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  Most popular articles (Since May 10, 2019)

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Asymptomatic triple vessel coronary artery disease: A treatment dilemma
M Premanath
October-December 2019, 7(4):137-140
Coronary artery bypass graft (CABG) is the treatment of choice in patients of diabetes with triple vessel disease (TVD). If the patient has TVD but is asymptomatic, the dilemma is whether to continue with medical management or to opt for revascularization. The patient in this case report was absolutely asymptomatic despite risk factors of diabetes, resistant hypertension, and TVD. Since his left main coronary artery was involved, he underwent CABG to prevent sudden cardiac death.
  29,681 246 -
Rickettsial infections: Past and present perspectives
Vasantha Kamath, Shreyashi Ganguly, Jasmine Kaur Bhatia, R Himabindu
January-March 2020, 8(1):4-10
Rickettsial infections are reported from various parts of India. But despite the surging number of cases, these diseases are often under-diagnosed. Rickettsial diseases have re-emerged as some of the most covert infections of the present time. These diseases are generally incapacitating and notoriously difficult to diagnose. The greatest challenge lies in overcoming the difficult diagnostic dilemma posed by these infections early in their courses- when antibiotic therapy is most effective. Untreated cases have a fatality of up to 30% but when promptly and properly diagnosed, it is often easily treated. Clinical manifestations combined with a thorough history (travel, epidemiological environment, and place of residence) and knowledge of the distribution of rickettsial agents and their vectors may help clinicians to correctly diagnose a rickettsiosis. Weil Felix, although not sensitive, aids in initiating antibiotics when interpreted in the correct clinical context. Antibiotic treatment with doxycycline (including for children) must be started whenever a possible rickettsiosis is suspected, taking into consideration pregnant women and allergic patients. The factors that predispose to rickettsial infections are widely prevalent in this country hence the physicians and paediatricians need to include rickettsial infections in their differential diagnosis of febrile thrombocytopaenia or an acute febrile illness.
  12,548 348 1
Medical education in India: Past, present, and future
Praveen Kulkarni, K Pushpalatha, Deepa Bhat
July-September 2019, 7(3):69-73
Medical education in global context has evolved over a period of time and so in India. With changing community needs, educational advancements and technological revolutions, we need to update the method of imparting knowledge and skills to the students. Major components of hidden curriculum like communication skills, attitude, empathy, altruism, professionalism, humanities etc need to be uncovered and delivered in a more systematic way. Ever increasing demand of doctors in the country has forced to establish new medical colleges across the country but the quality of Indian Medical Graduates produced out of them needs a lot to think and work upon. Reforms in curriculum Medical Council of India is planning to bring should be taken seriously and all efforts should be made to bring them to reality. In order to bring a competent Indian Medical Graduate in par with global standards should be the MANTRA of every medical education institution.
  11,250 863 10
COVID 19-Fighting an unseen enemy
Vasantha Kamath, Shreyashi Ganguly, B Nivea
July-September 2020, 8(3):114-120
In December 2019, a previously unknown coronavirus, named SARS-CoV-2, was discovered in Wuhan, Hubei province of China. It was sequenced and isolated by January 2020. SARS-CoV-2 is associated with an ongoing outbreak of atypical pneumonia (Covid-2019) that has affected over 2,118,700 people and killed more than 141,900 of those affected in >210 countries as of April 16, 2020. Community-acquired coronaviruses are ubiquitous. COVID-19 is predominantly seen in older population with chronic medical conditions. There is a male preponderance. Median age was 55-59 years. SARS-CoV-2 is also more likely to infect people with chronic comorbidities such as cardiovascular and cerebrovascular diseases and diabetes. Coronavirus has an R0 of 3.28. Unlike European countries and USA, majority of the cases in India were affecting people of age group between 31 and 40 years. Mortality rate is around 3.34%. WHO, described three main transmission routes for the COVID-19: 1) droplets transmission, 2) contact transmission, and 3) aerosol transmission. COVID presents with fever, dry cough, dyspnoea, chest pain, fatigue and myalgia. Less common symptoms include headache, dizziness, abdominal pain, diarrhoea, nausea, and vomiting. Characteristic cutaneous, haematological, gastrointestinal, neurological manifestations are also seen. Testing with RT-PCR, antibody testing, and quarantine, social distancing, contact tracing are the only arsenals to reduce the burden. Every case is different; beyond standard antipyretics, anti-tussives, the role of ventilation, anticoagulation, antivirals, steroids, hydroxychloroquine, retroviral agents are still being dynamically assessed. In the absence of dedicated cures, vaccines, the novel coronavirus, is a challenge and exercise of public health measures and effective governance like no other phenomenon in the 21st century.
