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   Table of Contents - Current issue
Coverpage
October-December 2019
Volume 12 | Issue 4
Page Nos. 147-243

Online since Monday, November 11, 2019

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INVITED REVIEW  

E-Learning in medicine: Current status and future developments p. 147
Matthias Schneider, Thomas Binder
DOI:10.4103/HMJ.HMJ_74_19  
We are confronted with a rapid growth in medical knowledge. It has become more and more difficult for health care professionals to keep pace with the state of knowledge. At the same time teaching concepts have changed with a similar speed, propelled by the evolution of the internet, social media, and digital technology. Online education plays an increasing role in all stages of education and can help to overcome some of the difficulties that health care professionals encounter. E-Learning can be more effective, interactive, and adaptive to the needs of the learner. But most importantly, it is available anytime and anywhere. This article focuses on the different stages of learning in a physician's career and on new teaching concepts that are applying innovative technologies to improve education.
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REVIEW ARTICLES Top

Smoking and its risks in Saudi Arabia: Literature review Highly accessed article p. 152
Muhammad Zubair Tahir
DOI:10.4103/HMJ.HMJ_7_18  
Smoking, as recreational activity, is being practiced by over 1 billion people globally. The main objective of the present study was to explore smoking prevalence, its effects and people attitude in the Kingdom of Saudi Arabia (KSA) by literature review. PubMed was used for systematic search. Search was made with key words ‘Smoking AND Saudi Arabia’ and a total of 790 articles were found. When limits were applied with English language and studies on human, 502 articles were left. All abstracts of these articles were reviewed with the application of inclusion criteria of studies in the KSA and Saudi Arabia population and 75 articles were left. Then, these articles were categorised according to content, attitudes, cross-sectional studies, factors or diseases, its effects and associations to risk factors, original articles, prospective and retrospective studies, studies about smoking, surveys, studies showed different prevalences of smoking among schoolchildren, medical colleges, university students, health professionals and other population. Tobacco smoking was a major and modifiable risk factor for cardiac diseases and other diseases in Saudi Arabian population. Majority of smokers were found motivated to quit smoking, needed guidance and treatment. Second-hand smoke (SHS) affects newborns and children's health. Waterpipe smoking and SHS were potential threats for population's health in SA. It was concluded that in the KSA, smoking is a forthcoming alarming threat for different tobacco-related diseases. Now, it can be controlled in minimal time with lesser efforts by strategic planning, designing tobacco control programmes according to sex, age groups and education levels.
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An overview on interference in clinical immunoassays: A cause for concern p. 158
Shiefa Sequeira
DOI:10.4103/HMJ.HMJ_3_19  
Immunoassays are rapid, simple, cost-effective, robust and sensitive laboratory techniques that are extensively used in many important areas of clinical medicine such as diagnosis, prevention, treatment and management of diseases. Universally, it is one of the most extensively used in vitro diagnostic testing methods, and its demand has been increasing exponentially over the past four decades. Routinely, these methods can quantify minute amounts of diverse analytes such as hormones, antibodies, proteins and drugs present in highly complex biological fluids, such as serum, urine, sweat, meconium and cerebrospinal fluid. Immunoassays are successful techniques that can detect up to picomolar concentrations using antigen–antibody reactions without the need of prior extraction. Although immunoassays are useful techniques that help physicians to take quick decisions, they too are subjected to interference from both exogenous and endogenous sources, resulting in false-positive and false-negative results. When the immunoassay results do not appear to fit the clinical picture, it becomes a great challenge to a clinical biochemist, alarms clinicians and confounds immunoassay manufacturers. Sometimes, these results can mislead or miss a diagnosis, resulting in unnecessary investigations and mental trauma to the patient and families. Hence, it is very important for one to be aware of the limitations of this immunoassay, to have knowledge about them and to take necessary actions or precautions to get the right result. There is no single procedure that can rule out all interferences. Furthermore, it is difficult for the laboratorians to identify antibody interference with immunoassay, and thus, physicians should be encouraged to communicate specifically with the laboratory about discordance between results and clinical findings. If there is any suspicion of discordance between the clinical and the laboratory data, an attempt should be made to reconcile the difference. Procedures should be put in place when interference is suspected. Constant communication is required between physician and laboratory about unexpected immunoassay results. Manufacturers can also be communicated to identify the presence of interfering antibody.
