bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical measurement of intermalleolar distance in Western Indian population
Authors: Gupta Renu , Nayyar Ashish Kumar , Ghatak Surajit
Published: January 2021

Background: Angular deformities around the knee are one of the common basis of presentation at orthopaedic clinic and intermalleolar distance (IMD) is an essential anthropometric tool for evaluation of the angular status of the lower limb.Methods: 500 healthy (330 male and 170 female) subjects between 20 to 40 years of age were taken for IMD measurement in standing and supine position by digital vernier caliper.Results: The normal range of IMD in western Indian population in between 32-58 mm. IMD in standing position was 42.47 mm with (95% CI = 40.51 to 44.42 mm) and in supine position was 34.45 mm with (95% CI = 32.78 to 36.13 mm). Mean IMD in male in standing position was 40.01 mm while in female it was 43.74 mm observed. Statically significant difference was observed in posture change and according to age.Conclusions: Significantly higher value in female, in standing position and in higher age group were observed.
Clinical pharmacokinetics and pharmacodynamics of vildagliptin 50 mg sustained release tablet formulation in healthy Indian males after single and multiple-dose
Authors: Pote Alok , Ravisankar Santhanam , Sangle Ganesh , Agarwal Sunil , Patil Mohan , Deshmukh Nitin , Kale Sushil , Baig M.L.A. , Yarramshetti Viresh , Debnath Khokan , Shah Ruchi , Ingole Shahu , Jain Rishi
Published: January 2021

Background: Vildagliptin 50 mg once-daily is a clinically established anti-diabetic therapy in combination with a sulphonylurea and renally impaired patients. We developed sustained release (SR) vildagliptin 50 mg tablet formulation for prolongation of dipeptidyl peptidase-4 (DPP-4) inhibition coverage. The present study compares the pharmacokinetic (PK) and pharmacodynamic (PD) characteristics of investigational vildagliptin SR 50 mg tablet with Galvus® in healthy Indian adult males after single and multiple-dose administration.Methods: Each randomized, open-label, two-period, cross-over study enrolled 36 healthy Indian adult male subjects for the assessment of single and multiple-dose PK/PD profiles of SR 50 mg vildagliptin under fed condition. The plasma drug concentrations were quantified using a validated liquid chromatography-tandem mass spectrometry (LC-MS/MS) method. PK parameters (Cmax (ng/ml), AUC0-18, AUC0-36, and AUC0-τ (ng.hr/ml), Tmax (hour), t1/2 (hour), Tmaxss (hour), Cτss (ng.hr/ml) were calculated using Phoenix® WinNonlin® software. The DPP-4 inhibition was determined in a fluorescence-based assay.Results: Vildagliptin SR tablet showed prolonged PK/PD characters compared to Galvus®. All PK parameters expressed as Mean±SD. The single-dose PK measures were Cmax (58.22±11.31), AUC0-18 (556.92±135.84), AUC0-36 (608.82±159.84), Tmax (6.48±3.78). In the multiple-dose study, PK findings were Cmax (73.20±17.71), AUC0-τ (714.36±303.21), Cτss (4.15±6.51), Tmaxss (5.60±3.12). Vildagliptin SR 50 mg achieved prolonged DPP-4 inhibition (≥80%) for18-20 hours after single and multiple-dose administration as compared to Galvus® (12-13 hours).Conclusions: Investigational vildagliptin SR tablet was found safe, well-tolerated after single and multiple-dose administration. Its extended DPP-4 inhibition profile compared to Galvus® may benefit the patient population on combination therapy with a sulphonylurea and renally impaired patients.
A study of etiology and epidemiology of onychomycosis from a tertiary care hospital in North India
Authors: Tyagi Shivani , . Neha , Kaur Ravinder , Rawat Deepti
Published: January 2021

Background: Onychomycosis is the fungal infec­tion of nail of which the incidence varies from 0.5-12% in India and around 5% worldwide.Onychomycosis is considered to be gender and age-related disease, being commoner in males and older adults in both genders. Apart from dermatophytes, other fungal agents like yeasts and non-dermatophyte moulds are increasingly being acknowledged as important etiological agents for the same. Our aim was to study the etiology of the nail infections in patients presenting to a dermatology department in a tertiary care hospital in central Delhi.Methods: This study included nail samples from patients of various age groups with suspected onychomycosis attending dermatology clinics in our hospital over a period of 2 years. For all samples, KOH wet mount microscopic examination followed by culture on Sabouraud’s dextrose agar was done. Growth of filamentous fungi and yeast obtained on SDA were identified using conventional microbiology techniques. Statistical analysis was performed using Epitools.Results: Of the total 1061 nail samples received, maximum prevalence seen in patients of age group 21 to 50 years. The positivity of onychomycosis was 57.02%. Out of culture positive samples, 24.62% grew dermatophytes and 75.37% grew non-dermatophytes (31.40% yeasts and 43.97% non-dermatophyte moulds). Trichophyton mentagrophytes was the most common (59.73%) dermatophyte followed by T. rubrum (23.49%) while among non-dermatophyte moulds; Aspergillus niger (20.68%) was the most common followed by A. flavus (16.54%) and others. Common yeasts included Candida spp. (65.79%) and Trichosporon spp. (28.95%).Conclusions: Non- dermatophytes are emerging as major etiological agents of onychomycosis which may be accounted various host factors. So, it becomes important to correctly identify the causative fungi to ensure appropriate treatment.
Poncet’s disease (tuberculous rheumatism) in a Nigerian male: a frequently overlooked diagnosis
Authors: Emorinken Airenakho , Ugheoke Asuwemhe J. , Agbadaola Oluwaseun R. , Okoh Babara
Published: January 2021

