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Objective: To study the clinico-hematological profile, complications, and management of children with non-transfusion dependent thalassemia (NTDT) in northern India. Method: We retrieved and analyzed the data of 69 children with NTDT diagnosed between January, 2006 to December, 2018, aged under 18 years from our unit’s records. Result: The participants mean (SD) age was 4.4 (3.1) years, and they presented with anemia (29%), jaundice (13%), hemolytic facies (13%), splenomegaly (87%), thromboembolism (2.9%) and pathological short stature (28.5%). The most common cause of NTDT was ?-thalassemia (45%), followed by either compound-heterozygous or homozygous for E?-thalassemia mutation. The most frequent single genotype observed was compound heterozygous for IVS1-5 (G>C) and codon 26 (G>A). The mean (SD) follow-up duration was 3.5 (2.4) years. On follow-up, 27 children (%) remained transfusion free, and 30 (%) needed occasional transfusions. 63% of patients initially presenting with pathological short stature showed improvement in growth. Amongst children older than 10 years (n=20), subclinical hypothyroidism was detected in 6 children and impaired glucose tolerance test in 1 child. Conclusion: Eß-thalassemia was the commonest cause of NTDT in this population.
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Objective: We examined the ‘nutrients of concern’ in pre-packaged food products that are commonly advertised, as per WHO standards and Nova Classification. Methods: This was a qualitative study, using a convenience sampling method, to identify advertisements of prepackaged food products. We also analyzed their content from information on the packets, and their compliance with applicable Indian laws. Results: We found that all the advertisements of the food products in this study did not provide important information about the amount of nutrients of concern i.e., total fat, sodium, and total sugars. These advertisements mostly targeted children, made health claims, and used endorsements of celebrities. All the food products were also found to be ultra-processed in nature and high in one or more nutrients of concern. Conclusion: Most of the advertisements are misleading, needing effective monitoring. Health warnings on the front-of- pack label and restrictions on marketing of such food products may go a long way in reducing non-communicable diseases.
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Purpose: To study the safety and efficacy of optic nerve sheath fenestration surgery in patients with optic disc edema due to different etiologies. Methods: Records of 18 eyes of 15 patients who underwent optic nerve sheath fenestration for vision threatening optic disc edema were reviewed retrospectively, and results were analyzed. Improvement of visual acuity was the main measure of outcome. Improved visual fields, resolution of optic disc edema, diplopia, and headache were other benefits that were observed. Results: Fifteen patients between 13 and 54 years of age were included in the study. Three patients underwent successive bilateral surgery. Idiopathic intracranial hypertension was the most common cause for optic disc edema and was found in 80% of the patients. Mean preoperative logMAR acuity was ?1.9789 ± 1.46270, which improved to ?0.9022 ± 1.23181 (p < 0.005) in the operated eye, and mean logMAR acuity of contralateral eye improved from ?1.3378 ± 1.50107 to ?1.0667 ± 1.33813 (p < 0.05). Conclusion: Early optic nerve sheath fenestration is an effective modality for treating optic disc edema due to a wide myriad of causes and helps resolve the associated symptoms.
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Background: Subarachnoid block has been used for intracavitary radiotherapy (ICRT) for carcinoma cervix, but the literature on the appropriate dose of local anesthetic required to achieve the desired effect is lacking. We compared two different intrathecal doses of 0.5% hyperbaric bupivacaine (1.2 and 1.5 mL) for providing optimal surgical conditions and readiness to discharge in patients undergoing ICRT for carcinoma cervix. Materials and Methods: This prospective double?blind study was done in 80 patients undergoing ICRT. The patients were randomized into two groups (Groups I and II) to receive 1.2 and 1.5 mL of intrathecal hyperbaric bupivacaine, respectively, for ICRT. The level of sensory achieved, the patient satisfaction score, radiation oncologist score, time to L5 regression, and time to motor recovery (walking unaided) were assessed. Statistical Analysis Used: The data were analyzed using SPSS 20 for Windows (IBM, Chicago, IL, USA). Results: The time taken for the block to regress to L5 (Group I: 134.6 � 32.4 minutes vs. Group II: 143.2 � 43.0 minutes, P = 0.31) were comparable. However, the mean time for walking unaided (Group I: 220.87 � 47.12 minutes versus Group II: 247.00 � 49.83 minutes, P = 0.032) after the subarachnoid block was significantly less in Group I. The patient satisfaction with the procedure and overall satisfaction of the radiation oncologists regarding the operating condition were comparable in both the groups. Conclusions: Hence, a 1.2 mL dose of intrathecal hyperbaric bupivacaine for ICRT provides optimal surgical conditions with hemodynamic stability and ensures the early discharge of the patient.
