Endoscopic versus surgical management for colonic volvulus hospitalizations in the United States

Background/Aims@#Colonic volvulus (CV), a common cause of bowel obstruction, often requires intervention. We aimed to identify hospitalization trends and CV outcomes in the United States. @*Methods@#We used the National Inpatient Sample to identify all adult CV hospitalizations in the United States from 2007 to 2017. Patient demographics, comorbidities, and inpatient outcomes were highlighted. Outcomes of endoscopic and surgical management were compared. @*Results@#From 2007 to 2017, there were 220,666 CV hospitalizations. CV-related hospitalizations increased from 17,888 in 2007 to 21,715 in 2017 (p=0.001). However, inpatient mortality decreased from 7.6% in 2007 to 6.2% in 2017 (p<0.001). Of all CV-related hospitalizations, 13,745 underwent endoscopic intervention, and 77,157 underwent surgery. Although the endoscopic cohort had patients with a higher Charlson comorbidity index, we noted lower inpatient mortality (6.1% vs. 7.0%, p<0.001), mean length of stay (8.3 vs. 11.8 days, p<0.001), and mean total healthcare charge ($68,126 vs. $106,703, p<0.001) compared to the surgical cohort. Male sex, increased Charlson comorbidity index scores, acute kidney injury, and malnutrition were associated with higher odds of inpatient mortality in patients with CV who underwent endoscopic management. @*Conclusions@#Endoscopic intervention has lower inpatient mortality and is an excellent alternative to surgery for appropriately selected CV hospitalizations.

Evaluation of antifungal susceptibility pattern of dermatophytes isolated in a tertiary care hospital

Background: Superficial fungal infections are extremely common in the tropical and subtropical regions all over the world. Although numerous antifungal drugs are available for the treatment, the pattern of susceptibility to the drugs being used for dermatophytes varies with time and place. Aims and Objectives: The objective of the study was to isolate, identify, and determine antifungal susceptibility pattern in dermatophytes isolated from patients attending dermatology OPD in a tertiary care hospital. Materials and Methods: This study was conducted on 150 dermatophytes isolated from clinically diagnosed patients with dermatomycosis of skin and nail attending the Department of Dermatology Outpatient Clinic of JJM Medical College over a period of 1 year. These cases were referred to the Department of Microbiology for fungal isolation, culture and sensitivity testing. Results: The most frequently affected age group was 21–30 years. The most common clinical manifestation was tinea corporis (52.56%) followed by tinea cruris (26%). The most common dermatophytes implicated were Trichophyton species in 88%. Irrespective of the species, about 96% of our isolates exhibited high minimum inhibitory concentration (MIC) (>1 ?g/ml) to fluconazole. The MIC of luliconazole was < 0.004 ?g/ml to all the dermatophytes isolates tested, compared to other antifungal agents that were ?0.25 ?g/ml. The MIC range was narrowest for luliconazole 0.002–0.128 ?g/ml and the widest for fluconazole, itraconazole, and ketoconazole (0.125–64, 0.0321–16, and 0.0321–16, respectively). Conclusion: Our study showed that luliconazole was the most active drug against all dermatophytes isolates, followed by itraconazole, ketoconazole, and fluconazole. The higher and wider range in MIC values for itraconazole, ketoconazole, and fluconazole found for some of our isolates raise the possibility of increasing resistance to these drugs.

Placement of Oral Formulations of Brivaracetam in Various Patient Profiles: An Indian Perspective

Brivaracetam (BRV), an analog of levetiracetam (LEV), lowers seizure frequency through a unique mechanism. Although BRV is approved for focal epilepsy in patients aged >1 month (by the US Food and Drug Administration) or >16 years (in India), clinical studies have suggested its potential role in other indications such as generalized seizures, secondarily generalized tonic-clonic seizures, and drug-resistant focal epilepsy, and in certain special populations. Here, we discuss the potential role of BRV in different patient populations and present expert opinions for positioning the pre-existing and newly available oral formulations of BRV to aid both clinicians and diverse patient groupswith a simple and easy dosing and titration-based treatment, including safe and effective switching from LEV to BRV.

