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TOXICOLOGY SYMPOSIA – REVIEW ARTICLES
Snake bite poisoning
HS Bawaskar, PH Bawaskar
January-June 2015, 20(1):5-14
DOI:10.4103/0971-9903.151717  
Envenoming by venomous snake evokes a life-threatening response. Rapid diagnosis of acute hemorrhagic disorders, neurorespiratory, renal, and hemodynamic failure subsequent to snake bite and their rapid interventions saves life. Early administration of the appropriate dose of potent snake antivenom along with adjuvant treatment, proper care of the wound, correcting electrolyte imbalance, tissue oxygenation, and maintenance of adequate nutrition may help rapid recovery.
  6 8,554 905
Aluminum phosphide poisoning
Surjit Singh, Ashish Bhalla
January-June 2015, 20(1):15-19
DOI:10.4103/0971-9903.151721  
Over the last three decades, aluminum phosphide has emerged as an important pesticide agent being sued for self-harm in India is well as other countries. High mortality is due to severe mitochondrial dysfunction leading to disruption of cellular respiration leading to tissue hypoxia and organ dysfunction. In spite of a lot of research, no definitive anbtidote is available, and the treatment remains largely supportive.
  4 2,388 349
REVIEW ARTICLES
Rationale use of blood and its components in obstetric-gynecological practice
Shakuntala Chhabra, Anu Namgyal
July-December 2014, 19(2):93-99
DOI:10.4103/0971-9903.138427  
Appropriate and rational use of blood/components is essential for ensuring availability for the needy as well as preventing risks of transfusion-transmitted diseases and saving resources. Rational use means providing the right blood or products, in the right quantity, to the right patient and at the right time, bridging demand, and supply gap. The safety, adequacy, and effectiveness can only be achieved if unnecessary transfusions can be prevented. Further, risk can be reduced, but cannot be eliminated completely. Alternative to banked blood, autologous blood donation, normovolemic hemodilution, and intraoperative cell salvage should be considered as possible options. Recombinant factor VIIa is a new adjunct for treatment of massive hemorrhage and should be considered, if available.
  3 2,367 293
ORIGINAL ARTICLES
Influence of practice on visual reaction time
Tejas P Ghuntla, Hemant B Mehta, Pradnya A Gokhale, Chinmay J Shah
July-December 2014, 19(2):119-122
DOI:10.4103/0971-9903.138431  
Background: The present study was aimed to see the effect of practice on visual information processing speed. Reaction time is one of the important physiological parameters, which gives information how fast and quickly person responses. Reaction is purposeful voluntary response to different stimuli as visual stimuli. Visual reaction time (VRT) is the time required to response to visual stimuli. Materials and Methods: The VRT was measured by the multiple choice apparatus in subjects. Simple reaction time and choice reaction time measured. Reaction time was measured in two sessions. In the first session, VRT was measured without practice of task and in the second session VRT was measured after practice of task. The results were statistically analyzed and were recorded as mean ± standard deviation and Student's paired t-test was applied to check the level of significance. Result and Conclusion: In the present study, we found that VRT was less after practice for both simple and choice VRT tasks. Reaction time decreases by practice. Skills can be improved by practice. In daily life majority of work is done by the use of visual information. By the practice of an important task time required for stimulus identification and response can be decreased. Practice is useful for driving vehicles. It is helpful to students, as they have identification of bones, instruments, graphs and viva questions in examination of various medical subjects. Hence by practice students can identify, understand and answer quickly.
  2 2,464 287
SYMPOSIUM-RHEUMATOLOGY - CASE REPORTS
Catatonia as a first presentation of systemic lupus erythematosus: A case report
Amrish Saxena, Vina Lakhotia, Atul Singh Rajput, Nitin Verma
January-June 2014, 19(1):37-39
DOI:10.4103/0971-9903.126239  
Systemic lupus erythematosus (SLE) is a chronic inflammatory autoimmune disease characterized by multisystemic involvement. Neuropsychiatric manifestations are found in 50-70% of SLE patients. These manifestations include mild cognitive dysfunction, mood disorders, headache, depression, anxiety, seizures, psychosis, acute confusional states, and delirium, to life-threatening coma. Psychiatric symptoms as an initial presentation of SLE are rare and difficult to diagnose. We present the case of a 23-year-old woman, who developed the catatonic syndrome for the first time during hospitalization for lower respiratory tract infection, and she was eventually diagnosed with SLE. Her catatonia responded well to oral corticosteroids, lorazepam, risperidone, and modafinil. This case illustrates the importance of considering medical causes (SLE) in the diagnosis and treatment of the catatonic syndrome. The recognition of SLE as a cause of catatonia is essential for its optimal management.
