Nil Ratan Sircar Medical College Research Articles

Concurrent chemoradiation with paclitaxel in locally advanced head and neck cancer: A feasibility study from tertiary cancer care center

Background: In India, the majority of the head and neck squamous cell carcinoma (SCC) of head and neck (60–80%) presented in locally or locoregionally advanced stage but non-metastatic disease as compared to 40% in developed nations. Uncontrolled local and/or locoregional disease causes most fatalities and predominant failure pattern is local and/or locoregional. Concurrent chemoradiation (CRT) is now standard of care. However, regarding either the optimal scheduling of chemotherapy regimen or radiotherapy (RT) dose fractionation scheme, no consensus exists. Paclitaxel is also active agents against squamous cell carcinoma of head and neck. Weekly paclitaxel appeared to be equivalent to weekly cisplatin with concurrent radiation in the treatment of locally advanced SCC of head and neck cancer (HNC). Concurrent chemoradiotherapy with paclitaxel in locally advanced head and neck malignancy is recommended in NCCN Guideline. Objectives: The aim of our study is feasibility and efficacy of CRT with paclitaxel for the treatment locally advanced HNC in our institute, Nil Ratan Sircar Medical College and Hospital, Kolkata. Material and Methods: Between January 2014 and December 2018 ninety eight (98) previously untreated patients with locally advanced histologically confirmed carcinoma oral cavity, oropharynx, and hypopharynx treated with CRT. Chemotherapy consisted of paclitaxel at a dose 40 mg/m2 over 1 h given once weekly from 1st week of RT, up to 4–6 cycles. RT consisted of 66 Gy/33#/61/2 weeks, 2 Gy/fraction, delivered by two parallel opposed lateral face and neck and low anterior neck portal, in cobalt 60 machines. Toxicity was graded using Common Terminology Criteria for Adverse Events v3. To assess response to therapy contrast-enhanced computed tomography (CECT) head and neck and/or magnetic resonance imaging head and neck; CECT chest or whole-body fluorodeoxyglucose and positron emission tomography computed tomography scan were done. Results: Overall complete response (CR) rate seen in 68% and partial response seen in 32% patients. Two-year disease-free survival, progression free survival, and overall survival were 59%, 72% and 85%, respectively. Grade II acute skin reaction seen in 45% patients and Grade III acute skin reaction seen in 55% patients. Similarly, Grades II and III mucosal reaction is seen in 48% and 52% patients. All patients experience Grade II dysphagia and managed conservatively. Conclusions: CRT with paclitaxel in locally advanced HNC is safe and confers high CR rate with acceptable toxicity. However, more randomized study with large number of patients is needed to come to conclusions regarding its efficacy.

Asok Ranjan Das Gupta

Asok Ranjan Das Gupta was born into a highly educated Hindu family in Dualaptur, East Bengal. His father later became professor of mathematics at the University of Calcutta (now Kolkata)....

Delayed presenting traumatic Extradural Haematoma- whether surgery always necessary? – An experience in a tertiary care hospital.

Background: Extradural haematoma (EDH), considered being the most serious preventable complication of head injury, requiring immediate diagnosis and surgical intervention. Though surgical evacuation constitutes the definitive treatment of this condition but many patients who presented late to emergency can be saved from craniotomy with watchful repeated neurological assessments.Aims and Objectives: To evaluate the role of surgical and non surgical management of delayed presenting traumatic EDH at a tertiary care Hospital.Materials and Methods: This study was conducted from December 2015 to February 2017 at Nil Ratan Sircar medical College, Kolkata. A total 100 cases of traumatic Extradural Haematoma were admitted with history of prior head injury of greater than 8 hours duration. All the patients were assessed clinically on admission and by NECT brain either prior to or immediately after admission. All patients with traumatic EDH were evaluated by dedicated trauma team and by Neurosurgeons, patients who came to hospital facility with more than 8 hours history of incident with haematoma <30 cm3, no associated midline shift and no signs of focal neurodeficits or papillary asymmetry with GCS 13-15, were initially managed conservatively, those who failed any of the chosen criteria treated by operative interventions.Results: Of all patients more 50% cases were associated with vehicular accident. Eighty percent cases were referred from primary or secondary care level hospitals and the remaining directly from accident site or scene of injury. Fifteen patients had post injury seizures, most of the cases were associated with additional intradural lesions like contusions or intracerebral haematoma. Approximately one forth patients presented with GCS >13, all these patients experiences positive outcomes. In this series of EDH location was temporoparietal region constitute 45% of the total, in 36 % of cases there were associated skull fracture. 55% of the patients in this series underwent operative intervention and 45% treated non operatively. Overall, 78% patients had good recovery, whereas 12% patients remained moderate to severe disabled at 6 weeks follow up period.Conclusion: Although surgical management is the treatment of choice in EDH, in selected delayed presenting EDH patients can be managed non-operatively with good outcome.Asian Journal of Medical Sciences Vol.9(4) 2018 41-45

