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   Table of Contents - Current issue
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November-December 2018
Volume 11 | Issue 6
Page Nos. 459-575

Online since Thursday, November 15, 2018

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EDITORIAL  

The way forward: Reinventing the wheel: Aligning and re-aligning Highly accessed article p. 459
Amitav Banerjee
DOI:10.4103/mjdrdypu.mjdrdypu_148_18  
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REVIEW ARTICLES Top

Preta grahonmada - Catatonia? p. 461
Kshama Gupta, Prasad Mamidi
DOI:10.4103/mjdrdypu.mjdrdypu_36_18  
Unmada (a broad clinical entity which includes various psychiatric problems) is a major psychiatric condition described in Ayurvedic classics, and it is characterized by deranged mental functions. Unmaada is classified into two groups, doshajaunmaada (occurs due to vitiation of humors inside the body) and bhutonmaada or grahonmaada (not related to vitiation of humors and not caused by the factors inside the body). Bhootonmada is caused by the affliction of evil spirits or supernatural powers or extraterrestrial forces. Preta grahonmada (PG) is one among 18 types (deva, asura, rushi, guru, vruddha, siddha, pitru, gandharva, yaksha, rakshasa, sarpa, brahma rakshasa, pishacha, kushmanda, nishada, preta, maukirana, and vetala) of grahonmada. Till date, no studies have been conducted on PG, and the present study aims at better understanding of PG along with its clinical utility. PG is characterized by Pretakriti, cheshta, and gandha (appearance, behavior/activities and emitting odor-like dead body), Trinacchedinam (purposeless activities), Bheetam (fear or anxiety), and Aahaaradveshinam (aversion to food). Catatonia is a complex neuropsychiatric syndrome characterized by a broad range of motor, speech, and behavioral abnormalities. “Waxy flexibility,” “posturing,” and “catalepsy” are among the well-recognized motor abnormalities associated with catatonia. Catatonia is characterized by the features such as stupor, catalepsy, waxy flexibility, mutism, negativism, posturing, mannerisms, stereotypy, agitation, grimacing, echolalia, and echopraxia. Other common symptoms are motor resistance to simple commands, posturing, rigidity, automatic obedience, and repetitive movements. The features of PG have shown similarity with “Catatonia.” There is profound similarity found between PG and Catatonia.
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Maukirana grahonmada – Psychiatric manifestations of Graves' hyperthyroidism and ophthalmopathy? p. 466
Prasad Mamidi, Kshama Gupta
DOI:10.4103/mjdrdypu.mjdrdypu_75_18  
Bhuta vidya (Ayurvedic psychiatry) is one of the eight specialties of Ayurveda. It deals with various psychiatric conditions caused by the affliction of evil spirits. Unmada (a broad term which consists various psychiatric problems) is a major psychiatric condition described in Ayurvedic and it is characterized by deranged mental functions. “Bhutonmada” (psychiatric conditions of idiopathic nature) is a type of unmada caused by the affliction of “bhoota”/“graha” (evil spirits or supernatural powers). Maukirana grahonmada (MG) is one among 18 types (deva, asura, rushi, guru, vruddha, siddha, pitru, gandharva, yaksha, rakshasa, sarpa, brahma rakshasa, pishacha, kushmanda, nishada, preta, maukirana, and vetala) of bhutonmada. Till date, there were no studies available on MG and the present study aims at better understanding along with clinical applicability of MG. MG is characterized by Ugravaadinam (agitation/aggression/verbal abuse), Rakta, trasta netram (reddish and tired eyes), Yaachantam annam (begging food), and Yaachantam udakarm (begging water). It is very difficult to understand MG based on these few lakshana's (signs and symptoms). Graves' disease (GD) (hyperthyroidism) with ophthalmopathy has shown similarity with MG. GD associated with hyperthyroidism and ophthalmopathy has shown marked similarity with MG. MG is having similarity with GD and Graves' ophthalmopathy.
