bluuebunny/crossref_metadata_2025 huggingface dataset:
Mutation of the ALDH7A1 gene in a patient with pyridoxal phosphate-dependent neonatal epileptic encephalopathy: a clinical case
Authors: Kozhanova T. V. , Zhilina S. S. , Mescheryakova T. I. , Lukyanova E. G. , Osipova K. V. , Ayvazyan S. O. , Prityko A. G.
Published: April 2019

The article presents a clinical case of severe infantile generalized idiopathic epilepsy with status-like seizures, muscular dystonia and developmental delay. The examination included a phenotypic analysis: the course of the perinatal period, the nature of seizures, cognitive and behavioral disorders; video electroencephalography, and brain MRI. Using the targeted exome sequencing of genes associated with epileptic encephalopathy (NGS), we detected a nucleotide heterozygous variant of the ALDH7A1 gene (previously not described). This mutation led to the appearance of a stop codon in position 82 of the protein p.Arg82Ter and the amino acid substitution in position 399 of the protein p.Glu399Gln. This clinical observation demonstrates the importance of DNA-based diagnosis involving the targeted exome sequencing to identify molecular defects, especially in severe neonatal drug-resistant seizures. In the case of confirmed mutations in the ALDH7A1 gene, the patient should be given vitamin B6 at the therapeutic doses for seizure relief.
Association between migraine and vestibular disorders
Authors: Gassieva D. M. , Zamergrad M. V. , Tabeeva G. R.
Published: April 2019

Dizziness (vertigo) and migraine headache are among the most common neurological disorders. The association of dizziness and migraine in the population occurs more often than these conditions diagnosed separately. The probability of their random coincidence is about 1% among the adult population, and the prevalence of migraines combined with dizziness is 3.2%, i. e. about 3 times higher than a mere coincidence. Epidemiological studies have found that the associations between migraine and vertigo is bi-directional. On the one hand, migraine is more common among patients with dizziness, and on the other hand, dizziness is more common among patients with migraine. Moreover, such comorbidity with dizziness is more typical for migraine, and not for other forms of headache. On this background, the term “migraine-associated dizziness”, or “vestibular migraine” (VM) has been introduced. In 2001, H. Neuhauser et al. proposed a list of diagnostic criteria for VM, and this condition has been recently included in the ICDB-3 beta version as a separate nosological unit. By now, the pathophysiology of the VM is not well understood; the current hypotheses are mainly based on the pathophysiology of migraine itself. Yet, a number of recent studies have made a significant contribution to the understanding of the neurophysiological processes involved in the development of VM. There is a hypothesis that dizziness in migraine represents a migraine aura; this mechanism is based on the phenomenon of spreading cortical depression, i. e., a wave of depolarization that originates in the occipital cortex and slowly moves to the ventrally located areas. Vestibular disorders are known to be caused by the release of neuropeptides (substance P, neurokinin A, calcitonin-like peptide); these peptides stimulate the impulse activity of the sensory epithelium in the inner ear and the vestibular nuclei of the brain stem. In addition to the existence of vestibular migraine, as an independent form of headache, other migraine-associated vestibular disorders have been identified. The most commonly seen are nonspecific symptoms, e. g., motion sickness (that occurs in about 50% of patients), peripheral vestibulopathies, and subclinical vestibular disorders detected in patients with migraine by an instrumental neurovestibular examination in the interictal period. The precise mechanisms of the association between migraine and vertigo are not well understood. Clarifying the clinical and pathophysiological details of the relationship between these conditions is very important for optimal management of patients with migraine.
Pediatric Maxillary Osteomyelitis: A Case Report of a Rare Entity
Authors: Wehl Goetz , Zimmermann Veit , Meyer Thomas , Beinborn Wolfgang , Gaumann Andreas , Rauchenzauner Markus
Published: April 2019

Maxillary osteomyelitis is a rare disease, especially in the pediatric population. We present a case of maxillary osteomyelitis in an eight-year-old girl with favorable outcome. Diagnosis was based on magnetic resonance imaging as well as on direct inspection intra operatively. Treatment should be based primarily on clinical signs (e.g. loose teeth). Teeth should not been extracted if healthy.
The role of sildenafil citrate in the treatment of fetal growth restriction: a randomized controlled trial
Authors: Abdelshafy Ahmed , Abdullah Khaled Ibrahim , Ashoush Sherif , Hosni Heba E.
Published: April 2019

Background: This study was aimed to evaluate the effect of sildenafil citrate on Doppler velocity indices in patients with fetal growth restriction (FGR) associated with impaired placental circulation.Methods: A double-blinded, parallel group randomized clinical trial (clinicaltrials.gov NCT02590536) was conducted in Ain Shams Maternity Hospital, in the period between October 2015 and June 2017. Ninety pregnant women with documented intrauterine growth retardation at 24-37 weeks of gestation were randomized to either sildenafil citrate 25 mg orally every 8 hours or placebo visually-identical placebo tablets with the same regimen. The primary outcome of the study was the change in umbilical artery and fetal middle cerebral artery indices.Results: There was a significant improvement in umbilical and middle cerebral artery indices after sildenafil administration p<0.001. Present study observed that, sildenafil group, in comparison to placebo, has a significantly higher mean neonatal birth weight. 1783±241g vs 1570±455g (p<0.001). There was a significantly higher mean gestational age at delivery in women in sildenafil group 35.3±1.67 weeks, whereas it was lower in the placebo group 33.5±1.7 weeks. The side effects as headache, palpitation and facial flushing were significantly higher in sildenafil group compared to placebo group.Conclusions: The use sildenafil citrate in pregnancies with fetal growth restriction (FGR) improved the feto-placental Doppler indices (pulsatility index of umbilical artery and middle cerebral artery) and improved neonatal outcomes.
Assessment of knowledge and practice of menstrual hygiene among the female nursing students in a selected private nursing college in Dhaka City
Authors: Nahar Niru Shamsun , Khatun Ratna , Akter Halim Khondoker Mahmuda , Islam Sharmin , Muhammad Faisal
Published: April 2019

