bluuebunny/crossref_metadata_2025 huggingface dataset:
Does gum chewing affect the timing of return of intestinal motility after elective cesarean section?
Authors: Darwish Atef M. , Farghly Tarek A. , Gad Beshoy T. , Abbas Ahmed M.
Published: December 2018

Background: The aim is to evaluate the effect of gum chewing on the return of intestinal motility after elective CS.Methods: Study period was from September 2017 to March 2018 at the Assiut Women Health University Hospital. The study was registered as a prospective cohort study (Clinicaltrial.gov   NCT03355378). Women planned for elective CS according to selection criteria randomized to two groups: Group 1: included 100 patients who received intraoperative and postoperative non-sugary gum chewing as 15 minutes every 2 hours post-operatively for 6 hours with regular care and Group 2: included 100 patients who received regular care without gum chewing.Results: No statistically significant difference regarding the baseline criteria of both groups. There was a statistically significant lower systolic and diastolic blood pressure in gum chewing group. Hospital stay of gum chewing group was 7.33±0.73 hours versus in non-gum chewing group 20.28 ± 9.92 (p=0.000). Passage of flatus of gum chewing group was 8.54±0.98 hours versus in non-gum chewing group 13.22 ± 3.75 (P= 0.000).Conclusions: Gum chewing during elective CS improves gut motility in a safe way resulting in early passage of flatus, less hospital stay, and minimal pain score less cost on hospitals.
A prospective analysis of polycystic ovarian syndrome in infertile women
Authors: Patil Soumya , Ramesh Saraswathi , Murthy Kharidhi Harinath Srinivasa
Published: December 2018

Background: Polycystic ovarian syndrome (PCOS) is a frequently occurring metabolic and reproductive endocrinopathy. Young women with PCOS mainly present with reproductive problems such as hyperandrogenism, menstrual irregularities, infertility and chronic anovulation. Despite its high prevalence and implications on reproductive health, PCOS is underdiagnosed. The objective was to study the prevalence of PCO in women with infertility, their symptomatology, endocrine profiles and coexisting factors of infertility in women with PCOS.Methods: A prospective study was performed over a period of 6 months. Women presenting with infertility were subjected to detailed history taking, general and gynecological examination. Women with features of PCOS on ultrasound were identified and advised investigations such as serum FSH, LH, prolactin and laparoscopy when indicated.Results: During the study period, 102 patients consulted the infertility clinic, out of which 56 were diagnosed with PCOS. The prevalence of PCOS was found to be 54.9% among infertile women. Menstrual irregularity was found in 33 (59%) women, however, 23 (41%) had regular menstrual cycles. 4 among the 33 patients complained of dysmenorrhea, 5 had heavy menstrual bleeding. On examination, 19 (33.9%) were found hirsute, 8 (14.28%) had thyroid enlargement and 2 (3.57%) had galactorrhea. Investigations revealed mean FSH and LH levels of 8.7±2SD and 13.7±2SD respectively and mean LH/FSH ratio of 1.57±2SD.Conclusions: PCOS is a heterogenous disorder and with its high prevalence in infertile women, proper diagnosis and management is essential as it has many potential metabolic and cardiovascular risks if not managed appropriately.
Camylofin dihydrochloride injection: a drug monograph review
Authors: Mayadeo Niranjan
Published: December 2018

Camylofin dihydrochloride is an anti-spasmodic drug available in India and other Latin American and African countries, for the treatment of abdominal colic and for acceleration of labor. Although, the drug has been in use for over six decades, with multiple citations in academic text books of repute, treatment protocols, and multiple research publications, there is no consolidated published information on the pharmacology and clinical details of camylofin. This drug statement/monograph is an attempt to collate and present scientific information that will come in handy to practicing obstetricians and gynaecologists, as well as other primary care physicians, when treating cases of abdominal colic or managing prolonged labor. Approved clinical indications, clinical pharmacology, dosage, contraindications, precautions, drug interactions, adverse effects, overdose and clinical evidence in different indications are covered herein.
A clinicoepidemiological study of fixed drug eruptions at a tertiary centre of North India
Authors: Sharma Rohini , Abrol Sameer
Published: December 2018

Background: Various studies have found the overall incidence of cutaneous adverse drug reactions (CADR’s) in developed countries as 1-3%, while the incidence in developing countries is thought to be higher between 2 and 5%. FDEs’ share is seen to be about 15 -30% of all CADR’s as reported in various studies. Aim of the research work was to study the clinical and epidemiological features of fixed drug eruptions and to identify probable culprit drug or drugs using Naranjo ADR probability scale and to provide information to the patient regarding the drug responsible for his/her drug rash.Methods: A total of 180 patients of fixed drug eruptions were taken up for study who presented to skin OPD at a tertiary centre of North India. Diagnosis was made on the basis of history of drug intake prior to drug eruption, repetition of similar lesions on same as well as new sites on intake of same drug with improvement of skin lesions on discontinuation of the causative drug. Further on examination, skin lesions with typical morphology compatible with FDE were seen. Causality of the FDE was assessed according to the NARANJO ADR probability scale.Results: A total of 180 patients of FDE were studied. Males outnumbered the females. The most common class of drug implicated was antimicrobials seen in 115 patients followed by NSAIDS 65 patients. Regarding the clinical presentation both skin and mucosal involvement was seen. The most common skin lesions were erythematous to hyperpigmented and violaceous macules followed by bullous FDE.Conclusions: In summary, early recognition of FDE is important not only for the dermatologists but also for the clinicians of other specialties, so that the culprit drug is recognized and stopped immediately. Drug reactions are a common reason for litigation and has medicolegal pitfalls.
Identification of bacterial urinary tract pathogens from urine samples using conventional methods and matrix-assisted laser desorption ionization-time of flight mass spectrometry
Authors: Kanwar Supreet , Oberoi Loveena , Singh Kanwardeep , Devi Bimla
Published: December 2018

