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PubMed | Gian Sagar Medical College & Hospital and Post Graduate Institute of Medical Education and Research
Type: Journal Article | Journal: International journal of dermatology | Year: 2016

Rhinofacial conidiobolomycosis (RFC) is an uncommon subcutaneous fungal infection producing painless swelling with grotesque deformity of the face. Although there are case reports and small case series; there are very few prospective studies evaluating treatment outcome and long-term follow-up.To evaluate the safety and efficacy of combination of itraconazole (200mg twice daily) and saturated solution of potassium iodide (SSKI) in patients with RFC.Ten patients of RFC were studied over a period of 5years. Diagnosis was confirmed by clinical, histopathological, and microbiological evaluation. Conidiobolus was cultured in four cases and in the rest of the cases, the histopathology was suggestive of RFC. They were treated with itraconazole (200mg twice daily) and SSKI and followed up for a minimum of 1year after stopping treatment.The mean age was 38.7years and the mean duration of symptoms was 22.4months. Males were predominantly involved (9:1). Seven patients responded to thecombination treatment, five had complete resolution and two had good improvement (50-75%); however, in two patients the response was minimal (<25% regression of the swelling) and one patient did not show any improvement after 6months of treatment.Combination of itraconazole and SSKI is an effective treatment modality for RFC with relatively faster onset of action, low relapse rates, and minimal adverse effects. It can be considered as first-line treatment in patients with RFC.


Singh J.,Panjab University | Garg A.,Gian Sagar Medical College Hospital
Journal of Punjab Academy of Forensic Medicine and Toxicology | Year: 2014

The introduction of molecular techniques in biological anthropology has opened up new possibilities in the discipline. Ancient DNA studies have answered a number of archaeological, paleontological and forensic anthropological questions as it exposes the identity of our ancient ancestors through molecular techniques from ancient/exhumed skeletal remains. The retrieval of DNA sequences from skeletal remains like bones and teeth can reveal the genetic and evolutionary history of humans as well as can reveal routes of ancient human migrations. The lineages of our ancient ancestors have survived by chance in the special pieces of DNA. Human genome contains many genetic traits of their contemporaries which help in identifying the most recent common ancestors. Though DNA is passed on from one generation to another and gets mixed up in the progeny; however, special pieces of it remain unaltered and are subjected to inheritable genetic mutations. The number, rate and order (time) and age of these mutations can be determined since the time they appeared and hence their time of burial can be predicted. Modern humans are thought to evolve from a common female ancestor some about 1, 40,000 years ago in sub-Saharan Africa. It has now been estimated that the limit for DNA preservation is approximately 19.000 years at 10°C, hence specimens from any site that has a thermal age normalized as 10°C >19.000 years are unlikely to contain ancient DNA. Presence of PCR inhibitors, endogenous DNA, damage and fragmentation are the main challenges commonly encountered in ancient DNA analyses. © 2014 JPAFMAT. All rights reserved.


Singh V.,Gian Sagar Medical College & Hospital
Skinmed | Year: 2012

A 16-year-old young man presented with intensely itchy erythematous dermatitis on the body for 1 week and vesicular lesions on the palms and soles for 4 to 5 days. Lesions on the palms and soles were accompanied by severe burning and itching. The patient gave a history of sore throat and fever, 1 week prior to the onset of lesions. A general physical examination was normal, and cutaneous examination revealed multiple, well-defined erythematous scaly plaques with collaret scaling on the trunk and extremities (Figure 1). Vesicular lesions were seen on the palms and soles (Figure 2). The differential diagnoses we considered were pityriasis rosea and secondary syphilis. The possibility of dermatophytid, vesicular pityriasis rosea, and pompholyx was limited to the palms and sole lesions. Complete blood cell count was within normal limits. Results from antistreptolysin O titer, potassium hydroxide mount, and venereal disease research laboratory were negative. Skin biopsies were taken from the back and left palm. The biopsy specimen from the back revealed focal spongiosis, lymphocyte exocytosis, vacuolar changes in the basal layer, and perivascular lymphocytic infiltrate in the dermis (Figure 3). The biopsy obtained from the vesicular lesion on the left palm revealed an intraepidermal vesicle with no evidence of acantolytic process (Figure 4). A diagnosis of pityriasis rosea was made and the patient was started on clarithromycin 500 mg once a day for 7 days, along with antihistamines and emollients. The lesions faded dramatically in a very short period, and there was significant involution of almost all of the lesions after 7 days of clarithromycin. During the 6 months of follow-up, no recurrence was observed.


