Δευτέρα, 1 Αυγούστου 2016

Rapid Recovery after Early Initiation of Plasmapheresis in Atypical HUS: A Case Report

2016-08-01T18-40-25Z
Source: National Journal of Medical Research
Sengupta D,Mehta V, Singh P, Singhvi A.
We report a case of a thirteen year old female diagnosed as aHUS, complicated by malignant hypertension and central nervous system involvement. The patient was treated with plasmapheresis(plasma exchange) and corticosteroids along with supportive care. The patient showed remission immediately and recovered after four weeks of hospital stay and three months later is well on antihypertensives.


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Empirical Treatment in Clinically Diagnosed Cases of Vitamin B12 Deficiency

2016-08-01T18-40-25Z
Source: National Journal of Medical Research
Pulkit Modi, Vikki J Parikh.
Background: Vitamin B12 deficiency may present with fatigue, weakness, numbness, decreased memory, irritability, confusion and depression, although initial symptoms might often be vague. Even though the human body can store vitamin B12 to last for up to five years, its deficiency is not very uncommon. The diagnosis is frequently made on the basis of a costly tests like low serum vitamin B12 level or megaloblastic bone marrow or both. This study was aimed to measure the effect of Empirical treatment in clinically diagnosed cases of Vitamin B12 deficiency. Methodology: Current study was a prospective study, done in a private hospital. All patients attending OPD during July 2015 to December 2015 forms the study population. All patients full filling inclusion criteria and willing to give informed written consent were treated with 2ml Intramuscular injection of Vit B 12 1000mcg thrice a week for total ten injections. Follow up of patients were done on weekly basis for first month, then every two weekly for next two month and then monthly basis for next three months. After this period, symptoms were reassessed and recorded. Results: Total 90 clinically suspected patients of Vitamin B12 deficiency were willing to participate in the study. Out of total 90 patients, 39 (43.33%) patients were male and 51 (56.67%) patients were female. Out of total 90 patients, maximum number of patients i.e 31 (34.44%) were from age group of 41 to 50 years. All symptoms were significantly improved after completion of standard course of Vit B12. In out of total 90 patients having complain of generalized weakness, improvement was observed in 83 (92.22%) patients. Out of total 88 patients having complain of myalgia and 84 patients having complain of paresthesia, improvement was recorded in 76 (86.36%) and 73 (86.9%) patients respectively. Conclusion: We conclude and recommend from the study that diagnosis based on clinical assessment is reliable. Thus, in resource poor country like India diagnosis should be advocated on symptoms of Vit B12 deficiency and empirical treatment should be suggested.


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A Study on Correlation of Carotid Intima and Media Thickness With Stress ECG and 2D Echo In Type 2 Diabetes Mellitus patients in Tertiary Care Hospital of Pune City

2016-08-01T18-40-25Z
Source: National Journal of Medical Research
Pradnya M Diggikar, Prasanna K Satpathy, Deepak D Baldania, Thakapalli V Babu, Kanishka D Jain, Ankit Hissaria.
Background: The atherosclerotic process in diabetes mellitus causes intimal thickening and luminal narrowing. The present study was conducted with an objective to study correlation of Carotid Intima and Media Thickness with Stress ECG and 2D Echo in type 2 DM. Methodology: This cross-sectional study was conducted on cases of asymptomatic type 2 DM. A detailed history was taken and clinical examination consisting of all diabetic manifestations including carotid bruit and other peripheral vascular disease was noted. All patients were subjected to necessary laboratory investigations, stress ECG and 2D Echo. Results: Among the 50 DM cases, there was no significant correlation found between CIMT and Age (P value>0.05). There was significant correlation found between CIMT (group ≤0.9 - ≥0.7) with sex and duration of DM with p value


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Outcome of Low Maintenance Dose Magnesium Sulphate in Eclampsia Patients of a Tertiary Care Hospital of Gujarat, India- A Prospective Study

2016-08-01T18-40-25Z
Source: National Journal of Medical Research
Krina K Kathawadia, Priyanka C Patel, Smruti B Vaishnav.
Background: Eclamptic convulsions are life-threatening emergencies and require proper treatment to decrease maternal morbidity and mortality. Amongst the principles of management of eclampsia, the first and foremost is the control of convulsions. In the last decade researchers in developing countries (like India) are constantly striving to steadily decrease the doses of MgSo4 regimes in view of decrease the toxicity of MgSo4 therapy. Methodology: Present study was a prospective interventional study and hdsanalysed all antenatal, intranatal and postnatal cases diagnosed as eclampsia and admitted to Obstetric ward, HDU, ICU (medical and surgical), IMC of Shree Krishna Hospital and Pramukhswami Medical college, Karamsad. All patients of Eclampsia admitted in the hospital during the study period were included in the study. Patients fulfilling the inclusion criteria, MgSo4 4gm was administered slowly intravenously over 10-15 minutes as loading dose and maintenance dose 0.5g/hr continue up to 24 hrs of delivery or 24hrs after convulsions whichever was later. Those patient were developed recurrent convulsion, they were given 2g MgSo4i.v. stat and maintenance dose was converted in standard dose 1g/hr. Results: In the present study we could achieve the average serum magnesium level around 3.3-3.4 mEq/L. These were below therapeutic range for eclampsia but within the range of normal blood level. Even serum magnesium level in subtherapeutic range, 89.2%patients had not developed recurrent convulsions. 33(71.73%) patients delivered Vaginally and 13(28.26%) were delivered by LSCS. Most common indicationsfor LSCS were fetal distress in 1st stage of labour followed by severe oligohydroamniosis and failure of induction of labour. Conclusion: Low maintenance dose of magnesium sulphate therapy is effective for controlling convulsion in cases of eclampsia. The toxicity is reduced to nil. There was no maternal complication due to recurrent convulsions because patient was under close monitoring and immediately the stepping up of dose was enough.


