JMS SKIMS
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Published By Sheri-I-Kashmir Institute Of Medical Sciences

0972-110x, 0972-110x

JMS SKIMS ◽  
2020 ◽  
Vol 23 (3) ◽  
Author(s):  
Tajamul Hussain Shah ◽  
Suhail Mantoo ◽  
Rafi Ahmad Jan

High Flow Nasal Cannula Oxygenation The current pandemic of COVID-19 caused by novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) tested the healthcare infrastructure throughout the globe at all possible levels. Early reports suggest about 20% of patients infected with SARS-CoV-2 require hospitalization and 5-8% require admission to intensive care unit (ICU) due to severe disease.Supplementation of oxygen provided by various conventional oxygen therapy (COT) devices (like nasal prongs, face mask, venture mask or non-rebreather mask) may not be sufficient in cases of worsening respiratory failure. One form of escalating respiratory support in such patients is a high flow nasal oxygenation device. High flow nasal cannula oxygenation (HFNC) is a form of non invasive respiratory support. It acts as a bridge between low flow devices and non invasive ventilation and may reduce the need for intubation.


JMS SKIMS ◽  
2020 ◽  
Vol 23 (3) ◽  
Author(s):  
Vishnu Vasudevan ◽  
Arun Viswanath ◽  
Riaz Ahmad Misgar

Background: Hypothyroidism in childhood typically leads to delayed puberty, rarely can it cause precocious puberty - this latter complex is eponymously known as Van-Wyk Grumbach syndrome. Case description: We report a case of a seven and a half-year-old girl who was referred with vaginal bleeding after a diagnosis of primary hypothyroidism and starting treatment with levothyroxine. This case report illustrates the typical features of this rare syndrome for primarily educational purposes. Many case reports of Van Wyk Grumbach syndrome have been published in world literature over the past seven decades after the initial description. Though the features of this syndrome are fairly well described previously, the understanding of pathophysiological mechanisms is speculative and still evolving. Clinical relevance: Further widespread awareness of the complex will encourage primary physicians and pediatricians to counsel the family of a child before starting treatment for hypothyroidism which will help avoid unnecessary worry and more importantly inadvertent procedures or intervention.


JMS SKIMS ◽  
2020 ◽  
Vol 23 (3) ◽  
Author(s):  
Maqsood Ahmad Dar ◽  
Vasundhara Aggarwal Saika ◽  
Joy Dev Mukherjee ◽  
Mukesh Kumar ◽  
Khushbu Goel

Background: About 11% of all epilepsies and 30% of newly diagnosed seizures in those older than 60 years have been reported to follow cerebrovascular accidents. Acute symptomatic (early) seizures occur in 3-8% of patients, more commonly in those with severe cortical strokes and intra-parenchymal hemorrhages. This study was undertaken to determine the incidence, risk factors and clinical outcome for early seizures after acute stroke.Aims and objectives: To study the incidence, risk factors and clinical outcomes of early seizures in post stroke patients in a tertiary care hospital.Study design: This prospective observational analytical study was conducted from -01-06-2017 to 31-01-2019 in Max Superspeciality Hospital Saket New Delhi. All consecutive patients of acute stroke fulfilling the inclusion and exclusion criteria were included in the study. Inclusion criteria and exclusion criteria: All patients with acute ischemic or hemorrhagic stroke with age above 18 years, either male or female were included in the study. Patients with a history of seizure or epilepsy before admission, patients with SAH, venous infarct and causes other than vascular origin were excluded from the study. Results and observation: Out of two hundred and fifty (n=250) patients of acute stroke included in the study early seizures were diagnosed in 29 patients (11.6%).Conclusions: We concluded that the incidence of post stroke early seizures was 11.6% in our study. We found that Patients with post stroke early seizures had higher NIHSS score, low GCS score and higher modified Rankin score at the time of admission. We recommend that stroke scores like NIHSS, ICH, GCS and mRS should be applied to all the patients of acute stroke to stratify the patients with regard to their risk of developing early seizures and prognosticating the clinical outcome.


JMS SKIMS ◽  
2020 ◽  
Vol 23 (3) ◽  
Author(s):  
Mohmad Hussian Mir ◽  
Tariq Ahmad Bhat ◽  
Khalid Parvez Sofi ◽  
Imtiyaz Ahmad Wani ◽  
Muzafar Maqsood Wani

Immune check point inhibitors (ICPIs) are a new class of anti-neoplastic agents being increasingly used by oncologists to treat various malignancies. These drugs have been associated with varied side effects and have a nephrotoxic potential. Many cases of ICPI induced acute kidney injury are increasingly being reported. Their use in CKD patients on dialysis as well as in kidney transplant recipients is associated with various challenges. This review discusses the use of ICPIs in CKD, dialysis and renal transplant patients and their nephrotoxic potential  


JMS SKIMS ◽  
2020 ◽  
Vol 23 (3) ◽  
Author(s):  
Tasaduk Sultan Khan ◽  
Musadiq Sultan Khan

Barrow in Furness, UHMBT, LA14 4LF, Cumbria, UK Coronavirus disease 2019 is the outbreak caused by a new strain of coronavirus named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) 1. The outbreak that leads to a global pandemic originated from the city of Wuhan in China 2. According to a CDC report, the commonest underlying conditions among those hospitalized with COVID-19 were diabetes, chronic lung disease, and cardiovascular disease 1. Obesity is a common denominator for cardiovascular disease and diabetes. Previous experience with the H1N1 epidemic showed that obesity is associated with high mortality 3. All of these observations have raised concerns about the impacts that obesity could have on COVID-19.


