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Παρασκευή, 21 Οκτωβρίου 2016

Examination of The Predictive Power of Electromyography and Urodynamic Study in Patients with Cauda Equina Syndrome (Horse Tail Syndrome)

2016-10-21T17-13-47Z
Source: Acta Informatica Medica
Mohammadreza Shahmohammadi, Reza Jalil Khoshuod, Alireza Zali, Amir Saied Seddeghi, and Nima Mohseni Kabir.
Background: Cauda equina syndrome is a rare disorder that causes loss of Lumbar plexus function (nerve roots) lower than conus medullaris. No risk factor has been defined for this disease yet. Due to the high morbidity of Cauda equina syndrome and lack of sufficient information about the connection between the disease and urodynamic findings and EMG (Electromyography) findings, the need for this comprehensive study is felt. Objective: The aim is to determine the predictive power of findings resulted from urodynamics and electromyography of perineal region and around sphincter in the clinical cure rate of urination in patients with urinary retention followed by Cauda equina syndrome. Method: Patients referred to Shohadaye Tajrish Hospital during the years 2009 to 2013, in case of having Cauda equina syndrome symptoms (confirmed with Lumbar MRI), were undergone urodynamic examination and perineal electromyography after surgical decompression action. These both assessments (urodynamic study and electromyography) were repeated during the follow-up of 15 patients in the first and sixth months after surgery and findings were compared with each other. Results: Among the Urodynamic findings, Qmax (maximum urine flow) during three studies had a significant relationship with long-term recovery rate of patients (P


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Comparing Three Data Mining Methods to Predict Kidney Transplant Survival

2016-10-21T17-13-47Z
Source: Acta Informatica Medica
Leila Shahmoradi, Mostafa Langarizadeh, Gholamreza Pourmand, Ziba Aghsaei fard, and Alireza Borhani.
Introduction: One of the most important complications of post-transplant is rejection. Analyzing survival is one of the areas of medical prognosis and data mining, as an effective approach, has the capacity of analyzing and estimating outcomes in advance through discovering appropriate models among data. The present study aims at comparing the effectiveness of C5.0 algorithms, neural network and C&RTree to predict kidney transplant survival before transplant. Method: To detect factors effective in predicting transplant survival, information needs analysis was performed via a researcher-made questionnaire. A checklist was prepared and data of 513 kidney disease patient files were extracted from Sina Urology Research Center. Following CRISP methodology for data mining, IBM SPSS Modeler 14.2, C5.0, C&RTree algorithms and neural network were used. Results: Body Mass Index (BMI), cause of renal dysfunction and duration of dialysis were evaluated in all three models as the most effective factors in transplant survival. C5.0 algorithm with the highest validity (96.77%) was the first in estimating kidney transplant survival in patients followed by C&RTree (83.7%) and neural network (79.5%) models. Conclusion: Among the three models, C5.0 algorithm was the top model with high validity that confirms its strength in predicting survival. The most effective kidney transplant survival factors were detected in this study; therefore, duration of transplant survival (year) can be determined considering the regulations set for a new sample with specific characteristics.


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Effect of Dental Chair Light on Enamel Bonding of Orthodontic Brackets Using Light Cure Based Adhesive System: An In-Vitro Study

2016-10-21T17-13-47Z
Source: Acta Informatica Medica
Anil Tiwari, Tarulatha Shyagali, Sarvraj Kohli, Rishi Joshi, Abhishek Gupta, and Rana Tiwari.
Aim: The aim of this in vitro study was to evaluate the influence of the Dental chair light on the bond strength of light cured composite resin. Materials and Methods: Sixty therapeutically extracted human premolar teeth were randomly allocated to two groups of 30 specimens each. In both groups light cured composite resin (Transbond XT) and MBT premolar metal brackets (3M Unitek) was used to bond brackets. In group I and II light curing was done using Light-emitting diode light curing units without and with the dental chair light respectively. After bonding, all samples were stored in distilled water at room temperature for 24 hours and subsequently tested for shear bond strength and Adhesive Remnant Index (ARI) scores. Data was subjected to Mann Whitney U statistical test. Results: Results indicated that there was significantly higher shear bond strength (7.71 ± 1.90) for the Group II (composite cured with LED and dental chair light ) compared with Group I (composite cured with LED LCU only) (5.74 ± 1.13).the obtained difference was statistically significant. There was no statistical significant difference between ARI scores in between the groups. Conclusions: light cure bonding with dental chair light switched on will produce greater bond strength than the conventional bonding. However, the ARI score were similar to both the groups. It is advised that the inexperienced orthodontist should always switch off the dental chair light while bonding for enough working time during the bracket placement.


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Role of Endothelial Cell Function Assessment Using Flow-mediated Dilation for Diagnosing Coronary Artery Disease in Low-risk Patients

2016-10-21T17-13-47Z
Source: Acta Informatica Medica
Seyed Mahmoud Nouraei, Ali Ghaemian,Hanieh Shiraj,Reza Ali Mohammadpour, and Alireza Malekrah.
Introduction: Flow-mediated dilation (FMD) measurement in the brachial artery (BA) is a method of endothelial cell function assessment. We can use it to predict atherosclerotic coronary artery disease. We investigated the predictive value of FMD for the presence of coronary artery disease (CAD) in a low-risk population of patients without major (CAD) risk factors. Materials and Methods: Three hundred and ninety-seven patients (age 53.2±9 years; 194 men) with chest pain admitted for coronary angiography were enrolled in this study. FMD was measured in the BA before coronary angiography using high-resolution ultrasound. Results: Coronary angiography was normal in (151)patient, (149) with single and (97) multi-vessel disease. FMD was significantly higher in normal coronary groupagainst patients with coronary artery disease (11.1±2.6% vs. 6.8±3.1%; P


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Designing and Implementation of Retina Image Drawing System and Automatic Report Generation from Retina Examinations

2016-10-21T17-13-47Z
Source: Acta Informatica Medica
Reza Safdari, Mehrshad Mokhtaran, and Shahram Tahmasebian.
Introduction: Electronic medical records as one of major parts of electronic health records is an important application of Medical Informatics. EMR includes different types of data, Graphical items being one of these data types. To this end, a standard structure for storing and recovering and finally exchanging this data type is required. In order to standardize information items in this research, UMLS standard is used. In this research, graphical information from fondues designing in retina surgery forms is used for the task of implementation. Implementation: Three-layer software architecture is used for implementation of this system, which includes user interface, data base access and business logic. XML database is used for storing and exchanging of data. User interface is designed by the means of Adobe Flash. Also in the user interface for eye examinations, appropriate icons compatible with current pathologies in retina examinations are considered and UMLS codes are used for standardizations purposes. Results: As this project is independently implemented in Adobe Flash, it can be run in most of electronic patient records software. For evaluation purposes of this research, an EMR system for eye clinics is used. Tree structure is used for data entry and finally a text report based on the entered data will be generated. By storing graphical items in this software editing and searching in medical concepts and also comparing features will be available. Conclusion: One of the data items that we encounter in various medical records is graphical data. In order to cover the patients complete electronic medical records, the Electronic Implementation of this information is important. For this purpose, graphical items in retina surgery forms were used and finally a software application for drawing retina picture was developed. Also, XML files were used for the purpose of storing valuable medical data from the pictures, and also UMLS were applied for the standardization purpose. The developed software is currently being used in some of eye clinics in Iran.


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Keratoacanthoma of the oral cavity with osteomyelitis of the mandible

2016-10-21T07-20-27Z
Source: The Southeast Asian Journal of Case Report and Review
Kumaraswamy Mohan Kumar, Dr Harish K.
Introduction- Keratoacanthoma is a benign proliferative disease of the epithelium. It is commonly seen in the exposed parts on the lips, cheek nose and dorsum of the hand. It is rarely seen in the oral cavity. Keratoacanthoma of the oral cavity with mandibular osteomyelitis has not been reported until now. Case report- We report a case of keratoacanthoma of the oral cavity with mandibular osteomyelitis. 82 years old patient with oral lesion of 5 months duration with history of tooth extraction, biopsy was nonconfirmative for malignancy and the CT scan showed destructed mandible. He underwent excision and reconstruction with mandibular reconstruction plate and advancement flap. Histo pathology was reported askeratoacanthoma of the oral mucosa and osteomyelitis of the mandible. Conclusion- Keratoacanthoma may be a differential diagnosis for well differentiated squamous cell carcinoma. Tooth extraction could be the aetiology for keratoacanthoma and the osteomyelitis of the mandible.


