Publications by authors named "Vikas Bhatia"

79 Publications

The "Hockey-Stick" Sign: Spontaneous Unilateral Basal Vein Thrombosis.

Neurol India 2021 May-Jun;69(3):779

Department of Internal Medicine, PGIMER, Chandigarh, India.

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http://dx.doi.org/10.4103/0028-3886.319206DOI Listing
June 2021

Mechanical Thrombectomy in Embolic Cardiac Myxoma: Case Report and Literature Review.

Neurol India 2021 May-Jun;69(3):707-710

Department of Radio-diagnosis and Imaging, PGIMER, Chandigarh, India.

Myxomas are the most common cardiac tumors and present clinically with cardiac manifestations, systemic constitutional symptoms, and embolic events. Posterior circulation involvement occurs in approximately 20 percent of cerebral ischemic events.The endovascular technique is an established life-saving therapy for eligible patients upto 24 hours from symptom onset. However, the role of endovascular management in embolic atrial myxoma remains unknown with no international consensus guidelines for the management of stroke in such patient population. Here, we present a case report of an embolic posterior circulation stroke in a young female treated with mechanical thrombectomy at 23 hours from symptom onset. To the best of our knowledge, this is the first thrombectomy case in posterior circulation with embolism from myxoma. Further workup confirmed an atrial myxoma which was resected. We also review the previous cases with mechanical thrombectomy done in such cases.
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http://dx.doi.org/10.4103/0028-3886.319216DOI Listing
June 2021

The Conundrum of 'Long-COVID-19': A Narrative Review.

Int J Gen Med 2021 14;14:2491-2506. Epub 2021 Jun 14.

Department of Radiodiagnosis & Imaging, PGIMER, Chandigarh, India.

COVID-19 is an ongoing pandemic with many challenges that are now extending to its intriguing long-term sequel. 'Long-COVID-19' is a term given to the lingering or protracted illness that patients of COVID-19 continue to experience even in their post-recovery phase. It is also being called 'post-acute COVID-19', 'ongoing symptomatic COVID-19', 'chronic COVID-19', 'post COVID-19 syndrome', and 'long-haul COVID-19'. Fatigue, dyspnea, cough, headache, brain fog, anosmia, and dysgeusia are common symptoms seen in Long-COVID-19, but more varied and debilitating injuries involving pulmonary, cardiovascular, cutaneous, musculoskeletal and neuropsychiatric systems are also being reported. With the data on Long-COVID-19 still emerging, the present review aims to highlight its epidemiology, protean clinical manifestations, risk predictors, and management strategies. With the re-emergence of new waves of SARS-CoV-2 infection, Long-COVID-19 is expected to produce another public health crisis on the heels of current pandemic. Thus, it becomes imperative to emphasize this condition and disseminate its awareness to medical professionals, patients, the public, and policymakers alike to prepare and augment health care facilities for continued surveillance of these patients. Further research comprising cataloging of symptoms, longer-ranging observational studies, and clinical trials are necessary to evaluate long-term consequences of COVID-19, and it warrants setting-up of dedicated, post-COVID care, multi-disciplinary clinics, and rehabilitation centers.
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http://dx.doi.org/10.2147/IJGM.S316708DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8214209PMC
June 2021

Effects of COVID-19 on Pregnant women: Evidence-based review.

J Family Med Prim Care 2021 Apr 29;10(4):1530-1533. Epub 2021 Apr 29.

Department of Medicine, AIIMS, Bibinagar, Hyderabad, Telangana, India.

Corona virus infection (COVID-19) is increasing exponentially globally. It is also affecting pregnant women among others. Complications arising during pregnancy because of COVID-19 must be considered a health issue. The objective of the study was to analyse symptoms of pregnant women affected with COVID-19 based on the available literature. The articles were searched from Medline/PubMed, Scopus which were published till June 2020 and reviewed for the determined outcomes. The review demonstrated that common symptoms were fever, cough, nausea and myalgia. Vertical transmission of Corona virus infection was not found in any of the articles reviewed. Multicenter studies are important to better understand the pathogenesis and treatment planning for COVID-19 affected pregnant women.
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http://dx.doi.org/10.4103/jfmpc.jfmpc_1557_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8144763PMC
April 2021

Comment on "effects of dexamethasone on foetal Doppler flow velocimetry".

J Obstet Gynaecol 2021 May 27. Epub 2021 May 27.

Research Associate, Department of Obstetrics and Gynecology, Nehru hospital, PGIMER, Chandigarh, India.

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http://dx.doi.org/10.1080/01443615.2021.1907561DOI Listing
May 2021

Metabolic epilepsy in hyperprolinemia type II due to a novel nonsense ALDH4A1 gene variant.

Metab Brain Dis 2021 Aug 26;36(6):1413-1417. Epub 2021 May 26.

Pediatric Biochemistry Unit, Department of Pediatrics, PGIMER, Chandigarh, India.

