Internet Scientific Publications

The Need for Patient Teaching, Follow Up, and Physician Availability for the Prevention of Perineural Catheter Complications

Wed, 02 Nov 2011 00:04:27 -0500

Perineural catheters have influenced the way we manage postoperative pain and sometimes require us to care for patients beyond the postoperative period on an outpatient basis. We have found that while appropriate instruction, follow up and physician availability are essential in the management of outpatient perineural catheters, patient misunderstanding or noncompliance contributes to complications. Here we report such a misunderstanding with a complication.

Comparison Of Measurements Of Body Temperature With Four Thermometers In A Children Health Care Setting. Comparison Of Thermometers.

Wed, 02 Nov 2011 00:04:12 -0500

Introduction. Body temperature is measure in all setting of primary health care. There are some thermometers for use, but the results of their measurements are controversial.Patients and methods. We made measurements of body temperature with cutaneous, ear, digital axillary and mercurial axillary in 100 children under 18 years old that attended a private ambulatory pediatric health care; they were rest 15 minutes and then we made the measurements, two times for one researcher and another time for a different research. The time between measurements were 15 minutes. We calculated validity and repeatability in cutaneous, ear and digital axillary thermometers compared with mercurial axillary; we obtained r Pearson and regression lineal equation. We calculated Kappa for the agreement intra-researcher and inter-researchers.Results. Sensitivity was low (<70%) for cutaneous and ear thermometers, but it was high for digital axillary. Predictive positive value was high for digital axillary thermometry compared with mercurial axillary (>90%). r de Pearson was excellent (>0.90) between digital axillary and mercurial with regression lineal equation significative (p<.05). Kappa was higher, o89 y 0.90 for digital axillary and mercurial axillary thermometry. Conclusion. In our sample, digital axillary thermometer measured the body temperature more similar that mercurial axillary thermometer.

Prevalence Of Overweight/Obesity In School-Aged Children From Celaya, Guanajuato, Mexico, And Its Association With Arterial Hypertension: A Cross-Sectional Study.

Wed, 02 Nov 2011 00:04:11 -0500

Introduction. Obesity represents a major public health threat due to the high incidence of chronic disease in persons who are obese. Objective: to determine the prevalence of overweight/obesity in school age children in Celaya, Mexico, and its association with arterial hypertension. The protocol for this study was reviewed and approved by the Research and Bioethics Committee at the School of Nursing and Obstetrics at the University of Guanajuato. Materials and methods. The study is a cross-sectional, analytic, comparative, and community-based. Population: students enrolled in public elementary schools in Celaya, Guanajuato, Mexico. Inclusion criteria: both male and female children eight years of age and older were enrolled in the study given that their parents signed an informed consent, and that they assented to participate. Male and female children ages six and seven were also included in the study if their parents signed the informed consent. Exclusion criteria: children younger than six years of age, children who did not assent to participate in the study, children whose parents did not sign the informed consent. Sample: We randomized select four elementary schools in Celaya; in them, we invited parents and children to participate in the study. We measured age, gender, weight, height, Body Mass Index (BMI) and arterial tension. Outcomes were: not overweight: children at or below the 74th percentile of the CDC’s 2000 BMI curve; overweight/obese: children at or above the 75th BMI percentile. Hypertension was defined as having arterial tension above the 95th percentile given height, age, and gender. Statistical analysis. Chi-squared and Odds Ratio tests were performed to assess the association between overweight/obesity and arterial hypertension. Results. Our final sample included 301 children. The prevalence of overweight/obesity in our sample was 66.11% (199/301), while the prevalence of arterial hypertension was 7.97% (24/301). A Chi-squared test resulted in X2 = 3.45 df 1 p=0.06 when testing the association between overweight/obesity and arterial hypertension; the Odds Ratio was OR= 2.74 CI95%=0.90 to 8.30.Discussion. The prevalence of overweight/obesity in elementary school children was higher than we had expected to find. We also conclude that overweight/obesity and arterial hypertension are associated within this population.

Histopathological Profile Of Tumours Of Midgut And Hindgut—Five Year Study In Tertiary Care Hospital With Review Of Literature.

Wed, 02 Nov 2011 00:01:28 -0500

This is a five year study of 400 cases of tumours of midgut and hindgut reported by pathology department in a tertiary care hospital. They were studied taking into consideration pathological findings and classification was done as per WHO guidelines. The study highlighted that hindgut tumours (large intestine & anal canal) were more common than midgut (small intestine) i.e. about ten times the midgut tumours along with male to female ratio of 2.2:1.The mean age of presentation of benign and malignant tumours was 32.6 years and 54.5 years respectively. Tubular adenoma was the most common benign tumour and adenocarcinoma was the most common malignant tumour and large intestine was the most common site for both of these tumours. But almost all kinds of tumours ranging from benign epithelial tumours to carcinoids even rare like Maltomas, Lipomas, FAP, Peutz Jeghers polyps, metastatic tumours and malignant mesenchymal tumours were observed and highlighted in the study.

Substantial Interobserver Variation Among Morphopathological Diagnosis Of Canine Mammary Gland Tumours From Veterinary And Human Pathologists

Wed, 02 Nov 2011 00:01:27 -0500

Because the morphopathological diagnosis for the benignity or malignance of tumours has played a key role of therapeutic decisions and prognosis, the reproducibility and coherence among pathologists is important. To determine the level of interobserver variation for comparative studies among veterinary and human pathologists for the diagnosis of canine mammary gland tumours (MGTs), one hundred and thirty-six selected canine MGTs with histological slides were randomly divided into two groups: 68 cases were evaluated independently by three veterinary pathologists and one human pathologist; other 68 cases were reviewed blindly by one veterinary pathologists and three human pathologists. All the participating pathologists designated whether the canine MGTs are benign or malignant. Kappa (κ) statistics were calculated to evaluate the level of agreement. For three human pathologists involved in this study, moderate to good levels of agreement among their diagnosis (κ=0.68-0.81). However, three veterinary pathologists participated in this study show less than chance to slight levels agreement (κ= -0.06 to 0.25). In this study, human pathologists tend to diagnosed canine MGTs as benign lesions while veterinary pathologists tend to diagnose as malignant lesions. We conclude that substantially high interobserver variations do exist among pathologists and will greatly influence the research result and therefore; internationally accepted pathological diagnostic definitions with high accuracy and reproducibility among pathologists are required to assist global researchers in characterizing the tumour biology, natural history, and the comparison of treatment modalities of canine MGTs.

Primary Localized Amyloidosis Of The Neck - A Unique Differential Of Neck Masses.

Wed, 02 Nov 2011 00:01:27 -0500

Amyloidosis is a group of disorders characterized by an extracellular deposition of an abnormal amount of proteins in a variety of organs. It typically presents as disseminated deposits. However rarely, localized deposits of amyloidosis are seen. Tumor like localized presentation of amyloidosis, referred to as amyloidoma, is uncommon, especially in the head and neck. We report a case of a 40year old man who presented with a large mass on the left side of the neck.

Diagnostic Accuracy Of Fine Needle Aspiration Cytology In The Diagnosis Of Thyroid Lesions

Wed, 02 Nov 2011 00:01:23 -0500

Objectives : (1) to study the cytological features in thyroid lesions(2) to correlate the cytological and histopathological observations in thyroid lesions , whenever possible(3) to assess the diagnostic accuracy of aspiration cytology as a pre-operative screening tool Methods : This was a retrospective study to find the utility of fine needle aspiration cytology in thyroid lesions conducted at Maharajahs Institute of Medical Sciences , Vizianagaram. Fine needle aspiration specimens from 140 patients between January 2008 and December 2010 with thyroid swelling were analysed. Smears were stained with papanicoluou stain and haematoxylin and eosine stain. The smears were classified into categories like benign , suspicious/indeterminate , malignant and unsatisfactory. Cytological diagnosis was correlated with the histopathology report wherever possible. Results : Of the total cases the non-neoplastic category constituted the majority of the cases (82.85 %).These cases included colloid goiter , colloid goiter with haemorrhage , colloid goiter with cystic degeneration , thyroiditis , thyroglossal duct cyst and hyperthyroidism. Neoplastic lesions constituted 15.72 % of all cases and included follicular neoplasm and papillary carcinoma.52 cases underwent surgery and biopsy report was correlated with the cytological diagnosis. The overall sensitivity of the study was calculated to be 90.0 % ; specificity 100 % ; positive predictive value 100 % ; negative predictive value 90.5 % and diagnostic accuracy of 92.3 %. Conclusions : FNAC is considered as an invaluable and minimally invasive , simple , cost-effective , easily repeated procedure for pre-operative screening in the non-operative diagnosis for most of the thyroid lesions.

Unilateral Orbital Proptosis Secondary To A Carotico- Cavernous Fistula: A Case Report

Wed, 02 Nov 2011 00:01:04 -0500

Carotico- Cavernous Fistulas (CCF) are caused by the laceration of the intercavernous portion of the carotid artery, or one of its intercavernous branches resulting in arterialisation of blood within the cavernous sinus. There are four types (A,B,C,D) of CCF out which type A (Direct type) and types B, C, and D (Indirect types) occur spontaneously. Prompt diagnosis and treatment of this condition can prevent visual loss, development of secondary glaucoma and intracranial hemorrhages.A unilateral orbital proptosis associated with sinusitis is an indication for endoscopic decompression. In our case even though there was unilateral orbital proptosis along with sinusitis, endoscopic surgery was unnecessary and did not significantly effect the course of patients illness. We present a case of unilateral orbital proptosis in a middle aged male with an indirect type of CCF detected on Magnetic Resonance Angiogram. The role of MR imaging and indications for endoscopic surgery in a unilateral orbital proptosis with review of relevant literature is discussed in this paper.

Facial Nerve Preservation In Vestibular Schwannoma Surgery- Anatomical And Functional Status

Wed, 02 Nov 2011 00:00:49 -0500

IntroductionSurgery for vestibular schwannoma taxes the surgeon’s skill to the hilt especially in removing the tumor completely and preserving the facial nerve.Aims To study the anatomical and functional status of the facial nerve in patients after vestibular schwannoma surgery and analyze the factors contributing to the outcome after surgery.Materials and methodsA retrospective analysis of all the case records of patients operated for Vestibular Schwannoma from 1980 to December 2007 in Kasturba Hospital Manipal was done which included their pre operative facial nerve function and post operative anatomical and functional status. The data was analyzed and conclusions drawn.Results210 patients who underwent surgery for vestibular schwannoma were included. In 111 patients(53%) preoperative facial nerve deficit was present and graded by House and Brackman grading. 207 out of 210 patients were operated by suboccipital retromastoid route. In 138 patients anatomical preservation of facial nerve was done, of which 120 patients underwent internal auditory meatus drilling. The rate of anatomical preservation has increased from 10% in the initial part of the study period to 100% in the latter part. Overall, 82.8% of the patients had a good functional outcome and 17.2% had a worse functional state than their preoperative status. We had operative mortality of 2.5%ConclusionsAbility to preserve the facial nerve improves with number of cases. Transmeatal drilling helped in identifying and protecting the facial nerve. Majority of patients in our series have presented as large tumors (69%) inspite of which good functional outcome was achieved.

Airbag Associated Bilateral Internal Carotid Artery Dissection with Hyperdense Middle Cerebral Artery Sign - A Case Report

Wed, 02 Nov 2011 00:00:47 -0500

Although an uncommon injury, bilateral dissection of the internal carotid arteries can have devastating consequences. Awareness and diagnosis has risen since it was described in 1967 by Yamada et al. However, given the vague presentation and difficulty in diagnosis, it is important to identify all associated signs and symptoms. We present a previously unreported finding of bilateral hyperdense middle cerebral arteries in the absence of previously described contributing factors. Knowledge of this highly specific sign in patients involved in airbag-associated motor vehicle accidents can contribute to the early diagnosis and treatment of such patients.

Ocular Propionibacterium Acnes: A Study On Antibiotic Susceptibility Profiling And Their Epidemiological Pattern

Wed, 02 Nov 2011 00:00:22 -0500

Purpose: To identify the antibiotic pattern of commonly used P. acnes isolates and to analyse the epidemiological patterns using Random Amplification of Polymorphic DNA (RAPD) technique. Methods: One hundred P. acnes isolates (90 % extraocular and 10% intraocular) recovered from ocular clinical specimens identified by conventional method were studied. MIC of ciprofloxacin, norfloxacin, nalidixic acid, clindamycin, penicillin G, vancomycin and metronidazole, cefotaxime and imepenum were carried out for 100 P. acnes ophthalmic isolates by spot inoculation technique. Results: Six distinct RAPD patterns were observed among these isolates of which the 4th pattern was the most predominant one (41%), which was isolated mostly from conjunctival swabs. Of the 100 clinical anaerobic P. acnes isolates, highest resistant antibiotic pattern was seen among conjunctival swabs isolates for metronidazole (100%). Following it was the clindamycin (79%) and penicillin G (64%). Conclusion: This study has proven that RAPD is a reproducible, powerful technique for P. acnes genomic typing and may definitely play a vital role in identifying epidemiology of P. acnes. There was no correlation between the antibiotic pattern and the corresponding RAPD fingerprinting results in our study. Resistance to Vancomycin, the most commonly used intravitreal antibiotic is emerging among P. acnes is being reported for the first time. Studies at molecular level with vancomycin resistant isolates will help to understand the mechanism of resistance.

Book Review

Tue, 01 Nov 2011 23:59:41 -0500

Psychological Aspects And Their Management During Dental Treatment In Geriatric Patients

Tue, 01 Nov 2011 23:59:29 -0500

Life expectancy has increased worldwide, with India (having 8% who are senior citizens),Falling into the ‘‘Greying Country’’ category. It also leads to an increase in age related diseases and disabilities. In this scenario chronic disease play a significant role and dental diseases are the most prevalent chronic conditions. This ageing population constitutes a high-risk oral healthgroup, vis-à-vis impaired manual dexterity, cognitive deterioration and unmet treatment needs, which could be compounded by psychiatric morbidity. Authorities in dental medicine have long recognized a relationship between psychology and dentistry and have attempted to describe the factors that require consideration during the dental therapy. Theoretical approaches are now replaced by practical approach of patient management. Diagnosis and treatment planning for the elderly must include considerations of the biological, psychological, social and economic status of the patient in addition to the obvious dental problems. The aim of this article is to provide a review of the psychological and emotional factors involved in the dental treatment and the methods to develop a right dental attitude.

