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Introduction: Age-related macular degeneration (AMD) is a neurodegenerative disease which is one of the leading causes of vision loss affecting population above the age of 50 years. Of the two types wet and dry AMD, dry AMD constitute 90% of cases. Currently there is no effective treatment for AMD except for antioxidant supplementation which can delay the progression of AMD and its associated vision loss. In Ayurveda, it is a Vata Pitthadhika Drishtigata Roga compounded by Dhatukshaya in Vardhakya. The treatment should be Brimhana, Chakshushya and Rasayana to tackle the degenerative changes. Gandhaka Kalpa from Rasaratnasamucchaya and Ksheerabala 101 Avarti Taila has these properties to ameliorate the disease pathology. Hence a clinical study was planned with the objective to assess the effect of Gandhakakalpa internally and Ksheerabala 101 Avarti Taila Nasya in dry AMD. Methods: The study design was interventional, pre and post evaluation without control. After preparatory phase, patients were given Nasya with Ksheerabala 101 Avarti Taila followed by administration of Gandhaka Kalpa with concurrent administration of Ksheerabala 101 Avarti Taila as Pratimarsa Nasya. Study and follow up were done in 30 eyes. Results were documented and statistically analysed using Friedmains’s test, paired t test, Wilcoxon’s signed rank test and McNemar test according to type of variable. Result: The intervention is statistically significant while considering visual acuity (p < 0.001) and Daily Living Tasks Dependent on Vision questionnaire scores (p< 0.0001) and not significant for optical coherence tomography and Amsler grid findings. Conclusion: The intervention is an effective protocol to be followed in Ayurveda for dry AMD.
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Background: Lateral condyle fractures of the distal humerus are the second most common fractures at the elbow in the paediatric population usually between the ages of 6-10 years old making up 5-20% of fractures in children. The aim of the present study was to assess the early results of patients with a displaced lateral humeral condyle fracture treated with open reduction and internal fixation. Methods: Our clinical trial was conducted involving 12 patients treated with open reduction and internal fixation (ORIF). Preoperative stage included clinical evaluation, routine investigations and radiological evaluation. Fractures were classified using the Milch. Patients were followed up weekly until radiological union of the fracture was evident. Results: 83.3% of our patients were males, while 16.7% were females. According to mechanism of injury, falling down continues to play a major role in causing disability. At (3-5) weeks all cases were with soft callus remove K wire; at 8 weeks, all cases were with union fracture; but at 12 weeks, one case (8.3%) was with mild stiffness and the rest was with full range of motion. As regards the carrying angle in our study, only 16.7% were with abnormal carrying angle. 33.3% were complicated; one case with mild limitation of motion and valgus; one case with varus and two cases with superficial infection. Conclusions: The open reduction and internal fixation of lateral humeral condyle fracture is the ideal treatment and it has a rate of complications
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Bone and Bones , Egypt , Fracture Fixation, Internal , Open Fracture ReductionABSTRACT
Lutembacher syndrome is a rare combination of congenital Atrial Septal Defect (ASD) and acquired Rheumatic Mitral Stenosis (MS).It is usually treated by surgical repair with potential risk of cardiopulmonary bypass. With the advancement of interventional methods of treatment it is amenable to nonsurgical transcatheter management. We are reporting a case of Lutembacher syndrome that was successfully treated with percutaneouos Inoue balloon mitral valvuloplasty and device closure of atrial septal defect.
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Aim: To study the impact of sweet potatoes on α-glucosidase, β-glucosidase, acid phosphatase, and phytase activity of Lactobacillus. Study Design: Enzymatic activity of seven strains of Lactobacillus grown in a sweet potato medium (SPM) was determined and compared to the standard lactobacilli MRS. Strains having the highest enzymatic activity were further enhanced by metal ions. Place and Duration of Study: Food Microbiology and Biotechnology Laboratory, North Carolina A&T State University, Greensboro, NC, USA, between September 2012 and May 2013. Methodology: Lactobacillus strains were grown in SPM and MRS at 37ºC for 16 h. At the end of incubation, bacterial population (log CFU/mL) was determined by plating and enzymatic activity was determined spectrophotometrically using the corresponding substrate. Results: Lactobacillus strains continue to grow in SPM and MRS and reached averages of 10.98±0.49 and 10.92±0.55 log CFU/mL respectively. Growth of Lactobacillus strains in SPM led to higher β-glucosidase, acid phosphatase, and phytase activity than MRS. Strains of L. reuteri (CF2-7F and SD2112) grown in SPM showed the highest acid phosphatase (15.84±1.05 and 20.56±1.49 Ph U/mL), and phytase (0.66±0.14 and 0.65±0.11 Ph U/mL) respectively. The highest β-glucosidase (36.04±3.16 Glu U/mL) activity was obtained from L. delbrueckii subsp. bulgaricus SR35 grown in SPM. In addition, acid phosphatase and phytase produced by L. reuteri CF2-7F growing in SPM were further increased by the addition of Mn2+ (70.1 and 41.8%) or Mg2+ (94.7 and 20.9%) respectively. β-glucosidase activity of L. reuteri was increased in a range of 4.1 to 130.6% due to the addition of metal ions. Conclusion: Components in sweet potatoes could increase enzymatic activity of Lactobacillus and the addition of metal ions could further produce an enhanced level of these enzymes.
