Σάββατο 27 Φεβρουαρίου 2016

Normal and impaired control of functional movements in stroke: Role of neural interlimb coupling

While close cooperation of muscle activation between the two legs during gait has been known for several years, only during recent years has it become evident that the mechanism of "neural interlimb coupling" plays a major role in the control of a number of functional movements. Neural interlimb coupling is defined as a flexible, task-specific, physiologically meaningful linkage of limbs during complex movements. Experimentally, this mechanism can be demonstrated through the analysis of reflex responses.

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Vestibular Evoked Myogenic Potentials (VEMPs) for Examining Vestibular Function and Dysfunction

Vestibular evoked myogenic potentials (VEMPs) allow one to evaluate function (and dysfunction) of the vestibular nervous system, using stimuli that are now more reliable than earlier similar versions of this exam. Stimuli that have been developed include air-conducted sound and bone-conducted vibration and are reproducible, with a short rise-time and short duration. Responses are recorded against a background of tonic muscle activity, and the muscles that are used nowadays are the sternocleidomastoid muscle (cervical VEMPs or cVEMPs) and the inferior oblique muscle (ocular VEMPs or oVEMPs) (Colebatch et al., 1994; Rosengren et al., 2005; Iwasaki et al., 2007; Todd et al., 2007; Rosengren et al., 2009; Zhang et al., 2011).

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Normal pressure hydrocephalus: Increase of utricular input in responders to spinal tap test

Idiopathic normal pressure hydrocephalus (NPH) is characterized by the clinical triad of cognitive impairment, urinary incontinence and gait disturbance (Hebb et al., 2001, Relkin et al., 2005). Although this disease was first described nearly 50 years ago, (Adams et al., 1965) the pathophysiology is still under discussion. There is some evidence that increased cerebrospinal fluid (CSF) pulse pressure (Lenfeldt et al., 2004) could lead to increased liquor diapedesis in the periventricular white matter following ventricular dilatation (Kristensen et al., 1996).

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The diagnostic accuracy of in Transthyretin Familial Amyloid Polyneuropathy

Transthyretin familial amyloid polyneuropathy (TTR-FAP) is a rare, adult-onset, hereditary disorder characterized by the primary extracellular deposition of amyloid fibrils in unmyelinated and small myelinated fibers, with later involvement of the large fibers (Said et al., 1984).

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New immunoassays for total, IgA and IgM antibodies against hepatitis E virus: Prevalence in Italian blood donors and patients with chronic liver or kidney diseases

Hepatitis E virus (HEV) is a zoonotic agent that causes acute hepatitis in humans with sporadic infections and outbreaks in developing countries worldwide. The global spread of HEV remains underestimated because of subclinical infections and lack of sensitive diagnostic assays.

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Full title with Editorial board members

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Publication date: March 2016
Source:International Journal of Psychophysiology, Volume 101





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Instructions to Authors

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Publication date: March 2016
Source:International Journal of Psychophysiology, Volume 101





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IOP-details

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Publication date: March 2016
Source:International Journal of Psychophysiology, Volume 101





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Adverse drug events due to Antiretroviral Therapy in a Northern Indian Tertiary Care Institution

2016-02-27T07-25-17Z
Source: National Journal of Physiology, Pharmacy and Pharmacology
Shamiya Sadiq, Sapna Gupta, Vijay Khajuria, Vishal R Tandon, Annil Mahajan, Mrityunjay Gupta.
Background: The introduction of highly active antiretroviral therapy (HAART) has led to significant reduction in acquired immune deficiency syndrome (AIDS) related to morbidity and mortality. However, adverse drug reactions (ADRs) to antiretroviral treatment (ART) are major obstacles. Aims and Objective: To examine the adverse effects of antiretroviral therapy in a tertiary care hospital. Materials and Methods: Ninety patients receiving antiretroviral therapy were studied prospectively over a period of 6 months and were evaluated for ADRs. Result: Of the 90 patients, 80 (89%) developed ADRs. A total of 111 ADR events were seen in 80 patients. The number of adverse drug events was seen higher in females (64%) than males (36%). The maximum frequency of ADRs was seen with Zidovudine + Lamivudine + Nevirapine (70.27%) combination followed by Stavudine + Lamivudine + Nevirapine (21.62%) and Stavudine + Lamivudine + Efavirenz (8.10%). Anemia and gastritis (12% each) were most common ADRs followed by vomiting (11.7%) and rash (10.8%). Most of the adverse drug events (ADE) were of type A (83.78%). The severity of most of the ADR events was mild (70.27%), followed by moderate (27.02%) and severe (1.78%). Conclusion: ADRs are common with HAART. Maximum number of ADRs occurred in females and Zidovudine + Lamivudine + Nevirapine (70.27%) combination was the main culprit. To minimize the potential risks of ADR due to ART, the clinicians need to detect them earlier and prevent them whenever possible and choose drugs with safer adverse drug profile.


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Effect of topical sodium fusidate, calcium mupirocin and papain—urea on wound healing in diabetic wistar rats

2016-02-27T07-25-17Z
Source: National Journal of Physiology, Pharmacy and Pharmacology
Smita Shenoy, Raghu Murthy, Lalit Mohan, Amoolya Gowda, Venu Madhav Nelluri.
Background: Poor wound healing is a complication of diabetes mellitus. Various agents have been used to promote wound healing in diabetic patients. Papain urea is used as a sloughing agent, whereas sodium fusidate and calcium mupirocin are used as topical antimicrobials for wounds in diabetics. Aims and Objective: To evaluate effect of topical sodium fusidate, calcium mupirocin, and papainurea on wound healing in diabetic wistar rats. Materials and Methods: Incision and excision wound models were used. Each model had five groups of six rats each and one group was nondiabetic control. Diabetes was induced in the remaining four groups, one diabetic control, and three test groups in each model, using streptozotocin (30 mg/kg intraperitoneally). Wounds were made in diabetic rats with blood glucose levels of more than 250 mg/dL. Paraffin ointment base was applied to wounds of nondiabetic and diabetic control, whereas sodium fusidate, mupirocin, and papainurea were applied topically to three test groups, respectively, in each model. Result: In sodium fusidate-treated group, there was a significant increase in breaking strength of incision wound, contraction rate, and hydroxyproline content of excision wound as compared to diabetic control group. There was significant decrease in period of epithelization in sodium fusidate-treated group compared to diabetic control group. There was no significant alteration in wound healing by mupirocin and papainurea. Conclusion: Topical application of sodium fusidate promoted wound healing in diabetic rats.


