Bombay Hospital Journal (BHJ) is a peer-reviewed quarterly published Print and Online journal. It is an official Journal of Bombay Hospital institute of medical sciences. The aim of BHJ is to improve medical care by publishing sound scientific articles (both research and practice papers) and focusing on topics that are of great importance to its readership. Editor-in-Chief- Dr Satish Vasant Khadilkar
© The Author(s). 2024 Open Access. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons. org/licenses/by-nc/4.0/), which permits unrestricted use, distribution, and non-commercial reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/ zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Case Report Manubriosternal Osteomyelitis – Rare Cause of Acute Onset Chest Pain
The aim of this case report is to establish the role of radiology in diagnosing manubriosternal osteomyelitis – a rare cause of acute onset chest pain that is difficult to diagnose clinically and, most of the time, misdiagnosed as angina. Early diagnosis and timely management are clinically important to avoid fatal complications in the later stages of the disease.
Angina, Manubriosternal osteomyelitis, Steroids
Copyright (c) 2026 Bombay Hospital Journal https://creativecommons.org/licenses/by-nc-sa/4.0
REVIEW OF LITERATURE Comprehensive Physical and Systemic Examination in Neurological Disorders
Introduction: A comprehensive general physical and systemic examination is fundamental in evaluating patients with neurological disorders. It helps not only in localizing neurological dysfunction but also in identifying systemic conditions, such as diabetes, hypertension, and infections, that may contribute to or mimic neurological symptoms. A thorough examination is crucial for accurate diagnosis and effective management. Key components of the physical examination: This includes an assessment of the patient’s general appearance, vital signs, head and neck, cardiovascular, respiratory, musculoskeletal, gastrointestinal and dermatological systems. Each of these aspects can reveal significant clinical findings, ranging from facial expressions and posture indicative of specific neurological disorders to skin manifestations and cardiovascular irregularities that provide clues for underlying conditions. The systemic examination’s depth depends on the patient’s history, yet a complete assessment is crucial for uncovering unexpected findings and ensuring accurate diagnosis and management of neurological conditions. Conclusion: By incorporating both targeted neurological and broader systemic assessments, this approach facilitates the holistic evaluation of patients helping in optimizing treatment strategies for neurological disorders
Amyotrophic lateral sclerosis, Mucopolysaccharidosis, Transient ischemic attack, Arteriovenous malformation
Original Article Exploring the Efficacy of Telmisartan and Cilnidipine Combination Therapy in Hypertension: A Cross-sectional Analysis
Introduction: Hypertension is a common non-communicable disease and is of major public health concern accounting for 19% of all deaths globally. The lack of awareness about hypertension is a major contributory factor for the delayed diagnosis of asymptomatic cases, thus being labeled as a “silent killer disease.” Effective control of blood pressure is a must and for achieving it, a long-acting antihypertensive agent is required. Telmisartan is one of the angiotensin II receptor blockers whereas cilnidipine is a novel calcium antagonist. Cilnidipine has shown prolonged and desirable antihypertensive effects. The present questionnaire-based study conducted on various clinicians across different parts of the country analyses the pattern of patients with hypertension and other comorbidities in their clinical practice along with the trend in the prescription of antihypertensives either mono and/or combination therapy. Materials and Methods: The present study is a questionnairebased cross-sectional study consisting of 25 validated structured questions. The study was approved by the Institutional Ethical Committee. All the completed forms were included in the study whereas incomplete form was excluded from the study. Observation and Results: The survey reflects that 87% of the patients have diabetes mellitus as one of the most common comorbid conditions associated with hypertension. About 86.5% of the clinicians (86.5%) are of the opinion that more than 30% of the patients required combination therapy of telmisartan and cilnidipine with the addition of diuretics in uncontrolled hypertension. The combination also offers many other benefits such as its anti-atherosclerotic properties and endorgan protection. Conclusion: The study highlights that combination therapy is very effective in treating hypertension even if associated with other comorbid conditions such as diabetes and chronic kidney disease.
Cilnidipine, Combination therapy, Diuretics, Hypertension, Telmisartan
progressive lower limb paraplegia in pregnancy -An vertebral haemangioma - A case report
We present a rare case of spinal cord haemangioma in a pregnancy at 38 weeks of gestation, managed with multidisciplinary approach. The patient presented with back pain and neurological symptoms, diagnosed via MRI. Successful management involve close monitoring, pain control, and planned delivery. This case highlights the importance of prompt diagnosis and collaborative care in ensuring optimal outcome for both mother and baby.