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Student can be stressed due to different stressors such as academic, financial, health related or loss of close family member or friend, etc. Stress is the bodies’ reaction both neurologically and physiologically to adapt to the new condition. Stress has a negative effect on the academic performance of the students. This study was aimed to explore the stress and stressors and also to determine the association between stress levels and the academic performances in terms of cumulative grade point average (CGPA) of undergraduate medical students. Methods: It was a cross-sectional study conducted among all 234 year-4 medical students of Universiti Kebangsaan Malaysia (UKM), session 2011-2012. Sample size comprised of 179 students after fulfilling all inclusion and exclusion criteria. A validated Medical Students’ Stressor Questionnaire (MSSQ) was used to collect the data. Stress level and its association with CGPA of semester-1 examination were analysed. Results: Response rate was 76.49%, where 72% were female and 69% resided in the hostel. Academic Related and Social-related Stressors caused for severe and high stress in 84% and 49% respondents respectively, with insignificant differences between gender and residency. Respondents with a high and severe stress level were observed to have higher CGPA. Conclusion: UKM medical students are highly resourceful to manage their stress well and thus denying the negative effect of stress towards their academic performance. Medical schools should train students exposing various personal and professional developmental activities that able to face the everyday challenges and manage stress well and thereby achieve better academic performance.
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Background: Treatment of Congenital Heart Disease (CHD) is either Surgical or Interventional. Medical management is mainly symptomatic / palliative. Although surgery is the main mode of treatment but in the recent past non-surgical Interventional method is replacing it because of its multiple advantages over surgical procedures. Since 2005, we started our journey in National Institute of Cardiovascular Diseases with a PDA device closure. In this article we tried to review the success rate of the interventional procedures in this hospital. Methods: The aim of this retrospective study is to review the short term & Intermediate outcome of the non surgical interventional treatment of congenital heart diseases. We included all the interventional rocedures done in this Institute since 2005 upto December 2013. Results: During this period, we performed total 150 cases of patent ductus arteriosus (PDA) device, 20 cases of PDA Coil closure, 60 cases of atrial septal defect (ASD) device, 90 cases of Balloon Pulmonary Valvuloplasty (BPV), 20 cases of Balloon Aortic Valvuloplasty (BAV), 22 cases of Coarctation Balloon Angioplasty, 35 cases of Mitral Valvuloplasty (PTMC), 15 cases of Balloon Atrial Septostomy. Almost all of our intervention procedures were successful except one case of mortality related to procedure of PDA device closure, 4 device embolization (2 ASD & 2 PDA) and one case of PDA coil with persistent Intravascular hemolysis. All the embolized devices were subsequently retrieved surgically with repair. All other patients of interventional treatment are enjoying new life without any morbidity. Conclusion: Thus, we concluded that interventional methods of suitably selected case of congenital heart disease may be an alternative lucrative safe & effective option of remedy for many of the congenital heart diseases.
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Background: Medical education in Bangladesh is totally controlled by the Government and run a unique undergraduate curriculum throughout the country in both public and private sectors. This paper is aimed to briefly describe the medical education reform in Bangladesh and suggests further assessment changes. The present official form of undergraduate medical curriculum has first evolved in 1988 followed by revision in 2002 and 2012. Assessment and teaching are the two sides of the same coin. Assessment drives learning and learning drives practices. Following the curriculum reform since 2002, the assessment in undergraduate medical education has been greatly changed. There are a lot of in-course formative assessments which include item examination, card final and term final, designed to improve the quality of education. Ten percent marks of summative written examinations derive from formative assessment. Traditional oral examination has been changed to structured form to ensure greater reliability. Even then, teachers are not yet building up to conduct oral examination in such a structured way. Examiners differ in their personality, style and level of experience with variation of questioning and scoring from student to students. Weakness of reliability on oral examination still exists. Students also feel very stressful during the oral examinations. Moreover, to conduct such oral examination, three to four months times per year are lost by the faculties which can be efficiently utilised for teaching and research purposes. Worlds' leading medical schools now-a-days used oral examination only for borderline and distinction students. Bangladesh also must consider oral examination only for borderline and distinction students.
