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   Table of Contents - Current issue
Coverpage
October-December 2017
Volume 15 | Issue 4
Page Nos. 261-311

Online since Friday, November 17, 2017

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CLINICAL QUERIES  

Clinical questions: Responses to queries from readers p. 261
D Samuel Abraham
DOI:10.4103/cmi.cmi_82_17  
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TOPIC IN FOCUS - REVIEW ARTICLES Top

Risk assessment of intrauterine growth restriction p. 262
Reeta Vijayaselvi, Anne George Cherian
DOI:10.4103/cmi.cmi_76_17  
Intrauterine growth restriction is a condition where the estimated fetal weight is less than the 10th percentile on ultrasound and the fetus has not attained its biologically determined growth potential because of a pathologic process. This review deals with the definitions of fetal growth restriction, the etiology associated with it, the types of fetal growth restriction and discusses how to differentiate between them. The various screening mechanisms available, the approach to a patient who is at risk for fetal growth restriction and whether they will benefit from any of the prophylactic measures available are also discussed.
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Diagnosis of intrauterine growth restriction p. 267
Anne George Cherian
DOI:10.4103/cmi.cmi_77_17  
Fetal growth restriction is an adverse event in pregnancy, and the goal of antenatal monitoring is early detection of intrauterine growth restriction (IUGR). This involves the correct determination of gestational age to differentiate fetal growth restriction from a perceived restriction due to the wrong estimation of the gestational age. The use of ultrasound studies to estimate fetal size, growth, and volume of liquor along with simple charting of fetal growth can help diagnose IUGR and guide the physician toward remedial measures. This review discusses clinical examination as well as investigations needed to confirm the diagnosis of fetal growth restriction.
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Management of intrauterine growth restriction p. 271
Liji S David, Anne George Cherian, Manisha Madhai Beck
DOI:10.4103/cmi.cmi_78_17  
Intrauterine growth restriction (IUGR) is a condition where the fetus does not attain its biologically determined growth potential due to a pathological process. The main tools for antenatal surveillance in a growth-restricted fetus include amniotic fluid volume, Doppler studies, and biophysical profile. The frequency of surveillance depends on the severity of the growth restriction and the findings on previous ultrasound studies. The decision to deliver the fetus is dependent on factors such as gestational age, severity of growth restriction, and findings on the Doppler studies. If there is severe abnormality in the Doppler studies, lower segment cesarean section is recommended as the mode of delivery. Vaginal delivery may be attempted after induction of labor if Doppler parameters are normal, in a center with adequate facilities for monitoring facilities and when there are personnel with expertise. This review provides an overview of antenatal monitoring in a pregnancy with IUGR and decision-making during the time of delivery.
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ARTICLES: ORIGINAL ARTICLE Top

Splenic injuries in blunt trauma of the abdomen presenting to the emergency department of a large tertiary care hospital in South India p. 278
Kundavaram Paul Prabhakar Abhilash, Moses Amos Kirubairaj, Kiruthika Meenavarthini
DOI:10.4103/cmi.cmi_21_17  
Background: Trauma is an increasing cause of morbidity and mortality in India. Blunt injury to the abdomen frequently results in life-threatening splenic injuries. Materials and Methods: This was a retrospective observational study of all patients more than 18 years old presenting to our emergency department with blunt abdominal trauma resulting in a splenic injury between 2006 and 2011. Details of the incident, injuries, and outcome were noted. Results: During the study of 2006–2011, 51 patients with splenic injury following blunt trauma to the abdomen were enrolled. There was a significant male predominance (94.1%). Road traffic accident (RTA) was the predominant mode of injury (66.7%) followed by fall from height (25.5%). On examination, the majority of the patients (82.4%) had abdominal tenderness while abdominal distension and guarding were seen in 60.8% and 31.4% of patients, respectively. A third (35.3%) of the patients was hypotensive at presentation. All the patients were started on crystalloids while blood products were transfused in 70.6% of the patients. Splenic injury was diagnosed during the primary survey in 92% of the patients. Emergency department (ED) physicians diagnosed free fluid and solid organ injuries on focused abdominal sonography in trauma (FAST) in 80.4% and 47.1% of patients, respectively. Computed tomography scan of the abdomen was performed in 57% of the patients. More than half (58.8%) were managed conservatively. The mortality rate was 10%. Conclusions: RTAs are the most common cause of splenic injury. ED physicians are quite reliable in diagnosing free fluid in the abdomen with FAST. Aggressive fluid resuscitation with blood products is the key to survival in both conservatively and surgically managed patients.
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ARTICLES - CASE REPORT Top