Background: Early diagnosis of urinary tract infections (UTIs) is essential to avoid inadequate or unnecessary empirical antibiotic therapy. In this study, we evaluate the coincidence rate between conventional method for the diagnosis of UTIs (plate cultures and identification based on biochemical characteristics) and a fast method based on Matrix-Assisted Laser Desorption Ionization-Time of Flight Mass Spectrometry (MALDI-TOF MS). In recent years, proteomic techniques have achieved a relevant role in the identification of microorganisms in the field of clinical microbiology. MALDI-TOF MS has been suggested as a fast and reliable method for bacterial identification.Methods: Around 50 midstream urine samples submitted to Microbiology laboratory for Gram staining and bacterial culture were analyzed. Samples were microscopically tested, characterized, and identified using different media such as blood agar and Mac Conkey agar and by applying suitable biochemical tests. Urine specimens showing a significant bacteriuria on culture and single morphological type by Gram staining were then processed by MALDI-TOF MS.Results: Of 50 specimens, colony growth was observed in 43(86%) specimens, and 38(88.3%) specimens had growth of single-colony morphological type in culture. 32(84.2%) of them had colony counts of >105 colony forming units (CFUs)/ml. 7(14%) samples were negative in culture, and all of them were also negative by MALDI-TOF MS. Microorganism identifications in this group were coincident at the species level in 28(87.5%) specimens. The most frequent microorganism identified was Escherichia coli, followed by Klebsiella species and Acinetobacter baumanii. MALDI-TOF MS identified Providencia stuartii in 3 samples and Pseudomonas putida in 1 of them; which were not in accordance with the conventional method used for identification.Conclusions: Present study results show that MALDI-TOF MS allows bacterial identification from infected urine in a short time, with high accuracy, and especially when uncommon uropathogens are involved.
A six-year study of leiomyomata with emphasis on lipoleiomyoma
Authors: Manjula C. P. , Simon Naina Mary , Venkatesh Kusuma , Muneer Fazeela , Hemalata M. , R. Rangaswamy
Published: December 2018

Background: Leiomyoma is the most common benign neoplasm of the uterus. Lipoleiomyoma is a rare variant usually affecting women in the postmenopausal age group. Incidence of lipoleiomyoma varies from 0.59% - 2.1%. This study was undertaken to analyse the different variants, degenerative changes and to determine the incidence, clinical and morphological features of lipoleiomyoma amongst all the leiomyomas studied.Methods: This study was done in the Department of Pathology over a period of 6 years. Authors studied 575 patients with leiomyoma constituting a total of 1122 leiomyomata as some patients presented with multiple leiomyomata. Further clinicopathological correlation was done.Results: In the present study 98.03% of leiomyomata were uterine in location, 1.06% were cervical, 0.62% were in broad ligament and 0.26 % were in ovary. Among the 1122 leiomyomata studied, degenerative changes were noted in 19.6% of which hyaline degeneration was the most common. Leiomyoma variants constituted 5.27% of all leiomyomata. The incidence of lipoleiomyoma was 0.71% with size ranging from 3-10cm.Conclusions: Leiomyoma is a common tumor of the uterus and lipoleiomyoma variant is very uncommon with unknown etiology. They occur in postmenopausal as well as reproductive age group. The site of lipoleiomyoma can be uterine or extrauterine location such as broad ligament. Coexistance of metabolic derangement is an observation that may have a role in development of lipoleiomyoma.
A study to evaluate the outcome following Anderson Hynes pyeloplasty in hydronephrosis patients with cummings stent and D-J stent
Authors: Mukherjee Ramanuj , Mullick Mitrajit , Samanta Sudipta
Published: December 2018

Background: Uretero-Pelvic Junction Obstruction (UPJO) is an important cause of hydronephrosis in pediatric age group. The choice of treatment could be conservative or surgical. Commonly Anderson-Hynes pyeloplasty is practiced with internal, external or partly internal partly external stent.Methods: This was a prospective study of 40 patients with UPJO, divided into 2 groups consecutively, each consisting of 20 patients. All patients underwent open Anderson-Hynes pyeloplasty. Cummings stent were given in one group for drainage and conventional DJ stent were used for another group.Results: The mean hospital stay was lesser in DJ stent group (8.4±2.13) compared to Cummings stent group (11.4±0.68), not only in respect to primary admission, but also including readmission for cystoscopic stent removal. The incidence of complications was also fewer in Cumming stent group. Stent migration and urinary tract infection (UTI) were more associated with DJ stent (2 each) than Cumming stent (0 each). However, dysuria was more in case of cumming stent (2 patients) than DJ stent (1 patient).Conclusions: The mean hospital stay in DJ stent insertion is less even if duration for cystoscopic removal is considered. The complication of stent removal and UTI are more with DJ stent though dysuria is more in case of Cummings stent.
Knowledge, attitude and practices regarding malaria among residents of rural Mangalore, India
Authors: Gupta Animesh , Bhat Aishwarya
Published: December 2018