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Parous Septate uterus: to treat or not to?

2016-10-21T05-16-47Z
Source: The Southeast Asian Journal of Case Report and Review
Ushakiran T.S, Rajshree Dayanand Katke.
Mullerian duct anomalies are the most common congenital anomalies of the reproductive system and septate uterus is the most frequently diagnosed Mullerian anomaly. The true incidence of Mullerian duct anomalies is difficult to state because some cases may be asymptomatic and there are pitfalls associated with various diagnostic methods.(1)Septate uterus is the most common cause of uterine anamoly and has the highest reproductive failure rate. In this study, we have 4 case reports of patients presenting with different problems in the OPD of Cama and Albless hospital in whom septate uterus was incidently diagnosed during various operative procedures . Septate uterus may present with altogether different symptoms. To treat or not to is the dilemma we are addressing in this presentation


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Unavoidable Caesarian Myomectomy In A Case Of Transverse Lie With Huge Fibroid At Incision

2016-10-21T05-16-48Z
Source: The Southeast Asian Journal of Case Report and Review
Rajshree Dayanand Katke, Shubhangi Nawarange, Nishtha Tripathi.
Myomectomy during caesarean delivery may lead to hemorrhage and uterine atony ,hence it is not recommended. Myomectomy has been reported during cesarean section in recent studies. We presented a patient who was 30 yr old, primigravida with 40wks gestation with transverse lie in prelabour, taken for emergency lower segment caesarian section, and was accidentally found to have a huge myoma in the incision site. As uterine incision could not be closed because of the myoma, myomectomy was performed during caesarean section unavoidably. A single 760 g and 9 cmx 7 cm sized and another fibroid of 4cm x3cm myoma was removed. The physical examinations were unremarkable in the postoperative period. If myomectomy during caesarean delivery becomes a widespread practice, it could potentially eliminate multiple surgeries for both indications. Many surgeons have been reluctant to adopt this policy without conclusive evidence demonstrating its safety. However, most of the authors suggested that the complications and morbidity following caesarean myomectomy do not significantly differ from those occurring during caesarean section alone, while fertility is apparently not compromised by this treatment.


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Patent Vitellointeststinal duct with prolapsed and gangrenous small bowel.

2016-10-21T05-16-48Z
Source: The Southeast Asian Journal of Case Report and Review
Yadvendra Dheer, Anand Pandey, Archika Gupta, Shiv Narayan.
A wide variety of anomalies may occur as a result of the vitellointestinal duct (VID) failing to obliterate completely. Most reports on symptomatic VID focus on Meckel's diverticulum, while other anomalies are given little attention. We report a case of a baby of 2 months who presented with prolapsed intestinal loop through umbilicus with gangrenous changes. The gangrenous part of intestine was resected and end to end anastomosis was done.


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Impaired fasting glucose and impaired glucose tolerance in rural central India: A study of prediabetes in the first degree relatives of patients with type 2 diabetes mellitus in a rural region of Malwa in Madhya Pradesh

2016-10-21T03-53-30Z
Source: National Journal of Physiology, Pharmacy and Pharmacology
Abhilasha Dutta, Abhishek Kumar, S N Shukla, Amol Daniel.
Background: Prediabetes is a category of glucose tolerance representing an intermediate stage between normal glucose tolerance and diabetes and is characterized by impaired fasting glucose (IFG) and impaired glucose tolerance (IGT). People with prediabetes eventually progress to diabetes over a period, and this factor becomes a more important when first-degree relatives (FDRs) of patients with Type 2 diabetes are concerned as genetics is an unmodifiable risk factor. Aims and Objectives: To determine the prevalence of IFG and IGT in the FDRs of patients with Type 2 diabetes mellitus (T2DM) in a rural population of central India. Materials and Methods: A total of 200 subjects (134 males and 66 females), over the age of 20 years from village Hatpiplia, Dist Dewas, Madhya Pradesh who were FDRs of patients with T2DM were evaluated. Blood samples for fasting blood sugar (FBS) and 2 h postglucose blood sugar were taken and analyzed on fully automated analyzer MERCK Microlab 300 LX by enzymatic colorimetric method. Results: The prevalence of IFG was found to be almost 14.5% (95% confidence interval [CI] 10.29-20.05) in the FDRs of relatives with T2DM and 10% (95% CI 6.5-14.9) had newly diagnosed DM on the basis of their fasting sugar levels. Only 13% (95% CI 9.0-18.3) of the subjects had impaired glucose levels on 2 h postglucose loading blood sugar and DM by this method came to be very similar to the FBS method. Conclusion: Diabetes is a rapidly developing condition even in rural sectors of our nation and necessary measures should be taken to bring down the prevalence of this disease.


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Mesial temporal sclerosis

2016-10-21T02-09-39Z
Source: International Journal of Research in Medical Sciences
Sheetal Deshpande, Prashant Kashyap, Dhaval Dave, Anannya Mukherji.
Mesial temporal sclerosis is closely related to temporal lobe epilepsy, a type of partial (focal) epilepsy in which the seizure initiation point can be identified within the temporal lobe of the brain. Mesial temporal sclerosis is the loss of neurons and scarring of the deepest portion of the temporal lobe and is associated with certain brain injuries. We present a case of a 40year old male who was presented with generalized seizures and was diagnosed with mesial temporal sclerosis.


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Ring chromosome 15 presenting as short stature, intellectual disability and café-au-lait spots

2016-10-21T02-09-39Z
Source: International Journal of Research in Medical Sciences
Sandip G. Gediya, Lakhan Poswal, Anuradha Sanadhya, Suresh Goyal.
Ring Chromosome 15 results from loss of genetic material from both ends of chromosome 15 and joining of the ends to form ring. Only 50 cases are reported in literature with none from India. We report a case of 17 years old female approached us for short stature and low intelligence. On examination we noticed childish facial features, microcephaly and cafe-au-lait spots in significant number and size. Her karyotype result was 46xx r15. CONCLUSION: Ring chromosome 15 syndromes should be considered in a case having short stature with cafe-au-lait spots. Timely recognition and hereditary tendency counselling is required.


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Post craniectomy paradoxical brain herniation: a case report with radiological review

2016-10-21T02-09-39Z
Source: International Journal of Research in Medical Sciences
Sanjay M. Khaladkar, Raunak Raj, Rajul Bhargava, Rohan Khujat, Amaya Mahajan.
Sinking skin flap (SSF) syndrome and paradoxical brain herniation are rare complications after craniectomy. On CT scan, there is shrunken appearance of the skin flap at craniectomy site. The meningogaleal complex is drawn inwards and is resting on underlying deformed brain with resultant concave surface. It results due to altered CSF hydrodynamics. Paradoxical brain herniation is rare complications which occur in patients who undergo cerebrospinal fluid (CSF) drainage procedures like lumbar puncture (LP), external ventricular drainage, ventriculo-peritoneal shunting and post craniectomy. Its early detection on imaging is essential as it is a neurosurgical emergency. We report a case of 75 year old male previously operated for left chronic subdural hematoma in the left fronto-temporo-parietal region presenting with altered consciousness and inability to walk. Plain CT scan showed craniectomy defect in the left fronto-temporo-parietal region with indrawing of meningogaleal complex suggestive of Shrunken Skin Flap. There was mass effect on the left lateral ventricle and third ventricle with shift of the midline structures towards right (1cm) with evidence of subfalcine herniation suggestive of paradoxical brain herniation.


