MR Imaging in Eclampsia

Background : The aim of this study is to determine the distribution and nature of Cranial MRI findings in eclamptic patients, and to correlate them with clinical and laboratory data. Materials and Methods : This study was conducted in the Department of Obstetrics and Gynecology in Sri Ramachandra Institute of Higher Education and Research. A total number of 35 Eclamptic patients were included in this study and they were analyzed retrospectively. Laboratory parameters, Blood Pressure and Cranial MRI was performed for all and the same were analyzed statistically. Results : Out of 35 Eclamptic patients, MR Imaging was normal in 6 patients. Among the 29 patients with abnormal MRI, Cortical-subcortical Lesion, appeared iso/hypo-intense in T-1 weighted images and hyper intense in T-2 weighted images. In most of the patients, occipital lobe was involved followed by involvement of other lobes such as Parietal, Frontal, Temporal, Basal Ganglia and Cerebellum. When patients with and without positive MRI findings were compared regarding clinical features such as Headache, Blurred Vision, Nausea and Vomiting, Epigastric Pain, Loss of Consciousness, Reduced Urine Output there was no statistically significant difference between the two groups. Similarly, there was no statistical difference in mean arterial pressures between MRI positive and MRI negative patients (p=0.218) however, it was found that those with MR imaging positive features had a higher Blood Pressure than those with MRI negative findings. Among the laboratory parameters, in the patients with abnormal MRI findings Fibrinogen was found to be significantly low than those with normal MRI findings (p=0.0002).

Potentials of Immunonutrition in Wound Healing: A Review (Potensi Imunonutrisi dalam Penyembuhan Luka: Tinjauan) / Jurnal Sains Kesihatan Malaysia

@#A delayed wound healing process can lead to detrimental complications in chronic wound patients such as tissue necrosis and systemic infections. Application of immunonutrition (IN) in experimental animal models and chronic wound patients has shown promising and improved wound healing processes. IN restores the supply of essential nutrients that are critical for cell growth and tissue repair in the wounded subjects. Several commonly found nutrients in IN formulations include polyunsaturated fatty acids (PUFAs), essential amino acids, trace elements such as zinc and vitamins. Recently, some studies suggested the use of traditionally used herbs like curcumin in IN recipes due to its efficient wound healing properties. The roles and functions of IN in wound healing encompass recruitment of white blood cells, platelets and fibroblasts into the wounded area during the coagulation and inflammation phases, enhancement of fibroblast proliferation, collagen synthesis and neovascularization in the proliferation phase; and lastly, regulation of tissue re-epithelization for wound closure and recovery. In this review, the roles and functions of individual nutrients were deliberately discussed alongside their mechanisms of action in wound healing. This aims to provide a more holistic insight into the potentials of those nutrients when used as part of IN for major wound patients. Despite its remarkable effects in wound healing, several criteria should be considered in an IN formulation: the type and severity of wounds, administration timing and mode of administration, and concoction of immune-boosting nutrients in order to ensure the optimal wound healing effects.

Study comparing the clinical profile of patients with stroke in diabetic and non-diabetic patients

Background: A stroke occurs when a blood vessel that carries oxygen and nutrients to the brain is either blocked by a clot or bursts (or ruptures). Computed tomography (CT) and magnetic resonance imaging (MRI) was done to determine the type of stroke. Diabetes mellitus is a well-recognized risk factor for ischemic stroke. The study was undertaken to assess the clinical characteristics, outcome pattern and to compare the pattern of stroke in diabetics and non-diabetics.Methods: An observational cross-sectional prospective study wherein a hundred stroke patients being admitted to MGMGH, Trichy were sampled and the clinical profile along with outcome is compared in diabetic and non- diabetic populations and the statistical significance of the same.Results: The proportion of patients with poor outcome following stroke was significantly higher in diabetics compared with non-diabetic patients being chi square value was 37.6514 and p value was found to be significantly less than 0.0001.Conclusions: The study resulted the large hemorrhages are twice as much common in the diabetic population compared to the non-diabetic population , the incidence increases with the chronicity of diabetes and the outcome is superior in the non-diabetics compared to the diabetics admitted in Mahatma Gandhi Memorial Government Hospital, Tiruchirappalli, Tamil Nadu, India.

Blood transfusion a bless or curse-a single institution retrospective study

Background: An adverse blood transfusion reaction (ABTR) is an unfavorable, unwanted reaction to the transfused unit. It may be acute or delayed , immune or non immune and infections . Materials and methods A study was conducted to detect the frequency of various ABTRs (both immunologic and &infections) and associated morbidity in a surgical oncology tertiary care centre for the past 2 years. Results: A total 7823 units of blood and blood components was issued for entire hospital, out of these 1120 units of blood and blood products was transfused in surgical oncology department over a period of two years. In these transfusions one patient(0.89%) was developed ABTR for that transfusion immediately stopped. A total 30patients (2.67%) developed minor transfusion related reaction that was managed with antihistamine and steroids. The most common adverse event was allergic reactions –20/30(66.6%) followed by feile episodes – 10/30(33.3%). We noticed that out of 27 recently positive hepatitis virus patients 7 patients had previous blood transfusion history. Within the 7 patients 6 patients also received chemotherapy and 1 patient had previous history of surgery. Conclusion : The most common adverse reactions to blood transfusions reported here are allergic reactions and feile episodes. Clerical error is the commonest cause for mismatch transfusion. Hepatitis B&C virus may be transmitted during window period. It can be prevented by using nucleic acid tests (NAT) as screening tests to prevent window period transmission.

