Single-Level Cervical Artificial Disc Replacement Compared with Cage Screw Implants: 2-Year Clinical and Radiological Outcomes Especially Adjacent Level Ossification

Methods@#Patients who received single-level ADR or CS between January 2008 and December 2018 were included. Data collected was preoperatively, intraoperatively, and postoperatively (6, 12, 24 months). Demographic information, surgical information, complications, follow-up surgery, and outcome ratings (Japanese Orthopaedic Association [JOA], Neck Disability Index [NDI], Visual Analog Scale [VAS] neck and arm, 36-item Short Form Health Survey [SF-36], EuroQoL-5 Dimension [EQ-5D]) were gathered. The radiological assessment included motion segment height, adjacent disc height, lordosis, cervical lordosis, T1 slope, the sagittal vertical axis C2–7, and adjacent level ossification development (ALOD). @*Results@#Fifty-eight patients were included (ADR: 37 and CS: 21). At 6 months, both groups’ JOA, VAS, NDI, SF-36, and EQ-5D scores significantly improved, and the positive trends persisted at 2 years. Noted no significant difference in the enhancement of clinical scores except for the VAS arm (ADR: 5.95 vs. CS: 3.43, p =0.001). Radiological parameters were comparable except for the progression of ALOD of the subjacent disc (ADR: 29.7% vs. CS: 66.9%, p =0.02). No significant difference in adverse events or severe complications seen. @*Conclusions@#ADR and CS obtain good clinical results for symptomatic single-level cervical DDD. ADR demonstrated a significant advantage over CS in the improvement of VAS arm and reduced progression of ALOD of the adjacent lower disc. No statistically significant difference of dysphonia or dysphagia between the two groups were seen, attributed to their comparable zero profile.

Choroidal and retinal thickness variations in ocular albinism

Purpose: To study the retinal and choroidal thickness variations on enhanced depth imaging optical coherence tomography scans in ocular albinism (OA) and compare with age?matched healthy subjects. Methods: This retrospective observational study had 48 eyes of 24 patients diagnosed clinically as OA and age, sex, and axial length?matched control healthy subjects. All patients underwent detailed ophthalmic examination and a single?line horizontal?raster enhanced depth imaging – optical coherence tomography scan (Spectralis, Heidelberg Engineering). Retinal and choroidal thickness was measured, compared, and analyzed between the two groups. Mann–Whitney U test was used for analysis between the two groups. P < 0.05 was considered significant. Results: The mean age was 28.3 ± 11.6 and 29.9 ± 10.6 years in the OA group and control group, respectively. Spherical equivalents ranged from ?8.5D to +10.5D in the OA group and from ?8.0D to +10.0D in the control group. The mean axial length between the two groups (P = 0.652) were comparable. The average retinal thickness (272 ± 34.3 vs. 213 ± 13.8 ?m; P < 0.001) was greater in the OA group as compared to controls. The mean choroidal thickness (184 ± 78.4 vs. 287 ± 46.4 ?m; P < 0.001) was significantly thinner in the OA group. Conclusion: Acquisition of OCT scans in OA can be challenging. This study showed that the subfoveal retinal thickness and choroidal thickness measured across the scans were significantly different in the OA group compared to controls. In the future, more studies are required to evaluate the role of the choroid and its relationship to emmetropization in albinism.

Thoracolumbar Injury Classification and Severity Score Is Predictive of Perioperative Adverse Events in Operatively Treated Thoracic and Lumbar Fractures

Methods@#We performed a retrospective review of 199 patients with surgically treated thoracolumbar fractures operated between January 2007 and January 2018. The potential risk factors for the development of AEs as well as the development of common complications were evaluated by univariate analysis, and a multivariate logistic regression analysis was performed to identify independent risk factors predictive of the above. @*Results@#The overall rate of AEs was 46.7%; 83 patients (41.7%) had nonsurgical AEs, whereas 24 (12.1%) had surgical adverse events. The most common AEs were urinary tract infections in 43 patients (21.6%), and hospital-acquired pneumonia in 21 patients (10.6%). On multivariate logistic regression, a Thoracolumbar Injury Classification and Severity (TLICS) score of 8–10 (odds ratio [OR], 6.39; 95% confidence interval [CI], 2.33–17.51), the presence of polytrauma (OR, 2.64; 95% CI, 1.17–5.99), and undergoing open surgery (OR, 2.31; 95% CI, 1.09–4.88) were significant risk factors for AEs. The absence of neurological deficit was associated with a lower rate of AEs (OR, 0.47; 95% CI, 0.31–0.70). @*Conclusions@#This study suggests the presence of polytrauma, preoperative American Spinal Injury Association score, and TLICS score are predictive of AEs in patients with surgically treated thoracolumbar fractures. The results might also suggest a role for minimally invasive surgical methods in reducing AEs in these patients.

