Background: Hypothyroidism is associated with many biochemical abnormalities. Many studies were done abroad regarding serum creatinine levels in hypothyroid patients. We designed this study in our population to evaluate serum creatinine levels in hypothyroid patients. Objective: To assess serum creatinine levels in hypothyroid patients and to find out the relationship of creatinine levels with the severity of hypothyroidism. Materials and methods: This is a retrospective cross-sectional study that aims to evaluate the serum creatinine levels of hypothyroid patients and to find out the relationship between hypercreatininemia and severity of hypothyroidism. The study was done in the Department of Biochemistry, PDU Medical College and attached group of hospitals, Churu, western Rajasthan. Results were compared with that of age- and sex-matched healthy euthyroid controls. Statistical analyses were done by using the SPSS version 16.0. ANOVA and unpaired t tests were done to see the significance among the groups and between groups, respectively. The Pearson\'s correlation coefficient test was done to see the correlation of serum creatinine with the severity of hypothyroidism. Results: Mean serum creatinine levels in cases were 0.922 ± 0.16 compared to 0.798 ± 0.098 mg/dL in controls. Conclusion: Mean serum creatinine levels were found significantly higher in hypothyroid patients compared to controls. These findings suggest that hypercreatininemia is associated with hypothyroidism. Therefore, patients presenting with this biochemical abnormality are recommended to be investigated to explore hypothyroidism.
Introduction: We are all biologically unique and become more diverse as we age, enhancing the spice of life with increasing variety. In many ways, the teeth are unique organs of the body; they are the most durable part of the skeleton. The gradual changes taking place in the dental tissue after the teeth are fully formed are of clinical importance and need to be recognized by the dental surgeon as being a normal finding and not a part of the disease process. Aims and Objectives: The aim of this study is to estimate relationship between size of the pulp and the dentin with age and to know if there is a significant difference in size of the pulp and the dentin among various age groups. The clinical significance of the study will be to use the average tooth length and width obtained by this study as the standard guideline for age estimation and to utilize the results of the present study in forensic science and anthropology and as an aging biomarker. Results: From the study, it was concluded that in both males and females there is decrease in root canal length and width with increasing age, which is attributed to secondary dentin formation. In the age group of 11–60, the length and width of pulp canals of mandibular central and lateral incisors decreased with the advancing age and this difference is statistically significant with the p value of less than 0.000. Conclusion: In the future computer-assisted measurements, i.e., latest digital radiographic techniques are suggested to measure the above parameters; this may could throw light on forensic applications, medicolegal issues, and legal issues regarding age estimation by measuring root canal length and width.
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Goyal S, Sharma BK, Misra MC. Study the Sensitivity and Positive Predictive Value of Clinical Finding, Ultrasonography, and Computed Tomography Finding to Detect the Defect Size and Number of Incisional/Ventral Hernia. J Mahatma Gandhi Univ Med Sci Tech 2018; 3 (3):88-92.
Despite the importance of defect size, there are no standardized recommendations on how to measure ventral hernias. Our aims were to determine1 if any significant differences existed between various methods of measuring ventral hernias and2 the effect of these methods of measurement on selection of mesh size. Materials and methods: A prospective study of all patients enrolled in a randomized trial assessing ventral hernia repair at our institution from January 2018 to June 2019 was eligible for inclusion. Abdominal wall hernia defect size will be obtained using the following methods: clinical examination, ultrasonography (USG), and computed tomography (CT) finding. Clinically, measurement will be determined by feeling the edges of muscle and measuring the defect using the measuring tape or thread. Computed tomography abdomen/USG abdomen was done to every patient to confirm the size of defect and its contents of hernia and other associated hernia for estimating the size of the prosthesis to be used. Then, defect size and number of incisional/ventral hernia will be measured intraoperatively using the measuring tape or thread, and this measurement will be compared with the earlier three findings of clinical examination, USG, and CT findings. Results: Thirty patients met inclusion criteria for assessment. Defect size measured by clinical examination in comparison with intraoperative finding of defect size is found out to be statistically significant with a mean value (5.10) more than that of the intraoperative finding (4.85), and p value is <0.05, i.e., 0.012, and defect size measured by USG in comparison with intraoperative finding of defect size is also found out to be statistically significant with a mean value (3.87) less than that of the intraoperative finding (4.85), and p value is <0.05, i.e., 0.036. But the size of defect of hernia measured by CT scan is almost same as that of hernia measured during intraoperative finding with a mean value of 4.60 and 4.85, respectively. Conclusion: Among the three methods of measuring ventral hernia defect, CT scan is most sensitive in detecting the number of hernia and measuring the size of defect followed by clinical examination. Although our study has some limitations due to which we can make no recommendations regarding the ideal measurement method right now. Further studies are needed to determine which method results in optimally sized abdominal wall prostheses and superior ventral hernia repair.
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Rijhwani P, Goyal C, Pahadia M. Microscopic Colitis Presenting as Difficult Diarrhea in a Patient of Rheumatoid Arthritis. J Mahatma Gandhi Univ Med Sci Tech 2018; 3 (3):93-96.
