Laboratory reports as a learning tool – Early clinical exposure in 1st-year MBBS physiology (Hematology)

Background: Early clinical exposure (ECE) aims to bridge the gap between pre-clinical and clinical subjects. ECE exposes students to the health-care system at an early stage of professional life, follows patient-centered approach, and increases motivation for classroom learning. Most of the studies have reported a positive attitude of students toward ECE. However, very few studies have reported the difficulties that may be faced by the students during implementation of ECE. Aim and Objectives: The aim of this was to explore the attitude of students and difficulties faced if any during implementation of ECE in 1st MBBS Physiology (Hematology) with the help of laboratory reports and clinical scenarios. Materials and Methods: One hundred and ten students participated after completion of theory and practical classes of hematology. Clinical scenarios and laboratory forms were prepared based on actual laboratory reports of patients from pathology department. Group discussions and discussion with faculty was done. Attitude of the students was noted. Results: Most of the students found this method to be interesting and better than routine methods, helped in better understanding of theory and practical concepts, and helped in better preparation for examinations and better clinical correlations. However, about half of the students agreed or were not sure about the difficulty of ECE. Conclusion: The positive attitude of the students shows that ECE provides a successful integration of basic science and clinical subjects. It also helps in understanding the relevance of a basic science subject. Concepts of the subjects are made easier and interesting by ECE. However, the difficulties faced by the students should be kept in mind and more practice sessions may be done

Treatment outcomes and adverse drug reactions among patients with drug-resistant tuberculosis receiving all-oral, long-term regimens: First record viewing report from Pakistan

Objective: To assess the effectiveness and adverse drug reactions of all-oral regimens for patients with multidrug-resistant tuberculosis. Methods: This retrospective study was conducted at 10 Programmatic Management of Drug Resistant Tuberculosis sites in Punjab province of Pakistan. Patients receiving treatment for drug resistant tuberculosis from July 2019 to December 2020 with at least interim result i.e. 6th month culture conversion or final outcomes (cured, complete, lost to follow-up, failure, death) available, were included in the study. Data was extracted from electronic data management system. For the reporting and management of adverse drug events, active tuberculosis drug safety monitoring and management was implemented across all sites. All the data was analyzed using SPSS version 22. Results: Out of 947 drug resistant tuberculosis patients included in this study, 579 (68%) of the patients had final outcomes available. Of these, 384 (67.9%) successfully completed their treatment. Out of 368 (32%) patients who had their interim results available, all had their 6th month culture negative. Combining new medications was thought to result in serious adverse outcomes such as QT prolongation. However, this study did not record any severe adverse events among patients. Conclusions: All-oral regimens formulation guided by overall treatment effectiveness resulted in treatment outcomes comparable to those obtained with traditional injectable treatment.

Dyspnea, Obstruction, Smoking, Exacerbation Index, and Chronic Obstructive Pulmonary Disease Test Score: Correlation in Predicting Outcomes in Patients with Chronic Obstructive Pulmonary Disease Exacerbations

Objectives: Chronic obstructive pulmonary disease (COPD) being a disease with systemic consequences necessitate the use of multidimensional indices for a comprehensive assessment of the disease's impact including the future risk of exacerbations and mortality. To study the role of dyspnea, obstruction, smoking, and exacerbation (DOSE) index as a predictor of future disease severity and its correlation with chronic obstructive pulmonary disease test (CAT) score. Measurements and results: A total of 60 inpatients with COPD exacerbations were followed up for 6 months to record the number of exacerbations of COPD. The DOSE index and CAT score were calculated after stabilization within 48 hours of admission, at 1 week, and again at 6 months. The mean difference between DOSE index score at admission and at 1 week was 1.382 � 0.561 and at admission and at 6 months was 2.15 � 0.988, both being statistically significant (p < 0.001). A high DOSE index score (?4) was associated with a greater risk of 2 or more exacerbations [odds ratio (OR), 12 (3.09�.60) and risk estimate, 3.75 (1.53�17)]. For the prediction of exacerbations, the area under the curve (AUC) was larger for the DOSE index (0.854) than the global initiative for chronic obstructive lung disease (GOLD) stage (0.789), p < 0.001 for both. Furthermore, DOSE index correlated significantly with the CAT score, an established health status measure, at all stages of disease severity; at the onset of exacerbation (r = 0.719, p < 0.001), after stabilization at 1 week (r = 0.736, p < 0.001) and at 6 months (r = 0.884, p < 0.001). Conclusion: The DOSE index is a simple, practical multidimensional grading tool for assessing current symptoms, health status, and future risk in COPD and acts as a guide to disease management as its component items can be modified by interventions. Its correlation with CAT, a well-known score is a novel observation, which further corroborates the validity of the DOSE index.