  2 1,472 163
TOXICOLOGY SYMPOSIA – REVIEW ARTICLES
Recreational drugs in India
Ashsih Bhalla, Debasish Basu, Shubhmohan Singh
January-June 2015, 20(1):20-30
DOI:10.4103/0971-9903.151724  
Substance use has been present in India since many millennia, and the type and pattern of substances being abused have seen changes over time. In the review, we look at the traditional recreational substance and then describe the newer and emerging recreational drugs in India.
  2 4,336 279
CASE REPORTS
Case report of autosomal recessive spastic ataxia of Charlevoix-Saguenay
Suresh Pandi, Anirudda Deshpande, Supriya Khardenavis
January-June 2014, 19(1):62-64
DOI:10.4103/0971-9903.126253  
Autosomal recessive spastic ataxia of Charlevoix-Saguenay is a neurodegenerative disorder characterized by early-onset cerebellar ataxia with spasticity, a pyramidal syndrome and peripheral neuropathy Here, we present a 28-year-old male patient with symptoms of gait instability, distal sensory loss and spasticity since 10 years of age with slow progression and is currently moderately disabled in his daily activities. His nerve conduction studies and neuroimaging were consistent with the diagnosis. Our emphasis would be on the specific magnetic resonance imaging features of the entity, which would help narrow down the genetic testing and provide the practitioner with a rather accurate diagnosis needed for prognostication and valuable counseling thereafter.
  1 2,271 176
Monochorionic triplet with concordant congenital cardiac defects
Ibrahim Aliyu
September 2013, 18(2):125-128
DOI:10.4103/0971-9903.117790  
The chances of congenital cardiac defects are often increased in multiple birth orders. However, there is a paucity of data on its incidence amongst triplets in Nigeria. Here is a report of a set of triplet with concordant atrial septal defects and the third triplet found to have a concomitant ventricular septal defect.
  1 1,201 105
Dyschromatosis universalis hereditaria: A rare case report
Esha Bisne, Sonia Jain, VB Shivkumar
September 2013, 18(2):137-139
DOI:10.4103/0971-9903.117794  
Dyschromatosis universalis hereditaria is an autosomal dominant disorder but may be recessive or sporadically inherited disorder, infrequently occurring genodermatosis with peculiar pigmentary changes, consisting of varying sized, intermingled hyperpigmented and hypopigmented macules that give an overall impression of mottling. Herein, we report this extremely rare case of dyschromatosis universalis hereditaria in a young male with a family history of the same disorder in his younger brother.
  1 1,622 169
Single jejunal blowout perforation following blunt abdominal trauma: Diagnostic dilemma
Sunder Goyal, Snigdha Goyal, MK Garg
September 2013, 18(2):144-146
DOI:10.4103/0971-9903.117798  
Single isolated jejunal perforation (IJP) due to blunt abdominal trauma is uncommon and most often occurs with road traffic accidents. The diagnosis of traumatic single IJP is challenging as there are minimal clinical features initially. For most favorable results, strict monitoring, a high index of clinical suspicion, and the help of available appropriate diagnostic tools like diagnostic peritoneal lav age (DPL)/focused abdominal sonography for trauma (FAST) are preferable. Here we report a case of IJP following blunt trauma abdomen.
  1 1,659 158
Lemierre's syndrome: A rare entity with classical findings on computed tomography
Chandan Kakkar, Ritu Galhotra, Kavita Saggar, Anurag Arora
July-December 2015, 20(2):179-182
DOI:10.4103/0971-9903.164252  
Lemierre's syndrome is a form of septic thrombophlebitis characterized by internal jugular vein thrombosis and septic emboli caused by Fusobacterium species which follows a spell of pharyngotonsillits. We highlight a case of 16 year old female, a known case of lupus nephritis presenting with Lemierre's syndrome. A brief review of imaging findings on various imaging modalities with an emphasis on classical computed tomographic features of the disease is presented.
  1 793 87
Hydrocephalic newborn in a missed advanced abdominal pregnancy - diagnostic challenges in a rural setting: A case report
Ibrahim Aliyu, Adewale Ashimi
January-June 2016, 21(1):46-49
DOI:10.4103/0971-9903.178105  
Advanced abdominal pregnancy (AAP) is a rare event associated with high maternal and perinatal morbidity and mortality. It is commonly seen among patients in the low socioeconomic class, those with previous history of infertility, and women with pelvic infection that seems to be more in the developing countries like Nigeria. It could, however, pose a diagnostic challenge, especially in resource-limited settings where there is lack or restriction of healthcare professionals and medical diagnostic facilities; hence diagnosis is often clinical that is fraught with errors. This may result in misdiagnosis as was observed in our case. Abdominal pregnancy is often associated with congenital deformation anomalies such as talipes and spinal dysraphism. However, the case of a live newborn delivered at term with combination of talipes and hydrocephalus, which are deformation and malformation anomalies respectively is reported.
