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   Table of Contents - Current issue
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April-June 2019
Volume 6 | Issue 2
Page Nos. 79-129

Online since Thursday, May 23, 2019

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ORIGINAL ARTICLES  

Clinical profile and cardiovascular autonomic function tests in patients with postural orthostatic tachycardia syndrome Highly accessed article p. 79
Neeraj , Suchitra Deolalikar, Aman Pannu, Jeyaraj Durai Pandian
DOI:10.4103/cjhr.cjhr_81_18  
Background: Postural orthostatic tachycardia syndrome (POTS) is an autonomic disorder characterized by the clinical symptoms of orthostatic intolerance such as light-headedness, fatigue, sweating, tremor, anxiety, palpitation, exercise intolerance, and near syncope on standing in the absence of orthostatic hypotension. Objective: The objective of this study is to evaluate the clinical profile and autonomic parameters in patients with POTS. Materials and Methods: A total of 70 patients with POTS underwent cardiovascular autonomic function tests, i.e., heart rate (HR) response to deep breathing, heart rate and blood pressure (BP) changes in Valsalva maneuver and tilt study in the autonomic laboratory of the Department of Neurology from January 2014 to February 2016 using WR Medical Works, USA. Results: Mean age of cohort was 28.07 ± 10.64 years, and there were 36 (51%) women. Light-headedness 59 (84.3%) was the most common orthostatic symptom, followed by dizziness 56 (80%), palpitation 41 (58.57%), anxiety 26 (37.14%), loss of consciousness 21 (30%), disequilibrium 19 (27.14%), visual symptoms 12 (17.14%), weakness 8 (11.43%), and shortness of breath 2 (2.86%). The average heart rate response to deep breathing was 24.79 ± 7.20 bpm. Average Valsalva ratio was 1.78 ± 0.30. During the tilt, average maximum HR increase was 43.47 ± 11.19 bpm. Conclusion: POTS is an underrecognized disorder and majority of them present with vague orthostatic symptoms ways, hence clinicians should be made aware of the symptomatology. The tilt table test with beat-to-beat monitoring of HR and BP is the standard test for diagnosis.
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Surgical management for pleural empyema – Single-center experience p. 83
Elamaran Elamurugan, Pajanivel Ranganadin, Jaya Velraj, Duvuru Ram, Karthik Panchanatheeswaran
DOI:10.4103/cjhr.cjhr_119_18  
Background: Pleural empyema occurs due to primary lung parenchymal infection or due to other pathologies. In this study, we analyzed the surgical management of empyema at our center. Patients and Methods: This study is a retrospective analysis of the patients who were surgically managed for pleural empyema between September 2014 and September 2017. A total of 54 patients underwent surgical management in the form of video-assisted thoracoscopic surgery (VATS) decortication or open procedure or a combination of both. The study population was evaluated for comorbid conditions, association with tuberculosis, bacteriological culture, length of hospital stay, morbidity and mortality. Results: Primary empyema was present in 52 patients while two patients had secondary empyema. Mycobacterium tuberculosis was associated in 17 (32%) patients, while 25 patients had other bacterial organisms. VATS decortication was performed in 21 (39%) patients and 23 (43%) patients underwent the open procedure. The remaining 10 patients underwent the combined procedure. The operative time and mean duration of hospital stay were less in the VATS group compared to the open group. Conclusion: In our experience, early surgical management of Stage II and Stage III empyema is successful with VATS. The nature of the disease process and the learning curve for VATS plays an important role in the conversion to open procedure.
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A comparative study of norethisterone and combined oral contraceptive pill in the treatment of dysfunctional uterine bleeding Highly accessed article p. 87
Sayantan Sen, Tapan Kumar Mandal, Arijit Dutta, Himel Mondal, Tufan Khalua
DOI:10.4103/cjhr.cjhr_92_18  
Background: A significant percentage of women in India suffer from dysfunctional uterine bleeding (DUB), which has a negative impact on physical and social life. Norethisterone and low-dose combined oral contraceptive (COC) pills are used in the treatment of DUB. Aim: The aim of this study was to compare the efficacy and safety of norethisterone and low-dose COC pills in reduction of blood loss in DUB. Materials and Methods: A prospective randomized interventional study was conducted with patients with DUB. Pretreatment pictorial blood loss assessment chart (PBAC) and hemoglobin in blood were obtained from patients. Then, Group I (n = 50) and Group II (n = 50) patients were provided treatment with norethisterone and low-dose COC pills, respectively. Posttreatment PBAC and hemoglobin level in blood was obtained after 6 months of treatment. Improvements in PBAC and hemoglobin level (difference between posttest and pretest value) were compared by unpaired t-test with α = 0.05. Results: Mean age of Group I and Group II patients was 28.62 ± 9.84 and 28.42 ± 10.08 years, respectively. Improvement in PBAC score in patients treated with norethisterone versus low-dose COC pill was −98.62 ± 7.82 versus −96.44 ± 8.74 (P = 0.19). Improvement in hemoglobin level in patients treated with norethisterone versus low-dose COC pill was 2.75 ± 1.06 gm/dL versus 2.71 ± 0.86 gm/dL (P = 0.84). Conclusion: Norethisterone and low-dose COC pills were found to be equally efficacious in reducing bleeding in DUB. Hence, any one of the drugs can be used in the treatment of DUB according to patients' profile. However, considering the side effects, low-dose COC pills may be a better choice.
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Kayakalp – Utility of a novel Indian tool for the assessment of biomedical waste management in a district hospital of Northern India p. 93
Ankit Chaudhary, Anjali Mahajan, Vijay Barwal, Priyanka Gautam, Saurabh Rattan, Shaina Chamotra
DOI:10.4103/cjhr.cjhr_130_18  
