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   Table of Contents - Current issue
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September-December 2021
Volume 14 | Issue 3
Page Nos. 295-397

Online since Thursday, September 30, 2021

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GUEST EDITORIAL  

COVID-19: Is it merely about the third wave Highly accessed article p. 295
Madhav Prabhu
DOI:10.4103/kleuhsj.kleuhsj_227_21  
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REVIEW ARTICLES Top

Nutrition insights in COVID-19 Highly accessed article p. 297
Harpreet Kour, Richa Shrivastava
DOI:10.4103/kleuhsj.kleuhsj_131_21  
The COVID-19 is compromising individuals' immunity to a larger extent, it becomes imperative to strengthen and support the immune system with the right nutrition. Immune functioning can be improved through the right nutrition. Hence, adequate nutrition becomes paramount in leveling up the immune functioning through higher and wider Immunoglobulin generation. This review article is attempted to highlight the importance of nutrition during compromised immunity as in the case of COVID-19.
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Ofloxacin resistance in Mycobacterium tuberculosis: An increasing concern p. 302
Ramesh S Kumar, K. R. Uma Devi, Azger Dusthackeer, Christy Rosaline Nirmal
DOI:10.4103/kleuhsj.kleuhsj_390_20  
Multidrug resistance tuberculosis (MDR-TB) associated with the development of resistance to fluoroquinolones (FQs) especially ofloxacin is a matter of concern, as they had been earlier recommended drugs for usage in the MDR-TB treatment regimens, and moxifloxacin and other quinolones are still on the list. Mycobacterium tuberculosis acquires resistance to FQs mainly through mutations in the quinolone resistance determining regions (QRDRs) of the gyrA gene and less frequently in the gyrB gene. A literature search on the geographical distribution of ofloxacin resistance in TB shows that there is a mild surge in reporting of the resistance to ofloxacin in tuberculosis patients. Molecular tests demonstrating mutations in gyrA and gyrB genes is widely used to detect ofloxacin resistance and the broadly available commercial assay for the rapid detection of second-line-drug resistance, including FQ resistance, the GenoType MTBDRsl assay (Hain Life science, Nehren, Germany), detects the most common mutations found in the QRDR of gyrA while its new version 2.0 detects mutations in the gyrB as well. It has been shown that on reviewing the frequency and geographic distribution of gyrA and gyr B mutations associated with FQ resistance, there do exist geographic differences in the frequencies within and across countries. Cross-resistance to FQs is an area of concern, although some studies show that concordance in resistance among the FQ agents, lower level of cross-resistance has also been reported. The presence of ofloxacin resistance is an alarm signal while Moxifloxacin and other FQs are still the recommended drugs for the resistant TB cases. The WHO recommendation that ofloxacin be phased out from MDR-TB regimens is well justified. It is important that rationale usage of ofloxacin is needed for preventing ofloxacin resistance, to aid in the management of tuberculosis.
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Strategies in laboratory diagnosis of COVID-19 in India p. 310
Abhijit Vinodrao Boratne, Lalithambigai Chellamuthu, Yogesh Bahurupi
DOI:10.4103/kleuhsj.kleuhsj_405_20  
COVID-19 has been documented as the fifth pandemic since 1918 Spanish flu (H1N1). It began as a human cluster of pneumonia cases of unknown etiology, reported from Wuhan, China, during late December 2019. The etiological agent of the pandemic was detected as severe acute respiratory syndrome coronavirus-2. The Indian Council of Medical Research along with the Ministry of Health and Family Welfare expanded and diversified testing capacity. Reverse transcription-polymerase chain reaction (RT-PCR) is the gold standard for COVID-19 diagnosis. TrueNat or cartridge-based nucleic acid amplification test is for testing at primary and secondary health care level. Rapid antigen test has been designated for field level testing in containment zones as well as hospitals supplementary to RT-PCR. Antibody testing had been adopted mainly for surveillance purpose and not for confirmation of COVID-19.