Poncet’s disease is an uncommon syndrome and a reactive polyarthritis associated with active tuberculosis with no evidence of mycobacterial infection of the joint. The condition is different from tuberculous arthritis which is usually monoarticular and caused by direct tubercular involvement of the joint. There has been a paucity of case reports on Poncet’s disease in Nigeria despite the high incidence of tuberculosis. We report a case of a 45-year male who presented with inflammatory polyarthritis involving the knees, wrists, ankles, small joints of the hands bilaterally of four weeks duration. This was preceded by three week’s history of productive cough. Chest radiograph and sputum Gene Xpert revealed features consistent with tuberculosis. Synovial fluid from knee joint effusion showed no evidence of mycobacterium tuberculosis. He was diagnosed to have Poncet’s disease based on the clinical findings and investigation results. He was commenced on antituberculous medications with complete resolution of symptoms after two months. Poncet’s disease is a rare manifestation of tuberculosis and should be considered a differential in any case of active tuberculosis presenting with arthritis. The correct and prompt identification of this condition by clinicians is important with the aim of instituting the appropriate therapy.
Skin graft of contralateral aesthetic unit for reconstruction of the upper eyelid: case report and literature review
Authors: Llave Heriberto Garza de la , Orozco-Grados Jose De Jesus , Rodriguez Carlos Eduardo , Chavez-Serna Enrique
Published: January 2021

Eyelids represent a complex structure; its principal function is to provide physical and immunological barrier. The complexity of this structure lies in the blinking and in the range of movement they carry out respecting the integrity of the cornea. The objective of this study is to provide a surgical alternative with minimal morbidity for the reconstruction of the upper eyelid, as well as to present the available tools for the treatment of this complex area of the facial anatomy. We present the case of a female patient of 62 years, with 50% of necrosis on the surface of the upper eyelid and infection data, surgical management was initiated with debridement, systemic antibiotic therapy and negative pressure system device, once the infectious process was resolved and according to the principles of reconstruction by aesthetic subunits, it was decided to reconstruct 100% of the subunit affected by a skin graft of total thickness of the contralateral eyelid through a blepharoplasty with good aesthetic-functional results. The reconstruction of the eyelids should be managed by a plastic surgeon, taking into account the principles of the aesthetic subunits, optimally the donor tissue should have similarity with the tissue to be reconstructed, with respect to the size, color and flexibility, to obtain an adequate aesthetic and functional result.
Two broken pieces make a whole: adductor canal block
Authors: Nagtilak Harshada Hanamant , Deshmukh Vidhya , Gupta Ankit , Mehta Hemant
Published: January 2021

Total knee arthroplasty (TKA) is expounded to intense postoperative pain with a desire for early ambulation and reduce postoperative complications. Adductor canal blockade (ACB) blocks primarily the pain sensation while preserving the quadriceps strength facilitating early rehabilitation after knee surgery. ACB has been gaining popularity over femoral nerve block (FNB), continuous epidural analgesia (CEA), and psoas compartment block (PCB). Studies show that use of ultrasound alone reduced the possibilities of vascular and multiple skin punctures. Though there's emerging evidence proving the efficacy of ACB, there's limited literature on safe use of continuous ACB catheters. We report 2 cases of catheter fracture with USG guided ACB employed in TKA.
An unusual case of malignant mesothelioma mimicking as Fournier’s gangrene
Authors: Sundar Geoffrey E. , Laxminarayana Kishan Prasad Hosapatna , Shetty Jayaprakash Kubalady , Lobo Lancelot
Published: January 2021

Fournier gangrene is a rare, life-threatening necrotizing fasciitis that usually involves the perineal or genital areas. Malignant mesothelioma in the inguinal and paratesticular region is a very rare entity and manifesting as Fournier’s gangrene is still rare. Here we present a case of malignant mesothelioma which presented clinically as Fournier’s gangrene.
Congenital granular cell tumour - a case report
Authors: R. Atheetha , Sundaram Sankar
Published: January 2021

Congenital granular cell tumour (epulis) is a rare benign tumour occurring in gingiva of neonates, of unknown histogenesis, predominantly occurring in girls. It can cause feeding and respiratory difficulty. We describe a case of a newborn male baby born with swelling in the gingiva of anterior segment of upper jaw. The lesion was excised, with baby doing well at follow up.
Fungal necrotizing fasciitis of face- a reconstructive challenge
Authors: Gupta Deepti , Sarabahi Sujata , K. T. Ananda Murthy , Aggarwal Nupur
Published: January 2021

Fungal necrotizing fasciitis (NF), particularly in the face, is an unusual infection. It is mostly seen in immunocompromised individuals and can be gravely destructive if diagnosis and treatment are delayed. We report this rare case of a 27-year-old, immunocompetent male who presented with gangrenous patch of skin on the cheek following blunt trauma to the right side of the face. Till now no case has been reported in literature with such an extensive soft tissue loss of face and involvement of facial skeleton due to fungal etiology. Clinical suspicion of necrotizing fasciitis led to early surgical intervention. Histopathological examination of the debrided tissue identified the infective organism as Apophysomyces elegans. Intravenous antifungal therapy with liposomal amphotericin B was initiated. Despite the prompt commencement of the treatment, the infection continued to spread, and the patient had to undergo serial debridement which resulted in orbital exenteration, partial maxillectomy and mandibulectomy on the right side. This resulted in a huge soft tissue defect requiring flap cover. A free anterolateral thigh flap was harvested to cover the soft tissue defect, but the blood flow could not be established. For salvage, scalp and pectoralis major muscle flaps were raised and used to cover the large hemifacial defect. The oral lining was created with a folded deltopectoral flap in a second stage. However, there was persistence of the fungal elements in wound bed even after prolonged systemic liposomal amphotericin B therapy and it invaded the flap margins due to which there was partial necrosis of the flap. In this article, we aim to describe the difficulties faced by us in the management of such devastating infection and the reconstructive challenge that it posed.
Post prandial glucose can be a substitute for HbA1c in low resource setting: answering the diagnostic dilemma
Authors: Kumar Binay , Prasad Nidhi , Shekhar Ravi
Published: January 2021

