St. John's College, Agra

Introduction Melanoma arising in blue nevus (BN) is usually evident on histopathology. However, there are cases in the gray zone where neither morphology nor immunostains and molecular studies are conclusive. Case Report A 33-year-old man presented with greenish discoloration of the abdominal skin at birth. Over time, the lesion increased in size to involve the entire left half of the abdomen, extending to the back and chest wall. He noticed nodules beneath the lesion, which were enlarging. Magentic resonanace imaging showed a lesion within the left external oblique measuring 8.3 × 6 × 4 cm and smaller lesions in the adjacent muscular planes. Gross examination of the excision showed an 8 × 6.5 × 5 cm brown-black, intramuscular nodule. Histopathology showed a BN of the overlying skin extending into the subcutis. The intramuscular nodule showed infiltrative, cellular areas with nonpigmented, plump spindle cells in nests and pseudorosettes with focal necrosis. There was minimal pleomorphism and prominent eosinophilic nucleoli. Mitoses were scarce. The neoplastic cells expressed Melan A, S100, and HMB45 with a low proliferative index (<1%). The lack of atypia and mitoses, despite clinically suspicious for melanoma, lead us to perform comparative genomic hybridization, which showed an abnormality suggesting malignancy. The patient remains with localized disease 6 years after surgery and no distant metastases. Conclusions Cellular nodules in a plaque-like blue nevus presenting as an intramuscular mass is hitherto unreported. It is prudent to follow-up such cases like a melanoma, despite lacking overt atypia and mutations, because metastases have been reported as late as 16 years after diagnosis.

Despite India's overall economic growth and targeted antimalnutrition efforts, certain districts in Chhattisgarh, exhibit high severe acute malnutrition (SAM) rates, at 17.4% in 2022 per NFHS-5 data. We retrospectively studied four SAM-affected children, finding common factors: maternal malnutrition, poverty, recurrent infections, poor child-rearing knowledge, inadequate birth spacing, and the use and dependence on processed foods. The prevalence of these foods alongside declining traditional feeding practices highlights a "Nutrition Paradox."

Introduction: Tibia plateau fractures are complex knee injuries and have been classified by Schatzker's. The objective of treatment remains anatomical reduction, and limb alignment with stable fixation.This article is used in posteromedial tibial plateau fractures to evaluate the functional and radiological outcome using posteromedial approach in prone position. Methodology: A quasi-prospective review of 22 patients with posteromedial proximal tibia condyle fractures from June 2021 to December 2022 and were followed up for 1 year. Variables assessed included patient age, type of fracture according to Schatzker's classification, functional and radiological outcome according to Rassmussen's scoring system. Results: 6 patients out of 22 patients with type IV fracture had a mean radiological score of 18 points while 9 patients with type V fracture had 14 points. 11(91.47%) of them had excellent score and 1 of them (8.3%) had good score, out of 12 patients with Schatzker type IV fracture. 3 of them (50.0%) had excellent score while the other 3(55.6%) had good scores, Out of 6 patients with Schatzker fracture type V. Of the 4 patients with type VI fracture, 1(25%) had excellent score and 3(75%) had a good score. The posteromedial approach in p Conclusion: rone position (Lobenhoffer approach and Burks and Schaffer approach) is considered a safe and efficient approach. The approach allows anatomical reduction of the posteromedial fragment using the posterior buttressing plate while protecting the neurovascular bundle.