El largo camino de la tricotilomania al síndrome de Rapunzel / The Long Road from Trichotillomania to Rapunzel Syndrome

Introducción: La tricotilomania, la tricofagia y el tricobezoar son afecciones entrelazadas e interconectadas. Estas deben tenerse en cuenta especialmente en féminas jóvenes que a menudo tienen una enfermedad psiquiátrica o trastorno social subyacente y es posible que la historia sea difícil de obtener. Objetivo: Presentar un caso portador de tricobezoar gástrico, por su baja incidencia en nuestro medio y a nivel mundial. Caso clínico: Paciente femenina de 12 años de edad, con antecedentes de retraso psicomotor, sin seguimiento o tratamiento previo. Acudió a consulta traída por su madre que aduce aumento de volumen en hemiabdomen superior de 5 años de evolución con pérdida de peso insidiosa. Los estudios radiológicos revelaron un tricobezoar gástrico que se corrobora, asociado a un síndrome de Rapunzel, en la laparotomía exploratoria. La paciente evolucionó satisfactoriamente y es seguida por grupo multidisciplinario. Conclusiones: Los bezoares gástricos son entidades poco frecuentes. Para el diagnóstico es necesario un alto índice de sospecha de conjunto con estudios radiográficos y/o endoscópicos. El tratamiento estará determinado por el tipo de bezoar, tamaño y consistencia. La opción quirúrgica es la más usada, con el consecuente seguimiento interdisciplinario para evitar recurrencias(AU)

Introduction: Trichotillomania, trichophagia and trichobezoar are intertwined and interconnected conditions. These should be considered, especially in young women who often have an underlying psychiatric illness or social disorder and possibly a history difficult to get. Objective: To report a case of gastric trichobezoar due to its low incidence in our environment and worldwide. Clinical case report: We report the case of a 12-year-old female patient with a history of psychomotor retardation, with no prior follow-up or treatment, who came to consult with her mother, complaining of increased volume in the upper abdomen, of 5 years of evolution with malignant weight loss. Radiological studies reveal a gastric trichobezoar that is corroborated, associated with Rapunzel syndrome, in the exploratory laparotomy. The patient evolved satisfactorily and a multidisciplinary group assisted her. Conclusions: Gastric bezoars are rare entities. Diagnosis requires high level of suspicion together with radiographic and/or endoscopic studies. The treatment will be determined by the type of bezoar, size and consistency. The surgical option is the most used, requiring interdisciplinary follow-up to avoid recurrences(AU)

Neglected basicervical neck of femur fracture treated with closed reduction and internal fixation with a cephalomedullary nail alone: A case report

A fractured neck femur presenting beyond 3 weeks is referred to as a neglected fracture. The current literature is silent about neglected Basicervical fractures. The latter behave more like an intertrochanteric fracture and thus are less prone to complications such as non-union and avascular necrosis. We report a case of an adult male of 42-year-old of age presenting with a 10-month-old history fracture neck of the left femur following high energy injury. We treated the fracture with isolated closed-reduction and internal fixation with PFNA II, as the fracture was basicervical. We have achieved a union in 6 months of surgery. The patient had an excellent functional status 1-year follow-up.

