MGM Journal of Medical Sciences

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The incidence of a true knot of the umbilical cord is not only very low ranging from 0.3% to 2.1%, but also it often remains undiagnosed antenatally despite the availability of ultrasonography (USG). If the true knot remains tight, it may impede the circulation of the fetus and results in intrauterine fetal death (IUFD). We reported two cases of the true knot of the umbilical cord that ultimately led to fetal demise. Our first patient was a 25-year-old primigravida, with a singleton pregnancy of 35 weeks reported with complaints of absent fetal movements for the day. On examination, the patient was normotensive; the fundal height corresponded with the gestational age. The fetal heart sounds were absent on auscultation. The ultrasound confirmed IUFD. Labor was induced and the patient underwent uneventful vaginal delivery. However, the baby was stillborn. Two tight loops of the umbilical cord around the neck with true knots were found. Our second patient was gravida 2 with previous cesarean delivered 3 years back. She was pregnant 25 weeks and had a loss of fetal movement for the day. The fetal heart sounds were absent. She went into spontaneous labor and delivered vaginally. On examination, the true knot in the umbilical cord was seen.

China is presently the most populous country; the annual birth rate is estimated at above 18 million each year over the next 5 years. The number of the aged population is also increasing. Continuous in-country demand for vaccines will, therefore, be maintained, providing opportunities for the manufacturers. China produces a large number of vaccines, presently estimated at 55 different types, which are used to protect against 28 types of individual infectious microbial diseases. The country has presently a total of 41 vaccine manufacturing companies, of which 21 are the major ones. The manufacturing capacity appears to be over 1000 a million doses per annum and the annual production in 2019 was over 700 million doses. Chinese imports of vaccines have remained low. The major government establishment, the China National Biotec Group (CNBG) companies are the leading manufacturer of vaccines in China and supply more than 50% of all the vaccines consumed in the country. CNBG is a research-driven biotech establishment and is engaged in R&D, manufacturing, marketing, and distribution of vaccines and blood products. CNBG has six institutes of biological products besides other assets; the six institutes are also engaged in the manufacture, distribution, and sale of vaccines through their manufacturing companies and establishments in China. CNBG has seven vaccine manufacturing units. CNBG is a subsidiary of China National Pharmaceutical Group Corporation (Sinopharm). Sinopharm infrastructure shoulders the social responsibility of Chinese national medical and pharmaceutical reserve on a sustainable long-term basis, including handling of emergency situations. Sinopharm is under the State-owned Assets Supervision and Administration Commission (SASAC) of the State Council of China and is engaged in 10 core business activities that cover biopharmaceutical products, including vaccines.

Introduction: Both terbinafine and fluconazole are effective systemic drugs for dermatophytosis. They can be used intermittently as pulse doses or as daily doses for the treatment of the same. Aim: The aim of this study was to assess the efficacy and safety of 1 week twice a day therapy of terbinafine and to compare it with that of a daily 2-week course of terbinafine and weekly pulse fluconazole therapy. The adverse effects and relapse rates after the completion of therapy were assessed. Materials and Methods: A study was conducted with 90 patients divided into three Groups A, B, and C. Patients were assessed at 2 and 4 weeks of starting treatment and 6 weeks following the completion of treatment. Adverse effects if any were noted. Clinical scores were calculated, and skin scraping for potassium hydroxide (KOH) examination was done. Clinical improvement was assessed. A mycological cure is defined as a negative KOH examination. Results: There was a significant decrease in clinical scores before treatment and at 2 and 4 weeks of visits. The highest clinical cure rates were attained in Group A (80%), followed by Group B (73.33%) and Group C (63.3%). Mycological cure rate at 4 weeks was highest in Group A (93.3%), followed by Group B (86.7%) and Group C (83.3%). This difference in clinical and mycological cure rates in the three groups was not found to be statistically significant. Of the patients who had responded to treatment at 4 weeks, the clinical and mycological cure was maintained in 96.4% individuals in Group A, 96.1% in Group B, and 88% in Group C at 6 weeks. Thus, the highest number of recurrences was seen in Group C, followed by Group B and Group A. All the three treatment regimens were well tolerated. Side effects were seen in 17 patients. They were mild and predominantly gastrointestinal. Conclusion: All three drugs in different regimens were found to be equally efficacious in the treatment of dermatophytic infections in our center.