Original article Radial SNAP- Optimal site of stimulation in healthy Indian subjects
Abstract Background: The radial sensory nerve action potential (SNAP) is an important electrodiagnostic study of the upper limbs for a large variety of conditions. Inappropriate distance of stimulation and unavailability of reference data can lead to erroneous conclusions. Objectives: To establish the optimal site of recording the Radial SNAP and obtain reference data for radial SNAP in age-stratified healthy subjects. Materials and Methods: A prospective study was conducted in 181 nerves from healthy subjects aged between 18 years and 86 years, stratified into five groups as per age: a = 18-30 years, b = 31-40 years, c = 41-50 years, d = 51-60 years, e > 61 years. Radial SNAP was recorded antidromically, stimulating at 10 cm from the recording electrode. Mean – 2 standard deviation (SD) of the transformed data was used to generate reference values for amplitudes. Results: The lower limits of amplitude at 10 cm were 28.8, 30.4, 24.4, 23.7 and 16.2 mV for groups a, b, c, d and e, respectively and at 12 cm were 25, 29.2, 18.9, 17.9 and 14.5 mV respectively. A statistically significant difference in amplitudes was noted from the three different sites of stimulation (P < 0.001). A 17% variation in amplitude is explained by age. Height, BMI and wrist girth had minimal effect on the amplitude obtained (r2= 0.05, 0.01, 0.00) Conclusion: This study provides age stratified reference data for antidromic Radial SNAP in Indian population and also gives the optimal site of stimulation of the SNAP.
CASE REPORT PROGRESSIVE LWER LIMB PARAPLEGIA IN PREGNANCY - AN AGRESSIVE VERTEBRAL HAEMANGIOMA
We present a rare case of spinal cord haemangioma in a pregnancy at 38 weeks of gestation, managed with multidisciplinary approach. The patient presented with back pain and neurological symptoms, diagnosed via MRI. Successful management involve close monitoring, pain control and planned delivery. This case heighlights the importance of prompt diagnosis and collaborative cae in ensuring optimal outcome for both mother and baby
Case Series – Retrospective case series analysis: Clinical and functional outcomes of Dacryocystorhinostomy surgery
Abstract Background - Dacryocystorhinostomy (DCR) is the surgical gold standard for treating nasolacrimal duct obstruction (NLDO), creating a direct passage between the lacrimal sac and nasal cavity to restore tear drainage. Despite high success rates, failures can occur due to anatomical or functional factors. This five-year retrospective study analyses 50 DCR cases, focusing on demographics, causes of failure, intranasal pathologies, and outcomes of revision procedures with silicone intubation. Methods - A retrospective review of 50 consecutive DCR surgeries was conducted at a tertiary care centre. Data regarding demographics, surgical approach, failure causes, and associated intranasal findings such as deviated nasal septum (DNS) and adhesions were collected. Revision outcomes with silicone intubation and adjunct Mitomycin C (MMC) were also evaluated. Both adult and paediatric cases were included. Results - Among 50 patients, 45 were adults and 5 were paediatric (ages 5–11); 33 were females and 17 males. Thirty-five surgeries were left-sided and 15 right-sided, all with silicone intubation. The overall failure rate was 10% (5 cases). Three failures were related to high DNS and resolved after septoplasty; one due to intranasal adhesion was corrected endoscopically, and one was managed by nasolacrimal probing. Four revision DCRs with MMC achieved successful outcomes. Paediatric patients showed good anatomical response and recovery. Conclusion - Comprehensive nasal evaluation and ENT collaboration are essential for identifying intranasal causes of DCR failure. Silicone intubation and adjunctive MMC improve success rates, while postoperative endoscopic follow-up ensures durable results. Keywords: Dacryocystorhinostomy, deviated nasal septum, nasolacrimal duct obstruction, revision surgery, silicon tube insertion
Case Report A Rare Case of Geleophysic Dysplasia: Clinical and Radiological Insights
Background Geleophysic dysplasia (GD) is predominantly a disorder of the musculoskeletal system which also affects the skeletal, cardiovascular, respiratory, otologic, and ophthalmologic systems. A suspicion of GD can arise right from the abnormalities in the obstetric scans of the patients. Further, the diagnostic workup encompasses of a primary skeletal survey, MRI of brain and spine for suspected neurologic problems, 2D echocardiography for congenital heart defects and genetic study. Retrospectively, workup of the parents is also necessary. The management is a multimodality approach with regular visits with a pediatrician who overall monitors the child, an orthopedic surgeon and other specialties depending on the involvement of other systems. Case Description The case described by us is a one-month old neonate who had fetal growth restriction and scalloping of the skull bones on obstetric scans. On further workup, the spinal cord was low tethered showing type II diastematomyelia. Multiple cardiac defects were also present along with bilateral cryptorchidism. Clinical Significance This case showcases an autosomal recessive variant of GD in a neonate, emphasizing its multisystemic features, diagnosis, and multidisciplinary management. Neurological involvement which is not usually seen in GD, was encountered in our case. KEYWORDS: Neural tube defects, Heart defects Congenital, Skeletal dysplasia.