In Vitro Evaluation of Dalbergia sissoo and Acacia modesta gum as Pharmaceutical Binders for Drug Delivery System

Abstract The present study aimed to compare the crude, modified and hydrolyzed gums of Dalbergia sissoo and Acacia modesta as a biodegradable binder for drug delivery system using acetaminophen as a model drug. The physiochemical properties such as pH, fluorescence analysis and swelling index were determined. The gums were hydrolyzed and modified. Acetaminophen tablets were prepared using wet granulation technique and the gum solutions were used as a binder. Hydroxypropyl methylcellulose was used as a synthetic binder. Different properties of granules and tablets were evaluated. Results showed that both gums were acidic in nature, while D. sissoo and A. modesta showed light brown and creamy color in fluorescence analysis. The swelling ratio was the highest in water followed by 0.1N HCl and least in phosphate buffer. The prepared tablets showed faster and slower dissolution profiles in the same dissolution system. The crude gums have the highest dissolution rate, and this rate was decreased in the case of modified and hydrolyzed gums samples. The crude gums showing slower release can be useful in sustained-release tablets, while the modified gums having faster release rate are helpful in conventional tablet formulation. Taken together, the selected gums could be a good model for evaluation as a binder or hydrophilic polymer in tablet formulation.

Autoimmune Sclerosing Cholangitis in Children: A Prospective Case-Control Study / 대한소아소화기영양학회지

Purpose@#In children overlap of autoimmune hepatitis (AIH) and primary sclerosing cholangitis is labelled as autoimmune sclerosing cholangitis (ASC). The only prospective pediatric study showed a high prevalence of ASC by using endoscopic retrograde cholangiopancreatography. Aims of our study were to find the prevalence of ASC by using magnetic resonance cholangiography (MRC) in AIH and in non-AIH cirrhosis and to compare clinical presentation and outcome of AIH and ASC. @*Methods@#Prospectively we did MRC in 38 children with AIH (cases) and 19 disease controls (Wilson disease). Multiple biliary strictures with proximal dilatation on MRC were taken as definitive changes of ASC. Detail clinical, laboratory parameters, liver histopathology and treatment outcome were recorded. @*Results@#The median age of cases was 11.5 (3–18) years, 22 (57.9%) were girls and 28 (73.7%) were diagnosed as type 1 AIH. MRC was done in 11 children (28.9%) at the time of diagnosis and in 27 (71.1%) after a median follow-up of 2.5 (0.3–10) years. Abnormal MRC changes were seen in 14/38 (36.8%) of AIH and 8/19 (42.1%) of controls. However, definite changes of ASC were present in four (10.5%) children in AIH and none in controls. None of the clinical, laboratory, histological parameters and treatment response were significantly different between ASC and AIH groups. @*Conclusion@#The prevalence of ASC in children with AIH was just 10.5%. We suggest MRC in select group with cholestatic features, inflammatory bowel disease and in those who showed poor response to immunosuppression instead of all children with AIH.

Autoimmune Sclerosing Cholangitis in Children: A Prospective Case-Control Study / 대한소아소화기영양학회지

Purpose@#In children overlap of autoimmune hepatitis (AIH) and primary sclerosing cholangitis is labelled as autoimmune sclerosing cholangitis (ASC). The only prospective pediatric study showed a high prevalence of ASC by using endoscopic retrograde cholangiopancreatography. Aims of our study were to find the prevalence of ASC by using magnetic resonance cholangiography (MRC) in AIH and in non-AIH cirrhosis and to compare clinical presentation and outcome of AIH and ASC. @*Methods@#Prospectively we did MRC in 38 children with AIH (cases) and 19 disease controls (Wilson disease). Multiple biliary strictures with proximal dilatation on MRC were taken as definitive changes of ASC. Detail clinical, laboratory parameters, liver histopathology and treatment outcome were recorded. @*Results@#The median age of cases was 11.5 (3–18) years, 22 (57.9%) were girls and 28 (73.7%) were diagnosed as type 1 AIH. MRC was done in 11 children (28.9%) at the time of diagnosis and in 27 (71.1%) after a median follow-up of 2.5 (0.3–10) years. Abnormal MRC changes were seen in 14/38 (36.8%) of AIH and 8/19 (42.1%) of controls. However, definite changes of ASC were present in four (10.5%) children in AIH and none in controls. None of the clinical, laboratory, histological parameters and treatment response were significantly different between ASC and AIH groups. @*Conclusion@#The prevalence of ASC in children with AIH was just 10.5%. We suggest MRC in select group with cholestatic features, inflammatory bowel disease and in those who showed poor response to immunosuppression instead of all children with AIH.

