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A varicocele is a dilation of veins within the pampiniform plexus and affects 15% of males worldwide. It often occurs during puberty and gets worse with age. There are 3 grades of varicoceles. Grade 1 and 2 varicoceles are tiny and challenging to find without the help of a medical expert. Varicoceles of grade 3 are easily palpable and frequently visible. When standing upright, they may feel like a sack of worms around the testicles or may give the impression that one testicle is larger than the other. The testicles and scrotum may experience a mild ache from larger varicoceles. Physical examination is used to make the diagnosis; grade 1 and 2 conditions are typically detected with color doppler ultrasonography.
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In ayurvedic system of traditional medicine, 'medhyarasayanas' — decoction of selected plants are used to improve intellect or cognition abilities. Here, we investigated one such polyherbal formulation (PHF) with ingredients Bacopa monniera, Glycyrrhiza glabra, Valeriana wallechii and Withania somnifera used as a facilitator of learning, retention and recall. We evaluated the safety of this PHF in animal models. We performed acute oral toxicity test using 2000 mg/kg of the formulation as per OECD guideline 423 and observed for toxicity over 14 days. Thereafter, we divided them into four groups of six animals each and administered Normal saline 5 mL/kg, The PHF (Wilmer®) @500, 1000 and 2000 mg/kg in the respective groups over 28 days. We observed no mortality or physical and behavioural abnormalities in both acute and subacute toxicity study. On the 28th day, animals were sacrificed, blood collected for estimation of haematological and biochemical parameters and histopathological examination of organs was performed. There was significant difference (P <0.05) in Mean ± SEM values of haemoglobin, total cholesterol, total protein, ALT, AST, ALP and serum creatinine in the test groups compared to control as analysed by One-way ANOVA followed by Tukey’s multiple comparison test. We observed steatosis and ballooning of hepatocytes, lymphocytic periglomerular infiltrate, eosinophilic hyaline casts and renal tubular coagulation necrosis in histopathology of test groups. Haematologic abnormalities (decrease in haemoglobin concentration), hepatotoxic, nephrotoxic and dyslipidemic effects of the tested PHF were seen in the rats in subacute toxicity study over 28 days, which could be due to the individual plant products, microbial contamination or heavy metals in the formulation in excess of regulatory limits. Hence, it needs further safety evaluation in animals and humans.
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Abstract Over the years, a handful of drugs have been approved to be used in the fight against Alzheimer's Disease but unfortunately none of these drugs have proven to be solid-treatments. Alzheimer's Disease is one of the most prominent diseases observed in the elderly population. In this review article, we discuss how aluminum toxicity can lead to neuro degeneration. Aluminum is abundantly present on the earth's crust and hence becomes easily accessible to man. This makes it an obvious choice in the preparation of numerous substances, packaging, etc. Such wide usage of the metal can pave an easy access to the body, leading to toxicities. Aluminum toxicity has been linked to oxidative stress which has an established relation with neurodegeneration and mitochondrial damage. We also discuss how consumption of antioxidants can be useful in combating oxidative stress.