Introduction: Kayakalp is an innovative initiative launched by the Ministry of Health and Family Welfare as a part of the Swachh Bharat Abhiyan campaign. The primary objective of this venture is the promotion of cleanliness and delivery of quality health-care services through public health facilities in India. This standardized tool was used to evaluate six key parameters of hospital management of a district hospital in northern India. In this study, we present findings of biomedical waste (BMW) management assessment, one of the six assessment domains of the tool. Methods: A cross-sectional observational study was done using Kayakalp assessment tool in a district hospital of a north Indian state in the year 2015. Methods used to assess facility were direct observation, staff interviews, and review of documents. Results were recorded as full, partial, and no compliance for the domain of waste management. Results: The total score for BMW management as per Kayakalp tool was 82 (out of a maximum of 100), with mean score of 8.2 and standard deviation ± 1.48. Overall, there were ten criteria (C1 to C10). The scores were excellent, i.e., 100% for disposal of BMW, solid general waste, and liquid waste management. Minimum score of 60% was seen in the area of sharps management. Conclusion: The standardized approach of the evaluation of public health facilities through Kayakalp tool would help in judging their performance on a uniform pedestal. Such model tools after adjustment to local needs can also be adopted by other nations for the assessment of their health services.
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Mental health status of flood-affected adults in rural Tamil Nadu: A cross-sectional study p. 97
Venkatesh Ashok, KC Premarajan, Ravi Philip Rajkumar, Bijaya Nanda Naik
DOI:10.4103/cjhr.cjhr_146_18  
Objectives: The objective is to study the mental health status (in terms of posttraumatic stress disorder [PTSD]) of flood-affected adults aged 18 years and above residing in a rural village of Tamil Nadu affected by flood in December 2015. Methods: The study adopted a cross-sectional descriptive design. One adult member (age >18 years) preferably, head from each of the flood-affected households of Koonimedu village, Tamil Nadu, was included in the study. Participants were interviewed face to face 8 months after the occurrence of flood, and information on sociodemographic details and immediate effect of flood on health and property was obtained using semi-structured pretested questionnaire. Mental health and social support were assessed using the Impact of Event Scale-Revised (IES-R) and Crisis Support Scale, respectively. Mental health was expressed in terms of PTSD based on IES-R screening. Data analysis was done using statistical software. Results: The prevalence of PTSD as screened by IES-R among adults was found to be 51.3%. PTSD was found to be higher among females (56.7%) than males (43.3%). The elderly reported highest PTSD (63%). PTSD was found to be higher among participants who had received adequate social support. Conclusions: Even after 8 months of flood, the prevalence of screened PTSD was found to be very high and crisis social support low among individuals aged 18 years or above. Hence, mental health-care services including counseling support during and after the flood should be given priority by policy-maker.
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Spectrum of mandibular and maxillary pathologies as assessed with dentascan: A pictorial essay p. 102
Gurleen Kaur, Uttam B George, Subhash Singla, Sumir Gandhi, Shubhra Rathore
DOI:10.4103/cjhr.cjhr_29_18  
Introduction: Dentascan is a CT imaging software that provides three dimensional display and high resolution panoramic views of the jaw. It has become an important aspect of evaluation of mandibular and maxillary pathologies due to its advantages over two dimensional techniques and conventional CT. Materials and Methods: 60 patients presenting with jaw lesions, were studied using Dentascan software. The aim of the study was to explore the spectrum of findings in various mandibular and maxillary pathologies as well as define their extent and involvement using DentaScan. Results: Impacted mandibular molars constituted 45% of cases followed by tumors and inflammatory lesions (36.6 %). Of the 22 tumors and inflammatory lesions, giant cell granulomas and radicular cysts, accounted for 22.7% each while osteomyelitis constituted 18%. Other lesions included osteosarcoma, buccal space infection, ameloblastoma, adenomatoid odontogenic tumor, dentigerous cysts and carcinoma alveolus. Trauma leading to facial fractures and TMJ pathologies constituted 8.3% and 10% of cases respectively. Conclusion: DentaScan is a valuable tool in evaluation of maxillary and mandibular pathologies including tumors/cysts, inflammatory /infectious lesions, TMJ ankylosis and facial fractures. By providing information superior to radiographs and conventional computed tomography, it plays a valuable role in pre-operative assessment of various pathologies.
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Quality of life of patients with hernia and comparison after its repair p. 108
Farah Ahmed, Muhammad Khizar Memon, Sidra Memon, Syed Ali Haider
DOI:10.4103/cjhr.cjhr_45_17  
Background: Hernia is quite common in Pakistan. Hernia repair techniques have been of various types and have improved over the period to achieve best repair with minimal complications. Hernia repair technique such as the laparoscopic hernia repair is widely used in Pakistan and has superiority over open surgery due to short hospital stay, better cosmetic results, less postoperative pain, and less chance of wound infection. The quality of life of patients postoperatively, has thus been improving now. Methodology: The investigators interviewed the participants themselves. A total of 56 male patients aged 33.5 ± 10 years who had undergone hernia repair surgeries preoperatively and 3 months after surgery agreed to participate in the study. The questionnaire to evaluate patients' preoperatively and postoperatively had 13 questions regarding the effect of abdominal pain due to hernia on daily activities, religious activities, and impact on their health and mood. Likert scale was used to assess the difference in the quality of life of the patients and SPSS version 24 was used to analyze the data. Results: Response rate was 93.33% and the mean age is 33.5 ± 10 years. It was found out that the quality of life of patients improved after surgery so significantly that around 64.48% of people who had stopped doing work-related tasks before surgery due to hernia were then able to carry out work related tasks (87.03%). The quantity of patients with abdominal pain also decreased from 83.3% to 33.32%. Overall, the mood of the patients remained better to such an extent that before surgery, only 25.91% people could carry out daily tasks with minimal irritation but after surgery, 92.59% people started feeling better than before. Conclusion: Abdominal wall surgeries have improved the quality of life of the patients. Thus, the patients should be counseled to get their abdominal wall hernia corrected as soon as possible to lead a good quality and healthy life. Newer advanced techniques have emerged which has led to fewer complications and short hospital stay.
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MEDICAL EDUCATION Top