Narang T.,Gian Sagar Medical College & Hospital
Skinmed | Year: 2011

A 39-year-old Sikh businessman of Asian origin was referred to us with complaints of a painless scrotal lesion that had enlarged over a 2-year period and was causing him discomfort. There was no history of trauma, inflammation, or infection, and no significant urologic history. Physical examination revealed a 2x2 cm skin-colored nodule of rubbery consistency on the left side of the scrotum (Figure 1), which was separate from the testicles or epididymis. There was no inguinal lymphadenopathy. Scrotal ultrasonography demonstrated that the testicles and epididymis were normal. The scrotal mass and surrounding skin were surgically resected using a vertical elliptical incision and sent for histopathology. Histologic examination was consistent with leiomyoma. The epidermis was normal with a prominent proliferation of intertwined smooth muscle fibers with interlacing collagen bundles in the dermis. At higher magnification, the cells were spindle-shaped with eosinophilic cytoplasm and long nuclei. These interweaving bundles of cells surrounded the vessels and the pilosebaceous apparatus. There was no evidence of atypia and the mitotic index was low (Figure 2 and Figure 3). Some normal dartoic muscle fibers were seen in the periphery of the tumor. The patient's postoperative recovery was uneventful. On follow-up visit 10 days later, he did not have any complications, and the sutures were removed. At his last visit 6 months after the procedure, he was still asymptomatic and did not have any recurrence.


PubMed | Gian Sagar Medical College & Hospital
Type: Case Reports | Journal: Acta gastro-enterologica Belgica | Year: 2012

Chronic intussusception is defined as intussusception with a history of more than 14 days and is generally associated with a predisposing factor. We are reporting a rare case of chronic intussusception due to Non Hodgkin lymphoma of ileum, appendix, caecum and ascending colon presented as acute intestinal obstruction in emergency. Chronic Intussusception is rare in childhood due to Non Hodgkin lymphoma. A five year male child presented with fever, pain abdomen, vomiting, diarrhoea and mass in right flank. Ultrasonography of the abdomen revealed a mass in ileao-caecal region with chronic intussusception which was confirmed on surgery. X ray of the abdomen showed dilated bowel loops. It is very difficult to make diagnosis of intestinal lymphoma on pre-operative investigations. Patient presented with obstruction should be explored as surgery is the treatment of the choice. Diagnosis can be confirmed by histopathologically. In conclusion, a high index of suspicion and appropriate investigations (USS, Barium enema and CT scan) can result in prompt diagnosis. In majority of children the diagnosis is made at laparotomy and surgery plays a pivotal role in the management.


PubMed | Gian Sagar Medical College & Hospital
Type: Case Reports | Journal: Skinmed | Year: 2012

A 16-year-old young man presented with intensely itchy erythematous dermatitis on the body for 1 week and vesicular lesions on the palms and soles for 4 to 5 days. Lesions on the palms and soles were accompanied by severe burning and itching. The patient gave a history of sore throat and fever, 1 week prior to the onset of lesions. A general physical examination was normal, and cutaneous examination revealed multiple, well-defined erythematous scaly plaques with collaret scaling on the trunk and extremities (Figure 1). Vesicular lesions were seen on the palms and soles (Figure 2). The differential diagnoses we considered were pityriasis rosea and secondary syphilis. The possibility of dermatophytid, vesicular pityriasis rosea, and pompholyx was limited to the palms and sole lesions. Complete blood cell count was within normal limits. Results from antistreptolysin O titer, potassium hydroxide mount, and venereal disease research laboratory were negative. Skin biopsies were taken from the back and left palm. The biopsy specimen from the back revealed focal spongiosis, lymphocyte exocytosis, vacuolar changes in the basal layer, and perivascular lymphocytic infiltrate in the dermis (Figure 3). The biopsy obtained from the vesicular lesion on the left palm revealed an intraepidermal vesicle with no evidence of acantolytic process (Figure 4). A diagnosis of pityriasis rosea was made and the patient was started on clarithromycin 500 mg once a day for 7 days, along with antihistamines and emollients. The lesions faded dramatically in a very short period, and there was significant involution of almost all of the lesions after 7 days of clarithromycin. During the 6 months of follow-up, no recurrence was observed.


PubMed | Gian Sagar Medical College & Hospital
Type: Journal Article | Journal: North American journal of medical sciences | Year: 2012

Superior mesenteric artery syndrome is a life- threatening upper gastrointestinal disorder due to compression of duodenum as it poses a difficult diagnostic dilemma. Third part of duodenum is in fixed compartment bounded anteriorly by the root of mesentery and superior mesentery artery and posteriorly by the aorta and lumbar spine. On barium contrast study and abdominal computerized tomography (CT) showed the dilatation of second part of duodenum and compression of the third part of duodenum between aorta and superior mesentery artery.A 22 year young asthenic man admitted with the complaint of recurrent abdominal pain, epigastric fullness, and vomiting and weight loss. Abdominal examination revealed epigastric fullness and hyper peristaltic bowel sounds. Upper gastrointestinal barium study showed a dilated stomach with dilated second part of the duodenum and cut off at the third part of duodenum with no intrinsic mucosal abnormalities. There was no relief of obstruction in the left lateral decubitus or prone position. Conservative treatment was tried for one month but failed. Intra-operative findings confirmed the extrinsic obstruction of third part of duodenum with distension of 2(nd) part. A retrocolic duodenojejunostomy, side to side anastomosis done. In post-operative follow up, patient was symptom free.Superior mesentery artery syndrome is a life threatening disease. It should be treated as soon as possible. Conservative trial can be given but Surgery is the treatment of the choice.


