tobacco. Results: A total of 4394 responses were collected from Andhra Pradesh. The mean age of the respondents was 20.4 ± 2.9 years and 67.6% were males. The overall smoking rate was found to be 41.03%. Of the total respondents, 1254 (28.5%) were enrolled in pre-university course, whereas graduates and postgraduates constituted 2348 (53.4%) and 792 (18.0%), respectively. A majority of smokers (72.6%) and nonsmokers (91.6%) stated that people adapt to smoking as a fashionable trend, while only a meager (12.1%) respondents thought stress as a stimulant to resort to smoking habits. 44.9% respondents felt smoking cigarettes in a group increased interaction among their peers; 81.1% confessed to initiation of smoking during their teenage years; About 66.8% admitted to smoking up to 5 cigarettes/day, while 76.2% were aware of the fact nicotine in cigarettes causes addiction. Of the suggested measures to quit smoking, 64.9% of the respondents recommended prohibition of smoking at public places, 66.1% advised cigarettes to be made expensive, 87.2% sought counseling by a physician or a pharmacist as a valuable resource to help youngsters curb their smoking habits and 77.1% thought the use of e-cigarettes could be a potential alternative measure to avoid tobacco smoking. Conclusion: A high percentage of youngsters admitting to smoking cigarettes as demonstrated from our survey highlights a poor indicator of national health status. Perhaps, it also reflects a failure of state government policies aimed to prevent tobacco use. The need to formulate stringent policies to guide youngsters to understand the deleterious effects of tobacco, including but not limited to, advertisements, banners, setting up of de-addiction and counseling centers, national wide campaign and broadcasting should be done.
  3,750 378 2
Questionnaire-based community periodontal susceptibility screening index
Pankaj Bansal, Pritma Singh, Afshan Bey, ND Gupta
July-December 2014, 4(2):41-43
Periodontal diseases are major causes of tooth loss and contribute to significant morbidity and healthcare costs. Therefore, identifying areas that deliver substantial returns with community-based preventive programs are a dire necessity. Planning and implementing preventive measures in periodontal oral care require identification of not only a population with current disease burden, but also of future susceptibility to disease. All major periodontal indices that have been used in community periodontal surveys are designed to identify either severity, prevalence, or treatment needs of periodontal diseases. No known index exists based on scientifically proven risk factors of periodontal disease to identify population susceptible to the disease, and to determine the need for preventive planning and interventions. In this article, a simple questionnaire-based index has been proposed to identify both individual and community susceptibility to periodontal disease.
  3,754 356 -
Understanding of flail chest injuries and concepts in management
Ranjan Kumar Jena, Amit Agrawal, Yashwant Sandeep, Ninad Nareschandra Shrikhande
January-June 2016, 6(1):3-5
Flail chest in thoracic injuries can be a cause of concern, as in the presence of associated injuries; it carries high morbidity and mortality. Flail chest injuries usually result from deceleration injuries and may be associated with sternal fracture, aortic and tracheobronchial disruption. Flail chest influences the morbidity encountered in multiple injured patients. The clinical presentation of the flail chest depends on the size of the flail segment, the intrathoracic pressure gradient during breathing, and the associated injury to the lung and thoracic wall. Treatment of these patients depends on the physiologic impairment caused by the flail segment and the severity of other associated injuries.
  3,538 375 -
Role of the oral bacteria in dental caries
Mohammad Akheel, Saranjeet Singh Bedi
January-June 2013, 3(1):31-31
  3,147 331 -
Highlighting the role of nonsurgical (conservative) method in the management of complete rectal prolapse in an Indian male
Meena H Shaikh, Bhushan Shah, Suman Sahu, Ankit Sahu, Sagar Kotalwar, Kanika Sharma
July-December 2013, 3(2):54-56
We report a case of a 35-year-old male who presented to our emergency room with debilitating, complete, irreducible, edematous rectal prolapse along with retention of urine. Due to marked edema and inflammation, the reduction was unsuccessful under general anesthesia; hence a conservative approach was considered. With local sugar application for a week, the edema was reduced and via manual digital maneuver, the prolapse was reduced with anal encirclement the day after to maintain the reduction. With our experience, where laproscopic facilities were unavailable, we wish to highlight the role of nonsurgical/conservative conventional methods of management of such severe cases that are associated with edema and present to clinics/institutes where limited surgical facilities are available.