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Context: In India nearly 71% of adolescent girls have no knowledge about menstruation until menarche. Menstrual practices still face several social, cultural, and religious restrictions and discouragement of open discussion on the topic acts like a major deterrent in the path of menstrual hygiene management. Moreover, lack of knowledge and incorrect practices during menstruation can sometimes have serious health outcomes. Hence, it becomes imperative to ascertain the knowledge of adolescent girls about menstruation and reproductive health and the practices adopted by them during menstruation so that health education programs can to tailored to address the gaps. The study Aims: aims to assess the knowledge of adolescent girls and their current practices with regard to menstrual hygiene and reproductive health and study the association of these with socio-demographic variables. This cross-sectional community based Methods: descriptive study was conducted among 181 adolescent girls selected from two urbanized villages of Meerut district of India using a semi-structured questionnaire. For assessment of level of knowledge a scoring system was developed. Both descriptive and inferential statistics were used for analysis. Based on the scoring, 77.3% of our study participants had overall poor Results: knowledge about menstruation and reproductive health, nearly 20% had satisfactory knowledge and only 2.2% had good knowledge. Most participants reported using sanitary napkins during menses (80.7%) and the remaining were using clean cloth (19.3%). 100% of the participants whose mothers were illiterate had poor knowledge about menstrual hygiene and reproductive health. Participants whose mothers were engaged in semi-skilled or skilled work were more likely to have satisfactory (39.4%) or good (4.3%) knowledge scores. Overall knowledge of our study participants regarding Conclusion: menstrual hygiene and reproductive health was poor; however the practices adopted by them during menstruation were good. The two main impediments in the path of menstrual hygiene management were lack of knowledge and non availability of services at affordable cost
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Background: A large surge of intensive care unit (ICU) admissions leading to mortal outcome was observed in wave-2 of coronavirus disease 2019 (COVID-19) due to the higher virulence of the Delta variant of the COVID-19 virus, which led to the scarcity of resources in hospitals. This study was done to observe the clinical characteristics of COVID-19 patients with fatal outcome. Materials and methods: We conducted a retrospective cross-sectional study in adults with COVID-19 pneumonia having fatal outcome during wave-2 of COVID-19, and their clinical characteristics were studied. Results: Out of 136 patients included in the study, the most common risk factors leading to adverse outcome were in the male gender, age (middle and elderly), with hypertension and diabetes mellitus (DM) as predominant comorbidities, early onset dyspnea, high C-reactive protein (CRP), high neutrophil to lymphocyte ratio (NLR), high D-dimer, bilateral lower zone involvement of lungs in chest X-ray (CXR), and development of acute kidney injury (AKI). Conclusion: The characteristics of the severely ill COVID-19 patients highlighted in the study could help clinicians in the early identification and management of high-risk patients. This study would help with resource planning and preparation for further COVID-19 waves and future pandemics.