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Dengue: multicentre clinical profile of patients admitted in intensive care unit

2016-02-27T04-42-06Z
Source: International Journal of Research in Medical Sciences
Akash Rajender, Deepa C., Krishna K., R. S. Chaudhri, Gaurav R., Priyanka C..
Background: Dengue with 2.5 billion people at risk and 50 million new cases every year is one of the most rapidly spreading vectors borne disease in world. We aimed to analyse the clinical profile of dengue patients requiring ICU admission. Methods: In a cross-sectional, observational, multicenter case study 105randomly selected laboratory positive dengue subjects were randomly selected from four tertiary care centers ICUs. Socio-demographical, clinical, therapeutic & laboratory parameters were evaluated. Statistical analysis was done using SPSS version 14.0. Results: The main cause of ICU admission was shock or hypotension due to sepsis (20%). Most patients presenting complaint was fever (93.33%), bodyache (84.76%) and retro-orbital pain (34.3%). Most prevalent warning sign indicating severe dengue was abdominal pain (37.4%). Mucosal bleed (20.9%) was the most common haemorrhagic manifestation. 37.14% with warning signs and 62.86% patients with severe dengue required ICU care. Conclusions: A rapid assessment of clinical profile, presenting symptoms and warning signs can aid in early decision for requirement of ICU admission & may go a long way in decreasing mortality.


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Bipedicled transverse abdominal flap for coverage of exposed iliac crest due to post traumatic tissue loss in left inguinal region

2016-02-27T04-42-06Z
Source: International Journal of Research in Medical Sciences
Narendra G. Naik, Sangram Karandikar.
It is a surgical challenge for any plastic surgeon to choose the type of flap in the case of large inguinal canal tissue loss with exposed crest of ilium. Most repair methods provide inadequate closure of the defect for the large tissue loss over the inguinal region with exposure of the iliac crest. There are very few cases reported in the literature about transverse bipedicled abdominal flap for tissue defect over the inguinal region with exposure of the iliac crest bone and upper part of the thigh. In this case, by taking advantage of the large, loose, and lax nature of the abdominal skin, systematic primary closure of the donor as well as recipient site has been successfully achieved.


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Diagnostic surprises in early pregnancy: two case reports

2016-02-27T04-42-06Z
Source: International Journal of Research in Medical Sciences
Madhuri N..
Early pregnancy poses diagnostic challenges to the clinician in developing countries because of lack of early antenatal check-up and lack of ultrasound use in first trimester. Extrauterine pregnancies are rare and mostly tubal. Non tubal ectopic pregnancies are still rarer and most often surprise the surgeons intraoperatively. Here two such cases are reported, of women presenting with acute abdomen, no significant period of amenorrhea and no specific risk factors for ectopic pregnancy. First is an ovarian pregnancy managed conservatively by wedge resection. Second is a case of cornual pregnancy managed by cornual resection and uterine repair.


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Digital gangrene a rare early manifestation of Wegener’s granulomatosis: a case report

2016-02-27T04-42-06Z
Source: International Journal of Research in Medical Sciences
Akash Mathur, Dinesh Gurjar, Arvind Lakesar, Ramkrishna Sai, Aradhana Singh, Hemant Malhotra.
Wegener's granulomatosis (WG) or Granulomatosis with polyangiitis (GPA) rarely presents with digital gangrene being an early manifestation. We report a case of 60-year-old woman who presented with fever and cough with occasional hemoptysis along with painful bilateral feet digital gangrene. X ray chest and HRCT thorax of the patient was suggestive of multiple nodulo-cavitatory lesions. HPE of the lung lesion showed granulomatous pathology. CT Angiography was suggestive of multiple calcified and non-calcified lesions in infra renal aorta with stenosis of right dorsalis pedis artery. Biopsy of the skin lesion revealed a leucocytoclastic vasculitis. We eventually diagnosed GPA in light of clinical symptomatology with HPE of lung mass showing granulomatous lesion along with a positive cANCA. A few months after starting combined cyclophosphamide and steroids patient had significant symptomatic improvement. Hence Wegeners granulomatosis should always be considered as a possibility while evaluating a patient of digital gangrene specially with pulmonary and renal involvement.


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A rare case of bacteremia due to Acinetobacter junii in an immunocompetent adult

2016-02-27T04-42-06Z
Source: International Journal of Research in Medical Sciences
Asifa Nazir, Rumana Farooq, Nahid Nahvi.
The genus Acinetobacter comprises a complex and heterogeneous group of bacteria, many of which are capable of causing a range of opportunistic, often nosocomial, infections in humans. Acinetobacter junii is a rare human pathogen associated with bacteraemia in neonates and paediatric oncology patients. We report a unique case of bacteremia caused by Acinetobacter junii, in a patient with no risk factors identified.


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Single coronary artery with origin of right coronary artery from left circumflex in a patient with ventricular tachycardia: a case report

2016-02-27T04-42-06Z
Source: International Journal of Research in Medical Sciences
Sanjeev Sanghvi, Satish Lingaraju.
Only a few cases of a single coronary artery (CA) have been described. Almost all cases reported so far also had associated atherosclerotic coronary artery or valvular heart disease. We present a 48 years old male with atypical chest pain with an episode of Ventricular Tachycardia (VT) on treadmill test (TMT). Coronary angiography (CAG) showed a single Left coronary artery (LCA) with Right coronary artery (RCA) arising from left circumflex artery (LCX) without any atherosclerotic disease.


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Metanephric adenoma of kidney: a rare and distinct entity

2016-02-27T04-42-06Z
Source: International Journal of Research in Medical Sciences
Purwa Patil, Varsha Bhatia, Vidya Arole, Nisha Thakare.
Metanephric adenoma (MA) is an unusual renal neoplasm with benign behaviour most of the times. Clinically MA mimics malignant renal neoplasms due to nonspecific signs and symptoms such as polycythaemia, haematuria and abdominal pain. MA usually presents as a mass lesion on radiographic studies and can be found incidentally. The treatment of choice is surgical excision. Though MA is usually a benign tumour, increase in the knowledge of MA pathology may lead to less invasive treatments in the future. Less than 200 cases of metanephric adenoma are reported till date in the literature.


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Basal cell carcinoma involving tip and alar area of nose in a patient of hills of Uttarakhand: report of a rare case and review of literature

2016-02-27T04-42-06Z
Source: International Journal of Research in Medical Sciences
Hitendra Prakash Singh, Malti Kumari Maurya, Ashok Kumar.
Basal cell carcinoma (BCC) account for the vast majority of non-melanoma skin cancers (75%) and well over 25 percent of all cancers diagnosed each year. BCC has a predilection for fair-skinned individuals but can occur in Latin American and African American patients. Treatment of this tumour revolves around surgical excision or radiation therapy. Surgical excision can be accomplished using a variety of techniques including curettage and electrodessication, Mohs surgery and wide surgical excision. A case of BCC occurring in a lady of hilly areas of Uttarakhand, India and was treated with wide surgical excision and repaired with nasolabial flap has been described here.


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Dengue and HEV co-infection in a case of hepatitis

2016-02-27T04-42-06Z
Source: International Journal of Research in Medical Sciences
Mohd Amir Khan, Cyrus Cavina, Varun Shetty, Santwana Dinesh Chandrakar, S. T. Nabar.
A 35 years old male presented in the casualty of D.Y. Patil hospital with chief complaints of fever with chills since 10 days. Due to high endemicity of malaria in the Navi Mumbai region an initial diagnosis of malaria was made. Patient was admitted and started on anti-malarials. Initial reports were positive for dengue NS1 antigen. As the patient had severe jaundice a possibility of another co-infection was considered. On further investigation hepatitis E (HEV) Ig M was positive. This case illustrates the importance of considering co-infections in endemic areas that can pose diagnostic dilemmas.


