Journal of Case Reports and Scientific Images

Journal Information
ISSN / EISSN : 2708-0056 / 2708-0064
Current Publisher: AkiNik Publications (10.22271)
Total articles ≅ 25
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Latest articles in this journal

N Rajendran, Shruthy Ps, Biju Gopal, V Divya
Journal of Case Reports and Scientific Images, Volume 3, pp 04-07; doi:10.22271/27080056.2021.v3.i1a.22

Abstract:
Background: Pseudoexfoliation is the common identifiable cause of secondary glaucoma. It is noted to be more aggressive with a high mean progression rate leading to full field blindness within 10 years. Aim of study: The aim of this study is to assess the demographic aspects, magnitude, clinical spectrum and response to treatment of glaucoma in pseudoexfoliation syndrome. Materials and methods: All patients with pseudoexfoliation syndrome who attended Ophthalmology department, Sree Mookambika Institute of medical sciences, Kulasekharam were selected for this study. This is a cross sectional study done over a period from January 2019 to June 2019 in patients who fulfilled the inclusion criteria. All patients have undergone complete ocular examination including visual acuity, slit lamp examination, Ophthalmoscopic examination, IOP measurement, Gonioscopy, Pachymetry and visual field examination and these patients were advised to follow up at regular intervals. Observation and results: In this study of 96 patients, males with age group of 61-70 years are commonly affected. Pseudoexfoliation syndrome is unilateral on presentation but eventually becomes bilateral. The IOP is fluctuating and produce severe optic nerve damage. The course is aggressive and recalcitrant to treatment needs definitive surgical therapy. Conclusion: Pseudoexfoliation is a common identifiable cause of secondary glaucoma producing ocular morbidity. Due to its fluctuating IOP, aggressive course and difficulty in managing with medical treatment it stands as a distinct enigmatic clinical entity. Pseudoexfoliation needs early detection, regular follow up and definitive therapy.
Subbu Rathinam, Karthick Mp, Mohammed Imram, Sree Lakshmi
Journal of Case Reports and Scientific Images, Volume 3, pp 08-11; doi:10.22271/27080056.2021.v3.i1a.24

Abstract:
Aim and objectives: Lower Limb Amputation Is the Most Dreadful Complication of Various Factors for the patient as well as his families. This Study is to find the Prevalence of Lower Limb Amputations and factors contributing to amputation in our population. Method: The Retrospective quantitative study was conducted in Sree Mookambika Institute of Medical Sciences and hospital in the period of June 2018 to November 2019. Each patients are assessed periodically and evaluated. Following parameters are used to evaluate the contributing factors like age, sex, diabetes mellitus, systemic hypertension, chronic kidney disease, coronary heart disease, smoking, level of amputation and its post-operative complications. These parameters help to find the prevalence of lower limb amputations and study about the contributing factors which lead to amputation. Complications we encountered here are infections following the procedure, progression of gangrene due to inadequate blood supply or infective aetiology, uncontrolled diabetes mellitus. Infective cases are treated with appropriate antibiotics according to the culture and sensitivity report. In some cases where below knee amputations are converted to above knee amputations due to inadequate blood supply or progression of infection. Results: Over the period of 18 months, 124 lower limb amputation are performed (which includes ray amputation, below knee amputation and above knee amputation). Majority of patients in my study group belong to 41-50 years of age with 50% in total population. Male is more predominant with 64% comparing female gender with 34%. Among the total group diabetes were found in 75% of study population. Among those diabetic patients 58% were found to have HBA1C more than 10. Smoking is the only of the modifiable risk factors among the other risk factors which account for 54.8%. Chronic kidney disease with stage 4&5 were noted in 31 patients, majority of the patients were presented with non-healing chronic ulcer with 63%, where remaining presented with gangrene formations. Depending up on the mode of presentation and level of involvement, patients underwent amputation most common amputation we done are ray amputation for 67 patients followed by below knee amputation for 35 and above knee amputation for 14 patients, 8 patients who initially underwent below knee amputation due to inadequate blood supply and ascend of infections which was converted in to above knee amputation.
Soundara Rajan, Aswathy Harikumar
Journal of Case Reports and Scientific Images, Volume 3, pp 01-03; doi:10.22271/27080056.2021.v3.i1a.21