Physiological effect of cholecystectomy on lipid profile of patients with cholelithiasis

Background:The association of cholecystectomy with alterations in lipid profile is well documented. Objectives of this study were to determine the effect of cholecystectomy on lipid profile of cholelithiasis patients.Methods:This cross-sectional observational study was done on 170 patients admitted in general surgery department of Naz Memorial Hospital, Karachi from July 2018 to June 2019. Symptomatic cholelithaisis patients between 18 to 60 years, elective cholecystectomy was included while patients previously on lipid lowering agents, diagnosed renal failure, nephrotic syndrome, cardiac failure, pregnant mothers, hypothyroidism, pancreatitis and obstructive jaundice were excluded. For data analysis, SPSS was used. Wilcoxon signed ranked test was used to compare mean values of pre-and post-operative lipid profiles after cholecystectomy keeping p value of <0.05 as significant.Results:60% of patients were females with majority, 31% patients between 31-40 years while least, i.e. 11% were between 61-70 years. The mean pre-operative and post-operative difference of 52±7.32 mg/dl was seen in total cholesterol levels (p<0.001). The mean difference in high density lipoprotein (HDL)between preand post-operative was of 13±0.36 mg/dl (p<0.001). The mean difference in low density lipoprotein (LDL) between preand post-operative was 61±10.45 mg/dl (p<0.001). The mean difference in triglycerides levels between preand post-operative was 46±25.49 mg/dl (p<0.001).Conclusions:Cholecystectomy in gall stone disease patients elicited favorable response in significantly lowering levels of total serum cholesterol, LDL and triglycerides while substantially increasing levels of HDL cholesterol.

Association of Central Corneal Thickness with Age and Serum Electrolytes in Hypertensive and Non-Hypertensive Patients

Background and Objectives: The normal Central corneal thickness (CCT) ranges about 510-520 microns. It is normally seen in clinical practice that corneas which are thicker are linked with greater intraocular pressures (IOPs). The purpose of the study was to determine the central corneal thickness and establish its relationship with age and serum electrolytes in hypertensive and non-hypertensive patients. Methodology: A total of 108 subjects were included in our cross-sectional comparative study (54 hypertensive and 54 non-hypertensive). Written informed consent was taken. We measured blood pressure with mercuric sphygmomanometer. Ultrasound pachymeter was used to measure central corneal thickness while we drew 5 ml of blood for estimation of the serum electrolytes. Data was entered and evaluated using IBM SPSS 17. Quantitative variables were presented as Mean ± SD. Pearson correlation was used to find correlation of normally distributed variables p-value ≤ 0.05 was considered to be statistically significant. Results: Central corneal thickness was statistically same in hypertensive and non-hypertensive subjects. Serum Na+ was significantly increased in hypertensive subjects while serum K+ and Cl- were significantly decreased in hypertensive subjects. No significant correlation was seen in hypertensive while weak negative correlation was observed between CCT and age in non-hypertensive patients. Weak positive correlation was observed between CCT and Na+ both in hypertensive and non-hypertensive. Significant correlation was observed in CCT and K+ in hypertensive while negative correlation was seen in non-hypertensive. Weak correlation was observed in CCT and Cl- both in hypertensive and non-hypertensive. Conclusion: Mean CCT was significantly lower in hypertension. CCT and age showed weak and positive correlation in hypertensive while weak and negative correlation in non-hypertensive. Serum electrolytes and CCT showed no significant correlation.

