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   2019| April-June  | Volume 8 | Issue 2  
    Online since July 30, 2019

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Atypical mycobacterial infection, a diagnostic and therapeutic challenge-Case report and review of literature
Nupur Pal, Sangeeta Pal, Raja Ray
April-June 2019, 8(2):138-140
As atypical mycobacterial disease is very difficult to be differentiated from Mycobacterium tuberculosis, mycobacterial culture results can be the corner stone to solve the problem and avoid the un-necessary suffering of the patient and in the same time it helps in prescribing the correct drug regime for the patient. Here we present a case of a 23-year-old female who underwent LUCS one year back that was complicated with development of multiple abdominal wall abscesses. Initially she was treated with a combination of intermittent surgical drainage and prolonged antibiotic course, later antitubercular drugs were put on based on the positive AFB smear and biopsy report. This case is of interest that Mycobacterium abscessus was isolated from the patient who was improved after therapy with sensitive drugs. Our case highlights the fact that NTM disease should be put into consideration in patients with positive AFB smear and requires referral of samples to specialized microbiology laboratories.
  5,177 282 -
Lymphangiectasia of varied etiology: Case series
Sudha Rani Chintagunta, Geetakiran Arakkal
April-June 2019, 8(2):125-128
Lymphangiectasias are dilated superficial lymphatic vessels following damage or obstruction to deep lymphatics leading to increased lymphatic pressure and formation of superficial vesicles. Lymphangiectasia clinically present as numerous translucent vesicles with chronic lymphedema, often associated with various conditions such as malignancies, radiotherapy, trauma, recurrent, and chronic infections and inflammatory conditions. The most common causes of lympangiectasia are surgery and radiotherapy. We herewith report six cases of lymphangiectasias of different etiology, of which five cases involving the genitalia following radiotherapy, malignancy, and blunt injury and another case involving the breast with carcinoma.
  3,201 151 3
Odontogenic myxoma- A rare case report
Kathoju Mounika, Surekha Ramulu, Guttikonda Venkateswara Rao, M Praveen Kumar
April-June 2019, 8(2):118-121
Odontogenic myxoma is benign, slow-growing, locally aggressive tumour arising from the ectomesenchyme of a developing tooth. It is the third most common odontogenic tumour. It occurs mainly in the 2nd and 3rd decades with slight predilection in females, and the mandible is more commonly involved than the maxilla. The lesion often grows without symptoms and presents as a painless swelling. Radiographic features are variable with a unilocular or multilocular radiolucency showing honeycomb, soap bubble or tennis racket pattern with cortical plate expansion. Histologically odontogenic myxoma shows loosely arranged stellate to spindle shaped cells interspersed in myxoid matrix. A case of odontogenic myxoma in 46- year-old female patient involving the right maxilla resulting in gross facial deformity within a span of 6 months is reported.
  2,903 198 1
Anesthesia management of elderly woman suffering with severe mitral regurgitation, pulmonary artery hypertension, and severe left ventricular dysfunction scheduled for hemiarthoplasty
A Naveen Kumar, B Vijayabhaskar, S Jagadeesa Charlu, T Madhusudan
April-June 2019, 8(2):134-137
We present a case of an elderly woman aged 76 years suffering from severe mitral regurgitation, moderate tricuspid regurgitation, and moderate pulmonary hypertension associated with severe left ventricular dysfunction scheduled for right hemiarthoplasty. Hypertension and diabetes were associated comorbid factors. Patient had grade IV exertional dysponea. Patient was on cardiovascular treatment and nebulization therapy since 4 years. We opted for graded epidural anesthesia as an anesthetic technique of choice for the patient because of its intraoperative hemodynamic stability and postoperative analgesia. Graded epidural provides minimal effects on the contractility and heart rate providing ideal intraoperative conditions. We used ropivacaine as a local anesthetic for graded epidural anesthesia for its cardiovascular stability compared to other local anesthetics. This case highlights the advantage of graded epidural anesthesia over general anesthesia and spinal anesthesia in patients suffering from valvular heart disease, pulmonary artery hypertension, and severe left ventricular dysfunction.