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ORIGINAL ARTICLES Top

Clinical profile, management, and outcome of neonates with congenital structural anomalies admitted in neonatal intensive care unit p. 315
Vinaya Ajaykumar Singh, Sushma Malik, Prachi Gandhi, Poonam Wade
DOI:10.4103/kleuhsj.kleuhsj_169_21  
BACKGROUND: The aim of this study was to describe the clinical profile, management, and outcome of neonates with congenital structural anomalies and to determine the proportion of neonates having major and minor congenital structural anomalies and requiring surgical intervention. This retrospective cross-sectional study included all neonates admitted in neonatal intensive care unit of a tertiary health-care referral center over a period of 1 year. Neonates with acquired form of surgical conditions (like abscess and necrotising enterocolitis) were excluded from the study. We also studied various maternal risk factors such as gestational diabetes, amniotic fluid volume, and pregnancy registration. RESULTS: Out of total 1667 admitted neonates during the study period, 157 (9.41%) had congenital structural anomalies, and in only 44 neonates, the anomaly was detected antenatally (28.02%). Majority of anomalies belonged to cardiovascular system (n = 44, 28.02%), followed by equal proportion in genitourinary and central nervous systems (n = 26, 16.56%), and 19 (12.10%) babies had multiple congenital anomalies. The maternal risk factors for structural anomalies included gestational diabetes, oligohydramnios, and number of antenatal visits. Surgical intervention was done in 22 (14.01%) neonates and the rest 135 (85.98%) babies were not operated. The patients who were not operated for their congenital anomalies include those who either died before intervention, or their surgery was deferred because of their poor general condition, babies who were discharged against medical advice or had multiple anomalies where the surgical intervention was not beneficial. Among the study group, 114 (72.61%) neonates were discharged, parents of 6 (3.82%) babies took discharge against medical advice, and 37 (23.56%) newborns succumbed. CONCLUSIONS: This study has highlighted the pattern of congenital malformations with associated maternal risk factors. Health education, regular antenatal visits, and extremely sensitive prenatal screening method are needed for prevention and early intervention for improving the outcome of high-risk pregnancy.
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Detection of human papillomavirus genotypes in human immunodeficiency virus-negative women in Belagavi, Karnataka p. 322
Vinay S Pala, Chidanand Patil, Mahantesh B Nagmoti, Anita Dadi Dalal, Arati Mane
DOI:10.4103/kleuhsj.kleuhsj_21_21  
BACKGROUND: Women are known to be at high risk of human papillomavirus (HPV) infection and its associated cervical pathology. However, limited data are available on circulating genotypes, especially among human immunodeficiency virus (HIV)-negative women. Therefore, the present study was designed to gauge the prevalence of HPV genotypes in HIV-negative women. MATERIALS AND METHODS: This cross-sectional study was conducted on a total of 96 HIV-negative women in the age range of 18–45 years. Cervical samples were collected from the transformation zone of the cervix using the deoxyribonucleic acid collection device (cytobrush), which was rinsed in 20 ml of PreservCyt® vial (Hologic, Inc.). HPV genotyping was done with the linear array HPV genotyping test (Roche, Branchburg, NJ, USA) at National Aids Research Institute, Pune. RESULTS: A significant linear increasing trend in proportion of carcinogenic and noncarcinogenic genotypes over grade was observed (P = 0.039 and P = 0.0024, respectively). HPV 59 was reported to be the most common genotype followed by 16, 53, 62, and 72 but without any statistical significance. CONCLUSION: Screening strategies incorporating HPV genotyping and vaccination should be effective in preventing cervical cancer in HIV-negative women.
