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Empty Sella syndrome (ESS) pertains to a phenomenon in which the Turkish sale seems through radiography to be larger and perhaps partially or entirely filled with brain fluids. It can be major illness/ develop as a result of pituitary medical procedures, radiation therapy cerebral infarction/bleeding process. A 50 years old female patient was admitted in emergency medicine ward with chief complaint of pain in abdomen, weakness and vomiting. MRI scan of pituitary cerebrospinal fluid (CSF) signal intensity is seen in Sella with no visible anterior pituitary gland tissue noted-likely suggestive of secondary empty Sella (SES). Long-term steroid use is principal therapy for adrenocorticotropic hormone deficiency (IAD). In this instance, ESS, which can be primary/secondary, also noticed.
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Background: Common antigenic pool is seen because of shared embryonic origins of gall bladder cancer (GBC) and pancreas. Hence, we analyzed the role of serum carbohydrate antigen 242 (CA242) which has been studied in pancreatic cancer, in GBC. The objectives were to identify whether serum CA242 provides added advantage in diagnosis of GBC when compared to controls and to determine its cut-off value. Methods: Serum CA 19-9 level was determined by chemiluminescent micro particle assay and CA242 by enzyme linked immunosorbent assay (ELISA) of age matched cases and controls. Results: Total enrolled patients were 83 including 10 (11.7%) healthy volunteers, 22 (25.9%) chronic cholecystitis cases, and 53 (62.4%) patients with histological evidence of carcinoma. Mean age of presentation of GBC was 51.64 SD10.88 years with F: M ratio of 5.6:1. Pain (90.6%, 48/53) accompanied with jaundice was significantly associated with GBC well reflected by significantly raised serum total bilirubin (p=0.011), direct bilirubin (p=0.008) along with alkaline phosphatase levels (p=0.001). Significantly higher median value of CA 19-9 and CA242 was observed in GBC when compared to CC and healthy volunteers (p<0.001) with a significant correlation between tumor size (>2.5 cm) and serum levels of CA242. The best cut-off limit for CA242 was 45.25 IU/ml. The specificity for carcinoma diagnosis increased to 100% when CA242 was included along with CA 19.9 in serological estimation. Conclusions: We recommend that CA antigen 19-9 may be complimented with CA242 for serological identification of malignancy in the gall bladder.
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Background: Adoption of the LIMS (laboratory information management system) serves varied purposes in the diagnostic laboratory and might take a very lengthy period for its implementation. But, without controls being put in place, it can create a barrier to the project’s execution and prevent it from being finished on time. Methods: A WhatsApp group with 22 members, including lab technicians, heads of lab sections, a billing manager, an operations assistant manager, an assistant nursing caretaker, and administrative staff, was created. The assistant operations manager posted the daily pending report status in the WhatsApp group to help the lab team ratify, correct, and complete the assignments. To track pending report closures in real-time, the WhatsApp group mediated weekly follow-ups. The laboratory services department head informed the team monthly on the project’s status. The nonparametric Wilcoxon rank test and paired student t-test were performed to compare pre and post-survey responses before and after the seven-month intervention period. Results: The non-parametric Wilcoxon rank test and paired t-test results of the post-test demonstrated that the participant’s answer had improved significantly since the pre-test. The questionnaire showed that participants liked the new WhatsApp control mechanism. The number of pending reports reduced from 4,000 to 240 in seven months, a statistically significant decrease at a p value of 0.01. This supports the newly implemented WhatsApp control. Conclusions: Based on this interventional study, WhatsApp-based controls can be employed in conjunction with more conventional ways to regulate process outcomes during LIMS adoption.
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Systemic lupus erythematosus (SLE) is a chronic autoimmune disease which presents most commonly in middle aged females and affects multiple organ systems. Amongst the many systems involved, the nervous system generally gets affected later in the course of the disease. We report a case of a male patient who developed quadriparesis as the initial presentation of SLE who progressed to lupus nephritis. The patient was started on methylprednisolone, and later planned on IVIg when he did not respond to the initial treatment. Unfortunately, the patient developed diaphragmatic paralysis and succumbed to the illness.