Asymptomatic Construct Failure after Metastatic Spine Tumor Surgery: A New Entity or a Continuum with Symptomatic Failure?

Methods@#We conducted a retrospective analysis of 288 patients (246 for final analysis) who underwent MSTS between 2005–2015. Data collected were demographics and peri/postoperative clinical and radiological features. Early and late radiological AsCF were defined as presentation before and after 3 months, respectively. We analyzed patients with AsCF for risk factors and survival duration by performing competing risk regression analyses where AsCF was the event of interest, with SF and death as competing events. @*Results@#We observed AsCF in 41/246 patients (16.7%). The mean time to onset of AsCF after MSTS was 2 months (range, 1–9 months). Median survival of patients with AsCF was 20 and 41 months for early and late failures, respectively. Early AsCF accounted for 80.5% of cases, while late AsCF accounted for 19.5%. The commonest radiologically detectable AsCF mechanism was angular deformity (increase in kyphus) in 29 patients. Increasing age (p<0.02) and primary breast (13/41, 31.7%) (p<0.01) tumors were associated with higher AsCF rates. There was a non-significant trend towards AsCF in patients with a spinal instability neoplastic score ≥7, instrumentation across junctional regions, and construct lengths of 6–9 levels. None of the patients with AsCF underwent revision surgery. @*Conclusions@#AsCF after MSTS is a distinct entity. Most patients with early AsCF did not require intervention. Patients who survived and maintained ambulation for longer periods had late failure. Increasing age and tumors with a better prognosis have a higher likelihood of developing AsCF. AsCF is not necessarily an indication for aggressive/urgent intervention.

Symptomatic Construct Failure after Metastatic Spine Tumor Surgery

Methods@#We conducted a retrospective analysis on 288 patients (246 for final analysis) who underwent MSTS between 2005–2015. Data collected were demographics and peri/postoperative clinical and radiological features. Early and late radiological SF were defined as presentation before and after 3 months from index surgery, respectively. Univariate and multivariate models of competing risk regression analysis were designed to determine the risk factors for SF with death as a competing event. @*Results@#We observed 14 SFs (5.7%) in 246 patients; 10 (4.1%) underwent revision surgery. Median survival was 13.4 months. The mean age was 58.8 years (range, 21–87 years); 48.4% were women. The median time to failure was 5 months (range, 1–60 months). Patients with SF were categorized into three groups: (1) SF when the primary implant was revised (n=5, 35.7%); (2) peri-construct progression of disease requiring extension (n=5, 35.7%); and (3) SFs that did not warrant revision (n=4, 28.5%). Four patients (28.5%) presented with early failure. SF commonly occurred at the implant-bone interface (9/14) and all patients had a spinal instability neoplastic score (SINS) >7. Thirteen patients (92.8%) who developed failure had fixation spanning junctional regions. Multivariate competing risk regression showed that preoperative Eastern Cooperative Oncology Group score was a significant risk factor for implant failure (adjusted sub-hazard ratio, 7.0; 95% confidence interval, 1.63–30.07; p7 and fixations spanning junctional regions were associated with SF. Majority of construct failures occurred at the implant-bone interface.