A case series A CLINICOPATHOLOGICAL STUDY WITH EVALUATION OF DIFFERENT OPERATIVE TECHNIQUES FOR FISTULA-IN-ANO ON PATIENTS: AN OBSERVATIONAL STUDY.
Title: A CLINICOPATHOLOGICAL STUDY WITH EVALUATION OF DIFFERENT OPERATIVE TECHNIQUES FOR FISTULA-IN-ANO ON PATIENTS: AN OBSERVATIONAL STUDY. Introduction: Fistula-in-ano form a good majority of benign treatable lesions of rectum and anal canal. Anal fistulas are considered as one of the commonest cause for a persistent seropurulent discharge that irritates the skin in the neighbourhood and causes discomfort. Anal fistulas develop secondary to perianal abscess. Complex fistula can have a characteristic of the following: multiple tracts, recurrence, pre-existing incontinence, fistula in Crohn’s disease. Most of these fistula-in-ano are easy to diagnose with a good source of light, a proctoscope, and a meticulous digital rectal examination. Managing fistula in ano is a challenge since it carries a significant recurrence rate after the operation. Management of fistula in ano includes control of sepsis, closure of fistulous tract, maintenance of continence and preventing recurrence. Surgical techniques like fistulotomy, fistulectomy, primary closure after excision of tract, seton use and staged operations have rendered the postoperative period uneventful, short and steep fall in recurrence rate. Complications of fistula surgery are myriad, like fecal soiling, mucus discharge, varying degrees of incontinence and recurrent abscess and fistula. Clearly the surgeon who has the first opportunity to treat the patient is the one most likely to effect a cure, to minimize disability and to limit morbidity. in this dissertation, an attempt is made to study the presenting symptoms, the findings on clinical examination and the various surgical procedures. Primary Research Question: To study the clinical presentations and evaluation of different operative techniques for fistula-in-ano. Primary Hypothesis: No hypothesis could be formulated since it is an observational study. Primary Objectives: To study age and sex distribution of fistula-in-ano. To study clinical presentation of fistula-in-ano. To study predisposing factors if any for the development of fistula-in-ano. To study co-morbid factors associated with fistula-in-ano. To study different modalities of surgical approach and efficacy with special reference to sphincter incontinence in the immediate post-op period. METHODS Study design: Observational study. Study setting: Tertiary health care center. Study population: Patients. 4.Duration of study: 18 months, January 2019 to July 2020 Sample size: 50 Sampling technique: Non-random, Purposive. Method of selection of study subjects: After having obtained permission from Institutional Ethics Committee and Institutional Scientific Review Committee approval, patients with fistula-in-ano will be included in the study as per the following criteria: a) Inclusion criteria: The patients who are clinically diagnosed as fistula-in-ano and admitted to the hospital, will be included in this study. b) Exclusion criteria: -All fistulas and sinuses occurring elsewhere in the body are excluded. -All congenital fistulas are excluded. -All fistulas due to perineal injuries are excluded. c) Subject withdrawal criteria: unwillingness on part of the patient is the only withdrawal criteria. Results: Included with the study in tabulated and graphical manner. CONCLUSION: Fistula in ano is commonly seen in the age group of 30-60 yrs. Gender-wise higher incidence of anal fistula is seen in males. Most common clinical presentation is perianal discharge followed by perianal pain, swelling, constipation, per rectal bleed. There are no specific predisposing factors associated. Chronic constipation and a past history of perianal abscess may be found in these patients. The most common co-morbidity found in these patients is diabetes. Fistulotomy and fistulectomy are the two most commonly performed procedures. The efficacy of both these procedures in terms of immediate postoperative measure in terms of incontinence is very good, and the patients remained continent postoperatively.
Case Report Acute Fatty Liver of Pregnancy
Acute Fatty Liver of Pregnancy is an obstetric emergency associated with high maternal mortality and morbidity. A decade ago , the maternal mortality rates were significantly higher reaching upto 70 %. Presently maternal mortality has decreased to around 18% with associated neonatal mortality ranging from 7% to 66% attributed to focused liver intensive careand a robust multidisciplinary team approach. Our patient had a late and critical presentation with hepatic encephalopathy on admission. Swift and promt decisions with a good liver team backup can reduce the mortalty rates associated with AFLP. The patient had multiple life threatening catastrophic and turbulent events post Caesarean section. After weeks of intensive post operative care she was discharged from the hospital .We had a successful outcome inspite of delayed presentation .