Radiological Approach to Diagnosis of Peribiliary Lesions

Peribiliary region is the anatomical space adjoining the intra and extrahepatic biliary system and comprises of portal vein, hepatic artery, nerves and lymphatics. This region is prone to several pathologies ranging from congenital, infective, inflammatory, traumatic and neoplastic. Due to the wide spectrum of abnormalities, it is often difficult to reach a final diagnosis. This review focusses to draw a roadmap to help reach a diagnosis of abnormalities encountered in this region by highlighting the characteristic imaging features associated with these abnormalities.

Cognitive Deficits And Alcohol Dependence Syndrome – A Paradigm Relationship

@#Objectives: Background- Chronic alcohol use causes not only physical consequences but causes cognitive deficits also. 50 and 80% of the Alcohol dependent syndrome patients present with cognitive deficits. These cognitive deficits will significantly contribute to poor functional outcomes which lead to reduced health related quality of life. Objectives- To assess Cognitive deficits in Alcohol Dependent syndrome (ADS). To find the relationship between early onset of alcohol use, duration of Alcohol use and large quantity of alcohol use with Cognitive deficit pattern. MethodA cross sectional study was done on 38 patients with ADS, aged 18- 45 years, education ≥7th std, with no major psychiatric or medical co- morbidities. AUDIT scale was administered to look for dependence pattern, CIWA scale was applied to look for withdrawal symptoms. MoCA scale was applied to screen for cognitive impairment in patient with MMSE score (25 and above). In subjects with cognitive impairment on MoCA scale (25 and below), neuropsychological assessment was done using neuropsychological battery of test from NIMHANS Neuropsych battery standardised on Indian Population. Results- There was impairment in the Cognitive domains as follows, speed of processing (BACS - 100%), attention (DF- 97%) working memory (DF-97%, DB-100%, LNS - 84%), visual memory (100%), visuospatial memory (78%), executive functions (CT2 -92%), reasoning and problem solving (maze- 81%) in majority and a significant relation between early onset of alcohol use, duration of Alcohol use. Conclusions- There is a significant impairment in the areas of speed of processing, attention, executive functions, reasoning and problem solving domains. Significant association between Age of onset of ADS (Early onset) with Executive functions. Attention domain was found to be associated with longer duration of alcohol intake, whereas working memory deficits was associated with large quantity of alcohol intake.

Antimicrobial Susceptibility Pattern of Klebsiella Species from Various Clinical Samples at a Tertiary Care Hospital

The aim of the study was to investigate the antimicrobial susceptibility pattern of Klebsiellaspecies from different clinical samples at Sree Balaji Medical College and Hospital, India. Overall 189 samples out of 980 non repetitive clinical samples obtained from wound/pus, urine, sputum swab and blood by disc diffusion method and identified as Klebsiellaand analysed. Out of total 189 Klebsiellaisolates, 76 out of 155 K. pneumoniae(49%)were resistant and none out of 34 Klebsiella oxytoca(0%) showed resistance to cefotaxime and ceftazidime by disc diffusion method. Antimicrobial susceptibility testing of Klebsiellaexhibited 100% resistance to Ampicillin. The present study highlights the need for the continued monitoring of antimicrobial susceptibility patterns of important bacterial pathogens, so that rational antibiotic policies can be formulated

Left ventricular dissecting hematoma caused by tissue stabilizer

Abstract Coronary artery bypass grafting is a commonly performed procedure for coronary revascularization. We describe the successful management of left ventricular dissecting hematoma, caused by the tissue stabilizer, while performing off-pump coronary artery bypass graft procedure.