Esophageal Foreign Body (Pheasant) Presenting As Myocardial Infarction

Tue, 01 Nov 2011 23:59:18 -0500

Chest pain is a common symptom among those visiting the emergency department. It is a manifestation of both cardiac and non-cardiac conditions. Accurately discerning the correct diagnosis and treatment of the patient with chest pain remains one of the most difficult tasks of the emergency physician. Oesophageal disorders are most common causes of non cardiac chest pain. The presentation of foreign body in the upper GI tract is usually straightforward but may be extremely subtle, as in this case. We describe here a case of pheasant bone entrapment in the oesophagus with dynamic ECG changes, diagnosed and treated as acute coronary syndrome (ACS) in a middle aged woman.

Benign Migratory Glossitis: A Review

Tue, 01 Nov 2011 23:58:37 -0500

Benign migratory glossitis also known as geographical tongue is a recurrent condition of unknown etiology characterized by loss of epithelium particularly of the filiform papillae on the dorsum of the tongue. Clinically the appearance is of multifocal, circinate, irregular erythematous patches bounded by slightly elevated, white colored keratotic bands. Several etiologic factors have been proposed. The condition may remain asymptomatic or patients may present with complains of pain and burning sensation. A review of the current opinion on benign migratory glossitis is presented.

Dental Pathology Overlapping With Cardiac Origin Of Jaw Pain Leading To Myocardial Infarction: A Case Report

Tue, 01 Nov 2011 23:58:12 -0500

Jaw pain with no accompanying pathology should raise suspicion of pain of cardiac origin. However, jaw pain associated with dental infection and a soft swelling may mask the prodromal stage of cardiac disease. In a unique case of a 43 year old Indian woman who came to the Emergency Room with a complaint of right-sided jaw pain; infection and swelling due to a right-sided carious tooth was diagnosed as being the cause. After dental treatment, her pain subsided. Six weeks later, she returned, claiming she had “exactly the same pain”. Doubts of failed dental treatment were unfounded and a neuropathic pain disorder was suspected. This oversight culminated in an acute myocardial infarction a day later.

Prevalence Of Overweight And Obesity In A Private School Of Orissa, India

Tue, 01 Nov 2011 23:57:58 -0500

Obesity has become a major epidemic causing serious public health concern and contributes to 2.6 million deaths worldwide every year. In developing countries such as India, especially in urban populations and affluent children, obesity is emerging as a major health problem. Objectives: 1. To study the prevalence of overweight & obesity among school children of an affluent school. 2. To assess the risk factors related to obesity. Materials and methods: The present study was a cross sectional study conducted in an affluent English Medium School of Bhubaneswar during Jan. - Feb. 2011. After getting permission from school authorities, the data was collected from students of Class 1 to 10. One section from each class is randomly selected and all the students present during the survey were screened for overweight and obesity. In this way, data was collected from 468 children. Complete data of each child were collected using a pre-designed, pre-tested questionnaire. Result: Out of total 468 school children, 41.9% were boys and 58.1% were girls. 44.4% children belong to 5-10 years age group while the 55.6% children belong to 10-15 years age group. The overall prevalence of overweight and obesity in school children of 5-15 years was found to be 28.63% (overweight – 14.1% and obesity – 14.53%). Maximum prevalence i.e. 36.54% was found in children of 5-10 years age group and 33.65% in boys. Overweight and Obesity was found significantly higher in Children of 5-10 years age group, with family H/O obesity, not playing outdoor games, not doing regular exercise, watching TV, Computer more than 2 hours daily and consuming junk food regularly. Conclusion: Periodic screening for overweight and obesity should be done in schools followed by counseling of parents of overweight and obese children. Counseling of adolescent children on lifestyle modification should be emphasized.

Anesthesia For Off Pump Bidirectional Glenn Shunt Surgery: Case Report.

Tue, 01 Nov 2011 23:57:21 -0500

The purpose of this case report was to enumerate the challenges confronted by the anesthesiologist while conducting anesthesia for Bidirectional Glenn Shunt (BDGS) surgery and discuss the complications that could arise from this procedure.The patient presented with multiple congenital heart anomalies and cyanosis. Off- pump BDGS surgery was carried out under general anesthesia. Surgery and anesthesia were uneventful.

Technical And Ethical Considerations During Regional Anaesthesia For Cesarean Section: Achieving A Balance

Tue, 01 Nov 2011 23:57:21 -0500

Report of Kikuchi-Fujimoto Disease in a 12yr old Caucasian Male

Tue, 01 Nov 2011 23:55:23 -0500

This case reports a rare disease known as Histiocytic Necrotizing Lymphadenitis or Kikuchi-Fujimoto Disease. This rare, self-limiting disease is not characteristically found in Caucasians. This case is of a 12yr old Caucasian male, referred for surgical review after a presumptive diagnosis of a strangulated inguinal hernia. Subsequent examination revealed a tender, erythematous swelling in his groin and exploratory surgery revealed reddish-brown inguinal lymph nodes. Excision relieved the patient’s symptoms and returned a histopathological diagnosis of Histiocytic Necrotizing Lymphadenitis or Kikuchi-Fujimoto Disease. The patient was subsequently discharged and it was arranged on the advice of pathology that he be referred to a paediatric haematologist for continued follow-up to rule out potential serious pathologies such as lymphoid or blood-borne malignancies. This case report hopes to raise clinician awareness of this rare disease, to consider surgical service delivery and support available in rural areas and reaffirm the need for exploratory surgery when appropriate.

Rapunzel Syndrome- Rare Presentation Of Trichobezoar

Tue, 01 Nov 2011 23:49:20 -0500

Rapunzel syndrome a rare presentation occurs predominantly in young women or girls with psychiatric or emotional disorders and consists of trichobezoarwith a tail extending at least to the jejunum with symptoms suggestive of obstruction. With less than 40 cases reported in literature till date we report a case in a young female diagnosed clinico-radiologically and treated surgically with removal of an intact trichobezoar extending from stomach till the jejunum.

Cancer of the Larynx- Management Challenges in Calabar, South-South Nigeria.

Wed, 26 Oct 2011 21:50:38 -0500

Aims: To review the management challenges and outcome of advanced carcinoma of the larynx associated with patient treatment preference regardless of available or clinically appropriate treatment modality. Materials and methods: This was a retrospective review of the records of patients with laryngeal cancer managed in the Otorhinolaryngology department of the University of Calabar Teaching Hospital, Calabar South eastern Nigeria. The period under review was April 2001 to march 2011. The age, sex, presentation, history cigarette smoking and alcohol consumption, histopathological diagnosis, patient treatment preference and outcome of management, were analysed. Results: There were 10 patients, all males in the age range 42 to 75 years. Hoarseness was the initial symptom in all the patients (100%) with stridor and difficulty in breathing in 8(80%) at presentation. There was history of recent or past cigarette smoking in all but 2 (20%) of the patients. Tumour was transglottic in 7 (70%) patients, glottic in 2 (20%) and supraglottic in 1 (10%). Emergency tracheostomy was done in 8 (80%) cases as the first line of treatment to relieve upper airway obstruction. The histological diagnosis was exclusively squamous cell carcinoma of variable degrees of differentiation in 9 (90%) cases and carcinoma in situ in a case (10%) patient. Clinical staying was T3 No in 8(80%) of cancer. Nodal staging was not confirmed by CT or MRI scans. There was biased to any form of laryngeal surgery as treatment option because of societal believes and ignorance. Chemoradiation therapy without surgery preferred by all the patients regardless of advanced stage of disease. There was high morbidity including disease recurrence within 1 year in 7(70%) patients and dependence on tracheotomy in 8(80%), feeding gastrostomy, intractable pain and pharyngocutaneus fistula. Voice optimisation was achieved only in the 2 patient with early glottic tumours. Mortality within 1 year was recorded in 5 patients despite Chemoradiation Therapy (CRT). Mortality was attributable to liquid morphine overdose/toxicity in 1 patient. Prognosis was abysmally poor.Conclusion: Treatment of Ca larynx in Calabar South eastern Nigeria is a management challenge with considerable morbidity and mortality. Cure rate and prognosis are very poor because of late presentation and patient’s preference for inappropriate treatment modality in advanced disease. Refusal of laryngeal surgery as treatment option even when conservative non-surgical options have failed was because of Beliefs and ignorance. There is need for public enlightenment on the possibility of high cure rates and voice preservation in early laryngeal cancer. Cost of oncology care should be subsidized by government while an oncology centre should be established in each of the six geopolitical zones in Nigeria.

Characterisation of Central Nervous System, Liver, and Abdomino-Pelvic Tumours using Meglumine Gadoterate: Pooled Phase III Studies.

Wed, 26 Oct 2011 21:50:18 -0500

Aim: To compare the diagnostic performance of Gd-DOTA-enhanced MRI with non-enhanced MRI in the characterization of tumoral lesions with histological (or other) corroboration.Materials and Methods: Pooled data included 381 patients from three comparable Phase III trials of patients with abdomino-pelvic, hepatic and cerebro-spinal lesions. Each patient underwent MRI with appropriate unenhanced sequences (pre), followed by an injection of Gd-DOTA (0.1 mmol/kg) and corresponding enhanced sequences (post). Histology was used as the gold standard or, in the hepatic study, a corroborative diagnosis. Qualitative and quantitative assessments of images were done by one on-site and two independent off-site blinded readers.Results: Technical failures were at least five times more frequent on the unenhanced sequences compared with the Gd-DOTA-enhanced sequences. Delineation of lesion borders was superior with enhanced MRI compared with unenhanced MRI, irrespective of evaluation off-site (‘post’-injection/‘pre+post’-injection: 60.9%/65.3% versus ‘pre’-injection: 35.5%, p<.0001) or on-site (post: 75.8%, versus pre: 39.9%, p<.0001). Gd-DOTA sequences improved diagnostic confidence both off-site (76.2%/83.2% versus pre: 57.6%, p<.0001) and on-site (88.7%/93.9% versus pre: 43.9%, p<.0001). Sensitivity and specificity were statistically significantly improved with Gd-DOTA for off-site (pre+post/post: 90.3%/88.8% versus pre 84.3%; and 71.1%/76.2% versus 65.3%) and on-site (95.2%/94.7% versus 71.2% and 81.9%/81.0% versus 60.8%) readings, respectively. There were no unexpected adverse events.Conclusion: Gd-DOTA-enhanced MRI resulted in fewer technical failures, better image quality and better diagnostic performance compared with unenhanced MRI, confirming that Gd-DOTA adds clinical value and greater diagnostic confidence to the characterization of tumoral lesions.

Compare The Incidence Of Epileptiform Activity During Intermittent Photic Stimulation Test On The Electroencephalogram Of Normal And Epileptic Patients.

Wed, 26 Oct 2011 21:47:43 -0500

Purpose of the study:Intermittent photic stimulation (IPS.test has been widely used in clinical Electroencephalogram (EEG.laboratories as “activation method” to enhance preexisting abnormalities and / or induce abnormal findings in an otherwise normal EEG. There has been considerable variability in the literature reported regarding EEG abnormalities in normal adult and epileptics using IPS test. Therefore the present work was done by using “IPS test” to,a. compare the incidence of epileptiform activity during IPS test on the EEGs of normal and epileptics.b. Quantification of Changes in different seizure categories like (a.Absent, (b.Focal and (c.Generalized.Methods: EEGs were recorded using IPS as activation procedure in 50 patients, who were proven cases of epilepsy with different seizure categories and compared with 50 age and sex matched normal subjects. Effects of IPS on EEG were recorded and changes were analyzed statistically.Results: IPS test had a significance result in activation of Interictal Epileptiform discharges.(IEDs.or photo paroxysmal response(PPR). (p=0.056). Effect of activation was seen maximally in patients of generalized seizures especially in patients with GTCS (30%).Interpretation and Conclusion: This work suggests that IPS provoke epileptiform changes in EEGs Of epileptic patients and hence increase the yield of EEG recordings.

Outcomes Of Endoscopic Quilting Of Nasal Septum Versus Nasal Packing Following Septoplasty

Wed, 26 Oct 2011 21:46:46 -0500

INTRODUCTION: Objective: To compare the outcomes of Endoscopic quilting of nasal septum with BIPP nasal packing following Septoplasty.MATERIALS AND METHODSA Prospective, longitudinal, comparative and a randomised study was conducted in 72 for 22 months at the Ganesh Man Singh Memorial Academy of ENT & HN Studies, IOM,TUTH , Kathmandu . Patients of both genders greater than or equal to 13 years undergoing Septoplasty for symptomatic DNS were included. In the BIPP packing group following Septoplasty nasal cavity was packed with BIPP. In the Septal suture group following Septoplasty septum was quilted under endoscopic guidance using 3/0 Vicryl. OUTCOME MEASURES: Pain, Demand of analgesia and significant reactionary haemorrhage requiring either repacking or blood transfusion. RESULTS : The mean post–operative pain on the first post-operative day was 2.58 in the Septal suture group and 4.51 in the BIPP pack group(p < 0.001) whereas on the second post –operative day was 2.20 and 3.40 respectively(p = 0.005). Six in the Septal suture group and twenty four in the BIPP pack group required demand of analgesia (p < 0.001). Two in the Septal suture group required packing for ‘significant haemorrage’ (p=0.246) and blood transfusion was required in none. CONCLUSION: Pain is significantly lower in the Septal suture group as compared to the BIPP pack group. Bleeding may occur and even if the patients are not packed there is no significant risk of haemorrhage. Septoplasty can be safely performed with Endoscopic quilting of nasal septum without BIPP nasal packing.

