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Volume-14 (2015);
No. 3 (July-September)
Published on Oct 15, 2015
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2015;3:1
Original Article |
Rupani MP, Gaonkar NT, Bhatt GS.
Low Osmolar Oral Rehydration Solution (ORS) for Treating Diarrhea in Children: A Systematic Review and Meta-Analysis. |
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Abstract: Context: Standard WHO-ORS reduces dehydration, but does not reduce stool volume and duration of diarrhea. Low osmolar ORS produce maximal water absorption. This meta-analysis was conducted to evaluate the efficacy of low osmolar ORS in comparison to standard WHO-ORS.
Evidence acquisition: A systematic review and meta-analysis of Randomized Controlled Trials (RCTs) comparing efficacy of low osmolar ORS and standard WHO-ORS in childhood diarrhea was carried out. RCTs were searched in PubMed, Cochrane CENTRAL, DOAJ, Google Scholar and Google. The data was extracted in Excel and entered in Review Manager 5.3 for calculation of effect sizes.
Results: The outcome of stool output was reported in 9 trails. Reduced osmolarity ORS resulted in significantly reduced stool output as compared with standard WHO-ORS (pooled standardized mean difference -0.44, 95% CI -0.72 to -0.15). Information for the outcome of duration of diarrhea was available from 6 trials. The pooled standardized mean difference was -0.21 (95% CI -0.79 to 0.37), suggesting that reduced osmolarity ORS did not have significant effect on the duration of diarrhea as compared to standard WHO-ORS. The outcome of need for intravenous fluid therapy was reported in 8 trials. The meta-analysis revealed that reduced osmolarity ORS when compared to WHO standard ORS was associated with fewer unscheduled intravenous infusions (Odds Ratio 0.62, 95% CI 0.47 to 0.83). The meta-analysis for the outcome of vomiting reported in 5 clinical trials showed that children treated with low osmolar ORS were less likely to vomit than children treated with standard WHO-ORS (Odds Ratio 0.74, 95% CI 0.57 to 0.97). Conclusion: Low osmolar ORS when compared to standard WHO-ORS is associated with reduced stool output, reduction in need for unscheduled intravenous infusion and lesser episodes of vomiting. However, there was no significant difference in duration of diarrhea
Key words: Low osmolar ORS, Childhood diarrhea, WHO standard ORS, Systematic review, Meta-analysis. |
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This Article |
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2015;3:2
Original Article |
Aleksandrova AA, Zolotukhin PV, Lebedeva UA, Belanova AA, Kuzminova ON, Goncharova AS, Gutnikova LV, Mashkina EV, Shestopalov AV, Shkurat TP.
GDF15 in the Physiological Human Pregnancy: Novel Data and A Systematic Review. |
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Abstract: Background: The involvement of GDF15 protein in modulating the processes of cellular migration and adhesion, tissue remodeling and inflammatory responses suggests that this factor may be of high importance for pregnancy establishment and its further maintenance. Analyzing pregnancy-associated dynamics of the factor confers a valuable addition to the case-control studies and can help advance our understanding of the fundamentals of the factor’s involvement in pregnancy. However, as seen from the systematic literature review presented in this paper, current data set significant questions on roles of GDF15 in pregnancy. Additionally, a significant controversy is seen in the literature regarding the gestational dynamics of GDF15. Thus, we tried to contribute to the field by assessing the dynamics of serum GDF15 protein in the course of the physiological human pregnancy. We found that serum maternal GDF15 levels increase by almost two orders of magnitude with progression of pregnancy from the mid-first trimester towards the early second trimester and then towards the term. These data were further compared with those found in the literature.
Key words: Growth/differentiation factor 15, Physiological pregnancy, GDF15 expression dynamics. |
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This Article |
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2015;3:3
Original Article |
Chudasama RK, Eshwar TKM, Eshwar ST, Thakrar D.
Overweight, Obesity and Thinness Prevalence with Different Growth Standards Among School Children and Adolescents in Saurashtra Region, India. |
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Abstract: Background: Overweight/obesity and thinness emerged as an important public health problem in India. The present study was conducted to estimate the prevalence and compare any difference in estimating prevalence of these conditions by using different standards among school children and adolescents. Methods: Anthropometric measurements of all students of four schools from 3rd to 12th standards were taken. Prevalence of overweight, obesity and thinness were assessed using two standards – Agarwal 2001 standards and revised IAP 2015 standards. Results: A total of 1496 children including 79.1% boys and 20.9% girls participated. Boys grow taller than girls from 12 years age and also gains more weight than girls from 11 years. The mean BMI of boys remain more than girls for all the years except age 16. Significant difference was observed (independent t test) for difference age years when height, weight and BMI of boys were compared with girls. Revised IAP 2015 standards reported high prevalence of overweight (19.1%) and obesity (14.0%) than Agarwal standards (17.0% & 9.1% respectively). Prevalence of thinness was reported more by Agarwal standards (59%) than IAP standards (3.4%). A good level of agreement (?=0.773) found between two standards considering four categories. The agreement was improved further up to 0.90 when compared for two combined categories – overweight/obese vs. normal weight/thinness. Conclusion: High prevalence of obesity and overweight was reported with IAP 2015 standards and Agarwal standards. Good agreement was found for both standards indicate Agarwal standards can still be used in current scenario like revised IAP 2015 standards.
