Indian Journal of Neonatal Medicine & Research

Post-Operative Outcome of Closed Reduction of Fracture Nasal Bone

Krishna Prasad Koirala, Vishal sharma

Introduction: Nose is the central part of face with special aesthetic value. It is commonly fractured in facial trauma. Most of the fractures are corrected by closed reduction. Aim: To assess the patient’s satisfaction following closed reduction of fracture nasal bone both in aesthetic and functional values. Materials and Methods: Retrospective chart review of patients with fracture nasal bone presenting to Manipal Teaching Hospital between 2012 October to 2015 March was performed. Manipulation was carried out with instrumentation under general anesthesia. Patients who had come for regular follow-up for at least two months were enrolled in the study. Their functional and aesthetic outcomes were assessed. Results: Out of 64 patients analyzed, 54 patients were satisfied in terms of facial aesthetics and 60 patients were satisfied with the functional outcome of the surgery. Conclusion: Patients treated with closed reduction of fracture nasal bone had moderate levels of aesthetic and high levels of functional satisfaction.

Cerebral Venous Sinus Thrombosis: An Institutional Experience

Saurabh Arora, Hanish Bansal, Sandeep Puri, Rajinder Bansal, Chetan Wadhwa

Introduction: Cerebral venous thrombosis (thrombosis of cerebral veins and sinuses) accounting for 0.5% of all strokes has a variable clinical presentation making early diagnosis difficult. A number of prothrombotic states have been implicated in causation of cerebral venous sinus thrombosis. Anticoagulation with intravenous heparin followed by warfarin for 3-6 months is currently recommended for majority of cases, even in the presence of mild or moderate hemorrhagic transformation. This may need to be continued for longer in some patients who have underlying prothrombotic states. Aim: To study clinical profile and outcome of patients of cerebral venous sinus thrombosis admitted in a tertiary care hospital in northern India. Materials and Methods: The study was carried out in a tertiary care hospital where all patients of cerebral venous thrombosis admitted between 1st January 2005 and 31st December, 2008 (retrospective) and between 1st January 2009 and 30th June 2010 (prospective) were included in the study. The enrolled patients were studied for their demographic profile and complete history was taken. Patients were followed up for minimum period of 6 months and outcome was assessed on basis of morbidity and mortality on follow-up. Results: A total of 46 patients of cerebral venous sinus thrombosis were included in the study. The mean age of the patients was 35.5 years. Out of 25 female patients in the study group, 8 female patients (32%) had puerperium as risk factor and 4 patients (16%) had oral contraceptive use as risk factor. Most common symptom was headache which was present in 41 patients comprising 89.1% of total patients. 39 patients (84.8%) were alive at the end of follow-up and 7 patients died (15.2%). Out of 39 patients who survived, 31 cases (79.4%) had no disability symptoms, 5 patients had mild disability (13%) and 3 patients had moderate disability at six months of follow-up. Conclusion: The recent advances in early diagnosis and prompt management of cerebral venous thrombosis have significantly improved its outcome with markedly decreased morbidity and mortality. The role of endovascular thrombolysis and decompressive craniectomy in the management of severe cerebral venous thrombosis cases remain to be defined. Cerebral venous sinus thrombosis is a clinical entity with a low risk of death and good long-term prognosis in modern era.

To Study the Utility of Intra Operative Parathyroid Hormone Levels in Management of Primary Hyperparathyroidism

Munish Trehan, Nikhil Garg, Anuj Mahajan, Parminder Singh, Jaspal Singh

Introduction: Treatment of primary hyperparathyroidism, caused by single adenoma in atleast 80% of the cases, has undergone a change from traditional bilateral neck exploration to minimal invasive parathyroidectomy. With proper preoperative workup and intraoperative parathyroid monitoring, majority of patients can be successfully treated by minimally invasive parathyroidectomy. Aim: To compare the sensitivity of preoperative radiological investigation with IOPM to successfully diagnose the site of lesion. Materials and Methods: We conducted a retrospective review of 50 cases of primary hyperparathyroidism at our institute for a period of 4 years. The lesion was preoperatively localized with the help of diagnostic modalities such as USG neck, Sestamibi scan or CT neck. Intraoperative PTH level monitoring was done as per the decision of the operating surgeon. Results: A total of 50 parathyroidectomies were performed. 76% of the patients were female with the patients in the age range of 15 to 85 years. The findings of USG neck and Sestamibi scan were concordant in 88% cases.In the rest 12% of the patients USG and sestamibi scans were discordant and Intra operative PTH monitoring was helpful in performing minimally invasive parathyroidectomy. Intraoperative PTH monitoring was done in 52% of the patients. Only one patient had to undergo a bilateral neck exploration, following minimal invasive procedure. Except this case there was no intra-operative or post operative complication. Conclusion: Excellent results are achievable with minimal invasive parathyroidectomy. Preoperative localization is paramount before taking up the patient for this procedure. We recommend minimally invasive surgery as the procedure of choice in patients with concordant findings of USG neck and Sestamibi scan.

