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Τετάρτη, 26 Οκτωβρίου 2016

A Case Of Multiple Relapses And Remissions Of Cervical Lymphadenopathy; Kikuchi-Fujimoto Disease

Source: The Southeast Asian Journal of Case Report and Review
Hasham Akram, Kiran Siddiqui, Naila Jabbar, Shareen Altaf, Masood Ahmed.
Once thought to be an east Asian disease, predominantly Japanese, cases of Kikuchis disease have been reported from other parts of Asia, Europe and America.The major clinical finding is painless cervical lymphadenopathy, mostly unilateral and involves posterior cervical lymph nodes. Routine laboratory investigations doesnt help in diagnosis. Accurate diagnosis is established by excisional biopsy of the effected lymph node. . It is usually self-limiting and treatment is mainly symptomatic. Recurrence has been reported in some cases. Our case appears to be an interesting variant as multiple relapses and remissions were observed with are always self-limiting and resolve without any specific medication or treatment.


Low tesla MRI in acute spinal injuries: a study in a teaching hospital

Source: International Journal of Advances in Medicine
Raghunath Anant Nagvekar, Pooja Nagvekar.
Background: Early detection of spinal cord lesions in patients of suspected acute spinal injury leads to better prognosis. MRI has become a standard technique for evaluating spinal injuries and especially helpful for diagnosing acute compression of the spinal cord and cord oedema. This study was conducted to evaluate the low tesla MRI findings in cases of suspected acute spinal injuries. Methods: 120 patients with a suspected history of spinal injury who came into the emergency ward of our hospital were included into the study. MRI was done for all the patients within 2 days of admission. Results: The most common age group to be affected was 21-40 years with 48%followed by 41-60 years with 34% being affected. 46% of the patients had cervical injuries, 24% had dorsolumbar and lumbar injuries were seen in 17% of the patients. Spinal cord injuries was seen in 73 of the patients, out of which 64 patients had cord edema,7 with cord haemorrhage and 2 had cord transection. Conclusions: 0.3T MRI was able to identify cord compression and swelling, traumatic disc herniations, epidural hematoma, soft tissue injuries, and prevertebral/paravertebral hematoma, while MR imaging was unsatisfactory in identifying small fractures especially of posterior elements.


Three-year experience with prolonged neonatal jaundice screening in a district general hospital

Source: International Journal of Contemporary Pediatrics
Prasad Adavappa Parvathamma, Emily P. Brockbank, Youssef Abourahma.
Background: Investigations for prolonged jaundice vary in complexity, especially in well neonates. The aim was to ascertain the causes of prolonged jaundice in well neonates and to analyse the extent and consistency of investigations performed. Methods: We performed a retrospective review of nurse-led prolonged jaundice screening in our childrens assessment unit from 2013 to 2016. The proforma included clinical assessment and recommended investigations. Data from electronic records and laboratory findings were compiled for analysis. Results: A total of 116 infants aged 14-73 days were referred for screening, with 100% utilization of the screening proforma. All patients had unconjugated hyperbilirubinaemia with normal urine and stool colour. Of the 113 with a full blood count performed, 74 (65.5%) were normal, with neutropenia in 32 (28.3%) and 1 blood film showing spherocytosis with haemolysis. Urine culture was performed in 106 infants, yielding 2 pure-growth cultures in infants subsequently treated for urinary tract infection (UTI) (1%). Seventy-four infants had one or more additional tests. The causes of prolonged jaundice identified were breast-milk jaundice (97), feeding difficulties (7), UTI (2) and hereditary spherocytosis (1). Conclusions: The most common cause of prolonged jaundice identified was breast-milk jaundice. The eldest referred infant was 73 days old, demonstrating a need for increased community awareness of guidelines to facilitate prompt referral. Additional investigations yielded little diagnostic value and we propose that in well neonates, following clinical evaluation, investigations may safely be reduced to full blood count and split bilirubin.


Doppler sonography in acute renal obstruction and role of intra venous urography: a study in a tertial care centre

Source: International Journal of Advances in Medicine
Raghunath Anant Nagvekar, Pooja Nagvekar.
Background: Arterial RI measurements by duplex Doppler USG have been advocated for the diagnosis of obstruction. In most centres, obstruction is indicated by an RI greater than 0.70 or a difference of greater than 0.10 between the kidneys. Our aim was to evaluate and compare the Doppler waveform alterations in unilateral acute renal obstruction (UARO) with the contralateral normal kidney as a control. Methods: 100 patients presenting to the emergency medical division with symptoms of unilateral acute renal colic were subjected to USG and Doppler USG. The renal RI was calculated in comparison to the collateral normal kidney. Results: The mean resistivity index (RI) was higher in obstructed kidneys in all cases. 80% patients had complete, while 20% had partial obstruction. RI value in completely obstructed kidneys was 0.72 versus 0.71; p


Relation between body mass index, forced expiratory volume in one second and 6 minute walk test in stable COPD patients

Source: International Journal of Research in Medical Sciences
Bhaskar Kakarla, Rajendra Prasad Boddula, Paramjyothi Gongati.
Background: Chronic obstructive pulmonary disease (COPD) is a common respiratory disorder characterized by irreversible, progressive airflow obstruction. It is diagnosed by spirometry which measures FEV1 and bronchoreversibility. Recent focus has been on COPD systemic effects like malnutrition, cardiovascular disorders, diabetes, musculoskeletal disorders, anxiety and depression. A composite index named BODE index (BMI, FEV1, dyspnea, 6MWT) has a better prediction of mortality than FEV1 alone in these patients. Relation between components of BODE like BMI, FEV1 and 6MWT has been an area of interest since it measures nutritional status (BMI), airway obstruction (FEV1) and exercise capacity (6MWT). We tried to evaluate the relation between lower BMI (˂21) and higher BMI groups (>21) with respect to FEV1 and 6MWT. Methods: A cross sectional observation study was conducted in a tertiary care centre. Stable patients of COPD were recruited from to outpatient department of respiratory medicine. BMI, FEV1 and 6MWT were calculated. Patients are made into 2 groups with BMI less than 21 and more than 21. Both FEV1 and 6MWT means were calculated and analyzed to find out any difference between these two groups. Results: There was no statistical difference of FEV1 and 6MWT between lower and higher BMI groups. Conclusions: In COPD patients, FEV1 and 6MWT values were not statistically different between lower and higher BMI groups. Further studies are needed to prove that other anthropometric measurement like fat free mass index can be a better substitute for more accurate assessment of exercise capacity.


