Medicine

Editorial RN Srivastava Apollo Medicine 2019 16(1):1-1

Posttraumatic brain edema: Pathophysiology, management, and current concept Subhas K Konar, Dhaval Shukla, Amit Agrawal Apollo Medicine 2019 16(1):2-7 Post traumatic cerebral edema is a multiplex process. Mainly two types of cerebral edema occurred after traumatic brain injury-vasogenic edema and cytotoxic edema. Cytotoxic cerebral edema is due to accumulation of water in the intercellular space. Mitochondria mainly cause cytotoxic edema due to the involvement of oxidative metabolism. Various molecules are involved in the formation of cytotoxic edema- like aquaporin, Sulfonylurea-receptor 1 – transient receptor potential member 4 (Sur1-Trpm4), Glutamate, Na+-K+-2Cl− cotransporter, Arginine vasopressin, Histamine, and Erythropoietin .Vasogenic edema develops due to disruption of blood-brain barrier or altered permeability of blood-brain barrier so correlate with the level of impact and or activation of molecular pathways related with neuroinflammation. Molecules involved in neuroinflammation are tumor necrosis factor (TNF), interleukins (IL) 6 and I beta, Substance P and Bradykinin. Management is mainly dived into two part- medical and surgical. Medical management includes management of increased intracranial pressure and later blocking of the pathways involved in the formation and progression of cerebral edema. In refractory cases, surgical decompression plays a role in controlling the intracranial pressure due to cerebral edema.

The importance of microscopic diagnosis of respiratory infections Isabella Princess, Rohit Vadala Apollo Medicine 2019 16(1):8-10 The need for mastering microscopic diagnosis arises in all laboratory specialties, especially when working in resource-poor community laboratories which lack newer diagnostic instruments. Certain clues from microscopic appearance should be carefully analyzed to clinch diagnosis and to not miss out these findings. In addition, if turnaround time is reduced, there is better patient outcome and satisfaction from the clinical colleagues.

Primary fungal laryngitis: An overlooked clinical entity Santosh Kumar Swain, Mahesh Chandra Sahu, Priyanka Debdta, Manas Ranjan Baisakh Apollo Medicine 2019 16(1):11-15 Primary fungal laryngitis is a fungal infection of the larynx without affecting the other body parts such as lungs, pharynx, and oral cavity. It is an extremely rare clinical entity, especially in immunocompetent patients. Aspergillus fumigatus and Candida albicans are common fungi associated with primary fungal laryngitis. Hoarseness of the voice is common clinical presentations. The diagnosis of the primary fungal laryngitis is often overlooked and delayed among patients as it is usually evident among immunocompromised patients. It is often confused with certain laryngeal diseases such as granulomatous diseases, leukoplakia, and malignancy. Misdiagnosis or delayed diagnosis or inadequate treatment may lead to impaired functioning of the larynx and sometimes suffered from permanent disability. It is always important to identify the lesion earliest for avoiding morbid or life-threatening consequences. The purpose of this review article is to discuss the etiopathology, clinical presentations, diagnosis, and treatment of primary fungal laryngitis.

Isolation and identification of fungus associated with skin and nail scalps of patients in a tertiary care teaching hospital Kaniska Uthansingh, Manoj Kumar Sahu, Nagen Kumar Debata, Debasmita Behera, Kirtika Panda, Mahesh Chandra Sahu Apollo Medicine 2019 16(1):16-21 Background and Objectives: Ringworm of the scalp is starting at now a disease of overall criticalness and a general prosperity teaching care hospitals. It is otherwise known as dermatophytes, which attack and create on dead animal keratin. This assessment was intended to recognize the regular dermatophyte causing parasitic infection with both minute just as social strategies. Materials and Methods: This is a Prospective study which was carried out for the period 1 year and included the patients with tinea cruris and tinea corporis, tinea unguium, tinea pedis, and tinea barbae which are seen in the patients between 6 to 70 years of age. Dermatophytes were confirmed with microscopic examination of skin and nail tests taken from the influenced lesion of the body. Both cotton blue and potassium hydroxide grouping of 10%– 30% were utilized to see under magnifying micrioscope. All information were broken down with SPPS 20 programming. Results: Out of 78 patients, the recurrence of ringworm infection among those patients attending in the department of Skin and VD, IMS and SUM Hospital was Trichophyton rubrum (73%), Trichophyton mentagrophytes (53%), Epidermophyton floccosum (26.82%), and Trichophyton verrucosum (7.31%). T. rubrum was the most widely recognized etiological fungus in tinea corporis, and this positioned first in the other type of ringworm infection. Recurrence of dermatophytes infection partner with various clinical examples; for example, nail pieces and skin swabs from the infected area. Conclusions: The greater part of the tinea corporis patients were infected with T. rubrum then comes the disease of Trichophyton violaceum, Trichophyton tonsurans, and T. mentagrophytes. The most astounding recurrence of disease was among the patients matured 20– 30 years. It is additionally essentially noticed that this infection takes a somewhat serious turn in patients of cutting edge in older age (60– 80 years).