Case Report Tropical Pyomyositis presented as false positive brucellosis with right sacroiliitis joint pain
Abstract: Aim: Tropical Pyomyositis presented as false positive brucellosis with right sacroiliitis joint pain Background: ). Pyomyositis, also known as “tropical pyomyositis” Myositis purulent atropica. In 90% cases the causative agent is Staphylococcus aureus Case Description: A young male presented with multiple skeletal muscle abscess with left sacroiliitis joint pain. Patient also showed false positive brucellosis antibody test with negative slide agglutination test. Conclusion: CT scan guided aspiration of pus inside the pelvic region as well as Laparoscopic drainage of pus with debridement showed Staphylococcus Aureus. Patient responded with debridement along with prolong antibiotic course. Clinical Significance: Pyomyositis is a poorly understood condition . The initial signs and symptoms are nonspecific and misleading and making it often underdiagnosed
Case Report Rare presentation of CNS manifestation of pseudo inflammatory tumor which responded to steroid
Abstract: Aim- Rare presentation of CNS manifestation of pseudo inflammatory tumor which responded to steroid. Background- Inflammatory pseudotumor are rare, benign, tumor-like lesions characterized by chronic inflammatory cell infiltration, which can mimic malignant tumors both clinically and radiologically. Case Description- Here, we present a case of a patient diagnosed with an inflammatory pseudotumor involving the left 7th and 8th cranial nerves, who presented with symptoms of severe headache, recurrent vomiting, dizziness, and gait ataxia. Initial examination revealed no fever or other systemic symptoms, and MRI imaging showed enhancement along the left 7th and 8th nerve complex. Conclusion-Elevated serum IgG4 levels supported an inflammatory etiology, while cerebrospinal fluid (CSF) analysis and other tests ruled out infection or malignancy. The patient showed significant improvement in symptoms after corticosteroid therapy with IV dexamethasone and supportive care Clinical Significance-This case highlights the diagnostic challenge posed by inflammatory pseudotumor in cranial nerves and underscores the importance of distinguishing them from other lesions to guide appropriate treatment.
Case Report Neuropsychiatric presentation following Teriparatide treatment causing altered sensorium
Aim- Neuropsychiatric presentation following Teriparatide treatment causing altered sensorium Background- Patient with a history of osteoporosis on Inj Teriparatide daily for the last two months were recently operated for Minimally invasive L3-L4 decompression and L3-L5 percutaneous fixation with L4 vertebroplasty Case Description-63 Yrs old postmenopausal female women, who presented with dizziness, increased thirst, constipation and persistent drowsiness. Patient was found to have hypercalcemia (13.5 mg%).MRI and CSF examination were inconclusive.PET scan was performed to rule out multiple myeloma and any underlying malignancies.Serum protein electrophoresis was normal. Conclusion- As patient was on regular Teriparatide treatment it was considered as the cause of her raised calcium levels. Patient responded to bisphosphonate therapy, hydration and calcitonin. After 48 hours of treatment , the patient's serum calcium levels returned to normal and patient improved. Clinical significance- Patients who are on regular treatment of Teriparatide should be closely monitored for hypercalcemia and evaluated for the symptoms related to it.
Case Report Acute febrile illness with skin rash with multiorgan affection presented as scrub typhus
Abstract : Aim: To diagnose and treat the patient with acute febrile illness and multiorgan failure affection who presented as scrub typhus Background: Scrub typhus fever is a disease caused by Orientia Tsutsugamushi Case Description: Adult male patient who has gone for picnic at hilly area and who presented after 5 days with acute febrile illness and deteriorated with skin rash and multi organ affection. His tropical fever panel investigations were normal and found to have high titre of Weil Felix test and PCR for rickettsia was positive. He responded well with doxycycline injection and was discharged. Conclusion: Scrub typhus is characterized by skin rash initially maculopapular, progressing to petechial and spreading centripetally in patient with high fever, myalgia, and headache with supportive epidemiologic or exposure history .Classical triad includes Morbilliform eruption plus fever plus necrotic papule (eschar at the tick bite site) should prompt diagnosis of scrub typhus infection. Clinical significance: With prompt diagnosis and identifying the main characteristic features of scrub typhus such as Eschar is important to identify so that the appropriate treatment can be started. Doxycycline is the mainstay treatment
Original Article VITAMIN B12 AND NON-VEGETARIANISM: MYTH vs REALITY
Background: Vitamin B12 deficiency has traditionally been linked to a vegetarian diet in medical texts, for decades. This alone, is probably only the tip of the iceberg. Hence, there is a dire need to know the other possible causes of this deficiency in our country. The number of such studies so far is rather scant. Objective: Our study aims to measure the prevalence of Vitamin B12 deficiency in healthy volunteers and to compare the levels between vegetarians and non-vegetarians, for statistical significance. Materials and Method: We carried out a comparative, single-centre study to analyse the levels of B12 in vegetarians and non-vegetarians. This was done at a Local Medical College in Mumbai, India, from March 2018. Data was collected over a period of one year. A sample size of 102 healthy volunteers were screened. We included students from the college between the ages of 18-22 years. They were divided into two groups, viz vegetarian and non-vegetarian based on their dietary patterns. Results: 50 subjects were on a vegetarian diet and 52 were on a non-vegetarian diet. 75 individuals (73.5%) were found to be B12 deficient. 78% of vegetarians and 59.3% of non-vegetarians were deficient. However, statistical analysis showed no significant difference between the mean and median serum B12 levels between vegetarian (148.46) and non-vegetarian (172.02) groups (p>0.05). Conclusion: Vitamin B12 deficiency is rampant amongst both vegetarian and non-vegetarian Indians. Clinicians should have a high index of suspicion in not only vegetarian but also non-vegetarian populations.