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Percutaneous nephrolithotripsy for renal pelvis stone in a crossed fused ectopic kidney: a case report

2016-10-21T02-09-39Z
Source: International Journal of Research in Medical Sciences
Rajeev Sarpal, Tarun Chaudhary, Manoj Biswas, Shikhar Agarwal, Ankur Mittal.
Crossed renal ectopia is the second most common fusion anomaly of the kidney after horseshoe kidney. The incidence of both fused and unfused cases is 1 in 7000 in autopsies. Percutaneous nephrolithotripsy (PCNL) is a well-established technique in the surgical management of nephrolithiasis. The conventional fluoroscopic guidance of PCNL will be of limited value in ectopic anomalous kidneys due to the abnormal anatomical landmarks with consequent compromise of the procedures safety. A 30-year old male patient, previously healthy, presented to our urology outpatient clinic complaining of dull flank pain of six month duration with tenderness in the right renal area and an enlarged right kidney and 1 episode of gross haematuria. Radiological investigations showed left side crossed ectopia with nephrolithiasis. Patient was managed successfully by fluoroscopic guided percutaneous nephrolithotripsy. The position of the stone-containing ectopic kidney can make it easy to reach the pelvis of the target kidney without injuring any adjoining structure. The superimposition of the different soft tissue densities in the radiologic view may limit the ability of the operator to distinguish between different tissue identities. Laparoscopic guidance can represent as a practical solution to this technical problem.


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An incidental finding of primary carcinoma of the fallopian tube: a case report

2016-10-21T02-09-39Z
Source: International Journal of Research in Medical Sciences
Nilima D. Lodha, Kiran S. Bharati, Neha K. Saxena, Snehlata R. Hingway.
Primary fallopian tube carcinoma (PFTC) is a rare malignancy of female genital tract that histologically and clinically resemble epithelial ovarian cancer. Diagnosis of PFTC is difficult, especially at earlier stages. Most of the time it is an incidental finding. Careful surgical and pathological staging is important. It has worse prognosis than ovarian cancer as it is not routinely suspected, hence treatment is delayed. We, hereby, report a rare case of PFTC diagnosed incidentally while doing bilateral salpingoopherectomy for removal of ovarian cyst.


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Hydatid cyst of the kidney: a case report and review of the literature

2016-10-21T02-09-39Z
Source: International Journal of Research in Medical Sciences
Neeta Shah, Mubin Patel, Vijay Agrawal, Meena Patel.
Primary involvement of the kidney is rare in case of hydatid disease. We present a case of primary left renal hydatid cyst in a 40 year old female patient admitted with left lumbar pain radiating to the back. Computed tomography of the patient was done and was suggestive of hydatid cyst involving the lower pole of the left kidney. The cyst was managed by left Nephrectomy with open surgical excision and preoperative course of Albendazole. This case emphasizes on better detection and evaluation of such rare cases to identify better treatment strategies.


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Undocumented variant branching pattern of axillary artery

2016-10-21T02-09-39Z
Source: International Journal of Research in Medical Sciences
Suman, Sunita Kalra, Sarika Rachel Tigga.
During routine dissection for teaching under graduate medical students, an atypical case of variant branching pattern in second and third part of the axillary artery was discovered. The posterior circumflex humeral artery and subscapular artery arose as a common trunk from third part of axillary artery. Also, subscapular artery was a small branch whereas lateral thoracic artery was the largest branch of axillary artery which was totally unusual. The lateral thoracic artery supplied second and third intercostal spaces, axillary fat, subscapularis, serratus anterior, teres major and lattisimus dorsi muscles. Also there was an aberrant branch arising from the second part of axillary artery which was observed to be coursing towards the shoulder joint. The co-existance of variant branches along with the extra aberrant artery found in this case is exceptional. The knowledge about this kind of variation is important for vascular surgeons and radiologists for repair of vessels; diagnostic and therapeutic angiography in addition to various skin flaps and muscle transfers for upper extremity and breast reconstruction.


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Management of a patient with severe pulmonary hypertension for urgent orthopaedic surgery

2016-10-21T02-09-39Z
Source: International Journal of Research in Medical Sciences
Shweta Bulle, Charuta Gadkari, Shubhada Deshmukh.
Pulmonary hypertension represents an important risk factor for increased peri-operative morbidity and mortality. Although pulmonary hypertension is a rare disease, there are special considerations to the anesthetic management in patients with severe pulmonary hypertension. Anesthetic aims in pulmonary hypertension are to avoid increased pulmonary vascular resistance, to avoid marked decrease in venous return or systemic vascular resistance, to avoid myocardial depression and to maintain normal heart rate. We present a case of 85 year old male patient having severe pulmonary hypertension, with reported pulmonary artery pressure of 72 mmHg, posted for proximal femoral nailing. We want to stress on the importance of pre-operative evaluation and careful anesthesia planning for successful peri-operative and post-operative outcomes.


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Portal vein thrombosis with protein C-S deficiency in a non-cirrhotic patient

2016-10-21T02-09-39Z
Source: International Journal of Research in Medical Sciences
Sheetal Deshpande, Smita Patil, Manish Pendse, Prashant Kashyap, Dhaval Dave.
There are several conditions that can lead to portal vein thrombosis (PVT), including including infection, malignancies, and coagulation disorders. Anew condition of interest is protein C and S deficiencies, associated with hypercoagulation and recurrent venous thromboembolism. We report the case of a non-cirrhotic 24-year-old male diagnosed with acute superior mesenteric vein thrombosis and PVT and combined deficiencies in proteins C and S.


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An osteological study of measurement of safe zone to prevent iatrogenic suprascapular nerve injury and its correlation with type of suprascapular notch

2016-10-21T02-09-39Z
Source: International Journal of Research in Medical Sciences
Hamzah M. Hafezji.
Background: Suprascapular nerve injury is commonly recognized as a cause of post-operative shoulder pain and rotator muscle dysfunction. The nerve may be injured during open or arthroscopic shoulder surgeries, due to its proximity to the operative field, particularly at the suprascapular and spinoglenoid notches. Safe zone is defined as an area within which iatrogenic injury to the suprascapular nerve is likely to be avoided and it presents definitive limits. Aims of study were to identify morphometric variations of suprascapular notch (SSN), to measure distances from commonly used surgical landmarks to the possible course of suprascapular nerve so as to identify safe zone and to correlate safe zone with the type of suprascapular notch (SSN). Methods: Total 200 dry human scapulae were obtained from Anatomy departments of three medical colleges of south Gujarat. Using digital vernier caliper, for each SSN, maximal depth (MD) and superior transverse diameters (STD) were measured and SSN classified into five types. The distances of suprascapular nerve from common surgical landmarks were measured as AB; CD and BD to obtain safe zone. These distances were correlated with dimension of notch. Results of the present study were compared with previous studies in different populations. Results: The suprascapular notch was classified into five types of which Type III (MD


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Cancers of the appendix: a case report and review of the literatures

2016-10-21T02-09-39Z
Source: International Journal of Research in Medical Sciences
Yumkhaibam Sobita Devi, Himadri Kumar Daru, Dulasiraman Ponnas, Nithin Raj, Gaurav Goswami, Laishram Jaichand Singh, R. K. Tamphasana.
Cancers of the appendix are rare. Most of them are found accidentally on appendectomies performed for appendicitis. Majority of the tumors are carcinoid, adenoma, and lymphoma. Adenocarcinomas of appendix constitute about only 0.08% of all cancers and the treatment remains controversial. Here we are reporting a 57 year old man presented with symptoms of appendicitis, diagnosed with mucinious adenocarcinoma of the appendix. The patient was treated with appendectomy. We performed a review of literature on tumors of the appendix. Benign conditions are treated with surgery alone. For lymphomas chemotherapy are required and carcinoid syndrome can be treated with somatostatin analogues.


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Rare case of a granulocytic sarcoma: cytological evaluation

2016-10-21T02-09-39Z
Source: International Journal of Research in Medical Sciences
Jayawant Mahadani, Pratik Chide, Sanjay Khandekar, Hitendra Khandekar, Nilima Lodha, Vaman Raut, Snehalata Hingway.
Granulocytic sarcomas (chloromas) are rare extramedullary tumors consisting of primitive granulocytic cells. They arise de novo, or are associated with other hematologic disorders such as acute myeloid leukemia, myelodysplastic syndrome, or myeloproliferative disorders. We report here a case of a 33-year-old man who presented with extensive skin lesions all over body, including face region. The patient is a known case of chronic myeloid Leukemia (CML). Fine needle aspiration cytology (FNAC) of skin lesion was suggestive of granulocytic sarcoma. Histological evaluation of skin biopsy revealed infiltration by atypical myeloid cells. Peripheral blood smear (PBS) examination was within normal limit. Immunohistochemistry (IHC) confirmed the diagnosis of Granulocytic sarcoma. Here we present a case of granulocytic sarcoma which was suspected on FNAC findings and which was confirmed on histochemistry and immunohistochemistry. These cases illustrate the utility of FNAC in diagnosis of granulocytic sarcoma.