  1 839 85
Multidetector computed tomography depiction of foramen of huschke with reversible herniation of temporomandibular joint soft tissue into external auditory canal
Preeti Garg, Puneet Mittal, Ranjana Gupta, Amit Mittal
January-June 2017, 22(1):26-28
DOI:10.4103/jmgims.jmgims_60_15  
We present a case of an adult male who presented with herniation of soft tissues of temporomandibular joint into the external auditory canal (EAC) through a persistent foramen tympanicum. The patient was referred for computed tomography (CT) for suspicious mass in the left EAC. Multidetector CT helped in correctly characterizing the lesion with retraction of the soft tissue mass in open mouth biopsy and thereby avoiding unnecessary biopsy.
  1 387 70
Giant lumbosacral plexiform neurofibroma without associated neurocutaneous syndrome: An unusual presentation
Pragya Singh, Binit Sureka, Mahesh Kumar Mittal, Brij Bhushan Thukral
January-June 2017, 22(1):34-37
DOI:10.4103/jmgims.jmgims_41_15  
Benign retroperitoneal and presacral neural sheath tumors of lumbosacral plexus in patients without Von-Recklinghausen's disease are quite rare with only few sporadic case reports. We report a case of giant unilateral plexiform neurofibroma of lumbosacral plexus extending into the thigh up to the level of knee joint in a patient without neurofibromatosis-1. Large unilateral retroperitoneal neurofibromas are rare while extension of the same up to the level of knee joint has not been reported yet. The purpose of the report is to highlight the characteristic imaging features in an unusual case of retroperitoneal neurofibroma extending up to the knee joint and thus avoiding unnecessary biopsy. Further imaging helps in defining presurgical extent of lesion, which in our case is essential as the lesion is seen extending along the entire course of the involved femoral nerve.
  1 695 73
EDITORIALS
Climatic variations and stroke: Indian perspective
Nalin Chaudhary
January-June 2017, 22(1):2-3
DOI:10.4103/0971-9903.202009  
  1 1,054 160
Frailty, muscle atrophy, and sarcopenia
PS Shankar
September 2013, 18(2):91-93
DOI:10.4103/0971-9903.117787  
  1 1,793 1,352
ORIGINAL ARTICLE
Magnitude and pattern of hypertension among diabetics; risk prediction for stroke and myocardial infarction
Madhu Basavegowda, Kavitha Hanumanahally Shankarappa, Ashok Nagaralu Channabasappa, Srinath Kenkere Marulaiah, Basavangowdappa Hathur
January-June 2014, 19(1):51-54
DOI:10.4103/0971-9903.126247  
Background: Hypertension and diabetes are closely related morbidities. Uncontrolled blood pressure in diabetic patients can pose severe threat to life. An attempt was made to screen for hypertension among diabetics and also to predict their risk for stroke or myocardial infarction. Material and Methods: Community-based cross-sectional study was conducted in an urban slum of Mysore. Data was collected between July and August 2011. Known diabetics residing in this area were included in the study. Socio-demographic information of diabetic patients, physician's conduct in identifying hypertensives, advice for blood pressure check-up, and the extent of patient's compliance to advice were assessed. Simultaneously subjects were screened for hypertension. Results: The study comprised of 104 patients. Only half of the subjects had an annual blood pressure recording by a physician. Prevalence of hypertension was 64.4% (67), with a known to unknown ratio of 1:2.5. Eleven (10.4%) diabetics with stage III hypertension have a very high risk of stroke and myocardial infarction. Conclusions: Timely diagnosis and management of hypertension among diabetics reduces the risk of cardiovascular complications. Physicians should adhere to guidelines and refocus on issues that influence patient's compliance in monitoring their blood pressure.
