While tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease among children, its first presentation in the third decade of life just after successful pregnancy outcome is ...extremely rare. In fact, survival of both child and mother having uncorrected TOF after noninstitutional delivery is unheard of. Herein, authors report a case of previously undiagnosed TOF associated with other midline congenital abnormalities, that is, nasal dermoid cyst and cleft palate, who presented for the first time with postpartum hemorrhage after an unsupervised home birth. To the best of our knowledge, this unique association has never been described before.
توفر الفحوص التي تجري بعد الوفاة لبقايا الهيكل العظمي وكذلك التصوير الشعاعي للأفراد الأحياء معلومات مفيدة للتمييز بين الجنسين. وكان الهدف من هذه الدراسة معرفة نموذج رياضي لتمييز الجنس تعتمد بدرجة ...أكبر الدقة مقارنة بالقياسات الأنثروبولوجية المأخوذة من عظم القص الذي تم الحصول عليه من تشريح جثة. أجريت الدراسة على ١٠٨ من البالغين الذين تم إحضارهم لفحص الصدر بسبب أسباب طبية مختلفة، وتراوحت أعمارهم بين ١٨ و٨٠ سنة. واختيرت الحالات عشوائيا بعد النظر معايير الإدراج والاستبعاد. وقد أخذت قياسات من منطقة القص sternal من خلال دراسة التصوير المقطعي CT)) ومسح الصور وإعادة تهيئتها. وكان ٧٣ من هذه الحالات من الذكور و٣٥ من الإناث. معادلة دالة التمايز هي: 0.075 + Manubrial Length 0.071= (Df) 0.036 + Manub1io-Sternal Length Width at S1 + Width at S3 0.037 (Constant) 11.367-. عموما تم تصنيف 80.6% من العينة بشكل صحيح في مجموعتهم. كشفت هذه الدراسة عن أن القياسات من الأشعة المقطعية لعظم القص يمكن استخدامها للتمييز بين جنس الأفراد ما يضيف إليها ميزة كبيرة في علم الأدلة الجنائية.
Landolfi’s sign, alternating systolic constriction and diastolic dilatation of pupils, is a clinical hallmark of aortic regurgitation. It is thought to stem from exacerbation of physiological ...circulatory hippus in the vessels of iris due to a wide pulse pressure in a backdrop of severe aortic valvular incompetence. Degenerative and rheumatic heart diseases are exquisitely common in rural India and often these patients turn up late with complications to the primary care physicians. Herein, the authors report a 34-year-old pregnant female who presented with acute heart failure, and on examination, Landolfi’s sign was found. It was immediately followed by Doppler echocardiography to stamp it as a case of severe aortic regurgitation. The patient was stabilized with anti-failure medications and feto-maternal health was closely monitored. The authors want to conclude claiming that bedside clinical training in cardiology will forever remain important, more so, while dealing patients at non-sophisticated primary health-care facilities. Besides, they also argue that basic tool supports like an echocardiography should be made available at those centers.
2019-coronavirus disease (COVID-19) is causing insurmountable psychosocial impact on the whole mankind. Marginalized community, particularly those with substance use disorders (SUD), are particularly ...vulnerable to contract the infection and also likely to suffer from greater psychosocial burden. This article analyses the intricate bi-directional relationship between COVID-19 and addiction.
Pubmed and Google Scholar are searched with the following key terms- “COVID-19”, “SARS-CoV2”, “Pandemic”, “Addiction”, “Opioid”, “Alcohol”, “Smoking”, “Addiction Psychiatry”, “Deaddiction”, “Substance use disorders”, “Behavioral addiction”. Few newspaper reports related to COVID-19 and addiction have also been added as per context.
People with SUD are at greater risk of worse COVID-19 outcome. There is surge of addictive behaviors (both new and relapse) including behavioral addiction in this period. Withdrawal emergencies and death are also being increasingly reported. Addicted people are especially facing difficulties in accessing the healthcare services which are making them prone to procure drugs by illegal means.