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Cryotherapy-induced lipolysis p. 165
Saad Sami AlSogair
DOI:10.4103/HMJ.HMJ_11_19  
Cold-based therapies have been used in the skin in the past due to its minimal damage of skin tissues. Cryolipolysis is a type of non-invasive body contouring technology that makes use of the ability of cold applications to create an inflammatory reaction within adipose tissues which may later on lead to apoptotic adipocyte cell death. Human and animal studies have revealed that cryolipolysis can significantly decrease subcutaneous fat and change body contour without causing damage to the overlying skin and surrounding structures or deleterious changes in blood lipids. Cryolipolysis has been described as a safe and effective procedure by previous studies. A thorough medical history and physical examination is done before the performance of this method to ensure its optimal efficacy. This method can either be used alone or in combination with other treatments such as shock wave treatment. More studies should be done to investigate further how cryolipolysis leads to adipocyte apoptosis so that new methods may be discovered that may enhance subcutaneous fat reduction.
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ORIGINAL ARTICLES Top

Transcriptional regulation of protein S gene p. 170
Maha Dawood Jaffarali, Adrian Hall
DOI:10.4103/HMJ.HMJ_49_18  
Background: Protein S (PS) is a known Vitamin K dependent plasma glycoprotein that is produced in many human tissues including the liver. Furthermore, it has an important function in the coagulation cascade as an anticoagulant cofactor when it binds active protein C. The deficiency of PS may lead to the development of deep vein thrombosis. There are many transcription factors which play an important role in the regulation of the transcription of PS. One of these regulatory factors is the liver specific transcription factor hepatocyte nuclear factor 1 (HNF1), a binding site which is located in the 638 base pair promoter area at the 5' end of the PS gene. HNF1 and PS is not well understood and to confirm the importance of HNF1 in regulating expression of PS small interfering ribonucleic acid (siRNA) which will knockout the HNF1 gene expression can be used, and the effect on PS expression monitored. The levels of expression of HNF1 and PS can be determined by real time polymerase chain reaction. Materials and Methods: Preparation of total ribonucleic acid for complementary DNA synthesis, Evaluation the quality of HepG2 ribonucleic acid by agarose gel electrophores is, Real time polymerase chain reaction, Acrylamide gel electrophoresis. Results: HepG2 rRNA bands shows a good quality of RNA expression, Analysis of the total RNA quantity can be determined by spectrophotometric analysis, The best housekeeping genes were UBC and YWHAZ therefore, there has been used as a reference for the primers samples in efficiency test. HNF1 and PROS1 shows a good expression but with low efficiency which is not required to carry further gene knockdown experiment, SYBR green dye is less sensitive than TaqMan because it presents a non specific detection (primer dimers) were all dsDNA products are detected including primer dimers, contaminating DNA, and PCR product from mis annealed primer. Conclusion: The primer pairs are not efficient to carry further gene knockdown experiment and required to design another HNF1 and PROS1 primers. The efficiency of the PCR should be 90%-100% meaning doubling of the amplicon at each cycle. This corresponds to a slope of -3.1 to -3.6 in the Ct vs log template amount standard curve. To obtain accurate and reproducible results, reactions should have efficiency as close to 100% as possible.
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Health sciences teaching staff's perception about quality of work life in Saudi Universities: Reliability and validity of the questionnaire instrument p. 182
Ahmed Al Kuwaiti, Arun Vijay Subbarayalu
DOI:10.4103/HMJ.HMJ_87_18  
Purpose: This study aimed to develop a valid quality of work life (QoWL) questionnaire for measuring the QoWL of health sciences teaching staff working in Saudi universities. Materials and Methods: A total of 300 teaching staff belonging to health sciences colleges at four Saudi government universities were randomly selected and given with QoWL tool. This tool consists of 24 Likert scale items and five different subscales i.e., (i) working conditions, (ii) psychosocial factors in the workplace, (iii) opportunities for training and development, (iv) compensation and rewards and (v) job satisfaction and job security. Two-hundred and ninety completed questionnaires were received, demonstrating a 97% response rate. Responses were subjected to statistical analysis to measure the reliability and validity of the tool. P < 0.05 was considered as 'statistically significant'. Results: Factor analysis extracted five factors which conjointly explained 93.31% of the variance in health sciences teaching staff attitude toward the QoWL at selected Saudi universities. The overall Cronbach's alpha coefficient was measured at 0.928 for internal consistency reliability. This study demonstrates that the five critical factors consisting of working conditions, psychosocial factors in the workplace, opportunity for training and development, compensation and rewards and job satisfaction and job security are important determinants of QoWL among the health sciences teaching staff working at the higher education institutions in Saudi Arabia. Conclusion: This study provides a reliable and valid tool for capturing the QoWL perceptions of health sciences teaching staff at Saudi universities and may be considered for possible use at comparable institutions elsewhere.