Subject(s)
Aluminum/agonists , Alzheimer Disease/chemically induced , Antioxidants/analysis , Pharmaceutical Preparations/analysis , Oxidative Stress/drug effects , ToxicityABSTRACT
Background: The sciatic nerve is one of the very vital nerves of the body, which has importance not only in the field of Anatomy but also in various clinical fields such as Orthopaedics, Anaesthesia, Plastic & Reconstructive Surgery, and Neurosurgery. This study was the first attempt to analyze the different dimensions of the anatomically normal sciatic nerves at different levels, involving Malaysian cadavers.Material & Methods:The study was conducted on 78 adult, both cadaveric and disarticulated lower limb specimens belonging to both genders. The morphometric analysis was done in 64 specimens having anatomically normal sciatic nerves. The dimensions were measured by a digital Vernier caliper, a measuring tape, and thread.Results:The average width, thickness and circumference of the nerve at the lower border of piriformis muscle (PM) were 15.86 mm ± 1.47 (right) & 16.56 mm ± 1.08 (left); 4.22 mm ± 0.29 (right) & 4.10 mm ± 0.20 (left) and 27.70 mm ± 2.02 (right) & 27.72 mm ± 2.39 (left), respectively. Similarly, at the level between ischial tuberosity (IT) and greater trochanter (GT), the mean width was 11.59 mm ± 1.43 (right) & 11.50 mm ± 1.53 (left); thickness was 3.48 mm ± 0.18 (right) & 3.35 mm ± 0.17 (left) and circumference was 27.08 mm ± 2.79 (right) & 27.22 mm ± 2.87 (left). At bifurcation, the mean width was 8.66 mm ± 0.65 (right) & 8.90 mm ± 0.81 (left); thickness was 2.41 mm ± 0.12 (right) & 2.31 mm ± 0.15 (left) and circumference was 19.75 mm ± 1.44 (right) & 19.99 mm ± 1.45 (left). The average distance between IT and GT was 50.37 mm ± 4.47 (right) & 47.73 mm ± 4.24 (left); between lateral border of IT and medial border of sciatic nerve was 15.43 mm ± 1.45 (right) & 14.66 mm ± 1.37 (left); and between medial border of GT and lateral border of the nerve was 27.13 mm ± 1.38 (right) & 25.07 mm ± 1.73 (left). The average length of the nerve was 328.20 ± 26.26 (right) & 332.31 ± 21.89 (left); and that of the thigh was 412.19 ± 24.50 (right) & 407.24 ± 25.82 (left).Conclusion: This knowledge will not only aid future researchers but also will assist surgeons, orthopaedicians, anaesthetists, reconstructive surgeons, and neurosurgeons by preventing iatrogenic nerve injuries.
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Aim:To determine the factors associated with an inadequate response to adenosine infusion during cardiac stress magnetic resonance imaging (MRI). Study Design: It is a retrospective cohort study. Introduction: Stress cardiac MRI is a highly accurate and non?invasive method to diagnose coronary artery disease (CAD). Stress MRI is performed by inducing stress with adenosine infusion.There is an increase in systemic andmyocardial blood flow (MBF) with vasodilator agents. Capillaries are maximally dilated in a diseased artery and cannot sustain increased myocardial oxygen demand. It results in delayed delivery of contrast, which leads to an area of perfusion defect in the myocardium. These perfusion defects can be accurately seen by cardiovascular magnetic resonance (CMR) and help in the prognosis of patients. Methods: A retrospective study on patients subjected to cardiac stress MRI was conducted in a Tertiary Care Cardiac Center from January 2019 to January 2022. In total, 99 patients underwent adenosine stress perfusion cardiac MRI. All patients received an adenosine infusion of 140 mcg/kg/min for 2 min. Subsequently, the dosage was increased by 20 mcg/kg/min every 2 min to a maximum of 210 mcg/kg/min until an adequate stress response was achieved. Adequate stress was defined as two or more of the following criteria: 1) Increase in heart rate >/= 10 beats perminute. 2) Decrease in systolic blood pressure SBP by >/= 10mmHg Symptoms like chest discomfort, breathlessness, and headache. Patients who satisfied two or more of the above criteria were labeled as responders and the patients who did not satisfy the above criteria with the maximum dose of 210 mcg/kg/min of adenosine infusion were labeled as non?responders. Multivariable logistic regression analysis with forward and backward stepwise selection was used to identify predictors in non?responders. Basic demographic variables with P value </= 0.2 were examined for inclusion in the model. A P value </= 0.05 was considered significant. Results: Nine patients (9.1%) showed inadequate stress response to adenosine infusion even with a maximum dose of 210 mcg/kg/min. Multivariate logistic regression analysis showed that left ventricular end?diastolic volume (LVEDV) was a predictor of inadequate response to adenosine infusion. Conclusion: Inadequate stress response to adenosine occurred in 9.1% of subjects with an infusion of 140–210 ug/kg/min. LVEDV is an independent and strong predictor in non?responders.