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ORIGINAL ARTICLES Top

Anti-tussive activity of Ashtangavaleha prepared by two different methods against sulphur dioxide induced cough in mice p. 471
Harmeet B Kaur, Galib Ruknuddin, Mukesh Nariya, Biswajyoti Patgiri, Prashant Bedarkar, Pradeep Kumar Prajapati
DOI:10.4103/mjdrdypu.mjdrdypu_72_18  
Context: Control of cough remains a major unmet medical need. There is a need to have safe and effective anti-tussive drug that can alleviate chronic cough without developing side effects. Ashtangavaleha is an effective compound formulation for combating the disease asthma. Aim: The present study was carried out to evaluate anti-tussive activity of two different samples of Ashtangavaleha prepared with classical (AC) and modified methods (AM) in sulfur dioxide (SO2)-induced cough in mice. Materials and Methods: Batches of both samples of Ashtangavaleha, namely AC and AM were prepared by following standard manufacturing procedures. Anti-tussive activity was carried out against SO2-induced cough reflex in mice. Swiss albino mice of either sex weighing 30 ± 5 g were selected and divided into four groups of six animals each. Test drugs were administered orally at a dose of 2.6 mg/kg. Recodex (Codeine phosphate [2 mg/ml] and chlorpheniramine maleate [0.8 mg/ml]) was used as standard drug. Results: Both test drugs showed significant (P < 0.001) anti-tussive activity against SO2-induced cough reflex. AC significantly reduced the number of cough reflexes by 40.18%, whereas AM reduced it to 34.97%. Conclusion: Both the trial drugs have highly significant anti-tussive effect in SO2-induced cough reflex comparable to the standard drug. Thus, both drugs AC and AM can be safely administered to alleviate cough.
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Association of antipsychotic and antidepressant treatment with metabolic syndrome and 10 years' coronary heart disease risk p. 476
Vivek Pratap Singh, Archana Javadekar, Suprakash Chaudhury, Daniel Saldanha
DOI:10.4103/mjdrdypu.mjdrdypu_25_18  
Background: Cardiovascular risk is becoming a growing concern in patients receiving psychotropic medications. An increased Framingham risk score (FRS) and 10-year coronary artery disease risk has been reported in patients suffering from mental diseases. Aim: This study aims to evaluate the cardiometabolic risk profile in patients suffering from psychiatric disorders being treated with antipsychotics and antidepressants. Materials and Methods: This cross-sectional study was conducted on 68 patients diagnosed with psychiatric disorders according to International Statistical Classification of Diseases-10 at a tertiary health-care center. Patient's demographic details, family history, level of education, duration of disease, use of alcohol and or nicotine, use of concomitant medications, psychotropic drug history, history of treatment of diabetes, dyslipidemia, hypertension, or any other medical conditions were also recorded. Waist circumference, blood pressure, fasting blood sugar, triglyceride, and high-density lipoprotein values were estimated by taking fasting venous samples under aseptic measures. Metabolic syndrome was diagnosed using the International Diabetes Federation Criteria. Ten-year cardiovascular risk was assessed using the FRS. Statistical evaluation was done using appropriate parametric and nonparametric statistical methods. Results: A total of 49 patients were being treated with antipsychotic drugs and 19 were receiving antidepressants. The mean age of patient receiving antipsychotics were 37.51, and those receiving antidepressant were 34.15. The metabolic syndrome was 36.76% in patients taking antipsychotics as compared to 11.76% in patients on antidepressant. The mean FRS score in antipsychotic group was 7.48, and those receiving antidepressants were 4.7. The 10-year coronary heart disease (CHD) risk score was significantly higher in patients receiving antipsychotics as compared to patients on antidepressants. Conclusion: Treatment with antipsychotics is associated with significantly higher 10-year CHD risk scores as compared to treatment with antidepressants.
