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Autologous platelet-rich fibrin to treat difficult nonhealing diabetic foot wounds with exposed bone – A case report of this safe, effective, and economical method
Riju Ramachandran Menon, Anoop Vasudevan Pillai, Veena Shenoy, Sundeep Vijayaraghavan
October-December 2020, 16(4):181-184
Diabetic wounds, especially with exposed bones, are notorious to cause complications. Various drugs and substances have been tried by different researchers in their quest for early painless healing. We report our patient with peripheral vascular disease (PVD) and chronic nonhealing wound with exposed bone successfully treated with autologous platelet-rich fibrin (PRF). Our patient with a diabetic foot ulcer and PVD underwent an amputation of the great toe. His wound could not be closed, and there was exposed bone on the floor of the ulcer. Regular treatment may have caused nonhealing, osteomyelitis, and spreading gangrene. His PVD contraindicated a vascular flap cover. Hence, we tried the use of autologous PRF on the wound. The hospital stay was minimized, adjuvant procedures were not needed, and the wound healed well in 4 weeks. PRF is a very economical and safe adjuvant in the fight to treat difficult wounds.
  2 1,788 125
Hearing loss: A neglected and morbid clinical entity in Corona Virus Disease 2019 pandemic
Santosh Kumar Swain, Somya Ranjan Pani
October-December 2020, 16(4):159-163
Hearing loss may be caused by certain viral infections. The hearing loss due to viral infection can be congenital or acquired, bilateral or unilateral. The viral infections typically cause sensorineural hearing loss (SNHL), although conductive or mixed hearing loss can be found. The corona virus disease 2019 (COVID-19) infection has deleterious impact on the cochlear hair cells. The hearing loss will not improve even patient recovered from COVID-19 infections. This is probably a neuro-auditory involvement in COVID-19 infections. The current COVID-19 is caused by severe acute respiratory syndrome corona virus 2. The audiologic and radiologic investigations are helpful for evaluation of the hearing loss in COVID-19 patients. Hearing loss due to COVID-19 infections is rarely reported in medical literature so far. Hearing loss specifically SNHL is often challenging to the clinicians in this current pandemic. The mechanism for this deleterious effect on the cochlear hair cells requires further research. There is a large gap in the understanding of the etiopathogenesis, epidemiology, and clinical presentations such as hearing loss and human transmission of this disease. There should be a continuous monitoring of the hearing loss and tracing of this COVID-19 infection is needed to ensure the detail understanding of this inner ear pathogenesis. This review article provides an overview of COVID-19 infections and its impact on hearing loss.
  2 3,110 189
Autologous platelet-rich fibrin in the management of recurrent complex fistula in ano: A novel safer and cost-effective approach
Riju Ramachandran, Anoop Vasudevan Pillai, Vaishnavi Gunasekharan, Suyambu Raja, Veena Shenoy
January-March 2021, 17(1):9-12
We present the case of a 26-year-old female with Crohn's disease who had undergone multiple procedures for recurrent complex fistula-in-ano now presenting with recurrent discharge for 3 months. She underwent video-assisted anal fistula treatment (VAAFT) in our department 2 years back. The patient had financial issues and was unwilling for another sitting of VAAFT. Hence, we tried autologous platelet-rich fibrin (PRF) as a more economical alternative to fibrin sealant used in VAAFT. The patient had a very comfortable postoperative period and the fistula healed well in 3 weeks. We present this case report to highlight a new indication for autologous PRF which is already in use in healing many other types of wounds.
  1 1,456 125
A case of idiopathic hypertrophic cranial pachymeningitis masquerading as Tolosa–Hunt syndrome in an elderly female
Tilottama Parate, Kizhakkemuriyil S Tony, Sonali Chavan, Ankita Khatri
April-June 2021, 17(2):58-62
Idiopathic hypertrophic cranial pachymeningitis (IHCP) is an extremely rare clinical entity of unknown etiology, characterized by a chronic inflammation causing thickening of the dura mater.[1] ICHP can produce similar presentation to Tolosa–Hunt syndrome (THS) if it involves cavernous sinus.[2] THS might represent a focal manifestation of IHCP.[2] The THS is a rare syndrome with an estimated annual incidence of one case per million per year.[3] It typically presents with orbital pain associated with palsy of the third, fourth, or sixth cranial nerve. We present an interesting case of a patient with IHCP associated with THS in an elderly female who responded well to high-dose steroids and in a few days had significant improvement in her retro-orbital pain and ocular movements. The importance of appropriate neuroimaging and serological investigation in patients with suspected THS, role of erythrocyte sedimentation rate in follow-up of these patients, and the relationship between IHCP and THS are discussed.
  1 880 74
Development of a new questionnaire to study students' perception toward online classes
Unnikrishnan K Menon, Suja Gopalakrishnan, C Sumithra N. Unni, Riju Ramachandran, B Poornima, MS Ashika, Anu Sasidharan, Natasha Radhakrishnan
October-December 2020, 16(4):143-145
Medical education is going through a new learning experience of its own due to the impossibility of physical classes in the present pandemic situation. This article describes in detail the conceptualization and development of a questionnaire for the specific purpose of studying the perception of undergraduate students of a medical college toward the online education program.
