Gujarat Medical Journal

Diagnostic Features Of Tuberculous Meningitis: A Cross Sectional Study

Dr. Moin Sheth*, Dr. Bhupendra Shah**, Dr. Manisha Panchal*** — Thu, 07 Apr 2022 00:00:00 +0000

Background: Tuberculous meningitis (TBM) is a common central nervous system infection however it is difficult
to diagnose as findings are non-specific. Hence we decided to determine if, among patients with chronic meningitis
syndrome, the following are associated with the diagnosis, new-onset seizures, focal neurologic deficit;
pulmonary tuberculosis (PTB) on chest X-ray, cerebrospinal fluid (CSF), pleocytosis with lymphocytic
predominance; decreased CSF glucose; increased CSF protein.
Methods : Adult patients with suspected TBM were enrolled after informed consent was obtained. Baseline
physical examination and diagnostic tests including CT scan of the head with contrast and CSF analysis for acid fast
bacilli (AFB) smear, TB culture and cryptococcal antigen detection were done and results collected. Definite TBM
was defined as positive AFB smear or positive TB culture or positive basal meningeal enhancement on CT contrast
study. Logistic regression was done to determine which were associated with a diagnosis of TBM.
Results : 91 patients were included. Using the gold standard criteria mentioned above, 44 had definite TBM; but if
subsequent clinical course and response to anti-Koch's therapy are considered, 68 had a final diagnosis of TBM.
After logistic regression was performed, only abnormal CSF (the combination of CSF pleocytosis with lymphocytic
predominance, decreased CSF glucose, and increased CSF protein) was associated with the diagnosis of TBM.
Conclusion : In patients with chronic meningitis syndrome, only abnormal CSF was associated with the
diagnosisof TBM.

Study of Effect of Ferrous Carboxymaltose on Postpartum Anemia

Dr. Samrudhi Jain*, Dr. Hardi Shukla*, Dr. Ajesh N. Desai** — Thu, 07 Apr 2022 00:00:00 +0000

Background: The incidence of post-partum anemia (PPA) is 14-24%. Treatment of PPA with injectable iron
replenishes the iron store. Ferric carboxy-maltose complex (FCM) is an intravenous iron agent designed to be
administered in large doses in a short period of time. This study aims to find the efficacy and safety of FCM in
treating postpartum anemia. Materials And Methods : The present study is a Prospective interventional hospital
based therapeutic trial conducted on postpartum anemic women of more than 18 years of age with HB <10gm.
Intravenous ferric carboxy-maltose (FCM) was given to the anemic women who has just delivered. Total 500
mg/10 ml in 250 ml of 0.9% normal saline was given over 15-20 min. Result : Mean hemoglobin level before
intravenous ferric carboxy maltose was 8.1+/-0.4gm% while it was 10.05+/-0.6 gm% after treatment. Hb level,
Serum ferritin, MCV and MCHC improved after 2 weeks of treatment. Conclusion : FCM was well tolerated and
effectively increased mean hemoglobin levels in postpartum women. The duration of hospital stay also shortened
and their were no serious side effects noted with the use of FCM.

â€œCoronary Atherosclerosisâ€- A Post-Mortem Histopathological study of 7 years

Thu, 07 Apr 2022 00:00:00 +0000

Background : The incidence of coronary heart disease has markedly increased in India over the past few years.
Coronary atherosclerosis, the largest cause of morbidity & mortality in developed and developing country.
Aim : To study the prevalence of coronary atherosclerosis cases on histopathology. To study different morphology
of coronary atherosclerosis on histopathology.To assess cases according to gender, age and socioeconomic
profile.
Material and Methods : Prospective and retrospective study of 7 years was designed to evaluate common
coronary atherosclerosis reported on autopsy viscera at histopathology department from August 2014 to August
2021.
Result : The study comprises the cases in the age group between 10 to 90 years. Both side coronary vessels
involvement is more common than single vessels involvement. The most common type of atherosclerosis seen was
Grade 2.
Conclusion : coronary atherosclerosis was most commonly diagnosed in the age group of 41 â€“ 50 years and have
a male preponderance. Urban population more affected than rural. Most common observed complication is
myocardial infraction.

