Joint replacement is a highly effective intervention that significantly improves patients' quality of life, providing symptom relief, restoration of joint function, improved mobility, and independence. Prosthetic joint infection (PJI) remains one of the most serious complications of prosthetic joint implantation. PJI positions a substantial burden on individuals, communities, and the health-care system, and thus early diagnosis and appropriate intervention are extremely important. Determining the various host and environmental factors that put an individual at risk for development of PJI may reduce the morbidity and cost of total joint arthroplasties. Microbial agents implicated in the causation of PJI range from Gram-positive to Gram-negative bacteria. PJI with fungi is commonly seen in immunocompromised patients. Numerous novel, uncultivable, and fastidious organisms have been identified as potential pathogens with the use of non-culture techniques. The majority of cases of PJI require surgical treatment, while the use of antimicrobials is essential when prosthetic removal is not possible or contraindicated. The microbiology and treatment of PJI in the light of improved culture and diagnostic methods are reviewed.

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Hydatid disease is an anthropozoonosis. Hydatid disease is caused by Echinococcus granulosus in tropical countries. Humans are accidental intermediate hosts of Echinococcus. Liver is the most commonly involved organ (59-75%) followed by the lung (27%), kidney (03%), and musculoskeletal system (1-4%); any organ of the body may be affected but pelvic hydatid cyst is rarely reported. Preoperative diagnosis can be established by imaging studies such as ultrasonography, computed tomography (CT), and magnetic resonance imaging (MRI). Serology for Echinococcus is also helpful in the diagnosis. However, diagnosis of pelvic hydatid cyst in females is possible only after operation. Preoperative anthelmintic therapy followed by surgery is the preferred treatment for hydatid cyst. Here, a case is presented of pelvic hydatid in a young female who presented with recurrent episodes of urinary retention, along with a hypogastric lump that is an unusual presentation.

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Ochrobactrum (O.) anthropi is an opportunistic emerging pathogen. Therapeutic approach is a rising challenge as it is resistant to most of the currently available beta lactam antibiotics with the exception of carbapenems. We report a case of septicaemia due to O. anthropi in a patient with Guillain Barre Syndrome in a neurology centre. The infection along with microbiological characteristics and clinical significance of the organism is described.

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Background: Patients undergoing caesarean section under spinal anaesthesia often experience pain in the perioperative period. The aim of this study was to evaluate the effect of intrathecal combination of clonidine and bupivacaine compared with bupivacaine and opioid on the incidence and severity of pain in elective caesarean section cases. Materials and Methods: Ninety healthy parturient at term scheduled for elective caesarean delivery were randomly allocated to receive intrathecally hyperbaric bupivacaine alone (Group B) or combined with 75 μg of clonidine (Group C) or with fentanyl 25 μg (Group F). The peak sensory block level, time to reach peak block level from injection, time to two segment regression, maximum degree of motor block, side effects, perioperative analgesic requirements and time to the first analgesic request after surgery were recorded and statistically analysed. Results: Time to two segment regression was significantly prolonged in Group C (78.87 ± 13.362 mins.) and Group F (84.17 ± 12.463 mins.) as compared to Group B (69.70 ± 14.005 min); (P < 0.05). There was significant prolongation of postoperative analgesia as seen by the time to first analgesic request after surgery in Group C (3.550 ± 1.1013 hours) and Group F (5.183 ± 1.1706 hours) as compared to Group B (2.350 ± 0.9016 hours). (P < 0.05). There was increased incidence of hypotension and nausea in Group C compared to other two groups. Conclusion: Perioperative analgesia was prolonged by the addition of 75 μg of clonidine and 25 μg fentanyl to bupivacaine, with increased side effects of nausea, vomiting and hypotension in the clonidine group.

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A rare case of disseminated infection with Trichosporon asahii (T. asahii) in a fifty year old immunocompetent male patient with tetraplegia with history of fever for ten days. Blood culture and urine culture showed growth of Trichosporon asahii. Identification was based on microscopic picture, colony morphology, conventional biochemical test and by means of Vitek 2 Compact System version: 06.01 (bioMerieux, France). Antifungal susceptibility testing was done by disk diffusion method. It was found sensitive to fluconazole, voriconazole and amphotericin B. Patient responded well to intravenous fluconazole treatment. To the best of our knowledge, this is the first case of disseminated Trichosporon asahii in immunocompetent patient in Eastern India.