B12 deficiency, anemia, vegetarian, non-vegetarian.
The PRE-OPERATIVE PREDICTORS FOR INTRAOPERATIVE DIFFICULTY IN LAPAROSCOPIC CHOLECYSTECTOMY: PROSPECTIVE OBSERVATIONAL STUDY
OBJECTIVE :- To find Preoperative predictors for intraoperative difficulty in Laparoscopic Cholecystectomy. METHOD :- This was an Observational study of 150 patients at a tertiary health care center , done over a period of two years from March 2022 to March 2024. Inclusion criteria- A Prospective observational study will be done in 150 patients of elective Laparoscopic Cholecystectomy, coming to a tertiary health care center, admitted and operated by a constant team at the aforementioned center. The average time taken by the said team to operate Uncomplicated Laparoscopic Cholecystectomy is about 60 mins. Exclusion criteria- i. The cases of LC conversion to open cholecystectomy due to equipment failure and surgery in emergency setting ii. Also, in cases of 1. Cholecystic intestinal fistula 2. Carcinoma gallbladder 3. GB perforation / peritonitis 4. Choledocholithiasis needing choledochotomy Subject withdrawal criteria- Unwillingness on part of the patient is the only withdrawal criteria. All patients who were operated were observed for the following preoperative factors 1. History a. History of attack of Acute Cholecystitis b. History of ERCP c. History of previous abdominal surgery 2. Clinical examination a. BMI <25 or >25 b. Palpable gallbladder c. P/A - Tenderness/ Guarding 3. Ultrasonography findings a. Wall thickness >4mm b. Pericholecystic collection c. Impacted stone d. CBD dilation RESULT :- The pre operative score was determined to be easy in 33 males and 47 females and postoperatively 29 males (87.87%) were found to be easy cases and all 47 females (100%) were categorised under Easy LC. The pre operative score was determined to be moderate in 23 males and 22 females and postoperatively all 23 males (100%) were found to be moderate LC cases and 19 females (86.36%) were categorised under Moderate LC. The pre operative score was determined to be difficult in 13 males and 12 females and postoperatively 17 males were found to be difficult cases and 15 females were categorised under Difficult LC. CONCLUSION :- Our study has shown that it is possible to predict difficulty pre operatively during laparoscopic cholecystectomy and the chances of conversion to open cholecystectomy can be predicted. In our study we found history of acute cholecystitis, symptoms and signs of acute cholecystitis, male gender, contracted GB, GB wall thickness > 4mm, presence of Pericholecystic fluid and history of previous abdominal surgery and ERCP to be significant predictors of difficulty in laparoscopic cholecystectomy.