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A male in his late teens presented with sudden onset left-sided hemiparesis and right-sided facial weakness. The patient had a history of persistent pulsatile headache for 1 year with the blurring of vision. He also had a history of diaphoresis and palpitations. The patient was diagnosed as a case of hypertension 1 year back. On examination, Right-sided upper motor neuron type facial palsy was present, and power was 0/5 in the left upper and lower limbs; BP was 220/120 mm Hg and was controlled using prazosin and nifedipine. A non-contrast computed-tomography scan (NCCT) of the brain revealed an intracerebral hemorrhage in the right ganglio-capsular region. Abdominal CT scan findings revealed a right suprarenal mass. 24-hour urinary normetanephrine was elevated, suggesting a diagnosis of pheochromocytoma. The surgical resection of the mass was delayed as the patient had developed Dengue shock syndrome, and he died of multiple organ dysfunction syndrome.
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Adenoid cystic carcinoma (ACC) is an uncommon malignant neoplasm usually confined to the salivary glands, lungs, and breasts. Primary cutaneous adenoid cystic carcinoma (PCACC) is an extremely rare entity with solitary cases reported at sites away from the scalp and chest. Hence, one must follow the multidisciplinary approach to exclude any primary ACC elsewhere in the body. We report a rare case of PCACC arising from the skin of the left lower limb in a 55-year-old woman with a history of recurrent swelling, clinically diagnosed as a metastatic tumor.
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Physiotherapy adds quality to the life of people. It provides support to people with disability. Leprosy is such a debilitating condition in which people suffer concerning their functionality and emotional parameters even after bacteriological cure. Leprosy is having several types of social stigmas attached to it which could be the reason for the discrimination among this population. Boosting the knowledge and building up a strong and positive attitude among physiotherapy students and practitioners against leprosy will be of help in overcoming the various multiple taboos associated with this condition. This research work aims at evaluating the knowledge and attitude towards leprosy among physiotherapy students and professionals in India. This study involves 300 voluntary participants from the physiotherapy field (students and professionals) above the age of 18 years from any gender from India, with a good hold on the English language. The response of all the participants was descriptively analyzed. Among study participants the mean score for the knowledge was estimated to be 65.47±14.69. Out of 300 participants, only 72 participants have shown a high level of knowledge with a mean score value of 84.54±5.23, and 228 participants showed a low level with a mean score value of 59.44±11.14. The mean score for the attitude related questions was 54.7±26.21. 189 respondents presented a favorable response with a mean of 71.16±16.56 whereas 111 respondents presented an unfavorable attitude with a mean value of 26.67±11.86. The findings of this research work gave us an insight into the “low-level knowledge” and a relatively “favorable behavior” towards the patient affected by leprosy among the physiotherapy students and practitioners in India. However, still, there is a need to enhance the knowledge and improve attitude among the Physiotherapy students and professionals by educating them and including leprosy in sufficient details in physiotherapy curriculum. Properly designed research cum intervention studies are necessary to understand the gaps in knowledge and attitudinal problems and take remedial measures.
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Introduction: A peptic ulcer (PU) is a break in the lining of the gastrointestinal tract, extending through to the muscular layer(muscularis mucosae) of the bowel wall. It is an endoscopic diagnosis. While they may technically appear anywhere in thegastrointestinal tract, they are most often located on the lesser curvature of the proximal stomach or the first part of the duodenum.Aim: This study aims to study the changes in stomach wall at sites other than the ulcer site in PU disease and to correlate theassociation of stomach wall changes with Helicobacter pylori infection.Materials and Methods: In this study, patients with duodenal ulcers diagnosed in endoscopy were included in the study. Duringan endoscopy, the stomach wall is examined and any changes in the stomach wall are noted. Endoscopically and biopsy fromtwo areas in the stomach are taken from antrum and body and sent to histopathological examination. Rapid urease test toconfirm the presence of H. pylori was done.Results: Sixty patients were included, 67% of patients were male, 82% of patients were positive in rapid urease test, 84%antrum was affected, and 50% in the body of the stomach was affected. The overall incidence of chronic atrophic gastritis isnearly 84.1% when compared to other types of lesions.Conclusion: Gastric antrum was the most common site for H. pylori than the body of the stomach. The presence of H. pyloriin the stomach wall is associated with active on chronic gastritis.
