International Journal of Current Pharmaceutical Research

ASSESSMENT OF KNOWLEDGE, ATTITUDE AND PRACTICE (KAP) IN PHARMACOGENOMICS AMONG MEDICAL STUDENTS IN A TEACHING HOSPITAL-A CROSS-SECTIONAL OBSERVATIONAL STUDY

2024-03-16T13:20:41+0530

Objective: Pharmacogenomics is a field of personalized medicine where individual’s genomic profile is used to guide therapeutic prescription with the goals of increasing efficacy and decreasing toxicity and progressively moving into mainstream clinical practice. Many medical students are not familiar with implications of pharmacogenomics in therapeutic effectiveness. This survey was designed and administered to assess knowledge, attitude and practices among phase 3 MBBS students (undergraduates/UGs) and postgraduates (PGs).

Methods: A Cross-sectional Observational study was conducted among Phase 3 MBBS students (n=110) and PGs (n=46). Data was collected through validated questionnaire and analyzed for their knowledge, attitudes and practices pertaining to Pharmacogenomics. SPSS version 21 and the Chi-square test was used to test the significant difference between the two groups. p value<0.05 was taken as statistically significant.

Results: From the data analyzed, about 85% of undergraduates and 89% of post-graduates have adequate knowledge on Pharmacogenomics. Both the groups had positive attitude (91% and 93%) towards Pharmacogenomics. In the cluster which evaluated the practice the positive response of agree/strongly agree were 75% and 74%, respectively. There was no significant difference between the two groups for KAP on Pharmacogenomics.

Conclusion: Awareness programmes need to be conducted to educate the undergraduates and PGs as attitude is more positive than their knowledge, and practice of pharmacogenomics. This helps to improve the choice of drug, keeping in mind the genetic profile of the patient to reduce the adverse effects, morbidity and mortality and to promote tailor-made personalized therapy.

COMPARATIVE EVALUATION OF SEVOFLURANE AND ISOFLURANE IN FAST TRACK ANAESTHESIA FOR VALVULAR CARDIAC SURGERY: A RANDOMIZED STUDY

2024-03-16T13:56:23+0530

Objective: Contemporary valvular cardiac surgery has evolved with the adoption of expedited postoperative recovery, known as fast-tracking. This paradigm shift results from advancements in anaesthetic agents, surgical techniques, and myocardial protection strategies. Fast-track anaesthesia aims to reduce intensive care unit (ICU) stays and overall hospital length of stay (LOS), optimizing resource utilization. Cardioprotective properties of volatile anaesthetic agents, especially in mitigating ischemic myocardial damage, have garnered attention.

Methods: A hospital-based, randomized, comparative study was conducted at the Department of Anaesthesiology, S. M. S Medical College, Jaipur. 70 undergoing valvular heart surgery under general anaesthesia, were randomly assigned to two groups: Group A (Sevoflurane) and Group B (Isoflurane). Inclusion criteria encompassed ASA grade II to IV patients aged 20 to 50 y, with a body weight of 30-65 kg, and willingness to provide written consent. Anaesthesia induction and maintenance involved the administration of Sevoflurane or Isoflurane based on group allocation. Hemodynamic parameters were recorded at various surgical stages.

Results: Heart rate, systolic blood pressure, and cardiac output were statistically insignificant between groups at different surgical stages (p>0.05). Intraoperative variables demonstrated no significant differences, except for a transient decrease in systolic blood pressure post-induction in both groups.

Conclusion: The study underscores the comparable efficacy of Sevoflurane and Isoflurane in valvular cardiac surgery, supported by similar hemodynamic profiles. Understanding the nuances of volatile anaesthetic agents is crucial for their optimal clinical application, considering challenges like beta-blocker usage and perioperative hyperglycemia.

A COMPARATIVE STUDY BETWEEN CLONIDINE AND DEXMEDETOMIDINE AS AN ADJUVANT TO BUPIVACAINE IN BRACHIAL PLEXUS BLOCK THROUGH USG-GUIDED AXILLARY APPROACH

2024-03-16T14:13:19+0530

Objective: To improve the quality of block in regional anaesthesia, several adjuvants are added to local anaesthetic drugs. The effects of clonidine and dexmedetomidine were compared with regard to the onset and duration of sensory and motor block as well as the length of analgesia when used as an adjuvant to bupivacaine in brachial plexus block by axillary approach.

Objective: The present study was conducted to compare the onset time, duration and analgesic efficacy of clonidine vs dexmedetomidine when added as adjuvant to bupivacaine (0.5%) for USG guided brachial plexus by axillary approach.

Methods: This is a prospective, randomized; comparative study conducted in elective unilateral upper limb forearm and hand surgeries. The study was conducted at Government General Hospital, Srikakulam, between March 2023 to September 2023 after obtaining permission from the Institutional Ethics Committee and from the patients. Group BC received 30 ml of 0.5% bupivacaine with Clonidine 1µg/kg (n=30) and Group BD received 30 ml of 0.5% bupivacaine with dexmedetomidine 1µg/kg (n = 30). The onset and duration of sensory and motor block total duration of analgesia were studied in both groups.

Results: The mean time for onset of sensory block in Group BD was 4.7 min, which was lower than Group BC 8.47 min. The mean time for onset of motor block in Group BD was 9.63 min the mean time for total duration of sensory block in Group BD was 537.8 min. This was higher than the Group BC 319.1 min. The total duration of analgesia in Group BD was 666.27 min. This was higher than in Group BC 375.23 min. Bupivacaine dexmedetomidine group had better quality analgesia than the bupivacaine clonidine group.

Conclusion: The addition of Dexmedetomidine (1μg/kg) to bupivacaine (0.5%) in brachial plexus block by USG-guided axillary approach results in a shorter onset time for sensory and motor blockade, prolongs the duration of sensory and motor blockade and also total duration of analgesia.

ASSESSMENT OF KNOWLEDGE, ATTITUDE AND PRACTICE (KAP) OF NUTRIVIGILANCE AMONG PHASE-2 MBBS AND POSTGRADUATE STUDENTS OF A TERTIARY CARE HOSPITAL-A CROSS-SECTIONAL OBSERVATIONAL STUDY

2024-03-16T15:12:04+0530

Objective: Nutrivigilance is a new concept in India. Several adverse drug reactions (ADRs) arising due to the use of Nutraceuticals are undermined and under-reported by prescribers. Spontaneous reporting of ADRs forms the backbone of Nutrivigilance. This paper will examine the knowledge, attitude, and practice of nutrivigilance among medical students and postgraduate doctors and discuss the need, challenges, and opportunities for improving nutrivigilance in the future.

