bluuebunny/crossref_metadata_2025 huggingface dataset:
Neuroendocrine tumors of the pancreas: from theory to practical recommendations
Authors: Morgoshiia Temuri Sh.
Published: April 2018

The article shows that a significant proportion of neuroendocrine tumors of the pancreas are non-functional, i.e., not secreting into the blood a variety of gastrointestinal hormones and polypeptides and as a result, not accompanied by typical clinical manifestations. Unfortunately, often the scan search starts in the detection of distant metastases of neuroendocrine tumors and development of cancer cachexia. Noted that the diagnosis of neuroendocrine tumors of the pancreas is a highly complex task, the solution of which depends on the choice of treatment and its remote results. Currently, the only radical method of treatment of hormonally functioning tumors of the pancreas is surgical. It is indicated that symptomatic therapy can be considered as a stage of preoperative preparation of the patient. The indication for surgical treatment in this situation, along with the ineffectiveness of conservative treatment is the size of detectable formations of 2 cm or more, which is a risk factor of distant metastases. Stressed that according to modern views of patients with nonfunctioning neuroendocrine tumors of the pancreas are subject to surgical treatment. Given that in 70-92% of cases they are malignant, most often used distal or extensive pancreatoduodenal resection. Currently, noted that the large size of the tumors are not a contraindication to surgery and if the tumor dormant, to 1 cm, the possibility of a short observation. Any tumors found in the pancreas, needs to be taken out of the context, or if it is possible – is widely excised. The article examines the rational and integrated use of modern Arsenal of surgical and therapeutic methods, which enable significantly prolong life, improve its quality in patients with metastatic forms of neuroendocrine tumors of the pancreas.
Non-destructive methods of concrete quality control as factor in reliability of concrete and reinforced concrete structures in transport facilities
Authors: Belentsov Yuri A. , Kazanskaya Liliya F.
Published: April 2018

Aim: The development of theory and practice of construction science leads to a need to enhance the basics of design, construction and operation of concrete and reinforced concrete structures. Despite significant progress, there is risk of collapse of different structures at various stages of their lifecycle. Current state of construction industry leads to a need to increase the quality and reliability of buildings and structures under construction.
Methods: The authors have used methods of probabilistic forecasting in this work
Results: The development of methods of construction materials control, particularly concrete and reinforced concrete, leads to a gradual implementation of non-destructive control methods. To assess the change of confidence and reliability coefficients of designed structures, the authors have substantiated the transition to probabilistic rationing of strength properties of concrete and reinforced concrete structures using classes. Also, the authors suggest implementation of non-destructive control methods. However, non-destructive control methods have a number of drawbacks, the key among these being the decrease of confidence coefficient while preparing a calibration curve, which drastically affects the results of quality control. It is possible to solve the problem by creating a set of control tests including both destructive and non-destructive quality control methods. This will provide systems for collecting testing information of high accuracy.
Ecological Relations and Indigenous Food Sovereignty in Standing Rock
Authors: Ruelle Morgan L.
Published: April 2018

Food sovereignty, the ability of communities and nations to determine their own food systems, is based on ecological relations between humans and our habitat. This article examines how human ecological relations with plants and animals contribute to the food sovereignty of indigenous communities in the Standing Rock Nation of the northern Great Plains. During the past one hundred and fifty years, the policies of the United States federal government have deliberately undermined these relations, including eradication of primary food sources, forced sedenterization on reservations, illegal land seizures, and compulsory reeducation of children at residential schools. The loss of food sovereignty has directly impacted the health of Standing Rock communities. Tribal government agencies, academic institutions, and nonprofit organizations in Standing Rock are working to enhance food sovereignty by revitalizing relations with plants and animals used to prepare healthy traditional foods. Interviews with elders and other participants in these activities reveal that tradition and sustainability are important dimensions of indigenous food sovereignty.
A study to assess knowledge and perception on obesity among female aged eighteen years and above living in ladies dorm at UEAB, Kenya
Authors: Ramasamy Poornima , David Njeru , Zipporah Wafula , Kiplagat Violah
Published: April 2018

Background: Obesity is an ongoing problem in the developed countries and it’s a new and growing problem in the developing countries. This study aimed to assess the knowledge and perception on obesity among female aged 18 years.Methods: The study is a descriptive cross-sectional research design on 186 students of UEAB in 2017. In order to collect the data was used a self-administered questionnaire, which will be used to measure the knowledge level and perception to gather factual information about the respondents. This questionnaire will involve a set of closed-ended questions. The data were analysed using SPSS 23. The researchers used descriptive statistics including mean, median and mode.Results: The knowledge on obesity, it was found that most of the participants have heard of obesity and they term it as the excessive fat accumulation to body. Participants also indicated that they knew the causes of obesity and in degrees of whether they agree or disagree, indicated that they strongly agreed and agreed that consumption of junk foods and lack of physical exercise caused obesity and they agreed that family history may also cause obesity. The perception on obesity, participants viewed obesity to be average among undergraduate ladies residing in ladies’ dorm. It was also revealed that 7.5 percent of the participants think they are obese and they are unsatisfied with their body weights.Conclusions: The study exposes the lack of knowledge regarding obesity. However, perceptions of the participants were promising. This is because nearly all of them felt those who are not obese should be encouraged to maintain their weight and the overweight people should lose weight or be treated to achieve medical benefit.
Comparison in haematological and biochemical changes in normal, acute and chronically castrated West African Dwarf goats
Authors: Olaifa Abayomi Kayode
Published: April 2018

