Πέμπτη, 20 Οκτωβρίου 2016

Anesthesiology mentoring.

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Purpose of review: Mentoring is fundamentally valuable and important to students considering a path into our specialty, as well as to colleagues already in it and with ambition to advance. General principles and personal experiences are collected and described to help inform future mentors and to reinforce the value of having a mentor and the satisfaction (and work) that is associated with such a role. Recent findings: Detecting a latent talent among medical students or residents may be challenging but is worth the effort to develop personal careers and the specialty itself. Upon agreeing to jointly move a certain project, a professional plan is needed to improve chances of success and decrease the likelihood of frustration. Various challenges always have to be detected and solved, with the ultimate goal to guide a medical student to residency, subsequently into faculty status and preferably to lifelong collaboration. Summary: Access to a mentor is an often-cited key to choosing a specialty and the success of junior colleagues and thus the entire department. Mentoring is fundamentally valuable in providing role modeling and also in protecting the mentee from the inefficiency of learning lessons the hard way. Copyright (C) 2016 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Current trends in anesthesia for esophagectomy.

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Purpose of review: Despite marked improvements in perioperative outcomes, esophagectomy continues to be a high-risk operation associated with significant morbidity and mortality. Progress has been achieved through evidence-based changes in preoperative optimization, intraoperative ventilation strategies, fluid therapy, and analgesia, as well as expedited postoperative recovery pathways. This review will summarize the recent literature on the anesthetic management of patients undergoing esophageal resection. Recent findings: The current focus in publications on the perioperative management of esophagectomy patients can be summarized under the umbrella term of enhanced recovery pathways, focusing on ventilation, fluid therapy, analgesia and minimally invasive surgical approaches. Lung protective ventilation reduces pulmonary complications in cases requiring one-lung ventilation. Excess fluid administration contributes to morbidity while restrictive approaches have not resulted in an increased risk of acute kidney injury. Goal-directed fluid therapy remains intuitive yet unproven. Thoracic epidural analgesia reduces the systemic inflammatory response, pulmonary complications, and enhances postoperative pain control, yet if causing perioperative hypotension may be associated with anastomotic leaks. Enhanced recovery pathways have facilitated low morbidity and mortality rates in a high-risk population but are heterogeneous and limited by a weak evidence base. Minimally invasive surgical approaches are increasingly popular and appear to have at least equivalent outcomes to open procedures. Summary: The morbidity and mortality after esophagectomy remains high despite significant improvements over the last decades. Enhanced recovery pathways appear promising in achieving further marginal gains but at present are lacking large scale, prospective, multicenter evidence. Copyright (C) 2016 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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The future of postoperative quality of recovery assessment: multidimensional, dichotomous, and directed to individualize care to patients after surgery.

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Purpose of review: Recovery after surgery is a complex interplay of the patient, the surgery, and the perioperative anaesthesia management. Assessment of recovery should address the needs of multiple stakeholders, including the institutions and healthcare providers, but primarily should be focused on the patients and their perception of quality of recovery and return to normalcy. This review will summarize the development of assessment of recovery to a multidimensional dichotomous construct that requires a real-time assessment tool validated for repeat measures and containing cognitive assessment. Recent findings: Recovery is neither defined by a single composite number nor is it quantified at a single time point, but rather it is a continuum occurring in multiple domains and over periods of time from hours, to days to weeks or months after surgery. Recovery is often incomplete which may persist long term, leading to patient suffering, loss of work, and increased demands on family and healthcare providers long after apparently successful surgery. The important correlation between poor recovery, cognitive decline, institutional placement, and increased short and long-term mortality has been hampered by the heterogeneity of definitions and tools used and their assessment of recovery as a continuous vs. dichotomous score and at the group vs. individual level. Most research has been aimed at audit or group comparison rather than attempting to identify incomplete recovery at an early time period after surgery in specific patients and individualization of care based on the domain where recovery has failed. Summary: Recovery is best defined as a multidimensional dichotomous construct encompassing nociceptive, emotive, functional, and cognitive domains. Its assessment tool should provide both real-time and restrospective recovery data, thus enabling clinical and research applications, and be validated for repeat measures over a breadth of multiple clinically relevant postoperative time points. Copyright (C) 2016 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Neural responses to affective pictures while anticipating and perceiving respiratory threat

Abstract

Emotional processes have an impact on the anticipation and perception of bodily threat sensations, such as breathlessness. However, little is known about the reverse influence of breathlessness on emotional processes, as well as its modulation by anxiety sensitivity (AS). Here, we investigated by means of visually evoked potentials how the perception versus anticipation of resistive-load-induced breathlessness (RLIB) influences emotional processing. High (HA) and low anxious (LA) participants viewed pictures of positive, neutral, or negative content under conditions of perceived RLIB, anticipated RLIB, or an unloaded baseline. The P2 (230–290 ms) was significantly less positive under perceived RLIB. Furthermore, the early late positive potential (LPP; 300–500 ms) was significantly less positive during both RLIB conditions, as compared to baseline. Overall, the P1 was significantly more positive in HA as compared to LA individuals. Additionally, across conditions, the late LPP (600–1,000 ms) was enhanced for positive and negative pictures as opposed to neutral ones for the LA group. In contrast, for the HA group only, the positive pictures elicited the typical enhanced LPP. Notably, for the HA participants, negative pictures elicited significantly blunted late LPPs during perceived RLIB as compared to anticipated RLIB and baseline. A reversed effect (i.e., more positivity) was observed for LA participants, suggesting motivational priming. Taken together, these results highlight the impact of perceived and anticipated respiratory threat on the neural processing of emotional picture stimuli, as well as its modulation by anxiety sensitivity levels.



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Physiological and neural correlates of worry and rumination: Support for the contrast avoidance model of worry

Abstract

The current experiments tested neural and physiological correlates of worry and rumination in comparison to thinking about neutral events. According to the avoidance model—stating that worry is a strategy to reduce intense emotions—physiological and neurobiological activity during worried thinking should not differ from activation during neutral thinking. According to the contrast avoidance model—stating that worry is a strategy to reduce abrupt shifts of emotions—activity should be increased. To test these competing models, we induced worry and neutral thinking in healthy participants using personal topics. A rumination condition was added to investigate the specificity of changes induced by the mental process. Two experiments were conducted assessing the effects on different response levels: (1) neural activation using fMRI, and (2) physiological response mobilization using startle and autonomic measures. During worry, participants showed a potentiated startle response and BOLD activity indicative of emotional network activation. These data partly support the contrast avoidance model of worry. Both mental processes showed elevated activity in a common network referred to as default network indicating self-referential activity.



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Associations Between Foot Placement Asymmetries and Metabolic Cost of Transport in Hemiparetic Gait

Stroke survivors often have a slow, asymmetric walking pattern. They also walk with a higher metabolic cost than healthy, age-matched controls. It is often assumed that spatial-temporal asymmetries contribute to the increased metabolic cost of walking poststroke. However, elucidating this relationship is made challenging because of the interdependence between spatial-temporal asymmetries, walking speed, and metabolic cost. Here, we address these potential confounds by measuring speed-dependent changes in metabolic cost and implementing a recently developed approach to dissociate spatial versus temporal contributions to asymmetry in a sample of stroke survivors. We used expired gas analysis to compute the metabolic cost of transport (CoT) for each participant at 4 different walking speeds: self-selected speed, 80% and 120% of their self-selected speed, and their fastest comfortable speed. We also computed CoT for a sample of age- and gender-matched control participants who walked at the same speeds as their matched stroke survivor. Kinematic data were used to compute the magnitude of a number of variables characterizing spatial-temporal asymmetries. Across all speeds, stroke survivors had a higher CoT than controls. We also found that our sample of stroke survivors did not choose a self-selected speed that minimized CoT, contrary to typical observations in healthy controls. Multiple regression analyses revealed negative associations between speed and CoT and a positive association between asymmetries in foot placement relative to the trunk and CoT. These findings suggest that interventions designed to increase self-selected walking speed and reduce foot-placement asymmetries may be ideal for improving walking economy poststroke.



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Conversions in laparoscopic surgery for rectal cancer

Abstract

Background

Laparoscopic surgery offers patients with rectal cancer short-term benefits and similar survival rates as open surgery. However, selecting patients who are suitable candidates for laparoscopic surgery is essential to prevent intra-operative conversion from laparoscopic to open surgery. Clinical and pathological variables were studied among patients who had converted laparoscopic surgeries within the COLOR II trial to improve patient selection for laparoscopic rectal cancer surgery.

Methods

Between January 20, 2004, and May 4, 2010, 1044 patients with rectal cancer enrolled in the COLOR II trial and were randomized to either laparoscopic or open surgery. Of 693 patients who had laparoscopic surgery, 114 (16 %) were converted to open surgery. Predictive factors were studied using multivariate analyses, and morbidity and mortality rates were determined.

Results

Factors correlating with conversion were as follows: age above 65 years (OR 1.9; 95 % CI 1.2–3.0: p = 0.003), BMI greater than 25 (OR 2.7; 95 % CI 1.7–4.3: p < 0.001), and tumor location more than 5 cm from the anal verge (OR 0.5; CI 0.3–0.9). Gender was not significantly related to conversion (p = 0.14). In the converted group, blood loss was greater (p < 0.001) and operating time was longer (p = 0.028) compared with the non-converted laparoscopies. Hospital stay did not differ (p = 0.06). Converted procedures were followed by more postoperative complications compared with laparoscopic or open surgery (p = 0.041 and p = 0.042, respectively). Mortality was similar in the laparoscopic and converted groups.

Conclusions

Age above 65 years, BMI greater than 25, and tumor location between 5 and 15 cm from the anal verge were risk factors for conversion of laparoscopic to open surgery in patients with rectal cancer.