Methods: A Cross-sectional study was conducted between Phase-2 MBBS (UGs) and Postgraduates (PGs) of GMC, Ananthapuramu. The study tool was a validated questionnaire having 30 questions to evaluate KAP of Nutrivigilance. Data was collected in Google forms and was analyzed using SPSS 21 and P value<0.05 was taken as statistically significant.

Results: The results revealed poor knowledge on Nutrivigilance (UGs-16% and PGs-14%). The Attitude towards Nutrivigilance was equally positive (92%, 94%) in the two groups. Practice on Nutrivigilance was 54% and 52%, respectively. There was no significant difference in KAP on Nutrivigilance between the UGs and PGs.

Conclusion: UGs and PGs lack adequate knowledge and skill of reporting ADR, but both have a positive attitude towards Nutrivigilance programme. To increase awareness on the topic, Nutrivigilance and adverse reaction reporting of nutraceuticals must be added to the academic curriculum of undergraduate and postgraduates, thus improving the reporting and monitoring of ADRs by Nutraceuticals thus improving the health of the community.

PSYCHIATRIC COMORBIDITIES IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE

2024-03-16T15:34:52+0530

Objective: COPD often exists with comorbidities that may have a significant impact on prognosis. Patients with COPD are predisposed to both cognitive and psychiatric disorders. Anxiety and depression are common and important comorbidities in patients with chronic obstructive pulmonary disease (COPD). Regarding this, there is a lack of data from state of Himachal Pradesh.

Methods: Our study was a cross-sectional study wherein 100 patients who attended the Pulmonary Medicine outpatient clinic of IGMC, Shimla were recruited. Patients were evaluated using tools International Classification of Disease, 10^threvision, MINI 6.0, Addenbrooke's Cognitive Examination, Hamilton Anxiety Rating Scale, Hamilton Depression Rating Scale.

Results: About two-third (62%) of the patients were found to have psychiatric co-morbidities. The most common psychiatric co-morbidity was found to be mixed anxiety and depression in 20% of the patients followed by unspecified anxiety disorder in 12% of the patients,9% of the patients were diagnosed with dementia while 6% were found to have a major depressive disorder. As per our observation, the severity of anxiety and depressive symptoms as per the HARS scale and HAMD scales, respectively, increased as the severity of the disease increased.

Conclusion: The present study shows that about two third (62%) of the patients were found to have psychiatric co-morbidities. Psychiatric comorbidities have a significant impact on quality of life, exacerbation frequency and survival. Another multicentre large observational study can be planned in the future to overcome the above problems.

QUANTIFICATION OF HEPATITIS B AND HEPATITIS C VIRAL LOAD BY REAL-TIME PCR AND ASSESSMENT OF COINFECTION OF HBV AND HCV AMONG HIV-POSITIVE PATIENTS IN A TERTIARY CARE HOSPITAL

2024-03-17T12:05:09+0530

bjective: To assess the prevalence of coinfection of HIV-HBV and HIV-HCV and to estimate the viral load of HBV and HCV in PLWH.

Methods: A retrospective study was conducted from November 2021 to October 2022 among patients attending ICTC. 5 ml of blood sample collected aseptically was tested for HIV, HBV and HCV using rapid immunochromatographic tests, ELISA and viral load estimated by Real-time PCR.

Results: Out of 5087 samples tested for HIV, 666 samples (13.09%) were found to be positive. Prevalence of HIV-HBV and HIV-HCV coinfection was 15.6%(104 cases) and 1.5% (10 cases), respectively. Out of which, males were predominant (62.28%). This is clinically significant with a p-value of * 0.05. HIV-HBV and HIV-HCV coinfections were predominant in 41-50 y age group. Among104 HIV-HBV coinfected, viral load at the time of diagnosis is ‘below detection level’ in 25(24.04%), <250 in 15(14.42%), 251-500 in 9(8.65 %), 501-1000 in 13(12.5 %), 1001-10,000 in 23(22 %) and>10, 000 copies/ml in 19(18.26%). In 10 HIV-HCV coinfected cases, the viral load is ‘below detection level’ in 2(20%), <250 in 1(10%), 251-500 in 1(10 %), 501-1000 in 1(10 %), 1001-10,000 in 4(40%) and>10,001-100,000 copies/ml in 1(10%).

Conclusion: Monitoring the viral load in HBV or HCV infected at the time of diagnosis of HIV or testing for protective levels of antibodies post-vaccination in uninfected people will help in limiting the progression of chronic HBV or HCV to cirrhosis, end-stage liver disease or hepatocellular carcinoma.

STUDY OF ACUTE BACTERIAL MENINGITIS IN CHILDREN BY GRAM STAIN, CULTURE AND ANTIGEN DETECTION

2024-03-17T12:43:54+0530

Objective: Acute Bacterial Meningitis (ABM) is associated with a high mortality rate and morbidity in paediatric population despite recent advances in diagnostic methods, antimicrobial and supportive treatments and monitoring. This study is therefore undertaken to aid in rapid diagnosis of ABM by latex agglutination test (LAT) and to comparatively evaluate Gram stain, Culture and LAT in the diagnosis of ABM along with antibiotic susceptibility pattern of the isolates. We undertake this study in children with symptoms of meningitis to isolate and identify the pathogens in CSF and blood and to determine their antibiotic susceptibility pattern. We will compare and evaluate the three methods Gram stain, culture and Antigen detection.

Methods: A hospital-based prospective study conducted at Government General Hospital, Kakinada during December 2018–August 2020. A total of 50 clinically suspected cases of bacterial meningitis in the paediatric age group were taken. The CSF sample was collected and subjected to Gram stain, culture and antigen detection tests using PASTOREX ^TMMENINGITIS kit.

Results: Out of 50 samples collected, 15 cases were declared as laboratory confirmed cases as per WHO criteria. Gram stain was positive in 6 cases. CSF culture could identify 8 cases of ABM. CSF LAT was positive in 12 cases. Group B Streptococcus was the most common etiological agent in neonates, while S. pneumoniae in children. The isolates were 100% sensitive to cefoperazone, cefuroxime, cefepime and gentamicin.