Background: Malaria is one of the most prevalent parasitic diseases worldwide and India has fourth highest number of malaria cases and deaths in the world. Prevention of the disease through better knowledge and awareness is the appropriate way to keep the disease away and remain healthy. Thus, the present study was aimed to assess the knowledge, attitude and practices regarding malaria among residents of Mangalore.Methods: Community based cross sectional study was conducted among residents in Mangalore. The data was collected by using pre-tested semi-structured questionnaire which include socio-demographic data, basic knowledge about malaria, transmission and preventive measures and health seeking behaviour regarding malaria through interview method.Results: Almost 98.4% respondents heard of malaria disease and 96% respondents had knowledge that malaria is caused by mosquito bite. Even, majority (72%) of respondents knew that malaria can be fatal. Regarding the symptoms of malaria, 52.4% respondents mentioned fever with chills and 11.6% respondents don’t know about malarial symptoms.Conclusions: Majority of the respondents were familiar with the malaria symptoms, mode of transmission and vector control measures. They had good knowledge of malaria disease and good practices of malaria control measures.
Morbidity and mortality profile of neonates admitted in special newborn care unit of a teaching hospital in Uttarakhand, India
Authors: Kumar Rakesh , Mundhra Rajlaxmi , Jain Anand , Jain Suchitra
Published: December 2018

Background: India accounts for 24% of global neonatal mortality. It is important to study the mortality and morbidity pattern as it helps to implement new treatment protocols, interventions, planning and policy making which helps in better survival and improvement in the quality of life among survivors. The aim of the project study was to determine the causes of morbidity and mortality in neonates admitted in our hospital.Methods: This study was conducted at Special Newborn Care Unit (SNCU) of Veer Chandra Singh Garhwali Government Institute of Medical Science and Research providing level II neonatal care. This is a retrospective hospital based observational study. Data from admission and discharge registers were extracted, compiled and analyzed from March 2016 to February 2018. Neonates taken against medical advice and those referred to tertiary care centers were excluded in calculation of survival outcome. Statistical analysis was done in form of percentage, proportions and chi square test was used to find statistical significance.Results: 1582 neonates were admitted during the study period. 60.80% were inborn and 39.20% were outborn. 59.54% were male and 40.46% were female. Major causes of admission were jaundice (24.72%), sepsis (20.48%), birth asphyxia (18.52%), meconium aspiration syndrome (10.11%). Birth asphyxia was the major cause of mortality, followed by sepsis and prematurity. Mortality was more in outborn babies 14.67% compared to inborn babies 9.80%.Conclusions: Neonatal jaundice, birth asphyxia and sepsis were the commonest causes of morbidity. Common causes of mortality were birth asphyxia and sepsis and prematurity. More deliveries at institutions with SNCU facility, early identification of danger signs and timely referral to tertiary care centers can prevent neonatal deaths.
Correlation of humeral length and its segments in a sample of Indian population: an osteological study
Authors: Samoon Saima , Itoo Mohd Saleem , Jan Neelufur , Bhat Gh. Mohd
Published: December 2018

Background: Anthropometry measurements are very useful and have definite medico legal significance. In case of missing persons in the absence of pelvis and cranium, the remains of long bones of an individual play an important role in anthropological practice for morphometric analysis. The stature of an individual can be estimated from the humerus alone. Estimating the mean values of different segments of humerus helps in forensic and anthropometric practice. Previous studies have confirmed that humerus is one of the strongest long bones of the human skeleton and its fragments can be recorded in a forensic case. The present study was done to assess the mean values of different segments of humerus and their correlation with its length.Methods: Seventy dry adult humerus bones (32 rights and 38 left) were collected randomly from the anatomy department. Broken bones and the bones in a poor condition were excluded from the study. The segments of the humerus were studied for morphometric analysis.Results: All of the measurements were obtained in millimetres (mm). The measurement of the maximum length of humerus (MHH) was done by using an otseometric board and the different segments of humerus were measured by a vernier calliper (precision=0.cm). Mean and SD were calculated.Conclusions: This study has helped us to observe the maximum length of humerus and the mean values of the different segments of humerus Indian population. The study also suggests that there are some differences between various segments of humerus within different populations.
Role of laparoscopy in the diagnosis and management of benign adnexal masses
Authors: Wakhloo Ajay , Sharma Suksham , Singh Gagan
Published: December 2018

