Clinical and ultrasonographic screening for carpal tunnel syndrome in hemodialysis patients

Background@#Carpal tunnel syndrome (CTS) is one of the most common complications among hemodialysis (HD) patients. This study aimed to assess the prevalence of CTS in HD patients using clinical and noninvasive ultrasound (US) criteria. @*Methods@#A cross-sectional, observational study was conducted on 94 HD patients to evaluate CTS manifestations and demographic, clinical, and laboratory data. The median nerve (MN) cross sectional area (CSA) (MN-CSA) was estimated by US examination at the pisiform and hamate levels. Both hands were evaluated, and the higher MN-CSA was considered. @*Results@#Neuropathic pain and nocturnal numbness at MN distribution were present in 40.4% and 18.1%, respectively, while Tinel’s test was positive in 25.5% of patients. A MN-CSA ≥ 11.5 mm2 identified the probability of CTS with 63% sensitivity and 80% specificity. Patients with CTS had higher serum calcium (P = 0.02) and lower parathyroid hormone (PTH) (P = 0.02). CTS was frequently developed on the same side of an arteriovenous fistula. The MN-CSA had positive correlations with age, serum phosphorus, and visual analogue scale (VAS) score (P = 0.01, 0.01, and 0.03 respectively) and a negative correlation with PTH level (P = 0.007). Serum phosphorus level (P = 0.015) and VAS (P = 0.04) were the significant predictors of MN-CSA. @*Conclusion@#CTS appears to frequently occur in HD patients. US examination may be helpful in detection of CTS and can be an alternative to electrodiagnostic studies in HD patients.

Sarcomatoid carcinoma of the maxilla: a case report with literature review

Sarcomatoid carcinoma is a very rare malignant and aggressive tumor that can involve the maxillary sinus. We report the case of a 46 y/o male who presented a tumor ot the right maxillary sinus with extension to the right nasal cavity. The diagnosis of Sarcomatoid carcinoma was set by histology and immunohistochemistry. The patient received concomitant cteplatin based chemorad//otherapy with no response after 3 months of treatment. He diedf months later. Through the present case and the review of literature i discuss all aspects of this entity: clinical presentation differential diagnoses, pathology, treatment and prognosis

Complementary/alternative medicine practices for sore throat - comparing practices in healthcare providers and the general population

OBJECTIVES: To determine the practice and varieties of Complementary and Alternative Medicine [CAM] for sore throat and common cold treatment in healthcare providers[HP] and the general population

METHOD: This is a questionnaire-based cross sectional study conducted at Ojha Campus, Dow International Medical Collge Karachi

RESULTS: This study shows that 62% of our total study population use CAM [62.8% healthcare providers, 61% general population]. Combination therapy was the most popular method of CAM usage [55.8% healthcare providers, 47% general population]. Family and friends were the most common source of CAM information in both groups. Steam, Saltwater gargles, Medicated vapors, honey and ginger were most frequently used, in both populations. Very few persons had a regular practice of informing their healthcare provider about their CAM use [23.8% healthcare providers, 2.7% general population]. Around 63% healthcare providers recommend CAM to their patients for treating sore throat. The most frequent reason for doing so being their personal effective experience

CONCLUSION: Our study demonstrates the high usage of CAM to treat sore throat. Some basic training in CAM should be considered for our healthcare providers, in order to integrate this cost effective form of therapy in our healthcare system. Healthcare providers should inquire about their patients' CAM usage to avoid interactions between the two forms of therapy

Testicular Biopsy Histopathology as an Indicator of Successful Restoration of Spermatogenesis after Varicocelectomy in Non-obstructive Azoospermia

PURPOSE: We aimed to evaluate the efficacy of using testicular biopsy histopathology as an indicator of the success of loupe-assisted subinguinal varicocelectomy in non-obstructive azoospermia (NOA) patients. MATERIALS AND METHODS: In a 2-year period, a prospective study was carried at Minoufiya University Hospital on 20 NOA patients with clinical bilateral varicoceles. These patients underwent loupe-assisted subinguinal varicocelectomy with simultaneous testicular biopsy. All patients were evaluated by determining their hormonal profile and performing semen analyses and scrotal Doppler and transrectal ultrasonography. Two semen analyses showing azoospermia were performed before the surgery and two semen analyses were received at 3 and 6 months post-operatively for follow-up. RESULTS: The mean age was 29.9+/-6.7 years, and the mean follow-up duration was 17.3+/-8.3 months. We noted the restoration of spermatogenesis in six men (30% of all patients). Testicular biopsy results were as follows: hypospermatogenesis in 7 patients, maturation arrest in 3, and Sertoli cell-only syndrome in 10. The improvement in the sperm counts of these patients ranged from 3 million to 15 million/mL. Sperms were recovered in the hypospermatogenesis (6 patients, 85.5%) patients only, but other patients with testicular biopsy results of Sertoli cell-only or maturation arrest did not show any improvement in their semen parameters. CONCLUSIONS: Testicular biopsy results showed that hypospermatogenesis patients have a better chance of improvement in their semen analysis after varicocelectomy in contrast to NOA patients with Sertoli cell-only syndrome or maturation arrest.

