Central India Journal of Medical Research

Stress Levels in Lesbians: An Update

Jabir P.K — 2024-12-17

Lesbians experience stress for several reasons, including violence, harassment, and discrimination. Lesbian, gay, and bisexual (LGB) people are more likely than heterosexual people to suffer from mood and anxiety disorders, and this stress can result in mental health issues. To explain the mental stress that sexual minorities face, the better theory put forward is the minority stress theory. It was Meyer who forwarded it in 2003 for a comprehensive explanation of different aspects of mental stress in sexual minorities, such as social, psychological, and structural factors. According to this theory, different stressors integrate into the culmination of sexual minority stress

Neonatal Sepsis: Prevention is Better Than Cure!

Sukrita Dhaneria — 2024-12-17

The word sepsis, derived from the Greek word “sepo” meaning “I rot,” was first used medically in Homer’s poems. Also mentioned in the writings of Hippocrates around 400 BC, who thought of it as a dangerous biological decay in the body, sepsis has been the nightmare of a clinician ever since one can recall. Over the years, several definitions of sepsis have been deduced, and in 2016, an updated definition of sepsis was published, which stated that ‘sepsis is life-threatening organ dysfunction caused by a dysregulated host response to infection.

Understanding of Study Designs in Clinical Research: Major Prompting Points

Sada Nand Dwivedi — 2024-12-17

Study design plays an important role in clinical epidemiology and public health. This helps in not only quantifying level of relationship between exposure and outcome accurately but also in differentiating whether a measured relationship between an exposure and outcome is an indication of merely association or suggestive of risk/ causality. It also helps in quantifying prevailing burden of disease/ disease frequency (i.e., prevalence, incidence rate, incidence density rate) in a considered region. Study designs are classified mainly based on evidence regarding involvement of comparison group; control of exposure (e.g., treatments) in the hand of the researcher (yes/no); exposure precedes outcome (e.g., cure) or not; use of randomization (yes/ no); timing of data collection (i.e., before occurrence of exposure and outcome; or otherwise); and direction of data collection between exposure and outcome. Taking into account these considerations, the focus of the present write-up is to briefly describe various study designs and related merits and demerits so that researchers can be aware and make use of them to specify study designs of their planned clinical studies accurately.

Difficult to Treat Tuberculosis: A Challenging Vignette in Indian Context

Mustafa Singapurwala — 2024-12-17

The magnitude of TB disease, including drug resistance, is huge and alarming in India, being the highest-burden country. The steps taken during the initial decades after getting independence in 1947 were slower and not very effective which is reflected in the timeline depicting changes (from NTP to RNTCP and then NTEP) in India’s TB control policies. India has been proactive for the last couple of years with strong scientific, political and financial support in its battle against TB with the ‘WHO End TB Strategy’. To achieve an ambitious goal of eliminating TB by 2025, the program has adopted a multifaceted approach that includes early detection of DSTB and DRTB cases with the genexpert diagnostics, use of potent regimen and preventive care of household contacts. However, a simultaneous multi-dimensional uplift of socioeconomic, educational, nutritional status, personal health and hygiene etc., of the community is not to be ignored. A vignette case of TB with multiple complicating events during management is included to highlight the problem of managing difficult-to-treat TB cases. The role of multidisciplinary specialist expert committee support to deal with adverse drug reactions (ADR) due to newer anti-TB (Bedaquiline, delamanid/pretomanid), use of repurposed antibiotics and efficacious management of comorbidities is also being recognized to strengthen the program. Potent new anti-TB drugs to shorten the duration of treatment, quick diagnostics tools, and effective preventive vaccine with a strong infrastructure laboratory network are the urgent needs of the day

