scholarly journals Hysterical Visual Loss and Malingering - Diagnostic Dilemma for an Ophthalmologist

2021 ◽  
Vol 10 (38) ◽  
pp. 3449-3453
Author(s):  
Deepak Kumar Sharma ◽  
Pankaj Kumar Thakur ◽  
Anubhav Chauhan ◽  
Anchit Wapa ◽  
Gian Chand Rajput
Keyword(s):  
Visual Loss ◽  
Vision Loss ◽  
Pathological Condition ◽  
Tertiary Care ◽  
Anterior Segment ◽  
Field Analysis ◽  
North India ◽  
Careful Examination ◽  
Routine Practice ◽  
Visual Disorder

BACKGROUND Attenuation of vision may be due to underlying organic condition or due to functional visual disorder or malingering if secondary gain is associated. Causes of pathological vision loss include advanced primary open angle glaucoma, hereditary macular dystrophies and optic neuropathies. Problem in establishing diagnosis is faced where superimposition of organic and functional visual loss is there. Distinction between functional visual loss and pathological visual loss is made by thorough and careful examination of the patient by applying basic rules and tools of ophthalmology in which examining surgeon is well versed, but patient is unaware. During routine practice, every ophthalmologist encounters patients with nonorganic vision loss. The purpose of the article is to demonstrate how to distinguish between normal visual function without missing any organic visual loss. Examination of such patients requires number of tests including baseline visual acuity, pupillary reactions, slit lamp examination of anterior segment, fundus examination, visual field analysis, optical coherence tomography, visual evoked potential and electroretinography. By proving integrity and functioning of visual system, diagnosis of functional visual loss can be confirmed. Once the conclusive diagnosis is established, it is to be revealed with caution to the patient/patient’s attendant as it can lead to medico legal issues. Here, we present series of cases who presented to us in a tertiary care center of North India during a period of six months in the year of 2019 where case 1 and case 2 presented with decreased vision due to underlying pathological condition, case 3 presented with reduced vision due to functional visual disorder. Case 4, 5 and 6 provided decisive evidence of malingering. KEY WORDS Fogging, Hysterical Visual Loss, Malingering, Menace Reflex, Optokinetic Nystagmus.

scholarly journals Primary Extranodal Non-Hodgkin Lymphomas: A First Tertiary Care Experience from Punjab, North India

2020 ◽  
Vol 09 (04) ◽  
pp. 230-232
Author(s):  
Vikram Narang ◽  
Aminder Singh ◽  
Neena Sood ◽  
Bhavna Garg ◽  
Harpreet Kaur ◽  
...  
Keyword(s):  
B Cell ◽  
Tertiary Care ◽  
Cell Lineage ◽  
B Cell Lymphoma ◽  
Extranodal Lymphoma ◽  
North India ◽  
Routine Practice ◽  
Care Experience ◽  
Predominant Subtype ◽  
Extranodal Lymphomas

Abstract Background Primary extranodal lymphomas are less frequently encountered and difficult to diagnose in routine practice. The histopathological and immunohistochemical studies are essential in addition to clinical details to diagnose. The incidence is varied in different parts of India along with variation in histopathological spectrum. Methodology The clinical features and histopathological findings of patients diagnosed with primary extranodal lymphoma over 3-year period were retrieved from archives of pathology department and analyzed. Results During the 3-year study period, a total of 135 cases of non-Hodgkin lymphomas were evaluated, and of these, 41.4% (56/135) of cases presented with primary extranodal involvement. The mean age of primary extranodal lymphoma presentation was 61.3 ± 17.5 with M:F ratio of 1:1.1 Most common extranodal site involved was gastrointestinal tract 32.1%, 18/56 (small intestine [17.8%, 10 cases] and large intestine [8.9%, 5 cases]). Non-Hodgkin lymphomas of B cell type were the predominant subtype (48/56, 85.7%), while 8/56 (14.2%) cases were of T cell lineage. Of the B cell non-Hodgkin lymphoma diffuse, large B cell lymphoma was the predominant subtype constituting ~83.3% (40/48). Conclusion Primary extranodal lymphomas exhibit varied histomorphological and clinical presentation. The present study is first such analysis from Punjab that intends to compare with studies from other parts of India.