  2,806 167 -
Shear bond strength of metal and ceramic brackets using conventional acid etch/primer and self-etch primer
Chandrika Katti, Girish Katti, Syed Shahbaz
April-June 2019, 8(2):101-106
Aims: The aim of this in vitro study is to evaluate shear bond strength (SBS) of metal and ceramic brackets using conventional acid etch/primer and self-etch primer (SEP) adhesive systems. Methodology: Healthy, extracted 120 human premolar teeth were collected and were divided into group 1 – teeth bonded with metal brackets and group 2 – teeth bonded with ceramic brackets. These two groups were further subdivided: subgroup 1a – 30 metal brackets bonded using conventional acid etch/primer adhesive system, subgroup 1b – 30 metal brackets bonded using SEP, subgroup 2a – 30 ceramic brackets bonded using conventional acid etch/primer adhesive system, and subgroup 2b – 30 ceramic bracket bonded using SEP; brackets were debonded using a computerized universal Instron Testing Machine and the teeth were examined under ×10 magnification for adhesive remnants and scored according to modified adhesive remnant index (ARI). Results: The mean SBS of metal and ceramic brackets bonded using conventional acid etch/primer adhesive system showed higher bond strength than those bonded using SEP. Bond strength ranged from 7.25 to 12.23 MPa which was in the acceptable clinical range. Modified ARI scores calculated showed varied results. Conclusion: SBS values of all four subgroups exceeded the range of 6–8 MPa considered to be suitable for routine clinical use.
  2,697 255 -
Bacteriological profile of post-operative orthopedic implant infections and their antibiotic sensitivity pattern in a tertiary care hospital of southern Odisha
Samir K Sarangi, Sanghamitra Padhi
April-June 2019, 8(2):114-117
Context: Prosthetic replacements and implants are becoming common in orthopedic operations for successfully alleviating the pain and improving the mobility in damaged joints. This sometimes leads to microbial infections contributing to high morbidities and prolonged hospital stay. Aims: This study was aimed to find out (1) the prevalence of bacterial infection in orthopedic implant surgeries; (2) to isolate and identify the bacteriological agents responsible for causing post-operative orthopedic implant infections; and (3) to perform their antimicrobial sensitivity. Methods: This was a prospective study carried out at a tertiary care hospital of southern Odisha, over a period of 24 months. The study was conducted on 112 cases of infected implants from orthopedic wards, from 1st January 2016 to 31st December 2018. Pus samples were collected using three sterile swabs. One was used for Grams stain, one for inoculation on MacConkey and Blood agar, and the 3rd one for inoculation in Robertson's cooked meat (RCM) broth. Blood agar and MacConkey agar plates were processed for culture of aerobic bacteria, while the RCM inoculate was processed for anaerobic bacteria. Biofilm production and Susceptibility testing was performed. Results: Out of the 112 samples processed, culture positivity was observed in 90 specimens. Among them, 78 were aerobic, while 12 were anaerobic infections. Staphylococcus aureus (35.89%) was the predominant aerobic isolate followed by Pseudomonas spp. (28.2%). Among anaerobes, Bacteroides spp. (7.7%) was the most common isolate. Conclusion: The appropriate pre- and post-operative care should be taken to prevent such infections. Staphylococcus spp. was the commonest isolate and its ability to produce biofilm stresses the need for an appropriate antibiotic policy to put in place to eradicate the infection.
  2,718 215 1
Adenomyoepithelioma of the breast misdiagnosed as metaplastic carcinoma in a 64-year-old female: A case report and review of literature
IF Ezejiofor, GU Chianakwana, CO Ukah, ME Onwukamuche, OA Egwuonwu, CC Ogbu, CC Okoli
April-June 2019, 8(2):129-133
Adenomyoepithelioma (AME) of the breast is a benign and indolent biphasic rare neoplasm characterized by dual proliferation of glandular and myoepithelial elements, which have propensity for local recurrences and malignant transformations. AME tumors are easily recognized in an excised biopsy, but it is more difficult to make a definitive diagnosis with core needle or limited biopsy because of morphologic heterogeneity. In these biopsies, diagnosis may be mistaken for invasive carcinoma most probably metaplastic carcinoma/carcinosarcoma or invasive ductal carcinoma. This article aims to highlight the diagnostic challenge of AME on core nipple biopsy or challenges encounter in inadequate sampling of the lesion, its recurrence potential, and rarity of this neoplasm in literature. We report a case of AME in the breast formerly diagnosed as an invasive ductal and metaplastic carcinoma on limited biopsies at different times and in different hospitals.
  2,778 154 -
Stress distribution in implant supported mandibular ovedentures and surrounding bone using three different types of attachments – a 3D finite element analysis
Vikram R Dulala, Lahoti Anurag, Puralasetty Srinivasa Rao, Kummari Subash Chander, Aditi C Sabnis, Asha O Reddy
April-June 2019, 8(2):95-100
Background: Since mandibular complete denture faces problems with retention, stability, support mandibular implant supported overdenture is a more successful and durable treatment option. Different types of attachments used with mandibular overdentures improve the retention and dissipate stress as well. It is of paramount importance for the success of the prosthesis. Finite element analysis (FEA) is a very precise method for stress assessment in the bone. Materials and Methods: Mandibular 2 implant supported overdenture was considered. Noble Biocare replace implant of diameter 4.3 mm, length 11.5 mm was used in the study. 3 models were considered: Model A – Implant overdenture with Ball/O-ring attachment, Model B – Implant overdenture with Locator Attachment, Model C – Implant overdenture with Ceka attachment. A detailed, precise 3D solid model of human mandible was obtained upon which FEA could be optimized using Autodesk NETFABB ver. 8.1, a software and MAYA 3D software tool. These models were subjected to vertical, oblique and horizontal forces of 35N, 70N and 10N, respectively. Stress was assessed at different sites namely silicon cap/ring, abutment, implant–abutment interface, implant body, surrounding bone. The amount of force required to uplift the dentures was assessed. Results and Conclusion: Results showed that locator attachment showed least amount of stress generation under all three types of loads. Within the limitations of the study, it was concluded that locator attachment was better in terms of stress generation in comparison to Ball and Ceka attachment. It was the most retentive attachment in comparison to the other two attachments.
