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   2019| July-September  | Volume 17 | Issue 3  
    Online since September 26, 2019

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Diuretic-induced dyselectrolytemia and its clinical implications
Vijoy Kumar Jha, KV Padmaprakash, Rajesh Pandey
July-September 2019, 17(3):69-74
Diuretics are the most important and commonly used therapeutic agent in daily clinical practice, particularly in edematous states and hypertension. They increase urinary sodium and water losses by diminishing sodium reabsorption at different sites of a nephron. These drugs can influence the renal handling of electrolyte-free water, sodium, potassium, calcium, etc., depending on the sites of action leading to electrolyte disturbances which sometimes can be life-threatening if not carefully monitored and managed. This review focuses on the electrolyte imbalances in the setting of diuretic use and its clinical implications.
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Open and endoscopic medial maxillectomy for maxillary tumors – a review of surgical options
Muhammad Nu'aim Ishak, Norhafiza Mat Lazim, Zul Izhar Mohd. Ismail, Baharudin Abdullah
July-September 2019, 17(3):75-79
It has been the gold standard approach for maxillary tumors to do an open radical maxillectomy. The introduction of endoscopic surgery has provided an alternative method for tumor removal without creating a cosmetically disfiguring scar. We reviewed the literature to describe the open and endoscopic medial maxillectomy for the management of maxillary tumors. This review is based on a selective literature search of the PubMed database, searching for the terms “medial maxillectomy,” “endoscopic medial maxillectomy,” “partial maxillectomy,” “maxillary tumors,” “sinonasal neoplasms,” and “inverted papilloma.” Some older standard publications, textbooks, and our own clinical experience were also included. No language or year of publication restriction was applied. The indication for medial maxillectomy, either open or endoscopic medial maxillectomy is inverted papilloma, a benign locally invasive sinonasal tumor. The aim is to remove all diseased tumor tissue together with complete margin clearance. At the same time, the wide cavities provide easier monitoring of recurrent tumor on follow-up. Lack of complications of open surgery as well as improved access to medial and posterior sinonasal regions suggests that the endoscopic techniques for selected lesions may be a good alternative to open surgery. The endoscopic medial maxillectomy is the preferred option for the treatment of benign sinonasal neoplasm involving the medial wall of maxilla specifically inverted papilloma. Adjuvant external approach may be performed when needed to allow complete eradication of any residual disease.
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Venomous snakebites: Management and anti-snake venom
John Emmanuel Jesudasan, Kundavaram Paul Prabhakar Abhilash
July-September 2019, 17(3):66-68
In the Indian subcontinent, the “Big four” snakes of cobra, krait, Russell's viper, and saw-scaled viper are responsible for most of the venomous snakebites. Diagnosing envenomation is a pure clinical skill with no diagnostic kit available yet. Anti-snake venom (ASV) is a precious commodity, and clinicians across the country must be aware of the process of production of ASV so that they may use it judiciously for the treatment of envenomation.
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To identify newer probable risk factors of chronic kidney disease in the indian population: A case–control study
Arti Muley, Saurabh Mamtani, Mahek Mistry, Hiteshree Kantharia, Vikas Raman Chandrakar
July-September 2019, 17(3):55-59
Introduction: This study was conducted to identify unknown factors which may have been contributing to the increasing incidence of chronic kidney disease (CKD) in the Indian population. Materials and Methods: We performed a population-based observational case–control study on patients having CKD as cases and their age- and sex-matched disease-free controls for 6 months. Detailed information on demographic, socioeconomic, behavioral, dietary, and medical history was collected using validated self-structured questionnaire, and the data were statistically analyzed to find out the association between various dietary, environmental, and behavioral factors and CKD. Results: The mean age of patients having CKD was 49.6 ± 14.59 years, with male-to-female ratio of 1.94:1. The history of consumption of nonsteroidal anti-inflammatory drugs, insomnia, obstructive sleep apnea, antibiotics, and smoking was present in 66%, 65%, 54%, 30%, and 27%, respectively. Anemia and malaria were present in 11.3% each. 17% gave a history of low water intake. People living in the rural area with no or limited medical facilities were more prone to CKD (55%). Conclusions: Although some of our observations may have been influenced by confounding and we cannot confirm these as causative associations, we were able to identify the unknown factors which may be contributory. This study at least opens up new areas of research to find causative factors for CKD and target health policies toward them to constraint the rapidly increasing prevalence and burden of the disease.