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Objectives: In a retrospective study, we aimed to explore the prevalence of risk factors and trends of obstructive coronary artery disease (CAD) in Indian females <45 years of age compared to males of the same age group who underwent percutaneous coronary intervention (PCI). Materials and Methods: This was a retrospective, observational, multi-centre study of young Indian females and males (<45 years) who underwent PCI as per the guidelines at three high-volume centres in India. Results: In a group of 3656 patients under the age of 45 who had PCI, 3.1% of those with obstructive CAD were young women (n ¼ 113), while 6.9% were young men (n ¼ 254). Traditional risk factors such as hypertension (p ¼ 0.73), diabetes (p ¼ 0.61), and family history of premature CAD (p ¼ 0.63) were equally common in both genders, whereas dyslipidaemia (p < 0.001), overweight (p < 0.006), smoking (p ¼ 0.004) and, alcoholism (p < 0.001) were more common in young males. Acute coronary syndrome was the most common clinical presentation. Single-vessel disease was common, with the involvement of the left anterior descending artery as the most common angiographic feature. The prevalence of cardiogenic shock was 4.4% in females and 4.1% in males, while the in-hospital mortality rate was 1.77% in young females and 2% in young males. Conclusions: Obstructive CAD in young men and women accounted for 10% of all CAD cases requiring PCI. Although men account for the majority of patients, CAD in women under the age of 45 is not uncommon. Traditional risk factors are becoming more prevalent in younger women
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Angiographically, a “dual LAD” is described as two distinct arteries supplying the vascular territory of the LAD in parts, identified as the short LAD/LAD1 and the long LAD/LAD2. Using an easy-to-understand three-step approach, Jariwala et al unveiled a novel classification strategy for dual LAD systems in an attempt to decrease ambiguity in diagnosis and management of the anomaly. As part of our research, we looked at a wide range of published cases and case series in the literature, and also those reported from our hospital. In our novel classification system, we divide dual LADs into three main groups based on their origin and vascular territory, each of which is further divided into subgroups based on the course of LAD1/LAD2 and the variable feature that is a distinguishing attribute of the type of anomaly to be specified. A review of 144 publications in the world literature revealed 340 patients eligible for the study. The median age was 58.8 years (SD - 11.42; range - 29e89) with male predominance (3.3:1). Cases in Group I comprised 60.6% of the total cases, followed by Group II (36.2%), and Group III (3.2%). Subgroup I-A was the most common in terms of dual LAD, followed by subgroup II-A. Acute coronary syndrome (45.5%) and chronic coronary syndrome (55.8%) were the most common clinical presentations in patients with significant coronary artery disease (30.8%).
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Introduction: Fractures pose a tremendous burden on the health care systems due to the prolonged duration of admission. Addressing various determinants that prolong hospital stay will help minimize the cost of treatment. Objective: To study the determinants associated with the duration of hospital stay among patients admitted with fractures. Methods: This was a retrospective observational study conducted at a private tertiary care hospital in Mangalore. A semi-structured proforma was used for collecting data from the medical records. Results: The mean age of the 124 patients were 48.3±21.4 years. The majority were males [69(55.6 por ciento)] and were from urban areas [86(69.3 por ciento)]. Co-morbidities were present among 69(55.6 por ciento) patients. Out of the total patients, 8(6.4 por ciento) were alcoholics, and 10(8.1 por ciento) were tobacco smokers. The majority [50(40.3 por ciento)] had fracture of the femur. Five (4 por ciento) patients developed complications during the post-operative period. Seventy-eight (62.9 por ciento) patients had medical insurance facilities. The mean duration of hospital stay was 9.6±3.2 days among the patients. The mean duration of hospital stay among patients (n=115) before surgery was 2.4±1.6 days. Increased pre-operative stay, increasing age, rural residential status, open type of fracture, and being given general anaesthesia for the operative procedure were significant predictors determining the period of stay among patients in the hospitals. Alcoholic status independently influenced the period of stay in the pre-operative period. Conclusion: Both patient and treatment characteristics were important determinants associated with the duration of hospital stay. Targeting these predictors will help to manage in-patients better and shorten their duration of hospital stay(AU)
