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Rubella, a common viral infection caused primarily by the rubella virus, is still a global public health concern. Every year, about 30000 instances of congenital rubella syndrome are reported in India, according to health ministry surveillance. A case study of a 6-year-old boy with congenital rubella syndrome was presented here. The child presented with classic abnormalities of congenital rubella syndrome like hearing loss, vision problems, heart defects and intellectual disabilities. Among its many manifestations, congenital heart defects are life threatening, this child was planned for surgical correction of above cardiac lesions. Treatment modalities differ in each type of congenital heart defects and its early detection and surgical intervention can reduce childhood mortality and morbidity.
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Rubella, a common viral infection caused primarily by the rubella virus, is still a global public health concern. Every year, about 30000 instances of congenital rubella syndrome are reported in India, according to health ministry surveillance. A case study of a 6-year-old boy with congenital rubella syndrome was presented here. The child presented with classic abnormalities of congenital rubella syndrome like hearing loss, vision problems, heart defects and intellectual disabilities. Among its many manifestations, congenital heart defects are life threatening, this child was planned for surgical correction of above cardiac lesions. Treatment modalities differ in each type of congenital heart defects and its early detection and surgical intervention can reduce childhood mortality and morbidity.
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Introduction: Lysosomal storage disorders (LSDs) are rare disorders and pose a diagnostic challenge for clinicians owing to their generalized symptomatology. In this study, we aim to classify LSDs into two broad categories, namely, Gaucher disease (GD) and Niemann–Pick/Niemann–Pick-like diseases (NP/NP-like diseases) based on the morphology of the storage cells in the bone marrow (BM) aspiration smears and trephine biopsy sections. Materials and Method: This retrospective study includes 32 BM specimens morphologically diagnosed as LSDs at our institute, in the last 10 years. Subsequently, they were subclassified into GD and NP/NP-like diseases. Further, we have compared and analyzed the clinical, hematological, and biochemical parameters for the two groups of LSDs. Results: Based on BM morphology, 59.4% (n = 19) cases were diagnosed as NP/NP-like diseases and 40.6% (n = 13) cases as GD. Abdominal distension and failure to thrive were the most common clinical manifestations in both groups of LSDs. Anemia and thrombocytopenia were frequently seen in either of the LSDs. On the assessment of metabolic profile, elevated total/direct bilirubin and liver enzymes were more commonly seen in NP/NP-like diseases when compared with GD. Conclusion: We have classified LSDs into GD and NP/NP-like diseases based on the morphology of the storage cells in the BM specimen. The hallmark findings on BM biopsy annexed with the comparative features of the two proposed categories can aid the clinician in clinching the diagnosis. Formulation of such a methodology will prove instrumental for patient care in an underresourced setting.
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Primary renal myoepithelial carcinoma is an exceedingly rare neoplasm with an aggressive phenotype and Ewing sarcoma breakpoint region 1 (EWSR1) rearrangement in a small fraction of cases. In addition to its rarity, the diagnosis can be challenging for the pathologist due to morphologic heterogeneity, particularly on the biopsy specimen. At times, immunohistochemistry may be indecisive; therefore, molecular studies should be undertaken for clinching the diagnosis. We aim to illustrate a case of primary myoepithelial carcinoma of the kidney with EWSR1-rearrangement in a 67-year-old male patient who presented with right supraclavicular mass, which was clinically diagnosed as carcinoma of an unknown primary. An elaborate immunohistochemical work-up aided by fluorescent in-situ hybridization allowed us to reach a conclusive diagnosis. This unusual case report advocates that one should be aware of the histological mimickers and begin with broad differential diagnoses alongside sporadic ones and then narrow them down with appropriate ancillary studies.
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Background@#Predicting difficult intubation (DI) is a key challenge, as no single clinical predictor is sufficiently valid to predict the outcome. We evaluated the effectiveness of four upper airway ultrasonographic parameters in predicting DI. The validity of the models using combinations of ultrasonography-based parameters was also investigated. @*Methods@#This prospective, observational, double-blinded cohort trial enrolled 1,043 surgical patients classified as American Society of Anesthesiologists physical status I–III without anticipated difficult airway. Preoperatively, their tongue thickness (TT), invisibility of hyoid bone (VH), and anterior neck soft tissue thickness from the skin to thyrohyoid membrane (ST) and hyoid bone (SH) were measured by sublingual and submandibular ultrasonography. The logistic regression, Youden index, and receiver operator characteristic analysis results were reported. @*Results@#Overall, 58 (5.6%) patients were classified as DI. The TT, SH, ST, and VH had accuracies of 78.4%, 85.0%, 84.7%, and 84.9%, respectively. The optimal values of TT, SH, and ST for predicting DI were > 5.8 cm (sensitivity, 84.5%; specificity; 78.1%; AUC, 0.880), > 1.4 cm (sensitivity, 81%; specificity, 85.2%; AUC, 0.898), and > 2.4 cm (sensitivity, 75.9%; specificity, 85.2%; AUC, 0.885), respectively. VH had a sensitivity and specificity of 72.4% and 85.6% (AUC, 0.790. The AUC values of the five models (with combinations of three or four parameters) ranged from 0.975–0.992. ST and VH had a significant impact on the individual models. @*Conclusions@#SH had the best accuracy. Individual parameters showed limited validity. The model including all four parameters offered the best diagnostic value.