  1 885 227
ORIGINAL ARTICLES
Inducible clindamycin resistance among clinical isolates of Staphylococcus aureus
Kanwal Deep Singh Lyall, Veenu Gupta, Deepinder Chhina
September 2013, 18(2):112-115
DOI:10.4103/0971-9903.117799  
Introduction: The resistance to antimicrobial agents among staphylococci is an increasing problem. This has led to renewed interest in the usage of macrolide-lincosamide-streptogramin B (MLSB) antibiotics to treat Staphylococcus aureus infections. Clinical failure has been reported due to multiple mechanisms that confer resistance to MLSB antibiotics. The present study was aimed to detect inducible clindamycin resistance among S. aureus isolates and to study the relationship between clindamycin and methicillin resistance. Materials and Methods: During a period of 1 year, a total of 593 S. aureus isolates from various clinical specimens were included in the study. Antimicrobial susceptibility test was done by Kirby-Bauer's disc diffusion method as per Clinical and Laboratory Standards Institute (CLSI) guidelines. For detection of inducible clindamycin resistance, D test using erythromycin and clindamycin as per CLSI guidelines was performed, and three different phenotypes were interpreted as methicillin-sensitive (MS) phenotype (D test negative), inducible MLSB (iMLSB) phenotype (D test positive), and constitutive MLSB phenotype. Results: Of the total 593 S. aureus isolates, majority were obtained from pus (31.1%) followed by blood and body fluids (27.3%). All the isolates were sensitive to vancomycin, teicoplanin, and linezolid. Out of 306 (51.7%) erythromycin resistant isolates, 280 (91.5%) were methicillin-resistant S. aureus (MRSA) and 26 (8.5%) were methicillin-sensitive S. aureus (MSSA). iMLSB phenotype in 33.3%, MS phenotype in 44.8%, and constitutive MLSB phenotype was observed in 21.9% of isolates. Inducible clindamycin resistance was almost equal among MRSA and MSSA isolates. Conclusion: D test should be included as a mandatory method in routine disc diffusion testing to detect inducible clindamycin resistance in staphylococci for the optimum treatment of patients.
  1 1,707 272
Prevalence of skin diseases in rural Central India: A community-based, cross-sectional, observational study
Sonia Jain, MS Barambhe, Jyoti Jain, UN Jajoo, Neha Pandey
July-December 2016, 21(2):111-115
DOI:10.4103/0971-9903.189537  
Aim: To identify prevalence of skin diseases and to determine the risk factors of skin diseases among the adult population of rural Central India. Materials and Methods: It was a community-based, observational study in which we prospectively recruited general population in and around Wardha beginning October 1, 2011, through March 2012. The main focus was to study population of 10 years and above. Results: Eczema was the most common dermatosis accounting for 22% participants and among them almost 60% sufferers were female. Fungal infection presented in 13.0% of all the affected participants and was found more in male participants (58%) than in female (42%) among those affected with fungal infection. Eczema, benign skin tumors, and pigmentary disorders were more common in participants aged 51 years and above accounting to 52.7%, 9.4%, and 6.3%, respectively. Fungal infection and acne were more in adolescent age group accounting to 17.4% and 30.4%, respectively. Conclusion: Hence, we concluded that of the entire study population prevalence of skin diseases was 60%. Our study brought a higher prevalence of eczema in female and fungal infection in male. Eczema, benign skin tumors, and pigmentary disorders were more common in participants aged 51 years and above, and fungal infection and acne were more in adolescent age group. Adolescents suffered predominantly from fungal infections and acne due to pubertal changes. Various causes such as environment, overcrowding, and poor living conditions are major factors and not only adolescents or old age group but also entire population between 21 and 50 years of age were found to be suffering more commonly from eczema and infective dermatoses.
  1 6,418 641
REVIEW ARTICLES
Mirabegron: A first-in-class beta-3 agonist for overactive bladder
Suruchi Aditya, Surya Kant Mathur
July-December 2015, 20(2):128-133
DOI:10.4103/0971-9903.164227  
Overactive bladder (OAB), an under-diagnosed and under-treated condition, is a symptom complex characterized by urinary urgency, with or without urinary incontinence. Although antimuscarinic agents are the established first-line pharmacological treatment, insufficient efficacy, resistance and adverse effects such as dry mouth, constipation and dysuria have created the need for better drugs. Mirabegron, an oral beta-3-adrenergic agonist and first in a new class of drugs, has been recently approved by the US Food and Drug Administration to treat adults with OAB with symptoms of urge urinary incontinence, urgency and urinary frequency. By relaxing the detrusor muscle during the filling phase, mirabegron increases the storage capacity of the bladder and lengthens the interval between voiding. It does not affect bladder contraction or residual urine volume. In clinical trials, mirabegron significantly reduced the mean number of daily incontinence episodes as well as the mean number of micturitions per 24 h as compared with placebo. The most common side-effects are nasopharyngitis, urinary tract infections and headache. By exploiting a novel target, mirabegron represents a new therapeutic approach to OAB treatment with a distinct mechanism of action and gives a new hope to patients with significantly impaired quality of life due to OAB who are unable to tolerate antimuscarinic agents and who show insufficient effect from antimuscarinics.
