Prosthetic shoulder arthroplasty in patients 40 years or younger: outcomes stratified by diagnosis and surgery

Background@#The outcomes of patients 50–55 years old or younger undergoing prosthetic shoulder arthroplasty (PSA) may not generalize to younger patients. We report outcomes following PSA in a consecutive series of patients 40 years or younger. We hypothesize that total shoulder arthroplasty (TSA) provides better outcome and durability than resurfacing hemiarthroplasty (RHA). @*Methods@#Patients were stratified by diagnosis and surgical procedure performed, RHA or TSA. Active range of motion and self-assessed outcome were evaluated preoperatively and at final follow-up. @*Results@#Twenty-nine consecutive PSAs were identified in 26 patients, comprising 9 TSAs and 20 RHAs, with a minimum of 2-year follow-up. Twelve PSAs were performed for chondrolysis. Mean active forward elevation, abduction, external rotation, and internal rotation improved significantly (p<0.001 for all). Mean pain score improved from 6.3 to 2.1, Simple Shoulder Test from 4.0 to 9.0, and American Shoulder and Elbow Surgeons score from 38 to 75 (p<0.001 for all). Patients undergoing RHA and TSA had similar outcomes; but three RHAs required revision, two of these within 4 years of implantation. Four of five patients undergoing revision during the study period had an original diagnosis of chondrolysis. @*Conclusions@#PSA in young patients provides substantial improvement in active range of motion and patient reported outcomes irrespective of diagnosis and glenoid management. However, patients undergoing RHA, especially for chondrolysis, frequently require subsequent revision surgery, so that RHA should be considered with caution in young patients and only after shared decision-making and counsel on the risk of early revision to TSA.

Antifilarial and Antibiotic Activities of Methanolic Extracts of Melaleuca cajuputi Flowers

We evaluated the activity of methanolic extracts of Melaleuca cajuputi flowers against the filarial worm Brugia pahangi and its bacterial endosymbiont Wolbachia. Anti-Wolbachia activity was measured in worms and in Aedes albopictus Aa23 cells by PCR, electron microscopy, and other biological assays. In particular, microfilarial release, worm motility, and viability were determined. M. cajuputi flower extracts were found to significantly reduce Wolbachia endosymbionts in Aa23 cells, Wolbachia surface protein, and microfilarial release, as well as the viability and motility of adult worms. Anti-Wolbachia activity was further confirmed by observation of degraded and phagocytized Wolbachia in worms treated with the flower extracts. The data provided in vitro and in vivo evidence that M. cajuputi flower extracts inhibit Wolbachia, an activity that may be exploited as an alternative strategy to treat human lymphatic filariasis.

Mixed Medullary and Papillary Carcinoma Thyroid in a Young Female- A Rare Case Report

The medullary thyroid carcinomas (MTC) comprise 5-10% of all thyroid carcinomas. It is known to show many cyto-architectural variations. The WHO classification of thyroid tumors includes an entity called mixed medullary-papillary carcinoma, a rare malignancy known to represent <1% of all thyroid malignancies. Fewer than 40 such cases have been reported so far and include tumors showing morphological features of both medullary carcinoma and papillary carcinoma with immunoreactivity for calcitonin and CK19 &thyroglobulin respectively. We report a case of a 27-year-old female with complaints of gradually increasing neck swelling for 2 years, with difficulty in swallowing in the last 2 months. The swelling was more localized towards left. Ultrasound neck revealed a nodule in the left lobe of thyroid with benign features most likely nodular colloid goiter. Thyroid profile of the patient was normal. FNA revealed sheets and follicles lined by both hyperplastic and involutional follicular cells. Few micro follicles showed pleomorphic cells having hyperchromatic nuclei and mild anisonucleosis. A diagnosis of colloid goiter was given on cytology; however, on grounds of suspicion of a neoplastic process, histopathology was advised. The patient underwent total thyroidectomy. Hematoxylin & Eosin stained sections showed features of mixed medullary-papillary carcinoma of the thyroid which was further confirmed on Immunohistochemistry and raised serum calcitonin levels. It is important to know about this entity due to its prognostic implications, association with other endocrine disorders and to prevent any diagnostic dilemmas.