Cholelithiasis, cholecystitis, difficult Laparoscopic Cholecystectomy, frozen calots triangle,aberrant bile ducts, iatrogenic bile duct injury
Original Article Internal Carotid Artery Dissection (ICAD) Presenting as Isolated Hypoglossal Nerve Palsy – A Case Report
Abstract: As compared to other cranial nerves, hypoglossal nerve palsy is rare; and is often associated with other lower cranial nerve palsies. The most common causes of hypoglossal nerve palsies are tumors followed by trauma, stroke, surgery, infection, and multiple sclerosis. We report a case of a 55-year-old male presenting with dysphagia, dysarthria, and difficult mastication. He was diagnosed to have isolated hypoglossal nerve palsy secondary to compression by Internal Carotid Artery Dissection (ICAD). He was treated conservatively with antiplatelets and showed improvement on a 6-month follow-up. ICAD is a dangerous entity with possible endangering complications and hence recognition of it is critical for appropriate treatment and prevention of possible complications. ICAD should be considered in differential diagnosis for isolated hypoglossal nerve palsy
Review article Approach and management of chronic hiccups- a common but difficult entity
Hiccups are quite common and often troublesome for patients and even for physicians as approach and management are not thoroughly clear. This review discusses about hiccups from epidemiology, classification, etiologies, mechanism involved, approach to patient, home remedies to pharmacological drugs to tackle the hiccups. In majority of cases underlying pathology is quite not clear when patient presents with hiccups of more than 48 hours duration. It is advisable to start proton pump inhibitors as initial drug of choice as gastroesophageal reflux diseases are found to be most common underlying etiology for hiccups. Treatment should be changed or combination therapy should be initiated if patient is not responding to first line agent after 1-2 weeks. Weightage should be given to associated symptoms with hiccups as they guide to pathology There is a lack of strong evidence based pharmacological and surgical data that suggests an effective step wise solution to this common problem. Large patient-controlled trials are necessary for alternative therapies like acupuncture and hypnosis to place them in proper management plan with enough evidence.
Case Report A RARE CASE OF HYPOGLOSSAL NERVE SCHWANNOMA ARISING AT THE LEVEL OF CAROTID BIFURCATION : A CASE REPORT
INTRODUCTION Schwannomas are benign slow growing tumors that originate from the myelin sheath of the nerves; predominantly arising from the vestibular nerve in 90% of the cases. [1] Most schwannomas are sporadic and few are associated with NF1, Schwannomatosis, Carney’s complex etc. Among the non-vestibular schwannomas, only about 5% arise from the hypoglossal nerve; tumor composed purely of motor nerves. Most hypoglossal schwannomas are intracranial in location, followed by intracranial lesion with a secondary extracranial extension - most frequently in the parapharyngeal space. [2] Primary extracranial hypoglossal schwannoma is very rare. Among them, to this date, there are only 3 reported cases of hypoglossal nerve schwannoma located at the carotid bifurcation. [3,4,5] These tumors are often diagnosed late due to non-specific clinical history and examination findings. They are asymptomatic for many years and hence histopathology is the gold standard of diagnosis. [6] We hereby present a case of a 52 year old female who came with a slow growing painless mass in the right side of the neck.
Review Article Breaking the Silence: A Comprehensive Look at Substance Use Among Medical Students.
Abstract: The study aims to amplify the voices of medical students and gain a better understanding of their perceptions regarding the issue as substance use disorder is a well-known, yet under-represented issue in the medical community A cross-sectional study of medical students was done using an anonymous online questionnaire to assess demographics, the rationale for continual use, and the students’ perception regarding the issue. The association of various factors leading to substance use was analysed. Statistical associations between the different variables were determined using the Chi- square test, Fisher's Exact Test, and Wilcoxon- Mann-Whitney U Test. A p-value of <.05 was considered a criterion of significance. A total of 541 individuals responded to the questionnaire. The primary reason for continual use was form of escapism (49%) and a way to deal with the stress of medical school (40.1%). 52.1% said they would not seek help because they do not want to ruin their public image, while 48.4% of the individuals fear judgment and isolation by their peers and family. Societal perceptions and judgment by their peers should not hinder students from seeking appropriate attention regarding substance use disorder. Anonymous access to professional psychological support and counselling for all medical students is advocated. Peer support and awareness programs can help substance users overcome isolation and their fear of judgment and prevent their spiral into dependence
Copyright (c) 2024 Bombay Hospital Journal https://creativecommons.org/licenses/by-nc/4.0
Case Report Lobar pneumonia in a patient with Covid induced neutropenia (ANC 12)
Neutropenia is a known but rare haematological complication of COVID-19 infection in immunocompetent patients. There is sparse literature on neutropenia in patients with COVID-19, except a few case reports. We encountered a similar case in an intensive care unit that presented with Lobar pneumonia with profound neutropenia (Neurtophil count 30 ) who had no co-morbidity and taken both covid vaccine as per recommondation. The patient was admitted to isolated negative pressure room with antiviral, antifungal and antibiotics along with low molecular heparin started. Patient deteriorated and required High flow Nasal Cannula (HFNC) oxygen support with steroid supplementation. . Thus, we treated successfully , a patient with SARS COV 2 infection with lobar pneumonia complicated with profound neutropenia with no co-morbidity which improved with Granulocyte colony stimulating factors to normal level=13.