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The prevalence and health impact of musculoskeletal disorders among farmers p. 485
Saket Anil Patil, Yugantara Ramesh Kadam, Anupriya Suresh Mane, Alka Dilip Gore, Girish Bhimrao Dhumale
DOI:10.4103/mjdrdypu.mjdrdypu_41_18  
Context: Prevalence of musculoskeletal disorders (MSDs) is common among farmers as agriculture work is highly physically demanding. India's 54.6% of the population is engaged in agriculture and allied activities. There is a need for accurate measurement and assessment of the impact of musculoskeletal conditions for public health action. Hence, in order to obtain prevalence and health impact of these problems as well as to evoke interest of researchers in this area, this study was conducted. Aim: To study the prevalence and health impact of MSD among farmers. Subjects and Methods: Study settings: Village from Sangli district. Study design: This was a cross-sectional study. Study subjects: Farmers of both sexes. Exclusion criteria: Farmers having history of arthritis or having MSD due to accidents. Sample size and sampling technique: Calculated sample 1150 from randomly selected village. Study tools: (a) Pro forma developed by investigator, (b) Modified Nordic Questionnaire, and (c) Ovako Working Posture Analyzing System. Statistical Analysis Used: Frequencies, percentages, Chi-square test, and binary logistic regression analysis was done with the help of SPSS software. Results: A total of 964 (83.8%) farmers experienced MSD in the last 1 year. Knee was the most commonly affected body part. Weeding with squatting position was most common posture. MSDs were significantly associated with age, addiction, and associated diseases. Binary logistic regression analysis concluded age, weight, height, and body mass index as strong predictors of MSD. Duration of disability as a result of MSD ranged from 1 to 190 days. Mean expenditure on medication was Rs. 3040.82. Conclusions: Prevalence of MSDs in farmers was high. MSDs had affected farmers adversely in terms of long disability days resulting into economic loss in terms of failure to work to earn and expenditure on treatment.
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Recurrence-free pterygium surgery with special surgical technique p. 492
Sujit Das
DOI:10.4103/mjdrdypu.mjdrdypu_49_18  
Aim: The aim of this study was to evaluate and analyze the surgical outcome of suture-free, glue-free limbal conjunctival autograft after pterygium excision. Design: This was a prospective, interventional, and hospital-based study. Materials and Methods: Forty eyes of 40 patients with primary pterygium were graded, and excision was performed by the single surgeon. To prevent recurrence-free LCAG was used with special surgical technique “subconjunctival resection of fibrovascular pteygium and cauterization of limbal base to destroy abnormal limbal cells along with resection of 7-mm pteygium.” In this technique, we used patient's own blood as a bioadhesive. The eye was patched for 24 h postoperatively. Patients were treated with topical eye drop prednisolone acetate (1%) 1 drop six times per day with gradual tapering every week, eye drop moxifloxacin (0.5%) 1 drop four times per day, eye drop nepafanac (0.5%) 1 drop four times per day, eye drop carboxymethyl cellulose 1 drop six times per day, and carboxymethyl gel at night for 6 weeks. The outcomes were assessed regarding any recurrence, complication(s), and operative time at each follow-up visit on day 1, day 7, day 30, 3 months, 6 months, and 1 year. Results: There were 30 males (75%) and 10 females (25%). The mean age of all the patients was −51.15 (51.15 ± 10.3 years), range 51–60 years. Cosmetic reason was the chief indication of surgery (11 eyes, 27.5%), followed by recurrent redness (nine eyes, 22.5%). There was no recurrence, and the most common complication was hemorrhagic graft (18 eyes, 45%). All grafts appear indistinguishable by 3 months and were free of symptoms. Average surgical time was 18 ± 2 min. Conclusion: (1) 8-mm LCAG with subconjunctival resection of fibrovascular pteygium and cauterization of limbal base to destroy abnormal limbal cells are very affecting in preventing recurrences. (2) Using patient's own blood as bioadhesive is associated with less postoperative discomfort, less postoperative time, and less complications.