Role of preoperative MR volumetry in patients with renal cell carcinoma for prediction of postoperative renal function after radical nephrectomy and nephron sparing surgery

ABSTRACT Purpose Preoperative computed tomography or magnetic resonance (MR) imaging are commonly used for radiological evaluation of renal cell carcinoma (RCC) before radical nephrectomy or nephron sparing surgery(NSS). This study aimed to assess the role of MRI for predicting postoperative renal function by preoperative estimation of renal parenchymal volume and correlation with glomerular filtration rate (GFR). Materials and Methods A prospective observational study was conducted from February 2015 to October 2016 at a tertiary care hospital in northern India. MR imaging was done on 3 Tesla MR scanner (Signa Hdxt General Electrics, Milwaukee, USA). MR volumetry was used to estimate the renal parenchymal volume. GFR was measured in all patients using Tc99m Diethyl-triamine-penta-acetic acid using Russell's algorithm. Such measurement was done preoperatively, and postoperatively 3 months after surgery. Results 30 patients with suspected RCC underwent NSS (n=10) and radical nephrectomy (n=20). Median tumour volume was 175.7cc (range: 4.8 to 631.8cc). The median volume of the residual parenchyma on the affected side was 84.25±41.97cc while that on the unaffected side was 112.25±26.35cc. There was good correlation among the unaffected kidney volume and postoperative GFR for the radical nephrectomy group (r=0.83) as well as unaffected kidney volume, total residual kidney volume and residual volume of affected kidney with postoperative GFR for the NSS group (r=0.71, r=0.73, r=0.79 respectively; P <0.05). Conclusion Preoperative residual parenchymal volume on MR renal volumetry correlates well with postoperative GFR in patients with RCC undergoing radical nephrectomy or NSS.

Expression of Salivary Resistin in Oral Premalignant Individuals

Introduction:Resistin, (Retn) a pro -inflammatory cytokine, accumulates at the site of inflammation.It is found to be elevated in chronic inflammation. The aim of this present study is to evaluate the levels of salivary resistin in healthy individuals and in patients with Oral pre-malignant lesion.Materials and Methods: This case control study comprises of total 90 patients which includes 45 healthy controls and 45 cases diagnosed with oral pre-malignant lesions. Salivary levels of resistin and clinical parameters were evaluated in all of them. Socio -demographic data (age, gender and residence) was collected from all participants through a questionnaire. In addition, we also recorded the total duration of tobacco usage (in years), daily frequency, and intra-oral examination and oral hygiene practices. This was followed by evaluation of clinical parameters of oral premalignant lesions and investigation of salivary levels of resistin through ELISA Results: Thesaliva of all the patients showed presence of resistin. On analyzing the samples present study shows no significant difference and variation in the salivary levels of resistin in healthy and OPML patients.Conclusion: With the results of this study, it can be concluded that there is no significant difference in the salivary levels of resistin in healthy individuals and individuals diagnosed with oral pre-malignant lesion

Comprehensive Account on Prevalence and Characteristics of Hydatid Cysts in Livestock from Pakistan

Pakistan is at intersection of hyperendemic regions for hydatidosis. Current study aimed to determine the prevalence of hydatid cysts and cyst characteristics in different intermediate hosts (sheep, goats, cattle and buffaloes) across the 4 provinces of Pakistan. A total of 991 sheep, 1,478 goats, 1,602 cattle and 1,343 buffaloes were examined for presence of hydatid cysts during 2 years (January 2016-December 2018). Differences in frequency of hydatidosis were observed with highest overall prevalence in buffaloes (11.9%) and sheep (11.5%). Highest prevalence and burden of infection were observed in older age animals (23.8%, 9.78±0.49) and females (26.5%, 12.53±0.67). Data for seasonal prevalence alluded to year-round presence of disease with non-significant statistical difference. Organ predilection indicated liver as the most preferred site of cyst localization followed mainly by lungs. An over-dispersion pattern was observed in all infected animals as majority of cysts belonged <10 cysts per infected host category. Highest percentage of fertile cysts was observed in liver of sheep. Interestingly, solitary form of cysts had higher fertility rate than multiple form. Amid lack of data and wide gap of knowledge, this study would try to fill up the lacunae regarding this neglected tropical disease. Extensive rearing of livestock, unregulated official slaughter and home slaughtering have played role in adaptability of E. granulosus in Pakistan.