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Personal otolaryngology–head-and-neck wet lab Highly accessed article p. 189
Munzer Abdulhadi Manzlgi, Ammar Mohammed Haidar Shehadeh
DOI:10.4103/HMJ.HMJ_92_18  
Objectives: To have professional surgical instrumentational skills in a low-cost, readily available, personal wet lab, instead of having it on a real patient in the operation theatre or in the costly cadaveric workshops. This study was conducted to assess the feasibility of sheep's head as a valid ear, nose and throat (ENT) surgical training model and to establish a small yet comprehensive ENT wet laboratory. Methods: Sheep's heads, already checked by the veterinarian and safe to use, were collected from the abattoir. However, neck surgery specimens were specifically requested from butchery with more neck tissue and intact skin. Surgical instruments were collected from medical exhibitions, online and the industrial market. With the help of cheap functional industrial instruments, a personal surgical laboratory was established. Ovine specimens were evaluated for human simulation. Moreover, the applicability of most ENT procedures and operations was assessed by a team of six ENT surgeons including three junior surgeons and three senior ENT surgical consultants. Results: Utilising simple basic surgical instruments, a wide variety of surgeries performed with very similar conditions to human operations. Endoscopic procedures include middle ear surgeries, laryngeal fissure, tracheal resection and laryngotracheal reconstruction. Open surgeries, facial nerve decompression, dissection and repair were also performed. Moreover, fibre-optic intubation, fibre-optic bronchoscopy and foreign-body extraction training were tried. Some structures are very similar to human ones; some show mild-to-moderate differences, whereas few structures are totally absent in the sheep head. The consistency of, skin, subcutaneous tissues and bone are remarkably similar to that seen in humans. Lamb's heads are good and accepted substitute models for cadaveric specimens. This personal laboratory could be (at a certain level) a good substitute solution to repeated cadaveric workshops. Personal wet laboratories low-cost training improves surgical skills and if followed by few human cadaveric workshops, could enable the surgeon to start human operations with lower complication rate and shorter intervention time. Conclusion: Province otolaryngologist must build up his own experience before practicing on humans. Using sheep tissues do not carry any risks for disease transmission and are ethically defensible. Structural fresh, ovine heads provide a readily available, anatomically compatible, affordable, model for training. It could hone dexterity, surgical skills and teamwork behaviour well before venturing into real patient training. Anatomical variations in sheep's head such as mastoid, paranasal sinuses and skull base are minimal and do not affect the applicability of most of the procedures.