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Comparative study in the outcome of intramedullary nailing to plating for both-bone forearm fracture in early and mid-adolescent age group p. 499
Upendra Jung Thapa, Krishna Wahegaonkar, Niraj Ranjeet, Krishna Sapkota, Pratyenta Raj Onta, Pabin Thapa
DOI:10.4103/mjdrdypu.mjdrdypu_84_18  
Objective: The objective of this study was to compare the outcome of intramedullary nailing to plating for both-bone forearm fractures in early and mid-adolescent age group. Design: This was a retrospective, comparative study. Methods: A total of 76 skeletally immature adolescents with a mean age of 12.5 years; range 10–17 years treated operatively for both-bone forearm fractures from 2012 to 2017. Patient with fixation of only one bone, hybrid fixation, bilateral forearm injuries, previous forearm injuries, Galeazzi, Monteggia and radial head fracture, underlying bone pathology, and fracture associated with neurovascular injury were excluded from the study. Intervention: Forty-six patients (mean age, 12.33 years) underwent intramedullary nailing and 30 patients (mean age, 12.77 years) underwent plating. Main Outcome Measure: Time to fracture union, magnitude and location of maximum radial bow (both as a percentage of radial length), forearm rotation, and complications. Results: The mean union time for nail was 7.86 weeks and for the plate was 7.33 weeks which showed no statistically significant differences between the groups for the union of fracture at 3 months (P = 0.780). There were no significant differences between the two groups for the value of maximum radial bow magnitude and its location (P = 0.60). The maximum radial bow magnitude was significantly different from normative values in both groups (P = 0.003 nail and P = 0.001 plate); however, no statistically significant differences for the location of maximum radial bow (P = 0.370 nail and P = 0.632 plate). There were no residual angulation, displacement, or malrotation. Nearly 88% of patients in both groups regained full forearm rotation. There were one major complication and seven minor complications in the intramedullary nailing group and one major complication in plating group. Conclusion: Based on similar functional and radiographic outcomes, intramedullary nail and plate fixation in early and mid-adolescent age group patients for both-bone forearm diaphyseal fractures are equally effective treatment.
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Self-care practices among diabetes patients attending a health center in a slum of Kolkata: A qualitative study p. 506
Nazrul Mallick, Swanya Prabha Maharana, Shobhit Garg, Sembagamuthu Sembiah, Rajarshi Banerjee
DOI:10.4103/mjdrdypu.mjdrdypu_16_18  
Introduction: Type-2 diabetes is a growing health problem worldwide. India has become the diabetes capital of the world. Diabetes requires continuous medical care and education for patient self-management to prevent complications. As self-care activities demand enormous efforts from the patient, there is a necessity to learn their experiences about the hardships they face while self-managing diabetes. Objectives: The main objective is to evaluate the self-care activities along with perceived barriers among patients attending a health centre in a slum of Kolkata. Materials and Methods: This study was conducted in Urban Health Unit and Training Center, Chetla, Kolkata, among 10 male patients of type 2 diabetes for >2 years attending noncommunicable diseases clinics using focus group discussion. Results: Patients with diabetes aged 38–57 years. All of them lived in the slum area. Their duration of diabetes ranged from 2 to 17 years. Most of the participants stated that they suffer from diabetes because of excess “chinta,” that is, worry or stress. They opined that diabetes affected every single part of the body irreversibly. According to the participants, walking, appropriate diet, timely medicines, regular blood glucose monitoring, and stress are to be reduced to control diabetes. Conclusion: Participants were aware of diabetes self-care activities though they lacked knowledge in few domains. Their practice was satisfactory. The patients were distressed due to diet restrictions and felt stress as a main factor in their lives.
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Study of hematological profile of adults presenting with pancytopenia in a tertiary care hospital of central India p. 512
Amit Varma, Prince Lokwani, Kamal Malukani, Sudarshan Gupta, Parul Maheshwari
DOI:10.4103/mjdrdypu.mjdrdypu_52_18  
Background: Pancytopenia is defined as the simultaneous presence of anemia, leukopenia, and thrombocytopenia. The present study was undertaken to explore various causes and clinical manifestations of pancytopenia and to correlate them with severity of pancytopenia in adult patients of Malwa region of central India. Materials and Methods: The study was conducted in Department of Pathology of our Institute with the help of clinical departments such as medicine, surgery, oncology, and others. Two hundred and fifty-one admitted adult male and female patients from October 2015 to March 2017 (18 months) presenting with pancytopenia were included in the study. Tests for complete blood count, peripheral smear, reticulocyte count, bleeding time, clotting time, bone marrow aspiration, and trephine biopsy were done. Results: Among all the hematological disorders (202/251) causing pancytopenia, the most common was megaloblastic anemia (98/202, 48.51%) followed by dimorphic anemia (36/202, 17.8%) and aplastic anemia (18/202, 8.9%). Least common causes included hemolytic anemia (2/202) and disseminated intravascular coagulation (2/202), that is, 0.99% each. Conclusion: Thus, a comprehensive, clinical, and hematological study of patients with pancytopenia will usually help in identifying the underlying cause. The early detection of the underlying conditions would also help to enhance the prognosis of patients with pancytopenia.