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Gut fermentation seems to promote decompression sickness in humans

Massive bubble formation after diving can lead to decompression sickness (DCS) that can result in neurological disorders. In experimental dives using hydrogen as the diluent gas, decreasing the body's H2 burden by inoculating hydrogen-metabolizing microbes into the gut reduces the risk of DCS. In contrast, we have shown that gut bacterial fermentation in rats on a standard diet promotes DCS through endogenous hydrogen production. Therefore, we set out to test these experimental results in humans. Thirty-nine divers admitted into our hyperbaric center with neurological DCS (Affected Divers) were compared with 39 healthy divers (Unaffected Divers). Their last meal time and composition were recorded. Gut fermentation rate was estimated by measuring breath hydrogen 1-4 h after the dive. Breath hydrogen concentrations were significantly higher in Affected Divers (15 ppm [6–23] vs. 7 ppm [3–12]; P = 0.0078). With the use of a threshold value of 16.5 ppm, specificity was 87% [95% confidence interval (CI) 73–95] for association with neurological DCS onset. We observed a strong association between hydrogen values above this threshold and an accident occurrence (odds ratio = 5.3, 95% CI 1.8–15.7, P = 0.0025). However, high fermentation potential foodstuffs consumption was not different between Affected and Unaffected Divers. Gut fermentation rate at dive time seemed to be higher in Affected Divers. Hydrogen generated by fermentation diffuses throughout the body and could increase DCS risk. Prevention could be helped by excluding divers who are showing a high fermentation rate, by eliminating gas produced in gut, or even by modifying intestinal microbiota to reduce fermentation rate during a dive.



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Optical coherence tomography in the assessment of acute changes in cutaneous vascular diameter induced by heat stress

There are limited imaging technologies available that can accurately assess or provide surrogate markers of the in vivo cutaneous microvessel network in humans. In this study, we establish the use of optical coherence tomography (OCT) as a novel imaging technique to assess acute changes in cutaneous microvessel area density and diameter in humans. OCT speckle decorrelation images of the skin on the ventral side of the forearm up to a depth of 500 μm were obtained prior to and following 20-25 min of lower limb heating in eight healthy men [30.3 ± 7.6 (SD) yr]. Skin red blood cell flux was also collected using laser Doppler flowmetry probes immediately adjacent to the OCT skin sites, along with skin temperature. OCT speckle decorrelation images were obtained at both baseline and heating time points. Forearm skin flux increased significantly (0.20 ± 0.15 to 1.75 ± 0.38 cutaneous vascular conductance, P < 0.01), along with forearm skin temperature (32.0 ± 1.2 to 34.3 ± 1.0°C, P < 0.01). Quantitative differences in the automated calculation of vascular area densities (26 ± 9 to 49 ± 19%, P < 0.01) and individual microvessel diameters (68 ± 17 to 105 ± 25 μm, P < 0.01) were evident following the heating session. This is the first in vivo within-subject assessment of acute changes in the cutaneous microvasculature in response to heating in humans and highlights the use of OCT as an exciting new imaging approach for skin physiology and clinical research.



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Assessment of the interaction of hyperbaric N2, CO2, and O2 on psychomotor performance in divers

Diving narcosis results from the complex interaction of gases, activities, and environmental conditions. We hypothesized that these interactions could be separated into their component parts. Where previous studies have tested single cognitive tasks sequentially, we varied inspired partial pressures of CO2, N2, and O2 in immersed, exercising subjects while assessing multitasking performance with the Multi-Attribute Task Battery II (MATB-II) flight simulator. Cognitive performance was tested under 20 conditions of gas partial pressure and exercise in 42 male subjects meeting U.S. Navy age and fitness profiles. Inspired nitrogen (N2) and oxygen (O2) partial pressures were 0, 4.5, and 5.6 ATA and 0.21, 1.0, and 1.22 ATA, respectively, at rest and during 100-W immersed exercise with and without 0.075-ATA CO2. Linear regression modeled the association of gas partial pressure with task performance while controlling for exercise, hypercapnic ventilatory response, dive training, video game frequency, and age. Subjects served as their own controls. Impairment of memory, attention, and planning, but not motor tasks, was associated with N2 partial pressures >4.5 ATA. Sea level O2 at 0.925 ATA partially rescued motor and memory reaction time impaired by 0.075-ATA CO2; however, at hyperbaric pressures an unexpectedly strong interaction between CO2, N2, and exercise caused incapacitating narcosis with amnesia, which was augmented by O2. Perception of narcosis was not correlated with actual scores. The relative contributions of factors associated with diving narcosis will be useful to predict the effects of gas mixtures and exercise conditions on the cognitive performance of divers. The O2 effects are consistent with O2 narcosis or enhanced O2 toxicity.



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THE BLOOD PRESSURE REDUCTION AFTER GASTRIC BYPASS SURGERY IS EXPLAINED BY A DECREASE IN CARDIAC OUTPUT

Background: Blood pressure (BP) decreases in the first weeks after Roux-and-Y gastric bypass surgery. Yet, the pathophysiology of the BP lowering effects observed after gastric bypass surgery are incompletely understood. Methods: We evaluated BP, systemic hemodynamics and baroreflex sensitivity in 15 obese women (mean age 42±7 yrs, body mass index 45±6 kg/m2) two weeks before and six weeks following Roux-and-Y gastric bypass surgery. Results: Six weeks after gastric bypass surgery mean body weight decreased by 13±5 kg (10%, p<0.001). Office blood pressure (BP) decreased from 137±10/86±6 to 128±12/81±9 mmHg (p<0.001, p<0.01), while daytime ambulatory BP decreased from 128±14/80±9 to 114±10/73±6 mmHg (p=0.01, p=0.05), whereas night-time BP decreased from 111±13/66±7 to 102±9/62±7 mmHg (p=0.04, p<0.01). The decrease in BP was associated with a 1.6±1.2 L/min (20%, p<0.01) decrease in cardiac output (CO), while systemic vascular resistance increased (153±189 dyn.s/cm5, 15%, p<0.01). The maximal rise in systolic blood pressure decreased (192 mmHg/s, 19%, p=0.01), suggesting a reduction in left ventricular contractility. Baroreflex sensitivity increased from 9.0 [6.4-14.3] to 13.8 [8.5-19.0] ms·mmHg-1 (median [IQR]; p<0.01) and was inversely correlated with the reductions in heart rate (R= -0.64, p=0.02) and CO (R= -0.61, p=0.03). In contrast, changes in body weight were not correlated with changes in either BP or CO. Conclusions: The BP reduction following Roux-and-Y gastric bypass surgery is correlated with a decrease in CO independent of changes in body weight. The contribution of heart rate to the reduction in CO together with enhanced baroreflex sensitivity suggests a shift towards increased parasympathetic cardiovascular control.



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THE RESERVOIR-WAVE APPROACH TO CHARACTERIZE PULMONARY VASCULAR-RIGHT VENTRICULAR INTERACTIONS IN MAN

Using the reservoir-wave approach (RWA) we previously characterized pulmonary vasculature mechanics in a normal canine model. We found reflected backward-travelling waves that decrease pressure and increase flow in the proximal pulmonary artery (PA). These waves decrease right ventricular (RV) afterload and facilitate RV ejection. With pathological alterations to the pulmonary vasculature, these waves may change and impact RV performance. Our objective in this study was to characterize PA wave reflection and the alterations in RV performance in cardiac patients, using the RWA. PA pressure, Doppler-flow velocity, and pulmonary arterial wedge pressure were measured in 11 patients with exertional dyspnea. The RWA was employed to analyze PA pressure and flow; wave intensity analysis characterized PA waves. Wave-related pressure was partitioned into two components: pressures due to forward-travelling and to backward-travelling waves. RV performance was assessed by examining the work done in raising reservoir pressure and that associated with the wave components of systolic PA pressure. Wave-related work, the mostly non-recoverable energy expended by the RV to eject blood, tended to vary directly with mean PA pressure. Where PA pressures were lower, there were pressure-decreasing/flow-increasing backward waves that aided RV ejection. Where PA pressures were higher, there were pressure-increasing/flow-decreasing backward waves that impeded RV ejection. Pressure-increasing/flow-decreasing backward waves were responsible for systolic notches in the Doppler flow velocity profiles in patients with the highest PA pressure. Pulmonary hypertension is characterized by reflected waves that impede RV ejection and an increase in wave-related work. The RWA may facilitate the development of therapeutic strategies.



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Intermittent hypobaric hypoxia combined with aerobic exercise improves muscle morphofunctional recovery after eccentric exercise to exhaustion in trained rats

Unaccustomed eccentric exercise leads to muscle morphological and functional alterations, including microvasculature damage, the repair of which is modulated by hypoxia. Here we present the effects of intermittent hypobaric hypoxia and exercise on recovery from eccentric-induced muscle damage (EEIMD). Soleus muscles from trained rats were excised pre- (CTRL) and 1, 3, 7 and 14 days after a double session of EEIMD protocol. A recovery treatment consisting of one of the following protocols was applied one day after the EEIMD: passive normobaric recovery (PNR), a 4-hour daily exposure to passive hypobaric hypoxia at 4000m (PHR) or hypobaric hypoxia exposure followed by aerobic exercise (AHR). EEIMD produced an increase in the percentage of abnormal fibers compared with the CTRL; and affected the microvasculature by decreasing capillary density (CD, capillaries per mm2) and the capillary-to-fiber ratio (CF). After 14 days, AHR exhibited a CD and CF similar to the CTRL (789 and 3.30 vs. 746 and 3.06) and significantly higher than PNR (575 and 2.62) and PHR (630 and 2.92). Furthermore, VEGF expression showed a significant 43% increase in AHR when compared with PNR. Moreover, after 14 days, the muscle fibers in AHR had a more oxidative phenotype than the other groups, with significantly smaller cross-sectional areas (AHR: 3745; PNR: 4502; PHR: 4790 µm2), higher citrate synthase activity (AHR: 14.8; PNR: 13.1; PHR: 12 µmol·min-1·mg-1) and a significant 27% increment in PGC-1α levels compared with PNR. Our data show that hypoxia combined with exercise attenuates or reverses the morphofunctional alterations induced by EEIMD.