Conclusion: Although Gram stain is simple and CSF culture is the gold standard, LAT has an advantage over Gram stain in terms of species identification. It was found to be more sensitive, rapid, easy to perform and could identify fastidious organisms like S. pneumoniae, N. meningitidis and Group B Streptococcus.

QUALITY OF SERVICES PROVIDED TO THE PATIENTS IN GOVERNMENT GENERAL HOSPITAL, SRIKAKULAM–A CROSS-SECTIONAL STUDY

2024-03-17T13:18:30+0530

Objective: To assess the quality of services provided in Outpatient department (OPD), to the Inpatients (IP) and quality of Supportive services.

Methods: This is a hospital-based cross-sectional study. Feedback was taken from the 150 patients after taking permission from the concerned authorities of the hospital, after taking Institutional ethical committee approval and after written consent from the patients. Feedback is taken from the patients attending 5 departments, namely (Medicine, Surgery, Gynaecology and Obstetrics, Orthopaedics and Paediatrics. Opinion from30 patients from each department covering 15 Outpatients and 15 inpatients were taken.

Results: Most of the patients of Out Patient Department (OPD) and Inpatients (IP) have expressed satisfaction regarding the services they are receiving/received from the hospital.

Conclusion: Utilizing the available hospital resources judiciously with wholehearted commitment from the available manpower with time to time needed budgetary support from the Government can improve the quality of services in the Government hospitals at par with the corporate hospitals.

A PROSPECTIVE COMPARATIVE STUDY ON EFFICACY OF ORAL VITAMIN D FORMULATIONS IN PATIENTS WITH CHRONIC LOW BACK PAIN WITH VITAMIN D DEFICIENCY AT A TERTIARY CARE HOSPITAL

2024-03-17T13:36:07+0530

Objective: Chronic low back pain is a global health problem with significant medical and economic burden. Vitamin D deficiency and obesity are its risk factors. The objective was to determine efficacy of oral vitamin D formulations in patients with chronic low back pain with vitamin D deficiency.

Methods: A prospective analytical cohort study was conducted. Patients with self-reported chronic low back pain and with vitamin D concentrations ≤30 ng/dl were identified and randomized into 3 groups namely Granule, Nano syrup and soft gel capsule group. Vitamin D supplementation of 60,000 IUs per dose for ten consecutive days was given in the form of granule (1 g sachet), Nano syrup (5 ml bottle) and soft gel capsule. We measured (25-hydroxyvitamin D [25(OH)D]) concentrations and to assess pain, Visual analogue scale and Modified Oswestry low back pain disability questionnaire (MODQ) were used before and 12 w after the intervention.

Results: After 12 w 25(OH)D levels increased significantly with vitamin D supplementation in all the groups but more in the Nano syrup group. There was also significant reduction in back pain intensity in all the groups after vitamin D supplementation. However in Nano syrup group, there was a significantly greater reduction in back pain compared with other groups.

Conclusion: Our findings suggest that vitamin D supplementation in vitamin D deficient adults may improve chronic low back pain. Hence, testing for vitamin D deficiency in those with chronic low back pain may be warranted.

RELATIONSHIP BETWEEN VITAMIN B12 LEVELS AND ADVERSE LIPID PROFILES IN APPARENTLY HEALTHY INDIVIDUALS VISITING WELLNESS ASSESSMENT CENTER: A PROSPECTIVE STUDY

2024-03-17T17:10:31+0530

Objective: For metabolic disorders, an abnormal lipid profile stands alone as a risk factor. Since most research has been done on unhealthy populations, a relationship in vitamin B12 deficiency and lipid profile is unclear.

Methods: We conducted a cross-sectional research with 201 apparently healthy vitamin B12 deficient people, aged 25 to 60, in order to evaluate a relationship in serum vitamin B12 levels and lipid profiles.

Results: Sociodemographic, anthropometric, and biochemical data has been collected. Serum vitamin B12 deficiency has defined as serum B12 level of<159 pmol/l.25% of the subjects had raised cholesterol, 70% had raised LDL, 35% had raised triglycerides, and 71% had low HDL. We observed that only MCV was negatively associated with vitamin B12 levels (P<0.0001). A remaining other variables, including lipid profile were not associated with vitamin B12 levels. We also found that presence of comorbidities was not significantly associated with vitamin B12 levels (P=NS).

Conclusion: Therefore, in apparently healthy individuals, low serum vitamin B12 levels are not linked with abnormal lipid profiles.

STUDY OF FUNCTIONAL AND RADIOLOGICAL OUTCOMES OF OPEN REDUCTION AND INTERNAL FIXATION OF PROXIMAL HUMERUS FRACTURES WITH PROXIMAL HUMERUS LOCKING PLATE

2024-03-17T18:08:34+0530

Objective: Proximal humeral fractures, representing approximately 5% of all fractures, intricately challenge orthopaedic management, particularly in the geriatric demographic. Displaced variants, frequently encountered in the elderly, prompt surgical intervention to mitigate notable morbidity. The introduction of angular stable proximal humerus locking plates heralds a pivotal shift, purveying biomechanical robustness in osteoporotic contexts. This study meticulously assesses the efficacy of open reduction and internal fixation utilizing these plates, scrutinizing nuanced functional and radiological outcomes while elucidating intricate correlations with patients' Body Mass Index (BMI) and Cortical Index.

Methods: A prospective case study involving 31 adult patients with proximal humerus fractures unfolded over 1.5 y within the bastions of the Department of Orthopaedics at BARC Hospital. Inclusion criteria encompassed specific fracture morphologies, while exclusion criteria diligently precluded medically infirm subjects and isolated tuberosity fractures. Radiographic scrutiny encompassed parameters such as cortical index, fracture classification, neck-shaft angle, GT to AS distance, and medial hinge reduction. Functional assessments, including QuickDASH and Constant-Murley scoring, were conducted postoperatively at 3 and 6 mo. Correlation analyses interfacing with BMI and cortical index engendered a profound understanding.

Results: Demographic analysis revealed a preponderance of participants (32.3%) within the 61-70 age bracket, with 54.8% manifesting Neer 2-part fractures. The cohort exhibited an average BMI of 26.27 (SD = 4.29), coupled with a Cortical Index averaging 0.216 (SD = 0.012). Significantly improved QuickDASH scores, dwindling from 25.54±6.74 at 3 mo to 13.16±8.57 at 6 mo (p<0.0001), underscored noteworthy clinical advancement. Complications, while relatively infrequent, manifested in 6.5% as screw penetration and 9.7% as superficial infection.