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Study of Platelet Rich Plasma Injections in Patients of Tendinopathy in South Gujarat Population

2016-08-01T18-40-25Z
Source: National Journal of Medical Research
Manish Patel, Chintan Sheth, Jignesh Patel, Prabhav Tijoriwala.
Introduction: Tendinopathy is a major medical problem associated with sports and physical activity in active people over 25 years of age. We study about the effect of PRP in the patients of chronic Tendinopathy. Methods: The patients of chronic tendinopathy come to OPD at government medical college, surat who failed medical treatment for last 3 months. After getting informed consent platelet rich plasma is prepared from patient's own blood. After giving platelet rich plasma injection, patient is advised to take rest for 3 weeks with analgesics. Physiotherapy is started after 3 weeks of injection as this is causing pain for first 3 weeks. Patients are advised to join their duty after 3 weeks of injection. All the patients were followed up in OPD at 3 weeks, 6 weeks, 3 months and 6 months. At every follow up, range of motion, visual analogue scale and functional activity score recorded. Results: The follow up shows that most of the patients do not get relief within 3 weeks after injection. Follow up shows that 16 patients out of 50 got relief within 6 weeks after injection. Result shows that 46 patients out of 50 get relief within 6 months after injection. That means 94% of patients are having relief within 6 months of injection. Conclusion: The findings of this study shows that platelet rich plasma injection under ultrasound guidance at the tendon is effective mode of treatment for patients and takes time but result in gradual decrease in symptoms.


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A Study of the Timing of Death in Patients with Tuberculosis Who Die During Anti-Tuberculosis Treatment

2016-08-01T18-40-25Z
Source: National Journal of Medical Research
Bhavik Patel, Prashant Gohil, J.N.Patel, Kshitij Mandke, Sonalba Solanki.
Introduction: India has 2.0 million estimated tuberculosis (TB) cases per annum with an estimated 280,000 TB related deaths per year. Understanding when in the course of TB treatment patients die is important for determining the type of intervention to be offered and crucially when this intervention should be given. The objectives of the current study were to determine in a large cohort of TB patients in India: - i) treatment outcomes including the number who died while on treatment, ii) the month of death and iii) characteristics associated with early death, occurring in the initial 8 weeks of treatment. Methodology: This was a retrospective study in C.U.Shah Medical College & Hospital in Surendranagar, Gujarat India. A review was performed of treatment cards and medical records of all TB patients (adults and children) registered and placed on standardized anti-tuberculosis treatment from January 2007 to April 2012. Results: There were 376 TB patients of whom 41 (11%) were known to have died during treatment. Case-fatality was higher in those previously treated (24%) and lower in those with extra-pulmonary TB (1%).Most of deaths during anti-tuberculosis treatment were early, with 66% of all patients dying in the first 8 weeks of treatment. Increasing age and new as compared to recurrent TB disease were significantly associated with early death. In this large cohort of TB patients, Most of deaths occurred early after starting anti-TB treatment. Reasons may relate to i) the treatment of the disease itself, raising concerns about drug adherence, quality of anti-tuberculosis drugs or the presence of undetected drug resistance and ii) co-morbidities, such as HIV/ AIDS and diabetes mellitus, which are known to influence mortality. iii) Late stage presentation by patients themselves. More research in this area from prospective and retrospective studies is needed.


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Profile of Congenital Surgical Anomalies in Neonates Admitted to Tertiary Care Neonatal Intensive Care Unit of Saurashtra Region

2016-08-01T18-40-25Z
Source: National Journal of Medical Research
Zalak Shah, Mitul Kalathia, Samir Patel, Yogesh Parikh.
Background: Congenital surgical anomaly is a major indication for admission of a neonate to an intensive care unit. Profile of surgical conditions is variable by system affecting the neonate and outcomes of the individual conditions depending upon treatment and post surgical facilities. This study was undertaken to highlight the surgical conditions, their burden and their prognosis encountered in our newborn care unit. Methodology: This study is a cross sectional study. All information was collected from the case records of all neonates admitted in newborn care unit of our centre between 1st April, 2011 and 31st October, 2014 with congenital surgical conditions and the following information extracted: surgical condition, age, sex, maturity, birth weight, its treatment and outcome, and other associated features were studied. Result: A total of 9213 neonates were admitted in the study period, of which 328 neonates (3.6%) had surgical conditions. Surgery was performed in 225 neonates. Commonest congenital surgical condition was of gastrointestinal tract (GIT). Commonest GIT anomalies were tracheo-oesophageal fistula (28.6%), intestinal obstruction (23.7%), anorectal malformation (17.9%), and omphalocoele (7%). The overall mortality in neonates with congenital surgical condition in this study was 51.2%. Significantly, more deaths occurred in preterm than in term neonates (P = 0.00003) and low birth weight babies more than normal weight (p=0.0002). Conclusion: High mortality is found in neonates suffering from surgical conditions. Commonest anomaly includes conditions of Gastrointestinal tract. Prematurity and low birth weight is a significant factor associated with high mortality.


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A Study on Clinical Profile of Patients Presenting with Rheumatoid Arthritis in a Tertiary Care Hospital of Pune City

2016-08-01T18-40-25Z
Source: National Journal of Medical Research
Pradnya M Diggikar, Vijayshree S Gokhale, Prasanna K Satpathy, Deepak D Baldania, Thakapalli V Babu, Kanishka D Jain.
Background: The clinical picture of Rheumatoid arthritis is mainly related to the affection of peripheral joints. The present study was planned with an objective to study clinical and laboratory profile of patients presenting with rheumatoid arthritis. Methodology: The present study was a cross-sectional study conducted on cases of rheumatoid arthritis. Special emphasis was placed on the clinical presentation grading at the time of presentation with associated etiological factors and exacerbating factors. All the patients were also subjected to necessary blood investigations and relevant radiological investigations. Results: Among the total 100 cases of RA, maximum incidence of rheumatoid arthritis was seen in the age group of 31 40 years (46%) and 41-50 years (30%). The commonest clinical features noted was joint pain (100%), commonest joint involved was proximal interphalangeal and metacarpophalangeal joints (96%), commonest upper limb deformity was ulnar deviation of digits (40%) and commonest radiological changes were juxta articular osteopenia and soft tissue swelling (74%). Rheumatoid arthritis factor was positive in 76 % (76 cases) and Anti CCP was positive in 94% (94 cases) of the patients. Conclusion: It is concluded from the present study that most common predisposing factors were family history and smoking and commonest exacerbating factor was climatic changes. The most common clinical features are morning stiffness, joint pain, joint swelling and limitation of joint movement.