Key words: Prevalence, Obesity, Overweight, Thinness, School children, Rajkot. |
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This Article |
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2015;3:4
Original Article |
Bhatia M, Mishra A, Rajpot M.
A Study to Assess the Role of Educational Intervention in Improving the Delivery of Routine Immunization Services. |
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Abstract: Background: Immunization has been regarded as the most cost-effective intervention for child health promotion. Even after improvements, the developing countries are still struggling with low coverage rates, immunization failure, high rates of adverse events following immunization (AEFI) etc. The present study was conducted to assess the role of educational intervention in improving immunization delivery services. Methodology: It was a pre-post intervention observational study carried out in immunization clinics of two tertiary care hospitals. The data from pre and post educational intervention assessment was compared and analyzed using SPSS 10.0. Results: At both clinics therewas 40% and 45% increase in cleaning of the spoon used for administration of vitamin A. Post-intervention there was 40% increase in use of hub cutter at both the centres. After intervention, there was 30% and 35% increase in the delivery of four key messages by staff nurse. Conclusion: Unlike Doctors, the health staff is not motivated for regular touch with the theory part of their work field and continued knowledge up-gradation. This strategy of periodic re-orientation of the topic in the form of educational intervention may help in improving service delivery to the beneficiaries. Further research is required in this aspect.
Key words: Routine Immunization, Educational Intervention, Supportive Supervision, Staff Nurse. |
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This Article |
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2015;3:5
Original Article |
Annadurai K, Venkatesh S, Ramasamy J.
Health Seeking Behavior on Child Care Among Fishermen Community of Kovalam Village, Tamil Nadu, India. |
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Abstract: While progress has been made to reduce under-five mortality in India from 52 to 39 per thousand live births by 2015 to meet Millennium Development Goal, it is unequally distributed between regions and remains insufficient to reach by 2015. Further, fishermen community possesses unique characteristics features, and remains homogeneous in socioeconomic and cultural matters. Objectives: 1) To assess the health seeking behaviour of parents for child care in children under five years of age among the fisherman community of Kovalam. 2) To assess the factors associated with health seeking behaviour among the above mentioned population. Material and methods: This was a descriptive cross sectional study conducted among 260 parents of children under five years of age in fishermen community with six months recall period in Kovalam, India during May to October, 2014 using pretested semi-structured questionnaire. Results: Prevalence of common childhood illness in the previous six months was 93.46% for ARI, 77.69% for ADD, and 69.23% for fever. Majority of them took their sick children (90.82%) immediately to health care facility especially. Conclusion: Health seeking behaviour among parents of children of this specific population was fairly adequate but the prevalence of childhood illnesses was quite high which needs further evaluation.
Key words: Childhood illnesses, Immunization, Hospital. |
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This Article |
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2015;3:6
Original Article |
Agrawal R, Sumana MN, Kishore A, Kulkarni M.
Simple Method for Detection of Metallo – β–Lactamase Among Gram Negative Isolates. |
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Abstract: Background: Carbapenem resistance due to the production of metallo-β -lactamase (MBL) in Gram-negative organism is an increasing public health problem. Aim: The purpose of this study is to detectMBL in Gram Negative bacterial isolates among Ventilator Associated Pneumonia patients. Materials and Methods: Phenotypic detection of MBL was done by three methods: 1.Modified Hodge Test (MHT) 2.Combined disc test (CDT) 3.Double Disc Synergy Test (DDST). Results: Out of 126 gram negative bacterial isolates, 80 (63.49%) showed resistance to carbapenem group of drugs. Among them maximum resistance was shown by Acinetobacter baumanii (90.32%), followed by Klebseilla pneumoniae (45.7%), Pseudomonas aeruginosa (26%). Out of 80 isolates, 66 were positive for MBL by MHT, 64 by CDT and 61 were detected positive for MBL by DDST. Conclusion: MHT and CDT were found equally efficient method to detect MBL. Maximum MBL production was detected in Acinetobacter baumanii. Simple and accurate screening test is required to prevent the spread of nosocomial strain in hospitals.
