International Journal of Research in Medical Sciences
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A case report of retroperitoneal dedifferentiated chondrosarcoma with femoral nerve involvement
Get PDFChondrosarcomas, a type of malignant bone tumour, are relatively rare and originate from cartilage producing cells. Dedifferentiated chondrosarcoma (DDCS), which makes up about 10% of all chondrosarcomas, is a rare and extremely aggressive subtype with high risk of metastasis. Here we report a case of 60-year-old lady with left lower abdomen lump of 10x10cm since 5months with normal gait, normal sensory, motor, spine and hip examination which shows no bony involvement in X-rays. On CECT and MRI there was large heterogenous enhancing soft tissue density mass lesion of size 11.7×10.9 cm with multiple coarse calcifications, without bone involvement. On Ultrasound guided core needle biopsy, it was found to be low grade chondrosarcoma. Patient was planned for wide local excision of tumor with adequate margins. Intraoperatively femoral nerve was seen passing inside the tumor which was resected and nerve repair done with sural nerve graft. In Post operative period patient had difficulty in extending left leg so knee gaiter was advised for support. After 6months follow up patient was seen healthy and walking without knee gaiter. Dedifferentiated chondrosarcoma (DDCS), which makes up about 10% of all chondrosarcomas, is a rare and extremely aggressive subtype. It is associated with high rates of metastasis and poor survival. Surgery is generally the standard of care for patients and adequate margins are recommended. Role of chemoradiotherapy is controversial. Surgery is the treatment of choice in dedifferentiated chondrosarcoma in patients with local disease with no metastasis
Post-duodenal polypectomy pancreatitis: an uncommon iatrogenic trigger
Get PDFAcute pancreatitis (AP) is a major cause of gastrointestinal-related admission in the United States, characterized by epigastric pain radiating to the back, and nausea and vomiting. Although commonly associated with alcohol consumption and gallstones, cases involving less frequent triggers, such as post-endoscopy, have been reported. We present an unusual case of post-polypectomy pancreatitis following esophagogastroduodenoscopy (EGD). A 20-year-old woman underwent polypectomy during a bariatric EGD screening procedure, resulting in a 2 mm non-bleeding pedunculated polyp's polypectomy from the second part of the duodenum. She experienced excruciating abdominal pain, nausea, and vomiting within an hour. Following an emergency evaluation, the diagnosis of acute pancreatitis was made; this was supported by increased lipase enzyme and physical manifestation. While AP tends to be triggered by well-known reasons, this particular case highlights a distinctive iatrogenic trigger-duodenal polypectomy. Only a handful of similar cases have been documented. The duodenum's peculiar proximity to important pancreatic structures may result in mechanical injury or heat-induced pancreatic damage. The management, similar to typical acute pancreatitis care, underscores the importance of supportive measures. This rare case of post-polypectomy pancreatitis emphasizes the risk of iatrogenic complications. Timely diagnosis and surveillance following procedures involving the duodenum can help with early diagnosis
An audit of hepatitis B vaccination status, knowledge and attitudes among healthcare professionals at northwest general hospital Peshawar
Get PDFBackground: This clinical audit assessed healthcare professionals’ (HCPs’) knowledge, awareness, and attitudes regarding hepatitis B vaccination at northwest general hospital Peshawar, Pakistan.
Methods: A self-administered questionnaire was distributed to HCPs (n=212) including doctors, nurses, pharmacists, technicians, and lab personnel. The questionnaire assessed demographics, vaccination status, knowledge of hepatitis B transmission and prevention, and attitudes towards the vaccine. Data was analyzed using descriptive statistics.
Results: The study found that while a majority of healthcare professionals (HCPs) were vaccinated against hepatitis B, many had not received the full recommended dose. Specifically, 84.9% of HCPs reported being vaccinated, but only 45.8% had received the full three doses. Despite a high perceived risk of exposure, only 24.5% of HCPs had participated in recent hepatitis B training. This suggested that there is a need for improved education and awareness programs regarding hepatitis B prevention among healthcare workers.
