Systemic sarcoidosis presenting as acute rapidly progressive proptosis / Sarcoidose sistêmica apresentando-se como proptose aguda rapidamente progressiva

ABSTRACT Sarcoidosis is a generalized systemic chronic inflammation that rarely involves the orbit. As a chronic inflammation, sarcoidosis typically manifests with an insidious onset and slowly progressive course. We report a case of acute-onset proptosis resulting from a rapidly growing diffuse orbital mass that simulated malignant growth, which was biopsy proven to be the first manifestation of systemic sarcoidosis. The patient demonstrated complete resolution of proptosis and systemic involvement with long-term corticosteroid treatment.

RESUMO A sarcoidose é uma inflamação sistêmica generalizada que raramente envolve a órbita. Sendo uma inflamação crônica, a sarcoidose geralmente se manifesta com um início insidioso e uma evolução lentamente progressiva. Neste artigo, é relatado um caso de proptose de início agudo, resultante de uma massa orbitária difusa de rápido crescimento, simulando um crescimento maligno, mas cuja biópsia comprovou ser a primeira manifestação de uma sarcoidose sistêmica. O paciente apresentou resolução completa da proptose e do envolvimento sistêmico com tratamento de longo prazo com corticosteroides.

Etiology of severe anemia in Kashmiri children aged 6 months to 6 years

Background: Anemia is said to be present when the hemoglobin level is more than two standard deviations below the mean for the child’s age and sex. Anemia is the most common global nutritional disorder and may lead to psychomotor retardation, low intelligence, decreased learning capability, weakening of immune system and predisposes to serious infections in children. Methods: The study was an observational study. Physical signs of severe anemia were looked in patients attending outpatient department or admitted in hospital. Children with hemoglobin levels <7 gm/dl and in the age group 6 months to 6 years were recruited in study. Results: The study included 192 patients with a male, female ratio of around 1:1. The mean age of the study subjects was 2.2±1.6 years. Most of the patients around 54% belonged to age group of 6 months to 1½ years. Fever was most common presentation in 86 cases (44.77%), followed by diarrhea and easy fatigability in 38 (19.79%) and 21 (10.93%) patients respectively. A total of 76.56% of patients were having nutritional and 23.44% non-nutritional causes. Iron deficiency anemia is most common etiology 115 (59.90%) with 14 patients having celiac disease, 19 cases (9.90%) were diagnosed as megaloblastic anemia, 13 cases (6.77%) were diagnosed as dual deficiency anemia, 30 cases (15.63%) were diagnosed as hemolytic anemia. Conclusions: Nutritional anemia is major cause of anemia in children. Celiac disease, trichuriasis, cow milk protein allergy should be ruled out in iron deficiency anemia patients.

Brown–Séquard Syndrome after Thoracic Endovascular Aortic Repair for a Stanford Type B Aortic Dissection

We present a case of Brown–Séquard syndrome (BSS) after thoracic endovascular aortic repair (TEVAR) to treat Stanford type B aortic dissection. A 49-year-old male presented to the emergency department with acute tearing pain between the scapulae, connected to respiratory movements. Computed tomography showed Stanford type B aortic dissection from the left subclavian artery to the level of the 11th thoracic vertebra. Conservative treatment was initiated with intravenous antihypertensives. However, due to persistent pain and an increase in the aortic diameter with an intramural hematoma, TEVAR was performed. The patient developed symptoms suspicious of spinal cord ischemia postoperatively. A lesion limited to the left-sided spinal cord was observed on magnetic resonance imaging at the level of the 4th to 5th thoracic vertebra. BSS after TEVAR is a rare phenomenon with a fairly good prognosis, depending on the initial injury severity.