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Live music therapy in waiting area of intensive care units: a novel concept for betterment of close relatives of ICU patients

2016-02-27T04-42-06Z
Source: International Journal of Research in Medical Sciences
Sundar Sumathy, Ramesh Bhuvaneswari, Varathan Kala.
Family members of ICU patients experience high levels of stress and anxiety. We explored a novel concept of live music therapy for relatives of ICU patients. Weekly 1-hour sessions of live music therapy consisting of devotional songs and prayers were performed in waiting area of ICU in a tertiary care hospital. Responses of 100 first degree relatives of ICU patients were documented using an 8-item questionnaire. 69% of the subjects rated live music therapy sessions as excellent; 50% of the subjects reported that they felt excellent after a single session. Such sessions were reported as a felt need by 77% of the subjects; 92% of the subjects reported that there were high chances that they would recommend such sessions in the hospital in future. In our study, we found our concept to be feasible, acceptable and highly appreciated as well as encouraged by first degree relatives of ICU patients.


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Self-medication among medical student in King Abdul-Aziz University

2016-02-27T04-42-06Z
Source: International Journal of Research in Medical Sciences
Mooataz Mohammed Aashi, Hisham Abdulhamid Alghanmi, Rabaa Hashim Alhibshi, Bashair Abdulrahim Alsaati, Naif Jeza Aljohani.
Background: A huge number of medications are used without prescriptions which make us face a real problem which is the overuse of medications. Medication overuse dose come with physical, mental and emotional abnormalities. The objective of the study was to investigate the irrational uses of these medications which are NSAIDS, paracetamol, antibiotic antihistamines, opioids, and anti-anxiety drugs among medical students in KAU. Methods: We conducted a descriptive cross sectional survey of 507 students enrolled at medical college of King Abdul-Aziz university in Jeddah 2015. The two steps stratified random sampling was used to collect the data. The questionnaire includes a socio-demographic information and data about using any of the following medication as anti-anxiety, antibiotics, paracetamol, opioids, (NSAIDs), and anti-histamine. The data entry and analysis was done by SPSS software package version 20. Results: Paracetamol were the most frequently 117 (23.1%) drug uses by medical students, followed by antihistaminic 48 (9.5%), antibiotic 33 (6.5%), NSAIDS 22 (4.3%), anti- anxiety 7 (1.4%) and opioid 4 (0.8%). Most of them were self-medication (74%). Relief fever was the most common cause for seeking self-medication reported by medical student 103 (20.4%), most frequent side effects was nausea and vomiting 47 (9.3%) Conclusions: There is an increase of self-medication in medical students of KAU especially paracetamol and NSAIDs use. We suggest increasing studies on the local irrational use of medications and increasing awareness on the importance of prescribed medications.


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Assessment on growth pattern of Khasi children in the state of Meghalaya, India

2016-02-27T04-42-06Z
Source: International Journal of Research in Medical Sciences
Barikor C. Warjri.
Background: This paper makes an attempt to describe the growth pattern and their sexual differences among the Khasi tribe in the state of Meghalaya in India. In the study we include 495 girls and 557 boys aged 3 to 18 years. Methods: In this Study the weight and height of these children were taken. Preece-Baines model 1 (PB1) has been used. This model was adopted for fitting the means of weight and some important linear measurements (Preece and Baines 1978), 1 using Levenberg-Marquardt method through SPSS (version 17.0) and origin software (version 8.0) for windows. All data were managed and analyzed using SPSS/PC software, version 15, in which the level of significance was set at 15%. The analysis will be carried out to present the basic descriptive statistics of anthropometric variables viz., height, weight, etc. according to sex and age groups. Results: The growth pattern of the Khasi children in the present study are described in terms of anthropometric measurement is observed that girls are heavier than boys at 3 and 4 years of age and boys are significantly heavier than girls from 5 to 6 years old. However girls are heavier than boys at the age of 12 years of age. It is further observed that boys are significantly heavier than girls and are statistically significant, except at the age of 15. It is found that both boys and girls are more or less similar in weight from 7 to 12 years of age. Conclusions: In terms of height boys are generally taller than girls across ages except at adolescence from 11 to 12 years where girls are taller than boys. The differences between the sexes are statistically significant after 14 years of age; the estimate values for adult height are 157.5 in males and 152 in females.


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Association of major depression with blood pressure and vascular complications of type 2 diabetes mellitus

2016-02-27T04-42-06Z
Source: International Journal of Research in Medical Sciences
Akash Rajender, Deepa C., Krishna Kanwal, R. S. Chaudhri, Gaurav Rajender, Priyanka Choudhary.
Background: The WHO estimates the diabetic population to increase to 366 million by 2030 worldwide, with maximum 79.4 million Indians. Depression is an undiagnosed co-morbidity leading to significant disability, non-compliance and postulated to cause poorer glycemic control leading to early disease complications. We aimed to detect depression and study its correlation with vascular complications among type 2 diabetes mellitus (T2DM) patients. Methods: In an observational study, 312 randomly selected T2DM patients were evaluated at tertiary care center in Northern India. Socio-demographic, clinical and laboratory data was collected. Montgomery Asberg depression rating scale (MADRS) was used to detect depression. Groups with and without major depression were compared for various diabetes variables. Statistical analysis was carried out using the SPSS version 14.0. Results: One third T2DM patients (32.05%) suffered from major depression. Depression was significantly associated with diabetic patients having cardiac (p 0.01), ophthalmic (p 0.04), nephropathy (p 0.01), cerebrovascular (p 0.001) complications and diabetic foot (p 0.04). However, depression showed no significant association with systolic blood pressure, neuropathic and infectious complications. Conclusions: Identification of depression and its appropriate management may go a long way in delaying diabetic vascular complications by improving treatment adherence and subsequently glycemic control.


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Clinical spectrum of hypothyroidism: a cross sectional study in Puducherry, South India

2016-02-27T04-42-06Z
Source: International Journal of Research in Medical Sciences
Darshan Savery M., Vijay Prasad C., Vishnu Prasad R..
Background: Hypothyroidism is characterised by underactive thyroid gland where there is reduced synthesis and secretion of thyroid hormones by the gland. With nearly one fifth of the population affected by hypothyroidism it is important to understand the clinical presentation of the disease. The present study aims to explore various clinical signs and symptoms of patients with hypothyroidism in Puducherry, South India. Methods: The study was carried out as a cross sectional study in a tertiary care medical college hospital, Puducherry among 213 patients who are admitted for various reasons and found to have hypothyroidism on laboratory investigations. With help of specialists in various fields all the patients were evaluated thoroughly and findings of the history and examination were noted down. Data entry was done in Epi Data version 3. Means and proportions were calculated using the software SPSS version 21. Results: Most of the hypothyroid patients (168/213) were females, giving a female: male ratio of approximately 3.4: 1. Primary hypothyroidism was found in most of the study participants (91%) and sub clinical hypothyroidism was seen in 6.2% of the patients. Commonest clinical presentation of the hypothyroid patients were fatigue (83.6%), weight gain (66.7%), were dry/coarse skin (52.1%) and voice change (50.7%). Conclusions: The commonest symptom being fatigue and weight gain while the commonest clinical sign was dry skin and voice change.