Achieving a strict glycaemic control is the key factor in diabetes management and associated complications. Although A1C is the best indicator of overall glycaemic control during the previous 2-3 months and remains the gold standard for assessing glycaemic control in patients with diabetes. But in low resource setting areas where HbA1c is a costlier affair, postprandial plasma glucose estimation can be a good alternative in estimating glycaemic control. By analyzing the results from many previous papers on glycaemic profiles, we conclude that contribution of postprandial plasma glucose was relatively high in patients with fairly good control of diabetes (HbA1c <7.5%) and decreased progressively with worsening diabetes (HbA1c >10.2%). Whereas the contribution of fasting plasma glucose showed a consistent contribution with increasing levels of HbA1c. So, we can understand that post-meal glycemia was a better predictor of good or satisfactory control of diabetes (HbA1c <7.5%) than was fasting glucose. Postprandial plasma glucose is the prominent contributor in patients with satisfactory to good control of diabetes, whereas the contribution of fasting plasma glucose increases with worsening diabetes. Hence, PPG is better in predicting overall glycaemic control in the absence of HbA1c.
Evaluation of role of preoperative chemotherapy for carcinoma of the gastro-esophageal junction
Authors: El-Kased Ahmed F. , Abdelbary Naser M. , Albatanony Ayman A. , Almelegi Mohamed H. , Youssef Fatma I.
Published: January 2021

Background: Preoperative chemotherapy has become an established management of locally advanced carcinoma of gastro-esophageal junction. Determining the down staging effect and predicting the pathological response to preoperative chemotherapy are mandatory.  Methods: This is a prospective study which started by 40 patients presenting with gastro-esophageal junction (GEJ) tumor to the General surgery and Oncology outpatient clinics of the Menoufia University Hospitals during the period from July 2017 to July 2020. Pretreatment staging and multidisciplinary group discussion were done for all patients. Inclusion criteria were patients with locally advanced GEJ carcinoma, performance status≤2 and no previous history of chemo or radiotherapies. We excluded patients with distant metastasis, performance state>2 and previous chemo or radiotherapies. Preoperative chemotherapy ECX regimen (epirubicin, cisplatin, capecitabine) was planned. Only 20 patients completed chemotherapeutic regimen for 3 to 4 cycles followed by a radical surgery. All patients were allocated a clinical stage before and after preoperative chemotherapy and were compared to post-operative pathological stage. Postoperative complications were recorded. Follow up of patients was done for 2 years. Results: Among total number of 40 patients, only 20 patients completed our study by preoperative ECX chemotherapy followed by radical surgery. The median overall survival was 30 months and the 2-year disease free survival ranged from 24-40 months with median time of 25.5 months. Complete pathological response was found in 6 patients (30%).  Conclusions: Pre-operative chemotherapy using ECX regimen followed by surgery could be used for treatment of locally advanced GEJ carcinoma and has showed a favourable survival.
Postoperative clinical outcome of aortic valve surgery in elderly patients and the effect of advanced age on atrial fibrillation: a comparative retrospective study
Authors: Borulu Ferhat , Arslan Umit , Çalik Eyupserhat , Erkut Bilgehan
Published: January 2021

Background: This study was conducted to evaluate the clinical outcomes of aortic valve surgery in elderly patients and to determine the factors associated with atrial fibrillation.Methods: Between 2011 and 2015, 54 patients who underwent isolated aortic valve replacement for aortic stenosis without preoperative arrhythmia were divided into two groups as 50-69 years old (group I; n=25) and 70 years and older (group II; n=29). Patient's medical record was retrospectively reviewed. Pre, peri and post operation data was compared. The deaths that occurred in the first 30 days were evaluated as mortality and complications as morbidity.Results: Mortality rate was found 9.2% (5/54) (p=0.358) in the first 30 days and 8.1% (4/49) the first six months follow-up and no difference was found between the two groups (p=0.153).  The following parameters were observed in group 2 and were found statistically significant: average age (p<0.01), euroscore (p<0.01), duration of cardiopulmonary bypass (p<0.01), duration of mechanical ventilation (p<0.01), duration of stay in intensive care unit (p<0.01), duration of stay hospital (p=0.01), acute renal failure (p=0.03), the need for dialysis (p<0.01), atrial fibrillation (p=0.04), pneumonia (p=0.03) and pleural fluid (p=0.01). We found that new-onset atrial fibrillation associated with advanced age (p=0.02), hypertension (p=0.04), duration of cardiopulmonary bypass (p=0.03), duration of aortic cross-clamp (p<0.01), postoperative anaemia (p=0.04), high creatinine values (p<0.01) and cerebrovascular events (p<0.01).Conclusions: Mortality rate was found 9.2% (5/54) (p=0.358) in the first 30 days and 8.1% (4/49) the first six months follow-up and no difference was found between the two groups (p=0.153).  The following parameters were observed in group 2 and were found statistically significant: average age (p<0.01), euroscore (p<0.01), duration of cardiopulmonary bypass (p<0.01), duration of mechanical ventilation (p<0.01), duration of stay in intensive care unit (p<0.01), duration of stay hospital (p=0.01), acute renal failure (p=0.03), the need for dialysis (p<0.01), atrial fibrillation (p=0.04), pneumonia (p=0.03) and pleural fluid (p=0.01). We found that new-onset atrial fibrillation associated with advanced age (p=0.02), hypertension (p=0.04), duration of cardiopulmonary bypass (p=0.03), duration of aortic cross-clamp (p<0.01), postoperative anaemia (p=0.04), high creatinine values (p<0.01) and cerebrovascular events (p<0.01).
Ureteric injuries during cancer surgery presentation and management over a 20-year
Authors: Tohamy Ali Zedan , Samy Haisam A. , Salah Tark , Hussien Marwa T. , Hussein Mohamed
Published: January 2021

