RESUMEN
Pyrexia of unknown origin (PUO) or fever of unknown origin (FUO) is clinically challenging for a treating physician; it is also a conundrum for the patient until a definitive diagnosis is made. Despite extensive investigations, many cases of PUO may remain undiagnosed for a long time. In a resource-limited country like India, due to the limited availability of various diagnostic tests, a great many fever cases are classified as PUO. Here, we present a case report of Takayasu arteritis in its pre-pulseless phase, presented as PUO. Takayasu arteritis presenting as PUO in the absence of a pulse deficit is uncommon and rarely reported. The patient's fever responded to steroids with methotrexate. The patient didn't develop any vascular complications during the follow-up.
RESUMEN
Introduction Due to the variable degree of pneumatization, the shape and size of the sphenoid sinus are irregular. An endoscopic intranasal transsphenoidal approach is made in sphenoid sinus pathologies, sphenoid sinusitis, and sellar and parasellar diseases. A diagnostic approach to the sphenoid sinus is also done to get a better MRI scan of the pituitary. The present study aims to describe the variant types of sphenoid sinus, morphometry, anatomy, and relations of sphenoid sinus, which will be helpful to surgeons during an endoscopic approach to the sphenoid sinus. Materials and methods We studied 76 cadaveric sphenoid sinuses that were exposed by taking a sagittal section of 38 formalin-fixed cadaveric heads. After examining the inter-sphenoidal septum, it was removed to observe the inside aspect of the sphenoid sinus. Different dimensions of the sinus were noted down. The bulges inside the sinus due to neurovascular structures in relation to the sinus were observed. Results The most prominent type found was the sellar in 68.4% of cases preceded by the postsellar in 23.7% of cases. Presellar type of pneumatization was seen only in 7.9% of cases and the conchal type was absent. Intersphenoid septum was seen in 92,1% of cases, out of which 11.4% of septums were deficient on the posterior aspect. An internal carotid artery bulge in the sphenoid sinus was seen in 46% of cases. In 27.6% and 19.7% of sphenoid sinuses, bulging of the optic and vidian nerves, respectively, were seen. Some of these structures were dehiscent in the sphenoid sinus. Conclusions To get more space in the sphenoid sinus, the septa in the sinus are removed by surgeons, which may damage the walls of the sphenoid sinus. Knowledge of the relations of neurovascular structures with the sphenoid sinus will be helpful to surgeons during the transsphenoidal endoscopic approach to avoid any injury to these structures.
RESUMEN
BACKGROUND: The medial patellofemoral ligament (MPFL) is one of the major soft tissue stabilizers on the medial side of the knee joint, extending from the medial condyle of the femur to the medial aspect of the patella. Different kinds of literature described different sizes and different origins and insertions of MPFL. Injury of MPFL causes patellar instability and dislocation. We reported the anatomy and morphology of MPFL and its implications in the repair of MPFL. The aim of the study was also to look at the variant forms of the MPFL. Methodology: A total of 40 lower limbs fixed in formalin were dissected to study the MPFL of the knee. After reflecting the deep fascia and retinaculum on the medial side of the knee joint the MPFL was exposed. For better learning the lower medial part of vastus medialis was reflected, so that the part of MPFL undercover was exposed. RESULTS: Different forms of MPFL were seen like two straps 12.5%, broad rectangle 20%, and triangular shaped 67.5% MPFL. The origin of MPFL was found between the adductor tubercle and medial epicondyle of the femur and insertion was seen extending from the proximal medial half of the patella to the tendinous aponeurosis of vastus medialis obliquus (VMO) and vastus intermedius muscle (VIM). CONCLUSIONS: This is the first study that described three variant patterns of MPFL in accordance with their morphological appearance. This knowledge will be helpful to the surgeons for easy identification and repair of the MPFL.
RESUMEN
Background: The first case of Coronavirus was reported by World Health Organisation (WHO) on 31 December 2019. Due to its high infectivity and increasing mortality, WHO on 30 January 2020 declared the infection as public health emergency of international concern. Various measures were initiated and carried out by health care facilities to tackle the pandemic. Our experiences of hospital preparedness may help future health policies to tackle the pandemics. Method: Various guidelines given by Ministry of Health and Family Welfare, Centre for Disease Control, Indian Council of Medical Research were studied and analysed. The hospital lay out plan was studied, modifications in the physical structure of the hospital as planned by the hospital authorities were observed and recorded. The impact of the new planning on patient management was recorded by the investigators. Results: It was observed that proper planning on the basis of laid down guidelines and the modifiable initial layout is very effective in the prevention and management of the pandemic. A total of 130 beds of the hospital under study could be separated from the main building with little modifications. Another important observation was dedicated leadership and coordination among different specialities ensuring successful planning. The investigators concluded that the new hospitals should be planned and constructed in such a way so that a major part of the hospital building can be converted to an isolation area with little modifications in the physical structure of the hospital at the time of pandemics.
RESUMEN
Purpose: Secondary infections (SI) in COVID-19 have been documented from 3.6% to 72% in various studies with mortality ranging from 8.1% to 57.6%. There is a gap in knowledge for clinico-epidemio-microbilogical association among COVID-19 patients with concomitant SI. Patients and Methods: This is a retrospective chart review, in central India. The study was undertaken for hospitalized adult patients during 1st June 2020 to 30th November 2020, with laboratory proven COVID-19 infection and secondary infection. Results: Out of the total 2338 number of patients, only 265 (11.3%) patients were investigated for microbiological identification of SI. Male gender was predominant (76.8%) and the mean age was 53.7 ± 17.8 years. Only 3.5% (82/2338) of patients were having microbiologically confirmed (bacterial or fungal) SI. The overall mortality was 50.9% (54/82) with a differential mortality of 88.8% (48/54) in high-priority areas and 21.4% (6/28) in low-priority areas. Blood was the most commonly investigated sample (56%) followed by urine (20.7%) and respiratory secretion (15.8%). A. baumanii complex (20/82, 24.3%) was the most common bacteria isolated followed by K. pneumonia (12/82, 14.6%) and E. coli (11/82, 13.4%). Candida spp. (20/82, 24.3%) was the most common fungal pathogen isolated. Sixty percent (12/20) of Acinetobacter spp. were carbapenam-resistant and 70.3% of Enterobacterales were carbapenam-resistant. Fluconazole resistant Candid a spp. was isolated only in 10% (2/20) of cases. Diabetes was the most common co-morbidity 54.8% (45/82) followed by hypertension (41.4%) and chronic heart disease (13.4%). The negative predictors of secondary infections are urinary catheterization, placement of central line and mechanical ventilation (invasive and non-invasive). Conclusion: There is an urgent need of better anti-microbial stewardship practices in India (institutional and extra institutional) for curtailment of secondary infection rates particularly among COVID-19 patients.