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COMMENTARY Top

Hematological profile of patient with pancytopenia p. 519
Viroj Wiwanitkit
DOI:10.4103/mjdrdypu.mjdrdypu_107_18  
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ORIGINAL ARTICLES Top

Awareness and practice of animal bite management among patients attending rabies clinic of a tertiary hospital, Burdwan, India p. 521
Kaushik Nag, Nabarun Karmakar, Indranil Saha, Avijit Paul, Arindam Sinha Mahapatra, Udit Pradhan
DOI:10.4103/mjdrdypu.MJDRDYPU_8_18  
Introduction: Rabies is a neglected disease of poor and vulnerable populations whose deaths are rarely reported. Although rabies is 100% fatal, it is 100% preventable also, but unfortunately, lots of death is occurring around the year. With this, the present study was performed to assess the sociodemographic profile and awareness and practice regarding management of animal bite among patients attending Rabies Clinic of Burdwan Medical College and Hospital (BMC&H), Burdwan, India. Methodology: This study was conducted among 220 patients in Rabies Clinic of BMC&H, Burdwan, India, between July and December 2012. Information about sociodemographic characteristics, awareness, and practices of animal bite were collected. Results: More than half (120, 54.6%) of the participants got animal bite-related information from health personnel (doctors, nurses, etc.). Dog bite was seen in 80% (176) of the cases; interestingly, monkey bite was seen in 4.1% (9) of the cases. Nearly sixty-six percent (65.8%) patients were classified as Category III according to the World Health Organization classification of the severity of wounds. Almost half of the victims (102, 46.3%) washed wound with soap under running tap water, whereas 12.9% (28) had taken no action. Most of the animal bite victims (177, 80.5%) received injection of tetanus toxoid and anti-rabies vaccine following animal bite. Conclusion: The present study showed that more than half of the participants got animal bite-related information from health personnel (doctors, nurses, etc.) and 12.9% (28) had taken no action after animal bite. These indicate proper control of stray animals as well as right medical advice and adequate treatment of animal bite cases can reduce the incidence of rabies.
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Quality of life of elderly people in a rural area of West Bengal: A community-based study p. 527
Aparajita Dasgupta, Tania Pan, Bobby Paul, Lina Bandopadhyay, Shamita Mandal
DOI:10.4103/mjdrdypu.mjdrdypu_78_18  
Introduction: The quality of life (QOL) among the elderly is a neglected issue, especially in developing countries, including India. This study aims to assess the QOL and its associated factors among the elderly population residing in villages of Singur, West Bengal. Materials and Methods: A community-based cross-sectional study was conducted among 146 elderly participants (aged 60 years and above) selected using simple random sampling from Singur block from April to June 2017. A structured questionnaire was used to collect data on sociodemographic characteristics and self-reported comorbidities and QOL assessment was done using the validated Bengali version of EQ-5D-3L (EuroQol) questionnaire. Data entry and analysis were performed using SPSS version 16.0. Categorization of good and poor QOL was based on the median score. Results: Of 146 participants, 54.1% of the participants were found to have poor QOL. The mean (standard deviation) age of the study participants was 68 (5.87) years and 59% of the respondents were female. Most of the study participants (76.7%) had reported comorbidities. Higher percentage of participants reported problems in the dimensions of pain/discomfort and anxiety/depression in both the 60–69 and >69 age groups. In multivariable logistic regression, increasing age, financial dependence, and the presence of one or more comorbidities were significantly associated with poor QOL after adjusting with the other variables. Conclusion: The findings suggest the need for effective health promotion strategies with an emphasis on the prevention and management of chronic diseases. Provision for geriatric care with counseling and social assistance such as old age pension will further help improve their QOL.