Clinical profile of carcinoma breast patients in working women population in a metro city

Background: In India, breast cancer is the second most common malignancy among women next to carcinoma of cervix. Since it present as a painless lump patient often neglect and present to hospital late. With increasing prominence and greater visibility in country specific health profiles around the world, breast cancer and its prevention detection and treatment will continue to emerge as a major priority and challenge for health system. As carcinoma of breast is a quite common clinical problem encountered in clinical practice, this study was an attempt to study clinical presentation modes of management of the disease.Methods: 50 patients who were admitted with a diagnosis of carcinoma breast were studied though history taking, clinical examination, relevant investigations depending on the stage of the disease. After completion, the results were analysed using Microsoft excel software and are compared with other studies.Results: Majority of patients belonging to age group 41-50 years (42%) with lump as major complaint at the time of presentation (78%). Disease in most patients was on upper outer quadrant (78%). Majority of patients belong to stage II (84%) of the disease clinically.Conclusions: The simple and effective methods of detecting the disease early like self-breast examination, clinical breast examination, ultrasonography, mammography, fine needle aspiration cytology should be made aware among the people for early detection and effective treatment of the disease.

Clear cell sarcoma like tumor of gastrointestinal tract: Experience of three cases and review of literature

Clear cell sarcoma-like tumor of the gastrointestinal tract (CCSGT) is a rare, aggressive tumor with many histological mimickers. Herein, we have documented our experience of three cases of CCSGT and reviewed the literature. The index cases were identified in male patients in their twenties, one in jejunum and two in the distal colon. Histomorphological examination revealed the characteristic heterogeneous histomorphology with patchy immunohistochemical positivity with S100 protein and negative melanocytic markers. The fluorescence in-situ hybridization test showed translocation of the EWSR1 (22q12) gene in >80% tumor cells. While one of our patients died after 2 years with lung metastasis, the other two patients are still alive on 1.5 years and 3 months follow up, respectively. CCSGT is a rare malignant tumor of the gastrointestinal tract. Although characteristic morphology, use of a judicial panel of immunohistochemical stains, and translocation study for EWSR1 gene can establish the diagnosis, experience in adjuvant therapy is still limited.

Primary mediastinal hydatid cyst causing diaphragmatic palsy

Abstract Hydatid cystic disease is a significant clinical problem in endemic countries. Hydatid cysts are most commonly located in the liver and lungs. Primary mediastinal hydatid cyst is a rare clinical entity. The diagnosis must be considered in a patient with a mediastinal mass, particularly in endemic regions. Mediastinal hydatid cysts causing paralysis of phrenic and recurrent laryngeal nerves have been rarely reported. We describe a rare case of primary mediastinal hydatid cyst associated with diaphragmatic palsy caused by compression of the left phrenic nerve, which was successfully treated with partial cystectomy and capitonnage with hemidiaphragmatic plication.

Papillary Variant of Nasopharyngeal Carcinoma: An Unusual Variant Previously Unreported in Malaysia

@#Nasopharyngeal carcinoma is a commonly encountered malignancy in endemic regions of the world namely South East Asia, China and Hong Kong. In Malaysia, the ethnic Chinese population is particularly at risk due to genetic susceptibilities and environmental exposure to carcinogenic agents. We herein report a case of nasopharyngeal carcinoma in a middle-aged man of Malay ethnicity who presented with nasal blockage and neck nodes. The biopsy of the nasopharyngeal mass came back as papillary variant of nasopharyngeal carcinoma. The commonly reported histopathological types are the keratinizing and non-keratinizing types, and rarely the basaloid type. In this case report, we aim to highlight one of the rare variants of the non-keratinizing nasopharyngeal carcinoma. When diagnosing the non-keratinizing type, appreciation of the different morphological variants is crucial not only to help aid in procuring an acurrate histopathologic diagnosis, but also to help in subsequent treatment plan.