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Background: Maternal hemodynamic changes are common during spinal anesthesia for caesarean delivery and many agents are used for treating hypotension. In this study, we compared the efficacy of ephedrine and phenylephrine in ameliorating hypotension in spinal anesthesia for caesarean delivery during crystalloid coloading and their effect on fetal outcome. Materials and Methods: A total of 80 American Society of Anesthesiologists (ASA) grade I/II patients undergoing elective cesarean delivery under spinal anesthesia with a normal singleton pregnancy beyond 36 weeks gestation were randomly allocated into two groups of 40 each. Group 1 received bolus dose of intravenous (IV) ephedrine 6 mg and group 2 received bolus doses of IV phenylephrine 100 μg. Hemodynamic variables like blood pressure and heart rate (HR) were recorded every 2 min up to delivery of the baby and thereafter every 5 min. Neonatal outcome was assessed using Apgar score at 1 min and 5 min and neonatal umbilical cord blood pH values. Results: There was no difference found in managing hypotension between the group 1 and group 2. The incidence of bradycardia was higher in phenylephrine group (group 2). The differences in umbilical cord pH, Apgar score, and birth weight between the two groups were found to be statistically insignificant. Conclusion: Phenylephrine and ephedrine are equally efficient in managing hypotension during spinal anesthesia for elective caesarean delivery. There was no difference between the two vasopressors in the incidence of true fetal acidosis and neonatal outcome.

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The growing number of legal issues in the various fields of medical specialities in the current era has been no different in radiology. Errors in diagnosis and interventional procedures are the areas of legal liability in the practice of radiology. The complexity associated with such issues has been the major concern of practicing radiologist. In this article, an attempt has been made to focus the legalities in the field of radiology with emphasis on the Indian set up and existing Laws governing such actions.

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Desmoid tumors (DTs) constitute a rare fibroblastic proliferative disease. In a female patient presenting a tumor of the lower abdominal wall especially after cesarean section, an endometriotic tumor as well as an aggressive DT should be considered. Here we report a case of pregnancy associated with an anterior abdominal wall DT in a second gravida with previous cesarean, being the first such case from the northeastern region. DTs are histologically benign neoplasms arising from the connective tissue sheath of striated muscles but may exhibit locally aggressive growth patterns and a high rate of recurrence. Large percentages of DTs in females arise in and around pregnancy, perhaps related to trauma from abdominal stretching during fetal growth and due to estrogen levels. It is not clear from currently available data whether pregnancy-associated desmoids are molecularly distinct from other desmoids. Currently, surgery is the most favored treatment for DTs.

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A case of microglossia is reported herewith. 7 month old child had a small tongue but there were no breathing, feeding difficulties. He had a small mandible with no arch collapse. He had no dentition on the mandible but had 4 teeth on the upper jaw.

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"Scrotal pearl" or calculus in the hydrocele fluid is found incidentally during an operation, ultrasound or clinical, if large in size. The exact etiopathogenesis of the disease is not clear but is linked to inflammation, injury, necrosis, and infections by parasites. It is a benign asymptomatic condition and a rare complication of hydrocele. A stone in hydrocele does not change the management or prognosis; however, if the stone is adherent to the tunica albuginea and does not change position on ultrasonography the possibility of a tumor has to be borne in mind.

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Background: Benign as well as malignant lesions can present as lymphadenopathy in the head and neck region. Fine-needle aspiration cytology (FNAC) is the least expensive and a well-established method for diagnosing palpable neck nodes. Aim: This was a baseline study done to evaluate the different cytomorphological patterns of metastatic neck nodes, the age and sex distribution of the same, and to study the patterns of lymph node involvement. Materials and Methods: This was a 5-year retrospective study carried out at the Department of Pathology, Regional Institute of Medical Sciences, Imphal, Manipur for the period between September 2005 and August 2010. The FNAC results were reviewed and the morphology of the individual cells and their patterns were studied in detail. All hematolymphoid neoplasms were excluded. Result: A total of 380 cases with metastasis to the head and neck nodes were encountered. Three hundred and twenty-six (90.2%) of the cases were seen in patients above 40 years of age. Males [248 (65.3%)] were affected more than females [132 (34.7%)], with a male-to-female ratio of 1.8:1. Metastatic squamous cell carcinoma [126 (31.3%)] was the most common tumor type. Single-lymph node involvement was noted in 360 (94.7%) cases and cervical lymph nodes were the most frequently involved in 241 (63.4%). Conclusion: An early diagnosis of metastatic neck node can be made by FNAC. Squamous cell carcinoma was the predominant cell type in our study, and undifferentiated carcinoma accounts for a significant proportion. Increasing age and male sex is associated with higher chances of developing metastasis.

