International Journal of Research in Medical Sciences
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Role of advanced magnetic resonance imaging techniques in the evaluation of glioblastoma multiforme
Get PDFBackground: Glioblastoma multiforme (GBM) is the most common and aggressive primary brain tumor in adults, often presenting with nonspecific clinical and radiological features that complicate early diagnosis. Advanced magnetic resonance imaging (MRI) techniques, including diffusion-weighted imaging (DWI), gradient-echo (GRE) sequences and magnetic resonance spectroscopy (MRS), may enhance diagnostic accuracy beyond conventional MRI.
Methods: This cross-sectional study was conducted in the Department of Radiology and Imaging, Sir Salimullah Medical College and Mitford Hospital, Dhaka, in collaboration with Neurosurgery and Pathology departments, from January 2018 to December 2019. A total of 31 patients with clinically suspected GBM were enrolled using purposive sampling. All patients underwent advanced MRI protocols, including DWI, GRE and MRS. MRI findings were compared with histopathological diagnoses, considered the gold standard.
Results: The mean patient age was 52.1±11.2 years, with most cases (41.9%) in the 51–60-year group. On DWI, partially restricted diffusion was observed in 51.6% of lesions, particularly among GBM cases (54.1%). Blooming artifacts on GRE were seen in 41.9% overall, including 37.5% of GBM. MRS consistently showed elevated choline, lactate and choline/creatinine ratio with reduced NAA and creatinine. A choline/creatinine ratio >2.5 distinguished GBM and anaplastic astrocytoma, while metastases showed ratios <2.5. Compared with histopathology, MRI achieved a sensitivity of 95.6%, specificity 75.0%, accuracy 90.3%, PPV 91.6% and NPV 85.7%.
Conclusion: Advanced MRI techniques provide significant diagnostic value in differentiating GBM from other intracranial tumors, with high sensitivity and accuracy when correlated with histopathology
Prevalence of anemia in pregnant women and its association with birth outcomes in Bhimpur block, Betul district, Madhya Pradesh
Get PDFBackground: Anemia Pregnant is an important and widely public health issue in the world and a leading cause of maternal morbidity and poor birth outcomes especially in low resources and tribal nations.
Methods: The sampling was done in the Bhimpur block of Betul district, Madhya Pradesh wherein 300 pregnant women were selected, and the study was conducted to estimate the prevalence and severity of anemia as well as its relationship with low birth weight (LBW) and preterm birth as adverse pregnancy outcomes.
Results: The hemoglobin level was measured with the help of hemoglobin meter, and anemia was determined according to WHO classification. It has been found that anemia was prevalent (64.7%), and most of the cases were mild (38.3%), moderate (24.7%), and only a small proportion of severe cases was observed (1.7%). LBW was found (27.5%) in a higher rate of 39.2% in anemic mothers and 11.8% in non-anemic mothers (p < 0.001). Anemia also revealed a dose-response relationship, with the higher the anemia, the higher the number of preterm births (p = 0.004), i.e., it is also found to be significant between the anemic and non-anemic women, with preterm births being higher in the former.
Conclusions: The results indicate that a continuously high prevalence of anemia in tribal pregnant women and its close relationship with unfavorable perinatal outcomes. Enhancement of culturally sensitive nutrition education, antenatal care and program execution through such initiative as Anemia Mukt Bharat is essential in the enhancement of maternal and new-born health
Treatment of posttraumatic hemobilia in penetrating abdominal wound injury
Get PDFThis case report details a rare occurrence of traumatic hemobilia in a 29-year-old male following a penetrating stab wound to the abdomen. After initial surgical treatment, the patient developed severe right hypochondrial pain, prompting further investigation that revealed hemobilia. Magnetic resonance imaging (MRI) showed a blood-filled gallbladder and thrombotic masses obstructing the hepatic ducts, leading to a laparotomy that confirmed a liver wound with hemobilia. Postoperative complications included hemorrhagic drainage from the common bile duct, which was addressed through selective angiography that identified a false aneurysm in the liver artery. Successful angioembolization achieved hemostasis, allowing for a smooth recovery without further invasive procedures. This case highlights the effectiveness of X-ray endovascular methods in managing traumatic hemobilia, demonstrating their minimally invasive nature, quicker recovery times, and reduced complications. It advocates for the integration of endovascular techniques in complex trauma management to improve patient outcomes
Fine needle aspiration cytology of breast lumps: how reliable is it? A correlative study with histopathology
Get PDFBackground: Breast carcinoma is one of the most common malignancies in women. Palpable breast lesions are one of the commonest presentations in general and surgical practice. To study the spectrum of benign and malignant breast lesions and the efficacy of FNAC as a diagnostic tool by correlating with histopathological findings.
