Primary hepatic tuberculosis:A rare but fatal clinical entity if undiagnosed

Hepatic tuberculosis particularly in the absence of military tuberculosis is rare.It can occur as a primary case or due to reactivation of an old tubercular focus.We report case of a 24 year old married female who died of primary hepatic tuberculosis.She had no evidence of tuberculosis elsewhere.Appropriale treatment initiated early can result in marked recovery whereas failure to recognize this entity can prove to be fatal.

Fracture Bilateral Talus in Children

Talar body injuries are rare, particularly in children. To our knowledge, there has not been a single case report of bilateral talus fracture in a child till date. We report two cases of fracture bilateral talus in children. The first case is of a fracture separation of the distal tibial epiphysis and a fracture of the body of the talus with subluxation of ankle on right side and a fracture neck of talus on left side. The second is fracture bilateral talus with epiphyseal injury of left distal tibia. A minimal or undisplaced fracture of talus is less likely to undergo avascular necrosis than a displaced fracture but even with optimal treatment, avascular necrosis may still occur. It is of prime significance that these fractures should be diagnosed well in time to avert complications. Therefore an appropriate length of follow-up is required.

Can Waist Circumference Be Used as an Anthropometric Parameter to Assess the Obesity Related Pregnancy Outcome: A Case Control Study

Introduction: The prevalence of obesity is increasing in women of reproductive age. Maternal obesity is associated with increased morbidity and mortality for both mother and offspring. BMI has been criticized as a limited measure of total obesity. Measurement of waist circumference can be useful in the assessment of abdominal obesity and disease risk. The study is aimed to evaluate the waist circumference as an anthropometric parameter in identifying women at risk of developing obstetric complications. Material and Methods: A prospective study was conducted at a tertiary health care centre on 200 antenatal women of age between 18 to 35 years with singleton pregnancy attending the antenatal clinic before 8 weeks of gestation. Women were divided into two groups. Group I included 100 women with waist circumference < 80 cm and Group II included 100 women with waist circumference ≥ 80 cm. Weight, height and waist circumference were measured and BMI was calculated. All the women were followed throughout their pregnancies as per the routine antenatal follow up. The fetomaternal outcome was recorded and analyzed statistically. Results: The two groups were comparable in age, parity and demographic profile. The maternal and neonatal complications—preeclampsia (p = 0.0052, RR 0.5062, 95% CI 0.2935 - 0.8728), gestational diabetes mellitus, preterm labor, postdatism, need for induction of labor (p value 0.0081, RR 0.6263, 95% CI 0.4314, 0.9091), instrumental vaginal delivery, cesarean delivery (p = 0.0072, RR 0.5745, 95% CI 0.3696, 0.8929), shoulder dystocia, PPH, macrosomia, neonatal asphyxia, admission to NICU were reported more in Group II women as compared to Group I. Conclusion: Assessment of waist circumference in early pregnancy provides a simple and practical parameter for predicting obesity related pregnancy outcome. All pregnancies in centrally obese women (waist circumference ≥ 80 cm) shall be acknowledged as high risk.

A comparison of APACHE II,BISAP,Ranson’s score and modified CTSI in predicting the severity of acute pancreatitis based on the 2012 revised Atlanta Classification

Objective:Our aim was to prospectively compare the Accuracy of Acute Physiology and Chronic Health Evaluation(APACHE)II,Bedside Index of Severity in Acute Pancreatitis(BISAP),Ranson’s score and modified Computed Tomography Severity Index(CTSI)in predicting the severity of acute pancreatitis based on Atlanta 2012 definitions in a tertiary care hospital in northern India.Methods:Fifty patients with acute pancreatitis admitted to our hospital during the period of March 2015 to September 2016 were included in the study.APACHE II,BISAP and Ranson’s score were calculated for all the cases.Modified CTSI was also determined based on a pancreatic protocol contrast enhanced computerized tomography(CT).Optimal cut-offs for these scoring systems and the area under the curve(AUC)were evaluated based on the receiver operating characteristics(ROC)curve and these scoring systems were compared prospectively.Results:Of the 50 cases,14 were graded as severe acute pancreatitis.Pancreatic necrosis was present in 15 patients,while 14 developed persistent organ failure and 14 needed intensive care unit(ICU)admission.The AUC for modified CTSI was consistently the highest for predicting severe acute pancreatitis(0.919),pancreatic necrosis(0.993),organ failure(0.893)and ICU admission(0.993).APACHE II was the second most accurate in predicting severe acute pancreatitis(AUC 0.834)and organ failure(0.831).APACHE II had a high sensitivity for predicting pancreatic necrosis(93.33%),organ failure(92.86%)and ICU admission(92.31%),and also had a high negative predictive value for predicting pancreatic necrosis(96.15%),organ failure(96.15%)and ICU admission(95.83%).Conclusion:APACHE II is a useful prognostic scoring system for predicting the severity of acute pancreatitis and can be a crucial aid in determining the group of patients that have a high chance of need for tertiary care during the course of their illness and therefore need early resuscitation and prompt referral,especially in resource-limited developing countries.