Usefulness Of Tei Index In Patients With Heart Failure

Wed, 26 Oct 2011 21:46:07 -0500

Background: Tei index is a Doppler derived myocardial performance index. It is a measure of combined systolic and diastolic myocardial performance of both the left and right ventricles. Incidence of heart failure (HF) is increasing globally. Systolic and diastolic dysfunctions frequently co-exist in HF hence a combined measure of left ventricular chamber performance may be more reflective of overall cardiac dysfunction than systolic or diastolic measures alone.Method: Ninety newly presenting patients with HF in New York Heart Association (NYHA) Class II to IV and ninety age and sex matched normal controls were recruited consecutively in the Cardiac Care Unit, Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife, Nigeria. Using conventional 2–D and Doppler echo techniques, parameters assessed were; isovolumic relaxation time (IVRT), isovolumic contraction time (IVCT), ejection time (ET) and ejection fraction (EF). Tei index was obtained with the formula IVCT + IVRT/ET. Result: Mean Tei index (TI) of patients was significantly higher than that of controls (0.861 ± 0.501 vs. 0.36 ± 0.07; p = 0.0001). TI ranged 0.33 to 1.938 in patients and 0.29 to 0.43 in controls. There was an inverse relationship between TI and EF. As TI increased, EF decreased (r = −0.322, p = 0.002). There were significant differences between mean TI of patients in each of NYHA class II, III and IV and mean TI of controls (p = <0.0001 for all three comparisons). Comparison of mean Tei indices of patients in NYHA Classes II, III and IV by means of ANOVA showed statistically significant difference between all three groups (p=0.000). Conclusion: Tei index is a simple reproducible myocardial performance index which can reasonably separate normal controls (low and narrow TI) from patients with HF (high and wide TI). It shows significant difference with HF severity and an inverse relationship with EF.

Syndrome of Inappropriate Secretion of Anti-Diuretic Hormone (SIADH) Secondary to Single Dose of Quetiapine

Wed, 26 Oct 2011 21:46:05 -0500

Hyponatremia (serum sodium <135 mmol/L) has been reported with antipsychotic drugs and selective serotonin reuptake inhibitors (SSRIs). A recent case control study from the Netherlands by Mannesse et al. described 912 cases of reported hyponatremia secondary to antipsychotics with reported odds ratio for association between antipsychotic and hyponatremia to be 1.58 (95% CI, 1.46-1.70)1. Here we present a rare case report of hyponatremia from a single dose of 12.5mg quetiapine.

Clostridium Difficile Septicemia following Head and Neck Surgery- A Case Report

Wed, 26 Oct 2011 21:45:23 -0500

Clostridium difficile can cause a number of pathologies in the human body including colitis, deep-seated abscesses, arthritis, osteomyelitis, and blood-stream infections. (3). Of the aforementioned complications of C difficile infection, bacteremia is a rare complication of C difficile infection, and typically occurs in patients following colon surgery or those with underlying gastrointestinal disease. The literature has recorded multiple patients with C difficile bacteremia; however, most of them had either underlying gastrointestinal disease or colonic manipulation with the exception of one case (3). Here we present a patient with C difficile bacteremia following resection of laryngeal squamous cell carcinoma. Our patient initially did not have any evidence of bowel pathology or history of gastrointestinal surgery, however was later found to have C difficile bacteremia. None of the previously reported cases of C difficile bacteremia had an associated history of head and neck cancer surgery.

Safe Distance for Superior Gluteal Nerve and its Relation with Thigh Length: A Cadaveric Study

Wed, 26 Oct 2011 21:45:08 -0500

Superior gluteal nerve emerges through the greater sciatic foramen above the piriformis muscle. The nerve curves upwards and forwards between the gluteus medius and minimus muscles, supplies both of them and ends by supplying the tensor fasciae latae muscle, from its deep surface. During hip surgeries, this nerve often gets injured resulting in complications. An exact knowledge of its course is helpful in avoiding such injuries. The aims of this study are to find the distance of the most inferior branch of superior gluteal nerve from the tip of the greater trochanter; to find the correlation of this distance with the length of thigh and also to find the safe zone where the chances of injury to superior gluteal nerve, during hip surgeries, would be minimal. 20 lower limbs of formalin fixed cadavers were subjected to dissection for their superior gluteal nerve. The distance of the most inferior branch of superior gluteal nerve from the tip of the greater trochanter was measured in the anterior third, middle third and posterior third of the gluteus medius muscle. The correlation between these distances and the thigh length was evaluated. The range of distance from tip of the greater trochanter to superior gluteal nerve was found to be 4.0-8.3 cm (mean 6.0 cm) in the anterior third, 5.0-7.6 cm (mean 5.9 cm) in the middle third and 5.0-7.8 cm (mean 6.2 cm) in the posterior third of gluteus medius muscle. From the tip of the greater trochanter a distance of 4.0 cm in the anterior third; and 5.0 cm in the middle third and posterior third of the gluteus medius muscle, can be considered safe for the superior gluteal nerve, in hip surgeries. The results of the present study also showed that the there was no statistically significant correlation between distance of most inferior branch of superior gluteal nerve from the tip of the greater trochanter and thigh length.

Role Of Laprostomy In Septic Abdomen Cases

Wed, 26 Oct 2011 21:43:36 -0500

Abstract:Background: The fundamental principles of management of severe peritonitis include general supportive management, antibiotic therapy, and prompt surgical intervention. Surgical intervention includes source control, peritoneal toileting, and Prevention of recurrent infection. The definitive closure of the abdominal wall, i.e., a closure of the fascial layer and skin may not be favourable in the treatment of numerous surgical conditions, e. g., peritonitis, trauma, or mesenteric ischemia. In these cases, the abdominal wall is temporarily closed. And a Laprostomy is created to facilitate re-exploration or to prevent abdominal compartment syndrome. Objectives: To study the role of laprostomy in septic abdomen cases and to evaluate the importance of laprostomy in septic abdomen cases in rural hospital setup.Methods: Patients admitted with severe peritonitis where managed with prompt surgical intervention, 25 cases abdomen wall has been closed primarily and other group 25cases had undergone laprostomy, patients has been monitored post operatively and assessed by APACHE II. Results: Laprostomy patients had greater postoperative recovery and decrease in septicaemia when compared to primary closure. Conclusion: Laprostomy facilitates re-intervention, Prevents and treats persistent / recurrent infections, Avoids increased intra-abdominal pressure. Lastly, the risk of abdominal compartment syndrome is virtually eliminated.

Prevalance Of Disease With Epigastric Pain With Reference To Gastric Pathology

Wed, 26 Oct 2011 21:43:35 -0500

Back ground:Epigastric pain - pain in the mid-upper abdomen. The differential diagnosis of epigastric pain is broad. Pain in this area can be due to gastroenterological, pancreaticobiliary and other causes, including non-gastroenterological disease. The prevalence of gastric pathology has been studied in detail and incidence of Helicobacter Pylori in peptic ulcer disease has been analysed.Methods:All the patients attending the OPD with epigastric pain has been examined and those cases with pathology affecting organs other than stomach have been excluded. The remaining patients has been subjected to routine endoscopic biopsy and screening for H.Pylori (by Rapid Urease Test).Results:Prevalence of disease with epigastric pain with reference to gastric pathology in this community is 83.3%.Incidence of helicobacter pylori among the patients with acid peptic ulcer disease symptoms was up to 74% which correlate with the world wide prevalence.Conclusion:Patients attending hospital with epigastric pain are mostly due to gastric pathology-acid peptic ulcer disease with high incidence of Helicobacter pylori. Hence patients attending hospital with epigastric pain, after excluding the causes of pain due to organs other than stomach should be subjected to routine upper gastro intestinal endoscopy, endoscopic biopsy and should be screened for Helicobacter pylori. Which highly prevent the patients more susceptible for carcinoma stomach. More over promotion of health education and awareness of the disease makes the patients present to hospital at earlier stage and prevents devastating complications.

Forensic Applications Of Vibrational Spectroscopy Techniques To Identify Prescription Drugs And Mixtures

Wed, 26 Oct 2011 21:41:40 -0500

One major issue faced by law enforcement is drug related crimes. In the past, drug related crimes included drugs such as cocaine, methamphetamines etc. Today, prescription drugs, specifically pain medications are almost as prevalent due to rampant drug abuse. Officials responding to crime scenes (e.g. firefighters, police and hazmat teams) are often ill equipped to handle the ever growing magnitude of drugs that are encountered at crime scenes. These samples generally are collected, sent to crime labs for extensive analysis which can be time-consuming and impede swift justices. However, recently several analytical techniques have been developed which can be used in the portable mode. These techniques can be used to identify white powders which are otherwise indistinguishable based on color, texture and odor. In the present study we have utilized two analytical techniques: Fourier Transform Infrared spectroscopy (FT-IR), and Raman Spectroscopy to identify various prescription drugs.

An Unusual Retroperitoneal Mass –Non Functioning Retroperitoneal Paraganglioma

Wed, 26 Oct 2011 21:41:21 -0500

A paraganglioma is a rare neuroendocrine neoplasm that may develop at various body sites (including the head, neck, thorax and abdomen). About 97% are benign and cured by surgical removal; the remaining 3% are malignant because they are able to produce distant metastases. When presenting within the abdominal cavity, they may arise as a primary retroperitoneal neoplasm and can mimic vascular malformations or other conditions related to specific retroperitoneal organs such as the pancreas, kidneys, or adrenals. Retroperitoneal paragangliomas are mostly benign with good prognosis; however, they can present with abdominal pain, palpable mass, or hypertensive episodes. Patients should be initially evaluated with catecholamine levels, followed by computed tomography or magnetic resonance imaging to locate the primary lesion. Surgical excision remains the mainstay of treatment, although advanced disease and proximity to vital organs can make excision difficult or impossible. We report a rare case of retroperitoneal mass presented to be a non-functioning Paraganglioma.

Prevalence Of Periodontal Diseases In Diabetic And Non-Diabetic Patients- A Clinical Study.

Wed, 26 Oct 2011 21:41:08 -0500

Background: The sixth long-term complication of diabetes is periodontitis. The link between periodontal and systemic health is a two-way street. Patients with diabetes are at a greater risk for developing infections, and these infections can impair these patients' metabolic control. Patients with both diabetes mellitus and periodontal disease present the challenge of managing two chronic diseases, each of which may impact the other.Aim: The aim of this study was to determine the prevalence of periodontal disease in patients with type 2 DM in a single center Mauras College Of Dentistry, Oral Research Institute and Hospital at Arsenal in Mauritian population.Methods: A clinical study was carried out. A total of 2000 patients were included (980 diabetic patients and 1020 nondiabetic patients as controls). Patients with type 2 diabetes mellitus who were dentate aged 40 years and above and with ≥ 6 remaining teeth were studied. The study period was 3 months. Results: Periodontal disease was seen in 49.9% of the subjects when both diabetics and controls were taken into consideration. Periodontal disease is prevalent in all diabetic patients.Conclusion: Mauritian subjects with Diabetes Mellitus had more prevalent periodontitis than healthy Mauritian subjects

Acute Onset Dysphagia Secondary To Cervical Injury In A Young Male – A Case Report

Wed, 26 Oct 2011 21:40:52 -0500

Dysphagia may have oropharyngeal or esophageal causes. Extrinsic compression of oesophagus or intraluminal abnormalities in the esophagus can cause dysphagia. Anatomic causes of dysphagia are tumors, abscesses, and cervical bony outgrowths (osteophytes). Anterior cervical osteophytes can rarely cause dysphagia due to mechanical compression and inflammatory reactions in the tissues around the esophagus. For this reason Non steroidal anti-inflammatory drugs might have a role in improving patient symptomatology. We present a case of a young man with cervical osteophytes presenting with an acute onset of dysphagia following mechanical injury to the neck that improved rapidly with non steroidal anti-inflammatory medications. The report is discussed with a review of relevant literature.

An Audit Of Informed Consent For Elective Gynaecological Surgery In A District General Hospital

Tue, 25 Oct 2011 20:50:09 -0500

Objective: To measure compliance with standards in available guidelines for informed consent for elective gynaecological surgery and to make recommendations to improve the process of consenting in the obstetrics and gynaecology unit. Methods: We retrospectively studied the medical notes of patients undergoing 3 types of elective gynaecological surgery over a seven-month period. These were assessed for the presence of consent forms, the legibility of the doctor’s name, and his/her suitability and the extent to which risks of the operations were documented. Result: Of the 54 patients’ notes assessed, all contained signed NHS consent forms with signatures of doctors and patients. The names of two doctors were not legible. All the identified doctors were assessed suitable to take consent. The documentation of risks was found to be incomplete. Conclusion: The audit revealed the universal problem of incomplete documentation of risks. We recommend that this can be improved with use of operation-specific consent forms, a pro forma or aid memoir e.g. patient’s information leaflets

Adrenal Ganglioneuroma Presenting With Adrenal Insufficiency After Unilateral Adrenalectomy

Tue, 11 Oct 2011 22:32:11 -0500

Objective: To present a case of Adrenal Ganglioneuroma presenting with adrenal insufficiency after ulilateral adrenalectomyMethods: Adrenal insufficiency is rare after unilateral adrenalectomy for non-functioning adrenal tumours (1). Subclinical Cushing's syndrome, which is defined as mild and subtle elevations of cortisol level in the absence of clinical signs of Cushing's syndrome with adrenal incidentalomas, is more frequent than previously thought (2). If unrecognized prior to adrenal surgery this could lead to adrenocortical insufficiency due to hypothalamic-pituitary-adrenal axis suppression from the subtle cortisol elevations with life threatening implications(2) Results: A case of apparent subclinical Cushing's syndrome in a patient with adrenal ganglioneuroma manifesting as adrenocortical insufficiency in the immediate post operative period needing treatment with corticosteroids. Conclusion: Adrenal ganglioneuroma is a rare cause of subclinical Cushing's syndrome. If subclinical Cushing's syndrome is unrecognized prior to adrenalectomy it may lead to adrenal insufficiency in the immediate post operative period. Dynamic testing for subtle cortisol excess should be done in all patients before adrenalectomy.

Adrenal Trauma In The Absence Of Synchronous Intra-Abdominal Pathology.

Tue, 11 Oct 2011 22:32:10 -0500

Otomycosis - A Management Challenge In Calabar, South-South Nigeria

Tue, 11 Oct 2011 22:30:47 -0500

Otomycosis is a common clinical problem in our region of sub Saharan African because of the hot, humid, dusty and wet climate of this region. The infection can be diagnosed clinically on the basis of symptoms like pruritus, otalgia, discharge, blockage, hearing loss and presence of murky debris resembling wet newspaper in the external auditory meatus. It is commoner in females and occurs more in the 21-30 year age range. The most common symptoms in our review were pruritus followed by hearing loss, Murky otorrhoea and blockage. Otomycosis was predominantly unilateral with both ears almost equally affected. Our study highlights a management challenge in the treatment of otomycosis in Calabar, South-South Nigeria. The species of fungus causing the disease in our center could not be established because of poor access to mycological facilities. However, cure rates following antifungal treatment was high (86%) even in the absence of mycological identification of causative fungal agent. Drugs like Clioquinone/flumethasone (eardrops/cream), Beclomethasone dipropionate/clotrimazole/lidocaine hydrochloride (eardrops) or Gentian violet are indespensible topical agents in the management of otomycosis in the Third World. Gentian violet should only be used as treatment of last resort because it discolors the external auditory canal giving a poor cosmetic appearance during treatment. Although confirmatory test to identify causative fugal agent is important, in the absence of adequate mycological diagnostic facilities, presumptive clinical diagnosis and treatment based on signs and symptoms has a high (86%) cure rate.

