Atharva Scientific Publications (E-Jounals)
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Role of imaging in neonatal Chikungunya encephalitis acquired by vertical transmission
Get PDFBackground: Chikungunya is a viral infection which usually manifests as fever, rash, and arthralgia. Neurological complications are rare but are increasingly been seen in children and adults in endemic countries like India. Vertical transmission is seen in neonates with mothers who have been infected with the virus in the antenatal period. Objective: The objective of the study was to identify the essential role of imaging in the workup of these neonates, especially magnetic resonance imaging (MRI). Methods: A retrospective descriptive analysis of 10 neonates presenting with hypoactivity, maculopapular rash, and fever progressing to generalized seizures, and apnea suggestive of encephalitis was done. Chikungunya was confirmed by serum IgM CHICK enzyme-linked immune sorbent assay. Imaging evaluation included neurosonogram, computed tomography, and MRI with diffusion-weighted sequence with follow-up imaging at 1–3 months. Results: All the neonates had encephalopathy (100%) with or without seizures and perioral rashes. Cerebrospinal fluid showed mononuclear pleocytosis, raised protein or hypoglycorrhachia in 75% cases. Bacterial markers including cultures were negative. MRI showed features of viral encephalitis involving frontoparietal subcortical and deep white matter and corpus callosum with restricted diffusion. Neurocognitive outcomes in these neonates revealed neurodevelopmental delays for which follow-up MRI imaging was important, revealing reversal in diffusion changes, cystic encephalomalacia, and diffuse cerebral atrophy. Conclusion: In countries like India, experiencing annual outbreaks of Chikungunya infections radiologists must be familiar with the neuroimaging features and its possible sequelae
Meleney’s gangrene with superadded aspergillosis: Case report of a rare but fatal surgical complication
Get PDFMeleney’s ulcer or post-operative synergistic bacterial gangrene is a rare form of necrotizing infection of the abdominal wall which develops following intra-abdominal surgery. If not promptly identified and treated, it can lead to extensive gangrene leading to fatal complications. We report a case of Meleney’s gangrene with superadded aspergillosis which rapidly progressed to gangrene of a large area of the anterior abdominal wall leading to mortality of the patient. We also discuss the difficulties in the management of such cases highlighting the need of early and aggressive debridement besides other measures
Dermatofibrosarcoma protuberans of breast - A case report
Get PDFDermatofibrosarcoma protuberans (DFSP) is best regarded as well differentiated, primary fibrosarcoma of skin. It is an uncommon, slow growing, locally aggressive, and reoccurring but rarely metastasizing tumor of the deep dermis and subcutaneous tissue. Clinically they present as firm solid nodules that arise most frequently on trunk and extremities. DFSP of the breast has been rarely reported. Here, we report a rare case of DFSP of the breast in 47-year-old woman
Erythema nodosum and reactive arthritis accompanying tuberculosis: A case report
Get PDFErythema nodosum (EN) is the most common panniculitis, appearing as crops of erythematous nodules located symmetrically on the anterior aspect of lower extremities. It is precipitated by several infectious and non-infectious causes with primary tuberculosis (TB) being its most common cause in developing countries. Reactive arthritis associated with TB is known a
Splenic abscess and perisplenic hematoma complicating Osler
Get PDFA 52-year-old diabetic gentleman was referred to our center with a 3-week history of fever, left-sided abdominal pain, and progressive breathlessness. He also had history of recurrent epistaxis since childhood. Contrast-enhanced computerized tomography chest and abdomen revealed a splenic abscess, left pulmonary arteriovenous malformation, and left pleural effusion. He was managed conservatively with intravenous antibiotics and an antifungal. A repeat imaging was done after 3 weeks which showed resolution of abscess but an increase in the size of the perisplenic hematoma. An ultrasound guided pigtail catheter was inserted into the peri-splenic hematoma and it was drained. He had also developed an acute cerebellar infarct detected on magnetic resonance imaging of brain, which also showed other chronic infarcts of varying age. A diagnostic nasal endoscopy revealed multiple telangiectasias, and Osle
Painful finger, diagnosis and surgical management: Clinical puzzle
Get PDFIt is really very difficult to live with a painful finger. Here, we are discussing a case who presented with a complaint of severe lancinating pain in her left index finger for about 7 years. This pain was so distressing to her that she was requesting for the amputation of her finger. Being a reconstructive surgeon, it was really very difficult to fulfill her wish. In the past 7 years, she consulted to several practitioners but did not get relief of her pain. Clinical suspicion of Glomus tumor was made and magnetic resonance imaging was done to confirm the diagnosis. Surgical excision of the swelling was done, and the patient was completely relieved of her pain
Tumor-related denervation pseudohypertrophy of the tongue: A clinical entity in disguise!