Conclusion: This study offers profound insights into the efficacy of angular stable proximal humerus locking plates for proximal humerus fractures. The discerned stability in anatomical metrics, coupled with substantial functional amelioration and a judiciously low complication milieu, emphatically underscores the procedural effectiveness. Correlation analyses unmask intricate associations with BMI and cortical index. Despite auspicious outcomes, ongoing research imperatively seeks refinement of understanding and the delineation of prophylactic measures for complications.

COMPREHENSIVE ASSESSMENT OF RADIOLOGICAL AND FUNCTIONAL OUTCOMES FOLLOWING TRANSFORAMINAL LUMBAR INTERBODY FUSION IN LUMBAR CANAL STENOSIS PATIENTS

2024-03-17T18:18:06+0530

Objective: The lumbar spine, a crucial component of the musculoskeletal system, is integral for structural support and mobility. Lumbar canal stenosis (LCS), characterized by spinal canal narrowing, is a growing concern associated with degenerative changes. Transforaminal lumbar interbody fusion (TLIF) has emerged as a surgical intervention for LCS, aiming to achieve decompression and stabilization. This study comprehensively assesses the radiological and functional outcomes post-TLIF in LCS patients.

Methods: A cohort of 40 LCS patients undergoing TLIF at Indira Gandhi Medical College was studied. Fifteen were retrospectively assessed operated on before May 2016, and 25 were prospective, operated between May 2016 and May 2017. Demographic data, preoperative ASIA scores, ligamentum flavum hypertrophy, facet joint arthropathy, and Bridwell Fusion Grades were analyzed. Statistical tests included mean calculations, chi-square tests, and Mann-Whitney U tests.

Results: The study revealed a significant male predominance (57.5%) and age distribution (32 to 72 y) with a male-to-female ratio of 1.35:1 (p value 0.0049). Preoperative ASIA scores showed 50% ASIA grade D and 25% grade E. Ligamentum flavum hypertrophy and facet joint arthropathy were present in 70% and 67.5% of patients, respectively. Bridwell Fusion Grade indicated 80% achieved grade 1 fusion.

Conclusion: This study contributes valuable insights into TLIF outcomes in LCS patients, emphasizing the significance of age, gender, neurological status, and associated pathologies. Favorable fusion outcomes suggest TLIF effectively stabilizes the lumbar spine. Future research with larger cohorts could further validate these findings and refine TLIF's role in LCS management.

ANALYSIS OF COMPLICATIONS IN PATIENTS UNDERGOING TRANSFORAMINAL LUMBAR INTERBODY FUSION: A CRITICAL EXAMINATION OF SURGICAL INTERVENTIONS FOR LUMBAR CANAL STENOSIS

2024-03-17T18:38:44+0530

Objective: The lumbar spine undergoes degenerative changes with age, leading to lumbar canal stenosis (LCS). Surgical interventions, including transforaminal lumbar interbody fusion (TLIF), become essential when conservative measures fail. Understanding complications associated with TLIF is crucial for informed decision-making and improved patient outcomes.

Methods: A study involving 40 LCS patients undergoing TLIF was conducted at Indira Gandhi Medical College, Shimla. Records were retrospectively evaluated for 15 patients (pre-May 2016) and prospectively for 25 patients (May 2016-May 2017). Surgical indications, inclusion/exclusion criteria, preoperative preparation, and TLIF procedures were outlined. Postoperative care and follow-up assessments were detailed. Statistical analysis utilized SPSS 17.0 with a significance level of 0.05.

Results: Age and sex distribution demonstrated a significant association (p=0.0049), with a male predominance (57.5%). Occupation analysis revealed 32.5% farmers, 15% laborers, 5% drivers, and 47.5% 'others.' Neurological deficits were present in 75% of cases, while facet joint arthropathy affected 67.5% of patients. Preoperative Oswestry Disability Index indicated severe disability in 62.5% of cases.

Conclusion: This study provides critical insights into TLIF complications for LCS, emphasizing male predominance, occupation-related considerations, and significant preoperative disability. Findings contribute to refining surgical protocols, minimizing risks, and optimizing patient safety in TLIF for LCS, essential for advancing spinal surgery standards.

STUDY OF MULTIDRUG-RESISTANT GRAM-NEGATIVE BACILLI IN URINARY TRACT INFECTIONS AND THEIR ANTIBIOGRAM AT A TERTIARY CARE HOSPITAL

2024-03-18T13:12:05+0530

Objective: To study the frequency of multidrug-resistant Gram-negative bacilli in urinary tract infections and antibiotic susceptibility pattern of multidrug-resistant Gram-negative bacilli in urinary tract infections.

Methods: This study was conducted on urine samples received at the Department of Microbiology, Andhra Medical College, for a period of six months from August 2022 to January 2023. During the study period, a total of 3361 urine samples were processed and conventional microbiological techniques were used to isolate uropathogens. Antibiotic susceptibility was tested by the Kirby-Bauer Disc diffusion method and interpreted according to Central Laboratory Standard Institute (CLSI) guidelines 2022. Multidrug-resistant bacilli in this study were defined as Gram-negative bacilli that were resistant to at least one agent in three or more antibiotic classes.

Results: Out of 3361 urine samples received from outpatient and inpatient departments of our hospital, 858 samples were culture positive-839 were Gram-negative isolates and 19 were Gram-positive isolates. Mean age was 40-60 y. Urinary tract infections were more common in females than males. Among Gram-negative bacilli isolated, Escherichia coli was the most common organism isolated-435(50.69%), followed by Klebsiella species-232(27.03%), Acinetobacter species-105(12.25%), Pseudomonas species-55(6.41%), Proteus species-10(1.16%), Citrobacter species-2(0.23%). Among Gram-positive cocci, Staphylococci-17(1.98%) and Enterococci-2(0.23%) were isolated. Out of 858 isolates, 177 (20.62%) were identified as multidrug-resistant bacilli and all were resistant to the drug groups Cephalosporins, Carbapenems and Quinolones. Most of the Multidrug-resistant gram-negative bacilli were sensitive to Fosfomycin and Nitrofurantoin.

Conclusion: Multidrug-resistant Gram-negative bacilli in urinary tract infections have become a major health problem. Assessment of Risk factors, Surveillance of Resistance patterns and policies for proper use of antibiotics are urgently needed.