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ADRENODEMEDULLATION ACTIVATES THE Ca2+-DEPENDENT PROTEOLYSIS IN SOLEUS MUSCLES FROM RATS EXPOSED TO COLD

Previous studies have shown that catecholamines in vivo and in vitro inhibit the activity of Ca2+-dependent proteolysis in skeletal muscles under basal conditions. In the present study we sought to investigate the role of catecholamines in regulating the Ca2+-dependent proteolysis in soleus and extensor digitorum longus (EDL) muscles from rats acutely exposed to cold. Overall proteolysis, the activity of proteolytic systems as well as protein levels and gene expression of different components of calpain system were investigated in rats submitted to adrenodemedullation (ADMX) and exposed to cold for 24 h. ADMX drastically reduced plasma epinephrine and promoted an additional increase in the overall proteolysis, which was already increased by cold exposure. The rise in the rate of protein degradation in soleus muscles from adrenodemedullated cold-exposed rats was due to the high activity of the Ca2+-dependent proteolysis, which was associated with the generation of a 145-kDa cleaved α-fodrin fragment, a typical calpain substrate, and lower protein levels and mRNA expression of calpastatin, the endogenous calpain inhibitor. Unlike that observed for soleus muscles, the cold-induced muscle proteolysis in EDL was not affected by ADMX. In isolated soleus muscle, clenbuterol, a selective β2-adrenoceptor agonist reduced the basal Ca2+-dependent proteolysis and completely abolished the activation of this pathway by the cholinergic agonist carbachol. These data suggest that catecholamines released from the adrenal medulla inhibit cold-induced protein breakdown in soleus, and this anti-proteolytic effect on the Ca2+-dependent proteolytic system is apparently mediated through activation of calpastatin, which leads to suppression of calpain activation.



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Non-invasive Assessment of Cardiac Output by Brachial Cuff Technique; Comparison to the Open Circuit Acetylene Washin Method

Cardiac output (CO) assessment as a basic hemodynamic parameter has been of interest in exercise physiology, cardiology and anesthesiology. Non-invasive techniques available are technically challenging, and thus difficult to use outside of the clinical or laboratory setting. We propose a novel method of non-invasive CO assessment using a single upper arm cuff. The method uses the arterial pressure pulse wave signal acquired from the brachial artery during 20 second intervals of suprasystolic occlusion. This method was evaluated on a cohort of 12 healthy individuals (age of 27.7±5.4 years, 50% male) and compared to an established method for non-invasive CO assessment, the open circuit acetylene method (OpCirc) at rest, and during low- to - moderate intensity exercise. CO increased from rest to exercise (rest: 7.4±0.8 vs. 7.2±0.8; low: 9.8±1.8 vs. 9.9±2.0; moderate: 14.1±2.8 vs. 14.8±3.2 l/min) as assessed by the cuff-occlusion and OpCirc techniques, respectively. The average error of experimental technique compared to OpCirc was -0.25±1.02 l/min, Pearson's correlation coefficient of 0.96 (resting + exercise), and 0.21±0.42 l/min with Pearson's correlation coefficient of 0.87 (rest only). Bland-Altman analysis demonstrated good agreement between methods (within 95% boundaries) the reproducibility coefficient (RPC) = 0.84 l/min with R2=0.75 at rest and RPC=2 l/min with R2=0.92 at rest and during exercise, respectively. In comparison with an established method to quantify cardiac output, the cuff-occlusion method provides similar measures at rest and with light to moderate exercise. Thus we believe this method has the potential to be used as a new noninvasive method for use during exercise.



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National Conference on Basic And Clinical Pharmacology

2016-10-20T19-12-02Z
Source: Narayana Medical Journal
Edited By T.V.S.Divyalasya and .P.RamMohan.



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Modeling and experimental examination of water level effects on radon exhalation from fragmented uranium ore

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Publication date: December 2016
Source:Journal of Environmental Radioactivity, Volume 165
Author(s): Yong-jun Ye, Xin-tao Dai, De-xin Ding, Ya-li Zhao
In this study, a one-dimensional steady-state mathematical model of radon transport in fragmented uranium ore was established according to Fick's law and radon transfer theory in an air-water interface. The model was utilized to obtain an analytical solution for radon concentration in the air-water, two-phase system under steady state conditions, as well as a corresponding radon exhalation rate calculation formula. We also designed a one-dimensional experimental apparatus for simulating radon diffusion migration in the uranium ore with various water levels to verify the mathematical model. The predicted results were in close agreement with the measured results, suggesting that the proposed model can be readily used to determine radon concentrations and exhalation rates in fragmented uranium ore with varying water levels.



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Derivation and validation of a novel Semi Empirical Deposition Estimation Model (SEDEM)

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Publication date: December 2016
Source:Journal of Environmental Radioactivity, Volume 165
Author(s): Matias Koivurova, Ari-Pekka Leppänen
Predictive models are necessary in order to minimize potential damages in the event of a nuclear or radiological release. For this reason, a novel model for the calculation of both wet and dry deposition from airborne radioactivity is proposed. Full derivation of the model and the estimation of uncertainty are presented, and the validity of the model is evaluated by calculating deposition based on several measured airborne activities in different countries. The results are compared with the corresponding measured deposition activities and the predictive power of the model is found to be good, i.e. calculated depositions being within the limits of measurement uncertainty. Additionally, limitations of the model and possible sources of error in the calculations are discussed.



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Opiat ohne Nebenwirkung

Anästhesiol Intensivmed Notfallmed Schmerzther 2016; 51: 644-644
DOI: 10.1055/s-0042-117046


[...]

© Georg Thieme Verlag Stuttgart · New York

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



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Für den Einsatz alles dabei?

Anästhesiol Intensivmed Notfallmed Schmerzther 2016; 51: 646-646
DOI: 10.1055/s-0042-104753


[...]

© Georg Thieme Verlag Stuttgart · New York

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



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BIS-Monitoring unzuverlässig bei relaxierten Patienten?

Anästhesiol Intensivmed Notfallmed Schmerzther 2016; 51: 592-592
DOI: 10.1055/s-0042-115510


[...]

© Georg Thieme Verlag Stuttgart · New York

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



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Wie kommen multiresistente Bakterien ins Krankenhaus?

Anästhesiol Intensivmed Notfallmed Schmerzther 2016; 51: 645-645
DOI: 10.1055/s-0042-117052


[...]

© Georg Thieme Verlag Stuttgart · New York

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



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Unterbrechungsfreie Kompression ohne Vorteil bei Reanimation

Anästhesiol Intensivmed Notfallmed Schmerzther 2016; 51: 592-593
DOI: 10.1055/s-0042-115511


[...]

© Georg Thieme Verlag Stuttgart · New York

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



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Crawford Williamson Long - Der eigentliche Entdecker der Anästhesie?

Anästhesiol Intensivmed Notfallmed Schmerzther 2016; 51: 636-639
DOI: 10.1055/s-0042-117817

Als Geburtsstunde der Anästhesie gilt der 16. Oktober 1846 am Massachusetts General Hospital in Boston. Doch war dies tatsächlich die erste Narkose mit Schwefeläther? Der bereits 1846 begonnene Prioritätsstreit hatte mehrere Beteiligte: WTG Morton, CT Jackson und H Wells. Unbeteiligt blieb CW Long, der bereits 1842 Äthernarkosen durchgeführt hatte. Er hatte seine Ergebnisse erst 1849 veröffentlicht und so blieb ihm der Ruhm verwehrt.
[...]

© Georg Thieme Verlag Stuttgart · New York

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



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Neue Leitlinie für die opioid-induzierte Obstipation

Anästhesiol Intensivmed Notfallmed Schmerzther 2016; 51: 593-594
DOI: 10.1055/s-0042-115512


[...]

© Georg Thieme Verlag Stuttgart · New York

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



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Terrorgefahr: Spezialausrüstung für Rettungswagen

Anästhesiol Intensivmed Notfallmed Schmerzther 2016; 51: 644-644
DOI: 10.1055/s-0042-117048


[...]

© Georg Thieme Verlag Stuttgart · New York

Article in Thieme eJournals:
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Cholangitis: Schock als zentraler Pathomechanismus

Anästhesiol Intensivmed Notfallmed Schmerzther 2016; 51: 594-594
DOI: 10.1055/s-0042-115513


[...]

© Georg Thieme Verlag Stuttgart · New York

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Grundlage der Neuro-Intensivtherapie

Anästhesiol Intensivmed Notfallmed Schmerzther 2016; 51: 646-646
DOI: 10.1055/s-0041-109586


[...]

© Georg Thieme Verlag Stuttgart · New York

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Optimierte Stimulationsschwelle bei Regionalanästhesie

Anästhesiol Intensivmed Notfallmed Schmerzther 2016; 51: 594-594
DOI: 10.1055/s-0042-115514


[...]