Quantitative determination of three angiotensin-II-receptor antagonists in presence of hydrochlorothiazide by RP-HPLC in their tablet preparations

Losartan potassium, Valsartan, Telmisartan and Irbesartan are angiotensin-II-receptor antagonists [ARA II] group which used in treatment of hypertension alone or in combination with other drugs mainly Hydrochlorothiazide. RP- HPLC method was developed for the assay of three angiotensin-II-receptor antagonists [ARA-IIs] in presence of Hydrochlorothiazide. The method was performed by reversed phase high performance liquid chromatography using a mobile phase which is consisted of 0.025 M potassium dihydrogen phosphate [pH 6.0]: acetonitrile = 65:35% with detection at 220 nm on an ACE CIS column [250 mm x 4.6 mm, 5 microm] at flow rate 1.5 mL/min in an isocratic manner. The proposed method was validated according to ICH guidline in terms of linearity, accuracy, precision, robustness, limit of detection and limit of quantitation

Healing of surgical wounds in maxillofacial region - a Bangladesh study

This prospective study was carried out to identify certain risk factors responsible for delayed incisional healing on day 7 in the maxillofacial region, and was carried out at the Department of Maxillofacial Surgery and Department of Pathology of Bangabandhu Sheikh Mujib Medical University [BSMMU], Dhaka, Bangladesh from 1[st] July 2005 to 30[th] June 2007. Six risk factors for delayed maxillofacial area wound healing were studied. Out of 32 patients, cases with risk factors were in study group [mean age 43.5 years] and apparently healthy patients without risk factors were in control group [mean age 45.9 years] were examined. Postoperative clinical evaluation of wound was done on 3[rd], 5[th], 7[th], 9[th] and 11[th] day and histological examination of tissue specimen [skin, scalp and oral mucosa] was done on day 0 and day 7 based on six histological parameters of wound healing. Peroperatively taken tissue specimen from the wound margin containing healthy tissue was used as a conrol of postoperative day 7 healing tissue specimen. Statistically significant association was found between study and control subjects in terms of pattern of collagen tissue and amount of early and mature collagen tissue [p<0.05] on the 7th day of follow up. Clinical evaluation also had strong association with histological state of healing. It was concluded that patients with risk factors had significantly weaker wounds than those without risk factors

Hand disability related variables in an Egyptian female RA patients sample

The aim of the present work is to study hand affection in Rheumatoid Arthritis [RA] in an Egyptian female sample to establish a map of lesions underlying the rheumatoid hand dysfunction using clinical, laboratory and imaging techniques. This study comprised 100 adult female RA patients. They were clinically assessed for pain using visual analogue scale [VAS], joint tenderness using Ritchie Articular Index, assessment of grip strength, assessment of functional ability using Health Assessment Questionnaire [HAQ], and assessment of hand function using Sequential Occupational Dexterity Assessment score [SODA] patients were subjected to the following laboratory investigations: full blood picture, ESR, C-reactive protein concentration and rheumatoid factor. Radiological investigations included plain X-ray examination and Magnetic resonance imaging. SODA score for hand dexterity had highly significant correlations with disease duration, morning stiffness, ESR, Ritchie index, VAS, HAQ, Duke index disease activity, and hand grip [p<0.001 for all]. It was significantly higher in patients with muscle wasting, deformity and tenosynovitis of the hand, moreover, it showed highly significant correlations with X-ray score and MRI scores. SODA score for hand dexterity had highly significant correlations with clinical findings. SODA score is valuable for evaluation of hand disability and disclosure of the underlying clinical, laboratory and imaging variables in RA female patients

Prehepatic portal hypertension in Egyptian children: a single center study

Background: Portal vein thrombosis [PVT] is considered the most important etiology of prehepatic portal hypertension in children and a leading cause of esophageal varices and hematemesis in these children

Aim of the study: The aim is to analyze the data of children with prehepatic portal hypertension secondary to PVT presenting to the Pediatric Hepatology Unit, Cairo University. Egypt. Study design. The study included 120 children with PVT who presented during the period 1987-2002. They were retrospectively analyzed for the presenting symptoms, the risk factors for the development of PVT, the diagnostic tools and the therapeutic measures carried out for them. Most of them 114/120 were followed up for variable periods. [ranging from 2 months to 12 years]

Results: The male: female ratio was 1.4:1, with ages ranging between 1-18 years. The most important presenting symptoms were: hematemesis in 32%, abdominal distention in 25% and accidentally detected splenomegaly in 181%.Risk factors for the development of PVT included: neonatal sepsis: 3.3%, umbilical catheterization: 5.8%, umbilical sepsis: 5% and severe gastroenteritis and dehydration 1 7%, while there was no risk factor detected in 81%. Ultrasonography was diagnostic in 99% and the remaining 1% were diagnosed by Doppler examination. In contrast, out of 36 children with portal vein occlusion detected by ultrasonography, 9 showed patent portal vein by Doppler examination. Upper gastrointestinal endoscopy revealed esophageal varices in 91% Therapeutic sclerotherapy and band ligation were done for 74.2%, and 13.3% respectively. Prophylactic sclerotherapy was performed in 7.5% and only one case underwent prophylactic band ligation

Conclusion: Prehepatic portal hypertension presents early in life commonly with bleeding esophageal varices. Ultrasonography is a helpful diagnostic tool. Sclerotherapy and band ligation are the most important therapeutic measures in the present study