Clinical Ndings Research Articles

ROLE OF MRI IN EVALUATION OF THE SYMPTOMATIC LUMBAR DEGENERATIVE DISC DISEASE: A CLINICO-RADIOLOGICAL CORRELATION

The present study utilizes MRI as the investigative modality to evaluate symptomatic patients with low backache with or without radiculopathy. Correlation between degree of patients' clinical ndings and MRI ndings is noted and an association between symptomatology and degenerative changes in spine is arrived at, with specic note for morphology of disc changes and extra-discal pathology. Occupational variables are also taken into account, in order to demarcate the contribution of physical factors to the development of degenerative spinal disease

ROLE OF MDCT IN PERIPHERAL ARTERIAL DISEASE OF LOWER EXTREMITIES : SEGMENTAL EVALUATION AND ASSOCIATION WITH RISK FACTORS AND CLINICAL SYMPTOMS

Introduction: Peripheral arterial disease causes narrowing or luminal occlusion of the the peripheral arteries, leading to problems that might range from moderate impairments to limb amputation. In the setting of acute care, computed tomographic angiography (CTA) provides precise methods for identifying and classifying the severity of vascular disease. This study was done to evaluate the arterial segments affected by peripheral vascular disease and the frequency of segments involved and to assess the association of risk factors and clinical ndings with the radiological presentation. Material and methods: A total of 42 patients with peripheral vascular disease were included in our study. After taking an informed consent a brief history was taken regarding symptomatology, risk factors and duration of disease. Patients were studied by using Computed tomographic angiography to interpret lower limb arterial system. Results: In this study17.6 % of total arterial segments had signicant (>75%), and almost 40 % of all the arterial segments had complete occlusion. Almost 95.2% segments showed presence of collateral channels. Out of the patients who had signicant stenosis, 22 (55%) patients had history of smoking, 12(30%) patients had diabetes mellitus and 7(17.5%) patients had history of hypertension. 26 (65%) patients had of blackish discoloration, out of which 16 (61.5%) patients had wet gangrene and 10(38.4%) patients had dry gangrene. Conclusion: MDCT is a non invasive modality for Lower Limb Arterial Disease Evaluation with good agreement between clinical and CT angiography ndings

PANCYTOPENIA: A CLINICO-HEMATOLOGICAL STUDY IN A TERTIARY CARE CENTRE

Pancytopenia is a clinico-haematological entity often seen in clinical practice as a characteristic of various diseases, vary from non-malignant as drug-induced pancytopenia, nutritional deciencies or infections, to malignant neoplasms. The aim of this study was to evaluate Aim: pancytopenia's clinico-hematological prole. The study was conducted in the depart Materials and Methods: ment of pathology of our college. A prospective study was carried out among 100 patients of pancytopenia. Clinical ndings, CBC & bone marrow examination were performed. Result: Out of 100 cases, 65% were megaloblastic anemia, 11% were dimorphic anemia. Generalized weakness seen in 85% cases. Pallor was present in all cases of pancytopenia. The present study concludes that the e Conclusion: arly hematological investigations along with clinical and bone marrow examination of pancytopenia are helpful in understanding the disease process and to diagnose and to rule out various causes of pancytopenia

CLINICAL AND RADIOLOGICAL CORRELATION IN ACUTE AND SUBACUTE LOW BACK PAIN IN ADULT MALES OF 20 TO 30 YEAR AGE GROUP

Low back pain (LBP) is one of the most common health problems affecting 75% to 85% of the general population. Young adults are suffering from LBP more frequently than in the past, where loss of working days is a great personal and national loss. This study aims to determine the correlation of clinical features with plain radiograph and Magnetic resonance imaging (MRI) ndings in adult males of 20 to 30 years age group. 100 male patients with acute or subacute low backache were enrolled in the present study. Personal details and history noted and clinical examination was performed. The Oswestry disability index was used for quantication of pain. Plain radiograph and MRI was done. The plain radiograph and MRI ndings were correlated with the clinical ndings. The mean age of patients was 25.18±3.28 years. Sensory loss was found in 15% and paraesthesia in 18% cases. The mean Oswestry lower back pain score was 16.66±10.44. The most common abnormality found on plain radiograph was abnormal disc intensity followed by reduced disc height. The most common abnormality found on MRI was disc bulge followed by abnormal disc intensity. The most common site for osteophytes was anterior of L4 vertebral body followed by anterior of L3. There was a poor agreement between clinical ndings and radiological ndings. Both plain x-ray and MRI imaging found a signicantly higher rate of spine changes which did not correlate well with clinical & neurological ndings

DISCERNING THE EFFICACY OF TOPICAL 2% ACETIC ACID IN CHRONIC SUPPURATIVE OTITIS MEDIA USING OTOLOGICAL SYMPTOMS SCORE: A PROSPECTIVE STUDY.