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Management of ankylosing spondylitis; present concepts and guidelines
Ramaswamy Subramanian, Shiva Prasad
July-September 2020, 8(3):107-113
Ankylosing spondylitis (AS) belongs to spondyloarthritis (SpA) group of inflammatory arthritis, which has common genetic, clinical, and radiological features. The management aims at improving the quality of life, long-term control of inflammation so as to prevent structural damage, preserve functional abilities, and maintain the social life of patients. Treatment strategies and modalities in inflammatory arthritis have tremendously improved in recent times. With the discovery of molecular mechanisms, a new series of targets involving the cytokines, cells, and intracellular signaling pathways have been explored. The introduction of tumor necrosis factor inhibitor drugs heralded a new era of therapeutics for SpA, especially AS. Recently, the licensing of secukinumab, an interleukin 17A inhibitor for the treatment of AS, has given a new pathway to look at. These new targets give us an opportunity to achieve disease remission in both AS and nonradiologic axial SpA. They have also opened up new horizon to look for different research strategies in achieving disease remission using biological drugs in early disease and in stratified manner. International societies have been regularly providing and updating the guidelines for the management of AS. In this review, we discuss the treatment of AS and future trends in the management.
  5,037 362 -
Secondary hypokalemic periodic paralysis: A study of a case series
Vasantha Kamath, Shreyashi Ganguly, BL Avinash, V Vinodh
July-September 2019, 7(3):74-79
Background: Periodic paralysis is a group of heterogeneous disorders of different etiologies, with episodic, short-lived, and hyporeflexic skeletal muscle weakness, with or without myotonia. There is neither sensory deficit nor loss of consciousness. They can be familial (primary) or acquired (secondary). Secondary periodic paralysis is due to demonstrably known causes. The interictal potassium level is abnormal in these cases. Hypokalemic paralysis is more common than hyperkalemic. Materials and Methods: This is a prospective observational study elucidating the clinical profile of the cases of secondary hypokalaemic periodic paralysis seen in our care over a period of 14 months. Results: In this study, we present nine patients with hypokalemic periodic paralysis, in which four were diagnosed with thyrotoxicosis and five with dengue. They were given potassium correction under judicious cardiac monitoring. Antithyroid drugs and beta-blockers were used in thyrotoxicosis. Dengue patient received adequate fluid and antipyretic cover. All the patients made complete recovery, without any neurological sequelae. Conclusion: Secondary hypokalemic periodic paralysis should always be kept in mind as a differential in the setting of acute, painless, flaccid motor paralysis, especially in young patients with no significant family history or risk factors for stroke or Guillain–Barre Syndrome. A clinician must be aware of causes of secondary periodic paralysis as recognition and diagnosis can completely prevent further attacks of periodic paralysis. Routine estimation of thyroid levels should be the initial line of investigation even if features of thyrotoxicosis are absent. In the presence of acute febrile illness, ordering serology for dengue, after ruling out thyrotoxicosis, is the preferred approach in India.