Microscopic colitis is an uncommon intestinal disorder that presents with chronic diarrhea. It is treatable, but its diagnosis may often prove difficult specifically in developing countries as it requires a GI endoscopy unit and since its incidence is on rise now it needs a high index of suspicion followed by colonic biopsy for diagnosis. It is a condition diagnosed when a patient with chronic watery nonbloody diarrhea has an endoscopically or radiographically normal colon, but colonic mucosal biopsies show unique inflammatory changes; because the mucosa is not otherwise disrupted or ulcerated, diarrhea does not contain blood or pus. We present the case of a 53-year-old woman with pathogen-negative chronic diarrhea who is a k/c/o rheumatoid arthritis (RA) since past 12 years and hypothyroidism since past 5 years. She responded well to treatment of low-dose steroids after colonoscopy and colonic biopsy successfully hinted her illness. Conclusion: Patients with pathogen-negative chronic diarrhea having h/o multiple drugs intake or autoimmune diseases not responding to usual treatment should be subjected to a colonoscopy followed by biopsy to diagnose microscopic colitis.
Carbamazepine is an anticonvulsant medication used primarily in the treatment of epilepsy, seizure disorder, neuropathic pain, some psychiatric disorders such as schizophrenia, and as a second-line agent in bipolar disorders. Generally, it is safe to use with some nonserious side effects. However, a clinician has to be alert regarding some of its uncommon but serious side effects. Here we discuss a rare case who developed carbamazepine-induced pancytopenia. The offending drug was stopped and pancytopenia recovered within a few days.
Progressive disseminated histoplasmosis is a rare fungal infection and occurs in immunocompromised and immunosuppressed patients in the endemic area. It is difficult to differentiate it from tuberculosis on the basis of imaging finding alone. Here, we report a biopsy proven case of bilateral adrenal histoplasmosis with involvement of central nervous system (CNS). This patient showed good response to antifungal treatment.
Conjoined twins is a rare congenital malformation. It is a rare type of monozygotic monoamniotic monochorionic twins. Ultrasound is the standard investigation for fetal scanning. Here we present a case of conjoined twins diagnosed by transabdominal ultrasound examination at 23 weeks and 1 day gestation in a young female with a history of primary infertility and ovulation induction. They were joined at the chest and the abdomen and had one functional heart and one liver. The pregnancy was terminated by cesarean section at 23 weeks’ gestation, with the approval of the family.
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Nijhawan S, Nijhawan M, Agarwal S, Goel P, Jain S, Sharma A, Meherda A. Refractory Crohn's Disease of External Genitalia in a Female Successfully Treated with Adalimumab. J Mahatma Gandhi Univ Med Sci Tech 2018; 3 (3):105-107.
Crohn\'s disease (CD) is a chronic inflammatory bowel disease with granulomas and ulcers in the bowel. Cutaneous lesions may occur as a totally separate entity without involvement of gastrointestinal (GI) tract, in which case it is termed as metastatic Crohn\'s disease. Gynecologic involvement is infrequent and difficult to diagnose. A 23-year-old female presented to us with complaints of vulvar swelling and multiple, oval to linear, typical knife cutting deep ulcers on the perineal folds since 6 years. We performed a biopsy, which showed follicular plugging with epitheloid cell granuloma in subcutis and foci of chronic inflammation. The list of differential diagnosis included cutaneous tuberculosis, sarcoidosis, deep fungal infection, lymphogranuloma venerum (LGV), and Crohn\'s disease of vulva. Clinical correlation with investigations leads to a diagnosis of Crohn\'s disease of vulva by exclusion. Patient was earlier treated with oral steroids, antibiotics, and immunosuppressants like azathioprine but showed only mild improvement. In view of previous nonresponse, the condition was regarded as a refractory one. We thus planned biological therapy in the form of adalimumab. The patient showed a significant improvement in ulcers.
Down syndrome (DS) is the most common genetic cause of significant intellectual disability in the human population. It is caused by the presence of all or a part of a third copy of “chromosome 21 (47, XY, +21 or 47, XX, +21)”. In 1838, Esquirol first described this, later John Langdon Down in 1866 named this syndrome as “mongolism.” These patients are associated with some medical as well as dental disorders. The oral structures that are commonly affected in patients with DS include the tongue (macroglossia), teeth (number and shape), and poor quality of alveolar and jaw bones (osteoporotic-like). This article presents a case of DS in 28-year-old male patient who had been prescribed multiple intentional root canal therapies (RCTs) in both maxillary and mandibular teeth as a part of rehabilitative treatment plan for congenitally missing teeth.
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Mishra M, Jain VK, Jayaswal RM. Mycoplasma pneumoniae-associated Severe Fatal Autoimmune Hemolytic Anemia: A Rare Entity. J Mahatma Gandhi Univ Med Sci Tech 2018; 3 (3):113-115.
Mycoplasma is the smallest living-free organism in the nature. It is an important and common cause of respiratory infections. It mainly affects children more than 5 years of age and younger adult causing disease of varied severity of illness from asymptomatic or upper respiratory infection to severe pneumonias. Hemolytic anemia is known as a rare but severe complication of Mycoplasma infection. We encountered a 15-year-old male with cold agglutinin antibody-associated fatal autoimmune hemolytic anemia secondary to Mycoplasma pneumonia hence reported.