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Medicine and Dentistry >
International Journal of Medical Paediatrics and Oncology
Editor in chief:Dr. Pravakar Mishra
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Pediatric Optic Ner-Glioma: A Case Study
Author:Prasuna Jelly, Sk Mohana Sundari
Volume: 2 | Issue no: 3-2016 | Pagination: 127-131
An optic nerve glioma is a type of brain tumor. There are multiple kinds with brain tumors and glioma?s account for approximately one-third of brain tumors. They are typically named after the kind of cells they affect. It is a rare kind of cancer, they are considered low-grade and do not grow as quickly as other types of brain tumors. They are found in the optic chiasm, where the optic nerves cross or surround the optic nerves. They are also referred to as optic glioma or juvenile pilocytic astrocytoma. It is rarely found in individuals over the age of 20. It has also been associated with the genetic disorder neurofibromatosis Type 1, or NF1. Evidence suggests that adult malignant gliomas (glioblastoma) are rare & almost always occur in adult males with a very poor prognosis & almost certain death within one year. Optic-nerve gliomas comprise about 1% of all intracranial tumors and Optic nerve glioma is a slow-growing tumours, which typically affects children. 30% of patients have associated neurofibromatosis type 1 & those have better prognosis. However, optic nerve glioma of children is discussed in this article.
Neonatal Candida Guilliermondii Sepsis-An Unusual Bug In Neonatal Intensive Care Unit
Author:Uma Raju, Shashank Panwar, Geetanjali Srivastava, Harshal Khade, Prasanna Srinivas
Volume: 2 | Issue no: 3-2016 | Pagination: 123-126
Fungemia particularly due to candida species is a well-recognized entity in Neonatal Intensive Care Units(NICU). A cause of concern is the increasing occurrence of sepsis due to non-albicans candida species. These are associated with increasing morbidity and drug resistance. We report a rare case of neonatal sepsis due to Candida Guilliermondii, a yeast which was considered to rarely cause infection in humans. The neonate, born in an outreach facility, was admitted in NICU with features of systemic, CNS and dermatological manifestations. The initial investigation revealed thrombocytopenia with positive CRP and CSF suggestive of infection for which empirical antibiotic therapy(Vancomycin+Meropenem) in meningitic doses was started. Initial blood culture was sterile. Thrombocytopenia progressively worsened and patient manifested dermatological lesions in the form of hyperpigmented macular lesions over face which progressed caudally. In view of clinical sepsis, persistent thrombocytopenia and dermatological manifestations, a fungal etiology of sepsis was suspected. Blood and urine culture for fungus was sent and patient was started on IV Fluconazole along with topical antifungal ointment (Clotrimazole). Blood culture grew Candida Guilliermondii which was sensitive to Caspofungin, Micafungin, Flucytosine and resistant to Fluconazole and Amphotericin B. As the patient had already been on fluconazole therapy for 4 days on which she had shown clinical improvement in the form of improved activity, some regression of hyperpigmented patches and thrombocytopenia, IV fluconazole along with topical clotrimazole was continued for 3 weeks. After three weeks of antifungal therapy, there was normalising of haematological parameters in the form of resolving of thrombocytopenia, negative CRP and CSF studies within normal limits. The neonate was treated successfully with intravenous Fluconazole, in spite of antibiotic sensitivity pattern suggesting its resistance in-vitro. This demonstrates a difference in in-vivo and in-vitro efficacy of drugs and the necessity of exercising clinical judgement before rapidly changing antibiotic therapy which could in the long run stem development of drug resistance.
Periampullary Carcinoma With Skull Metastasis: A Rare Case Report
Author:Deepti Sharma, Garima Singh
Volume: 2 | Issue no: 3-2016 | Pagination: 120-122
Periampullary cancer consist of pancreatic cancer, carcinoma of ampulla of vater, distal common bile duct and duodenum. With the use of multimodality treatment, the prognosis of periampullary carcinoma has been improved. Skull (calvarium) metastasis is uncommon presentation. Only few cases of periampullary carcinoma with skull metastasis are available in English literature. Although rare, metastatic periampullary adenocarcinoma should be considered as a differential diagnosis in patients presenting with abnormal scalp swelling and tenderness. We reported a case of 48 year old female who presented with lytic expansile bony lesion with associated soft tissue mass in left parietal region with no neurological defecit 18 months after the whipples procedure.
Spindle Cell Carcinoma Of The Tongue: A Case Report And Review Of Literature
Author:Deepti Sharma, Garima Singh
Volume: 2 | Issue no: 3-2016 | Pagination: 118-119
Spindle cell carcinoma (SpCC) or sarcomatoid carcinoma of the tongue is rare and aggressive variant of squamous cell carcinoma with incidence of <1%. It is characterised by proliferation of epithelial and mesenchymal components. It is important to diagnose this variant of SCC, because of its tendency to recur and early metastasis. We are reporting this rare tumor with an unusual location in a forty year old gentleman to contribute in part to the better understanding and awareness of this rare malignancy.