Impact of a Baby-Friendly hospital on breastfeeding indicators in Shaqlawa district in Erbil governorate, Kurdistan region of Iraq

This study aimed to assess the impact of the Baby-Friendly Hospital Initiative on WHO-defined breastfeeding indicators in Shaqlawa district in Kurdistan region of Iraq. A household survey was carried out on a purposive non-probability sample of 200 mothers with a child aged < 30 months. Mothers were interviewed using a structured form to determine demographic data and feeding practices of the most recent child. The rate of early initiation of breastfeeding was 38.1%, exclusive breastfeeding was 15.4% and continued breastfeeding was 61.0% and 39.5% at 1 and 2 years of age respectively. A significant relationship was found between delivery at the Baby- Friendly accredited hospital and early initiation of breastfeeding but not with exclusive or continued breastfeeding. While continued breastfeeding at 1 year and 2 year was good, early initiation and exclusive breastfeeding indicators were not at an acceptable level, which indicates an ineffective role for the Baby-Friendly Hospital Initiative

Lipid peroxidation and antioxidant status in schizophrenic patients treated by quetiapine

To find the effect of quetiapine on lipid peroxidation and serum total antioxidant status [TAS] in schizophrenic patients. The subjects comprised 27 schizophrenic patients and 27 healthy volunteers. Clinical symptoms for the patients were assessed in Brief Individual Psychiatry Rating Scale [BPRS] items. The patients were treated with quetiapine [200-500 mg/day] orally for 8 weeks then reevaluated after the treatment. Blood samples from the patients were taken before and after quetiapine treatments. Other blood samples were taken from healthy subjects as a control group. Serum was obtained and analyzed for malondialdehyde [MDA] and TAS. Base time and after 8 weeks of quetiapine treatment showed a significant decrease in BPRS score in the schizophrenic patients. Serum MDA was significantly higher in the schizophrenic patients [difference = 124.1% of control] than controls. The parameter decreased significantly after quetiapine treatment by 16.9% compared with before treatment values. Serum TAS, in the schizophrenic patients, was significantly lower [38.4%] than controls. Quetiapine increased serum TAS significantly by 21.1%. Quetiapine treatment significantly increased body mass index [BMI] by 2.9%. Quetiapine depressed lipid peroxidation, and raised serum TAS in schizophrenic patients. The change in these parameters by quetiapine may play a role in its therapeutic activit

Prolonged mechanical ventilation causing tracheoesophageal fistula

Tracheo esophageal fistula [TEF] is a congenital or acquired communication between the trachea and esophagus. These fistulae can often lead to fatal complications. Prolonged intubation with high compliance endotracheal tube cuffs used to prevent gas leak and also pulmonary aspiration may cause tracheal damageand lead to tracheoesophageal fistulae

We report a case of a young man developing a TEF after being intubated for multiple injuries with the intent to highlight this rare cause of severe complication and even death

Level of empathy among medical students in Kuwait university, Kuwait

To evaluate the level of empathy among medical students in Kuwait University Medical School and its association with sociodemographic factors, stress levels and personality. A cross-sectional survey of 264 medical students was conducted in the Faculty of Medicine, Kuwait University. Empathy levels were measured using the Jefferson Scale, personality was assessed using the Zuckerman-Kuhlman Personality Scale and the Perceived Stress Scale was used to measure stress levels. Factors associated with empathy were evaluated using t test/ANOVA for categorical variables and correlation for continuous predictors. Mean empathy score was 104.6 +/- 16.3. Empathy scores were significantly associated with gender, year of study, mother's level of education, household income, satisfactory relationship with the mother and stress levels. Male medical students in their clinical years also had significantly lower empathy levels. However, factors such as grade point average, desired specialty, marital status of parents, father's educational level and relationship with father were not significantly [p > 0.05] associated with levels of empathy. Stress scores were significantly and positively associated with empathy [r = 0.13; p = 0.041]. Medical students in Kuwait University had low empathy level and this may be a cause for concern; as such we suggest a possible inclusion of emphasis on empathy in the curriculum

[ effect of obesity and endurance training-induced weight loss on UCP3 mRNA expression in C57BL/6 MICE]