JMS SKIMS ◽  
2020 ◽  
Vol 23 (3) ◽  
Author(s):  
Sameer Anand ◽  
Owais Ahmed ◽  
Vijay Kundal

Background: Snakebite is a major public health problem and its prevalence is high in India. Insufficient epidemiological data and global neglect of this condition prompted the World Health organization to recognize it as a ‘‘neglected tropical disease’’ Objective: To study demographic characteristics of snakebite victims, to see clinical symptoms of bite and outcomes of snakebite. Methods: A prospective observational hospital-based study carried out from November 2016 to October 2017, in patients with a history of snakebite. Results:Total 300 patients were included in this study,170 (56.67%) were bitten by heamotoxic snakes and 130 (43.33%) were bitten by neurotoxic snakes. Majority of patients  were in the age group of 20-39 years  ( n=153; 51%). Men outnumbered women( n=190; 63.33%), with male to female ratio of 1.7: 1. Higher incidence of snake bite was found in July – September (n=135;45.00 %) followed by April to June( n=124; 41.33%).Majority of patients were farmers in rural areas ( n=242; 80.80%).Out of 300 patients,80required ICU care.In patients with neuroparalytic snake bites, clinical features were; ptosis (n=126; 96.92%),ophthalmoplegia  (n=98; 75.38%),respiratory paralysis (n=60; 46.15%),bulbar weakness ( n=74; 56.92%) andabdomen pain(n=25; 19.23%).Clinical features in patients of haemotoxic snake bites were ; bleeding from bite site(n=110; 65.29%) , cellulitis(n=100; 58.82%), gum bleed(n=53; 31.18%), ecchymosis(n=49; 28.82%),epistaxis(n=27; 15.82%),gastrointestinal bleeding(n=25; 14.71%) andhaemoptysis(n=19; 11.18%). Complications  observed  were  acute kidney injury ( n=62; 20.67%) , respiratory failure ( n=51; 17.00%) , DIC( n=7; 2.33%) and  ARDS( n=5; 1.67%) . Out of 170 hemotoxic snake bite patients, 157 (92.35%)  patients  recovered  and 13 (7.65%) patients  died and out of 130 neurotoxic snake bites, 124 (95.39%) patients  recovered and 6 (4.61%)  patients   died, overall mortality was 6.3%. In our study, bite to needle time  was less than 1 hour in 47 patients (15.66%), less than  6 hrs in 120 patients (40%) and more than 24 hours in 45 (15%). Conclusion: Snakebite is common in adult males between 20 to 50 years and the commonest site is the lower limb. The majority of the victims are farmers who work in fields. A maximum number of cases presented within 1-6 hours of bite using a tourniquet on the affected limb as first aid. The complications and mortality of snakebite are high.


JMS SKIMS ◽  
2020 ◽  
Vol 23 (3) ◽  
Author(s):  
Mudassir Ahmad Khan ◽  
Asif Mehraj ◽  
Arshad Baba ◽  
Mushtaq Laway ◽  
Rauf A Wani ◽  
...  

Fecaloma is a mass of hardened faeces difficult to pass through the intestinal lumen. Due to various reasons, a bolus of fecal matter stagnates, accumulates and inspisates in the intestinal lumen, until it becomes big enough to cause intestinal obstruction. Though there are various predisposing factors for the formation of fecaloma but the actual cause of fecaloma formation is still unknown. Small gut fecalomas are very rare. Herein we are presenting a case of 50 year male who underwent laparotomy three times for small gut obstruction caused due to recurrent formation of small gut fecaloma. To our knowledge it is the first case report of recurrent small gut fecaloma obstruction to be reported.


JMS SKIMS ◽  
2020 ◽  
Vol 23 (3) ◽  
Author(s):  
Peerzada Umar Farooq Baba ◽  
Adil Hafeez Wani

A 65 year male presented with squamous cell carcinoma of left side of nose.


JMS SKIMS ◽  
2020 ◽  
Vol 23 (3) ◽  
Author(s):  
Ajaz Ahmad Lone ◽  
Nisar Ahmad Tramboo ◽  
Syed Bilal

A 35-year female patient presented with recurrent palpitations. Her baseline ECG was normal but during the episode of palpitations, it revealed short RP tachycardia. Intracardiac ECG revealed orthodromic reentrant tachycardia due to concealed left lateral pathway (Figure 1). She was successfully treated by radio-frequency ablation through a trans-septal approach. Figure 2 shows RV pacing getting conducted over the left lateral pathway to atria which disappears after ablation of the pathway.


JMS SKIMS ◽  
2020 ◽  
Vol 23 (3) ◽  
Author(s):  
Rauf Ahmad Wani

Brown pigment stones are an important cause of acute cholangitis in Oriental Cholangiohepatitis. Bacterial infection and the deconjugation of bile by bacterial b-Glucourindase have been implicated as etiological factors in formation of brown pigment stones but controversy exists regarding their primary importance and causal relationship.


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