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Comparison of pseudoexfoliation syndrome and normal cases undergoing manual small-incision cataract surgery in a tertiary health-care center in Eastern India p. 328
Suprava Das, Swati Samant, Pradeep Kumar Panigrahi, Lipika Mehra
DOI:10.4103/kleuhsj.kleuhsj_27_21  
INTRODUCTION: Pseudoexfoliation (PXF) syndrome has been known to be a genetically inherited syndrome which generally affects the population above 50 years of age. It further increases the chances of complications during cataract surgery. AIM: In our study, we aim to compare the results of manual small-incision cataract surgery (MSICS) in PXF eyes and controls and report the intraoperative and postoperative outcomes (up to 6 weeks) in both groups. MATERIALS AND METHODS: This was a prospective, observational, nonrandomized study, which was conducted in the ophthalmology department in a tertiary hospital in Eastern India from February 1, 2018, to December 31, 2019. 50 patients with PXF (Group 1) and 50 controls (Group 2) were included in this study and assigned to undergo MSICS. RESULTS: Group 1 patients (with PXF) were found to be significantly of older age (P = 0.0315). Mixed cataract, i.e. with cortical and nuclear sclerosis, was present in 22 (44%) eyes in Group 1 and 31 (62%) eyes in Group 2. After attaining maximum dilatation, the 1st group was observed to have significantly smaller mean pupil diameter than 2nd group (P = 0.0001). In Group 1, intraoperative complications were observed: zonular dehiscence in 3 (6%) eyes, posterior capsule tear/rupture in 7 (14%) eyes, and vitreous loss in 6 (12%) eyes (including 3 eyes of zonular dialysis). In the 2nd group, no such complications were encountered during surgery. Postoperatively, anterior chamber cells and flares were significantly more in the 1st group than that in the 2nd group (P = 0.0002). Best-corrected visual acuity of 6/12 or better was found in 43 eyes (86%) of the 1st group and in 46 eyes (92%) of the 2nd group. CONCLUSION: We conclude that with meticulous preoperative evaluation, vigilant intraoperative measures, and proper surgical expertise, MSICS can be an apparently safe procedure in patients with PXF syndrome.
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A cross-sectional study on predictors of quality of life of persons living with human immunodeficiency virus p. 334
Anuradha Gautam
DOI:10.4103/kleuhsj.kleuhsj_371_20  
CONTEXT: Quality of life (QoL) in persons living with human immunodeficiency virus (HIV) (PLHIV)/acquired immune deficiency syndrome (AIDS) is a salient issue. The advent of highly active antiretroviral treatment has changed this deadly disease to a chronic manageable illness with focus shifting from fighting virus to ensuring a good QoL. AIMS: The aim of the study was to assess the predictors of health-related QoL (HRQoL) of PLHIV. SUBJECTS AND METHODS: A questionnaire-based cross-sectional study was conducted on 205 PLHIV at antiretroviral therapy (ART) plus center of a tertiary care hospital of Lucknow. Interview method was used to collect the data. The questionnaire contained the sociodemographic, clinical characteristics, and QoL, measured by the World Health Organization (WHO) QOL-HIV-BREF. STATISTICAL ANALYSIS USED: The data were analyzed by using SPSS version 23.0. Bivariate associations were observed through Chi-square test and multivariate logistic regression analysis was performed to find the significant predictors of HRQoL. RESULTS: The mean age of the study subjects was 39.42 years and 42.4% of the participants were females. Mean of HRQoL in the present study was 3.37 (standard deviations = 0.8) and 58.5% participants reported good HRQoL. Male gender, joint family, higher socioeconomic status, unreserved category, working functional status, and treatment other than ART were identified as independent predictors of good HRQoL. CONCLUSIONS: Family and vocational counseling should be an essential component of the care of PLHIV to improve their HRQoL. It may create a better home environment.