Retroperitoneal fibrosis: A rare manifestation of extramedullary dissemination of multiple myeloma p. 282
Fibi Ninan, Ajay Kumar Mishra, Ajoy Oommen John, Iyadurai Ramya
DOI:10.4103/cmi.cmi_58_17  
Multiple myeloma is a neoplasm that occurs due to monoclonal proliferation of plasma cells. Anemia, hypercalcemia, renal failure, and osteolytic lesions are the common manifestations. Less than 5% of patients present with extramedullary dissemination at the time of diagnosis. The common sites of extramedullary dissemination are liver, spleen, adrenals, and lung. Spread of myeloma into retroperitoneum causing retroperitoneal fibrosis is one of the rare manifestations. Patients with disseminated myeloma are usually young and have a poor disease-free survival rate. Aggressive therapy in the form of stem cell transplant has shown to be of benefit in such patients.
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EVIDENCE BASED MEDICINE SUMMARY OF STUDY Top

Rehabilitation of stroke: A summary of the ATTEND study p. 285
Anna T Valson
DOI:10.4103/cmi.cmi_70_17  
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Are saturated fats in the diet bad for the heart? – A summary of the prospective urban rural epidemiology study p. 288
Tony Abraham Thomas
DOI:10.4103/cmi.cmi_79_17  
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FAMILY MEDICINE / PRIMARY HEALTH Top

Why family physicians are the best people to stop the tragedy of untreated mental illness in India p. 290
Rajkumar Ramasamy
DOI:10.4103/cmi.cmi_37_17  
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MEDICINE AND LAW Top

Is a university competent to confer a “Recognized” medical degree or diploma in India p. 295
D Samuel Abraham
DOI:10.4103/cmi.cmi_75_17  
There have been several legal enactments in the Indian legal system that were put into force with the intention of standardizing and regulating medical education and the conferring of medical qualifications. There is a common misunderstanding that a medical degree or diploma is recognized or is legally valid if it is provided by a university. However, from a legal standpoint, while Indian Universities may provide medical education courses, they are not fully competent and cannot independently confer a degree/diploma on their own, unless they have obtained sanction from the Medical Council of India and Central government. No medical professional can suffix the name of the Diploma/Degree/Certificate after their name in the business card or seal if they are not approved by both MCI and Central Government. The issue of a Medical Degree or Medical Diploma by a University without the approval of the Central Government and the Medical Council of India (MCI) will be incomplete and invalid legally.
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HISTORY OF MEDICINE Top

Theodor Schwann: A founding father of biology and medicine p. 299
Tony Abraham Thomas
DOI:10.4103/cmi.cmi_81_17  
Theodor Schwann is best remembered for the eponymous Schwann cell that he studied and described in his microscopic studies of nervous tissue. However, his most important contribution to science would be the fact that he was one of the founders of the 'Cell doctrine' which proposed that all living beings were made of fundamental units called cells - a foundational principle on which rests much of our understanding of biological science. Schwann was one of the first scientists to break away from vitalism to lean toward a mechanistic or physico-chemical explanation of living processes which proposed that the biological processes in cells and living beings could be explained by physical and chemical phenomena. He was also involved in describing the physiology of bile and the enzyme pepsin which furthered our understanding of the physiology of digestion. His contributions to biology and medicine has paved the way for the emergence and blooming of several fields of study such as microbiology, pathology, histology and the principle of antibiotics.
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PRACTICE STORY/OPINION Top

Health advocacy as freedom of expression p. 302
Valson Thampu
DOI:10.4103/cmi.cmi_80_17  
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REGULARS Top

Drug Dialogues – Medication news and new medications p. 305

DOI:10.4103/0973-4651.218651  
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Medical news – from around the world p. 309

DOI:10.4103/0973-4651.218652  
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DEVOTIONAL Top

Faith or experience? p. 311

DOI:10.4103/0973-4651.218650  
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