Introducción: Las fracturas suponen una enorme carga para los sistemas sanitarios debido a la duración prolongada del ingreso. Abordar varios determinantes que prolongan la estadía en el hospital ayudará a minimizar el costo del tratamiento. Objetivo: Estudiar los determinantes asociados a la duración de la estancia hospitalaria en pacientes ingresados con fracturas. Métodos: Este es un estudio observacional retrospectivo realizado en un hospital privado de atención terciaria en Mangalore. Se utilizó una proforma semiestructurada para la recolección de datos de las historias clínicas. Resultados: La edad media de los 124 pacientes fue de 48,3±21,4 años. La mayoría eran hombres [69 (55,6 percent)] y de áreas urbanas [86 (69,3 percent)]. Las comorbilidades estuvieron presentes en 69 (55,6 percent) pacientes. Del total de pacientes, 8 (6,4 percent) eran alcohólicos y 10 (8,1 percent) fumadores. La mayoría [50 (40,3 percent)] tenía fractura de fémur. Cinco (4 percent) pacientes desarrollaron complicaciones durante el postoperatorio. Setenta y ocho (62,9 percent) pacientes tenían seguro médico. La duración media de la estancia hospitalaria fue de 9,6±3,2 días entre los pacientes. La duración media de la estancia hospitalaria de los pacientes (n=115) antes de la cirugía fue de 2,4±1,6 días. El aumento de la estancia preoperatoria, el aumento de la edad, el estado residencial rural, el tipo de fractura abierta y la anestesia general para el procedimiento quirúrgico fueron predictores significativos que determinaron el período de estancia entre los pacientes en los hospitales. El estado alcohólico influyó de forma independiente en el tiempo de estancia en el preoperatorio. Conclusión: Tanto las características del paciente como las del tratamiento fueron determinantes importantes asociadas con la duración de la estancia hospitalaria. Abordar estos predictores ayudará a manejar mejor a los pacientes hospitalizados y acortar la duración de su estadía en el hospital(AU)
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Humans , Male , Female , Adult , Middle Aged , Patient Admission , Fractures, Bone/therapy , Retrospective Studies , Observational Studies as TopicABSTRACT
Background: Amoebic liver abscesses (ALA) in the presence of Alcoholic liver disease (ALD) constitutes a high-risk group of patients who are prone to complications and may need more aggressive treatment. This study was aimed at evaluating disease course and outcomes in patients of ALA with ALD, in comparison to those without ALD. Material & Methods: This prospective observational study was conducted on 60 consecutive patients of ALA without ALD (Group-I) and 60 consecutive patients of ALA with ALD (Group II). Result: The patients ALA with ALD were older (47.2 ±13.3 years) than those without ALD (34.1±14 years). Mean size of the abscess cavity was significantly larger in patients with ALD (391.2± 208.7 cc in Group I and 594.3 ± 297.9 cc in Group II). In Group I, conservative management was most common (43.3%); while in Group II pigtail catheter insertion was the most frequently used modality of treatment (45%). Complications like empyema (6.6%), acute on chronic liver failure (8.3%) and impending liver failure (23.3%) manifesting as ascites and oedema were seen only in patients in Group II and they also had longer hospital stay. (4.87 days in Group I vs 8.37 in Group II). Conclusion: Patients of ALA with ALD have a more aggressive course of disease and should be managed with a lower threshold for abscess drainage.
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Background: The massive toll due to COVID-19 has resulted in stretching of resources of healthcare systems and has led to unique demands on healthcare workers (HCWs) that are not seen in usual practice, which predispose them to mental health problems. The aim of the study was to assess mental health status in healthcare workers posted in COVID hospital as Mental health issues may impact decision making among HCWs, leading to medical errors and may also impact wellbeing in the long term. Methodology: This was a cross-sectional study. 799 HCWs posted in the COVID-19 wing of a tertiary care hospital were studied. Socio-demographic details were recorded and a Gujarati version of GHQ-28 was applied. A total score of ? 4 on GHQ-28 was considered indicative of ‘caseness’ or ‘psychiatric morbidity’. Association of outcomes like total GHQ-28 score, and responses on individual items of GHQ indicative of fatigue, sleep disturbances, stress, irritability, anxiety and others with variables like age, gender, profession, years of experience, marital status and family type was assessed. Results: 40 individuals (5%) reported at least one of the symptoms. The most commonly reported symptom was sleep disturbance, reported by 38 participants (4.75%), followed by stress in 34 participants (4.25%), fatigue in 29 participants (3.62%) and anxiety in 24 (3.00%). Decision-making problems, hopelessness, death wishes/suicidal ideation were rare. Conclusion: Age > 45 years was a significant predictor for GHQ-28 total score being ?4 and stress, experience > 5 years was statistically significantly associated with sleep disturbance, and being female was a significant predictor for fatigue.