Computer Keyboard and Mice: Potential Sources of Disease Transmission and Infections

Tue, 11 Oct 2011 22:29:56 -0500

Computers just like microbes are ubiquitous and continue to have an increased presence in everyday lives. The aim of this study was to investigate and compare the level, types and antibiotic susceptibility of bacterial contaminants of keyboards and mice in general offices and internet cafés. A total of 100 samples were collected by swabbing the surfaces of keyboards and mice. Serial dilution and aerobic colony counting was performed by pour plating on PCA (Plate Count Agar) for each sample. Isolates were identified by standard biochemical methods whilst the disc diffusion technique was applied in Antibiotic Susceptibility Testing of each bacterial isolate. All surfaces of keyboard and mice were contaminated (>105) with means of 5.664×108 and 1.305×107 CFU for office keyboard and mice respectively and 1.52×109 and 1.901×107 CFU for café keyboard and mice respectively. There was a 48.02% contamination difference between office and cafés which was significant; keyboards (P=0.000) and mice (P=0.001). Eight bacteria species were isolated with the highest B. cereus, 70(47.95%) and the least E. coli 3(2.05%). Majority of the contaminants were pathogenic 117(80.41%) made up of 42.47% from café samples and 37.94% from office. S. pneumonia, Enterococcus spp. and Coagulase Negative Staphylococcus were the least susceptible organisms (25%) whilst Ampicillin was the least effective antibiotic (0%). These findings suggest high contamination of keyboard and mice with pathogenic bacteria and associated potential of transmission and infection.

Isolated Granulocytic Sarcoma Of Head And Neck Region Without Any Marrow Involvement

Tue, 11 Oct 2011 22:29:26 -0500

Granulocytic sarcoma is usually seen concomitantly with or subsequently to the appearance of leukemia but may rarely precede appearance of AML. Granulocytic sarcoma presenting as an isolated mass without any peripheral evidence of leukemia is very rare presentation and poses diagnostic and therapeutic challenges to the doctor .We report a case of fifty year old male presenting as isolated GS involving head and neck region without any marrow or peripheral evidence of leukemia.

A Study On Qt Dispersion And Thrombolytic Therapy In Acute Myocardial Infarction

Tue, 11 Oct 2011 22:29:04 -0500

Objective: QT dispersion has been considered as noninvasive measure of ventricular excitability. A greater QT dispersion is associated ventricular arrhythmias and sudden death. In our study we have analyzed the impact of early thrombolytic therapy on QT dispersion in patients with acute myocardial infarction. Methods and Results: In a total of 102 patients with Acute Myocardial infarction, QT dispersion was compared among patients treated with early thrombolytic therapy and those not treated with early thrombolytic therapy. In the first 3 days of Acute Myocardial infarction, the QT dispersion was not different in the group of patients treated with and those not treated with thrombolysis, whereas on day 8±2 QT dispersion was greater in untreated patient group. When correlated totally with all walls of Acute Myocardial infarction taken together and individually, there were significantly greater reduction in QT, QTc dispersions in patients treated with thrombolytic therapy when compared with those who were not treated with thrombolytic therapyConclusion: Early successful thrombolysis significantly reduces QT dispersion in acute myocardial infarction. The ventricular excitability and the subsequent ventricular arrhythmias and the risk of sudden death is substantially decreased by successful thrombolysis. QT dispersion can be considered as a simple method of identifying ventricular excitability

A Randomized Double Blind Placebo Controlled Study Of Prophylactic Gabapentin For Prevention Of Postoperative Pain And Morphine Consumption In Patients Undergoing Mastectomy.

Tue, 11 Oct 2011 22:28:19 -0500

Background: Gabapentin, an antiepileptic has over the years been used as an analgesic. It is known to have opioid sparing properties thereby reducing the use of narcotic analgesic in the perioperative period.Method: 50 patients each of ASA I –II were randomly allocated to two study groups- one group received gabapentin (1200mg) and other group received placebo 1 hour prior to surgery. Both groups received morphine (0.1mg/kg) as intraoperative analgesic at induction of anaesthesia. After the completion of mastectomy postoperative analgesia was assessed with visual analogue scale (VAS) method (0cm- no pain and 10cm- worst possible pain). Rescue analgesic was administered to patients whose VAS was above 3 (morphine 0.1mg/kg).Apart from VAS haemodynamic parameters and oxygen saturation were regularly recorded half hourly for first two hours, then hourly for next 4 hours and then 2 hourly till the patient requested for analgesia postoperatively.Result: There was a statistically significant difference (p < 0.05) among the two groups as regards the intraoperative and postoperative heart rates. Systolic blood pressure showed significant variation (p < 0.05) among the two groups.Conclusion: Prophylactic use of oral gabapentin prior to surgery reduced the incidence of pain and significant degree of analgesia was achieved in such patients as compared to placebo group. Prophylactic use of oral gabapentin before mastectomy reduced the overall consumption of morphine as well as incidence of postoperative pain.

Effect Of Abdominal Insufflation On Bacterial Growth In An Experimental Model Of Peritonitis - A Randomized Controlled Trial.

Tue, 04 Oct 2011 20:50:36 -0500

Background: Despite the advantages of laparoscopy, studies suggest that gases used for insufflation may adversely affect patients with peritonitis by bacterial proliferation and impair the clearance of bacteria from the peritoneal cavity.Methods: This was an experimental study conducted on 33 albino-rats from February 2004 to September 2004 in Department of Surgery N.S.C.B, Government Medical College, Jabalpur (MP), India. This study was done to assess the effect of pneumoperitoneum on peritonitis. The rats were divided in three groups (A, B, and C). In group A (control group) 0.5ml of normal saline (5%) was instilled intraperitoneally. In group B and C, a single infusion of 0.5ml suspension containing 1×109 Escherichia coli/ml was instilled intraperitoneally. In group A and C, an additional 5ml of atmospheric air was instilled. The colony counts in each group were noted after 72 hours after laparotomy. Results: In the control group there was no peritoneal contamination, no bacterial growth, none of the rats had died and there was no evidence of pus or pus pockets seen. In the experimental group the mean colony count was 659.91 (±680.34). There were no macroscopic pus pockets or adhesions seen but there was frank pus in one of the rats of this group. The t-value for comparison of colony count was tA/B =3.22 (p<.05). In group C there were no macroscopic pus pockets seen, no adhesions observed and a mean colony count of 840.09 (±681.21) was observed.Conclusion: There is an increase in average colony count in the pneumoperitoneum group as compared to non-pneumoperitoneum group.

The Evaluation Of Concurrent Supplementation With Vitamin E And Omega- 3 Fatty Acids On Plasma Lipid Per Oxidation And Antioxidant Levels In Patients With Rheumatoid Arthritis

Tue, 04 Oct 2011 20:50:22 -0500

Introduction: Rheumatoid Arthritis (RA) is a chronic inflammatory disorder which can cause oxidative stress [1]. The main characteristic of the disease is inflammation of synovial membrane with swelling and pain that ultimately leads to the destruction of cartilage and bone [2].Routine clinical practices in management of rheumatoid arthritis aim at reducing the patients’ pain and joint inflammation, minimizing loss of function and decrease the progression of joint damage.Methods: In this double blind- randomized clinical trial, 90 patients were included who were divided into three groups based on received drugs (group EO: one omega-3 capsule (1g/d of fish oil,) plus one vitamin E capsule (400 IU/d); group O: one omega-3 capsule plus placebo of vitamin E; group P: placebo of omega-3 and vitamin E). At the beginning and end of the study, all patients were examined, 72-h recall was completed and 10 ml of fasting blood sample was obtained to assess the serum levels of malondialdehyde (MDA), plasma antioxidant capacity (TAC) and C-reactive protein (CRP) as well as the activity of superoxide dismutase (SOD) and Glutathione peroxides (GPX).Results: In group (EO), there was a significant decrease in lipid peroxidation (MDA concentration) compared with the other groups (P= 0.032). None of the interventions could affect the activity of antioxidant enzymes, SOD and GPX, or total antioxidant capacity of serum. Also there was no significant improvement in the clinical outcomes of different groups. Conclusion: Omega-3 and vitamin E supplements in the prescribed doses did not show any beneficial effect on clinical outcomes of the patients or activity of antioxidant enzymes, however adding vitamin E supplements to omega 3 fatty acid supplements could reduced MDA levels comparing to omega 3 fatty acids alone or placebo.

The Cost Effectiveness Of Topical Minoxidil Therapy In Management Of Baldness

Tue, 04 Oct 2011 20:50:02 -0500

“Use it or loss it (Rogaine),” is an advertisement as a cure for baldness. Rogaine is a commercial name for Minoxidil. Minoxidil is a vasodilator used orally for treatment of severe to malignant hypertension. Minoxidil therapy also causes hypertrichosis (increase of body hair). This drug is used topically to treat baldness. Minoxidil is not effective in halting the receding hairline on the frontal scalp. Its antibald effect is limited to the vertex of the head. It takes several months (2-4) to regrow hair by twice-a-day application. Continuous use of Minoxidil topical solution is needed to maintain hair regrowth. Stopping Minoxidil application causes loss of newly regrown hair in 3 to 4 months. Purpose of this case study will answer several questions. Is Minoxidil effective against baldness? Is it a permanent, cost-effective remedy for baldness? What age group will get the maximum benefit from Minoxidil therapy? What types of baldness are amenable to Minoxidil therapy? Is it effective in female baldness? Is Rogaine free from remarkable adverse effects? What are the causes of baldness? Is there any permanent remedy for baldness?

Esophagopleural Fistula In A 3 Year Old Child Following Disk Battery Ingestion.

Tue, 04 Oct 2011 20:49:19 -0500

Disk Battery ingestion is a medical emergency often seen children under the age of 6 years with a peak incidence in the 1 to 3 year old.2 In most cases ingestion is not witnessed however in some cases especially in the older children, there is a history or suspicion of ingestion of the foreign body by the child or caregiver. Of all dangerous oesophageal FB, disk battery is the most dangerous. Occasionally, referral for endoscopic removal of ingested DB body is delayed because transition through the GIT is expected. Disk Battery ingestion seems to be an emerging pediatric emergency associated with clinically significant outcomes in our region.7 We report a case of a three year old baby who ingested a disk battery and immediately informed the parents. A chest x-ray taken within 2 hours of ingestion revealed a coin like opacity but was misdiagnosed as a 50Kobo coin. The 50Kobo coin hitherto was the commonest circular metallic foreign body in the esophagus in our region. Referral for endoscopic assessment was delayed because transit through the gastrointestinal tract expected. The child seemed comfortable and asymptomatic but suffered significant injury resulting in esophageal pleural fistula within 4 days of ingestion. Battery type was CR2025 and lodgment was at the gastro esophageal sphincter. The need for early presentation to the hospital, correct diagnosis, undelayed endoscopic evaluation and removal of Disk Battery foreign body is reemphasized. The importance of careful history taking, examination and simple plain radiograph of the neck and chest and abdomen in a seeming comfortable and well child with suspicion of foreign body ingestion is highlighted. A review of relevant literature is also done.

Rare Presentation Of Adenoidcystic Carcinoma Of External Auditory Canal With Subcutaneous Metastasis In Temporal Region

Tue, 04 Oct 2011 20:49:17 -0500

Adenoid cystic carcinoma of external auditory canal is a rare and specific variant of adenocarcinoma of the salivary gland. In this article we spot the case of a patient with adenoid cystic carcinoma of external auditory canal with subcutaneous metastasis in temporal region.

Hepatitis C Virus Co-Infection In Human Immuno Deficiency Virus Positive Population In Bida, North Central Nigeria.

Tue, 04 Oct 2011 20:49:01 -0500

Co-infection of HIV–positive patients with hepatitis viruses worsens the long term prognosis and this is summative for each new infection in any individual.This study was carried out to establish the seroprevalence of hepatitis C virus among HIV infected population in Bida –North Central Nigeria. A total of 250 HIV –infected patients 119 males and 131females paticipated in this study with age range of 18-65years .Rapid Chromatogenic Enzyme Immuno Assay (EIA) kit was used for the detection of HCV antibodies in the serum samples. Nineteen (7.6%) of the patients had antibodies to HCV. Co-infection of hepatitis are more in male 10( 8.4%) than female 9(6.9%) subjects.Statistical analysis showed no significant difference(p>0.05) Age group 41-50years had the highest prevalence of HCV (50.7%) followed by age group 31-40 years (16.5%) , 21-30years ( 9.9%) and <20years(6.7%).No significant difference was observed in association between age and prevalence of HCV antibodies(p>0.05) .Routine screening of patients with HIV infection for HCV antibodies should be encouraged for early diagnosis.The high prevalence is a cause for concern in Bida, North central Nigeria.

Aloe Vera: Medical Marvel or Mumbo Jumbo?

Tue, 04 Oct 2011 20:48:40 -0500

For centuries the aloe vera plant has been exulted for its medicinal properties. From ancient Egypt to 21st century America, we have made use of the plant as a topical preparation, for ingestion, and as a cure all for a variety of other ills. It is proposed to be of benefit for the digestive and immune systems, as well as having healing effects on the skin. Although it is believed to originate in tropical Africa, the plant is now cultivated across the continents in order to match supply to demand for this popular “alternative” therapy. Preparations on sale to the public may be extremely costly, and vary widely in the proportion of aloe vera that they contain. Health professionals need to be able to offer objective advice to patients who may be considering using products containing aloe, in order to prevent unnecessary cost, and possible adverse effects. In this article we highlighted the possible benefits of aloe vera and assess the evidence to support these claims. We found the that popular anecdotal belief by the general public regarding the health benefits of aloe vera cannot be substantiated, however the placebo effect cannot ignored and there a safe side effect profile.