The purpose of this study was evaluating the effect of obesity and weight reduction induced by endurance training on UCP3 mRNA expression in C57BL/6 mice. Twenty-four C57BL/6 mice consumed a high-fat diet, while 6 [NB Group] were fed a normal chow for 12 weeks. After the fattening period, 6 obese mice [OB Group] were sacrificed. Twelve mice trained 5 sessions per week for 12 weeks on a rodent treadmill with high [HI Group] [75% VO2max] and/or low intensity [LI Group] [50% VO2max] during a training period. The control group [OC Group] was kept inactive in the cages till the end of the period. Body weight was measured and recorded weekly. UCP3 mRNA expression was measured in gastrocnemius muscle using Real Time-PCR method and plasma FFA concentrations were measured using the ELISA method. In the training groups, weight reduction was significant in the 8th week [p<0.05]. Average relative UCP3 mRNA expression was significantly lower in the HI and LI groups, than in the OC group [0.5 +/- 0.25 and 1.04 +/- 0.96, respectively, vs. 2.58 +/- 0.57 arbitrary unit; p<0.05]. Plasma FFA concentrations were significantly lower in the HI and OB groups compared to the LI group [p<0.05]. When energy intake and consequently body weight increases, UCP3 increases to extend the thermogenesis and fatty acid oxidation's process. In contrast, UCP3 downregulates with exercise-induced weight loss in order to counteract this process

Patient-reported adverse drug reactions and drug-drug interactions: a cross-sectional study on malaysian HIV/AIDS patients

This study aimed to explore the adverse drug reactions [ADRs] reported by patients and to identify drug-drug interactions [DDIs] among human immunodeficiency virus/acquired immunodeficiency syndrome [HIV/AIDS] patients. This cross-sectional study was conducted at the Medication Therapy Adherence Clinic, Hospital Sungai Buloh, an HIV/AIDS referral centre. The patients were randomly selected and were encouraged to describe ADRs caused specifically by any of the prescribed antiretroviral drugs [ARDs]. Sociodemographic characteristics were recorded from the patients' medical records. In addition data on antiretroviral treatment [ART], DDIs and other conventional medication were also documented. A total of 325 randomly selected HIV/AIDS patients with a mean age of 22.94 years participated in the study. The most frequently prescribed ARDs were lamivudine [64.6%], zidovudine [40.6%] and efavirenz [42.5%]. Commonly reported ADRs were fatigue [54.8%], allergic reactions [41.5%], weight loss [41.5%], dry mouth [35.1%] and memory loss [35.1%]. Female [87.8%], non-complementary and alternative medicine [CAM] users [87.3%] and participants below 50 years old [81.1%] were identified as having a higher prevalence of ADRs compared to males [79.6%], CAM users [78.7%] and participants aged 50 years or more [77.5%]. Patient age was found to be significantly associated [p = 0.048] with the ADRs. In addition, a total of 44 cases of DDIs belonging to category D were also found in this study. This study enabled us to identify the most common ADRs and DDIs associated with the use of ART. Safe and effective treatment depends on the healthcare providers' knowledge of the same

Assessment of oxidized low density lipoprotein, as atherosclerosis risk marker in type 1 diabetic children with short history of diabetes mellitus

To evaluate the type-1 diabetic children for early atherosclerosis risk by measuring serum oxidized lipoprotein in relation with glycaemic control. Recent studies indicate that systemic markers of inflammation can identify subjects at high risk of cardiovascular disease [CVD]. Oxidized low density lipoprotein [OxLDL] levels have been regarded as one of the independent determinants of atherosclerosis. This cross sectional study involved a total 79 subjects including 39 type 1 diabetics and 40 non-diabetic controls between the ages of 9 to 16 years. A detailed medical history was taken from each subject and the individual with history of type-1 diabetes underwent clinical examination. Individuals with obesity, hypertension, smoking, and chronic infections, autoimmune and renal diseases were excluded. Serum concentrations of glucose and lipid profile were measured in duplicate by kits based on enzymatic methods. OxLDL was measured in duplicate by using standard enzyme linked immunosorbent assay [ELISA] method. Haemoglobin A[1c] and Body mass index [BMI] were also measured. Diabetic patients had significantly elevated levels of blood glucose [320.1 vs 97] and HbA1c [10.3% vs 5.21%] as compared to controls [p<0.001] but the serum levels of OXLDL were found to be significantly elevated in diabetic children [222.4 vs 140.2] as compared to controls [p>0.05]. OxLDL is a strong independent risk marker for atherosclerosis observed in diagnosed old age patients of CVD but in present study we could not find statistically significant elevated levels of OxLDL in young diabetic subjects with short duration of diabetes