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Purpose@#To evaluate the safety and efficacy of long vascular sheaths for transfemoral neuroendovascular procedures in children. @*Materials and Methods@#A retrospective evaluation of transfemoral neuroendovascular procedures in children 15 kg subcohorts. There were no aorto-femoro-iliac or limb-ischemic complications. @*Conclusion@#Long vascular sheaths without short femoral sheaths can be safely used for pediatric neuroendovascular procedures as they effectively increase inner diameter access without increasing the outer sheath diameter. This property increases the range of devices used and intracranial techniques that can be safely performed without arterial compromise, thus increasing the repertoire of the neurointerventionist.
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Purpose@#To evaluate the safety and efficacy of long vascular sheaths for transfemoral neuroendovascular procedures in children. @*Materials and Methods@#A retrospective evaluation of transfemoral neuroendovascular procedures in children 15 kg subcohorts. There were no aorto-femoro-iliac or limb-ischemic complications. @*Conclusion@#Long vascular sheaths without short femoral sheaths can be safely used for pediatric neuroendovascular procedures as they effectively increase inner diameter access without increasing the outer sheath diameter. This property increases the range of devices used and intracranial techniques that can be safely performed without arterial compromise, thus increasing the repertoire of the neurointerventionist.
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Globally, cardiovascular diseases and chronic obstructive pulmonary disease (COPD) are the leading causes of the noncommunicable disease burden. Overlapping symptoms such as breathing difficulty and fatigue, with a lack of awareness about COPD among physicians, are key reasons for under-diagnosis and resulting sub-optimal care relative to COPD. Much has been published in the past on the pathogenesis and implications of cardiovascular comorbidities in COPD. However, a comprehensive review of the prevalence and impact of COPD management in commonly encountered cardiac diseases is lacking. The purpose of this study was to summarize the current knowledge regarding the prevalence of COPD in heart failure, ischemic heart disease, and atrial fibrillation. We also discuss the real-life clinical presentation and practical implications of managing COPD in cardiac diseases. We searched PubMed, Scopus, EMBASE, and Google Scholar for studies published 1981–May 2020 reporting the prevalence of COPD in the three specified cardiac diseases. COPD has high prevalence in heart failure, atrial fibrillation, and ischemic heart disease. Despite this, COPD remains under-diagnosed and under-managed in the majority of patients with cardiac diseases. The clinical implications of the diagnosis of COPD in cardiac disease includes the recognition of hyperinflation (a treatable trait), implementation of acute exacerbations of COPD (AECOPD) prevention strategies, and reducing the risk of overuse of diuretics. The pharmacological agents for the management of COPD have shown a beneficial effect on cardiac functions and mortality. The appropriate management of COPD improves the cardiovascular outcomes by reducing hyperinflation and preventing AECOPD, thus reducing the risk of mortality, improving exercise tolerance, and quality of life.
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In the world of pharmaceuticals, there is a vital role for robotics to play in thecomplicated processes of research and development, production, and packaging. Justificationfor robots ranges from improved worker safety to improved quality. A number of robotmanufacturers have products specifically designed for this industry. Industrial robotics forpharmaceutical applications has a bright future. With a rapidly aging population that urgentlyrequires sophisticated medical devices and newer drugs, robotics systems are increasinglyadopted for improved productivity and efficiency to meet this growing demand. Robots inlaboratory, life science and pharmaceutical applications perform tasks at rates beyond humancapability. These robots function in potentially hazardous settings in proximity to biologicaldangers, the threat of radioactive contamination and toxic chemotherapy compounds.Robotics is called upon to assemble and package a variety of medical devices and implants aswell as preparing prescriptions for mail-order pharmacies or hospitals. The Laboratory RoboticsInterest Group (LRIG) is an international non-profit organization dedicated to the study anddiscussion of laboratory automation. LRIG activates the uses of laboratory automation in highthroughput screening, drug discovery, combinatorial chemistry, chemical synthesis, compoundpurification, compound distribution, data management, pharmaceutical dosage form samplepreparation, dissolution testing, bio analytical technology, chemical analysis, solid phaseextraction, validation and product formulation.