scholarly journals Comparative evaluation of composite and simplified who partograms in a tertiary care centre in North India

2017 ◽  
Vol 6 (11) ◽  
pp. 5003
Author(s):  
Prachi Sarin Sethi ◽  
Sujata Sharma ◽  
Indu Chawla
Keyword(s):  
Perinatal Outcome ◽  
Randomized Study ◽  
Tertiary Care ◽  
North India ◽  
Routine Practice ◽  
Care Centre ◽  
Tertiary Care Centre ◽  
Medical College ◽  
Vaginal Deliveries ◽  
Latent Phase

Background: Early detection of abnormal progress and prevention of prolonged labour can significantly improve the outcome of labour. Partograph is an inexpensive tool which can provide a continuous pictorial overview of labour and is essential to monitor and manage labour. The objectives were to study the course of normal and abnormal labour and to evaluate the maternal and perinatal outcome using simple and composite WHO partogram.Methods: This was a randomized study conducted at Department of Obstetrics and Gynaecology, Government Medical College, Amritsar, a tertiary care centre in North India. 200 women with term, singleton, vertex gestation, in spontaneous labor were included in the study. In 100 cases composite partograph was plotted and in rest 100 cases simple partograph was plotted. The following outcomes were compared: labor crossing the alert and action line, augmentation of labor, rate of cesarean section, perinatal and maternal outcome.Results: The partogram crossed the alert line (p 0.008) and action lines (p 0.017), causing increased need for augmentation (p 0.034) in the composite partogram which was statistically significant. The numbers of vaginal deliveries were high (p<0.001) and decrease number of cesarean sections (p 0.007) and instrumental deliveries (p 0.009) in the simplified group. NICU admissions were also higher in the composite group (p<0.05), though most of the NICU admissions were due to hyperbilirubinemia and low birth weight and was not directly related to monitoring of labour.Conclusions: It was observed in the present study that labour can be managed without the latent phase being plotted on the partograph. The interventions were higher when the latent phase was included, with increased number of labours crossing the alert and action lines, increased no. of augmentations and larger number of caesarean sections. Our study favours the use of the WHO modified partograph, which should become routine practice in monitoring labour for better maternal and perinatal outcome.

Emerging Antimicrobial Resistance Among Methicillin Resistant Staphylococcus Aureus (MRSA) in a Tertiary Care Centre in North India

JMS SKIMS ◽  
2020 ◽  
Vol 23 (1) ◽  
pp. 48-49
Author(s):  
Javaid Ahmad Bhat ◽  
Shariq Rashid Masoodi
Keyword(s):  
Staphylococcus Aureus ◽  
Antimicrobial Resistance ◽  
Tertiary Care ◽  
Resistance Mechanisms ◽  
North India ◽  
Global Public Health ◽  
Care Centre ◽  
Tertiary Care Centre ◽  
Effective Prevention ◽  
Mupirocin Resistance

Apropos to the article by Dr Bali, titled “Mupirocin resistance in clinical isolates of methicillin-sensitive and resistant Staphylococcus aureus in a tertiary care centre of North India” (1), the authors have raised important issue of emerging antimicrobial resistance (AMR). Antimicrobial resistance is an increasingly serious threat to global public health that requires action across all government sectors and society. As per WHO, AMR lurks the effective prevention and management of an ever-increasing spectrum of infections caused by bacteria, parasites, fungi and viruses. Novel resistance mechanisms are emerging and spreading globally, threatening the man’s ability to treat common infectious diseases.

The Spectrum of Skin Biopsies from a Tertiary Care Hospital in North India

2016 ◽  
Vol 2 (5) ◽  
Author(s):  
Abhilasha Williams ◽  
Anuradha Bhatia ◽  
EmyAbi Thomas ◽  
Clarence J Samuel
Keyword(s):  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
North India ◽  
Care Hospital ◽  
Skin Biopsies

Evaluation of Various Diagnostic Techniques for the Diagnosis of Pulmonary and Extra Pulmonary Tuberculosis at a Tertiary Care Center in North India