Background: Fine needle aspiration cytology (FNAC) of the breast is a reliable, simple, minimally invasive, cost-effective procedure with high sensitivity, specificity, and diagnostic accuracy. It is commonly used for the assessment of breast lesions and as a guide to preoperative evaluation and management. Objective: The objective of this study was to assess the accuracy of fine needle aspiration of the breast and critically evaluate the cases, which showed discordance between cytology and histopathology. Materials and Methods: This is a retrospective study of cases of FNAC done for breast lumps. The slides were retrieved from the archives of the Pathology Department. Breast cytology findings were reported according to the six standard categories—positive for malignancy, suspicious for malignancy, atypical, proliferative without atypia, benign/unremarkable, and unsatisfactory. The FNAC findings were correlated with the histopathology diagnosis. Cases showing cytological and histological disparity were reevaluated for the detection of possible causes of the discrepancy. Results: The study consisted of 100 cases. For the diagnosis of carcinoma, the sensitivity was found to be 92.9%, specificity was 100%, positive predictive value was 100%, negative predictive value was 97.2%, and the total accuracy was 99%. False positives were not seen, and two cases were false negatives. Suboptimal material, lack of extensive sampling, and absence of all the characteristic features caused under diagnoses were recognized as common pitfalls. Conclusion: This study highlights the causes of cytological pitfalls. Strict adherence to the proposed criteria and extensive sampling of the lesions are of paramount importance in reducing the number of false-positive and false-negative cases.

Background: In India, millions of people are suffering from chronic kidney disease (CKD). Hemodialysis imposes a variety of physical and psychosocial stressors that challenge not only the patients but also the caregivers. Psychiatric illness in patients with end-stage renal disease (ESRD) has persistently intrigued health-care workers due to its effect on morbidity and health-care costs in ESRD. Objective: The objective of this study was to assess psychiatric morbidity among ESRD patients on hemodialysis. Materials and Methods: The study enrolled 170 patients with ESRD undergoing hemodialysis. Psychiatric morbidity was assessed using Mini International Neuropsychiatric Interview. Results and Discussion: Of the 170 patients studied, 70.6% were males and 29.4% were females. The mean age of the patients was 40.8 (SD = 14.8). Psychiatric morbidity was present in 42(24.7%) patients. The common diagnosis was major depressive episode (n = 37) followed by generalized anxiety disorder (n = 3), dysthymia (n = 1), and alcohol dependence syndrome (n = 1). No significant association was seen between gender and marital status in psychiatric morbidity. Duration of renal illness had a significant association with psychiatric illness (P < 0.0001). A similar duration of dialysis also had an association with psychiatric illness (P < 0.0001) with a majority of patients having psychiatric complaints within 6 months of onset of dialysis. The presence of nonrenal comorbidities also had a significant association with psychiatric illness (P < 0.005). Conclusion: This study has shown psychiatric illness among patients with ESRD on hemodialysis and its association with various factors such as duration of renal illness, duration of dialysis, and the presence of comorbidities.