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Study on Factors Associated With Chronic Low Back Pain in Western India

2016-08-01T18-40-25Z
Source: National Journal of Medical Research
Vikki J Parikh, Pulkit Modi.
Introduction: Low back pain is a leading cause of disability. It occurs in similar proportions in all cultures, interferes with quality of life and work performance, and is the most common reason for medical consultations. Few cases of back pain are due to specific causes; most cases are non-specific. Acute back pain is the most common presentation and is usually self-limiting, lasting less than three months regardless of treatment. Chronic back pain is a more difficult problem, which often has strong psychological overlay: work dissatisfaction, boredom, and a generous compensation system contribute to it. Methodology: This is a retrospective study. The study was conducted in private multispecialty hospital of Ahmedabad, Gujarat. Data from April 2014 to March 2015 was analyzed. Permission was taken from the hospital authority to conduct the study and stringent confidentiality of data was maintained at all levels of the project. Result: We have analyzed data of 210 patients diagnosed with chronic low back pain. People between age of 36 years to 40 years were most common culprits. Among these, 82 (39.05%) were male and 128 (60.95%) were female. Among males, 65 (79.27) were overweight (BMI >= 25.00) and among females, 95 (74.22%) were overweight. Disc prolapse was most common diagnosis in both males and females. It was followed by fractures and Lumber spondylosis. Conclusion: Females were more affected by Lower back pain. People in age group of 36 years to 40 years were commonly affected. Disc prolapsed was most common the most common diagnosis.


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Role of intravitreal Bevacizumab Injection for Management of Neovascular Age Related Macular Degeneration

2016-08-01T18-40-25Z
Source: National Journal of Medical Research
Neha K Desai, Somesh V Aggarwal, Puja S Negi, Sonali S Shah.
Background: Age related macular degeneration ( ARMD ) is the major cause of severe visual loss in older adults. Different treatment modalities are available such as: Laser photocoagulation, photodynamic therapy,transpupillary thermotherapy,submacular surgery & anti-veg. Aims & Objectives: The aim of our study was to evaluate the efficacy and safety of intravitreally administered Bevacizumab a humanized monoclonal anti VEGF in Neovascular Age related Macular Degeneration. Methodology: This non randomized, prospective study was carried out on 75 eyes of 75 patients attending the OPD at M & J Institute Of Ophthalmology and diagnosed as having Neovascular ARMD confirmed on FFA and SD-OCT . After taking written informed consent all patients were injected with intravitreal Bevacizumab 1.25 mg/0.05 ml. Follow up visits were scheduled one week, one month post procedure and every monthly thereafter. Results: 75 eyes of 75 patients were included in this non randomized prospective study. & 29.33% patients required 2 injections. Visual acuity is improved more than 3 lines from baseline in 21.33% patient, 64% patient have 2-3 lines gain & 6.66% patients showed 0-1 line gain in snellens visual acuity. 5.33% patients have a loss of 1 line from baseline & 2.66% patients showed loss of 2-3 lines. Central foveal thickness decreased more than 200 microns from baseline in 52% patients, 28% patients have decreased of 100-200 microns & 20% patients have decreased of less than 100 microns. Discussion: Approximately 10 % of ARMD patients manifest the neovascular form of the disease. 12 weeks). Our study showed that 80% patients had decrease in central foveal thickness more than 100 microns from baseline at the end of one year. 85% patients had gain of 2 or more lines on Snellens visual acuity chart from baseline.No patient had any serious local or systemic adverse reactions.Limitations of our study is small number of patients,ICG not done,not compared with other anti-vegf drugs. Conclusion: Intravitreal Bevacizumab is a safe and effective drug in treatment of neovascular age related macular degeneration without any serious systemic or local adverse effects


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Safety of Laprascopic Tubal Ligation in patients with Previous Casarean Section

2016-08-01T18-40-25Z
Source: National Journal of Medical Research
Kanupriya Singh, Vipul Patel.
Aims: To evaluate the technique of laparoscopic tubal sterilization in patients with previous caesarean section with respect to age, parity, technical difficulty, operative time, intra-postoperative comfort and its suitability for mass sterilization camps. Methods: A prospective study of laparoscopic tubal ligation done at teaching Medical College and in camp from August 2010 to August 2011. Total 70 cases were operated under intramuscular sedation (Pentazocine and Promethazine) and local anesthesia(inj xylocaine). Operations were performed in interval and post-abortal cases. Data were analyzed with respect to age, parity, technical difficulty, operative time, intra/postoperative complication and postoperative comfort. Result: Most of the patients were in age group of 20-30 indicating long post-TL period. Most of the patients were having two children. Adhesions were present in 15.7% and difficulties in getting tube were present in 5.7% and TL was not possible in one (1.4%) patient. Most of the patients were comfortable in postoperative period within 24 hours. Conclusion: Laparoscopic tubal ligation is possible in previous caeserean with minimal risk and devoid of complication. It also requires further study and follow up to comment on the failure rates.