Background: Iatrogenic ureteral injury rare 0.3-1.5%. complication of abdominopelvic cancer surgery. We aimed to study the risk and management of ureteral injury among cancer patients.  Methods: Diagnosis can be achieved retrograde pyelography, ureteroscopy, CT, or intravenous urography. Results: Years 2000 to 2020, 2904 patients in the Department of Surgical oncology, Assuit University, and 47 ureteral injury cases were identified. (1.62), 4/231 cervical cancer, 9/611 ovarian cancer and 7/462 endometrial cancer.,11/818 colon cancer,12/620 rectal cancer, 1/11 prostatic cancer, 3/151 retroperitoneal sarcoma. 34% (radical abdominal hysterectomy 8.5% Wertheim hysterectomies 4%), colorectal surgery colectomy 25.5%, low anterior resection2.1% in radical prostatectomy and 6.4% in retroperitoneal tumor, intraoperative diagnosis 48.9%, 8.5% in laparoscopic surgeries, the distal third (53.2%),23.4% catheterization, complete transection 31.9%; partial 14.9%, ligation 8.5%, laceration in 19.1%, resection. 8.5%; and devascularization in 17%. Fever in 14.9%, abdominal or flank pain in 38.5%. Oligura in 6.4%, ileus in 19.3%, urinary leakage (vaginally or via abdominal wound) in 10.6% rise creatinine in 10.6%, hydronephrosis in 6.4%, urinoma in 27.7%, extravasation in 8.5% asymptomatic in 4.3%, 40.4% percutaneous nephrostomy. 19.1%primary repair Ureteroneocystostomy in (17%) Boari flap in 12.7%, Psoas hitch in 23.4% stenting in 14.9%, 8.5% ileum interposition, anastomosis to contralateral ureter in 4.3%, ureteral stricture 6.4%, ureterovaginal fistulas in 10.6%, acute renal failure 2.1%, peritonitis 4.3, urinary tract infection in 14.9%.Conclusions: The recognition and immediate repair of ureteral injuries early during the same procedure was highly desirable and to avoid a second operation.
Accuracy of mammography and sonomammography and its correlation with histopathology in the detection of breast cancer
Authors: Yamakanamardi Soundarya , Hiremath Bharati V.
Published: January 2021

Background: Mammography (MMG) plays a pivotal role in the early diagnosis of breast cancer (BC). However, it is sometimes difficult to use it to diagnose palpable breast lesions among young patients. Ultrasound can be used as an adjunct in differentiating cystic and solid masses. Studies evaluating the combination of MMG and sonomammography (SMG) as an adjunct to detect Breast cancer, are quite scarce in the literature. This study aimed to assess the accuracy of MMG and to comprehend the role of ultrasound as an adjunct to MMG for finding breast lesions.Methods: Women attending the outpatient department (OPD) with complaints of breast lump, or those undergoing MMG screening were included. All patients then subsequently underwent MMG, SMG and biopsy. MMG and SMG findings were then correlated with the histopathology results.Results: Irregular shape and calcifications (MMG) and hypoechoic pattern (SMG) were found to be significant features differentiating malignant from benign lesions. Calcifications in benign tumors were observed 5.05 times less frequently than in malignant tumors. MMG combined with SMG had a sensitivity of 90.4%, specificity of 82.4%, positive and negative predictive value of 95% and 67% respectively, along with an accuracy of 88.9% in differentiating benign from malignant masses.Conclusions: SMG used as an adjunct to MMG is a reliable modality, especially in detecting lesions that are not picked up on MMG, including intraductal papilloma and duct ectasia.
Laparoscopic management of liver abscess: a viable alternative in USG guided percutaneous drainage failure cases
Authors: Tak Nikhil , Bagree Rajendra , Jalendra Gaurav , Reddy Hetish M.
Published: January 2021

Background: Liver abscesses are conventionally treated by ultrasonography (USG) guided percutaneous aspiration or drainage under antibiotic cover. We performed laparoscopic liver abscess drainage successfully in patients where medical management and percutaneous drainage had proven inadequate.Methods: Cases were received either from outpatient department (OPD) or were transferred from medical wards. Patients were first treated conservatively and percutaneous aspiration was attempted. Patients not responding to these treatment modalities were considered for diagnostic laparoscopy with drainage of abscess cavity and placement of 28 Fr drain under vision.Results: 20 patients with large liver abscess were treated successfully by laparoscopic drainage. Mean age in the study was 47 years (range 19-70 years) and average hospital stay was 5 days (range 4-12 days). Major postoperative morbidity or deaths were not registered. Patients with ruptured liver abscess, deep seated abscess cavity and medically unfit patients were excluded from the study.Conclusions: Laparoscopic drainage of liver abscesses, in combination with systemic antibiotics is a safe and viable alternative in all patients who require surgical drainage. It helps in the early return of gastrointestinal function and resumption of normal activities also potentially achieving better abscess drainage.
Nigam’s pinch test to locate a chronic deep seated small perianal abscess
Authors: Nigam Vinod Kumar , Nigam Siddharth
Published: January 2021