COVID-19 and addiction are the two pandemics which are on the verge of collision causing major public health threat. While every effort must be taken to make the public aware of deleterious effects of SUD on COVID-19 prognosis, the resumption of deaddiction services and easier accessibility of prescription drugs are needs of the hour.
•Addiction and COVID-19 fuel each other to cause a global public health threat.•Resumption of deaddiction service and relaxation of accessibility of prescription drugs are needed.•Psychiatrists must be prepared for imminent hike in withdrawal symptoms and addictive behaviors.
Clinical spectrum of Moyamoya angiopathy (MMA) differs across populations with different ethnicity. This study, the largest one done among Indian population was undertaken to assess ...clinico-radiological profile of MMA patients in eastern India.
A single centre cross-sectional study was undertaken among 76 MMA cases. Each patient was evaluated for epidemiological, clinical and radiological characteristics. SPSS 25 was used for statistical analysis. P < 0.05 was taken as statistically significant.
36 (47.4%) were children without gender preponderance. There were female predominance among adults (male:female = 1:2.33). Mean age at onset of first neurological symptoms for children was 4.2 ± 2.0years, followed by 34.9 ± 58.2months of latency with final diagnosis at the mean age of 7.4 ± 3.5years. For adults, mean age of onset of first neurological symptoms was 31.5 ± 12.3years, followed by 14.7 ± 41.7months time gap and diagnosed at the mean age of 33.5 ± 12.5years. There was a statistically significant difference between child and adult regarding the diagnostic latency (p = 0.035). Fixed motor weakness (FMW) was the predominant symptom across the whole disease course. Among children predominant first neurological symptom was fixed motor weakness (FMW) (52.8%), followed by seizures (22.2%). FMW was predominant (55%) first neurological complaint, followed by headache (22.5%) among adults. Seizure was more prevalent among children both as first (p = 0.002) and presenting symptom at the time of diagnosis (p = 0.048). Over the course of the disease seizure was more common among children (p = 0.001), while headache was more common among adults (p = 0.017). Recurrence of symptoms was more common among children (p = 0.059). Infarcts were more common among children (91.7%) than adults (72.5%), while hemorrhage was seen only among adults (25%) (p = 0.004). Isolated cerebral cortex was involved more commonly among children (59.4%) than adults (36.1%), while isolated subcortical involvement was seen only among adults (19.4%) (p = 0.016). Majority of the MMA cases were of Suzuki stage 4 (39.5%) and 5 (27.6%). Brain atrophy was associated with diagnostic latency (p = 0.009).
Indian Moyamoya presents similar to disease presentation in Caucasian and Japanese patients. It is a frequently overlooked cause of stroke in young, often with various non-motor presentations, failure to recognize which leads to delay in diagnosis. Radiological burden disproportionate to number of acute vascular events, with subtle neurological manifestations like headache or seizure, often with cognitive decline, should raise suspicion of MMA.
Brain tumors have long been considered one of the most prevalent causes of potentially reversible cognitive impairment. An accurate underlying cause of cognitive impairment due to brain tumor needs ...to be evaluated pragmatically. Patterns of cognitive impairment associated with brain tumors depend mainly on their location, lateralization, pathological classification and secondary effects of the treatment, as well as the structural plasticity and diaschisis. Hence, it is not rare that lesions with different locations and histologies may manifest with a similar pattern of cognitive impairment due to the complex interplay of determinants. We herein report 3 patients with brain tumors affecting different locations and with differing histologies, who shared a similar presentation as “frontal dysexecutive syndrome” masqueraded as psychiatric conditions. Detailed examination of saccades and pursuit along with eye movements and conventional motor examinations were essential not only to diagnose brain tumor as the potential cause of cognitive impairment, but also to rule out other coexisting etiologies with completely different underlying pathological mechanisms (i.e., Huntington’s disease in 1 of the cases). A detailed neurological examination, including eye movement assessment, in patients with psychiatric symptoms provides not only important clues to delineate the underlying anatomical substrate involved, but also helps clinicians to make an accurate diagnosis and to select appropriate therapeutic options.