[Effect of caffeine on blood pressure during exercise and at rest in overweight men]

Caffeine is a naturally occurring substance that is widely consumed in a variety of forms. The aim of this study was to assess the effect of caffeine on blood pressure in overweight men during exercise and at rest. In double-blind randomly designed study, six men [BMI 29.55 +/- 1.22 kg/m2, age 22.50 +/- 0.83 yr, height 174 +/- 9.12cm, weight 89.31 +/- 8.85kg, body fat percent 26.38 +/- 3.62] with sedentary lifestyles, performed 30 minutes running on treadmill at similar exercise intensities [60% VO2max], 1 hour after taking caffeine [5 mg/kg body weight] or placebo. Heart rate was recorded during exercise, and blood pressure [BP] was measured before and 1 hour after taking caffeine and immediately after exercise, and data analysis was conducted using student' t-test. Results indicated that systolic and diastolic BP and mean arterial pressure significantly elevated following caffeine intake at rest, but no significant differences were observed after exercise no significant differences were observed between caffeine and placebo in heart rate during exercise. The findings indicate that caffeine at this dosage level alters cardiovascular dynamics by augmenting arterial blood pressure in moderately obese men at rest. However, it seems that taking caffeine before exercise does not cause abnormal elevations in blood pressure in moderately obese men

Surgical site infection in lumbar surgeries, pre and postoperative antibiotics and length of stay: a case study

Postoperative wound infection also called as surgical site infection [SSI], is a troublesome complications of lumbar spine surgeries and they can be associated with serious morbidities, mortalities and increase resource utilization. With the improvement in diagnostic modalities, proper surgical techniques, antibiotic therapy and postoperative care, infectious complications can result in various compromises afterwards. The objective was to study the relation of surgical site infection in clean lumbar surgeries with the doses of antibiotics. This retrospective study was conducted at Shifa International Hospital, from January 2006 to March 2008. Hundred post operated cases of lumber disc prolapse, lumber stenosis or both studied retrospectively by tracing their operated data from hospital record section for the development of surgical site infection [SSI]. The patients were divided into three groups depending upon whether they received single, three or more than three doses of antibiotics respectively. Complete data analyses and cross tabulation done with SPSS version 16. Of 100 cases, only 6% had superficial surgical site infection; only 1 case with co morbidity of hypertension was detected. Twenty-one cases had single dose of antibiotic [Group-I], 59 cases had 3 doses [Group II] and 20 cases received multiple doses [Group III]. There was no infection in Group-I. Only one patient in Group-II and 5 patients in Group III developed superficial SSI. While 4 in Group-II, 3 in Group-III, and none of Group-I had >6 days length of stay [LOS]. The dose of antibiotic directly correlates with the surgical site infection in clean lumbar surgeries. When compared with multiple doses of antibiotics a single preoperative shot of antibiotic is equally effective for patients with SSI

Risk to household contacts of tuberculous patients based on Mantoux test and antibody titre

Tuberculosis, being an infectious disease, carries a risk of infection to contacts attending tuberculous patients. This study was conducted to evaluate the risk for household contacts of tuberculous patients as compared to non-contacts. The study was conducted at PGMI, Gulab Devi Hospital and Defence Housing Authority Lahore. The study included 120 household contacts and 80 non-contacts. A Cross sectional study for evaluation of antituberculous antibodies levels by ELISA method in two groups; Mantoux positive household contacts 49, Mantoux negative household contacts 71 and normal healthy persons 'non contacts' 80. Routine Haematological investigations like HB, TLC and ESR were done by conventional methods and all the sera of 200 subjects included in the study were tested for IgM, IgG and IgA anti tuberculous antibodies by enzyme linked immunosorbant assay [ELISA].Purified protein derivative 0.1 ml containing 5 TU was injected intradermally. The test was read after 72 hours by measuring the induration around injection site of forearm. There was no difference in the average age of the household contacts and non-contacts. The complaints of pyrexia, night sweats and weight loss were more in house hold contacts as compared to non-contacts. The awareness about BCG vaccination was equal in both. There were 49 contacts with positive Mantoux test while negative Mantoux test was found in 71 contacts. There were only three Mantoux positive among eighty non-contacts. There was no significant difference in the presence of IgM among household contacts as compared to non-contacts. However both IgG and IgA were present in significantly higher number of household contacts compared to non-contacts. Household contacts of patients suffering from active pulmonary tuberculosis have more chances of being infected with Mycobacterium tuberculosis as compared to the healthy non-contact, as shown by the higher levels of antituberculous antibodies and positivity of Mantoux test