Abstract:
Background: The role of prophylactic antibiotics in preventing surgical site infection (SSI) after surgeries like gastrointestinal, Orthopedics, and plastic surgical procedures are quite well known, although their efficacy in clean, elective major surgeries are still debatable. An effective antimicrobial prophylaxis that providing coverage throughout the entire procedure, not only reduces the risk of surgical site infections, but also of complications associated with it. Various studies have shown that appropriately-timed “single shot” antibiotic prophylaxis is as effective as multiple-dose prophylaxis. Aim: To assess the efficacy of single dose prophylactic antibiotics in preventing SSI after clean, elective surgery. Materials and methods: Patients planned for clean, elective surgeries were included in a prospective study which was conducted for a year in a tertiary centre. Post operatively, the patients were then assesses. Results: Of the total 100 cases, 55 patients belonged to the female gender and 45 cases belonged to male gender. In this study, maximum number of patients belonged to the age group of 26 to 50 years, 48 cases belonged to 51 to 75 years, and single case belonged to the age group less than 25 years. Regarding the complication developed post surgically 7 cases were observed to develop purulent discharge from the surgical site and about 7 other cases developed seroma and discharge. Of the 100 cases, 4 cases were discharged on the first postoperative day, 86 patients were discharged on second or third post operative day. The rest were discharged on subsequent days. Conclusion: Recent developments in the antibiotic prophylaxis, including the initial time of antibiotic administration, proper choice of antibiotic agent that cover all possible infective agents, the short duration of antibiotic treatment have proved to improve the efficacy of these drugs in surgical settings. A systemic regimen of a single dose of an appropriately selected cephalosporin given during the immediate preoperative period is safe and effective in clean elective surgeries.
Rajendran N, Divya V, Biju Gopal
Journal of Case Reports and Scientific Images, Volume 3, pp 12-14; doi:10.22271/27080056.2021.v3.i1a.25

Abstract:
Background: Dry eye is a disorder of precorneal tear film frequently present in patients with diabetes mellitus (DM) either symptomatic or asymptomatic. It can cause mild symptoms to severe corneal complications affecting the visual quality of life. Objective: To assess the dry eye status among type 2 diabetes mellitus in patients attending Ophthalmology OPD in Sree Mookambika institute Of Medical Sciences, kulasekharam. Materials and methods: This was a hospital based cross-sectional study where 87 patients with type 2 diabetes mellitus of age more than 40 years are studied. The dry eye status was evaluated using schirmer's test, Tear Film breakup time (TBUT) measurement. Statistical method of analysis: study parameters entered in Microsoft office Excel 2013.SPSS trail version-20. Result: Among 87 type 2 diabetes mellitus patient above the age of 40 years, 55.3% had significant dry eye, more prevalent in patients aged over 50 years. Conclusion: Dry eye is more prevalent among diabetic patients. Strict glycemic control is important for the prevention of dry eye syndrome and other ocular surface pathology among type 2 diabetes mellitus patients.
Vinod S, Arifkhan, Kavitha N
Journal of Case Reports and Scientific Images, Volume 2, pp 01-06; doi:10.22271/27080056.2020.v2.i2a.17