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Oral premedication with pregabalin or clonidine for attenuating the pressor response to laryngoscopy and tracheal intubation in laparoscopic cholecystectomy p. 532
Alka Chandra, SK Yathish, Anshumali Gupta, Dheeraj Narain Agarwal, Ratna Chopra
DOI:10.4103/mjdrdypu.mjdrdypu_42_18  
Background and Aims: The aim of the study was to compare the hemodynamic response to laryngoscopy and intubation after pregabalin and clonidine premedication and the effect of pneumoperitoneum on hemodynamic parameters in laparoscopic cholecystectomy. Materials and Methods: One hundred and twenty patients aged 18–60 years scheduled for laparoscopic cholecystectomy were randomly divided into three groups of 40 each. Group I received vitamin tablet, Group II received pregabalin 150 mg, and Group III received clonidine 200 μg as oral premedication 60 min before induction. The heart rate (HR), systolic blood pressure (SBP), and mean arterial pressure were monitored at predefined intervals, i.e., before giving test drug (T1), 30 min after the drug (T2), before induction (T3), immediately after induction (T4), immediately after intubation (T5), 1, 3, 5, and 10 min after intubation (T6, T7, T8, and T9), before creating pneumoperitoneum (T10), 15 min after creating pneumoperitoneum (T11), and 10 min after release of pneumoperitoneum (T12). Results: HR was comparable in the three groups preoperatively. Compared to Group I in Group II, HR was lower at T5 and also at T6, T7, T8, T9, T10, T11, and T12 intervals (P < 0.001). In Group III, HR was statistically lower at all the intervals after 30 min of giving the test drug (P < 0.05) compared to Group I. Compared to Group II in Group III, there was a significant fall in HR at T2, T4, T6, T8, T9, T10, T11, and T12 intervals (P < 0.05). SBP was comparable in all the three groups at baseline. Compared to the Group I in Group II, it was significantly lower at T3, T4, T5, T6, T7, T8, and T11 intervals (P < 0.05). Compared to Group I in Group III, SBP was significantly lower at T2, T5, T6, T7, T8, T9, T10, and T11 intervals (P < 0.05). In Group III, there was a significant fall of SBP at T6, T7, T8, T9, T10, and T11 intervals (P < 0.05) in comparison to Group II. Conclusion: Pregabalin 150 mg as premedicant obtunds the pressor response to laryngoscopy, intubation, and pneumoperitoneum with minimal side effects in laparoscopic cholecystectomy compared to clonidine.
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CASE REPORTS Top

A case of hepatic encephalopathy in an young female due to acute hepatitis E followed by complete recovery: A rare case report p. 539
Atanu Chandra, Indranil Sen
DOI:10.4103/mjdrdypu.mjdrdypu_19_18  
Hepatic encephalopathy is a fatal complication of both chronic liver disease and acute hepatocellular failure. Usually, in such cases, the disease has a rapid progression and fatal prognosis. We report a young female who was admitted in Medical College, Kolkata, India, in 2016 with clinical and biochemical evidence of encephalopathy and coagulopathy (hyperacute liver failure) following an acute hepatitis-like illness. Blood for hepatitis B surface antigen, anti-hepatitis C virus, IgM-hepatitis A virus, and IgM anti-Leptospira all were negative, but anti-hepatitis E virus (HEV) IgM came out to be positive (titer of 6.8 U/ml; whereas <0.9 – negative, 0.9–1.1 – borderline, and >1.1 – positive). IgM anti-HEV was tested using commercially available ELISA kits (Genelabs) using sandwich ELISA technique. The patient was aggressively managed with intravenous fluid, antibiotics, lactulose syrup and enema, and transfusion of fresh frozen plasma along with strict monitoring for other vital organ damage. Symptoms of encephalopathy completely reversed within 5–6 days, and prothrombin time and liver enzymes were normalized gradually. Although acute liver failure with high mortality is common in acute hepatitis E in pregnancy, here, in our case, it happened to a young nonpregnant female followed by complete recovery.