Delays to Operating Theatre Lists: Observations from a UK Centre

Tue, 04 Oct 2011 20:48:23 -0500

The aim was to measure the incidence of delays to operating theatre lists and the reasons behind them. A cost implications analysis was also performed to discover the potential savings to be made from improvement in this aspect of theatre efficiency. Prospective surveys recording start-time delays and total daily delay during 227 multiple-specialty cases were completed over five days in March 2010 in a UK District General Hospital, split over two sites. Information was collected onto a proforma for each case about specialty, procedure, start-time and end-time of the case, with request for an explanation for duration and reason for any delays incurred. An analysis of costs to the Trust was performed using estimated theatre hours lost with average cost of theatre use per hour.Overall 78% of cases started on time, i.e. within 15 minutes of the scheduled time, but orthopaedics and plastics achieved only 69% and 66% respectively. Orthopaedics and plastics also exceed the acceptable total daily delay time of 45 minutes (70 and 66 minutes respectively). Hospital-wide factors were the most common reason for the delays (72%). 48% were due to ward bed issues, 15% due to doctor factors and 13% inadequate pre-operative assessment. Estimated projected cost to the Trust over one year is significant at over £1 million ($1.5 million).During the study period, theatre time was lost for usually multi-factorial reasons, with hospital organisational factors being predominant. Opportunities to improve theater efficiency were identified.

Non-Adherence To Diabetic Treatment And Its Effect On Glycemic Control, Study At A Rural Hospital Of Tiruchirappalli, Tamilnadu,India

Tue, 04 Oct 2011 20:48:23 -0500

Objective: To study the Non-Adherence of the diabetic patients to the medical management in terms of diet, exercise and drugs and its effect on glycemic control.Materials and Methods: One hundred diabetic patients, randomly selected, excluding juvenile diabetes and gestational diabetes; age ranging between 30 – 75 years were interviewed using a standardized questionnaire.Results: The adherence was good with drugs & poor with exercise. Adherence was higher in males than in females. Among the 81(81%) patients following diet, exercise and drugs, 32(39%) had good adherence, 41(51%) and 8(10%) had fair and poor adherence respectively. All the eight (100% ) patients with poor adherence had poor glycemic control, while 33(80.5%) patients with fair and 6(18.75%) patients with good adherence had poor glycemic control. The awareness was slightly better in the group with positive family history. The number of patients having regular practice of monitoring blood glucose level, blood pressure and weight was74(74%),46(46%) and52(52%) respectively. Conclusion: The study confirms that good adherence to diabetic management is the cornerstone for good glycemic control and to ultimately reduce its complications .The study reveals the necessity of knowledge6 for the patients about the disease and its progress.

Hepatitis B Surface Antigen In Human Immuno Deficiency Virus Positive Patients In Bida, North Central Nigeria.

Tue, 04 Oct 2011 20:47:40 -0500

A prospective cross-sectional and analytical study was carried out to establish the prevalence of hepatitis B surface antigen in HIV infected population in Bida –North Central Nigeria.A total of 250 HIV seropositive patients comprising of 118 (47.2%) males and 132 (52.8%) females paticipated in this study.The age range of participants was 18 - 65 years. Rapid Chromatogenic Enzyme Immuno Assay (EIA) kit was used for the detection of Hepatitis B surface antigen in the serum samples. Our result shows that thirty three (13.2%) of the patients are Hepatitis B surface antigen seropositive. Co-infection of hepatitis were more in female 23(17.6%) than male 10(8.4%) subjects. Statistical analysis showed significant difference (p<.05). Age group interval of 21-30 years had the highest prevalence of Hepatitis B surface antigen seropositivity. 18(36.5%) followed by age group interval of 31-40 years 7(18.9%), 41-50 years interval 4( 20.7%) and <20 years interval 3 (13.3%). No significant difference was observed in association between age and prevalence of Hepatitis B surface antigen (p>0.05). Routine screening of patients with HIV infection for Hepatitis B surface should be encouraged for early diagnosis.The high prevalence is a reflection of the endemicity of hepatitis B viral infection in Bida, North central Nigeria.HBV, Co-infection, HIV,Nigeria.

Early Food Allergen Exposure May Be Protective Against Food Allergies: An Extension Of The Hygiene Hypothesis

Tue, 04 Oct 2011 20:47:13 -0500

Background and Objective: Food allergy affects 6% of U.S. children and 4% of the overall U.S. population. Health officials have recommended food allergen avoidance to prevent food allergies, but according to the Hygiene Hypothesis, exposure to allergens and pathogens is necessary for an effective immune system. The purpose of this study was to challenge conventions and determine whether early exposure might be beneficial rather than detrimental. Participants: 258 teenagers between the ages of 14-18 from a regional high school in New England were studied. Of the 258 participants, 67 had allergies (cases) while 191 did not (controls). Methods: A Food Allergy & Diet History questionnaire was administered to the participants’ parents. 2x2 contingency tables were constructed based on case and control exposure before and after a particular age cutoff for each of 6 common food allergens. Odds of exposure for the cases and controls were calculated and compared in an odds ratio (OR). Significance was evaluated with a P-value in a Chi-square test. Results: The types of food allergies within the 67 cases consisted of nuts (39%), dairy (25%), shellfish (19%), wheat/gluten (9%), eggs (6%), seeds (3%), and other (24%). Exposure to eggs (OR, 0.15 [95% CI, 0.08-0.27]), dairy (OR, 0.32 [95% CI, 0.18-0.57]), and wheat/gluten (OR, 0.18 [95% CI, 0.10-0.33]) before the age of 12 months was most protective against food allergies. Exposure to seeds (OR, 0.19 [95% CI, 0.10-0.36]) and peanuts/tree nuts (OR, 0.19 [95% CI, 0.10-0.36]) before 24 months was most protective, and exposure to shellfish (OR, 0.15 [95% CI, 0.08-0.30]) before 36 months was most protective. Conclusions: Exposure to dairy, eggs, and wheat/gluten before 12 months, peanuts/tree nuts and seeds before 24 months, and shellfish before 36 months of age may be protective factors against food allergies. The results from this study, which demonstrate that early exposure is indeed beneficial, are crucial to rewriting and improving the recommendations of health officials for future prevention of food allergies in children and young adults.

Antischistosomal Effects Of Solanum Incanum And Carica Papaya Crude Extracts On The Parasite Schistosoma Mansoni In Vivo And In Vitro

Fri, 30 Sep 2011 22:02:34 -0500

In schistosomiasis infection, the disease is managed by exposing the definitive host to a dose of Praziquantel. However, Praziquantelis still not reaching the majority of those who most need it due to its high cost and there is possibility of drug resistance, hence need for alternatives. Antischistosomal effects of crude Solanum incanum and Carica papaya extacts were studied. Patterns on immune response, worm recovery, gross pathology in vivo and cercaricidal killing in vitro of Schistosoma mansoni was observed. In vivo S. mansoni infections were treated with two doses of 150 mg/kg of Solanum incanum or Carica papaya (methanol or aqueous) extracts and a treatment control of 450 mg/kg of Praziquantel. Various concentrations of plant extracts were used in cercaricidal assay. Carica papaya, showed highly reduced pathology, elevated immune responses and least time in destroying cercariae. On the other hand, S. incanum had the highest reduction in worm counts, similar to Praziquantel. Further studies are required to isolate the active compound(s) and determine mechanism(s) of their action.

Training Workshop for Traditional Birth Attendants at Aliero, Kebbi State, Nigeria; A Community Development Service at Aliero, Kebbi State, Nigeria

Fri, 30 Sep 2011 22:02:33 -0500

A significant proportion of births in Nigeria still occur in the homes of traditional birth attendants (TBA) 1. Recent studies have revealed many complicated cases of obstructed labour from TBAs. TBAs are popular in developing countries. They lack formal education or medical training and some of their clients end up with obstetric complications, which may lead to severe maternal and perinatal morbidity and mortality. Women in the developing world are forty times more likely to die from pregnancy related complications than women living in the industrial world. More than 90% of maternal deaths occur in low income countries where others factors may contribute to the presence of severe postpartum haemorrhage. Most deliveries in Nigeria still occur in the homes of traditional birth attendants. Increased community awareness, promotion of appropriate technology, effective health care, planning starting from the grassroots levels to tertiary levels establishment of a streamlined and effective referral system will help reduce maternal mortality from obstetric emergencies reducing maternal morbidity and mortality are among the key international development goals.

The Embryology Of Recurrent Discharge From The Umbilicus Of A 16-Year-Old Boy

Fri, 30 Sep 2011 22:01:44 -0500

A 16-year-old, high-school boy’s complaints of painless discharge from the umbilicus. The discharge stopped without medication but recurred a few months later. They sought advice from their family pediatrician who found a pea shaped swelling in the umbilicus and prescribed cephalexin and advised the patient to take the antibiotic for couple of weeks. The pediatrician could not explain the cause but assured the parents that the swelling in the umbilicus would disappear within a couple of weeks. The discharge continued despite five days of cephalexin therapy. The discharge appeared ‘whitish’ and mucus-like and had no urine or fecal odor. They eventually saw a plastic surgeon who excised the pea shaped granuloma under local anesthesia and cauterized it with silver nitrate. The plastic surgeon advised to contact a general surgeon if the discharge did not stop. The discharge stopped on the 5th day post-surgery but reappeared again after a few days. They sought the advice of a general surgeon who diagnosed it as a urachal cyst and advised it be removed. Immediately after the surgery the tissue was sent for histopathology for a confirmation of the diagnosis. The histopathological report showed a diagnosis of abscess.

Sigmoid Volvulus: A New Twist to an Old Problem

Fri, 30 Sep 2011 22:01:44 -0500

Reports of a volvulus (twisting) of the sigmoid colon can be found in a papyrus from ancient Egypt. However, sigmoid volvulus represents a spectrum of disease across the globe from young men in central Africa to the elderly institutionalised patients in Western Europe and the USA. As the population ages the prevalence of sigmoid volvulus is likely to rise. As an acute presentation, it represents a multidisciplinary challenge in its management, because whilst surgery is a definitive cure, this has to be balanced against co-existing morbidity. In the chronic or recurrent case, definitive treatment must again be tailored to the ‘fitness’ of the patient to minimise an acute recurrence with its inherent increased morbidity and mortality.In this review we have looked at the results of the published series for the different management options, which may be surgical or endoscopic. We have proposed an algorithm for the management of an acute or chronic sigmoid volvulus within the multidisciplinary team setting.

Two-Port Laparoscopic Appendectomy

Fri, 30 Sep 2011 22:01:44 -0500

Background: Acute appendicitis is one of the most common surgical emergencies encountered by a general surgeon. Open appendectomy has been the surgical procedure of choice. Nowadays laparoscopic appendectomy is becoming popular because of its advantages like less pain, decreased hospital stay and assisting the diagnosis. The two disadvantages are that it takes more time and involves more cost. Method: The aim of this study was to compare the outcome of two-port with three-port laparoscopic appendectomy. This is a prospective study of 75 laparoscopic appendectomies out of which two-port appendectomies were done in 24 patients. Outcomes of both groups of patients were analyzed in relation to length of hospital stay, surgical time, wound infection and intra-abdominal abscess.Results: The length of hospital stay, incidence of wound infection and intra-abdominal abscess were almost equal in both the groups. However, the operative time and procedure cost were significantly reduced in two-port appendectomy. Conclusion: Two-port appendectomies have all the advantages of conventional laparoscopic appendectomy with significantly reduced operative time and cost. This can be considered as best procedure for interval appendectomy and selective cases of acute appendicitis.

Perforated Peptic Ulcer Disease: Factors Predicting The Mortality And Morbidity In A Tertiary Care Centre In Southern India.

Fri, 30 Sep 2011 22:01:43 -0500

Background: Perforation is the most common complication of peptic ulcer disease. In spite of modern progress in the management, it is still a life-threatening catastrophe. Perforation may occur in a patient with previous history of ulcer disease or it may happen without any prior symptoms.Methods: This study comprises a retrospective analysis of all patients diagnosed of perforated peptic ulcer disease at SNMC AND HSK HOSPITAL, Bagalkot, INDIA, during the years 2006 to 2011. Clinical data were recorded and analyzed.Results: Out of 180 patients, 136 were males and 44 were females. The age of the patients varied from 18 to 86 years. Gastric perforation was seen in only 17 patients out of 180 and the rest of the patients had duodenal perforation. All the patients underwent surgical treatment of simple closure with omental patch and peritoneal lavage. Postoperative complications occurred in 47 [26.1%] patients and there were 24 deaths [13.3%].Conclusion: We conclude that morbidity and mortality are associated with age of the patients, haemodynamic instability, operative delay, site of the ulcer, peritoneal contamination and quality of postoperative care.

Synchronous Ruptured Amoebic Liver Abscess With Caecal Perforation - A Rare Case Presentation

Fri, 30 Sep 2011 22:01:42 -0500

Amoebiasis refers to an infection caused by Entamoeba histolytica, a gastrointestinal infection that may or may not be symptomatic and can remain latent for years. Most infected people, perhaps 90%, are asymptomatic, but this disease can be fatal, too. Severe amoeba infection is known as invasive or fulminant amoebiasis. In invasive amoebiasis, the trophozoites penetrate the intestinal mucosa causing amoebic colitis. In about 10% of the cases, they can enter the blood stream and cause extra-intestinal amoebiasis. The invasive form is an unusual pathology and leads to life-threatening complications with high morbidity and mortality. Synchronous pathological lesions in liver and colon are rare. Still rarer is the occurrence of complicated colonic and hepatic invasive amoebiasis presenting as an acute abdomen. One such presentation of synchronous ruptured liver abscess with caecal perforation in a 64-year-old male is reported.

A Classic Case Of Polysplenia Syndrome With A Pancreatic Mass And SOLs In Liver

Fri, 30 Sep 2011 21:53:37 -0500

The ultrasound and CT appearance of a classic case of polysplenia syndrome is presented with an overview of associated anomalies. Note was made of a pancreatic mass in the same patient with multiple space occupying lesions (SOLs) in the liver.

Expedient Treatment of a Collodion Baby

Fri, 30 Sep 2011 21:53:24 -0500

Only about 270 cases of collodion babies have been reported in the literature since 1892, when the term was first introduced by Hallopeau and Watelet.1,2 Collodion baby is a prodromal stage that precedes the true underlying disease entity. As the name suggests, the term “collodion baby” refers to a phenotype that can be characterized by a yellow, shiny, tight parchment-like membrane stretched over the skin. Observers may sometimes use the descriptor “dipped in hot wax.”2 Although the collodion membrane is only an evanescent condition of the newborn, neonatal complications can occur in 45% of all collodion babies, leading to a mortality rate of ~11% in the first few weeks of life.3,4 Most children born as collodion babies will spontaneously desquamate within 2 weeks, but may be as long as 3 months. Eventually, these children develop signs of one of several types of ichthyosis, which gives the skin the appearance of “fish scales.”5 We report a unique case of a Caucasian male that was born as a Collodion baby at the University of Kentucky Children’s Hospital in Lexington, Kentucky. Although the impairment of the skin barrier function put the patient at risk for a number of complications, he improved significantly after being treated with emollients and antibiotics. In contrast to the findings of van Gysel et al., we found that skin emollients were beneficial and did not increase the risk of infection.