The rare case of a cystic pancreatic neuroendocrine tumor

The pancreatic neuroendocrine tumors (PanNETs) most commonly present as solid neoplasms; however, very rarely, they may present primarily as cystic neoplasms. Most of the cystic PanNETs are non-secreting tumors, and the radiological features are not well defined. Hence pre-operative diagnosis is usually challenging and the tumors are misdiagnosed as mucinous cystic neoplasms, intraductal papillary mucinous neoplasms, serous cystic neoplasms, solid pseudopapillary neoplasms, and non-neoplastic cysts. However, the management depends on the accurate diagnosis of these cystic lesions, which poses a dilemma. Herein, we report the case of a cystic PanNET in the tail of the pancreas, which was clinically and radiologically misdiagnosed as a mucinous cystic neoplasm. This case is reported to highlight this issue to the medical community regarding the diagnostic difficulty in such rare non-functioning pancreatic neuroendocrine tumors.

Ameloblastic fibro-odontoma in a 14 year old girl: A case report

Ameloblastic fibro-odontoma (AFO) is a benign, epithelial odontogenic tumor with odontogenic mesenchyme having the histologic characteristics of both ameloblastic fibroma and complex odontoma. This report describes the case of a 14-year-old girl with AFO on the right posterior mandibular region that mimics complex odontoma on incisional biopsy due to the presence of atypical dentin- and cementum-like areas. On histological examination, sections of excisional biopsy showed odontogenic epithelial islands with embryonic connective tissue and decalcified sections showed atypical dentin with dentinal tubules and islands of cementum. These features led to the diagnosis of AFO.

Caregiver Burden and self-efficacy: A Hospital- based Comparison between General and Special Ward Patients

India has one of the largest health-care systems in the world, and caregivers play an important role in assisting the patients in seeking services, supporting the patient during treatment and also in recovery, as there is a culturally determined emphasis on kinship

Outcome of complex tibial plateau fractures with Ilizarov external fixation with or without minimal internal fixation / 中华创伤杂志(英文版)

PURPOSE@#To evaluate the clinico-radiological outcome of complex tibial plateau fractures treated with Ilizarov external fixation with or without minimal internal fixation.@*METHODS@#This retrospective review was conducted on all the cases of Schatzker types V and VI tibial plateau fractures treated by Ilizarov external fixation between July 2006 and December 2015 with the minimum follow-up duration of one year. There were 30 patients: 24 males and 6 females, mean age 43.33 years, and mean follow-up 3.6 years. Three of them were open fractures; 15 cases were Schatzkertype V fractures and the other 15 type VI. According to AO/OTA classification, there were 11 type C1, 12 C2 and 7 type C3 fractures. Outcome assessment was made with American Knee Society Score (AKSS) and Rasmussen's Radiological Score (RRS) at final follow-up.@*RESULTS@#Out of the 30 cases, mini-open reduction was performed in 7, bone graft in 4, minimal internal fixation in 10 and knee temporary immobilisation in 11 patients. Mean duration of external fixation was 11.8 weeks. All fractures united. Pin tract infections in 7 and common peroneal neuropathy in 2 patients were self-limiting. Two patients had axial misalignment of less than 10°. At final follow-up, the mean knee range of motion was 114.7, mean AKSS 81.5 and mean RRS 16.7. On statistical analysis, Schatzker type of fractures, use of minimal internal fixation and knee-spanning did not influence the final outcome.@*CONCLUSION@#Ilizarov external fixator with or without minimal internal fixation provides acceptable outcome for complex tibial plateau fractures. Care must be taken to look for minor loss of alignment, especially in Type VI Schatzker fractures after removal of the fixator. However small sample size precludes firm conclusions.

Duplication of the Gallbladder: A Rare Congenital Anomaly

Biliary tract shows a large number of anatomic variations and duplication of the gallbladder (GB) is a rare congenital anomaly. Although it is very often detected incidentally, it may present with complications due to gall stone disease. Careful identification of this anomaly on imaging is important to prevent any serious surgical complications. We here report a case of duplicated GB in a 26-year-old male, who presented with right hypochondriac pain and detected to have two GB on magnetic resonance imaging (MRI).