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Objectives: We investigated the correlation of transient elastography (TE) with MRI R2* values and serum ferritin in patients with transfusion-dependent thalassemia (TDT) Methods: We reviewed hospital records of 59 patients with TDT aged ?8 years without any evidence of chronic liver disease and who had fibroscan within 3 months of MRI T2*, who seen at our center between January, 2014 and December, 2019. Spearman correlation and linear regression analysis were used to evaluate the correlation between TE liver stiffness measurements and R2* MRI values and with serum ferritin. Results: Mean (SD) age of the subjects was 13.0 (3.1) years and body mass index was 16.6 (2.3) kg/m2. Mean liver stiffness measurement, MRI T2*(3T), corresponding MRI R2*(3T), and ferritin values were 6.55 (3.10) kPa, 3.4 (4.6) milliseconds, 616.20 (383.9) Hz, and 2874.69 (1570.7) ng/ mL, respectively. TE measurements correlated with MRI R2* values (r=0.61; P=0.001) and with serum ferritin level (r=0.59, P=0.001). Conclusion: TE is a reliable tool to estimate hepatic iron overload in patients with TDT.
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Background & objectives: Majority of the studies of hospital-acquired diarrhoea conducted in Western countries have focused on the detection of Clostridium difficile in stool samples. Limited Asian and Indian literature is available on hospital-acquired diarrhoea. This study was aimed to describe the aetiological profile for hospital-acquired diarrhoea in children aged below five years. Methods: One hundred children aged one month to five years who developed diarrhoea (?3 loose stools for >12 h) after hospitalization for at least 72 h were enrolled. Children who were prescribed purgatives or undergoing procedures such as enema and endoscopy or those with underlying chronic gastrointestinal disorders such as celiac disease and inflammatory bowel disease were excluded from the study. Stool samples from the enrolled children were subjected to routine microscopic examination, modified Ziel- Nielson (ZN) staining for Cryptosporidium and culture for various enteropathogens. Multiplex PCR was used to identify the strains of diarrhoeagenic Escherichia coli. Rotavirus detection was done using rapid antigen kit. Toxins (A and B) of C. difficile were detected using enzyme immunoassay. Results: Of the 100 samples of hospital-acquired diarrhoea analysed, diarrhoeagenic E. coli (DEC) was found to be the most common organism, detected in 37 per cent of cases (enteropathogenic E. coli-18%, enterotoxigenic E. coli-8%, enteroaggregative E. coli-4% and mixed infections-7%). Cryptosporidium was detected in 10 per cent of cases. Rotavirus was detected in six per cent and C. difficile in four per cent of cases. Interpretation & conclusions: The findings of this study suggest that the aetiological profile of hospital- acquired diarrhoea appears to be similar to that of community-acquired diarrhoea, with DEC and Cryptosporidium being the most common causes. The efforts for the prevention and management of hospital-acquired diarrhoea should, thus, be directed towards these organisms.
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Lymphatic filariasis (LF) is a vector-borne neglected tropical disease, causing permanent disability. The disease is debilitating and widespread, leading to tremendous productivity and economic loss. The Government of India (GOI) prioritized the elimination of LF through the annual mass drug administration (MDA) programme in 2004 and continued with a single dose of diethylcarbamazine citrate (DEC), 6 mg/kg of body weight, plus albendazole annually over a period of 5-6 years. The GOI had set the target to achieve LF elimination by 2015 and now by 2030. The progress so far has been suboptimal. Much remains to be done as about 84 per cent of the total 328 endemic districts are still under MDA. The major challenge in implementing MDA is poor compliance. It is necessary to have a feasible alternative strategy addressing the above challenge to achieve the desired goal of LF elimination. At this juncture, a well-researched approach, i.e. the use of DEC-fortified salt, also advocated by the World Health Organization, as a unique form of MDA, is proposed. As per this strategy, a low dose of DEC (0.2% w/w) is added to the cooking salt at the manufacturing facility of iodized salt and consumed by the LF-endemic communities for about two years. Many examples of successful use of this strategy for LF elimination in small- and large-scale trials have been documented in India and several other endemic countries in the world. Implementing DEC–iodine-fortified salt is a safe, less expensive, more efficient and prompt approach for achieving the elimination of LF in India. Adverse effects are none or minor and self-limiting. The DEC-fortified salt strategy can easily piggyback on the existing countrywide deployment of iodized salt under the National Iodine Deficiency Disorders Control Programme (NIDDCP), which has achieved a great success in reducing iodine-deficiency disorders such as hypothyroidism. This existing robust programme can be leveraged to launch DEC-fortified salt for the community. If implemented appropriately, this strategy will ensure the complete cessation of LF transmission within two years from its introduction. If the said strategy is implemented in 2022, it is expected that India will be able to achieve the LF elimination by 2024, much before the global target of 2030.