Giant Cell Myocarditis: A Rare Diagnosis Made On Autopsy

Fri, 30 Sep 2011 21:53:05 -0500

An autopsy case report of 60 year old female patient who died suddenly after getting in minor altercation with neighbors. An autopsy was conducted and the heart was sent for histopathological examination. Histopathological examination revealed presence of multinucleated giant cells, lymphocytes, neutrophils, plasma cells and macrophages around areas of necrotic zone with absence of granulomas. No previous history of tuberculosis was known. The present case highlights the giant cell myocarditis as a rare fatal diagnosis made on autopsy.

Fixation Of Compound Fractures Of Tibia By Intermedullary Nail After The Golden Period

Fri, 30 Sep 2011 21:52:46 -0500

Patients often reach the hospital late after passage of golden hours (initial 6 hours) after sustaining high-velocity injuries. The decision of internal fixation in compound fractures of the tibia becomes a formidable challenge in patients reaching the hospital late. The purpose of the present study was to find out if internal fixation could be safely undertaken in these patients.Thirty patients, having 30 compound fractures (10 Type II, 15 type III A and 5 IIIB), which were internally fixed after 6h but within 24h after injury, were included in the present analysis. Follow-up ranged six to eighteen months.Result: Overall infection rate noted was (n = 4) 13.3% (0% in II, 6.66%in IIIA and 6.66% in IIIB). Nonunion was seen in two fractures. Functional evaluation using Katenjian's criteria, showed 73% (22 fractures of 30) good to excellent results.Conclusion: Satisfactory results may be obtained in compound fractures even if fixed after the golden period, provided strict protocol such as aggressive debridement, prophylactic antibiotic coverage, early soft tissue reconstruction and timely bone grafting is followed. The primary coverage of the wound is discouraged.

Composite Bone Cement Arthrodesis In Acrometastasis Of The Proximal Phalanx Of The Hand– A Case Report

Fri, 30 Sep 2011 21:52:45 -0500

Bone metastases to the hand are extremely rare with a reported incidence rate of approximately 0.1% of all metastatic lesions to the bone (1, 10, 11). The appearance resembles an acute infection and is often mistaken for more common hand sequela (3, 13-15,) even when a primary malignant tumor is known. Acrometastases usually develop late in the course of tumor seeding and are associated with a low life expectancy (5). Treatment is palliative with focus on pain relief and improvement of hand function in order to maintain the patients independency. For distal lesions, amputation is the treatment of choice. Suggested treatment for proximal metastases consists of systemic therapy and/or radiation with or without local excision. A radical resection requires amputation of a significant part or the hand (3, 6). The concept of palliative tumor surgery with local tumor resection and bridging of the defect with a cement osteosynthesis is widely accepted for the long bones. This case presents an attempt to resect a painful acrometastasis to the proximal phalanx and provide stability by a composite cement arthrodesis of the metacarpophalangeal joint in order to avoid amputation.

Clinicopathological Profile Of Hoarseness Of The Voice

Fri, 30 Sep 2011 21:51:57 -0500

Whether the patient notices vocal fatigue or says that it's harder to go with a worsening voice as the day progresses, the underlying cause of hoarseness must be found. Proper knowledge of clinicopathological profile is important to treat it competently and to bring the patient voice back .Considering this fact in mind, the study was designed in 100 patients irrespective of their age, sex and duration of disease. Chronic non specific laryngitis was found to comprise largest group responsible for hoarseness followed by carcinoma larynx

Disk Battery Ingestion And Tracheoesophageal Fistula – A Comparative Review Of Two Cases.

Fri, 30 Sep 2011 21:51:55 -0500

The incidence of disk battery ingestion is increasing and parallels the increasing use of electronic devices.1, 2 Children less than 6 years are mostly involved with a peak incidence in 1 to 3 year old.3 Most ingested disk battery pass harmlessly through the gastrointestinal tract4. Lodgments in the aerodigestive tract require immediate endoscopic removal to prevent or minimize major sequelae or fatality such as esophageal perforation, Tracheoesophageal Fistula (TEF) and aorta-esophageal fistula. 3, 5, 6, TEF secondary to disk battery ingestion has been reported within 4-6hrs of ingestion and lodgement.4, 7 We saw for the first time in our region, South-Eastern Nigeria, two babies aged 13 and 14 months with disk battery ingestion and lodgment in the esophagus of 6-7weeks and 48-72 hours duration respectively. They presented within 4 months between September, 2010 and January, 2011. The first baby was misdiagnosed and managed by the family physician and pediatrician for respiratory tract infection and later Asthma without significant improvement. The second baby was promptly and correctly diagnosed and appropriately managed. Both babies had endoscopic evaluation and removal of the Disk battery of similar type (Lithium) and size (20mm). Lodgment was in the lower cervical esophagus, 12-14 cm from the upper incisor tooth in both cases. Tracheoesophageal fistula was an accompanying major sequelae within 48-72 hour of lodgment in one baby while the other baby ran a relatively a benign course without esophageal perforation despite over 6 weeks of lodgment. The anode (-) surface of the disk battery was forward facing in the baby with TEF and backward-facing in the baby with the benign course.The forward-facing anode (-) surface of impacted disk battery seemed independent of duration of lodgment as a risk factor to the rapid development of tracheoesophageal fistula. This further highlights the need for a prompt endoscopic evaluation and removal of impacted disk battery in the esophagus. Nigeria is a rapidly developing economy with increasing use of electronic devices; therefore an aggressive awareness campaign is needed to prevent increasing incidence and morbidity that accompany late presentation to the hospital. A high index of suspicion is needed by family physicians and pediatrician to for early diagnosis and reduced complications and mortality of disk battery ingestion in children in Nigeria. The relevance of simple plain radiograph of the neck, chest and abdomen in a seeming comfortable and well child with suspicion of foreign body ingestion is emphasized.

Prevalence And Antibiotic Resistance Pattern Of Methicillin-Resistance Staphylococcus Aureus Among In-Patients At A Tertiary Health Facility In Ido-Ekiti, Nigeria

Fri, 30 Sep 2011 21:51:38 -0500

Aim: Methicillin-resistant Staphylococcus aureus (MRSA) is a known nosocomial pathogen associated with therapeutic difficulties as a result of intrinsic resistance to beta-lactam antibiotics and the development of multidrug resistance. This study aims at determining the prevalence and antibiotic resistance pattern of MRSA among in-patient at Federal Medical Centre, Ido-Ekiti, Nigeria.Materials and method: Between January 2009 and December 2009, all specimens from in-patients submitted to Medical Microbiology laboratory of the hospital were processed and all Staphylococcus aureus isolates were included in the study, they were identified morphologically and biochemically by the standard laboratory procedures. Antibiotc susceptibility test was done using the Modified Kirby-Bauer disc diffusion technique with zones of inhibition evaluated according to the Clinical and Laboratory Standard Institute (CLSI) guidelines. Methicillin resistance was determined by the Cefoxitin disk diffusion test.Results: Of the 158 S. aureus isolates, 49 (31%) were MRSA. All MRSA were resistant to penicillin and cephalexin while none was resistant to vancomycin. The MRSA strains showed higher resistance rate than methicillin-sensitive S. aureus (MSSA) strains to all tested antibiotics; ciprofloxacin (12.2% vs 9.2%), gentamicin (75.5% vs 50.5%), erythromycin (69.4% vs 13.8%), trimetoprim/sulphamethoxazole (91.8% vs 61.5%), clindamycin (24.5% vs 11.9%). Multidrug resistance was found in 63.3% of the MRSA strains.Conclusion: There is high rate of MRSA and multidrug-resistant strains. Vancomycin is the drug of choice while ciprofloxacin can be considered in its absence. There is need for strict antibiotic policy, continuous monitoring of antibiotic susceptibility pattern of all S.aureus and observation of infection control measures to curtail the evolution of these resistant strains. Further molecular study on MRSA epidemiology in future is desirable.

Evaluation of Empirical Antibiotic Prescription and Urinalysis in Patients with Symptoms Suggestive of Uncomplicated Urinary Tract Infection in Abakaliki, Nigeria

Fri, 30 Sep 2011 21:51:37 -0500

Objective: To investigate the pattern of antibiotic prescriptions to patients with symptoms suggestive of uncomplicated urinary tract infection (UTI), the appropriateness of such prescriptions based on outcomes of subsequent urine culture and susceptibility test and the role of routine urinalysis in the diagnosis of UTI.Methods: Urine samples from 500 patients provisionally diagnosed of UTI and given empirical antibiotic prescription were subjected to dipstick analysis, microscopy and quantitative culture using standard methods. Antimicrobial susceptibility of isolates from cultures that yielded significant bacteriuria (≥ 105 cfu/ml) was carried out using the Kirby-Bauer disc diffusion technique.Results: Significant bacteriuria was recorded in 213 (42.6 %) of the urine specimens while 182 (36.4 %) showed insignificant bacteriuria and 105 (21.0 %) were sterile. Amoxycillin plus clavulanic acid was the most frequently prescribed antibiotic (23.6 %) and Clarithromycin was the least (1.4 %). Only 99 (46.5 %) of the isolates from the 213 positive cultures were found to be sensitive to the antibiotics empirically prescribed, with ciprofloxacin exhibiting the broadest spectrum of in vitro activity against the isolates. Urinalysis results for nitrite, protein and pyuria were comparable to that of culture. Conclusion: UTI is likely over-diagnosed in the study area and urinalysis result if well interpreted could be a guide to empirical prescriptions prior to results of culture and sensitivity tests. However, ciprofloxacin should be considered as the choice antibiotic when empirical prescriptions are inevitable.

Influence Of H1N1 Pandemic On Attitude And Intended Behaviour Of University Students: A Cross Sectional Study From South India

Fri, 30 Sep 2011 21:51:17 -0500

Background: To understand the attitude and behaviour in institutionalised population is critically important to undertake any preventive and health education measure. During H1N1 outbreak a lot of preventive and health education measures have been taken in our institute. To assess the impact of these measures we aimed to evaluate the knowledge, perception and behaviour changes among university students towards H1N1 pandemic. Objective: To evaluate the knowledge, attitude and behaviour among young institutelized population towards H1N1 influenza pandemic and its influence on hand washing behaviourMethods: A cross sectional questionnaire based survey was done among 957 university students in south India. The survey was based on assessing the knowledge regarding influenza virus and its vaccination, attitude and motivation factors towards hand washing. Results: Out of total 957 Respondents, 62.4% were males and 37.6% were females. Overall, 79.6% and 88.3% of respondents had correct knowledge regarding route of transmission. Female participants have more knowledge compared to male counterpart regarding current practices, self-protection (P<0.001) and vaccination of H1N1 (P<0.05), Participants having acquaintances with recent flu like symptoms were positively correlated with recent flu like symptoms (P value<0.001). Males are more likely to perceive hand wash as effective means of preventing the infection (P value *lt;0.01). After gender stratification, both groups reported to have high perceived severity (P=0.778) towards H1N1 infection.Conclusion: Better measures can be taken during second wave of H1N1 pandemic as students respond differently according to knowledge they acquire, hand hygiene habits tends to change during pre and post endemic period. Positive health behaviour amongst young students helps in prevention of influenza transmission.

Molecular Characterization of Nosocomial Methicillin Resistant Staphylococci aureus by Rep-PCR

Fri, 30 Sep 2011 21:51:16 -0500

Nosocomial methicillin-resistance Staphylococcus aureus (MRSA) poses problem to clinicians and hospital administrators for its management. In the present study isolation, identification molecular characterizations of methicillin-resistance Staphylococcus aureus were performed at Hospital Kuala Lumpur, Malaysia during December 2005 to April 2007. Twenty seven MRSA positive samples were identified based on cultural, biochemical and antibiotic sensitivity assay. These were, 51% from blood samples, 33.3% from tracheal aspirate and 11,1% from nasal swab and pus. Molecular method rep-PCR was used to characterize the MRSA positive strains. Results of rep-PCR showed 5 different pattern of bands based on their genomic nature. Thus, rep-PCR was proved to be potential tool to determine genomic differences of nosocomial MRSA in resource limited setting.

Developing Strategies to Reduce Children’s Health Care Disparities

Fri, 30 Sep 2011 21:50:31 -0500

Cytogenetic Study In Patients With Menstruation Disorders

Fri, 30 Sep 2011 21:48:30 -0500

Primary amenorrhea, secondary amenorrhea, oligomenorrhea and hypomenorrhea are usually referred for cytogenetic evaluation. The study was conducted over a period of 24 months. The patients diagnosed by clinical departments as menstruation disorder cases were included in the study. The chromosomes were obtained using conventional short term culture method. There was a striking finding of 46XY patients in 6 cases. Only 2 patients were seen with Turner syndrome. The remaining 7 patients had mosaicism. Only one patient had isochromosome.Aims: The study was undertaken to evaluate the chromosomal causes and their frequency in relation to menstruation disorders. The authors wanted to compare the data of this study with previous studies.Settings and Design: Hundred cases referred for the complaints of menstruation disorders were included in the study which was conducted over a period of 24 months.Methods and Material:Chromosomes were obtained through conventional short term culture method. Karyotype was prepared and analyzed after arranging the chromosomes according to Denver classification. Statistical analysis used: Nil.Results: Out of 100 patients 16 showed abnormal chromosome complement. Other patients had normal complement.There were six cases with 46XY complement. Only two patients had Turner syndrome. Remaining seven patients had mosaicism and one patient had isochromosome.Conclusions:Male chromosomal complement has been discovered in normal looking phenotypic females in present study. Therefore it is recommended that Cytogenetic study be carried out in evaluating cases of amenorrhea.