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Association between serum cholinesterase levels and clinical outcome in patients of organophosphorus compound poisoning – One-year hospital-based longitudinal study
Veerappa Annasaheb Kothiwale, Vivek Veereshkumar Shirol, Viraj V Yerramalla, Vijayakumar G Somannavar
October-December 2019, 7(4):109-116
Background and Objectives: The activity of serum cholinesterase (SChE) decreases in organophosphate compound poisoning. This study was aimed to evaluate SChE levels as a prognostic marker for patients with organophosphorus (OP) poisoning. Materials and Methods: The present 1-year hospital-based longitudinal study was done on a total of 85 patients admitted with OP compound poisoning in the Department of Medicine, Hospital and Medical Research Centre, from January 2014 to December 2014. The estimation of pseudocholinesterase levels was done at the time of admission, on the 5th day and at the time of discharge. Results: Maximum number of cases had age <30 years (55.29%), and the mean age was 35.28 ± 15.34 years. There was male preponderance with a male to female ratio of 2.4:1. The most commonly consumed compound was malathion (24.71%). Majority of the patients (62.35%) presented after 3–6 h of consumption. The most common symptom was vomiting (87.06%), and peradeniya OP poisoning score revealed moderate intoxication in 58.82% of the patients. SChE levels were profoundly low (≤2500 U/L) in 62.35% of the patients at admission, 65.33% on 5th day, and 62.71% at the time of discharge. Acute renal failure was the most common complication, noted in 23.08% of the patients. Mortality was noted in 15.29% of the patients, and intermediate syndrome was the most common cause (30.77%). Conclusion: There is a positive association of SChE with hospital stay (1st day levels and serial estimation); requirement of ventilatory support (1st day levels); and outcome (serial estimation).
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Are periodic health checkups useful or necessary?
Vasantha Kamath, Shreyashi Ganguly
April-June 2020, 8(2):51-55
Much has been debated about routine periodic health screening in recent years. Those in favor of such screening of laboratory investigations point to the economic and social advantages of early detection and better diagnosis of disease to an individual and the community. The opponents of this type of blanket screening point to the dubious diagnostic value of many of the abnormal results found and the impracticability of making laboratory screening generally available even if it was shown to be of definite value. Despite contrary evidence, most primary care providers believe that an annual physical examination detects subclinical illness. This is partly driven and shaped by factors such as apparent perception of benefit, patient expectation, employer requirement, and insurance industry protocols. Healthcare institutions in India often offer structured health checkup “packages” for routine screening of common diseases. Some tests included within their ambit are in keeping with international and Indian recommendations; however, many are entirely unwarranted. Unnecessary and inappropriate screening tests cause financial and resource burden. Furthermore, there may be overdiagnosis and overtreatment, psychological distress due to false-positive test results, harm from invasive follow-up tests, and false reassurance due to false-negative test results. Evidence suggests that only certain diseases are amenable for screening in an asymptomatic adult. It is recommended that physicians should abandon recommending these general panels in favor of a more selective approach to prevent health problems individualized to every unique patient.
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Can waist circumference be a screening tool for obesity?
M Suresh Babu
January-March 2020, 8(1):2-3
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Hyponatremia: A clinician's perspective
Sudha Vidyasagar
July-September 2019, 7(3):62-68
Hyponatremia is a commonly encountered clinical problem by all physicians. It is classified according to volume status as hypovolemic, euvolemic, or hypervolemic hyponatremia. The clinical presentation depends on the type of hyponatremia and the speed of onset. Acute hyponatremias can result in altered sensorium, convulsions, and coma, making it a medical emergency. Chronic hyponatremias can be due to drugs and several systemic illnesses. The syndrome of inappropriate secretion of antidiuretic hormone is common and can occur in several diseases as euvolemic hyponatremia. Its onset can be deceptively slow but needs attention to prevent complications. Investigations of serum and urine, osmolality and sodium, help in classification of this condition. Apart from intravenous correction with hypertonic saline, which may be urgently needed in acute hyponatremia to prevent mortality, vaptans offer an oral option in chronic hyponatremia. Care must be taken to avoid rapid correction of serum sodium, to prevent osmotic demyelination syndrome.