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Effects of fixed twin-block and forsus fatigue resistant device on mandibular third molar angulation – A comparative study p. 340
Pooja Milind Tendulkar, Tejashri Pradhan
DOI:10.4103/kleuhsj.kleuhsj_333_20  
INTRODUCTION: Fixed functional appliances such as fixed twin-block (FTB) and forsus fatigue resistant device (FRD) improve Class II skeletal relationships by increasing the length of the mandible, which subsequently leads to an increase in the retromolar space. This would bring about a positional and angular change in the mandibular third molar. These appliances also produce forward movement of the mandibular buccal segments, which has also been cited as an important factor providing space and therefore improving the angulation and eruption potential of the third molars. OBJECTIVE: To evaluate and compare the effects of FTB and forsus FRD treatment on mandibular third molar angulation. MATERIALS AND METHODS: Pretreatment and posttreatment lateral cephalograms and orthopantomograms of 25 patients with Class II division 1 malocclusion treated with FTB were compared with those of 25 patients treated with forsus FRD. Sagittal and vertical skeletal relationships and mandibular length were assessed on lateral cephalogram, whereas linear parameters such as retromolar space; space width ratio (SWR); distance of Xi point from the distal surface of the lower second molar; and angular parameters such as α, β, and ϒ; and gonial angles were measured using orthopantomograms. Intragroup comparison was done using paired t-test, while unpaired t-test was done for intergroup comparison of the observed changes. RESULTS: Mandibular length increased significantly in the FTB group, whereas mesialization of the mandibular dentition was significantly high in the FRD group. Both groups showed a significant increase in retromolar space, SWR, Xi point to 7 distance, α angle, and a decrease in β angle. These changes were significantly more pronounced in the FTB group. CONCLUSION: There was a significant improvement in the third molar angulation following treatment with fixed functional appliances, which was comparatively more in the FTB group than that in the FRD group, owing to an increase in mandibular length.
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Obesity among the urban poor: Evidence from a community-based study among adults residing in an underprivileged area of Bengaluru city, India p. 348
Avita Rose Johnson, Sakthi Arasu, Mitchell Singstock, Nancy Angeline
DOI:10.4103/kleuhsj.kleuhsj_60_21  
BACKGROUND AND OBJECTIVE: Obesity is increasing among the urban poor and is a major risk factor for diabetes, cardiovascular disease, and cancer. The objective of this study is to assess the prevalence and determinants of obesity among adults over the age of 30 years in an underprivileged community of Bengaluru city. MATERIALS AND METHODS: A cross-sectional study was conducted in an underprivileged area of Southern Bangalore. Sociodemographic details, diet, and lifestyle risk factors were assessed by a pretested questionnaire. Anthropometric measurements of height, weight, and waist circumference were recorded and World Health Organization Asian cutoffs for body mass index (BMI) and waist circumference were used. The Chi-square and Fischer exact tests were used, and adjusted odds ratios (AORs) with 95% confidence interval calculated by logistic regression. RESULTS: Of the 2244 participants in the study, 60.8% were obese and 14.7% were overweight. The prevalence of abdominal obesity was 79.2% and was significantly higher among women than among men (P < 0.001). Among those with normal BMI, 42.4% had abdominal obesity. Obesity was significantly associated with 40–59 years age group (AOR = 1.35 [1.10–1.64], P = 0.004), higher education (AOR = 1.49 [1.08–2.06], P = 0.016), higher income (AOR = 1.52 [1.18–2.280, P = 0.042), married status (AOR = 1.43 [1.13–1.820, P = 0.003), and daily consumption of salty foods (AOR = 2.01 [1.30–3.92], P = 0.041). CONCLUSION: Our study in an urban underprivileged area of Bengaluru city found a high prevalence of obesity and abdominal obesity. Targeted interventions are needed to reduce obesogenic environments in urban underprivileged areas, improve access to fresh fruits and vegetables, behavior change communication and screening for diabetes, hypertension and dyslipidemia among the urban poor, considering the high levels of obesity in this population.