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Quality of life in diabetics with different complications: A cross-sectional study with patients visiting a hospital on an outpatient basis p. 195
Paul Simon, Datson Marian Pereiera, Rashmi Theresa Mathai, Thomas George, Soniya Abraham, Ovine Loyster DíSouza, Manjeshwar Shrinath Baliga
DOI:10.4103/HMJ.HMJ_15_19  
Objective: Recent data suggest that the incidence of Type II diabetes mellitus (DM2) is on a rise and is a major cause for health-care costs, morbidity and mortality. The major problem with DM II is the secondary complications such as retinopathy, nephropathy, diabetic foot disease, cardiovascular complications and neuropathy which severely hamper the afflicted individual's resources and quality of life (QOL). In the present study, we have attempted at understanding the QOL using the QOL instrument for Indian diabetic patients (QOLID). Aim: The principal objective of the study is to ascertain the QOL is DM II with and without complications in patients visiting a hospital on an outpatient basis. The QOLID is of advantage herewith as the eight domains address all relevant aspects afflicting the QOL of the patients. Materials and Methods: Depending on the complications and prevalence, we included six groups; diabetics without complications (Group I, n = 89), retinopathy (Group II, n = 72), nephropathy (Group III, n = 53), diabetic foot disease (Group IV, n = 86), cardiovascular complications (Group V, n = 25) and neuropathy (Group VI, n = 57). The demographic information, diabetes history, medication and QOLID were collected using a structured questionnaire. The collected data were analysed using the analysis of variance followed by Bonferroni post-multiple comparison test. A value of P < 0.05 was considered statistically significant. Results: In this study, 238 (62.3%) males and 144 (37.7%) females with a mean age of 58.5 years. The overall QOLID score was the highest (126.60 ± 18.54) in Group I and least (59.67 ± 13.4) in Group III. Role limitation due to physical health, physical endurance, financial worries, diet satisfaction and the overall score were lower among the groups with diabetic complications (Groups II–VI) compared to Group I and this was statistically significant. General health, treatment satisfaction, symptom botherness and emotional/mental health scored lower in the groups with diabetic complications (Groups II–VI) compared to Group I and this was statistically significant in all except with diabetic retinopathy. Conclusion: When compared to people without any complications, patients with complications had reduced QOL. Individuals with diabetic neuropathy and nephropathy had very reduced QOL compared to other diabetic complications. Prevention or delay of onset of complications through better management of diabetes may help improve the QOL.
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The prevalence of metabolic syndrome among hypertensive patients in Hadramout: A hospital-based study p. 200
Rasheed Mohammed Bamekhlah, Mohammed Rasheed Bamekhlah, Hussain Saeed Alghazali, Abdulrahman Rasheed Bamekhlah
DOI:10.4103/HMJ.HMJ_20_19  
Background and Objectives: Hypertension (HTN) is one of the most common medical diseases worldwide, and it is one component of metabolic syndrome (MetS). The aim was to determine the prevalence of MetS among hypertensive patients. Subjects and Methods: A prospective hospital-based cross-sectional study conducted at Al-Rayan Specialized Hospital, Mukalla, Hadramout, Republic of Yemen, from February 2015 to April 2016. MetS was estimated according to the National Cholesterol Education Program-Adult Treatment Panel criteria. Results: From 345 patients, 207 were diagnosed as MetS (60%), whose age was 57.9 ± 9.2 years and significantly higher than that of patients without the syndrome (44.7 ± 6.6) years (P < 0.0001). Males with the syndrome were significantly less than females (32.4% and 67.6%, respectively) compared with patients without, (odds ratio 0.28 95% confidence interval [0.18–0.44], P < 0.0001). As HTN was present in all studied patients, diabetes was more common MetS component in patients with the syndrome (79.2%), followed by the high waist circumference (76.3%), then high triglycerides (66.2%) and the least was low high-density lipoprotein (59.9%). There was 58% of patients with MetS had four MetS components, 32.8% with five and only 7.2% had only three components. Conclusion: The prevalence of MetS among hypertensive patients was high. It was more common in females and older age. Diabetes and central obesity were the most frequent syndrome components. More than half of the patients had >3 components, but a considerable number of patients were with the all 5 components.
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Radiographic assessment of cardiothoracic ratio in apparently healthy adults in Maiduguri p. 204
Alhaji Modu Ali, Amina Sanda Gangrang, Ahmed Abubakar, Umar Abubakar
DOI:10.4103/HMJ.HMJ_25_19  
Background: Cardiothoracic ratio (CTR) is an easy and cheap diagnostic tool in the estimation of the cardiac sizes which is used for the screening and diagnosis of cardiac diseases. Objectives: The study objectives were to assess the normal cardiac size in apparently healthy adults and establish reference ranges in our population for comparison when investigating cardiac diseases. Materials and Methods: Radiographic evaluations of the cardiac size were performed from March 2017 to February 2018 in 172 apparently healthy individuals who were referred to the Radiology Department, Federal Neuro-Psychiatric Hospital, Maiduguri, in Nigeria, for medical examinations. The individuals were divided into the following five age groups: 18–27, 28–37, 38–47, 48–57 and 58 years and above, in order to determine the influence of age on cardiac size. Results: The mean CTR for males and females was 45.10% and 45.71%, respectively, and was statistically insignificant (0.362). The mean CTR of the general population was 45.6%, and the mean CTR value increased with age until the fourth decade when it reduces with age. Conclusion: The result of this study has established the CTR of the Nigerian population in Maiduguri. The CTR gradually increased with age until the fourth decade when it reduces with age. Therefore, establishing normal ranges of CTR is necessary for comparison in a condition where a possible cardiac disease is being examined.
