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   Table of Contents - Current issue
July-August 2021
Volume 14 | Issue 4
Page Nos. 367-475

Online since Thursday, June 17, 2021

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Child health in the times of COVID-19 Highly accessed article p. 367
Amitav Banerjee
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Supporting efforts to address malnutrition in the context of the COVID-19 pandemic in India: An emergency need Highly accessed article p. 369
Purnima Menon, Arjan de Wagt, Vignesh Reddy, Kartheek Reddy, Chandrakant Sambhaji Pandav, Rasmi Avula, Pratima Mathews, Supreet Kaur, Sameer Pawar, Sujeet Ranjan, Sahil Sharma, Rajan Sankar
India has been on a steady march to address malnutrition in the last decade. The nutrition community has worked on building consensus on key actions, implementation platforms were put in place and financing for nutrition slowly increased. Under the strong leadership of the Prime Minister, a revolutionary program to address malnutrition was launched in 2018. As actions under the mission accelerated, the COVID-19 pandemic arrived in early 2020. Affecting health systems, food systems, nutrition programs, social safety nets, and the economy, the pandemic has the potential to exacerbate the challenge of malnutrition in multiple ways. India can mitigate some of the possible ways in which COVID-19 will affect malnutrition but will require strong leadership and continued commitment, adaptation of the national nutrition mission, strengthening of the social safety net and innovative evidence-based data to take informed decisions, implement them and ensure feedback to take necessary corrective action. In this article, we outline some challenges and key areas for action. We conclude that India's nutrition journey is too important to be derailed by a crisis like COVID-19. This is a clarion call for the nutrition community in India to rally strongly to support continued attention to malnutrition in all its forms, to generate relevant evidence, and to support and engage all of society to urgently and adequately address malnutrition in the context of the COVID-19 pandemic. We have come too far to turn back now.
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Otorhinolaryngological manifestations in pregnant women Highly accessed article p. 374
Santosh Kumar Swain, Tapan Pattnaik
There are several physiological changes in the body of the pregnant women. Otological, rhinological, and laryngological changes are quite often seen in pregnancy. Most of the otorhinolaryngological manifestations during pregnancy are benign and reverse during the postpartum period and few do not. These changes in pregnancy are mainly due to alteration of the sex hormones in the female body which returns to a normal level once the pregnancy period over. There should be clear understanding between the otolaryngologists and obstetrician for improving the quality of life of the pregnant women by avoiding the drugs for controlling otorhinolaryngological symptoms, especially in the first trimester. It is important to have clinical knowledge in all clinicians regarding the manifestation of otorhinolaryngological manifestations and treatment options with precautions considering effects on the mother and fetus during pregnancy. Here, this review article discusses the alteration in body physiology, clinical manifestations, and current treatment practice of the ear, nose, and throat manifestations during pregnancy. Electronic search of the SCOPUS, Medline, and PubMed databases was done. The search items in the database included pregnancy, otorhinolaryngological manifestations, gravidarum, gestational epistaxis, gestational rhinitis, hearing loss, and vestibular manifestations in pregnancy. All literature was searched for and reviewed by two authors independently. Search results were then cross-examined, and any differences were settled by consensus.
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Perception and acceptance of Coronavirus Disease-2019 vaccines among doctors p. 380
Arun Kumar Yadav, Nikunj Kumar Kansara, Sonal Nimbhorkar, Atul Kotwal, Subhadeep Ghosh, Saurabh Bobdey
Introduction: Numerous vaccine candidates are in the race of successful clinical trials in response to the ongoing coronavirus disease-2019 (COVID-19) pandemic. This study was conducted to assess the perception and hesitancy among the physicians of major cities of India toward the upcoming COVID-19 vaccine. Methodology: A cross-sectional online survey was conducted between November 25, and December 25, 2020, among the frontline physicians, and they were asked if they would get vaccinated as soon as the vaccine is available in the market. Associations between sociodemographic characteristics and acceptance and hesitancy of an upcoming COVID-19 vaccine were analyzed. Results: Among 139 respondents who gave consent, the majority was male (121, 83.4%). Seventy-six (54.7%) respondents would like to get vaccinated as soon as the vaccine is available. Fifty-six (40.28%) participants had shown fear against the new vaccines, and self-perceived knowledge about the vaccine was found low (79, 56.83%). The majority of the physicians agreed to get vaccinated once reverse transcription–polymerase chain reaction positive or recovered in the past. Self-perceived protection of the new COVID-19 vaccine was high (102, 73.4%), and most physicians thought it safe for humans (89, 64%). Conclusion: The acceptance among the physicians positively influences the approval of a COVID-19 vaccine in the general population. Failure to address physicians' hesitancy leaves immunization programs at significant risk of any country.