A Survey Of Psychological Reaction And Perception Of Pregnant Women, To Prenatal Ultrasonography In Lagos University Teaching Hospital, Idi-Araba, Lagos

Fri, 30 Sep 2011 21:37:14 -0500

Aim The aim of the study is to assess and describe the perception and reaction of pregnant women to ultrasonography during their antenatal period.MethodA descriptive cross sectional study, using structured interview, administered through a questionnaire which was completed by patients who present in the Radiodiagnosis Department of Lagos University Teaching Hospital (LUTH) for ultrasonography and who have given informed consent to participate in the study. Statistical Packages for Social Sciences (SPSS) was used for analyzing the completed questionnaires. Two hundred patients were recruited for this study. Results The respondent’s knowledge about ultrasonography was very high 182 (92.5%). 191(95.5%) had underdone investigation with ultrasonography at one time or the other, in the past. Majority 186 (93.0%) obtained their information from friends. The psychological response of respondents to ultrasonography was good. Most of the respondents 188(94.0%) indicate that their doctor communicated with them during ultrasonography, 194(97.0%) wished they received results immediately after an investigation; 176(88.0%) believed ultrasonography cannot cause cancer and 168(84.0%) believed that ultrasonography is not dangerous to their baby. ConclusionPrenatal ultrasonography has been embraced as being a vital part of prenatal care. A large percentage of respondents have heard about prenatal ultrasonography and duly opt for it. However their interpretation on what ultrasonography entails varied greatly with a lot of them having little or no knowledge about ultrasonography.

Can Cleanliness Be Injurious To Health?

Fri, 30 Sep 2011 21:37:14 -0500

The Double Monofilament Stitch Still Relevant In Cervical Cerclage: A Report From Makurdi, Nigeria

Fri, 30 Sep 2011 21:36:55 -0500

Cervical cerclage for the incompetent cervix aimed at the prevention of mid trimester abortions and the risk of premature labour has been used extensively. Various surgical techniques have been advocated ranging from the complex shirodkar method to the more common McDonald′s cerclage. With the application of different kinds of sutures ranging from catgut, polypropylene, to the traditional mersilene tape applied at the level of the internal cervical os. The application of the double suture was also tried. The use of the so called occlusion suture at the external cervix as a beneficial concept for the management of recurrent preterm, pre labour rupture of membranes has recently been advocated. Double suture at the level of the internal cervical os was used in a patient with recurrent mid trimester abortions and previous preterm birth with successful delivery at term. In view of this, it is suggested that the use of double monofilament cervical sutures for some selected women with cervical incompetence may still be relevant in resource limited countries as was seen in this case.NigeriaDepartment of Obstetrics and GynecologyBenue State UniversityMakurdiHembah-Hilekaan S.K.

Spontaneous Foetal Reduction In Multiple Pregnancies Complicating Fertility Treatment: Descriptive Study Of Pregnancy And Fetal Outcomes In A Low Resourse Setting

Fri, 30 Sep 2011 21:36:55 -0500

Objective: Spontaneous reduction resulting from missed abortion of one or more of the foetuses before the 12th week of pregnancy could affect obstetrics outcome. This study sought to analyse pregnancy and foetal outcome following vanishing foetal event in multifoetal pregnancies conceived through assisted and non-assisted technology fertility treatment.Methods: A 5 year prospective observational study conducted In Ahmadu Bello University Teaching Hospital Zaria, 345 Aero medical Hospital Kaduna and Alba Clinics and Medical Centre Kaduna. Patients either conceived with clomiphene citrate enhanced fertility treatment or through assisted reproductive technology (ART) treatment. Results: Fifteen cases were managed, of which 9 (60%) were non-ART conceptions and 6 (40%) ART conceptions. The 9 non – ART pregnancies were all twins spontaneously reduced to singletons, while the 6 ART pregnancies comprised of 4 (66.7%) twins reduced to singleton. 1 (16.7%) triplet reduced to twin and 1 quintuplet (16.7%) reduced to quadruplet. Outcome of 13 pregnancies reduced to singleton was favourable with 1 (7.7%) infant death due to complications of congenital heart disease. Triplet pregnancy reduced to twin was complicated with severe hypertension in pregnancy and spontaneous abortion at 19 weeks while the patient with quintuplet pregnancy reduced to quadruplet delivered at 7 months preceded by preterm premature rupture of membrane; 3 neonatal deaths was recorded. Conclusion: Outcome of vanishing foetus syndrome in higher order multiple pregnancy was associated with poor foetal outcome, however this may be unrelated to spontaneous foetal reduction event but to effect of multiple foetuses on pregnancy and inadequacies of intensive care units in the developing world.

Postoperative Complications After Tension-Free Vaginal Tape Versus Transobturator Tape Procedure For Stress Urinary Incontinence

Fri, 30 Sep 2011 21:36:55 -0500

ObjectiveTo determine the frequency of post operative complications after tension-free vaginal tape (TVT) compared with the transobturator tape (TOT) procedure in women with stress urinary incontinence (SUI).Study designProspective study of all consecutive women with urodynamically confirmed SUI undergoing anti-incontinence surgery between January 2000 and January 2010. All procedures were performed by experienced urogynaecologists well trained in TVT and TOT surgery. Assessments were carried out at 1, 6, 12 and, 36 months after surgery.ResultsThe study population included 366 women (mean age 59.5 years), 243 in the TVT group and 123 in the TOT group. The groups were similar in terms of demographics, preoperative data, and cure rates. De novo urgency occurred in 13.4% of patients at 6 months after surgery, in 19.3% at 12 months, and in 22.1% at 36 months. De novo urgency was significantly more frequent in the TVT group than in the TOT group at 12 (22.2% vs 11.2%, P = 0.025), 24 (24.8% vs 12.3%, P = 0.033), and 36 (0% vs 24.7%, P = 0.034) months. Cure rates were similar in both groups. The final adjusted cure rate was 87.3% (319/366).ConclusionTreatment of SUI using the TOT procedure was associated with a lower rate of de novo urgency.

Eclampsia In Eastern India: Incidence, Demographic Profile And Response To Three Different Anticonvulsant Regimes Of Magnesium Sulphate

Fri, 30 Sep 2011 21:36:54 -0500

IntroductionEclampsia continues to be a major cause of maternal and perinatal morbidity and mortality in the developing world. We evaluated the incidence and outcome of women diagnosed with eclampsia in a tertiary referral centre in eastern India.MethodsThe prospective randomized study was carried out in the department of Obstetrics & Gynecology, MKCG Medical College and Hospital, Berhampur, Orissa, India, a tertiary level Government referral centre for whole of Southern Orissa, over a 2 year period. The incidence, demographics of women with eclampsia and response to three different regimens of magnesium sulphate was studied.Results160 women presented with convulsions against a background of preeclampsia of which 2 were diagnosed with cerebral malaria and hence excluded. Out of 4925 live births during the study period, there were 158 women with eclampsia, giving an incidence of 3.2 %. Majority were unbooked 154 (97.4%) and from rural areas 133 (84.2%). Antepartum eclampsia occurred in 21(13.3%) patients; antepartum / intrapartum eclampsia in 108(68.3%) while postpartum eclampsia occurred in 29 patients (18.4%). Primigravidas accounted for 105/129 cases with antepartum & intrapartum eclampsia while primiparas accounted for 25/29 cases with postpartum eclampsia. The all cause maternal mortality in the study period was 67, of which a total of 7 women died due to eclampsia, giving a case fatality rate of 4.4 % and maternal mortality ratio of 10.44%. Majority of the patients 75/158(47.45%) received magnesium sulphate at 4-8 hours after of onset of convulsions. 60 women received magnesium sulphate by Pritchard regimen (Group-A), while 49 each received magnesium sulphate by Zuspan regimen (Group-B) and Sibai regimen (Group-C) . There was no recurrence of convulsions in any patient after start of magnesium sulphate in both Groups A and C, whereas there was recurrence of convulsion in 1 patient in Group-B. There were a total of 50 still births and 5 neonatal deaths out of total of 167 deliveries in the 158 women with eclampsia. The maternal mortality and morbidity did not differ significantly between the three groups; neither did the perinatal mortality and morbidity.ConclusionEclampsia continues to be a major cause of both maternal and perinatal morbidity and mortality. Magnesium sulphate was equally effective in controlling seizures in the three groups.

Knowledge Of Reproductive Cycle And Sexuality Among Infertile Women In Nigeria

Fri, 30 Sep 2011 21:36:53 -0500

BACKGROUND: The situation in Africa is a paradox, records the highest percentage of fertility and infertility globally. Reproductive behavior in Africa is fertility oriented, resulting in huge psychosocial burden beyond comprehension to the infertile women / couple. Sexual practice and knowledge of reproductive cycle are important factors to the attainment of conception. OBJECTIVE: To evaluate knowledge of reproductive cycle amongst women attending infertility clinic and their sexuality practice. RESULTS: Twenty eight (32.2%) out of the 87 subjects knew their menstrual cycle length and 39.1% (34 / 87) had an idea of their ovulatory period. Sixty nine (79.3%) subjects did not have an idea of symptoms of ovulation. Of the 18 (20.7%) subjects that knew the signs of ovulation, 13 (72.2%) of them do experience signs of ovulation. Sexuality practice revealed coital frequency that ranged from 0 to 5 times weekly. Seventy two (82.5%) of the 87 subjects did not have a say as to the timing of coital act. Of the 15 (17.2%) subjects that had a say in the timing of sexual act, 13 (86.7%) of them made conscious effort to have coitus during the ovulatory period. Overall, only 21 (24.1%) of the 87 subjects believed that pregnancy could occur during menstrual flow. The effect of subjects’ sub fertile status on their interest in intercourse showed that infertility enhance coital interest in 45 (51.7%) subjects, diminish coital interest in 29 (33.3%) subjects and infertility made no difference in 13 (15%) subjects.CONCLUSION: Gender equality, women empowerment, provision of universal basic education and eradication of poverty are programs to be targeted towards improving reproductive rights of women and their knowledge base. Health education and counseling should be an integral part of infertility management.

How Safe Is The Quality Of Medical Care During Medical Outreaches

Fri, 30 Sep 2011 21:36:39 -0500

BACKGROUND: Medical outreaches are common in developing countries where most of the populace live in rural communities sand villages living below one dollar per day. METHOD: This is a prospective study in Nigeria of 37 free medical outreaches from 2005-2008 on outreaches with surgical performed on monitoring of anaesthesia.RESULT: During the study period 18(51.35%) had attending medical personnel trained in the administration of anaesthesia. Anaesthesia was monitored with pulse, non-invasive sphygmomanometer and respiratory rate. An anaesthetic chart was designed by that anaesthetist to monitor the course of anaesthesia.CONCLUSION: Safety in anaesthesia and medical practice is important. There is need for the presence of a qualified anaesthetist during the duration of any surgical procedure.

Comparison of Predictive Protocols in Chest Pain Patients in a Tertiary Care Hospital in Karachi, Pakistan

Fri, 30 Sep 2011 21:35:49 -0500

Background: The most challenging aspect in evaluation of a patient presenting with chest pain in the Emergency Department (ED) is diagnosis of acute cardiac ischemia (ACI). Various decisions aids have been developed to aid the ED physician in the diagnosis of chest pain. Three different predictive protocols – the Goldman protocol, ACI-TIPI, and the Troponin protocol are used in predicting the occurrence of ACI. None of these decision aids have been tested in the Pakistani population, where risk factors and prevalence of CAD are much different than what is seen in other regions of the world.Aims: The aim of this study was to compare how three different predictive protocols for ACI fared in the Pakistani population.Methods:This retrospective case series included a consecutive sample of 212 patients who presented to the ED with symptoms of chest pain or its equivalent. Patient data was collected and retrospectively analyzed with each predictive protocol to analyze sensitivity, specificity, PPV, and NPV of each protocol.Results: 63% of patients were diagnosed with ACI. The sensitivities of the Goldman, ACI-TIPI, and Troponin protocols were 94%, 98%, and 38% respectively. The specificities of the Goldman, ACI-TIPI, and Troponin protocols were 14%, 29%, and 95% respectively. Conclusion: Sensitivities from a small sample size show promise in the use of predictive protocols for chest pain in the Pakistani population. However, prospective studies on a larger level need to be conducted to validate these findings.

Playgrounds Without Borders: Methods For A Playground Environmental Intervention Among U.S. Schoolchildren

Fri, 30 Sep 2011 21:35:35 -0500

Background: Playground environmental interventions that increase children’s moderate-to-vigorous physical activity (MVPA) have not been adequately tested among low-income and minority children. Schools are key venues for environmental interventions because they reach children from all socioeconomic groups. Some issues remain unclear: whether these interventions benefit low-income and minority U.S. children; whether increases in MVPA at school are matched by increases outside school; whether benefits last beyond the immediate post-intervention period; and how children’s school and neighborhood environments affect their response to the intervention.Methods: Evaluation/study design: quasi-experimental intervention study, using both longitudinal and cross-sectional measurements during seven-day measurement sessions pre-intervention, immediately after intervention inception and every six months thereafter.Intervention: Walking/nature trails enhanced with fixed play equipment designed to stimulate activity directly on playgrounds and indirectly in local parks, trails and neighborhoods. Two schools will receive intervention early (Fall 2011) and two late (Spring 2012).Setting and population: 283 fourth-grade children and their parents (>50% of whom will be from low-income families) from four under-resourced elementary schools in a mid-western, mid-sized city. Measures: Pre- and post-intervention: MVPA measured using geographically-linked accelerometers (indicating location and intensity of MVPA) and cross-sectionally using SOPARC methods to quantify the proportion of 4th graders playing actively on school playgrounds; qualitative interviews with children (cognitive mapping, photo-elicitation) ; questionnaires including secondary aim outcomes, family socioeconomic data and parent perceptions regarding neighborhood environments; children’s height and weight Post-intervention only: focus group discussions with children and parentsAnalysis: Quantitative outcomes: hierarchical longitudinal data analysis, testing intervention effects as the interaction between study condition and time; Qualitative outcomes: identification and iterative review of codes and themes, using a grounded theory approach to identify cross-cutting concepts that characterize interview and discussion responses.Conclusion: This study will contribute to the prevention of childhood obesity nationally by developing, implementing and documenting an approach to assess the effects of community-developed environmental playground interventions using geographically attributed, longitudinal accelerometer data, cross-sectional SOPARC place-based data and qualitative interview data.

