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   Table of Contents - Current issue
Coverpage
July-September 2022
Volume 18 | Issue 3
Page Nos. 73-104

Online since Tuesday, December 13, 2022

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ORIGINAL ARTICLES  

Classifying ANCA-associated vasculitis and correlating outcomes based on anti-PR3/MPO serology: A prospective study from a tertiary care center p. 73
Gayatri G Ekbote, Natasha Negalur, Dhaval Tanna, Muzaffar Bindroo, Dhiren Raval, Shruti Bajad, Rajiva Gupta, Wasim Kazi
DOI:10.4103/AMJM.AMJM_19_22  
Introduction: Diagnosis and management of anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a challenge for all. Overlapping features in granulomatosis with polyangiitis (GPA) and microscopic polyangiitis (MPA) make diagnosis sometimes difficult. We aimed to classify clinical features and outcomes of proven AAV according to their serology, viz., anti-PR3/myeloperoxidase (MPO) by the enzyme-linked immunosorbent assay (ELISA). Materials and Methods: This was a prospective observational study of a total of 66 patients. This study included all consequent (old and new) AAV patients visiting a tertiary care center in northern India from August 2012 to June 2018. Patients were followed up for a minimum of 6 months. ANCA was done by both immunofluorescence assay and ELISA. Results and Conclusion: When compared, serological classification yielded findings similar to clinical counterparts [PR3/MPO vs. GPA/MPA]. The majority [80.3%] of patients were PR3-positive and were GPA clinically. Lung involvement was common in the PR3 group; however, there was no significant difference between the two groups [viz., PR3 and MPO, P = 0.18]. ENT involvement was significantly higher in the PR3 group when compared with the MPO group [P-value=0.009]. The difference in renal involvement in both the groups was not significant [P = 0.28]. Renal biopsy findings were similar in both the PR3/MPO groups. The median follow-up period was 18 vs. 12 months in the PR3 and MPO groups, respectively. Relapse was significantly higher in the PR3 group [P = 0.017]. The PR3 group significantly required rituximab for second induction treatment [P = 0.028]. Eight patients (12.12%) died during the study period. There was no significant difference in mortality, and there was permanent organ damage in both the PR3 and MPO groups. Autoantibody-based classification is supplemental to the clinical segregation of AAV phenotypes.
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Performance of neurodevelopment questionnaire among school children across optimal and high birth weight in a rural cohort of northern India p. 80
Dinesh Kumar, Seema Sharma, Sunil K Raina
DOI:10.4103/AMJM.AMJM_28_22  
Background: Neurodevelopmental outcomes up to 6 years of age were observed to be negatively associated with birth weight. Limited evidence exists for its association with high birth weight in rural parts of India. Objective: The objective of the study was to assess the performance of Denver Development Screening Test II (DDST-II) questionnaire among children with high birth weight (>3500 g) and normal birth weight (2500–2999 g) in an established birth cohort in the rural area of Himachal Pradesh, India. Materials and Methods: A birth cohort study was carried out from April 2021 to March 2022 in an established birth cohort of children. Participants with birth weight from 2500 to 2999 g were considered as the not-exposed and more than 3500 as the exposed group. Neurodevelopmental assessment was done by DDST-II, and its overall score along with seven domain scores was compared. The association was measured by adjusted odds ratio (aOR) with 95% confidence interval (CI). Results: A total of 379 and 377 participants in the nonexposed and exposed groups were enrolled, respectively. Exposed group observed with significantly more mean age (9.0 years) as compared to the not-exposed (8.6 years) group. Multivariate analysis of variance and multivariate analysis of covariance for observation-based neurodevelopmental assessment found that except for mentioning the correct use of items (cup, chair, and pencil) and for their action in case of cold, tired, and hungry, all domains have discriminatory value for a statistical difference between the not-exposed and exposed group. Linear regression analysis observed a significant association between DDST-II score and exposure (aOR: 2.3; 95% CI: 0.8–3.4) after adjusting for gender, age, years of schooling, and body mass index. Conclusion: High birth weight (>3500 g) was observed with a better performance of DDST-II with a significant association.
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Improving the diagnosis of tuberculosis through optimization of sputum microscopy p. 86
Raman Chauhan, Sunil K Raina, Dinesh Kumar, Abhilash Sood
DOI:10.4103/AMJM.AMJM_29_22  
Background: Patient compliance is an important component of the case detection. The feasibility of sputum examination on the same day was assessed without compromising on the quality. Materials and Methods: This study was conducted as a cross-sectional study on 215 patients attending the DOTS center in Dr. Rajendra Prasad Government Medical College, Kangra, at Tanda from July 2018 to December 2018. The patients were divided into three arms of the study based on the timing of the sputum sample. Results: There was a high correlation of the test result across all study groups. Combined for all arms, the correlation between the first spot and second spot sputum sample was 0.87, between the first spot and morning sputum sample was 0.82, and between the second spot and morning sputum sample was 0.85. There was no significant statistical difference in the sputum positivity among the groups. The loss to follow-up (LFU) was high (21.9%) for the second and third spot (early morning) samples in group 2, and no LFU was observed for the second spot (after 1 h) and morning sample in group 1 patients. Conclusion: The combination of the first and early morning samples offers a feasible mechanism to diagnose tuberculosis (TB) based on acid fast bacillus identification. Establishing the diagnosis for TB based on two sample results is feasible without any significant drop in the yield.
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CASE REPORTS Top