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A nondescript sow with the history of delivering eight piglets and one remain in uterus since three days but unable to deliver was reported. The case was diagnosed as dystocia due to uterine inertia and laparohysterotomy was performed under general anesthesia, one male dead piglet was recovered successfully. The animal showed uneventful recovery.
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Background & objectives: COVID-19 pandemic has triggered social stigma towards individuals affected and their families. This study describes the process undertaken for the development and validation of scales to assess stigmatizing attitudes and experiences among COVID-19 and non-COVID-19 participants from the community. Methods: COVID-19 Stigma Scale and Community COVID-19 Stigma Scale constituting 13 and six items, respectively, were developed based on review of literature and news reports, expert committee evaluation and participants’ interviews through telephone for a multicentric study in India. For content validity, 61 (30 COVID-19-recovered and 31 non-COVID-19 participants from the community) were recruited. Test–retest reliability of the scales was assessed among 99 participants (41 COVID-19 recovered and 58 non-COVID-19). Participants were administered the scale at two-time points after a gap of 7-12 days. Cronbach’s alpha, overall percentage agreement and kappa statistics were used to assess internal consistency and test–retest reliability. Results: Items in the scales were relevant and comprehensible. Both the scales had Cronbach’s ? above 0.6 indicating moderate-to-good internal consistency. Test–retest reliability assessed using kappa statistics indicated that for the COVID-19 Stigma Scale, seven items had a moderate agreement (0.4-0.6). For the Community COVID-19 Stigma Scale, four items had a moderate agreement. Interpretation & conclusions: Validity and reliability of the two stigma scales indicated that the scales were comprehensible and had moderate internal consistency. These scales could be used to assess COVID-19 stigma and help in the development of appropriate stigma reduction interventions for COVID-19 infected, and mitigation of stigmatizing attitudes in the community.
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ABSTRACT Objective: To evaluate small airway disease in COVID-19 patients using the prevalence of air trapping (AT) and correlating it with clinical outcomes. The relationship between CT-based opacities in small blood vessels and ventilation in patients with SARS-CoV-2 pneumonia was also assessed. Methods: We retrospectively included 53 patients with positive RT-PCR results for SARS-CoV-2 between March and April of 2020. All subjects underwent HRCT scanning, including inspiratory and expiratory acquisitions. Subjects were divided into two groups based on visual identification of AT. Small blood vessel volumes were estimated by means of cross-sectional areas < 5 mm2 (BV5) derived from automated segmentation algorithms. Mixed-effect models were obtained to represent the BV5 as a function of CT-based lobar opacities and lobar ventilation. Results: Of the 53 participants, AT was identified in 23 (43.4%). The presence of AT was associated with increased SpO2 at admission (OR = 1.25; 95% CI, 1.07-1.45; p = 0.004) and reduced D-dimer levels (OR = 0.99; 95% CI, 0.99-0.99; p = 0.039). Patients with AT were less likely to be hospitalized (OR = 0.27; 95% CI, 0.08-0.89; p = 0.032). There was a significant but weak inverse correlation between BV5 and CT-based lobar opacities (R2 = 0.19; p = 0.03), as well as a nonsignificant and weak direct correlation between BV5 and lobar ventilation (R2 = 0.08; p = 0.54). Conclusions: AT is a common finding in patients with COVID-19 that undergo expiratory CT scanning. The presence of AT may correlate with higher SpO2 at admission, lower D-dimer levels, and fewer hospitalizations when compared with absence of AT. Also, the volume of small pulmonary vessels may negatively correlate with CT opacities but not with lobar ventilation.