Hyperprolinemia type II (HPII) is a rare autosomal recessive disorder of proline degradation pathway due to deficiency of delta-1-pyrroline-5-carboxylate dehydrogenase. Pathogenic variants in the ALDH4A1 gene are responsible for this disorder. We here describe an 11-month-old infant with recurrent seizures refractory to multiple antiepileptic drugs. She was hospitalized in view of acute-onset encephalopathy, exacerbation of generalized seizures following an upper respiratory infection. Laboratory investigation revealed significantly elevated proline levels in dried blood spots. DNA sample of the child was subjected to a targeted next-generation sequencing gene panel for hyperprolinemias. We detected a novel nonsense homozygous variant in the ALDH4A1 gene in the child and the heterozygous variant of the same in both the parents. Based on the location of the variant i.e. in the last exon, truncated protein is expected to be expressed by skipping nonsense-mediated decay and such point-nonsense variants could be an ideal target for readthrough drugs to correct genetic defects.
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http://dx.doi.org/10.1007/s11011-021-00757-wDOI Listing
August 2021

Pineal anlage tumor: A case report and clinico-pathological review.

Clin Neurol Neurosurg 2021 Jul 5;206:106629. Epub 2021 May 5.

Department of Radiotherapy and Oncology, PGIMER, Chandigarh.

Pineal anlage tumor (PAT) is an extremely rare tumor of paediatric population. It is considered as a subtype of pineoblastoma having ectomesenchymal/ rhabdomyoblastic and cartilaginous differentiation. PAT is presumed to have an aggressive behaviour with propensity for craniospinal fluid (CSF) spread due to histologically resemblance with pineoblastoma, thus requiring intensive multimodality treatment with craniospinal irradiation and chemotherapy. Here we report a case of PAT in a 35 years old lady along with clinical and pathological review. To the best of our knowledge only less than ten cases of pineal anlage tumors have been reported in the literature and index case is only second in the adult age group (rare histology in rare age group).
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http://dx.doi.org/10.1016/j.clineuro.2021.106629DOI Listing
July 2021

Anti-Rabies Vaccine Compliance and Knowledge of Community Health Worker Regarding Animal Bite Management in Rural Area of Eastern India.

Cureus 2021 Mar 31;13(3):e14229. Epub 2021 Mar 31.

Community Medicine and Family Medicine, All India Institute of Medical Sciences, Bhubaneswar, Bhubaneswar, IND.

Background Rabies is a public health problem in developing countries like India accounting for the second-highest number of rabies-related deaths worldwide. Anti-rabies vaccine (ARV) is the only proven and effective way of preventing death in this 100% fatal disease. However, compliance is a real concern. This study aims to assess the compliance of ARV and rabies immunoglobulin (RIG) among the ARV-clinic beneficiaries and also the knowledge of the health workers regarding animal bite management. Methods A cross-sectional study was conducted in an ARV clinic of a community health centre in a rural Odisha (Eastern India) between February and April 2019. All the beneficiaries attending the ARV clinic were followed up for 28 days to assess their ARV and RIG compliance. Data were collected using a pre-designed semi-structured questionnaire and analysis was performed using SPSS v.22 (IBM Corp, Armonk, NY, USA). Proportion was calculated for categorical variables and mean for continuous variables. Chi-square test was applied to test for significance of categorical variables. Results A total of 468 beneficiaries were followed up. More than half (59.8%) of the animal bite victims had a category-II bite, followed by 33.4% having category-III, and 6.8% having a category-I bite. Around three-fourth were exposed to dog bite. Only 52.3% of the patients were compliant with ARV, and 49.4% were compliant with RIG. Knowledge of the health workers regarding wound management was found to be sub-optimal. Conclusion Poor ARV compliance was seen among the beneficiaries. Awareness activities need to be strengthened further to improve health-seeking behaviour. The significant gap in knowledge of the health workers indicates the need for professional training at regular intervals.
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http://dx.doi.org/10.7759/cureus.14229DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8087540PMC
March 2021

A Prospective Randomized Controlled Trial Using Propofol or Dexmedetomidine for Conscious Sedation in Pediatric Patients Undergoing Sclerotherapy.

J Pediatr Neurosci 2020 Oct-Dec;15(4):379-385. Epub 2021 Jan 19.

Department of Anaesthesia, Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India.

Aim: Sodium tetradecyl sulfate (STS) sclerotherapy in pediatric patients is usually undertaken under sedation inside digital subtraction angiography (DSA) suite. These patients are day-care patients and need adequate sedation for small duration. We performed this study to compare propofol and dexmedetomidine as sedative agents in these patients.

Materials And Methods: Seventy American Society of Anesthesiologists (ASA) physical status I patients scheduled to undergo sclerotherapy for low-flow venous malformations under sedation were randomized to be administered either dexmedetomidine (Group D) or propofol (Group P). In Group D, initially 2 µg/kg of dexmedetomidine was administered over 10min (or till attainment of a Ramsay sedation score [RSS] of 5), followed by an infusion at the rate of 0.3 µg/kg/h. In Group P, propofol 1mg/kg bolus followed by an infusion at 100 µg/kg/min was administered, titrated to an RSS of 5. We measured intraoperative heart rate, blood pressure, respiratory rate, duration of procedure, and incidence of arterial desaturation, bradycardia, and respiratory depression in the two groups.