BACKGROUND: Chronic suppurative otitis media (CSOM)- mucosal type is “dened as a chronic inammation of the middle ear and mastoid cavity, which presents with recurrent ear discharges or otorrhoea through a tympanic perforation.” Acetic acid demonstrates antimicrobial, antipersister and antibiolm potential. The objective of our study is to nd out the efcacy of medical treatment using acetic acid for patients of CSOM. This prospec RESULTS: tive study comprised of 100 patients suffering from CSOM who presented to the Department of ENT, HSK Hospital, Bagalkot from July 2021 to December 2022. The patients with chronic otitis media mucosal type with active discharge were enrolled in our study as per the inclusion and exclusion criteria. They underwent complete evaluation including otomicroscopy and pure tone audiometry to determine the nature of disease and its severity. Otological symptom score was calculated in all patients at the time of presentation. They were treated conservatively with topical 2% Acetic acid ear drops. Scores were assessed based on clinical ndings at day 7, day 14, day 21 and day 30 follow-up visit. Patients were segregated into those with clinical cure (<3), clinical improvement (3-5) and treatment failure (>5) as per their score. Achieving “treatment success” at the end of the study was considered as an effective parameter to measure effectiveness of topical acetic acid ear drops. 'Treatment success” i.e. either clinical cure or clinical improvement was seen in 95% patients after using acetic acid, whereas “treatment failure” was seen in 5% patients at the end of 1 month. In CONCLUSION: the present study using topical preparation of 2% acetic acid, the resolution of CSOM was shown with success rate in 95% patients. This shows that acetic acid was effective in reducing the symptoms of CSOM.

SCREENING FOR THROMBOPHILIA IN STROKE: ARE WE OKAY?

Stroke is now a global epidemic. It is on the rise, especially among the young population. The mechanism of stroke needs to be determined for appropriate management. Unfortunately, 40 percent of young strokes have an unknown aetiology. So, we should not leave any stone unturned to nd a possibility to treat. Thrombophilia in stroke is one such condition and is still a neglected entity in many parts of the world. Clinicians need to remember the appropriate time to test, the methodology, standard laboratory values, and the selection of patients for lifelong anticoagulation. In the absence of denitive data, it should be practised to obtain testing for hypercoagulable conditions in patients who have a personal or family history of systemic thromboses, no clear aetiology for ischemic stroke or transient ischemic attack (TIA), and clinical ndings that suggest systemic lupus erythematosus or the antiphospholipid antibody syndrome

A STUDY ON UTILIZATION OF VISUALLY EVOKED POTENTIAL IN IDIOPATHIC INTRACRANIAL HYPERTENSION

Introduction: Idiopathic Intracranial Hypertension (IIH) can be dened as raised intracranial pressure with a normal cerebrospinal uid. VEP is one of the electrophysiological test which helps in evaluating the visual system and useful in patients with IIH. Aim:To demonstrate the utilization of Visually Evoked Potential (VEP) in patients with Idiopathic Intracranial Hypertension (IIH). Materials and Methods: This is a prospective cross sectional study done from January 2021 to June 2022. This study included 19 patients detected recently with IIH and 19 healthy volunteers. The demographic data clinical presentation data collected and ophthalmological evaluation done in both groups. Comparison of the VEPvalues of IIH patient done with VEPvalues of controls and their association with demographic data and clinical ndings done. Results:The mean age of the patients is 28.15±4.7 years. Of the 19 patients, 2 were males (10.52%) and 17 (89.73%) were females. There was statistically signicant association between patients with normal and pathological VEP in terms of obesity (p 0.0449 (<0.05)) and visual eld abnormalities (p value-0.0379 (<0.05)).The P100 latency showed a statistically signicant difference between IIH patients and controls in terms of right eye(p < 0.001) and left eye (p < 0.001). Conclusion: The values of P 100 latencies are prolonged in IIH patients as compared to the control group also there was a statistically signicant association between the visual eld abnormalities and obesity in IIH patients. VEPcan be used as a screening tool in patients with IIH