Background: Adolescent females are often uninformed and inexperienced on most health-related issues including menstruation. The problems of menstrual hygiene are inadequately acknowledged and has not received any proper attention as well. This study was aimed to assess the level of knowledge and practice of menstrual hygiene among the female nursing students in Bangladesh.Methods: A total of 106 female nursing students were selected from Grameen Caledonian College of nursing using purposive sampling technique.  A descriptive cross-sectional type of study was used. Data were collected directly using self-administered semi-structured questionnaire developed and was analysed using SPSS version 22.0.Results: In this study more than six-tenths (63.2%) of the respondents were 20 years and below and most of them (74.5%) were unmarried.  About 60.4% of them were currently running diploma in nursing and the rest (38.6%) were B.Sc. nursing students. About 72.6% of the respondent’s mothers had above HSC level of education and most of them (61.3%) were from nuclear family.  Little above half (51.9%) of the respondents mentioned that menstruation is the uterine bleeding and the majority (67.0%) of the respondents were surprised during their first menstruation. Most of the respondents source of information about menstruation before menarche was sister (95.3%), followed by friend (92.5%), mother (67.9%) and the rest mentioned the teacher (62.3%). About 76.5% of the respondents mentioned that their mode of disposal of absorbents was dustbin and most of them (68.9%) used water and soap to clean their genital area after menstruation.Conclusions: The study was concluded that more than half of the respondents had moderate level of knowledge and practice regarding the menstrual hygiene. Most of the (67.0%) of the respondents were surprised during their first menstruation and close to eight-tenths (79.2%) mentioned they had a regular usual menstrual cycle. There is need for more awareness regarding the information on good menstrual hygiene practices.
Evaluation of effect of pospartum intrauterine contraceptive device
Authors: Wade Dinesh , Khade Shweta Avinash
Published: April 2019

Background: This study was done to compare and evaluate safety, efficacy and complications of PPIUCD and interval IUCD insertion and to generate evidence on the safety and effectiveness of these two types of IUCD insertions.Methods: This prospective study was carried out at tertiary care center and Teaching Institute in the Department of obstetrics and gynecology. All enrolled patients in obstetrics and gynecology from 1/2/16 to 31/7/16 were included in this study. Women fulfilling inclusion criteria were included in the study after informed consent. Study protocol was approved by ethics committee.Results: A total of 44 women fulfilling WHO standard medical criteria for PPIUCD insertion and willing to comply with study protocol had PPIUCD insertion.  Cause of removal was mainly bleeding (2 cases, 50%) in interval IUCD group. 4 cases of spontaneous expulsion noted in vaginal delivery group prior to 6 weeks. The cumulative rate of complications were higher in PPIUCD group in our study (12 out of 44 i.e. 27.27% and 4 out of 20% in PPIUCD group and interval IUCD group respectively). Compliance of patient was highest in trans cesarean group 87.5%.Conclusions: Postpartum insertion of PPIUCD is safe effective, feasible and reversible method of contraception.
A clinical study of effects of pregnancy on diseases like painful crisis, seizure disorders, hepatopathy, acute anemia and its outcome
Authors: Sitalakshmi V. , . Narmada , . Kavitha
Published: April 2019

Background: The ability of the blood cells to carry oxygen is especially important in pregnancy. Anemia may result in lower amount of oxygen going to the fetus and slowed fetal growth. Because it affects so many organs and body systems, women with the disease are more likely to have complications in pregnancy. The main objective was to study the effects of pregnancy on disease and its outcomes.Methods: It is a hospital based prospective study. The study was conducted at Narayana Medical College Nellore, Andhra Pradesh. The patients admitted in Obstetrics and Gynecology Department were included in the study. The study included total of 45 patients. Detailed history included age, socioeconomic status, address, education and occupation of the patient’s Permission from Institutional Ethics Committee was obtained.Results: Maximum patients were gravida 2-3, and minimum were gravida 4 or more. Maximum numbers of patients were in group 20-25. The patients with preterm birth that is delivery before 37 weeks of pregnancy were 15. Low birth weights were 20 and of still birth and new born death was 4.Conclusions: The present study was carried out in 45 cases and appropriate prenatal care and careful monitoring throughout pregnancy, can have healthy pregnancy with significant improvement in pregnancy outcome.
Acceptance for Human Papilloma virus vaccines, experience at tertiary care centre of northern india: a hospital-based survey
Authors: Verma Manju Lata , Singh Uma , Rai Prachi , Qureshi Sabuhi
Published: April 2019