Study of Medical Disease Affecting Pregnancy other than Pregnancy induced and its Effect on Outcome

Dr . Tushar M. Shah*, Dr. Janki B. Shingadia**, Dr. Bhakti Modi*** — Thu, 07 Apr 2022 00:00:00 +0000

Total 100 antenatal patients were selected on basis of history, clinical examination and investigation who came in
OPD of department of Obstetrics and Gynaecology B.J. Medical College, Ahmedabad, with various medical
conditions between May 2020 to september 2020And observed till the termination of pregnancy. This s t u d y d o e s
not include those medical conditions which are pregnancy Induced like pregnancy induced hypertention,
Gestational diabetes mellitus, Physiological anaemia etc. Study includes those medical conditions which are
already presents before pregnancy or not directly related to the pregnancy. Study shows that highest chances
of neonatal mortalityamong studied diseases is seen in pregnancy with jaundice, HIV, HBsAg, Asthma, Heart
disease, epilepsy, TB, UTI, influenza, Typhoid, Dengue, thyroid dysfunction in pregnancy. Highest chances of
Maternalmortality among studied diseases is seen in pregnancy withjaundice in pregnancy followed by
Heartdisease, epilepsy, tuberculosis, influenza and dengue in pregnancy. Where chances of Medically terminated
abortion inearly pregnancy is seen highest with heart disease in pregnancy followed by and thalassemia minor in
pregnancy. Highest chances of Spontaneous Abortion. Aims and Objectives : Aim is to study the various medical
condition which affects pregnancy and its outcome. Material and methods : Total 100 Random antenatal
patients were selected on basis of history, clinical examination and investigation who came in OPD of department
of Obstetrics and Gynecology B. J. Medical College, Ahmedabad, with various medical conditions between May
2020 to September 2020. Exclusion Criteria : this study does not involve those medical conditions which are
directly related to the pregnancy which occurs or exaggerates because of pregnancy, for example Pregnancy
induced hypertension, Gestational diabetes mellitus, Physiological anemia etc. Inclusion Criteria : This study
includes medical disorders that women had before they became pregnant (preexisting disorders), such
as diabetes or chronic high blood pressure and Disorders that develop during the pregnancy but are not
directly related to the pregnancy. 14 cases of cardiac disease, 10 cases of jaundice (viral hepatitis), 8 cases of
HbsAg, 8 cases of HIV, 8 cases of urinary tract infections, 8 cases of typhoid, 6 cases of epilepsy, 6 cases of dengue,
5 cases of thyroid disease, 5 cases of asthma, 5 cases of influenza, 5 cases of tuberculosis, 4 cases of renal
disease, 4 cases of malaria, 4 cases of chronic hypertension.

A Comparative study on visual outcomes in Myopic Astigmatic Refractive error correction by Customized Femtosecond Laser and Mechanical Microkeratome.

Ankit S. Varshney*, Dr. Mahendrasinh D. Chauhan** — Thu, 07 Apr 2022 00:00:00 +0000

To compare the visual outcomes in myopic astigmatic refractive error correction by Customized femtosecond laser
and Mechanical Microkeratome LASIK.This was aprospective observational study, performed on 200 eyes of 100
patients treated between 2016 to 2020 for myopia and astigmatism (sphere â‰¤ -6.00 Diopters; cylinder â‰¤ -6.00
Diopters). The first 100 consecutive eyes that had LASIK flaps created with a femtosecond laser were compared
with the first 100 consecutive eyes that had flaps created with a mechanical microkeratome. All eyes received
wavefront-guided LASIK treatments performed with a VISX S4 IR Advanced CustomVueexcimer laser (AMO).
Refractive predictability, change in mean spherical equivalent refraction, postoperative uncorrected visual acuity
(UCVA), and best spectacle-corrected visual acuity (BSCVA) were compared at 1 day, 1 week and 1 month
following surgery. The refractive accuracy was the same for both groups. At allfollow-up, the percentage of eyes that
achieved a postoperative UCVA of 20/20 or better was significantly higher in the femtosecond laser group than in the
mechanical keratome group. In addition, a higher percentage of eyes in the femtosecond laser group achieved a
postoperative UCVA of 20/16 at 1months. Creating LASIK flaps with the femtosecond laser resulted in faster visual
recovery and better UCVA.