Key words: Metallo-β-lactamases, VAP, Screening methods, Modified Hodge test, Combined Disc test, Double disc synergy test |
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This Article |
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2015;3:7
Original Article |
Pandey AK, Kumar P, Radhakrishnan P, Kumar S, Kotian SR, D'Souza A, D'Souza AS.
Computed Tomographic Study of Superficial Fascia of the Abdomen: Implication to Localized Fat Deposits (LFD) Areas. |
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Abstract: Background: Superficial fascia of the abdomen, being a supportive structure plays a vital role in abdominal localized fat deposits (LFDs) as well as in surgical treatment of obesity. Interest in the anatomy of the superficial fascia is increasing with increasing popularity of surgical procedures for abdominal obesity. The study aims at computed tomographic evaluation and classification of the superficial fascia of abdomen & comparing with the earlier published cadaveric study. Materials and methods: One hundred two 64 slice CT scans films of abdominal region of 102 subjects showing radiologically normal abdominal fat of either sex (64 males 38 females) between 25 to 70 year age were analyzed. Results: Superficial fascia of the abdomen was multilayered in the midline & gradually merged with each other laterally. Multiple layers of superficial fascia in form of multiple loculi were seen mainly over central abdomen and loin region. Conclusion: Multiple layers of superficial fascia in the form of multiple loculi may be one of the reasons for resistant nature of LFD areas like loin and central abdomen.
Key words: Superficial fascia, Obesity, Localized fat deposit (LFD), Central abdomen, Loin area. |
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This Article |
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2015;3:8
Original Article |
Neskubina OM, Derevyanchuk EG, Demakova NA, Shkurat TP.
The usefulness of high-resolution carotid ultrasonography for the detection of subclinical atherosclerosis. |
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Abstract: Background: This study aimed to evaluate diagnostic possibilities of the high-resolution carotid ultrasonography for determining early manifestations of atherosclerosis taking into account gender and lipid profile differences of patients. Patients and methods: In this case-control setting, we included 431 subjects aged 55 to 79 years with no history of hypertension, ischemic heart disease, heart attack, stroke and other cardiovascular diseases. Non-invasive assessment of carotid intima-media thickness (CIMT) was held by high-resolution carotid ultrasonography. Results: We detected the atherosclerotic lesions in more than 50% of the patients. The appearance of atherosclerotic plaques in carotid arteries was associated with gender and alterations in the lipid spectrum of blood. Conclusion: The high-resolution carotid ultrasonography combined with blood lipid spectrum test could be considered as a screening method to reveal early atherosclerosis.
Key words: Atherosclerosis, Carotid intima-media thickness, High-resolution carotid ultrasonography. |
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This Article |
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2015;3:9
Original Article |
Ferreira AH.
A Morphological Insight of the Femoral Vein. |
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Abstract: A total of 13 cadavers (12 men and 1 women) of different age group were used for the study with the purpose to determine the prevalence of femoral vein duplication. Lower limb regions (26 sides) were carefully dissected as per the standard dissection procedure. Femoral vein (unitruncular) was found in 96.15% of specimen. Bitruncular configurations (total bifidity) was found in a male cadaver of 75 years of age (3.85%). In the right lower limb, 6.5 cms below the inguinal ligament the femoral vein - lateral ramus received the lateral circumflex femoral vein, and the medial circumflex femoral vein, and the lateral and medial ramii formed a common venous trunk. Knowledge of the truncular venous variations is important to recognize and avoid potential errors in diagnosis of deep venous thrombosis of the femoral vein, in the case of an occluded duplicated trunk.
Key words: Lower limb, Femoral vein, Unitruncular configuration, Bitruncular configuration, Deep vein thrombosis, Anatomical variation. |
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This Article |
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2015;3:10
Short Report |
D'Souza A, Ankolekar VH, Malsawmzuali JC, D'Souza AS, Hosapatna M.
Renal Artery Variations, Hilar Arrangement and Its Distances to Ventral Branches of Abdominal Aorta: A Morphometric Study. |
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Abstract: Purpose: To measure the distance of origin of renal artery in relation to the ventral branches of abdominal aorta and also to study the variations in the number and the hilar branching pattern of renal arteries. Materials and methods: The present study was carried out using ten embalmed adult cadavers. The distances were measured bilaterally from the origin of renal artery to the origin of superior and inferior mesenteric artery and the bifurcation of abdominal aorta. Results: Out of ten cadavers studied, bilateral accessory renal artery was observed in two cases. The hilar branching pattern varied from a single artery to maximum of six branches. The mean and standard deviations of the measured parameters were calculated. Conclusion: Knowledge of variations of renal artery is important for surgeons in performing many procedures and may help to avoid clinical complications in the abdominal region.