Case Report Internal Carotid Artery Dissection Presenting as Isolated Hypoglossal Nerve Palsy – A Case Report
As compared to other cranial nerves, hypoglossal nerve palsy is rare; and is often associated with other lower cranial nerve palsies. The most common causes of hypoglossal nerve palsies are tumors followed by trauma, stroke, surgery, infection, and multiple sclerosis. We report a case of a 55-year-old male presenting with dysphagia, dysarthria, and difficult mastication. He was diagnosed to have isolated hypoglossal nerve palsy secondary to compression by internal carotid artery dissection (ICAD). He was treated conservatively with antiplatelets and showed improvement on a 6-month follow-up. ICAD is a dangerous entity with possible endangering complications and hence recognition of it is critical for appropriate treatment and prevention of possible complications. ICAD should be considered in differential diagnosis for isolated hypoglossal nerve palsy.
Carotid dissection, Hypoglossal nerve palsy, Treatment of dissection
Case Report Cecal Ganglioneuromatous Polyp-A Rare Case
Background: Ganglioneuromas (GNs) are hamartomas that are rarely found in the colon. Intestinal GNs are characterized by an overgrowth of ganglion cells, nerve fibers, and supporting cells. They are slow-growing and benign. Case Description: A 20-year-old female presented with complaints of abdominal pain for 1 year, with exacerbation of pain and loose stools for 1 week. Colonoscopy showed multiple small superficial polyps in the ascending colon and a large polyp in the cecum. A cecal polypectomy was done and sent for histopathological examination. The final histopathological diagnosis was a ganglioneuromatous polyp of cecum. Conclusion: The cecal polyp was detected on colonoscopy and histologically diagnosed as a GN. As GNs are associated with systemic and familial diseases, further screening and follow-up were recommended
Cecum, Ganglioneuromatous polyp, Hamartomas
case report Thermal Burn At An Unusual Site In The Oral Cavity : A Case Report
Aim-To report a case of thermal burn at an unusual site in the oral cavity. Background-Thermal burns of the oral cavity are caused by accidental ingestion of hot foods and beverages. Most of the cases are minor and treated conservatively but in some cases surgical management is required. Case Description -A 38 year old male had burning sensation of mouth following accidental ingestion of hot liquids and on clinical examination whitish lesions with erythema noted on floor of the mouth.Case was managed conservatively. Conclusion-Prompt management of such a case has to be done.
SOUMICK RANJAN SAHOO SOUMICK RANJAN SAHOO
case report Omental adhesion to degenerating fibroid- a rare cause of acute small bowel obstruction in pregnancy
Intestinal obstruction during pregnancy is a rare condition, which is associated with significant risk for feto-maternal morbidity and mortality. Often there is a delay in diagnosis due to lack of specific symptoms. A 34 years primigravida at 27 weeks of gestation presented with small bowel obstruction which was confirmed on CT scan. She underwent a laparotomy which revealed an adhesive band from omentum to the degenerating fibroid obstructing the ileum. Prompt diagnosis and timely surgical intervention avoids increased morbidity and mortality.
Case Report Metastatic mammary lobular carcinoma presenting with ileal obstruction: A Case Report
Abstract: Aim: The aim of this article is to present a rare case of ileal metastasis from lobular mammary carcinoma. Background: Breast cancer has the highest incidence among women and is prone to develop distant metastasis. Metastasis to the gastrointestinal (GI) tract is rare and occurs more frequently in invasive lobular carcinoma. Patients may be asymptomatic or present with variable vague symptoms that may be mistakenly attributed to side effects of chemotherapy or other benign GI diseases. Case Description: This case report describes a 78-year-old Indian female patient with bilateral lobular mammary cancer who presented with ileal obstruction. Conclusion: Metastatic lobular mammary carcinoma has a wide range of clinical presentations. Adequate procedures should be performed promptly to obtain histological diagnosis. The possibility of intestinal involvement by metastasis should be considered in a known case of breast carcinoma with acute abdominal symptoms. Clinical Significance: Increased awareness of bowel metastasis secondary to breast cancer and a thorough understanding of the clinical and histological features, are fundamental to avoid delay in diagnosis and management.