RESUMO Objetivo: Avaliar a doença das pequenas vias aéreas em pacientes com COVID-19 por meio da prevalência de aprisionamento aéreo (AA) e sua correlação com desfechos clínicos. Também foi avaliada a relação entre opacidades tomográficas nos pequenos vasos sanguíneos e ventilação em pacientes com pneumonia por SARS-CoV-2. Métodos: Foram incluídos, retrospectivamente, 53 pacientes com teste de RT-PCR positivo para SARS-CoV-2 entre março e abril de 2020. Todos os indivíduos foram submetidos à TCAR, incluindo aquisições inspiratórias e expiratórias. Os indivíduos foram divididos em dois grupos com base na identificação visual de AA. Os volumes dos pequenos vasos sanguíneos foram estimados por meio de seções transversais < 5 mm2 (VS5) derivadas de algoritmos automatizados de segmentação. Modelos de efeito misto foram obtidos para representar o VS5 em função das opacidades lobares tomográficas e da ventilação lobar. Resultados: Identificou-se AA em 23 (43,4%) dos 53 participantes. A presença de AA apresentou associação com SpO2 elevada na admissão (OR = 1,25; IC95%: 1,07-1,45; p = 0,004) e níveis reduzidos de dímero D (OR = 0,99; IC95%: 0,99-0,99; p = 0,039). Pacientes com AA apresentaram menor probabilidade de hospitalização (OR = 0,27; IC95%: 0,08-0,89; p = 0,032). Houve correlação inversa significativa, mas fraca, entre VS5 e opacidades lobares tomográficas (R2 = 0,19; p = 0,03) e correlação direta não significativa e fraca entre VS5 e ventilação lobar (R2 = 0,08; p = 0,54). Conclusões: AA é um achado comum em pacientes com COVID-19 submetidos à TC expiratória. A presença de AA pode apresentar correlação com SpO2 elevada na admissão, níveis reduzidos de dímero D e menor probabilidade de hospitalização. Além disso, o volume dos pequenos vasos pulmonares pode apresentar correlação negativa com opacidades tomográficas, mas não com ventilação lobar.
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Abstract Objective: To establish the diagnostic performance of diffusion-weighted magnetic resonance imaging (DWI) in discriminating malignant from non-malignant thoracic lymph nodes. Materials and Methods: This was a meta-analysis involving systematic searches of the MEDLINE, EMBASE, and Web of Science databases up through April 2020. Studies reporting thoracic DWI and lymph node evaluation were included. The pooled sensitivity, specificity, diagnostic odds ratio, positive predictive value, negative predictive value, and area under the receiver operating characteristic curve (AUC) were calculated. Results: We evaluated six studies, involving a collective total of 356 mediastinal lymph nodes in 214 patients. Thoracic DWI had a pooled sensitivity and specificity of 92% (95% confidence interval [95% CI]: 71-98%) and 93% (95% CI: 79-98%), respectively. The positive and negative likelihood ratios were 13.2 (95% CI: 4.0-43.8) and 0.09 (95% CI: 0.02-0.36), respectively. The diagnostic odds ratio was 149 (95% CI: 18-1,243), and the AUC was 0.97 (95% CI: 0.95-0.98). Conclusion: DWI is a reproducible technique and has demonstrated high accuracy for differentiating between malignant and benign states in thoracic lymph nodes.