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Background: In the aetiopathogenesis of multifactorial glaucoma autoregulation of ocular blood flow plays an important role as failure of autoregulation may lead to progression of disease. Aim of this study to understand this better this study was designed to investigate the quantum of these abnormalities and their likely role in pathogenesis and prognosis of primary open angle glaucoma(POAG).Methods: This is a case control study design which involved 67 POAG patients and 67 matched controls. The parameters assessed includes peak systolic velocity(PSV), end diastolic velocity(EDV) and resistive index(RI) of ophthalmic artery(OA) and central retinal artery(CRA) of patients having POAG with age and sex matched healthy subjects. The data obtained was statistically analysed using IBM SPSS 21.Results: The study showed decreased PSV of 31.7 cm/s vs 42.7 cm/s(p=0.0001) and EDV11.7 cm/s vs 19.8 cm/s(p=0.002) with increased RI 0.63 vs 0.53(p=0.000) in OA and PSV of 15.2 cm/s vs 21.4 cm/s(p=0.001) and EDV4.7 cm/s vs 11.7 cm/s(p=0.003) with increased RI 0.69 vs 0.45(p=0.000) in CRA in both eyes in POAG patients as compared to healthy controls.Conclusion: The study has shown the promising application of ocular Doppler in evaluating POAG patients. However, more such studies are needed with larger study sample and on follow up basis for better understanding glaucoma hemodynamics and applicability of ocular Doppler in management of glaucoma.
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Background: Meconium staining of amniotic fluid has for long been considered to be a bad predictor of the fetal outcome because of its direct correlation of fetal distress, and increased the likelihood of inhalation of meconium, resultant deleterious effects on the neonatal lung. To evaluate etiological factors and severity of MAS in the study group.Methods: This study was done in the Neonatal intensive care unit of the Department of Paediatrics, Government Mohan Kumaramangalam Medical College Hospital Salem, Tamil Nadu, India in the year 2018. Complete maternal and neonatal details were recorded in to the proforma. Delivery details, resuscitation did were also recorded.Results: In present study, fetal distress was found to be the most common (42.5%) factor associated with MAS followed by PIH (21.6%) and PROM (17%). 22 (9.1%) cases were associated with Postdatism, 18 (7.5%) cases were associated with placental insufficiency. 88 babies had fetal distress (36.6%) prior to delivery. 138 babies had no fetal distress (57.5%).Conclusions: MAS is known to cause severe respiratory distress and Downe's score ranging between 4-8, usually a few hours after the onset of respiratory distress. Nearly 73.3% of the cases with MAS had birth asphyxia, out of which 30% had severe birth asphyxia. This indicates that passage of meconium can occur in utero, often considered a feature of the stressed fetus. Undoubtedly aspiration had occurred before delivery in these babies.
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Background: Acute lower respiratory tract infections are a common cause of morbidity and mortality in children. Respiratory infections in infants and small children are of great importance because of small airways. Infection may cause a further narrowing and may lead to respiratory distress. To evaluate the etiological factors, clinical profile and outcome of acute respiratory distress in the age group 2 months to 2 years.Methods: This study was conducted in the Paediatric department of Government Mohan Kumarmangalam medical college hospital, Salem, Tamil Nadu, India in the year September 2017-March 2018. Totally 183 cases of acute respiratory distress children were included in the study. A thorough clinical examination was done at the time of admission and management details were recorded into the proforma. Respiratory distress is defined as per WHO protocol as respiratory rate more than 50/minute in infants from 2 months to 12 months of age, and more than 40/minute in children from 13 months to 24 months of age.Results: Of the 72 cases of bronchiolitis, 32 cases (44%) tested positive for IgM at the time of admission and no cases in the control population tested positive for IgM. Of the 72 cases of bronchiolitis in the study population, 52 cases (72%) tested positive for ELISA IgG at the time of admission and 2 cases among the controls tested positive for ELISA IgG.Conclusions: Pneumonia was the most common cause of respiratory illness in the study population. Overcrowding was the major risk factor contributing to acute respiratory illness. Incidence of acute respiratory distress was high among undernourished children.