Assessment of level of depression and anxiety in pre- and postoperative stages: A prospective cross-sectional study in SCB Medical College, Cuttack Srikanta Panda, Narendranath Samantaray, Monisha Patanaik, Debasish Sahoo, Anshuman Sarangi, Somanatha Jena Apollo Medicine 2019 16(1):22-25 Objectives: Mood disorders are considered to be prevalent in hospitalized patients. Our study aimed to investigate the prevalence of depression and anxiety symptoms in pre- and postoperative stage in surgical patients. Methods: We included 60 surgical patients in this cross-sectional study which includes 43 male and 17 female patients and average age of 38.8 years. Hamilton Anxiety Rating Scale and Hamilton Depression Rating Scale were used to screen for symptoms of depression and anxiety at 12 h after admission for electively scheduled surgeries and 12–24 h after the surgery for patients undergoing emergency surgery. Results: In presurgery stage, anxiety was found to be prevalent in 43.3% of patients while depression is 38%. In postsurgery stage, anxiety and depression were found in 18.3% and 35% of patients, respectively. Conclusions: Both anxiety and depression are highly prevalent in pre- and postoperative stage of surgery. Such symptoms should be attended with more seriousness, otherwise would lead to higher morbidity and mortality.

Surgical outcome of 60 operated patients with acute extradural hematomas based on the preoperative glasgow coma scale Ajaydeep Singh, Arvinpreet Kour, GS Bindra, Ajay K Gehlot, Rahul Midha, Kartik Nandra Apollo Medicine 2019 16(1):26-32 Aim and Objective: This study aims to evaluate the outcome of the patients operated for acute extradural hematoma (EDH). Patients and Methods: Sixty consecutive cases of acute EDH were treated at medical college hospital to assess the outcome of the patients based on their Glasgow Coma Scale (GCS), radiological assessment, and pupil size. The patients were monitored of their GCS, pupillary size, and vitals. The Glasgow outcome scale was used to evaluate patient outcome at the discharge from the hospital and after 3 months. Observation and Results: Sixty patients constituting 56 males and 4 females were the part of the study. The mean age of the patients was 23.21 years (range: 2–47 years). On an average, the patients were operated around 9.91 h after the trauma (ranging 2–24 h). Out of sixty patients, 25, 17, and 18 patients had GCS of mild, moderate, and severe groups. Prompt surgery with better care obtained us with mortality 1.6%, morbidity 21.7%, and complete recovery in 83% patients. Conclusion: We may conclude in our study that presurgical clinical findings such as sensorium of patient and pupillary status were an important indicator for surgical outcome. In most of the cases, the outcome was favorable with progressive recovery.

Aggressive surgical resection following neoadjuvant imatinib therapy for advanced duodenal tumor with hepatic metastasis Varun Madaan, Rigved Gupta, GK Adithya, Satya Prakash Jindal, Deepak Govil Apollo Medicine 2019 16(1):33-35 Duodenal gastrointestinal stromal tumors (GISTs) are rare tumors which constitute <5&#37; of all cases of GIST. The treatment of locally advanced/inoperable and metastatic GIST is primarily tyrosine kinase inhibitor therapy (TKI), i.e., imatinib mesylate. In some patients, initial TKI therapy may result in significant downstaging of the primary tumor and metastatic disease. The role of aggressive surgical resection in such patients remains controversial. We present a case of advanced duodenal GIST treated successfully by Whipple&#39;s procedure with liver wedge resection following neoadjuvant TKI therapy. This case shows that aggressive surgical resection for metastatic duodenal GIST following neoadjuvant imatinib seems to be a feasible treatment option.

Primary paravertebral low-grade fibromyxoid sarcoma Binod Kumar Singhania, Jummo Jini, Gobinda Pramanick Apollo Medicine 2019 16(1):36-38 Low-grade fibromyxoid sarcoma is a distinctive variant of fibrosarcoma. Despite its benign histological appearance, it is a tumor with malignant potential. Usually, it is occur in the proximal lower extremities and trunk. However, it is very rare in paravertebral region. The diagnosis is based on the histology and specific immunohistochemistry results. The treatment of choice is total excision followed by radiotherapy to prevent the possibility of recurrence. We excised the tumor to near total and a wide fixation has been done. Frozen section biopsy was misleading and reported a schwannoma.

Multiple spinal neurofibromas Kodeeswaran Marappan, Prabhu Marudamuthu, Sherina Paul Raj Apollo Medicine 2019 16(1):39-41 A 55-year-old male, with a 2-month history of urinary incontinence, a suspected case of pyelonephritis was initially treated by a nephrologist, but with no relief in spite of medication. On further evaluation, he was found to have a history of back pain, progressive bilateral weakness of lower extremities, and difficulty walking. He was thus referred to us for further management. Magnetic resonance imaging (MRI) of the spine was done, which revealed the presence of multiple bilateral dumbbell-shaped lesions at multiple spinal levels, associated with widening of the neural foramina of the cervical, dorsal, and lumbar regions. Surgical excision of all lesions was done in a single sitting. The patient had postoperative weakness and urinary incontinence, which slowly recovered and weakness gradually improved by physiotherapy. On follow-up, the patient was able to walk without any weakness. Surgical excision is the treatment of choice for spinal neurofibromatosis. Diagnosis of the condition may be difficult due to the lack of symptoms in majority of the cases or presentation with rare symptoms. However, it is recommended that a routine MRI of the spine be performed in patients with a history of urinary incontinence associated with weakness of limbs.