Calvarial Tuberculosis in a Preschool-Aged Child: An uncommon entity.

Calvarial tuberculosis is a rare manifestation of tuberculosis, especially in children under five years of age. We report a two-and-a-half-year-old male child who presented to the Nilratan Sircar Medical College, Kolkata, India, in 2015 with frontoparietal fluctuant swelling of three months' duration. He had also had chronic sinus discharge from the left lower eyelid over the previous six months. Computed tomography of the head revealed a frontal swelling along with erosion of both the outer and inner plates of the left frontal bone. Fine needle aspiration of the pus indicated the presence of acid-fast bacilli. Unfortunately, no primary focus of tuberculosis could be established. The patient improved after one year of antitubercular therapy without requiring any surgical intervention and with no sign of subsequent disease recurrence.

Osteolytic Skull Lesions-Our Experience.

Objective:To present an overview of varied clinical presentations, investigations and treatment options for Osteolytic skull lesions.Study Design:It is a prospective study.Materials and Methods:We conducted this study from January 2013 to December 2015 in the Department of Neurosurgery, Nil Ratan Sircar Medical College and Hospital, Kolkata. During this period, 14 patients presented with osteolytic skull lesions through the outpatient department. All patients were thoroughly investigated with appropriate hematological and radiological investigations and treated following admission, and surgery was performed in the Neurosurgery Department. All were followed regularly in OPD.Results:Total 14 patients were included in the study. Amongst these 7 were male and 7 female. Age group of patients ranged from 5 to 72 years. Of 14 cases, three cases had dermoid cyst, four cases had metastasis, and one each case had epidermoid cyst, intradiploic meningioma, benign cystic lesion, tuberculosis, histiocytosis X, hemangioma, and osteomyelitis. All underwent diagnostic/therapeutic procedures and referred for Radio or chemotherapy where indicated.Conclusion:All scalp/skull lesions need careful clinical correlation, appropriate radiological investigations to establish diagnosis and subject them to suitable treatment.

Contrecoup Head Injury

AbstractContrecoup injuries comprise a group of focal brain injuries that occur at areas distant from the point of impact. It has been hypothesized that patients with contrecoup injuries would have a worse outcome because of the diffuse nature of injury. At Nilratan Sircar Medical College, Kolkata, 74 patients presenting with contrecoup injuries over a period of 1 year were prospectively analyzed. Site of primary impact was determined by clinical and CT scan criteria. The age, modes of injury, Glasgow coma scale (GCS), site of injury, pattern of injury, and mortality were analyzed. Delayed presentation of contrecoup injury in patients who deteriorated over time was also noted in imaging. The presence of contrecoup injury implies that the traumatic forces have dissipated into the brain, and from the biomechanisms explained, the brain is likely to have suffered greater damage than the case in coup injury alone. The present study shows that the presence of contrecoup contusions is associated with a poor prognosis across all GCS and age categories.

Perception of Learning Environment among Undergraduate Medical Students in Two Different Medical Schools through DREEM and JHLES Questionnaire.