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A retrospective clinico-epidemiological study of leprosy cases treated at a tertiary care hospital in Western Maharashtra p. 385
Deepak Vashisht, Prerna Shankar, Vikas Pathania, Surabhi Sharma, Sunmeet Sandhu, Ruby Venugopal
Background: Leprosy is a chronic communicable disease caused by Mycobacterium Leprae. Despite the multidrug regimen against this formidable pathogen for nearly four decades, leprosy remains a public health scourge. The World Health Organization has intensified its efforts to eliminate leprosy by launching “Global Leprosy Strategy 2016–2020. Notwithstanding, India had accounted for 60% of new cases globally in 2016. Aims: The aim of this study is to describe the clinical and epidemiological spectrum of leprosy patients encountered at a tertiary care center in Western Maharashtra. Settings and Design: Record-based, retrospective, descriptive study. Methods: Case records of leprosy patients treated at a tertiary care hospital over 10 years were studied. Two hundred and thirteen cases that fulfilled the World Health Organization's 1998 case definition of leprosy and whose case records were replete with a basic demographic, case history, examination, and treatment details were included in the study. Statistical Analysis: Data were compiled in MS Excel and analyzed with the SPSS statistical software version 20. Results: Majority (87.3%) cases were multibacillary leprosy. A significant number of patients had borderline tuberculoid leprosy (71.5%). Meantime taken for the diagnosis, i.e., time taken from the onset of symptoms to diagnosis was 271.74 days. Contact tracing could be elicited in only 1.4% of cases. A light-colored numb patch was the most common clinical presentation in 79% of patients. 96.7% of patients had peripheral nerve thickening, of which, the ulnar nerve was the most frequently involved (93.5%). Ninety-nine (46.5%) cases had documented leprosy reactions. Grade 2 disability accounted for 23% cases with claw hand as the most common deformity in17.4%. Conclusions: The present study provides an insight into disease burden as well as the effectiveness of health services at a tertiary care hospital in Western Maharashtra. The study also highlights the importance of early diagnosis and management of leprosy and reactions, thereby minimizing deformities and disabilities.
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Characteristics of gastrointestinal metastasis in lung cancer: Single-center experience from Eastern India p. 392
Chaitanya Patil, Shrikant Atreya
Background: Lung cancer is one of the most common cancers associated with a poor prognosis. Gastrointestinal (GI) metastasis among lung cancer patients is often misdiagnosed or missed as a diagnosis. With a paucity of literature on this theme, we conducted a study to understand the clinicopathological characteristics of GI metastasis in lung cancer patients. Materials and Methods: A retrospective review of 793 primary lung cancer patients registered from January 2018 to December 2018 was done at a tertiary cancer hospital. The present study focused on lung cancer patients with an objective to find out the cases of GI metastasis. GI metastasis was confirmed on radiological imaging in the records and positron emission tomography, magnetic resonance imaging, or computed tomography scans. Quantitative variables were either expressed in terms of mean and standard deviation or categorized and expressed in percentages. Pearson's correlation coefficient was used to find the correlation between different symptom clusters in patients with GI metastasis in lung cancer. Results: Of the 793 lung cancer patients, 31 (3.9%) patients had metastasis to the GI tract, with as high as 70.97% (22/31) patients presenting with peritoneal/omental deposits. Of the 31 patients with GI metastasis, five (16.13%) patients were symptomatic, four patients had intestinal obstruction, and one had intestinal perforation. Due to advanced metastatic cancer and poor performance status, patients were provided palliative care and symptom management as they were deemed unfit for surgical intervention. Conclusion: With the advent of targeted and immunological therapies, patients with metastatic lung cancers are surviving longer. Palliative care specialists must work in close collaboration with oncologists to identify an impending GI complication at an early stage to direct specific interventions to avert the complication.