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Migraine is a primary headache disorder. It includes transient aura symptoms that occur before the headache phase. Auditory hallucinations are very infrequently reported as part of migraine and are a very rare presentation. We report a 15-year-old nonpsychotic adolescent boy who has had migraine and auditory hallucinations for the past 6 years, and it worsened over the last 2 months, which was closely correlated with the severity, frequency, and duration of episodes of symptoms. The auditory hallucinations and the migraine attacks disappeared together under prophylaxis with tab. topiramate. This report suggests the possibility of auditory hallucinations as an acoustic aura in migraine attacks.

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Background: Pauci-immune crescentic glomerulonephritis is the most common cause of crescentic glomerulonephritis (CrGN). Patients usually present with rapidly progressive glomerulonephritis (RPGN) with hematuria, proteinuria, and elevated serum creatinine levels. The characteristic feature of pauci-immune CrGN is focal necrotizing CrGN associated with little or no glomerular staining for immunoglobulin (Ig) by immunofluorescence microscopic examination. Most patients (80-85%) with pauci-immune CrGN, including the patients with and without systemic vasculitis, have antineutrophil cytoplasmic autoantibodies (ANCAs). Aims and Objectives: To study and compare the histological and laboratory features of ANCA-positive and ANCA-negative pauci-immune CrGN. Materials and Methods: Patients who were diagnosed with pauci-immune CrGN from January 2012 to May 2015, at BABINA Diagnostics, were included in this retrospective study. The terms "pauci-immune" and "crescentic glomerulonephritis" were defined according to standard guidelines. The demographic and laboratory data were extracted from the Laboratory Information System (LIS) for analysis. ANCA tests were performed by both indirect immunofluorescence (IIF) assay (EUROIMMUN, Lubeck, Germany) and antigen-specific enzyme-linked immunosorbent assay (ELISA) (ORGENTEC Diagnostika GmbH, Germany). Renal specimens were evaluated using direct immunofluorescence (for Ig and complement components) and light microscopy using routine and special stains. Results: Four (19%) out of the 21 cases of pauci-immune CrGN were ANCA negative. Acute features on histology were seen more than chronic features than ANCA-negative cases. Conclusion: Among the patients with pauci-immune CrGN, ANCA-negative patients were not rare. Compared with ANCA-positive patients, ANCA-negative patients had a lower percentage of normal glomeruli, more of chronic features, and a higher level of proteinuria.

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Background: Local anesthetics are often combined with adjuvants such as opioids and α₂ agonists to improve or prolong the anesthetic effect. This study was taken up to compare the duration of postoperative analgesia between ropivacaine with clonidine and ropivacaine with dexmedetomidine. Materials and Methods: In this prospective, randomized, double-blinded study, 50 adult patients of both sexes undergoing lower abdominal surgeries under spinal anesthesia were allocated to two groups, C and D, by a computer-generated randomization table. Group C (clonidine group) received 2.5 mL of 0.75% hyperbaric ropivacaine with 50 μgm of clonidine (0.5 mL) and Group D (dexmedetomidine group) received 2.5 mL of 0.75% hyperbaric ropivacaine with 5 μgm of dexmedetomidine in 0.5 mL of normal saline. The spinal block characteristics, duration of surgery, duration of postoperative analgesia, first 24 h analgesic consumption, hemodynamic parameters, and adverse effects (if any) were recorded. Results: The time to S2 regression was significantly more with Group D (Group D vs Group C: 448.78 ± 41.52 vs 392.68 ± 38.72 min (P < 0.001). There was significant difference between Groups C and D in duration of analgesia (269.20 ± 51.61 vs 303.20 ± 48.65 min; P = 0.020) respectively. Analgesic consumption (in mg) in the first 24 h was statistically less in the dexmedetomidine group than in the clonidine group (248.00 ± 58.59 vs 312.00 ± 60 min; P < 0.001). The incidence of hypotension and bradycardia was: Group D vs Group C: 12 vs 10, 5:4, respectively. Conclusion: Dexmedetomidine as an adjuvant to ropivacaine spinal anesthesia, provided excellent quality of postoperative analgesia with minimal side effects in prolonged surgeries compared to clonidine.