Biological Reference Interval for Hematological Profile of Umbilical Cord Blood: A Study Conducted at A Tertiary Care Centre in South India

Introduction: Umbilical cord blood (UCB) a source of hematopoietic stem cells, is also an acceptable sample to assess neonatal sepsis. Though reports are available for stem cell counts very minimal literature is available regarding hematologic parameters, which may vary on ethnicity. Aim: To establish biological reference interval for hematological parameters of umbilical cord blood to guide neonatologists, hematopoietic stem cell transplant specialists and future analysis. Materials and Methods: Prospective longitudinal study was done from January 2014 to April 2014 after ethics committee approval. UCB from 120 full term new borns of normal birth weight born out of uneventful pregnancy to mothers aged between 21 to 45 years with hemoglobin above 10g/dL were processed in Beckman Coulter LH780 analyzer for complete blood count and counter checked by peripheral smear. Results tabulated in Microsoft excel are analyzed using IBM SPSS statistics 16 software. Results: Male to female ratio is 1:1.05. There is no difference in the values between males and females. When compared with few studies available, though many values are comparable a few values are not comparable. Conclusion: This study can be a useful guide to neonatologists, hematopoietic stem cells transplant hematologists and future analysis.

SNAPPE-II (Score for Neonatal Acute Physiology with Perinatal Extension-II) in Predicting Mortality and Morbidity in NICU

Shivanna Sree Harsha, Banur Raju Archana

Introduction: A number of illness severity scores have evolved which would predict mortality and morbidity in intensive care units. One such scoring system developed by Richardson etal in 1998 was SNAPPE-II (Score for Neonatal Acute Physiology with Perinatal extension-II). Aim: The present study was conducted to assess the validity of SNAPPE-II score as a predictor of mortality and morbidity. Materials and Methods: A total of 248 neonates who met the inclusion criteria were included in the study and SNAPPE-II score was calculated. Receiver Operating Characteristic (ROC) curve was constructed to derive the best cut-off score and SPSS package (Statistical Package for the Social Sciences) was used for statistical analysis. Results: SNAPPE-II score was higher among expired neonates compared to survived ones. A mean score of 37 was associated with higher mortality. However, it didn’t accurately predict the length of stay. Conclusion: SNAPPE II score is a better predictor of mortality irrespective of gestational ages and it is not a good predictor of morbidity.

Doctors in the Making: How Aware are They About Eye Donation

Introduction: A significant cause of visual impairment in the developing world is corneal blindness which may be reversed successfully by transplantation. The availability of corneas transplantation however, is way less than the actual requirement in India. Aim: To assess the knowledge of medical students regarding the eye donation. Settings and Design: Questionnaire based cross-sectional study. Materials and Methods: One hundred and twenty six newly enrolled medical students in age group 17-23 years were made to answer a pre tested semi-structured questionnaire on eye donation. Questions were based on testing their knowledge as well as their views towards eye donation. Statistical Analysis was done using SPSS 22 Results: It was observed that a majority (70.63%) of the students, though willing to pledge their eyes, were unaware of the technicalities and held a lot of misconceptions. Mass media was revealed to be the main informant. Many, however did not wish to pledge their eyes due to religious and social beliefs. Conclusion: Even though medical students were aware about eye donation and corneal transplantation, there were many lacunae and misconceptions which need to be refined and cleared to enhance their knowledge and hence increase the number of eye donations in our country.

Anatomical Study and Clinical Considerations of Greater Palatine Foramen in Adult Human Skulls of North Indian Population

Introduction : The knowledge of position of greater palatine foramen is fundamental in oral surgery interventions because the neurovascular bundle, greater palatine nerve and vessels emerge through it and can be principally assessed here for performing anaesthetic techniques for desensitization of the hard palate or harvesting a gingival mucoperiosteal graft. Aim : The present study was carried out to identify the morphological shape, position and location of greater palatine foramen and the direction of greater palatine foramen in adult human skulls. Materials and Methods: The location of the greater palatine foramen in relation to 3rd molar along with shape and direction of the opening on palate was observed in 50 (25 males and 25 females) adult human dry skulls of North Indian population. The perpendicular distance of GPF from mid-maxillary suture and posterior border of hard palate was also measured on both sides. Measurements were done with vernier caliper. Results: The mean distance of the greater palatine foramen from palatine suture was 13.38 mm while the mean distance from posterior border of hard palate was 3.36 mm. There was no statistically significant difference between male and female skulls as well as right and left sides. Conclusion: It was concluded that the 3rd molar can be taken as a reliable landmark for locating greater palatine foramen and in cases of unerupted 3rd molar, palatine suture and posterior border of hard palate can be used as standard landmarks for this purpose.