TASTE PERCEPTION A PREDICTOR OF DENTAL CARIES: A RESEARCH BASED ANALYSIS

This is an original research paper based on clinical ndings in pediatric population of 6-14 years age group from a regular dental OPD over 1-1.5 years duration. 6-n-propylthiouracil or PROP an anti-thyroid medication has been used to discriminate non-tasters from medium tasters, and supertasters. Sugar consumption has always been co related to dental caries. It's a new horizon when we can identify early in life the ones more prone on basis of their taste perception. 122 Candidates were selected Materials and methods: randomly from a dental OPD in the age group of 6-14 years and their taste perception and dental caries experience were documented after taking parents written consent. Caries experience of supertasters was found to be much Results: less compared to non-tasters and tasters with mean DMFT of 0.48, 1.45 and 1.38 respectively. The result was statistically highly signicant with a p value of 0.0034. Mean deft was found to be 4.4, 2.2 and 0.75 among non-tasters, tasters and supertasters respectively with p<0.0001 which is statistically highly signicant. Clinical Conclusion: applications of ndings from this study indicate that taste perception can be used as an early indicator of dental caries.

CORRELATION OF MODERATE TO SEVERE TRAUMATIC BRAIN INJURY WITH CT IMAGING & CLINICAL OUTCOME.

In the study we have conducted prospectively on 60 patients for moderate to severe traumatic brain injury, Where it is major cause for loss of productivity and mortality. Patients who are admitted after head injury with GCS < 12 for a duration of 12 months and patients with polytrauma were excluded. All these patients were undergone CT Scan to study the intracranial bleeds, contusions, subdural hemorrhage, subarachnoid hemorrhage and midline shift etc. All these patients were evaluated clinically after 6 months with glassgow outcome score (GOS). Apart from the clinical ndings, CT variables can helpful in prognostic indicators in this traumatic brain injury.

Reporte de caso: Tumor del estroma gastrointestinal (GIST) en yeyuno

Gastrointestinalstromaltumors(GIST)aremesenchymalneoplasmsthatrepresentlessthan3%of gastrointestinal neoplasms, with an incidence of 1 to 2 cases per hundred thousand inhabitants. It originates more frequently in the stomach and small intestine and is characterized by the expression of the tyrosine kinase growth factor receptor, CD117. Therefore, its diagnosis requires an immunohischemical study to rule it out from other mesenchymal tumors. However, enteroscopic imaging and analysis of the biopsy may suggest a preoperative diagnosis of probable GIST. The case of a 62-year-old woman with rectorrhagia and recurrent anemia caused by mid-intestinal bleeding observed by capsule endoscopy is reported. Enteroscopy revealed a subepithelial ulcerated lesion in the proximal jejunum, and a biopsy was taken, the anatomopathological study of which suggested a gastrointestinal stromal tumor. The biopsy sample subjected to immunohistochemical studies conrms the suspicion of a cKit/CD117-positive GIST tumor. Surgical resection of the tumor with dimensions 4.2x3 cm is performed. After surgery, the patient was stable and under clinical follow-up until she was discharged. Clinical ndings, diagnosis and timely treatment contribute to increasing survival from complications.

CURRENT TRENDS OF CARDIAC SEPTAL DEFECTS IN CHILDREN IN EASTERN INDIA: AN OBSERVATIONAL STUDY

Congenital Heart Disease (CHD) is the most common among all congenital anomalies. CHDs are majorly classied into either cyanotic or acyanotic variety and both may have septal defects. Isolated cardiac septal defects mainly constitute the acyanotic CHDs namely Ventricular Septal Defect (VSD), Atrial Septal Defect (ASD) and Endocardial Cushion Defects (ECD). With recent advances and ease of availability of diagnostic aids and specialists, CHDs have become a common disease entity faced by Paediatric practitioners today. Acyanotic cardiac septal defects are relatively easier to manage and treat as compared to the cyanotic and complex CHDs. Still data detailing the epidemiology of these defects in India are scarce. This study was aimed to typify ndings from pediatric CHD patients with septal defects at a medical college hospital in northern part of West Bengal, catering to a previously understudied demographic. A sequence of CHD cases, picked contiguously from the pediatric indoor and outdoor patients over a period, were surveyed. Data was recorded under multiple headings including demographics, clinical ndings, investigations and outcomes