Background: Nigam’s pinch test (NPT) is for localization of chronic perianal abscess and incision over it.Methods: A description of Nigam’s pinch test and demographics are presented.Results: 20 cases of chronic deep seated perianal abscess were treated with the help of Nigam’s pinch test at Max Hospital, Gurgaon from August 2013 to August 2020. All incisions were directly made over the abscess and in no case a second incision was required. No recurrence and fistula formation occurred.Conclusions: Chronic deep seated perianal abscess usually has no signs except deep pain in perianal area or pain while passing stool. In such cases, there is no visible or palpable swelling, oedema or redness. Sometimes, it becomes difficult to put incision on the right site and more than one incisions are applied. Nigam’s pinch test helps in localization of small deep perianal abscess and correct site of application of incision avoiding multiple incisions. Nigam’s pinch test avoids post operative complications, specially recurrence and fistula-in-ano formation.
Outcome of pregnancy with acute appendicitis–a retrospective study
Authors: Bhardwaj Suraj , Sharma Shuchi , Bhardwaj Vatika , Lal Roshan
Published: January 2021

Acute appendicitis is the most common surgical non-gynaecological pathology during pregnancy. In this study, pregnant patients admitted with diagnosis of acute appendicitis in the last two years were evaluated retrospectively.  Aim was to study the outcome of pregnancy with acute appendicitis. This was a retrospective study done on pregnant patients with acute appendicitis admitted between october 2017 and September 2019 in SLBS Government Medical College and Hospital, Mandi, HP. 7 pregnant patients were admitted for acute appendicitis. Patients were evaluated regarding age, gestational age, clinical and laboratory examinations, imaging studies, operative findings, mean hospital stay and outcome. In 4 out of 7 patients, acute appendicitis was confirmed and appendicectomy was performed. All of them were operated with open technique. There was no fetal or maternal morbidity or mortality in any patient. All patients delivered healthy babies during the postoperative course. Early surgical intervention is indicated if acute appendicitis is suspected. Pregnancy is not a reason to delay surgery.
Hypernatremia post hydatid cyst resection: case report
Authors: Sharma S. P. , Pathak Nishant , Grewal Ritu , Singh Anuj
Published: January 2021

Hypernatremia or increased sodium level is defined as the plasma sodium level over 145 m mol/l. The electrolyte abnormality is associated with severe mortality (40-60%). Patients presenting acutely with this entity have varied clinical spectrum ranging from unresponsive state, dysphagia, shortness of breath, vomiting to seizures, coma or to even death. Iatrogenic hypernatremia usually a rare entity ensues after usage of hypertonic saline as scolicidal agent during hydatid cyst resection surgeries. There is a need of high level of suspicion, to be maintained in all patients being managed for clinical conditions requiring use of hypertonic saline (3-20% NS). Here we present a case of iatrogenic hypernatremia, post-surgical resection of hydatid cyst, with clinical manifestation and subsequent management in our tertiary care hospital.
Concomitant case of thyroid nodule with parathyroid adenoma - a case report
Authors: Tambat Ramesh Mahadev , Rao R. Rajashekhar , Kulkarni A. V. , S. Rekha V. , Bhattacharya Anchita
Published: January 2021

Coexistence of PHPT in patients with thyroid nodules can complicate patient management if associated with undetected hypercalcemia or unrecognized thyroid cancer. It is an uncommonly diagnosed condition, due to overlapping symptoms in developing countries like India and almost all patient get symptomatic treatment. A 47-year-old female patient presented a history of progressively increasing swelling in the thyroid region associated with continuous dull ache and whose was diagnosed as thyroid nodule with parathyroid adenoma. Thyroidectomy with parathyroidectomy is the preferred modality of treatment for thyroid disorder with additional parathyroid adenoma. The thyroid nodules should be carefully evaluated during the preoperative work-up of a patient with primary hyperparathyroidism. Both MIBI and neck USG should be done in the evaluation of patients undergoing thyroidectomy and parathyroid excision simultaneously to locate the parathyroid adenomas.
Pleomorphic leiomyosarcoma of colonic mesentery: an unusual cause of lower GI bleed - case report and literature review
Authors: Singh Vandana , Aggarwal Lalit , Hazrah Priya , Ali Shadan , Kumar Ashok , Mohta Anup
Published: January 2021