Giant Verruca Vulgaris-Rare Presentation

Fri, 30 Sep 2011 21:33:20 -0500

Common wart is the most frequent clinical lesion caused by human papillomaviruses (HPVs). Giant, chronic raised lesion, bilaterally on the same anatomical area is uncommon. We reported a case of giant verruca vulgaris in a 25 year-old man on both legs that slowly enlarged and hardened in 5 years. It was a hyperkeratotic verruca vulgaris, grey brownish in color, circumscribe, round, and 4.0x3.0x1.0 cm in size on the right leg and 3.5x3.4x0.5 cm on the left leg and around 0.4cm raised from the skin surface. Histopathologic examination revealed compact hyperkeratosis/orthokeratosis, many koilocytes in the granular and upper spinous layer, acanthosis, and elongated rete ridges that were pointing radially toward the center of the lesion. The patient was successfully treated with surgical excision followed by split skin grafting.

Alcoholic Cardiomyopathy In A 39 Year Old Female: A Case Report

Fri, 30 Sep 2011 21:32:41 -0500

Background: Alcoholic cardiomyopathy is a dilated cardiomyopathy, caused by long standing chronic ingestion of alcohol. It is very similar to idiopathic dilated cardiomyopathy (DCM). However, total cessation of alcohol is strongly associated with improvement of symptoms and even reversal of the DCM. Method: Case Report Result: A 39 year old school teacher, presented on account of progressive dyspnoea associated with orthopnea, palpitations and bilateral leg swelling. There was no previous remarkable illness or hospital admission. She had a history of daily ingestion of alcohol based fertility potions for 8 years.On examination she was in respiratory distress, had bilateral basal crepitations, an irregular pulse, elevated jugular venous pulse, a displaced non heaving apex with left parasternal heave, and a non radiating apical pansystolic murmur. She also had a tender hepatomegaly, and bilateral pitting pedal oedema.A chest radiograph showed upperlobe diversion, bilateral hilar opacities and a multichamber cardiomegaly. A 12 lead surface electrocardiogram (ECG) showed atrial supraventricular and ventricular ectopics, and echocardiography showed, four chamber dilatation with poor systolic function and absent a waves. Conclusion: Congestive cardiac failure (CCF) secondary to alcoholic cardiomyopathy, precipitated by arrhythmias.

Modelling Of Heat Conduction Along Vein Walls In Endovenous Laser Treatment

Fri, 30 Sep 2011 21:30:13 -0500

Laser ablation of the saphenous vein uses laser-tipped probes to produce photothermal effects in the vein. In this study we construct a mathematical model of the effects of laser-induced thermal heating and conduction along the vein wall. We formulate and solve the relevant two-dimensional heat conduction problem. Simulations of the solution to the problem resolve an aspect of a debated question of the procedure.

Obliteration Of Furcation Defects With Glass Ionomer Cements- A Literature Review

Fri, 30 Sep 2011 21:30:12 -0500

Over the years, various modalities have been used to treat furcation involvement in periodontal disease. These have traditionally included scaling and root planing, furcationplasty, root resection, hemisection, tunneling, bone grafting, guided tissue regeneration and apically repositioned flaps. The following article reviews the literature regarding the use of glass ionomer cements in the management of furcation defects.

Post-Induction Stress-Cardiomyopathy: A Case Report

Fri, 30 Sep 2011 21:29:49 -0500

We present a case of a 38 year-old morbidly obese female with an unremarkable cardiac history undergoing elective diagnostic laparoscopy for removal of a left ovarian cyst. Despite modified sequence induction and successful intubation, arterial oxygen saturations continued to decline. Bilateral wheezing was heard on auscultation and shortly thereafter, pink frothy liquid filled the endotracheal tube and circuit. Upon stabilizing the patient, radiography and echocardiogram demonstrated diffuse pulmonary vascular congestion and an ejection fraction of 15%, respectively. Remarkably, despite initial elevation in cardiac enzymes and ECG changes, cardiac function completely normalized by hospital day three.

A Huge Bifrontal Meningioma Associated With Intraoperative Massive Bleeding

Fri, 30 Sep 2011 21:29:45 -0500

We report a 25-year-old Iranian female who presented with progressive memory disturbance, headache, and personality change associated with loss of visual acuity since 3 months before admission; bilateral optic atrophy was also noted. Magnetic resonance imaging disclosed a large bifrontal lesion accompanied by prominent edema in both frontal lobes. Cerebral angiography demonstrated a rich-vessel tumor that drained through the diploic vein. A bifrontal craniotomy was performed. We encountered massive bleeding from the diploic vein and dura mater immediately after craniotomy. We were also faced with severe brain swelling at the dural incision. The tumor was solid, highly vascularized, and fairly well demarcated. We performed total removal of the tumor as quickly as possible to reduce intracranial hypertension and avoid impending brain herniation. The patient had an uneventful recovery, and no new neurologic deficits were noted at follow-up.

Does Perioperative Bispectral Index Monitoring Decrease Time To Extubation In Patients Undergoing Coronary Artery Bypass Graft Procedures?

Fri, 30 Sep 2011 21:29:45 -0500

In a prospective randomized study the Bispectral index (BIS) was used to titrate propofol infusion during cardiopulmonary bypass (CPB) (between 40-50) and in the postoperative period in the ICU ( between 60-70) until extubation. We studied a total of 40 patients undergoing cardiac surgery under CPB. They were randomized to 20 patients each in the BIS and standard therapy group (STG). In the STG group the propofol infusion was titrated to mean arterial pressures (MAPS) of 55 to 65 mm Hg during CPB and to a sedation score of zero on the Sedation-Agitation Scale (SAS). Patients in both groups had similar demographic characteristics, duration of CPB and surgery. The total amount of propofol used (BIS 1662mg, STG 1729 mg)] showed no statistical difference despite BIS monitoring. The time to the average time to eye opening (190 min), time to wean (210 min) and extubation (BIS 352 minutes, STG 380 minutes) were comparable in the both groups. Monitoring of hypnotic component with BIS during cardiac surgery failed to demonstrate an earlier time to recovery and extubation.

The Effect Of Coinfection By Hepatotropic And Hepatomimetic Viruses In Physical Evolution Of Hcv Hepatitis

Thu, 29 Sep 2011 20:55:59 -0500

The liver is involved in infections by hepatotropic viruses that replicate in the liver and for which the liver is the main target. These include hepatitis A (HAV), B (HBV), C (HCV), D (HDV) and E (HEV) viruses. In all of these infections, hepatitis and liver damage arise as a consequence of the immune response to virus within the liver (1-6). We, retrospectively, studied 75 patients with HCV related chronic liver disease. We concluded that latent infections by hepatomimetic viruses may play a crucial role in the progression of liver disease in HCV-infected patients and may deteriorate the prognosis of those patients in relation with the response to combination therapy. However, further studies of a greater number of cirrhotic and HCC-related HCV patients are needed in order to clarify the role of “silent” CMV and/or EBV infection in HCV patients (75). As occult hepatitis B infection is an important clinical entity, which may progress to severe sequelae, some other yet-to-be determined factors, including hepatomimetic viruses, play a key role to the progression of chronic hepatitis C and its response to combination therapy. In agreement with most studies, environmental, genetic and immunologic determinants are involved in the development of occult hepatitis B, latent CMV and EBV infections and the consequent liver cirrhosis, HCC and the decreased response to combination therapy in HCV-infected patients. These certain risk factors should be included in a long-term follow-up study on HCV patients. Repeated measurements of HBV infection markers (antiHBs, antiHBc, HBV DNA) and PCR for CMV and EBV in combination with periodic health examinations of study subjects may provide useful information on their clinical outcome and identify development and progression of occult hepatitis B, CMV and EBV and its related liver diseases.

Metastatic Small Bowel Carcinoid Tumour: Long-Term Survival - A Case Report and Review of Literature

Fri, 09 Sep 2011 23:58:29 -0500

Long-term patient survivability with a metastatic bowel carcinoid tumour is seldom heard of.We present a unique case of a patient in his seventh decade who was originally diagnosed with a primary carcinoid of the small bowel (the initial diagnosis being unknown to us) and who waited for more than 35 years before finally being diagnosed with a metastatic recurrence. Until his presentation to our department he remained totally asymptomatic. Interestingly the patient was totally oblivious of the findings of his surgery for a primary cancer many years ago until it was proven by his old medical records.

Learning Experience In Immunohistochemical Reporting Of Breast Cancer At A Rural Tertiary Hospital In India: A Comparison In Initial And Reviewed Reporting Of ER,PR, HER2 Status

Fri, 09 Sep 2011 23:58:05 -0500

Aim- To compare between the initial reporting and reviewed reporting of estrogen receptor, progesterone receptor and Her2-neu receptor status.Methods- Information regarding ER/PR and Her2 expression of cases with available stored slides was reviewed and analyzed concurrently by 2 pathologists. The levels of significance were analyzed by Fischer test using SPSS 16.0 software.Results- There was statistically significant difference between initial reporting and reviewed reporting of Her-2 neu receptor whereas no significance was seen in the initial and reviewed reporting of ER and PR status.

Possible Pathogenetic Mechanisms And Overview Of Metastatic Tumours To The Oral Cavity.

Fri, 09 Sep 2011 23:57:11 -0500

Metastasis to the oral region are uncommon and account for about 1% of the oral malignant tumors and it may occur in the oral soft tissue or jaw bones. In 25% of cases, oral metastasis were found to be the first sign of the metastatic spread and in 23% it was the first indication of an undiscovered malignancy at a distant site. So we can say that oral cavity is the mirror of whole body. Oral lesions and manifestations suspect the possibility of metastasis from distant sites and that initiate the necessary investigations. This article has emphasised on various pathogenetic mechanisms related to tumours metastasizing to oral cavity.

Possible Role Of Human Papilloma Virus In Oral Diseases- An Update

Fri, 09 Sep 2011 23:56:32 -0500

Human papillomaviruses (HPV) has been an area of interest since last two decades because of its potential role in the pathogenesis of malignant tumors. Approximately 35 years ago a role of human papillomaviruses (HPV) in cervical cancer has been postulated. Today it is well established that this very heterogeneous virus family harbours important human carcinogens, causing not only the vast majority of cervical, but also a substantial proportion of other anogenital and head and neck cancers. This review will cover some of the pathogenetic aspects of papillomavirus research; it tries briefly to analyze the present state of linking HPV to human cancers and other oral lesions and will discuss some emerging developments.

Use Of Herbal Medicine Among Pregnant Women Attending A Tertiary Hospital In Northern Nigeria

Fri, 09 Sep 2011 23:56:18 -0500

Background: There is limited data on the use of herbal medicine by pregnant women in Nigeria. This study was aimed at determining the prevalence of use, socio-demographic pattern, knowledge and attitude of pregnant women to the use of herbal medicine among those attending the antenatal clinic of the Aminu Kano Teaching Hospital, Kano, a tertiary hospital in Northern Nigeria.Methods: A pre- piloted structured questionnaire was administered on 500 pregnant women attending the clinic to collect data on demographic s, obstetric factors, knowledge and use of herbal medicine during pregnancy. Results: 31.4% of pregnant women used herbal medicines in the subsisting pregnancy. Over 40% of respondents had at least primary education while nearly 30% had an income of less than 20,000 naira(130 USD) monthly. Statistically Significant associations were found between herbal medicine use and no formal education(p<.05), low economic status (p<5) and self medication with orthodox drugs(p<.05). Ginger (zingiber officinale) and Garlic (allium sativa) were the most commonly used herbal medicines recalled by respondents. There was a significant association between education of respondents and their knowledge on safety of herbal medicines while a disparity was found between their views and practice.Conclusion: Use of herbal medicine among pregnant women in this environment was high. Clinicians and caregivers should have knowledge of the herbs commonly used by pregnant women and the potentials for toxicity. Attention should be given to enlightenment of pregnant women and the community on the dangers of herbal drug use during pregnancy.

Anaesthetic Management Of Patients With Acute Spinal Injury

Fri, 09 Sep 2011 23:55:53 -0500

Acute Spinal Injury (ASI) is relatively rare, presenting most frequently in young male adults. The commonest cause of spinal injury is road traffic accidents, followed by domestic, industrial and sporting injuries. Self-harm and assault count for less than 10% of the cases. A high index of suspicion of spinal injury and timely, safe intervention is important in multiple trauma patients and where the mechanism of injury is suggestive of ASI. The anaesthetist, in encountering these patients at several points in their hospital management, has an important role in optimal care of ASI. The choice of anaesthetic technique and intervention, together with the timing of intervention, must be carefully considered. The aim is to protect the spinal cord from further damage, avoid further disruption in alignment, and facilitate stability of the vertebral column to permit maximal neurological recovery and rehabilitation.

Adrenal Myelolipoma And Membranoproliferative Glomerulonephritis: Case Report

Mon, 29 Aug 2011 22:10:21 -0500

Adrenal myelolipoma is a rare neoplasm typically <4 cm. It is usually discovered as an incidental finding and is asymptomatic. Currently, no known association exists between adrenal myelolipomas and membranous glomerulonephritis. This case demonstrates the coexistence of a large adrenal myelolipoma with a history of membranous glomerulonephritis (MGN) in the ipsilateral kidney.

Chronic Prostatitis Is A Risk Factor For Erectile Dysfunction

Mon, 29 Aug 2011 22:10:20 -0500

Objectives. Chronic prostatitis (CP) is associated with a variety of irritative and obstructive voiding symptoms. A significant number of patients also complain of sexual dysfunction. Ejaculatory dysfunction has been reported in more than half of patients with CP. Our goal was to determine whether CP is a risk factor for erectile dysfunction (ED).Methods. The Sexual Health Inventory for Men (SHIM) was administered in our clinic and online at the Interstitial Cystitis Network. 305 men completed the SHIM questionnaire, which included 47 controls (healthy volunteers), 150 men for evaluation of other urologic complaints (urology group), and 108 men being treated for CP. The total SHIM score and response to each SHIM question were analyzed using ANOVA.Results: In the control group, the mean SHIM score was 22.7 of a possible 25 points, and mean SHIM Q1 score was 4.0 of a possible 5 points. In the general urology group, the mean SHIM score was 21 and mean SHIM Q1 score was 3.3. In the CP group, the mean SHIM score was 17 and mean SHIM Q1 was 2.91. The results had statistical significance (p=0.05). Patients with CP have significantly lower total SHIM and SHIM Q1 scores when compared with controls and patients seen for urologic complaints. Patients with prostatitis are younger than those typically seen for general urologic complaints. Conclusion: CP is a risk factor for ED. Patients with CP should be questioned about ED as part of their routine urologic care and offered treatment options.