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Drug-induced liver injury in children – Case series from Mumbai p. 542
Viplav Narayan Deogaonkar, Ira Shah
DOI:10.4103/mjdrdypu.mjdrdypu_24_18  
Drug-induced liver injury is one of the most common and most important forms of injury to the liver, accounting for over 20%–40% of all instances of fulminant hepatic failure. We present five cases, of which four were started on antituberculosis therapy and one was started on a therapy for seizures with carbamazepine. All of them showed adverse reactions on the liver and its functioning as was evident by the raised liver enzymes or jaundice.
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Bilateral supernumerary pectoral muscle p. 545
M Maitreyee, Dinit Tom, Purushottam R Manvikar
DOI:10.4103/mjdrdypu.mjdrdypu_27_18  
Pectoral muscles are important muscles in the anterior chest wall, and they have a key role in the axillary region from the point of view of imaging and surgical procedures. In the present case, there was a presence of supernumerary pectoral muscles on both sides. Both of them were lying deep to pectoralis major muscle, arising inferior to but in the same plane of the pectoralis minor muscle. There were three slips of muscle present on the left side and only one slip on the right side. Laterally, these slips were merging with the deep part of the lower border of pectoralis major muscle. They seem to be the part of the pectoralis major of their respective side, which probably failed to migrate along with it during embryological development. Such supernumerary pectoral muscles cannot be ignored as their presence can considerably influence different clinical scenarios.
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Intrahepatic pseudocyst following acute pancreatitis p. 548
Amit Chaturvedi, Saurabh Gaba, Monica Gupta, Sanjay D Cruz
DOI:10.4103/MJDRDYPU.MJDRDYPU_166_17  
Intrahepatic location of pancreatic pseudocyst is a rare manifestation of this common complication of acute pancreatitis. We present a case of 32-year-old man with pancreatic pseudocyst located in liver secondary to an episode of alcoholic pancreatitis. The patient presented with abdominal pain of 1-month duration associated with fever for 10 days. During admission, the patient underwent an abdominal computerized tomography (CT) scan which revealed two large-sized hypodense areas, one in liver and one in pancreas. A percutaneous needle aspiration of the liver was done under ultrasound guidance which showed elevated amylase level. Pigtail catheter was placed to drain the intrahepatic cyst. The patient responded well to this intervention treatment, and there were no complications on follow-up. Intrahepatic pseudocysts should be considered when an intrahepatic collection is encountered in patients with a recent episode of acute pancreatitis. CT associated with high levels of amylase in the hepatic collection is often helpful in diagnosing this unusual complication.
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Right atrial myxoma in a 65-year-old female: A rare presentation p. 551
V Sahitya, G Anandam, Srikanth Shastry
DOI:10.4103/mjdrdypu.mjdrdypu_66_18  
Primary tumors of the heart are quite rare found in 0.04% of autopsies. In decreasing order of frequency, the benign tumors encountered in the heart are myxoma, lipoma, fibroelastoma, rhabdomyoma, hemangioma, and lymphangioma. Malignant tumors are still rare such as rhabdomyosarcoma, angiosarcoma, and malignant mesothelioma. Myxoma is the most common primary tumor of the heart comprising about 50% of all primary cardiac tumors. Majority of them occur in the age group of 30–60 years. Myxomas may be located in any cardiac chamber or the valves, but 90% of them are situated in the left atrium. We here present a case of myxoma in the 65-year-old female which is located in the right atrium.
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Type 5 congenital pouch colon and its embryopathogenesis p. 554
Rahul Gupta
DOI:10.4103/mjdrdypu.mjdrdypu_17_18  
Congenital pouch colon (CPC) is a rare variant of anorectal malformation. It has been classified anatomically into five types as per the length of colon involved. Type 5 is the rarest form of CPC with only six cases reported in the literature till date. It has been originally described as pouch-like (segmental) dilatation of the colon with intervening normal colon of varying length, the distal pouch opening into the genitourinary system with a fistula. We present here a 3-day-old male neonate with CPC Type 5, managed with excision of both pouches and end ileostomy; abdominoperineal posterior sagittal anorectoplasty is planned.