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Prevalence, phenomenology and etiology of delirium in medically ill patients

2016-02-27T04-42-06Z
Source: International Journal of Research in Medical Sciences
Susan Solomon, Pradeep Thilakan, Jesudas Jayakar.
Background: Delirium is one of the most common causes of referral of medically ill patients for psychiatric management and is associated with significant morbidity and mortality. The aim of the study was to determine the prevalence and etiology of delirium among medically ill patients and to describe its phenomenology. Methods: A cross-sectional descriptive study was conducted in the general medical ward of a tertiary care hospital. Four hundred patients were screened for delirium using the confusion assessment method. The delirium rating scale revised-98 was used to further characterize the severity and phenomenology of delirium. Descriptive statistics such as frequencies, means and standard deviation were used. Chi square test was applied to compare categorical variables and Fishers exact test was used to test associations. Student t test was used to compare the means of independent groups. Results: The prevalence of delirium was 9.75%. Male gender (69.23%) and age above 60 years (66.67%) were significantly associated with delirium (p values of 0.04 and


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Functional outcome of surgical management of tibial plateau fractures in adults

2016-02-27T04-42-06Z
Source: International Journal of Research in Medical Sciences
Arunim Swarup, Avinash Rastogi, Siddharth Singh, Kamal Swarn.
Background: Tibial plateau fractures are one of the commonest intra articular fractures. These injuries encompass many varied fracture configuration that involve medial, lateral or both tibial plateau with varied degree of compression and articular displacements. Being one of the major weight bearing joints of the body, these fractures are of paramount importance. Since there are various modalities for fixation of these fractures with satisfactory results, but there is no general consensus as to which modality is the best in terms of functional outcome and proving the superiority of one over the other. Keeping this aim in mind, we have conducted the present study to determine the efficacy of different practised methods of fixation, and if one are superior to the other. Methods: Sixty cases of tibial plateau fractures were treated with various surgical modalities and were followed up for a period of 2 years (2013 to 2015) at N.S.C.B Subharti hospital and their functional outcome was evaluated using Rasmussens functional score. Results: On selection these patients were classified according to Schatzker classification and were fixed accordingly using percutaneous cannulated cancellous screw, plating using LCP/ buttressing by open or MIPPO technique and screws depending upon the fracture configuration. Early range of motion was started as soon as pain subsided and weight bearing was deferred until radiological signs of union were evident. The knee range of motion was excellent to very good and weight bearing after complete union was satisfactory. Infection and stiffness in 2 cases was seen and there was one case of non-union in this series. Conclusions: Surgical management of tibial condylar fracture will give excellent anatomical reduction and rigid fixation to restore anatomical congruity, facilitate early motion, hence to achieve optimal knee function and reducing post traumatic osteo-arthritis.


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Radial nerve palsy following plate osteosynthesis of shaft humerus in relation to posterior verses anterolateral approach

2016-02-27T04-42-06Z
Source: International Journal of Research in Medical Sciences
Bishnu Prasad Patra, Saroj Kumar Patra.
Background: Fracture shaft of humerus is a relatively common upper limb injury. Although it can be managed conservatively still surgical management is the recent trend worldwide. Open reduction and plate osteosynthesis is the gold standard and commonly practiced method of management. Iatrogenic radial nerve palsy following fracture fixation is a usual complication. Though most cases recover with time, but the incidence is variable in different approach. We compared two common approaches for fixation of middle 1/3rd of shaft of humerus fracture based on frequency of secondary radial nerve palsy and fracture healing. Methods: A prospective comparative study of management of all middle 1/3rd shaft humerus fracture was undertaken in our institute from Jan 2012 to Nov 2014. Total 42 patients were operated in this period of which six patients lost to follow up, so all total 36 cases were included in the study. Among these 36 patients 16 patients were operated by posterior approach and rest 20 were operated by Anterolateral approach. All patients were followed up at 2nd post-operative day, 2 weeks, 6 weeks, 3 months, 6 month and 1year. Frequency of radial nerve palsy with its outcome and fracture union was accessed in postoperative follow-ups. Results: There were total 3 cases of iatrogenic radial nerve palsy found in patients operated by posterior approach but all these patients recovered by average 5 month (3 to 6 months). There was not a single case of radial nerve palsy seen following humerus fixation by anterolateral approach. All 36 patients had good radiological union by 1 year, of which 2 patients of anterolateral approach and 1 patient from posterior approach required bone grafting to achieve union. Conclusions: Both the approaches had similar outcome in terms of fracture healing but there was significant difference in frequency of secondary radial nerve palsy, commonly seen in posterior approach.


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A prospective observational study of dengue fever with thrombocytopenia with reference to treatment

2016-02-27T04-42-06Z
Source: International Journal of Research in Medical Sciences
Shashidhara Kuppegala Chikkaveeraiah, Rajashekar Reddy, Arun Kumar.
Background: Dengue fever is treated according to the WHO guidelines worldwide but due to the unavailability of blood products and economic constraints treating physicians often modify according to the patients requirements and try to give best available treatment for the patients. So we did an observational study of dengue fever and evaluated the clinical profiles and prognosis of dengue fever with reference to the treatment in JSS Medical College, Mysore in south India, a tertiary medical centre. Methods: This two year prospective, observational study was conducted in JSS Medical College. A total of 128 patients were evaluated and were divided into three groups like group 1-mild risk, group 2-moderate risk and group 3-high risk depending on the platelet count levels and bleeding diathesis. Group 1 received supportive treatment, group 2 received supportive treatment and steroids (Inj dexamethasone 4mg IV q8h) and group 3 received supportive treatment with steroids and platelet transfusion. Clinical evaluation and relevant investigations like blood culture; malarial parasites and febrile serology (acute and convalescent) were performed. Results: This observational study revealed that dengue fever can be managed symptomatically according WHO guidelines and platelet transfusion is done only when platelet count is less than 10000/cumm or in bleeding diathesis irrespective of platelet count. Conclusions: Steroid usage alone or along with platelet transfusion had no effect on the platelet count or on the overall outcome of the patient.


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Effect of Anulom Vilom Pranayam on auditory reaction time in Indian population aged 18-22 years

2016-02-27T04-42-06Z
Source: International Journal of Research in Medical Sciences
Manish Dhadse, Ameet Fadia.
Background: Reaction time is one of the important methods to study a persons central information processing speed and is an index of sensory, motor and cognitive processes. Auditory reaction time, an important psychophysical method useful for relating mental events to physical measures is significantly correlated to changes in breathing period. Objective of the study was to evaluate effect of Anulom Vilom pranayam on auditory reaction time. Methods: 60 volunteers from a tertiary care hospital of Mumbai were divided into two groups (study group and control group) of 30 each. Study group practised Anulom Vilom pranayam for 8 weeks. Control group were busy in their routine activities during that period. Pre-study and post-study measurements of auditory reaction times for high tone and low tone were done in both groups. Results: Statistical analysis was carried out and paired t-test was applied. Post-study auditory reaction time of study group for high tone and low tone showed significant decline than control group. Conclusions: Anulom Vilom pranayam which observed to reduce auditory reaction time have health promoting, boosting, toning effects on central neural structures; quantity, pattern of release of neurotransmitters and mental interaction involved in information processing. In light of the influence of psychosocial stressors, inappropriate nutrition and lack of physical activity in modern life on the development of stress related disorders, Anulom Vilom pranayam may have considerable potential in its prevention and is complementary to overall stress management.