  1 2,724 322
What clinician's need to know about imaging features in lung cancer?
Binit Sureka, Mahesh Kumar Mittal, Aliza Mittal, Mukul Sinha, Brij Bhushan Thukral
July-December 2014, 19(2):100-105
DOI:10.4103/0971-9903.138428  
Bronchogenic carcinoma is one of the most common cancers both in males and females worldwide. Lung malignancies can present with manifestations involving any organ system and also mimic like benign nodules or infective consolidation. Present review highlights spectrum of typical presentations and imaging features of lung malignancies.
  1 3,714 226
SYMPOSIUM-RHEUMATOLOGY
An approach to monoarthritis
Molly Mary Thabah, Ved Chaturvedi
January-June 2014, 19(1):12-18
DOI:10.4103/0971-9903.126229  
Monoarthritis can be inflammatory or non-inflammatory, and can be acute or chronic. A thorough history and physical examination can differentiate inflammatory from non-inflammatory monoarthritis. The most common causes of acute inflammatory monoarthritis are infectious arthritis, crystal induced arthritis (gout and pseudogout). Examination of synovial fluid often is essential in making a definitive diagnosis. Immunoinflammatory diseases like rheumatoid arthritis, systemic lupus erythematosus, spondyloarthritis, Behηet's disease, and reactive arthritis can all begin as acute inflammatory monarthritis. Synovial biopsy is useful to diagnose chronic infections like tuberculosis and brucellosis. In order to arrive at a final diagnosis other organ systems should be thoroughly reviewed, because other systemic illness like sickle cell disease, thalassemia, sarcoidosis can all cause monoarthritis.
  1 8,352 832
Antiphospholipid syndrome: A review
Varun Dhir, Benzeeta Pinto
January-June 2014, 19(1):19-27
DOI:10.4103/0971-9903.126231  
Antiphospholipid syndrome is being increasingly recognized as a disease with a myriad of clinical manifestations ranging from recurrent thrombosis and pregnancy morbidity to valvular lesions, transverse myelitis, thrombocytopenia and hemolytic anemia. It may be primary or secondary, i.e., associated with other autoimmune diseases. The latest classification criteria (Sydney 2006) recognize just three tests to define this syndrome-lupus anticoagulant, anticardiolipin antobodies and anti β2 glycoprotein 1 antibodies. Treatment of thrombotic events involves lifelong anticoagulation with vitamin K antagonists like warfarin. Antiphospholipid antibody syndrome (APS) with only pregnancy morbidity is treated with thromboprophylaxis using heparin during pregnancy and postpartum for 6 weeks. Catastrophic APS occurs in approximately 1% of APS, and is characterized by microvascular thrombosis (thrombotic storm) and organ dysfunction. In this review we discuss the pathogenesis, diagnosis, treatment and prognosis of the APS.
  1 3,381 527
TOXICOLOGY SYMPOSIA – REVIEW ARTICLES
Acute hair dye poisoning: Lurking dangers
Subramanian Senthilkumaran, Ponniah Thirumalaikolundusubramanian
January-June 2015, 20(1):33-37
DOI:10.4103/0971-9903.151731  
Hair dye poisoning has emerged as one of the major causes of deliberate self-harm in the rural areas of developing world. This systematic toxicological literature reviews the pathophysiology and clinical features of hair dye poisoning.
  1 4,649 313
Organophosphorus poisoning: A social calamity
Udit Narang, Purvasha Narang, OmPrakash Gupta
January-June 2015, 20(1):46-51
DOI:10.4103/0971-9903.151736  
Poisoning with organophosphorus (OP) compounds is a global public health problem. According to World Health Organization (WHO), 3 million cases of pesticide (mainly OP compounds) poisoning occur every year, resulting in an excess of 250,000 deaths. Of these, about 1 million are accidental, and 2 million are suicidal poisonings. The incidence has steadily increased in the recent past and has reached a level in the developing countries, where it can be called a "social calamity." Diagnosis is mainly on clinical grounds. The wellknown antidotes of OP poisonings are atropine and oximes. However, investigations over the recent years have introduced new adjunct therapy and cheap medications such as sodium bicarbonate and magnesium sulfate as well as antioxidants that should be considered for the management of OP poisoning. While efficacy of atropine is clinically proven, clinical experience with pralidoxime has been controversial. A lot of new modalities of management like K-oximes, hemoperfusion, and Fresh frozen plasma are under evaluation. Prevention still appears to be the best modality of management. Appropriate legislations and pesticides control are recommended for the developing countries to prevent occupational, accidental, and intentional poisonings.
  1 2,268 289
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