Conclusions: While a majority of HCPs reported being vaccinated against hepatitis B, knowledge about the complete vaccination schedule and the importance of training was limited. Efforts are needed to improve vaccination completion rates and address knowledge gaps through training programs
Comparison of incidence of acute kidney injury following percutaneous coronary intervention between transradial and transfemoral approaches
Get PDFBackground: Acute kidney injury (AKI) is a significant complication in percutaneous coronary intervention (PCI) patients. Periprocedural bleeding and vascular access site complications are emerging risk factors for post-PCI AKI. Recent studies suggest that transradial PCI has a lower incidence of AKI compared to transfemoral PCI, attributed to reduced vascular and bleeding complications. This study aimed to compare the incidence of acute kidney injury following PCI between transradial and transfemoral approaches.
Methods: This cross-sectional study included 200 ischemic heart disease patients who underwent percutaneous coronary intervention (PCI) via transradial access (TRA, n=98) or transfemoral access (TFA, n=102) from June 2018 to May 2019 at the National Institute of Cardiovascular Diseases (NICVD) Hospital, Dhaka, Bangladesh. Samples were selected purposively, and AKI incidence was assessed post-procedure through serum creatinine levels and urine output. Data analysis was performed using SPSS version 23.0.
Results: Demographic and risk factor variables were similar in both groups. Compared to transfemoral approaches (TFA), transradial approaches (TRA) resulted in significantly fewer major bleeding events (0% vs. 4%, p=0.04) and vascular access site complications (p=0.04). TRA was also associated with a lower incidence of AKI post-PCI (2% vs. 8.8%, p=0.03). Multivariate logistic regression identified transfemoral access as the strongest predictor of AKI after PCI (p=0.001).
Conclusions: The transradial approach is associated with a lower incidence of acute kidney injury (AKI) following percutaneous coronary intervention (PCI) compared to the femoral approach
PLA2-R positive primary membranous nephropathy: a case report
Get PDFMembranous nephropathy (MN) is a significant cause of nephrotic syndrome in adults, often linked to the presence of circulating antibodies against phospholipase A2 receptor (PLA2R). This case report details the clinical presentation, diagnostic process, treatment, and outcomes of a patient diagnosed with PLA2R-positive membranous nephropathy. The report highlights the importance of early diagnosis and personalized treatment strategies, demonstrating the evolving landscape of MN management. A brief review of the literature related to the topic is also presented. For this purpose, a search was made in freely accessible sources, selecting those with the most relevant and up-to-date information
Russell’s viper venom induced reverse takotsubo cardiomyopathy
Get PDFReverse takotsubo cardiomyopathy is a rare variant of takotsubo cardiomyopathy characterized by basal akinesis/hypokinesis associated with apical hyperkinesis, with no evident obstructive coronary artery disease, which often resolves spontaneously. This condition was observed in a 15-year-old girl after being bitten by Russell’s viper. She presented with pain and swelling at the bitten area. Further evaluation, showed elevated cardiac biomarkers, ECG showed ST-segment changes and echocardiographic findings of basal akinesis with preserved apical function. After receiving anti-snake venom and supportive care treatment, she fully recovered and her cardiac function returned to normal. This case emphasizes the significance of assessing the heart in situations of viper bites among patients.
Demographic and clinical profile of amblyopia in paediatric age group at a tertiary care centre in northern India
Get PDFBackground: Amblyopia, also referred to as "lazy eye," is one of the most common leading causes of monocular visual impairments among children around the world. This study was aimed to study the demographic profile, type and treatment outcome of amblyopia in children visiting a tertiary care centre in Northern India.
Methods: A retrospective observational study was conducted on 250 children between the ages of 3-18 years, diagnosed with amblyopia between 2020-2024 in GMC, Jammu. A patient register was developed, comprising patient’s name, age, gender, type of amblyopia and treatment outcome. The data were analysed using descriptive statistics and chi-square tests.
Results: Most cases (76%) were diagnosed in children aged 3-10 years, with a male predominance (64.8%). The most common type was refractive amblyopia (48%) followed by strabismic (32%) and deprivation amblyopia (20%). Astigmatism was the most common refractive error (58.3%). Outcomes of treatment were reported, improved in 72% of cases, non-improved in 20%, and non-applicable in 8% of patients.