Background: Acceptance of HPV vaccine is varying widely worldwide in   range of 10-70%. For increasing the acceptability for HPV vaccine, finding the obstacles and catering them diligently is required. The aim of the study was to find out acceptability rate for HPV vaccine in northern India and various obstacles and facilitators affecting acceptance of HPV vaccine.Methods: A questionnaire based descriptive study was done in the Department of Obstetrics and Gynecology of King George Medical University, Lucknow, Uttar Pradesh, India from June 2016 to June 2017.  Questionnaire was filled by doctor after taking face to face interview of individuals. Ethical approval was obtained from the Institutional Ethical Committee of the KGMU, Lucknow, Uttar Pradesh, India. (1689/Ethics/R cell/17) acceptability rate and various facilitators and obstacles for HPV vaccine were studied. For continuous variables mean with standard deviation was used. For categorical variables frequencies and percentages were used. IBM SPSS statistics applied.Results: A total of 302 cases were face to face interviewed, amongst which, 70 cases (23%) showed acceptability and 232 did not accept the vaccine. The most common obstacles were lack of knowledge and high monetary cost being the cause of nonacceptance in 48.3% and   33.6% of cases respectively.Conclusions: Higher level of awareness and knowledge about HPV vaccine and inclusion in government immunization programmed may increase acceptability.
Evaluation of urinary calcium to creatinine ratio as a predictor of preeclampsia
Authors: Solanki Garima , Agrawal Sunita , Dora Arun K.
Published: April 2019

Background: Hypertension in pregnancy is a big threat to the mother as well as the fetus. Prediction of preeclampsia with reasonable accuracy is one of the essential prerequisites for its prevention. Various biological markers are available for the prediction of preeclampsia but none of those is reasonably reliable, valid and economical. In this present study, the predictive value of the urinary calcium-creatinine ratio (CCR) for the prediction of preeclampsia was studied.Methods: This Prospective, observational study was conducted in the department of obstetrics and gynecology, Jawaharlal Nehru Hospital, Bhilai, Chhattisgarh, India. The study population was comprised of consecutive 174 pregnant women with gestational age between 20-28 weeks attending antenatal OPD. Calcium and creatinine levels were estimated in the midstream clean catch urine sample. After initial workup, all patients were followed in the antenatal clinic till the time of delivery. The number of patients who develop the hypertensive disorder in pregnancy was noted and the correlation studied.Results: On statistical analysis, CCR at ≤0.04 had a sensitivity of 71.43%, specificity of 98.75%, and the positive predictive value of 83.33% and negative predictive value of 97.53%. The accuracy of the test was 96.55%.Conclusions: A single estimation of calcium to creatinine ratio in asymptomatic pregnant women between 20-28 week of gestation is a simple and cost-effective test. A value of less than or equal to 0.04, in a spot urine sample, has a good predictive value for preeclampsia.
Efficacy of internal iliac artery ligation for control of post-partum haemorrhage
Authors: S. Beeresh C. , Doopadapalli Divyasree , L. Krishna
Published: April 2019

Background: Pelvic hemorrhage is associated with a great degree of morbidity and mortality and has to be controlled immediately. Ligation of the internal iliac arteries is a method to achieve the goal. We conducted this study to assess the outcome, effectiveness and complications of internal iliac artery ligation (IIAL) in controlling postpartum haemorrhage.Methods: This study was a retrospective study conducted in a rural tertiary referral centre from April 2015 to March 2018. IIAL was performed in women with PPH either at caesarean section or at laparotomy performed at a variable time after vaginal or caesarean delivery.Results: Over the study period of 3 years, 29 cases of IIAL were performed. The most common indication for IIAL was atonic PPH. Uterine salvagability was 62% in this study.Conclusions: All obstetric surgeons should be fully aware of the indications, timing and technical aspects of IIAL. Bilateral internal iliac artery ligation remains a safe, fast, effective and life saving salvage procedure which should be encouraged and used routinely by obstetricians when faced with cases of severe obstetric hemorrhage, especially in young women of low parity.
A clinicoetiological study of vulvovaginitis in a tertiary care hospital
Authors: Mahur Jayalaxmi , Humera Aisha
Published: April 2019

Background: Vulvovaginitis is a common unavoidable health problem encountered in a woman’s life. Because of its recurrent and persistent symptoms, it leaves a negative impact on the quality of woman’s life and its management poses a challenge. This study is aimed to analyse the clinical profile, clinical symptoms - presentations and various etiological agents in vulvovaginitis.Methods: A study of 125 cases of vulvovaginitis in the age group of 18-50 years was done. This study was based on the data collected like - age, parity, symptoms, clinical presentations and cytological findings. Speculum examination was done with the given consent and high vaginal swabs were taken for cytological study. Based on Amsel’s criteria bacterial vaginosis was confirmed, trichomoniasis by wet mount examination and candidiasis by culture study were confirmed.Results: The present study showed maximum incidence of vaginitis 63.2% among 21-30 years age group, more common in multiparous women 44.8% and vaginal discharge was the commonest symptom 88%. Cytological study showed 53.6% bacterial vaginosis {BV), 27.2% vulvovaginal candidiasis (VVC), 2.4% trichomoniasis and remaining 17% mixed infections like BV + VVC 15.2% and 1.6% BV + VVC + Trichomoniasis.Conclusions: All women of reproductive age should have mandatory regular evaluation for early detection and proper management of vulvovaginitis. Creating awareness among women improves their quality of life.
Do accessory parameters affect the outcome of the endoscopic procedures in female infertile patients?: an experience at a single tertiary care center
Authors: Agrawal Namita , Yadav Poonam , Fayyaz S. , Jain Tarun Kumar
Published: April 2019