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Observation on analgesic efficacy and adverse effects of intrathecal administration of bupivacaine versus bupivacaine-midazolam combination in lower limb surgeries in a tertiary care hospital

2016-02-27T04-42-06Z
Source: International Journal of Research in Medical Sciences
Md. Mohsin, Rekha Kumari.
Background: Postoperative pain relief can improve functionality, reduce physiological and emotional morbidity and improve quality of life. Neuraxial blocks not only reduce the incidence of venous thrombosis, pulmonary embolism, cardiac complications, bleeding transfusion requirements and respiratory depressions but also provide effective postoperative analgesia. One of the methods of providing postoperative is to prolong the duration of intrathecally administered bupivacaine by using additives such as opioids such as midazolam, clonidine and ketamine. Intrathecal administration of midazolam induces antinociceptive effects in humans. The present study was undertaken to evaluate the additive analgesic effects of intrathecal midazolam in combination with bupivacaine in lower limb surgeries in a tertiary care hospital and to compare the results with the use of bupivacaine alone. The aim of this study was to observe and compare the quality of spinal anaesthesia and occurrence of side effects in thirty cases administered with bupivacaine and thirty cases administered with bupivacaine-midazolam combination. Methods: Sixty cases admitted for lower limb surgery were divided into equal groups I and II. Cases in group I received intrathecal bupivacaine while those in group II received intrathecal combination of bupivacaine and midazolam. Data regarding quality of anesthesia and side effects were recorded and compared. Results: There was a significantly higher duration of a pain-free period in cases administered with intrathecal combination of bupivacaine and midazolam. Conclusions: Addition of preservative free midazolam to 0.5% hyperbaric bupivacaine for subarachnoid block prolongs the duration of effective analgesia as compared to bupivacaine alone. The utilization of intrathecal midazolam also decreases the incidence of postoperative nausea-vomiting.


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The ageing neuromuscular system and sarcopenia – A mitochondrial perspective

Abstract

Skeletal muscles undergo structural and functional decline with ageing, culminating in sarcopenia. The underlying neuromuscular mechanisms have been the subject of intense investigation, revealing mitochondrial abnormalities as potential culprit within both nerve and muscle cells. Implicated mechanisms involve impaired mitochondrial dynamics, reduced organelle biogenesis and quality control via mitophagy, accumulation of mitochondrial DNA (mtDNA) damage and respiratory chain defect, metabolic disturbance, pro-apoptotic signalling, and oxidative stress. This article provides an overview of the cellular mechanisms whereby mitochondria may promote maladaptive changes within motor neurons, the neuromuscular junction (NMJ), and muscle fibres. Lifelong physical activity, which promotes mitochondrial health across tissues, is emerging as an effective countermeasure for sarcopenia.

This article is protected by copyright. All rights reserved



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A clinical study of minor physical anomalies in patients with schizophrenia

2016-02-27T02-38-39Z
Source: International Journal of Research in Medical Sciences
Kamal Nath, Mithun Dutta, Aparajeeta Baruah, Subrata Naskar.
Background: Minor physical anomalies (MPA) are unusual morphological deviations that have no serious medical or cosmetic significance to an individual. But however minor they may be, various studies across the world have revealed their significance as a possible endophenotype of schizophrenia. This study is an attempt towards understanding the various sociodemographic and illness correlates as well as the prevalence of MPA in people with schizophrenia. Methods: 100 admitted patients who fulfilled the criteria for schizophrenia as laid down by international classification of diseases version 10 (ICD-10) and other inclusion and exclusion criteria over one year period with age between 16-60 years were included in the study. A standardized semi structured proforma for various sociodemographic and illness variables and Waldrop minor congenital anomaly scale (weighted version) were applied on the study subjects. Data obtained was analyzed using SPSS and chi-square was applied to find out statistical association. Results: Minor physical anomalies were found to be present in only 15% of subjects and they have a statistically significant association with age (p=0.041) and occupation (p=0.002). Conclusions: The study of MPA in schizophrenia is a novel attempt to unearth any subtle associations between the genetic abnormality and its interactions with the various psychophysiological as well as other environmental factors which ultimately leads to the endophenotype and in some cases to the ultimate illness state. In our study the presence of MPA in 15% of the subjects with various degree of severity probably indicates heterogeneity of the schizophrenia illness and a complex interaction with various factors from genotype to phenotype.


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Self-perceived risk and barriers to cervical cancer screening among patients seeking care at a tertiary care teaching hospital in Tamil Nadu

2016-02-27T02-38-39Z
Source: International Journal of Research in Medical Sciences
Lokeshwari Jayaraman, Maheshwari K., Sanjeev Kumar Khichi, Abhishek Singh, Shewtank Goel, Avijit Roy, Jayaprakash K., Pooja Goyal.
Background: Identification of characteristics of women, their perceptions of own risk and barriers to accessing existing screening services can provide important information for shaping screening services. The objective of the study was, the present study was undertaken to ascertain the perceptions of risk and barriers to cervical cancer screening by women seeking care at a tertiary care teaching hospital in Tamil Nadu. Methods: The current survey was planned and executed by the Department of Obstetrics and Gynecology of a tertiary care teaching institution of Tamil Nadu during February to July 2015 using a pre-designed questionnaire among 177 study participants. Inclusion criteria were 18 years and above, non-pregnant and consenting for the survey. Women seeking the antenatal care were excluded from this study. The study population consisted of women seeking family planning services at Obstetrics and Gynecology Department. Results: The traditional risk factors for development of cervical cancer were observed in a considerable proportion of the study participants. Sexual debut earlier than 20 years was very common mentioned by nearly 67% of participants. Majority of study participants i.e. more than 50% had multiple sexual partners. About 32% of the study subjects felt that they were at no risk of developing cervical cancer and 34.5% felt no need for screening for the condition. Of women perceiving themselves to be at risk of cancer of the cervix, 80% expressed the need for cervical cancer screening compared to 58.75% of those who had no opinion on own risk. Conclusions: self-perception of not being at risk is documented to be associated with low uptake of screening. Concerned health education programs need to bring clearly to the end user the difference between precancerous lesions and invasive cervical cancer and the treatment options available.