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Aims: To evaluate salivary and serum IgG levels in patients with head and neck squamous cell carcinoma (HNSCC) and healthy control subjects and to assess the effect of treatment on IgG levels. Study Design: A cross sectional study. Place and Duration of Study: Department of Oral Pathology and Department of Radiotherapy, University College Hospital, Ibadan, Nigeria between January 2010 and December 2010. Methodology: Seventy eight subjects comprising 30 patients with untreated HNSCC, 18 patients with HNSCC receiving treatment and 30 healthy, age and gender-matched individuals were included. Serum and salivary samples from the participants were analysed for total IgG using ELISA technique. Results: The mean serum IgG in untreated and treated HNSCC patients was significantly lower compared with healthy controls (P=.001), while mean salivary IgG was significantly elevated (P=.001) in untreated HNSCC patients compared with treated and healthy controls. There was no significant correlation between serum and salivary IgG levels. Conclusion: In patients with head and neck squamous cell carcinoma, serum IgG was reduced while salivary IgG was elevated compared with healthy controls. Our finding suggests differential roles of immunoglobulin G in serum and saliva of patients with head and neck squamous cell carcinoma. Hence, salivary IgG may be a useful biomarker in patients with head and neck squamous cell carcinoma, while serum IgG levels may be useful in monitoring treatment in these individuals.
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Background: Tobacco control policy can only succeed if the burdens of smoking are known. The objective of this study was to determine the prevalence and correlates of secondhand smoke (SHS) exposure among nonsmoking adults in two Nigerian cities. Materials and Methods: We carried out a cross-sectional study from October 2009 to April 2010 among adult population of two Nigerian cities: Enugu and Ilorin. A semi-structured questionnaire was administered by interviewers to obtain socio-demographic information; and information regarding pattern of SHS exposure; wareness of tobacco control policy and the harmful effects of SHS. SHS exposure was defined as regular exposure to tobacco smoke in the previous 30 days in a nonsmoking adult. Results: Of the 585 nonsmoking adults that completed the study; 38.8had regular exposure to SHS; mostly; in public places (24.4). More men were exposed at public places when compared with women (27.0vs. 19.5). The strongest factor associated with exposure to SHS in women was having a smoking spouse [prevalence rate (PR) ratio-7.76; 95confidence interval (CI); 3.08-9.42]; and in men; it was lack of home smoking restriction (PR ratio-6.35; 95CI; 4.51-8.93). Among men; SHS exposure at any location was associated with lack of secondary school education; residing in slum apartment (house with many households); living with a smoking family member (non-spouse); lack of home smoking restriction; and alcohol intake. Among women; SHS exposure at any location was associated with having a smoking spouse; residing in slum apartment and lack of home smoking restriction. Seventy-two percent of respondents were aware of the harmful effects of SHS on their health. Lack of awareness of the harmful effects was significantly associated with increasing age (r= +0.45; P = 0.01); lack of secondary school education (rof the employees reported availability of outdoor smoking area at their workplaces. Conclusion: Our results show that prevalence of SHS exposure was the highest in public places. These findings underscore the need for enactment of comprehensive smoke-free legislation and implementation of educational strategies to reduce SHS exposure in homes
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Adult , Inhalation Exposure , Prevalence , Tobacco Smoke PollutionABSTRACT
Primarily double chamber of Right ventricle (DCRV) is an uncommon congenital anomaly consists of one or more anomalous muscle bundles(AMB) that divide Right ventricle into proximal high and distal low pressure chamber .Outcome of surgical treatment is excellent if diagnosed properly. A 5years old girl presented with breathlessness on exertion and repeated attack of cough, fever for last 4 years .patient ultimately diagnosed as DCRVand underwent intracardiac repair by open heart surgery. Her postoperative outcome was uneventful. Patient is discharged on 8th postoperative day after follow up postoperative chest X Ray and Echocardiography .
