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   2017| July-December  | Volume 3 | Issue 2  
    Online since December 11, 2020

 
 
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ORIGINAL ARTICLES
Comparative Dosimetric Study of Five Field, Seven Field, Nine Field and Eleven Field Intensity-Modulated Radiotherapy for Carcinoma Cervix Treatment Using High Energy Linear Accelerator (Synergy Platform & XIO TPS)
Deepali Bhaskar Patil, Mukesh Kr Zope, Rajesh Kumar Singh
July-December 2017, 3(2):31-36
Objective: The purpose of this dosimetric study is the targeted dose Homogeneity Index (HI), conformity index (CI) and integral dose comparison of 5. 7, 9 & 11 field Intensity Modulated Radiotherapy (IMRT) for Carcinoma Cervix (Ca Cx) patients. Material and Methods: Fifteen patients of ca.cx were selected for this study at Radiation Oncology Department, Mahavir Cancer Sansthan, Patna between January 2009 and December 2012. Eight patients had PTV >1500 cc and seven patients had PTV< 1500 cc Dosimetric plans for all 5, 7, 9 & 11-field IMRT plan have been generated for each patient to comparatively evaluate the dosimetric status (HI, CI and Integral Dose) for all the patients. Results: For PTV (PTV >1500 cc), the three dosimetric parameters had approximate values for all fields (five fields, seven fields and nine fields) IMRT. The CI for the IMRT with nine fields plans was seems to be better than five fields For PTV <1500 cc. The three IMRTs plans were competitive with each other. The nine filed IMRT plans had a CI nearly to 1, better target coverage at the prescription dose, and a better Homogeneity Index. Conclusion: It can be concluded that IMRT is an effective definitive management tool for Cervical cancer with improved critical organ sparing and excellent dose homogenization in target organs. According to this study as the results from these algorithms differed, significant care should be taken when evaluating treatment plans, as the choice of the beam segment may influence treatment planning as well as clinical results.
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CASE REPORTS
Acute Bilateral Cerbellar and Brain Stem Infarction in The Territory of The Medial Branches of Posterior Inferior Cerebellar Arteries
Kalyan Kumar Saha, Amarendu Kumar, Amit Kumar Mishra, Sudhir Kumar, Praveen Kumar
July-December 2017, 3(2):48-49
We repot a rare case of acute bilateral cerebellar and brain stem infarction confined to the territory of the medial branches of the posterior inferior cerebellar arteries. The diagnosis was based on clinical and radiological examination. Case Description A known hypertensive 66-year old female presented with sudden onset of headache, vertigo, followed by brief loss of consciousness. Cranial computed tomographic scan showed edema in bilateral medial cerebellar zone and brainstem suggestive of acute ischemic infarction. On examination the patient showed mild dysarthria, dysequilibrium with retropulsion, symmetrical bilateral horizontal gaze evoked nystagmus on lateral gaze, and marked gait ataxia with brain stem signs, followed by marked vertigo that was induced by motion. Her blood pressure was recorded to be 190/110mmHg in right arm. The patient improved with conservative therapy, including intravenous administration of mannitol. Conclusions We suspect that our patient likely had initial transient occlusion of the right vertebral artery at the origin of the right posterior inferior cerebellar artery, which probably gave rise to the bilateral medial branches of posterior inferior cerebellar arteries. This caused infarction in the territory of the medial branches on both sides with brain stem signs. Such an unusual pattern of cerebellar infarction accompanied by brain stem sign posed a diagnostic challenge in the ward, and correct diagnosis was facilitated by cranial computed tomography.
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Iatrogenic Left Main Coronary Artery Dissection During Transradial Primary Percutaneous Intervention (PPCI); A Case Report
Pankaj Kumar, Nishant Tripathi, Nirav Kumar
July-December 2017, 3(2):55-56
Primary Percutaneous Intervention (PPCI) is the standard of care in ST elevation Myocardial Infarction (STEMI) if it can be done in a timely fashion. The growing use of the transradial approach for primary percutaneous coronary interventions has been shown to decrease the risk of major vascular complications. However, in this case report, we describe an iatrogenic left main artery dissection during transradial PPCI, which is a catastrophic complication, successfully treated with multiple stents.
