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ABSTRACT Background: In natural history of cirrhosis, variceal bleeding is one of the earliest decompensations to happen, and, if adequately managed, survival is improved. Gastric varices have challenges in management due to their location, size and propensity to bleed. The N-butyl 2-cyanoacrylate (NBC) glue application has emerged as definitive therapy in bleeding gastric varices. Here we present our experience with use of NBC in management of gastric and difficult cases of esophageal varices. Methods: A total of 75 patients underwent NBC glue application for varices which included 69 patients with gastric varices and six patients with esophageal varices. All the procedures were done with flexible endoscope and sclerotherapy needle after due precautionary measures. Results: Hemostasis was varices in all patients after endotherapy. The average quantity of glue used was 2.75±0.95 mL. Complete obliteration with single session of NBC application was achieved in 55 patients. Re-bleeding occurred in five patients within 5 days of index event. 20 patients had in-hospital mortality but none was related to gastrointestinal bleeding. 6-week all-cause mortality was 26 (35%). Conclusion: Glue therapy with NBC is a life saving therapy in patients with bleeding gastric varices and esophageal varices not amenable to endoscopic variceal ligation or sclerotherapy.
RESUMO Contexto: Na história natural da cirrose, o sangramento de varizes é uma das primeiras descompensações a acontecer e, se adequadamente controlada, a sobrevivência é melhorada. Varizes gástricas têm desafios na sua gestão devido à sua localização, tamanho e propensão a sangrar. A aplicação de cola N butil 2-cianoacrilato (NBC) surgiu como terapia definitiva em varizes gástricas sangrantes. Apresentamos nossa experiência com o uso da NBC na gestão de casos gástricos e difíceis de varizes esofágicas. Métodos: Um total de 75 pacientes foram submetidos à aplicação de cola NBC para varizes que incluiu 69 pacientes com varizes gástricas e seis pacientes com varizes de esôfago. Todos os procedimentos foram feitos com endoscópio flexível e agulha de escleroterapia após as devidas medidas de precaução. Resultados: A hemostasia foi alcançada em todos os pacientes após a endoterapia. A quantidade média de cola utilizada foi de 2,75+0,95 mL. A obliteração completa com sessão única de aplicação da NBC foi alcançada em 55 pacientes. O reexame ocorreu em cinco pacientes dentro de 5 dias após o evento de índice. 20 pacientes tiveram mortalidade hospitalar, mas nenhum foi relacionado com o sangramento gastrointestinal. A mortalidade após 6 semanas foi de 26 (35%). Conclusão: A terapia de cola com a NBC é uma terapia que salva vidas em pacientes com varizes gástricas hemorrágicas e varizes esofágicas não condizíveis à ligadura endoscópica ou escleroterapia.
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We aimed to emphasise the role of screening beyond conventional serological markers (HBsAg and Anti HCV antibodies for chronic viral hepatitis B and C respectively) in patients with cirrhosis. Patients with cirrhosis of liver are often labelled as having cryptogenic cirrhosis (CC), if no etiology is found. In chronic viral hepatitis B and C (CHB and CHC) induced cirrhosis, HBsAg and Anti HCV antibodies respectively are usually done to rule out the viral infections however their absence have been documented in subset of patients having these infections. In this regard, we hereby present a case labelled as CC and developed HCC; later on, further evaluation turned out to be having both CHB and CHC. A 51-year-old male with diabetes presented with index episode of hemetemesis. On further evaluation he was diagnosed to have cirrhosis of liver. No etiology was found and he was labeled as cirrhosis secondary to Non-alcoholic steatohepatitis (NASH)/cryptogenic cirrhosis. Later on, he developed hepatocellular carcinoma (HCC). We evaluated the patient with HBV DNA and HCV RNA levels keeping possibility of occult hepatitis B (OBI)/ seronegative hepatitis C infection despite HBsAg and Anti HCV antibodies being negative. Both levels were found to be raised and we attributed cirrhosis to dual hit by CHB and CHC. Patient was managed with antiviral drugs successfully with no recurrence of HCC and control of blood sugar levels. We hereby stress that screening beyond the HBsAg and Anti HCV antibodies should be done in all cases of liver cirrhosis in which etiology is not found on initial screening.
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Introduction: In India, Hypertension (HT) has emerged as a leading risk factor for mortality. The burden of hypertension in India is expected to almost double from 118 million in 2000 to 213.5 million by 2025. Objective: Anthropometric analysis of the Sub-Himalayan population suffering from HT with calculation of the cut-off point to predict HT. Methodology: Cross sectional study was carried out on 63 healthy and 51 hypertensives. Results: The waist circumference (WC), waist to height ratio (WHtR) and body mass index (BMI) cut-off point to predict hypertension was found to be 93.5cm, 0.54 and 24.58kg/m2 in men and 88.5cm, 0.59 and 25.3kg/m2 in females respectively. Conclusion: BMI is considered as the best indicator to predict HT in males with a cut-off point of 24.58kg/m2 and in females, WHtR was found to be the best indicator to predict HT with a cut-off point of 0.59.