Management of house fly, Musca domestica L. (Muscidae: Diptera), through botanical baits

ABSTRACT The house fly, Musca domestica L. (Diptera: Muscidae), is a major pest of all aspects of life, like the domestic, medical and veterinary and causal agent of several pathogenic diseases. The present study was conducted to evaluate the potential of different insecticide-free baits against house fly by incorporating flower methanol extract of Helianthus annuus (sunflower) and Tegetes erecta (marigold) at 10%, 20% and 30% bait formulation of corn syrup, dried milk and water. However, imidacloprid and thiacloprid (each at 5% concentration) were also included in the study for comparison. Results showed that insecticide baits were superior in causing mortality of adult house fly but dependent upon syrup. Overall, 20% baits of both extracts caused more than half population death of house fly within 48h. On the other hand, the mortality rate by 30% baits (from sunflower and marigold) had a similar impact as observed in case of imidacloprid and thiacloprid baits. Therefore, biological baits could play a more active and safer role in the management of house fly as compared to synthetic insecticides.

Biological activity of synthesized 5-{1-[(4-chlorophenyl)sulfonyl]piperidin-4-yl}-2-mercapto-1, 3, 4-oxadiazole derivatives demonstrated by in silico and BSA binding studies

We synthesized a series of compounds bearing pharmacologically important 1,3,4-oxadiazole and piperidine moieties. Spectral data analysis by 1H-NMR, 13C-NMR, IR and EI-MS was used to elucidate the structures of the synthesized molecules. Docking studies explained the different types of interaction of the compounds with amino acids, while bovine serum albumin (BSA) binding interactions showed their pharmacological effectiveness. Antibacterial screening of these compounds demonstrated moderate to strong activity against Salmonella typhi and Bacillus subtilis but only weak to moderate activity against the other three bacterial strains tested. Seven compounds were the most active members as acetyl cholinesterase inhibitors. All the compounds presented displayed strong inhibitory activity against urease. Compounds 7l, 7m, 7n, 7o, 7p, 7r, 7u, 7v, 7x and 7v were highly active, with respective IC50 values of 2.14±0.003, 0.63±0.001, 2.17±0.006, 1.13±0.003, 1.21±0.005, 6.28±0.003, 2.39±0.005, 2.15±0.002, 2.26±0.003 and 2.14±0.002 µM, compared to thiourea, used as the reference standard (IC50 = 21.25±0.15 µM). These new urease inhibitors could replace existing drugs after their evaluation in comprehensive in vivo studies.

Levels of Empathy among Dental Students at CMH Lahore Medical College and Institute of Dentistry (NUMS ) Lahore Pakistan

Objectives: To measure levels of empathy among undergraduate dental students in Pakistani Dentistry Institute and to find the difference with respect to gender and academic year in the dental college. Methods: This cross-sectional study was conducted at CMHLMC and IOD in Pakistan, from December 2018 to April 2019, and comprised dental students of all four years. A valid and reliable “The Toronto empathy questionnaire” was used for the collection of data. Responses were indicated on a four-point Likert scale and total scores ranged from 0-64, with higher values indicating higher levels of empathy. Eight out of sixteen items were positively worded and the remaining eight items were negatively worded. Comparison of empathy scores across the year of study was analyzed using one-way ANOVA whereas a t-test was utilized for gender differences. SPSS version 20 was used for data analysis. Results: Questionnaire was returned by 281 students, with a 94% response rate. First-year dentistry students scored the highest mean score of 3.0, followed by second and third-year students by scoring 2.8 whereas the final year students obtained the lowest mean empathy score of 2.7. When mean empathy scores were compared among students of all 4 years by ANOVA test, it was found to be statistically significant, F=3.22, p=0.02. No significant differences in empathy scores were found with respect to gender (p ≥ 0.05). Conclusion: The present study reported a decline of empathy mean scores among dentistry students as the years of study progressed. This study reflects the need for early exposure to clinical training, educational programs and innovative teaching strategies in the undergraduate dentistry curriculum by emphasizing on dentists-patient communication skills, which in turn could encourage dentistry students to become empathetic health professionals.