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Variables Associated with Knee Osteoarthritis in A Tertiary Care Hospital of Kanchipuram, Tamilnadu

2016-08-01T18-40-25Z
Source: National Journal of Medical Research
Deepak D Chitragar, Sadik I Shaikh.
Introduction: Osteoarthritis (OA) is a chronic degenerative disorder of multifactorial etiology characterized by loss of articular cartilage, hypertrophy of bone at the margins, subchondral sclerosis and range of biochemical and morphological alterations of the synovial membrane and joint capsule. Osteoarthritis (OA) is the second most common rheumatological problem and is most frequent joint disease with prevalence of 22% to 39% in India. Methodology: A cross sectional study, done in 3 private hospitals of Tamilnadu. Total 135 patients interviewed after taking informed written consent. Questions pertaining to their physical activities, symptoms experienced, postures etc. were asked. Results: Maximum number of patients were from age group of 61 to 70 years (37.04%). It was followed by age group of 51 to 60 years (29.63%).There were 91 (67.41%) female patients in the study group. Only 12 (8.89%) patient were illiterate. Maximum number of patients have completed their secondary schooling. As there was female predominance, we found 52 (38.52%) patients were house wife. Whereas, 22 (16.30%) patients were laborer. BMI was an important correlates of OA as 79 (58.52%) patients were obese. It was observed that OA patients were using Squatting and Cross legged positions in day to day activities like Job work, Food Preparation, Sweeping and Moping.Most common symptom was Usage related pain (42.22%) and persistent pain (27.41%). Most common sign was crepitus and it was followed by bony enlargement. Conclusion: Present study shows that age group of 61 to 70 years is the most common age group for OA of knee. Study also shows predominance of female gender. Overweight and Obesity are one of the most common risk factors. Patients using Indian style toilets, having squatting crossed leg position and bending position in day to day activities are more commonly affected. Most common symptom is Usage related pain followed by persistent pain. Most common sign is crepitus and it was followed by bony enlargement.


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Radiotherapy for Pigmented Villonodular Synovitis: A Case Report

2016-08-01T18-40-25Z
Source: National Journal of Medical Research
Navin Nayan, Vikas Kantilal Jagtap.
This is a case report of a 13 year old boy who has been operated for Pigmented Villonodular Synovitis (PVNS) and treated with adjuvant post-operative radiotherapy for incomplete surgical resection. This report mainly highlights the role of radiotherapy in managing this rare benign condition with emphasis on improving local control rates with functional joint preservation and avoiding repeated surgeries.


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A Retrospective, Molecular Study of EGFR and ALK Mutations in Non small cell Lung Cancer Patients

2016-08-01T18-40-25Z
Source: National Journal of Medical Research
Rakesh Taran, Deepak Singla, Prashant Kumbhaj, Prakash Chitalkar, vishesh Gumdal.
Background Epidermal growth factor receptor EGFR/ALK mutations are the strongest response predictors to EGFR tyrosine kinase inhibitors (TKI) and ALK inhibitor respectively,but knowledge of the EGFR/ALK mutation frequency on lung adenocarcinoma is still limited. Materials & Methods Our study is a retrospective study of the metastatic non small cell lung cancer patients harboring EGFR/ALK receptors.A total of 94 metastatic non small cell lung carcinoma patients data were evaluated,out of which 74 patients EGFR&ALK mutation status was known. Results All of the patients data evaluated in this study were in the age group of 30-74.Total 74 patients EGFR &ALK mutation status was known,out of which 34.2% were positive for EGFR and 4% for ALK respectively.In EGFR positive group 62.96%were male and 37.04% were female.Among males patients 34% were positive for EGFR as compared to 42% of EGFR Positive female patients. Conclusion Efforts to obtain tissue samples should be encouraged for EGFR&ALK mutation testing in non small cell lung carcinoma patients to provide a molecular basis to treat patients with available targeted therapy.


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Chronic Kidney Disease and risk factor prevalence in Dehradun district

2016-08-01T18-40-25Z
Source: National Journal of Medical Research
Shivashish Gupta, Jayanti Semwal, Ashok Kumar Srivastava, Deepshikha Varshney.
Chronic Kidney Disease and risk factor prevalence in Dehradun district Abstract Research question: What is the prevalence of risk factors for chronic kidney disease in urban population of district Dehradun? Objectives: To assess the prevalence of risk factors for Chronic Kidney Disease and to find out the prevalence of CKD. Material and Methods: A cross-sectional, community based study was carried out among adult population of the urban community of Dehradun. A pretested predesigned questionnaire was used to collect data by interview technique from study participants. The risk factor scoring was done on the basis of SCORED (Screening for Occult Renal Disease) screening test tool. The subjects who were at risk were screened for chronic kidney disease. The data was compiled, entered & analyzed using SPSS version 19. Results: Raised BP, diabetes and cases of heart attack were more among males as compared to females. The prevalence of CKD was 2.1 percent. Proportion of CKD cases was almost same in both sexes. Chronic kidney disease prevalence was 1.1%, 5.1% and 8.2% in 50-59, 60-69 and >70 year age groups. Conclusion: The prevalence of diseases like hypertension, diabetes was high in the urban population etc. The disease prevalence tends to increase with the advancing age.


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A study on the effect of music in the perioperative period in breast cancer patients undergoing modified radical mastectomy

2016-08-01T18-40-25Z
Source: National Journal of Medical Research
Anupam Das, Kishore Das, Arudyuti Choudhury, Minoti Baruah, Amal Chandra Kataki, Manoj Kalita.
Aim: Our aim of this study was to analyze the beneficial effects (if any) of music therapy in decreasing anxiety, providing stable haemodynamics and decreasing anaesthetic agent requirement in patients coming for modified radical mastectomy. Methods: Forty patients in the age group of 40 -50 years scheduled for modified radical mastectomy were selected for this prospective observational study. They were randomly assigned to Group M (receiving music therapy) and Group N (not receiving music therapy). Musical intervention was started one hour prior to surgery. The level of anxiety (score of 1 to 4, based on simplified version of state-trait anxiety inventory), pulse rate, MAP were recorded at 15 minutes interval up to one hour post surgery and compared with their baseline values. Results: With musical intervention, anxiety score declined to 2 in 80 % of cases at the time of induction and in Group N no such improvement was observed. Postoperatively, level of anxiety decreased in Group M was 100 % displaying a score of 1. Group M patients also displayed stable haemodynamics throughout the peri-operative period. However, in Group N, there was a significant increase in both pulse rate and MAP intra-operatively (p

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Role of Fiber-Optic Bronchoscopy in Sputum Smear Negative Pulmonary Tuberculosis