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Organophosphorus compound poisoning: Hoping against hope to reduce morbidity and mortality
Y J Vishewshwara Reddy
October-December 2019, 7(4):100-102
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What's new in COVID-19?
Umar M M A Shareef, Vinod Kumar, Vasantha Kamath
January-March 2021, 9(1):29-37
COVID-19 has affected over 57,410,025 people and killed more than 1,368,848 of those affected in 220 countries as on November 20, 2020. Community-acquired coronaviruses are ubiquitous with a male preponderance. Unlike Western nations, majority of the cases in India are in the age group of 31–50 years, and the mortality rate is around 1.46%. The possible modes of transmission for severe acute respiratory syndrome coronavirus 2 include droplet, airborne, fomite, fecal-oral, bloodborne, mother-to-child, and animal-to-human transmission as per the World Health Organization. Apart from the known symptoms of influenza-like illness, COVID also presents with cutaneous, hematological, gastrointestinal, and neurological manifestations. In the absence of dedicated cures, until there is a hope of appropriate and effective vaccine development, the novel coronavirus will be a challenge to the existence of humanity.
  2,768 179 -
Co-infection of scrub typhus and COVID-19: A diagnostic challenge
Gautam Jesrani, Ankit Chhabra, Aman Garg, Amandeep Kaur, Monica Gupta
October-December 2021, 9(4):268-271
Scrub typhus is a bacterial disease, caused by Orientia tsutsugamushi and has widespread clinical presentations. Coronavirus-19 disease (COVID-19) is an ongoing pandemic, which can demonstrate clinical symptoms similar to the scrub typhus. Herein, we are describing two such cases of scrub typhus and COVID-19 co-infection. A 35-year-old male and a 42-year-old female presented with respiratory failure, for which COVID-19 was diagnosed, but both of them had persistent thrombocytopenia. The patients were investigated for other tropical co-infections and the diagnosis of scrub typhus was established in both of the cases. Doxycycline was added to their ongoing treatment, which led to an uneventful recovery. The cases highlight the importance of keeping a high index of suspicion of concurrent infection in the regions where seasonal tropical infections are endemic.
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A study of clinical and laboratory evaluation and outcome of patients with acute febrile illness with thrombocytopenia
S Sumangala, Sangram Biradar, Mohd Zeeshan Ali, Mushtaq Saudagar
July-September 2020, 8(3):121-127
Introduction: Fever with thrombocytopenia has become a common presenting problem. Infection is the main cause of thrombocytopenia. Fever with thrombocytopenia is frequently associated with an increased risk of morbidity and mortality. Infections such as malaria, dengue, enteric fever, and septicemia are some of the major causes of fever with thrombocytopenia in India. Aims and Objectives: To evaluate clinical profile of febrile thrombocytopenia, to identify different causes and the most common cause of febrile thrombocytopenia, and to assess the outcome and complications associated with febrile thrombocytopenia. Materials and Methods: A cross-sectional study of 160 patients was carried out at Basaveshwar Teaching and General Hospital. Patients with thrombocytopenia who were ≥18 years of age at admission between November 2016 and May 2018 were observed and followed up during their stay in hospital, diagnoses were made, and bleeding manifestations and requirement of platelet transfusion were also recorded. Results: Febrile thrombocytopenia affected all age groups ranging from 18 to 75 years of age but was common in 21–30 years of age group (40.60%), with a male-to-female ratio 57:43. Infection (88.12%) was the most common cause of thrombocytopenia, while dengue (53.13%) was the most common of the infections followed by malaria (15.63%) and septicemia (8.75%). Bleeding manifestations were seen in 33.13% of patients. 81% of the patients with bleeding tendencies had petechiae/purpura as the most common bleeding manifestation, followed by spontaneous bleeding in 54.70%. Melena (34.48%) was the most common among spontaneous bleeding. Bleeding manifestations were more common when the platelet counts were <20,000 cells/cumm. Good recovery was noted in 92.50%, while 5% had mortality and 2.50% cases were referred. Septicemia was the major cause of mortality. Conclusion: In our setup, infection such as dengue fever was the common cause of fever with thrombocytopenia followed by malaria and septicemia. In majority of patients, thrombocytopenia was transient and asymptomatic, but in significant number of cases, there were bleeding manifestations. On treating the specific cause, drastic improvement in the platelet count was noted. Mortality in febrile thrombocytopenia is not directly associated with degree of thrombocytopenia but with concomitant involvement of other organs, leading to multiorgan dysfunction.