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Ondansetron in combination with fluoxetine for obsessive–compulsive disorder: A randomized, double-blind, placebo-controlled study from North India p. 356
Jamshed Ahmad, Anuradha Nischal, Anil Nischal, Bandna Gupta, Manu Agarwal, Adarsh Tripathi
DOI:10.4103/kleuhsj.kleuhsj_29_21  
BACKGROUND: A large percentage of patients with obsessive–compulsive disorder (OCD) do not respond to first-line medications. Ondansetron, a 5-HT3 receptor antagonist, has been shown to be effective in the treatment of OCD as an augmentation agent to selective serotonin reuptake inhibitors. However, scientific evidence in this regard is limited. AIMS: This study aimed to study the effect of ondansetron in combination with fluoxetine on psychopathology, functioning, and quality of life in patients with obsessive–compulsive disorder and to compare these parameters with patients treated with fluoxetine alone. METHODS: This was a 12-week prospective, randomized, double-blind, placebo-controlled study. Patients fulfilling diagnostic criteria for OCD on the basis of the International Classification of Diseases 10-DCR and having a score of ≥4 clinical global impression-severity (CGI-S) were enrolled in the study. The patients received either fluoxetine with Ondansetron (4 mg/day in two divided doses) or fluoxetine with placebo randomly for a period of 12 weeks. The patients were assessed using the Yale–Brown Obsessive–Compulsive Scale (Y-BOCS), Social and Occupational Functioning Assessment Scale, CGI, WHO Quality of Life-BREF, and an adverse event checklist at baseline and at weeks 4, 8, and 12. Seventy patients completed the study. Results: The Y-BOCS total score, obsession subscale score, and compulsion subscale score showed a significantly greater reduction in the ondansetron group than in the placebo group. Improvement in functioning and quality of life was significantly higher in ondansetron group than in placebo group. There was no statistically significant difference between the two groups in terms of side effects. Conclusion: A significant beneficial effect of combining ondansetron to fluoxetine in patients with OCD was observed.
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Factors affecting outcome in neonates with congenital diaphragmatic hernia at tertiary care center p. 365
Nandkishor Dhanvantrao Shinde, Vinod Uplaonkar, Vaishnavi Koneru, Maria Akhtar
DOI:10.4103/kleuhsj.kleuhsj_190_21  
BACKGROUND: Congenital diaphragmatic hernia (CDH) is a major congenital anomaly requiring surgical intervention after birth. Due to improvements in antenatal diagnosis and perinatal management with well advanced neonatal intensive care, there are better overall survival rates in the developed countries. However, the outcome is still poor in developing countries where multiple factors contribute to higher morbidity and mortality. AIM: The aim of the study is to evaluate various factors affecting the perioperative management and their outcome in neonates with CDH. MATERIALS AND METHODS: This descriptive observational study was conducted over a period of 4 years. Neonates who underwent surgery for CDH were included. Demographic data, clinical data, gender, birth weight, period of gestation, antenatal diagnosis records, additional congenital anomalies, initial blood gases in the first 24 h of life, stomach or liver herniation in the thorax, postoperative complications, and final outcome were recorded. RESULTS: During our study period, 36 neonates underwent surgery for CDH. Associated anomalies were detected in 47.2% cases. Persistent pulmonary hypertension was seen in 44.4% cases. Sepsis (55.5%) was the most common complication. Mortality in our study was 64%. Persistent pulmonary hypertension (93.75%) was the most common factor associated with mortality followed by sepsis (80%). Antenatal diagnosis before 20 weeks had the highest mortality (85.7%). Liver or stomach as a thoracic content in diaphragmatic hernia had high mortality. CONCLUSION: Sepsis, shock, hypothermia, metabolic acidosis, and pneumonitis were the preventable factors affecting outcome in CDH. Improving pediatric surgical facilities and neonatal care can improve survival in developing countries.