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Pre-test and post-test resuscitation assessment among healthcare workers at Dubai health authority p. 208
Zulfiqar Ali, Bindhu Misbahudeen, Mohammed Anas Mohtasham, KT Mohammed Fasil
DOI:10.4103/HMJ.HMJ_34_19  
Background: Understanding the concept of resuscitation is extremely important in the professional life of all healthcare workers. By achieving the appropriate resuscitation knowledge and psychomotor skills, the efficacy of performance can be enhanced in real-time situations. The level of resuscitation knowledge differs among healthcare workers, and inadequate knowledge raises a considerable concern about the effectiveness when it is performed in real life. Aims: The aim of the study is to assess the changes in pre-intervention and post-intervention knowledge (pre-test and post-test scores) once the individuals are exposed to an intervention (resuscitation training). Methods: We used a pre-test-post-test design that compares different participant groups and measures the degree of change occurring as a result of intervention. Data from all the individuals (n = 4028) were scrutinised and exposed to statistical analysis. Results: We assessed the pre-test and post-test resuscitation knowledge according to type of organisation (Dubai Health Authority [DHA] or non-DHA), type of intervention (advance cardiac life support [ACLS], pediatric advance life support [PALS] or pre-hospital trauma life support [PHTLS]) and the specialty (physicians, nurses, paramedics and others). We found that the DHA staff gained better resuscitation knowledge post-intervention (P = 0.00) as compared to non-DHA staff. ACLS course (P = 0.00) is found to be a better intervention as compared to PALS (P = 0.78) and PHTLS (P = 0.41). Physicians and nurses achieved better pre-test and post-test scores as compared to paramedics and other disciplines. The overall improvement in resuscitation knowledge (pre-test 85 ± 12 vs. post-test 87 ± 9) is marginal, but the impact of intervention (ACLS, PALS and PHTLS courses) is statistically significant (P = 0.00). Conclusions: The study revealed statistically significant overall post-training improvement in resuscitation knowledge for most of the healthcare workers involved in or expected to perform resuscitation at their workplace. Life support training raises the bar of resuscitation knowledge of many DHA staff from an average to excellent level.
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CASE REPORTS Top

Hypopharyngeal synovial sarcoma: A case report and literature review p. 214
Eyad Darraj, Hassan Hotait, Yusur Abdulghafoor, Muhammad Jabbr
DOI:10.4103/HMJ.HMJ_63_18  
Among the wide variety of soft-tissue malignancy subtypes, synovial sarcoma (SS) has always been deemed a rare tumour. While extremities are the main target of this tumour, it can affect any other body region including the head and neck. We reported a case of a male in his third decade who presented to the emergency department with breathing difficulty due to a huge neck mass. After securing the airways by a challenging tracheostomy and a full workout, histopathology results came as SS. The huge size of the mass, its histopathological type and its life-threatening presentation urged us to present this case report and review the literature.
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Extraluminal heterotopic pancreatic tissue: An unusual finding p. 220
Asim Ahmed, Raga Dilip, Ali Khammas, Yousif Eltayeb
DOI:10.4103/HMJ.HMJ_9_19  
Heterotopic pancreas is defined as pancreatic tissue outside usual anatomic location of the pancreas. The most common location is in the submucosa of the proximal part of the gastrointestinal tract, namely stomach, duodenum, and jejunum. Less commonly, other locations have been reported like the mesentery. It usually presents as an incidental finding during the investigation or operation for acute abdomen. We here present a case of unusual heterotopic extraluminal pancreatic tissue found as scattered multiple tiny spots on the surface of the distal small bowel and its mesentery detected during a laparoscopic appendectomy. A finding that we believe has not been reported before.