Micropenis & Leucocyturia: A Pointer To Underlying Urological Anomaly
Author:Naved Akhter, A Puri, V. Agrawal
Volume: 2 | Issue no: 3-2016 | Pagination: 116-117
UTI is common childhood infection yet frequently missed. The anomalies of genito-urinary tract are important predisposing factor for UTI. Certain anomalies of external genitalias points towards these internal urogenital anomalies. Present case an infant of 11 months with predominant presentation of bronchiolitis also had micropenis, which lead to focused renal screening and detection of multiple urological anomalies. Infant responded well to the treatment and is doing well on follow up. Learning Points: Careful genital examination for external genital anomalies can help to unmask serious yet asymptomatic underlying urological malformation, if present should be followed by urine R/M +/-C/S
Perceived Understanding Of Informed Consent Among Pg Students And Patients Undergoing Major Abdominal Surgeries In A Selected Hospital
Author:Syed Imran, Ravi N Vaswani, Vina R Vaswani
Volume: 2 | Issue no: 3-2016 | Pagination: 113-115
Informed consent was developed as an ethical guideline 150 years ago. The concept began to take shape in 1914, when U.S. Supreme Court Justice Benjamin Cardozo stated, ?Every human being of adult years and sound mind has a right to determine what shall be done with his own body, and a surgeon who performs an operation without his patient?s consent commits an assault for which he is liable.? Whatever we believe informed consent embodies, it has become first and foremost a legal system document designed to protect the patient from the physician. The quality of the administration of informed consent determines whether it is used as a prosecutorial or defense weapon in legal proceedings. Informed consent has evolved over the past 85 years to its current standardized form. Physicians contemplating surgical intervention are required to disclose a description of the problem and its natural history. They must explain the proposed treatment and alternatives to treatment. Risks general to the surgery and specific to the patient are to be delineated. Finally, outcome probabilities and postoperative expectations must be discussed. Purpose: The main aim of the study was to know the perceived understanding of informed consent among PG students as well as among Patients undergoing major abdominal surgeries. Method: A descriptive survey design was used for the study. A dyad sample of PG students and patients undergoing major abdominal surgeries participated in this study. Samples were selected through purposive sampling technique. Data was collected from PG students by administering a rating scale on perceived understanding of informed consent, and the data from patients undergoing major abdominal surgeries was collected by using structured interview techniques with the help of rating scale. Results: The study result showed that 84% of the PG students and 40% of the patients undergoing major abdominal surgeries were having good perceived understanding about informed consent. 16% of the PG students and 52% of the patients were having average understanding of informed consent, whereas, 8% of the patients were having poor understanding of the informed consent. There was a association between the perceived understanding and the demographic variables of both PG students and the patients undergoing major abdominal surgeries
Clinical Profile Of Children Presented With Seizure In Tertiary Care Hospital Pmch Patna, A Retrospective Study
Author:Tauhid Iqbali, Ak Jaiswal, Amit Kumar
Volume: 2 | Issue no: 3-2016 | Pagination: 107-112
Objective: To find the common causes of seizure and to classify seizure types in various age groups as well to predict outcome in relation to different variables. Design: Retrospective hospital-based, analytic and descriptive study. Setting: The Department of Paediatrics, PMCH, Patna. Participants/patients: This study includes all children in the age group 6 months to 15 years presented in the department of paediatrics with seizure. Outcome Measure(s): Demographic analysis and analysis of different seizure types, analysis of patient based on the cause of seizure as well as outcome of patient presented with seizure in relation to demographic, fever diagnosis and status epilepticus. Results: The total number of patient presented with seizure are 956 of them 574 were males and 382 were females. 562 had fever on presentation and most of them were less than 5 years of age amount to 562. The most common clinical seizure type were generalized tonic- clonic (60.5%). Seizure disorder (14.4%), febrile seizures (16.1%), central nervous system infections and neurocysticercosis were common etiologies. Tubercular meningitis was more common etiology in 6?10 years age group. Neurocysticercosis were more common in 11-15 years age group. Encephalitis were more common in children below 5 years of age. Conclusions: seizures are one of the common cause of hospitalization and high mortality. It can be inferred from this study that CNS infection are the most common cause of acute symptomatic seizure. Thus improvement in health care facilities like sanitation and immunization is warranted to prevent it.