Results: All the patients in both groups completed the procedure. The mean anesthesia time was significantly longer in Group D. Intraoperative heart rates remained comparable in the two groups, whereas systolic and diastolic BP were significantly higher in Group D throughout the procedure. No patient in Group D experienced arterial desaturation, whereas five patients in Group P reported a SpO of <90%.

Conclusion: Both propofol and dexmedetomidine can be used for administering sedation in pediatric patients undergoing sclerotherapy for superficial venous malformations in DSA suite. Although propofol provides a rapid onset and reduced duration of action, dexmedetomidine provides reduced episodes of arterial desaturation and respiratory depression.
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http://dx.doi.org/10.4103/jpn.JPN_167_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8078632PMC
January 2021

Assessment of clinical and behavioral profile of clients attending integrated counseling and testing centers of a tertiary care institute in Eastern India: A secondary data analysis.

Indian J Sex Transm Dis AIDS 2020 Jul-Dec;41(2):149-155. Epub 2020 Nov 11.

Department of Community and Family Medicine, AIIMS, Bhubaneswar, Odisha, India.

Introduction: Integrated counseling and testing center (ICTC) forms the major forum under the National AIDS Control Organization (NACO) for counseling and testing of HIV-suspected patients. ICTC setup in a tertiary care institute also provides a chance for opportunistic screening of large number of individuals.

Aims: The study was done to assess and to profile the ICTC clients with respect to their seropositivity rate, their biological and behavioral risk factors, and seroconcordance rate.

Methodology: We did a secondary analysis of routine health data collected in the ICTC in the formats prescribed by the NACO.

Statistical Data Analysis: The data were entered into MS Excel and analyzed using SPSS version 22.

Results: Majority of the clients of ICTC were in the age group of 35-49 years. Seropositivity among client-initiated group (11.9%) was much higher compared to provider-initiated group (0.3%). None of the pregnant women were found to be positive. Heterosexual route was most common form of transmission in both provider-initiated and client-initiated groups. Seroconcordance rate was 43.4% in our study.

Conclusion: The ICTC of a tertiary care center attracted a huge number of patients. The seropositivity in our study was greater than those generated by sentinel surveillance system. A well-functioning ICTC can help in detecting a large number of cases and also provide a forum for counseling and education about risk factors of HIV.
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http://dx.doi.org/10.4103/ijstd.IJSTD_40_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8000672PMC
November 2020

Adherence of Doctors to Standard Diarrhoeal Management Guideline During Treatment of Under-Five Diarrhoeal Episodes: A Study From Eastern India.

Cureus 2021 Feb 18;13(2):e13433. Epub 2021 Feb 18.

Community Medicine and Family Medicine, All India Institute of Medical Sciences, Bhubaneswar, Bhubaneswar, IND.

Introduction Diarrhoea is one of the major preventable causes of childhood death in tribal areas of India. Most acute diarrhoea in childhood can be managed with oral rehydration salt (ORS) and zinc. This study aimed to assess the adherence of doctors to standard diarrheal management guidelines while treating under-five diarrhoeal episodes. Methods The cross-sectional study was conducted in 10 blocks of Kandhamal district in southern Odisha, India. The under-five childhood diarrhoea prescriptions from July to August 2018 were audited during September 2018. One health facility from each block and 15 prescriptions from each health facility were selected randomly. Data were collected and entered in Epicollect5 and analyzed using Statistical Packages for Social Sciences Version 22.0 (IBM Corp., Armonk, NY). Categorical variables were presented as proportions. Results A total of 150 under-five acute diarrhoea prescriptions were audited from 10 health facilities. One hundred ten prescriptions were from the out-patient department and 40 prescriptions were from the admitted diarrhoeal patients. The majority of them included ORS (77.3%) and zinc (75.3%) in the prescription, however, only half of the prescriptions (52.7%) had recommended dose and duration of zinc. All admitted patients received intravenous fluids. Most prescriptions (89.3%) did not document the hydration status of the patient. All prescriptions were silent about the severe acute malnutrition status of the children before administering fluid therapy. Antibiotics were prescribed in 80% of the prescriptions. Prebiotics, probiotics and anti-spasmodic were prescribed in 37.3% of the prescriptions. Conclusion Adherence of doctors to acute diarrheal management guidelines for the management of under-five diarrhoea was poor in our study. Further researches and training are required to improve childhood diarrhoea management in health facilities of tribal areas of India.
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http://dx.doi.org/10.7759/cureus.13433DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7981585PMC
February 2021

Carpal tunnel syndrome or C8/T1 radiculoneuropathy due to perinural cyst: A diagnostic conundrum.

Indian J Radiol Imaging 2020 Oct-Dec;30(4):510-512. Epub 2021 Jan 13.

Department of Radio-Diagnosis and Imaging, PGIMER, Chandigarh, India.