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Irritable bowel syndrome (IBS) is a chronic gastrointestinal disorder.Patients may suffer from abdominal discomfort, bloating or pain associated with disturbed defecation.The etiology has not been clear.Colonic diverticula are mucosal outpouchings through the large bowel. Recent study demonstrated more prevalence of diverticulosis in IBS.
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Background & objectives: Dyslipidaemia is a major contributor to cardiovascular morbidity, which is increased in HIV. Data on dyslipidaemia in Indians with HIV are scant. This study was undertaken to determine the predictors of dyslipidaemia and lipoatrophy in Indians with HIV infection and their relation with body composition parameters. Methods: A total of 382 consecutive patients with HIV infection were screened, of whom 257 clinically stable patients, without any acute comorbidity, having at least one year follow up underwent biochemical and DEXA analysis. Results: The most common dyslipidaemia was hypertriglyceridaemia (47.08%), followed by hypercholesterolaemia [total cholesterol (TC)] (38.91%) and low high-density lipoprotein (HDL) cholesterol (38.52%), in patients having median age 37 (32-42) yr and HIV duration 57 (33-101) months. Patients with at least one dyslipidaemia (78.99%) had significantly higher insulin resistance (IR), per cent body fat, per cent trunk fat (PTF) and trunk limb fat ratio (TLFR). Baseline CD4 count and delta CD4 count (change in CD4 count 6-12 months following ART) had significant inverse correlation with triglycerides and TC. Patients with highest triglycerides and cholesterol quartiles had significantly higher immune reconstitution, metabolic syndrome, IR, trunk fat mass (FM), PTF and TLFR, with comparable total FM. Logistic regression revealed that body mass index, HIV duration and PTF were independent predictors of hypertriglyceridaemia, with only PTF being significant predictor of hypercholesterolaemia. Every unit increase in PTF was associated with 13 and 4.1 per cent increased hypertriglyceridaemia and hypercholesterolaemia. Lipoatrophy was present in 8.57 per cent patients and was a poor predictor of dyslipidaemia. Interpretation & conclusions: High occurrence of dyslipidaemia was observed in patients with HIV on anti retroviral therapy. Central adiposity (TFM) was the most important predictor of dyslipidaemia in these patients.
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Background & objectives: Data on bone mineral density (BMD) and sarcopenia are scant from young females with HIV. This study was conducted to determine occurrence, predictors and impact of body composition alterations on osteoporosis in pre-menopausal women with HIV. Methods: A total of 214 females with serologically documented HIV infection were screened, of whom 103 pre-menopausal women, 25-45 yr age, clinically stable, having at least one year follow up data, underwent hormonal and dual-energy X-ray absorptiometry analysis for BMD and body composition. Seventy five matched controls were also evaluated. Results: Females with HIV had significantly lower BMD and Z-score at lumbar spine (LS), total femur, neck of femur (NOF), and radius ultra-distal (UD) compared to controls. Osteoporosis at least at one site was observed in 34.95 per cent patients, compared to eight per cent in controls (P<0.001). Most common site of osteoporosis in females with HIV was radius UD (24.27%), followed by radius 33 per cent (17.48%), radius total (15.53%) and greater trochanter, NOF and LS (6.80% each). HIV patients had significantly lower bone mineral content, lean mass (LM), fat per cent, android (A) fat, gynoid (G) fat, and A/G ratio. LM and fat mass (FM) were ?15.65 and ?11.54 per cent lower in HIV patients, respectively. Osteoporosis patients had significantly higher use of antiretroviral therapy and lower LM, FM and fat per cent. On logistic regression, LM followed by A/G ratio and BMI were the best predictors of osteoporosis. Sarcopenia was observed in 17.5 per cent patients. Interpretation & conclusions: Our results showed that osteoporosis and sarcopenia were significant problems in young women with HIV. HIV was associated with greater LM loss, which was critical for bone health. Sarcopenia may predict low BMD in HIV.