  2,399 179 -
A comparative study of concurrent infections of rickettsial infection, Malaria, Typhoid, and Chikungunya with Dengue
Vasantha Kamath, Shreyashi Ganguly, BL Avinash
October-December 2019, 7(4):120-126
Introduction: In endemic countries such as India, the possibility that acute febrile illnesses are caused due to multiple infectious etiologies is not a rarity. In the postmonsoon season, dengue may often co-exist in the same patient concurrently with other infections such as scrub typhus, chikungunya, malaria, and typhoid. Materials and Methods: This is a prospective observational study aiming to understand the clinical and laboratory parameters and complications of concurrent infections such as typhoid, malaria, rickettsial infection, or chikungunya with dengue. Results: A total of 420 cases of dengue mono-infections were noted. Ninety-two of 512 patients with dengue were co-infected. The most common co-infection was dengue with rickettsiae (48.8%) followed by typhoid (22.2%). Rural, young, males were most affected by co-infections in contrast to mono-infections where rural and urban distribution is similar. The incidence of significant bleed increased in cases of malaria with dengue. Musculoskeletal, gastrointestinal, cardiac, and respiratory complications were seen in increased frequency in co-infections cases. Two deaths were noted in the co-infected groups of rickettsial diseases. Conclusion: The clinical picture and management of co-infected patients differ substantially from patients with mono-infections of dengue. Prompt recognition is necessary to allow the initiation of appropriate intervention in a timely manner. This excludes the possibility of increased morbidity and mortality, which is often avoidable.
  2,293 222 5
Coronavirus disease 2019 and the kidney
Ravi Jangamani, Chakravarthy Thirumal, Sankaran Sundar
October-December 2020, 8(4):172-178
Coronavirus disease 2019 (COVID-19) is a highly contagious infection caused by severe acute respiratory syndrome coronavirus-2, primarily manifesting as acute respiratory illness but can affect multiple organs. The COVID-19 individuals have varied renal manifestations which includes acute kidney injury, proteinuria, and hematuria. The involvement of kidneys indicates the severity of illness and is one of the determinants of mortality. The individuals with chronic kidney diseases (CKD), on dialysis and with kidney transplantation are at higher risk of severe COVID-19 infection due to the poor immune response and a high prevalence of comorbidities. Here, we review the effects of COVID-19 on kidneys and its management in CKD, dialysis, and kidney transplantation individuals.
