Prevalence of cervical ribs and elongated transverse processes in Kashmiri population

Background: The aim of this study was to describe the prevalence of cervical ribs and elongated transverse process in the Kashmiri population.Methods: We reviewed 2000 chest x rays of adult patients which were done in a period of 4 months in the department of Radiology, Govt Medical College Hospital, Srinagar, J& K.Results: The diagnosis of cervical rib was made in a total of 50 radiographs with a prevalence of 2.67%. The prevalence of cervical rib was higher in females (3.1%) as compared to males (2.1%). A total of 67 cervical ribs were seen in 50 patients. Unilateral cervical rib was seen in 33(66.0%) patients, right sided in 20(40.0%) and left sided in 13(26.0%). Bilateral cervical ribs were seen in 17(34.0%) patients. Elongated transverse process was seen in 280 patients constituting a prevalence of 14.96%. The prevalence in females (17.95%) was higher than males (12.15%).Conclusions: Prevalence of cervical rib and C7 transversomegaly is high in Kashmiri population. Similar results have been noted in Saudi population. Thus it is concluded that in the populations with higher rates of consanguinity, there is high probability of occurrence of cervical ribs because of HOX gene mutations. There is need for many more well designed studies to prove this association. Keeping in mind the high prevalence of cervical rib, patients with unexplained cervical pain need to be evaluated for this entity.

Clinicopathological profile and operative outcomes of gastric cancer patients in Kashmir: a high incidence area

Background: The objective of the present study was to analyse the demographic, clinicopathological and perioperative outcome of patients undergoing D2 gastrectomy in a high-volume tertiary care hospital in Kashmir a high incidence area.Methods: A total of 89 gastric cancer patients operated in the department of surgical gastroenterology, SKIMS, Kashmir, from January 2018 to December 2021 were included. A standardized D2 lymphadenectomy with spleen/pancreas preservation was performed.Results: Most of the patients in our study were elderly males and the mean age of patients in our series was 60.12±9.4. Majority of the patients in this study had stage III (91%) disease. Nodal involvement (N2, N3) was seen in 66% of patients. The average blood loss during operation was (380.23±48.53 ml) in our patients. The mean number of harvested lymph nodes was (26.6±10.1) with the range of (12-40). Mean operative time was (180±32.58 min). Average hospital stay was (8±2.46 days) in this series.Conclusions: Data from our study suggests that D2-gastrectomy when performed by skilled team in high volume centre like SKIMS is safe and should be the standard of care for gastric cancer for improved outcome. 

Unusual foreign body insertion in rectum and vagina in schizophrenic patient

Insertion of foreign body in to the body is rare in medical literature. Here we report a case of 21 year old female who presented to emergency with acute abdomen and on detailed evaluation turned out to be schizophrenia. Our patient had history of insertion of ball pen in rectum following command hallucination. The foreign body was later removed through laparotomy. The cause of insertion of foreign body are multiple from command hallucination, suicidal attempt, erotism to somatic delusions. Thus the clinician should always be vigilant while dealing with psychiatric patients as sometimes impacted foreign body can present as acute emergency

Surgery for complicated pulmonary tuberculosis

Abstract not availabl

Surgery for complicated pulmonary tuberculosis

Abstract not availabl

Posterior reversible encephalopathy syndrome after augmentation cystoplasty in a child with neurogenic bladder

Posterior reversible encephalopathy syndrome (PRES) or leukoencephalopathy syndrome was introduced into clinical practice in 1996 by Hinchey et al., to describe unique syndrome, clinically expressed during hypertensive and uremic encephalopathy, eclampsia, and immunosuppressive therapy. Hyperperfusion with resultant disruption of the blood–brain barrier results in vasogenic edema, but not infarction, most commonly in the parieto-occipital regions. The severity of this clinical symptom varies. For example, the visual disturbance can manifest as blurred vision, homonymous hemianopsia, or even cortical blindness.Patients may be mildly confused or agitated but can become comatose.Other symptoms less commonly seen include nausea, vomiting, seizures, and brainstem deficits.Chronic kidney disease (CKD) and acute kidney injury are both commonly present in patients with PRES. We are presenting a rare case of neurogenic bladder who developed PRES after augmentation cystoplasty due to underlying CKD

Profile and outcome of children with Acute Lymphoblastic Leukemia: A study from a tertiary care centre from North India