Endoscopic And Histopathologic Changes In Children With Chronic Dyspepsia In A Rural Medical College Hospital In Melmaruvathur ? Tamil Nadu
Author:K. Padma, S. Sumathi, Nagendram Dinakaran, C. Kannan
Volume: 2 | Issue no: 3-2016 | Pagination: 102-106
Introduction: Chronic pain abdomen and dyspepsia is the most common presenting symptoms in the paediatric outpatient department (OPD) after respiratory illnesses. It is increasing alarmingly both in the paediatric and adult population. We, therefore carried out a cross sectional study among children aged between 5 to 15 years, attending Paediatric OPD with chronic dyspepsia in a rural medical college hospital, Melmaruvathur, Tamil Nadu, South India. Objective: To evaluate the gastroduodenal morbidity in children presenting to the paediatric department of a rural medical college hospital with chronic dyspeptic symptoms. Methods: Forty six children between the age group of 5 to 15 years with chronic dyspeptic symptoms of at least one month duration were evaluated for their symptom profile, epidemiological profile, nutritional status, endoscopic appearance and histopathological changes. Data analysis was done using SPSS version 18. Results: Of the 46 children studied, 43% were between the age group of 5-10 years and 70% were female children. Pain abdomen lasting for more than at least one month was the most common finding (93%) observed. Other common symptoms in the order of decreasing frequency were, early satiety (87%), Poor appetite (76%), Nausea (57%) and not thriving (57%). History of loss of appetite was significantly associated with chronic dyspepsia with an odds ratio of 68.9394 and 95% confidence interval 26.62 to 178.54, p value of <0.0001. Most of the children belonged to lower income group predominantly of a rural background. 33 (72%) children had under nutrition as per IAP (Indian Academy of Paediatrics) classification based on WHO growth charts. 10 (30%) Grade I, 15 (45%) Grade II and eight (24%) had Grade III malnutrition. 26 children (57%) had abnormal endoscopic findings. Antral mucosal biopsy done showed chronic lymphocytic gastritis in 44 (96%) cases. 38 of these 44 (86%) were H.pylori positive. H. pylori positivity in chronic dyspepsia was highly statistically significant with a p value of 0.0001. Conclusion: The incidence of dyspepsia is common among children between the age group of 5-10 years with a female preponderance. The predominant symptoms noted among these rural children are abdominal pain and loss of appetite. We found that endoscopy has a very high pick up rate of macroscopic gastroduodenal pathology. Multiple gastric erosions is the most common finding observed endoscopically and H.pylori associated lymphocytic gastritis is the overwhelming finding in our children with chronic dyspepsia.
Male Breast Cancer: An 8-Year Experience In A Single Tertiary Oncology Centre In India
Author:Himanshu Srivastava, Surender Kumar Sharma, Abhinav Dewan, Preety Negi, Parveen Ahlawat
Volume: 2 | Issue no: 3-2016 | Pagination: 96-101
Background and Objectives: Male breast cancer is a rare disease with a paucity of published literature on this topic. The purpose of this study was to report our experience with male breast cancer, focusing on the need of pooling of multi-institutional data for these patients. Methods: A retrospective review of 23 male patients with carcinoma breast from 2008 to 2015 was performed. All documented data on patient and tumour characteristics, treatment and clinical outcome information were analyzed. Results: The median age at diagnosis was 54 years. Majority of our patients had Stage III disease (52.2%) with infiltrating ductal carcinoma (82.6%) being the commonest histology. Estrogen receptor and progesterone receptor positivity was seen in 91.3% and 78.26% patients respectively while Her-2 (human epidermal growth factor receptor-2) positivity was seen only in one patient. All patients underwent surgery and adjuvant radiation therapy was used in 10 (43.5%) patients. All patients except one received systemic chemotherapy. The 5-year disease-free survival was found to be 78%. Median follow-up was 40 months (6 - 68 months). Conclusion: Unfortunately, in the face of the limitation of current scientific knowledge in determining the optimal treatment strategy for male patients with breast cancer we recommend that there is an urgent need for publishing multi-institutional experience with these tumours. Hence, allowing the physicians in forming guidelines with the goal of improving clinical outcomes for these patients
Music Therapy For Improving Bio-Physiological And Psychological Outcomes In Patients With Cancer-A Review Article
Author:Syed Imran, Ms Moosabba, Sr. Alphonsa Ancheril
Volume: 2 | Issue no: 3-2016 | Pagination: 92-95
The diagnosis of cancer not only effects the person physically but also it disturbs the person psychological wellbeing. Anxiety and pain are the common problems usually experienced by the patients with cancer beginning from the diagnosis to the treatment part. There is a growing body of research documenting the effects of many alternative treatment modalities in cancer care, one among which is the music therapy. Research has proved that engaging in the music listening or music composing activities will reduce the overall health ailmnents which will arise due to the treatment part and increases the quality of life in terms of comfort, relaxation in patients with cancer.
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