Differentiating Benign and Malignant Metastatic Cervical Lymph Nodes by Diffusion Weighted MRI Sequence

Pratap Singh H.Parihar, Varun Goel

Introduction: The metastasis to the regional cervical lymph nodes is associated with an increase in nuclear to cytoplasmic ratio leading to reduction in water diffusivity and micro circulation of the node. Aim: To analyze the potential role of diffusion-weighted imaging to differentiate benign and malignant lymph nodes in oral squamous cell carcinoma. Materials and Methods: The diffusion-weighted imaging, T1 and T2-weighted MR sequences were performed on biopsy proven squamous cell carcinomas(47 cases) involving oral tongue and/or gingivo-buccal region with cervical lymphadenopathy. The apparent diffusion coefficient [ADC] was measured by using two b factors (500 and 1000 s/mm2). Results: On diffusion images, 26/47 patients with malignant lymph nodes showed restricted diffusion on DWI with low signal intensity on ADC maps. Whereas all patients with benign nodes showed no restricted diffusion.The ADC was significantly greater in metastatic lymph nodes [0.82×10-3mm2/s, p< 0.01] than in benign lymphadenopathy [1.21×10-3mm2/s] Conclusion: Diffusion-weighted imaging helps in discriminating malignant from benign lymph nodes resulting from oral cavity squamous cell carcinomas. A minimum threshold value of ADC should be kept in mind to identify malignant lymph nodes after taking an appropriate region of interest.

Effect of Intervention on Awareness of Appropriate Infant Feeding Practices Among Undergraduate Women Students in an Urban and Taluka Area of Karnataka State in India

Introduction: Awareness of advantages of breast feeding and infant feeding practices among young women would help in optimal feeding of future children. Aim: To assess the awareness and to determine the effect of intervention on the knowledge of infant feeding practices among undergraduate women students in an urban and taluka area of Karnataka state in India. Materials and Methods: An interventional study was conducted among 634 females in final year of college of an urban and taluka area. Their knowledge of breastfeeding and infant feeding was assessed followed by an interactive session on the advantages of breastfeeding and appropriate feeding of infants. A follow-up assessment of their knowledge was done after two weeks. Results: We observed that the mean scores among the students improved from mean of 21.23 (S D ± 4.19) to mean of 30.37 (S D ± 3.42) after the intervention and this difference was found to be statistically significant p < 0.001. The domain wise scores also showed improvement except among taluka students in domain related to initiation of feeds. Conclusion: Knowledge regarding infant feeding practices among young women in college is inadequate. This can be improved in a significant way by including a health educational session on the same.

A Case of Radial Nerve Schwannoma

affee asma, Anandi andappan, Choundappan Madhavan

Schwannoma are the most common peripheral nerve sheath tumors in adults. They are the benign tumours arising from the Schwann cells. However, radial nerve is uncommonly involved. We are presenting this case for its rarity. We report a 35 years old female who presented with a painless lump in the right forearm. Radiological investigations showed it was a schwannoma arising from the radial nerve. We excised the tumour, and there was no postoperative nerve paresis. The histopathology confirmed that it was a schwannoma. Surgical excision is the treatment and various factors contribute to the avoidance of postoperative nerve palsies.

Formation of A Vesical Calculus Over A Migrated IUCD: A Case Report

Pulkit Sethi, Chiranjiv Singh Gill, Anuj Mahajan

Intrauterine contraceptive device (IUCD) has been one of the most common methods of contraception by women over 3 decades. IUCD is still the most common method of contraception amongst women in remote areas where adequate pharmaceutical aids like contraceptive pills and vaginal condoms donot reach common women owing to social and economic barriers. Uterine perforation due to an IUCD is very rare, having an incidence of 0.04% to 2.8 %. We report such a case of vesical calculus formed over a migrated IUCD, whose tail was identified as a nidus intraoperatively.

Osteopetrosis with Typical Radiological Findings: Rare Case Report

Shingade Raman Gangadhar, Suthar Pokhraj Prakashchandra, Patel Rupal

Osteopetrosis is a rare hereditary bone disorder character-ized by overgrowth and sclerosis of bone due to faulty bone remodelling. Clinical features include severe anemia, repeated infections and fractures, hepatosplenomegaly, and cranial neuropathies due to entrapment. On X-ray there is generalized increased in density of the bones, which are devoid of trabeculations and appreciable medullary cavity. Differentials are pyknodysostosis and heavy-metal poisoning. The diagnosis of osteopetrosis can primarily be made by clinical and radiographic features.