Background: Acute lymphoblastic leukemia (ALL) is the most common type of childhood malignancy. The study of prognostic indicators that can predict the survival of these patients is necessary to identify the factors associated with the rate of relapse in any set of patients. Therefore, the present study aimed to evaluate the clinical characteristics, prognostic factors and the treatment outcome measurements of pediatric ALL patients treated in a tertiary care center in North India. Material and methods: This hospital-based observational study was conducted on 180 pediatric patients aged between 1 year to 18 years who had visited the Department of Medical Oncology at Sher-I-Kashmir institute of Medical science, Srinagar Jammu and Kashmir between the January 2015 to December 2019 were included. Result: A total of 180 children with ALL were included in this study. 57.8% were males and 42.2% were females with a mean age of 9.2 (±3.5) years and median of 8 years. Majority of patients (68%) were below 10 years. 57.8% were males and 42.2% were females. The male: female ratio was 1.3:1. Central nervous system disease at diagnosis was seen in 7.8% patients. The mean and the median TLC were 56000/μl and 12000/μl respectively. The TLC was more than 20000/μl in 63.3% patients. The immune phenotyping analysis revealed Pre B ALL in 77.8%, B cell in 9.4% and T cell ALL in 12.8% patients. Conventional cytogenetic revealed normal cytogenetics in 87.6%, hyperdiploidy in 8.5% and hypodiploidy in 3.9%. FISH for TEL AML, MLL, BCR-ABL gene rearrangement analysis was positive in 23.3%, 4.4%, 11.1% patients respectively. No statistical significant association was observed between the age of the patients, gender, TLC count, BCR-ABL or TEL-AML assays. The presence of CNS disease and survival of the patients showed a significant statistical correlation (P=0.038). The MLL-gene rearrangement analysis had significant statistical correlation (p-value=00). The overall survival rate was 78%. The EFS rate was 70.5%. There were a total of 45 relapses, among the relapse cases, 55.5% had bone marrow relapse, 11.1% had CNS relapse, 26.7% had combined CNS and bone marrow, and 6.7% had a testicular relapse. Conclusion: The study results show that our results are comparable to some other centres in India. Identification of prognostic risk factors and risk stratification helps to achieve a higher survival rate childhood ALL patients

Lung Ultrasonography Is an Acceptable Imaging Modality to Diagnose COVID-19 and Effectively Correlates with HRCT Chest—A Prospective Study

It has been validated beyond doubt that High-Resolution Computed Tomography (HRCT) chest and to some extent chest radiographs have a role in corona virus disease-19 (COVID-19). Much less is known about the role of lung ultrasonography (LUS) in COVID-19. In this paper, our main purpose was to gauge the relationship between LUS and chest HRCT in reverse transcriptase polymerase chain reaction (RT–PCR) documented cases of COVID-19, as well as in those with high suspicion of COVID-19 with negative RT–PCR. It was a prospective study carried out at our tertiary care hospital, namely, SKIMS Soura. The total number of patients in this study were 152 (200 patients were selected out of which only 152 had undergone both LUS and chest HRCT). The patients were subjected to both LUS and chest HRCT. The radiologist who performed LUS was blinded to clinical findings and HRCT was evaluated by a radiologist with about a decade of experience. The LUS findings compatible with the disease were subpleural consolidations, B-lines and irregular pleural lines. Findings that were compatible with COVID-19 on chest HRCT were bibasilar, subpleural predominant ground glass opacities, crazy paving and consolidations. COVID-19-positive patients were taken up for chest HRCT for disease severity stratification and were also subjected to LUS. On HRCT chest, the imaging abnormalities compatible with COVID-19 were evident in 110 individuals (72.37%), and on Lung Ultrasound they were observed in 120 individuals (78.95%). Imaging of COVID-19 patients assessed by both LUS and HRCT chest,, showed a positive correlation (p p < 0.0001 with a kappa of 0.431). Similar precision compared with chest HRCT in the detection of chest flaws in COVID-19 patients was obtained on LUS

Assessment of Predictors of Mortality in Neonatal Intestinal Obstruction

Background: Neonatal intestinal obstruction (NIO) continues to be a life-threatening condition with high mortality rates especially in developing countries. Highly skilled specialized care and facilities are required for survival. This study was conducted to assess various factors responsible for outcome in such neonates, so that extra attention is paid to the ones at high risk, with the idea to bring down the mortality rates in neonates admitted with intestinal obstruction. Materials and Methods: This study was a prospective observational study conducted on all neonates admitted with features of intestinal obstruction in our hospital from February 2014 to August 2016. The patients were followed up for a minimum of 1 month. Data was collected on prescribed proforma and analyzed for age, sex, prematurity, birth weight, clinical features, duration of symptoms, diagnosis, lab investigations, surgical procedure performed, complications etc. using the Statistical Package for Social Sciences (SPSS). Results: There were 120 neonates with intestinal obstruction, of which 92 neonates survived and 28 died. The mortality rate was 23.33%. There were 74 males and 46 females. The mean gestational age was 38.2±1.77 wks with a range between 32 to 41 wks. The mean age at presentation was 5.58 days with a range between 5 hrs to 26 days. The mean weight at presentation was 2510g. Mean duration of symptoms was 3.40 days. Gross congenital anomaly was seen in 22 neonates. Sepsis on admission was noted in 51 patients out of whom 23 died. Twenty-two patients presented with perforation peritonitis, of which 14 expired. Fifty-four neonates experienced significant in-hospital delay in surgery. The mean duration of stay in the hospital was 8.40 days. Overall, 92 neonates were discharged from the hospital. Conclusion: Neonatal intestinal obstruction is still associated with high mortality. After analyzing various factors we conclude, that increased age at presentation, delay in seeking treatment after the onset of symptoms, CRP/ blood culture positive sepsis on arrival, thrombocytopenia, acute kidney injury (raised urea and creatinine), acidosis and coagulopathy on admission, bowel perforation with peritonitis and the need for continued mechanical ventilation after surgery were the statistically significant risk factors for mortality in neonates with NIO in our series. However, sex, mode of delivery, gestational age, weight at presentation, hypothermia on arrival, associated gross congenital anomalies, delay in surgery after admission (in-hospital delay) and duration of stay in hospital were found to be statistically insignificant risk factors for mortality in our series