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Utility of Napsin-A in diagnosis of non-small cell lung carcinomas and its addition with thyroid transcription factor-1 (TTF-1) in small biopsies of lung: Does it help in morphologically challenging situations? p. 397
Richa Ranjan, Manoj Prashar, Nishant Taur, Sankalp Singh, Nishant Lohia, R Sivasubramananian, Viswanath Sundaram, Anand Subramananiam
Background: Lung cancer is the leading cause of cancer-related deaths in the world. Primary lung carcinomas were being divided simply as small cell lung carcinoma (SCLC) and non-small cell lung carcinoma (NSCLC) in recent past as the chemotherapy offered in NSCLC was not majorly different in the various subtypes. With the advent of targeted therapy, the management of primary lung adenocarcinomas (PLA) and squamous cell carcinomas (SqCCs) became divergent and hence a stringent separation of the two subgroups is imperative. This study was designed to see whether inclusion of immunohistochemistry (IHC) for Napsin-A in the panel of CK7, CK20, p40, and thyroid transcription factor-1 (TTF-1) improves the diagnostic rates of lung adenocarcinomas. Materials and Methods: A total of 56 cases of primary lung malignancies were studied and subtyped, based on Hematoxylin and Eosin stained slides along with IHC for CK 7, CK 20, p40, TTF-1, and Napsin-A. NSCLC was divided into five groups-PLA, SqCC, NSCLC–favor adenocarcinoma, NSCLC–favor SqCC, and NSCLC–not otherwise specified (NOS). Results: Out of the total, 38 cases were diagnosed to be NSCLC. Of these 38, only 55% cases were diagnosed using histomorphology alone. The rest required immunohistochemical stains for classification. The NSCLC-NOS group comprised 11% in this study. It was observed that by including Napsin-A in the panel, 01/04 (25%) cases in NSCLC-NOS group could be included in NSCLC–favor adenocarcinoma group. Conclusions: This study finds that Napsin-A labels additional cases as adenocarcinomas in NSCLC-NOS group. Napsin-A is more sensitive but less specific than TTF-1 in diagnosis of PLA and has a definite use, in conjunction with TTF-1 to classify NSCLC.
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Surveillance of health-care workers hand to detect carriage of multidrug-resistant Staphylococcus spp. in a tertiary care center: An observational study p. 403
Neelima Kulshrestha, Tanmoy Ghatak, Prasant Gupta, Mastan Singh, Jyotsna Agarwal, Prabhaker Mishra
Objective: Healthcare-associated infection (HCAI) has become a potential peril in intensive care unit (ICU), operation theater (OT) as well as postoperative wards. Those infections are often caused by multidrug-resistant (MDR) organisms. Health-care workers (HCWs), who are taking care of sick patients, often colonize and transmit microorganism from infected to noninfected patient causing HCAIs. The purpose of this study was for surveillance of potential pathogens as hand carriage among HCWs. Materials and Methods: Hand swabs were collected from palmar surface and interdigital space of predominant hands of HCWs working in ICU, OT, and postoperative wards. Antimicrobial susceptibility profile of the potential pathogen isolates including Staphylococcus spp. was also determined for several antibiotics. Methicillin resistance was detected using cefoxitin 30 μg disc. Results: In our study, among 199 HCWs, there was a high carriage rate of Staphylococcus spp. in hands 98 (49.2%) (male: female 1:1). Among Staphylococcus spp., Coagulase-negative staphylococci (CoNS) was around 69 (34.6%) and Staphylococcus aureus was around 29 (14.5%). (including methicillin-resistant S. aureus [MRSA] and methicillin-resistant coagulase-negative Staphylococci [MR-CoNS]). Nearly 65% in MRSA and 75% MR-CoNS were macrolide resistant also. The MRSA hand carriage was significantly high in HCWs having <10 years of service (P = 0.035). No Gram-negative bacteria were identified. Nearly 54 (27%) HCWs were found to be noncarriers (sterile). Conclusion: In our tertiary care center, hand carriage of potential pathogens such as MDR Staphylococcus spp. was very high among HCWs.