Background: Castration is one of the frequent management practices in large animal husbandry and burdizzo castration has been shown to produce fewer long-term behavioral signs of pain and distress than banding. Castration is known to reduce virility and aggression due to the elimination of testicular androgens.Methods: This is a comparative study of hematological and biochemical parameters in intact, acute and chronically castrated West African dwarf goats. Twelve adult West African Dwarf bucks weighing between 8 to 14 kg randomly divided into 3 groups of intact, acute and chronic castrated. They were castrated using burdizzo castrator. Hematological and biochemical parameters were estimated by standard laboratory procedures.Results: There were significant decreases (P<0.05) in the PCV, Hb, RBC, WBC and MCH of acute and chronically castrated goat compared to the control group. The MCV and platelets increased significantly in acute and chronically castrated goat; while the neutrophil and lymphocyte showed no significant changes. The result also showed no significant changes in Na+, Cl-, K+, Ca2+, Cu2+, AST and Creatinine. Mg2+ and ALT significantly increased in chronically castrated goats compared with the acutely castrated goats while Zinc increased significantly (P<0.05) in acute castrated compared with the control goats.Conclusions: Therefore, from this study, either acute or chronic castration in goats have no detrimental effect on blood electrolytes, but mainly deter the hematopoietic process in the animal owing to testosterone and androgen depletion in castrate animals.
The relationship between vitamin D level and severity and control of bronchial asthma among adult Sudanese patients
Authors: Mustafa Nadia A. , Elhag Omer E. Y. , Abukanna Abdelrahman M. , Sulaiman Ahmed H. , IbnIdris Hafiz O.
Published: April 2018

Background: The aim of this study was to assess the relationship between vitamin D level and severity and control of bronchial asthma among adult Sudanese patients at Alshaab Teaching Hospital.Methods: This prospective cross-sectional study, conducted at Alshaab Teaching Hospital, Khartoum Sudan in the period from June to August 2015. Eighty-six asthmatic patients participated in the study after taking their consent. Demographic data were collected using structured questionnaire, the clinical parameters of asthma severity and control were measured according to the criteria of Global Strategy for Asthma Management and Prevention 2014 of the Global Initiative for Asthma (GINA). Airway limitation was assessed using Peak Flow Meter. Three ml of blood was taken from each patient to measure vitamin D (25(OH)D) using enzyme-linked immunosorbent assay (ELISA) and data were analyzed using the statistical package for social science (SPSS) version 20.Results: Normal serum 25(OH)D (30-50ng/ml) was found in only 2.3% of patients. The mean serum 25(OH)D level in patients with controlled asthma was 25.82±17.27ng/ml while in patients with uncontrolled asthma it was16.48±7.14ng/ml. (P value = 0.005). The mean serum 25(OH)D level in patients with severe asthma was 16.15±6.9ng/ml (P value = 0.151).Conclusions: There was a positive correlation between vitamin D level and bronchial asthma control and a negative correlation with bronchial asthma severity among the study group.
Association between components of metabolic syndrome with chronic kidney disease in Benin City, Nigeria
Authors: Egbi Oghenekaro G. , Unuigbe Evelyn I. , Oviasu Efosa
Published: April 2018

Background: The metabolic syndrome (MetS) is a constellation of risk factors of metabolic origin that promote the development of cardiovascular disease. More recently, an association with chronic kidney disease (CKD) is being reported. However, most of these studies are non-indigenous. The aim of the study was to determine the association between components of MetS and CKD in a Nigerian population.Methods: Patients with MetS were recruited from a tertiary hospital in Benin City, Nigeria. Blood pressures and body mass indices were measured. Plasma glucose, serum lipids, urea and creatinine and spot urine albumin: creatinine ratio were analyzed. CKD was defined as estimated glomerular filtration rate <60mls/min+ urinary ACR >30mg/g creatinine.Results: Obesity, waist/hip ratio, diastolic blood pressure, total cholesterol and LDL-cholesterol were associated with CKD in univariate analysis. Body mass index and diastolic blood pressure were independent predictors of CKD. There was a relationship between the number of MetS traits and CKD.Conclusions: CKD in patients with MetS may therefore result from a synergistic effect of components of the syndrome. Diastolic blood pressure and obesity may predict CKD in MetS patients. Early detection and treatment of obesity and hypertension may thus be a strategy to target the increasing prevalence of renal disease in MetS.
A comparative study of dexmedetomidine versus clonidine in epidural anaesthesia to assess the level of sedation in patients undergoing lower abdominal and lower limb surgery
Authors: Pathak Vinay , Kushwaha B. B. , Chandra Girish , Bhatia V. K. , Gupta Akash , Kumar Shubham
Published: April 2018