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Pulmonary Silicotuberculosis in A Stone Miner
Mukesh Kumar Tiwari, Manish Shankar, Kalyan Kumar Saha
July-December 2017, 3(2):50-51
We are presenting a case of a patient a former stone miner, male, 45 years old, who developed silicosis after almost a decade of occupational exposure to silica dust in stone mining industry. He was detected to have sputum positive pulmonary tuberculosis 4 years after leaving the profession. The case affirms that silicosis is increasingly associated with tuberculosis. The history of occupational exposure to inciting agent, radiological features (conventional chest X-ray and computerized tomography) and microbiological examination of sputum help in diagnosing the case, correctly. In comparison to general population tuberculosis morbidity is more pronounced in silicosis.
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ORIGINAL ARTICLES
Extended Umbilical Incision for Pyloromyotomy: Our Experience
Ramdhani Yadav, Sandip Kumar Rahul, Vijayendra Kumar, Vinit Kumar Thakur, Zaheer Hasan, Apurva Agarwal
July-December 2017, 3(2):22-26
Background: Classical incision for open Pyloromyotomy in patients of Infantile hypertrophic pyloric stenosis (IHPS) leaves a prominent scar. By providing better cosmesis without affecting the accessibility to the pathologic site, incision hidden in the umbilical scar would serve as an alternative to the classical incision. Objective: To compare the results of Extended umbilical incision with that of classical incision for Pyloromyotomy in patients of IHPS. Methods: Intra-operative and post-operative details of 20 patients of IHPS who underwent pyloromyotomy through extended umbilical incision were compared to 20 other patients where Right upper transverse incision (classical incision) was used in the Department of Paediatric surgery, at a tertiary care centre. Results: No statistically significant differences were observed between the two groups in intra-operative time, complications and post-operative stay in hospital. Umbilical incision had better cosmesis. Conclusion: Although right upper transverse incision has been generally advocated in neonates and infants, we found that a less conspicuous wound in the garb of the umbilical scar is more cosmetic and convenient, within the current principles of minimally invasive surgery. It combines the ease and safety of open pyloromyotomy with the advantages of minimal invasiveness.
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Outcomes of Multiple Myeloma in The Era of Novel Agents: A Retrospective Study from Tertiary Cancer Centre
Pandey Avinash, Sengar Manju, Amre Pratibha, Khattry Navin, Bagal Bhausaheb, Menon Hari
July-December 2017, 3(2):27-30
Background: Multiple myeloma is a plasma cell neoplasm characterised by skeletal destruction, renal failure, anaemia and hypercalcemia. Use of novel agents have led to significant increase in response rates and hence, limited the benefits of transplant. Aims and Objectives: To evaluate outcomes and toxicities with use of novel agents. To evaluate Progression Free Survival, Overall Survival and factors affecting outcome. Material and Methods: Case records of all patients diagnosed as Multiple Myeloma registered between 1st January 2012 to 31st December 2013 have been retrospectively analysed. Demographic data was collected along with response rates, date of progression and death. Toxicity with use of novel agents was recorded. Progression free survival and Overall Survival was analyzed with the Kaplan-Meier method. Log-rank tests was utilized to assess the differences in outcomes between various subgroups. Results: Total 101 patients were analysed out of which 90 were multiple myeloma and 11 had light chain disease. Median age of presentation was 56 years with male:female ratio of 3:1. Median time to best response was 4 months. Median follow up was 36 months with median time to second treatment 18 months. Response rates with VGPR (very good partial response) and PR (partial response) was seen in 60% of patients. Median progression free survival was 18 months while median overall survival was not reached. Out of 15 deaths, 7 patients had progressive disease, 6 had stable disease and 2 had partial response at the time of last assessment. Conclusion: Use of novel agents in the management of multiple myeloma improved response rates and outcomes. Majority of patients including those with higher stage or high risk cytogenetic enjoyed better response rates and longer duration of remission. Despite such advances, prognosis of stage III patients needs further improvement with newer strategies for better outcome.