2020 ◽  
Vol 20 (4) ◽  
pp. 433-439
Author(s):  
Monika Rajani ◽  
Molay Banerjee
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Diagnostic System ◽  
Diagnostic Techniques ◽  
Automated System ◽  
North India ◽  
Mortality And Morbidity ◽  
Indicator Tube ◽  
Extra Pulmonary ◽  
Uv Lamp

Introduction: Tuberculosis (TB) is a one of the main causes of mortality and morbidity worldwide. Bactec MGIT (Mycobacteria Growth Indicator Tube) system is a rapid, reliable automated system for early diagnosis of pulmonary and extra pulmonary TB in setups where purchase of expensive instruments is not possible. The present study was thus carried out to evaluate AFB microscopy, culture on Lowenstein Jensen media and micro MGIT system for early and accurate diagnosis of Tuberculosis. Methods: A total of 280 samples were processed for direct AFB smear examination, and culture on micro MGIT and LJ media. The identification of Mycobacterium tuberculosis complex in positive cultures was done by MPT64 Ag card test (BD MGIT TBC Identification Test). Results: Out of the processed samples, (47.1%) 132/280 were positive for Mycobacterium spp by Micro MGIT, (35%) 98/280 on LJ medium and (25.7%) 72/280 by AFB smear. A total of (48.5%) 136 samples were positive by a combination of Micro MGIT and LJ medium. Among the total positive samples (136/280), Micro MGIT was found to be positive in 97% (132/136) of samples, LJ was positive in 72% (98/136), while 52.9% (72/136) were positive by AFB smear. Conclusion: Manual MGIT System is a simple and efficient, safe to use the diagnostic system. It does not require any expensive/special instrumentation other than the UV lamp for the detection of fluorescence. In areas with limited resources where the purchase of expensive instruments such as the MGIT 960 is out of scope, the use of manual MGIT for rapid susceptibility testing for MDR-TB could be an option. We would recommend testing MGIT 960 using first and secondline drugs to determine DST.

Seroprevalence of anti-SARS-CoV-2 IgG antibodies in hospitalized patients at a tertiary referral center in North India (Preprint)

2020 ◽  
Author(s):  
Dr. Animesh Ray ◽  
Dr. Komal Singh ◽  
Souvick Chattopadhyay ◽  
Farha Mehdi ◽  
Dr. Gaurav Batra ◽  
...  
Keyword(s):  
Tertiary Care ◽  
Age Groups ◽  
Hospitalized Patients ◽  
North India ◽  
P Value ◽  
Care Hospital ◽  
Igg Antibodies ◽  
Igg Antibody ◽  
Increased Risk ◽  
Significant Difference

BACKGROUND Seroprevalence of IgG antibodies against SARS-CoV-2 is an important tool to estimate the true extent of infection in a population. However, seroprevalence studies have been scarce in South East Asia including India, which, as of now, carries the third largest burden of confirmed cases in the world. The present study aimed to estimate the seroprevalence of anti-SARS-CoV-2 IgG antibody among hospitalized patients at one of the largest government hospital in India OBJECTIVE The primary objective of this study is to estimate the seroprevalence of SARS-CoV-2 antibody among patients admitted to the Medicine ward and ICU METHODS This cross-sectional study, conducted at a tertiary care hospital in North India, recruited consecutive patients who were negative for SARS-CoV-2 by RT-PCR or CB-NAAT. Anti-SARS-CoV-2 IgG antibody levels targeting recombinant spike receptor-binding domain (RBD) protein of SARS CoV-2 were estimated in serum sample by the ELISA method RESULTS A total of 212 hospitalized patients were recruited in the study with mean age (±SD) of 41.2 (±15.4) years and 55% male population. Positive serology against SARS CoV-2 was detected in 19.8%patients(95% CI 14.7-25.8). Residency in Delhi conferred a higher frequency of seropositivity 26.5% (95% CI 19.3-34.7) as compared to that of other states 8% (95% CI 3.0-16.4) with p-value 0.001. No particular age groups or socio-economic strata showed a higher proportion of seropositivity CONCLUSIONS Around, one-fifth of hospitalized patients, who were not diagnosed with COVID-19 before, demonstrated seropositivity against SARS-CoV-2. While there was no significant difference in the different age groups and socio-economic classes; residence in Delhi was associated with increased risk (relative risk of 3.62, 95% CI 1.59-8.21)

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