CLINICO-HISTOPATHOLOGICAL CORRELATION OF GRANULOMATOUS LESIONS OF SKIN: A RETROSPECTIVE ANALYSIS OF 111 CASES

Introduction: Granulomatous skin lesions present as wide spectrum of clinical conditions where diagnosis with signicant accuracy is possible only through the histopathological examination of biopsy samples. The study was to a Aims and objective: ssess the frequency of granulomatous skin lesions and their pattern in relation to their clinical ndings and histopathology. The retrospective study was conducted Material & Methods: in the department of pathology of our institute. The data related to the age, gender, clinical presentation, and the biopsy ndings was analyzed. Results: Amongst 111 histologically proven cases of granulomatous lesions, there was male preponderance. The commonest age group involved was between 21-40 years. The common primary clinical types were plaque, nodule, and macule present in 42.34%, 31.53% and 15.31% cases respectively. The most common diagnosis was leprosy (54.05%), followed by tuberculosis (39.63%). Among the leprosy cases, borderline tuberculoid and borderline lepromatous were the most common types. Histologically, all lesions showed epithelioid cell granulomas, the commonest type being tuberculoid granuloma. This study reafrms that histopathology is Conclusions: a fundamental tool to diagnose granulomatous skin diseases. Type of granulomas, their pattern and associated features suggest about the diagnosis. Infective diseases (leprosy and cutaneous tuberculosis) are still the most common granulomatous skin diseases.

A RARE CASE REPORT OF MULTIPLE CONNECTIVE TISSUE DISEASE WITH SEVERE PULMONARY HYPERTENSION

A 38 year old female presented with complaints of tightness, dryness, hyperpigmentation of skin , tightness of mouth, tingling numbness and pain in ngers while handling cold water since 6 months. Exertional breathelessness since 1 month .She had history of swelling of hands six months back. Finger examination showed sclerodactyly and ulceration over skin on interphalangeal joints of both hands without any deformity .Since clinical ndings were suggestive of Raynaud's phenomenon, sclerodactyly, swelling of hands , scleroderma, she was further investigated for presence of connective tissue disease . On immunological investigations , ANA prole was positive with presence of strong positive U1RNP antibodies (titre>1:1600). Chest x ray and 2d echocardiography revealed presence of Pulmonary Hypertension. She was diagnosed with Multiple Connective Tissue Disease (MCTD) with severe pulmonary hypertension based on clinical , radiological and laboratory ndings satisfying Alarcon Segovia criteria.

ORAL CONDITIONS AND DENTAL PHENOTYPES IN SUBJECTS WITH PIERRE ROBIN SYNDROMIC SEQUENCE: LITERATURE REVIEW

Purpose: The purpose of this study was to conduct a critical literature review on oral conditions and dental phenotypes described in patients with Syndromic Pierre Robin Sequence (SPRS). The review of theMaterials and Methods: literature on oral conditions and dental phenotypes was performed in patients with SPRS through an active search in three databases, PubMed, Medline and SciELO, using the descriptors: “Dental Abnormalities”, “Tooth Abnormalities”, “Oral Diagnosis”, “Dentistry”, “Oral Health”, combined with: “Pierre Robin Syndrome”, “Mandibulofacial Dysostosis”, “22q11 Deletion Syndrome”, and “Stickler”. For the selection of manuscripts, papers published between 2014 and 2022 were analyzed according to the inclusion criteria. Were selected 7 studiesResults: addressing dental conditions or dental anomalies in SPRS in the 3 syndromes chosen: 22q11.2 Deletion Syndrome (22q11.2 DS), Treacher Collins Syndrome (TCS) and Stickler Syndrome (SS). In the 3 studies on 22q.11 DS, it was observed that the most reported anomalies were dental agenesis, impacted canine, enamel hypoplasia and supernumerary tooth, respectively. In studies on TCS, with a reduced number of subjects, dental crowding and occlusal changes were the most common oral conditions. No study addressed the dental phenotypes of SS. Conclusions: The importance of further studies on this specic topic is emphasized, since SPRS involves micrognathia and mandibular retroposition. Thus, these clinical ndings can be valuable for all professionals who provide assistance to these patients. Thus, based on this knowledge, it is possible to plan more effective rehabilitation, contributing to improving the quality of life of these individuals.