Symptomatic Construct Failure after Metastatic Spine Tumor Surgery

Methods@#We conducted a retrospective analysis on 288 patients (246 for final analysis) who underwent MSTS between 2005–2015. Data collected were demographics and peri/postoperative clinical and radiological features. Early and late radiological SF were defined as presentation before and after 3 months from index surgery, respectively. Univariate and multivariate models of competing risk regression analysis were designed to determine the risk factors for SF with death as a competing event. @*Results@#We observed 14 SFs (5.7%) in 246 patients; 10 (4.1%) underwent revision surgery. Median survival was 13.4 months. The mean age was 58.8 years (range, 21–87 years); 48.4% were women. The median time to failure was 5 months (range, 1–60 months). Patients with SF were categorized into three groups: (1) SF when the primary implant was revised (n=5, 35.7%); (2) peri-construct progression of disease requiring extension (n=5, 35.7%); and (3) SFs that did not warrant revision (n=4, 28.5%). Four patients (28.5%) presented with early failure. SF commonly occurred at the implant-bone interface (9/14) and all patients had a spinal instability neoplastic score (SINS) >7. Thirteen patients (92.8%) who developed failure had fixation spanning junctional regions. Multivariate competing risk regression showed that preoperative Eastern Cooperative Oncology Group score was a significant risk factor for implant failure (adjusted sub-hazard ratio, 7.0; 95% confidence interval, 1.63–30.07; p7 and fixations spanning junctional regions were associated with SF. Majority of construct failures occurred at the implant-bone interface.

Pranayama and Breathing Exercises - Types and Its Role in Disease Prevention & Rehabilitation

Yoga is a multi-faceted spiritual tool enhancing health and well-being. Physical postures (Asan), regulated breathing (Pranayama), and meditations (Dhyana) are its main components. Breathing exercises of various types, particularly diaphragmatic breathing, alternate nostril breathing (anulom vilom), and kapalbhati have been noted to be useful in chronic asthma, chronic obstructive pulmonary disease (COPD), gastroesophageal reflux disease (GERD), post-operative management in head & neck surgery, cardiovascular surgery, and upper abdominal surgery. Its calming effect reduces blood pressure and agitation in various psychiatric disorders also. Common types of breathing exercises which are easy to learn and practice for day to day fitness and prevention of disease are: equal breathing (bhastrika), clavicular breathing, costal breathing, and diaphragmatic breathing. kapalbhati, alternate nostril breathing (anulom vilom), bhramari pranayama, and tribandh breathing. These require proper learning under guidance. Ujjayi pranayama, sitali, and surya bhedan pranayama also require proper training and have a calming effect on the body. Various types of breathing produce their beneficial effects on the body when they are done regularly for the minimum recommended period. These exercises can be practiced in any comfortable posture on the floor or sitting on a chair. Regulation of rate and rhythm during its practice helps towards achieving meditation. Pranayama and Yoga have proven their utility in various diseases as noted in studies done in various medical centers. The western world also recognizes its importance and recommends it to their people. In India, health is given a low priority and outdoor physical activities are becoming less popular. In these conditions of living, Yoga and Pranayama (breathing exercises) are recommended for persons of all ages because these are easy to learn, simple to practice, and do not require any separate space or instruments. Regularity and execution in a proper way for the optimum time alone are needed for general well-being, better lung functions, and as a preventive measure for various respiratory and psychiatric disorders. In the present pandemic of COVID-19, warranting house quarantine for a large number of people, this is going to prove a boon for physical and mental alleviation.

Can Sentinel Lymph Node Biopsy Predict Various Levels of Echelon Nodes in Oral Cancers?

Abstract Introduction The efficacy of sentinel node biopsy in early stage oral cancer is well established. Its evolving role can be reinforced by further studies. Objective Analyzing the predictability of the levels of echelon nodes for various oral cavity tumor subsites on sentinel node biopsy. Methods A prospective study of 20 patients with stage I/II oral squamous cell carcinoma who underwent sentinel node biopsy-guided neck dissection between January 2017 and 2018 at our institute. The procedure included radiotracer injection, imaging (lymphoscintigraphy, single photon emission computed tomography-computed tomography), and gamma probe application. Sentinel node detection on imaging and gamma probe were compared. Results Out of 20 patients, 13 (65%) had carcinoma of the tongue, 6 (30%) had buccal mucosa carcinoma, and 1 (5%) had retromolar trigone carcinoma. Themean age of the patients was 52.3 years. A total of 13 (65%) patients were male, and 7 (35%) were female. The sentinel node identification rates with imaging and gamma probe were of 70% and 100% respectively. In tongue and retromolar trigone primaries, the most common first-echelon nodes in both modalities were levels IIA and IB respectively. For buccal mucosa primaries, first-echelon nodes were detected only with the gamma probe, which was level IB. On imaging, second-echelon nodes were detected only for tongue primaries, and had equivalent incidence of levels II, III, and IV. On the gamma probe, level IIA, followed by III, and IV for the tongue, and level IIA were the most common second-echelon nodes for the buccal mucosa. Third-echelon nodes were detected only with the gamma probe for tongue carcinoma at level IV. Conclusion The combined use of imaging and gamma probe provides the best results, with high identification rate and predictability of echelon levels.