Background: Rotator cuff tears, with a prevalence of 20.7% in the general population, significantly impact daily activities and quality of life. Arthroscopic rotator cuff repair (ARCR) is widely used due to its benefits in reducing post-operative pain and facilitating early rehabilitation. This cohort study aimed to assess the correlation between the postoperative strength of the rotator cuff muscles and the functional outcomes post-ARCR. Methodology: A total of 34 patients were evaluated, with 26 completing the study. Preoperative and six-month postoperative assessments included isokinetic and isometric strength measurements, along with functional scores such as the Constant and American Shoulder and Elbow Surgeons (ASES) scores. The results showed significant improvements in both strength and functional outcomes, Results: with the Constant score increasing by 38 points and the ASES score by 53.8 points postoperatively. However, no significant correlation was found between the improvement in rotator cuff strength and the functional outcome scores. The study highlights the effe Conclusion: ctiveness of ARCR in improving both strength and functional outcomes, though it suggests that factors other than muscle strength may influence functional recovery

How to cite this article: Havaldar AA. Is Red Cell Distribution Width the Universal Biomarker of Disease Severity and Outcome? Indian J Crit Care Med 2024;28(12):1087–1088.

In the intensive care unit (ICU), acute kidney injury (AKI) is the most common cause of morbidity and mortality. Hospital-acquired acute kidney injury (HAAKI) is AKI developing after 48 h. We aimed to study the development of AKI and its associated risk factors. We conducted a longitudinal observational study. Inclusion criteria were patients > 18 years of age admitted to ICU. The primary outcome was the development of AKI as defined by Kidney Disease Improving Global Outcomes (KDIGO) criteria. A total of 273 patients were included in the study. Out of 273, 44(16.11%) patients developed AKI. The mean age was 45.80(17.39) years, and 60.81% were males. The median acute physiology and chronic health evaluation (APACHE II) and sequential organ failure assessment (SOFA) scores were 12(8–18) and 5(3–7), respectively. Diabetes mellitus (23.44%) and hypertension (23.81%) were predominant comorbidities. The risk factors associated with AKI were serum chloride level, colistin, invasive ventilation, positive end-expiratory pressure (PEEP), and fluid balance. The hospital mortality was significantly higher in patients with AKI (43.18%) as compared with no AKI (14.41%). Among the secondary outcomes, 7 (15.90%) patients required renal replacement therapy (RRT) during hospitalisation. The length of ICU stay was higher in patients with AKI 8(5–13) compared to no AKI 5(3–8). A total of 16.11% developed HAAKI, and mortality was 43.18%. Post 6 months follow-up of AKI patients, mortality was 23%. Among survivors none of the patients were on RRT.Patients admitted with normal kidney function can develop AKI. Hence, careful monitoring of ICU patients is necessary.

Making a person with quadruple amputation walk again is a challenging task for the rehabilitation team. Quadruple amputation secondary to symmetrical peripheral gangrene is a rare clinical scenario posing challenges in rehabilitation. Literature regarding rehabilitation of persons with multiple amputations is limited. This case describes the rehabilitation of a 57-year-old lady suffering from acute myeloid leukaemia who underwent quadruple amputation. She had undergone bilateral transtibial and bilateral transradial amputation after vasopressor-induced symmetrical peripheral gangrene. In view of expected guarded level of functional independence, ambulatory independence was the primary goal at admission to Department of PMR. The various steps taken in rehabilitation and modifications made to assistive devices are described in this article. Challenges faced during various phases of training, and subsequent ambulation are detailed in this article. Overcoming limitations, the client was made to be an indoor ambulator with appropriate prostheses and mobility aids. She was partially independent for activities of daily life after in-patient rehabilitation. The background of leukaemia and subsequent chemotherapy also affected the rehabilitation of this patient. Although various studies have described cases of quadruple amputation rehabilitation achieving functional independence and ambulation, the absence of specific guidelines and protocols make rehabilitation of persons with multiple amputations inefficient. This case study also shows the need for personalized goal setting for persons with multiple amputations. Realistic goal setting, psychological counselling, and an interdisciplinary approach are imperative in rehabilitation of persons with quadruple amputation. Flexible functional scales specific to persons with multiple amputations are necessary to evaluate such persons objectively. Studies with larger sample size, longer follow-ups, and comprehensive review of existing literature are needed to standardize rehabilitation of quadruple amputation and evaluate the various factors that may affect rehabilitation outcome.