Abstract:
Introduction: Anatomical variations of ethmoidal sinuses are complex and surgically very important. Preoperative detection of these variants is important to prevent surgical complications. Multidetector Computed Tomography (MDCT) is the modality of choice for evaluation of these variants of ethmoidal sinuses.Aim: To study the normal anatomical variations of ethmoidal sinuses by 16 slice MDCT.Materials and Methods: This was a retrospective analysis of paranasal sinuses in 70 cases by MDCT in adults. Axial and coronal images of Paranasal Sinuses (PNS) were taken by 16 slice MDCT. Statistical analysis was done using SPSS version 20.0.Results: Present study shows haller cells as the most common anatomical variant with 21 (30%) cases, followed by onodi cells in 10 (14.29%) cases, agger nasi cell in 9 (12.86%) cases and supra orbital cell in 8 (11.43%) patients.Conclusion: Ethmoidal sinuses form a major component of paranasal sinuses that have high prevalence of anatomical variations. These ethmoid sinus anatomical variants are frequent causes for complicated sinus inflammatory pathologies and failed sinus surgeries. The surgeons must be aware of the anatomical variations to avoid untoward surgical complications and for better surgical outcome.
Vinod S, Jagadeep, Abdul Eksana As
Journal of Case Reports and Scientific Images, Volume 2, pp 12-16; doi:10.22271/27080056.2020.v2.i2a.19

Abstract:
Objective: A prospective study developed to determine the relationship between renal parenchymal thickness and glomerular filtration rate in patients with chronic kidney disease.Materials and Methods: From June 2019 to June 2020, 50 patients were clinically diagnosed with chronic kidney disease. The lowest serum creatinine was used for calculation of the glomerular filtration rate (eGFR) using the Modification of Diet in Renal Disease Study (MDRD) equations. The ultrasounds were done by a single radiologist and reviewed by 2 consultants. The renal parenchymal thickness was measured in the longitudinal from the renal sinus to the outer renal cortical margin at upper, mid and lower levels of each kidney and the mean value was estimated for each kidney. Statistical Package for Social Science (SPSS 20.0) version used for data analysis and an unpaired test was applied to find the statistical significance. Pearson correlation test applied to find the correlation between the variables. A P value less than 0.05 (p
Sathish Babu, Jagdeep, Kavitha N
Journal of Case Reports and Scientific Images, Volume 2, pp 07-11; doi:10.22271/27080056.2020.v2.i2a.18

Abstract:
Background: Maxillary sinus shows normal anatomical variations and it is important to know about them. Evaluating maxillary sinus and identifying its variations on computed tomography not only detects the different variations but also helps in planning and guiding various sinus surgery and preventing possible complications.Purpose: Aim of this study was to detect anatomical variations of maxillary sinuses in patients using Multi-detector Computed Tomography.Materials and Methods: Paranasal sinuses of 56 patients who were subjected to Computerised Tomography of Paranasal Sinus with CT (Seimens 16 slice Somatomscope) machine were studied.Results: A total Para Nasal Sinuses of total 56 patients were studied. Out of which only 33 patients had maxillary sinus variations. Among accessory ostia of maxillary sinus was the commonest anatomical variation and was seen in 14(25%) of cases. Hyper pneumatization of maxillary sinus was detected in 12 cases (21.4%) and maxillary antral septa were found in 7 cases (12.5%).Conclusion: Accurately assess the maxillary sinus on Computed Tomography and to determine the various anatomical variations of the same so as to differentiate pathological lesions from an anatomical variation and avoiding unnecessary surgical explorations and complications.
Divya V, Rajendran N, Kishore Kumar J
Journal of Case Reports and Scientific Images, Volume 2, pp 17-20; doi:10.22271/27080056.2020.v2.i2a.20

Abstract:
Background: Diabetes mellitus is one of the most insidious disease across the globe. Diabetic retinopathy is recognised as a leading cause of blindness and visual impairment in working-age adults in developed and developing countries.Objective: To assess the prevalence of diabetic retinopathy among type 2 diabetes mellitus and severity of diabetic retinopathy attending ophthalmology out patient department in sree mookambika institute of medical sciences, Kulesekharam, Kanyakumari.Material and Method: Cross sectional study among 85 Type 2 diabetes mellitus patients of age more than 40 years, duration more than 5 years. Statistical methods of analysis: Study parameters will be entered in Microsoft Office Excel 2013, Descriptive statistics-Mean and Standard Deviation; Qualitative test-Chi square test using SPSS TRAIL VERSION-20.0.Result: In my study prevalence of diabetic retinopathy was 55.30 % (47 patients) of which 14.89 % mild NPDR (7 patients); moderate NPDR 34.05% (16 patients); Severe NPDR 25.53% (12 patients); PDR 25.53 % (12 patients).Conclusion: This study estimated the prevalence of DR in Kulesekharam, Kanyakumari, Hospital based type 2 diabetic population attending ophthalmology out patient department sree mookambiga institute of medical sciences. Our study also created awareness among the patients who participated about diabetic retinopathy.
Pandy V, Anandaraj A, Joseline Princy, Joe Thomas Rajkumar
Journal of Case Reports and Scientific Images, Volume 2, pp 21-25; doi:10.22271/27080056.2020.v2.i2a.23