Get PDFIsolated hypoglossal nerve palsy in the base of tongue carcinomas is seldom noticed. The clinical signs are subtle in early stageand can often be overlooked. There may be slight tongue deviation to the affected side, and the tongue feels soft and edematouson careful palpation. There may be associated enlargement of the affected side of the tongue known as “pseudo hypertrophy” dueto denervation of its motor supply. Contrast-enhanced magnetic resonance imaging is the gold standard of diagnosis which showsdiffuse fatty changes in the affected half of tongue with the preservation of architecture. Clinicians need to be aware of this clinicalentity to distinguish it from actual tumor invasion
Phototherapy induced hypocalcemia in neonates: A case
Get PDFObjective: The objective of the study was to evaluate the adverse effects of phototherapy both total and ionic calcium levels in neonates. Methods: A case–control prospective study was conducted in the Department of Pediatrics, over a period of 15 months. All neonates preterm or term with icterus in phototherapy range formed the study group(s). Serum calcium total and ionized were measured on a serial basis. Results: Neonates in the study group had significant fall in total serum calcium after phototherapy (0.94±0.49 mg/dl). Similarly, ionized serum calcium also decreased after phototherapy in study group (0.56±0.36 mg/dl), p<0.001 statistically significant. The overall incidence of hypocalcemia was 9.6%, higher in preterm (11.7%) than term (8.5%) neonates. Jitteriness and irritability both were seen in 25% of the neonates. None of the neonate had convulsion, but it may occur if the level falls further. Conclusions: While giving phototherapy to a premature baby or a sick baby we should monitor serum calcium levels. Prophylactically oral supplementation of calcium may be considered in newborns receiving phototherapy as it induces hypocalcemia
Unintentional home injuries among children aged 1–9 years in slums of Burdwan Municipality, West Bengal: A cross-sectional study
Get PDFContext: Unintentional home injuries result in morbidities among children. Aims: This study aimed to find out the prevalence and patterns of unintentional home injuries among children aged 1–9 years, in slums of Burdwan Municipality; to determine an association of various sociodemographic factors with such injuries; and to assess known risk factors for unintentional injuries. Settings and Design: This community-based cross-sectional study was conducted in three randomly selected slums of Burdwan Municipality, West Bengal. Materials and Methods: The study was conducted during July–November 2017 among 219 children aged 1–9 years residing in the study area. Data were collected at the household level by interviewing the respondents, record review, and observation. The occurrence of any unintentional home injury during the last 1 year was considered to estimate period prevalence. Results: Overall prevalence of unintentional home injury was 19.6%; with 20.8% and 18.6% among girls and boys, respectively. Mean episode of injuries was 0.37±0.9 in a year. Majority of injury episodes were cut by fall (73.2%), affected ankle and foot (44%), and occurred in the living room (84.1%) and while playing (98.8%). Overcrowding (82.2%), access to sharps in the kitchen (59.4%), and sharp objects within reach in living rooms (44.7%) were the prevalent known risk factors at the households. Conclusions: Unintentional home injuries among children are substantially high in the area with some of theprevalent risk factors. Intensive health education activities for mothers and awareness campaigns for preventive measures need to be implemented.Context: Unintentional home injuries result in morbidities among children. Aims: This study aimed to find out the prevalence and patterns of unintentional home injuries among children aged 1–9 years, in slums of Burdwan Municipality; to determine an association of various sociodemographic factors with such injuries; and to assess known risk factors for unintentional injuries.Settings and Design: This community-based cross-sectional study was conducted in three randomly selected slums of Burdwan Municipality, West Bengal. Materials and Methods: The study was conducted during July–November 2017 among 219 children aged 1–9 years residing in the study area. Data were collected at the household level by interviewing the respondents, record review, and observation. The occurrence of any unintentional home injury during the last 1 year was considered to estimate period prevalence. Results: Overall prevalence of unintentional home injury was 19.6%; with 20.8% and 18.6% among girls and boys, respectively. Mean episode of injuries was 0.37±0.9 in a year. Majority of injury episodes were cut by fall (73.2%), affected ankle and foot (44%), and occurred in the living room (84.1%) and while playing (98.8%). Overcrowding (82.2%), access to sharps in the kitchen (59.4%), and sharp objects within reach in living rooms (44.7%) were the prevalent known risk factors at the households. Conclusions: Unintentional home injuries among children are substantially high in the area with some of the prevalent risk factors. Intensive health education activities for mothers and awareness campaigns for preventive measures need to be implemented
Cerebrospinal fluid C-reactive protein - A point of care test in the diagnosis of bacterial meningitis
Get PDFBackground: Bacterial meningitis is a significant life-threatening illness during infancy and childhood. Delay in distinguishing bacterial from viral or other aseptic meningoencephalitis may have irrevocable consequences. A typical case of pyogenic meningitis without prior antibiotics may not create any diagnostic problems, but prior treatment with inappropriate and inadequate antibiotics may cause sufficient alteration in biochemistry and cytology of cerebrospinal fluid (CSF), and organisms may not get isolated from blood or CSF culture. Objective: C-reactive protein in CSF (CSF-CRP) has been reported to be one of the most reliable and early indices to differentiate bacterial from non-bacterial meningitis. This study was undertaken to evaluate the diagnostic significance of CSF- CRP as an early indicator in the differentiation of bacterial from non-bacterial meningitis. Materials and Methods: This descriptive study was done in children in the age group of 1 month to 12 years who were admitted with history and clinical features suggestive of acute central nervous system infection. CSF was analyzed for macroscopic appearance, pleocytosis, proteins, and sugar content, Grams and Zieh