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Hämodynamisches Monitoring - Bildgebende bzw. Ultraschallverfahren

Anästhesiol Intensivmed Notfallmed Schmerzther 2016; 51: 626-634
DOI: 10.1055/s-0041-110009

Die Echokardiografie hat als bildgebendes Verfahren in der Anästhesie und Intensivmedizin eine neue Dimension des hämodynamischen Monitorings ermöglicht: die direkte Visualisierung der kardialen Funktion und ihrer Störungen. Voraussetzungen für eine breite Anwendung in diesem Bereich waren die Entwicklung mobiler hochauflösender Ultraschallgeräte und die Entstehung fokussierter Untersuchungstechniken. Ein erfolgreicher Einsatz dieser Technik ist nur mit einer entsprechenden Erfahrung des Untersuchers möglich, um therapierelevante Entscheidungen zu treffen und Fehldiagnosen zu vermeiden. Der nachfolgende Artikel zeigt die Vorteile und Grenzen der Echokardiografie bei der Diagnostik der hämodynamischen Instabilität auf. Für TTE und TEE werden fokussierte Untersuchungstechniken dargestellt und hinsichtlich ihrer Möglichkeiten für ein hämodynamisches Monitoring bewertet. Darüber hinaus werden die Anforderungen an die Gerätetechnik und an die Ausbildung des Untersuchers diskutiert.
[...]

© Georg Thieme Verlag Stuttgart · New York

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Remote Ischaemic Conditioning - Eine Übersicht

Anästhesiol Intensivmed Notfallmed Schmerzther 2016; 51: 596-603
DOI: 10.1055/s-0042-116628

Die Strategie des Remote Ischaemic Conditionings (RIC) ist einfach, günstig, nebenwirkungsarm und gehört zu den potentesten kardioprotektiven Strategien der letzten Jahre. Die praktische Durchführung erfolgt mit Hilfe einer Blutdruckmanschette, beispielweise durch 4 wiederholte Zyklen, bei denen pro Zyklus für jeweils 5 min eine Blutdruckmanschette am Oberarm des Patienten auf >200 mmHg aufgepumpt und anschließend entlüftet wird. Erste experimentelle und klinische Pilotdaten zeigten wiederholt eine signifikante Reduktion der Myokardschädigung nach Ischämie/Reperfusion. Dennoch bleibt vor dem Hintergrund der neutralen Ergebnisse von zwei großen klinischen Studien aktuell unklar, ob RIC einen klinisch relevanten Nutzen bei herzchirurgischen Patienten hervorruft. Es scheint wahrscheinlich, dass die Konstellation aus Begleit- und Narkosemedikation für das Versagen des RIC im klinischen Einsatz eine relevante Rolle spielt.
[...]

© Georg Thieme Verlag Stuttgart · New York

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Anästhesisten für Eritrea - „Ausbildung ist das, was bleibt“

Anästhesiol Intensivmed Notfallmed Schmerzther 2016; 51: 640-643
DOI: 10.1055/s-0042-113211

Medizinische Grundversorgung – davon ist Eritrea weit entfernt: Im ganzen Land gibt es gerade einmal 40 Fachärzte; Medikamente – selbst zur Basisversorgung – sind nur in beschränkter Auswahl verfügbar. Es mangelt an OP-Ausstattung und anästhesiologischen Fachkräften. Das Eritrea-Hilfswerks Deutschland (EHD) will das ändern: Durch die Ausbildung von Anästhesisten soll langfristig eine eigenständige und hochwertige anästhesiologische Versorgung in dem kleinen afrikanischen Land gesichert werden. Prof. Traudl Elsholz leitet das Projekt in der Hauptstadt Asmara. Sie strukturiert die Ausbildung und koordiniert die Einsätze deutscher Ärzte, wie z. B. die von Dr. Lothar Klimpel.
[...]

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Pssst ... AINS-Secrets! - Heute aus der Notfallmedizin

Anästhesiol Intensivmed Notfallmed Schmerzther 2016; 51: 604-606
DOI: 10.1055/s-0042-101667

Es ist ein normaler hektischer Dienstagmorgen im Zentral-OP. Assistenzärztin Dr. M. ist im 1. Weiterbildungsjahr und steht gerade noch am Beginn ihrer Rotation in der Traumatologie. Sie freut sich darauf, viel Neues zu lernen und Erfahrungen zu sammeln; v. a. auf Regionalverfahren hat sie sich vorbereitet.Nach dem Kaffee im Aufenthaltsraum mit Begrüßung der Kollegen überfliegt sie den OP-Plan für den zugewiesenen Saal. Um sich auf die anstehenden Narkosen vorzubereiten, sieht sie die Anästhesieprotokolle ihrer heutigen Patienten durch.Die 1. Patientin scheint zunächst keine besonderen Schwierigkeiten zu machen. Sie ist 23 Jahre alt, bekommt „nur" eine Arthroskopie des rechten Handgelenks, hat keinerlei Vorerkrankungen, auch keine Allergien, weist keinerlei Anzeichen für einen schwierigen Atemweg auf und wiegt 72 kg bei 1,77 m Größe.Dr. M. begrüßt die aufgeregte Patientin in der Einleitung, stellt sich vor und beginnt mit dem Team-Time-out. Sie stellt fest, dass es sich um die richtige Person handelt. Die vorgesehene OP an der rechten Hand stimmt, die Patientin ist nüchtern und alle nötigen Unterschriften zur Einwilligung in den Eingriff liegen vor. Die Frage, ob sie eine Prämedikation bekommen habe, verneint die Patientin. Auf weitere Nachfrage berichtet die Patientin, dass sie bei einer Voroperation ein zentrales anticholinerges Syndrom (ZAS) hatte und deswegen keine Benzodiazepine nehmen solle; das wäre auch so mit dem prämedizierenden Kollegen besprochen worden. Beim erneuten Blick auf das Anästhesieprotokoll kann Dr. M. nun auch entziffern, dass die Patientin nach der letzten OP ein ZAS hatte. Es liegen jedoch keine weiteren Informationen vor, da die Patientin weder über einen Anästhesieausweis verfügt noch andere Dokumente, wie z. B. einen Arztbrief mit Beschreibung der Symptomatik, vorweisen kann.Dr. M. entscheidet sich nach Rücksprache mit dem zuständigen Facharzt für eine möglichst triggerfreie Narkose. Es soll weder ein Lokalanästhetikum oder Muskelrelaxans noch ein volatiles Anästhetikum zum Einsatz kommen. Der kurze Eingriff (ca. 30 min) am Handgelenk soll in einer Vollnarkose mit Larynxmaske durchgeführt werden. Außerdem entscheidet sich Dr. M. für eine totalintravenöse Anästhesie (TIVA) mit Fentanyl und Propofol. Sie hat zwar nachgelesen, dass auch diese Medikamente ein ZAS triggern können – wie übrigens jedes andere Narkosemedikament auch – hofft aber durch die Anwendung wenig verschiedener Substanzen zu erreichen, dass die Patientin postoperativ kein ZAS entwickelt.
[...]

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Hochdruckliga bleibt dabei: Zu viel Salz schadet der Gesundheit

Anästhesiol Intensivmed Notfallmed Schmerzther 2016; 51: 644-644
DOI: 10.1055/s-0042-117047


[...]

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Hämodynamisches Monitoring - Von der Anwendung zur Interpretation

Anästhesiol Intensivmed Notfallmed Schmerzther 2016; 51: 608-609
DOI: 10.1055/s-0042-116825

Das hämodynamische Monitoring ist ein wichtiger Bestandteil der anästhesiologischen und intensivmedizinischen Überwachung. Wenngleich es bei nahezu jedem Patienten angewendet wird, sind die daraus gezogenen Gewinne durchaus anwenderbezogen unterschiedlich. Darum ist es essenziell, die Grundlagen des hämodynamischen Monitorings zu kennen, die Hintergründe und Funktionsweisen der verschiedenen Methoden zu verstehen und v. a. die Ergebnisse richtig interpretieren zu können.
[...]

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Neue Leitlinie: Versorgung nach Fremdkörperaspiration

Anästhesiol Intensivmed Notfallmed Schmerzther 2016; 51: 645-645
DOI: 10.1055/s-0042-117050


[...]

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Hämodynamisches Monitoring - Basismonitoring

Anästhesiol Intensivmed Notfallmed Schmerzther 2016; 51: 610-615
DOI: 10.1055/s-0041-110005

Das hämodynamische Basismonitoring gehört zur essenziellen apparativen Mindestausstattung eines anästhesiologischen Arbeitsplatzes. Dazu gehören EKG-Monitor, Blutdruckmessung und Pulsoxymeter. Um perioperative Komplikationen früh erkennen zu können, sollte jeder Patient unabhängig vom Gesundheitszustand oder der anzuwendenden Verfahren ein hämodynamisches Basismonitoring erhalten. Kenntnisse über Funktionsweise, Messprinzipien und Limitationen sind notwendig, um die erhaltenen Messwerte richtig zu bewerten. Beschrieben werden die Funktionsweisen und Anwendungen des EKGs, der nicht-invasiven intermittierenden Blutdruckmessung und der Pulsoxymetrie in der perioperativen Anwendung sowie deren Limitationen.
[...]

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Deutscher Preis für Patientensicherheit ausgelobt

Anästhesiol Intensivmed Notfallmed Schmerzther 2016; 51: 645-645
DOI: 10.1055/s-0042-117054


[...]

© Georg Thieme Verlag Stuttgart · New York

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The Effect of a Youth-Centered Sexual Risk Event History Calendar (SREHC) Assessment on Sexual Risk Attitudes, Intentions, and Behavior

The purpose of this study was to examine the effect of a youth-centered assessment, the Sexual Risk Event History Calendar (SREHC), compared with the Guidelines for Adolescent Preventive Services (GAPS) assessment, on sexual risk attitudes, intentions, and behaviors.

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EMS eSchedule adds team member

Alex Cook recently joined eSchedule as a Support Team member and eSchedule Expert. His role will cover many areas including customer support, outreach and setting up and configuring new customer accounts. Mr. Cook is a certified paramedic in New York State. Prior to that, he was an EMT in New York for a number of years. Alex received a BA in biology from SUNY Geneseo in 2010. Prior work experience includes ...

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The top 5 benefits of using a Biometric Time Clock

Organizations around the world have started integrating biometric time clocks with their workforce management systems and are enjoying the benefits. Biometric technology offers end users higher levels of security and a convenient way of identification that is simply not found through other identification methods. Combining biometric identification with a workforce management solution has its advantages; ...