Background: Adnexal masses are frequent findings in women of all age groups. It consists of the ovaries, fallopian tubes and uterine ligaments. Women can present with various gynaecological complaints and adnexal masses could be detected while examining and investigating for these complaints. The aim was to study the role of laparoscopy in diagnosis and management of benign adnexal masses.Methods: The study was conducted on 48 women of reproductive age group. Per speculum examination was done and PAP smear was taken before bimanual examination was done. A complete per vaginum examination was done and the adnexal mass was assessed for its size, side, consistency, laterality and tenderness. Laparoscopy was done to confirm preoperative diagnosis and appropriate procedure done depending on diagnosis.Results: Pain in the lower abdomen was the commonest chief complaint seen in 87.5% cases. 41.67% cases were suspected to have endometriosis while on laparoscopy it was seen in 47.92%, 33.33% were suspected to have ovarian cyst which decreased to 25% on laparoscopy, ectopic pregnancy in 16.67% cases both pre-operative and on laparoscopic examination and tubo-ovarian mass in 8.33% cases pre-operatively and 2.08% on laparoscopy.Conclusions: This study has shown that if proper preoperative evaluation was done, author can select the appropriate patients for laparoscopic approach.
Arthroscopic posterior-inferior capsular release in the treatment of overhead athlete with GHIRD: a case report
Authors: Adnyana Christian Stedy , Aryana I. G. N. Wien , Wirakarna I. B. Aditya , Angganugraha P. J. I. G. B. Indra , Trysna Andika Komang Arie , Ambong Hafidz Addatuang , Pranata Soehartono Hadi
Published: December 2018

Glenohumeral internal rotation deficit (GHIRD) is one of most controversial joint diseases in terms of diagnosis and treatment. The use of arthroscopy has improved the recognition of pathologic findings in glenohumeral internal rotation deficit (GHIRD) and allowed a better understanding of the etiology of it and the correlation between symptoms and lesion patterns. We present our technique for arthroscopic posterior-inferior capsular release in athlete with symptomatic glenohumeral internal rotation deficit (GIRD) that was unresponsive to nonoperative treatment and was preventing him from returning to sport. By this technique resulted in a successful outcome. We evaluate a 28 years old male with right shoulder pain and limitation in abduction internanal rotation after 3 months conservative treatment. We performed Arthrospcopic posterior-inferior capsular release. After 2 months correspondingly, we performed follow-up assessments on shoulder function (using the ases and rowe score) and pain (using a visual analogue scale) were made. Arthroscopic posterior-inferior capsular release can be recommended as a reasonable operative solution for overhead athletes with symptomatic GIRD that has not responden to conservative management. Evaluation of patient in whom we performed arthroscopic repair base on ases and rowe score. Arthroscopic posterior-inferior capsular release showed satisfactory shoulder function after 2 months follow up correspondingly.
Dietary diversity and associated factors among lactating mothers in Debre Tabor General Hospital, Northcentral Ethiopia
Authors: Engidaw Melaku Tadege , Gebremariam Alemayehu Digssie , Tiruneh Sofonyas Abebaw , Asnakew Desalegn Tesfa , Abate Bedilu Abebe
Published: December 2018

Background: Dietary diversity score indicates that the intake of general nutritional adequacy. Low dietary diversity is a major problem among poor populations in the developing world due to consumption of monotonous staple diet consumption. Therefore, it has various consequences on the health and wellbeing of the family, communities, and nation at large. Overall, there are limited studies on this major issue and its contributing factors among lactating mothers.

Methods: Institution based cross-sectional study was employed among 419 participants who were selected by using a systematic sampling method. The data were collected using a pretested structured questionnaire. The collected data were checked for completeness, cleaned, coded and entered into EPI info version 7 and exported into SPSS version 20.0 software for further analysis. The degree of association between dependent and independent variables were assessed by using odds ratio with a 95% of confidence interval and variables with p≤0.05 were considered significant after fitting into logistic regression.  

Results: The average dietary diversity score±SD was 4.94±0.76. The magnitude of low dietary diversity score was 25% (95% CI: 22.1, 30.4). Women’s, being government employer and having meal 2 times per day were the factors associated with low dietary diversity score among lactating mothers.

Conclusions: One-fourth of the lactating women were had poor dietary diversity and age of the women, meal frequency, and respondent occupation were the determinant factors. So, appropriate counseling during maternal care are very important to halt this problem.
A retrospective analysis with quality of life assessment of nasal surgery for nasal obstruction
Authors: Karakus Mehmet Fatih , Karakurt Suleyman Emre , Colak Mustafa
Published: December 2018

Background: Nasal obstruction is a common health problem that disrupts a person’s quality of life (QoL). The Nasal Obstruction Symptom Evaluation scale (NOSE) is a QoL scale with questions specific to nasal obstruction symptoms. This study aimed to evaluate surgical success in patients who underwent nasal septal deviation surgery by using a NOSE assessment, thus determining the importance and efficacy of surgery in this group of patients.

Methods: This study was conducted in between January 2016 and June 2017, including a total of 60 patients. The age range of the patients was 18–57 (mean, 34.4±9.9 years). The preoperative and postoperative scoring and surgeries were performed by the same investigator. The surgeries were septoplasty and radiofrequency applied to the inferior concha to overcome conchal hypertrophy. Preoperative mean scores were compared with postoperative second-month values. The importance of difference was evaluated with the Wilcoxon signed-rank test.  

Results: Preoperative minimum, maximum and mean scores were 65.0, 100.0 and 83.4 (83.41±8.15), respectively. Postoperative minimum, maximum and mean scores were 10.0, 35.0 and 21.6 (21.66±8.06), respectively. The difference in mean scores was significant (Z=−6.778; p<0.001).

Conclusions: The difficulty in evaluating patient satisfaction and postoperative success stems from differences in each surgeon’s approach and the comparison of preoperative and postoperative findings. This study, which was carried out by the same researcher for all steps, differs it from similar studies.
A study of microbial gamut and antibiograms in chronic suppurative otitis media
Authors: Hussain Raj Tajamul , Altaf Sanam , Makhdoomi Owais , Ali Mariya
Published: December 2018

Background: The aim of the study was to discern the patterns in microbial diversity and the resistogram among the patients suffering from CSOM.