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Immunoglobulin profile in pulmonary tuberculosis in endemically prevalent Kashmiri population, Kashmir, India

2016-10-21T02-09-39Z
Source: International Journal of Research in Medical Sciences
Mohd Mubarik Naqash, Arif Nabi Bhat.
Background: Kashmir valley is endemically prevalent destination for tuberculosis. The role of T cell mediated immunity is very well known in the pathogenesis of tuberculosis. However, the B cell immune response has been studied less often. Thus, it was very interesting to estimate the levels of serum immunoglobulins in pulmonary tuberculosis. Methods: Serum levels of the immunoglobulins IgG, IgA and IgM were evaluated in 100 adult patients of untreated sputum positive cases of pulmonary tuberculosis in the age group of 20-65 years (36.42±8.95) and 50 controls of the same age group (34.26±9.46). The Immunoglobulins were estimated using single radial immunodiffusion method of Mancini et al. Results: The mean IgG and IgA levels were observed to be significantly increased in the patient group when compared with the controls (P


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A cross sectional study on the risk factors of gallbladder stone

2016-10-21T02-09-39Z
Source: International Journal of Research in Medical Sciences
Amna Younas Bhatti, Ahmad Bilal Waqar, Sidrah Aamir Zia, Naveed Hussain, Taiba Zulfiqar.
Background: Gallstone diseases are one of the most common public health problems. Approximately 10%-20% of the national adult populations currently carry gallstones, and gallstone prevalence is rising. The purpose of the study was to find out association of gallstone with fatty liver, gender and age in Lahore, Pakistan. Methods: Ultrasonographically Hundred patients were scanned for liver type and gall stone. The data was analyzed by using SPSS version 17.0. Chi-Square statistics was used to check the association between the variables. The effect of age and gender was also statistically analysed. Results: One hundred patients were scanned between ages 21-60 years. Out of hundred 76% patients were female and 24% were male. In this study there were no stones in 37% cases and there were stones in 63% cases. Gallbladder stone found associated with age as p-value is found less than 5% level of significance, maximum patients were found in age ranges between 31-35 years, showing that risk of developing gallstone increases by age. Gallstone is gender specific, females are more victims of developing the stone than among males, and those who have fatty liver are more at risk of developing gallstone than those having normal liver. Conclusions: The study showed that ultrasound (US) is the most sensitive, specific, yet very practical and useful imaging test for the detection of gallstones with a high degree of confidence. Gallstones represent high prevalence disease in adult females more than males and it increases by age where as those who have fatty liver, they are more likely to develop gallstone.


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Computed tomography guided laser ablation of osteoid osteoma: a study of 30 cases

2016-10-21T02-09-39Z
Source: International Journal of Research in Medical Sciences
Manohar Baburao Kachare, Sanjay B. Kulkarni, Satish A. Patil.
Background: Osteoid osteoma (OO) is a benign but painful bone lesion that primarily occurs in children and young adults 1. Male:Female ratio is 3:1. The aim of the study was to present our experience of CT guided LASER ablation of radiologicaly proven Osteoid osteomas in the various bones. Methods: Over the period of 5 years 30 cases of osteoid osteomas in various bones diagnosed on various modalities were treated by CT guided LASER ablation. Bone wise distribution of cases was spine (3), upper end of femur (11), lower end of femur (6), upper end of tibia (4), upper end of humerus (3), lower end of radius (2) and calcaneum (1). 22 patients were treated under spinal and regional anesthesia and 8 patients were treated under short general anesthesia. All the patients were treated on day care basis. The LASER fiber was inserted in the nidus under CT guidance through bone biopsy needle and 1800 joules energy delivered in the lesion continuous mode. Results: 29 (96%) patients have complete relief of pain in twenty-four hours after LASER ablation, One week after treatment all 30 patients were pain free. No neurologic complication was observed in any of our patients with spinal osteoid osteomas. Conclusions: CT guided LASER ablation is a safe, simple and effective method of treatment for osteoid osteoma.


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Factors associated with zidovudine substitution in HIV/AIDS patients attending Badung Hospital, Bali, Indonesia between 2006-2014

2016-10-21T02-09-39Z
Source: International Journal of Research in Medical Sciences
Sukma Adnyani, Sawitri A. A. S., Wulandari L., Swandewi A., Artawan E.P., Reekie J., Wirawan D. N..
Background: Zidovudine (AZT) is the most commonly used drug in first line antiretroviral therapy (ART) in Indonesia; however, substitution due to its side effect is common. The majority of HIV positive patients in Badung Hospital Bali are treated with AZT yet no longitudinal studies in Bali have investigated the number of substitutions or the factors associated with it. Methods: A retrospective cohort study of HIV positive persons aged >15 years, receiving AZT between 1st January 2006 31st August 2014 was conducted. Persons were included from their date of starting AZT. Cox proportional hazard models were applied to estimate the risk and time to substitution. Substitution was defined as single drug change due to side effects and initiating another drug of the same class. Results: During our study 260 patients started AZT, of which 77 (29.6%) experienced substitution. The risk of substitution was 19 per 100 person years. Of those 77, the median time to AZT substitution was 69 days (IQR 25-178). Factors significantly associated with an increased risk of AZT substitution included women (HR 1.79; 95% CI 1.09-2.94), having low hemoglobin levels


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Clinical profile and outcome of rodenticide poisoning in patients admitted to a tertiary care teaching hospital in Mysore, Karnataka, India

2016-10-21T02-09-39Z
Source: International Journal of Research in Medical Sciences
Shashidhara Kuppegala Chikkaveeraiah, Manthappa Marijayanth, Prabhath Kiran Reddy, Sumanth Kaluvakuri.
Background: Rodenticide poisoning is of the major types of poisoning prevalent in India. However this broad category consists of different type of compounds with different mechanisms of toxicity and variable mortality rates. Methods: This study was performed on all cases of rodenticide poisonings admitted to a tertiary care hospital in Mysore between May 2014 and April 2015. Study consisted of 64 subjects. Results: 31 subjects had consumed aluminium phosphide, 18 had consumed Yellow Phosphorus and 12 had consumed Zinc Phosphide while 3 patients had consumed bromadiolone. There were 13 mortalities among the study group out of which 9 were in aluminium phosphide group while 4 were in the yellow phosphorus group. There were no mortalities in cases who had consumed zinc phosphide and bromodiolone. Conclusions: Aluminium phosphide was the most common compound rodenticide consumed and it was associated with increased mortality as compared to other Rodenticide poison.


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Trial of ORG 10172 in acute stroke treatment classification and associated risk factors of ischemic stroke: a prospective study from a tertiary care center in South India

2016-10-21T02-09-39Z
Source: International Journal of Research in Medical Sciences
Sandhya Manorenj, Snehalatha Inturi, Jyotsna B..
Background: Stroke is the leading cause of acquired disability worldwide. Better understanding of risk factors helps to reduce the community burden of stroke. Aim of the study was to determine pattern of ischemic stroke subtype and associated risk factors. Methods: Of 220 patients with first ever stroke, 168 patients of ischemic stroke were enrolled prospectively from January 2016 to May 2016 at ESIC Superspeciality hospital, Hyderabad. Patients were categorized in accordance with the Trial of Org 10172 in Acute Stroke treatment (TOAST) criteria. Results: Of 168 patients, 110 (65.4%) were males; male to female ratio was 1.8:1. The mean age was 53.912.3 years. Small vessel occlusion (SVO) occurred in younger age group as compared to other stroke subtypes. Frequency of large-artery atherosclerosis (LAA) (46.4%) was highest (Extracranial: 41.1%, intracranial: 36.9%), followed by SVO (32.4%), cardio embolism (15.4%), undetermined (4.7%) and other determined causes (1.1%). Risk factors included dyslipidemia (79%), hypertension (67.8%), smoking (58.3%), alcohol use (54.7%), diabetes (40.4%) and physical inactivity (27.3%). Common association observed was smoking (P - 0.004) and alcohol (P - 0.003) with LAA and SVO, and dilated cardiomyopathy with cardio embolism. Conclusions: LAA was observed frequently than SVO. Frequency of SVO was lower than Asian but higher than western, while cardio embolism was lower than Western and similar to Asian stroke studies. Dyslipidemia was the predominant risk factor than hypertension reported from Asian and Western stroke registry. This unique pattern can be attributed to differences in demographic and risk factor profiles. The study confirms the need for vigorous primary and secondary prevention measures targeting modifiable risk factors of stroke.