A pilot cross-sectional survey on awareness and practice regarding Type 2 Diabetes mellitus and its management with Yoga

Diabetes mellitus is a metabolic disorder of multiple etiology, characterized by chronic hyperglycaemia with disturbance of carbohydrate, fat, and protein metabolism resulting from defect ininsulin secretion, insulin action or both. Improper lifestyle contributes to the increasing number ofpeople affected with Type 2 diabetes mellitus (T2DM). Systematic reviews on the management ofT2DM in adults through Yoga reported significant improvements in multiple modifiable indices ofdiabetes mellitus management including glycemic control, lipid levels, and body composition.Awareness levels of a condition among the population play a critical role in behaviour change.However, studies related to assessing the awareness and practice of Yoga for managing diseases arelimited. Hence, this study was formulated with the objective of assessing the awareness level andextent of knowledge about diabetes mellitus and its management through yoga. A cross-sectionalsurvey with a sample size of 317 was conducted using a structured questionnaire at 5 districts inTamil Nadu and Kerala. 95% of the study population were aware of diabetes mellitus while 61.2%responded that diabetes can be prevented by regular exercise and healthy diet. 62.4% peopleperceived that yoga practices can prevent diabetes mellitus and 59% mentioned that regular yogapractice can help in controlling diabetes and prevent further complications. Only 13% reported topractice Yoga regularly at least three days a week. Identifying a qualified Yoga trainer was reportedto be a limiting factor for regular yoga practice. The study suggested that there is a need to increasethe access to qualified Yoga professionals at community level. Further large scale studies withrandom sampling method to assess the awareness level and practice of Yoga in different settings isindicated.© 2020 The Authors. Published by Elsevier B.V. on behalf of Institute of Transdisciplinary Health Sciencesand Technology and World Ayurveda Foundation. This is an open access article under the CC BY-NC-NDlicense (http://creativecommons.org/licenses/by-nc-nd/4.0/).

A prospective randomized trial of xylometazoline drops and epinephrine merocele nasal pack for reducing epistaxis during nasotracheal intubation

Background@#The most frequent complication of nasotracheal intubation (NTI) is epistaxis. Epinephrine nasal gauze packing has been used conventionally as a pre-treatment for reducing epistaxis, but it carries a disadvantage of pain and anxiety in patients. However, xylometazoline drops are easier to administer and more convenient for patients. We aimed at comparing the effectiveness of xylometazoline drops and epinephrine merocele packing in reducing bleeding and postoperative complications in our population. @*Methods@#Our study enrolled 120 patients in a double-blind randomized controlled trial. We randomly allocated ASA1 or 2 adult patients into 2 groups: Group X and Group E. Group X received 0.1% xylometazoline nasal drops, and epinephrine (1:10,000) merocele nasal packing was used in Group E. The primary outcome was the incidence of bleeding during NTI; the severity of bleeding, navigability, bleeding during extubation, and postoperative complications were secondary outcomes. We used IBM SPSS and Minitab software for statistical analysis, and P < 0.05 was considered statistically significant. @*Results@#We analyzed the data of 110 patients: 55 in Group X and 55 in Group E. The two groups did not have different bleeding incidence (56.4% vs 60.0%; P = 0.70); however, the incidence of severe bleeding was less with xylometazoline than with epinephrine (3.63% vs 14.54%; P < 0.05). We also observed less bleeding during extubation (38.2% vs 68.5%; P < 0.05) with xylometazoline. Other secondary outcomes were akin to both groups. @*Conclusion@#The incidence of severe and post-extubation bleeding was significantly less with xylometazoline.Hence, it may be an effective alternative for reducing the incidence and severity of epistaxis during NTI.