Methods: A total number of 100 ear swabs were investigated for the present study. Their gram staining, direct microscopy with KOH, culture sensitivity, and biochemical tests were carried out to identify the organisms and to know their sensitivity pattern. All the swabs were collected from clinically diagnosed cases of chronic suppurative otitis media visiting otolaryngology outpatient department of tertiary care hospital. The study period was one year, from January 2016 to December 2017.  

Results: Out of total 100 cases, 90 were culture positives, 6 showed no growth and 4 were skin contaminants (mirococci). Out of 90 culture positives, fungal culture was positive in 5 (5.5%) while combined bacteria and fungi obtained in 18 (20%) cases and only bacteria in 67 (74.4%) cases. Among the aerobic bacterial isolates, Pseudomonas aeruginosa was the most common bacteria isolated from the bacterial culture (n=36; 34.95%) followed by Staphylococcus aureus (n=28; 27.18%) and Proteus (n=13; 12.62%). Among the fungal isolates, Aspergillus niger was predominant followed by Candida albicans & Aspergillus flavus. Amikacin and imipenem were found to be the most effective antibiotics with low resistance rates.

Conclusions: The present study gave an insight into the bacteriological profile of the cases of CSOM and their antibiotic sensitivity patterns. This in turn will ensure rational and judicious use of antibiotics and thus prevent emergence of resistant bugs and also the complications associated with CSOM.
A review of pharyngeal mucosal closure technique in total laryngectomy
Authors: Govindasamy Gopu , Shanmugam Subbiah , Murugan Arul
Published: December 2018

Background: The purpose of this retrospective analysis was to review our single institute based experience with the pharyngocutaneous fistula following total laryngectomy and to determine the impact of pharyngeal closure technique in the development of PCF in our patients.

Methods: The medical records of the patients, who underwent total laryngectomy for squamous cell carcinoma of the larynx and hypopharynx in Government Royapettah Hospital, center for oncology between January 2010 and December 2017, were retrospectively reviewed.  

Results: 26 patients were included in the study of which 25 were male and 1 was female. Mean age of the patients were 58 years. Horizontal closure was done in 9 patients (35%) and T closure was done in 17 patients (65%). PCF was observed in 1 of 9 patients in horizontal closure. Remaining 17 patients underwent T closure of whom 8 patients developed PCF (p=0.06). Eight out of 18 patients (44%) developed PCF after salvage surgery after radiotherapy failure, Remaining 8 patients underwent primary laryngectomy for advanced stage cancers with cartilage involvement, of whom 1 patient developed PCF (12.5%) (p=0.11). In salvage laryngectomy (n=18), 1 of 6 cases developed PCF in horizontal closure and 7 of 12 cases in T closure technique (p=0.09).

Conclusions: The incidence of fistula in our study was 34%. Horizontal closure was associated with decreased incidence of PCF when compared to ‘T’ closure of the defect. Prior radiotherapy had increased incidence of PCF.
Reconstruction of the larynx with unipedicled sternohyoid myofascial flap following open extended vertical partial laryngectomy
Authors: Yagudin Ramil K. , Yagudin Kamil F.
Published: December 2018

The extent of resection during open vertical partial laryngectomy may vary considerably and even an experienced surgeon may encounter difficulties in reconstructing the larynx to preserve laryngeal function and to prevent stenosis. Different local flaps were proposed for reconstruction; however, the ideal technique is still under development. A simple modification to the technique originally described by Calcaterra (1983) is presented. The unipedicled sternohyoid myofascial flap consists of the unsplit sternohyoid muscle with all three overlying fasciae harvested as a whole. The flap is rotated 90° and horizontally sutured in position to supply the necessary bulk to the entire neocord to produce a functional voice. Completely filling the mucosal defect USMF-flap allows laryngeal structures to maintain their native position and retain protective function of the larynx. The thick multilayered fascia covering facilitates rapid epithelization and prevents excessive granulation and secondary stenosis. The technique is indicated in glottic cancer patients treated by open extended vertical partial laryngectomy when the laryngeal mucosa defect is too extensive for primary closure and poses significant risk of developing postoperative stenosis.
Management of the neck in malignant parotid neoplasm
Authors: Abdelwanis Ahmed , Barman Sowrav
Published: December 2018

Parotid gland cancer (PGC) are rare and accounts for 3% of all head and neck malignancies.The classification of parotid tumour is complex and comprises both benign and malignant neoplasms of epithelial and non-epithelial origin.There is marked variation in the histological features of these tumours,therefore treatment options of parotid cancer is widely varied.Lymph node metastasis to the neck is one of the most important factors in therapy and prognosis for patients with parotid malignancy. This article reviews the literature regarding neck management of parotid cancer in cases of both clinically positive (cN+) and clinically negative (cN-) neck nodes. The literature search was performed using Google search engine, PUB Med to identify relevant articles on recommendations for neck management in patients with parotid cancer in cases of both clinically positive (cN+) and negative (cN-) neck nodes. Due to the rarity of parotid cancer and the wide histopathological varieties, the literature was hard to interpret. There is a consensus about managing clinically positive neck with therapeutic neck dissection. Most studies agree on elective neck dissection in certain indications which are high T stage, high grade histology, facial paralysis, age, extraglandular extension, peri-lymphatic invasion. Level II to IV appears to be at higher risk and can be done through the same parotidectomy incision. The role of irradiation in cN- necks is not clear but some studies recommend its usage for curative intent and argue that it adds less morbidity than the elective neck dissection. Although the management of the neck in cN+ patients is widely agreed, controversy still exists about the need for elective neck dissection in cN- patients and the levels which should be dissected.
Management of radiation-related supraglottic stenosis with serial in-office steroid injections
Authors: Kim Christine M. , Patel Pratik B. , Feinstein Aaron J. , Chhetri Dinesh K.
Published: December 2018