Assessment of learning environment is essential to assess the acceptability of the curriculum among students. Several tools are available to assess undergraduate medical students' perception of learning environment. Dundee Ready Education Environment Measure (DREEM) questionnaire is the most commonly used tool. Here, we have used both the widely used DREEM questionnaire and a relatively new questionnaire Johns Hopkins Learning Environment Scale (JHLES). Assessment of students' perception of learning environment of two eastern Indian medical schools using DREEM and JHLES questionnaire. In this cross-sectional questionnaire based study, 200 students from Nil Ratan Sircar Medical College (NRSMC) and 78 students from College of Medicine and Sagore Dutta Hospital (CMSDH) of 5th semester batch duly completed the two questionnaires, DREEM scale and JHLES tool. The DREEM questionnaire has 50 questions arranged in five domains. The JHLES questionnaire has 28 questions arranged in seven domains. Comparison of scores between the two colleges was done by unpaired t-test. There were altogether 100 female and 178 male participants with mean age of 20.46±0.67. There were no significant difference between the overall DREEM score (p=0.81) and the JHLES scores (p=0.10) obtained from NRSMC and that obtained from CMSDH. Analysis of individual domain scores on DREEM scale revealed that there were no significant differences in domain scores for the two medical schools except for Students' Perception of Atmosphere (SPA) score (p=0.0086). JHLES revealed significant differences in terms of engagement, inclusion and safety, and physical space (p<0.001). The DREEM and JHLES results revealed positive correlation (r=0.59). Both DREEM and JHLES scores revealed comparable results from two schools with positive correlation between DREEM and JHLES tools, however some areas with low scores require modification especially the domain assessing Students' Academic Self-Perception (SASP) and Students' Social Self Perceptions (SSSP).

A Brief Study on Recent Epidemiological Trend of Dengue in ATeriary Care Hospital In Kolkata

Introduction: Dengue fever is a recurrent problem in West Bengal. Dengue Haemorrhagic Fever (DHF) and Dengue Shock Syndrome(DSS) are two potentially fatal complications of Dengue fever. Objectives:The study was performed to find out the seroprevalence and recent trend of Dengue among the symptomatic patients attending a tertiary care hospital in Kolkata. Materials & Methods:A total of 673 suspected cases fulfilling the inclusion criteria were tested by Dengue IgM Capture ELISA over a period of four years (2012-2015) in the department of Microbiology, NilRatanSircar Medical College & Hospital, Kolkata. Results:Total 150 samples were found to be Dengue IgM reactive (22.28%).Amongst the Dengue IgMseropositive cases, 92 cases were male (61.33%) whereas 58 cases were female (38.67%). Male predominance was thus observed over the females throughout the study period.Majority of the reactive cases (46%) were in the age group (10 to 29 years) in all four years of the study period. A clear post rainy season peak was noted in each year of the study period. A peak rise was observed in 2012, then a fall during 2013 and 2014 followed by a sharp rise in 2015.Dengue IgMseropositive cases during the year 2015 on follow uprevealedno report of any death. Conclusion: Strict surveillance and compliance with the vector control programme are required to prevent Dengue outbreak

Renal Tuberculosis Presenting as a Mass Lesion in a Two-year-old Girl: Report of a rare case.

Genitourinary tuberculosis usually occurs in young adults and the middle-aged and is very uncommon in the paediatric population. It generally presents with haematuria, pyuria, irritative voiding symptoms and flank pain; presentation as a renal mass is highly unusual. We report a two-year-old girl who was referred to the Nil Ratan Sircar Medical College, Kolkata, India, in June 2014 with abdominal pain. Subsequent radiological investigations revealed a left renal hypoechoic mass lesion. A left nephroureterectomy was performed on suspicion of a Wilms' tumour. Histopathology indicated an epithelioid granuloma with lymphocytic infiltration, suggestive of a tubercular aetiology. A Mantoux tuberculin skin test was positive; however, there was no evidence of tuberculosis detected elsewhere in the body and the source of the infection could not be identified. A diagnosis of renal tuberculosis was made and the child was treated with antitubercular drugs. The patient was asymptomatic at a six-month follow-up.

Surgical Site Infection by Methicillin Resistant Staphylococcus aureus– on Decline?