PubMed | Gian Sagar Medical College & Hospital
Type: Comparative Study | Journal: B-ENT | Year: 2011

To study and compare the effects of complete nasal packing and nasal packing with airways (uni/bilateral) on blood pressure, arterial oxygen saturation, middle ear pressure, and post-operative subjective complaints.Ninety patients who underwent bilateral anterior nasal packing for epistaxis or following nasal surgery were divided into three equal groups by randomization. Group A received bilateral complete nasal packing, without an airway. In the other two groups, an airway designed from a poly-vinyl chloride, uncuffed endotracheal tube (number 5) was placed below the nasal pack between the inferior turbinate and septum on one (Group B) or both sides (Group C) of the nasal cavity. Patients were monitored in the ward when asleep, especially overnight, for blood pressure and SpO2 levels.Almost all patients in Group A had nasal obstruction with dry mouth, difficulty swallowing, and disturbed sleep. Only 33-40% patients in Groups B and C had similar complaints. Blood pressure rose > 20 mm of Hg in 20 (67%) patients in Group A, while no patients in the airway groups showed any change in blood pressure. In Group A, the average SpO2 during sleep decreased > 4% from baseline in 10 (33%) patients and negative middle ear pressure was found in 5 (17%) patients. The SpO2 and middle ear pressure was within normal limits for all patients with airway packing.Nasal packing with an airway may help to reduce post operative morbidity and reduce the risk of hypoxemia.


PubMed | Gian Sagar Medical College & Hospital
Type: Journal Article | Journal: Indian journal of palliative care | Year: 2011

Treatment of terminally ill cancer patients always poses great challenges especially when these critical patients are admitted in intensive care unit (ICU). The severity of their diseases throws a clinical and ethical dilemma to the treating intensivist.To evaluate the benefits of intensive care treatment in terminally ill cancer patients and also to find out whether optimal utilization of critical care resources has got any positive financial, psychological and clinical outcome.A retrospective evaluation of 53 terminally ill cancer patients, who got admitted to ICU of our department, was carried out. Majority of these patients presented with terminal phase of illness involving multi-organ pathologies with diverse range of symptoms. These patients were provided ventilatory, symptomatic and supportive treatment on patient-to-patient basis. Strict and vigilant monitoring of all vital parameters was carried out. At the end of study, all the data was compiled systematically and was subjected to statistical analysis using non parametric tests.The demographic profile of such patients was highly variable with regard to educational, social and financial status (P<0.05). The most common group of cancer was hematological malignancies (24.53%) followed by lung cancer (18.87%), uteri-ovarian (15.09), colorectal (13.2%) and others. Significant number (P<0.05) of patients (64.15%) required mechanical ventilation and ionotropic support (79.24%). Mortality increased with increasing number of organ system involvement and reaching up to 100% with involvement of 5 or more organ systems.ICU care is the best form of treatment for terminally ill but resources should be used optimally so that a young deserving patient should not be sacrificed for the scarcity of resources.


PubMed | Gian Sagar Medical College & Hospital
Type: Journal Article | Journal: Anesthesia, essays and researches | Year: 2015

Cardiac diseases in the pregnancy pose a multitude of challenges to the obstetricians as well as anesthesiologists. Cardiac pregnant patients presenting for emergency cesarean section do not give time for cardiac optimization and stabilization if they come to the hospital for the first time without any antenatal check-up. The situation can get worse if there is no history related to the decompensated cardiac tissue with asymptomatic gestation and also if the relatives hide all the facts from the doctor about any past cardiac history. We report a case of term pregnancy for emergency cesarean section with asymptomatic dilated cardiomyopathy, which developed severe ventricular arrhythmias and cardiac arrest during the surgical procedure. She was resuscitated successfully on the operation table and was shifted to Intensive Care Unit for further management. The diagnosis of dilated cardiomyopathy was made only after carrying out echocardiography in the postoperative period. The history of previous cardiac complaints was not revealed purposefully by the relatives to avoid the expenses which they would have incurred on investigations and treatment of cardiac ailment.

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