Background: To compare study of dexmedetomidine versus clonidine in epidural anesthesia to assess the level of sedation in patients undergoing lower abdominal and lower limb surgery.Methods: This was a comparative study conducted on admitted ASA grade I and II patients undergoing lower abdominal and lower limb surgeries. The patients were divided into three groups of 30 patients each, according to the epidural medication they received:-Group A-received 15ml of bupivacaine (0.5%) and dexmedetomidine (1.0µg/kg body weight) in 1ml of normal saline; Group B-received 15ml of bupivacaine (0.5%) and clonidine (2.0µg/kg body weight) in 1ml of normal saline; Group C-received 15ml of bupivacaine (0.5%) with 1ml of normal saline. The heart rate, blood pressure, sensory dermatome level, Motor blocked level, pain and VAS were recorded at different time intervals. The side effects were also noted.Results: The baseline parameters were comparable among the groups. All the hemodynamic parameters and other study parameters were similar at Min. 0. All the hemodynamic parameters such as heart rate, blood pressure and SpO2 were variable at different time intervals. Motor block level   was significantly (p<0.05) lower in Group C than Group A and Group B from Min 50 to Min 90. The sedation score was observed to be nil in Group C. The post-op pain score became higher in Group C than Group A and Group B at subsequent time intervals. A 3 (10%) of the rescue agents was observed in Group C. Atropine (30%) and mephenteramine (10%) were common rescue agents in Group B. The bradycardia was observed in 30% patients of Group B and in 40% of Group A.Conclusions: On addition of dexmedetomidine as adjuvant to bupivacaine in epidural anesthesia provides better anesthesia and sedation than clonidine as adjuvant to bupivacaine or bupivacaine alone with mild hemodynamic changes which are easily manageable.
Comparison of hemodynamic responses along with perfusion index to tracheal intubation with Macintosh and McCoy laryngoscopes
Authors: Choudhary Vineet K. , Rastogi Bhawana , Singh V. P. , Ghalot Savita , Dabass Vijay , Ashraf Sameer
Published: April 2018

Background: The McCoy Laryngoscope in comparison to macintosh laryngoscope requires less force for performing laryngoscopy and as a result may alter the associated hemodynamic response. Perfusion index (PI) is a noninvasive numerical value of peripheral perfusion obtained from a pulse oximeter.Methods: A randomized prospective single blind comparative clinical study was conducted on 80 patients of ASA physical status I-II aged between 18 years to 58 years of either sex with body mass index (B.M.I) between 20 and 25 undergoing elective surgeries under general anesthesia. 80 patients were divided into 2 groups: Group A (n=40)- Tracheal Intubation with Macintosh Laryngoscope, Group B (n=40)-Tracheal Intubation with McCoy Laryngoscope. Blood Pressure (systolic blood pressure, diastolic blood pressure, and mean arterial pressure) and heart rate (HR), oxygen saturation (SpO2) via pulse oximeter were monitored.Results: The demographic profile showed no significant difference between the groups. Heart rate, systolic, diastolic and mean arterial pressure had highly significant difference in both groups. Perfusion index was statistically significant immediately post laryngoscopy and intubation till 4 mins. Immediately after laryngoscopy and intubation, the correlation between PI and MAP was statistically significant and it was a negative average to good correlation.Conclusions: The McCoy laryngoscope elicits lesser haemodynamic response to laryngoscopy and tracheal intubation as compared to Macintosh laryngoscope in normotensive patients. Perfusion index can also serve as an additional parameter to assess hemodynamic response since it has good negative correlation with the mean arterial pressure.
Treatment outcome of antiretroviral treatment naive HIV infected patients initiated on antiretroviral therapy in a tertiary care hospital in South India
Authors: S. Rajendra Prasad , J. Subhash Chandra B.
Published: April 2018

Background: About 2.1 million people are infected with HIV in India. Clinical profile of patients has evolved over a period of time in the Antiretroviral treatment (ART) era. This study was done to document the clinical presentation of patients in a tertiary care in Mysuru in Karnataka. The aim of the study was to follow the patients who were initiated on ART over a period of time and to know its effect on the clinical outcome and overall morbidity and mortality of the patients.Methods: A prospective study of HIV positive patients who were initiated on ART was done regarding clinical profile and outcome over a period of one and a half to two years depending on when they were initiated on ART.Results: Totally 183 patients were registered during the period, out of which 114 patients (62.29%) were males and the rest were females (37.70%). The commonest route of transmission was heterosexual route seen in 97.3% (178). Most (56.8%) of the patients were asymptomatic. The mean basal CD4 count was 162.70. The mean age of patients was 39.07. The mean BMI was 20.29. A 23.5% (43) had one or other side effects. Anemia (44.2%) was the most common side effects seen. There were 18 deaths (12.2%). A 39.34% (72) patients had opportunistic infections (OI), the commonest being tuberculosis 45(%).Conclusions: It was concluded that patients with low CD4 count, low BMI were more prone for Opportunistic infections and death. Early initiation of ART can prevent such incidences and improve the quality of life of HIV positive patients.
Diagnostic accuracy of serum lipase and amylase as biomarkers for acute pancreatitis
Authors: Kumar Anil , Kapoor Sangeeta
Published: April 2018