Resistance patterns of urinary isolates in a tertiary Indian hospital

To analyze the pathogenic organisms recovered from patients with urinary tract infection in a tertiary Indian hospital setting along with determination of the occurrence and anti-microbial sensitivity of uropathogens on a retrospective basis during a period of one year. A total of 5073 urine samples were processed. Urine culture was done using conventional microbiological techniques. Biochemical testing was used to identify the organisms and antibiotic sensitivity was done by the Kirby Bauer method. A total of 2436 uropathogens were isolated. E coli were seen in 50.7% samples followed by Klebsiella sp [27.6%]. Staphylococcus aureus was the commonest Gram-positive isolate [1.5%]. Urinary tract infection [UTI] was seen in 70.5% females as compared to 29.5% males. A high recovery of isolates was noted from July to September. Multi drug resistance was commonest with Enterococcus [78.8%] followed by Pseudomonas [65.1%]. Drugs, which retained usefulness for Gram-negative isolates, were amikacin, norfloxacin and cefotaxime. For Gram-positive isolates, vancomycin, teicoplanin, lincomycin and Norfloxacin were very effective. Our study highlights the changing etiology of UTI and emergence of drug resistance within the Indian subcontinent

Estimation of antithyroid microsomal antibodies in Egyptian vitiligo patients of different age groups

Controversial reports about the incidence of autoimmune thyroid disease in children with non-segmental vitiligo prompted us to detect a possible relationship between the serum level of antithyroid microsomal [=antithyroid peroxidase] antibodies and the frequency of associated autoimmune thyroid disease in different age groups of vitiligo patients. Sixty vitiligo patients divided into four age groups [childhood, adolescence, early adulthood and middle adulthood] were included in the current study. Forty healthy controls of comparable age and sex were included. Estimation of serum antithyroid peroxidase [anti-TPO] antibodies, thyroid stimulating hormone [TSH] and free thyroxine [fT4] was done using ELISA method. Results of our study revealed that serum level of anti-TPO was significantly elevated in vitiligo patients [27%] compared to healthy controls [7.5%]. There was no significant difference in the serum level of TSH and fT4 between the two groups. There was a positive significant correlation among cases between serum anti-TPO and serum TSH. In addition, there was a positive significant correlation between the serum level of anti-TPO and the prevalence of auto immune thyroid diseases [AITD]. Although there was no significant correlation between serum anti-TPO and the age of vitiligo patients, a higher percentage of patients in the adolescence [40%] and early adulthood age groups [33.3%] had elevated anti-TPO compared to children [13.3%]. A significantly higher prevalence of elevated serum anti-TPO was detected among female cases [36.7%] compared to male cases [16.7%]. Vitiligo patients are more susceptible to develop anti thyroid antibodies. Periodical estimation of serum anti-TPO level and scanning for AITD is recommended especially in adolescent female vitiligo patients

Simultaneous HPLC-UV quantification of diltiazem and N-demethyldiltiazem in human plasma

A simple and sensitive reversed phase high-performance liquid chromatographic method was developed for simultaneous quantification of diltiazem HCl and its major metabolite N-demethyldiltiazem in human plasma. The method involves one step solvent extraction of diltiazem, N-demethyldiltiazem and the internal standard, verapamil with n-hexane and diethyl ether [50:50 v/v]. The mobile phase comprised 0.1 M ammonium dihydrogen phosphate-acetonitrile [62:38 v/v] and triethylamine [0.08%] was added before the pH was adjusted to 5.9 with 85% phosphoric acid. Analysis was run at a flow rate of 1.0 ml/min at a detection wavelength of 238 nm. The completion time for assay was not more than 10 minutes and lower limit of quantification was 5 ng/ml. The calibration curve for diltiazem and its metabolite was linear over a concentration range of 5-200 ng/ml and average recovery was about 90%. The coefficient of variation and percent error values of the assay method within and between days were all less than 10%