Right Sided Costocoracoid Ligament- A Case Report

Chandrika G Teli, Vanitha, H S Kadlimattatti, Nilesh Katate

During routine dissection for first year medical students, we observed a thick fibrous band extending from first costal cartilage to the acromion process of scapula, along the inferior margin of subclavius muscle on right side. The fibrous band, identified as costocoracoid ligament, was very strong unyielding to even cuts/ pressure by forceps. The costocoracoid ligament had pulled acromion process forward so strongly that the acromion process was easily seen below the lateral end of clavicle, and 1.5 cm anterior to head of humerus. Left side was not showing any such variation. Presence of costocoracoid ligament may result in fixation of the scapula to the first rib, resulting in cosmetic deformity with rounding of the shoulders and loss of the anterior clavicular contour. Movements requiring rotation or retraction of the scapula may be limited. Congenitally short costocoracoid ligament condition shows autosomal dominant inheritance, can be surgically corrected. Ours is the first such report of costocoracoid ligament in cadaver, since it is seen only in right limb so suggesting acquired (probable traumatic) cause.

Sonographic Detection of Traumatic Intraperitoneal Bladder Rupture: A Case Report

Donboklang Lynser, Evarisalin Marbaniang

Urinary bladder rupture is associated with high morbidity and mortality. Early diagnosis and repair is the treatment of choice. Diagnosis is usually done by conventional X-ray or computed tomography (CT) cystography. We present a post-traumatic intraperitoneal bladder dome rupture which was diagnosed exclusively using ultrasound and then confirmed on fluoroscopic cystography and finally at laparotomy. Ultrasound imaging therefore, in an appropriate emergency clinical setting can diagnose urinary bladder rupture.

Isolated Gall Bladder Laceration in Left Sided Blunt Trauma Chest

Gall Bladder rupture following blunt trauma is a rare event which even if occur, is usually associated with other visceral organ injuries. Isolated gall bladder rupture is even rarer as it is a well protected organ. Diagnosis is very difficult due to delayed presentation of clinical features of peritonitis. Here we are presenting a case report of a male patient with isolated gall bladder laceration due to blunt trauma left sided chest.

Multiple Amoebic Liver Abscesses: A Case Report

Harish Kumar, Veer Bahadur Singh, Jatin Agrawal, rajesh Kumar

Amoebic liver abscess is common in tropical country, caused by a protozoan Entamoeba histolytica. It is the most common extra intestinal manifestation caused by invasion of amoeba. It is presented as fever, right hypochondria pain with tenderness and hepatomegaly. In recent year mortality by liver abscess is decreases by early diagnosis with ultrasonography. Most amoebic liver abscess presented with single and large. Multiple liver abscesses are not uncommon but in number of 15 liver abscesses are rare. Here we are presenting a case of 15 liver abscesses who was symptomatic in spite of intra venous antibiotics with metronidazole and ciprofloxacin of 7 days treatment. Symptoms were improved after ultrasonography guided percutaneous aspiration of large abscess. So aspiration has an important role in multiple liver abscesses.

MDCT Appearance of An Unusual Asymptomatic Celiac Artery Aneurysm

TEJAS MOHAN TAMHANE, SUSHIL G.KACHEWAR, DILIP L.LAKHKAR

Celiac artery aneurysms are the rarest forms of splanchnic artery aneurysms. They are usually detected incidentally, thanks to the advances in imaging technology. As the mortality rate in ruptured celiac artery aneurysms is high, timely diagnosis and management are important. The present case highlights the multi detector computerized tomography imaging appearances in one such rare case.

Posterior Descending Artery Arising as A Continuation of Hyperdominant Left Anterior Descending Artery

C.S.Ramesh Bab u, S.Khar e, A.K.Asthana, S. Saxena, O.P.Gupta

Coronary artery anomalies are rare with an incidence of 0.3% to 1.0% in general population and are discovered incidentally. Many such anomalies may remain asymptomatic. Posteroinferior part of the muscular interventricular septum is normally supplied by posterior descending artery which may arise from right coronary artery (in right dominance or co-dominance pattern) or from left circumflex artery (in left dominance pattern). Supply of the posteroinferior septum by a hyperdominant left anterior descending artery continuing as posterior descending artery is extremely rare and sporadically reported in the literature. We present here a case of hyperdominant left anterior descending artery continuing as posterior descending in the presence of a diminutive right coronary artery. An anomalous branch arising from left anterior descending artery was supplying the left atrium. To the best of our knowledge no such anomalous left atrial branch from left anterior descending is described in the literature.