Conclusions: Amblyopia is best addressed when detected early enough. Amblyopia burden can be significantly reduced by integrating school-based vision screening programs and addressing socio-cultural barriers. More population-based studies are needed to explore its prevalence and accompanying determinants in different contexts
Pityriasis rubra pilaris and HIV: a diagnostic challenge-case report and critical review of the literature
Get PDFPityriasis rubra pilaris (PRP) is a rare cutaneous disorder characterized by hyperkeratotic follicular papules and palmoplantar keratoderma. Its clinical presentation ranges from mild to severe forms, including erythroderma. There are six types of PRP. Type VI is associated with HIV, presenting with a more severe and challenging course. This variant can occur in HIV-positive patients regardless of their CD4 T cell count. This article provides a detailed review of the pathogenesis, clinical characteristics, diagnosis, differential diagnosis and therapeutic options of PRP, with an emphasis on its HIV-associated form. An illustrative clinical case is presented, analyzing the underlying pathogenesis and treatments used. Furthermore, these findings are compared with those reported in the literature to provide a broader perspective on how this disease affects immunocompromised patients.
Evaluation of functional magnetic resonance imaging in the identification of presurgical epileptic zones comparison between conventional and advanced techniques in patients with drug-refractory epilepsy: a systematic review
Get PDFDrug-refractory epilepsy (DRE) is a significant clinical challenge when conventional treatments are ineffective. Localization of epileptic zones is essential for successful surgery but conventional techniques such as scalp EEG, PET and structural MRI are usually ineffective, particularly in MRI-negative cases. Functional MRI (fMRI) has emerged as a valuable tool for presurgical assessment by offering information on seizure networks and functional connectivity. This systematic review evaluates the efficacy of traditional and novel fMRI methods in identifying epileptogenic areas and enhancing surgical outcomes. Traditional fMRI with task-based paradigms assists in mapping cerebral functions but is constrained by patient compliance and inability to detect deeply seated foci. Novel techniques like resting-state fMRI (rs-fMRI) EEG-fMRI fusion and analysis aided by AI provide greater spatial and temporal resolution for better epileptic network localisation. These methods are of use for MRI-negative patients and those patients with motor or cognitive deficits. Advanced fMRI techniques, though, require a lot of computational power and skill which can limit their application. Through consideration of the literature, this paper indicates the advantages and limitations of each technique and emphasizes the value of the integration of multiple methods to enhance presurgical planning. The results indicate that improved fMRI techniques have the potential to increase the success of surgery and enhance patients' quality of life with DRE. The research should further improve these techniques so that they are more accessible and feasible for use in clinics
A journey through the history and future of cadavers in anatomy education
Get PDFThis article traces the development of cadavers in anatomy education from ancient times to contemporary advances, analyzing both their historical significance and future potential. It utilizes academic databases and libraries to find relevant literature, including PubMed, Google Scholar, JSTOR, and Web of Science. Specific keywords and phrases such as “history of cadaver use in medicine,” “anatomical dissection history,” “ethical issues in cadaver studies,” “historical practices of dissection,” and “evolution of medical practices with cadavers” were used to search for relevant articles. We selected articles that are directly related to the history of cadavers in medicine and that provide historical context, ethical discussions, and notable practices, while excluding those that are unrelated. The use of cadavers for dissection in medical teaching dates back to ancient Egyptian, Indian, Greek, and Roman traditions. The Renaissance saw a revival of anatomical studies despite ethical debates and restrictions, particularly during the Middle Ages, with figures such as Andreas Vesalius redefining the field. Advances in cadaver preservation techniques, including plastination and embalming, have improved quality and durability. However, the use of formalin raised health concerns, leading to the search for safer alternatives. Emerging technologies such as virtual reality (VR), augmented reality (AR), and 3D printing are revolutionizing anatomy education by providing interactive, practical, and ethically sound teaching resources. The article anticipates a future shaped by technological advances while acknowledging the enduring impact of cadavers in medical education