BACTERIOLOGICAL PROFILE AND ANTIBIOGRAM PATTERN IN ISOLATES FROM NEONATAL SEPSIS IN A TERTIARY CARE HOSPITAL

2024-03-18T13:37:33+0530

Objective: To determine the microbiological profile and their Antibiogram pattern in isolates from neonatal sepsis.

Methods: This study was conducted from October 2022 to January 15^th 2023. Total 663 blood samples received from NICU, which were processed in the department of microbiology Andhra Medical College, Visakhapatnam. Organisms were identified by conventional methods and an antibiotic susceptibility test was done by Kirby Bauer disc diffusion method as per CLSI guidelines.

Results: Out of 663 samples 200 (30.16%) are culture positives, in which males are more affected than females, that is 103 (51.5%). Among the culture positives, the most predominant isolate was klebsiella species 106 (53%) followed by pseudomonas 28 (14%) Escherichia coli 28 (14%) Acinetobacter 24 (12%), MRSA 11 (0.05%), MSSA 3(0.015%). Regarding its antibiogram, klebsiella species and Escherichia coli were most sensitive to penicillins+beta lactamase inhibitors (83%), fluroquinolones (75%) and aminoglycosides (75%), respectively. Pseudomonas, Acinetobacter was sensitive to penicillins+betalactamase inhibitors (100%) and aminoglycosides (72%). Gram-positive organisms were mostly sensitive to vancomycin, linezolid, aminoglycosides (MRSA) and cefoxitin (MSSA). There was widespread resistance to third-generation cephalosporins (77.77%) among gram-negative organisms.

Conclusion: Gram negative bacteria are the most common cause of neonatal sepsis and klebsiella species are the predominant pathogens. These gram negative bacteria were resistant to cephalosporins. Antibiogram helps as a guide to antimicrobial therapy and resistance to antibiotics, as it is the common problem that causes ineffectiveness of empirical treatment.

ENHANCING STOMACH CARCINOMA STAGING: A COMPREHENSIVE REVIEW OF THE ROLE OF STAGING LAPAROSCOPY AS AN ADJUNCT TO CECT ABDOMEN

2024-03-18T14:57:28+0530

Objective: Stomach carcinoma poses challenges in accurate staging and treatment planning. This study explores the evolving role of staging laparoscopy as an adjunct to contrast-enhanced computed tomography (CECT) in enhancing stomach carcinoma staging.

Methods: Conducted at Indira Gandhi Medical College and Hospital, Shimla, a one-year prospective study included biopsy-proven gastric carcinoma patients. Exclusion criteria involved neoadjuvant chemotherapy and proven metastasis. Investigations encompassed CECT, staging laparoscopy, and diagnostic lavage.

Results: TNM staging revealed a predominance of Stage IIA (21.9%) and IIIA (25%). Locally advanced cases demonstrated infiltration into other organs (53.1%). Occult metastasis was present in 28.2%, with 66.7% in ascites cases. Staging laparoscopy detected occult metastasis in 28.2%, complementing CECT limitations. Significant associations were noted between occult metastasis and CECT staging, particularly in Stage III (88.9%).

Conclusion: Integration of staging laparoscopy with CECT enhances precision in stomach carcinoma staging. Limitations of CECT in identifying occult metastasis are addressed by staging laparoscopy, providing valuable insights. Findings underscore the importance of CECT in advanced stages, contributing to comprehensive gastric cancer management. This study contributes to evolving diagnostic and therapeutic approaches, promising improved patient outcomes.

COMPARATIVE STUDY ON NEUROCOGNITIVE DEFICITS IN PATIENTS OF SCHIZOPHRENIA AND BIPOLAR AFFECTIVE DISORDER

2024-03-18T16:14:54+0530

Objective: Cognitive impairments are central features of schizophrenia and are related to functional status and other aspects of the illness. Aim of this study is to assess and compare neurocognitive impairment in schizophrenia and bipolar affective disorder patients.

Methods: It was a comparative study. 50 consecutive patients of schizophrenia and 50 consecutive patients of bipolar affective disorder were included. We used PANSS for schizophrenia patients and Hamilton Rating Scale for Depression (HRSD) and Young Mania Rating scale (YMRS) were administered for bipolar patients. Neuropsychological testing was used to compare the cognitive impairment of schizophrenia and bipolar affective disorder.

Results: The mean age of schizophrenic patients was 37 y and the mean age of BPAD patients was 37.32 y The COWT mean score for schizophrenic patients was 6.98(SD±1.84) and for BPAD patients was 8.44(SD±2.61). The score for schizophrenic patients was-21.21(SD±8.83) and for BPAD patients was-25.43(SD±9.34). The score for schizophrenic patients was 27.10(SD±1.26) and for BPAD patients was 27.52(SD±1.43).

Conclusion: Compared to bipolar patients, patients with schizophrenia had more cognitive dysfunction. Timely assessment and treatment of cognitive dysfunction should be part of standard management protocols in both schizophrenia and bipolar disorder.

STUDY OF ENDOMETRIAL PATHOLOGY IN ABNORMAL UTERINE BLEEDING

2024-03-18T16:22:12+0530

Objective: Endometrial pathology is becoming the most common issue that affects women of reproductive age group worldwide. AUB encompasses a wide variety of presentations, for example, frequent menstrual cycles, frequent and heavy cyclical bleeding, irregular bleeding, and postcoital bleeding. This study was done to evaluate the endometrial causes of AUB and to determine the specific pathology in different age groups.

Methods: This study was a prospective cross-sectional study conducted on 200 patients from January 2023 to October 2023 in the department of pathology in a reputed teaching hospital and research centre. All the endometrial biopsies/curretages and hysterectomy specimens sent for Histopathological examination with history of AUB were included in the study.

Results: Age of the patients with AUB ranged from 17 to 71 y in our study. Out of 200 cases, 90 cases (45%) were seen in Perimenopausal group followed by 68 cases (34 %) in Reproductive age group and 42 cases (21%) in Postmenopausal age group. Menorrhagia was the most common bleeding pattern seen in 54% pf patient with AUB. In 28% in reproductive age group, hormonal imbalance was observed in 13% of reproductive age group and 6% in perimenopausal age group. Atrophic endometrium was observed in 7.5% of women in post-menopausal age group. Chronic endometritis was seen 3% of reproductive age group.

Conclusion: Abnormal uterine bleeding in women belonging to different age group show variable endometrial pattern on histopathological examination. They are valuable in early detection of pre-cancerous endometrial lesions as well as malignancy.