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Background & objectives: Adrenal insufficiency (AI) is rarely diagnosed in patients with HIV infection, in spite of autopsy studies showing very high rates of adrenal involvement. This study was aimed to determine the presence, patterns and predictors of AI in patients with HIV infection. Methods: Consecutive HIV patients, 18-70 yr age, without any severe co-morbid state, having at least one-year follow up at the antiretroviral therapy clinic, underwent clinical assessment and hormone assays. Results: From initially screened 527 patients, 359 patients having good immune function were analyzed. Basal morning cortisol <6 ?g/dl (<165 nmol/l; Group 1), 6-11 ?g/dl (165-300 nmol/l; Group 2), 11-18 ?g/dl (300-500 nmol/l; Group 3) and ?18 ?g/dl (500 nmol/l; Group 4) were observed in 13, 71, 199 and 76 patients, respectively. Adrenocorticotropic hormone (ACTH) stimulation test revealed 87 patients (24.23%) to have AI. AI in groups 1-4 was 100, 56.34, 17.09 and 0 per cent, respectively. AI patients were more likely to be females (P<0.05), having longer disease duration (P<0.05), immune reconstitution inflammatory syndrome, hyperkalaemia (P<0.01), lower fasting glucose (P<0.01), dehydroepiandrosterone sulphate (DHEAS) and vitamin D. Regression analysis revealed morning cortisol and DHEAS to be best predictors of AI (P=0.004 and 0.028, respectively). Interpretation & conclusions: AI is a significant problem in HIV-infected individuals, observed in nearly a quarter of patients. Diagnosis warrants high index of suspicion and low threshold for screening, especially in those having low DHEAS and hyperkalaemia. Morning cortisol is a reasonable screening test, with ACTH stimulation warranted to confirm diagnosis, especially in patients with morning cortisol <11 ?g/dl (300 nmol/l).
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Posotoprative nausea and vomiting remains a persistent and distressing problem inspite of many advances on perioperative care and anti-emetic drugs. A newer antiemetic drug Granisetron has not been studied in patients undergoing gynaecological surgery under spinal anaesthesia
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Background: This study was undertaken to report the results of weekly combination chemotherapy with cetuximab in recurrent/metastatic head and neck squamous cell carcinoma (R/M SCCHN). Materials and Methods: Retrospective analysis of 35 R/M SCCHN patients who received cetuximab with weekly paclitaxel and platin (cisplatin/carboplatin) from SCCHN August 2006 to October 2008 at our Institute was performed. Results: Thirty-five patients (33 [94.3%] males and 2 [5.7%] females) received the planned weekly chemotherapy protocol. Median age of these patients was 52 years. Of the SCCHN 32 evaluable patients, 25 patients showed symptomatic improvement and 7 showed no improvement. Radiological responses using RECIST criteria reported CR in 1 patient (3.1%), PR in 17 patients (53.1%), and SD in 6 patients (18.8%). The remaining six patients demonstrated disease progression while two could not be assessed. Median overall survival (OS) was 8.016 months (95% CI; 6.572--9.461) and median PFS was 5.782 months (95% CI; 4.521--7.044). The major chemotherapy-related grades 2 and 3 toxicity recorded was cetuximab-induced rash reported in 24 patients. No treatment-related death within 30 days was observed. Conclusion: Cetuximab with weekly combination chemotherapy (Paclitaxel + Platinum compound) has shown promise, demonstrating comparable response and outcomes with acceptable toxicity in R/M SCCHN patients.