  2,322 175 1
Impact of coronavirus disease-2019 pandemic on Hemodialysis care delivery pattern in Karnataka, India: A Cross-sectional, questionnaire-based survey
YJ Anupama, Arvind Conjeevaram, A Ravindra Prabhu, Manjunath Doshetty, Sanjay Srinivasa, Venkatesh Moger
January-March 2021, 9(1):4-9
Background: The coronavirus disease-2019 (COVID-19) pandemic has disrupted health-care delivery globally. Patients on in-center hemodialysis (HD) are particularly affected due to their multiple hospital visits and the need for uninterrupted care for their well-being and survival. We studied the impact of the pandemic and the national policy for pandemic control on the HD care delivery in Karnataka state in India in April 2020, when the first and second national lockdown were in place. Materials and Methods: An online, questionnaire-based survey of dialysis facilities was conducted, and the responses analyzed. The questions were pertaining to the key areas such as changes in a number of dialysis treatments, frequency, duration, expenses, transportation to and from dialysis units, impact on the availability of consumables, the effect on dialysis personnel, and on machine maintenance. Results: Sixty-two centers participated. Median of dialysis treatments for the months of March and April 2020 was 695.5 and 650, respectively. Reduction in dialysis treatments was noted in 29 (46.8%) facilities, decreased frequency reported by sixty centers. In at least 35 (56.5%) centers, dialysis patients had to bear increased expenses. Cost and availability of dialysis consumables were affected in 40 (64.5%) and 55 (88.7%) centers, respectively. Problems with transportation and movement restriction were the two key factors affecting both patients and dialysis facilities. Conclusions: This survey documents the collateral impact of COVID-19 on the vulnerable group of patients on HD, even when not affected by COVID. It identifies the key areas of challenges faced by the patients and the facilities and implores the care providers for finding newer avenues for mitigation of the problems.
  2,309 145 -
Biologics: A tectonic shift in the management of rheumatoid arthritis
Ramaswamy Subramanian, Shiva Prasad
October-December 2019, 7(4):103-108
Rheumatoid arthritis (RA) is a chronic inflammatory disease of the joints which if ongoing, has a significant bearing in the quality of life and has a variety of systemic manifestation which reduces the overall life span due to an ongoing inflammatory process. There has been a shift in the management of RA right from the early identification of the disease to targeting the pathogenic mechanisms. The changing modalities with emphasis on remission and low disease activity in early RA should be the primary goal. Disease control of RA with the use of combination synthetic disease modifying anti-rheumatic drugs or in combination with biological agents have improved disease-related outcomes. This prevents the progression of disease, morbidity, and has a significant bearing on the overall economic productivity of the patient and the society. Costs of the biological drugs is a major hurdle in their usage. Introduction of biosimilars have lead to a decrease in the cost of the biological molecules and hence their use becoming more widespread. The purpose of this review is to highlight the changing treatment modalities with the advent of biological disease modifiers in RA and a rationale for their use. The strategy in the treatment of RA should be goal directed rather than just relief of symptoms.
  2,087 198 -
A case of sentinel headache misdiagnosed: A catastrophe
Fida Hussain Mitha Bhai, Sangram Biradar
October-December 2019, 7(4):128-130
Headache is the main complaint in outpatients consulting the neurologist and of adult patients presenting to an emergency department (ED) complaining of a headache. About a quarter of all patients presenting to the ED with a sudden-onset severe headache, described as the “worst of their lives,” have a subarachnoid hemorrhage. Patients may report symptoms consistent with a minor hemorrhage such as mild headache before a major rupture, which has been called a sentinel headache. Hereby, we describe a case of warning headache, an underestimated diagnosis.