  1 2,497 223
Integration of yoga in the management of patients undergoing surgery for Prostate Cancer: A pilot study
Deepak Chandran Nair, Abhishek Laddha, Appu Thomas, Greeshma C Ravindran, Ginil Kumar Pooleri
January-March 2020, 16(1):6-8
Introduction: Integration of yoga in health-care management has beneficial effects in the management of many health-related issues with improved outcomes with no added cost. We conducted a pilot study to study the feasibility of yoga in the integrated management of patients with localized prostate cancer undergoing robotic-assisted radical prostatectomy. Methods: This prospective pilot study included twenty patients who underwent robotic-assisted radical prostatectomy between June 2019 and November 2019. The overall effects of yoga on health-related quality of life, recovery of urinary continence, and erectile function were the primary endpoints of our study. Results: Patients in the yoga group had significantly better continence rates at 1 month (90% vs. 50%) with better functional outcomes as compared to the control group at 1-month follow-up. The difference in sexual recovery was not significant in each group at 1-month follow-up.Conclusion: Yoga can be safely integrated in the postoperative management of patients undergoing radical prostatectomy with no short-term adverse side effects on overall outcomes.
  1 2,502 213
Deep neck space infection of the pediatric patients: Our experiences at a tertiary care teaching hospital of Eastern India
Santosh Kumar Swain, Prasenjit Baliarsingh, Swaha Panda
October-December 2020, 16(4):169-174
Background: Deep neck space infections are uncommon life-threatening clinical entity. It can cause significant morbidity in the pediatric age group. Objective: This study analyzes the clinical presentations, diagnosis, and management of the deep neck space infection of the pediatric patients. Materials and Methods: A retrospective study was conducted at a tertiary care teaching hospital during May 2015–June 2020. The medical records pediatric patients diagnosed with deep neck space infections with age <16 years were reviewed. Data of demographics, clinical symptoms, hospital course, and management were retrieved. Results: There was the predominance of male children with deep neck space infections (65.38%) and mean age of 8.3 years. The most common symptom was neck swelling (61.53%). The most common deep neck space infection was peritonsillitis (21.15%), followed by parapharyngeal abscess (17.30%). The important life-threatening complications in this study were stridor found in 3 children (5.76%). Conclusion: Deep neck space infections are an uncommon clinical entity in the pediatric age group. Odontogenic infections are the most common etiology for the deep neck space infection. The common clinical presentations are restricted neck movement, fever, neck swelling, and pain in the neck. Imaging like computed tomography scan is helpful to assess the site and extent of the deep neck space infection. Incision and drainage and appropriate antibiotics are important options for treatment.
  1 1,640 128
Pathophysiology of brain stem death
Eldo Issac, Sarath Venugopalan
April-June 2020, 16(2):50-54
Brain stem death (BD) is a pathological process which has a profound effect on hemodynamic balance, hormone levels and functioning of other organ systems. It also triggers a systemic inflammatory response. Knowledge about the changes that occur during brain stem death is necessary for subsequent management. This article discusses the pathophysiological changes in the body after brain stem death.
  1 3,651 319
Certification of brain stem death in India: Medico-Legal perspectives
Noble Gracious, Veena Roshan Jose
April-June 2020, 16(2):71-76
At present, the determination of brain stem death for the declaration of death in India is a clinical practice followed only in the context of organ donation. It has still not evolved into a standard clinical practice in the intensive care units for determination of death. The probable explanation for this could be that, in India, the declaration of death by determination of brain stem death is mentioned only in the Transplantation of Human Organs and Tissues Act, 1994. Even after 25 years of application of this legislation and the definition of brain stem death in place, no uniform guidelines on the procedure to be followed in the determination of brain stem death have been issued either by the statute or by a national or state authority. The article tries to analyze the lacunae existing in the legal framework in relation to the certification of brain stem death in India.
  1 12,479 585
Review of the correlation between social economic status and oral diseases in India
Chandrashekar Janakiram, Naveen Jacob Varghese, Joe Joseph
October-December 2020, 16(4):146-151
Socioeconomic inequalities in oral health can be defined as the differences in the prevalence or incidence of oral health problems. We assessed the pooled estimate of prevalence of oral diseases among different socioeconomic status (SES) in India by including all articles published up to December 2016 with the prevalence of the oral diseases in SES population using the confined research terms in databases of PubMed and Google Scholar. All articles which had assessed the dental caries, periodontal disease, malocclusion, and oral cancer in different socioeconomic groups were collected. Out of 209 articles retrieved, 19 studies were included. The pooled estimate for mean DMFT for upper, middle, and lower SES status was 3.1 (95% confidence interval [CI] 3–3.1), 2.6 (95% CI 2.6–2.9) and 3.05 (95% CI 3.05–3.04). The prevalence of periodontal disease for (upper SES 12 [95% CI 11–12], middle SES 28 [95% CI 28–29] and lower SES status 60 (95% CI 59–60)] and in (Kuppuswamy scale Upper SES 22 [95% CI 21–22], middle SES 24 (95% CI 23–24] lower SES status 28 [95% CI 27–28]). Our analysis shows that the SES was inversely proportional to the oral diseases. There was a minor variation between DMFT between groups which may be attributed to the lack of large number of studies assessing the SES and dental caries. The pooled estimate of the mean DMFT across the SES status was inconsistent.
  1 2,151 188
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