Resumo Objetivo: Uma meta-análise foi realizada para estabelecer o desempenho diagnóstico da ressonância magnética com imagem ponderada em difusão (DWI) na discriminação de linfonodos torácicos malignos de benignos. Materiais e Métodos: MEDLINE, EMBASE e Web of Science foram sistematicamente pesquisados até abril de 2020. Foram incluídos estudos que relatavam o uso de DWI na avaliação de linfonodos torácicos. Sensibilidade, especificidade, razão de chances de diagnóstico, valores preditivos positivos e negativos e área sob a curva (AUC) foram calculados. Resultados: Foram encontrados 356 linfonodos mediastinais de 214 pacientes nos seis estudos incluídos. DWI produziu sensibilidade e especificidade combinadas de 92% (intervalo de confiança 95% [IC 95%]: 71-98%) e 93% (IC 95%: 79-98%), respectivamente. A razão de verossimilhança positiva foi de 13,2 (IC 95%: 4,0-43,8), a razão de verossimilhança negativa foi de 0,09 (IC 95%: 0,02-0,36); A razão de chances de diagnóstico foi de 149 (IC 95%: 18-1.243). A DWI teve uma AUC de 0,97 (IC 95%: 0,95-0,98). Conclusão: DWI é uma técnica reprodutível que demonstrou alta acurácia na diferenciação de estados malignos e benignos nos linfonodos torácicos.
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Objectives@#Cleft lip and palate is a common congenital anomaly that impairs the aesthetics, speech, hearing, and psychological and social life of an individual. To achieve good aesthetic outcomes, presurgical nasoalveolar molding (NAM) has become important. Currently, the intraoral NAM technique is widely practiced. Numerous modifications have been made to intraoral NAM techniques, but the original problem of compliance leading to discontinuation of treatment remains unsolved. Therefore, the present study compared an extraoral NAM technique with the intraoral NAM technique. @*Materials and Methods@#Twenty infants with complete unilateral cleft lip and palate were included and divided into two equal groups. Group A received the intraoral NAM technique, and Group B received the extraoral NAM technique. Pre- and postoperative extraoral and intraoral measurements were recorded. @*Results@#Groups A and B did not differ significantly in any extraoral or intraoral parameter. @*Conclusion@#The extraoral NAM technique is as effective as the intraoral NAM technique in achieving significant nasal and alveolar changes in complete unilateral cleft lip and palate patients. Additionally, it reduces the need for frequent hospital visits for activation and the stress associated with the insertion and removal of the intraoral NAM plate, thereby improving compliance.
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Objectives@#Cleft lip and palate is a common congenital anomaly that impairs the aesthetics, speech, hearing, and psychological and social life of an individual. To achieve good aesthetic outcomes, presurgical nasoalveolar molding (NAM) has become important. Currently, the intraoral NAM technique is widely practiced. Numerous modifications have been made to intraoral NAM techniques, but the original problem of compliance leading to discontinuation of treatment remains unsolved. Therefore, the present study compared an extraoral NAM technique with the intraoral NAM technique. @*Materials and Methods@#Twenty infants with complete unilateral cleft lip and palate were included and divided into two equal groups. Group A received the intraoral NAM technique, and Group B received the extraoral NAM technique. Pre- and postoperative extraoral and intraoral measurements were recorded. @*Results@#Groups A and B did not differ significantly in any extraoral or intraoral parameter. @*Conclusion@#The extraoral NAM technique is as effective as the intraoral NAM technique in achieving significant nasal and alveolar changes in complete unilateral cleft lip and palate patients. Additionally, it reduces the need for frequent hospital visits for activation and the stress associated with the insertion and removal of the intraoral NAM plate, thereby improving compliance.
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Abstract INTRODUCTION: Dengue presents with a variable clinical course, ranging from mild illness to potentially fatal hemorrhage and shock. We aimed to evaluate the capabilities of various hematological parameters observed early in the course of illness for predicting the clinical outcomes of illness. METHODS: We retrospectively analyzed the records of children admitted in the pediatric inpatient services of the institute with dengue between 2017 and 2019. We determined the relationships between the hematological parameters observed during the first evaluation and the various clinical outcomes. RESULTS: We evaluated data from 613 patients (age range, 26 days to 17 years). Of these, 29.85% exhibited fever with warning signs, and 8.97% had severe dengue. Lower values of hemoglobin, platelet count, mean corpuscular volume, mean corpuscular hemoglobin concentration, and mean platelet volume, and higher values of total leukocyte count (TLC), hematocrit, and red cell distribution width variably correlated with numerous clinical outcomes-duration of hospital stay, development of complications, requirement of blood component transfusion, inotropic support, and mortality. Among the parameters, TLC ≥20,000/mL and initial platelet count ≤20,000/mL significantly associated with mortality, with odds ratios (95% confidence interval) of 11.81 (4.21-33.80) and 5.53 (1.90-16.09), respectively. CONCLUSIONS: Hematological parameters observed early during dengue infection may predict its clinical outcomes in infected children. Initial high TLC and low platelet count are potential predictors of fatal outcomes in the course of disease.