Perineural cysts are usually described in Lumbosacral region and are uncommonly seen in cervical spine. These are mostly asymptomatic, with only a few cases of symptomatic cervical perineural cysts. No previous case report of perineural cyst causing C8/T1 radiculoneuropathy mimicking clinically as Carpal tunnel syndrome is reported in the literature. We report a case of elderly female who was operated for presumed Carpal tunnel syndrome. However, her symptoms did not improve. The MRI of the patient revealed presence of perineural cysts at the level of C8/T1 exiting nerve root, compressing it and causing the symptoms. We present the clinical, nerve conduction study and radiological presentation of cervical perineural cyst mimicking Carpal tunnel syndrome in this patient.
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http://dx.doi.org/10.4103/ijri.IJRI_414_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7954159PMC
January 2021

X-Linked Agammaglobulinemia With Chronic Meningoencephalitis: A Diagnostic Challenge.

Indian Pediatr 2021 02;58(2):169-173

Department of Radiology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.

X-linked agammaglobulinemia (XLA) is a primary disorder of humoral immunity characterized by Bruton tyrosine kinase gene mutations resulting in a primary antibody deficiency. While an intact T-cell function largely protects against majority of viral infections, enteroviruses are notorious for infecting these patients due to impaired mucosal immunity. Although the incidence of enteroviral meningoencephalitis in XLA is only 1-5%, yet the mortality is quite high. A typical presentation of enteroviral encephalitis in XLA is a subacute to chronic nervous system infection. A progressive loss of motor and cognitive milestones, spastic quadriplegia, coma, and death are common presentations. The histopathological features reflect gliosis, gradual neuronal loss, neuronophagia, and microglial proliferation. We describe the clinical and brain histopathological findings in a 2-year-old boy with XLA and progressive encephalitis, possibly due to an enteroviral infection.
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February 2021

Brain MRI in Epstein-Barr Virus Meningoencephalitis in Children.

Ann Indian Acad Neurol 2020 Sep-Oct;23(5):621-624. Epub 2020 Feb 7.

Department of Pediatrics, Medanta, The Medicity, Gurugram, Haryana, India.

Background And Purpose: Epstein-Barr virus (EBV) meningoencephalitis can have variable and nonspecific brain magnetic resonance imaging (MRI) findings in children. This study was done with the purpose of describing brain MRI findings in children with EBV meningoencephalitis.

Materials And Methods: The study included 45 pediatric patients that presented with variable neurological symptoms and were found to have EBV meningoencephalitis based on positive EBV deoxyribonucleic acid (DNA) in the cerebrospinal fluid. All these patients had undergone brain MRI. Clinical and radiological features were evaluated.

Results: Fever was a presenting feature in all cases. Signs of meningitis and raised intracranial pressure (ICP) were seen in 24 (53.3%) cases, encephalopathy in 15 (33.3%), and seizures were present in 33 (73.3%). MRI was abnormal in 29 (64.4%) patients. The cortical/subcortical pattern was diagnosed in 9 (20%) cases, white matter involvement in 7 (15.5%), basal ganglia in 5 (11.1%), thalamic involvement in 4 (8.8%), brain stem involvement in 2 (6.2%), substantia nigra involvement in 2 (4.4%), and cerebellar involvement in 2 (4.4%). Diffusion restriction was present in 11 (24.4%) cases and susceptibility changes in 7 (15.5%). Meningeal enhancement was present in 10 (22.2%) cases. In addition, brain abscess and subdural effusion/empyema were present in 1 (2.2%) case each.

Conclusion: Pediatric EBV meningoencephalitis has varied clinicoradiological spectrum and there is no specific MRI pattern to characterize the meningoencephalitis on imaging. Common MRI findings include cortical-subcortical involvement, white matter changes, basal ganglia, and thalamic involvement.
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http://dx.doi.org/10.4103/aian.AIAN_537_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7887499PMC
February 2020

Rete middle cerebral artery: a rare association with anterior cerebral artery aneurysm rupture.

BMJ Case Rep 2021 Feb 1;14(2). Epub 2021 Feb 1.

Neurosurgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India.

Haemodynamic flow-related stress at the vessel curvatures is an important risk factor for intracranial aneurysmal growth and rupture. The rete middle cerebral artery (MCA) is a rare entity causing hyperdynamic blood flow into the ipsilateral anterior cerebral artery (ACA), especially when the contralateral A1-segment is non-dominant. Ruling out the clinicoradiological mimics like vasculitis, moyamoya and chronic occlusive disease with vessel wall imaging and detailed investigations helps manage the clinical entity effectively. We present a successfully managed case of ruptured ACA aneurysm at the acute curvature of the A1-A2 junction associated with ipsilateral rete MCA. Pre-emptive diagnosis of the rete MCA can aid preventive strategies to manage rupture and regrowth of the aneurysm at the points of flow-related stress.
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http://dx.doi.org/10.1136/bcr-2020-240219DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7852965PMC
February 2021

How healthy is our primary health care workforce? A cross-sectional study.