Renal replacement therapy (RRT) in Rwanda: benefits, challenges and recommendations

Worldwide, non-communicable diseases (NCDs) are a global health problem as they contribute to approximately 60% of deaths. There is limited data on the management of NCDs including kidney diseases at all levels of health care delivery in Rwanda. Yet renal replacement therapy (RRT), which seems to be the only option to provide an acceptable quality of life to patients with end stage renal disease (ERSD), is yet to be well established in Rwanda. Although there are policies and guidelines on renal replacement modalities in Rwanda, inadequate human and financial resources in the area of nephrology care remains a challenge. The purpose of the paper is to document an overview of kidney diseases and Renal Replacement Therapy (RRT) in Rwanda and highlight the benefits, challenges and recommendations to provide future directions for nephrology care. Improved knowledge about renal conditions and their risk factors is the initial step to create major interventions for improved kidney quality of life (KQoL) among patients with end stage renal disease. Notwithstanding, the Government of Rwanda has established several dialysis centers intended to provide services and for maintenance of the health status of patients with renal conditions. Further studies are necessary to provide evidence on the outcomes of RRT

A study on periampullary diverticula 6 years ERCP experience from a referral centre

Introduction: Periampullary diverticula (PAD) are mucosal outpouchings commonly situated on the medial aspect of second part of duodenum; usually within 2-3 cm of the ampulla of vater. PAD are usually asymptomatic incidental findings during side viewing scopy. We aimed to analyze the influence of PAD in the management of patients who underwent ERCP during past 6 years in our centre. Materials and methods: Patients between the ages of 13 and 74 with the diagnosis of pancreaticobiliary diseases who underwent ERCP at Institute of medical gastroenterology, Madras Medical College from January 2012 to December 2017 were taken into account for retrospective analysis. We assessed and compared ERCP results in patients with and without PAD. Results: A total of 3412 patients underwent ERCP that of these 197(5.77%) patients had PAD. Among the 3412 cases , the incidences of PAD in patients age group less than 50 years was 2.6% and age group more than 50 years was 8.1%(P<0.001). Successful biliary cannulation was achieved in 79.18% (n=156) of patients with PAD and 93.1% of patients of patients without PAD (P<0.001). Of that in patients with PAD, for 28.93 %( n=57) cases underwent precut needle papillotomy. The papilla Rabindranath Eswaran, Premkumar Karunakaran, Allwin James, Venkateswaran Arcot Rajeswaran, Rajkumar Solomon. A study on periampullary diverticula – 6 years ERCP experience from a referral centre. IAIM, 2018; 5(6): 20-26. Page 21 was undetectable in 6 cases with PAD. Incidence of PAD was higher in choledocholithiasis group (9.2% vs 4.1%, p=0.003), but in incidence of CBD stricture had no difference. Complete clearance of CBD stones was achieved lesser in patients with PAD (72.4% vs 86.8% P=0.02). Conclusion: The frequency of PAD increases with age and occurs more in choledocholithiasis cases. Our experience showed decreased rate of cannulation success with PAD, increased difficulty in cannulation and decreased rate of successful stone retrieval.

Role of MRI in Detecting Cerebral Anomalies and Cerebral Hypoperfusion in Surviving Twin after the Co Twin Demise of Monochorionic Twin Pregnancy.

Aim: To demonstrate the role of MRI in detecting cerebral anomalies and cerebral hypo perfusion in surviving twin after the co twin demise of monochorionic twin pregnancy. Case Presentation: 28 year old second gravida came for routine antenatal sonography at 29 weeks. Her routine anomaly scan at 20 weeks for her twin gestation was unremarkable. Present antenatal sonography revealed monochorionic diamniotic twin pregnancy with demise of one of the twins at 23 weeks. Ultrasound and doppler evaluation did not exhibit abnormality in surviving twin whereas MR evaluation revealed changes in feral brain due to ischaemia. Discussion: Mono chorionic twin pregnancies are associated with numerous complications due to vascular anastomotic channels in the shared placenta. Complications include Twin to Twin Transfusion Syndrome, Anaemia - polycythemia sequence, selective intra uterine growth retardation, cotwin demise, neurological damage in surviving twin. Though prenatal Doppler sonography is often used for neurological assessment of the surviving twin, in utero Magnetic Resonance Imaging of foetal brain aids in definitive diagnosis of cerebral pathologies. Conclusion: MRI plays an important role in assessing cerebral hypo perfusion injuries and cerebral anomalies.

Pseudo Meig's Syndrome: An Unusual Presentation.