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Importance of platelet indices in the establishment of etiopathological categorization of thrombocytopenia in children p. 370
Arijit Majumdar, Soumali Biswas, Angshuman Jana
DOI:10.4103/kleuhsj.kleuhsj_331_20  
BACKGROUND: Evaluation of thrombocytopenia requires thorough clinical history, examination, complete hemogram, including platelet indices and bone marrow study whenever indicated. The etiopathogenetic mechanism decides patient management. Platelet-derived indices have a well-established correlation with the differential diagnosis of thrombocytopenia in adult-based research. These indices include mean platelet volume (MPV), platelet distribution width (PDW), and platelet-large cell ratio. The aim of the present study is to evaluate the variation and relationship of platelet indices in hypoproductive and hyperdestructive thrombocytopenia in children. MATERIALS AND METHODS: A prospective, observational study for a period of 1 year was done on children with thrombocytopenia. Platelet count (PLT), PDW, MPV, and platelet-large cell ratio (PLCR) along with relevant clinical details of the thrombocytopenic patients were collected and tested for the statistical significance by the unpaired t-test. RESULTS: This study included 80 patients of thrombocytopenia who were classified into hypoproductive (40 cases) and hyperdestructive (40 cases). The mean PLT in hypoproduction group is 49.3 ± 27.8 × 109/l and in hyperdestruction group is 45.7 ± 35.4 × 109/l with a P value of 0.548. The MPV in hypoproduction group is 9.3 ± 0.5 fl and in hyperdestruction group is 12.5 ± 1.7 fl, with a statistically significant P value of 0.002. The mean PDW in hypoproduction group is 16.3 ± 2.3 fl and in hyperdestruction group is 17.7 ± 2.8 fl with a P value of 0.055. The PLCR in hypoproduction group is 27.57% ±3.57% and in hyperdestruction group is 39.65% ±3.53% with a P value of 0.0003. CONCLUSION: Platelet indices may provide useful information in discriminating the hypoproductive and hyperdestructive thrombocytopenia in children too. Interpretation of platelet indices can help the thrombocytopenic children in the initial management and can avoid invasive investigations.
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Oculo-orbital involvement in craniofacial injuries following road traffic accidents p. 375
Adyasha Dash, Pradeep Kumar Panigrahi
DOI:10.4103/kleuhsj.kleuhsj_163_21  
INTRODUCTION: Craniofacial injury is of common occurrence following road traffic accidents (RTAs). It often leads to serious disabilities, including significant damage to the visual system. AIM: This study aims to evaluate different ocular and orbital manifestations in patients of craniofacial injury following RTA and estimate the incidence of craniofacial injuries following RTA. MATERIALS AND METHODS: All patients with craniofacial injuries following RTA between August 2014 and August 2016 were included in the study. All patients underwent comprehensive ophthalmic evaluation. Imaging studies were done wherever indicated. RESULTS: Out of 840 cases of RTA, 77 cases presented with craniofacial injuries. Incidence of craniofacial injuries was 9.16%. Of the 77 patients, 65 (85%) were male and 12 (15%) were female. Average age was 31.15 ± 12.57 years. The most common age group affected was 21–30 years age group with 34 (44%) cases. Soft tissue injury to globe and adnexa was the most common injury seen in 69 (89.61%) cases. Injury to the orbital wall was present in 33 (42.85%) cases. The sphenoid bone in 28 (36.36%) cases was most commonly involved followed by frontal bone in 24 (31.16%) cases. Subconjunctival hemorrhage was the most common ocular finding noted on anterior segment examination in 51 (66.23%) cases. Commotio retinae was the most common retinal finding seen in 5 (6.49%) cases. CONCLUSION: Several human and environmental risk factors are associated with increased risk of RTA. If controlled properly, it can lead to reduction in mortality and morbidity associated with RTA.
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CASE REPORTS Top

Oculocutaneous manifestations of Xeroderma pigmentosum in children: A prospective case series p. 380
Suchismita Mishra, Jasmita Satapathy, Bikash Ranjan Kar
DOI:10.4103/kleuhsj.kleuhsj_24_21  
Xeroderma pigmentosum (XP) is a rare autosomal recessive disease caused by a gene defect, leading to deficient deoxyribonucleic acid repair. The sun-exposed areas of the body predominantly skin, eyelid, and ocular surface are greatly affected by ultraviolet radiation. In this case series, we report eight children with XP seen over a period of 5 years. All these cases had complaints of photophobia and early lentiginosis in sun-exposed area. Clinical presentation varied from lid freckles, conjunctival hyperemia, conjunctival melanosis, corneal opacity with vascularization, actinic keratosis to skin malignancy. One child with squamous cell carcinoma of the neck died at the age of 5 years. This case series describes the oculocutaneous manifestations seen in Indian children with XP. It also highlights the significance of regular multidisciplinary health check-up to prevent life-threatening complications in these patients.