In the Extraordinary Times of Coronavirus Disease 2019: Clinical Strategies for Performing Spinal Surgery

The coronavirus disease 2019 (COVID-19) pandemic has caused pronounced strain on global healthcare systems, forcing the streamlining of clinical activities and conservation of health resources. There is a pressing need for institutions to present discipline-specific strategies for the management of COVID-19 patients. We present the comprehensive considerations at the National University Hospital, Singapore from the surgeon’s and anesthetist’s perspectives in the performance of spinal surgery in COVID-19 patients. These are based on national guidelines and overarching principles of protection for the healthcare workers (HCWs) and efficiency in surgical planning. The workflow begins with the emergency department screening that has been adapted to the local epidemiology of COVID-19 in order to identify suspected/confirmed cases. If patient history cannot be obtained, demographic, clinical, and imaging data are used. Designated orthopedic “contaminated teams” are available 24/7 with an activation time of

Clinical Relevance of Modified Alvarado Score in Acute Appendicitis in Present Scenario

Introduction: Appendix is surely, the most commonlyharvested organ of the body. On looking up the literature,we found, that the negative appendectomy rates have beenconsistently maintained all through these years. Negativeappendectomy not only increases economic burden on healthcare facilities of a developing country like India, but alsohas a negative impact on the overall health of the patient.The following study was therefore, taken up to evaluate thediagnostic accuracy of the Modified Alvarado scoring systemand its ultimate effect on mortality and morbidity of the patient.Though this is an old score, but we restudied it, to revalidateas well as to promote the use of this simple, economicaland objective clinical score which actually uses establishedclinical methods, important for residents training program, toreach the diagnosis instead of the costly radiological methods.Material and methods: 50 patients presenting with thelower quadrant abdominal pain and fulfilling the inclusioncriteria were selected randomly and included in the study.Modified Alvarado Score was calculated for each one ofthem. Confirmation of the diagnosis was done after thehistopathological examination of appendix.Results: Modified Alvarado Score >7 was found in 80% (i.e.82.75% of males and 76.19% of females) of patients withappendicitis. In addition to these findings, we also got exactinformation about the age and sex distribution along withthe most common presenting complaint, the postoperativecomplications and the need for post operative stay inappendicitis patients.Conclusion: Modified Alvarado Score is a fast, simple,noninvasive, repeatable and highly economical score. Whenapplied purposefully and objectively, it can prevent delayin surgeries and hence complications as well as can reducenegative appendectomies.

A comprehensive review on phytopharmacological investigations of Acacia auriculiformis A.Cunn. ex Benth

Acacia auriculiformis A.Cunn. ex Benth. is a perennial shrub having a wide range of medicinal potentials and is widely distributed throughout the world. It is being used traditionally to overcome various medical complications like sore eyes, aches, rheumatism, allergy, itching, and rashes. Besides, Acacia auriculiformis has been proven for many pharmacological activities like central nervous system depressant activity, antioxidant, antimicrobial, antimalarial, anti-filarial, cestocidal, antimutagenic, chemopreventive, spermicidal, wound healing, hepatoprotective and antidiabetic activity due to its low toxicity (LD

Estimation of superoxide dismutase levels in saliva and gingival crevicular fluid among smokers and non-smokers in periodontitis patients - an observational study

Background: Smoking, which is an important risk factor for periodontitis, induces oxidative stress in the body and causes an imbalance between reactive oxygen species (ROS) and antioxidants, such as superoxide dismutase (SOD). The present study was done to quantify and compare the level of SOD enzyme levels in gingival crevicular fluid (GCF) and saliva among smokers and nonsmokers. Methodology: One hundred and thirty-five individuals in the age range of 20­55 years, including 45 light smokers, 45 heavy smokers, and 45 nonsmokers (controls), were selected and the clinical parameters recorded were plaque index, probing depth, and attachment loss. Smokers were divided into light smokers (<10 cigarettes/day) and heavy smokers (>10 cigarettes/day) and into three subgroups: healthy, mild periodontitis, and moderate periodontitis. GCF and saliva samples were collected then SOD levels were analyzed using spectrophotometric assay. Results: The mean levels of SOD in the GCF and saliva of smokers were decreased compared to controls. Intra- and inter-group analyses showed a significant reduction in the levels of SOD in the GCF and saliva of heavy smokers compared to light smokers and the control group. Conclusions: There was a progressive reduction in SOD levels from healthy nonsmokers to light smokers to heavy smokers