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Biologically prepared silver nanoparticles are in trend tobe used as antibacterial agents throughout the globe. Silvernanoparticles prepared from different biological sources havebeen tested against Staphylococcus aureus, Escherichia coli,and other clinical bacteria in West-Bengal also. The size, shapeand activity of the biogenic silver nanoparticles will varydepending upon the biological sources and its concentrationused for nanoparticle preparation. UV-Vis spectrophometry,Dynamic light scattering, FESEM, HRTEM are the techniqueswhich can be used for characterizing silver nanoparticles ofdifferent size and shape. From the history of last decade ofresearch upon silver nanoparticles’ green synthesis and itsantibacterial, antifungal, antilarval as well as anticancer agents,researchers used plant parts, fungus and bacteria as biologicalsources for the reduction of silver ions to silver nanoparticles.Which showed promising activity against different bacterialstrains, either procured from ATCC (American type culturecommittee) or from any clinical sources. When it comes toanalyse the activity of the prepared silver nanoparticles againstmultidrug-resistant (MDR) clinical bacterial strains, there arelesser evidences from West-Bengal. This review will work asa reservoir for biologically prepared silver nanoparticles inWest-Bengal in the last decade and will also help researchersto characterize biogenic silver nanoparticles
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Abstract Introduction: Cartilage is the grafting material of choice for certain disorders of the middle ear. The indications for its routine use remain controversial due to the possible detrimental effect on post-operative hearing. Objective: The present study was carried out to report a personal experience with "tragal cartilage shield" tympanoplasty to compare the results, in terms of graft uptake and hearing improvement, of endoscopic cartilage shield technique using either partial thickness or full thickness tragal cartilage for type 1 tympanoplasty and to highlight the tips for single-handed endoscopic ear surgery. Methods: Fifty patients with safe chronic suppurative otitis media, assisted at out-patient department from February 2014 to September 2015 were selected. They were randomly allocated into two groups, 25 patients were included in group A where a full thickness tragal cartilage was used and 25 patients included in group B where a partial thickness tragal cartilage was used. Audiometry was performed 2 months after the surgery in all cases and the patients were followed for one year. Results: Out of the total of 50 patients 39 (78%) had a successful graft take up, amongst these 22 belonged to group A and 17 belonged to the group B. The hearing improvement was similar in both groups. Conclusion: This study reveals that endoscopic tragal cartilage shield tympanoplasty is a reliable technique; with a high degree of graft take and good hearing results, irrespective of the thickness. Furthermore, the tragal cartilage is easily accessible, adaptable, resistant to resorption and single-handed endoscopic ear surgery is minimally invasive, sutureless and provides a panoramic view of the middle ear.
Resumo Introdução: A cartilagem é o material de enxerto de escolha no tratamento cirúrgico de certas condições clínicas da orelha média. Devido ao possível efeito prejudicial na audição pós-operatória, as indicações para seu uso rotineiro ainda são controversas. Objetivo: Relatar a experiência dos autores com a timpanoplastia tipo 1 endoscópica usando cartilagem tragal e comparar os resultados entre a cartilagem tragal com espessura parcial e espessura total, em termos de integração do enxerto e melhoria da audição. O estudo também buscou apresentar sugestões para cirurgia endoscópica de orelha média com uma única mão (single-handed endoscopic ear surgery). Método: Foram selecionados 50 pacientes com otite média crônica supurativa, atendidos neste ambulatório entre fevereiro de 2014 e setembro de 2015, alocados aleatoriamente em dois grupos: 25 pacientes foram incluídos no grupo A, no qual uma cartilagem tragal de espessura total foi usada e outros 25 pacientes foram incluídos no grupo B, no qual foi usada uma cartilagem tragal de espessura parcial. Em todos os casos, uma audiometria foi feita dois meses após a cirurgia; os pacientes foram acompanhados por um ano. Resultados: Dos 50 pacientes, o enxerto foi bem-sucedido em 39 (78%), entre os quais 22 pertenciam ao grupo A e 17 pertenciam ao grupo B. A melhoria da audição em ambos os grupos foi muito semelhante. Conclusão: O estudo indicou que a timpanoplastia endoscópica com cartilagem tragal é uma técnica confiável, com alto grau de integração do enxerto e bons resultados de audição, independentemente da espessura usada. Além disso, a cartilagem tragal é facilmente acessível, adaptável e resistente à reabsorção; a cirurgia endoscópica é minimamente invasiva, sem sutura e proporciona uma visão panorâmica da orelha média.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Young Adult , Otitis Media, Suppurative/complications , Tympanoplasty/methods , Tympanic Membrane Perforation/etiology , Ear Cartilage/transplantation , Otitis Media, Suppurative/surgery , Retrospective Studies , Follow-Up Studies , Treatment Outcome , Tympanic Membrane Perforation/surgeryABSTRACT