  2,676 251 -
Estimation of macrophage inflammatory protein-1α (MIP-1 α) levels in serum and gingival crevicular fluid in periodontal health, disease, and after treatment—A clinico-biochemical study
Madhu Babu Dandu Subramanyam, Sravani Reddy Cheppali, Deepa Anumla, Bindu Sighinam, E Prasuna, Ravindra Nagireddy Reddy
April-June 2019, 8(2):107-113
Objectives: Previous studies have revealed high macrophage inflammatory protein-1α (MIP-1α) levels in the gingival crevicular fluid (GCF) and the serum of patients with chronic periodontitis. However, reports correlating the GCF and serum MIP-1α levels are inadequate. Therefore, the present study estimates the GCF and serum MIP-1α levels and its effects on periodontal health, disease, and after periodontal treatment. Materials and Methods: Periodontal examination and collection of GCF and serum was performed for 60 subjects categorized into four groups with 20 subjects in each group: Group I (healthy), group II (gingivitis), and group III (chronic periodontitis). Eight weeks after scaling and root planing, the GCF and serum were collected from 20 patients of group III, who were considered as group IV. MIP-1α levels were estimated using the enzyme-linked immunosorbent assay. Results: MIP-1α was detected in all samples. However, the levels reduced significantly in group IV (P < 0.05). Mean MIP-1α levels in GCF and serum were the highest in group III (1.481 ng/μL) and the lowest in group I (0.209 ng/μL), and those in groups II (0.685 ng/μL) and IV (0.276 ng/μL) appeared between those of groups I and III. Conclusions: The GCF and serum MIP-1α levels increased proportionally with the progression of periodontal disease (PD) and decreased after treatment. Because MIP-1α levels in the GCF and serum correlated positively with clinical parameters, MIP-1α may be considered a “novel biomarker” in PD progression. However, controlled longitudinal studies are required to confirm this possibility.
  2,581 226 1
Cardiotoxicity with sequential use of Anthracycline and Trastuzumab in carcinoma breast patients in a North Indian tertiary care centre
Manoj Prashar, Dharmesh Soneji, Sundaram Viswanath, Sankalp Singh
April-June 2019, 8(2):83-88
Background: Anthracycline and Trastuzumab containing regimens demonstrate significant efficacy in human epidermal growth factor receptor 2 (HER2) positive breast cancer patients. The utility of this strategy is limited by significant cardiotoxicity associated with these drugs. This study was conducted to study the cardiotoxicity with sequential use of Anthracyclines and Trastuzumab to identify early signs of carditoxicity and tailor therapy for these patients. Materials and Methods: A total of 45 cases of breast cancer patients who expressed HER 2 by immunohistochemistry (IHC) (3+) or fluorescent in situ hybridisation (FISH) were included in this study. The patients were evaluated for cardiotoxicity by clinical examination, echocardiography and Multigated acquisition (MUGA) scan at periodic intervals. Results: Fall in ejection fraction was noticed in 20% of patients. Most of these patients were asymptomatic. Two dimensional echocardiography (2 D Echo) and MUGA scans were complimentary to each other. The fall of ejection fraction was reversible in 89% of these patients on stopping Trastuzumab for median of 6 weeks duration. All these patients completed planned treatment on reintroduction of Trastuzumab. Conclusion: The sequential use of Anthracyclines and Trastuzumab has cardiotoxic potential. Detecting early signs of cardiotoxicity and monitoring asymptomatic fall in ejection fraction can prevent long term cardiotoxic side effects. Due to reversible nature of cardiotoxicity of Trastuzumab, it can be reintroduced in most of the patients. Benefits of Trastuzumab therapy can be achieved by keeping close observation on cardiotoxicity and tailor treatment accordingly.