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Factors affecting the assessment of mitotic count in histopathological sections of tumors: a study of interobserver and intraobserver variability

2016-02-27T02-38-39Z
Source: International Journal of Research in Medical Sciences
Navya Narayanan Orchid, Sathi Puthanpurayil.
Background: Mitotic count is the most commonly used method of assessing the proliferative activity of a tumor. It is usually done in routine Hematoxylin & Eosin stained sections and is used for classification, grading, prognostication of tumors and sometimes as a decision factor for treatment. There are numerous variables that can influence the mitotic count like delay in fixation, thickness of the section, size of the high power field of the microscopes and so on. This study is designed to assess the relative importance of Intra-observer variability and Inter-observer variability on mitotic counting by keeping all different procedural factors constant. Methods: Sections from forty cases of breast cancer and twenty cases of high grade lymphoma formed the study material. Mitotic counts done by the principal investigator under standard conditions were compared with counts done by another experienced observer under standard conditions to evaluate the inter-observer variability. The principal investigator will make all counts twice at intervals of one month to assess intra-observer variability. Paired t test and linear regression were the statistical tests used in analysis. Ki-67 immunohistochemistry was also done in sections fixed at different intervals. Results: Our study showed that inter-observer (p=0.261) and intra-observer variation (p=0.261) is not statistically significant. In case of inter-observer variability the correlation is weak and not significant. Conclusions: Reproducibility in mitotic counting can be achieved by following a strict morphological criteria as well as a strict counting protocol.


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Study of altered platelet morphology with changes in glycaemic status

2016-02-27T02-38-39Z
Source: International Journal of Research in Medical Sciences
Mitakshara Sharma, Sanjeev Narang, S. K. Nema.
Background: Diabetes is a pandemic causing very high morbidity and mortality due to its complications which are a result of micro and macro angiopathy. Platelets play a key role in the vascular complications. These complications are attributed to platelet activation which can be recognised by an increase in platelet volume indices (PVI) including mean platelet volume (MPV) and platelet distribution width (PDW). Platelet indices can be potentially useful surrogate markers for the early diagnosis of thromboembolic and cardiovascular complications in diabetes. Methods: This is a cross-sectional study conducted for 2 years with total 930 subjects. The patients were segregated in 03 groups on basis of HbA1C as (a) Diabetic, (b) Non-Diabetic and (c) FG. Samples for HbA1C and platelet indices were collected using EDTA (ethylene diamine tetracetic acid) as anticoagulant and were processed on autoanalysers. Results: The study revealed a stepwise increase in the PVI from non-diabetics to IFG to diabetics. MPV and PDW were increased in the IFG cases as compared to the non-diabetic and were markedly increased in the diabetic patients. MPV and PDW of diabetics, IFG and non-diabetics were 17.60±2.04, 11.76±0.73, 9.93±0.64 and 19.17±1.48, 15.49±0.67, 10.59±0.67 respectively with a significant p value 0.00. Significant positive correlation between PVI with glycaemic levels and duration of diabetes across the groups (MPV-HbA1c r = 0.951; PDW-HbA1c r = 0.875). However, the total platelet count was found to decrease with the increasing glycaemic levels with a p value


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Knowledge, attitude and practice of Tanta University medical students towards hepatitis B and C

2016-02-27T02-38-39Z
Source: International Journal of Research in Medical Sciences
Salwa A. Atlam, Hala M. Elsabagh, Nihal S. Shehab.
Background: Egypt lies among the worlds highest prevalence rates of HCV and intermediate levels of HBV infection. The objectives of the study were detection of the knowledge, attitude and practice of Medical Students of Tanta University towards hepatitis B and C. Methods: This was a cross-sectional study, conducted in The Faculty of Medicine, Tanta University, Egypt; from 15th October 2013 to 15th of January 2014. Results: The study included 185 Students; their ages ranged between 17 to 28 years with a mean 20±1.731years. Sixty percent of students were males and 65% were urban residents. 50.8% of the participants were in the basic level of the academic study. More than half (57.85%) of the participants had sufficient knowledge, 77.3% of them had a positive attitude towards hepatitis C and B and more than two-thirds (68.1%) showed good practice. A significant association occurred between a positive attitude and good practice. Sufficient knowledge was significantly recorded among older students, females, urban residents and the clinical stage students. The most frequent sources of student information were family or friends, internet followed by TV or radio, healthcare workers, and newspapers. Conclusions: The students had reasonable knowledge, positive attitude and good practices towards B and C viral hepatitis. Areas of insufficient knowledge needed to be reinforced included some modes of transmission, complications, and treatment for B and C viral hepatitis.


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Clinical and laboratory profile of different dengue sub types in dengue virus infection

2016-02-27T02-38-39Z
Source: International Journal of Research in Medical Sciences
Niloy Gan Chaudhuri, S. Vithyavathi, K. Sankar.
Background: Dengue infection, an arthropod-borne viral hemorrhagic fever is caused by Arbovirus of Flavivirus genus and transmitted by Aedes aegypti, Aedes albopictus. Liver involvement in dengue fever is manifested by the elevation of transaminases representing reactive hepatitis, due to direct attack of virus itself or the use of hepatotoxic drugs. The objective of the study was to investigate clinical and laboratory profile of different dengue sub types patients admitted for dengue fever. Methods: All the adult patients with clinical features such as fever and later confirmed positive by dengue serology test admitted as inpatients were included in the study. Vitals parameters and systemic examination were performed. Investigation of dengue serotology, liver function test, routine investigations like hemoglobin percentage, total count, ESR, packed cell volume, platelet count, partial thromboplastin and activated partial thromboplastin time, blood urea, serum creatinine, and blood sugar estimation were done. Results: On comparison of clinical signs in different dengue subgroups it was observed that the mean value of pulse, blood pressure and respiratory rate were significantly more deranged in the DSS group as compared to the DF group. Platelet count was significantly lower in all the sub groups whereas PT/aPTT was more dearranged in the DSS and DHF group as compared to the DF group. Comparison between the mean values of liver function test in different dengue sub groups had been shown, elevated transaminases, hypoproteinaemia and hypoalbuminaemia, in higher frequency in dengue haemorrhagic fever (DHF) and dengue shock syndrome (DSS) as compared to classical dengue fever (DF) (P values significant). SGOT was significantly higher than the SGPT levels and SGOT was much more elevated in the DSS sub group compared to the DFS and DF group. Conclusions: The liver enzymes serum aminotransferase levels were significantly raised in patients with dengue shock syndrome compared to other two groups. Serum aminotransferases directly correlate with severity of infection in all the sub groups. Patients with secondary dengue infection were more prone for developing bleeding manifestations and shock syndrome.