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To assess the pattern of use and impact of patient sitters on the quality of healthcare in Taif Armed Forces Hospital, Taif, Kingdom of Saudi Arabia [KSA]. A cross-sectional survey was conducted at the Armed Forces Hospital, Taif Region, KSA from 1st January to 30th March 2008. The study included 203 admitted patients, 125 patient sitters, and 213 physicians and nurses. Three different questionnaires were specifically designed for each group of participants including information on the pattern and duration of patient sitting, and potential benefits and harm among sitters. Approximately 58.4% of the participating sitters were women, 88% were Saudis, with age range from 17-60 years old, and mean [ +/- standard deviation] of 33.0 [ +/- 9.64] years. More than 73% of the sitters have regular jobs. Types of the room and patient's age were the significant predictors for the presence of sitters. Patient satisfaction was not significantly associated with the presence, or absence of patient sitters. Pattern and use of patient sitters in Saudi Arabia is unique where socio-cultural factors play the most important role. This study is another reminder to the healthcare system in KSA, as well as other Arab countries to develop policies that clearly specify patient criteria that support the decision of patient sitter use
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Humans , Male , Female , Quality of Health Care , Rehabilitation Centers , Social Class , Self-Help DevicesABSTRACT
The association of Down syndrome (DS) with congenital cardiovascular malformation is well established. Complete atrioventricular septal defects have been associated most commonly with DS. There are also reports of VSD, ASD, TOF and PDA with DS. We here reported two patients of Down syndrome with ventricular septal defect (VSD), underwent repair of VSD, diagnosis was suggested by echocardiography and confirmed by surgery and chromosomal study. Both the patient discharged from hospital with good result. Survival and quality of life have been improving in patient with Down syndrome after repairing VSD.
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Repair of Total Pulmonary venous connection (TAPVC) continues to be associated to significant mortality and morbidity.We here reported a female patient of two and half years, underwent rechanneling of supracardiac TAPVC, diagnosis was suggested by Echocardiography and confirmed by catheter-angiography which allowed definition of the anatomy. The patient has got fluent pulmonary venous drainage and her heart function resumed to NYHA I. TAPVC should be operated on immediately at definite diagnosis, the fluency of common pulmonary vein-left atrium anastomosis and proper post operative care can ensure a satisfactory outcome.
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Background: Fast-track recovery protocols in cardiac surgery is gaining worldwide popularity and have contributed to significant reductions in the postoperative hospital stay and cost without any increase in postoperative mortality and morbidity. The aim of this study was to find out the feasibility of fast track paediatric cardiac surgery in Bangladeshi setting. Method: It was a prospective study conducted in National Institute of Cardio-vascular Diseases, Dhaka, from July 2009 to June 2010. All patients, between 3 to 18 years, underwent surgical closure of atrial or ventricular septal defect under cardio-pulmonary bypass. 20 patients from our unit served as fast track group and 30 patients from other units of the same hospital served as conventional group. Fast track patients were extubated in less than 6 hours after surgery, shifted from ICU in less than 24 hours and geared up to discharge home within 3 days of surgery. Result: 18 (90%) of the 20 patient of the fast track group were discharged within 3 days of surgery, 2 patients cannot be discharged within this time frame. Mean post operative hospital stay for study group was 3.1 days, whereas the mean hospital stay in the control group was 7.5 days. Follow-up was 100% complete at 30 days. There was no major in-hospital or out-of-hospital complications in either group. No patient was readmitted at our centre or elsewhere for any complication arising from this process. Conclusion: Fast tracking is feasible and safe in low-risk paediatric open-heart surgery in Bangladeshi scenario. A multidisciplinary approach with a set protocol is required to achieve this goal in a safe and reproducible manner.