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Compliance with standard norms in collection, segregation and transport of biomedical waste in a tertiary care hospital: a cross-sectional study

2016-10-21T02-09-39Z
Source: International Journal of Research in Medical Sciences
Aniruddha A. Malgaonkar, S. Kartikeyan.
Background: This cross-sectional study was conducted to determine the gaps between the stipulated procedures for collection, segregation and transportation of bio-medical waste (BMW) and the actual practices; the levels of BMW-related awareness and training status of hospital employees; the protocols for occupational exposure to hazardous BMW and their implementation; and to recommend corrective measures. Methods: Primary data were collected by interviewing the staff in-charge of all BMW generating units of a tertiary care hospital and by recording information by direct on-site observation on a checklist. The participants confidentiality was maintained throughout the study. Results: The interviews and actual observations in 26 BMW generating units (out-patient departments, in-patient wards, laboratories, operation theatres, post-mortem room) revealed availability of trained person in-charge for BMW (3.85%), mixing of infectious and non-infectious waste at point of generation (73.07%), untreated syringes sent for final disposal (60.86%), availability of colour-coded bags (50%) and absence of puncture-proof containers (85.71%). 84.61% of interviewees reported having taken tetanus and hepatitis B immunizations. Conclusions: The necessary interventions include periodic training and re-training of personnel, active supervision of BMW handlers to enforce the use of protective gear and vaccination of all staff against tetanus and hepatitis B. Periodic BMW audit would be essential to determine the trends in the diversity and quantities of waste produced in health care settings and facilitate administrators to devise strategies for improved management of BMW.


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Seroprevalence trends of transfusion transmitted infections among blood donors in a tertiary care hospital of Himachal Pradesh, India

2016-10-21T02-09-39Z
Source: International Journal of Research in Medical Sciences
Amit Sachdeva, Anmol Gupta, Brij Sharma, Deepak Shrama, Neetu Sharma.
Background: Transfusion transmitted infections (TTIs) is a major concern for patients and physicians worldwide. Blood banks in all health care institutions worldwide screen blood for TTIs and ensure that only non-reactive blood is released for clinical use. The present study aimed to study the seroprevalence and trends of transfusion transmitted infections in blood donors in Shimla district of Himachal Pradesh, India. Methods: retrospective review of blood donors hospital records (replacement donors and as voluntary donors) covering the period January 2008 to December 2014 was conducted. The serological results for Hepatitis B, Hepatitis C, HIV, syphilis and malaria were retrieved. Results: A total of 39,083 blood donors of both sexes attended the blood bank during this period. Overall, HBC, HIV, syphilis and malaria rate for blood donors was found to be 0.45%. 0.16%, 0.08%, 0.07% and 0.003% respectively. There is a downward trend in sereoprevalence of all screened TTIs namely HBV, HCV, HIV and syphilis and malaria from 2008-2011. Conclusions: The study exhibits that over a period of years there is rise in voluntary blood donations which is heartening and encouraging. Trend analysis for prevalence TTIs among blood donors has shown a decreasing trend. It is recommended that continual quality assured screening of donated blood should be carried out as per the prescribed norms to deal with acquired TTI's.


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Functional outcome and incidence of avascular necrosis after two years in four part proximal humeral fractures treated by proximal humerus internal locking system

2016-10-21T00-09-15Z
Source: International Journal of Research in Medical Sciences
Akshdeep Singh Bawa, Rajnish Garg, Pankaj Mahindra, Shekhar Singal, Mohammad Yamin.
Background: Fractures of proximal humerus are not uncommon, especially in older age groups. In osteoporotic bone requiring open reduction and internal fixation, locking plates offer the advantage of increased pull out resistance of the locking head screws compared with that of conventional screws. The aim of our study was to analyse the functional outcome and incidence of avascular necrosis in four part proximal humeral fractures managed with proximal humerus locking plate. Methods: It was a retrospective study of patients with NEERs four part proximal humerus fractures treated by proximal humerus locking plate. Patients operated at Dayanand Medical College and Hospital, Ludhiana, Punjab, India from 1st January 2007 to 30th June 2011 was included in the study with a minimum follow up of two years. Scoring system given by Constant et al was used for evaluation of functional outcome and results were graded as Excellent (score 80-100%), good (score 60-79%), fair (constant score 40-59%) or poor (constant score 0-39%). Results: In present study, a good to excellent result was achieved in 64.2 % patients. A mean constant score of 70.6 points was observed. Only 5.6% of patients had osteonecrosis of humeral head at 2-year follow up. Conclusions: The importance of early mobilization of the shoulder joint cannot be underestimated in the final outcome of these fractures. We observed better functional outcome in the patients who started early physiotherapy and continued it at home.


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A hospital based study to assess the prevalence of cardiovascular risk factors among patients of chronic plaque psoriasis

2016-10-21T00-09-15Z
Source: International Journal of Research in Medical Sciences
Bela Bhat, Naina Dogra, Devraj Dogra.
Background: Psoriasis is a chronic systemic inflammatory disease associated with several cardiometabolic co morbidities such as obesity, insulin resistance, dyslipidemia and hypertension, and with clinically significant increased risk of cardiovascular disease and cardiovascular mortality. Methods: The study group included 110 patients with chronic plaque psoriasis and an equally sized age and sex matched control group. Cardiovascular disease (CVD) risk factors studied included hypertension, diabetes mellitus, obesity, dyslipidemia, smoking, heavy alcohol use and family history of CVD. Results: Psoriatic patients had a significantly higher prevalence of alcohol use (p=0.014), current smokers (p= 0.023), impaired fasting glucose (p=0.032), central obesity based on waist circumference (p=0.008), central obesity based on waist hip ratio (p=0.020) and dyslipidemia (p=0.000). Conclusions: Psoriasis patients have a unfavourable cardiovascular risk profile. Therefore these patients should undergo screening and treatment of various modifiable risk factors to reduce morbidity and mortality.


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Effect of passive smoking as a risk factor for chronic obstructive pulmonary disease in normal healthy women

2016-10-21T00-09-15Z
Source: International Journal of Research in Medical Sciences
Meenakshi Kalyan, Shubhangi A. Kanitkar, Aayush Gupta, Devanshi Sharma, Sanam Singh.
Background: Environmental tobacco smoke (ETS) is a risk factor for cardiovascular disease, asthma in children and lung cancer. There is a biological plausibility of ETS as a causal factor for COPD. Objectives of the study were to examine the effect of passive smoking on lung function in non-smoking healthy women and to co-relate the effects of passive smoke as a risk factor for COPD. Methods: 50 women between 20-40 years of age exposed to passive smoke at home and workplace were assessed by questionnaire. The pulmonary function tests were performed and the values of FEV1 and FVC were obtained by a spirometer. Results: Out of 50 women, 34 % at workplace, 54% at home and 12% at home and workplace were exposed. Mean age was 30.3 years. Mean±SD of FEV1 was 1.94±0.9, FVC was 2.54±1.06, FEV1/FVC was 73.5±10.06 predicted FEV1 % was 63.2±23.2. FEV1/FVC of women exposed at home and workplace was 70.84 indicating that they have higher chances of developing COPD later in life. Conclusions: Passive smoking represents a serious health hazard that can be prevented by health education campaigns.