J Family Med Prim Care 2020 Oct 30;9(10):5212-5217. Epub 2020 Oct 30.

Assistant Professor, Dept of Community Medicine and Family Medicine AIIMS Bhubaneswar, Odisha, India.

Context: Progress of any nation depends on the health status of the population. A nation's health directly and indirectly depends on the quality of health-care facilities and how healthy the health care workforce is in that country. To achieve the health for all goal and to provide for most of the health services like maternal health services, child health services, nutrition, vaccination, and family planning services, the Indian health system have multipurpose health workers (female and male) and Accredited Social Health Activist to provide these services at the grass-root level. There is a paucity of literature revealing the health problems or the health status of grassroot level primary health care worker in India or abroad.

Methods And Material: All the grass-root level health workers, i.e., MPHWF and ASHAs in the BMC area were included in this cross-sectional study. Data was collected using a semi-structured interview schedule, followed by general examination and anthropometry using standard procedures.

Results: Half of the study participants 111 (50.2%) were having some or other kind of health issues during the data collection time; among them, 107 (48.4%) had a chronic disease condition. 10% of them had diabetes mellitus. More than half of the study participants 141 (63.8%) were found to be obese and hypertension was found in 27 (12.2%) study participants. 21 (9.5%) study participants were under high depression. One-fourth of the health workers among those who could conceive had not gone for antenatal check-ups and more than one-third (33.5%) never consumed iron and folic acid (IFA) tablets during their first pregnancy. 19.1% have children with incomplete immunization as per age. One-fifth of the participants know about the balanced diet and half of them could not ensure that their family eat a balanced diet and in the majority, the diet was calorie deficient as per the daily requirement.

Conclusions: There is an urgent need to formulate a policy to improve the health of the primary care grass-root level health-care workers and regular on-the-job training on nutrition needs to be given to them.
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http://dx.doi.org/10.4103/jfmpc.jfmpc_769_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7773110PMC
October 2020

Masks in COVID-19 pandemic: Are we doing it right?

J Family Med Prim Care 2020 Oct 30;9(10):5122-5126. Epub 2020 Oct 30.

Department of Community Medicine and Family Medicine, AIIMS, Bhubaneswar, Odisha, India.

The coronavirus (COVID-19) pandemic has caused the world to undergo an unprecedented change in a short period. Personal protective equipment such as the face mask or face cover has become a daily necessity. Moreover, since some states and countries have made the use of face covers or face masks compulsory, one cannot ignore or afford to have a wrong or incomplete awareness about face masks. Current information suggests that the two main routes of transmission of the COVID-19 virus are respiratory droplets and contact. This article aims to review the existing information and highlight the need for the use of face masks or face covers to combat the COVID-19 pandemic and promote and provide necessary recommendations. Many countries have implemented or recommended mask wearing in the community, but recommendation for rational use of masks is being issued, as the crisis and shortage for masks are universally existing. The use of different types of masks has been assigned according to the risk of exposure and should be therefore judiciously used. As this is a novel disease, the guidelines are changing every day and one needs to be updated with correct information so that one can protect themselves and their families from this extreme level of the crisis faced by the world now. The use of face covers or masks should not be discouraged as there has been substantial evidence that its use can help reduce the spread of infection. "Mass masking" along with hand hygiene and social distancing are the only effective recommended measures to prevent the spread of the disease.
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http://dx.doi.org/10.4103/jfmpc.jfmpc_657_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7773093PMC
October 2020

Isolated contralateral abducens palsy in direct carotid-cavernous fistula.

BMJ Case Rep 2020 Dec 21;13(12). Epub 2020 Dec 21.

Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India.

Post-traumatic direct carotid-cavernous fistulas may develop in patients with a closed head injury. The classical presentation is the Dandy's triad-chemosis, pulsatile proptosis and orbital bruit. Associated findings may include orbital pain, dilated episcleral corkscrew vessels, vision deficit and cranial nerve palsies. Cranial nerves-oculomotor (III), trochlear (IV), ophthalmic (V1), and maxillary (V2) divisions of trigeminal and the abducens (VI) lie in close association of the cavernous sinus. Abducens nerve (VI) lies close to the intracavernous internal carotid artery, within the substance of the sinus and is hence easily susceptible to vascular insult. The two sinuses connect across the midline and communicate freely with each other. Back pressure changes can present with the same sided or bilateral cranial nerve palsies. We report a rare association of a long-standing left-sided carotid-cavernous fistula with right eye abduction deficit and contralateral abducens palsy.
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http://dx.doi.org/10.1136/bcr-2020-238746DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7754622PMC
December 2020

Seronegative panencephalitis complicated by viral encephalomyelitis in a case of Good's syndrome - a neuropathological report.

Int J Neurosci 2020 Dec 15:1-6. Epub 2020 Dec 15.

Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

Background: The role of thymus in the immune cascade of the body is still under active clinical scrutiny. Meanwhile, there is an unravelling of myriad presentations of thymoma with effects on various organ systems. These effects arise both due to autoimmunity or a paraneoplastic process secondary to thymoma. However, an occasional patient can be a conundrum and may give no clue regarding the pathogenesis and etiology of its clinical profile.