Validation of the Brazilian Portuguese version of Evidence-based Practice Knowledge Assessment in Nursing (EKAN) / Validação da versão Brasileira da Evidence-based Practice Knowledge Assessment in Nursing (EKAN) / Validación de versión brasileña de la Evidence-based Practice Knowledge Assessment in Nursing (EKAN)

ABSTRACT Objective The Evidence-based Practice Knowledge Assessment in Nursing (EKAN) is an objective measure of evidence-based practice (EBP) knowledge. The aims of the project were to translate the EKAN instrument into Brazilian Portuguese, test its psychometric properties, and document a baseline assessment of students' EBP knowledge. Method This study used methodological design. The EKAN-Brazilian Portuguese was administered to nursing students from two baccalaureate programs. Data were analyzed using Rasch procedures. Results 123 students participated (87% ranged 19-25 years old; 60% were juniors; 38% perceived having no exposure to EBP). Validity indices showed the mean difficulty index = -2.48 to 2.07, the Infit (WMS) mean was.985 (SD = 2.13), and the Outfit (UMS) mean was.975 (SD = 0.17). Reliability indices showed sufficient item separation index (4.47); moderate person separation index (.47); high item reliability (.95); and low person reliability (.18). The mean EKAN sum score (max = 20) was 7.6 (SD = 2.13). Conclusion This study on the EKAN-Brazilian Portuguese version provided sufficient evidence for validity and reliability; the person reliabilities showed the need for improvement in incorporating EBP concepts and content in nursing programs.

RESUMO Objetivo A Evidence-based Practice Knowledge Assessment in Nursing (EKAN) é uma medida objetiva do conhecimento sobre prática baseada em evidência (PBE). Os objetivos do projeto foram traduzir a EKAN para o português do Brasil, testar suas propriedades psicométricas e documentar avaliação de linha de base do conhecimento de estudantes sobre a PBE. Método A EKAN-Versão Brasileira foi aplicada a estudantes de dois programas de bacharelado em enfermagem e os dados foram submetidos a análise de Rasch. Resultados Participaram 123 estudantes (87%-idades entre 19-25 anos; 60%-primeiro ano; 38% sem exposição prévia a conteúdo de PBE). Índices de validade: dificuldade média = -2,48 a 2,07; Infit (WMS) médio = 0,985 (DP = 2,13); Outfit (UMS) médio = 0,975 (DP = 0,17). Índices de confiabilidade mostraram índice de separação suficiente (4,47); de separação de pessoa moderado (0,47); alta confiabilidade dos itens (0,95); baixa confiabilidade de pessoas (0,18). O escore médio na EKAN (máximo = 20) foi 7,6 (DP = 2,13). Conclusão Esse estudo produziu evidências de validade e confiabilidade da EKAN-Versão Brasileira; a confiabilidade de pessoas mostrou a necessidade de incorporar conceitos e conteúdos sobre a PBE nos programas de enfermagem.

RESUMEN Objetivo La Evidence-based Practice Knowledge Assessment in Nursing (EKAN) es una medida objetiva del conocimiento sobre práctica basada en la evidencia (PBE). Los objetivos del proyecto fueron traducir el EKAN al portugués brasileño, testear sus propiedades psicométricas y documentar una evaluación de línea de base del conocimiento de estudiantes sobre la PBE. Método El EKAN-Versión Brasileña fue aplicado a estudiantes de dos programas de licenciatura en enfermería, los datos fueron sometidos a análisis de Rasch. Resultados Participaron 123 estudiantes (87%-edades entre 19-25 años; 60%-primer año; 38% sin contacto previo con material sobre PBE). Índices de validez: dificultad promedio = -2,48 a 2,07; Infit (WMS) promedio = 0,985 (SD = 2,13); Outfit (UMS) promedio = 0,975 (SD = 0,17). Los índices de confiabilidad mostraron índice de separación suficiente (4,47); de separación de persona moderado (0,47); alta confiabilidad de ítems (0,95); baja confiabilidad de personas (0,18). El puntaje promedio en la EKAN (máximo = 20) fue 7,6 (SD = 2,13). Conclusión El estudio produjo evidencias de validez y confiabilidad de la EKAN-Versión Brasileña; la confiabilidad de personas mostró necesidad de incorporar conceptos y contenidos sobre PBE en los programas de enfermería.