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Background@#Predicting difficult intubation (DI) is a key challenge, as no single clinical predictor is sufficiently valid to predict the outcome. We evaluated the effectiveness of four upper airway ultrasonographic parameters in predicting DI. The validity of the models using combinations of ultrasonography-based parameters was also investigated. @*Methods@#This prospective, observational, double-blinded cohort trial enrolled 1,043 surgical patients classified as American Society of Anesthesiologists physical status I–III without anticipated difficult airway. Preoperatively, their tongue thickness (TT), invisibility of hyoid bone (VH), and anterior neck soft tissue thickness from the skin to thyrohyoid membrane (ST) and hyoid bone (SH) were measured by sublingual and submandibular ultrasonography. The logistic regression, Youden index, and receiver operator characteristic analysis results were reported. @*Results@#Overall, 58 (5.6%) patients were classified as DI. The TT, SH, ST, and VH had accuracies of 78.4%, 85.0%, 84.7%, and 84.9%, respectively. The optimal values of TT, SH, and ST for predicting DI were > 5.8 cm (sensitivity, 84.5%; specificity; 78.1%; AUC, 0.880), > 1.4 cm (sensitivity, 81%; specificity, 85.2%; AUC, 0.898), and > 2.4 cm (sensitivity, 75.9%; specificity, 85.2%; AUC, 0.885), respectively. VH had a sensitivity and specificity of 72.4% and 85.6% (AUC, 0.790. The AUC values of the five models (with combinations of three or four parameters) ranged from 0.975–0.992. ST and VH had a significant impact on the individual models. @*Conclusions@#SH had the best accuracy. Individual parameters showed limited validity. The model including all four parameters offered the best diagnostic value.
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Background: Hemoglobinopathies pose a significant health burden in India. Prevention programmes can significantly reduce this burden. Although sophisticated methods of screening for β thalassemia trait are available, a cheap and simple method is beneficial for population screening. Although the Naked Eye Single Tube Red Cell Osmotic Fragility Test (NESTROFT) has been evaluated in many studies, sample sizes were small in some and many earlier studies have not done complete blood count (CBC) and High-Performance Liquid Chromatography (HPLC) in all the cases. We evaluate the suitability of NESTROFT for detection of β-thalassemia trait in a high prevalence region in Saurashtra, Gujarat.Methods: Here, 1000 unrelated individuals were studied. NESTROFT, CBC and estimation of HbA2 and HbF or other hemoglobin variants were done by HPLC.Results: Prevalence of β thalassemia trait was 7.8% in this population. NESTROFT showed an overall sensitivity and specificity of 94.87 and 85.38 respectively for the detection of β thalassaemia trait. Using red cell indices (MCH <27 pg and MCV <80 fl), One β thalassemia trait with normal indices would have been missed. Among twelve individuals with other hemoglobinopathies (HbS, HbD, HbE, δβ thalassemia trait or HPFH), seven had a positive NESTROFT while three had normal MCV & MCH values.Conclusions: NESTROFT is a cost-effective sensitive test which does not require any equipment and can be done in remote areas. It remains a useful first line screening test when large populations have to be screened.