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Child with dilated cardiomyopathy for colostomy closure: Anesthesia considerations p. 559
Sushama Raghunath Tandale, Sunita M Khedkar, Kalpana V Kelkar, Ranjeet Kumar
DOI:10.4103/mjdrdypu.mjdrdypu_40_18  
Perioperative management of a patient with dilated cardiomyopathy (DCM) is challenging for an anesthetist in view of depressed function of myocardium, ventricular enlargement, risk of perioperative arrhythmia, and sudden cardiac death. Preoperative assessment, optimization of medical condition with drug therapy, and appropriate anesthesia management help in better perioperative outcome. Here, we discuss successful perioperative management of DCM in a child scheduled for colostomy closure under general and epidural anesthesia.
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Female adnexal tumor of Wolffian origin: Case report of a rare tumor p. 562
Himadri Bal, Sharda A Agrawal, Harsh Kumar, Versha Shokeen
DOI:10.4103/mjdrdypu.mjdrdypu_71_18  
Female adnexal tumor of Wolffian origin (FATWO) is a rare, poorly understood lesion characterized by variety of epithelial patterns and is known to occur in the broad ligament, mesosalpinx, fallopian tube, ovary, and pelvic peritoneum. About 80 cases of FATWO have been reported till date. A 70-year-old posthysterectomized woman reported with lump abdomen. She was provisionally diagnosed as malignant ovarian tumor. The patient was taken up for staging laparotomy. A solid mass arising from the left adnexa was removed along with the right-sided salpingo-oophorectomy and pelvic lymphadenectomy. Histopathological report was “benign Wolffian adnexal tumor.” FATWOs are rare tumors arising from the remnants of the mesonephric duct. Although most of them are benign, some have the potential for malignant behavior. Diagnosis is often based on exclusion of other neoplasms. Total abdominal hysterectomy and bilateral salpingo-oophorectomy are considered the recommended mode of therapy. The role of adjuvant radiation therapy or chemotherapy remains debatable.
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Glassy cell carcinoma: A rare variant of cervical carcinoma – Case report with review of literature p. 565
Nidhi Raina, Anchana Gulati, Rajni Kaushik, Akshay Rana
DOI:10.4103/mjdrdypu.MJDRDYPU_5_18  
Glassy cell carcinoma is a rare clinical entity involving uterine cervix with aggressive course and relatively poor prognosis. It is a poorly differentiated variant of adenosquamous carcinoma. This neoplasm has poor response to radiotherapy and carries worse prognosis than the usual types of adenocarcinoma and squamous cell carcinoma. A case of a 40-year-old female patient is reported and the published literature is reviewed.
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Anomalous origin of the left coronary artery from the main pulmonary artery p. 568
Nuhu Garba, Ismail Inuwa Mohammed, Godpower Chinedu Michael, Igoche David Peter, Abubakar Mohammed Shakur, Mustafa O Asani, Ibrahim Aliyu
DOI:10.4103/mjdrdypu.mjdrdypu_28_18  
The anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital heart anomaly; this occurs in 1/300,000 live births. ALCAPA syndrome was first described in 1933 by Bland and co-authors in autopsy specimens; however, further description of its clinical manifestations resulted in the naming of Bland–White–Garland syndrome. The case of a 2-year-old boy who was referred for echocardiographic investigation due to recurrent cough, catarrh, and occasional noisy breathing is reported in this communication; his chest X-ray was normal, while electrocardiogram showed Q-waves on limb leads I and aVL and the echocardiographic study showed ALCAPA.
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COMMENTARY Top

Commentary on: Anomalous origin of the left coronary artery from the main pulmonary artery – A case report p. 571
Moises Rodriguez-Gonzalez
DOI:10.4103/mjdrdypu.mjdrdypu_51_18  
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LETTERS TO THE EDITOR Top

World health organization envisages for strengthening of primary care and integration of health services to improve well-being of elderly people p. 573
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava, Jegadeesh Ramasamy
DOI:10.4103/MJDRDYPU.MJDRDYPU_218_17  
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Normality in sex ratio of India: Where are we lacking? p. 574
Niraj Pandit, Jatin Chhaya
DOI:10.4103/mjdrdypu.mjdrdypu_82_18  
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