Dynamics of Selected Trace Minerals during Estrus Induction in Anestrus Sahiwal Cattle

The present study evaluated the effect of circulatory trace mineral profiles on fertility response during estrus induction by progesterone based therapy in acyclic Sahiwal cattle. Sahiwal cows and post-pubertal heifers (n=25 each) with true anestrus condition (acyclicity confirmed ultrasonographically) were subjected to CIDR-based protocol (intravaginal CIDR application for 7 days, 500 IU eCG at CIDR removal, followed by estrus observation and AI). In heifers, additionally an injection of 5.0 mg estradiol valerate at CIDR insertion was given. Blood samples on days 0 (before CIDR application), 3, 5, 7 and 9 were collected. Almost similar estrus induction (68% vs. 64%) and subsequent conception rates (41.2% vs. 50%) during the first induced estrus were recorded in cows and heifers, respectively. During the course of treatment, significant (P<0.05) variation in plasma copper and zinc concentrations was recorded both in cows and heifers. Contrarily, manganese concentrations varied significantly (P<0.05) in cows only. However, iron profiles remained uniform during the course of treatment. Significantly (P<0.05) higher pre-treatment plasma concentrations of copper, zinc and manganese was recorded in those cows and heifers in which estrus was induced, compared to those in which estrus induction failed to occur. No significant difference (P>0.05) was recorded for iron concentration vis-à-vis estrus induction response. Hence, it is indicated that circulatory copper, zinc and manganese profiles influence the reproductives energy in acyclic animals and their suboptimal profiles may reduce the efficacy of estrus induction protocols in Sahiwal cattle.

C.O.V.E.R. (Clinician’s Opinions, Views, and Expectations concerning the radiology Report) Study: A University Hospital Experience

Purpose@#The study seeks to examine if radiology reports at the University of Santo Tomas Hospital (USTH) meet referring physicians’ preferences pertaining to the following parameters of a well-composed radiology report: Importance, Clinical correlation, Referrer’s satisfaction, Content, Structure and Style. It also aims to compare outcomes from this region with its European (EURO) counterpart to highlight possible regional differences in preferences@*Methods and Materials@#A 41-item survey was distributed among consultants and fellows at USTH. Respondents graded their level of agreement using a Likert scale. A free text area was for comments, opinions, and/or suggestions on improving the radiology report. Reponses were collated, statistically analyzed, and compared with those of the EURO study. The study was approved by the hospital’s Review Board and voluntary consent was obtained for each participant.@*Results @#A total of 283 clinicians participated in the study with a good response rate. The majority of the statements showed similar results between this Southeast Asian study and the EURO study. The highlights of the study based on the different criteria are as follows: On Importance: The radiology report is a valued tool in the management of patients in everyday practice; On Clinical Correlation: Clinicians would rather radiologists know about the patients’ medical condition except for a few who think otherwise, due to the possibility of bias in the report; On Referrer’s Satisfaction: Clinicians are satisfi ed with the reports they receive although the use of common words is more appreciated; On content: Clinicians read the descriptive part of the report and they would like to receive an impression of the pathology at the end; On Structure and Style: The use of simpler style and vocabulary in making radiology reports should be considered for better understanding and also to include explicit technical details of the examination; Open communication with clinicians, faster release of results and specialty-based interpretation of images were also some of the suggestions in this study. Clinicians from both studies also advocate the incorporation of making a radiology report a part of the radiology training. @*Conclusion@#The radiology reports generated from USTH were able to meet referring physicians’ preferences, providing substantial information that is valued as an essential part of patient management. Outcomes from this study showed the majority of the fi ndings to be similar with its European (EURO) counterpart.