MRI Spectrum of Symptomatic and Non –Symptomatic Tarlov Cyst: Series of Seven Cases in Orthopaedic Management Point of View

Tarlov cysts are perineural cysts and are usually found in sacral region. The dorsal nerve root is encased in this type of the cyst. These may or may not be with any of the symptomatology. The entity is infrequently found as an incidental finding. These are cerebrospinal fluid (CSF) filled sacs which are diagnosed on cross sectional imaging modalities especially in magnetic resonance imaging (MRI). Tarlov cysts can cause different type of myelopathies as per their location and size. Methods: We present a series of seven cases where these perineural cysts were found during the routine imaging of lumbosacral spine. All these patients had undergone Magnetic Resonance Imaging (MRI) of lumbosacral spine for backache or some other pelvic complaints. In one case Computerized Tomography (CT) Myelography also helped in diagnosis and related bone remodeling.MR myelography adds to the delineation of CSF wrapping around the spinal cord. Results: Three patients were found to be symptomatic and the intensity of complaints corresponded to the size and location of the cysts. In our three cases, the etiopathogenesis also corresponded to the underlying development of these entities. Four patients were asymptomatic as the size of these cysts were small and not contributing to the complaints of the patient. Conclusion: MRI is the best modality to diagnose these perineural cysts which are responsible for different types of myelopathies .T2WI sequences in non contrast MRI studies are the best in delineating the size, shape, outline and location of these cysts. This also further elaborates their extension to the surrounding regions.MR myelography is adjuvant to more morphological features of these cysts.

Effect of Apple Cider Vinegar in Type 2 Diabetic Patients with Poor Glycemic Control: A Randomized Placebo Controlled Design

Aim: The aim of the trial was to measure the effect of apple cider vinegar on glycemic control and biochemical parameters in type 2 diabetes mellitus (DM) patients with poor glycemic control. Methods: A single-blind, randomized, placebo-controlled trial was conducted on 110 eligible types 2 DM patients who were selected and allocated into 2 groups. The interventional group was given 15 ml apple cider vinegar in 200 ml water during dinner for 3 months while the other group was placebo. Before and after HbA1C (glycosylated hemoglobin), fasting lipid profile, fasting blood sugar, anthropometrics, and dietary changes were assessed and analyzed using IBM SPSS version 20, through statistical tests. Formal ethical approval was obtained from the local institutional review board. Results: Significant mean change was found in interventional group in HbA1c (p<0.001), blood sugar fasting (p<0.001), total cholesterol (p=0.002), triglyceride (p=0.002) and hip-waist ratio (p=0.002). No significant change was observed in the mean of these statistics in the placebo group. No significant change was observed in height, weight, mid-upper arm ratio, and low density lipoprotein, high density lipoprotein and food frequency in intervention and placebo groups before and after. Conclusion: Apple cider vinegar if used regularly is effective in controlling diabetes, lowering hypercholesterolemia and hypertriglyceridemia in DM type 2 patients.