2016-08-01T18-40-25Z
Source: National Journal of Medical Research
Dimple Kumar Bhaglani, Malay Sarkar, Digvijay Singh, Rameshwar S Negi, Sunil Sharma.
Objective: To evaluate the utility of fiberoptic bronchoscopy in sputum smear negative PTB patients. Material and Methods : A total of 66 adult patients with sputum smear negative for Acid Fast Bacilli(AFB) and chest X-ray suggestive of pulmonary tuberculosis underwent fiberoptic bronchoscopy( FOB) . A thorough examination of bronchial tree was carried out and bronchoalveolar lavage(BAL) was taken and was sent for Ziehl-Neelsen staining,MGIT960 TBculture,pyogenic and fungal culture. Bronchial brushing,endo-bronchial and transbronchial lung biopsy(TBLB) wherever indicated were performed and Ziehl-Neelsen staining was performed and post bronchoscopy sputum(PBS) was also sent for Ziehl-Neelsen stain. Results are summarized in tables and percentages. Quantitative data is summarized using means& standard deviation. Cross tabulation with outcome variable of interest was done using statistical software Epi-info version 7 (7.1.1.0). A p-value of less than 0.05 was considered statistically significant. Results: Males constituted majority of our study population. The most common age group involved in the study was 18-28 years (36.3%). cough was the most common symptom reported by 62 patients (93.93%). The past history of PTB was present 6 patients (9.09%).Majority of study population, 39 patients (59.09%) had unilateral lesion on CXR. Out of 66 clinically suspected SSN-PTB patients, 52 patients (78.7%) were finally diagnosed as having active PTB. The diagnosis other than PTB was established in 6 (9.09%) cases, which included 3 cases of fungal (Candida) pneumonia and 3 cases of bacterial (pseudomonas species, citrobacter species, serratia marsecens) pneumonia. Conclusions: FOB and various bronchoscopy guided procedures can provide a rapid and definitive diagnosis of PTB in sputum negative patients.


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Tetanus immunoglobulin probably precipitated pleural effusion in a HIV patient

2016-08-01T18-40-25Z
Source: National Journal of Medical Research
Ranjan Kumar Singh.
A case report is about the development of tetanus in a HIV+ patient, who is immunized with tetanus toxoid. Later on patient developed pleural effusion. The role of tetanus immunoglobulin in precipitating pleural effusion has been doubted.


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The role of psychological factors on the perception of postneedling soreness and the influence of postneedling intervention

Myofascial trigger point dry needling is frequently associated with postneedling soreness, which can generate patient dissatisfaction and reduced treatment adherence. Psychological factors may influence the perception of postneedling soreness and the effectiveness of postneedling soreness treatments.

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2 tips if you are choking and alone



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2 tips if you are choking and alone



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2 tips if you are choking and alone



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EMS Outreach Coordinator - Engage Healthcare Marketing

Brownsville, TX We're looking for energetic self-starters who are looking to expand their horizons in both the EMS and healthcare industry. Do you love to meet new people and network" If so, we're looking for you! At our company, we work with healthcare providers at all levels of the patient care spectrum from Fire Departments and Emergency Medical Services (EMS) agencies to nursing homes ...

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EMS Outreach Coordinator - Engage Healthcare Marketing

We're looking for energetic self-starters who are looking to expand their horizons in both the EMS and healthcare industry. Do you love to meet new people and network" If so, we're looking for you! At our company, we work with healthcare providers at all levels of the patient care spectrum from Fire Departments and Emergency Medical Services (EMS) agencies to nursing homes, urgent care facilities ...

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Scalp-recorded high-frequency oscillations in atypical benign partial epilepsy

High-frequency oscillations (HFOs, ripples: 80–250 Hz, fast ripples: 250–500 Hz) in electroencephalography (EEG) have been associated with epileptogenesis (Melani et al., 2013) and ictogenesis (Staba et al., 2007; Urrestarazu et al., 2007). It has been established that HFOs are more specific in identifying seizure onset zone than traditional spikes (Jacobs et al., 2008), and removal of HFO generating tissue correlates with a favorable postsurgical seizure outcome (Haegelen et al., 2013; Jacobs et al., 2008; Staba et al., 2002; Urrestarazu et al., 2007).

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Etiological associations and outcome predictors of acute electroencephalography in childhood encephalitis

Abnormalities on electroencephalography (EEG) comprise one of the diagnostic criteria for encephalitis (Granerod et al., 2010). However, EEG features that suggest encephalitis, such as slowing of the background, remain non-specific. Some EEG features have proposed etiological associations, such as extreme delta brush in anti-N-Methyl-D-Aspartate Receptor (NMDAR) encephalitis (Schmitt et al., 2012), periodic discharges in Herpes simplex encephalitis (HSE) (Lai and Grasgin, 1988; Kim et al., 2016) and temporal slowing and epileptic discharges in limbic encephalitis (Kaplan and Sutter, 2013).

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Großartig für den Überblick und die Vertiefung

Anästhesiol Intensivmed Notfallmed Schmerzther 2016; 51: 502-503
DOI: 10.1055/s-0041-111254


[...]

© Georg Thieme Verlag Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text



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Opioidverschreibung bei Schmerz: Laxanzien nicht vergessen

Anästhesiol Intensivmed Notfallmed Schmerzther 2016; 51: 436-439
DOI: 10.1055/s-0042-111842


[...]

© Georg Thieme Verlag Stuttgart · New York

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Erste Portalpraxis eröffnet in Berlin

Anästhesiol Intensivmed Notfallmed Schmerzther 2016; 51: 498-500
DOI: 10.1055/s-0042-111838


[...]

© Georg Thieme Verlag Stuttgart · New York

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Mortalität von Risikopatienten während Kardio-Fortbildungen

Anästhesiol Intensivmed Notfallmed Schmerzther 2016; 51: 436-439
DOI: 10.1055/s-0042-111844


[...]