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Bilateral chromophobe renal cell carcinoma in an end-stage renal disease patient on haemodialysis p. 223
Yaser Saeedi, Mohammad Hassan Al Hamad, Kais Kotiesh, Rafe Alhayek
DOI:10.4103/HMJ.HMJ_17_19  
There is a well-known association between end-stage renal disease (ESRD) and the development of kidney cancer in the native kidney of patients requiring renal replacement therapy. There is now emerging evidence that lesser degrees of renal insufficiency (chronic kidney disease [CKD]) are also associated with an increased likelihood of cancer in general and kidney cancer in particular. Bilateral renal involvement by primary malignant processes is uncommon, although known to occur with Wilms tumours and in von Hippel–Lindau disease. Our patient is a 65-year-old female CKD, on haemodialysis for 8 years with bilateral renal tumours, underwent laparoscopic bilateral radical nephrectomy with histopathology reported as synchronous chromophobe bilateral renal cell carcinoma (RCC), which is the first case reported in the literature. In a study for 10 years on patients with CKD on haemodialysis, who developed acquired renal cystic disease (ARCD), there was an increase in the prevalence and severity of the ARCD as the dialysis continues over the years. Twenty per cent of patients dialysed for 1–3 years have ARCD, compared with >90% of patients dialysed for 5–10 years. In another study held at the Massachusetts General Hospital. They found that the occurrence of bilateral RCC is rare and found in only 1.8% of 329 patients who were treated RCC in 30 years. In a study published in the European Urology 2011. They also found that there are many favourable clinical, pathological and outcome features in the RCC accompanied with ESRD patients on dialysis which arising in the native kidneys compared with the RCC diagnosed in general population patients.
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Two rare cysts in the same patient: An unusual case of headache in the emergency department p. 226
Naveed Syed, Hasan Qayyum, Quatullah Rustum, Ayesha Musabbah Al Memari
DOI:10.4103/HMJ.HMJ_24_19  
An intracranial colloid cyst is a rare, slow-growing cyst typically found near the foramen of Monro. The mechanisms of its origin are still debated. It has a reported occurrence of 0.2%–2% of all intracranial tumours. A nasopharyngeal/Tornwaldt's cyst is also a rare developmental benign cyst commonly present in the midline of the posterior nasopharynx with a reported incidence of 1.4%–3.3% on autopsy specimens and 0.2%–5% on magnetic resonance imaging. To the best of our knowledge, while a few reports are available where these have been reported separately in different patients, the contemporaneous coexistence of these 2 cysts in the same patient has not been reported before.
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Incomplete gallbladder volvulus: A case report of a rare entity p. 230
Malek Bouhani, Mohamed Amine Attaoui
DOI:10.4103/HMJ.HMJ_28_19  
Gallbladder volvulus (GV) is described as the twist of the gallbladder. Unless diagnosed and treated early, it is a rare fatal condition. It often affects aged patients who present with a presumed acute cholecystitis diagnosis. A 92-year-old female presented with a 2-day history of hypochondria pain. The physical examination found a palpable gallbladder and peritoneal signs without jaundice. Blood tests showed acute renal failure without hyper-leucocytosis. An abdomino-pelvic non-contrast-enhanced computed tomography scan was performed and showed an unusual configuration of the gallbladder. She received an emergent laparotomy. At surgery, hyperaemic and incomplete rotated gallbladder was observed and cholecystectomy was performed. The patient's post-operative recovery was favourable. Early diagnosis and efficient surgical treatment are essential to reduce this entity's complications. Physicians should be guided by clinical signs and radiographic studies to diagnose GV correctly.
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Linking faculty development programmes with the intended outcomes and formulating measurable indices p. 233
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/HMJ.HMJ_7_19  
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LETTER TO THE EDITOR Top

Harmful use of alcohol: A global public health priority p. 234
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/HMJ.HMJ_84_18  
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Emergence of antibiotic resistance: A global public health and a political priority Highly accessed article p. 236
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/HMJ.HMJ_93_18  
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Safeguarding the health of the general population through promotion of safe environment: World Health Organization p. 238
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/HMJ.HMJ_95_18  
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Utility of faculty development programs in improving the professional outcome p. 240
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/HMJ.HMJ_6_19  
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Comparative pharmacokinetics of synthetic and natural pterostilbene p. 242
Roopesh Jain
DOI:10.4103/HMJ.HMJ_13_19  
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