Background: In modern era, endoscopic methods are commonly used in evaluation of female infertility. Hysterolaparoscopy is such a real time theranostic modality for anatomical causes of the infertility. The objective of this study was to evaluate the effect of accessory parameters (Age, Body mass index, duration of infertility, Rhesus factor, menstruation history and hemoglobin) on success rate of endoscopic procedures in terms of achieving pregnancy.Methods: A total 157 female infertile patients (Mean± standard deviation 27.72±3.82 years) were recruited in present study. During initial assessment detailed history was taken and hysterolaparoscopy was performed. The observed structural abnormalities on hysterolaparoscopy during diagnostic work up were tackled at same time if possible. After procedure, patients were counselled for regular sexual activity. The follow-up of all patients was done for 12 months.Results: A total 157 female infertile patients were recruited and divided into primary 93 (59.2%) and secondary infertile 64 (41.74%) patients on basis of obstetric history. The average age, BMI, hemoglobin and duration of infertility were 27.7years, 21.8 kg/m2, 12.3 gm and 3.9 years respectively. Out of 157 patients, anatomical abnormalities were detected in 125 patients during Hysterolaparoscopy and distributed in 77/93 (82.8%) primary and 48/64 (75%) secondary infertile patients. Of 125 patients with abnormal hysterolaparoscopic findings, 121 underwent active intervention and on follow up, 43 patients were conceived. We found that age; BMI, Rhesus factor, menstruation history and duration of the infertility were not correlated with fertility outcome while hemoglobin level was significantly correlated with conception rate.Conclusions: Authors concluded that outcome of the hysterolaparoscopy in female infertile patients is significantly depends upon hemoglobin levels, however outcome is irrelevant to age, duration of infertility, Rhesus factor and body mass index.
Study of factors affecting low birth weight of newborn in Uttar Pradesh, India
Authors: Agarwal Ambri , Tomar Prashant
Published: April 2019

Background: Low birth weight is defined as weight at birth is less than 2.5 kg. Low birth weight infants are at a greater risk of having a disability and survival and respiratory problems. To reduce the incidence of low birth weight babies we studied the maternal factors which affect the baby in utero and cause preterm or low birth weight babies.Methods: Eighty-two pregnant ladies aged between 16-30 years were studied who regularly visiting to obstetrics and gynecology department of G. S. medical college hospital, Peeplabandpur, Pilkahuwa, Uttar Pradesh, India were selected for study.Results: In this study, it was seen that mothers who were illiterate, belonging to lower socioeconomic status, multiparous and pregnancy associated with PIH, Anaemia and Oligohydramnios had high incidence of low birth weight babies.Conclusions: This pragmatic approach study of LBW will be quite helpful to obstetrics and gynecologist, pediatrician, physician to treat such patients actively to prevent morbidity and mortality of low birth newborn which is a great threat and challenge to the medical fraternity globally.
Assessment of platelet indices in pregnancy induced hypertensive patients versus normotensive pregnant patients
Authors: Shekhawat Harsha , Shrivastava Deepti
Published: April 2019

Background: Hypertensive disorders of pregnancy (HDP) represent a group of conditions associated with high blood pressure during pregnancy, proteinuria and in some cases convulsions. The most serious consequences for the mother and the baby result from pre-eclampsia and eclampsia. These are associated with vasospasm, pathologic vascular lesions in multiple organ systems, increased platelet activation and subsequent activation of the coagulation system in the micro-vasculature. It is a multisystem disease and many theories are proposed for pathophysiology. So there is a constant search for better prognostic factors to predict the progression and severity of disease. The fall in platelet count is most frequently found in preeclampsia and is probably due to consumption during low grade intravascular coagulation. The major adverse outcomes of pre-eclampsia and eclampsia include central nervous system injuries such as seizures (eclampsia), ischemic heart disease, stroke, type II diabetes, and venous thromboembolism hemorrhagic and ischemic strokes, hepatic damage, HELLP syndrome, renal dysfunction as well as increased frequency of cesarean delivery, preterm delivery, and abruptio placenta, in comparison with women without history of the disease.Methods: Total 100 subjects, 50 control and 50 cases were taken for study. Samples for platelet count were collected and estimation was carried out by the auto-analyzers. The statistical evaluation is done using SPSS version 22 along with Anova and student t-test.Results: There was a significant difference in platelet count in patients with preeclampsia as compared to control group. Mean platelet diameter was significantly increased in cases with preeclampsia.Conclusions: Thrombocytopenia is directly proportional to the severity of PIH. Platelet count less than 1 lakh/cumm indicate increasing risk of DIC and HELLP syndrome. In this study we noted significant association was established when the platelet counts of PIH cases were compared with the normotensive control patients. Strong association was made out between the platelet count and MPD and MPV and the severity of PIH.
Avoidance of hydrocele after non microsurgical varicocelectomy by pre-emptive eversion of tunica vaginalis in infertile men with varicocele
Authors: Abdelhameed Hosam Farouk , El‑Hamd Mohammed Abu , Zarif Helmy Mena
Published: April 2019