Management of supraglottic stenosis in patients with history of head and neck radiation presents a clinical challenge for otolaryngologists. The cornerstone of treatment has historically been surgical intervention, both endoscopic and open. However, recently described techniques related to outpatient management of subglottic and tracheal stenosis with routine in-office steroid injections may provide a translatable model for supraglottic stenosis management. We describe a clinical protocol for in-office steroid injections to the laryngopharynx for patients with supraglottic stenosis secondary to radiation fibrosis. Two patient cases are reported, including endoscopic examinations over a follow-up period of 12 to 16 months. Both patients experienced significant improvement in their supraglottic airways. In-office steroid injections may be beneficial to prevent or slow stenosis recurrence in patients treated with radiation for head and neck cancer. With continued refinement of this technique, a paradigm shift may occur in the management of supraglottic stenosis.
Changes in speech charactersitics post thymoma
Authors: Arya Shantanu , . Sachin , Garg L. N. , Wangmo Tashi , Zangmo Nima , Sharma Komal
Published: December 2018

Thymomas are rare tumors of the anterior mediastinum that may be benign or malignant. Thymomas are frequently associated with neuromuscular disorders like myasthenia gravis. Multiple cranial nerves are involved which may affect speech of the patients. Flaccid dysarthria is one of the common motor speech disorders associated with thymoma. Other characteristics may include decrease of intelligibility, reduced vocal stamina, reduction of emotional expressivity etc. The present case study illustrates changes in speech characteristics in a 35 year old male patient with thymoma associated with myasthenia gravis. Detailed speech assessment was done which revealed deviant speech patterns like vocal tremors, decreased loudness, hypernasality etc. The aim of the study was to document speech characteristics in a known case of thymoma associated with myasthenia gravis.
Verrucous carcinoma of the glottis and subglottis: a rare case report
Authors: Tiwari Markandeya , Gonzaga Fernandes Vinson Louis , Gouveia Pinto Nina Margarida De , Sukhthankar Isha Rajendra
Published: December 2018

Verrucous carcinoma is a rare well differentiated squamous cell carcinoma with minimal metastatic potential. Its occurrence in the glottic and subglottic subsets of the larynx is another very rare entity. We highlight a case of an elderly male who was histopathologically diagnosed as verrucous carcinoma of the glottic and subglottic larynx. We shall discuss the clinical presentation, diagnosis, management, prognosis and postoperative follow up of the patient.

 
Unilateral percutaneous vertebroplasty for symptomatic osteoporotic vertebral compression fractures -evaluation of radiological and clinical outcomes
Authors: Pooswamy Shanmuga Sundaram , Muralidharagopalan Niranjanan Raghavn
Published: December 2018

Background: Vertebral fractures are the most common type of osteoporotic fractures. These are developing into a significant health problem worldwide as about 30% of the patients above 50 years suffer from a fracture secondary to osteoporosis. Osteoporotic vertebral fractures may be treated with rest and analgesics. Some fractures may also require surgery. Percutaneous procedure like vertebroplasty and kyphoplasty done under local anaesthesia can reduce the pain and restore height of vertebral body without need for an open surgery. The aim of the study was to assess the clinical and radiological outcomes following unilateral percutaneous vertebroplasty under local anaesthesia.

Methods: 21 patients who underwent unilateral vertebroplasty for symptomatic osteoporotic compression fracture between 2012 and 2015 were included in the study. Unilateral vertebroplasty using an 11-gauge trocar through transpedicular technique was performed under c-arm guidance. Patient was mobilized as soon as tolerated. Oswestry disability index and visual analogue scale were assessed pre-operatively, in the immediate post-op and at 1-year follow up.

Results: There were 15 females and 6 males. The mean age was 70.04±6.07 years. The pre-op ODI score was 76.8±7.6. The pre-op VAS score was 7.66±0.71. The average time period from fracture to vertebroplasty is 4.19±3.19 days. The immediate post-operative VAS score was 5.76±0.8 and the ODI score was 62.85±7.17.  The VAS at final follow up was 1.23±1.19. ODI at final follow up was 9.04±3.19. There was a showed a significant improvement when preoperative, immediate post-operative ODI and VAS scores and final follow up (p<0.001).