Surgical Site Infection (SSI) is the most common healthcare associated infection that could be averted by antibiotics prophylaxis against the probable offending organisms. As Staphylococcus aureus has been playing a substantial role in the aetiology of SSIs, Methicillin Resistant Staphylococcus aureus (MRSA) happens to be a problem while dealing with the postoperative wound infection. To determine the prevalence of SSI caused by MRSA and the antibiotic sensitivity pattern of MRSA. A cross-sectional study was conducted at Nil Ratan Sircar Medical College, Kolkata, West Bengal from July 2009 to December 2012. A total of 19,359 surgical procedures were done of which 3003 culture positive SSIs have been documented. The clinical samples were collected from patients of both sexes and all ages suspected to be suffering from SSI from different specialities. Samples were processed according to CLSI, 2007 guidelines. The isolated strains of Staphylococcus aureus were screened for MRSA by detection of resistance to Cefoxitin disc (zone of inhibition was ≤21 mm) and slidex staph latex agglutination tests were done on cefoxitin resistant strains to spot phenotypic expression of mec A gene. Then PCR was performed for detection of mecA gene. Antibiotic sensitivity test was done following Kirby Bauer technique. In this 3½ year study, 1049 Staphylococcus aureus (34.93%) were reported from 3003 cases of SSI followed by Escherichia coli (20.34%), Klebsiella spp. (18.08%), Pseudomonas spp. (7.99%), Acinetobacter spp. (7.49%) respectively. Among the Staphylococcus aureus, 267 strains were derived as MRSA (25.45%). MRSA were isolated from 167 (62.54%) male patients and 100 (37.45%) female patients having surgical site infections. Inpatients and outpatients distribution of MRSA were 235 (88.01%) and 32 (11.98%) respectively. Majority of the MRSA cases were reported from Surgery (12.49%) and Orthopaedics (11.85%) departments in the age group above 75 years (15.63%). The MRSA strains have been found to be 100% sensitive to linezolid and tigecycline followed by fucidin (92.51%), mupirocin (88.39%), levofloxacin (75.66%) and doxycycline (72.28%). No vancomycin resistant strains were detected, but 3 strains (1.12%) were found to be intermediately susceptible to it (VISA). Incidence of MRSA in SSI has been decreased by 15.17 % in 2012 in comparison to 2009. PCR revealed mecA gene was present in 96.25% of cefoxitin resistant Staphylococcus aureus strains. Staphylococcus aureus being the predominant organism causing SSIs, MRSA needs the attention for its resistance to commonly used antibiotics in the hospital like penicillin, cephalosporin group of drugs. Regular monitoring of the MRSA, involved in the SSI of a particular setup is the basic requirement to trim down the incidence of the postoperative wound infections by proper antibiotic prophylaxis.

A Study of Socio-Demographical Profile of Dowry Death Victims in a Tertiary Care Unit of West Bengal

High incidence of unnatural deaths of young newly married females following disputes over the dowry is a dark spot on the noble tradition of our society. Sadly, awareness and education, particularly of young people and women, has not helped to control the situation. The aim of the present study is to describe the different pattern and socio demographic profile of dowry death cases. This study is a retrospective, observational Study which was conducted between July 2012 to June 2014 at the Department of Forensic Medicine & Toxicology, Nil Ratan Sircar Medical College & Hospital, Kolkata; where 216 cases were taken out of total 5589 autopsies conducted during the study period. Most of the victims of dowry deaths were aged between 18to 20 years (43%), religiously belonging to Hindu (67%). Joint family (83%) of lower socio-economic status (40%) in rural (58%) residence, housewife (73%) being educated up to primary school (55%) were predominant. Most common cause of death was due to burn injury (67%).

English

Address for Correspondence: Prof. Dr. Sharmila Pal, Dept. of Anatomy, Medical College, Kolkata 88, College Street, Kolkata-700073, West Bengal, India. E-Mail: shrmla_2006@yahoo.co.in Access this Article online Quick Response code Web site: *1 Professor, Dept. of Anatomy, Medical College, Kolkata, West Bengal, India. 2 Nil Ratan Sircar Medical College, Kolkata, West Bengal, India. 3 A.B.Shetty Memorial Institute of Dental Sciences, Mangalore, Karnataka, India. 4 Medical College, Kolkata, West Bengal, India. 5 ICARE Institute of Medical Sciences & Research, Haldia, West Bengal, India. A neonate with rare congenital anomalies was born at 25 weeks of gestation and died within 17 minutes of birth. On examination of the baby, it was found that the lower limbs were malrotated and fused all along the length with six toes. External genitalia, urogenital and anal orifices were absent. At autopsy, a single umbilical artery was found arising from the abdominal aorta. Both the kidneys were polycystic and were situated in the iliac fossae. Distal portion of the large gut beyond caecum was absent and rectum was atretic. No reproductive organ was found. On the basis of the findings, the case was diagnosed as sirenomelia (mermaid syndrome).