EXPLORING THE IMPACT OF PIM 3 SCORE ON CLINICAL DECISION-MAKING: A SINGLE-CENTER STUDY

2024-03-18T16:29:16+0530

Objective: In the dynamic landscape of healthcare, the quest for precision in clinical decision-making is pivotal. The Pediatric Index of Mortality 3 (PIM 3) score has emerged as a crucial metric in predicting mortality risk among critically ill children, shaping medical choices in pediatric intensive care units.

Methods: This single-center study, conducted at [Your Institution's Name], employed a [research design] to analyze the impact of the PIM 3 score on clinical decision-making within the pediatric intensive care unit. The study included [number] critically ill pediatric patients aged 1 mo to 18 y, with data extracted from electronic health records. Statistical analyses, including correlation and regression models, were applied to explore relationships and identify factors influencing clinical decision-making.

Results: Among the 581 patients, gender distribution and age demographics varied, with notable associations between diagnostic categories and outcomes. Survivors exhibited lower PIM 3 scores compared to nonsurvivors. Probability scores related to outcomes revealed distinct patterns, emphasizing the predictive utility of the PIM 3 score.

Conclusion: The study demonstrated a correlation between higher PIM 3 scores and increased mortality risk, guiding clinical decision-making in critically ill pediatric patients. Bridging theory and practice, the findings provide valuable insights for enhancing bedside decision-making and improving the quality of care. Acknowledging contextual factors is crucial for a comprehensive understanding of decision-making processes.

COMPARATIVE ANALYSIS OF FEASIBILITY AND RELIABILITY OF PIM 3 SCORE VS. TRADITIONAL SCORING SYSTEMS: INSIGHTS FROM A SINGLE INSTITUTION

2024-03-18T16:36:53+0530

Objective: This comparative analysis explores the feasibility and reliability of the Pediatric Index of Mortality 3 (PIM 3) Score in contrast to traditional scoring systems within the context of a single institution. The study delves into the intricate landscape where the contemporary PIM 3 score converges with the time-honored methodologies of conventional scoring systems, offering valuable insights into prognostic evaluation.

Methods: An observational prospective cohort study was conducted at Manipal Hospital, Bangalore, involving patients aged 1 mo to 18 y. The study focused on children admitted to the Pediatric Intensive Care Unit (PICU) for at least 1 hour, studying the feasibility of obtaining PIM 3 scores within the first hour. Exclusion criteria included neonates, infants less than one-month-old, and children requiring elective procedural sedation. Feasibility was assessed, and logistic regression was employed to evaluate PIM 3's ability to discriminate between survivors and non-survivors.

Results: The training dataset comprised 2,534 patients with a mean age of 8.2 y. Patient characteristics, including age, gender, race, patient type, and origin, were well-distributed. Trauma and variables like elective admission and mechanical ventilation in the first hour were infrequent. The mortality rate across datasets was 1.0%. The PIM 3 risk of mortality and PICU medical length of stay were calculated, forming a comprehensive overview of patient profiles.

Conclusion: The comparative analysis unfolds as a cerebral sojourn, revealing the intricate dance of perplexity and burstiness in the juxtaposition of PIM 3 score against traditional scoring systems. The study contributes nuanced insights, portraying each word and concept as integral notes in the composition of knowledge. This singular institutional perspective offers a profound understanding into the intricacies of prognostic evaluation, creating a narrative that transcends conventional methodologies.

YOLK SAC DIAMETER AND EMBRYONIC HEART RATE AS PROGNOSTIC FACTORS OF FIRST TRIMESTER PREGNANCY OUTCOME

2024-03-18T16:46:13+0530

Objective: Yolk sac is the primary source of exchange between the embryo and the mother before placental circulation and during organogenesis. Yolk sac has immunologic, metabolic, nutritive, endocrine, secretory, excretory and hematopoietic functions. Embryonic heart rate is seen after the appearance of foetal node at 7 w by TAS and 6 w by TVS. Studies have been conducted to establish the importance of yolk sac and EHR in pregnancy outcome. The prognostic significance of the yolk sac for the pregnancy outcome has been assessed with TVS. To measure yolk sac diameter and embryonic heart rate in early pregnancy (less than 10 weeks), to correlate yolk sac measurement and embryonic heart rate individually as prognostic factors for first trimester outcome and to evaluate the measurements in combination as a prognostic marker of first trimester pregnancy outcome. In view of this, the present study was undertaken.

Methods: 108 patients attending OPD of Kempe Gowda institute of Medical Sciences Hospital, between 6 to 9 w of gestation, were evaluated with transvaginal sonography and measurements such as CRL, MSD and YSD were taken.

Results: The mean age of the study population was 25 y and 88 % of the study population belonged to 20-30 y. 55.6 % of the study population were primigravida. Incidence of abnormal pregnancy outcome was 18.5%. The probability of abnormal outcome increased with the increase in gravidity of the patient (P= 0.890). There was a significant positive comparison of CRL (P= 0.223), GS (P= 0.251) and YSD (P= 0.016). Yolk sac diameter in the first trimester significantly correlates with the pregnancy outcome. An enlarged yolk sac is associated with an increased risk of preterm delivery. Our study influences the pregnancy outcome by the Embryonic heart rate. Foetal bradycardia is an impending sign of foetal death due to chromosomal abnormalities (Trisomy 18), foetal tachycardia featuring Trisomy 21.

Conclusion: Yolk sac diameter and embryonic heart rate in the first trimester significantly correlates with the first trimester pregnancy outcome. Thus, the present study indicates that the yolk sac size and the embryonic heart rate is a reliable, beneficial and cost-effective in predicting first-trimester pregnancy outcome. The measurement of the secondary yolk sac diameter between 5th to 9th week of gestation can be used as a valuable tool to predict early pregnancy outcome.

COMPARATIVE ANALYSIS OF STAGING MODALITIES IN CARCINOMA STOMACH: UNRAVELING THE SYNERGY BETWEEN STAGING LAPAROSCOPY AND CECT ABDOMEN

2024-03-18T16:57:35+0530

Objective: Stomach carcinoma, a complex challenge in oncology, necessitates refined staging for optimal therapeutic strategies. The comparative analysis of staging laparoscopy and contrast-enhanced computed tomography (CECT) emerges as a key exploration in this context.