Mesenteric masses are infrequent lesions ranging from benign cyst to aggressive malignancies and often present as diagnostic and therapeutic challenge. The mesentery is a frequent recipient of metastasis from the gastrointestinal tract, pancreas, and biliary cancers. Primary mesenteric tumours are relatively rare, mostly mesenchymal in origin and benign in nature. Examples include gastrointestinal stromal tumours and smooth muscle tumours. Pleomorphic leiomyosarcoma of mesocolon is extremely rare with a reported incidence of 1:350,000. So accurate preoperative diagnosis of mesenteric soft tissue tumours is generally difficult. It accounts for less than 1% of the malignant tumours found in colon. Leiomyosarcoma is a malignant tumour arising from smooth cell lineage. These tumours occur most commonly in middle aged individuals. We describe a case of pleomorphic leiomyosarcoma arising from the colonic mesentery in a 27-year-old male patient, with massive lower gastrointestinal bleed (LGI bleed) causing drop in haemoglobin level from 9 mg/dl to 6 mg/dl. Ultrasonography and CECT abdomen suggestive of (17.5×11.6×10.6) cm mass in left side upper abdomen in splenic hilar region. Left hemicolectomy with excision of mass with splenectomy and distal pancreatectomy done. The diagnosis was based on histopathological evaluation using immunohistochemistry (IHC). Histopathological report suggestive of pleomorphic leiomyosarcoma with SMA and vimentin positivity on immunohistochemistry but CD 34 and CD 117 were negative, differentiating it from GIST.
De-differentiation in thyroid cancer- an increasingly appreciated concept
Authors: Poolakkil Prasanth , Thavarool Sajith Babu , Balasubramanyam Satheesan , Philip Kandathil Joseph
Published: January 2021

Thyroid cancer is the most common endocrine malignancy. In general, they are said to be of good prognosis, still there are a few aggressive variants. Differentiated carcinomas like papillary and follicular comprise of major proportion and have a less aggressive clinical behaviour, even though some of them tend to be otherwise. De-differentiated and undifferentiated cancers are more aggressive. There has been an already existing theory that these de-differentiated cancers arise from differentiated ones by a process of stepwise molecular changes. There are already reported cases of coexistence of multiple histologies. Appreciation of dedifferentiation and identification of the genetic changes may be of help in forming improved treatment strategies, including targeted therapy. This article is to report a rare case we came across, in which three different histologies coexisted and may be pointing towards graded de-differentiation pattern. This is a further support to the stepwise de-differentiation theory.
Budi daya Terapung Tanaman Sawi Hijau dengan Perbedaan Dosis Pupuk NPK, Ukuran Polibag, dan Waktu Pemupukan
Authors: Siaga Erna , Lakitan Benyamin
Published: January 2021

Cultivation of mustards green on floating raft is one of alternative cultivations which is applied by traditional farmers during flooding period in Riparian Wetland. The cultivation will increase Cropping Index and farmer’s income. The objective of this research is to evaluate growth and yield of mustards green on floating cultivation with the application of different NPK doses, polybag sizes, and fertilization times to find cultivation of mustards green which effective and efficient. This research was conducted on October 2016–February 2017 in Jakabaring Facility (104°46’44” E; 3°01’35” S) and Kimia Hasil Pertanian (LKHP) Laboratory, Fakultas Pertanian, Universitas Sriwijaya, Palembang. This research consisted of two steps. The first experiment used a completely randomized design with four doses of NPK (16:16:16) namely 0 (control), 5, 10, and 15 g plant-1. The second experiment used a Split Plot Design consisted of two factors namely polybag size (A1 and A2) and fertilization time (F1, F2, and F3). The result of the first experiment showed that utilization three doses of NPK significantly increased shoot length, number of leaves, and fresh weight compared control. The second experiment showed that polybag size and fertilization time did not significantly affect growth and yield parameters. Utilization of 5 g plant-1 of NPK on 1 week after transplanting (WAT) which used polybag size of 30 x 30 cm on growing media consisted of soil, manure, and rice husk (1:1:1/v:v:v) produced an effective and efficient cultivation of mustards green.

 

Keywords: fertilizing, floating cultivation, green mustard, NPK
Komunitas Fitoplankton dan Konsentrasi Nutrien di Waduk Jatigede
Authors: FItriadi Randi , Niken Tunjung Murti Pratiwi  , Rahmat Kurnia
Published: January 2021

Jatigede reservoir is a new reservoir in West Java Province. There is not much information about phytoplankton and nutrients in this reservoir. The aim of the research was to study the relationship between phytoplankton community and nutrient in the reservoir. The research was conducted during the dry season, from September to October 2018. Analyzed parameters were phytoplankton abundance, diversity and dominance index, orthophosphate, nitrite, nitrate, and ammonium. Reservoir zonation was divided by cluster analysis. The relationship between phytoplankton and nutrients was analyzed by principal component analysis and Pearson’s correlation test. Phytoplankton in Jatigede Reservoir consisted of Bacillariophyceae, Chlorophyceae, Cyanophycea, Dinophyceae, and Euglenophyceae within 20333‒25308 cell/L. Nitrate concentration ranged within 0.6684‒3.6115 mg/L. Nitrite concentration ranged between 0.0544‒0.2301 mg/L and ammonium ranged within 0.00538‒0.2460 mg/L. The strongest correlation between phytoplankton and nutrients were shown by Cyanophyceae and Dinophyceae, especially with the concentration of orthophosphate, nitrate, nitrite, and ammonium (r > 0,78).   Keywords: Cyanophyceae, orthophosphate, nitrate, nitrite
Sensitivitas dan Kelayakan Indeks Biotik Menggunakan Makroavertebrata untuk Menentukan Status Kesehatan Sungai
Authors: Il Maknuun Luk luk , Krisanti Majariana , Wardiatno Yusli
Published: January 2021

Water-quality monitoring using macroinvertebrates has been developed by several countries to determine their water qualities. Meanwhile in Indonesia, water quality monitoring has not been developed to adapt to Indonesia’s natural conditions. Some researchers use the existing biotic indices such as FBI, LQI, SIGNAL, and others. Therefore, this study aims to determine the status of water quality using several biotic indices and to compare the sensitivity and feasibility of indices on monitoring activities using simple matrix and Pearson correlation test. The interpretation results of FBI, LQI, and Singscore to determine water quality on each station in Brantas, Opak, Progo, and Cileungsi Rivers were different. The Pearson’s correlations test showed that the sensitivities are different between rivers. Those results are affected by the river conditions and also the activities around the rivers which release the pollution into the river. The FBI index showed the greatest score number of sensitivities among the other indexes.