Key words: Renal artery, Superior mesenteric artery, Inferior mesenteric artery. |
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This Article |
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2015;3:11
Case Report |
Taksande AM, Meshram R, Lohakare A.
Masseter Muscle Hypertrophy and Pericardial Effusion in Kocher-Debre-Semelaigne Syndrome Child. |
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Abstract: Muscular pseudohypertrophy associated with severe congenital hypothyroidism has been described as Kocher Debre Semelaigne syndrome, which is a rare disorder. We report a case of 9year old female child with hypothyroidism, limb muscular pseudo-hypertrophy with involvement of masseter muscle along with pericardial effusion in Kocher-Debré-Semelaigne syndrome.
Key words: Hypothyroidism, Kocher Debre Semelaigne Syndrome, Pseudohypertrophy, Pericardial effusion |
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This Article |
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2015;3:12
Case Report |
Bist SS, Agrawal V, Shirazi N, Luthra M.
Primary Oropharyngeal and Laryngeal Histoplasmosis - A Diagnostic Challenge. |
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Abstract: Histoplasmosis is a rare tropical disease caused by Yeast-like dimorphic fungus Histoplasma capsulatum.Granulomatous diseases caused by infectious agents are being encounted more frequently nowadays. Infection by histoplasma capsulatum is one such granulomatous disease. In non-endemic areas, histoplasmosis poses a diagnostic challenge, especially since the presenting lesions can mimic carcinoma. The clinician should keep in mind histoplasmosis as a differential diagnosis when dealing with granulomatous lesions of oral cavity, oropharynx and larynx in both immunocompetent and immunocomparised patients. The histopathologist must be informed about the possibility of histoplasmosis, because special dyes have to be used to confirm this diagnosis. The treatment is mainly medical with Amphotericin B which remains the gold standard for treatment of this disease. The rarity of this disease in this part of country and variable clinical presentation prompted the authors to report this case.
Key words: Histoplasmosis, Oropharyngeal, Laryngeal, Granulomatous. |
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2015;3:13
Case Report |
Tyagi I, Puri AS, Sakhuja P, Majumdar K, Jain G.
Co occurrence of Hepatitis B Virus Infection and Autoimmune Hepatitis with Marked Hepatitis B Virus Replication Following Treatment of Autoimmune Hepatitis.. The usefulness of high-resolution carotid ultrasonography for the detection of subclinical atherosclerosis. |
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Abstract: Background: Children have different natural history of Hepatitis B virus (HBV) infection. They commonly develop asymptomatic chronic carrier state which is less frequently seen in adults. We describe a rare case of acute on chronic liver failure (ACLF) in the course of concurrent autoimmune hepatitis (AIH) and HBV infection and replication of HBV following the treatment for autoimmune hepatitis. Case Report: A 15 year old male child presented with jaundice and altered sensorium. Physical examination showed hepatosplenomegaly. The liver function tests were markedly altered. Serology was positive for anti liver kidney microsomal antibody (LKM), hepatitis B surface antigen (HBsAg) and immunoglobulin M (IgM) anti hepatitis B core antigen (HBc Ag). Liver biopsy showed chronic hepatitis with features of acute exacerbation. Patient was started on treatment with azathioprine and prednisolone for AIH following which clinical and biochmemical improvement was noted. After two years of continued treatment a repeat biopsy performed showed fairly reduced histological activity, but marked replication of the HBV (immunohistochemistry for HBsAg and anti HBcAg showed diffuse cytoplasmic and nuclear positivity respectively). These findings suggest viral replication although the patient was clinically stable. At six months follow-up after the second biopsy and cessation of azathioprine and prednisolone, there were raised liver enzymes and viral load, hence the patient was started on antiviral drug Entecavir to which there was good response and the patient is presently doing well. Conclusion: We describethe rare co occurrence of HBV infection and AIH with marked HBV replication following the treatment for AIH
Key words: Acute on chronic liver failure, Hepatitis B virus, Autoimmune hepatitis, Liver biopsy |
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2015;3:14
Case Report |
Mittal M, Mittal G, Goel D, Singh Y.