Background About 16% of worldwide dementia cases are in India. Evaluating the prospects for dementia prevention in India requires knowledge of context-specific risk factors, as relationships between risk factors and dementia observed in high-income countries (HICs) may not apply. Methods We computed population attributable fractions (PAFs) for dementia in India by estimating associations between risk factors and dementia, their prevalence and communality, within the same nationally representative sample of 4096 Indians aged 60 and older, surveyed through the Harmonised Diagnostic Assessment of Dementia for the Longitudinal Ageing Study in India. Results The risk factor with the largest PAF (>20%) was no education, followed by vision impairment (14%), physical inactivity (12%) and social isolation (8%). According to our estimates, eliminating exposure to risk factors significantly associated with dementia would potentially prevent up to 70% of dementia cases in India. Discussion Previous estimates, based on samples limited to specific geographic areas and using risk factors’ definitions and relative risks from HICs, may not correctly estimate the real opportunities for preventing dementia in India or identify the most critical areas for intervention.

Nail involvement is seen in 10% of lichen planus patients, with a subset developing severe destruction of the nail matrix. Nail biopsy is a complex procedure usually done when nails are the only site of involvement. The pathology of nail lichen planus (NLP) has been the subject of very few studies. Most studies refer to the major and minor histopathologic criteria proposed by Hanno et al. This study aims to characterize the histopathologic features of NLP. Twenty five patients of NLP with nail biopsies, diagnosed in the last 10 years were included in the study. Lichen planus was suspected in all patients, and the alternative diagnosis was psoriasis/onychomycosis and melanoma. On histopathology, the common features included acanthosis (88%), lichenoid lymphocytic inflammation (96%), and hypergranulosis (72%). Detachment of epithelium from the subepithelium, a hitherto unreported feature, was noted in 60% of cases. Less common features were lymphocytic exocytosis (48%), melanophages (40%), basal vacuolar alteration (24%), apoptotic keratinocytes (28%), fraying of the nail plate (24%), and spongiosis (20%). Understanding the common and less common histopathologic features and their correlation with clinical findings is essential to diagnose NLP accurately rather than stressing histologic criteria as major/minor, which may lead to the underdiagnosis of cases.

Self-efficacy plays a vital role in patients with Schizophrenia to overcome the problems that arise related to illness. Selfefficacy is the belief of an individual that he or she can perform a task to reach a goal. High social self-efficacy in daily life has a significant relationship with the quality of life of Schizophrenic patients where low self-efficacy can result in maladaptive coping. The success of the treatment is also largely decided by the level of self-efficacy. Evidence shows that the patient needs good self-efficacy to be able to control their behavior that will support in healing process. The purpose of this article is to discuss self-efficacy among patients with Schizophrenia and how it affects one's life as well as the steps to be taken to empower self-efficacy on patients with Schizophrenia.

This article provides an overview of neurosurgical therapies for movement disorders (MDs), including Tourette syndrome, dystonia, Parkinson's disease (PD), and others. It focuses on the benefits of these treatments and suggests directions for further research. A total of 10 years' worth of English-language PubMed articles were combed through, with an emphasis on studies conducted in North America. To manage MDs like Parkinson's disease and Tourette syndrome, the results suggest that non-invasive neuromodulation techniques, closed-loop deep brain stimulation (DBS), and other advanced therapies may become the treatment of choice in the future. Research on dystonia is being focused on improving treatment methods by investigating new areas of the brain that might be stimulated through neurosurgery and looking at gene therapy. Modern technological developments, such as non-invasive neuromodulation procedures and improved imaging, provide promising substitutes for traditional surgical approaches. This study highlights the need for continuous clinical trials for better outcomes, which is why research and development in this area must continue.