Comparison of the Cardiomyogenic Potency of Human Amniotic Fluid and Bone Marrow Mesenchymal Stem Cells

BACKGROUND AND OBJECTIVES: Most studies in cardiac regeneration have explored bone marrow mesenchymal stem cells (BM-MSC) with variable therapeutic effects. Amniotic fluid MSC (AF-MSC) having extended self-renewal and multi-potent properties may be superior to bone marrow MSC (BM-MSC). However, a comparison of their cardiomyogenic potency has not been studied yet.METHODS: The 5-azacytidine (5-aza) treated AF-MSC and BM-MSC were evaluated for the expression of GATA-4, Nkx2.5 and ISL-1 transcripts and proteins by quantitative RT-PCR and Western blotting, respectively as well as for the expression of cardiomyogenic differentiation markers cardiac troponin-T (cTNT), beta myosin heavy chain (βMHC) and alpha sarcomeric actinin (ASA) by immunocytochemistry.RESULTS: The AF-MSC as compared to BM-MSC had significantly higher expression of GATA-4 (183.06±29.85 vs. 9.80±0.05; p<0.01), Nkx2.5 (8.3±1.4 vs. 1.82±0.32; p<0.05), and ISL-1 (39.59±4.05 vs. 4.36±0.39; p<0.01) genes as well as GATA-4 (2.01±0.5 vs. 0.6±0.1; p<0.05), NKx2.5 (1.9±0.14 vs. 0.8±0.2; p<0.01) and ISL-1 (1.7±0.3 vs. 0.9±0.1; p<0.05) proteins. The AF-MSC also had significantly elevated expression of cTNT (5.0×10⁴±0.6×10⁴ vs. 3.5 ×10⁴±0.8×10⁴; p<0.01), β-MHC (15.7×10⁴±0.9×10⁴ vs. 8.2×10⁴±0.6×10⁴; p<0.01) and ASA (18.6×10⁴±4.9×10⁴ vs. 13.1×10⁴±3.0×10⁴; p<0.05) than BM-MSC.CONCLUSIONS: Our data suggest that AF-MSC have greater cardiomyogenic potency than BM-MSC, and thus may be a better source of MSC for therapeutic applications in cardiac regenerative medicine.

Medição do parâmetro de atenuação controlada: um marcador substituto da esteatose hepática em pacientes com doença hepática gordurosa não alcoólica na modificação do estilo de vida - acompanhamento de um estudo prospectivo / Measurement of controlled attenuation parameter: a surrogate marker of hepatic steatosis in patients of nonalcoholic fatty liver disease on lifestyle modification - a prospective follow-up study

ABSTRACT BACKGROUND: Liver biopsy is a gold standard method for hepatic steatosis assessment. However, liver biopsy is an invasive and painful procedure and can cause severe complications therefore it cannot be frequently used in case of follow-up of patients. Non-invasive assessment of steatosis and fibrosis is of growing relevance in non-alcoholic fatty liver disease (NAFLD). To evaluate hepatic steatosis, transient elastography with controlled attenuation parameter (CAP) measurement is an option now days. OBJECTIVE: Aim of this study is to evaluate role of measurement of controlled attenuation parameter, a surrogate marker of hepatic steatosis in patients of nonalcoholic fatty liver disease on lifestyle modification. METHODS: In this study, initially 37 participants were included who were followed up after 6 months with transient elastography, blood biochemical tests and anthropometric measurements. The results were analyzed by Multivariate linear regression analysis and paired samples t-test (Dependent t-test) with 95% confidence interval. Correlation is calculated by Pearson correlation coefficients. RESULTS: Mean CAP value for assessing hepatic steatosis during 1st consultation (278.57±49.13 dB/m) was significantly improved (P=0.03) after 6 months of lifestyle modification (252.91±62.02 dB/m). Only fasting blood sugar (P=0.008), weight (P=0.000), body mass index (BMI) (P=0.000) showed significant positive correlation with CAP. Only BMI (P=0.034) and weight (P=0.035) were the independent predictor of CAP value in NAFLD patients. CONCLUSION: Lifestyle modification improves the hepatic steatosis, and CAP can be used to detect the improvement of hepatic steatosis during follow-up in patients with NAFLD on lifestyle modification. There is no relation between CAP and Fibroscan score in NAFLD patients. Only BMI and weight can predict CAP value independently.