Correlation of Clinically & Sonographically estimated Fetal Birth Weight with Actual Birth Weight in Cephalic Presentation

Thu, 07 Apr 2022 00:00:00 +0000

Introduction : Knowledge of the weight of the fetus in utero is important for obstetrician to decide whether to deliver
or not to deliver the fetus. And also to decide the mode of delivery. Accurate estimation of fetal weight is of
paramount importance in the management of labor and delivery. High rate of perinatal mortality in developing
countries makes estimation of fetal weight (EFW) antenatally pivotal to obstetricians. Objective : EBW was
estimated by clinical method using Johnsonâ€™s formula, Dareâ€™s formula & by USG with Hadlockâ€™s formula. All EBW
derived from these 3 methods were compared with the actual birth weight, to find out EBW by which formula has
closest resemblance with actual birth weight. Results : In this analysis using paired t-test, the reissignificant
statistical difference found between actual birth weight & Johnsonâ€™s method ( p-value < .00001) and between actual
birth weight & Hadlockâ€™s method ( p-value < .00001). There is no statistically significant difference found between
actual birth weight & Dareâ€™s method ( p-value0.32725) Conclusion : The assessment of fetal weight using Dareâ€™s
formula is more accurate for predicting birth weight at term which is easy and cost-effective, amongst all 3 methods.

â€œShort term functional outcomes of single Stage Surgically treated Multiligamentous Knee injuries in cases of Knee Dislocationâ€

Dr. Ujjval Deliwala*, Dr. Sumit Jain Sethia**, Dr. Akshay Patel*** — Thu, 07 Apr 2022 00:00:00 +0000

Introduction: Knee dislocation is a disastrous injury with significant displacement of tibia over femur leading to
disruption of multiple ligaments of knee and other surrounding soft tissue structures. Open wounds and
neurovascular insult can put the limb in jeopardy. The complexity of injury and varied treatment makes this MLKI
challenging.
Purpose : This review article describes multiligament knee injuries (MLKI) in depth, with a focus on associated
injuries, operative management, outcomes, and complications.
Materials and Methods : We conducted a retrospective observational study of all patients who underwent MLKI
surgeries between 2014 to 2020 in a dedicated Arthoscopy and sports injury Center (Deliwala Hospital in
Bhavnagar). Over the past 7 years, we have treated many cases and have taken 30 cases for this article. The
Schenck knee dislocation classification was used to classify the ligament injury patterns.
Results : The male of age group 36-50 yrs most commonly involved. High Velocity flexion injury is most common
mechanism. Medial sided bicruciate injuries most common pattern. 3 patients develops knee stiffness, 2 superficial
wound infection and 1 had popliteal artery injury. Early surgeries (3-6 weeks) is always preferred over delayed
one.Repair had higher failure rate and lower return to sports activities compared to reconstructions. Surgical
treatment has higher mean Lysholm score96.3.
Conclusions : This review suggests that the best treatment guidelines for MLKI is still awaited due to
heterogeneous nature of the injuries themselves and the many treatment strategies available, but better functional
outcomes havebeen achieved with reconstruction rather than repair. Surgery must be performed early within 6
weeks for better results.When feasibleACL reconstruction can be delayed thereby reducing rate of
arthrofibrosis.High-quality research efforts needed to investigate best modality of treatment of MLKI.

A Retrospective Cross Sectional Study on Ectopic Pregnancy: A Two Year Study

Dr. Sneha*, Dr. A.U. Mehta**, Dr. Prerak Modi***, Dr. Rinky Agrawal**** — Thu, 07 Apr 2022 00:00:00 +0000

BACKGROUND : Ectopic pregnancy is a life threatening condition. It is importance to diagnose it early to prevent
complications. This study aims to understand the risk factors, common group age of presentation, signs , symptoms
and management. This study was conducted for 2 years in Civil Hospital, Ahmedabad.
AIM : To determine the incidence, clinical features, risk factors and morbidity and mortality associated with ectopic
pregnancy in a tertiary care hospital.
METHOD : A retrosceptive cross sectional study was done for years in Obstetrics and Gynecology Department,
Civil Hospital, Ahmedabad from August 2019 to July 2021 for the period of 2 years.
RESULTS : 82 cases of suspected ectopic gestation were observed during the study period of two years at our
institution. Total no. of delivery during the same period were 12660. The incidence of ectopic pregnancy was 0.64%.
Amenorrhoea was present in 79.2% cases,pallor was seen in 81.7% of cases. Ultrsonography reported 47.2 % of
them as ruptured, 24.3% unruptured.
CONCLUSION : Early diagnosis of ectopic is very crucial for appropriate conservative medical management.
Clinicians should be suspicious of ectopic pregnancy in any woman of reproductive age presenting with abdominal
or pelvic symptoms.

