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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 7,801 852
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 2,283 337
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 2,256 283
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 2,384 275
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 1,457 161
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 3,816 263
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 2,238 161
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 1,198 104
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 1,596 166
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 1,648 156
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.
  1 785 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.
  1 800 84
Glanzmann's thrombasthenia detected in a patient presenting with spontaneous rectus sheath hematoma
Somak Kumar Das, Anirban Ghosal, Radha Binod Pal, Indira Maisnam
January-June 2017, 22(1):47-49
DOI:10.4103/0971-9903.202018  
Spontaneous rectus sheath hematoma occurs commonly in patients with coagulation disorder or as a complication of anticoagulant therapy. Glanzmann's thrombasthenia (GT) usually presents with mucocutaneous bleed, menorrhagia, hematoma/hemarthrosis and, rarely, as visceral hematoma. We report a case of spontaneous rectus sheath hematoma as an emergency in a patient of GT, a very rare presentation. In this case, a 14-year-old girl presented with acute pain abdomen and a palpable mass at the left lower abdomen. She was investigated and was found to have GT, which presented as rectus sheath hematoma.
  1 505 66
EDITORIALS
Climatic variations and stroke: Indian perspective
Nalin Chaudhary
January-June 2017, 22(1):2-3
DOI:10.4103/0971-9903.202009  
  1 1,029 158
Frailty, muscle atrophy, and sarcopenia
PS Shankar
September 2013, 18(2):91-93
DOI:10.4103/0971-9903.117787  
  1 1,769 1,146
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.
  1 880 225
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 1,698 270
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 5,687 589
REVIEW ARTICLES
Adolescent health and adolescent health programs in India
Chetna Maliye, BS Garg
July-December 2017, 22(2):78-82
DOI:10.4103/jmgims.jmgims_32_17  
The 2030 Agenda for Sustainable Development and its Global Strategy for Women's, Children's and Adolescents' Health provides a unique opportunity for accelerated action for the health of adolescents. Investment in adolescent health is also essential to achieve the 17 SDGs and their 169 targets, each of which relates to adolescent development, health or well-being directly or indirectly. India has the largest adolescent population in the World. The health status of an adolescent determines the health status in his/her adulthood. Many serious diseases in adulthood have their roots in adolescence. The main health issues faced by the adolescents include: Mental health problems, early pregnancy and childbirth, (HIV/STI) and other infectious diseases, violence, injuries, malnutrition and substance abuse. To achieve wholesome adolescent health, we need to have a multidimensional approach covering all the adolescent health problems with special emphasis on mental health, behaviour change communication towards healthy lifestyle and positive social environment to acquire life skills.
  1 7,082 1,079
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 3,358 219
SHORT REVIEW
Epidemic diseases act 1897, India: Whether sufficient to address the current challenges?
Binod K Patro, Jaya Prasad Tripathy, Rashmi Kashyap
September 2013, 18(2):109-111
DOI:10.4103/0971-9903.117796  
In this age of noncommunicable diseases, communicable diseases still contribute 30% of disease burden in India. Hundreds of epidemics occur each year and we fail to respond and contain most of them. Apart from various biological and behavioral public health interventions, we need to closely look at the structural intervention, that is, the legal framework to review health system preparedness. Although India has a number of legal mechanisms to support public health measures in an epidemic situation, they are not being addressed under a single legislation. The Epidemic Act 1897 is a century old blunt act which needs a substantial overhaul to counter the rising burden of infectious diseases both new and old. Issues like definition of epidemic disease, territorial boundaries, ethics and human rights principles, empowerment of officials, punishment, etc., need more deliberations and warrant a relook.
  1 3,093 309
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 8,222 815
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 3,316 522
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 3,989 303
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 1,859 260
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