Conclusions: In our study unilateral percutaneous vertebroplasty has provided pain relief, early mobilization of the patient with less complication without the requirement of general anaesthesia.
Thoraco lumbar spinal tuberculosis-assessment of functional outcome following posterior decompression and posterior instrumentation
Authors: Pooswamy Shanmuga Sundaram , Muralidharagopalan Niranjanan Raghavn
Published: December 2018

Background: Spinal tuberculosis is the most common form of extra pulmonary tuberculosis. Complications of untreated spinal tuberculosis include neurological deficit and gibbus deformity. Treatment of spinal TB can be surgical or conservative. Surgical treatment is the mainstay in spinal tuberculosis with neurological deficit. Various approaches to surgical management are anterior only, combined anterior & posterior and posterior only. Posterior only approach is less traumatic and more familiar to orthopaedicians.

Methods: 23 patients diagnosed of spinal tuberculosis with neurological involvement who underwent single stage posterior decompression and posterior stabilization were analyzed with ASIA grading and VAS score..

Results: The mean age of the study population was 48.86. There were 12 females and 11 males. The mean operative time and blood loss were 152.19 minutes and 265 ml. Increasing age correlated with blood loss and operating time. The mean follow up period was 36.21 months. There were significant differences in the ASIA and the VAS scores when pre-operative, immediate post-op and final follow up where compared.

Conclusions: Single stage posterior decompression and instrumentation is a safe and effective procedure in the treatment of tuberculous spondylodiscitis with neurological deficit and a kyphotic angle <60o. The long-term results are better because of posterior instrumentation, which provide stability and the healing anteriorly following antituberculous treatment.
Platelet-rich plasma for the improvement in shoulder function in rotator cuff disorders
Authors: Singh Shashi Kant Kumar , Ojha Ankur
Published: December 2018

Background: Among causes of shoulder pain, rotator cuff disorders are very common. The exact pathogenesis of rotator cuff tears is not clearly understood. To improve outcomes, the relatively new technique of injection of PRP is under investigation. Purpose of this study is to clinically evaluate the efficacy of new treatment of PRP injection in shoulder pain due to rotator cuff pathology.

Methods: A prospective, observational study, on patients with shoulder pain diagnosed as rotator cuff disorders admitted in Department of Orthopaedics, RIMS, Ranchi during one year time interval (from 10th October 2016 to 09th October 2017) in the age ranging from 41 to 80 years with a mean age of 57.90 years was conducted. 20 Patients were selected for the study. Initial pre-injection score of patient taken on constant shoulder score and noted. Patient underwent intra-articular injection of PRP in shoulder joint through posterior approach under local anaesthesia. Patients were followed up at 1st post-injection day, 1 month, 3 months and 6 months after the injection.

Results: Results were analysed according to constant shoulder score. In partial tear 5 (41.67%) have excellent, 6 (50%) have good and 1 (8.33%) has fair outcome on 6 months follow up and in full tear all 8 (100%) patients have poor outcome and none of the patients developed any complication.
Conclusions: A single injection of PRP resulted in a safe, significant, sustained improvement in pain and functional outcomes for patients with refractory partial rotator cuff tear (RCT). 
 
Disseminated Tuberculosis in a Postpartum Young Women Presenting as Isolated Optic Neuritis
Authors: Sivakumar Priya
Published: December 2018

Tuberculosis (TB) is the first infectious disease declared by the World Health Organization as a global health mergency. It remains the leading cause of death among infectious diseases causing more deaths worldwide than uman immune deficiency virus (HIV) [1]. The following case report highlights the occult and non specific  resentations of the disease which makes it a diagnostic challenge. We report a case of extensively disseminated tuberculosis in an immune competent post partum young woman presenting as isolated optic neuritis. Extra pulmonary tuberculosis is commoner among immune compromised patients. Co-existence of military and intracranial tuberculosis in an immune competent person is extremely rare.
Acute Posterior Multifocal Placoid Pigment Epitheliopathy: A Case Report with Optical Coherence Tomography Angiography Images
Authors: Bilbao Valentina , Sádaba Luis Manuel , Ciufo Gianfranco , García-Layana Alfredo
Published: December 2018

The Acute Posterior Multifocal Placoid Pigment Epitheliopathy (APMPPE) is a rare acquired idiopathic inflammatory disease that affects the choriocapillaris and external retinal layers. It usually presents as a bilateral, asymmetric, acute, visual loss in young healthy adults. The etiology of APMPPE is unknown and the pathogenesis is controversial, but it is thought that an obstructive vasculitis is the underlying disorder, causing non-perfusion of the retina layers. Funduscopic evaluation is characterized by multiple yellow-white lesions at the level of the retinal pigment epithelium (RPE) and choriocapillaris. Recently, noninvasive techniques of optical coherence tomography angiography (OCT-A) have provided a detailed three-dimensional analysis of blood flow in the retina’s layers and the inner choroid. To our knowledge there have been only a few reports describing OCT-A findings in APMPPE, so we describe a case that might contribute to the growing evidence of a primary choroidal involvement with secondary damage to the overlying RPE and the outer retinal layers, rather than a primary RPE inflammatory etiology, as was originally thought.
Effectiveness of a Preservative-Free Eye Drop, Cyclosporine 0.05% Emulsion, and Omega-3 Supplementation as a Fixed Combination in Dry Eye Disease – a Pilot Study
Authors: HA Tokko , A Al-Awadi , S Somani
Published: December 2018