Material And Methods: We present an enigmatic case of a 30-year-old male presenting with superficial fungal infections followed by multiaxial neurological involvement against a background of thymoma. Extensive workup for bacterial, viral, autoimmune and paraneoplastic etiologies were negative. Thymectomy confirmed thymoma (Type AB) but failed to ameliorate the progression of symptoms. He developed recurrent episodes of severe sepsis which remitted with sensitive antibiotics only to reappear again. Immunological profile showed complete absence of peripheral circulating B-cells with reversal of CD4/CD8 ratio, findings compatible with Good's syndrome. Radiological findings showed only progressive brain atrophy without any hyperintensity. He was also treated with intravenous immunoglobulins but failed to respond with the same.

Results: Autopsy revealed features of panencephalitis (neuronophagia, neuronal loss, perivascular lymphocytic cuffing and microglial nodules) with virus particles detected ultrastructurally. Although the distinction between seronegative autoimmune encephalitis versus a viral encephalomyelitis often blurs histologically, we speculated viral encephalomyelitis to have happened toward the latter part of his long illness. To our knowledge, this is a case of Good's syndrome presenting with seronegative autoimmune panencephalitis superimposed with a viral infection.
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http://dx.doi.org/10.1080/00207454.2020.1860040DOI Listing
December 2020

Horizontal Gaze Palsy, Scoliosis, and Split Pons Sign in a 6-Year-Old Girl.

J Neuroophthalmol 2021 Jun;41(2):e237-e238

Pediatric Neurology Unit (BS, PM, LS), Department of Pediatrics, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India; Department of Ophthalmology (SC), Advanced Eye Centre, PGIMER, Chandigarh, India; Department of Neuroradiology (CJ, VB, NS), PGIMER, Chandigarh, India; Council of Scientific and Industrial Research (PM), CSIR Complex, Library Avenue, Pusa, New Delhi; and Department of Orthopedics (NRG), PGIMER, Chandigarh, India.

Abstract: A 6-year-old girl presented with complaints of absent horizontal eye movements since birth. There was also associated progressive scoliosis for past 1 year. Neuroimaging revealed split pons sign, butterfly-shaped medulla, and prominent inferior olivary nuclei. The presence of congenital horizontal gaze palsy, childhood onset progressive scoliosis, and abnormal neuroimaging findings confirmed the diagnosis of horizontal gaze palsy with progressive scoliosis. This case highlights the importance of neuroimaging in a child presenting with horizontal gaze palsy and scoliosis that helped for starting early rehabilitation of the child, prevention of permanent vision loss, and parental counseling for future pregnancies.
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http://dx.doi.org/10.1097/WNO.0000000000001131DOI Listing
June 2021

Association between mid-upper arm circumference and body mass index in pregnant women to assess their nutritional status.

J Family Med Prim Care 2020 Jul 30;9(7):3321-3327. Epub 2020 Jul 30.

Department of Community Medicine and Family Medicine, AIIMS Bhubaneswar, Odisha, India.

Background: Underweight/ Undernourished is a state when the body mass index (BMI) falls below 18.5 kg/m2 and as per National Family and Health Survey-4, 22.9% of women in the reproductive age group fall into this category. Despite being considered as an important anthropometry marker, it is not measured in most of the healthcare facilities across India due to lack of basic amenities and resources. In such instances, how helpful other indicators like mid-upper arm circumference (MUAC) can be to measure the undernourished status of pregnant needs to be determined.

Objectives: To estimate the prevalence of undernutrition in pregnant women (PW) based on baseline BMI and MUAC and to determine the association between them.

Materials And Methods: A cross-sectional study was conducted in Tangi Block of Odisha among 440 PW (in the first trimester) from July 2018 to November 2018 using a pre-tested, validated questionnaire and anthropometric instruments.

Results: PW having BMI <18.5 kg/m2 were found to be 16.6% and having MUAC <23.5 cm were 19.5%. A significant association was found between BMI and MUAC [aOR 7.91 (4.27-14.65)]. Also, a moderate correlation was established between the indicators (r = 0.57).

Conclusion: MUAC can be used instead of BMI as it is easier to measure, cheaper, does not require any training or calculations, and insensitive to changes during the period of gestation unlike BMI. This can be beneficial to the healthcare workers at primary level who are in resource-limited settings.
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http://dx.doi.org/10.4103/jfmpc.jfmpc_57_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7567285PMC
July 2020

Breaking the chain of malnutrition: Opportunities, challenges and actions.

Authors:
Vikas Bhatia

Indian J Public Health 2020 Jul-Sep;64(3):216-222

Executive Director, All India Institute of Medical Sciences, Bibinagar (Hyderabad), Telangana, Indiaia, India.