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Background@#Duloxetine is an antidepressant that is also useful in chronic neuropathic and central origin pain. In this study, the role of duloxetine in decreasing acute postoperative pain after lumbar canal stenosis surgery is explored. @*Methods@#In this single center, triple blinded, and placebo-controlled trial, 96 patients were randomized for statistical analysis. The intervention group received oral duloxetine 30 mg once a day (OD) for 2 days before surgery, 60 mg OD from the day of surgery to the postoperative second day and 30 mg OD for the next 2 days (a total duration of 7 days). A placebo capsule was given in the other group for a similar time and schedule. The same standard perioperative analgesia protocols were followed in both groups. @*Results@#Total morphine consumption up to 24 hours was significantly decreased in the duloxetine group (p < 0.01). The time to the first analgesia requirement was similar in both groups but the time to the second and third dose of rescue analgesia increased significantly in the duloxetine group. The time to ambulation was decreased significantly (p < 0.01) in the duloxetine group as compared to the placebo group. Pain scores remained similar during most of the time interval. No significant difference was observed in the complication rate and patient satisfaction score recorded. @*Conclusions@#Duloxetine reduces postoperative pain after lumbar canal stenosis surgery with no increase in adverse effects.
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PURPOSE@#Anterior cruciate ligament (ACL) repair was first described in the mid 1900's. However, due to poorly selected patients led to unsatisfactory early results. We aim to study the outcome of ACL repair in a carefully selected cohort.@*METHODS@#Thirteen consecutive patients of acute Type 1 (proximal ACL avulsion) were treated with arthroscopic ACL repair using a suture pull out technique. At the latest follow-up the patients were evaluated for Lysholm score, KT-1000 measurement and clinical assessment for any laxity.@*RESULTS@#At a mean follow-up of 31.3 months, none of the patients had any subjective laxity. The mean Lysholm score was 95 and instrumented laxity measurement did not reveal any significant laxity compared to the opposite knee.@*CONCLUSION@#The proximal ACL avulsion has healing potential similar to proximal MCL injuries. Performing microfracture of the lateral wall of the notch optimizes the healing environment by negating the effects of the synovial fluid. Performing ACL repair in a carefully selected patient leads to good short term results and saves the patient of a reconstruction procedure, at least in the immediate future.
Subject(s)
Adult , Aged , Female , Humans , Male , Young Adult , Anterior Cruciate Ligament , General Surgery , Anterior Cruciate Ligament Injuries , General Surgery , Anterior Cruciate Ligament Reconstruction , Methods , Follow-Up Studies , Fractures, Avulsion , General Surgery , Joint Instability , Sutures , Time Factors , Treatment OutcomeABSTRACT
Double J stents are an integral part of urological practice today. Ureteral stenting is done as an adjunct to ureteral surgery and for managing ureteral obstruction. Every urological surgery doesn't require DJ stenting and their use must be strictly restricted to selected cases. Retension is a common complication of ureteral stents and is mostly due to encrustations on a forgotten DJ stent. Here we report a case of retained DJ stent which was placed during open nephrolithotomy. It was neither forgotten nor encrusted, but was embedded in the renal parenchyma. As per our knowledge this is the first case of its kind to be reported in medical literature.
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Reported incidence of rectal foreign bodies is rather rare with only isolated published case reports or case series. Controlled studies of patients with rectal foreign bodies have not been conducted. The approach to the management of these patients has not changed in the last 10-20 years
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Objectives: Sympatholytic properties of dexmedetomidine have many advantages to use in general anesthesia especially in pediatric age group undergoing cochlear implant surgeries. This study is designed to compare the effects of bolus dose of dexmedetomidine followed by infusion with placebo in cochlear implant surgeries for quality of hypotensive anesthesia with hemodynamic stability and incidence of complications in pediatric age group particularly emergence delirium with sevoflurane
Methodology: 60 pediatric patient of ASA grade I or II with congenital or acquired deafness of age ranging from 2 to 8 years scheduled for cochlear implant surgery were included in this study. Group D were administered dexmedetomidine 0.5 micro g/kg in 100 ml 0.9% NaCI over 10 min followed by infusion of dexmedetomidine at 0.5 micro g/kghr[-1] and Group P was given placebo only i.e. 0.9% NaCl 100 ml over 10 min followed by infusion at 2 ml.hr[-1]. Heart rate [HR] and mean arterial pressure [MAP] at different time interval, intraoperative fentanyl and propofol consumption, surgeons' satisfaction score and complications, particularly incidences of emergence delirium were recorded
Statistical analysis: Mean with standard deviation of various parameters of both groups was compared using student's t test were analyzed
Result: statistical significant lowering of MAP, HR, opioid consumption and rate of complications were lower in dexmedetomidine group compared to placebo group
Conclusion: Intraoperative administration of dexmedetomidine provides better surgical field and subsequently higher surgeon's satisfaction score leading to reduced surgery time with better recovery profile
Subject(s)
Humans , Male , Female , Child, Preschool , Child , Cochlear Implantation , Cochlear Implants , Double-Blind Method , Placebos , Hypotension , Hemodynamics , Pediatrics , Emergence DeliriumABSTRACT
Background & Objective: The present study was conducted with the aim to clinically and radiographically evaluate the efficacy and efficiency of the direct sinus lift with simultaneous implant placement and bone grafting, and to evaluate bone height with the merits and demerits of lateral approach for sinus membrane elevation. Methodology: This randomized prospective study consisted of 10 patients who met the inclusion and exclusion criteria. The patients were selected irrespective of the age, sex & socioeconomic status, with the residual alveolar bone height between 1 to 4 mm in the edentulous posterior maxillary region. Direct sinus lift was carried out with simultaneous implant placement. Bovine graft (xenograft) was used as a sole grafting material. Patients were followed up for 36 months of prosthetic rehabilitation. Results: Pre-operative alveolar bone height was on an average 2.9 mm (ranging from 1 to 4 mm) with the standard deviation of 0.67 mm. After 36 months of loading, there wasn’t any clinical or radiographical complication. On an average 13 mm bone height was evident (ranging from 11.5 to 14 mm) with the standard deviation of 0.81 mm. Conclusion: Direct sinus lift is an excellent technique for the rehabilitation in the cases with severely atrophic posterior maxilla.