Behavioural and objective vestibular assessment in persons with osteoporosis and osteopenia: a preliminary investigation / Behavioural and objective vestibular assessment in persons with osteoporosis and osteopenia: a preliminary investigation

Abstract Introduction: Calcium is vital for the functioning of the inner ear hair cells as well as for the neurotransmitter release that triggers the generation of a nerve impulse. A reduction in calcium level could therefore impair the peripheric vestibular functioning. However, the outcome of balance assessment has rarely been explored in cases with osteopenia and osteoporosis, the medical conditions associated with reduction in calcium levels. Objective: The present study aimed to investigate the impact of osteopenia and osteoporosis on the outcomes of behavioural and objective vestibular assessment tests. Methods: The study included 12 individuals each in the healthy control group and osteopenia group, and 11 individuals were included in the osteoporosis group. The groups were divided based on the findings of bone mineral density. All the participants underwent behavioural tests (Fukuda stepping, tandem gait and subjective visual vertical) and objective assessment using cervical and ocular vestibular evoked myogenic potentials. Results: A significantly higher proportion of the individuals in the two clinical groups' demonstrated abnormal results on the behavioural balance assessment tests (p < 0.05) than the control group. However, there was no significant difference in latencies or amplitude of cervical vestibular evoked myogenic potential and oVEMP between the groups. The proportion of individuals with absence of ocular vestibular evoked myogenic potential was significantly higher in the osteoporosis group than the other two groups (p < 0.05). Conclusion: The findings of the present study confirm the presence of balance-related deficits in individuals with osteopenia and osteoporosis. Hence the clinical evaluations should include balance assessment as a mandatory aspect of the overall audiological assessment of individuals with osteopenia and osteoporosis.

Resumo: Introdução: O cálcio é vital para o funcionamento das células ciliadas, assim como para a liberação dos neurotransmissores que desencadeiam um impulso nervoso. Uma redução nos níveis de cálcio poderia, portanto, prejudicar o funcionamento vestibular periférico. No entanto, a avaliação do equilíbrio tem sido raramente explorada em casos de osteopenia e osteoporose, condições médicas associadas à redução dos níveis de cálcio. Objetivo: O presente estudo teve como objetivo investigar o impacto da osteopenia e da osteoporose nos resultados dos testes de avaliação comportamental e vestibular objetiva. Método: O estudo incluiu 12 indivíduos nos grupos controle e grupo de osteopenia e 11 indivíduos no grupo da osteoporose. Os grupos foram divididos com base nos achados da densidade mineral óssea. Todos os participantes foram submetidos a testes comportamentais (Prova dos Passos de Fukuda, Marcha em tandem e Vertical Visual Subjetiva) e à avaliação objetiva com o uso de potenciais evocados miogênicos vestibulares cervical e ocular (cVEMP e oVEMP). Resultados: Uma proporção significativamente maior de indivíduos nos dois grupos com condições clínicas mostrou resultados anormais nos testes de avaliação comportamental e do equilíbrio (p < 0,05) do que o grupo controle. Embora não tenha havido diferença significativa nas latências ou na amplitude de cVEMP e oVEMP entre os grupos, a proporção de indivíduos com ausência de oVEMP foi significativamente maior no grupo da osteoporose do que nos outros dois grupos (p < 0,05). Conclusão: Os resultados do presente estudo demonstram a presença de déficits de equilíbrio em indivíduos com osteopenia e osteoporose. Assim, as avaliações clínicas gerais e audiológicas de indivíduos com osteopenia e osteoporose deveriam incluir a avaliação do equilíbrio como um aspecto obrigatório.

Large Solitary Pulmonary Cryptococcoma Mimicking Lung Carcinoma in an Immunocompetent Patient

Cryptococcosis is a life-threatening mycosis typically seen in immunocompromised patients. Pulmonary cryptococcosis generally presents as multiple or solitary nodular opacities. Cryptococcal infection presenting as a destructing cavernoma (cryptococcoma) without diffuse infiltration of the lung is an extremely rare presentation, even in immunocompromised patients. This report presents a healthy, HIV negative, immunocompetent patient who presented with a large solitary lung mass provisionally diagnosed as a lung malignancy on radiological imaging that proved to be a large cryptococcoma after biopsy. The patient was treated with liposomal Amphotericin B and fluconazole, and the lesion showed regression on serial imaging. This case report thus highlights an unconventional presentation of pulmonary cryptococcosis in an immunocompetent individual.