Background: In infertile men with varicocele, controlled studies clearly indicate that varicocelectomy improves pregnancy rates.  Non microsurgical varicocelectomy is associated with many complications; hydrocele is the most common one. Many techniques have been done to reduce the incidence of post-varicocelectomy hydrocele which is somewhat difficult to be done. This study aimed to evaluate the efficacy of pre-emptive eversion of tunica vaginalis in avoidance of post-operative hydrocele after non microsurgical varicocelectomy and its effect on fertility.Methods: A total number of 115 infertile men with varicocele underwent varicocelectomy during August 2015 to December 2016 in Sohag university hospital. Fifty five patients underwent bilateral microsurgical varicocelectomy (group A), were compared with 60 patients who underwent bilateral non microsurgical varicocelectomy with pre-emptive eversion of tunica vaginalis (group B) as regard, development of post-operative hydrocele, operative time, complication rates, hospital stay and effect on spontaneous pregnancy.Results: Group A has longer duration of surgery (26±11.7minutes versus 20±10.2minutes) while there was no significant difference in hospital stay (6±2.5 hours versus 6±1.5 hours) in both groups. No post-operative wound infection in both groups. There was one case (1.6%) develop scrotal haematoma in (group B) only. No post-operative recurrence in both groups.  No post-operative hydrocele developed in both groups. Improvement in sperm count, motility and morphology occurred in both groups. No significant difference in percentage of paternity during 6-24 months.Conclusions: Pre-emptive eversion of tunica during non- microsurgical varicocelectomy might be offered as an adjunctive technique to avoid development of post-operative hydrocele that is easy, not time consuming and has comparable results of microsurgical varicocelectomy.
Challenging treatment of hidradenitis suppurativa with happy ending
Authors: Akici Murat , Cilekar Murat
Published: April 2019

Background: Hydradenitis supurativa (HS) is a chronic, recurrent and inflammatory disease which involves skin and subcutaneous fatty tissue. The aim of this study was to retrospectively evaluate the treatment results of 12 patients who were diagnosed as hidradenitis suppurativa with local or multiple site involvements in our clinic.Methods: Data of 12 patients with local or multiple site involvement, who had hidradenitis suppurativa surgery between January 2013 and January 2018 were evaluated retrospectively.Results: Twelve patients, who were male, were included in the study. The average age was 39.4 (25-56) years old. A total of 5 patients were with local and 7 patients were with multiple region involvements. 8 patients had axillary, 3 patients had genitalia, 4 patients had perianal and 7 patients had sacral region involvements. Two of 4 patients with perianal region had protective stomas. In total, 16 surgical procedures were performed to the patients. In 6 patients, some parts of wounds were primary closed and followed-up with secondary healing. Skin grafting was performed for the four of these patients in late period. In 4 patients, defects were closed with primary closure and with rotation flaps in 2 patients. No recurrence was observed among the patients. The average duration of follow-up was 32.5 months.Conclusions: The surgical treatment process of hidradenitis suppurativa, which is a chronic disease, is not more difficult and longer than its natural course. In recent years, complete recovery can be achieved with current surgical methods.
Comparative study of MRI fistulogram and X-ray fistulography with operative findings: in fistula in ano
Authors: Tripathi Nishant , Chavan Shahaji , Bendre Mahendra , Sharma Vishal
Published: April 2019

Background: The current study has attempted to evaluate the effectiveness and diagnostic accuracy of MRI fistulogram over X-ray fistulography by comparing their findings with intraoperative findings.Methods: A hospital based prospective study was conducted at Dr. D.Y. Patil Medical College, Hospital and Research Centre, Pimpri, Pune with 60 patients to compare the findings of MRI fistulogram and X-ray fistulography with operative finding in fistula in ano. The study was carried out with following two groups of 30 patients each. Group A -30 cases underwent MRI fistulogram. Group B: 30 cases had done X-ray fistulography. Its findings were compared with the final findings of the operation.Results: On evaluation of the intra-operative findings with MRI fistulogram, we found that inter-sphincteric fistulous tract were noted in 23 patients as compared to 22 patients detected by MRI. In the rest of the findings the sensitivity of MRI with intraoperative findings was nearly 100% with a significant correlation. Sensitivity and specificity of X-ray fistulogram for fistula in ano was very low.Conclusions: The results have been statistically significant in providing data in favour of MRI fistulogram as diagnostically superior to X-ray fistulography.
Pattern and management of bear maul injuries in tertiary hospital in Kashmir
Authors: Mala Tariq Ahmed , Ahmad Syeed Rayees , Malla Shahid Amin
Published: April 2019

Background: Bears are very powerful and strong animals that defend themselves and their young ones if they feel insecure once disturbed by humans. Encroachment of forest land and haphazard construction has led to increase in the conflicts between humans and animals. Our valley is surrounded by forests all around and lush green forest area is habitant of black bears (Ursus thiabetanus). The aim of this study was to report and manage these complicated injuries.Methods: This study was conducted for a period of two years and all the patients were received in the surgical casuality in Government Medical College Srinagar. A total of 32 patients were registered in the two years period.Results: A total of 32 patients were studied, majority of patients were males. Maximum number of patients was in the age group of 31 to 40 years. All patients had soft tissue injuries; bone involvement was seen in 13 patients. Deep lacerations were seen in 22 (68.75%). Primary suturing was done in 12 (37.5%) of patients, split skin grafting in 7 (21.87%). All 32 patients had ugly scar in follow up with loss of vision in one eye in 3 (9.37%) patients. Four patients were advised psychiatric consultation and further treatment.Conclusions: Conflicts between humans and bears are common in bear-prevalent areas of the world. Bear maul injuries should be evaluated in detail as some patients may have serious injuries which need multispecialty treatment to maintain cosmetic and identity of a person.
Clinicopathological catalogue of male breast diseases
Authors: Ramji Ashwath Narayan
Published: April 2019