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Humans , Child , Adult , Severe Dengue/diagnosis , Dengue/diagnosis , Retrospective Studies , Hematocrit , India/epidemiology , Leukocyte CountABSTRACT
ABSTRACT Objective: Evaluation of enlarged mediastinal lymph nodes is crucial for patient management. Malignant lymphoma and sarcoidosis are often difficult to differentiate. Our objective was to determine the diagnostic accuracy of MRI for differentiating between sarcoidosis and malignant lymphoma. Methods: This was a retrospective study involving 47 patients who underwent chest MRI and were diagnosed with one of the diseases between 2017 and 2019. T1, T2, and diffusion-weighted signal intensity were measured. Apparent diffusion coefficients (ADCs) and T2 ratios were calculated. The diagnostic performance of MRI was determined by ROC analysis. Results: Mean T2 ratio was significantly lower in the sarcoidosis group than in the lymphoma group (p = 0.009). The T2-ratio cutoff value that best differentiated between lymphoma-related and sarcoidosis-related enlarged lymph nodes was 7.1, with a sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 58.3%, 95.6%, 76.5%, 93.3%, and 68.7%, respectively. The mean ADC was significantly lower in the lymphoma group than in the sarcoidosis group (p = 0.002). The ADC cutoff value that best differentiated between lymphoma-related and sarcoidosis-related enlarged lymph nodes was 1.205, with a sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 87.5%, 82.6%, 85.1%, 84.0% and 86.3%, respectively. No significant differences were found between the two groups regarding T1 signal intensity, T2 signal intensity, and lymph node diameter. Conclusions: MRI parameters such as ADC, diffusion, and T2 ratio can be useful in the differentiation between sarcoidosis and lymphoma in the evaluation of enlarged lymph nodes.
RESUMO Objetivo: A avaliação de linfonodomegalias mediastinais é crucial para o manejo dos pacientes. O linfoma maligno e a sarcoidose costumam ser difíceis de diferenciar. Nosso objetivo foi determinar a precisão diagnóstica da RMN para diferenciar sarcoidose de linfoma maligno. Métodos: Estudo retrospectivo com 47 pacientes submetidos a RMN de tórax e diagnosticados com uma das doenças entre 2017 e 2019. Foi medida a intensidade do sinal em T1, T2 e difusão. Foram calculados o coeficiente de difusão aparente (ADC, do inglês apparent diffusion coefficient) e a razão T2. O desempenho diagnóstico da RMN foi determinado pela análise da curva ROC. Resultados: A média da razão T2 foi significativamente menor no grupo sarcoidose que no grupo linfoma (p = 0,009). A razão T2 = 7,1 foi o melhor valor de corte para diferenciar linfonodomegalias relacionadas com linfoma daquelas relacionadas com sarcoidose, com sensibilidade, especificidade, valor preditivo positivo, valor preditivo negativo e precisão de 58,3%, 95,6%, 76,5%, 93,3% e 68,7%, respectivamente. A média do ADC foi significativamente menor no grupo linfoma que no grupo sarcoidose (p = 0,002). O ADC = 1,205 foi o melhor valor de corte para diferenciar linfonodomegalias relacionadas com linfoma daquelas relacionadas com sarcoidose, com sensibilidade, especificidade, valor preditivo positivo, valor preditivo negativo e precisão de 87,5%, 82,6%, 85,1%, 84,0% e 86,3%, respectivamente. Não houve diferença significativa entre os grupos quanto à intensidade do sinal em T1, intensidade do sinal em T2 e diâmetro dos linfonodos. Conclusões: Parâmetros de RMN como ADC, difusão e razão T2 podem ser úteis na diferenciação entre sarcoidose e linfoma na avaliação de linfonodomegalias.