  3,058 176 1
Symmetrical thalamic and cerebellar hemorrhages following scorpion envenomation
Tekke Praveen Kumar, V Umamaheswara Reddy, Putcha Deekshanthi Narayan, Amit Agrawal
January-June 2014, 4(1):15-17
Clinical manifestations following scorpion envenomation are a result of autonomic outburst and direct actions of toxin on various systems. Involvement of central nervous system (CNS) following scorpion envenomation is rare. Encephalopathy, cerebral edema, subarachnoid hemorrhage, nonhemorrhagic strokes, and cortical necrosis are a few CNS complications described in the medical literature due to scorpion envenomation. We report a rare case of scorpion envenomation in which patient had symmetrical hemorrhages in the thalamus and cerebellum.
  2,988 244 1
An isolated infarction of cerebellar nodulus (lobule X)
Natuva Sai Sampath Kumar, Pentyala Suneetha, Anil Kumar Tatikonda, Venati Umamaheswara Reddy, Amit Agrawal
July-December 2013, 3(2):51-53
Cerebellar nodulus (lobule X) is an anterior and inferior structure of the vermis and is the epicenter of flocculonodular lobe (vestibulocerebellum). Nodulus coordinates with the vestibular nuclei through afferent Mossy and efferent Purkinje fibers and plays a pivotal role in maintaining balance and is responsible for vestibulo-ocular reflex. Any lesion disrupting these fiber tracts impairs the person's ability to control ocular movements during head tilting and posture while standing and walking. Isolated infarction of nodulus is extremely rare with only few cases been reported earlier. In this article, the authors present a case of an elderly female with severe giddiness and cerebellar signs and were diagnosed to have an isolated cerebellar nodulus infarction on imaging studies. Conservative management to which our patient responded well is also discussed.
  2,938 253 -
Restoration of function and esthetics in a patient with amelogenesis imperfecta
Deepak Chauhan, Kapil Rajeev Sharma, Tripti Chauhan
January-June 2013, 3(1):20-22
Amelogenesis imperfecta (AI) is a rare genetic disorder inherited as either autosomal dominant, autosomal recessive, or X- linked modes. AI is characterized by the defect in enamel formation, resulting in defective mineralization or formation of the matrix. Restoration of the dentition poses great challenges, especially when teeth are severely affected. Treatment aims to relieve pain or sensitivity of teeth and to preserve as much tooth structure as possible while preventing further loss of teeth, to maintain masticatory function, and last but not the least, to improve the aesthetic appearance and quality of life as it has a great psychological impact on the self-esteem of the patient. This case report describes the treatment of a young boy who presented with a severe form of AIimperfect (AI) with a minimally invasive, relatively simple, and cost-effective treatment with composite restorations.
  2,844 318 -
Recurrent Kimura disease of the parotid gland
Shailesh Patel, Sanjay Sen, Dhritiman Maitra, Aditya Baksi
July-December 2014, 4(2):50-51
Kimura disease is a rare chronic inflammatory disorder affecting young males of eastern countries. There are about 200 cases reported in the English literature , with <60 cases involving the parotid gland. It is characterized by abnormal proliferation of lymphoid follicles with eosinophil-rich infiltrate and peripheral eosinophilia. The disease presents as painless cervical lymphadenopathy or subcutaneous masses in the head and neck region. Although recurrence is common, radical surgery is not recommended, as the disease is essentially benign.
  2,856 178 -
Traumatic posterior hip dislocation in a child
Arvind Kishore, Kanika Sharma, Piyush Kalakoti, Puneet Jaiswal, Sanjeev Gambhir
July-December 2014, 4(2):52-53
Traumatic hip dislocation in children is an uncommon injury and constitutes an orthopedic emergency. We herein present a traumatic posterior dislocation of the hip in a 4-year-old child and emphasize on the role of early correction of the injury, preferably within 6 h since its occurrence to prevent long-term complications such as osteonecrosis, coxa magna, and osteoarthritis.
  2,805 170 -