Bilateral Symmetrical Brachial Plexopathy in Association with Scrub Typhus: A Rare Presentation. |
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Abstract: Scrub typhus is a commonly encountered rickettsial disease of the Indian subcontinent caused by Orientia tsutsugamushi. It can be associated with various neurological manifestations. We report a case of 50 year old man with bilateral symmetrical brachial plexopathy associated with scrub typhus from the Garhwal region of Uttarakhand state. The initial manifestations were fever, bodyaches and weakness in both upper limbs. Laboratory reports confirmed the diagnosis of scrub typhus. EMG and NCV were strongly suggestive of upper brachial plexopathy. Patient was discharged in satisfactory condition.
Key words: Brachial plexopathy, Scrub typhus |
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2015;3:15
Case Report |
Shirazi N, Rawat MS, Rehmani B.
Primary Intramural Vesical Endometriosis Mimicking Urothelial Carcinoma in a Middle Aged Female. |
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Abstract: Endometriosis is the presence of ectopic endometrial tissue outside the uterus. Presence of endometrial glands and/or stroma may interfere with the normal physiological process by their infiltrative nature or by forming adhesions. Endometriosis occurs in 15-20% of women of child bearing age and commonly involves the ovaries, utero-sacral ligaments, fallopian tubes, rectum, scar sites and cervico-vaginal regions. Incidence of urinary tract involvement is estimated to be 1%. We report a case of a 38 year female presenting with low back pain, single episode of haematuria and burning during micturition. Urine culture was negative. There was no past history of pelvic surgery. On cystoscopy, a growth was visualised in the posterior urinary bladder wall suspicious of neoplastic origin. Tansurethral resection of bladder nodule was done and sent for histopathology, on which it was diagnosed as endometriosis. The case merits interest due to its atypical clinical presentation and the rarity of the lesion at this site.
Key words: Urinary Bladder, Endometriosis, Hematuria. |
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2015;3:16
Case Report |
Sood S, Sharma S, Verma R, Bansal V.
Vein of Galen Aneurysmal Malformation: Antenatal Diagnosis by Ultrasound and MRI. |
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Abstract: Vein of Galen aneurysmal malformation is a rare intracranial arteriovenous malformation .It accounts for up to 30% of intracranial vascular malformations in pediatric population and 1% of all pediatric congenital anomalies. It causes severe morbidity and mortality in neonates in the form of high output cardiac failure, nonimmune hydrops, hydrocephalus and intracranial hemorrhage. It is often diagnosed in postnatal period. Prenatal diagnosis of VGAMs may be accomplished with prenatal ultrasound (US) and fetal MRI which helps in early diagnosis and effective management.
Key words: Vein of Galen, Aneurysmal malformation |
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This Article |
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2015;3:17
Case Report |
Krishna U, Chakravarthy S, Singh M.
A Rare Association of Trousseau’s Syndrome with Ovarian Serous Cystadenocarcinoma. |
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Abstract: Trousseau’s syndrome is defined as a migratory thrombophlebitis found typically in patients with an underlying malignancy. This is often associated with GIT malignancies. Limited literature is available showing its association with ovarian malignancies and there is no available report showing occurrence of thrombosis in internal jugular, subclavian & axillary veins with serous cystadenocarcinoma of ovary.
Key words: Internal jugular vein thrombosis, Trousseau’s Syndrome, Serous cystadenocarcinoma. |
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2015;3:18
Case Report |
Sood S, Sharma S, Verma R, Bansal V.
Acardiac Parabiotic Fetus: A Rare Complication of Twin Pregnancy |
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Abstract: Acardiac parabiotic fetus is sequelae of complication of monochorionic monoamniotic twin pregnancy also known as Twin Reversed Arterial Perfusion Sequence (TRAP). It is rare affecting 1 in 35,000 births and 1 % of monozygotic twins. Acardiac parabiotic twin commonly known as parasite occurs rarely and may lead to high output cardiac failure, hydrops or premature delivery in the pump fetus. In this report, we present a 23 years old primigravida with twin pregnancy, with twin reversed arterial perfusion sequence with one of the twins being acardiac anceps and the other normal pump fetus. This association is relatively uncommon and therefore rarely documented.
Key words: Acardiac parabiotic fetus, Twin Reversed Arterial Perfusion Sequence |
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2015;3:19
Case Report |
Krishna U, Sinha PP.
A Rare Association of Abdominal Aortic Aortoarteritis with Persistent Left Superior Vena Cava. |
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Abstract: We present findings of persistent left superior vena cava and abdominal aortic stenosis detected incidentally by CT pulmonary angiography. To our knowledge, there has been no previous case report with all of the above findings detected by CT. In addition to the radiological findings and their clinical significance, the anatomy and embryological explanation of each anomaly is discussed.
Key words: Left superior vena cava, Abdominal aortic stenosis, Aortoarteritis |
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