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Efficacy and safety of angiogenesis inhibitors in advanced gastric cancer: A systematic review and meta-analysis

Journal of Hematology & Oncology

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Discovery of novel plasma proteins as biomarkers for the development of incisional hernias after midline incision in patients with colorectal cancer: The ColoCare study

Surgery

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Virologic, clinical, and immune response outcomes of patients with hepatitis C virus-associated cryoglobulinemia treated with direct-acting antivirals

Clinical Gastroenterology and Hepatology

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Assessing the role of primary tumour resection in patients with synchronous unresectable liver metastases from pancreatic neuroendocrine tumour of the body and tail. A propensity score survival evaluation

European Journal of Surgical Oncology

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Quality of life assessment in patients with metastatic colorectal cancer receiving maintenance therapy after first-line induction treatment: A preplanned analysis of the phase III AIO KRK 0207 trial

Annals of Oncology

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Proposal of a novel meld exception point system for hepatocellular carcinoma based on tumor characteristics and dynamics

Journal of Hepatology

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Adrenal suppression in children treated with swallowed fluticasone and oral viscous budesonide for eosinophilic esophagitis

Allergy, Asthma & Clinical Immunology

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Concomitant, bismuth quadruple, and 14-day triple therapy in the first-line treatment of Helicobacter pylori: A multicentre, open-label, randomised trial

The Lancet

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Development of OXY111A, a novel hypoxia-modifier as a potential antitumor agent in patients with hepato-pancreato-biliary neoplasms - Protocol of a first Ib/IIa clinical trial

BMC Cancer

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Incretin-based pharmacotherapy and risk of adverse pancreatic events in the ethnic Chinese with diabetes mellitus: A population-based study in Taiwan

Pancreatology

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Laryngopharyngeal Reflux and Herpes Simplex Virus Type 2 are Possible Risk Factors for Adult-Onset Recurrent Respiratory Papillomatosis (prospective case-control study)

Clinical Otolaryngology

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Influence of Roux-en-Y gastric bypass on the hepatocellular function and bile flow of obese patients assessed by scintigraphy with DISIDA

Obesity Surgery

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The aetiology of primary Budd-Chiari syndrome - differences between the West and China

Alimentary Pharmacology and Therapeutics

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Usefulness of posterior sagittal anorectoplasty for redo pull-through in complicated and recurrent Hirschsprung disease: Experience with a single surgical group

Journal of Pediatric Surgery

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Protective effect of 3-O-methyl quercetin and kaempferol from Semecarpus anacardium against H2O2 induced cytotoxicity in lung and liver cells

BMC Complementary and Alternative Medicine

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Adult attention deficit hyperactivity disorder: a case report

2016-10-20T01-26-57Z
Source: International Journal of Advances in Medicine
Harish Agarwal, Deeptanshu Agarwal, Priyadarshi Srivastava.
Attention-Deficit/Hyperactivity Disorder (ADHD) has been accepted undoubtedly as a neuro-developmental disorder with main symptoms of inattention, hyperactivity and impulsiveness. Adult ADHD have lots of comorbidities such as anxiety disorder, substance use, depression which obscures the diagnosis of ADHD. Hyperactive symptoms in adults, other than speeding while driving, include feeling uncomfortable while sitting through meetings, impatience waiting in line, and having workaholic tendencies.


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Post dengue Guillain Barre syndrome: a rare case scenario

2016-10-20T01-26-57Z
Source: International Journal of Advances in Medicine
Vikram Singh Tanwar, Anjali Saini, Gagandeep Sukhija, Parminder Kaur.
Dengue fever is an emerging arboviral disease of great public health importance and has spread to all tropical and subtropical countries. Neurological involvement in dengue fever is quite unusual. Guillain-Barre syndrome (GBS) is one of the rare neurological manifestations of dengue fever which is generally under reported. We here presented with a patient who was initially diagnosed as having dengue fever, based on the clinical manifestations and high IgM titers. On the 6th day of admission, patient developed progressive limb weakness with areflexia. CSF examination showed albuminocytological dissociation and nerve conduction study suggested evidence of demyelinating neuropathy. So the diagnosis of post dengue GBS was made and intravenous immunoglobulin (IVIg) was given for 5 days. Patient responded well with the treatment. So our case report highlights an uncommon neurological complication of dengue infection in the form of GBS which has good prognosis if timely treated and responds well to the same therapy as given for the GBS due to other antecedent etiology.


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Magnetic resonance imaging findings in intracranial extramedullary hematopoiesis in myelofibrosis with myeloid metaplasia: a case report

2016-10-20T01-26-57Z
Source: International Journal of Advances in Medicine
Sandeep S., Reddy Ravikanth, Babu Philip.
The formation of blood cells in tissues other than bone marrow is known as extramedullary hematopoiesis. The most common sites of hematopoiesis are liver, spleen and lymph nodes. Extramedullary hematopoiesis can occur in various locations within the body and is characterized by soft tissue masses detected on imaging. Extramedullary hematopoiesis is a known complication of myeloproliferative disorders, which include chronic myelogenous leukemia, polycythemiavera, essential thrombocytosis and mylofibrosis with myeloid metaplasia. An intracranial extramedullary hematopoiesis is an extremely rare occurrence that frequently involves the cranial dura, falx, cerebral parenchyma, optic nerve sheath, and diploic space of skull. MRI remains the modality of choice in investigations for the same. This case report describes the intracranial MR imaging features seen in myelofibrosis with myeloid metaplasia.


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Fibrous dysplasia: a case series of five cases

2016-10-20T01-26-57Z
Source: International Journal of Advances in Medicine
Jagdale Amol, Mittal Saurav, Patel Krutik, Azhar Shaikh, Prasla Shopnil.
Fibrous dysplasia is development anomaly in which normal bone marrow is replaced by fibro-osseous tissue which characterized by deformities of the bone, fractures, nerve compression and bone pain. It is most commonly seen in young adult. In this study we report five case of fibrous dysplasia occurring at various locations with radiological interpretation.


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A case series of mamushi bite and adverse effects of antiserum injection in several cases

2016-10-20T01-26-57Z
Source: International Journal of Advances in Medicine
Makoto Kondo, Hiroyuki Goto, Shinya Yamamoto.
Eight cases of mamushi bite and associated adverse events, including serum sickness diseases, delayed response, and adverse effects of antivenom were reported at hospital from May to September 2015. Adverse effects were seen in cases 3, 6 and 7 during treatment for mamushi bite. The underlying causes for the high frequency and variety of adverse effects of mamushi antivenom, including adverse reactions and serum sickness disease, are still not fully elucidated. Mumashi antivenom can be a major contributing factor to reducing hospital stay duration. However, healthcare professionals should be aware of the potential adverse reactions to mamushi antivenom.


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Medicolegal study of determination of time since death from potassium level in vitreous humour

2016-10-20T01-26-57Z
Source: International Journal of Advances in Medicine
Chaitanya S. Kulkarni, Gajanan. S. Chavan, Avinash N. Jadhao.
Background: From the knowledge of science, various workers have established the methods of determining post mortem interval by the use of physical changes after death. Unfortunately the accuracy was low and margin of error high as evident from the literature available. Trends are now shifting towards the use of various chemical methods like estimation of electrolyte concentration of cerebrospinal fluid, synovial fluid and vitreous humour. Vitreous humour is stable, less contaminated by putrefaction, easily accessible in sufficient quantity. Thus, it is suitable to determine time since death. Methods: The present cross-sectional study was carried out in grant Govt. medical college; Mumbai on 200 cases brought to the mortuary from the period 1st January 2011 to 31st May 2013. Results: It was found that there was linear correlationship between vitreous humour potassium concentration and increasing post-mortem interval irrespective of age, sex, temperature, humidity and mode of death. Conclusions: There was linear relationship between vitreous potassium concentration and post-mortem interval. The accuracy of prediction of PMI can be improved by applying present study formula. The rate of rise of potassium level in vitreous humour was 0.23mEq/L/hr No significant difference in vitreous potassium concentration between the two eyes was noted when samples were drawn at the same PMI. There was no significant effect of age, sex, temperature, humidity and mode of death on vitreous potassium level after death.


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Neurological manifestations in HIV positive patients attending tertiary care teaching hospital in Western India

2016-10-20T01-26-57Z
Source: International Journal of Advances in Medicine
Shripad R. Kausadikar, Anand Chandak, Pramod Jha.
Background: Neurologic manifestations affecting the nervous system at all levels and stages of HIV infection are common and increasing with the extended survival of HIV-positive persons. Neurological manifestations occur due to either primary pathologic process of HIV or secondary to opportunistic infection. The neurological manifestations of HIV disease are likely to be different in Indian patients because of prevailing endemic infections, malnutrition, poverty and illiteracy. The present study was conducted to study various neurological manifestations in HIV positive patients presenting to tertiary care teaching institute. Methods: This was observational study of 100 HIV infected patients with clinical evidence of CNS involvement. A detailed clinical history and CNS examination was carried out. CD4 counts were measured and magnetic resonance imaging (MRI), brain/electromyography, nerve conduction studies and cerebrospinal fluid (CSF) examination were done as required for diagnosis. Results were analysed by using percentage and proportions whenever necessary. Results: HIV induced primary illness was present in about 27% cases, while 73% associated with secondary CNS manifestations were mainly due to opportunistic infection. The most common primary illness was distal symmetrical polyneuropathy (17%) followed by myopathy (6%). On the other hand, the most common secondary CNS infection was tuberculous meningitis (TBM; 30%), followed by cryptococcal meningitis (7%), and cerebral toxoplasmosis (4%). The commonest neurological presenting symptoms were headache (38%) whereas the commonest abnormal neurological finding was presence of signs of meningeal irritation (46.5%). The commonest abnormality found on neuroimaging was meningeal enhancement (32%). Conclusions: High index of suspicion of neurological involvement in HIV patients in all stages helps in early diagnosis and timely institution of specific therapeutic treatment which in turn may considerably reduce the morbidity and mortality due to the disease.