  1,975 152 -
Estimation of non-high-density lipoprotein cholesterol and its correlation as a surrogate measure of apolipoprotein B in patients with metabolic syndrome
KG Prakash, B Sumana, Abhiman B Shetty
April-June 2020, 8(2):60-64
Background: The primary target of therapy for dyslipidemia according to the present lipid guidelines is low-density lipoprotein cholesterol (LDL-C). Its main drawback is it is a derived value and erroneous values may be obtained if triglyceride values are high. Hence, direct measurement of apolipoprotein B (Apo-B), which is present in all atherogenic particles (very-LDL, intermediate-density lipoprotein, and LDL) would be ideal and is a superior indicator of cardiovascular risk. However, current limitations of Apo-B estimation are lack of standardization and lack of technical expertise and cost factor. To overcome these limitations, there is a need to test a particular lipid value from the standard lipid test, which can be used as a surrogate measure of Apo-B. As non-high-density lipoprotein cholesterol (HDL-C) is a measure of the cholesterol content of all Apo-B-containing lipoproteins, it may represent a simple and inexpensive surrogate to Apo-B in select patient subgroups. Hence, this study was undertaken to estimate non-HDL-C and LDL-C from the standard lipid test and also measure Apo-B levels in patients with metabolic syndrome using appropriate statistical methods, correlation and concordance between non-HDL-C versus Apo-B and LDL-C versus Apo-B were analyzed. Methodology: This was a cross-sectional study carried out in Bangalore on 135 patients of metabolic syndrome fulfilling the International Diabetes Federation criteria, from January 2019 to March 2019. Detailed history and examination was undertaken. Fasting blood glucose, Apo-B-100, and lipid profile were obtained in the fasting state venous blood sample. Results: A significant positive correlation was noted between non-HDL-C levels and Apo-B values with a correlation coefficient of 0.883 and area under the curve (AUC) of 0.972. In contrast, the correlation between LDL-C and Apo-B-100 showed a correlation coefficient of 0.815 and AUC of 0.949. Similarly, the concordance/discordance analysis of the same parameters showed concordance across the range of corresponding non-HDL-C and Apo-B quintiles except in the middle quintile where the values were discordant. Concordance was >50% across 80% of the range of values between LDL-C and non-HDL-C. Conclusion: This study showed that there is a good correlation between non-HDL-C levels and Apo-B values with less discordance. Hence, non-HDL-C can be used as a simple and cost-effective alternative (surrogate) to Apo-B estimation.
  1,957 167 -
A new era in the management of ischemic stroke: Advent of endovascular mechanical thrombectomy
Mithun G Sattur
April-June 2020, 8(2):56-59
Reduction in the mortality and disability resulting from acute ischemic stroke translates into restoration of blood flow to ischemic penumbra or tissue-at-risk. Reopening occluded large intracranial arteries is currently possible by timely institution of endovascular mechanical thrombectomy. In this topic, we discuss the physiologic basis of thrombectomy, technical steps and future directions in a concise yet eminently readable manner.
  1,959 129 -
Low-density lipoprotein cholesterol, non-high-density lipoprotein cholesterol, and apolipoprotein b for cardiovascular risk assessment – What is the right choice?
Shrikanth N Hegde
April-June 2020, 8(2):48-50
  1,876 177 -
An enigmatic case of pure neuritic leprosy with trophic ulcers
Mohd Zeeshan Ali, Sangram Biradar, S Sumangala
July-September 2019, 7(3):84-86
Leprosy is one of the most common diseases of peripheral nerves. In pure neuritic leprosy, skin along the distribution of the affected nerve is usually hypo-anesthetic or anesthetic, and as a rule, no classical leprosy skin lesions/patches should be present. However, depending on the severity of sensory and autonomic dysfunction, there could be a variable degree of hypo/anhidrosis, xerosis, fissuring, and ulcers along its distribution. Diagnosis of leprosy in the absence of typical dermatological features is difficult and requires histopathological confirmation using nerve biopsy. We report a case of leprosy with peripheral neuropathy without skin lesions. Nerve biopsy showed chronic inflammatory cell infiltration, epithelioid-cell granulomas, and the presence of Mycobacterium leprae on Modified Ziehl-Neelson stain. Hence, in leprosy prevalent countries like India, this form of leprosy should be thoroughly investigated, especially in patient without skin changes and presenting with trophic ulcers. It was a diagnostic challenge requiring high degree of clinical suspicion and thorough investigations.
  1,887 157 -
Pleural effusion - A radiological review
Raghavendra Bhat
January-March 2021, 9(1):58-61
Pleural effusion is a collection of fluid in the pleural cavity. Various types of pleural effusions are discussed with illustrations (8 images).
  1,921 97 -
Uncertainty in the time of Covid-19
BV Murali Mohan, George K Varghese
July-September 2020, 8(3):104-106
  1,864 150 -