Background: Malaria despite everything represents a danger to the strength of occupants and voyagers in tropical nations. The Plasmodium species that are known to infect humans worldwide are Plasmodium falciparum, Plasmodium vivax, Plasmodium ovale, Plasmodium malariae, and Plasmodium knowlesi. Of these, P. falciparum causes high morbidity and mortality, and it is during the asexual erythrocytic stages that the majority of the indications of malaria are shown. Aim: The aim of this study was to standardize an in vitro assay for antimalarial drug sensitivity of P. falciparum isolates. Materials and Methods: This prospective study was carried out over a period of 1 year from July 2014 to June 2015. We effectively completed in vitro drug susceptibility testing on 34 isolates of P. falciparum, which were collected from the patient admitted in Mahatma Gandhi Mission’s Teaching Hospital, Navi Mumbai, Maharashtra, India. We obtained the P. falciparum 3D7 strain from Haffkine Institute for Training, Research and Testing, and Indian Institute of Technology (IIT) Bombay, Mumbai, Maharashtra, India. World Health Organization (WHO) standard in vitro micro-test (Mark III) method was used for the assessment of the response of P. falciparum to chloroquine, mefloquine, quinine, amodiaquine, sulfadoxine/pyrimethamine, and artemisinin. The method was partially modified by replacement of leukocytes with AB serum in Roswell Park Memorial Institute (RPMI)-1640 medium. Results: The development of P. falciparum 3D7 chloroquine-sensitive strain from the ring stage to schizonts (not fewer than six merozoites) in control wells containing chloroquine was 100% recorded. This level of development in the control wells empowered fast minute assurance (5min for isolate per drug) of the Minimum inhibitory concentrations (MICs) of chloroquine. The test well shows the development from the ring stage to mature schizont stages were 67.65% in well containing chloroquine, 17.65% in well containing amodiaquine, and 14.71% in well containing sulfadoxine/pyrimethamine, it means these drugs are resistant to P. falciparum, and however, there is no development of the P. falciparum from the ring stage to mature schizont (with at least six merozoites) stage in the well containing artesunate, mefloquine and quinine were equal to the control well, it means these antimalarial drugs are sensitive to the P. falciparum. Conclusion: Antimalarial drug resistance has developed as a result of prescribing this medication without having malaria. Early diagnosis of malaria and drug sensitivity testing may prevent the emergence of resistance to antimalarial drugs. Monotherapy ought to be kept up a key decent way from; the combined antimalarial drug therapy may reduce the chances of emergence of antimalarial drug resistance.

Introduction: Vitiligo is a common, acquired, pigmentary disorder of the skin, mucous membrane, and hair, resulting from the destruction of functional melanocytes. Objective: The objective of this study was to describe the cutaneous and systemic manifestations of vitiligo. Materials and Methods: The study comprised 130 patients attending the outpatient department (OPD) of dermatology, MGM Medical College and Hospital, Aurangabad, India. Clinical details were noted in the pro formas, and cutaneous examination was done in relation to the size and type of lesions of vitiligo and other lesions if present. Pure-tone audiometry (PTA) and ophthalmological examinations were also performed to rule out audiometric and ocular changes. Further, lab investigations were conducted. Results: Of 130 patients, the female-to-male ratio was found to be 1.06:1. The most common age-group for the disease onset was 21–30 years. Vitiligo vulgaris and focal vitiligo were found to be the most common types, followed by generalized, acrofacial, segmental, poliosis in 3.8% patients, alopecia in 4.6% cases, hypoacusis was observed in 3.1%, halo nevi in 0.8%, thyroid disease in 7.7%, diabetes mellitus in 3.1%, and psoriasis in 0.8% of cases. Conclusion: Vitiligo vulgaris and focal vitiligo were the most common types found with associated cutaneous and systemic abnormalities such as thyroid disease, diabetes mellitus, and alopecia areata.

The severe acute respiratory syndrome coronavirus 2 (SARS CoV2) also called human coronavirus 2019 (HCoV-19) causing COVID-19 flu originated from China. The complete nucleotide sequence of SARS CoV2 was revealed in January 2020 by Chinese scientists, opening up opportunities for developing therapeutic agents and vaccines. The Chinese people were late in declaring the onset of the disease; only during January 2020, it was revealed that this disease was spreading like an epidemic from man to man contact. The spread of the disease and deaths, in the meantime, were very high in a short period all over the world from man to man contact. To prevent these, use of masks, social distancing among the noninfected and maintaining isolation in houses for a period to allow the surroundings to get absolved from infection, and locking down the infected in hospitals or at home with supportive therapy were effective to prevent the spread. Current country-wise world data on diseased individuals and the deaths reveal that the developing countries having a preponderance of tuberculosis perform better in comparison, to resist the disease with concomitant lesser deaths. The efforts of developing an effective vaccine would require a painstaking, precise understanding of the manner the virus mutates and mount vaccination strategies to effectively neutralize and opsonize.

We report herein a patient with endobronchial fistula post-patent ductus arteriosus ligation surgery, who presented with massive hemoptysis. Cook’s embolization coil 0.052 inch × 8cm × 6mm was used to close the fistula through the endovascular procedure.

Online since 28^th February 2020