 

Keywords: macroinvertebrate, monitoring, river, sensitivity
Efektivitas Campuran Ekstrak Daun Srikaya (Annona squamosal L.) dan Rimpang Kunyit (Curcuma domestica Val.) pada Mortalitas Larva Spodoptera litura F. (Lepidoptera: Noctuidae)
Authors: Taufika Ramadhan , Nugroho Setyo Andi , Anni Nuraisyah
Published: January 2021

Spodoptera litura F. larvae (Lepidoptera: Noctuidae) are polyphagous insects that cause damages to many types of plantations and horticulture that need to be protected. One of environmentally friendly method to protect ecological balance is the use of botanical insecticides whose bioactive compounds come from plant extracts. This study used a mixture of two plant extracts from A. squamosa leaves extract and C. domestica rhizome exstract (the mixed of experimental extracts). The mixed of experimental extracts are synergistic so that they are more effective and need a lower concentration to cause the mortality of S. litura larvae than the use of a single extract. The aims of the research were to know the efficacy of the mixed of experimental extracts on the mortality of S. litura larvae and determine the value of LC50 and LC90 extract test on its mortality. The initial and efficacy test were conducted by bait dip into the mixed of experimental extracts. The mortality data were analyzed using ANAVA, then continued by Duncan test and Probit analysis. The results of this research showed that the mixed of experimental extracts were effective to kill S. litura larvae. The calculated result of LC50 and LC90 showed that the LC50 value of the experimental extracts on the second and the third instar larvae were 5.252 ppm and 10.559 ppm, respectively, and the LC90 value for both instar larvae were 11.124 ppm and 13.638 ppm, respectively. It could be concluded that the mixed of experimental extracts is effective in S. litura larvae mortality and more effective in the mortality of the second instar larvae than that of the third instar larvae. Therefore, this test extract mixture can be developed further in a greenhouse to evaluate the effectiveness in the mortality of S. litura larvae which can be used as an alternative to controlling S. litura larvae with an environmentally friendly material in farmers.   Keywords: control, extract, mortality, Spodoptera litura
Aircraft Noise and its Effects on Blood Pressure and Heart Rate at Mehrabad Airport Employees
Authors: Khorshidi Behzadi Yaser , Ranjbarian Mohammad , Khodakarim Soheila
Published: January 2021

Background: Sound is an inevitable part of everyday life these days. Hypertension is the most significant preventible risk of immature death all around the world. The main purpose of this study is to answer this question: Does aircraft noise affect blood pressure and heart rate?
Methods: To achieve this objective, 100 personnel from the airport were selected. Additionally, 100 personnel were selected for the control group. In this case-control study the B&K dosimeter  model 4444 was used to record noise in a long time duration (8 hours) Blood pressure and heart rates were measured before and after their shift and during their work shift by connecting a dosimeter device to their body and recording noise exposure. SPSS V.22 software was used for statistical analysis.
Results: Analyses showed that the average noise intensity in the experimental group was 87.84 ± 2.76, and in the control group, it was 70.01 ± 4.01's. Compared with the control group, mean differences between systolic (P <0/001) and diastolic blood pressure (P=0.047) was significant, while the mean differences in heart rate after the shift not have a significant (P> 0.05).
Conclusions: research indicates that unacceptable noise could be a hazardous agent for hypertension. It is suggested that monitoring blood pressure, training workers, and periodic examination to be practiced to decrease blood pressure
Failure Mode and Effects Analysis and Risk Priority Number in a Combined Cycle Power Plant
Authors: Rahimi Elnaz , Nakhjavani Fateme , Safari Sara , Nematollahi Hanieh , Mardaneh Samira , Babaei-Pouya Amin
Published: January 2021

Background: Work-related accidents are one of the most important factors in the loss of human lives. With technology and industrial progress, the consequences of accidents due to hazards become more severe and may even stop the work of power plants. This study aimed to identify and assess the risk of hazards in a combined cycle power plant.
Methods: The descriptive cross-sectional study was conducted to assess the risk of a combined cycle power plant using the FMEA method. Having studied various documentation and records, holding different meetings, and brainstorming, the risk priority number was calculated and corrective suggestions have been presented.
Results: Out of a total of 74 identified risks, 34 (45.94%) were at high risk, and 40 (54.05%) were of medium risk. 85% of the risks had the highest severity levels that could cause explosions and fires, injuries, and burns.
Conclusion: It can be mentioned that the risks associated with industries such as power plants were high and preventive measures in such places are very important. Identifying hazards and risk assessments with a standard method such as FMEA was a useful way to prevent accidents and human and financial losses.
Fracture Resistance of Over Flared Endodontically Treated Central Incisors Restored with Multiple Prefabricated and Custom-Made Glass Fiber Posts
Authors: Darvishi Fatemeh , Alizadeh Oskoee Parnian , Ebrahimi Chaharom Mohammad Esmaeel , Ajami Amir Ahmad , Kimyai Soodabeh
Published: January 2021