Acute ischemic stroke during the convalescent phase of asymptomatic COVID-2019 infection in young male

Dr. Zubin Shah*, Dr. Meet Raval* ,Dr.Heli Shah **,Dr. Sudhir V. Shah *** — Thu, 07 Apr 2022 00:00:00 +0000

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) initially most appreciated for its pulmonary
symptoms, is now increasingly recognized for causing multi-organ disease and stroke in the setting of a hypercoagulable
state. Acute ischemic stroke (AIS) has not been described as late sequelae in patients without
respiratory symptoms of COVID-19. Here we report a case of 15 year old male with post COVID-19 status who
developed acute malignant middle cerebral artery infarction due to occlusion of left terminal internal carotid artery,
left middle cerebral artery stem and A1 segment of left anterior cerebral artery who undergone successful
intravenous thrombolysis followed by mechanical thrombectomy and decompressive craniectomy.

A 30 Weeks, Impending Rupture Ectopic Pregnancy in Rudimentary Horn

Thu, 07 Apr 2022 00:00:00 +0000

Rudimentary horn is one of the rarest congenital uterine anomalies. Pregnancy in a rudimentary horn of the uterus is
a rare clinical condition with a reported incidence of 1 in 100,000 to 140,000 pregnancies. It is difficult to diagnose
before surgery and hazardous to maternal life as rupture of pregnant horn result in severe hemoperitoneum. The
standard treatment is the surgical excision of the horn.

A rare case of Cavernous Hemangioma inLateral Rectus Muscle

Dr. Nitin Trivedi, Dr. Stuti Trivedi — Thu, 07 Apr 2022 00:00:00 +0000

Cavernous hemangioma is the commonest benign tumour of orbit. It is slow-growing and mostly asymptomatic.
Its presence in muscle tissue is very uncommon.A case of 23 year old woman presented with a cavernous
hemangioma in lateral retcus muscle in orbit. It was treated by surgical excision by Lateral orbitotomy.

Neonatal Chikungunya Infection with Perioral Hyperpigmentation

Dr. Chitra Prakashkar* Dr. Nirav Patel**, Dr. Meet Patel**, Nidhay Prakashkar*** — Thu, 07 Apr 2022 00:00:00 +0000

Background : During outbreak of Chikungunya, Neonatal Chikungunya Infection is not that uncommon and should
be suspected as closest differential diagnosis of sepsis
Case characteristics : Both babies had postnatal infection, one presented as signs and symptoms similar to
sepsis, both had hyperbilirubinemia and typical perioral hyperpigmented rash after phototherapy.
Message- : Perioral Hyperpigmentation is consistent with Neonatal Chikungunya Infection

Gujarat Medical Journal

Diagnostic Features Of Tuberculous Meningitis: A Cross Sectional Study

Study of Effect of Ferrous Carboxymaltose on Postpartum Anemia

â€œCoronary Atherosclerosisâ€- A Post-Mortem Histopathological study of 7 years

Study of Medical Disease Affecting Pregnancy other than Pregnancy induced and its Effect on Outcome

A Comparative study on visual outcomes in Myopic Astigmatic Refractive error correction by Customized Femtosecond Laser and Mechanical Microkeratome.

Correlation of Clinically & Sonographically estimated Fetal Birth Weight with Actual Birth Weight in Cephalic Presentation

â€œShort term functional outcomes of single Stage Surgically treated Multiligamentous Knee injuries in cases of Knee Dislocationâ€

A Retrospective Cross Sectional Study on Ectopic Pregnancy: A Two Year Study

Acute ischemic stroke during the convalescent phase of asymptomatic COVID-2019 infection in young male

A 30 Weeks, Impending Rupture Ectopic Pregnancy in Rudimentary Horn

A rare case of Cavernous Hemangioma inLateral Rectus Muscle

Neonatal Chikungunya Infection with Perioral Hyperpigmentation

â€œCoronary Atherosclerosisâ€- A Post-Mortem Histopathological study of 7 years

â€œShort term functional outcomes of single Stage Surgically treated Multiligamentous Knee injuries in cases of Knee Dislocationâ€