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CASE REPORTS
Co-Infection of Hookworm and Plasmodium Vivax Leading to Severe Anemia Associated with Diffuse Nodular Proctocolitis - A Case Report
Kumar Ajay, Kumar Shailesh, Kumar Rakesh, Kumari Namrata, Xess Anima, SK Shahi
July-December 2017, 3(2):39-41
Introduction Malaria is well known since antiquity, and its parasites are also found in various part of the world. The mixed parasitic infections are not very uncommon ,but the protozoal and intestinal nematode mixed infection is uncommon. We are presenting a case which is a proved mixed parasitic infection having protozoal and intestinal nematode infection admitted in IGIMS, Gastro1ogy department. Case Report A 35 year old male presented with febrile illness with severe anemia, anasarca, ascitis and melena. The hemoglobin value was 1.8gm percent. Gastrointestinal endoscopy was normal but white thread like structure attached to mucosa of duodenum was found. Later on it proved to be Hookworm during microscopic examination. Patient was positive for Plasmodium vivax also. The colonoscopic finding was diffuse nodular proctocolitis. No clinical sign or histopathological evidence was detected for inflammatory bowel Syndrome. No evidence of granuloma or neoplasia was seen in serial section. Conclusion Co-infection of Hookworm and Plasmodium vivax is an unusual finding. Both Hookworm and Plasmodium vivax cause anemia. Severe anemia in this case may be due to Hookworm or Plasmodium vivax individually or may be due to synergistic infection of both the parasites.
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Hernia in Mucopolysaccharidoses Patients: A Surgical Challenge
Sandip Kumar Rahul, Ramdhani Yadav, Vijayendra Kumar, Vinit Kumar Thakur, Zaheer Hasan, Sweta
July-December 2017, 3(2):45-47
Mucopolysaccharidoses patients tend to have large hernia at multiple sites which are prone to recurrences due to tissue weakening. They are difficult cases for surgery and usually need some form of abdominal wall repair as herniotomy alone does not suffice. We present two such cases - one with Hunter syndrome and the other with Hurler syndrome to stress upon the salient clinical features and management.
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Intravenous Glycopyrrolate for Priapism Following Spinal Anaesthesia in Turp
Mumtaz Hussain, Nidhi Arun, Sanjeev Kumar, KH Raghwendra
July-December 2017, 3(2):52-54
Priapism has been reported following spinal anaesthesia for urological procedures. It may pose challenge to the urologist for any urethral intervention during surgery. We present a case of priapism in a patient posted for transurethral resection of prostrate following spinal anaesthesia and the manner we treated it. Literature has advocated various techniques of treating this intraoperative complication, e.g. intracorporeal injection of vasopressors, subcutaneous or intravenous terbutaline and intravenous glycopyrrolate. In our case, we successfully used intravenous glycopyrrolate to treat this complication
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Retinal Cysticerci- A Contraindication for Albendazole Therapy
Sanjeev Kumar, Ashok Kumar, Abhay Ranjan, Bishwanth Kumar
July-December 2017, 3(2):37-38
Neurocysticercosis is the most common parasitic disease of the nervous system especially, in the Indian sub-continent. The disease manifests when humans become the intermediate host in the life cycle of Taenia solium by ingesting its eggs from contaminated food. Retinal cysticercosis is a dangerous situation where vision will be compromised. Surgical excision is the preferred treatment in place of anti-parasitic medication. We are reporting a case of multiple cysticerci in the brain parenchyma and a single cyst in subretinal space to highlight the association and treatment decision to prevent visual loss.
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ORIGINAL ARTICLES
Audit of Operated Cases of Gynecological Malignancies in Two Years at A Tertiary Care Centre of Bihar
Anjili Kumari, Syed Nazaneen, Sangeeta Panakj, Anita Kumari, Jaya Kumari
July-December 2017, 3(2):14-18
Non communicable diseases are form a major bulk of patients in our country and are now the target of policy makers in India. Cancer is a cause of significant morbidity and mortality and that needs to be tackled aggressively. The current study is a review and analysis of patients attending the Gynecological Oncology department of a tertiary care center of Bihar. We have found that cancer of the cervix is the most common genital malignancy in our region however but most cases are diagnosed at later stage and not detected in the operable stages. Cancer cervix is followed closely by cancer of the ovary. Thus we conclude that to bring down the rates of cervical cancer in India the government like its western counterparts needs to implement strict screening guidelines and strengthen our primary health centers and community health centres with facilities for screening.