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Effects of palonosetron and dexamethasone on postoperative nausea and vomiting in adult patients undergoing laparoscopic abdominal surgery: a randomized, double-blind, clinical trial at a tertiary care hospital

2016-10-20T01-26-57Z
Source: International Journal of Advances in Medicine
Sifna Tahir, Altaf Ahmad Mir, Abdul Hameed.
Background: Post-operative nausea and vomiting (PONV) is one of the common problems after laparoscopic abdominal surgery. It hampers the postoperative recovery in spite of the availability of many antiemetic drugs and regimens for its prevention. We evaluated the effectiveness of intravenous (IV) palonosetron in counteracting PONV during the first 48hrs following laparoscopic abdominal surgery, using dexamethasone as the comparator drug. Methods: In this study a single pre-induction IV doses of palonosetron (75mcg) or dexamethasone (8mg) were administered to adult patients of either sex undergoing elective laparoscopic abdominal surgery. There were 40 subjects per group. The pre-anesthetic regimen, anesthesia procedure and laparoscopic technique were uniform. The primary effectiveness measure was total number of PONV episodes in the 48 hours period following end of surgery. The frequencies of individual nausea, retching and vomiting episodes, visual analog scale (VAS) score for nausea at 2, 6, 12, 24 and 48 hours, use of rescue antiemetic (metoclopramide), number of complete responders (no PONV or use of rescue in 48 hours) and adverse events were secondary measures. SPSS software version 16 was employed to using students t-test, chi-square test or fishers exact tests. Value of P

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Superficial fungal infections in end stage renal disease patients

2016-10-20T01-26-57Z
Source: International Journal of Advances in Medicine
Upma Narain, Arvind Gupta.
Background: Patients with end stage renal disease commonly present a spectrum of dermatological disorders. Each one has its own unique presentation and treatment approaches. Superficial fungal infections of the skin do not account for much in the end stage renal disease patients; hence most of the reports do not discuss this issue. In the present study we analysed patients with end stage renal disease who had developed superficial fungal infections. Methods: During January 2015 to June 2016, we tried to analyse 150 patients with end stage renal disease, who developed superficial fungal infections and were undergoing haemodialysis at least thrice a week for a minimum of three months at our centre. Results: Out of the 150 suspected cases we identified, 36 cultures tested positive. The macroscopic examination of the scalp, skin and the nails revealed 2.2% Tinea capitis, 13.9% Tinea versicolor, 44.5% Tinea corporis, 8.4% Tinea mannum, 16.8% onychomycosis, 5.7% Tinea cruris and 8.5% Tinea pedis. The culture examination highlighted 44.4% Trichyopyton rubrum, 27.8% Trychophyton mentagrophyte, 2.8% Trychophyton violaceum, 2.8% Trichophyton verrucosum, 2.8% Microsporum canis, 2.8% Epidermophyton flucossum, 2.8% Scopulariopsis brevicaulis and 13.8% Malessesia). The predominant clinical abnormality observed was Tinea corporis and the prevalent fungal isolate was Trichophyton rubrum. Conclusions: The current study illustrates that a significant number of patients with the end stage renal disease had a prevalence of superficial fungal infections; hence, a prompt recognition of skin lesions and the identification of these superficial fungi may alarm us so that early and the judicious management to reduce the associated morbidity and in turn to improve the quality of life in these patients is taken.


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Prevalence of electrocardiographic abnormalities in heart failure patients attending Gujarat Adani institute of medical science, Kutch, Gujarat, India: a retrospective study

2016-10-20T01-26-57Z
Source: International Journal of Advances in Medicine
Vinit A. Thacker, Jayesh V. Trivedi.
Background: The ECG is a non-invasive and comparatively simple bedside test to perform. It is mostly utilized cardiovascular diagnostic test, and it is performed by cardiologists and other physicians who are not cardiologists. The ECG is an essential test in the evaluation of patients with heart failure. The aim was to establish the prevalence of electrocardiogram (ECG) abnormalities with heart failure patients attending department of medicine, Gujarat Adani Institute of medical science, Bhuj, Kutch, Gujarat, India. Methods: It was a retrospective study carried out department of medicine, Gujarat Adani Institute of medical science, Bhuj, Kutch, Gujarat, India. Simple random sampling technique was applied for medical records of 400 patients diagnosed with heart failure. The demographic, clinical, chest X-ray and 12-lead resting electrocardiographic (ECG) data of the patients were examined. Heart failure was diagnosed, by the modified Framingham criteria for the diagnosis of heart failure. Analysis was done using SPSS version 15 (SPSS Inc. Chicago, IL, USA) level of confidence interval and p value was set at 95% and 5% respectively. Results: The ECGs were abnormal in 92 % of the patients, and normal in 8% of the patients. The main ECG abnormalities included: left ventricular hypertrophy (42.9%), left axis deviation (39.8%), left bundle branch block (19.4%), and left atrial enlargement (25.80%). Arrhythmias seen included: ventricular extrasystoles (11.8%), atrial fibrillation (9.1%), complete heart block (5.7), and ventricular tachycardia (3.9%). Conclusions: ECG abnormalities are very frequent with heart failure patients in Bhuj, Kutch, Gujarat, India. The ECG is very helpful not merely in the analysis and etiology of heart failure but also it assists in recognizing significant complications of heart failure that might manipulate the option of treatment.


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Clinical profile and outcome of severe P. Falciparum malaria

2016-10-20T01-26-57Z
Source: International Journal of Advances in Medicine
Ramrao Mundhe, Maroti S. Karale, Chandrakant Usendi, Siddhant Yadav.
Background: Malaria is a public health problem in more than 90 countries. According to the latest estimates of WHO, released in December 2015, there were 214 million cases of malaria in 2015 and 438 000 deaths. The aim was to study clinical profile and outcome of severe falciparum malaria in patients at tertiary health care centre. Methods: In this prospective study, total 125 clinically diagnosed severe malaria cases admitted during period of November 2013 to October 2015, were enrolled excluding patients below 12 years of age. Detailed history and clinical examination was carried out to assess clinical severity and complications of malaria. Results: Of the 125 cases studied 110 cases were of severe malaria produced by Plasmodium falciparum infection diagnosed on peripheral smear examination or by antigen detection test. The remaining 15 cases were excluded from the study. In this study, seventy six (69.1%) cases were males and thirty four (30.9%) cases were females, with male: female ratio of 2.23:1. Common symptoms found were fever, chills and rigors, altered sensorium, jaundice and nausea or vomiting while most common complication was jaundice, seen in 45.45%. Mortality due to severe falciparum malaria observed was 13.63%. Conclusions: In this study of severe falciparum malaria, most common symptoms found were fever, chills and rigors, altered sensorium, jaundice, nausea and vomiting while most common signs were pallor, splenomegaly, icterus, hepatomegaly, bleeding tendencies and in a few cases neck stiffness and hypotension. Jaundice, renal failure, impaired consciousness and cerebral malaria were most common complications of severe falciparum malaria.


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Real world experience of GenXSync™ sirolimus eluting coronary stent system in patients with long coronary lesions: outcome of the GEL registry

2016-10-20T01-26-57Z
Source: International Journal of Advances in Medicine
Hiremath M. S., C. N. Makhale, Abhishek Gorlawar, Ashish Indani, Poonam Bhutada, Murlidhar Bendale.
Background: The study aimed to assess the immediate (procedural outcome) and long- term clinical (Cumulative hierarchical MACE up to 2 years) and angiographic outcomes (late lumen loss at 8 months) in the patients undergoing angioplasty with at least one 40 mm GenXSync SES. (Indian Study Regulatory ID CTRI/2014/07/004783). Methods: This single centre prospective study included 26 real-world coronary artery disease (CAD) patients with long and very long lesions (38 lesions, 48 stents). All patients were treated with one or more 40 mm GenxSync sirolimus eluting stent (SES). All the subjects were followed up for 2 years including angiographic follow-up at 8 months. Angiography data was evaluated and reported by an independent angiographic core-lab. Subset analyses were performed for all 40mm long stents and 40mm with small diameter stents. Results: The procedural success was observed in 94%. The acute gain was 2.25±0.53mm in stent and 2.09±0.71mm in segment despite of long and complex lesions including CTO. At 2 years, there was only 1 (3.84%) MACE (binary restenosis at 8 months) and stent thrombosis. At 8 months late lumen loss was in-segment 0.15±0.30mm and in-stent 0.14±0.17mm (p = 0.06). The 40mm stents subset, revealed acute gain of 2.21±0.58mm in-stent and 2.01±0.74mm in-segment. The late loss was 0.16± 0.31mm and 0.13±0.17mm in-stent and in-segment respectively. In 40mm stent with small diameter subset, the acute gain was 2.19±0.42mm in-stent and 1.69 ± 0.59mm in-segment and late lumen loss was 0.10±0.18mm in-segment and 0.13± 0.33mm in-stent. Conclusions: The results of real world long lesions PCI revealed efficacy, safety and procedural success observed with GenXSync stent comparable to other reported studies.