Functional Assessment Following Treatment of Acromioclavicular Joint Dislocation by Screw and Tension Band Wiring

Background: The acromioclavicular (AC) joint is commonly involved in traumatic injuries in male athletic population. Treatment of acute complete AC dislocation is controversial in literature. Both conservative and surgical treatment has been reported with similar results. Methods: We report a prospective study of 17 patients of Acromioclavicular dislocations (Type III) managed with screw and tension band wiring and were followed up for a period of 3 years. Repair of Coracoclavicular Ligament was performed if found completely torn. Results: Patients were assessed on basis of pain relief, tenderness, functional ability, range of motion at shoulder and cosmosis. Conclusion:Fixation with screw and Tension band wiring is a simple, easy, less time consuming surgical technique allowing faster rehabilitation in young and adult active patients to achieve a stable, pain free shoulder with no serious intra-operative or post-operative complications.

Phyto-constituents, pharmacological properties and biotechnological approaches for conservation of the anti-diabetic functional food medicinal plant salacia: a review note

Background and Objective: Genus Salacia L. [Celastraceae] is a woody climbing medicinal plant consisting of about 200 species with many endangered species located throughout the world's tropical areas. Various parts of the plant as food, functional food additive and tea have been extensively used to treat a variety of ailments like diabetes and obesity as well as inflammatory and skin diseases. The present work reviews the phytochemical properties, pharmacological activities, biotechnological strategy for conservation and safety evaluation of this valuable genus

Results and Conclusion: More efforts are needed to isolate new phytoconstituents from this important medicinal plant. The mechanism of anti-diabetic action has not been done at molecular and cellular levels, thus the fundamental biological understanding is required for future applications. Though the safety of plant species has been well documented and has been confirmed by many toxicological studies, further toxicity research and clinical trials are recommended. In order to sustain harvest and conservation, agronomic practices for cultivation have to be developed. Establishment of more efficient protocols for in vitro propagation is necessary too. Approaches like genetic manipulation, hairy root culture, media standardization, and use of inducers/precursors for elevation of secondary metabolite levels could also be attractive

Accuracy of computed tomographic features in differentiating intestinal tuberculosis from Crohn's disease: a systematic review with meta-analysis

Abdominal computed tomography (CT) can noninvasively image the entire gastrointestinal tract and assess extraintestinal features that are important in differentiating Crohn's disease (CD) and intestinal tuberculosis (ITB). The present meta-analysis pooled the results of all studies on the role of CT abdomen in differentiating between CD and ITB. We searched PubMed and Embase for all publications in English that analyzed the features differentiating between CD and ITB on abdominal CT. The features included comb sign, necrotic lymph nodes, asymmetric bowel wall thickening, skip lesions, fibrofatty proliferation, mural stratification, ileocaecal area, long segment, and left colonic involvements. Sensitivity, specificity, positive and negative likelihood ratios, and diagnostic odds ratio (DOR) were calculated for all the features. Symmetric receiver operating characteristic curve was plotted for features present in >3 studies. Heterogeneity and publication bias was assessed and sensitivity analysis was performed by excluding studies that compared features on conventional abdominal CT instead of CT enterography (CTE). We included 6 studies (4 CTE, 1 conventional abdominal CT, and 1 CTE+conventional abdominal CT) involving 417 and 195 patients with CD and ITB, respectively. Necrotic lymph nodes had the highest diagnostic accuracy (sensitivity, 23%; specificity, 100%; DOR, 30.2) for ITB diagnosis, and comb sign (sensitivity, 82%; specificity, 81%; DOR, 21.5) followed by skip lesions (sensitivity, 86%; specificity, 74%; DOR, 16.5) had the highest diagnostic accuracy for CD diagnosis. On sensitivity analysis, the diagnostic accuracy of other features excluding asymmetric bowel wall thickening remained similar. Necrotic lymph nodes and comb sign on abdominal CT had the best diagnostic accuracy in differentiating CD and ITB.