Methods: The present study was carried out among 250 patients who presented to ACPM medical college and hospital during a 5-year period from January 2018 to January 2023. All cases that presented with a palpable breast lump were evaluated with FNAC and the lesions were categorised as C1-C5 as per National Health Service Breast screening programme (NHSBSP) reporting criteria. Every patient subjected to FNAC with an adequate result, underwent a definitive surgical procedure. All specimens so obtained were subjected to histopathology. The results thus obtained were matched with those of FNAC and a correlation was sought based on statistical tests. In 243 cases cytohistopathological correlation was obtained.
Results: A total of 250 cases was studied which included 170 benign cases (68%), 52 malignant cases (20.8%), 21 proliferative lesions with atypia (8.4%) and 7 inadequate aspirates (2.8%). The diagnostic accuracy of FNAC in this study was 98.77%.
Conclusions: Aspiration cytology can be done as a first line procedure but cannot be considered as a substitute for histopathology
Association of achalasia and Down syndrome in an adult patient: a case report
Get PDFAchalasia is a rare primary esophageal motility disorder caused by degeneration of inhibitory neurons in the myenteric plexus, resulting in impaired lower esophageal sphincter (LES) relaxation and absent peristalsis. Adult-onset achalasia in individuals with Down syndrome is exceedingly uncommon and may be underrecognized due to subtle or atypical symptom expression. This case, reported adult with Down syndrome and achalasia, highlights the importance of early recognition and multidisciplinary care. We report a 63-year-old man with genetically confirmed Down syndrome presenting with progressive dysphagia to solids, postprandial regurgitation, intermittent retrosternal discomfort, and a 10 kg weight loss over six months. Oral intake was markedly restricted, and communication limitations hindered symptom reporting. Upper endoscopy revealed retained semi-solid food and resistance at the LES without mucosal lesions. High-resolution manometry (HRM) confirmed type II achalasia with 100% failed peristalsis and panesophageal pressurization. The patient underwent laparoscopic Heller myotomy with anterior (180°) Dor fundoplication. Intraoperative findings included tissue laxity, gastroesophageal junction fibrosis, and a 1.5 cm hiatal hernia, which was repaired. Recovery was uneventful. At one-year follow-up, the patient achieved complete resolution of dysphagia, normalized oral intake, sustained weight gain (BMI 17.8 to 23.1 kg/m²), and absence of reflux. Adult-onset achalasia in Down syndrome is rare but clinically significant. Diagnosis and timely laparoscopic intervention provide durable symptom relief and nutritional improvement. This case emphasizes the importance of clinical vigilance and multidisciplinary care for optimal outcomes in this population
Study of prevalence of depression, anxiety and sexual dysfunction in females attending infertility clinic
Get PDFBackground: Infertility is a significant social issue affecting individuals' personal, social, and mental health. Infertility can be caused by infection in the man or woman but often has no apparent underlying cause. The most common cause is ovulatory problems, while male infertility is most commonly due to semen deficiencies. The experience of infertility and its treatments can be highly stressful, affecting work, family, and relationships. It can also affect sexual self-esteem, desire, and performance, leading to depression and social isolation. So, we conducted this study to determine the prevalence of depression, anxiety and sexual dysfunction in females attending infertility clinics from July 2022 to December 2022.
Methods: This cross-sectional study included 100 females aged 18 to 45 years, who attended the infertility clinic at the obstetrics and gynaecology department of S.S.G. Hospital, Vadodara, from July to December 2022. Different diagnostic tools were used for depression, anxiety and sexual dysfunction, and the data were collected and analysed.
Results: According to the study, 44% of infertile patients suffered from depression, while 58% experienced anxiety. Depression was more common among people aged 23 to 27 years who lived in rural areas and had a lower socioeconomic position. Anxiety was more common among people aged 28 to 32 who lived in rural areas, had a poor level of education, and were unemployed. Furthermore, 54% of patients reported sexual dysfunction, which was more common in joint households.