Background: Currently, majority of clinicians ask for both amylase and lipase for diagnosis of acute pancreatitis but a large number of health care facilities in India still have facility for only amylase. Aim was to find which single marker to be used in for diagnosis of acute pancreatitis.Methods: Patients seeking care at emergency department for acute abdominal pain during the period from July 2016 to June 2017 formed the study population. The serum lipase and amylase were taken from 1725 patients. Diagnostic accuracy, sensitivity, specificity, positive and negative predictive values and positive and negative likelihood ratios were calculated.Results: Sixteen patients had amylase above 3-fold elevation, while there were 26 such patients in the lipase group. The sensitivity and specificity of amylase at 3-fold above normal limit were 62.8% and 99.2% while those of lipase were 96.1% and 99.1% respectively. Both amylase and lipase had high accuracy index in the area under the ROC curve (0.990 and 0.997 respectively).Conclusions: In this study, serum lipase had better diagnostic accuracy as compared to serum amylase. In resource-constrained settings with limited lab and radiological facilities, serum lipase should be preferred over serum amylase for diagnosis of acute pancreatitis.
Protein carbonyls and protein thiols in rheumatoid arthritis
Authors: P. Pullaiah , M. M. Suchitra , B. Siddhartha Kumar
Published: April 2018

Background: Oxidative stress (OS) has an important role in the pathogenesis and progression of rheumatoid arthritis (RA). OS causes protein modification, thereby impairing the biological functions of the protein. This study was conducted to assess the oxidatively modified protein as protein carbonyl content and the antioxidant status as protein thiols, and to study the association between protein carbonyls and protein thiols in RA.Methods: Newly diagnosed RA patients who were not taking any disease modifying anti-rheumatic drugs were included into the study group (n=45) along with age and sex matched healthy controls (n=45). Serum protein carbonyl content and protein thiols were estimated.Results: Elevated protein carbonyl content and decreased protein thiol levels (p<0.001) were observed in RA. A significant negative correlation was observed between protein carbonyl content and protein thiol levels (p<0.001).Conclusions: Oxidative stress in RA is evidenced by enhanced protein oxidation and decreased antioxidant protein thiol levels. Decreased protein thiols may also reflect protein modifications leading to compromise in the antioxidant properties. This oxidant and antioxidant imbalance needs to be addressed by therapeutic interventions to prevent disease progression.
A morphology and histological study of placenta in normal and diabetic pregnancies
Authors: Tandon Ashutosh , Singh Durgesh , Mishra Parmatma Prasad , Mishra Anshu
Published: April 2018

Background: The placenta is a vital organ for developing foetus, and it is also the most accessible organ of human body, pregnancy in a diabetogenic state by virtue of various physiological changes which cause insulin resistance. In normal pregnancy, glucose tolerance decreases by third trimester, though plasma levels of insulin increase. Aim was to study comparison of placenta of normal pregnancy with placenta of diabetic pregnancy and it the possible outcome of pregnancy.Methods: The present study was case-control and conducted on cases of 50 Specimens of placenta with intact umbilical cord were collected from the Department of Obstetrics and Gynecology.Results: Variation in the shape and weight of the placenta were observed. The mean placenta weight in control group was found to be 452.80 grams with standard deviation 140.93 grams while in the case group; it was 406.00 grams with standard deviation of 210.31 grams. The random blood sugar of mother in control group was significantly higher than cases (t=2.91, p<0.01).Conclusions: The present study shown that there was a tendency of increase in placental weight and weight of new born in complicated pregnancies as compared to the normal pregnancies. This indicated the earlier diagnosis and strict to treatment plan in diabetic pregnancies.
Chinese forearm flap technique in thumb injury: a case report
Authors: . Zainarda , Yuda Asmara A. A. Gde , Caksana Putu Suehandika
Published: April 2018

Hand injuries which involve substantial skin loss require immediate soft tissue cover to achieve early wound closure and to minimize wound infection and scarring. In 1978, Dr. Yang Guofan and Dr. Chen Baoqui described a flap from the forearm based on the radial artery or Chinese Forearm Flap. A 30-year-old male was admitted to the emergency room because of crush injury. From physical examination we found crush injuries of left hand followed with open wound between 1st and 2nd finger at dorsal and palmar side with muscle, tendon, and bone exposed, with open dislocation left 1st carpometacarpal joint, open fracture dislocation left 1st metacarpophalank joint, open fracture Left Base 2nd, 4th metacarpal, open dislocation 3rd base metacarpal, open fracture left trapezoid, open left trapezium. Soft tissue injuries of the hand which require flap cover pose a problem mainly because of the apparent lack of availability of local tissue. Wound healing problems can result in an impaired functional outcome. For complication, initially, sensory disturbances can be found in 17-75% but decrease during the next months. This radial forearm flap method of post-traumatic thumb reconstruction nowadays doesn’t require expert microsurgical knowledge, which is indispensable in case of replantation or revascularization of the amputated thumb. Correct planning and elevation presupposed the flap success rates average at least 90% with no relevant limitations in strength, motion and hemodynamics in the forearm or hand and non-disturbing sensory and cosmetic outcome at the donor site.
Extreme Idiopathic gigantomastia
Authors: Benna Mehdi , Naser Radhi Ben , Fertani Yasmine , Ayadi Mohammed Ali , Bettaieb Ilhem , Chargui Riadh , Hechiche Monia , Gammoudi Amor , Rahal Khaled
Published: April 2018