Teaching professionalism and leadership skills to an Indian medical graduate p. 112
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/cjhr.cjhr_148_18  
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CASE REPORTS Top

An unusual case of cardiovocal syndrome p. 114
Jyoti Bajpai, Surya Kant, Avishek Kar, Akshyaya Pradhan
DOI:10.4103/cjhr.cjhr_115_18  
Hoarseness of voice is the most common presenting symptom of vocal cord palsy, which can be due to different etiologies. Ortener's syndrome is one of them and is defined as hoarseness of voice due to recurrent laryngeal nerve palsy secondary to cardiovascular disorders. Hoarseness due to aortic aneurysm is a rare entity. Here we report an unusual case of a 61 year smoker male who presented to us with persistent hoarseness of voice due to asymptomatic aortic aneurysm.
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Tuberculosis of tongue, an enigma: Report of two cases p. 117
Parul Jain, Anindya Adhikari, Palash Kumar Mandal, Raison Shail Minz
DOI:10.4103/cjhr.cjhr_124_18  
Tuberculous granuloma of the tongue is a rare entity and constitutes a negligible percentage of all inflammatory lesions of that organ. Herein, we report two cases of granulomatous lesion of the tongue of tuberculous origin, both presented with only a small swelling. Fine-needle aspiration cytology (FNAC) and biopsy proved them to be granulomatous lesions. Antitubercular drugs (ATDs) were started, lesions healed completely without any residual effect.
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Holt–Oram syndrome – Case series of two reports p. 119
Mohd Ilyas, Arif Ahmad Wani, Zubair Ahmad, Mir Junaid Ahmad Kazimi, Naseer A Choh
DOI:10.4103/cjhr.cjhr_104_18  
Holt–Oram syndrome is a rare genetic autosomal dominant disorder which affects the upper limbs and heart. It is also known as “heart–hand” syndrome or “atriodigital dysplasia.” The present article describes the clinical and radiological images of the features of Holt–Oram syndrome in two patients.
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Multiple structural cardiac malformations in a macrosomic, possibly missed infant of a diabetic mother p. 123
Igoche David Peter, Zubaida L Farouk, Abdulsalam Mohammed, Mustafa Ohikhena Asani, Ibrahim Aliyu, Fatima Usman
DOI:10.4103/cjhr.cjhr_47_18  
Infants of diabetic mothers are prone to cardiac malformations due to teratogenicity of diabetes mellitus (DM). We present here the case of a macrosomic neonate who had marked difficulty with breathing. He had severe hypertrophic cardiomyopathy with patent ductus arteriosus and cor triatriatum dexter, and although his mother had obstetric and a family history suggestive of DM, this diagnosis was not made as her antenatal fasting plasma glucose assay was normal. The need for adequate diagnosis using oral glucose tolerance test or hemoglobin A1c is hereby emphasized.
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LETTERS TO EDITOR Top

The power of expectations: Undermining the role of pygmalion effect in mentoring p. 126
V Dinesh Kumar
DOI:10.4103/cjhr.cjhr_134_18  
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Role of Electronic Vaccine Intelligence Network (eVIN) system for quality improvement in immunization data in India p. 128
Arulmani Thiyagarajan, Sudip Bhattacharya, Deepika Khaladkar
DOI:10.4103/cjhr.cjhr_123_18  
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