Association Between Inflammatory Marker And Cognitive Impairment In Diagnosed Type 2 Diabetes Mellitus: A Case Control Study

Introduction: Type 2 diabetes mellitus (T2DM) is a common metabolic disease, especially in older people, with global prevalence estimates ranging from 2.8% in 2000 to a projected 4.4% in 2030 (Wild S et al.2004). Objectives: The present study was undertaken to assess association between inflammatory marker&Cognitive impairementin people with type 2 diabetes mellitus. Methods: The present study was conducted in Rajeev Gandhi Centre for Diabetes and Endocrinology and Department of Physiology on patients of Type 2 Diabetes Mellitus attending Diabetes clinic in Jawaharlal Nehru Medical college hospital, Aligarh Muslim University during year 2012-2013 after approval from the ethical committee of J. N. Medical College. Design of the study was case control.A detailed history and physical examination was carried out for every subject who entered the study as per pre-designed proforma. Results: For cognitive impairment, Type 2 DM subjects showed significantly decrease total MMSE score with decrease in orientation, registration,attention and calculation, recall and language in comparison to controls. Conclusion: The association between Type 2 DM and cognitive changes is becoming increasingly clear, rendering it necessary for physicians in charge of diabetic patients to have the means to assess cognitive performance as cognitive impairment among the older adults with Type 2 DM may worsen the health outcomes through negative impact on compliance with medical self care recommendations.

Prevalence of Underweight and its Risk Factors amongst Under-Five Children in a Rural Area of Varanasi District in Uttar Pradesh, India

Globally more than half of the under-five deaths are attributable to undernutrition. Under-nutrition is a major cause in more than half of under-five deaths. A community-based cross-sectional observational study was done in the rural area of Todarpur Village of Varanasi district of Uttar Pradesh India, which is the field practice area of Rural Health Training Centre under the Department of Community Medicine, Heritage Institute of Medical Sciences. The study period was January-April 2018. The prevalence of underweight was lower in comparison to National and State-based prevalence. Most of the underweight children were infants, females, whose mother was illiterate and those who belong to lower socio-economic status and SCT/ST community. Therefore, this section of the society is the most vulnerable group for malnutrition and appropriate cost-effective strategies and intervention are needed to address the burden of malnutrition in this section of society.

Evaluation of inhaler use techniques among asthmatic patients in King Faisal medical complex, Taif, Saudi Arabia

Background: Bronchial asthma is a prevalent health problem globally. Inhaled route is commonly used over other routes to manage asthmatic patients. Despite the efficacy of inhalers, the poor inhaler technique used by asthmatic patients leads to decrease drug delivery to lungs and poor asthma control

Objective: The main objective of this study was to evaluate the proper use of inhaler devices by asthmatic patients according to the standard recommended steps and to identify the factors related to the inaccurate or poor inhaler use among asthmatic patients at King Faisal Hospital in Taif, Saudi Arabia

Methods and Materials: This was a cross-sectional observational study conducted among Saudi asthmatic patients using inhaler devices and visiting out-patient's respiratory clinic. Patients were asked to use their inhaler devices and their inhaler technique and using a validated checklist. MDI, TurboHaler and Handihaler were the most commonly used whether alone or in combinations

Results: Around 74% and 92% responded to receive any education for asthma and asthma devices respectively. Of those who received any education, mostly reported that they received education about asthma and/or devices from their physicians. Breathing out, breath holding pattern and position of head during inhaling condition were three critical steps that led to improper use

Conclusion recommendation: Inhalation technique in asthma patients was unsatisfactory and was accompanied with errors, especially in patients with low education levels. This study suggested prioritizing and establishing the proper practice of inhaling devices to better manage asthmatic patients and quality of life

young girl with epigastric pain and episodic generalized motor weakness: a case report

A young female presented with epigastric pain, scant vomiting and generalized weakness. Ultrasound abdomen was normal. Serum lipase and amylase were raised. Arterial blood gases [ABGs] revealed metabolic acidosis, electrocardiogram [ECG] showed U-waves, serum potassium was 2.1, urine pH and urinary sodium were 6 and 82 mEq/L respectively and urine anion gap was raised. A diagnosis of distal renal tubular acidosis and acute pancreatitis was made. She was made pain free and nil per os [NPO] was ordered. For her renal tubular acidosis she was given intravenous potassium citrate followed by sodium bicarbonate. The patient got clinically improved and was then discharged home on oral potassium citrate

Prevalence of hepatitis-c viral antibodies among high school teachers and students in rural areas of Punjab Pakistan

Background: Approximately 80 percent of patients who are suffering from Hepatitis C are uninformed of their infection

Objective: To assess the prevalence of hepatitis C viral antibodies in high school teachers and students in the rural areas of Punjab, Pakistan