Oral cysticercosis-a rare presentation

Cysticercosis is a condition that occurs when man is infected with larvae of Taenia solium.Oral cysticercosis is a rare event,and it represenls difficulty in clinical diagnosis.A case of oral cysticercosis in 11 year old girl is presented which complained of painless swelling for 6 months. A FNAC was performed which revealed bluish pink fibrillary material and interspersed nuclei and fragments of wall of larvae.Patient was treated with antihelminthic.

The Corpse Is a Silent Witness Who Never Lies—A Case Report

There are two very common sayings about corpse (dead body). The first common saying is that “the corpse is a silent witness who never lies” and the other common saying is that “the dead body is extremely eloquent and honestly informative, if one exercises patience in listening to it.” Both these sayings were proved in one of our cases. In the present case, decomposed body of an unidentified female individual aged about 25 - 26 years was recovered from the bank of western Yamuna canal in Haryana. The police made the efforts for establishing the identity of the deceased but could not succeed. The body was forwarded to the district hospital for autopsy along with the inquest report. However, the body being in advanced stage of decomposition so it was referred from the district hospital to the department of Forensic Medicine, PGIMS, Rohtak (Haryana) for the examination and the expert opinion regarding the cause of death. The findings observed on examination of the body helped to deduce the cause, time and manner of death whereas certain important objective features of identification were also observed and ultimately proper identity of the deceased could be established beyond the reasonable doubt by DNA profile of the samples preserved at autopsy. The autopsy findings, DNA profile and the results of examination of other materials (exhibits) taken from the body not only revealed the truth from the silent witness—the corpse, but also provided objective and scientific evidence to establish the corpus delicti in this case.

To evaluate the role of platelet-rich plasma in healing of acute diaphyseal fractures of the femur

Purpose： New research is focusing on the use of autologous growth factors to increase the effect of bone fracture healing while decreasing the amount of healing time for the patient. Platelets have been demonstrated to be the natural storage vessel for several growth factors and cytokines that promote blood coagulation, tissue repair, and the process of bone mineralization. The present study aims to evaluate the role of platelet-rich plasma （PRP） in healing of acute femoral shaft fractures radiologically. We hypothesize that it provides artificial hematoma and releases various growth factors. Methods： This prospective randomized study was carried out in 72 patients of traumatic fracture of the femoral shaft operated with interlocking nails （closed or open）. Patients were divided into two groups： study group A （n - 33） treated with intramedullary nailing ＆ PRP injection/gel application in the same setting; and control group B （n - 39） treated with intramedullary nailing without PRP application. Both groups were further divided into two subgroups. Study group included subgroup AI （n = 14） operated with closed intTamedullary nailing and PRP injection at the fracture site under radiological control, and subgroup A2 （n = 19） operated with open intramedullary nailing and PRP gel along with fibrin membrane application at the fracture site; while control group included subgroup B1 （n - 16） operated with closed intramedullary nailing, and subgroup B2 （n -- 23） operated with open intramedullary nailing. Radiological assessment of fracture healing was done by measuring the cortex to callus ratio every month till union at 6 months. Results： Measurements of mean cortex to callus ratio revealed significant difference between the groups A ＆ B at third and fourth months. Measurements of mean cortex to callus ratio did not reveal significant difference between the subgroups at first and sixth months. A statistically significant difference was observed between subgroups A1 ＆ B2 and B1 ＆ B2 at the second month; between subgroups A1 ＆ B2, A2 ＆ B2 and BI ＆ B2 at the third month; and between subgroups A1 ＆ B2 at fourth and fifth months. Conclusion： PRP has no effect on femoral shaft fracture healing treated with closed intramedullary nailing. However, PRP and matrix scaffold provided by fibrin membrane may provide an artificial he- matoma effect in the initial phase of healing in open or failed closed intramedullarv nailing.

Simultaneous bilateral trochanteric fracturesma report of four cases

Simultaneous bilateral intertrochanteric fractures are very rare. There is a paucity of data in current literature documenting patients with such kind of hip fractures. It is severe and potentially life-threatening, associated with a high morbidity. The major determinants of successful outcome are high vigilance, early single stage stabilization and mobilization as well as management of associated comorbid conditions that may influence the longterm rehabilitation of patients. Here we reported 4 cases of concurrent bilateral trochanteric fractures along with review of the literature. Our study aimed to discover its frequency, identify the injury mechanisms as well as factors present in the pathogenesis of these fractures, and outline the available treatment modalities.