Aim: To describe the radiological findings in a case of pseudo Meig’s syndrome with rare association of pericardial effusion. Presentation of Case: We report a case of pseudo Meig's syndrome who also had pericardial effusion. The patient had sonography and MR imaging of the abdomen which showed uterine fibroid associated with bilateral pleural effusion, ascites and pericardial effusion. Subsequently, the patient underwent hysterectomy with bilateral salpingectomy following which ascites, pleural effusion and pericardial effusion resolved. Histopathological examination confirmed uterine leiomyoma with degenerative changes. Discussion: Pseudo-Meig's syndrome is a condition which describes the association of any ovarian tumor (benign or malignant) other than ovarian fibroma or any pelvic tumor with pleural effusion and ascites. Association of pericardial effusion along with this condition has been rarely reported. Most common tumors associated with this entity described in previous literature include leiomyoma of uterus and broad ligament, germ cell tumors etc. It becomes highly important to identify this condition as it is a curable condition mimicking malignancy and can avoid unnecessary interventions. Conclusion: Pseudo-Meig’s syndrome associated with pericardial effusion is a rarely reported entity which can mimic malignant condition and hence it is important to consider it as a possibility in patients who present with pericardial effusion of unknown cause.

Treatment of severe, disabling spasticity with continuous intrathecal baclofen therapy following acquired brain injury: the experience of a tertiary institution in Singapore

<p><b>INTRODUCTION</b>Intrathecal baclofen (ITB) therapy is a proven, effective treatment for disabling cortical spasticity. We describe the first local series of five patients with acquired brain injury (ABI) who received ITB and were followed up for 63.8 months.</p><p><b>METHODS</b>A retrospective review of medical and rehabilitation records of patients who received ITB therapy was carried out. Data studied included baseline demographic and injury variables, implantation data, spasticity and function, ITB dosage over time and complications.</p><p><b>RESULTS</b>From 2006 to 2010, a total of five patients received ITB therapy via implanted pumps about 39.4 months after ABI. Four out of five patients experienced significant reductions in their lower limb spasticity scores and improvements in global function and dependency. One patient had minor adverse events associated with baclofen-related sedation. The mean ITB dose at one year was 182.7 ± 65.6 mcg/day.</p><p><b>CONCLUSION</b>Our preliminary study showed encouraging long-term outcomes and safety for ITB therapy after ABI-related intractable spasticity. Individual ITB responses over time were variable, with gender differences. The outcomes experienced by our centre were comparable to those in the general ABI population, supporting the efficacy of ITB therapy for chronic disabling spasticity.</p>

Anaemia among schoolchildren from southern Kerala, India: A cross-sectional study.

Background. Iron deficiency anaemia remains a major nutritional problem among adolescents in India. The weekly iron and folic acid supplementation programme was launched in Kerala in 2013–14. We aimed to estimate the prevalence of anaemia among schoolchildren in Kollam district, Kerala and determine the associated factors. Methods. The haemoglobin level of 1600 boys and 1600 girls belonging to class V to IX in 32 randomly selected schools in Kollam district was measured using HemoCue 301 photometers by trained nurses. They also recorded details about the intake of food as well as iron tablets by the students. The anaemia status was evaluated as per the WHO guidelines. Univariate analysis for factors associated with anaemia was done and selected variables were entered into a logistic regression model. Results. The prevalence of anaemia among the students was estimated to be 31.4% (95% CI 29.76–33.04). About 1% had severe, 11.9% had moderate and 18.5% had mild anaemia. Among them 35.3%, 22.3% and 45.3% reported that they were not in the habit of consuming meat, green leafy vegetables and citrus fruits, respectively, at least once a week. Anaemia among schoolgoing children was associated with irregular consumption of weekly iron folic acid supplementation tablets (adjusted OR 1.39, 95% CI 1.08–1.82) and regular intake of tea/coffee along with major meals (adjusted OR 1.41, 95% CI 1.21–1.66). Conclusion. Anaemia among schoolgoing adolescents in Kollam district is a public health problem and is more among those who consumed less quantities of weekly iron and folic acid supplementation tablets and those who regularly consumed tea/coffee along with major meals. It may be helpful to introduce a comprehensive school health anaemia prevention package with effective behaviour change communication for dietary modification as well as strategies to improve the

Audits of Emergency Trolleys' Contents in Selected Hospitals in Botswana

Cardiac arrest is a life-threatening emergency situation. The outcome depends on timely and effective cardio-pulmonary resuscitation (CPR). Successful CPR attempts in hospitals require well-equipped emergency trolleys and properly functioning equipment; as well as staff members skilled in performing CPR. The study aimed to determine whether the emergency trolleys in Botswana's hospitals' wards or units met the expected standards. The contents of the emergency trolleys in 20 wards or units of two referral government hospitals in Botswana were audited by using a standardised checklist. No hospital ward or unit had all the expected equipment or drugs on its emergency trolley; some units failed to check their emergency trolleys' contents daily. All 20 hospital wards or units that participated in this study; needed to improve the contents and maintenance of their emergency trolleys; otherwise in-hospital CPR efforts in Botswana might be doomed to failure; losing lives that could have been saved if emergency trolleys' equipment and supplies had been up to standard