Simultaneous HPLC quantification of diltiazem and N-demethyldiltiazem in plasma

A simple and sensitive reversed phase high-performance liquid chromatographic method was developed for simultaneous quantification of diltiazem and its major metabolite N-demethyldiltiazem in human plasma. The method involves one-step solvent extraction of diltiazem, N-demethyldiltiazem and the internal standard, verapamil with n-hexane and diethyl ether [50:50 v/v]. The mobile phase comprised 0.1M ammonium dihydrogen phosphate-acetonitrile [62:38 v/v] and triethylamine [0.08%] was added before the pH was ajusted to 5.9 with 85% phosphoric acid. Analysis was run at a flow rate of 1.0 ml/mm at a detection wavelength of 238 nm. The completion time for assay was not more than 10 minutes and lower limit of quantification was 5 ng/ml. The calibration curve for diltiazem and its metabolite was linear over a concentration range of 5-200 ng/ml and average recovery was about 90%. The coefficient of variation and percent error values of the assay method within and between day were all less than 10%

Prevention of postoperative intraperitoneal adhesions in rats by alcoholic extract of piper longum an experimental study

Postoperative intraperitoneal adhesion formation is a common clinical occurrence, a major cause of morbidity and an occasional cause of mortality. This study was designed to evaluate the role of alcoholic extract of Piper longum in the prevention of Acetic Acid induced intraperitoneal adhesions in rats. Intraperitoneal injections of Piper longum extract, 10 mg/100 mg b.w. [Test Group], showed a potent activity comparable to Betamethasone 1 ml/100 gm b.w. [Standard Group] and grades of adhesions were confined to 0, 1 and 2 in these two groups as compared to grades 3 and 4 in rats in which Normal Saline was used [as control]. Mononuclear cell infiltration, fibroblastic proliferation and mesothelial thickening were mostly mild to moderate in the test group and the standard group as compared to the control group in which it was severe. This study suggests that alcoholic extract of Piper longum has a potent activity in the prevention of Acetic Acid induced intraperitoneal adhesions in rats

Serum cardiac troponin-T and total homocysteine abnormalities in hemodialysed chronic renal failure patients

Objective: Accelerated atherosclerosis is associated with chronic hemodialysis and more than one half of deaths in dialysis patients are of cardiovascular etiology. The study was designed to assess the concentration of serum total homocysteine [t-Hcy] and cardiac troponin-T [cTn-T] for the early detection of cardiovascular disease in chronic renal failure [CRF] and also to clarify their possible role as risk factors for the development of atherosclerosis in these patients to prevent and/or delay complications and to find out if there is a relation between these atherogenic markers with lipid profile and renal functions

Subjects and Methods: Sixty patients divided into three groups, GI: 20 chronic kidney disease [CKD] patients under conservative treatment. GII: 20 CKD patients on regular hemodialysis, GIII: 20 CKD patients with cardiac complications, all together with twenty healthy age and sex matched control subjects. Cardiac troponin-T, total homocysteine as well as lipid profile [total cholesterol, triacylglycerols, high density lipoprotein cholesterol and low density lipoprotein cholesterol] and renal profile [serum creatinine, BUN and uric acid] were determined

Results: Serum cTn-T was highly significantly increased in the three studied groups by 242, 614 and 7757%, respectively as compared to controls. Meanwhile, t-Hcy was significantly increased [p<0.05] in GI and highly significantly increased [p<0.001] in GII and GIII when compared to control group. There was a significant negative correlation between cTn-T and t-Hcy in GI [r=-0.38], uric acid in GII [r=-0.37] and creatinine in GIII [r=-0.39]. Such abnormalities might contribute to accelerated atherosclerosis in CKD patients

Conclusions: Laboratory determination of serum cTn-T together with t-Hcy is strongly recommended for early detection of cardiovascular disease in CKD

Enteric fever in adult patients: clinical features, outcome and antibiotic susceptibility patterns

Enteric fever is one of the commonest causes of fever in our country. In majority of the cases, the diagnosis and treatment are based on suggestive clinical features alone, without confirmatory laboratory tests. We studied the clinical and laboratory features, sensitivity pattern of isolates and disease outcome in culture-proven cases of enteric fever in adult patients, with a view to highlight those features which would help general practioners in the diagnosis and empiric treatment of enteric fever in the community