RESUMO CONTEXTO: A biópsia hepática é o método padrão-ouro para avaliação de esteatose hepática. No entanto, é um procedimento invasivo e doloroso que pode causar complicações graves e, portanto, não pode ser usado com frequência em caso de acompanhamento dos pacientes. A avaliação não invasiva de esteatose e fibrose é de crescente relevância na doença hepática gordurosa não alcoólica (DHGNA). Para avaliar a esteatose hepática, a elastografia transitória com parâmetro de atenuação controlada (PAC) é uma opção atual. OBJETIVO: O objetivo deste estudo foi de avaliar o papel da medição do PAC, um marcador substituto da esteatose hepática em pacientes da doença hepática gordurosa não alcoólica, com modificação do estilo de vida. MÉTODOS: Foram incluídos inicialmente neste estudo 37 participantes acompanhados por 6 meses com elastografia transitória, testes bioquímicos no sangue, e medidas antropométricas. Os resultados foram analisados por análise de regressão linear multivariada e emparelhado em amostras-teste t (teste t-dependente) com intervalo de confiança de 95%. A correlação foi calculada pelos coeficientes de correlação de Pearson. RESULTADOS: O valor do PAC para avaliar esteatose hepática durante a primeira consulta (278,57±49,13 dB/m) foi significativamente melhorado (P=0,03) após 6 meses de modificação do estilo de vida (252,91±62,02 dB/m). Somente a glicemia de jejum (P=0,008), o peso (valor de P=0,000), o índice de massa corporal (IMC) (P=0,000) mostraram correlação positiva significativa com PAC. Apenas o IMC (P=0,034) e o peso (P=0,035) foram o preditores independentes de valor de PAC em pacientes com DHGNA. CONCLUSÃO: A modificação do estilo de vida melhora a esteatose hepática, e o PAC pode ser usado para detectar a melhoria da esteatose hepática durante o seguimento em pacientes com DHGNA. Não existe relação entre o PAC e o escore do Fibroscan em pacientes com DHGNA. Só o IMC e o peso podem prever o valor do PAC independentemente.

Echocardiography guided bed side balloon atrial septostomy in dextro transposed great arteries [dtga] with intact ventricular septum [ivs]: a resource limited country experience

Objective: To determine effectiveness and safety of echocardiography guided bed side Balloon Atrial Septostomy [BAS] in dextro transposition of great Arteries [dTGA] with intact ventricular septum [IVS] at a public sector tertiary care hospital Karachi, Pakistan

Methods: This case series include 40 patients with echocardiographic findings of dTGA with IVS and restricted PFO [

Results: Median age was 16 days, Majority of them [n=23, 58%] were severely cyanosed with SpO[2] of 41.4 +/- 3.4% and underwent emergency BAS and remaining underwent elective procedure. An increase in SpO[2]% from 46.0 +/- 6% to 81.0 +/- 3.0% [p=<0.001] and ASD size from 1.4 +/- 2.8mm to 5.45 +/- 0.4mm was observed [p=<0.001]. No complication was observed in most of cases [n=28, 70%]. Mean hospital stay was 3.4 +/- 1 days. Success rate was 97.5% however, one neonate died due to neonatal sepsis

Conclusion: Our study provides sufficient evidence that bed side balloon atrial septostomy is a safer technique, save a lot of time and resources which were required otherwise in transporting these patients to catheterization laboratory

Imaging the Intraoperative Macular Morphology Changes using a Handheld Spectral Domain Optical Coherence Tomography.