Nutrition continues to be a major challenge in India. Children, Adolescents, Pregnant and Lactating women have various nutrition related public health issues which needs accelerated efforts. Department of Community Medicine & Family Medicine, AIIMS, Bhubaneswar undertook various community-based nutrition interventions and initiatives in Odisha and documented the good practices and results. This article captures multiple nutritional programmes implemented in Odisha with support of Government and other organizations.
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http://dx.doi.org/10.4103/ijph.IJPH_801_20DOI Listing
September 2020

Mechanical Thrombectomy in Stroke: When Crossing a Road Less Traveled.

JACC Cardiovasc Interv 2020 09;13(18):2187-2188

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http://dx.doi.org/10.1016/j.jcin.2020.08.014DOI Listing
September 2020

Maternal Nutrition and Inadequate Gestational Weight Gain in Relation to Birth Weight: Results from a Prospective Cohort Study in India.

Clin Nutr Res 2020 Jul 28;9(3):213-222. Epub 2020 Jul 28.

Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences (AIIMS) Bhubaneswar, Bhubaneswar, Odisha 751019, India.

Inadequate/excessive gestational weight gain (GWG) can cause adverse pregnancy outcomes and only few studies have described patterns of weight gain in Indian women. Also, studies pertaining to dietary intake throughout gestation are insufficient. This prospective cohort study was conducted to evaluate GWG and nutrient intake in all trimesters of pregnancy and investigate the relationship between themselves along with that of birth weight (BW). Our study was carried out in a population-based prospective birth cohort in Odisha, India. The 418 pregnant women were followed till delivery with measurements of maternal weight, weight gain throughout gestation, and BW. Macronutrients were assessed based on a 24-hour dietary recall method in each trimester. Women characterized by under-weight pre-pregnancy body mass index (BMI) were 16.20%, and a total of 6.45% did not comply with current weight gain recommendations. Particularly, overweight and obese women gained more weight than recommended. In a multivariate analysis GWG correlated significantly with BMI (p = 0.03), total calorie intake (p < 0.001) and fat intake (p < 0.001), while BW of newborns correlated significantly with adequacy of weight gain and fat intake (p < 0.001). Though measures are taken by health workers to record the weight but nutritional counseling is not being provided regularly. A high priority should be given to increase awareness among general population regarding the importance of diet in pregnancy and how to adhere to the balanced diet for optimal growth of child.
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http://dx.doi.org/10.7762/cnr.2020.9.3.213DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7402978PMC
July 2020

Predictors of the diets consumed by adolescent girls, pregnant women and mothers with children under age two years in rural eastern India.

J Biosoc Sci 2020 Aug 12:1-20. Epub 2020 Aug 12.

Country Office, UNICEF, New Delhi, India.

Adolescents, pregnant women and mothers of children under 2 years of age are in stages of life characterized by higher nutritional demands. The study measured the dietary diversity of 17,680 adolescent girls, pregnant women and mothers of children under age 2 years in the eastern Indian states of Bihar, Chhattisgarh and Odisha using data from the Swabhimaan baseline survey conducted in 2016. The association of women's mean Dietary Diversity Scores with socioeconomic, health and nutrition service indicators was assessed. The sampled population was socioeconomically more vulnerable than the average Indian population. There was not much variation in the types of foods consumed daily across target groups, with diet being predominantly cereal (98%) and vegetable (83%) based. Nearly 30% of the mothers had low Dietary Diversity Scores, compared with 25% of pregnant women and 24% of adolescent girls. In each target group, more than half of the respondents were unable to meet the Minimum Dietary Diversity score of at least five of ten food groups consumed daily. Irrespective of their background characteristics, mean Dietary Diversity Scores were significantly lower in Bihar than in Chhattisgarh and Odisha for all target groups. Having at least 6 years of education, belonging to a relatively rich household and possessing a ration card predicted mean dietary diversity. Project interventions of participatory women's group meetings improved mean Dietary Diversity Scores for mothers and adolescent girls. Considering the association between poverty and dietary diversity, the linkage between girls and women and nutrition-focused livelihoods and supplementary nutrition programmes needs to be tested.
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http://dx.doi.org/10.1017/S0021932020000462DOI Listing
August 2020

ADSL Deficiency - The Lesser-Known Metabolic Epilepsy in Infancy.

Indian J Pediatr 2021 03 18;88(3):263-265. Epub 2020 Jul 18.

Pediatric Neurology Unit, Department of Pediatrics, Advanced Pediatric Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

Adenylosuccinate lyase deficiency is a rare inherited disorder of purine metabolism causing severe neurological impairment ranging from early-onset neonatal epileptic encephalopathy to progressive psychomotor retardation and autism in later life. Diagnostic workup involves the measurement of toxic succinyl purines in body fluids and gene sequencing. The authors describe a 13-mo-old girl with compound heterozygous variants in the ADSL gene, presenting as early-onset seizures, severe neurological impairment, development delay, and hypotonia. Neuroimaging revealed cerebral atrophy, delayed myelination and diffusion restriction in bilateral basal ganglia, thalamus and periventricular white matter. The present case highlights ADSL deficiency as a rare cause of metabolic epilepsy that needs timely recognition and prevention of unnecessary investigations.
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http://dx.doi.org/10.1007/s12098-020-03435-4DOI Listing
March 2021

Abdominal Aortic Occlusion by Hydatid Cysts.

