Chettinad Health City MEDICAL JOURNAL
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pISSN NO. 2277 - 8845 eISSN NO. 2278 - 2044 Volume - 2, Number - 1, January- March 2013 Chettinad Health City MEDICAL JOURNAL In this issue To do or Not to do! An Objective View of Problems in Rural Healthcare Infrastructure in India Hand, Foot and Mouth Disease Solitary Giant Neurocysticercosis in a Child With Combined Immunodeficiency T- Cell Lymphoma Arising From Gluteal Muscle – A Rare Presentation Aniridia with Sydney Crease Management of Lingual Thyroid by Suprahyoid Approach All rights are reserved Chettinad Academy of Research and Education (CARE) Chettinad Health City Medical Journal is published by the Chettinad Academy Dr. M.A.M.Ramaswamy Shri M.A.M.R. Muthiah of Research and Education. Chancellor - CARE Trustee - CARE Apart from the fair dealing for the Dr. V. Raji Mr. SPK. Chidambaram purposes of research or private study, Vice Chancellor - CARE Registrar - CARE or criticism or review, no part of the publication can be reproduced, stored, or transmitted in any form or by any Editorial Advisors means without prior permission. Dr. V. Raji Chettinad Health City Medical Journal Dr. K.Ravindran and /or its publisher cannot be held responsible for errors or for any Dr. R.M.Pitchappan consequences arising from the use of Dr. P. Rajesh the information contained in this Mrs. L. Lakshmi journal. The appearance of advertising or product information in the various sections in the journal does not constitute an endorsement or approval Chief Editor by the journal and / or its publisher of the quality or the value of the said Dr. N. Pandiyan product or of claims made for it by its manufacturer. Editors Associate Editors EDITORIAL OFFICE Dr. K. Ramesh Rao Dr. D. C. Mathangi Dr. N. Pandiyan Dr. R. Murugesan Dr. V. Anitha Chief Consultant, Dr. Pradeep G. Nayar Dr. Thilaka Muthiah Department of Reproductive Medicine, Dr. K. Senthil Kumar Chettinad Health City, Rajiv Gandhi Salai, (OMR, Chennai), Kelambakkam, Kanchipuram Dist., Tamil Nadu - 603 103 Section Editors India T. +91 (0)44 4742 8300 Dr. Ashok Palaniappan Dr. A.S. Natarajan F. +91 (0)44 4741 3343 Dr. John Paul Evangel Judson Dr. R. Pandurangan Email: [email protected] Dr. R. Ganesan Dr. D. Rajasekaran Dr. M. Jeya Dr. Ramnath Shyamala Dr. S. B. Jothi Ramalingam Dr. R. Ravi Kumar Dr. Lailu Mathews Dr. A. Ruckmani Dr. E. Malligai Dr. B. Srinivasan PUBLISHED BY Chettinad Academy of Research and Education Dr. C. Manohar Dr. M. S. Srinivasan Dr. R. Murali Dr.S. Thayumanavan Dr. Nagajothi Dr. Vasantha N Subbiah WEBSITE Dr. M. Narayana Reddy Mrs. Veena M Joseph www.chettinaduniversity.com/journal IT Support & Design Legal Support Mr. S. M. Michael Mr. Balaji All disputes within the jurisdiction of the Madras High Court only Mr. Ramesh Palaniappan Mr. S. T. Manigandan (Designs) pISSN NO. 2277 - 8845 eISSN NO. 2278 - 2044 Chettinad Health City MEDICAL JOURNAL Contents Editorial 1 N Pandiyan Perspective Article To do or Not to do! 2 Raj Kumar V J Commentary An Objective View of Problems in Rural Healthcare Infrastructure in India 4 Syed Meraj Ahmed Original Article Hand, Foot and Mouth Disease 7 Anitha Elango, Rathinasamy, Umadevi, Jaishree, Suresh, Shilpa Jha Case Report Solitary Giant Neurocysticercosis in a Child with Combined Immunodeficiency 9 Karthikeyan K V, Ramesh V G T- Cell Lymphoma Arising From Gluteal Muscle –A Rare Presentation 11 Senthil Kumar K, Anantharamakrishnan R, Karunanithi R Aniridia with Sydney Crease 14 Srinivasan, Thayumanavan, Padmapriya Management of Lingual Thyroid by Suprahyoid Approach 17 Ramanujam S, Karunanithi R, Ganesan R, Loganathan M A Case of Central Giant Cell Granuloma Involving the Maxillary Sinus 19 Clinically Masquerading as a Malignant Neoplasm Ramesh V, Sriram K, Arunprasad G From the Pages of History Hippocrates and his Oath 23 Ramesh Rao Instruction to Authors 25 Editorial An original article reports on a series of cases with hand, foot and mouth disease. Vanakkam. This issue also carries several interesting case reports. A case report describes surgical approach to solitary The journal enters the second year with this issue. This giant neuro cysticercosis in a child with combined issue carries several interesting and informative immunodeficiency. Another case report presents T- articles, a perspective article, commentaries and case cell lymphoma arising from the gluteal muscle. A reports. dysmorphic child with aniridia and Sydney crease is described in a case report, emphasizing the need for Screening has been the mantra of the last century, early diagnosis. which is carried well into this century. Several screening methods were advocated for many chronic A case report on lingual thyroid describes the clinical conditions - Diabetes, Cancer, and Preeclampsia. presentation. The issue also presents several useful Many of these screening methods have now come medical updates. The pages of history traces the origin under