intestinal metastasis, breast cancer, ileal obstruction
Original Article Comparison of three difficult endotracheal intubation predictors in obese individuals in an Indian population
Abstract: Context: Unanticipated difficult intubation is a challenge that no single bedside screening test can accurately predict. Independent indices or single anthropometric measurements have demonstrated lower reliability in patients with increased Body mass index (BMI). Using two or three related independent indices is therefore preferred. Aim: To assess applicability of three bedside measurements, the modified Mallampati Classification (MMPC), Neck circumference and Thyromental distance ratio (NC/TM) and Neck Circumference minus acromio-acromion distance (NEMA) in obese subset of Indian population. Design: Prospective observational study Methods and Material: One twenty adults with BMI > 29 undergoing general anesthesia were enrolled after consenting. Pre-operative measurements and intubation details were recorded. Difficult intubation was determined using the intubation difficulty scale (IDS≥5 termed difficult). The NC/TM ratio, NEMA, MMPC were compared with respect to sensitivity, specificity, positive, negative predictive value with receiver operating characteristics (ROC) curve and logistic regression. Statistical analysis used: SPSS software version 25 Results Incidence of difficult intubation was 12.5%. By binary univariate logistic regression, NC/TM independently predicted difficult intubation in obese {p = 0.00 and exponential B 29.173(95% CI of 5.862 to 145.185)}. NC/TM showed the highest sensitivity, negative predictive value, and largest area under the curve.. Mean NC/TM was 4.71(SD ± 0.44) and mean NEMA was 0.83(SD ± 2.7) Conclusion The NC/TM ≥5 with its good sensitivity, specificity, negative and positive predictive values, appears an independently useful, simple bedside test predicting difficult intubation in obese Indian population and superior to MMPC and NEMA.
predictors; laryngoscopy; obesity; airway risk assessment; difficult endotracheal intubation
Original Article Clinical Experience on Usage of Apixaban in Thrombosis Management Study (CEATMS)
Oral anticoagulation therapy (OAT) has been increasing in clinical practice for the prophylaxis and treatment of thromboembolic conditions, such as atrial fibrillation (AF). Warfarin is the standard of care, but its disadvantages include interactions with drugs and food, slow onset of action, and narrow therapeutic index. Non-VKA oral anticoagulants (NOACs) such as dabigatran, rivaroxaban, and apixaban are now approved for prevention of thrombosis in both NVAF and VTE. The aim of the present study is to explicate the use of NOACs in various thromboembolic disorders.
Oral anticoagulation therapy, Prophylaxis, Thromboembolic conditions
Original Article Electrodiagnostic referrals at a tertiary center
Introduction: Electrodiagnostic studies are used for the diagnosis of various lower motor neuron disorders. A set of necessary tests are performed for exact localization of disease. The aim of this study is to assess the frequency of the different lower motor neuron diseases and to see how many patients require follow up EDx studies for different conditions. Material and methods This is a retrospective study and data of consecutive patients assessed in our EDx laboratory in the years 2021 and 2022 were included. Data was included as number of cases with a final EDx diagnosis. Total number of cases of each type were entered month wise with the total number of cases of each EDx diagnosis as inferred after the test. Results: In the year 2021, a total of 2732 patients were tested for EMG and EPs in the EDx laboratory. In the year 2022, 3425 patients were tested. The maximum number of patients (905) had normal EDx findings. The most common abnormal diagnosis included traumatic nerve / plexus injuries (668), closely followed by upper / lower limb radiculopathies (645). Somatosensory evoked potential studies for assessing posterior column conduction defects formed the next large referral (598). 478 patients underwent follow up studies followed by Carpal tunnel syndrome (357) and Diabetic peripheral neuropathies (347). Also, a special mention of 130 cases of EMG guided laryngeal botulinum toxin injections for patients with spasmodic dysphonia where the injection is given by Laryngologist /Voice surgeon. Conclusion: To conclude, in our study, the order of electrodiagnostic outcome is normal study followed by peripheral neuropathies, followed by traumatic neuropathies / plexopathies and somatosensory evoked potential studies over the course of 2 years in a total of 6157 patients. Our study reports the maximum percentage of normal EDx findings as consistent with other studies. Most other studies have reported polyneuropathy, entrapment neuropathy, and disorders of the motor nerve root and plexus as the most common reasons for electrodiagnostic requests(19,20). The large number of SSEP referrals as in our laboratory, have not been studied at other centres as reviewed. The strength of our study is 1) the large sample size even though the study has been done only at one centre, and, 2) the maintenance of accurate records.
Case Report A CURIOUS CASE OF PASSING GANGRENOUS COLON PER RECTUM
We report a case of a 66 year old male who presented with bleeding per rectum since 3-4 months. He had a history of being operated for hemorrhoidectomy 9 years ago. He underwent a colonoscopy which detected a large sessile polyp at the rectosigmoid junction for which polypectomy was done. The histopathology of the polyp revealed moderately differentiated adenocarcinoma arising within the villoglandular polyp (malignant polyp) with base involved. He was then operated for anterior resection followed by colorectal anastomosis. There was an anastomotic leak noted in the post operative period for which the patient was re-explored and Hartmans procedure was done in view of gangrenous sloughing of descending colon with resultant leak. 7 months later, patient was taken up for soma reversal and a covering ileostomy was done. He later followed up with an entire bowel wall coming out per rectum.It is a rare and poorly understood case of colonic mucosal sloughing out per rectum presenting without high fever, tachycardia, a rigid abdomen and hemodynamic instability.