Objectives: This study aimed to evaluate the fracture resistance of over flared endodontically treated bovine central incisors restored with prefabricated and custom-made glass fiber posts, using the multi-post approach. 
Materials and Methods: Sixty-eight crownless over flared endodontically treated incisors were used for this study. The depth of prepared post space was 10 mm, and the remaining dentin thickness of the roots was 1 mm. The samples were randomly divided into four groups (n=17): Group 1: two prefabricated glass fiber posts; group 2: prefabricated glass fiber post + braided glass fiber; group 3: braided glass fiber; group 4: no post. Static load was applied at a crosshead speed of 0.5 mm/min at 135º angle relative to the root longitudinal axis until fracture. The data were analyzed using one-way ANOVA and post hoc Tukey’s test at a significance level of P<0.05.
Results: Groups 3 and 4 exhibited the maximum (981 N) and minimum (461 N) fracture strength values, respectively. The differences between group 4 and other groups were significant (P<0.001), but the differences between groups 1, 2, and 3 were not significant (P>0.05).
Conclusion: Multiple prefabricated and custom-made glass fiber posts significantly increased the fracture resistance of crownless endodontically treated central incisors with over flared root canals.
Ecology of Malaria Vectors in an Endemic Area, Southeast of Iran
Authors: Edalat Hamideh , Mahmoudi Mehran , Sedaghat Mohammad Mehdi , Moosa-Kazemi ; Seyed Hassan , Kheirandish Sedigheh
Published: January 2021

Background: Malaria has long been regarded as one of the most important public health issues in Iran. Although the country is now in the elimination phase, some endemic foci of malaria are still present in the southeastern areas of the country. In some endemic foci, there are no data on the malaria vectors. To fill this gap, the present study was designed to provide basic entomological data on malaria vectors in the southeastern areas of Iran.
Methods: Adult and larval stages of Anopheles mosquitoes were collected by using different catch methods. Resistance of the main malaria vector in the study area to selected insecticides was evaluated using diagnostic doses advised by the World Health Organization in 2013–2014.
Results: A total of 3288 larvae and 1055 adult Anopheles mosquitoes were collected, and identified as: Anopheles stephensi (32.1%), Anopheles culicifacies s.l. (23.4%), Anopheles dthali (23.2%), Anopheles superpictus s.l. (12.7%), and Anopheles fluviatilis s.l. (8.6%). Anopheles stephensi was the most predominant mosquito species collected indoors at the study area, with two peaks of activity in May and November. This species was found to be resistant to DDT 4%, tolerant to malathion 5% and susceptible to other tested insecticides.
Conclusion: All the five malaria vectors endemic to the south of Iran were collected and identified in the study area. Our findings on the ecology and resting/feeding habitats of these malaria vectors provide information useful for planning vector control program in this malarious area.
Employing Different Traps for Collection of Mosquitoes and Detection of Dengue, Chikungunya and Zika Vector, Aedes albopictus, in Borderline of Iran and Pakistan
Authors: Nejati Jalil , Zaim Morteza , Vatandoost Hassan , Moosa-Kazemi Seyed Hassan , Bueno-Marí Rubén , Azari-Hamidian Shahyad , Sedaghat Mohammad Mehdi , HanafiBojd Ahmad Ali , Yaghoobi-Ershadi Mohammad Reza , Okati-Aliabad Hassan , Collantes Francisco , Hoffmann Ary A.
Published: January 2021

Background: Southeastern Iran has been established as an area with the potential to harbor Asian tiger mosquito populations. In 2013, a few numbers of Aedes albopictus were detected in three sampling sites of this region. This field study was aimed to evaluate the efficacy of various traps on monitoring mosquitoes and status of this dengue vector, in five urban and 15 suburban/rural areas.
Methods: For this purpose, four adult mosquito traps (BG-sentinel 2, bednet, Malaise, and resting box trap) were used and their efficacy compared. In addition, large numbers of CDC ovitraps were employed, within 12 months.
Results: A total of 4878 adult samples including 22 species covering five genera were collected and identified from traps. It was not revealed any collection of Ae. albopictus. Statistical analysis showed no significant difference in meteorological variables between the two periods, the previous report and the current study. There were significant differences in the total number of mosquitoes collected by various traps in the region across different months.
Conclusion: The resulting data collected here on the efficiency of the various trap types can be useful for monitoring the densities of mosquito populations, which is an important component of a vector surveillance system. While the presence of Ae. albopictus was determined in this potential risk area, there is no evidence for its establishment and further monitoring needs to be carried out.
Temporomandibular joint disorder therapy: A review
Authors: Khayamzadeh Mina , Ahmadi Paniz , Razmara Farnoosh , Safavi Keyhan
Published: January 2021

Aims: Temporomandibular disorders (TMD) are one of the most prevalent disorders in maxillofacial area. Due to lack of understanding of the etiology or pathogenesis of TMD and a definitive diagnostic or therapeutic approach, patients have to tolerate symptoms such as pain. This study was aimed to perform a review of non-surgical treatment methods for TMD.
Materials and Methods: In this review, Google, Google Scholar, PubMed, SID, ISI Web of Science, SID and IranMedex databases were searched using key terms: temporomandibular disorders, temporomandibular joint, temporomandibular pain, non-surgical treatment. Articles meeting the inclusion criteria were recruited in the study. Finally, a total of 63 prospective clinical trials were evaluated from 2015 to 2020.
Results: From the 61 studies evaluated, 27 studies were on low-level laser therapy (LLLT), 13 studies on transcutaneous electrical nerve stimulation (TENS), 5 studies on acupuncture and dry needling, 1 study on laser acupuncture, 9 studies on platelet-rich plasma (PRP) and 6 studies on Botox injection.
Conclusion: Laser acupuncture had similar treatment effects in reducing pain to TENS, low-level laser, acupuncture and dry needling. It seems that the use of laser acupuncture is safer than other methods in decreasing pain of patients with TMD.