High-Grade Appendicular Mucinous Neoplasia (jelly belly): A Rare Case Report

Sudarshan Odiya — 2024-12-17

Introduction: Primary neoplasms of the appendix are present in less than 2% of surgical appendectomy specimens. The major categories of primary neoplasms include epithelial tumors, mesenchymal tumors and lymphomas. Mucinous neoplasms of the appendix are a complex, diverse group of epithelial neoplasms often causing cystic dilation of the appendix due to accumulation of gelatinous material, morphologically referred to as mucoceles. A case of High grade Mucinous Neoplasia of appendix with Pseudomyxoma peritonei is presented with a discussion of the histologic and radiologic features as well as the surgical management.
Material and Methods: This is a case report of Patient with Appendicular mucinous neoplasia with pseudomyxoma peritonei diagnosed in an elderly with it’s surgical management.
Discussion: Appendiceal mucinous neoplasms are a heterogeneous group of neoplasms ranging from simple mucoceles to complex pseudomyxoma peritonei. Mucoceles are subset that consists of gradual cystic dilation of the vermiform appendix due to slow accumulation of mucoid contents. It is uncommonly seen, occurring in between 0.2% and 0.4% of appendectomies and 0.3 %and 0.7% of all appendiceal pathology. The classification of mucinous neoplasms of the appendix is controversial and different terminologies have been used to describe these lesions. Recent efforts to build a consensus naming system have led to the development of a classification system that includes LAMN, HAMN, and mucinous adenocarcinomas.
Conclusion: In conclusion, Classification and taxonomy of mucinous neoplasms is complex and controversial. Distribution of mucin and the presence of nodal and visceral metastases beyond the peritoneum help to differentiate low-grade and high-grade PMPs. PMP with simultaneous appendix and ovarian neoplasm should be treated as a primary appendiceal tumor. Clear communication between the radiologist, pathologist and surgeon is important for optimal patient manageme.

Autoimmune Hemolytic Anemia in 62 Year Old Lady with Mixed Connective Tissue Disorder with Subclinical Hypothyroidism: A Rare Presentation

Vipin Porwal — 2024-12-17

Mixed connective tissue disease (MCTD) is an overlap syndrome characterized by the presence of U1RNP antibody with features of polymyositis, scleroderma, and systemic lupus erythematosus. A female 62-year-old patient presented with generalized body weakness since 4 months and shortness of breath for 3 months. The patient had a history of repeated blood transfusions, in view of a clinical history of recurrent blood transfusion with hypothyroidism (anti-TPO positive) with direct coomb test positive with ANA positive. She is a case of autoimmune hemolytic anemia. ANA immunoblot shows U1RNP positive, suggestive of mixed connective tissue disorder. She responded well with prednisolone (1-mg/kg) with a tapering dose.

A Rare Case Report-Idiopathic CD4 Lymphocytopenia Leading to Disseminated Histoplasmosis

Shivangi Tiwari — 2024-12-17

Histoplasmosis, a granulomatous mycosis caused by the intracellular dimorphic fungus Histoplasma capsulatum, has not been reported in Indian literature. The clinical spectrum of histoplasmosis varies from asymptomatic infections to disseminated histoplasmosis (PDH), depending on the intensity of the injury and the immunity of the exposed person. Infections most often occur in immunocompromised individuals, especially those with compromised immune systems such as HIV with low CD4+ lymphocytes, malignancies, or those who have received other immunosuppressive therapies. Keeping a high clinical suspicion regarding a differential diagnosis of histoplasmosis is required to prevent misdiagnosis, particularly in high-risk patients and initiate early antifungal therapy, which ameliorates the patient’s prognosis. Here, we present a case report of a middle-aged diabetic man who presented in our institute as a referral case from a private hospital with complaints of anorexia, fatigue, low-grade fever and decreased urination for 2 months with subsequent weight loss. His bone marrow biopsy confirmed infiltration with H. capsulatum. Subsequent 6 week apart CD4 counts were less than 300/mm3 without HIV-positive status or other acquired immunodeficiency, consistent with idiopathic cd4 lymphocytopenia. After a varied clinical course of intensive care stay, the patient was well treated with antifungal medications, showed remarkable improvement and was subsequently discharged in good condition.

Dilemma in Diagnosis Surprise at Histopathology

J.K. Saluja — 2024-12-17

A 65-year post-menopausal woman presented in the Gynaecology OPD of RD Gardi Medical College, Ujjain, with complaints of pain, a lump in her lower abdomen along with difficulty of micturition, defecation and vaginal bleeding for 4 years. She has had a known case of hypertension for 10 years and is taking treatment. Clinically diagnosed as 20 weeks size uterine fibroid, ultrasonography reported 11 to 14.5 cm fibroid, and MRI showed degenerating fibroid. The patient was managed by abdominal hysterectomy with bilateral salpingo-oophrectomy. The post-operative period was uneventful. Histopathology reported leiomyosarcoma. The patient was discharged and followed by chemotherapy.