Norethisterone enanthate–induced cerebral sino-venous thrombosis (CSVT): A rare case report p. 92
Vijayan Sharmila, Sri S Kalluri
DOI:10.4103/AMJM.AMJM_23_22  
Cerebral sino-venous thrombosis is a potential life-threatening condition that requires rapid diagnosis and urgent treatment. The association between progestin-only pill used for the treatment of menstrual disorders and cerebral venous thrombosis has rarely been reported in the literature. We report a case of cerebral venous thrombosis following the intake of norethisterone for menorrhagia in a young woman. Although venous thrombosis is usually linked to the ingestion of estrogen, rather than progestogen, this case illustrates that patients who are prescribed progestogen-only pills for gynecological disorders may develop thrombosis.
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Quaint metastasis and markedly elevated prostate-specific antigen: An unusual manifestation of prostate cancer p. 96
Nwachukwu Olusegun Nwachukwu, Ayodeji Akinwunmi Ayeni, Olutomiwa Ayoola Omokore, Adetomilayo Adeotan Arijeniwa, Segun Idris Odejayi, Peter Kehinde Uduagbamen
DOI:10.4103/AMJM.AMJM_24_22  
Prostate cancer is one of the most common malignancies in males globally with records of approximately 1.6 million diagnosis and over 0.36 million deaths annually. The discovering and subsequent clinical application of the prostate-specific antigen (PSA) improved the diagnostic rates. Values of PSA (a tissue-specific marker) persistently greater than 4 ng/mL are regarded as abnormal hence histological studies are often required to confirm malignancy. Adenocarcinomatous cells, commonly osteoblastic, typically metastasize to the lumbar region via the veins of Batson. We report a case of prostatic cancer in a 69-year-old Nigerian with markedly elevated PSA, thoracic spine, and pelvic metastasis.
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An unusual presentation of filariasis as pyrexia of unknown origin: Case report p. 100
Sai Chandra Hakeem, Arun Valsan, Niveda Srivatsa, Kumar A Shrutiraaj, Swaraj Paul Khajuria, Nimitha K Mohan, Kingshuk Kohli
DOI:10.4103/AMJM.AMJM_27_22  
Filariasis is a common, yet neglected tropical disease and has a wide spectrum of clinical presentations. It is particularly endemic in certain regions of India. We report this case due to the rare isolation of Microfilariae from the bone marrow aspirate preparation. Here, we report a patient with a history of pyrexia of unknown origin (PUO). The relevant investigations done failed to identify the causative organism. After ruling out routine causes of fever, bone marrow analysis was done and it revealed Microfilariae in the aspirate. The surprising aspect of the case is the absence of eosinophilia in the complete blood picture. The patient was treated with anthelmintics and the fever subsided within 48 h. This case emphasizes the importance of bone marrow study in patients with PUO and the presence of microfilaria in the absence of eosinophilia.
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SHORT COMMUNICATION Top

Strengthening the component of obtaining feedback from patients and using the same to facilitate the teaching of medical students p. 102
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/AMJM.AMJM_21_22  
The process of assessment and delivering feedback to the medical students has been acknowledged as the key aspects to ensure comprehensive professional development. This calls for the need to utilize every learning opportunity and provide students with some form of constructive feedback for aiding them to attain the learning competencies. The exposure or interaction with patients plays an important role in helping the medical students establish linkage between theoretical knowledge and clinical practice and understands the practical relevance of the learned topics. Feedback received from patients can prove to be a significant add-on and help students to ascertain what has been done well and which area needs improvement. To conclude, patients are an important stakeholder and, apart from contributing to the advancement of medicine, can also help medical students learn various skills through both formal and informal ways. The need of the hour is to actively involve patients in the process of clinical teaching and make students learn medicine from the beneficiary perspective.
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