Gigantomastia is a rare mastopathy of unknown cause. Due to mechanical and psychological complications related to excessive breast weights and volume, effective surgical treatment is required. Most cases of gigantomastia in the literature are associated with pregnancy or puberty and very rare cases of spontaneous gigantomastia have been reported We report a 38 years old woman with an idiopathic gigantomastia treated successfully with Thorek technique.
Plummer-Vinson syndrome: a case report
Authors: A. Bhat Rafiq , Wani Saleem A. , Soni Pankaj
Published: April 2018

Plummer-Vinson syndrome (PVS) also named as Patterson-Brown-Kelly syndrome is a combined presentation of three things- dysphagia, iron deficiency anemia, and esophageal webs, seen more often in middle aged females. A 30-year-old female presented to us with shortness of breath on exertion and long standing dysphagia and weight loss. After investigations she was found to be severely anemic. Upper GI endoscopy revealed esophageal web. Dilatation of esophageal web was done, anemia was corrected. Patient is on regular follow-up with marked improvement in terms of weight gain and increased functional capacity.
Successful management of severe acute respiratory distress syndrome caused by H1N1 viral pneumonia using early institution of extra corporeal membrane oxygenation therapy
Authors: Taneja Rajesh S. , Kapoor Ruchi , Kashav Ramesh , Ramu Ramadoss
Published: April 2018

Swine flu is H1N1 influenza A virus infection that has serious consequences in susceptible individuals leading to acute respiratory distress syndrome (ARDS). Sometimes ARDS can be refractory to conventional management and ventilator strategies. In such patients Extracorporeal Membrane Oxygenation (ECMO) improves respiratory functions wherein the gas exchange is done via a membrane oxygenator and a pump. We report a case of 50 years old female presented in February 2016 with complaints of fever, headache, dry cough, rhinorrhea and difficulty in breathing for four days. Her throat swab showed positive report for H1N1 infection. She developed severe ARDS due to pneumonia caused by H1N1 influenza infection. Her paO2/FiO2 was less than 100. The patient did not respond to initial management with anti- influenza therapy and mechanical ventilation. Murray score was calculated to institute ECMO therapy. Murray score of our patient was 2.75. Since there was no co- morbid illness or irreversible lung disease, ECMO therapy was started. After 14 days of ECMO therapy, ARDS resolved and the patient was successfully weaned from the ventilator. Patient was monitored intensively for coagulopathies and other complications related to ECMO therapy. She developed hemothorax and critical illness neuropathy during ECMO therapy. ECMO is a salvage therapy that has the potential to save lives when conventional treatment fails in H1N1 associated ARDS. It not only ensures much needed lung protection to the inflamed lung but also provides better hemodynamic stability. Early institution of ECMO along with ultra-protective ventilation of lung and timed weaning is the key to successful management of severe ARDS due to swine flu. There are very few case reports of successful ECMO therapy in H1N1 associated ARDS available from Delhi.
Thrombophlebitis at infusion sites in surgical ward: a clinical study
Authors: Dwivedi Rajeev , Singh Atul Kumar , Gaharwar A. P. S.
Published: April 2018

Background: Peripheral venous Cannulation is indispensable in admitted patients in surgical ward, thrombophlebitis following infusion is seldom serious, but it effects on postoperative recovery, hospital stay and hence burden of disease are magnanimous. The objective of the study to know the common sites of thrombophlebitis, Frequency of thrombophlebitis in relations to type of fluid and drugs used, and to find out the incidence of thrombophlebitis in relation to diseased condition and type of surgical patient.Methods: this prospective observational study was conducted on 300 patients admitted in surgical ward of S.S Medical College and associated S.G.M. hospital, Rewa (M.P.) patients selected randomly. These Patients were visited daily for any sign and symptoms at infusion site. The incidence of thrombophlebitis according to common infusion sites, in relations to type of fluid and drugs used and in relation to diseased condition and type of surgical patients were recorded. The tool designed to collect the data were sociodemographic Performa and observational check list.Results: In total 300 patients the incidence of thrombophlebits is highest (100%) in Saphenous vein (Lower Limb) minimum (17%) in Basilicvein (Upper Limb). Incidence of thrombophlebitis is higher in earlier days (within 2 days) of infusion with Dextrose containing fluid (D5%+ D10%) and higher in critically ill and emergency operated patients.Conclusions: Thrombophelebitis is still an important ongoing problem in admitted patients in surgical ward. Incidence is highest in saphenous vein, with dextrose containing fluid and in critically ill & emergency operated patients.  It has definite relationship with site of infusion site, type of fluid, illness of patients and nature of operation
Prognostic value of peripheral blood eosinophil count on first day of infancy in the incidence of neonatal hyperbilirubinemia
Authors: Ahadi Adel , Mirzarahimi Mehrdad , Alaei Saeid , Ahmadabadi Farzad
Published: April 2018

Background: Neonatal jaundice is one of the most common problems in the neonatal period. Eosinophilia is common in preterm and term newborns, and it is considered when the absolute count of eosinophil is ≥500 cell/mm3. It is thought that there was some relationship between hyperbilirubinemia and increasing of blood eosinophil count in newborns hospitalized by jaundice. The aim of this study was to determine the prognostic value of peripheral blood eosinophil count on first day of infancy in the incidence of neonatal hyperbilirubinemia.