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A comparative evaluation of rapid card and widal slide agglutination tests for rapid diagnosis of typhoid fever p. 409
Noor Jahan, Razia Khatoon, Priyanka Mishra, Sudhir Mehrotra, Siraj Ahmad
Background: Typhoid fever is a serious public health problem. It causes severe systemic infection in lesser developed areas of the world. Although blood culture is regarded as the gold standard for diagnosis, it is a time taking procedure. An early and accurate diagnosis is necessary for an effective treatment. Aims: The present study was done to comparatively evaluate rapid card and Widal slide agglutination tests for rapid diagnosis of typhoid cases. Settings and Design: The study design was a cross-sectional descriptive study done over a period of 6 months from January to June 2018. Materials and Methods: A total of 265 patients suspected of typhoid fever who gave their consent were included in the study whose blood samples were tested by both rapid card and Widal slide agglutination tests. Statistical Analysis Used: The collected data were analyzed using SPSS Data Editor Software version 20. Percentage of variables was calculated. Results: Of 265 patients, 97 patients were positive by the Widal slide test, whereas 113 patients were positive by the rapid card test, with 96.9% sensitivity and 88.7% specificity. Of 113 positives, 83 cases were positive for immunoglobulin M (IgM) only, whereas 30 cases were positive for both IgM and IgG. Conclusion: Rapid card test is a simple and easy to perform the diagnostic test for rapid detection of typhoid cases with an additional advantage of separate determination of IgM and IgG antibody, thereby aiding in identification of current infection and previous exposure so that appropriate and timely treatment could be given to the patients.
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Relative influence of overall and central body adiposity on lung function and development of lung function predictive model for adolescents in Tripura p. 415
Balaram Sutradhar, Dipayan Choudhuri, Samrat Hore
Background: Population-specific reference values are necessary for maintaining the reliability of pulmonary function evaluation. There are very few studies that have included body adiposity markers as the predictors of lung function, instead of age and height. Objectives: A gender-specific lung function predictive model of adolescents was developed using overall and central adiposity markers. The relative influences of both markers on pulmonary functions were also evaluated. Methods: Anthropometric and pulmonary function parameters of the subjects were recorded. The percentage body fat, fat mass (FM), fat-free mass (FFM), and body density were calculated. Statistical analysis was done using SPSS 16.0. Results: Significant differences between sexes for anthropometric measures were observed. The mean values of waist circumference (71.94 ± 2.33 mm for female vs. 71.37 ± 2.25 mm for male; P < 0.0005), body composition (5.83 ± 1.27 mm for female vs. 4.71 ± 0.83 mm for male; P < 0.0005), and sum of skinfolds (35.71 ± 4.48 mm for female vs. 34.66 ± 3.01 mm for male; P < 0.0005) were higher in female in comparison to male. Males had significantly higher subscapular skinfold thickness (9.39 ± 1.05 mm, compared with 9.17 ± 1.05 mm for females; P = 0.003). Mean values of central adiposity markers such as waist-hip-ratio (0.88 ± 0.01 for female vs. 0.87 ± 0.01, for male; P < 0.0005) and waist-to-height ratio (0.47 ± 0.004 for female vs. 0.47 ± 0.01, for male; P = 0.002) as well as overall adiposity markers such as percentage body fat (23.81 ± 1.11 for female vs. 18.98 ± 1.20, for male; P = 0.001) and FM (11.27 ± 1.83 kg for female vs. 8.94 ± 1.16, kg for male; P < 0.0005) were significantly higher in female compared to male. Mean FFM (38.17 ± 4.38 mm for male vs. 35.81 ± 3.93 mm for female; P < 0.0005) was significantly higher in male. All the pulmonary function parameters were significantly higher in male compared to female. Results showed the existence of significant mean differences in pulmonary function measures across the three body fat percentage groups in both sexes, with linear decrease of mean values of lung function with the increase of body fat percentage. Post hoc pair-wise multiple comparisons were done to compare the lung function between groups. Conclusion: Overall adiposity marker would explain variation in the pulmonary function parameters better than central adiposity markers in adolescents of both sexes.