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Introduction: Palatal rugoscopy is the study of palatal rugae pattern. Rugae pattern remain unchanged during an individual's life time. Personal identification can be possible based on the rugae pattern since palate would remain intact till 7 days after death; due to their internal position in the head when most other anatomical structures are destroyed or burned. Rugae pattern is as unique to a human as his or her fingerprints. Objectives: The purpose of the study was to identify the palatal rugae patterns in Rwandan patients attending the Dental Dept at King Faisal Hospital; Kigali; Rwanda and to find sexual differences if any. Methods: 114 maxillary study models of 51 males and 63 females were randomly obtained from the Dental Clinic of King Faisal Hospital; Kigali; Rwanda; and from the Dental Clinic of Polyclinique La Medicale; Kigali; Rwanda. Different types of rugae patterns and their orientation in relation to the mid-palatal raphe were evaluated. Results: The study revealed that although there were some significant differences in the pattern and orientation of rugae in both genders and on both sides of palate; there was no significant sexual dimorphism regarding the total number of rugae. The females showed more of the wavy type of rugae; while males had curved type. Their orientation was also found to be significantly different in both the genders. Conclusion: It can be concluded that different rugae patterns and rugae orientation are present which show sexual dimorphism among the Rwanda population. But further studies are needed to corroborate these findings. Rugae pattern can be used as an additional method of identification in forensic science
Subject(s)
Palatal Expansion Technique , Palate , Practice Patterns, Dentists'ABSTRACT
Background: Dental malocclusion is present in all societies but its prevalence varies. Identifying occlusal problems; their incidence and the need for treatment can help to determine the appropriate awareness plans; preventive and interceptive treatment and manpower needed in orthodontics. There is no study of such kind to evaluate the pattern of malocclusion in Rwandese population. Aim: The aim of the study was to analyze and to provide quantitative information on the pattern of dental malocclusion among orthodontic population in Rwanda. Methods: Various parameters retrieved from patients' records of 243 selected patients with dental malocclusion who visited Dental Department of King Faisal Hospital; Rwanda; during the period of January 2009 to July 2012 were analyzed in this retrospective study. Chi-square test was used to find the gender difference at p 0.05. Results: Angle's Class I malocclusion was found to be the most common malocclusion with 60.9 followed by 28.8 Angle's class II and 10.3 Angle's class III. Increased crowding (71.2 ) was the most common problem; followed by increased overjet; deep bite and anterior open bite in that order. No significant gender differences were found except in deep bite. Conclusion: The results give a pattern of malocclusion in orthodontic patients and may provide a base line data for planning awareness programs; preventive and interceptive orthodontic services et the future studies. There is a strong need of multicentric; epidemiological survey to find out the prevalence et causes of malocclusion in Rwandese population
Subject(s)
Dental Bonding , Dental Occlusion , Malocclusion , PatientsABSTRACT
Background: Neuropsychological deficits are common among epileptic children and these deficits of epileptic children may be influenced by factors like age, gender, frequency of seizures, duration of seizures, age at onset of seizures, type of seizures and family history. Material and Method: A non experimental research design was utilized to assess the Neuropsychological Deficits among Sample of 60 children with epilepsy, with age group of 8-16 years, attending outpatient neurology unit of Christian Medical College & Hospital, Ludhiana, Punjab. Symptom checklist -90 was used to assess the psychological deficits and Performance of intelligence to assess neurological deficits was assessed with the help of Bhatia’s Battery. Analysis and interpretation of data was done by using descriptive and inferential statistics. Results: Out of 60 patients, 60% of epileptic children were free of psychological deficits, 36.7% had mild and 3.3% had moderate level of psychological deficits. Children had maximum psychological deficits score (50.08%) in anger hostility related symptoms and least (12.75%) in phobic anxiety symptoms. 43% of epileptic children had borderline and dull normal IQ level which indirectly represented neurological deficits, maximum in cognition i.e. 43.33% and lowest in loss of coordination or loss of fine motor control. Epileptic children had more mean percentage neurological deficits score but with little difference in both Koh’s block design test (68.6%) and in ‘Pattern Drawing Test’ (68.1%) i.e. they had more problems related to the analytical- synthetics ability and the lowest mean percentage neurological deficits score (19.2%) were in “Immediate Memory Test”. Conclusion: Epileptic patients suffers from various degrees of neuropsychological problems, which if could be recognized early and intervened in time can further reduce the disability among these children’s and will lower the psychosocial impact of epilepsy at large.
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The present study has been undertaken to investigate the effect of exendin-4 (a glucagon-like peptide-1 agonist) in diabetes mellitus (DM) and hyperhomocysteinemia (HHcy)-induced vascular endothelial dysfunction (VED). Streptozotocin (55 mg kg−1, iv, once) and methionine (1.7% w/w, po, 4 weeks) were administered to rats to produce DM (serum glucose >200 mg dl−1) and HHcy (serum homocysteine >10 μM) respectively. VED was assessed using isolated aortic ring preparation, microscopy of thoracic aorta, and serum nitrite/nitrate concentration. Serum TBARS concentration was estimated to assess oxidative stress. Atorvastatin has been employed as standard agent. Exendin-4 (1 μg kg−1, ip) and atorvastatin (30 mg kg−1, po) treatments significantly attenuated increase in serum glucose and homocysteine but their concentrations remained markedly higher than sham control value. Exendin-4 and atorvastatin treatments markedly prevented DM and HHcy-induced (i) attenuation of acetylcholine-induced endothelium-dependent relaxation, (ii) impairment of vascular endothelial lining, (iii) decrease in serum nitrite/nitrate concentration, and (iv) increase in serum TBARS. However, this ameliorative effect of exendin-4 has been prevented by L-NAME (25 mg kg-1, ip), an inhibitor of NOS. It may be concluded that exendin-4 may activate eNOS due to activation of GLP-1 and consequently reduce oxidative stress to improve vascular endothelial dysfunction.