Methods: 150 newborns with gestational ages of 35-40 weeks, born in Ardabil city hospital, were engaged in this study. After obtaining the parents' consent, getting patients biography and their physical examination, we got a blood sample from umbilical cord of newborns to measure differential count of white blood cells. The neonates were observed up to 28 day followed. Then, second blood test conducted for the purpose of measuring serum level of bilirubin. Data were analyzed by statistical methods in SPSS version 19.  

Results: Various group of age, sex, blood type and gestational age showed no significant difference in their eosinophil rate. Total serum bilirubin doesn't had a significant relationship with gestational age, sex, type of delivery and major or minor blood groups of neonates.

Conclusions: Results showed that there was no significant relationship between the amount of eosinophil in newborn umbilical cord and total serum bilirubin. So, we could say that newborns eosinophil count isn’t a good criteria for predicating the appearance of neonate hyperbilirubinemia.
Biochemical constituents of gallstones from indigenous blacks of Nigerian origin
Authors: Amadi Collins , Wichendu Promise N.
Published: April 2018

Background: The biochemical constituents of gallstones predict its etiopathogenesis. Hence, this study is conducted to investigate the biochemical constituents of gallstones from indigenous Nigerian patients.

Methods: It was a retrospective study of the biochemical constituents of post-operative gallstones from 48 adult patients of the University of Port Harcourt Teaching Hospital, Nigeria. Records on age, sex, and concentrations of gallstone biochemical constituents (total cholesterol, triglyceride, total bilirubin, and calcium) from 1st January 2007 to December 2016 were extrapolated from laboratory records and analyzed using SPSS version 15.  

Results: The gallstones were of more females than the males (70.8% versus 29.2%; p=0.004). The mean age of the study cohorts was 46.88±7.96 with age range 31–64 years. No sex difference in age was observed, however, females were younger (males 50.39±8.31 versus females 45.47±7.52; p=0.056) with a lower age range (males 40–64 versus females 31- 63) than the males. The gallstone comprised of cholesterol stones (64.7%), mixed stones (22.9%), and pigment stones (12.5%). Though the females dominated among the three types of gallstones, the predominant stone type in both sexes remained cholesterol stones. Cholesterol lipid was the main constituent of the gallstones with no sex difference (p=0.227).

Conclusions: Cholesterol gallstones are the most common type of gallstones in this study and the cholesterol lipid is the most prevalent constituent of these gallstones. The females presented with more of the gallstones disease than the males.
Thyroid dysfunction in region of excess iodine intake of Eastern Nepal
Authors: Thapa Saroj , Lamsal Madhab , Chaudhari Rajendra K. , Gelal Basanta , Kunwar Saroj , Baral Nirmal
Published: April 2018

Background: Iodine deficiency as well as iodine excess can result in an increased prevalence of thyroid disorders. The prevalence of excess iodine nutrition is increasing all over the world. The aim of the present study was to find the occurrence of iodine nutrition status in primary school children of Eastern Nepal and find the prevalence of associated thyroid dysfunction among those with excess urinary iodine concentration.

Methods: A community based cross sectional study was conducted in Udayapur district which is located in Eastern part of Nepal. Primary school aged children (6 years to 12 years) were enrolled in this study from three schools. Blood and urine samples were collected and assayed for urinary iodine concentration (UIC), free thyroid hormones (fT3 and fT4), and thyroid stimulating hormone (TSH).  

Results: The median UIC was 232.27 µg/L. The iodine status showed that 15.5% (n=31) had low UIC, 21% (n=42) had above requirement and 36% (n=72) had excessive iodine nutrition status. The mean concentration of fT3 and fT4 was 2.87 pg/ml and 1.21 ng/dl respectively, while the median TSH concentration was 3.03 mIU/L. The prevalence of thyroid dysfunction was 10% (n=20) with subclinical hypothyroidism being the most common. Majority of participants with subclinical hypothyroidism had excess UIC.

Conclusions: Above requirement and excess iodine nutrition is more common in region where there is unregulated consumption and improper monitoring of iodized salt. Subclinical hypothyroidism is common in regions of excess iodine nutrition.
A prospective study to analyse the outcome of locking compression plating by minimally invasive percutaneous plate osteosynthesis technique in proximal tibial fractures
Authors: D. Anjaneyulu Reddy , P. Krishna Redy
Published: April 2018

Background: The proximal tibial fractures are one of the commonest intra articular fractures majority are of high energy fractures. We did the study to measure the outcome of locking compression plating by minimally invasive percutaeneous plate osteosynthesis technique in proximal tibial fractures.

Methods: Study comprises 20 cases of proximal tibial fractures, which have been managed by MIPPO technique during the period December 2014 to August 2016.