Along with its high infectivity and fatality rates, the 2019 Corona Virus Disease (COVID-19) has caused universal psychosocial impact by causing mass hysteria, economic burden and financial losses. ...Mass fear of COVID-19, termed as “coronaphobia”, has generated a plethora of psychiatric manifestations across the different strata of the society. So, this review has been undertaken to define psychosocial impact of COVID-19.
Pubmed and GoogleScholar are searched with the following key terms- “COVID-19”, “SARS-CoV2”, “Pandemic”, “Psychology”, “Psychosocial”, “Psychitry”, “marginalized”, “telemedicine”, “mental health”, “quarantine”, “infodemic”, “social media” and” “internet”. Few news paper reports related to COVID-19 and psychosocial impacts have also been added as per context.
Disease itself multiplied by forced quarantine to combat COVID-19 applied by nationwide lockdowns can produce acute panic, anxiety, obsessive behaviors, hoarding, paranoia, and depression, and post-traumatic stress disorder (PTSD) in the long run. These have been fueled by an “infodemic” spread via different platforms of social media. Outbursts of racism, stigmatization, and xenophobia against particular communities are also being widely reported. Nevertheless, frontline healthcare workers are at higher-risk of contracting the disease as well as experiencing adverse psychological outcomes in form of burnout, anxiety, fear of transmitting infection, feeling of incompatibility, depression, increased substance-dependence, and PTSD. Community-based mitigation programs to combat COVID-19 will disrupt children’s usual lifestyle and may cause florid mental distress. The psychosocial aspects of older people, their caregivers, psychiatric patients and marginalized communities are affected by this pandemic in different ways and need special attention.
For better dealing with these psychosocial issues of different strata of the society, psychosocial crisis prevention and intervention models should be urgently developed by the government, health care personnel and other stakeholders. Apt application of internet services, technology and social media to curb both pandemic and infodemic needs to be instigated. Psychosocial preparedness by setting up mental organizations specific for future pandemics is certainly necessary.
•Apart from its physical burden on patients and health-care services, COVID-19 has enormous psychosocial impact.•Although all the sections of the society are affected, people from marginalized society are probably the worst sufferers.•Doctors must be aware of the psychological impact of the disease.•Psychiatrists and stake-holders must device plans to mitigate the psychosocial consequences of COVID-19.
Albeit, all forms of tuberculosis (TB) are endemic in India, spinal intramedullary TB and tubercular longitudinally extensive transverse myelitis (LETM) is deemed extremely rare. With recent advances ...in the field of neurology, autoimmune astrocytopathy (neuromyelitis optica spectrum disorders, NMOSD), myelin-oligodendrocyte glycoprotein associated encephalomyelitis (MOG-EM), metabolic myelopathy, connective tissue diseases and viral infections have gained considerable focus in the list of differentials of LETM whereas tubercular association is often forgotten. This report presents a rare case of acute transverse myelopathy which unveiled previously undiagnosed pulmonary tuberculosis in an adult rural Indian male. The patient responded well to anti-tubercular therapy and corticosteroids. Exact pathogenesis of LETM in TB remains elusive. Association of TB with MOG-EM has been one of the recent hot-cakes. However, an ill-defined immune-inflammatory response to the infectious agent is the likely cause of tubercular LETM. Hence, the primary care physicians who are the first medical contacts of acute LETM cases and in most cases due to diagnostic dilemma there is an unavoidable delay in accurate diagnosis and initiation of therapy. Primary care doctors should nurture a high index of suspicion to diagnose this potentially lifetime-debilitating yet absolutely treatable clinical condition i.e. tubercular LETM.
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