© Georg Thieme Verlag Stuttgart · New York

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4-fach resistente Klinikkeime in Baden-Württemberg

Anästhesiol Intensivmed Notfallmed Schmerzther 2016; 51: 498-500
DOI: 10.1055/s-0042-111834


[...]

© Georg Thieme Verlag Stuttgart · New York

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PCA-Pumpe überflüssig bei lang wirkenden Lokalanästhetika?

Anästhesiol Intensivmed Notfallmed Schmerzther 2016; 51: 436-439
DOI: 10.1055/s-0042-111845


[...]

© Georg Thieme Verlag Stuttgart · New York

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Übersichtlich und praxisorientiert

Anästhesiol Intensivmed Notfallmed Schmerzther 2016; 51: 502-503
DOI: 10.1055/s-0041-109551


[...]

© Georg Thieme Verlag Stuttgart · New York

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Reduzieren balancierte Kristalloide renale Komplikationen?

Anästhesiol Intensivmed Notfallmed Schmerzther 2016; 51: 436-439
DOI: 10.1055/s-0042-111846


[...]

© Georg Thieme Verlag Stuttgart · New York

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Weiterbildung - Die Zusatzweiterbildung in der Intensiv-medizin: Wie kann das europäische Konzept in Deutschland integriert werden?

Anästhesiol Intensivmed Notfallmed Schmerzther 2016; 51: 494-497
DOI: 10.1055/s-0042-104111

Im Rahmen der Europäischen Union haben sich auch die medizinischen Disziplinen organisiert. Die Union Européene des Médecins Spécialistes (UEMS) vertritt auf europäischer Ebene die Interessen von aktuell 42 medizinischen Fachdisziplinen und unterstützt, dass Ärzte in jedem Land Europas arbeiten können. Hierfür wurde bereits 2005 eine Richtlinie verabschiedet, die u. a. eine automatische Anerkennung der Berufsqualifikationen regelt. Für die Intensivmedizin gilt dies bislang nicht, da sie in den meisten europäischen Ländern keine unabhängige Fachdisziplin (Facharzt) ist. Nun jedoch soll sie als „besondere Kompetenz" in die Richtlinie aufgenommen werden. Dafür wurden von einem multidiszilpinären gemeinsamen Kommitee der UEMS sog. „European Training Requirements" (ETR) formuliert, welche die Fachkompetenzen der in der Intensivmedizin arbeitenden europäischen Ärzte auf ein einheitliches, höchtsmögliches Qualitätsniveau heben sollen. Diese ETR befinden sich aktuell in der Abstimmung. Nach derzeitigem Stand würde die Zusatzweiterbildung Intensivmedizin in Deutschland die Auflagen bzw. Anforderungen dieser ETR erfüllen.
[...]

© Georg Thieme Verlag Stuttgart · New York

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Größerer Intubationserfolg mit Videolaryngoskopie

Anästhesiol Intensivmed Notfallmed Schmerzther 2016; 51: 436-439
DOI: 10.1055/s-0042-111847


[...]

© Georg Thieme Verlag Stuttgart · New York

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Verhindert Telemedizin Tod und Krankenhausaufenthalte?

Anästhesiol Intensivmed Notfallmed Schmerzther 2016; 51: 498-500
DOI: 10.1055/s-0042-111836


[...]

© Georg Thieme Verlag Stuttgart · New York

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Kardiogener Schock: perkutanes LVAD

Anästhesiol Intensivmed Notfallmed Schmerzther 2016; 51: 436-439
DOI: 10.1055/s-0042-111848


[...]

© Georg Thieme Verlag Stuttgart · New York

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Patientenwunsch rechtfertigt keine Fehlbehandlung

Anästhesiol Intensivmed Notfallmed Schmerzther 2016; 51: 498-500
DOI: 10.1055/s-0042-111840


[...]

© Georg Thieme Verlag Stuttgart · New York

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Pneumonie: Intensivstation vs. Normalstation

Anästhesiol Intensivmed Notfallmed Schmerzther 2016; 51: 436-439
DOI: 10.1055/s-0042-111849


[...]

© Georg Thieme Verlag Stuttgart · New York

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Kinder, Kinder!

Anästhesiol Intensivmed Notfallmed Schmerzther 2016; 51: 433-433
DOI: 10.1055/s-0042-106024



© Georg Thieme Verlag Stuttgart · New York

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Kardiale Evaluation vor nicht herzchirurgischen Eingriffen - Nach den ESA-Leitlinien von 2014

Anästhesiol Intensivmed Notfallmed Schmerzther 2016; 51: 440-446
DOI: 10.1055/s-0041-110638

Bei nicht herzchirurgischen Patienten findet im Rahmen der Indikationsstellung zum Eingriff durch den Operateur i. d. R. keine kardiale Diagnostik statt. Für die anästhesiologische Betreuung dieser Patienten ist allerdings eine Einschätzung des Herz-Kreislauf-Systems essenzieller Bestandteil der präoperativen Evaluation. Zur Umsetzung eines sinnvollen, risikoadjustierten Einsatzes diagnostischer Ressourcen haben die europäischen Fachgesellschaften für Anästhesiologie und Kardiologie 2014 revidierte Leitlinien zur kardiovaskulären Evaluation und Behandlung nicht herzchirurgischer Patienten publiziert 1. Die Ansätze der deutschen Leitlinie von 2010 sind bei der Konsensbildung eingeflossen und in die Struktur der systematischen kardialen Evaluation integriert worden. Der folgende Artikel stellt die Kriterien zur Abschätzung des kardialen Risikos und die daraus abgeleiteten Indikationen für eine präoperative kardiale Diagnostik vor.
[...]