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In elderly patients the tolerance of elbow joint to immobilization is very poor and stiffness develops easily, so conservative treatment is not suitable method for intraarticular fractures of the distal humerus. Although open reduction and internal fixation is the treatment of choice for these fractures in adults, in elderly patients disagreement remains on how to treat these fractures. Also the reports on the functional results after internal fixation of these fractures in elderly patients are rare. The purpose of this study is to evaluate the results of open reduction and stable internal fixation for treatment of intra-articular fractures of distal humerus in elderly patients above 60 years old. 10 patients with 10 intr a-articular fractures of distal humerus. The average age was 63 years [ranged 60-73 years]. There were sex females [60%] and four male [40%]. The right side was affected in seven patients [70%] and left side in three patients [30%]. The fractures were classified according to the AO/ASIF classification. There was one fracture [10%] type B1, four fractures [40%] type C1, three fractures [30%] type C2 and two fractures [20%] type C3. All the patients were treated by open reduction and internal fixation through a posterior approach. The average follow up period was 18 months [ranged 12-32 months] During it the patients were examined both clinically and radiographically for union of the fractures, Post-traumatic arthritis, range of motion, the elbow and forearm, muscle strength, degree of pain, return to previous activities. The final results tuere evaluated according to the Mayo Elbow scoring points system. Average time to union were 3.5 months [ranged 2-4.5months]. Four patients [40%] had Post-traumatic arthritis of the elbow [three patients with mild degree and one patient with severe degree]. The motion at the elbow was mainly affected, the median arc of flexion/ extension was 1000 [ranged 600-1300]. The forearm motion was not affected and it was near normal in all of the cases. The final clinical results were excellent in three patients [30%], good in five patients [50%], fair in one patient [10%], and poor in one patient [10%]. Open reduction and internal fixation of distal humeral intra-articular fractures in elderly patients can achieve excellent and good results in majority of the patients. Advancing age is not a contraindication for open reduction and internal fixation of these fractures
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Humans , Male , Female , Fracture Fixation, Internal , Aged , Postoperative Complications , Follow-Up StudiesABSTRACT
Treatment of a mallet finger due to an intra-articular fracture of the distal phalanx involving one-third or more of the articular surface is controversial Twenty one mallet fractures involving more than 33% of the articular surface and fractures associated with subluxation of the distal phalanx that could not be corrected by closed reduction are treated with an extension block pin and transarticular fixation of the distal interphalangeal joint. The average patient age was 26.8 years and the average fracture size was 40.5% of the joint surface. The average delay after injury was 5.6 days [range, 0-14 days] Average time to fracture union was 32 days. The average active flexion of the distal interphalangeal joint was 81.2° and the average extensor lag was 1.4°. There were no major complications. Using the established outcome criteria for mallet injuries, 95.2% had excellent or good results. This surgical technique resulted in rapid fracture union with only minor complications and has excellent functional outcome
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Humans , Male , Female , Fractures, Bone , Fracture Fixation , Treatment OutcomeABSTRACT
Background: The antifibrinolytic drug tranexamic acid (TA) decreases blood loss in Pediatric patients under going cardiac Surgery. However its efficacy has not been extensively studied in children. Method: We examined 750 children under going cardiac surgery form 2004 to 2007 in National Institute of Cardiovascular Diseases (NICVD), 379 children in the Tranexamic Acid group (TA) and 371 included in placebo (P) group. After induction of anesthesia and prior to skin incision, patients received either tranexamic acid (10mg/kg followed by 1mg/kg/hr) and saline placebo. After admission to intensive care unit total blood loss and transfusion requirements during the first12 hours were recorded. Result: Children who were treated with tranexamic acid had 24% less total blood loss (26±7 vs 34±17 ml/kg) compared with children who received placebo (p<0.05). Additionally, the total transfusion requirements, total donor unit exposure and financial cost of blood components were less in the tranexamic acid group. Conclusion: Tranexamic acid can reduce perioperative blood loss in children undergoing cardiac surgery.
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To determine the prevalence of both pre-hypertension and hypertension, and risk factors associated with the newly diagnosed Saudi military active duty personnel. A community-based cross-sectional screening of 1238 Saudi military active duty service personnel was conducted during the period from September to December 2007 at the military units of Taif region, western Saudi Arabia. Screening tools included self-administrated questionnaire, general physical examination, anthropometric measurements, and assessment of blood pressure. All participants were Saudi males. Their age ranged from +/- 7.02. By applying the Joint National Committee on prevention, detection, evaluation, and treatment of high hypertension criteria, 214 [17.3%] were considered pre-hypertensive. Multivariate logistic regression analysis showed that obesity as measured by body mass index [odds ratio [OR]=2.71, confidence interval [CI]: 1.39-5.28], positive family history [OR=1.46, CI: 1.03-2.06], ever smoking [OR=1.45, CI: 1.05-2.02], and increased waist circumference [OR=1.04, CI: 1.02-1.06] were the significant predictors of hypertension among military active duty personnel. Pre-hypertension is a common hidden problem and it predicts the development of frank hypertension. Findings of the current study support the recommendation of lifestyle modification for pre-hypertension patients. However, further prospective studies are required to determine the role of pharmacotherapy in pre-hypertension