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Clinical results of arthroscopic all-inside meniscal repair

2016-10-21T00-09-15Z
Source: International Journal of Research in Medical Sciences
Suresh Perumal, Sadem Amer, Prakash Ayyadurai, Sivaraman Arumugam.
Background: The meniscus plays a key role in normal knee function. Recently, meniscal repair has become an important mode treatment for meniscal tears. Compared to open surgery, arthroscopic meniscal repair has become popular because of shorter duration of the surgery, the smaller incision and better accessibility to the torn portion, which is particularly difficult during open Surgery. Inside-out, outside-in, and all-inside arthroscopic techniques are widely used. Arthroscopy by all inside meniscal repair has the lowest neurovascular injury rate. In this study we have evaluated clinical outcomes of arthroscopic all inside menisceal repair technique. Methods: This study prospectively evaluated 24 consecutively treated patients to determine the effectiveness of arthroscopic meniscal repair using the Fast Fix repair system. Average age of patients at the time of surgery was 24.The inclusion criteria for this study were: vertical full thickness tear >10 mm in length; location of the meniscal tear

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A study of the effect of pre-radiation on healing of surgical wounds in the treatment of cancers of the head and neck

2016-10-21T00-09-15Z
Source: International Journal of Research in Medical Sciences
Sayandev Dasgupta, Arup Dasgupta, Supratik Sen, Sukanta Sen, P. K. Dutta, Samir Kr Sen.
Background: Radiation therapy is an established modality in the treatment of head and neck cancer patients. It is used alone or in combination with surgery and chemotherapy. Although radiotherapy is useful to affect tumour death, it also exerts a deleterious effect on surrounding normal tissues. These effects are either acute or can manifest months or years after the treatment. The chronic wounds are a result of impaired wound healing. Compromised wound healing in irradiated tissues is a common and challenging clinical problem. Methods: A prospective observational study was done in a tertiary care teaching institute, Kolkata. The effect of radiation on surgery of cancers of head and neck was studied in 50 patients. The patients were divided into 2 groups of 25 each. The cases in the first group were irradiated prior to surgery and those on the second group were operated upon without any pre-radiation. Results: The highest incidence of wound complications in those patients who were operated upon within 2 weeks to 6 months of completion of RT (83.33%). Patients who had their blood Hb level at or above 11 gm% developed less number of wound complications (34.78%) as compared to those who had their blood Hb level between 8-11 gm% where complication rate was 48.15%. Those patients who had their oral cavity or pharynx opened during surgery had a much higher incidence of wound complications (54.54%) than whose oral cavity or pharynx were not interfered with (17.64%). Wound infection was 36% in the irradiated group and 12% in the non-irradiated group. Separation of wound edges or skin necrosis followed in 28% cases in the pre-radiated group and in 8% cases in the non-pre-radiated group. Conclusions: Radiotherapy is an integral modality of head and neck cancer therapy. Compromised wound healing is an important side effect of radiation therapy. All sorts of local complications as wound infection and necrosis, or ocutaneous fistulae, carotid artery perforation etc. are more pronounced in patients, who received prior radiotherapy. The complication of surgery after radiotherapy was found to be more pronounced between 2 weeks to 6 months in this series.


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Factors affecting maternal health care seeking behaviour in northeast states, India: evidence from district level household survey-4 (2012-2013)

2016-10-21T00-09-15Z
Source: International Journal of Research in Medical Sciences
Kh. Jitenkumar Singh, Kanika Grover.
Background: In context of reducing maternal mortality ratio, Government of India has implemented various programs and public health facility centres in order to provide quality services at the time of delivery. In this paper, we assessed the factors for home, private and public health facility sector utilization of delivery care in Northeast state, India. District Level Household Survey fourth round was used to carried out analysis and data was extracted for the childbirth during the last five years preceding the survey. Methods: The outcome variable was categorical, thus multinomial logistic regression was used to assess the factors of each variable independently on the predictor variables. To check the collinearity, variance inflation factor (VIF) was computed for all variables prior to inclusion of multilevel logistic regression. Results: This shows that equal proportion of delivery was conducted at home (45%) and public health facility (45.2%) in comparison with private health facility (9.8%). For the choice set of public versus home, women with higher number of living children, wealth quintile and living in urban areas were associated with greater odds of delivering at public health facility centres. Conclusions: The initiative programs can be implemented by the government by sending trained professionals with supplements required by pregnant women at each and every district in order to promote maternal health and recruit more interdisciplinary team, which will be responsible for maintaining women and infant health, and thus providing appropriate medical advice.


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Seroprevalence of Helicobacter pylori in patients with symptoms of upper gastro intestinal tract at a tertiary care hospital

2016-10-21T00-09-15Z
Source: International Journal of Research in Medical Sciences
Ramakumar Manimaran, Ananthi Boj.
Background: The association of helicobacter pylori with upper gastrointestinal diseases is widely reported. Currently according to guidelines the test and treat option is preferable in population with a moderate to high prevalence of Helicobacter pylori infection (≥10%), and empiric trial of acid suppression with a proton pump inhibitor for 4 to 8 weeks in low prevalence situation. Hence prevalence rate of Helicobacter pylori is significant for the treatment strategies. Aim of the study was to determine the prevalence of Helicobacter pylori in patients with symptoms of upper gastrointestinal tract in our tertiary care hospital and to analyse its distribution according to age and sex. Methods: The study was conducted in the department of surgery at ACS medical college for a period of 6 months from February 2016 to July 2016.Adult patients attending the outpatient department in our hospital with symptoms of upper gastrointestinal tract for more than 6 weeks were evaluated for Helicobacter pylori by doing the immuno-card test one step antibodies to Helicobacter pylori (SD Bioloine). Analysis of Helicobacter pylori distribution according to age and sex were done in these positive patients. Results: Out of 400 patients, 117 were found positive for Helicobacter pylori by giving a prevalence rate of 29.25%. Age-wise distribution showed prevalence rate progressively increased with age and the high prevalence was seen in the 41 to 50 years age group and thereafter decreased gradually in the older age groups. High prevalence was observed in males, as out of the 117 Helicobacter pylori positive patients, 74 (63.25%) were males and 43 (36.75%) were females. Conclusions: The prevalence of Helicobacter pylori infection in patients with symptoms of upper gastrointestinal tract was lower than rates reported in developing countries. But as the prevalence rates in our study is more than 10%, the test and treat approach is more appropriate than starting empirical treatment with a proton pump inhibitor.


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Evaluation of polymorphonuclear leukocyte elastase levels in neonatal sepsis

2016-10-21T00-09-15Z
Source: International Journal of Research in Medical Sciences
Shaimaa Abdelmalik Pessar.
Background: Sepsis is an important cause of neonatal morbidity and mortality. In Egypt, A multi-center study reported that 45.9% of the neonates admitted to neonatal intensive care units (NICUs) were due to suspected neonatal sepsis. Proper management is not guaranteed due to nonspecific symptoms and signs especially at the onset of disease, delay of culture results and high rate of false negative results. Attempts have been made to use hematologic parameters, acute phase reactants and cytokine profiles for early and accurate diagnosis of neonatal sepsis; however, none was adequately sensitive or specific. Polymorphonuclear elastase (PMN-E) is a serine protease secreted during inflammatory diseases. The aim of the current study was to explore the reliability of PMN-E level for the diagnosis of neonatal sepsis and assess response to treatment in comparison to hematological parameters and C - reactive protein (CRP). Methods: The study comprised 30 neonates with proven sepsis, 30 neonates as control group. Both groups were subjected to calculation of hematologic sepsis score (HSS), CRP measurement, blood culture and serum PMN-E levels, the latter was measured both at diagnosis and 6 days after treatment in sepsis group. Results: Serum PMN-E levels were significantly higher in sepsis group (118.4±21.8) than in control group (57.9±27.9) and the best cut-off value was at 85 ng/ml with 97% sensitivity and 81% specificity, PMN-E levels also decreased significantly with response to treatment. Conclusions: Raised PMN-E level was found to be a diagnostic and prognostic marker in neonates with sepsis comparable with CRP and HSS.