Growth and inactivation of Salmonella at low refrigerated storage temperatures and thermal inactivation on raw chicken meat and laboratory media: mixed effect meta-analysis

Growth and inactivation regression equations were developed to describe the effects of temperature on Salmonella concentration on chicken meat for refrigerated temperatures [

Treatment review of sight threatening circumscribed choroidal haemangioma / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To describe our clinical experience in treating circumscribed choroidal haemangioma(CCH)in a tertiary referral centre over a fifteen year period prior to photodynamic therapy.METHODS:The departmental database and photographic records of a tertiary referral center were used to identify patients who were treated for CCH between 1992 and 2007.Their case records were reviewed.RESULTS:Visual acuity improved(＞2 Snellen lines)in eleven patients(69%)remained stable in one patient (6%)and deteriorated in four patients(25%).Six of the seven treated with brachytherapy and three of the four treated with transpupillary thermotherapy achieved better visual acuity after treatment.86% of patients treated within six months of onset of symptoms and 50% of patients treated after six months of onset of symptoms noted an improvement in visual acuity.Only one patient in our series had a final VA of 6/60 or worse.Mean follow-up was thirty-five months.CONCLUSION:Visual outcome is better when treatment is performed within 6 months of symptoms.The majority of patients achieved an improvement in visual acuity without any adverse effect following treatment.

Treatment of muscle invasive bladder tumor comparison between chemotherapy and cystectomy

Bladder Tumor is the second most common cancer of the genitor-urinary tract. Male to Female ratio: has been demonstrated as 3.5:1. To compare the efficacy of combined chemotherapy/or radical cystectomy with or without urinary diversion. The present study was conducted on 26 consecutive patients of either age and sex having histologically proven muscle invasive transitional cell carcinoma of the bladder .These patients were selected from different hospitals in Lahore including Lahore General Hospital, Mayo Hospital, Shaikh Zaid Hospital, and Services Hospital from 1994-1996. These patients were thoroughly investigated. At the initial diagnosis 18-30% of patients of bladder tumors are muscle invasive and 70% superficial. Although radical cystectomy is the treatment of choice for invasive bladder tumor, bladder-sparing technique are more often being used e.g. TURGB and Intra-vesicle chemo/immunotherapy in superficial bladder cancer, TURGB and Systemic chemotherapy in muscle invasive tumor. The use of combination Chemotherapy in advance disease is routine e.g. CMV and MVAC. In our present study a total of 26 consecutive patients of either age or sex having histologically proven muscle invasive tumor of bladder were included. These patients were collected from different hospitals at Lahore, from 1994 to 1996. Out of these 26 patients, 13 patients were included in group-A, [they were given MVAC chemotherapy] and the remaining 13 patients were included in group B, [in these patients cystectomy and urinary diversion were done]. It is concluded that the result using combined Chemotherapy MVAC are better [20%] as compared to total cystectomy/urinary diversion [12.23%] after one year follow up

Effect metformin on urinary VMA levels in type II diabetic subjects

The purpose of this study was to observe the effect of metformin on 24-hours urinary VMA levels in newly diagnosed untreated type 2 diabetic subjects. The study consisted of four weeks for each participant with weekly follow up visits. Samples were collected at 0800-0900 hours after over night fast. Study was conducted in the Department of Pharmacology and Therapeutics, BMSI, JPMC, Karachi. Total duration of study was six months. Fifteen newly diagnosed untreated type 2 diabetics, with fasting plasma glucose levels >/= 126 mg/dl on two occasions and/or postprandial glucose levels >/= 200 mg/dl were enrolled in the study. Patients with concurrent illness or diabetic complications were excluded. Metformin was started from 500 mg/day and titrated at weekly intervals according to glycaemic control and the subjects tolerance to the drug. A 24-hour urinary VMA was assessed at day - 0 [before metformin therapy] and day - 28 [4 weeks after metformin therapy] by using VMA reagent kit of Biosystems Spain on Spectronic -21 spectrophotometer USA. Metformin caused highly significant [P < 0.001] reduction in mean fasting plasma glucose from 233.33 +/- 15.62 mg /dl on day-0 to 151.53 +/- 6.02 mg/dl on day - 28, and a significant [P < 0.01] decrease in 24 - hour urinary VMA levels from 5.18 + 0.50 mg / 24 hours on day-0 to 3.32 + 0.28 mg / 24 hours on day-28. Our results indicate that metformin causes highly significant reduction in fasting plasma glucose and a significant decrease in 24 - hour urinary VMA levels in newly diagnosed untreated type 2 diabetic subjects

Comparison of transvesical repair of vesico-vaginal fistula and use of free bladder mucosal graft