Results: The sex distribution in our study was 18 males and 2 females with 30 to 57 years age. The most common mode of injury in this study was road traffic accident. Type V Schatzker tibial plateau fractures were the commonest in 8 patients. 70% of our patients had excellent and good results in the functional outcome. In our study the average functional knee score was 22.40. The average range of movement achieved was 120 degrees. The average time taken for fracture healing was 16.52 weeks. In conclusion, MIPPO technique gives good to excellent results even in high energy tibial condyle fractures (70% cases in our study). Those who were treated with early fixation and early mobilization were found to have a better functional outcome irrespective of the fracture type. No secondary bone grafting was required.

Conclusions: The study reports that MIPPO technique is an effective method of treating proximal tibial fractures due to its overall good functional outcome.

 
Radiological correlation with functional outcome in displaced proximal humerus fractures treated with locking plates: a prospective study of 35 cases
Authors: Mahajan Neetin Pralhad , Palange Nikhil Dilip , Pawar Eknath D. , Jivrajbhai Mangukiya Hitesh , Ramteke Ujwal Suryabhan , Ravesh Vedashish , Jadhav Umesh , G. S. Prasannakumar
Published: April 2018

Background: The objective of this prospective study is to investigate the relationship between the functional outcome and the radiographic results of two-, three- and four part proximal humeral fractures treated with open reduction and fixation with PHILOS locking plate.

Methods: 35 patients (30 males and 5 females) with displaced proximal humerus fracture were treated with PHILOS plating and studied prospectively. According to Neer’s classification there were 16 two part fracture (45%), 15 three part fracture (42%) and 4 four part fracture (13%). The healing of fracture, head shaft angle (HSA) and complications were evaluated radiologically with plain radiographs whereas the functional outcome was assessed by the Shoulder Pain and Disability Index (SPADI) at 6 weeks, 3 months, 6 months and 1 year after surgery.

Results: In our study, patients treated with locking plates had mean forward flexion of 123°, abduction of 124°, mean external rotation of 30° and internal rotation 53° at 1 year follow-up. Maximum improvement in range of movement occurred between interval of 12 weeks to 24 weeks due to complete fracture union occurred approximately up to 12 weeks. The mean SPADI score at end of 1 year were 10.22, 10.38 and 10.20 for two, three and four part fractures respectively. Average postoperative and follow-up HSA's were 134.1±4.4 and 132.5±1.2 degrees, respectively. Varus progression was more prominent in patients with postoperative HSA <130 (p<0.001). Complications included impingement in 1 case, joint penetration by screw in 1 case, failure of fixation in 1 case and infection in 1 case.

Conclusions: Fixed angle locked plate is an extremely useful implant for reconstruction and salvage of proximal humeral fractures. Precise surgical technique, stable fracture fixation and restoration of anatomical reduction are absolutely necessary for improved outcome.
Improved rehabilitation and functional outcome with dedicated joint irrigation at the end of ACL reconstruction
Authors: Singh Ajeet , Kumar Rakesh , Ranjan Rajni , Mahajan Avijit
Published: April 2018

Background: ACL is most common ligament injured during sports. Postoperative pain and swelling is one of the major limiting factors for the rehabilitation of ACL reconstructed patients. Cryotherapy and intra-articular bupivacaine injection are few measures to reduce the pain. One of the main reason for pain is inflammatory mediators, by joint irrigation it reduce the inflammatory mediator that reduce pain and swelling.

Methods: We treated 33 patients of ACL injury with arthroscopic ACL reconstruction from July 2015 to April 2017. Postoperative pain and swellings were assed with VAS and suprapatellar fullness. VAS assessment done on 1st day, 2nd day and 12th day and for swelling 2nd day and 12th day. We had used closed loop endobutton for femur and bioscrew for tibia. In twenty patients at the end of the surgery we used 2 liter saline for joint irrigation.

Results: As a result of wash of pro inflammatory mediators and debris, there were reduced inflammation which reduces pain and swelling. Patients who received irrigation had less VAS score and suprapatellar fullness than the other group. There was better knee flexion on 12th day.

Conclusions: Adding up a dedicated joint irrigation at the end of surgery does not deviate from standard surgical protocol. No studies have stress upon joint irrigation. It reduce the pain and swelling by reducing inflammation which gives better result.

 
Determinants of range of motion in cruciate retaining total knee arthroplasty: a prospective study
Authors: Rao K. Nageswara , Harsha T. S. S.
Published: April 2018

Background: Total knee replacement (TKR) is to provide a stable painless knee with adequate range of motion (ROM) for daily activities. The aim of the study is to evaluate various factors that influence ROM in cruciate retaining TKR postoperatively.

Methods: Fourty four patients with osteoarthritis knee treated in our institute with TKR using cruciate retaining prosthesis are included in study and analysed prospectively. Mean follow up was 6 months. Patients are analyzed for following factors–age, gender, BMI, preoperative ROM, changes in posterior femoral condylar offset, posterior tibial slope after surgery. Statistical analysis of effect of all factors on knee ROM was done. Assessment was done preoperatively and 3 and 6 months postoperatively.