Background: Though relatively uncommon compared to diseases of the female breast, diseases of the male breast do occur, but are poorly studied. These range from benign lesions to malignant disease. The purpose of this study was to enumerate the various disorders of the male breast encountered in our practice, so as to develop a better understanding of the clinicopathological profile of these conditions.Methods: This was a retrospective study conducted in the Department of Surgery, KIMS Hospital, Bangalore, from September 2017 to September 2018. Male patients treated for disorders of the breast were included in the study. The clinical profile of the patients and the disease conditions were studied.Results: 21 patients were included in the study. The most common presentation was due to swelling, pain or lump in the breast. The most commonly encountered condition was gynaecomastia (66.66%). Primary malignancy of the breast was encountered in 2 cases.Conclusions: The male breast is subjected to various disease conditions. Most presentations are due to aesthetic defects. Rarely, primary malignancy can develop in the male breast. The breast is an often-neglected part of the male anatomy, and hence patients often present late with complications.
Laparoscopic subtotal cholecystectomy: a safe approach in difficult cholecystectomy
Authors: Khan Hosni Mubarak , B. G. Manjunath , Shenoy Vasanth G.
Published: April 2019

Background: Laparoscopic cholecystectomy (LC) has been recognized as the new "gold standard" for the treatment of symptomatic gallstone disease. In order to prevent serious bile duct and vascular injuries, conversion is advocated for unclear anatomy at the Calot’s. Our aim was to assess the safety and effectiveness of laparoscopic subtotal cholecystectomy (LSC) in difficult cholecystectomy in order to reduce the incidence of bile duct injury and conversion rates.Methods: An analysis of retrospectively collected data of 452 patients who underwent LC was done at our Hospital during the period of January 2010 to December 2013. In few cases of difficult GB when Calot’s could not be dissected, laparoscopic retrograde cholecystectomy (LRC) was attempted and if that failed we adopted the technique of LSC.Results: A total of 452 patients were included. The median age was 48 years. All the 452 patients were posted for LC. Of the 452 patients, 404 patients underwent LC and the remaining 48 patients had difficult GB. Among the 48 patients having a difficult GB, 44 cases underwent LSC (3 cases underwent LSC Type-1 and 41 cases underwent LSC Type-2) and the remaining 4 cases underwent conversion to open cholecystectomy. The mean operative time was 130mins and median post op stay was 2 days.Conclusions: In our technique of LSC the conversion rates were <1% with no bile duct injury and believe that it is feasible and safe for operating on difficult GB’s.
Surgical management of the impacted dormia basket during ERCP
Authors: Tandup Cherring , Kaman Lileswar , Sinha Saroj Kant
Published: April 2019

The incidence of associated common bile duct stones in patients undergoing cholecystectomy is 10%. The present day management of common bile duct stone is pre- or post-operative endoscopic retrograde cholangio-pancreatography and clearance of common bile duct. Complications of ERCP and CBD stone extraction have been reported to occur in 5 to 10% cases which may range from mild to life threatenin Here we report a case of cholelithiasis with choledocholithiasis with obstructive jaundice and patient while undergoing ERCP and stone retrieval had complication of impacted dormia basket which was managed by surgery.
Unusual presentation of peripancreatic abscess associated with streptococcus anginosus and colonic diverticulosis
Authors: Berevoescu Nicolae-Iustin , Bordea Adrian , Berevoescu Mihaela , Cristian Daniel-Alin
Published: April 2019

Pancreatic abscesses are rare and usually occur as a pancreatitis complication. The absence of acute pancreatitis and the clinical presentation that mimics a neoplasm are very unexpected. A 49-year-old man, known with arterial hypertension and chronic infection with virus hepatitis B came to the hospital for weight loss, marked asthenia, nausea/vomiting and jaundice, associated with mild pain in the upper abdomen. At admission, without fever and no medical history of acute pancreatitis. Laboratory values showed an important inflammatory syndrome, near normal pancreatic enzymes and increased tumour markers. Abdominal computed tomography (CT) revealed a heterogeneous fluid collection with gas bubbles inside, localized into the lesser sac that tended to extend peri splenic, towards the anterior and posterior pararenal spaces and the pelvis. Surgery has led to evacuation of peripancreatic and left retrocolic abscesses, associated with debridement and peritoneal drainage. The culture yielded Streptococcus Anginosus. At 7 days post-intervention hemoperitoneum occurred and was required a second intervention for haemostasis. Subsequent favourable clinical and biological evolution, with patient discharge from the clinic 16 days after admission. Repeated CT scans of the abdomen showed resolution of lesions and at colonoscopy it was observed uncomplicated colonic diverticulosis. In this case is highlighted a rare presentation of a peripancreatic pyogenic abscess caused by Streptococcus anginosus, associated with colonic diverticulosis.
The effect of pedometer supported walking and telemonitoring after disc hernia surgery on pain, disability levels, and quality of life: study protocol
Authors: Aldemir Kadriye , Gürkan Aysel
Published: April 2019

Background: Surgical intervention is the most common among the methods used to treat LDH, and its success rate is high. Despite this, patients can experience mild to moderate pain and disability after surgery. In the management of this pain and disability, walking forms the first step of rehabilitation and is an easy and long term method. This study was planned to determine the effect of a pedometer supported walking program and telemonitoring after disc hernia surgery on pain, disability levels and quality of life.