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Socioeconomic and demographic profile of autism spectrum disorder p. 424
Shivaji Marella, Samiksha Sahu, Swaleha Mujawar, Daniel Saldanha, Suprakash Chaudhury
Background: Autism spectrum disorder (ASD) is a multifactorial disorder resulting from genetic and nongenetic risk factors and their interaction. There is a paucity of data on the socioeconomic and demographic factors underlying ASD from India. Aim: The aim of this study was to evaluate the socioeconomic and demographic profile of ASD. Materials and Methods: Six hundred patients with behavioral complaints reporting to either psychiatric or pediatric outpatient departments were screened and validated as per Autism questionnaire (Childhood Autism Rating Scale [CARS]). Included patients were evaluated on socioeconomic and demographic scale the appropriate Child Behavior Checklist (CBCL). Results: Twenty-eight children out of 600 (4.66%) were found to have ASD. The average age at which parents first noticed symptoms was 16 months (range: 9–24 months). The mean age at first consultation for ASD symptoms was delayed for girls. A highly significant association between intelligence quotient (IQ) and a diagnosis of ASD was seen. The mean IQ of ASD patients (93.2 n = 28) was significantly lesser than either psychiatric diagnoses or no diagnosis. Even though all patients had an IQ >70, there were still 9/28 patients with a level 3 severity of ASD. A highly significant association between ASD diagnosis and CARS scores was seen. Out of the documented 26 presenting complaints, 17 were social impairment related and 9 related to repetitive patterns of behaviors. The clinical findings from the CBCL conform to a previously developed autism profile for CBCL. Conclusion: Children are taking longer than recommended for optimal outcome to receive a diagnosis. Girls were brought for consultation with the pediatrician later than the boys. Male preponderance in ASD with M: F ratio of 6:1 was highly significant. ASD was found higher in MSES and HSES families. Living in urban areas predicted higher severity. IQ was lesser than for other conditions in ASD.
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Need for autism spectrum disorder research in India p. 432
Sunil Kumar Raina
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Peer-assisted learning versus faculty led learning in procedural skill acquisition utilizing skills laboratory p. 434
Kalpana George, Asma Rahim, Anitha Puduvail Moorkoth, Shabina Methele Pangat Balakrishnan
Background: The aims of this study were to compare the outcomes of faculty led learning with peer assisted learning in acquiring procedural skills and to analyze perceptions on the learning experience of both groups so that feasibility of adopting peer teaching can be considered in the skills laboratory. Methods: Medical students from 4th semester were divided into two groups – A - Individual learners and B - peer tutored students. Group A was taught bladder catheterization by faculty. Six volunteers were chosen as peer teachers, trained by faculty to perform and teach the procedure. Each peer teacher was assessed for training skills. Five to six students were then assigned to each peer teacher. At the end of the study period, each student was assessed for skills acquired by objective structured practical examination. Feedback from students on perceptions of their learning experience was collected using validated feedback instrument. Results: Fifty-seven students excluding peer teachers were assessed–30 in Group A and 27 in Group B. Mean competency scores of Group B was higher than those of Group A (P < 0.012). Median scores of perceptions on overall skill development, teacher contribution, and student satisfaction were not different between the groups. Conclusion: This study has demonstrated that peer teaching can be an effective and feasible tool to teach basic procedural skills to students. Perceptions on the learning experiences of individual and peer led groups in the skills laboratory were not different emphasizing the acceptability of the peer tutor approach.
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Solitary extramedullary plasmacytoma: A rare gingival lesion p. 442
Anshul Sawhney, Megha Ralli Sawhney
Plasma cell tumors consist of extramedullary plasmacytoma (EMP), multiple myeloma (MM), and solitary bone plasmacytoma (SBP). EMP is defined as neoplastic proliferation of plasma cells in soft tissues. It presents as a solitary discrete mass either in soft tissue as EMP or in bone as SBP or as disseminated MM. It is a very rare manifestation. It accounts for <1% of all head-and-neck malignancies with oral cavity being the rarest.
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Large omphalocele with limb deficiency p. 446
Supriya Verma, Ravikala V Rao
Omphalocele is defined as herniation of abdominal contents into the base of umbilical cord and covered by a membrane. Large omphalocele contains liver. We report a case of twin pregnancy (monochorionic diamniotic) with one stillborn anomalous fetus, whereas the other was a live-born preterm low birth weight baby. The anomalous baby had a herniated sac at the insertion of umbilical cord covered by a membrane and absent left upper limb. Content of herniated sac included liver with part of it outside the sac. Microscopic examination of the membrane showed a layer of amnion.