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Focal hematopoietic hyperplasia of the rib, a rare form of pseudotumor: Report of a case with review of literature p. 384
Kavita Mardi, Pooja Murugai, Meena Bhardwaj
DOI:10.4103/kleuhsj.kleuhsj_22_21  
Focal hematopoietic hyperplasia is a rare and localized proliferation of the bone marrow to such a degree that it produces a tumor-like expansion and hence called a pseudotumor. It is a rare benign condition and only 11 cases of focal hematopoietic hyperplasia have been reported in the English literature so far. We report one such rare case of focal hematopoietic hyperplasia in the rib of a 53-year-old female and reviewed the relevant literature. Our patient presented with backache and palpable swelling in the rib. Radiologically, they all manifested as an expansive and radiolucent lesion and contained ill-defined areas of increased density or calcification. Histologically, all have been characterized by mixed areas of hypercellular marrow and fatty marrow. Treatment in our case was by wide marginal excision of the rib.
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Ophthalmomyiasis externa caused by Oestrus ovis p. 387
Sangameshwarayya B Salimath, Shruti M Agadi, Brijesh A Patil
DOI:10.4103/kleuhsj.kleuhsj_12_21  
External Ophthalmomyiasis caused by Oestrus ovis is the most common cause of human myiasis worldwide. Distinguishing it from other causes is important to prevent sight-threatening complications. Two patients present with pain, redness, and foreign-body sensation in affected eye. Motile larvae were seen on slit-lamp examination later diagnosed as O. ovis infestation on microbiological examination. Larvae were removed and patients were started on topical antibiotics, lubricating eye drops, and systemic antihistaminics and followed up for 3 weeks. Improvement was observed within 1 week of treatment. Early diagnosis will help to know the possibility of internal ophthalmomyiasis.
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A case of acquired external auditory canal stenosis following trauma p. 390
Soumick Ranjan Sahoo, Mandira Sarma
DOI:10.4103/kleuhsj.kleuhsj_406_20  
Acquired external auditory canal (EAC) stenosis is a rare clinical condition. Infection is most common cause which cause acquired EAC stenosis. Trauma is a rare cause. Treatment should be removal of the soft tissue causing the stenosis, doing a canaloplasty, covering the bare areas with skin graft to achieve a patent EAC. We describe a case of the left EAC partial stenosis following road traffic accident 10 years back in which the soft tissue causing the stenosis was surgically removed, canaloplasty was done and bare areas covered with skin graft. The patient has been followed up and no restenosis has occurred.
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Palatine tonsil: An unusual location of rhinosporidiosis p. 392
Santosh Kumar Swain
DOI:10.4103/kleuhsj.kleuhsj_176_21  
Rhinosporidiosis is a granulomatous disease caused by Rhinosporidium seeberi which belongs to class Mesomycetozoea. It mainly affects mucous membranes of the nose, nasopharynx, and oropharynx. It can also involve uncommon sites of the human body to disseminated types. Water and soil act as a reservoir for this organism. Isolated involvement of the palatine tonsil by rhinosporidiosis is extremely uncommon. Extra-nasal manifestations of rhinosporidiosis are relatively uncommon in clinical practice. Tonsillar rhinosporidiosis is extremely rare and often confused with oropharyngeal tumors. The mainstay of treatment of rhinosporidiosis is surgical excision by coblation, laser, or electric diathermy. Here, we report a 32-year-old man presented with a red, polypoidal mass of the palatine tonsil and bleeding occasionally and the diagnosis of rhinosporidiosis was confirmed by histopathological examination. The mass was completely removed along with the tonsil by coblation technique and the base was coagulated under general anesthesia. Hence, the possibility of this atypical site of rhinosporidiosis should be included in the clinical differential diagnosis of any pinkish mass originating from the palatine tonsil, particularly in the endemic area.
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LETTER TO EDITOR Top

Training medical students about research skills: Existing challenges and the potential solutions p. 396
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/kleuhsj.kleuhsj_26_21  
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