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Sweat gland carcinoma is a rare malignant tumour, first described in 1865, with approximately 220 cases reported in last 30 years. Lower limbs are the most common site of involvement, followed by the upper extremities, and the head. Trunk is rarely involved. Five histological types have been described, most common being porocarcinomas followed by ductal carcinomas, adenoid cystic carcinomas, syringomatous carcinomas and mucinous carcinomas. These are aggressive tumours with potential for distant metastasis. Wide surgical excision is the treatment of choice and the overall prognosis is poor. Here we report another case of sweat gland adenocarcinoma with no evidence of metastasis
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“Triphala”, the Ayurvedic wonder is used traditionally for the treatment of different types of diseases since antiquity. The hydroalcoholic extracts of the three components of Triphala powder demonstrated varying degrees of strain specific antibacterial activity against multidrug-resistant uropathogenic bacteria. Terminalia chebula fruit extract was active against all the test isolates followed by Terminalia belerica and Emblica officinalis. There was a close association between antibacterial activity and total phenolic content of Triphala components.The test plant extracts were also found to be non-toxic on human erythrocyte membrane at recommended and even higher doses. The preliminary results of the present study may help in developing effective and safe antimicrobial agents from Triphala components for the treatment of urinary tract infections caused by multidrug-resistant bacteria.
Subject(s)
Bacteria/drug effects , Drug Resistance, Bacterial , Drug Resistance, Multiple , Ethanol , Microbial Sensitivity Tests , Plant Extracts/pharmacology , Urinary Bladder/microbiologyABSTRACT
OBJECTIVE@#To evaluate the antibacterial activity of Ocimum sanctum (O. sanctum) leaf extract, alone, and in combination with chloramphenicol (C) and trimethoprim (Tm) against Salmonella enterica serovar Typhi (S. typhi).@*METHODS@#The antibacterial activity of ethanolic extract of tulsi, O. sanctum, leaf (TLE; 500 μg) for 23 S. typhi isolates was determined following agar diffusion. The C (30 μg) and Tm (5 μg) activity alone and in combination with TLE (250 μg) was determined by disk diffusion. The zone diameter of inhibition (ZDI) for the agents was recorded, and growth inhibitory indices (GIIs) were calculated.@*RESULTS@#The S. typhi isolates (n=23), which were resistant to both C (ZDI 6 mm) and Tm (ZDI 6 mm), had TLE (500 μg) ZDIs 16-24 mm. The ZDIs of C and Tm were increased up to 15-21 mm and 17-23 mm, respectively, when TLE (250 μg) was added to the C and Tm discs. The GIIs ranged 0.789-1.235 and 0.894-1.352, due to combined activity against S. typhi isolates, of C and TLE and Tm and TLE, respectively.@*CONCLUSIONS@#The data suggest that TLE, in combination with C and Tm, had synergistic activity for S. typhi isolates, and hence O. sanctum is potential in combating S. typhi drug resistance, as well promising in the development of non-antibiotic drug for S. typhi infection.