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Correlation of non alcoholic fatty liver disease in patients of coronary artery disease

2016-02-27T02-38-39Z
Source: International Journal of Research in Medical Sciences
Khwaja Saifullah Zafar, N. A. Wafai, S. F. Haque.
Background: In NAFLD, increase in factor VIII and a reduction of protein C leads to the progression from steatosis to cirrhosi. The aim was to study the correlation of NAFLD with other associated risk factors of CAD. Methods: A total number of 100 patients of coronary artery disease were assessed for presence of NAFLD, dyslipidemia, metabolic syndrome & diabetes by various laboratory tests. Results: 46% of the CAD patients were found to have NAFLD. 69.6% patients of NAFLD were in the age group of 40-60 years. 21.7% were above 60 years. 91.1% of NAFLD patients were males. Half of the NAFLD patients were diabetic. 21.7% of NAFLD patients were found to have a total cholesterol level >200. Triglyceride level was also high among these patients (58.7%). All the NAFLD patients had LDL


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An open model cross sectional observational study of hyponatremic patients in a tertiary care hospital

2016-02-27T02-38-39Z
Source: International Journal of Research in Medical Sciences
Harsha Gopinath, T. Duraickannu, Roopak Mohan, G. Rakesh Kumar.
Background: Hyponatremia is the most common electrolyte disturbance encountered in clinical practice. Hyponatremia frequently develops in hospitalized patients, especially in metabolic encephalopathy patients, their causes are multiple. Symptomatology depends more on the rate of development of the electrolyte abnormality than on its severity. We undertook this study to determine etiological, clinico-lab profile and differential diagnosis in a group of hyponatremic patients. Methods: We included retrospectively 50 patients of hyponatremia admitted in medical intensive care unit between June 2013 and May 2014. We excluded all patients who presented with chronic hyponatremia, chronic use of diuretics and recent cases undergoing surgery and chronic cases of malnutrition and those with age below 18 years. Data were analyzed by univariate methods, followed by multivariate analysis. Results: Among the 50 patients with hyponatremia, 42% of encephalopathy patients had metabolic encephalopathy. Majority who developed hyponatremia had age between 61 to 80 years. Clinical profile of patients with hyponatremia was revealed that most of the patients with hyponatremia were observed having confusion followed by nausea/vomiting, delirium, seizure. The most common etiology of metabolic encephalopathy with hyponatremia is diuretic induced, followed by diabetic ketoacidosis, chronic liver disease, chronic kidney disease, SIADH and hypothyroidism. The common co-morbid conditions for hyponatremia were hypertension 55.93%, diabetes mellitus 43.85%, and chronic renal failure 35.29%. In the patients with hyponatremia high urine sodium level suggests that most of the patients had hyponatremia due to renal loss of sodium other than extra renal cause. Conclusions: In the present study, hypertension was found a major risk factor for hyponatremia. Common causes of hyponatremia found are intake of diuretics and excessive renal loss. Most of the hypertensive patients in the present study group were on thiazide or potassium sparing diuretics. Diabetes mellitus and dyslipidemia were important co-morbidities of hyponatremia.


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The spectrum of renal changes in patients with liver diseases: an immunofluorescent and light microscopic study

2016-02-27T02-38-39Z
Source: International Journal of Research in Medical Sciences
Gireesh K. Bhasin, Shweta Rana, Kanchan Bhasin.
Background: There are divergent observations on renal function tests and renal morphology in patients with liver diseases. The present study was designed (1) To study the morphological changes in kidney in patients with various types of Liver diseases; (2) To study the correlation between the renal histology, clinical and other laboratory parameters in these cases; (3) To suggest the possible mechanisms of renal injury secondary to liver diseases. Methods: This prospective study was carried out at the department of pathology of a tertiary care centre in Delhi. A total of 30 patients admitted with liver diseases were included in the study. All kidney samples were evaluated by light microscopy and immunofluorescence microscopy. The sections were stained by fluorescent labeled antisera for human IgG, IgA and IgM. Postmortem kidney biopsy from 10 patients dying of unrelated diseases served as controls. Results: Glomerular changes on light microscopy were present in twenty four patients (80%) as compared to two controls (20%). The difference was statistically significant (x2= 11.75; p


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Plasma levels of vitamin B12, epidermal growth factor and tumor necrosis factor alpha in patients with alzheimer dementia

2016-02-27T02-38-39Z
Source: International Journal of Research in Medical Sciences
Hatice Ferhan Komurcu, Nedret Kilic, Melike Erol Demirbilek, Kadir Okhan Akin.
Background: It was previously reported that vitamin B12 (Vit B12) has the regulatory effects on epidermal growth factor (EGF) and tumor necrosis factor alpha (TNF-α). The role of Vit B12, EGF and TNF-α in the pathogenesis of alzheimer dementia has not been elucidated yet. In this study the plasma Vit B12, EGF and TNF-α level were examined in individuals, between 65-99 years old with and without alzheimer dementia (AD). Methods: The study group comprised 47 patients with AD and 38 cases without dementia. EGF and TNF-α were analyzed by ELISA, and Vit B12 was analyzed by chemiluminescence method. Results: Vit B12 and EGF levels were significantly lower (p


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Comparison of single dose transdermal patches of diclofenac and ketoprofen for postoperative analgesia in lower limb orthopaedic surgery

2016-02-27T02-38-39Z
Source: International Journal of Research in Medical Sciences
Reetu Verma, Sanjiv Kumar, Ankur Goyal, Ajay Chaudhary.
Background: Transdermal patch is a very simple and painless method for providing postoperative analgesia. The aim of the study was to compare the efficacy and safety of transdermal patch of ketoprofen in comparison to diclofenac patch for postoperative analgesia. It is a randomized single blind study. Methods: Sixty patients were randomly allocated to receive either ketoprofen or diclofenac patch at the end of surgery under spinal anaesthesia. Statistical analyses used, data were analyzed using statistical package for social sciences version 15.0. Results: In diclofenac group the post-operative VAS was 2.4±0.72 and in ketoprofen group, post-operative VAS was 1.4±0.3 which was significantly low when compared to group D (p


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Breast cancer awareness and breast self-examination among future female university graduates: comparison between medical and non-medical students

2016-02-27T02-38-39Z
Source: International Journal of Research in Medical Sciences
Elsadig Yousif Mohamed, Waqas Sami, Abdullah Atallah Alenezi, Abdulrahman Mubarak Almutairi, Ahmad Khalid Alsalboud, Khalid Mohammad Alhusainy, Mohammad Awadh Almutairi, Syed Meraj Ahmed, Khalid Altohami Medani, Mohammed Abdullah Al Mansour, Mansour Khatir Alzahrani, Talal Shakhs Algamdi, Fahad Bin Mohamed Alfhaid, Tahir Ansari.
Background: Breast cancer is a common health problem among females in Saudi Arabia. The disease account for 27% of all female malignancies representing 25.1% of all newly diagnosed female cancers. The objectives of the current study were to assess the level of carcinoma breast awareness of female university students, Majmaah University in Saudi Arabia and to compare the level of awareness, breast self-examination and breast cancer screening between medical and non-medical students. Methods: The current study was a cross-sectional, conducted among female students in Majmaah University in Saudi Arabia. The stratified and the systematic sampling were employed to select the colleges and the students respectively. The sample size was calculated as 325. Data was collected by a pre tested questionnaire and analyzed by SPSS. Results: The university students who acquired good knowledge were 111 (34.2%). Students who acquired average and poor knowledge were 42.2% and 23.6% respectively. Medical students who had good knowledge were 37.6% compared to 26.9% of non-medical students. The results showed that 94 (28.9%) of the participants practice breast self-examination and 25 (7.6%) performed a screening test. Conclusions: The study concluded that Majmaah University students awareness of carcinoma breast is low. There is no significant difference in the level of awareness between students of medical colleges and those of non-medical colleges. The level of practicing breast self-examination and performing screening test for carcinoma breast among female university students is low. There is a significant difference in performing carcinoma breast screening test between medical and non-medical students.