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Study of C-reactive protein in patients with acute myocardial infarction attending tertiary care teaching hospital in Saurashtra region of Gujarat, India

2016-10-20T01-26-57Z
Source: International Journal of Advances in Medicine
Shripad R. Kausadikar, Hina A. Mehra, Krishnakant P. Pathak.
Background: Acute Myocardial Infarction is a major contributor to morbidity and mortality globally. A growing body of evidence supports the concept of local and systemic inflammation playing a critical pathophysiologic role in progression of atherothrombosis and occurrence of infarction. Objectives of the study were to assess the role of serum C-reactive protein (CRP) levels in patients with first acute myocardial infarction attending tertiary care teaching hospital. Methods: A cross sectional study was carried out from October 2009 to September 2010 in tertiary care teaching institute in Saurashtra region, Gujarat, India. A total of 50 patients admitted to intensive cardiac care unit with a diagnosis of acute myocardial infarction were enrolled. Serum CRP levels were sent at 6 hrs to 36 hrs of chest pain. Patients were assessed for early complications as well as left ventricular function on Echocardiography. Results were analysed using appropriate statistical methods. Results: In this study, the mean age of presentation of acute myocardial infarction was 52.7 years which is a decade younger than in previous studies. CRP levels were found to be elevated in 79.4% of patients with anterior wall myocardial infarction. Raised CRP levels were associated with greater incidence of (50%) early complications after acute myocardial infarction. Raised CRP levels were also associated with a LVEF


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Evaluation of pulmonary functions in patients of type-2 diabetes mellitus

2016-10-20T01-26-57Z
Source: International Journal of Advances in Medicine
Maroti Karale, Bhanudas Karale, Chandrakant Usendi, Sadanand Kamble.
Background: The review of literature revealed conflicting documentation regarding the effect of type-2 DM (diabetes mellitus) on pulmonary functions. Some authors have reported normal pulmonary functions and even concluded that spirometry testing is not at all necessary in diabetic patients. Some studies have shown abnormal pulmonary functions in patients of DM. Moreover, the duration of DM and glycemic control have varied impact on the pulmonary functions. The present study was undertaken to resolve the conflict and also to explore the pulmonary functions in type-2 diabetics of this cross section of population. Methods: The pulmonary function tests FVC, FEV1, FEV3, PEFR and MVV were performed in 50 type-2 diabetics and 50 controls by computerized medspiror using standard laboratory methods. The data was documented statistically analyzed. By giving suitable class intervals, intra-diabetic groups were made to assess the effect of extent duration of diabetics on pulmonary function test. Results: Pulmonary functions FVC, FEV1, FEV3 PEFR and MVV were decreased in type-2 diabetes mellitus. Duration of type 2 DM was significantly associated with decrease in FVC, FEV1%, PEFR and MVV. Conclusions: Longer duration of type 2 diabetes is significantly associated with reduction in pulmonary functions FVC, FEV1%, PEFR and MVV which underlines the respiratory system as one of the target organs of type-2 diabetes mellitus.


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Prevalence of depression and associated risk factors among the elderly in rural field practice areas of a tertiary care institution in Katihar, Bihar

2016-10-20T01-26-57Z
Source: International Journal of Advances in Medicine
Sneha Soni, Mukesh Shukla, Manish Kumar.
Background: Despite depression is one of the most common emerging psychiatric morbidity among elderly now days, yet the depressive symptoms are not diagnosed appropriately. The objective of the study was to estimate the prevalence of depression and identify associated risk factors in the elderly population. Methods: A community based cross-sectional descriptive study was conducted from January 2013 to December 2013 in villages under field practice area of Katihar Medical College in the state of Bihar, India. Multistage sampling technique was employed, and a total 450 elderly persons were interviewed after obtaining written informed consent. Subjects with score >20 on the mini-mental state examination, were assessed for depression using the Short Form Geriatric Depression Scale. Study variables included bio-social parameters such as age, gender, literacy status, occupation, socioeconomic status, financial dependency and marital status. Results: The prevalence of depression in the study population was 39.6%. Mild depression was present in one-fourth (24.4%) of the study population followed by moderate depression (11.55%). Even 3.7% of the elderly were severely depressed. It was significantly higher in females (p = 0.00), those who were single (p = 0.00), those who belonged to upper socioeconomic strata (0.00) and were financially dependent on others. Conclusions: The study revealed the need for development of community based comprehensive strategy for early diagnosis and prompt treatment of depression among elderly as well as to promote mental health.


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Profile of hyponatremia in a tertiary care centre in North India

2016-10-20T01-26-57Z
Source: International Journal of Advances in Medicine
Mahim Mittal, Deepshikha, Hunny Khurana.
Background: Hyponatremia is the commonest electrolyte imbalance. Hyponatremia is a heterogenous disorder and classified into hypovolemic, euvolemic and hypervolemic types depending on the volume status of the patient. Approach is based on etiology and type of hyponatremia. The aim of the present study was to determine the profile of hyponatremia in adult patients including underlying etiology, type, clinical features and outcome Methods: The study was conducted at BRD medical college Gorakhpur, India between July 2014 to August 2015 after approval by the ethical committee. Consenting patients >18 years of age with hyponatremia (


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Trends in the clinical and hematological profile of patients with dengue fever

2016-10-20T01-26-57Z
Source: International Journal of Advances in Medicine
Tejas N. Modi, A. Santosh Sriram, Amit D. Mehta, Pankaj S. Patil.
Background: World Health Organization (WHO) estimates that 50-100 million dengue infections occur every year with 22000 deaths. The increasing magnitude of the problem together with its changing epidemiology is an important public health concern. The aim of the present study was to evaluate clinical profile, hematological profile, biochemical profile and outcome of dengue fever and to determine the relationship between clinical profile and hematological profile. Methods: This is a retrospective, observational, hospital-based study. 369 patients, aged more than 12 years, admitted between 1st January to 31st December 2015 with dengue fever were studied for clinical profile including documented bleeding manifestations/bleeding tendencies, hematological profile, biochemical profile and outcome. Results: Dengue cases occurred at higher frequency in 12-30 year age (81.30%), in males (M: F ratio- 2.35:1) and in rainy season (87.26% from September to November). Common presentations on clinical, radiological, haematological and biochemical profile were: fever (100%), headache (73.98%), bodyache (71.81%); hepatomegaly (66.93%), pericholecystic oedema (48.23%), distended GB (38.21%); thrombocytopenia (92.68%), leucopenia (58.26%) and raised liver enzymes (79.94%) respectively. Bleeding manifestations were observed in 48.61% cases of which petechiae (74.68%) was the commonest followed by epistaxis (7.59%), gum bleeding (2.16%), melena (2.16%) mainly. Mean duration of fever prior to hospitalization was 5.06±1.70 days. Mean nadir of platelet count was on 6.83±1.47 day from onset of illness (1st symptom-fever) and 1.77±0.89 day of hospitalization.100% patients had good recovery. Conclusions: Maximum prevalence of dengue was in young, in males and in rainy season. Thrombcytopenia, leucopenia, hepatomegaly, raised liver enzymes-aspartate aminotransferase (AST) and alanine aminotransferase (ALT), pericholecystic oedema are prima facie of dengue. Prompt diagnosis and immediate specific treatment with maintenance of platelet count and haemostatic function gives good recovery.


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Study to determine various echocardiographic abnormalities and its correlation with CD4 count in patients with HIV infection at tertiary care hospital in Mumbai, India

2016-10-20T01-26-57Z
Source: International Journal of Advances in Medicine
Sushma S. Gaikwad, H. Bhamare, D. S. Asgaonkar.
Background: The prevalence of echocardiograhic abnormalities in HIV/AIDS patients is uncertain in India. Early screening and prompt treatment are important to prevent significant morbidity from cardiac involvement and to promote long term health in PLHIV. Hence the present study was undertaken to determine various Echocardiographic abnormalities and their correlation to CD4 counts. Methods: This prospective cross-sectional study was carried out in the BYL Nair Hospital, Mumbai during the period of Nov 2011 to Oct 2012. A total of 150 adult patients (age >18 years) were included. Their demographic, clinical data along with routine investigations, CD4 count, and 2D ECHO using Philips iE 33 were carried out and recorded. Echocardiographic criteria for various abnormalities were applied as per American Society of Echocardiography Guidelines. Data was analysed by using SPSS 13 software. Results reported as percentage or mean±standard deviation and p value


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Antibiotic resistance pattern of bacterial enteritis among hospitalized children in Ardabil: a single center experience

2016-10-20T01-26-57Z
Source: International Journal of Advances in Medicine
Manouchehr Barak, Mohsen Arzanlou, Behnam Babapour, Lida Ghorbani.
Background: Gastroenteritis is one of the most important diseases in all parts of the world; and more dangerous among children, elderly, people who are undernourished and those who live in worse conditions. This study was set up to assess the antibiotic resistance pattern of bacterial enteritis among hospitalized children in Ardabil. Methods: This prospective cross-sectional study was carried out on 52 children who were referred to Bu- Ali hospital with dysentery in 2014. Results: Among all 52 collected Stool samples, 33 (63.4%) yielded Shigella. The most common Shigella isolate was S. flexneri (n = 17, 48.6%). Of 52 cases, 61.5% were boy, with the average age of 4.8 years. In the antibiogram, Ciprofloxacin and Gentamiycin were the most sensitive antibiotics to Shigella spp. and Co-trimoxazole and Azithromycin showed the highest resistance. Also, Imipenem, Ciprofloxacin and Gentamicin were the most sensitive antibiotics to E. coli and Co-trimoxazole showed the highest resistance. Finally, Azithromycin, Ceftazidime and Nalidixic acid were the most sensitive antibiotics for Salmonella group D. Conclusions: The results showed that different bacterial species showed maximum sensitivity to different drugs whereas the majority of them were resistant to Co-trimoxazole.