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Charles bonnet syndrome p. 449
Furqan Mohd Akram Khan, Dhaval Dave, Satish Nirhale, Shalesh Rohatgi, Prajwal Rao, Pravin Naphade
Charles Bonnet Syndrome (CBS) or visual release hallucinations are a type of psychophysical visual disturbance and the experience of complex visual hallucinations (VHs) in a person with partial or severe blindness. We present a case of 73-year-old blind male, who lost his vision due to glaucoma, presented with a history of complex VHs. The investigations for alternative pathological causes of VHs were negative and therefore, the etiology of hallucinations was attributed to CBS. Excellent response to low-dose olanzapine was seen, with complete remission by the end of 5th week after starting olanzapine.
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Anesthesia concerns in patients with hypertrophic obstructive cardiomyopathy posted for orthopedic surgery p. 452
Payal A Kankal, Sushama R Tandale, Sanyogita V Naik, Sunita M Khade
Hypertrophic cardiomyopathy (HCM) is the most common genetic cardiovascular disorder, characterized by asymmetric hypertrophy of the interventricular septum that leads to intermittent obstruction of the left ventricular outflow tract (LVOT). Clinical presentation ranges from the absence of symptoms to sudden death at any age. Anesthesia and surgical stress can lead to exacerbation of the LVOT obstruction and may complicate the perioperative course. We hereby describe the perioperative management of two patients with HCM posted for orthopedic surgery.
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Ocular rosacea and corneal perforation: A rare case report p. 455
Sujit Das, B Pradeep, Chhanda Mandal
Acne rosacea is a chronic skin condition with exacerbations and remissions, which requires long-term therapy to maintain symptomatic control. Etiology of rosacea is not fully understood and more than 50% of patients with rosacea have ocular manifestations such as blepharitis, conjunctival hyperemia, and rosacea-associated keratitis. Sight-threatening disease is rare with rosacea; however, keratitis can result in corneal ulceration and eventual perforation if not treated aggressively. Here, in my case, there is acne rosacea associated with blepharitis, dryness, peripheral keratitis, and eventually landed up with corneal perforation which then managed with corneal grafting.
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Hepatic amyloidosis: A rare entity p. 459
Charusheela R Gore, Namrata Patro, Banyameen Iqbal, Tushar Kambale
Hepatic amyloidosis is a unique and uncommon disease which shows its presentation in the form of an infiltrative disease involving the liver. Amyloidosis is a systemic disease entity which is characterized by deposition of amyloid protein in the extracellular tissues of multiple organs. A 45-year-old female was admitted with complaints of yellowish discoloration of sclera and decreased appetite since 1 month. Liver enzymes were raised with a significantly high serum alkaline phosphatase. Microscopy showed linear sinusoidal deposition of an amorphous eosinophilic material which was also causing atrophy of liver cell plates. The portal tracts as well showed similar eosinophilic deposits. There was no significant lobular or portal inflammation. The material was found to be congophilic on congo red stain and it also showed apple green birefringence on polarizing microscopy. A diagnosis of hepatic amyloidosis was made. Amyloidosis of the liver is a rare disease entity that often presents with vague, nonspecific findings and has a poor prognosis. Prompt diagnosis and management are required to improve outcomes for this patient population. Further investigation and research are needed to elucidate the risks and effectiveness of hepatic amyloidosis treatment regimens. Liver involvement of amyloidosis presents with nonspecific clinical symptoms such as weight loss and fatigue. The prompt diagnosis is however very critical as liver-biopsy-proven amyloidosis has a poor prognosis as the median survival is only 8.5 months. Progressive organ involvement most often leads to organ malfunction and subsequently death due to renal and/or cardiac involvement.
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Hepatic amyloidosis p. 463
Subhashish Das
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Herpes simplex, encephalitis, and predisposing factor p. 465
Viroj Wiwanitkit
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Indigenous intubation techniques using out of label devices: Boon or bane? p. 466
Anju Gupta, Nishkarsh Gupta
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Organ shortage: Can educating the medical students be the key? p. 468
Vaishaly Bharambe
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Analysing neonatal transport p. 469
Manas Pratim Roy
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COVID-19: The curious case of the dog that did not bark p. 471
A Sule Altinda, Caner Şahin
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Commentary on “the curious case of the dog that did not bark” p. 473
Sudhir Kumar
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Strengthening outbreak readiness and emergency response to COVID-19 in cities and urban pockets p. 474
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
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