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Rheumatological Manifestations in Diabetic Population from Bihar
Arshad Ahmad, Ved Prakash, Praveen Kumar, Amit Kumar Mishra, Shishir Kumar, Faiyaz Ahmad Ansari, Rakesh Roshan
July-December 2017, 3(2):19-21
Rheumatological disorders in diabetic patients are generally neglected, but their prevalence is quite high in diabetic patients. This was an observational, prospective hospital based study conducted on 200 diabetic patients from IGIMS OPD, Department of Medicine and Department of Endocrinology. Females (60.5%) predominated the males (39.5%). Most of the patients were of type 2 Diabetes Mellitus. Mean age of the groups was 50.77 years, mean duration of Diabetes Mellitus was 76 months, mean Body Mass Index was 31.3kg/m2, and mean HBA1c of the groups was 8.07%. Osteoarthritis is the most commonly encountered Rheumatological manifestation in our study (43%) followed by frozen shoulder (30.5 %) and limited joint mobility (20.5%). Flexor tenosynovitis was present in 6.5%, Diffuse idiopathic skeletal hyperostosis (DISH) was present in 8% and Dupuytren’s Contracture was present in 9.5%. Our study shows common rheumatological manifestation in Diabetes mellitus were Osteoarthritis, Frozen shoulder and Limited joint Mobility. Our study shows duration of diabetes has important risk factors for development of rheumatological manifestations.
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To Evaluate the In Vitro Transcorneal Penetration of Ofloxaxcin, Pefloxacin, Lomefloxacin and Sparfloxacin in The Presence and Absence of Amniotic Membrane Using Goat Cornea
Alok Kumar Ravi, Nihar Ranjan Biswas, Thirumurthy Velepandian, Raju Sampangi, Sat Pal Garg, Supriyo Ghose
July-December 2017, 3(2):9-13
This study was intended to evaluate the in vitro transcorneal penetration of ofloxaxcin, pefloxacin, lomefloxacin and sparfloxacin in the presence and absence of amniotic membrane using goat cornea. This was an experimental study to estimate transcorneal penetration of four 0.3% fluoroquinolone formulations. In the absence of amniotic membrane, the calculated flux of the transfer in case of ofloxaxcin, pefloxacin, lomefloxacin and sparfloxacin 0.3% were found to be 2.41μg/cm2/hr, 4.45 μg/cm2/hr, 7.4 μg/cm2/hr and 0.968 μg/cm2/hr respectively. In the presence of amniotic membrane these values changed to 3.38 μg/cm2/hr, 2.15μg/cm2/hr, 5.75 μg/cm2/hr and 2.4 μg/cm2/hr respectively. The transcorneal permeation studies using goat cornea showed the cumulative release in the following order as lomefloxacin>pefloxacin>ofloxacin>sparfloxacin
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CASE REPORTS
A Case Report of Retroperitoneal Dermoid
Sanjay Kumar, Utpal Anand, Amarjeet K Raj, Rakesh K Singh, Manish Mandal
July-December 2017, 3(2):57-58
Primary dermoid of retroperitoneal space is exceedingly uncommon. Primary dermoid, mainly occurs in gonads (testes and ovaries), mostly in adults. Extragonadal dermoids are less common, mainly occur in infants and young children. We report a case of mature retroperitoneal dermoid in left upper quadrant retroperitoneal space in a 15 year old boy.
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EDITORIAL
From the Pen of Editorial Secretary…………
Sangeeta Pankaj
July-December 2017, 3(2):1-1
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CASE REPORTS
A Case of Sarcoidosis Misdiagnosed as Tuberculosis
Manish Shankar, Samir Kumar, Mukesh Kumar Tiwari
July-December 2017, 3(2):42-44
Sarcoidosis is a multisystemic chronic granulomatous disease of unknown origin, which can involve nearly all organs. In India tuberculosis is one of the common chronic infectious diseases presenting with high degree of morbidity and mortality. Almost any organ of the body can also be infected with tuberculosis. Both diseases have got high degree of similarity radiologically and histopathologically with the only difference being lack of caseation necrosis in sarcoidosis. We present here a case of sarcoidosis which were misdiagnosed as tuberculosis and treated with antituberculous drugs initially.
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