Self-medication practice among children in Antananarivo, Madagascar

Source: International Journal of Research in Medical Sciences
Rosa L. Tsifiregna, Safidinarindra H. Razafimahatratra, Nirina H. Raveloharimino, Rivo L. H. Rakotomalala, Noeline Ravelomanana.
Background: Self-medication is very common in pediatrics. Little is known about self-medication on children in Antananarivo. The main objective of this study is to evaluate the practice of self-medication on children by their mothers. Methods: A cross sectional descriptive study was done by visiting homes. An interviewer-administered questionnaire was used to gather data on self-medication. Mothers were selected by simple random sampling. Results: Out of the 383 mothers interviewed, 157 have practiced self-medication. The prevalence was 40.99%. The fever was the main symptom treated with paracetamol. On the other hand, the oral rehydration salt has been little used, 6.25% before the consultation. The inappropriate use of antibiotics was found in this study. Drugs were of illegal origin in 40.27% of the cases. The urgency was the main reason for self-medication. Over 80% of mothers knew the risks of self-medication. Thus, the high level of maternal education was among the factors influencing this practice, particularly for children older than 60 months. Conclusions: Information to mothers about the responsible self-medication is necessary.


Retrospective study of chemotherapy induced cardiotoxicity from a tertiary cancer centre in South India

Source: International Journal of Research in Medical Sciences
Manjunath I. Nandennavar, Annalakshmi Sekar, Shashidhar V. Karpurmath.
Background: Ever increasing therapeutic modalities in treatment of various malignancies has resulted in an enormous number of cancer survivors. Cancer survivors face various issues in their long term health due to the cancer and/or its treatment. Late effects including organ damage, functional disability and risk of second malignancy continue to be elucidated. One of the most debilitating and serious toxicity is cardiotoxicity due to chemotherapy. Methods: This study was a retrospective analysis of all patients who developed chemotherapy induced cardiotoxicity between January 2013 to December 2015. Results: A total of 16 patients developed cardiotoxicity. 13 patients had doxorubicin induced toxicity. Cardiotoxicity was noted to occur at low cumulative doses. 2 patients had complete recovery of left ventricular ejection fraction (LVEF) on follow up. 1 patient had progressive worsening of LVEF. 1 patient died due to cardiotoxicity. On detection of cardiotoxicity, most of the patients received cardiac remodeling drugs - angiotensin converting enzyme inhibitors (mostly enalapril), other drugs used were carvedilol and diuretics. Conclusions: In Indian patients, cardiotoxicity can occur at very low cumulative doses of doxorubicin and in young patients too. Most of the patients did not have any underlying comorbid illnesses. We wish to highlight the need to diligently repeat cardiac screening investigations at frequent intervals to detect asymptomatic cardiotoxicity.


Two siblings with familial subclinical hyperthyroidism with unknown etiology

Source: Medicine Science | International Medical Journal
Elif Ozsu, Gul Yesiltepe Mutlu, Filiz Mine Cizmecioglu, Rifat Bircan, Sukru Hatun.
Subclinical hyperthyroidism is defined as low or undetectable concentration of serum thyrotrophin (TSH) with normal free triiodothyronine (FT3) and free thyroxine (FT4) levels. 1). Familial subclinical hyperthyroidism is a rare entity. Activating mutations of the TSH receptor (TSH-R) gene cause genetic hyperthyroidism. Here we present a family with more than one affected individual. All family members were investigated for TSH-R mutation. No mutation was detected, while a A459 polymorphism was found in one of the cases and three other siblings. Despite the clinical and biochemical findings suggesting a TSH-R mutation, a reasonable cause could not be detected. Epigenetic and environmental modifiers, including iodine intake, should be considered in families with mutation negative, familial non auto-immune hyperthyroidism (FNAH).


Comparing mycobacterium tuberculosis complex susceptibility methods, a developing country’s experience

Source: Medicine Science | International Medical Journal
Yasemin Ay Altintop, Duygu Percin.
In spite of current diagnosis and treatment, Mycobacterium tuberculosis complex is still an important cause of mortality and morbidity. Uneffective drug combinations and patient incompliance lead to increasing drug resistance. This study by managing four different -non molecular- susceptibility methods was carried out to determine the susceptibility patterns of Mycobacterium tuberculosis complex isolates in central part of Turkey and to compare the methods. The susceptibility testing of 33 isolates were initially performed using the agar proportion method, the results of which were compared with the other three methods; BACTEC 460TB, MGIT 960, and Etest prospectively. According to the gold standard agar proportion method, none of the strains were resistant to STR or ETM, while two isolates were found to be resistant to both isoniazid and rifampicin. BACTEC 460 TB remains the reference method of choice, and for low-volume centers. The MGIT 960 system is more suited for high-volume laboratories but has a high risk of contamination. Etest may seem expensive and produces cumbersome results. Regardless of the test used, validation with the gold standard method should be performed periodically as well as in the event of a discordant result. There remains a need for further studies to establish whether available rapid tests will eventually become the gold standard.