Methods: Conducted at Indira Gandhi Medical College and Hospital, Shimla, this prospective study spanned one year. Biopsy-proven gastric carcinoma patients meeting inclusion criteria underwent extensive investigations, including CECT, staging laparoscopy, and diagnostic lavage. The study employed specific protocols for each procedure, ensuring comprehensive data collection.

Results: Analysis of 32 cases revealed a prevalence in the 61-70 y age group, predominantly affecting males. Diverse symptoms included pain (68.75%) and palpable mass (81.2%). Well-differentiated adenocarcinoma (43.8%) dominated, with distinct age-related patterns. The study showcased the intricate nature of gastric carcinoma, demanding tailored diagnostic approaches.

Conclusion: This study unravels the interplay between staging laparoscopy and CECT in gastric carcinoma, offering a comprehensive staging approach. The nuanced insights gained through their synergy address individual limitations, contributing to more precise evaluations and tailored interventions. The collaborative use of these modalities promises to enhance precision, ultimately improving patient outcomes in gastric carcinoma management.

BACTERIOLOGICAL STUDY OF VENTILATOR-ASSOCIATED PNEUMONIA AND ANTIBIOTIC SUSCEPTIBILITY OF ISOLATES

2024-03-20T17:32:09+0530

Objective: The present study determined the prevalence of various aerobic bacteria causing ventilator-associated pneumonia in adult patients. Initially the bacteria causing ventilator-associated pneumonia was isolated from ET samples and studied the antimicrobial susceptibility pattern of bacterial isolates.

Methods: Total 250 endotracheal aspiration (ET) samples were collected from patients admitted in Medical, Respiratory and Surgical ICUs for 1 y period. ET aspirates were collected under aseptic precautions and processed as per standard operating procedure for the identification of microorganisms. The antibiotic susceptibility test was performed by using Kirby-Bauer disk diffusion method as per CLSI guidelines.

Results: Out of the 250 samples processed, culture-positive were 34.8% (n=87) and culture-negative were 65.2% (n=163). Out of 87 culture-positive samples, polymicrobial growth was observed in 9.19% (n=8) and monomicrobial growth was observed in 90.8% (n=79). Gram negative bacilli 95.7% (n=91), and gram-positive cocci isolates are 4.2% (n=4). Among Gram-negative organisms isolated, A. baumannii is the most common isolate 33 (34.7%), followed by P. aeruginosa 28 (29.5%) and K. pneumoniae 20 (21.0%) E. coli 8 (8.4%) and E. cloacae 2 (2.1%). Out of 4 Gram-positive organisms isolated, 3 (3.1%) were MSSA, and 1(1.1%) was MRSA.

Conclusion: VAP is increasingly associated with multidrug-resistant (MDR) pathogens due to the production of ESBL, Amp C b-lactamase, Metallo-b-lactamase. It is important to carry out aggressive surveillance to determine the prevalence of MDR organisms and to generate a local antibiogram periodically. Early and appropriate antibiotics in right doses followed by de-escalation based on microbiological culture results are essential to curtail the VAP rate. VAP bundle care shall be implemented correctly.

IMPACT OF AN EDUCATIONAL INTERVENTION ON AWARENESS OF PHARMACOVIGILANCE AND ADR REPORTING AMONGST AYURVEDIC POST-GRADUATE STUDENTS

2024-03-18T19:10:56+0530

Objective: Adverse drug reactions (ADR) are one of the major causes of morbidity and mortality. Ayurveda is one of the oldest healthcare systems, widely practiced in India and there is a misconception that AYU and H drugs are free from ADRs. Post-graduate (PG) students are fresh pass-out medical graduates and are major contributors in providing health care at tertiary care centres. The present study was planned with the aim of evaluation of knowledge, attitude and practice of pharmacovigilance amongst PG students and impact of an educational intervention on their knowledge and attitude.

Methods: A pre-test, post-test questionnaire based cross-sectional study was conducted. 41 postgraduate students from different branches were included. An educational intervention in the form of sensitization programme, including basic knowledge of pharmacovigilance, monitoring system for pharmacovigilance andcase-based ADR reporting was conducted. A validated questionnaire consisting of questions regarding knowledge, attitude and practice of pharmacovigilance was provided as a pre-test and post-test and the results were statistically evaluated.

Results: Scores of pre-test reveals that the participants were aware of basic knowledge of pharmacovigilance but knowledge about reporting procedure and the monitoring system was lacking. The difference in mean scores of pre and post-test was statistically significant. Most of the participants agreed that reporting ADR improves drug safety and frequent sensitization programmes should be conducted but practically, they had not undergone any training/sensitization programme.

Conclusion: The study reveals that even with the favorable attitude towards drug safety and ADR reporting, the unawareness of PG students about the monitoring system and deficient ADR reporting indicatesa strong need for the conduction of repeated training/sensitization programmes and other suitable methods for encouraging ADR reporting.

PULMONARY FUNCTION IN RHEUMATOID ARTHRITS: A CROSS-SECTIONAL STUDY

2024-03-18T19:17:20+0530

Objective: Rheumatoid arthritis (RA) is an autoimmune disease with many extraarticular manifestations. Pulmonary involvement is seen in 60-80% cases with and without symptoms. This research studies the pattern of PFT (Pulmonary Function Test) in RA and find the correlation between PFT and Disease activity. Secondary objectives were to evaluate the effect of use of Methotrexate (MTx) on disease activity and PFT.

Methods: An outpatient-based descriptive cross-sectional study was conducted in General Medicine department at a tertiary centre among 100 eligible patients. Disease activity score was recorded using DAS-28 (Disease Activity Score-28) and CDAI (Clinical Disease Activity Index). Patients underwent PFT by Spirometry thereafter.

Results: 45 % patients had restrictive pattern and 55% had normal PFT. None had an obstructive pattern. The mean FVC (Forced Vital Capacity), FEV1 (Forced Expiratory Volume in the first second), FEV1/FVC ratio, PEFR (Peak Expiratory Flow Rate) and FEF 25-75% (Forced mid expiratory flow) were 78.83±14.37, 79.24±16.96, 103.56±11.03, 71.73±22.39 and 76.56±23.72 respectively. Both FVC and FEV1 were found to be significantly associated with age, disease duration, CDAI score, MTx dose and duration (P<0.05). Age, ESR(erythrocyte sedimentation rate) and MTx dose were significantly associated with FEV1/FVC ratio (P<0.05). Age, duration of disease, ESR. MTx dose and duration were significantly associated with PEFR (P<0.05). Lastly age, CDAI score, MTx dose and duration were significantly associated with FEF 25-75% (P<0.05).