Subject(s)
Humans , Sarcoidosis/diagnostic imaging , Lymphoma/diagnostic imaging , Retrospective Studies , Sensitivity and Specificity , Lymph Nodes/diagnostic imaging , Lymphatic MetastasisABSTRACT
Background: Seitz bath in post-perineal surgery minimizes pain by reducing anal sphincter tone and also maintains hygiene. The aim and objective of this retrospective study is to compare the effect of warm versus regular room temperature seitz bath. The article clears the concept of seitz bath. The seitz bath gives psychological satisfaction of dressing to patient and helps in boosting the concept of hygiene in their mind.Method: Study design for this study was comparative study of warm and room temperature seitz bath on 60 patients by convenience sampling operated for perineal diseases from 01 November 2019 to 30 March 2020 with written informed consent of patient and fulfilling ethical requirements at Rajiv Gandhi Medical College, Thane, Mumbai. Patients with immunocompromised status and comorbidities like diabetes, tuberculosis, HIV were excluded from study this was the criteria for the study.Results: Out of 60 postoperative cases having perineal wounds, 35 (58.33%) patients opted for warm water seitz bath, while the rest 25 (41.66%) preferred regular room temperature seitz bath. In spite of a greater number of patients opting for warm seitz bath, wound recovery in terms of healing and wound discharge was almost similar in both the study groups. All the patients involved in the study were comfortable to resume their daily activities with significant reduction in pain by the end of first week irrespective of the choice of seitz bath they opted for.Conclusion: The study concludes that symptomatic relief and wound recovery in the operated cases of perineal surgeries completely independent of the choice of seitz bath practiced.
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Vein of GALEN aneurysmal malformation (VGAM) is a rare congenital disease caused by arteriovenous shunts between the choroidal arteries and the porencephalic ectatic vein. The diagnosis is often made in utero or during infancy, endovascular treatment remains the most suitable therapeutic means in a well-equipped environment. Here we report here the case of a patient complaining of headache for 1 year, and whose brain CT imaging showed the presence of Galen veinaneurysm with associated non-communicating hydrocephalus. In the absence of the appropriate technical platform, the placement of a ventriculoperitoneal shunt relieved our patient’s symptoms
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In the general population, shoulder pain is a common musculoskeletal problem. Older people are frequently affected, and the most common causes of shoulder pain are the problems with rotator cuffs which are seen in primary care practice. The incidence of rotator cuff tear increases with advanced age and it has been estimated that the prevalence of shoulder pain in older patients ranges from 21% to 27%.(1)Tendons are thick, fibrous tissues that transmits muscle-generated force to the bones and thus generates joint movement. Repeated activities and complex muscle-tendon overuse can damage tendons that lead to pain and decrease function.(2)The supraspinatus muscle is a part of the rotator cuff of shoulder.(3) The inflammation of a muscle tendon causes tendinitis and it has varying levels of pain. Supraspinatus tendonitis is an inflammation of supraspinatus tendon often associated with shoulder impingement syndrome.(4) The Supraspinatus tear that causes the supraspinatus tendon to affect the acromion leading to pain is the cause of Supraspinatus Tendinitis. The main cause of the Supraspinatus tear is constant pressure, increased workload and wear and tear associated with age.(5)Total loss of active abduction at the glenohumeral joint is due to a complete tear of supraspinatus.(6) Supraspinatus tendonitis complications include leading to a rotator cuff tear. Initially, rotator cuff tears were almost identified as secondary to tendon haemorrhage and tendonitis products of untreated impingement.(7)The primary purpose of rehabilitation to achieve short-term and long-term goal, patient education and consistent plan of care. The patient's awareness on the need to take non-operative steps, improvement, and the availability of choices will assist them in being active participants in their treatment.(7)