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Current perspective in the treatment of bile duct injuries

2016-02-27T02-38-39Z
Source: International Journal of Research in Medical Sciences
Juan José Granados-Romero, Aranza Guadalupe Estrada-Mata, Mariana Espejel-Deloiza, Jesús Carlos Ceballos-Villalva, Ericka Hazzel Contreras-Flores, Benjamín León-Mancilla, Germán Eduardo Mendoza-Barrera, Carlos Aarón Méndez-Celis, Alan Isaac Valderrama-Treviño.
The laparoscopic cholecystectomy is considered the gold standard for the treatment of benign gallbladder disease, which is associated with an increased incidence of biliary injuries. These types of injuries are multicausal, and anatomical variations or anatomical perception errors are the most common risk factors. The objective of this study is to describe the evolution in the management of bile duct injuries and actual, diagnostic tools, incidence, prognosis and treatment. A literature research about diagnosis and treatment of iatrogenic bile duct injuries as well as their impact on the incidence of morbidity and mortality, based on a 30-year period, was performed on Medline, Cochrane, Embase, MedScape and PubMed database, for all studies that met the eligibility criteria. A thorough quality assessment of all included studies was performed. Synthesis of the results was achieved by narrative review. The bile duct injury is a complication that requires a complex therapy and multidisciplinary management. Reconstruction and treatment techniques have been evolving. The selection of adequate treatment will impact on the patient´s quality of life. The results of the existing studies reporting on iatrogenic bile duct injuries are useful; because the iatrogenic bile duct injuries are complex alterations and constitute one of the most serious complications of a cholecystectomy and require a comprehensive approach, immediate repair, proper drainage and timely referral to adequate treatment to improve long-term prognosis. According to the literature review, currently there better treatments such as absorbable prosthesis, which improve the prognosis and patient´s quality of life, and represent less risk of complications in short/long term.


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Replacing Sedentary Time with Physical Activity in Relation to Mortality.

Introduction: Data evaluating mortality benefit from replacing sedentary time with physical activity are sparse. We explored reallocating time spent in sedentary behavior to physical activity of different intensities in relation to mortality risk. Methods: Women and men aged 50-85 years from the National Health and Nutrition Examination Survey (NHANES) 2003-2004 and 2005-2006 cycles with follow-up through December 31, 2011 were included. Sedentary time and physical activity were assessed using an ActiGraph accelerometer. Isotemporal substitution models were used to estimate the effect of replacing one activity behavior with another activity behavior for the same amount of time while holding total accelerometer wear time constant. Results: During a mean follow-up of 6.35 years, 697 deaths from any cause occurred. Replacing 30 minutes of sedentary time with an equal amount of light activity was associated with 14% reduced risk of mortality (multivariable-adjusted hazard ratio (HR)=0.86, 95% confidence interval (CI)=0.83-0.90). Replacement of sedentary time with moderate to vigorous activity was related to 50% mortality risk reduction (HR=0.50, 95% CI=0.31-0.80). We also noted a 42% reduced risk of mortality when light physical activity was replaced by moderate to vigorous activity (HR=0.58, 95% CI=0.36-0.93). Conclusion: Replacing sedentary time with an equal amount of physical activity may protect against preterm mortality. Replacement of light physical activity with moderate to vigorous activity is also associated with protection from premature mortality. (C) 2016 American College of Sports Medicine

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Intensive Exercise Does Not Preferentially Mobilize Skin-Homing T Cells and NK Cells.

Purpose: This study investigated whether natural killer (NK) cells and CD8+ T cells expressing cutaneous lymphocyte antigen (CLA) - a homing molecule for endothelial cell leukocyte adhesion molecule 1 (ELAM-1), which enables transmigration to the skin - are selectively mobilised in response to acute exercise. Methods: Nine healthy males (mean +/- SD age: 22.1 +/- 3.4 years) completed two exercise sessions: high-intensity continuous cycling ('continuous exercise' at 80% V[spacing dot above]O2MAX for 20 min) and low-volume high-intensity interval exercise ('HIIE' at 90% V[spacing dot above]O2MAX 10 x 1 min repetitions with 1 min recovery intervals). Blood was collected before, immediately- and 30 min post-exercise for cryo-preservation of peripheral blood mononuclear cells. CLA+ and CLA- cells were quantified within NK subpopulations (CD56bright 'regulatory' and CD56dim 'cytotoxic' cells) as well as the following CD8+ T cell subpopulations: naive ('NA'; CD45RA+CCR7+), central memory ('CM'; CD45RA-CCR7+), effector-memory ('EM'; CD45RA-CCR7-) and CD45RA-expressing effector-memory cells ('EMRA'; CD45RA+CCR7-). Results: CLA+ NK cells and CD8+ memory T cells increased in response to both exercise bouts, but, overall, their numerical contribution to the exercise lymphocytosis was inferior to CLA- cells, which increased to a much greater extent during exercise. Tellingly, the most exercise-responsive cells - effector memory CD8+ cells and CD56dim cells - were CLA-. Conclusions: A small subset of CLA+ lymphocytes are mobilised into blood during acute intensive exercise, but CLA+ cells are not major contributors to exercise lymphocytosis, thus providing preliminary evidence that the skin is not a major origin, or homing-destination, of exercise-sensitive lymphocytes. (C) 2016 American College of Sports Medicine

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Whole-Body Vibration Intensities in Chronic Stroke: A Randomized Controlled Trial.

Purpose: A single-blinded, randomized controlled study was conducted to investigate the effects of different whole-body vibration (WBV) intensities on body functions/structures, activity, and participation in individuals with stroke. Methods: Eighty-four individuals with chronic stroke (mean age: 61.2 years, SD: 9.2) with mild to moderate motor impairment (Chedoke-McMaster Stroke Assessment lower limb motor score: median = 9 out of 14, interquartile range = 7-11.8) were randomly assigned to a low-intensity WBV, high-intensity WBV, or control group. The former 2 groups performed various leg exercises while receiving low-intensity and high-intensity WBV, respectively. Controls performed the same exercises without WBV. All individuals received 30 training sessions over an average period of 75.5 days (SD = 5.2). Outcome measurements included knee muscle strength (isokinetic dynamometry), knee and ankle joint spasticity (Modified Ashworth Scale), balance (Mini Balance Evaluation Systems Test, Mini-BESTest), mobility (Timed-Up-and-Go test, TUG), walking endurance (6-Minute Walk Test, 6MWT), balance self-efficacy (Activities-specific Balance Confidence scale, ABC), participation in daily activities (Frenchay Activity Index), perceived environmental barriers to societal participation (Craig Hospital Inventory of Environmental Factors), and quality of life (Short-Form 12 Health Survey, SF-12). Assessments were performed at baseline and post-intervention. Results: Intention-to-treat analysis revealed a significant time effect for muscle strength, TUG, distance, and oxygen consumption rate achieved during 6MWT, Mini-BESTest, ABC, and SF-12 physical composite score domain (P 0.05). Conclusion: Addition of the 30-session WBV paradigm to the leg exercise protocol was no more effective in enhancing body functions/structures, activity, and participation than leg exercises alone, chronic stroke patients with mild to moderate motor impairments. (C) 2016 American College of Sports Medicine

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