Results: Gender did not affect the final ROM. Mean age of patients is 65. Age has negative correlation with ROM (p=-0.45). The mean knee range improved from 92˚ to 101˚. Factors that negatively affect ROM include, BMI (p=-0.04) and Preoperative flexion deformity (p=-0.03). Factors that positively affect ROM include, knee scores and good preoperative flexion (p=0.001). Males have good amount of flexion preoperatively and post operatively when compared to females.

Conclusions: Preoperative ROM, flexion contracture and BMI are the important factors affecting the range of motion in total knee arthroplasty. Proper counselling of patient preoperatively regarding these various factors and appropriate selection of patient is of utmost important for satisfactory functional outcome.
A study of verapamil in treatment of keloid
Authors: Shah Yogesh M. , Garg Adit M. , Paliwal Gaurav , Ansari Amir S. , Jain Chandni , Rastogi Rashmi
Published: April 2018

Background: Keloid is a common presentation in clinical practice. Symptoms due to keloid are mild, but disfigurement and functional impairment can be severe. It is difficult to treat. Intralesional, injection triamcinolone acetonide, has limited efficacy, causes adverse effects such as local dermal atrophy, telengiectasia and hypopigmentation. Injection verapamil is reported to have similar efficacy, but lesser side effects, and is cheaper. Aim was to study efficacy and adverse effects of intralesional verapamil in treatment of keloid.

Methods: An open label study on 25 patients of keloid, either gender, age 11 to 55 years at a medical college hospital. Injection verapamil 2.5 mg/ml was administered intralesionally, at an interval of 3 weeks, for a total of 6 sittings, over a period of 18 weeks. Vancouver scar scale (VSS) was used to assess the improvement. The statistical analysis was done using SPSS version 21.0.

Results: Median duration of keloids was 8 months. The mean VSS score before treatment was 7.68 which reduced to 4.28 after treatment. Mean percentage change in VSS score was 46.21%, very highly significant (p<0.001). Physician’s assessment was ‘very good’ in 32.0% and 'excellent' in 8.0%. The complaint of post-procedure pain was present in almost all.

Conclusions: Intralesional injection verapamil, gives very good to excellent improvement in 40% of patients of keloid. Post injection pain persists for more than 24 hours. Drug does not cause local dermal atrophy or hypopigmentation.
A study on incidence of various allergens involved in allergic contact dermatitis by patch testing among 150 patients in a tertiary care hospital in South India
Authors: Shariff V. N. S. Ahamed , Deepa K. , Balamurugan L. , Nirmala S.
Published: April 2018

Background: Allergic contact dermatitis is common dermatoses seen among patients attending dermatology clinics. Allergic contact dermatitis is due to delayed type of hypersensitivity reaction. The diagnosis of allergic contact dermatitis is made by patch testing. A positive reaction to a patch test commonly proves the cause of dermatitis.

Methods: A retrospective study was conducted to estimate the incidence of various allergens among 150 patch test positive patients with allergic contact dermatitis who had attended the dermatology OPD in Rajiv Gandhi Government General Hospital, Chennai, between October 2014 and September 2016. All the details regarding history, examination findings, investigations and patch test results were collected from case records, the data were tabulated and analysed.

Results: Allergic contact dermatitis to cement was the commonest (44.7%), followed by nickel (10%) and plant antigens (9.3%). The commonest allergen to be tested positive was Potassium dichromate (82 cases), followed nickel (15 cases) and formaldehyde (8 cases). Most of the patients were in the age category between 41 and 50 years (47 cases– 31.33%). Male to female ratio was 2.41:1. 14 were atopic individuals (9.33%) by Hanifin and Rajka's criteria. Allergic contact dermatitis in 103 cases of our study were of occupational in origin (67%).

Conclusions: Avoidance of allergen and proper preventive measures in workplace and day to day activities will lead to significant decrease in the morbidity of the disease and improvement in quality of life in patients with allergic contact dermatitis. 
Myriad cutaneous presentation of chikungunya fever during recent epidemic in Gujarat: a case study of 124 cases
Authors: Bhuptani Neela , Sondarva Priyanka , Patel Dipti , . Tejashwani
Published: April 2018

Background: Chikungunya fever (CKG) epidemic had been recently re-emerged in Gujarat affecting large population. It is an acute viral infection caused by Togavirus, transmitted by Aedes mosquitos, can present with abrupt onset of fever, severe arthralgia, constitutional symptoms and cutaneous manifestations. We have reviewed cutaneous manifestations of CKG during recent epidemic (July-October 2017). The object of the study was to determine incidence of various cutaneous manifestations of Chikungunya fever.

Methods: A total of 124 patients (56 males and 68 females) with cutaneous manifestations of CKG were enrolled in the study and serological confirmation was done.

Results: Cutaneous manifestations were found more in females. Generalized erythematous maculo-papular rash was the most common finding (62.9%). Vesiculo-bullous eruption (7.25%) and toxic epidermal necrolysis-like lesions sparing mucosa (4.03%) were the other interesting findings. Different types of pigmentation were observed with striking nasal pigmentation in 7.25% patients. Aphthous like ulcers in intertriginous area were seen in 8.87%. There was flare up of existing conditions like Still’s disease and psoriasis.

Conclusions: A wide variety of cutaneous manifestations of CKG with an unusual presentation was encountered with confirmed serological evidence.