© Georg Thieme Verlag Stuttgart · New York

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Veranstaltungen

Anästhesiol Intensivmed Notfallmed Schmerzther 2016; 51: 506-506
DOI: 10.1055/s-0042-106029



© Georg Thieme Verlag Stuttgart · New York

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Emergence Delir - Prophylaxe und Therapie

Anästhesiol Intensivmed Notfallmed Schmerzther 2016; 51: 448-457
DOI: 10.1055/s-0041-106569

Das Emergence Delirium (ED) ist ein in der Kinderanästhesie bekanntes Phänomen. Problematisch sind trotz fehlender vitaler Gefährdung und i. d. R. kompletter Remission v. a. die Eigen- und Fremdgefährdung sowie die negative Außenwirkung auf Eltern und Beteiligte. Die Symptome des ED bestehen aus Agitation und Delir. Da v. a. bei Kleinkindern viele Gründe für auffälliges Verhalten nach Operationen in Frage kommen (Hunger, Durst, Schmerzen, Übelkeit, Trennung von den Eltern) ist die Diagnosestellung häufig nicht einfach. Die Verwendung entsprechend validierter Scores wie der PAED-Scale, ist dabei hilfreich. Die genaue Genese des ED ist bisher unklar. Neuere Untersuchungen deuten auf eine unterschiedliche Clearance der (volatilen) Anästhetika in verschiedenen Bereichen des Gehirns (Gehör vor Kognition) oder den unterschiedlichen Einfluss der Anästhetika auf verschiedene neuronale Netzwerke.
Im Rahmen einer Metaanalyse wurde der präventive Effekt vieler gängiger Substanzen untersucht. Grundsätzlich reduzieren alle Substanzen die Inzidenz des ED, die auch postoperativ noch eine sedierende und analgetische Wirkung haben. Zusammenfassend lässt sich sagen, dass der Aufwachphase die gleiche Aufmerksamkeit wie der Einleitung zukommen sollte und beides schonend und kindgerecht in ruhiger Atmosphäre zu erfolgen hat. Liegen Risikofaktoren vor, ist eine TIVA zu bevorzugen. Zusätzlich kann ein Alpha-2-Agonist verwendet werden. Zur Differenzierung zwischen postoperativen Schmerzen und Delir können altersgerechte, standardisierte Scores für ED und Schmerzen hilfreich sein. Bei milderer Ausprägung kann ein beobachtendes Zuwarten gerechtfertigt sein. Sollte Eigen- oder Fremdgefährdung bestehen, eignen sich kurzwirksame Substanzen, um die Akutsituation zu durchbrechen. Dabei hat sich v. a. Propofol bewährt. Verängstigte Eltern müssen beruhigt und entsprechend aufgeklärt werden. Midazolam hat weder einen präventiven Effekt, noch eignet es sich als Akutmedikament und sollte daher zurückhaltend eingesetzt werden (auch im Rahmen der Prämedikation). Eine effektive Anxiolyse sollte nach Möglichkeit bereits im Vorfeld durch Schulung von Patient und Eltern beginnen, welche die Ablenkung des Kindes und Einbeziehung der Eltern zum Ziel hat. Auch aus diesem Grund ist die Anwesenheit der Eltern bei Einleitung und im Aufwachraum begrüßenswert.
[...]

© Georg Thieme Verlag Stuttgart · New York

Article in Thieme eJournals:
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Weibliche Karriere in der Medizin gelingt zu selten

Anästhesiol Intensivmed Notfallmed Schmerzther 2016; 51: 498-500
DOI: 10.1055/s-0042-111833


[...]

© Georg Thieme Verlag Stuttgart · New York

Article in Thieme eJournals:
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Anästhesie und Multiple Sklerose - Was gilt es zu beachten?

Anästhesiol Intensivmed Notfallmed Schmerzther 2016; 51: 458-467
DOI: 10.1055/s-0042-111033

Patienten mit seltenen neurologischen Erkrankungen sind stets eine Herausforderung im klinisch-operativen Alltag. Insbesondere anästhesiologische Interventionen können dabei mit vielfältigen Problemen behaftet sein. Der Artikel befasst sich mit dem aktuellen Wissensstand zur Multiplen Sklerose in der Anästhesie. Dabei beziehen sich die Autoren auf die sichere Vorbereitung und Durchführung verschiedener Anästhesieformen sowie die Vermeidung und ggfs. die Therapie möglicher Komplikationen.
[...]

© Georg Thieme Verlag Stuttgart · New York

Article in Thieme eJournals:
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2 tips if you are choking and alone



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Worse Breast Cancer Outcomes for Southern Nevadans, Filipina and Black Women

Abstract

Breast cancer is the second deadliest cancer for women in the demographically unique mountainous west state of Nevada. This study aims to accurately characterize breast cancer survival among the diverse women of the flourishing Silver State. Nevada Central Cancer Registry data was linked with the National Death Index and the Social Security Administration Masterfile. Overall 5-year age-adjusted cause-specific survival, survival stratified by race/ethnicity, and stage-specific survival stratified by region of Nevada were calculated. Adjusted hazard ratios were computed with Cox proportional hazards regression. 11,111 cases of breast cancer were diagnosed from 2003 to 2010. Overall 5-year breast cancer survival in Nevada was 84.4 %, significantly lower than the US, at 89.2 %. Black and Filipina women had a higher risk of death than white women. Poor survival in the racially and ethnically diverse Las Vegas metropolitan area, with a large foreign-born population, drives Nevada's low overall survival. System-wide changes are recommended to reduce the racial/ethnic disparities seen for black and Filipina women and improve outcomes for all.



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Firefighter - Duvall Fire - King County Fire District #45

DUVALL FIRE - KING COUNTY FIRE DISTRICT 45 15600 FIRST AVE NE DUVALL, WASHINGTON 98019 Updated: August 01, 2016 Classification: Firefighter The District is currently testing for the position of Firefighter. The testing is in preparation for creating a hiring list that is to be published in November 2016. All testing through National Testing Network (NTN) must be completed by September 30, 2016. Salary ...

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Medic ‘secretly’ in Laos receives Medal of Honor

HUNTSVILLE, Ala. — A U.S. Army medic will receive the Medal of Honor for his heroic acts during a "secret war" in Laos during the Vietnam War.

Sgt. Gary Rose, 68, was unofficially part of a secret Studies and Observations Group, an elite division of Special Forces that was in Laos in 1970. 