MUCOPOLYSACCHARIDOSIS TYPE 2: NARRATIVE REVIEW

Mucopolysaccharidosis type II, also known as Hunter syndrome, is a rare, progressive, multisystemic lysosomal storage disease caused by deciency of iduronate 2 sulfatase, an enzyme responsible for the degradation of the mucopolysaccharides dermatan (DS) and keratan sulfate (QS), causing their accumulation at the lysosomal level. It is an X-linked disease, therefore it is common to nd most cases in men, rarely in women, it is considered an orphan disease given an incidence of approximately 1/100,000 live births. Various phenotypes of severe (2/3) and attenuated disease have been described. The diagnosis is based on clinical ndings and the measurement of mucopolysaccharides DS and QS in urine, which are elevated, conrmed by determining the enzyme deciency in serum, leukocytes and broblasts. It has been observed that in patients with enzyme replacement therapy somatic symptoms have decreased, however there are several studies of alternative therapies in the future, including gene therapy as an alternative in the future.

GORHAM STOUT DISEASE:A RARE CASE REPORT

Background: Disappearing bone disease -Gorham Stout disease a unparallel case of Unknown Origin . Medical condition of Bones, which does not have any specic etiology. An extremely rare disorder, which causes the proliferation of endothelial channels and can lead to results and disappearance of bone. Here sudden bone osseous matrix is destroyed and also lymphatic vascular structures up proliferated and further leads to excessive regional osteolysis.With a variating clinical presentation and very often is diagnosed as benign disease which further spreads to an unclear prognosis.Mainly diagnosed by single and various combinations like clinical features, histological ndings and radiological ndings. Many therapeutic options have managed to provide certain efcacy, but most effective therapeutic option is still controversial without a certain standard treatment protocol Case presentation:A case of disappearing bone disease affecting the proximal femur, pelvis, sacrum in a 45 year old male has been described here. Clinical features of the disease are pain , swelling of the affected region, functional impairment. In this case the diagnosis was made after the pathological fracture of femur. Based on radiological and clinical ndings. Considering stabilisation as an important aspect internal xation that was done followed by Bisphosphonates used for progession control and is now being currently followed up with no cessation of disease. But internal xation has prevented complete severe disability. Conclusion:Hereby given that conrmed ethiopathology of disappearing bone disease is not completely veried and further study is still needed to effectively treat and provide intervention. But the need for every physician to know of it's presence, promptly direct a patient towards the right direction and we are hence reporting this for it's rarity.

A CASE OF INFANTILE POMPE DISEASE: A CASE REPORT AND REVIEW OF INDIAN LITERATURE.

Background: Pompe disease is a metabolic disorder due to deciency of lysosomal acid alpha-glucosidase enzyme. Deciency of this enzyme leads to lysosomal glycogen accumulation in multiple tissues and cell types, predominantly affecting cardiac, skeletal, and smooth muscle cells, eventually causing progressive muscle destruction. The pattern of inheritance is autosomal recessive. Our case describes a Clinical Description: four-month-old female child, rst born baby to a non-consanguineous marriage, who presented to our out-patient department with respiratory tract infection, and difculty in swallowing for last 10 days. Clinical examination revealed hypotonia along with hepatosplenomegaly. Management: There was cardiomegaly evident on routine chest X ray. This signicant nding was further dwelled upon and an ECG with echocardiography was planned. ECG showed short PR interval with tall QRS complex, and Echocardiography revealed a hypertrophic cardiomyopathy. Based on the above ndings, the importance of ruling out possible storage disorders was considered eminent. Further tests revealed elevated CPK and LDH. Based on the clinical ndings and laboratory results, the differentials of storage disorders were narrowed to Pompe disease. Dried blood spots for quantitative enzyme assay of acid alpha glucosidase (GAA) activity were tested. The result conrmed that the GAA activity was lower than the normal range, leading to a diagnosis of Pompe disease. Infantile pompe disease Conclusion: is fatal without specic enzyme replacement therapy. The subtle clinical features or routine ndings heralding this ominous disease need to be dealt with a high index of suspicion for the same, the advantage being early diagnosis and initiation of enzyme replacement therapy.