This study was designed to compare the efficacy and complications of the conventional transvesical repair of vesicovaginal fistula versus new technique using free bladder mucosal graft for repair. It was carried out on 16 patients aged 16-45 years in the Departments of Urology, Services Hospital and Jinnah Hospital, Lahore from 1999 to 2001. Patients were randomly divided into two groups A and B. In group A, 8 patients who underwent conventional transvesical repair of.vesicovaginal fistula whereas in group B, 8 patients who underwent repair using free bladder mucosal graft. Out of 16 patients, the recurrence was observed in 3 patients [37.5%] in group A and i patient in group B, [12.5%]. There was statistically no significant difference P > 0.05. The transvesical free bladder mucosal graft repair provides good result with minimum complications. This method is recommended for routine repair of vesicovaginal fistulae without extensive dissection of the diseased area

Efecto del nivel de complementación sobre la ganancia de peso de corderos Pelibuey estabulados / Effect of supplement level on average daily gains of Pelibuey ram lambs in the feedlot

El presente estudio se llevó a cabo con el fin de estimar el desempeño productivo del corderos Pelibuey, del destete al peso de comercialización, en función del nivel de complemento recibido. El estudio se realizó en un sitio con clima cálido (23.5ºC de temperatura media anual) y húmedo (1991 mm anuales), con lluvias todo el año, clasificado como Af(m) w'(e) que posee suelos ultisoles ácidos (pH de 4.5 a 5.2) de baja fertilidad (deficientes en N y P). La investigación duró 98 días; se utilizaron 84 corderos Pelibuey de 3 meses de edad sin castrar, con peso de 12.5 ñ 3.1 kg que se asignaron al azar dentro de cuatro grupos de 21 borregos. Los animales fueron alimentados con forraje fresco y picado de pasto Taiwán (Pennisetum purpureum) de aproximadamente 90 días de rebrote más concentrado 17.8 por ciento de proteína cruda y 11.5 MJ/kg MS de energía metabolizable, a razón de 0 por ciento, 1 por ciento, 2 por ciento y 3 por ciento del peso del animal. Las ganancias diarias de peso (GDP) por grupo fueron 0.006, 0.048, 0.094 y 0.144 kg/cordero. El consumo del materia seca del concentrado (CMS) fue de 0, 0.143, 0.324, y 0.525 kg/cordero/día y el forraje (CMS) de 0.412, 0.376, 0.344 y 0.321 kg/cordero/día. En el mismo orden, las conversiones alimenticias fueron 68.7, 8.9, 7.0 y 5.9 kg de MS/kg de GDP. Los meses para alcanzar el peso de mercado (30 kg) fueron 97.5, 9.9 5.9 y 4.0, respectivamente. La regresión lineal entre consumo total de materia seca (CMS Y) y GDP (X) mostró que el CMS cuando la GDP=0 fue 0.368 kg/cordero día (ordenada al origen) y que cada 0.1 kg de aumento en GDP requirió de un aumento de 0.319 kg/cordero/día en el CMS (coeficiente de regresión). El consumo de proteína cruda a cero GDP fue de 0.024 kg/cordero/día (ordenada al origen) y cada 0.1 kg de aumento de GDP requirió un aumento en el consumo de proteína cruda de 0.053 kg/cordero/día (coeficiente de regresión). La tasa de retorno directo [(ingreso bruto-costo de alimentación/costo de alimentación)x100] fue de: -77 por ciento, 66 por ciento, 104 por ciento y 139 por ciento para los niveles de complementación de 0 por ciento, 1 por ciento, 2 por ciento y 3 por ciento, respectivamente. Se concluyó que los animales pudieron haber consumido más materia seca y ganado más peso, dada la respuesta scendente a la complementación...