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The development of resistance to tamoxifen in patients with breast cancer: our experience

2016-10-21T00-09-15Z
Source: International Journal of Research in Medical Sciences
Sinisa Maksimovic, Biljana Marjanovic, Branislava Jakovljevic, Zdenka Gojkovic, Dejan Opric, Dusan Mileusnic.
Background: The study used data from medical and counselling of patients who were diagnosed with hormone-dependent breast cancer. Aim: The objective of the paper is to identify within a group of patients diagnosed with hormone sensitive breast cancer and those who have received adjuvant tamoxifen, and then to isolate the patients with whom the therapeutic effect of tamoxifen stopped (resistance to tamoxifen). Methods: The study analyzed 153 patients in the period from 2005 to 2011, at the Public Health Institution Hospital, Sveti Vračevi" in Bijeljina. Resistance to tamoxifen was developed by 60 patients (39.2%) and 93 patients (60.8%) did not develop resistance to it. Results: More common emergence of resistance is in the premenopausal group of patients (p


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Anatomical arrangement of the lobar bronchi, broncho-pulmonary segments and their variations

2016-10-21T00-09-15Z
Source: International Journal of Research in Medical Sciences
Sathidevi V. K..
Background: The segmental concept of lungs was still in dispute in the literature. Although the segments differ considerably in shape and size, they all contain a well-defined area of lung and they are all well demarcated from the neighbouring segments. Therefore, in the present study, an attempt has been made to demonstrate the anatomical arrangement of the lobar bronchi, broncho-pulmonary segments and their variations. Methods: The study was conducted in fifty human lungs, obtained from autopsies, dissection hall cadavers and full term foetuses. The bronchial tree was investigated by air inflation, dye injection and using dissection, preparation of casts, air inflation, dye injection and bronchographic techniques. The external morphology of lungs and their lobes has been studied and the bronchopulmonary segments are described in detail. Results: In humans, the right lung is found to consist of ten segments in only 77% cases, and the left lung of ten segments in 84% cases. Thus in the study of 50 human lungs, the classical textbook description has occurred only in 80.5% of cases. Remaining 19.5% showed variations. Among the variations observed, right lung showed (59%) predominance over (41%) on left side. Conclusions: In man there is an increase in the number of bronchial generations and alveoli after birth. An increase in their size was noted as well. Thus the study of variations in the pattern of bronchopulmonary segments aids the clinician very much. It is necessary for Thoracic Surgeons, Anaesthetists, Chest physicians, Radiologists, Ultrasonologists, Pathologists and Anatomists for investigative procedures, diagnosis and various treatment modalities including surgeries like segmentectomy.


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Factors affecting sputum and culture conversion in pulmonary tuberculosis patients on directly observed treatment, short-course

2016-10-21T00-09-15Z
Source: International Journal of Research in Medical Sciences
Suresh Kumar Boorsu, Venkata Subba Narasimha Myreddy, Jithendra Kandati, Muni Lakshmi Ponugoti.
Background: Sputum smear positive patients are infectious for a variable period after starting of treatment. Patients receiving anti-tuberculosis treatment by DOTS become noninfectious and times taken to become non-infectious are assessed by sputum smear conversion (SSC) by smear microscopy and culture conversion by growth on Lowenstein-Jensen medium. The aim of present study was to determine the time taken for SSC and culture conversion and factors delaying it. Methods: A prospective cross-sectional study was undertaken in a tertiary hospital over a period of one year from January 2015 to December 2015 by Department of Respiratory medicine. 150 patients diagnosed as pulmonary tuberculosis by sputum smear microscopy and on DOTS were included and followed at regular intervals of 4th, 8th, 12th, 16th and 20th week or until they were sputum and culture negative which was earlier. At each follow-up sputum, smear and culture were done as per standard guidelines. Results: 150 patients were enrolled which included 63 (42%) males and 87 (58%) females with mean age of 36.41 years and all were followed up. Fever was the most common clinical symptom (98.67%). 146 patients (97.33%) underwent sputum and culture conversion. The median time taken for sputum conversion for cases in the study was by the end of 4th week [day 28] and culture conversion was by end of 5th week [day 35]. 4 cases were positive for sputum and culture which were seropositive for HIV. Conclusions: Smear-positive patients are infectious to close contacts and to the community. Hence initiation of infection control measures should be applied until the patient is non-infectious. The results of our study reveal that patients of smear positive pulmonary tuberculosis continue to expel the bacilli for a considerable period of time after initiation of DOTS regimen. There is a strong need to reinforce infection control measures until the patients are judged noninfectious.


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Evaluation of serum ferritin in in type II diabetes mellitus: a hospital based observational study from Dibrugarh, Assam, India

2016-10-21T00-09-15Z
Source: International Journal of Research in Medical Sciences
Meghna Borah, Rohini K. Goswami.
Background: Increased serum ferritin, reflecting body iron overload, is often associated with insulin resistance. The role of iron in the pathogenesis of diabetes is suggested by an increased incidence of type 2 diabetes mellitus in diverse causes of iron overload, and reversal or improvement in glycemic control) with a reduction in iron load achieved using either phlebotomy or iron chelation therapy. Methods: This study was carried out to assess Serum Ferritin levels in Type 2 diabetes mellitus and to examine whether a correlation between Serum ferritin and HbA1c% and fasting blood glucose levels exists. 92 type 2 diabetes subjects (M:F - 52:40) were studied and compared with age and gender matched controls. Results: The study showed that serum ferritin levels was significantly increased in diagnosed cases of type 2 diabetes mellitus in comparison with the age and gender matched healthy individuals (p value


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Evaluation of immune status in patients with breast cancer in Sokoto, Northwestern, Nigeria

2016-10-21T00-09-15Z
Source: International Journal of Research in Medical Sciences
Bashir B. M., Yeldu M. H..
Background: Breast cancer is a major public health problem especially in Sub-Saharan Africa, Nigeria inclusive. It is a leading cause of cancer- related deaths worldwide. The present study assessed the immune status of breast cancer patients using CD4+ T cell count, CD8+ T cell count, CD4+/CD8+ ratio and some leucocytes. Methods: A total of sixty nine (69) subjects that comprised of forty six (46) breast cancer patients attending the Breast Clinic of Usmanu Danfodiyo University Teaching Hospital, Sokoto and twenty three (23) age- and gender-marched apparently healthy individuals as controls were included in the study. Results: The CD4+ T cells (cell/ μl) and CD8+ T cells (cell/ μl) were enumerated using Flow Cytometric method, while CD4/CD8 ratio was calculated from the values obtained from the CD4+ T cells and CD8+ T cells. Even though, there were no significant differences in CD4+ T cells, CD8+ T cells and CD4+/CD8+ ratio based on breast cancer stages and therapy types. Conclusions: It is hereby concluded that, the monocyte counts and CD4+/CD8+ ratio were higher in breast cancer patients and this could be used to differentiate the breast cancer patients from the normal control subjects.


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Quality of life among lung cancer patients undergoing treatment at a tertiary cancer institute in North India

2016-10-21T00-09-15Z
Source: International Journal of Research in Medical Sciences
Vijay Kumar Barwal, Salig Ram Mazta, Anita Thakur, Rajeev Kumar Seam, Manish Gupta.
Background: Lung cancer patients mostly present with advanced disease. Its treatment has shown limited progress in recent decades, so we studied their quality of life (QOL) and how it is affected during treatment. Methods: Patients ≥18 years of age, diagnosed/registered at our institute from 1st September 2012 through August 2013 were included in the study. QOL was assessed by means of the EORTC QLQ-C30 and QLQ-LC13. Data was analyzed using descriptive and inferential statistics Results: Out of 91 patients included in the study, 73 (80.2%) were males and 18 (19.8%) were females. Mean age of the study population was 59.24±10.53 years and median age was 60 years. A better QOL for nausea and vomiting (P=0.011), sleep disturbance (p=0.021), and coughing (p=0.016) was observed in female patients. There was significant worsening in symptom scales of fatigue (p=0.000), nausea and vomiting (p=0.000), sleep (0.006), appetite (p=0.000) and constipation (p=0.000). Though the mean scores of pain, dyspnoea and financial difficulties decreased, but they were not significant. According to the LC13 module, significant improvement was seen in the symptom scales of cough (p=0.000), haemoptysis (p=0.000) and pain chest (p=0.040). Conclusions: Lung cancer patients undergoing treatment suffer many limitations due to an array of symptoms and disruptions in various areas of QOL, arising from both the disease process and its treatment. It should be studied at every visit for each individual patient.