Aorta (Stamford) 2020 Feb 29;8(1):21-22. Epub 2020 Jun 29.

Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India.

Hydatid disease is a parasitic infestation caused by the larval stage of . It can infest any part of the body; however, aortic hydatid disease is rare. Involvement of the abdominal aorta is usually due to embolization from cardiac hydatid cysts or direct invasion and can be present at intravascular or intramural locations. Aortic hydatid disease may present with fatal complications, such as anaphylaxis, pseudoaneurysm formation, systemic embolism, and arterial occlusion.
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http://dx.doi.org/10.1055/s-0039-3401994DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7324249PMC
February 2020

Yellow fever vaccination: how much do travelers from Eastern India know?

Hum Vaccin Immunother 2020 09 15;16(9):2151-2155. Epub 2020 May 15.

Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences , Bhubaneswar, India.

: International tourism has grown tremendously in the past 2-3 decades in India resulting in exposure of travelers to varied spectrum of diseases prevalent in different parts of the world. Immunization plays a prominent role in protection of the exposed individuals. The objective of the present study was to assess the awareness and knowledge regarding yellow fever and other travel vaccinations amongst travelers of eastern India. : In the present cross-sectional study, participants attending Yellow Fever Vaccination Clinic at All India Institute of Medical Sciences, Bhubaneswar, during August-September 2018 were approached. Newly registered participants aged 15 y and above were interviewed consecutively till the required sample size of 300 was fulfilled. Awareness and knowledge regarding travel vaccinations and their adverse effects were assessed with pretested structured interview schedule. Bivariate and multivariate logistic regressions were done to assess the association of various factors with awareness of travel vaccinations. : Among the participants, most of them were males (90.7%), belonged to the age group of 15-45 y (87.3%), married (64.3%), graduates (19%), and were working (78.3%). Most of the participants were traveling to South Africa (85.4%). Only 57.3% participants were aware of any travel vaccinations. Only 37.5% participants knew that yellow fever vaccine confers lifelong immunity. On multivariate logistic regression higher education, working occupation and history of previous vaccination were significantly associated with awareness of travel vaccinations. : Awareness regarding travel vaccinations is important to prevent fatal diseases like yellow fever. Vital information pertaining to diseases in different locations and availability of vaccines for prevention needs to be disseminated to the travelers to prevent occurrence of travel bound diseases.
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http://dx.doi.org/10.1080/21645515.2020.1757988DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7553678PMC
September 2020

Prevalence and determinants of the dangerous selfie among medical and nursing students: a cross-sectional study from eastern India.

BMC Public Health 2020 May 6;20(1):628. Epub 2020 May 6.

Department of Community Medicine and Family Medicine, AIIMS, Bhubaneswar, 751019, India.

Background: Globally, there has been an exponential rise in smartphone use and selfie taking among youth. To make selfies exciting, dangerous selfies are often taken that may lead to catastrophic consequences, including death. This study aims to estimate the prevalence of dangerous selfies and to determine the factors associated with dangerous selfies among medical and nursing students in India.

Methods: The study was conducted at the All India Institute of Medical Sciences (AIIMS), Bhubaneswar, India, in April-August 2018. The inclusion criteria were students enrolled in the Bachelor of Medicine and Bachelor of Surgery (MBBS) and nursing courses of AIIMS, Bhubaneswar. Students who did not use smartphones were excluded from the study. The interview schedule and Selfitis Behaviour Scale (SBS) were used to collect information on sociodemographic variables, smartphone use and variables related to selfies and dangerous selfies. Forward stepwise logistic regression was undertaken with the probability of entry and removal as 0.05 and 0.10, respectively.

Results: Of 633 eligible participants, 595 were included in the study. The mean (SD) age of the participants was 21.2 (1.6) years. More than half (56.8%) of the participants were female, 384 (64.5%) were medical students and 211 (35.5%) were nursing students. Nearly two-thirds of the participants (70.6%) preferred to take selfie. One hundred thirty three (40.3%) of the participants posted selfies on social media daily. The prevalence of dangerous selfies was 8.74% (95% CI: 6.73-11.28). Eight injury episodes while taking selfies were reported by seven (1.2%) participants. Being male (AOR 4.96, 95% CI 2.53-9.74), posting selfies on social media daily (AOR 3.33, 95% CI 1.71-6.47) and an SBS score > 75 (AOR 4.97, 95% CI 1.43-17.28) were independent predictors of dangerous selfies.

Conclusion: Nearly one in ten medical and nursing students reported having taken a dangerous selfie, and one in one hundred reported having been injured while attempting to take a selfie. Being male, posting selfies on social media daily and an SBS score > 75 were independent predictors of dangerous selfies. Further research is required to identify the community burden of dangerous selfies and to develop strategies to prevent selfie-related fatalities among youths.
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http://dx.doi.org/10.1186/s12889-020-08785-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7203966PMC
May 2020
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