  2,510 249 -
Post renal transplant pulmonary nocardiosis - A case report
Akhil Purushothaman Rajeswari, Gullipalli Prasad, Ramesh Chandra Vyasam, Bura Naga Raja Ramesh, Gunnam Sireesha, Athota Sam, Revu Praveen, Kondari Sai Sundeep, Kanala Sai Harisha
April-June 2019, 8(2):147-150
Nocardiosis is a rare opportunistic infection caused by an aerobic actinomycete, producing either local or disseminated disease. It is a systemic infection that usually begins in the lungs and has high predilection for brain, skin and subcutaneous tissues. It commonly affects solid organ transplant recipients on immunosuppressive drugs. The incidence of nocardiosis in solid organ transplant recipients is about 0.6%. In India, nocardiosis was reported in 1.4% of renal transplant recipients. We report a case of pulmonary nocardiosis in a postrenal transplant recipient. Patient presented with features suggestive of pneumonia not responding to antibiotics. Initial sputum gram stain and AFB was negative. Chest radiograph showed right parahilar non-homogenous opacity, and CT chest revealed right parahilar, and subcarinal adenopathy. Bronchoscopy was done which showed purulent secretion from right 6th bronchial segment and AFB stain of broncho alveolar lavage fluid, showed weak acid fast filamentous bacteria, suggestive of nocardiosis. Patient was treated with antibiotics imipenem and co-trimoxazole. Patient responded well to treatment and pneumonia was resolved.
  2,413 155 -
Strongyloides stercoralis hyperinfection masquerading as chronic obstructive pulmonary disease: A case report
Narasimhulu Koyalagundla, Vidyasagar Kekathi, Syfulla Shariff, Sharfraz Ahamed Mohammed, Rajendra Naik Banavath
April-June 2019, 8(2):143-146
Strongyloides stercoralis is a soil-transmitted helminth. Infection in human beings may be asymptomatic in immunocompetent individuals or cause life-threatening symptoms in immunocompromised individuals. We present a case of S. stercoralis in an immunocompetent individual who was misdiagnosed as obstructive airway disease.
  2,388 133 -
Atherogenic ratios and serum lipid levels in patients with end-stage renal disease on continuous ambulatory peritoneal dialysis
Sulochana Narasimha, N Harini Devi, Alok Sachan, V Siva Kumar
April-June 2019, 8(2):89-94
Background: Patients with end-stage renal disease (ESRD) on continuous ambulatory peritoneal dialysis (CAPD) often have an atherogenic lipid profile. Lipid disturbances that have been observed in patients with ESRD on CAPD include hypercholesterolemia, hypertriglyceridemia, and decreased high-density lipoprotein cholesterol (HDL-c). Aim and Objectives: To study the atherogenic ratios and serum lipid levels in patients with ESRD on CAPD and compare with healthy controls. Materials and Methods: This study included 30 patients with ESRD before and after the initiation of continuous ambulatory peritoneal dialysis and 30 healthy controls. Thirty patients with ESRD after the start of peritoneal dialysis were regularly followed up for 3rd, 6th, 9th, 12th, and 15th months. The biochemical parameters were measured in baseline and follow-up samples. Results: The concentrations of (TC), serum triglycerides (TGs), very low-density lipoprotein cholesterol (VLDL-c), and atherogenic ratios were increased and levels of serum TC, low-density lipoprotein cholesterol (LDL-c), and HDL-c were decreased significantly during 3rd and 6th months. However, after 1 year of CAPD, the serum TGs, VLDL-c, TC, and LDL-c levels were significantly higher than the baseline values and HDL-c was significantly lower than the baseline values. Conclusion: The present study findings conclude that the continuous peritoneal absorption of glucose during CAPD contributes to alteration in serum lipids. However, the changes are fluctuating as an adaptation to the peritoneal absorption of glucose.
  2,097 183 -
Bilateral optic atrophy in snake envenomation – A case report
Ravala Siddeswari, Sikindar Mohan, Santosh Kante, Tejaswi Ponnam
April-June 2019, 8(2):122-124
Ocular complications following snake bite are usually rare. Snake bite accounts for 4% of all ophthalmoplegias. Optic neuritis and optic atrophy following snake bite have been reported in very few cases. Various causes of optic neuritis following snake bite have been postulated, including capillary damage and extensive hemorrhage, allergy to ASV and the direct toxic effect of snake venom. Here, one such rare case of optic atrophy following snake bite, admitted at Government General Hospital, vijayawada is discussed.
  1,976 145 -
Azygos lobe and partial eventration of diaphragm
Srikanti Raghu
April-June 2019, 8(2):141-142
An azygos lobe is an accessory lobe of the lung that may occasionally be confused with a pathological process such as a bulla, lung abscess, or neoplasm. Eventration of the diaphragm is generally regarded as a condition in which the left or the right leaf of the diaphragm has ascended abnormally high into the chest. In this case, both eventration of diaphragm and azygos lobe presented in the same patient on the same side.
  1,904 132 -
Will screening for antenatal anxiety and depression improve neonatal outcome?
Indra Bala Sundarrajan, Kalaivani Annadurai, Prateek Bobhate
April-June 2019, 8(2):151-152
  1,530 136 -