Mucormycosis is a group of clinical syndromes resulting from infection by one of a group of related filamentous fungi. It is an opportunistic fungal infection that rarely occurs in immunocompetent individual. Isolated involvement of any organ is rare and only a few cases of renal mucormycosis have been reported. We present a case report of atypical presentation of a case of renal mucormycosis in a healthy adult with no predisposing factors. A 48 year non diabetic immunocompetent patient underwent right nephrectomy for painful non-functioning kidney. Biopsy showed chronic pyelonephritis with broad non-septate hyphae suggestive of mucormycosis. Post op followup of patient is normal. Mucormycosis of kidney causes extensive infarction and necrosis due to direct angioinvasion and vascular thrombosis leading to fulminant acute renal failure. The disease mimics pyogenic infection leading to delay in diagnosis and hence resulting in high mortality. High index of suspicion is needed for early diagnosis. Urine and blood cultures are usually sterile. Characteristic CT findings include diffuse enlargement of the kidney with absence of contrast excretion and multiple low-density areas in the renal parenchyma representing fungal abscess. Whenever suspected, FNAC or biopsy is strongly advocated as no imaging can confirm the diagnosis. Nephrectomy or debridement of necrotic tissue along with IV Amphotericin B consist the principal treatment. Renal mucormycosis presenting an indolent course and found incidentally after nephrectomy is extremely rare. In an incidentally found mucormycosis, the role of further investigations to find the source and the role of antifungals have to be further studied.
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Ingestion of corrosive substances and chronic sequelae associated with it is the major public health problem in the developing countries. The most severe forms of injury can lead to mortality; however, the major concern with this type of injury in life-long morbidity. Colonic conduit for bypassing diseased oesophagus with distal anastomosis with stomach is well documented and practiced procedure. Authors have encountered a case of 21-year-old lady with corrosive injuries to oesophagus and stomach, later developed non dilatable oesophageal stricture with completely cicatrised and adherent stomach. Due to unavailability of stomach, authors have used colon as a conduit and colo-jejunal anastomosis bypassing the oesophagus, stomach and duodenum. Colo-jejunal anastomosis for chronic corrosive oesophageal stricture is not commonly practiced procedure which makes this case a rare one.
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Background: Almost 80% population of diabetic foot are from low to middle income countries like India, a country with second largest number of diabetic populations. Prevalence of diabetes mellitus in India is 9.3%. Lower extremity diseases, including peripheral neuropathy, peripheral arterial disease, and foot ulceration, is twice common in diabetic subjects. the most feared consequence of diabetic foot ulcer is limb amputation, which is seen 10 to 30 times more often in person with diabetes. The objective of this study concentrates on surgical management of diabetic foot ulcer.Methods: This is an observational prospective study of 100 cases for evaluation of diabetic foot ulcer and its surgical management at P.D.U. Hospital, Rajkot from January 2017 to November 2018.Results: The average age of presentation is 55.70 year. The male to female ratio was 1.27:1. Most of the patients are from lower middle class and upper lower class according to modified kuppuswamy socioeconomic classification. Most of the patients have duration of diabetes more than 5 years. Most common microorganism grown from culture was Staphylococcus aureus. This study has higher rate of amputations of 74% due to late presentation and neglected disease due to peripheral neuropathy causes decreased pain sensation. There was no mortality in this study.Conclusions: Management of diabetic foot ulcer is by multimodal approach with conservative and surgical approaches. Preventive measures, early diagnosis and timely surgical intervention prevents limb amputations in diabetic foot ulcer.