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Factors associated with anti-retroviral therapy adherence among people living with HIV visiting IRT Perundurai medical college hospital link ART centre, Perundurai, Tamilnadu, India

2016-10-20T01-26-57Z
Source: International Journal of Advances in Medicine
Mohankumar Vedhanayagam, Rajesh Rajagopalan, Balamurgan Bhavani Rajendran, Sendhil Sengodan, Senthilkumar Sengodan.
Background: National AIDS control organisation aims to provide wholesome management to PLHIV. This is ensured by universal access to free and comprehensive care, support and treatment in health delivery facilities across the country by dynamic linkages and referral mechanism for monitoring, mentoring, decentralization and specialized care and treatment. Objective of the study was to analyse factors associated with ART adherence among PLHIV visiting IRT Perundurai Medical College Hospital link ART centre, Tamilnadu, India. Methods: A prospective observational study was conducted during June 2015 to May 2016. All PLHIV receiving ART drugs as per protocol from LAC were included. Results: 139 clients were registered for treatment and follow up till May 2016 in our centre. 31 were transferred to nearby ART, link ART centres. Currently 98 (38 male; 60 female) were utilizing our services. Majority of the patients were on ZLN followed by TLE and ZLE. Most of clients were from rural areas belonging to low or low middle income group. Common occupation was found to be farming and cattle rearing. Most women were housewives. The average age in present study was 38.3 years. Oldest was 73 years old male and youngest 10 years old female. Family support and benefits of ART drugs tops the list of facilitators; supply chain, alcohol issues, family issues were commonly observed barriers. Conclusions: Our results supported the measurement of multiple dimensions of medication-taking behaviours in order to avoid overestimating adherence to ART. Investigation of factors associated with long term adherence would require elaborate and constant follow-ups than in this study period.


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Histopathological study of Round Cell tumors - A retrospective study

2016-10-19T22-45-34Z
Source: International Journal of Medical Science and Public Health
Ravi G Patel, Pooja Y Shah, Shridhan G Prajapati, Nirali S Amin, Varsha S Khant.
Background: Round Cell Tumors are heterogeneous malignancy featuring primitive undifferentiated small cell morphology. Small round cell tumors mostly occur in children, adolescents, and young adults. Because of their significant morphological overlap, have become a paradigm for an integrated approach to diagnosis. Immunohistochemistry (IHC) is the most common ancillary technique used for differential diagnosis of round cell tumors. Finding from all these studies are reviewed and interpreted in respect with clinical history, laboratory investigations, and diagnostic imaging finding. Objectives: (i) To study the incidence, and age vs. sex wise distribution of round cell tumors. (ii) To study the Immunohistochemical (IHC) pattern of these different round cell tumors and correlate the morphological diagnosis with IHC to determine its role as a confirmatory or diagnostic marker of the round cell tumors. Materials and Methods: As a part of study 75 (seventy-five) cases were selected during the year 2013-2015. Relevant findings were obtained. Biopsy tissues/ samples were fixed, paraffin embedded, sectioned and, stained with hematoxylin and eosin. IHC was performed on each case. Results were analyzed and compared. Results: Out of 75 cases, there were 22 cases (29.33%) of Non-Hodgkins lymphoma with the highest incidence. According to age wise distribution, the highest incidence was observed in 0-10 years of age group. According to sex wise distribution, a higher incidence was observed in males. There were 50 cases (66.66 %) of Males and 25 cases (33.33%) of Females. Overall M:F ratio was 2:1. Based on IHC, 22 cases of NHL were further classified into Burkitts lymphoma, Lymphoblastic lymphoma, and Diffuse Large B-cell lymphoma. IHC study of PNET and Rhabdomyosarcoma showed CD 99(86.7%), NSE(73.3%) and Vimentin(100%) positivity and Desmin, Actin, CD 99 and Vimentin positivity respectively. IHC study of Neuroblastoma and medulloblastoma showed NSE, NF, Chromogranin, S 100 and Synaptophysin positivity and GFAP, Synaptophysin, Vimentin, and Ki67 positivity respectively. Conclusion: Most frequent Round Cell Tumors are Non-Hodgkins Lymphoma, Neuroblastoma, Ewing/PNET and Rhabdomyosarcoma. Neuroblastoma, Retinoblastoma, Wilms Tumor, Hepatoblastoma show presentation in early childhood while Rhabdomyosarcoma is seen throughout childhood. The majority of round cells tumors have male predominance. This study emphasizes the role of immunohistochemistry (IHC) to arrive a definite diagnosis.


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A cross-sectional study on exclusive breastfeeding practice among lactating females attending medical college, district Jhansi (U.P)

2016-10-19T22-45-34Z
Source: International Journal of Medical Science and Public Health
Swati Singh, Nitin Tiwari, Anil Kumar Malhotra.
Background: Breast milk is an unequaled way of providing ideal food for the healthy growth and development of infants and has a unique biological and emotional influence on the health of both mother and child. Objectives: The present study was conducted to study the exclusive breastfeeding practice among females and its association with socio-demographic variables. Materials and Methods: The study was conducted on mothers attending the immunization clinic, for the period of four months between September 2015 to December 2015. The study was conducted on 400 nursing mothers, who were selected randomly using the simple random technique. Data was analyzed in SPSS 16 trial version. Chi-square test was used for comparison and statistical significance was taken at P value


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Predictors of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis in patients with type-2 diabetes mellitus

2016-10-19T22-45-34Z
Source: International Journal of Medical Science and Public Health
R S Pushpa Kumari, V A Vipula, B Suresh Reddy, W Nagadeepa, B L N Reddy.
Background: Hepatic steatosis in Non-Alcoholics may range from a benign indolent deposition of fat [known as non-alcoholic fatty liver diseases (NAFLD)] to severe lipotoxicity-induced steatohepatitis with neuroinflammation [known as non-alcoholic steatohepatitis (NASH)]. NASH is an overlooked complication of Type-2 diabetes mellitus (T2DM) that if missed may carry serious long-term consequences. Objectives: To determine the Predictors of Non-alcoholic fatty liver disease and Non-alcoholic steatohepatitis in patients with Type-2 Diabetes Mellitus. Materials and Methods: Fatty liver Disease by Ultrasonography & various other relevant factors (clinical and biochemical) were measured in all study subjects. These parameters were compared among two study groups i.e. (NAFLD and normal Liver). The statistical analyses were done using Statistical Analytic system (SAS), Chi-square test & Fisher Exact test were applied. Results: Incidence of Non-alcoholic fatty liver disease in our study is around 62 (59.7%) of which 37 (55%) are males and 25 (45%) are females. The incidence of Non-alcoholic steatohepatitis in this study is around 22 (25.5%) of which 15 are males and 7 are females. BMI and WC values are significantly higher in the fatty liver group than normal group. (p


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A study of morbidity profile amongst construction workers at selected construction sites in Surendranagar city

2016-10-19T22-45-34Z
Source: International Journal of Medical Science and Public Health
Pratik K. Jasani, Jay H. Nimavat, Jwalant B Joshi, Girija P. Kartha.
Background: Work plays a central role in peoples lives whether it is on a construction site, in an office or in a factory. Workers constitute a large & important sector of the worlds population. The two broad categories of construction works are building & civil engineering. Construction workers in both categories are at greater risk of developing certain health disorders & sickness than workers in many other industries. They are exposed to multiple physical, chemical & biological agents, which make them vulnerable to various health problems that include injuries, respiratory problems, dermatitis, and musculoskeletal disorders (MSDs). Apart from this, in most of the construction projects, the workers employed are unorganized in nature & often not guided by the legislations made for the health & welfare of the workers & hence are not eligible for free or subsidized care. In this context, this study was conducted to understand the health problems of construction workers & to advocate public health measures for the promotion of health & prevention of diseases among construction workers. Objectives: To assess the morbidity profile amongst the construction workers & correlate the findings with the occupational profile of the workers. Materials and Methods: It was a Cross-sectional study carried out among 312 construction workers from 10 different construction sites selected by simple random sampling. Data was collected and analyzed by the Statistical package for Social Sciences. Microsoft Word & Excel have been used to generate graphs, tables etc. Results: The study revealed that most common morbidity among construction workers was one or other types of minor injuries (34%) followed by skin problems (25.64%) & MSDs (19.55%). Conclusion: Illiteracy, poor working conditions, lack of infrastructure & security, inadequate health service utilization make these workers a vulnerable population & it shows the imperative need for an overall socioeconomic development as a key for achieving the desired status.


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Treatment-seeking behaviour and community perceptions regarding malaria in Surat city

2016-10-19T22-45-34Z
Source: International Journal of Medical Science and Public Health
Anjali Modi, Sukesha Gamit, Sankalp Raj Choudhary, Rohit Parmar, Prakash Goghara, Abhay Kavishvar.
Background: Mosquito-borne diseases (MBDs) are a public health challenge in India. Rapid industrialisation and urbanisation leading to rural-urban migration have led to a surge in cases of malaria. Intense surveillance and vector control strategies are also essential for its control. Surat city being inhabited by migrants is endemic for malaria. Objectives: This study was conducted to find out knowledge about mosquito-borne diseases, treatment seeking behaviour and community perceptions about malaria in Surat city. Materials and Methods: A cross-sectional survey was conducted in all the seven zones of Surat city namely Central, West, North, West, South East, South West and East zones in the last quarter of the year 2010 with data collection in the month of October 2010. Data was collected in a pre-tested semi-structured open-ended questionnaire, containing questions on socio-demographic profile, knowledge about MBDs, protection from MBDs, public surveillance activities carried out by Government for MBDs and treatment seeking behaviour. Results: About 38.4 % people utilised public sector services for peripheral blood smear examination. The majority (95.4%) of the fever cases took treatment for malaria. Only 59 cases received radical treatment out of 78 Plasmodium vivax cases. About 70% and 55 % of the respondents had correct knowledge about diseases transmitted by mosquitoes and mosquito breeding habits respectively. Around 81% fever cases reported that health workers come to their area for taking peripheral blood smears. Conclusions: The MBD control efforts need to be directed more to health education regarding complete treatment of malaria including the radical treatment. More endeavours for information about mosquitoes and their breeding habits are required.


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