Purpose: We aim to evaluate the impact of combining a preservative-free drop, cyclosporine 0.05% emulsion, and omega-3 oral supplementation on the signs and symptoms of dry eye in a typical ophthalmic practice.Design: A retrospective case series conducted on patients with dry eye disease.Methods: Patients diagnosed with dry eye in a typical ophthalmology practice were initiated on a fixed combination regimen which included a preservative-free eye drop (I-DROP ® PUR GEL, I-MED pharma), cyclosporine 0.05% ophthalmic emulsion, and oral omega-3 supplement(Dry Eye Omega Benefits®, PRN)for 3 monthsconsecutively. The primary outcome measured was a symptom score using the Canadian Dry Eye Assessment Tool (CDEA). Secondary outcome measure was Non-invasive Keratograph Break-up Time (NIKBUT). Primary and secondary outcomes measured at baseline and 3 months following intervention were compared.Results: Thirty-six patients were included with a female male ratio of 2.6:1 and average age of 64.Patient symptoms improved significantly following the intervention as demonstrated by a lower CDEA score during the second visit compared to the first visit (16.11 vs. 19.50, respectively) (p< .05). NIKBUT scores were also significantly improved as demonstrated by a higher score during the second visit compared to the first in both the right (13.18 vs. 11.44) (p< .05) and left (14.62 vs. 12.78) (p< .01) eyes, respectively.Conclusion: A fixed combination of preservative-free eye drops, cyclosporine 0.05% and omega-3 supplementation may be an effective first line treatment option in alleviating symptoms and improving signs of patients suffering from dry eye.
Long Term Use of Proton Pump Inhibitors: Where to Draw the Line
Authors: Haque M. Manzurul
Published: December 2018

Proton pump inhibitors are the leading evidence-based therapy for acid related upper gastrointestinal disorders including dyspepsia, GERD and peptic ulcer disease. These are among the most frequently prescribed drugs globally. However, PPIs have been subjected to studies and have been associated with increased risk of adverse effects like Clostridium difficile-associated diarrhea, community-acquired pneumonia, bone fracture, reduced intestinal absorption of vitamins and minerals, and more recently kidney damage and dementia etc. In this review the recent literature regarding these adverse effects and their association with long-term proton pump inhibitor treatment is discussed. The objective of this review is to analyse the potential adverse effects of long-term PPI use and summarize the clinical implications. We documented a considerable increase in the use of PPIs over the last decade. This increase is due to over-prescription and use of PPIs for inappropriate indications. On the other hand, some patients may have had PPI therapy discontinued abruptly or inappropriately due to safety concerns. However the patients with a proven indication for a PPI should continue to receive it in the lowest effective dose for a shortest possible time. Finally, in most cases and based on the available evidence, PPIs benefits seem to outweigh potential adverse effects. Large randomized prospective trials are required to more firmly establish direct cause and effect relationships between PPIs and adverse events.
Spatz3 Adjustable Balloon: Weight Loss and Response Rates in Brazil
Authors: De Almeida Leonard Salles
Published: December 2018

Background: The degree of efficacy and duration of effect of Intragastric Balloons (IGBs) can be variable and unpredictable. The Spatz Adjustable Intragastric Balloon (AIGB) was developed to address these issues by extending implantation to 1 year, decreasing balloon volume for intolerance and increasing volume for decreased balloon effect.Aims: To determine the efficacy and response rate of the Spatz3 AIGB.Methods: Results of 379 consecutive patients (pts) implanted with the Spatz3 AIGB were retrospectively reviewed (3 lost to follow up). Mean BMI 35.5; mean weight (wt) 97.5 kg; mean excess wt 29.1 kg; mean balloon volume 600ml. Balloon volume adjustments were offered: Down adjustments for intolerance and up adjustments for decreased balloon effect.Results: The mean implantation time of 376 pts was 10.6 months yielding mean wt loss 14.9 kg; mean 15.1% Total Body Wt Loss (%TBL) and 58% Excess Wt Loss(%EWL). Response rate (> 25%EWL) was achieved in 79% (297/376) of pts. Down adjustments in 95 pts (mean 2.4 months; mean -152.4 ml) allowed 76/95 (80%) to continue IGB therapy for at least 6 months (mean 9.1 months). Up adjustments in 205/376 (54.5%) pts (mean 5.8 months; mean + 179.2 ml) yielded additional mean wt loss of 6.5 kg. There was 1 gastric ulcer (0.27%). One balloon deflated at 7.4 months and 4 others deflated after 1 year (13-23 months).Conclusions: In this retrospective review of 376 Spatz3 AIGB patients, up adjustments yielded a mean 6.5kg extra wt loss for those with wt loss plateau, and down adjustments alleviated early intolerance. These two adjustment functions may be instrumental in yielding a successful outcome (> 25% EWL) in 79% of pts.
Orthopedic Problems in Overweight and Obese Children
Authors: Gennaro GL Di
Published: December 2018

According to the data published by Haslam and James, about 10% of the world populations aged up to 18 areoverweight or obese [1]. In Europe, there are about 20% children with excessive body mass, 5% of whom sufferfrom obesity [2,3]. Childhood obesity is an ongoing epidemic in the United States [4,5]. The most recent data fromthe US indicate that 16.9% of children and adolescents are obese, defined as a body mass index (BMI) for age >95thpercentile [6,7] and there is evidence that the prevalence of obesity among children will reach 30% by 2030 [8].Childhood obesity is a risk factor for greater morbidity later in life, including diabetes, coronary artery disease andincreased mortality [4,5,9,10].