“STUDY OF FUNCTIONAL OUTCOME IN DISPLACED BIMALLEOLAR FRACTURE TREATED WITH FIBULAR PLATING FOR LATERAL MALLEOLUS AND PINNING OR SCREW FOR MEDIAL MALLEOLUS “

Fractures of the ankle joint are among the commonest fractures in adults, with an incidence of up to 174 cases per 100 000 persons per year1. A study was conducted to learn the functional outcome of displaced bimalleolar fracture treated with bular plating for lateral malleolus and pinning or screw for medial malleolus. For a good long-term functional outcome to be achieved, reliable early evaluation is crucial so that it can be determined whether the problem is a distortion (sprain), ligament rupture, bony ligament avulsion, or fracture of the talocrural joint. The proper treatment is chosen on the basis of the mechanism of the accident and the correct classication of the injury and accompanying soft-tissue damage. The goal of treatment is to enable the patient to put his or her full weight on the joint once again without pain and to prevent permanent damage2. In this study, a total of 25 patients were included. Detailed history and clinical ndings are conrmed and noted. After surgery patients followed on at 1 month, 3 months & 6 months, and thereafter yearly for their radiological and functional outcome.

A RARE CASE OF OSTEOGENESIS IMPERFECTA TYPE I

A 7 year old female patient was admitted to hospital having experienced bowing of upper and lower limbs, repeated fractures over the past 4 years. Clinical ndings and radiological investigations such as recurrent fractures and deformity of bones while bearing weight, blue sclera and low bone mineral density, all led us to conclude that this child has a mild form of osteogenesis imperfecta type I. The patient was immediately started on calcium (1000mg/day), vitamin D (800mg/day) and pamidronate (60mg) was given intravenously. Following the above protocol, we found that the quality of life of the patient showed signicant improvement. This patient is a rare case of OI type I.

SIGNIFICANCE OF ULTRASONOGRAPHY IN EVALUATION OF VITREORETINAL PATHOLOGY

INTRODUCTION:Vitreoretinal pathologies include vitreal haemmorhage and vitreal detachment, retinal detachment, retinoblastoma, diabetic retinopathy, leukocoria, trauma over eye. The eye being an external sense organ lends itself to an easy and rapid examination of anterior segment but structure posterior to the papillary plane i.e lens, vitreous cavity and humor, retina, choroid in an opaque media could not be evaluated by just fundus examination. OBJECTIVES OF RESEARCH: Demographic prole of patient with vitreoretinal pathologies. Diagnose the patient with vitreoretinal pathologies by ultrasonography. Detect and characterize the vitreoretinal pathologies by ultrasonography, clinical ndings and post management conrmatory ndings to establish the diagnostic accuracy of ultrasonography in vitreoretinal pathologies. MATERIALAND METHOD: Study design:Institution based prospective, descriptive study Study setting: USG section at Dept. of Radiodiagnosis, Medical College, Kolkata Place of study: Dept. of Radiodiagnosis, Medical College, Kolkata Period of study:January 2018 to august 2019 Study population:Referred patient from regional institute of opthalmology Sample size: 50 patients. RESULT AND ANALYSIS: We showed that 29(48.3%0 patients had vitreous haemorrhage. 19(31.7%) patients had retinal detachment. 10(16.7%) patients had posterior vitreous detachment. 7(11.7%) patients had endophthalmitis. 9(15.0%) patients had retinoblastoma. 1(1.7%) patients had PHPV. 1(1.7%) patients had asteroid hyalosis. 1(1.7%) patients had retinoschisis. 5(8.3%) patients had normal. SUMMARYAND CONCLUSION: From, the present study it was noted that Ultrasonography is very efcient tool in diagnosing various ocular abnormalities. Ultrasonography can categorize the lesions in the posterior chamber well, depending on the echotexture and anatomy. Even the exact location of the lesion and surrounding structures can be well made out. Ultrasonography can detect structural changes that were missed or could not be detected by clinical examination especially with opaque media as well. Ultrasonography is proved to be very useful diagnostic tool in detection and evaluation of vitreo-retinal pathologies in patients with opacities in the vitreous cavity.