Abstract:
Background: Breast cancer is the most common invasive cancer in the woman and second leading cause of cancer death. Early detection of breast cancer by clinical assessment, and further radiological investigation and early treatment can reduce the morbidity and mortality in such patients. Aim: To evaluate usefulness of BIRADS grading of mammography, fine needle aspiration cytology. To study the Sensitivity and specificity of mammography, ultrasonography and fine needle aspiration cytology. Materials and Methods: It is a prospective study of patients who presented with breast lump in the department of general surgery in the duration of August 2018 – December 2019. The primary outcome of the study was evaluated on the basis of clinical examination, investigations like mammogram and or ultrasound and fine needle aspiration cytology in that order. Results:The present study deals with the Clinocopathological and Radiological correlation of breast lesions. A total of 50 cases were studied. The youngest patient in this study was 19 yrs and the oldest was 80 years. The Triple Test components (Physical Examination, Mammogram & / or Ultrasound and Fine needle aspiration cytology) were categorized as benign, suspicious and malignant. Triple Test was considered concordant when all the three elements indicated benign or all the three indicated malignant results. Among the 50 cases which had Clinocopathological and radiological correlation, 38 had all benign results and 8 had all malignant results.The age group of 31-40 yrs showed maximum number of benign cases. All the palpable lesions of the breast occurring in the age group of 10-30 years were benign in this study. Majority of the lesions occurring in the age group of 61-80yrs were malignant. Conclusion:Triple test reliably guides evaluation of palpable breast masses. Patients with palpable breast lesions should be evaluated by physical examination, mammogram and/or USG and fine needle aspiration. Cystic masses are best evaluated by USG. When all the three components of TT are concordant i.e., either concordant benign or concordant malignant, it yields 100% diagnostic accuracy. Amongst the three components of TT, FNA has the highest sensitivity of 100%.In the non-concordant cases it is found that FNA was more sensitive. TTS has a high diagnostic accuracy when the lesions score a TTS of S 6 and T 4. However, a TTS of 5 has low predictive value and such cases require open biopsy for confirmation of the diagnosis. Sites of fine needle aspiration increases the diagnostic accuracy by reducing the false negative results.
Kokila R, Imran Ali, Anil Kumar Kr, Harsh Gupta, Surender Kumar, Manoj Mali, Harish Arya, Anil Kumar Samariya
Journal of Case Reports and Scientific Images, Volume 2, pp 14-15; doi:10.22271/27080056.2020.v2.i1a.15

Abstract:
A 36 year old gentleman with no significant past medical history but had recent COVID-19 exposure presented to the hospital with the chief complaints of fever, shortness of breath, cough and pain abdomen. He was unfortunately found to SARS-CoV-2 positive. Laboratory findings showed S. amylase, S. lipase along with elevated inflammatory markers and unremarkable creatinine, bilirubin, cardiac troponin level. The cause of his elevated S. amylase and lipase was discovered to be due to COVID-19 and no evidence of other common etiology like gallstones, viral, bacterial infections, strenuous exercise, non-traumatic exertional etiology. He received aggressive fluid with antibiotics throughout his hospitalization course. His pain abdomen and breathlessness improved with treatment and he was found to maintain stable hemodynamics and was subsequently discharged home.
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