Although U.S. troops were unofficially there, Rose is poised to be recognized for his service in Laos. While there, Rose cared for 51 wounded soldiers as hundreds of North Vietnamese troops closed in on a small team of U.S. Army commandos, reported the Houston Chronicle. Rose sprinted through crossfire to aid the injured, hefting a man over his shoulder and firing back with one hand. He didn't sleep for days, and continued to aid others after being hit by a rocket. 

"I didn't do anything heroic. I was just doing my job like anyone else," Rose said. 

Rose's service, though, remained unrecognized at the time, as President Richard Nixon denied there were U.S. troops even in Laos. 

During the Vietnam War, Laos was deemed neutral territory and off-limits to foreign troops. 
However, North Vietnamese forces used Laotian jungles to funnel weapons into Vietnam. In turn, the U.S. sent in special forces to disrupt them. 

"The Army still doesn't want to admit it. Even to this day, I put in a Laos citation, the Army takes it out. It's almost a game, but it's not really funny. Rose is unique in that they finally left in the truth," Army veteran and researcher Neith Thorne said. 

Veterans of the Studies and Observations Group have worked to gain recognition for men like Rose; the elite team had one of the highest kill rates and highest casualty rates in Vietnam. 

"Because we were where we weren't supposed to be, a lot of men never got what they deserved," Eugene McCarley, a retired lieutenant colonel who was Rose's commander said. "Rose is one of them. He was a damn good medic and the level of gallantry and disregard for his own safety that he showed — I've rarely seen anything like it."

Rose, who now lives in Alabama and volunteers with poor and disabled people, remarked that he has rarely thought about Operation Tailwind.

"I don't want to make it sound like I'm brave. The trembling, the throwing up, the fear, that always happened, but only after. In the moment, I was just concentrating on what I had to do. I didn't want to let anyone down," Rose said. 



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Psyllium fiber reduces abdominal pain in children with irritable bowel syndrome in a randomized, double-blind trial

Clinical Gastroenterology and Hepatology

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Percutaneous endoscopic gastrostomy in direct puncture technique: When, why and how?

Digestive Surgery

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Effectiveness of exercise in hepatic fat mobilization in non-alcoholic fatty liver disease: Systematic review

World Journal of Gastroenterology

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Exenatide treatment increases serum irisin levels in patients with obesity and newly diagnosed type 2 diabetes

Journal of Diabetes and its Complications

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Using multiplex molecular testing to determine the etiology of acute gastroenteritis in children

The Journal of Pediatrics

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Comparative effectiveness and safety of anti-tumor necrosis factor agents in biologic-naive patients with Crohn's disease

Clinical Gastroenterology and Hepatology

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Biliary effects of liraglutide and sitagliptin, a 12-week randomised placebo-controlled trial in type 2 diabetes patients

Diabetes, Obesity and Metabolism

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Outcomes after endoscopic versus surgical therapy for early esophageal cancers in an older population

Gastrointestinal Endoscopy

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A prospective longitudinal cohort to investigate the effects of early life giardiasis on growth and all cause diarrhea

Clinical Infectious Diseases

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Pancreaticoduodenectomy in the elderly patient: Age-adapted risk assessment

Digestive Surgery

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Male sexual dysfunction after rectal cancer surgery: Results of a randomized trial comparing mesorectal excision with and without lateral lymph node dissection for patients with lower rectal cancer: Japan Clinical Oncology Group Study JCOG0212

European Journal of Surgical Oncology

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Alcohol and substance abuse, depression and suicide attempts after Roux-en-Y gastric bypass surgery

British Journal of Surgery

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Serum fibrosis markers for the diagnosis of liver disease among people with chronic hepatitis C in Chennai, India

Open Forum Infectious Diseases

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Discrepancies between asthma control criteria in asthmatic patients with and without obesity

Obesity

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Quantitative sensory testing in type 1 diabetic patients with painful and painless diabetic neuropathy

2016-08-01T01-58-39Z
Source: Disease and Molecular Medicine
Ahmed T Alahmar.
The mechanism underlying the development of painful diabetic neuropathy (DN) is unknown. The aim of this study was to compare quantitative sensory testing (QST) characteristics of patients with painful and painless DN and to correlate QST measures with DN pain. Fifty type 1 diabetic patients with DN (30 with painful DN and 20 with painless DN) and 32 age-matched non-diabetic controls were included in this study. For all patients and controls, a detailed assessment of DN was performed which comprised McGill visual analogue scale (McGill VAS) for pain, neuropathy symptom profile and neuropathy disability score (NDS), quantitative sensory testing in form of cold, warm and vibration perception thresholds, nerve conduction studies (NCS), deep-breathing hear rate variability and Neuropad staining scores. Measures of QST, NCS and DB-HRV were correlated with McGill VAS for pain. There were no significant differences in cold, warm and vibration perception thresholds, NCS, DB-HRV and Neuropad scores between patients with painful and painless DN. Cold (r=-0.57, P=0.005), warm (r=0.47, P=0.026) and DB-HRV (r=0.50, P=0.023), however, correlated significantly with McGill VAS scores of pain. In conclusion, Quantitative sensory testing is a helpful tool to identify small nerve fibres damage of DN, correlates with pain intensity but cannot differentiate between painful and painless DN. Both central and peripheral neural injury could be implicated in the genesis of DN pain.


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Counter-regulatory control of homeostasis during hypoglycaemia: adrenaline hits the sweet spot in the controversy concerning carotid body glucose sensing



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Lost your nerve? Modulating the parasympathetic nervous system to treat inflammatory bowel disease



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Chronic constipation: improved understanding offers a new therapeutic approach



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Non-selective cationic channels in chemical and physical stress



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Issue Information



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hERG long QT syndrome type 2 mutants need more than a chaperone to dance



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PET imaging of glucose movement into tissues in vivo sheds new light on an old problem



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Challenging dogma: is hepatic lipid accumulation in type 2 diabetes due to mitochondrial dysfunction?



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Gaseous regulation of Ca2+ homeostasis; for better or worse?



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