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A retrospective study on the profile of long bone injuries in trauma patients presenting to emergency department
Iashanlang Dkhar, Darpanarayan Hazra, Mamta Madhiyazhagan, Joshua Vijay Joseph, Kundavaram Paul Prabhakar Abhilash
July-September 2019, 17(3):60-65
Background: Trauma is one of the major causes of long bone injuries in India. This study was done to improve the understanding of the mode of trauma, type of injury and severity and outcome of trauma victims with long bone injuries in our hospital. Materials and Methods: This was a retrospective observational study of all trauma patients aged 18 years or more with long bone injuries presenting to our emergency department. Details of the incident, injuries, management, and outcome were noted. Results: We received a total of 2207 trauma patients during the 4-month study period with 14.31% (316/2207) being adult patients with long bone injuries. Male (71.8%) predominance were noted. The mean age was 45.7 (±17.9) years. Road traffic accident (68.35%) was the most common mechanism of the incident followed by slip and fall (20.56%). Majority of patients (43.98%) came during 15.00–22.00 h. The most common long bone injured was the tibia in the young (51.68%)- and middle-aged (58%) patients. In the elderly, femur (58.19%) was the most common bone involved. Head injury accounted for 13% of the associated injuries. Among these 316 trauma patients 186 were admitted, 105 (57.37%) patients had to undergo an emergency operation on the same day of arrival, whereas 78 (42.62%) patients were managed conservatively in the wards or had an elective surgery done at a later date. Conclusions: The tibia is the most common long bone injured in young adults, whereas the femur is the most common in the elderly. Prevention, education, legislative enforcement, and prehospital management and transportation of trauma-inflicted patients would impact immensely on the health of the people.
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A prospective study to determine the clinical profile of patients suspected to have acute intestinal obstruction in the emergency department
B Kirubagaran, Kundavaram Paul Prabhakar Abhilash, Srujan Lam Sharma
July-September 2019, 17(3):49-54
Background: Acute intestinal obstruction (AIO) is a surgical emergency, with its varied symptomatology and presentation, and diagnosing it is always a challenge to the emergency physician. This study was done to understand the prevalence, various etiologies, usefulness of computerized tomography (CT) of the abdomen in the diagnosis, rate of surgical management, and outcome of AIO in the emergency department (ED). Materials and Methods: This prospective study included all the patients who presented to the ED with a history of inability to pass stools and flatus and diagnosed to have intestinal obstruction clinically. This study was conducted for a duration of 6 months (December 2017–May 2018). Patient's clinical parameters, radiological imaging, etiology, treatment given, and outcome of the patients were noted. Results: Among 15,857 patients who presented to the ED over a study period, 90 (0.567%) patients had AIO out of 120 suspected cases. The most common age group (22%) was more than 60 years of age with female preponderance (55.6%). Most common etiological factor was adhesion (26.67%), followed by hernia (23.3%). Among 120 suspected patients, those who had undergone CT abdomen (n = 59) showed 95.6% of sensitivity, 100% of specificity, and 96.6% of accuracy in comparison with abdomen X-ray and ultrasonography abdomen. Forty-two (46.7%) patients diagnosed with AIO were operated, while 32 (35.6%) patients were managed conservatively and the remaining 16 (17.8%) patients were discharged against medical advice. The mortality rate among the operated patients was 2.7% (n = 2). Conclusion: In the ED, women in their sixties were the one who most commonly presented with AIO. The most common cause of admission with AIO was adhesions. CT abdomen is an accurate modality for diagnosing AIO.
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A rare case of digital ischemia and gangrene
Muhammed Jasim Abdul Jalal, K M Mohammad Iqbal, Thara Pratap, Pushpa Mahadevan
July-September 2019, 17(3):80-84
Granulomatosis with polyangiitis (GPA) is a small-to-medium vessel vasculitis, which affects multiple organs. We describe a patient with GPA who initially presented with multiple ischemic toes. The diagnosis was supported by a positive c-ANCA (anti-neutrophil cytoplasmic antibody). The involvement of digital arteries in this condition is very unusual, and only a few cases have been reported so far.
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Multiple vasculitic ulcers with lupus nephritis flare in pregnancy
Vijoy Kumar Jha, KV Padmaprakash, T Rajkamal, Ajay Sharma
July-September 2019, 17(3):85-88
Vasculitic ulcer in a case of systemic lupus erythematosus is considered as nonspecific cutaneous manifestations and those presenting with multiorgan involvement in pregnancy carry a higher maternal and fetal risk with disease flares. Presentation of a pregnant patient with severe lupus nephritis (LN) along with multiple cutaneous vasculitic ulcers is very uncommon. Aggressive treatment with immunosuppressants along with supportive treatment of cutaneous ulcerations will not only control the disease flares including LN but also result in complete healing of ulcerations.
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History of Emergency Medicine
M Sanjay, Kundavaram Paul Prabhakar Abhilash
July-September 2019, 17(3):89-90
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Train-related accidents at the railway station
Kundavaram Paul Prabhakar Abhilash, Gudivada John Pradeep, GT Jemy
July-September 2019, 17(3):91-91
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Right lung broncholith
Darpanarayan Hazra, Ajay Christopher, Kundavaram Paul Prabhakar Abhilash
July-September 2019, 17(3):94-95
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A more common reaction than thought
Marisa Benigno Bizarro, Luís Duarte, Manuela Beirão
July-September 2019, 17(3):92-93
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