Sleep disorders in pregnancy: A prospective observational study

This study aimed to find out different patterns of sleep disturbances in pregnancy and their effect on mother and fetus. A questionnaire-based prospective observational study was conducted at the Department of Gynaecology and Obstetrics, Nil Ratan Sircar Medical College, Kolkata, West Bengal, India. Women with sleep disturbances at start and during pregnancy included in the study were interviewed and examined at recruitment, at 24–32 weeks of gestation, and at term. Of 103 enrolled patients, 99 were followed up till delivery. All the recruited patients developed insomnia. “Changes in sleep-disordered breathing status” was associated with development of hypertension (p = 0.003), albuminuria (p = 0.037), and gestational diabetes mellitus (p = 0.012). It was also associated with 1-min APGAR score of <7 in newborns (p = 0.013). Association between sleep parameters and other fetomaternal outcomes, labor, and delivery is statistically insignificant. Insomnia is the most common sleep problem among women having sleep disorders. Little short-term effect on babies’ health (such as low 1-min APGAR score) was found in women having sleep disorders, but no comment can be made on the longterm effects as these were not assessed in this study.

A Study on the Performance of Medical Students in Internal Assessment and its Correlates to Final Examinations of 2 nd MBBS Pharmacology Curriculum in a Medical College of Eastern India

The present study was undertaken to assess whether performance in the continuous assessment method as determined by internal assessment, correlates to the final summative evaluation in 2(nd) professional MBBS students in Pharmacology for the last four years (2009-2012). This study was conducted over a period of three months at Nilratan Sircar Medical College and Hospital, Kolkata (West Bengal, India). It was a retrospective non-interventional record-based study based on the students' score sheets of 2(nd) MBBS Pharmacology examinations. The strength of correlation between internal assessment marks and total summative examination was fond to be highly significant at p < 0.0001, thereby implying that continuous assessment plays a vital role in influencing the overall performance of the undergraduate medical students. This study revealed that performance in the internal assessment and final examination have a direct correlation although not completely linear, thereby indicating that other possible variables would have influenced the final result of the 2(nd) MBBS Pharmacology curriculum.

Cervical lymphadenopathy with special reference to fine needle aspiration cytology corroborated with histological examination: A cross sectional study

Introduction: Cervical lymphadenoparthy is a common presentation of many diseases, though it is mostly tubercular in origin in developing countries. This cross sectional study was done to corroborate fine needle aspiration cytology (FNAC) findings with histopathological examinations (HPE) in cervical lymphadenopathy. Materials and methods: 120 patients of both sexes attending the FNAC unit of Nilratan Sircar Medical College and Hospital, Kolkata were enrolled in this study. They were evaluated by thorough clinical examination followed by routine investigations, FNAC and histopathological examination (HPE). Results: There was maximum corroboration of FNAC and HPE reports in tubercular lymphadenitis (76 v/s 76) and Hodgkin’s disease (2 v/s 2) followed by metastatic carcinoma (20 v/s 16) and non specific lymphadenitis (14 v/s 5) respectively. Overall correlation was 88.4% (excluding 8 cases where FNAC results were inconclusive due to unsatisfactory smear). The sensitivity, specificity, positive predictive value and negative predictive value of FNAC to diagnose tubercular lymphadenopathies were 86.36%. 100.0%, 100.0% and 72.73% respectively. In case of metastatic CA, these were 100.0%, 96.15%, 80.0% and 100.0% respectively. Conclusion: FNAC is simple, safe, quick, cheap, acceptable yet accurate method of establishing the etiology in cases of cervical lymphadenopathy.