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Objective: The sciatic nerve is the largest branch of the sacral plexus (L ₄ -S ₃ ) that is formed within the pelvis before its entry into the greater sciatic foramen. It leaves the pelvic cavity by passing through the greater sciatic foramen below the piriformis and descends along the back of the thigh, and usually divides into the common peroneal nerve and the tibial nerve just proximal to the knee. The present study aimed to study the level of division of the sciatic nerve. Materials and Methods: This study was carried out in 25 fetuses of 27-40 weeks of gestation obtained from the Department of Obstetrics and Gynecology, Regional Institute of Medical Sciences (RIMS), Imphal. The lower limbs of 25 fetuses were dissected and the sciatic nerve traced up to the level of the popliteal fossa. Results: In the present study, the lowest incidence of sciatic nerve division was found in the gluteal region (2%). In 12% of the fetuses the sciatic nerve was found to divide in the pelvic cavity before it entered into the gluteal region. The highest incidence of sciatic nerve division was found in the popliteal fossa (86%). Conclusion: Various possible variations of the sciatic nerve should be kept in mind during a surgical procedure or at the time of giving anesthesia to avoid any unwanted events. The high level of division of the sciatic nerve into the common peroneal nerve and the tibial nerve results in the involvement of only one out of the two divisions from sciatic neuropathy.

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Background: Inflammatory bowel disease (IBD) including Ulcerative colitis (UC) and Crohn's disease (CD) are an immune-mediated chronic intestinal condition. The arthritis accompanying the inflammatory bowel diseases are included in the family of spondyloarthritis. Peripheral arthritis develops in about 15-20% of IBD patients. Asymetric oligoarthicular large joint involvement have inflammatory characteristics at this patients and occurs in upper and lower extremities. Aim: The aim of this retrospective study was analysis of acute inflammation of joints in 15 patients with ulcerative colitis during 2 years from January 2011 to December 2013. Materials and Methods: This is a retrospective study of ulcerative colitis patients with acute arthritis during two years from January 2011 to December 2013 that refers to rheumatologic clinic of Mazandaran University of medical sciences. Data were analyzed using the SPSS version 20. Variables analyzed include age, sex, presence of arthritis/periarthritis, the number of involved joints, kind and pattern of arthritis. Results: At these study 15 patients with ulcerative colitis and acute arthritis refers to BAGHBAN rheumatologic clinic. All of patients were adults between 18 to 42 years old with median age of 31.5 years old. Ten patients (66%) were female and five patients (33%) were male. The media duration of ulcerative colitis was 3.9 years. Periarthrtis occurs in 7 (46%) patients in association with arthritis. The most commonly involved join was ankle in 11 (73%) cases. Another involved joints were knee in 5(33%), wrist in 2 (12%), MTPs in 3(20%), MCPs in 1(6%) and hip in 1(6%) of cases. In 4 (27%) patients arthritis were monoarthicular and eight (53%) of patients arthritis were oligoathicular in 3 (20%) cases, arthritis were polyarthicular. All of arthritis were inflammatory. In 2(13%) of patients, arthritis were symmetric and in 9(60%) of cases were asymmetric. Conclusion: Inflammatory joint disease including arthritis and periarthrtis are important findings in ulcerative colitis. Asymmetric lower extremity large joint arthritis especially in ankles are common kind of peripheral arthritis of this disease.

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The causes of pleural fluid eosinophilia have been a controversial issue. This prospective study was conducted in RIMS, Imphal with objectives to find out the causes of pleural fluid eosinophilia (PFE), prevalence rate, explore its clinical importance and to evaluate the outcome of treatment. A total of 53 patients who presented in the Respiratory Medicine Department of Regional Institute of Medical Sciences, Imphal with PFE were analyzed from October 2012 to September 2014. Prevalence rate was found to be 7.89%. Out of the 53 patients, 35 (66%) were males and 18 (34%) were females with age ranging from 16 to 86 years (mean age: 47.43 ± 18.34). The causes were paragonimiasis: 15 (28.30%); tuberculosis: 10 (18.87%); carcinoma: 8 (15.09); parapneumonic effusions: 6 (11.32%); pneumothorax: 5 (9.43%); haemothorax: 4 (7.55%); Meig's Syndrome and amoebiasis: 1 each (1.89%) and unknown: 3 (5.66%). It occurred mainly in people from rural areas (64.2%) and most of them were Christians (49.05%). The majority of effusion associated was seen to be exudative effusion (94.3%) and maximum cases (60.4%) had peripheral blood eosinophilia (>500 eosinophils/cumm of whole blood). All the cases were given appropriate treatment according to the aetiology and all the treatable causes recovered satisfactorily. It concluded that young Christian males from rural and mostly hilly regions of Manipur have PFE due to Paragonimiasis which is due to consumption of undercooked crabs or snails which are the hosts of Paragonimus species and PFE with blood eosinophilia is associated with non-malignant conditions.

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