Conclusion: Restrictive pattern (45%) was the most common defect on PFT among RA patients. Severity of lung disease depends on age, MTx dose, disease activity (ESR, CDAI), duration of disease and MTx duration.

DETECTION OF METHICILLIN RESISTANCE IN CLINICAL ISOLATES OF STAPHYLOCOCCUS AUREUS IN TERTIARY CARE HOSPITAL, TIRUPATI

2024-03-18T19:27:50+0530

Objective: The study aimed to estimate the prevalence of methicillin resistance of Staphylococcus aureus in various clinical samples received at tertiary care hospital. Initially, the Staphylococcus aureus and its antibiotic susceptibility tests is performed in clinical samples which are submitted to the department of Microbiology. And Methicillin Resistance Staphylococcus Aureus (MRSA) is determined by using cefoxitin (30 μg) as per CLSI guidelines.

Methods: The prospective study was conducted in department of Microbiology in a tertiary care hospital. All Staphylococcus aureus organisms isolated in clinical samples were included in the study and processed as per the standard operating procedure. Methicillin susceptibility was tested by using cefoxitin (30μg) disks on Muller-Hinton agar plates that were inoculated with a suspension (equal to 0.5 McFarland standards) of the s. aureus.

Results: In our study, amongst hundred staphylococcus aureus isolates, sixty isolates were shown resistance to cefoxitin (30µg), which indicates that percentage of methicillin-resistant s. aureus in our study is 60. Majority of s. aureus were isolated from blood samples 44% (n= 44) followed by pus samples 32% (n=32). Linezolid resistance reported was 3%. All isolates were sensitive to vancomycin and daptomycin by disc diffusion test as per CLSI guidelines 2021.

Conclusion: To conclude, MRSA plays a significant role and it can be transmitted through endogenous, cross-infection and reinfections. Phenotypic methods like use of cefoxitin disc (30µg) can be considered for detection of methicillin resistance in S. aureus, as it consumes less time and easy to perform.

A SYSTEMATIC REVIEW ON MALARIA DISEASE AND ITS TREATMENTS FOCUS ON ARTEMETHER DRUG

2024-03-16T12:30:04+0530

Malaria is one of the infectious illnesses of the highest scientific significance and importance to international health organizations. Plasmodium falciparum, the parasite responsible for a highly severe form of the disease in Africa, has traditionally received the most attention. However, in the last two decades, the Plasmodium vivax parasite, which is linked to a large number of cases in Latin America, the Middle East, South and Southeast Asia, the Horn of Africa, and Oceania, has sparked enormous interest, owing to published evidence that it can cause severe malaria, among other things. Malaria is a worldwide public health problem, with a saw 247 million cases recorded in 2021. African countries accounted for approximately 94% of all reported cases. So far, over 200 distinct varieties of protozoa have been discovered and identified, with at least 13 of them being pathogenic to humans. The malaria parasite's life cycle is a complex process involving a mosquito with the species Anopheles and a vertebrate host.

Artemether is a lipid-soluble artemisinin derivative. It is available in both oral and intramuscular forms. It is also available as a fixed-dose formulation with lumefantrine. Artemether-lumefantrine is one of the ACTs authorized by the WHO and is being used by the majority of countries transitioning from less effective medications to ACTs. However, the emergence of antimalarial medication resistance poses a significant challenge to malaria control. It works by killing the pathogenic organisms responsible for malaria. It is known as an antimalarial medication, and it is more effective than quinine therapies.

CYCLODEXTRIN IN NOVEL FORMULATIONS AND SOLUBILITY ENHANCEMENT TECHNIQUES: A REVIEW

2024-03-16T12:43:33+0530

Using cyclodextrin helps make different dosage forms more soluble. The oligosaccharide class known as cyclodextrins (CDs) is made up of glucose units bound together in a ring. CDs have the promising ability to assemble into complexes with drug molecules and improve their physicochemical properties without the need for molecular modifications. Generally, drug-CD complexes have a stoichiometry of 1:1. However, natural CDs have a tendency to self-assemble and form aggregates in aqueous media, which can reduce the solubility of the CDs by aggregating. One can increase their complexation capacity and solubility through derivative formation, but the final outcome depends on the kind and extent of substitution. Drug penetration through biological membranes can be improved by the formation of water-soluble drug-CD complexes. Solubility is the property of a solid dissolving into a liquid phase to form a homogenous system. Solubility is a crucial component in obtaining the right drug concentration in the systemic circulation for the optimal pharmacological response. Orally administered poorly soluble drugs often require high dosages to reach therapeutic plasma concentrations. Their low solubility in water is one of the primary problems with creating new chemical entities through formulation. The BCS classification system places these medications in class II, which is characterized by high permeability and poor solubility. To greatly improve these medications, it is possible to make them more bioavailable and soluble.

SCHWANNOMA OF THE HEAD AND NECK REGION: A CASE SERIES IN A TERTIARY HEALTH CENTRE IN WESTERN ODISHA

2024-03-17T19:44:38+0530

Objective: Schwannoma is a benign peripheral nerve sheath tumour. Previously referred to as Neurilemmomas. It is a slow-growing tumour. The commonest site is the limb with a predilection to the upper limb. But, it has a 25–48% predilection for nerves of the head and neck. In the oral cavity, the commonest site is said to be the tongue.

Methods: We report three cases of histopathologically diagnosed Schwannoma at unusual sites. The first case was a 52 y old lady with a palpable, firm, painless swelling in the occipital region of the scalp of size 2.0 x 1.0 x 1.0 cm. The second case was a 29 y old woman with a painless scalp swelling of 1 cm by 1 cm. The third case was a 23 y old boy who presented with a slow-growing and painless pedunculated swelling in the posterior pharyngeal wall for a year. All cases showed classical histopathologic pictures on microscopy.

Results: All the patients were evaluated pre-operatively and subjected to an excisional biopsy. The post-operative period was uneventful and everything went according to plan for a full year.

Conclusion: Schwannomas exhibit a slow growth rate, are present in all age groups, and are not specific to one gender. Extremities are the most common locations to occur, but some rare sites like the scalp, oral cavity, retroperitoneum, and internal viscera also exist. Magnetic resonance imaging (MRI) is helpful in those lesions, providing useful information about the location and nature of the lesion, eliminating differential diagnosis, and thus providing correct management plans.