Methods: This study was planned as a randomized controlled study. Patients will be randomized into the study and control groups through the closed envelope method. Patients in the study group will receive an intervention through a 12 week walking program and weekly telemonitoring. The pain levels of the patients included in the study will be evaluated using the short form Mcgill pain questionnaire, their disability levels will be evaluated using the Oswestry disability index, and their quality of life will be evaluated using the SF-36. Patients in both the study and control groups will be evaluated with regard to pain and disability levels in the follow ups in the 3rd, 7th, and 11th weeks, and with regard to pain, disability, and quality of life in the 15th week.

Conclusions: Daily regular walks have great importance in the management of mild lower back pain. This study was planned to determine the effect of walking with a pedometer after LDH surgery with weekly monitoring.
YAŞAM KOŞULLARI VE SAĞLIK HASTALIK ALGILARI
Authors: AYDIN Kemal
Published: April 2019

Bu makalede fertlerin

subjektif algılarına dayalı sağlık durumları, kronik hastalıklar ve sağlık

sorunları nedeni ile günlük faaliyetlerde aksama gibi değişkenler analiz

edilerek Türkiye, Avrupa Birliği ve OECD ülkelerinde sağlık-hastalık durumu ve

algıları incelenmektedir. TÜİK ve EUROSTAT’ın 2006-2016 yılları arasında

yaptığı Gelir ve Yaşam Koşulları Araştırması’nın verileri ve OECD’nin daha iyi

yaşam endeksi verileri kullanılmıştır. İncelenen ülkelerde üç değişken

açısından yaygınlık oranları değerlendirildiğinde sağlık-hastalık durumlarının

birbirine yakın olduğu görülmektedir. Türkiye, Avrupa Birliği ve OECD

ülkelerinde insanların yaklaşık %30-32’si sağlık sorunu olduğunu rapor ederken

%65-70 oranında bir kitle sağlık durumunun “iyi” olduğunu belirtmiştir. Sağlık

durumu algılarında Türkiye ortalamaları kır-kent, cinsiyet, medeni durum, gelir

ve eğitim düzeyine göre detaylandırıldığında pozitif sağlık algılarına etki

eden en önemli faktörler sırası ile medeni durum, eğitim seviyesi ve gelir

düzeyidir. 
UZUN YOL ŞOFÖRLERİ HAKKINDA BİR SAHA ARAŞTIRMASI
Authors: UCA Onur
Published: April 2019

Bu araştırma Türkiye’de çalışan uzun yol şoförleri hakkındadır. Araştırmada nitel araştırma yöntemi kullanılmıştır ve şoförlerle derinlemesine görüşmeler gerçekleştirilmiştir. Araştırma sonucunda belirli verilere ulaşılmıştır. Uzun yol şoförlerinin ilişki ağı çıkartılmış; hız, korku, umut, yemek, uzak konularına dair fikirleri öğrenilmiş ve yaşadıkları sorunlar ve önerileri tespit edilmiştir. Sonuç bölümünde ise uzun yol şoförlerinin yaşamlarında ortaklaşan yönler aktarılmıştır.
A Simple and Cost-Effective Freeze-Thaw Based Method for Plasmodium DNA Extraction from Dried Blood Spot
Authors: SHARMA Supriya , MANN Riti , KUMAR Sandeep , MISHRA Neelima , SRIVASTAVA Bina , VALECHA Neena , R. ANVIKAR Anupkumar
Published: April 2019

Background: Available DNA isolation methods for Plasmodium involve numerous processing steps, adding to the cost and conferring risk of contamination. Here we devise a simple and cost-effective method for direct extraction of Plasmodium DNA from dried filter paper spot (DBS), appropriate for resource-limited setups.
Methods: The protocol involves simple freezing and thawing of DBS, neither involves any purification step nor any chemical reagent. The method was assessed in terms of DNA quantity, PCR detection sensitivity, time requirement, cost effectiveness, labor intensiveness and degree of shearing. The reliability of this method was confirmed by comparing it with other in use methods for Plasmodium DNA isolation.
Results: Pure DNA was obtained with this method, as exemplified by the absorbance ratio (260nm /280nm) of 1.2. The protocol produced digestible, PCR-grade genomic DNA, also found to be suitable for sequencing. DNA isolated remained stable and retained its integrity after storage for one month at 4 0C.
Conclusion: Our process substantiated as efficient, reproducible, simple, fast, and inexpensive. Development of this optimized freeze-thaw based DNA extraction method for malaria parasite may provide a valuable tool for molecular analysis in resource-limited setups. This is the first report of DNA extraction from DBS of Plasmodium utilizing freeze-thaw.
Bioclimatic Analysis and Spatial Distribution of Livestock Fascioliasis in Iran
Authors: GHANIMATDAN Mohamad , CHALECHALE Abdolali , REZAEI Farid , ROKNI Mohamad Bagher , SHAHROKHI Seyed Reza
Published: April 2019