Background Anterior cruciate ligament (ACL) injuries are prevalent, especially among active individuals, and are increasingly observed even in Indian women who are not active in sports. ACL reconstruction (ACLR) is commonly performed using various graft options, but optimal choices for women remain debated. The aim of our study was to examine the use of the peroneus longus tendon as an autograft for ACLR in Indian female patients. Materials and methods A prospective cohort study was carried out on 44 non-athlete female patients who met the inclusion criteria. The study evaluates functional outcomes using the International Knee Documentation Committee (IKDC), Lysholm-Tegner, and American Orthopaedic Foot and Ankle Society (AOFAS) scores, as well as knee stability through clinical tests, over a one-year postoperative period. Results The study demonstrates significant improvements in knee function, with substantial increases in IKDC and Lysholm-Tegner scores from preoperative levels (p-value < 0.01), and effective restoration of knee stability, as shown by improved Lachman, Anterior Drawer, and Pivot Shift test results. Moreover, the peroneus longus graft had minimal impact on ankle morbidity, as indicated by consistent AOFAS scores before and after surgery. Conclusion The study highlights the peroneus longus tendon as a viable graft option for ACLR in symptomatic Indian female patients who were not active in sports, offering both mechanical strength and favorable functional outcomes without affecting the ankle strength or the function.

Objectives To assess the impact of nutritional and multiple-micronutrient supplementation to lactating mothers on the micronutrient status of mother–infant dyad at 6 months of age postnatally. Design This study was a trial that aimed to investigate the impact of maternal nutritional supplementation on infant growth. A secondary objective was to assess the effect on the micronutrient status of mother–infant pairs. The intervention group mothers received snacks with 600 kcal energy, 20 g protein and daily micronutrient tablets. Setting Blood samples were collected from both mothers and infants at 6 months. Participants The participants in this study were mother–infant pairs. The micronutrient status of these pairs was assessed through blood samples, focusing on vitamins A, D, B 12 , ferritin, Zn and folate. Results Micronutrient analysis of serum samples from 600 mother–infant pairs showed that mothers in the intervention group had higher levels of serum ferritin (mean difference (MD) 14·7 ng/ml), retinol (MD 0·6 μmol/l), folate (MD 3·3 ng/ml) and vitamin D (1·03 ng/ml) at 6 months postpartum. Additionally, the supplementation was associated with a higher mean ± sd of serum ferritin (MD 8·9 ng/ml) and vitamin A (MD 0·2 μmol/l) levels in infants at 6 months. Conclusions The study found that supplementing maternal nutrition with additional dietary and micronutrient intakes during lactation improved maternal micronutrient status and slightly increased ferritin and vitamin A levels in infants at 6 months. The findings highlight the importance of nutritional interventions for improving the micronutrient health of mother–infant pairs, with significant public health implications. Trial registered at www.clinicaltrials.gov (CTRI/2018/04/013095).

BACKGROUND: Tele-neurorehabilitation (TNR) allows for remote delivery of rehabilitation services for those with neurological disabilities. Despite growing global interest and uptake, its adoption remains challenging in Low-and-Middle-Income-Countries (LMICs). OBJECTIVE: To explore available literature on the nature of training and education, research and practice of TNR in LMICs. METHODS: Following PRISMA-ScR guidelines and predefined selection criteria, four databases were screened. Quality assessment was performed using the Joanna Briggs Institute tools. Relevant data was extracted to using a data extraction form in Microsoft Excel and were narratively synthesised under Education/training, Research and Clinical Practice of TNR. RESULTS: We identified no formal structured training courses/programs for TNR users/providers. Sessions were mainly delivered as part of a research project. The included studies highlighted the need to engage stakeholders in TNR research and improve digital-literacy among healthcare providers/users. Development and use of clinical decision-making-tools, models of TNR suitable for varied populations and prior area-mapping were a few suggestions for clinical/research practice. CONCLUSION: There is an immense need to develop academic/structured programs for TNR to build capacity among providers/users in LMICs. Practice must adhere to principles of safety, effectiveness, and based on high quality clinical-guidelines suitable to the context to ensure optimal uptake and practice of TNR in LMICs.