Methodology: A total of 1200 apparently healthy high school teachers and students [9[th] and 10[th] class] from rural rural rural communities of Punjab were randomly selected from 1[st] January to 31[st] December 2016. Probability based random sampling method was used. 5ml blood was drawn from each individual. Subsequently serum was separated from the blood sample for testing the antibodies of hepatitis C virus. The data was entered and analyzed in SPSS version 22

Results: A maximum prevalence of 16.6% of the antibodies against hepatitis C virus infection was observed in the category of male high school students, followed by 10.6%, 8.3% and 5.3% in the category of male high school teachers, female high school teachers and female high school students in the descending order respectively. The prevalence rate of hepatitis C antibodies in Southern, Central and Northern Punjab was 10%, 14.25% and 6.5% respectively. Our all the prevalence of hepatitis C antibodies was 10.5%

Conclusion: The prevalence of hepatitis C antibodies was high in our study subjects. Male high school students were found mostly infected in the Central Punjab as compared to other categories in the rural communities of Punjab

Tinospora cordifolia induces cell cycle arrest in human oral squamous cell carcinoma cells

Natural products with medicinal value are gradually gaining importance in clinical research due to their well-known property of no side effects as compared to drugs. Tinospora cordifolia [Guduchi] has been used for centuries in Ayurvedic system of medicine for treating various ailments including cancer. In present study, we found that the Tinospora cordifolia extracts [TCE] induced inhibition of proliferation of KB cells was associated with arrest of GO/G1-phase of cell cycle. The effectiveness of TCE in checking the growth of KB cells without altering the growth of normal peripheral blood mononuclear cells [PBMC] indicates that Tinospora cordifolia has differential effect on normal and malignant cells hence, it may have therapeutic potential in cancer

Inferior rectus muscle ocular cysticercosis: a case report

Cysticercosis is a systemic parasitic disease caused by the larval form of cestode Taenia solium. It has a worldwide distribution and is potentially harmful with variable clinical manifestations. The most commonly involved sites include eye, brain, bladder wall, and heart. Ocular cysticercosis can be extraocular or intraocular and may present with varied clinical symptoms. We report the condition in a thirteen year old female child who presented with mild lower lid swelling and diplopia in upgaze, wherein cysticercus cellulosae cyst was found within the mass of the right inferior rectus muscle. It becomes important to report this case because of the relative rarity of the condition these days, unusual site of the cyst and the young age of the patient

Diagnostic dilemmas in intraductal papillomas of the breast - experience at Sultan Qaboos University Hospital in the Sultanate of Oman

The aim of this retrospective study was to correlate the significance and accuracy of the colour of nipple discharge and breast ultrasound imaging in the diagnosis of intraductal papilloma. This is a retrospective study of 34 patients who underwent 36 microdochectomies in Sultan Qaboos University Hospital [SQUH] in the Sultanate of Oman, over a 4 year period of January 2009 till December 2012. The confounders considered were patient age, physical examination findings, nipple discharge cytology result, ultrasound results and biopsy report following microdochectomy. Comparisons analysis, charts and graphs were made using the SPSS software [version 20]. The mean age of the patients was 44 [27-73] years old. Twenty-seven out 36 [75%] patients had presented with nipple discharge, 14 out 27 [52%] had blood stained nipple discharge and 13 [48%] with coloured discharge [yellow, brown and green], 9 patients had no discharge. The final histopathology showed intraductal papilloma 13 [36%], duct ectasia 18 [50%], DCIS 1 [2.7%], fibrocystic disease 3 [8.3%] and LCIS 1 [2.7%]. Thirteen out of 36 had intraductal papilloma on final histopathology. The correlation between blood stained discharge and final histopathology of intraductal papilloma was insignificant [p=0.44]. Nipple discharge is irrelevant to the diagnosis of intraductal papilloma. Spontaneous nipple discharge regardless of color is to be referred to breast surgeon and to be assessed with triple assessment. Surgery remains the mainstay of treatment

Demographic profile, vaccination status and outcome of measles patients at civil hospital, Bahawalpur during measles epidemic

Background: Measles is a vaccine preventable disease of childhood. It occurs in epidemics in developing world like Pakistan. It has significant morbidity and mortality due to its complications

Objective: This study was conducted to determine the demographic factors, immunization status, complications and outcome in measles patients, admitted at Civil Hospital, Bahawalpur during measles epidemic

Material and Methods: The cross-sectional study was conducted at Civil Hospital, Bahawalpur from 4[th] March, to 15[th] August, 2013. A total of 166 patients were admitted who presented with signs and symptoms of measles according to WHO criteria. Demographic profile including age, gender, residential status, immunization status and nutritional status of these patients was observed. They were evaluated for complications like pneumonia, gastroenteritis, encephalitis, otitis media, post measles state, dysentery and myocarditis. The outcome of these admitted patients was seen in terms of discharge, leave against medical advice, referral and death. The data was entered and analyzed by using SPSS 15