Background: This study aimed to investigate the prevalence of fascioliasis and to perform a climatological analysis of different regions of Iran based on the current situation of the parasite and its intermediate host using Geographical Information System (GIS).
Methods: Meteorological data were obtained from Iran Meteorological Organization. Risk map of fascioliasis transmission was prepared based on this data and using forecasting indices. Further, the number of fascioliasis cases from 31 provinces reported to the Iran Veterinary Organization were collected and prevalence maps of livestock fascioliasis were drawn.
Results: The main risk hotspots were found in Northern provinces like Golestan, Mazandaran and Gilan as well as some Southern provinces such as Kohgiluyeh and Boyer-Ahmad and Chaharmahal and Bakhtiari and Fars, which have ideal conditions for completion of the parasite life cycle. Moreover, Gilan Province with 10.83% had the highest rate of fascioliasis infection in slaughtered animal.
Conclusion: Iran is one of the most important foci of fascioliasis globally. Several provinces of Iran have appropriate conditions for evolution of parasite life cycle and presence of its intermediate host. These regions require special attention and serious determination in order to control fascioliasis in human and animals.
Generation of a CRISPR/Cas9-Based Vector Specific for Gene Manipulation in Leishmania major
Authors: SALEHI SANGANI Ghodratollah , JAJARMI Vahid , KHAMESIPOUR Ali , MAHMOUDI Mahmoud , FATA Abdolmajid , MOHEBALI Mehdi
Published: April 2019

Background: Gene manipulation strategies including gene knockout and editing are becoming more sophisticated in terms of mechanism of action, efficacy and ease of use. In classical molecular methods of gene knockout, homologous arms are designed for induction of crossing over event in double strand DNA. Recently, CRISPR/Cas9 system has been emerged as a precise and powerful tool for gene targeting. In this effort, we aimed to generate a CRISPR/Cas9-based vector specific for targeting genes in Leishmania parasites.
Methods: U6 and DHFR promoters and neomycin-resistance gene were amplified from genome of L. major (MHRO/IR/75/ER) and pEGFP-N1, respectively. U6 promoter was cloned in pX330 vector which is named as pX330-U6. DHFR promoter and neo resistance gene sequence fragments were fused using a combination of SOE (Splicing by overlap extension)-PCR and T/A cloning techniques. To generate pX-leish, fused fragments su-bcloned into the pX330-U6. Two sgRNAs were designed to target the gp63 gene and cloned in pX-leish.
Results: The pX-leish vector was designed for simultaneous expression of cas9 and G418 resistance proteins along with a self-cleaving 2A peptide for efficient separation of the two proteins. In this study pX-leish was designed with 3 features: 1) Compatible promoters with Leishmania parasites. 2) Insertion of antibiotic selection marker 3) Designing an all-in-one vector containing all components required for CRISPR/Cas9 system.
Conclusion: This modified system would be valuable in genome manipulation studies in Leishmania for vaccine research in future.
Infection of the Jackal (Canis aureus) by Haplor-chis taichui (Trematoda: Heterophyidae) in Southwestern Iran: A Clue for Potential Human Infection
Authors: TEIMOORI Salma , MOWLAVI Gholamreza , ARIMATSU Yuji , SRIPA Banchob , MOBEDI Iraj , SHARIFDINI Meysam , MASSOUD Jafar , NADDAF Saied Reza
Published: April 2019

Background: We detected eight trematodes in the small intestine of a road-killed jackal (Canis aureus) from Hamidiyeh District near the city of Ahvaz, Khuzestan Province in 2010.
Methods: Three worms were stained with carmine acid, mounted in Canada balsam on glass slides and examined under a light microscope at 1000X magnification. PCR and sequencing of a partial ITS2 sequence were used to approve the diagnosis.
Results: The flukes measured ≈1 mm in length with an elongated ovoid shape resembling the members of heterophyid, and only one testis, characteristics of the genus Haplorchis. Sequencing of a 481-bp fragment of the ITS2 locus from the worms revealed 97%-98% identity with the similar sequences of the H. taichui flukes previously identified in the fish, cat, and humans from Thailand, China, and Vietnam.
Conclusion: Further studies with the application of reliable molecular tools to diagnose trematode infections in wildlife and humans can bring more insight into the epidemiology of fish-borne flukes including H. taichui in this area.
Efficacy of Artemisinin Base Combination Therapy and Genetic Diversity of Plasmodium falciparum from Uncomplicated Ma-laria Falciparum Patient in District of Pesawaran, Province of Lampung, Indonesia
Authors: Fatriyadi SUWANDI Jhons , ASMARA Widya , KUSNANTO Hari , SYAFRUDDIN Din , SUPARGIYONO Supargiyono
Published: April 2019

Background: Malaria is an infectious disease caused by Plasmodium sp., that still prevalence in some part of Indonesia. District of Pesawaran is one of malaria endemic area in the Province of Lampung. The purpose of this study was to evaluate the efficacy of the ACT treatment in the District of Pesawaran Province of Lampung, Indonesia from Dec 2012 to Jul 2013 and the genetic variation of the Plasmodium falciparum also studied.
Methods: This study was observational analytic study of falciparum malaria patients treated with ACT and primaquine (DHP-PQ and AAQ-PQ) at Hanura Primary Health Centre (Puskesmas). DNA isolation was done with QIAmp DNA Mini Kit. Amplification of PfMDR1, MSP1, and MSP2 genes was done with appropriate forward and reverse primer and procedures optimized first. PCR Product of PfMDR1 gene was prepared for sequencing. Data analysis was done with MEGA 6 software.
Results: The results of this research are DHP-PQ effectiveness was still wellness among falciparum malaria patients in District of Pesawaran, Province of Lampung, Indonesia. There is Single-nucleotide mutation of N86Y of PfMDR1 gene. The dominant alleles found are MAD20 and 3D7 alleles with Multiplicity of Infection (MOI) are low.
Conclusion: Therapy of DHP-PQ as an antimalarial falciparum in Pesawaran District, Lampung, Indonesia is still good. The genetic variation found was the SNP on the N86Y PfMDR1 gene, with dominant allele MAD20 and 3D7.