careful scrutiny and critical thinking. A of Hippocratic oath. An interesting ECG triggers your perspective article deals with prostate specific antigen thinking brain into action. screening for prostate cancer. We hope you will enjoy going through this issue; do Health care planning for the fastest growing country in give us your valuable feed back. the world is not an easy task, with majority of the country’s population living in the rural areas. Health care infrastructure in the rural areas leaves much to be desired. A commentary article deals with the problems in rural health care infrastructure in India. Dr. N. Pandiyan An original article reports on a series of cases with Chief Editor : Chettinad Health City Medical Journal hand, foot and mouth disease. E-mail : [email protected] 1 Chettinad Health City Medical Journal Perspective Article To do or Not to do! Dr. V.J. Raj Kumar V J Rajkumar, M.S; FRCSI; FRCS (Glas), Cons Urological Surgeon, ABM University Health Board, Morriston Hospital, Swansea, UK Corresponding author - Dr. V.J. Raj Kumar ([email protected]) Chettinad Health City Medical Journal 2014; 2(1): 2 - 3 Introduction Prostate Specific Antigen (PSA) is a protein produced the PSA level is elevated but no cancer is actually by the cells of prostate gland. It is present in small present. Only 25-35% of men who have a biopsy quantities in the serum of men with healthy prostate but due to an elevated PSA actually have prostate is often elevated in presence of prostate cancer and cancer. Hence a false positive test may lead to other prostate disorders. additional medical procedures that have potential risk and significant financial cost and can create A Blood test to measure PSA is considered the most anxiety for the patient and for the family effective test currently available for early detection of prostate cancer but this effectiveness has also been . False negative test – False negative test occurs questioned1. when the PSA level is normal range even though prostate cancer is actually present. Most prostate However PSA is neither specific for prostate nor cancers are slow growing and may exist for cancer. Although present in large amount in prostatic decades before they cause symptoms. tissue, semen and serum in men, it has also been detected in other body fluids and tissues including Factors Enhancing Perfomance Of PSA female ejaculate, breast milk, amniotic fluid, endome- trium, normal breast tissue and salivary gland tissue2. The major efforts to improve PSA testing have addressed enhancement of specificity. The question of Normal/Reference Range whether to improve sensitivity or specificity is impor- tant as they are generally inversely related parameters. Defining a normal range is difficult. Rather than Efforts to enhance specificity would appear to be more attempting to define a normal range, it would probably logical because with serial testing, a false negative more appropriate to provide the clinician with an result is of less consequence. By increasing the PSA cut appropriate PSA cut off level that affords a reasonable off level, specificity improves but at the cost of decreas- yield of cancer. Even more appropriate, perhaps, ing sensitivity. False positive test are exceedingly would be to establish additional criteria e.g. age, race, expensive as they mandate further testing with atten- digital rectal examination results that would provide a dant increase in expenses and morbidity risk assessment of prostate cancer being present. Number of approaches have been widely used to Various factors such as benign hyperplasia, inflamma- enhance PSA performance tion, ejaculation, cycling, prostatic massage and instru- Age specific PSA cut off point have been used, mentation have all been known to alter the PSA level. taking into account that prostate grows with age Even though there is no specific normal or abnormal and PSA gradually increase with age. PSA level, 4.0ng/ml it is generally taken as a cut off level. However prostate cancer was diagnosed in 15.2% 40-49yrs -----------2.5ng/ml of men with PSA level below 4.0ng/ml3. In another study 65-75% of men of PSA between 4.1- 9.9ng/ml 50-59yrs------------3.5ng/ml 4 did not have prostate cancer . 60-69yrs------------4.5ng/ml Limitation Of PSA Test 70-79yrs------------6.5ng/ml The age specific ranges have not been generally . Detecting tumour does not always mean saving favoured because their use may lead to missing or lives- finding a small tumour does not necessarily delaying detection of prostate cancer in as many as 20% reduce the chances of dying from prostate cancer. of men in the 60’s and 60% of men in their 70’s. PSA testing may identify very slow growing tumours that are unlikely to threaten life. 2 . False positive test – False positive test occurs when Perspective Article To do or Not to do! . PSA velocity - change in PSA overtime may be . Many factors affect PSA levels in serum greater in men with prostate cancer.