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Clinical spectrum and complications of scrub typhus: a single-centre, pilot observation from central India

2016-10-21T00-09-15Z
Source: International Journal of Research in Medical Sciences
Jay Deshmukh, Sandhya Saoji, Arjun Deshmukh, Vijay M. Katekhaye.
Background: Scrub typhus is known from various parts of India. However, reports from central India are lacking. We performed pilot observation of confirmed scrub typhus cases from a single, tertiary care centre from central India. Methods: A retrospective analysis of 16 IgM ELISA confirmed scrub typhus cases was done. Clinical features, signs, laboratory parameters and complications were identified. Age (40 years) and gender (male versuss female) specific comparisons were performed. Data were analysed descriptively with appropriate statistical tests. Results: Diagnosed cases of scrub typhus were frequent in patients aged below 40 years (68.8) and in females (81.2%). Fever (100%), nausea±vomiting (68.8%) and headache (56.2%) were common symptoms. Rash was reported in a single case whereas characteristic eschar of scrub typhus was not observed in any patient. Mean hospital stay duration did not vary either by gender or by age-groups. Laboratory abnormalities did not show any significant deviation by gender or age analysis except mean haemoglobin being lower in females than males (10.1±1.4 Vs 12.3±1.1, p


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Identification of patients at high risk for hypocalcemia after total thyroidectomy with serial calcium estimation and intact parathyroid hormone levels-a comparative study

2016-10-21T00-09-15Z
Source: International Journal of Research in Medical Sciences
Pauly T. J., Santhosh P. V., Santhosh T. V., Vinodh M..
Background: In recent years, multiple retrospective and prospective studies have emerged, which support the use of postoperative serum intact parathyroid hormone (iPTH) levels can also predict hypocalcaemia in postoperative thyroidectomy patients. Therefore, the present study was designed to determine the incidence of hypocalcaemia after total thyroidectomy. Methods: 146 patients who underwent total thyroidectomy were recruited. The incidence of hypocalcaemia was analyzed with serial calcium estimation results with 6 hours, 24 hours, 48 hours and 2 weeks post-operative calcium level estimations. The incidence of hypocalcaemia with regards to the number of parathyroid glands was determined and the results between the three groups were compared. Results: The incidence of transient hypocalcaemia at 24hr postoperative period and intact parathyroid hormone (iPTH) level showed a significant difference (p


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Giant adrenal myelolipoma - clinical spectrum and management: a single centre experience

2016-10-21T00-09-15Z
Source: International Journal of Research in Medical Sciences
Santosh Kumar, Ankur Mittal, Aditya Prakash Sharma, Abhinandan Mukhopadhyay.
Background: Adrenal myelolipomas are rare benign tumor composed of mature adipocytes and normal haematopoetic cells. Giant adrenal myelolipomas are rare clinical entities. Most of them are symptomatic. We present 15 such cases, their clinical spectrum and management. Methods: Retrospective analysis of giant adrenal myelolipomas from a tertiary level institute. Initial diagnosis was made by computed tomography. Results: Mean age of patient was 45.6±11 years with slightly higher female preponderance. All patients were overweight with predominantly left sided adrenal myelolipoma. Majority of them (93%) were symptomatic and presented with abdominal pain, anemia or fever. Mean size of the mass on imaging was 14 cm±6 cm, with largest lesion measuring 26 cm. Conclusions: The article highlights the varying clinical presentations including rare emergency presentations of giant adrenal myelolipomas. A brief literature review is also presented.


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Comparative study between histological changes in placenta from pre-eclampsia cases and normal pregnancy with special reference to cytotrophoblastic cell hyperplasia, villous stromal fibrosis and fibrinoid necrosis

2016-10-21T00-09-15Z
Source: International Journal of Research in Medical Sciences
Bhawana Sahay, Leena Talukdar, Pallavi Sahay, Debashish Datta, Rangnath Chaubey.
Background: Placenta is a vital organ and the most accurate record of the infants prenatal experience. Pregnancy complications like hypertension significantly affect the placenta. Thus there is a need for thorough examination of it. Therefore the present study is dedicated to see the histological changes in placenta of pre-eclampsia with special reference to cytotrophoblastic cell hyperplasia, villous stromal fibrosis and fibrinoid necrosis and compared it with that of normal placenta. Methods: Total 60 placentas were collected (30 from pre-eclampsia and 30 from normal pregnancy). Results were expressed in percentage after counting 100 villi. Data analysis has been done using Graphpad InStat 3 version and data is significant when p value is


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Role of multiparametric MRI in detection of prostatic lesions; of evaluation contrast enhanced MRI, diffusion weighted imaging and MR spectroscopy in malignant and benign prostatic lesions

2016-10-21T00-09-15Z
Source: International Journal of Research in Medical Sciences
Pratiksha Yadav, Rajul Bhargava.
Background: Prostate cancer is the most commonly diagnosed cancer in males and one of the leading causes of cancer-related death in men. Pretreatment assessment of prostate cancer is divided into detection, localization, and staging; accurate assessment is a prerequisite for optimal clinical management and therapy selection. The purpose of the study is to determine the diagnostic accuracy of multiparametric MRI for prostatic cancer detection using T2 weighted MR imaging, diffusion weighted imaging (DWI) and contrast enhanced MRI. To determine the use of MR spectroscopy in prostatic lesions. Methods: It is a prospective single institutional study done on 29 patients with prostate lesions and elevated PSA level. Axial, coronal and sagittal images were obtained using T1WI, T2WI and STIR sequences. Advanced sequences like Diffusion weighted images, Spectroscopy and post gadolinium T1WI were taken after the basic MRI images. Results: Study was done in 29 patients, age was ranging between 51years to 90 years, mean age is 70.7 years. On multiparametric MRI findings 45% were detected malignant lesions and 55% patients detected benign lesions. On biopsy correlation 42% of these cases turned out to be malignant and 58% as benign lesions. Detection of malignancy by T2WI imaging alone given sensitivity of 80.1% and specificity of 85.4%.By DWI alone sensitivity was 85.7% and specificity was 89.4%,on MRS sensitivity is 90.6% and specificity was 91.1%. Combined (MRI+DWI+MRS) gave sensitivity of 92.3% and specificity of 94.4% for detection of malignant prostatic lesion. Positive predictive value is 90% and negative predictive value was 88%. Conclusions: The best characterization of prostatic cancer in individual patients will most likely result from a multiparametric exam. Recent advances include additional functional and physiologic MR imaging techniques (diffusion weighted imaging, MR spectroscopy, and perfusion imaging), which allow extension of the obtainable information beyond anatomic assessment. Multiparametric MR imaging provides the highest accuracy in diagnosis and staging of prostate cancer.


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Clinico-radiological correlation of osteoarthritis knee using Western Ontario and McMaster Universities score and Kellegren and Lawrance grading

2016-10-21T00-09-15Z
Source: International Journal of Research in Medical Sciences
Manish Singh Rajpoot, Digember Peepra, Krishna Kumar Pandey, H. S. Varma.
Background: Diagnosis OA is basically based upon clinical and radiological features. In our study we have used a clinical scoring system of OA called as WOMAC (Western Ontario and McMaster Universities) score and a radiological staging system KL staging (Kellegren and Lawrance) OA radiological staging system and correlation between them. Methods: There were total 66 patients with 102 knees. X ray of bilateral knee was taken in weight bearing position (standing) and WOMAC score was calculated. X-rays were assessed with KL grading. WOMAC score a clinical scoring was correlated with a radiological KL grading for the OA of knee. Results: Range of WOMAC score was 11.5-67.7. Mean WOMAC score were 18.75, 31.31, 52.57 and 67.2 in patients of KL grade 1, 2, 3 and 4 respectively. Correlation between KL grading and WOMAC scoring were found to be significant; there were rise in the WOMAC scoring when KL grading increases. Conclusions: Both the KL grading and WOMAC score are directly proportional to each other, and hence, WOMAC scoring can be used to diagnose, assess the progression of the disease and the response to treatment of osteoarthritis.


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