Tropical pyomyositis

Background:Tropical pyomyositis is characterized by suppuration within skeletal muscles, manifesting as single or multiple abscesses. Though primarily a disease of tropics, it is increasingly being reported from temperate regions in immunosuppressed patients. However, India has only few sporadic case reports.Aims:The aim of this study is to evaluate the causative organisms, clinical presentations, diagnostic modalities, treatment protocols and outcome data in tropical pyomyositis patients.Subjects and Methods:The study was carried out in Nilratan Sircar Medical College and Hospital, Kolkata over 3 years (July 2010 to June 2013). A total of 12 patients were diagnosed with tropical pyomyositis (confirmed with aspiration and culture of pus from muscle). All the investigation and treatment data were recorded systematically.Results:The presenting feature was high fever and myalgia in all 12 patients. Quadriceps femoris was the most commonly involved muscle (50%); followed by iliopsoas (25%). Culture of the aspirate showed Staphylococcus aureus in nine patients (75%), Klebsiella pneumonia in one patient (8.33%) and no growth in two patients (16.67%) even after tubercular and fungal culture.Conclusions:Tropical pyomyositis can affect immune-competent individuals. S. aureus is the most commonly cultured organism. Immediate initiation of appropriate antibiotics and surgical debridement are required to avoid complications. The prognosis remains excellent if promptly treated.

Clinical, biochemical and pathological correlation in alcoholic liver disease among Indian patients

A total of 28 consecutive patients suffering from alcoholic liver disease who were admitted to the Department of Medicine, Nilratan Sircar Medical College and Hospital, Kolkata, from January 2009 to August 2010, were enrolled in this study. Patients in whom liver biopsy was contradicted because of co-morbid conditions like coagulopathy, tense ascites and hepatic space occupying lesions, or those who did not consent for biopsy were excluded from the study.

Comparison of intramuscular magnesium sulfate with low dose intravenous magnesium sulfate regimen for treatment of eclampsia

Our objective was to compare intramuscular (i.m.) magnesium sulfate with a low dose intravenous (i.v.) magnesium sulfate regimen in prevention of convulsion recurrence and maternal deaths in women with eclampsia. This prospective trial was conducted in Nilratan Sircar Medical College, India from January 2001 to December 2005. All women with a clinical diagnosis of eclampsia were included in the trial. Magnesium sulfate (4 gm) was given as an i.v. loading dose, followed by either i.m. injections as recommended by Pritchard or low dose i.v. infusions (0.6 gm/h). Primary measures of outcome were recurrence of convulsions and maternal death. Secondary measures of outcome were potentially life threatening events, events related to labor and delivery as well as perinatal mortality and morbidity. Of the 630 women participating in the trial, 480 women received i.m. magnesium sulphate according to the Pritchard regimen and 150 women were subjected to a low dose i.v. regimen of magnesium sulphate. There was no significant difference in recurrence of convulsion (3.3% in the i.m. and 2% in the i.v. groups P = 0.586). Maternal deaths were not significantly lower in the i.v. group than the i.m. group (5% in the i.m. and 3.3% in the i.v. groups, P = 0.506) There were no significant differences in other measures of serious maternal morbidity, in perinatal morbidity or mortality. Low dose i.v. magnesium sulfate regimen is equally effective in prevention of convulsion recurrence and maternal deaths in eclamptic women when compared with an i.m. magnesium sulfate regimen.

A Study of Excessive Day Time Sleepiness in Asthma

A study was conducted in the Department of Respiratory Medicine, Nil Ratan Sircar Medical College, Kolkata over a period of two years on 120 uncomplicated stable adult asthmatics selected by random sampling to assess the incidence of Excessive Daytime Sleepiness (EDS) in patients with asthma, and to find out its correlation with the severity and the level of control of asthma. Diagnosis of asthma and its severity and level of control were assessed clinically, by peak flow meter and by spirometry. EDS was assessed by (Epworth Sleepiness Scale score ≥ 10). We found incidence of EDS was 30.8% where as EDS in general population of Kolkata was 11.3% (Z = 4.627, P = < 0.05). We also found a definite correlation between EDS with the severity of asthma (5.9% in intermittent, 19.4% in mild persistent, 39.3% in moderate and 83.3% in severe asthmatics) and the level of control (none in good level of control, 25.5% in fair level of control and 58.9% in poor level of control of asthma). However there was no correlation between the mode of diagnosis of asthma and EDS (31.8% in asthmatics diagnosed clinically, 25% by peak flow meter and 31.6% by spirometry).

Mechanism of Shoulder Movements and a Plea for the Recognition of ???Zero Position??? of Glenohumeral Joint

Mechanism of Shoulder Movements and a Plea for the Recognition of ???Zero Position??? of Glenohumeral Joint