Transurethral resection of prostate versus open prostatectomy

A study on 150 cases of benign prostatic hypertrophy was carried out from January, 1990 to December, 1992 at the Urology Department of Liaquat Medical College, Jamshoro to compare the results of two operative procedures viz. TURP [75 cases] and open prostatectomy [75 cases]. The ages of the patients ranged from 50 to 100 years with maximum incidence [86.67%] between 50 to 70 years. Ninety five [63.33%] cases presented with urinary retention. Secondary haemorrhage seen in 10 [13.33%] cases of TURP and 15 [20%] cases of open prostatectomy and transient incontinence in 12% cases in TURP and 22.67% cases in open prostatectomy were the most common complications encountered. Wound infection [28%] and urinary leakage [6.67%] were only seen in open procedures. The average hospital stay with TURP was 8.3 days as compared to 22.4 days in open prostatectomy

Post-BCG axillary abscess: results of excision vs simple drainage

A prospective study was carried out in 80 patients with axillary abscess following BCG vaccination to compare the results of surgical excision versus incision and drainage, together with six months anti-tuberculous chemotherapy in both groups. Four [10%] out of 40 patients who underwent simple incision and drainage required re-operation for residual lymph glands and/or persistent sinuses. On the other hand all 40 cases who underwent total excision had no postoperative problem

Breast cancer: epidemiological, pathological and clinical presentation

Out of the 100 patients studied breast cancer was seen in 99 females, mostly [63%] in the age growth of 31-50 years, and one male. A lump was palpable in all women with involvement of left breast in 56% cases. Majority of the women [90.90%] were married, parous [84.84%] and had breast fed [80.80%] their children. Awareness regarding breast cancer is increasing as is evident by the earlier presentation i.e. in stage-I [35%] and stage-II [44%]. On histopathology invasive duct cell carcinoma [72%] was the commonest type of breast cancer seen in this study

Gastro-intestinal perforation - frequency, presentation and management

This study includes 165 [105 males, 60 females] cases of Gastro-intestinal perforation who presented as acute surgical emergency at Liaquat Medical College Hospital, Hyderabad from January, 1992 to December, 1993. Their age ranged from 1-70 years and majority [61%] were from areas of Sindh. One hundred and twenty two [74%] patients had pathological and 43 [20%] had traumatic perforations. Of the pathological perforations, 90 [74%] had typhoid perforation, 15 [12%], perforated appendix and 7[6%] perforated peptic ulcer. Wound infection occurred in 36 [55%] patients Mortality rate was 10%

Eficácia e segurança do tramadol versus morfina na dor pós-operatória moderada e severa com especial atençäo à depressäo respiratória / Efficacy and safety of tramadol versus morphine for moderate and severe postoperative pain with special regard to respiratory depression

A eficácia analgésica e a segurança do tramadol e da morfina foram comparadas em um estudo randomizado e duplo-cego realizado em 150 mulheres após cirurgia ginecológica. Se necessário, as pacientes poderiam receber até três doses intravenosas ou de 50 mg de tramadol ou de 5 mg de morfina dentro de um período de 6 horas. A intensidade da dor (escore de resposta verbal) foi registrada antes da administraçäo e 0,5 1, 2, 3, 5 e 6 horas depois da dose inicial; nestes períodos o alívio da dor também foi monitorada continuamente através de pulso-oximetria por ao mínimo 30 minutos depois de cada administraçäo. Em 13,3 por cento do grupo morfina (mas em nenhuma do grupo tramadol) a saturaçäo transcutânea de oxigênio na artéria radial diminuiu para menos de 86 por cento, em 50 por cento destas pacientes a reduçäo já ocorreu depois da primeira dose de 5mg de morfina. Ambas as drogas produziram uma analgesia aceitável e näo foram observados efeitos adversos clinicamente significativos. Pela demonstraçäo da ausência de depressäo respiratória clinicamente relevante com o tramadol nós enfatizamos a sua segurança no alívio da dor pós-operatória

Intestinal perforation experience in 80 cases

Eighty patients ranging from 10-60 years were treated for Intestinal perforation. Seventy one [89%] were males. Mortality rate was 15%, and was influenced by duration of illness, duration of perforation, shock, uraemia and faecal peritonitis. Seventy four patients were treated by simple closure of perforation, four required right hemicolectomy and two were in terminal stage and were intubated under local anaesthesia. 56 patients [70%] had post-operative complications