Results: In the patients, 93 [56%] were males and 73 [44%] were females. Mean age was 3.72 + 2.7 years. One hundred and fifty seven [94.6%] patients were unvaccinated and 9 [5.4%] were partially vaccinated for measles. One hundred and seven [64.5%] were from rural area and 59 [35.5%] to urban area. Fifty nine [35.5%] were well nourished and 107 [64.5%] undernourished. Seventy two [43.4%] patients were having pneumonia. Thirty seven [22.3%] patients were having gastroenteritis. Nine [5.4%] patients were having encephalitis. Post measles state was found in 11[6.6%]. Majority of patients [88.6%] were discharged in a satisfactory condition while 9 patients [5.4%] expired

Conclusion: Measles was mainly found in unvaccinated children aged 1-5 years. Malnutrition was a major risk factor for mortality in our study. So we recommend two doses measles vaccine schedule and > 90% routine coverage in order to minimize the chances of measles outbreak

Vascular endothelial growth factor [VEGF-634G/C] polymorphism and retinopathy of prematurity a meta-analysis

Vascular endothelial growth factor polymorphism [VEGF-634G/C, rs 2010963] has been considered a risk factor for the development of retinopathy of prematurity [ROP]. However, the results remain controversial. Therefore, the aim of the present meta-analysis was to determine the association between VEGF-634G/C polymorphism and ROP risk. Published literature from PubMed and other databases were retrieved. All studies evaluating the association between VEGF-634G/C polymorphism and ROP risk were included. Pooled odds ratio [OR] and 95% confidence interval [Cl] were calculated using random or fixed effects model. A total of six case-control studies including 355 cases and 471 controls were included. By pooling all the studies, we found that VEGF-634G/C polymorphism was not associated with ROP risk at co-dominant and allele levels and no association was also found in dominant and recessive models. While stratifying on ethnicity level no association was observed in Caucasian and Asian population. This meta-analysis suggests that VEGF-634G/C polymorphism may not be associated with ROP risk, the association between single VEGF-634G/C polymorphism and ROP risk awaits further investigation

Mucinous breast cancer with solitary metastasis to humeral head: a case report

Breast cancer is the most common cause of metastatic deposits in the skeleton, and bone is the most common site of recurrence of breast cancer. Breast cancer metastasis most commonly affects the spine, ribs, pelvis, and proximal long bones; however, only 3.5% of breast cancer patients develop long-bone metastases. The humerus is the most common upper-extremity site for bony metastasis, and pathologic fractures can result. The patient in the current study presented with breast cancer and discovered to have humeral head metastasis during initial workup. The dilemma was in investigation the modality to confirm humeral head metastasis as there are many differential diagnoses with similar findings. After staging workup, the patient was treated with neoadjuvant chemotherapy followed by modified radical mastectomy and radiotherapy of the chest wall and the shoulder. The lesion in humerus was well healed.

First reported case of reactive airway dysfunction syndrome in a laborer due to porcelain tile dust

Reactive airway dysfunction syndrome [RADS] is a type of non-immunologically mediated asthma-like disease. It usually occurs after a massive exposure to an irritating substance in the atmosphere in the form of smoke, fumes, gases, and vapor. Unlike bronchial asthma, there is no latency to the symptoms seen in RADS. A number of agents are known to cause RADS, but tile dust, as an etiological agent, has not been previously reported. We report a 45-year-old male laborer, who presented with an acute onset of cough, chest tightness, breathlessness, and audible wheeze after his first time exposure to porcelain tile dust within 5 hours of exposure. Lab tests, including, chest X-ray, electrocardiogram, air blood gas analysis, and serum IgE, were unremarkable. Spirometry showed a mild obstruction [forced expiratory volume in 1 second [FEV1]=72% of predicted], while the bronchodilator reversibility test was significant[14% increase in FEV1 above the baseline].Bronchial biopsy revealed a chronic inflammatory reaction with lymphocytic and plasma cell infiltration and more importantly a striking absence of eosinophils. To t he best of our knowledge, this is the first reported case of RADS as a result of exposure to tile dust [porcelain ceramics]