Purpose: To study the intraoperative retinal macular morphology during macular surgery using handheld spectral domain optical coherence tomography (SDOCT). Design: Prospective, observational case series. Methods: A handheld SDOCT device was used to characterize the preoperative and intraoperative OCT images in 10 eyes of 10 patients undergoing vitrectomy for macular hole (MH) and epiretinal membrane (ERM). I intraoperative imaging was repeated after removal of the internal limiting membrane or the ERM and the images were analyzed. Results: Intraoperative SDOCT images from patients undergoing surgery (5 for full thickness MH including 2 previously failed surgeries and 5 for ERM were reviewed and quantitatively analyzed. In the 5 eyes undergoing surgery for MH, the minimum diameter of the hole showed a significant decrease (P = 0.031; the mean reduction 15.18%; range 6.14- 34.88%). Basal diameter increased in 2 eyes (mean change 9.96%), reduced in 2 (mean reduction 3.28%) while it remained unchanged in 1 case. The MH height decreased in 2 eyes (mean reduction 5.43%) and increased in 3 (mean change 20.04%). Intraoperative imaging in 5 eyes undergoing surgery for ERM revealed immediate decrease in retinal thickness in 3 eyes (mean change 5.00%), and increase in 2 eyes (mean change 17.76%). Comparison of the preincisional and intraoperative handheld SDOCT images demonstrated distinct changes in retinal macular morphology. Conclusion: The intraoperative use of handheld SDOCT provides a novel method for visualizing and quantifying changes in retinal anatomy during macular surgery. Further study is warranted to determine whether intraoperative macular morphological changes could affect and prognosticate MH closure.

Malaria in dengue patients

Objective: To determine frequency of malaria in dengue patients

Study Design: Cross sectional study

Place and Duration of Study: The study was carried out in the Department of Medicine, Civil Hospital Karachi from June 2008 to December 2008

Materials and Methods: 274 dengue patients with Ig M antibody positive results were included in the study after informed consent Malaria parasite peripheral film and malarial ICT [immunochromatography] test of all these dengue patients were performed in order to detect the presence of co-infection with malaria. Age and sex of the patients were also noted

Results: In the study, out of 274 dengue patients, 189 [69%] were males and 85 [31%] were females. Mean age was 31.01 +/- 14.83 years. 41 [15%] dengue patients had concomitant malarial infection. Out of these 41 dengue-malaria co-infected patients, 29 [10.6%] had plasmodium vivax; 8 [2.9%] had plasmodium falciparum and 4 [1.5%] had both falciparum + vivax

Conclusion: Patients with dengue fever are predisposed to have concomitant malarial infection. Hence, these must be investigated for malaria as undiagnosed and untreated malaria can increase the morbidity and mortality of the dengue patients

Genotype distribution of hepatitis C Virus in district Jacobabad, Sind, Pakistan and the risk factors associated with it

Objectives: Our study focused on HCV's genotype distribution in district Jacobabad and its associated risk factors

Study Design: Cross sectional study

Place and Duration of Study: This study was carried out at a Private Clinic in Jacobabad, Sind, Pakistan from January 2013 to July 2013

Materials and Methods: 153 samples were collected and their HCV status was confirmed by PCR

Results: Out of 153 people, 100 were male and 53 females .Majority of the people were natives of Jacobabad city [90%].Genotype 3 was the most prevalent form [80%] with 3a being the most prevalent subtype.65% had a history of using unsterilized needle of which 3a had the highest association [87.4%].5.5% of the subjects had received transfusions during their lifetime, with type 1 and 4 genotype having a 50% history of it.69% had no history of sharing needles. 12.2% had a history of surgical intervention

Surgery had a 100% associated with genotype 1. 2.5% had received dental treatments in the past, most evident with types 3 [65%].61.4% had visited their barber recently .6.3% people had ever received a tattoo, while majority of the people [92.8%] had no history of drug addiction

Reports of accidental pricks, sexual contacts or transmissions during delivery were negligible

History of tattooing, accidental pricks and transmission via sexual contact were mostly seen with type 3.No apparent cause of HCV was seen in 15%

Conclusion: Unsterilized needles and visits to the barbers for shaving are a major risk factor for Hepatitis C in this region of Pakistan. This could be attributed to the lack of knowledge about these dangerous practices