Subject(s)
Humans , Anti-Bacterial Agents , Pharmacology , Chloramphenicol , Pharmacology , Drug Resistance, Bacterial , Drug Synergism , Ocimum , Chemistry , Plant Extracts , Pharmacology , Plant Leaves , Chemistry , Salmonella typhi , Trimethoprim , Pharmacology , Typhoid Fever , Drug TherapyABSTRACT
Objective: Terminalia chebula Retz. (combretaceae) is called the “King of Medicine” in Tibet and is always listed at the top of the list of “Ayurvedic Materia Medica” because of its extraordinary power of healing. The present study was carried out to evaluate the possible in vitro antibacterial potential of different solvent extracts of T. chebula fruit against multidrug-resistant uropathogens. Methods: A total of 52 multidrug-resistant uropathogenic bacteria were used in this study. Successive extractions of T. chebula fruits were performed with solvents of different polarities. Agar well diffusion and microbroth dilution assay methods were used for antibacterial susceptibility testing. Kill-kinetics study was done to know the rate and extent of bacterial killing. Qualitative phytochemical screening was done to know the major phytoconstituents present in the plant material. Acute oral toxicity study in mice was performed to evaluate the toxic potential of the plant material, if any. Results:The ethanol extract of T. chebula fruits demonstrated a strong antimicrobial activity against all the test isolates and found to be most effective over others. Kill-kinetics study showed dose and time dependent antibacterial activity of ethanol extract. Phytochemical analysis revealed the presence of high concentration of phenolics and low concentration of flavonoids and terpenoids. In acute oral toxicity study, no gross behavioral changes were observed in mice at recommended dosage level and 24 h LD50 of ethanol extract was found to be >4 g/kg, p.o. in mice. Conclusions: The results provide justification for the use of Terminalia chebula fruit in folk medicine to treat various infectious diseases and could be useful for the development of alternative/ complementary medicine for multidrug-resistant uropathogens.
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To explore the in vitro antibacterial activity of ethanolic extracts of cinnamon [Cinnamomum zeylanicum; CIN], clove [Syzygium aromaticum, CLV] and cumin [Cuminum cyminum, CMN] against clinical isolates of methicillin resistant Staphylococcus aureus [MRSA], from Kolkata, India. The CIN, CLV and CMN were tested for their antibacterial activity against MRSA by in vitro methods. Minimum inhibitory concentration [MIC] values of the three extracts were determined, and time-kill studies were performed in order to investigate the bactericidal activity of the extracts [at the MIC level] for the isolates. The killing efficacy of the extracts was determined at various concentrations. The zone diameter of inhibition [ZDI] obtained due to CIN, CLV and CMN ranged between 22-27 mm, 19-23 mm and 9-15 mm, respectively; while the MICs, for the isolates, were in the range of 64-256, 64-512 and 128-512 microg/ml, respectively. When tested for their MIC levels; the CIN and CLV were found to be bactericidal after 6 hrs of incubation, while CMN showed bactericidal activity after 24 hrs. However, when tested at various concentrations; CIN, CLV and CMN displayed bactericidal activity against S. aureus, after 24 hrs of incubation, at 200, 200 and 300 microg/ml, respectively. The C. zeylanicum and S. aromaticum showed the strongest in vitro antibacterial activity followed by C. cyminum against MRSA, and such findings could be considered a valuable support in the treatment of infection and may contribute to the development of potential antimicrobial agents for inclusion in anti- S. aureus regimens
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OBJECTIVE@#To investigate the prevalence of leptospirosis among patients from within and outside Kolkata, India, attending the Calcutta School of Tropical Medicine, for treatment during August 2002 to August 2008.@*METHODS@#The leptospirosis cases were determined on the basis of clinical, epidemiological, and biochemical factors, and were tested for leptospiral antibodies using IgM ELISA. Serum samples with absorbance ratio ≥ 1.21 were interpreted as reactive.@*RESULTS@#The commonest presentation involved fever, headache and jaundice. The male-female ratio was 61:46. A total of 65(64.20%) cases had abnormal liver and renal functions respectively, and 57.1% had both the abnormalities. The highest incidence (75, 35.04%) was recorded in September-October followed by July-August (53, 24.77%). The reactive cases had absorbance ratios between 1.21 and 8.21, and 53 showed equivocal result, while IgM non reactivity were seen in 90 patients (absorbance ratios 0.10-0.90). The patients responded to treatment with parenteral antibiotics, penicillin, ceftriaxone and cefotaxime; follow up did not reveal case fatality.@*CONCLUSIONS@#The cardinal signs of leptospirosis help in making clinical diagnosis, but in any hyper-endemic situation any patient reporting with acute fever and signs of pulmonary, hepatic or renal involvement should be suspected to have leptospirosis and investigated accordingly. Increased awareness, and early diagnosis and treatment, can reduce mortality due to leptospirosis.