Conclusions: This study concluded that the prevalence of depression and anxiety was 44%, and 58% in patients with infertility and sexual dysfunction was 54%
An incidental finding of splenic vein aneurysm in 59-year-old woman with systemic lupus erythematosus
Get PDFThis case report discusses a rare presentation of a splenic vein aneurysm (SVA) incidentally discovered in a 59-year-old female patient with a history of systemic lupus erythematosus (SLE), interstitial lung disease (ILD), and chronic liver disease (CLD). The patient presented with symptoms of cough and breathlessness, leading to an abdominal ultrasound, which revealed a cystic lesion in the distal pancreas with a venous waveform. Further evaluation through contrast-enhanced computed tomography (CECT) confirmed the diagnosis of SVA, showing a saccular outpouching from the splenic vein without thrombosis or extravasation. Given the patient’s asymptomatic status, conservative management and follow-up were advised. SVA is an uncommon entity with potential complications, including thrombosis and rupture. This report adds to the limited literature on SVA, particularly in patients with connective tissue disorders like SLE and conditions of portal hypertension. It underscores the need for further research to establish clearer guidelines for the management and treatment of such aneurysms.
Recurrent vulvar carcinoma - reconstruction options with review of literature
Get PDFVulvar cancer is a rare gynecological malignancy that can be aggressive and have a high rate of recurrence. The surgical management of recurrent vulvar cancer often involves wide local excision and the use of various reconstructive techniques to restore formal function. The keystone flap is a type of local tissue flap that has gained popularity in recent years due to its versatility and low complication rates. Our patients are elderly female who had previously undergone modified radical vulvectomy with bilateral inguinal femoral lymph nodal dissection for vulvar cancer. They presented symptoms and signs of recurrence and underwent wide local excision along with a keystone flap reconstruction. The postoperative course was uneventful, and the patient had no complications. Lotus petal suprafascial flap is a simple alternative procedure that can be done during the same surgery as the radical vulvectomy, improving the aesthetic results and reducing both the rate of complications and hospital stay. Soft tissue reconstruction in patients undergoing resection of recurrent vulvar malignancies is associated with a low rate of postoperative complications, decreased pain, and improved functional status
Uncommon cause of vertigo: Bow Hunter syndrome
Get PDFRotational vertebral artery syndrome, recognized as Bow Hunter syndrome (BHS), was a rare but potentially debilitating condition characterized with triggered vertigo, dizziness, and syncope. It results from dynamic vertebral artery (VA) stenosis due by compression from adjacent anatomical structures during specific neck movements. It may be easily overlooked even with the use of advanced imaging techniques because its symptoms closely resemble other episodic vestibular disorders, including benign paroxysmal positional vertigo. However, BHS may cause posterior circulation stroke. The only definitive diagnostic method for BHS is provocative neck movement testing, with provocative digital subtraction angiography (DSA) as the gold standard. A 61-year-old female had vertigo, dizziness, and presyncope which was triggered by rotating her neck to the left. Angiographic head-to-neck CT showed cervical spondylosis with osteophytes at C5-C6 vertebral level without any blood vessel abnormalities. Conventional DSA discovered hypoplastic right VA. Following provocative neck movement to the left, significant stenosis of left VA was detected. She was advised to immobilized her neck and consulted to neurosurgeons for the consideration of surgical decompression. Although rare, BHS should be considered as a potential cause of vertigo. Normal vascular assessment from ancillary tests did not rule out BHS. Recognizing BHS was crucial for its comprehensive evaluation of provocative physical examination to provocative DSA. Treatment options include neck immobilization, anticoagulation therapy, and surgical intervention, with or without dynamic intraoperative angiography
Efficacy of core stability exercises and short foot exercises in patellofemoral pain syndrome: a brief review
Get PDFPatellofemoral pain syndrome (PFPS) is one of the most common knee problems that disturb function and daily activities. Symptoms of PFPS can develop either slowly or abruptly and pain tends to worsen with activities such as squatting, prolonged sitting, stair climbing, jumping or running. Deficits in neuromuscular control of the core muscles and weakness of foot muscles have been associated with occurrence of PFPS. Physical therapy has got a profound role in treatment of patellofemoral pain syndrome patient. Strengthening of the core muscles must have rectified the improper recruitment of the muscles, in order to provide proximal stability, reported that improvement in core muscles could be an effective strategy in the rehabilitation of patients with PFPS. Aim of this review is to find out effect of core stabilization exercises and short foot exercises in patellofemoral pain syndrome. Following electronic databases MEDLINE, PubMed, Cochrane Library and one search engine (google scholar) were searched for literature between 2005 to 2023