Intra-abdominal pathologies

To evaluate relative frequency, reasons, avoidable responsible factors and outcomes of relaparotomy. Observational case series study. Department of Surgery Unit III BVH Bahawalpur. From 01-9-2009 to 31-8-2010. All the patients who presented in surgical outdoor, indoor and casualty department with severe intra-abdominal pathologies after primary laparotomies referred from low level, secondary care and tertiary care hospital and underwent relaparotomy electively or on demand were included in the study. Retrospectively their demographic characteristics, initial diagnosis with surgical information of primary laparotomy, factors and outcomes after relaparotomies were analyzed statistically. A total 54 patients were included in the study with male to female ratio of 1:2. Mean age of the study group was 30.91 +/- 12.5 years. Relative frequency of relaparotomy was 5.6%. Common center of referral was low level hospital 66.7%. Most common indication of relaparotomy was peritonitis in 52%. Most common complication of relaparotomy was wound infection 74%. Avoidable factors responsible for relaparotomies were found to be surgery at low level hospitals [77.3%] and by nonqualified surgeons [72.1%]. The rate of relaparotomy is very high because of unsupervised primary surgery in institutions and surgery by unqualified operators in private sector. Many of these are avoidable. In addition to decreasing the complication rate, primary surgery performed at tertiary care hospitals would decrease need for patients to undergo re-exploration

Assessment of process measures of quality of care through client flow analysis

Background: Quality of health care services is emerging as a field with multifaceted approach. Measuring the quality is tricky and needs standards. Many global standards are in place but still the contextual applications of standards need research on the measurable aspects of the quality of care

Material and Methods: A cross-sectional study was conducted at general medical out patient departments of two tertiary care hospitals of Lahore, one from the public sector and the other from the private sector selected using multi-stage sampling. 93 patients were selected from each hospital. Process measures of quality of care delivered in medical out patient departments were assessed using client flow analysis technique, performed by trained personnel

Results: Access to the hospital OPD, waiting time outside the consultant room, physical environment of the OPD and provision of relevant information to the patient were observed for adherence to standards and statistical association found with the patient satisfaction on these aspects

Conclusion: The process measures must be assessed in order to evaluate the quality of care in a specific service or hospital as patient satisfaction [outcome measure] alone is not enough to judge the quality of care

Computerized tomographic scanning of brain for evaluation of children with delayed milestones

To assess the utility of Computerized Tomographic [CT] scanning of brain in the evaluation of children with delayed milestones. Cross-sectional retrospective study. Department of Radiology, Pakistan Air Force Hospital, Islamabad from April 2007 to September 2009. We retrospectively reviewed the referral forms of CT scanning of brain for evaluation of children with delayed milestones. A total of 48 patients had a CT brain for evaluation of delayed milestones. They were divided into two groups. There were 15 patients in group A, who had significant history and clinical findings. Group B had 33 patients, in whom there was no clue to the etiology of developmental delay. The results of their CT scans of brain were compiled and analyzed. Out of a total of 15 patients in group A, fourteen [93.3%] had an abnormality. Mild cerebral atrophy was seen in 11 patients, two had calcification in basal ganglia and one had leukodystrophy. No abnormality was seen in CT scan of brain in group B patients. CT scanning of brain is useful in reaching a diagnosis of delayed developmental milestones where there are significant historical and abnormal physical findings

Eosinophilic cholecystitis: an infrequent cause of cholecystectomy

Eosinophilic cholecystitis is a rare condition with obscure etiology. They are diagnosed histopathologically on resected specimens. We report a similar case confirmed on histopathology of a 49 years old diabetic lady who underwent routine elective cholecystectomy for chronic cholecystitis due to gall stones. The rarity of the condition prompted us to report this entity

Left sided amyand's hernia

Appendicitis within an Amyand's hernia is a rare clinical entity in itself and becomes especially more rare if it occurs in the left inguinal region. We report this rare case of Amyand's hernia where the appendix was found along with gangrenous ceacum during surgery for strangulated left inguinal hernia in an adult, who underwent resection, anastomosis and simple repair for his hernia

Torsion of an epiploic appendix pretending as acute appendicitis

Torsion of an epiploic appendix is a rare surgical entity. Its unusual symptomatology, wide variation in physical findings and the absence of helpful laboratory and radiological studies makes it very difficult to diagnose pre-operatively. This is a report of this rare entity found in a patient upon diagnostic laparoscopy performed for suspected acute appendicitis

Pilonidal sinus: prevalence and comparison of excision and primary closure with lay open procedures

To study the prevalence of pilonidal sinus and compare the outcome of the excision and primary closure with lay open surgical procedures. Prospective randomized comparative study. Department of surgery, Bahawal Victoria Hospital Bahawalpur. From 1st December 2002 to 30th November 2007. A total of 40 patients with pilonidal sinus were randomized into two groups. Group I underwent excision and primary closure while Group II underwent excision and lay open procedure. Patients of Group I and II had comparable mean operation time of 42.7 minutes. Group I patients had a shorter mean hospital stay of 4.87 days, earlier return to light work after 13.21 days, less treatment expenses and low rate of postoperative complications and good patient satisfaction. We conclude that primary closure after excision of pilonidal sinus is superior surgical procedure than excision and laying it open