A rectal gastrointestinal stromal tumor - a plea for neoadjuvant imatinib and TAMIS / Tumor estromal gastrointestinal no reto - um caso de uso de imatinibe neoadjuvante e TAMIS

Abstract Here we describe an infrequent case of gastrointestinal stromal tumor of the rectum in a 57 year-old man with spindle cell neoplasm probably gastrointestinal stromal tumor and CT scan showed tumor from the anterior rectal wall and offered abdominoperineal resection for the same. The patient was started on imatinib and had a significant reduction in symptoms. The patient was reassessed with the CT scan, which showed a reduction in tumor size and Transanal minimally invasive surgery was planned for the patient. Use of imatinib prior to surgical resection to attain the reduced size of the tumor within the limit of resection is an attractive approach. Since tumor development can happen rapidly again after substantial tumor shrinkage, the best time to operate depending on resectability and the maximum therapeutic outcome remains divisive.

Resumo No presente estudo, os autores descrevem um caso raro de tumor estromal gastrointestinal no reto em um homem de 57 anos que se apresentou com neoplasia de células fusiformes, com provável tumor estromal gastrointestinal. A tomografia computadorizada demonstrou tumor na parede anterior do reto e foi sugerida sua ressecção abdominoperineal. O paciente iniciou tratamento com imatinibe e apresentou uma redução significativa nos sintomas. O paciente foi reavaliado por tomografia computadorizada, que evidenciou redução do tamanho do tumor; portanto, foi indicada cirurgia transanal minimamente invasiva. O tumor era ressecável e foi necessário um extenso acompanhamento para romper o órgão, de forma a alcançar a ressecção máxima; caso contrário, o tumor estromal gastrointestinal também seria irressecável. O uso de imatinibe antes da ressecção cirúrgica para reduzir o tamanho do tumor dentro do limite de ressecção é uma abordagem interessante. Como o tumor pode se crescer rapidamente após ser substancialmente reduzido, a literatura ainda apresenta controvérsias quanto ao melhor momento para operar e quanto ao melhor desfecho terapêutico.

Gall bladder ejection fraction as a marker of autonomic neuropathy in type 2 diabetes mellitus

Background: Diabetic neuropathy is one of the commonest complications of diabetes mellitus and associated with considerable morbidity and mortality. The influence of diabetes on gall bladder function was not demonstrated in many studies. In this study, the association of fasting gall bladder volume and gall bladder ejection fraction with degree of cardiac autonomic neuropathy was assessed and correlated with duration of diabetes and severity of diabetes..Methods: The study was conducted in Government Sivagangai Medical College Hospital, Sivagangai, Madurai during a period of January 2018 to September 2018 as a Prospective observational study conducted among 100 patients in study group and 50 healthy subjects in control group. The aim of the study was to find out the incidence of autonomic neuropathy in study group by simple bed side tests, to determine the fasting gall bladder ejection fraction in diabetics, comparison of gall bladder volume in both study and control group, correlation of gall bladder ejection fraction with autonomic neuropathy.Results: The incidence of CAN is found to be high with longer duration of the disease and the degree is also correlated with duration of the disease. The correlation coefficient of this association is 0.792 which indicates high correlation. The correlation of severity of DM   with incidence and degree of CAN was 0.81 which indicates high correlation and also the study showed an increase in the FGBV and a decrease in the GBEF with increase in the severity of cardiac autonomic neuropathy.Conclusions: In patients with type 2 diabetes mellitus, the gall bladder ejection fraction is  significantly  related  to  the  duration  of diabetes mellitus and degree of hyperglycemia in addition to cardiac autonomic neuropathy(CAN). Similarly,  fasting  gall  bladder  volume (FGBV)  is  significantly increased  in  type 2  diabetes  mellitus  patients  with  cardiac autonomic neuropathy.

Serum uric acid level in type 2 diabetes mellitus

Background: Diabetes mellitus is the most important risk factor associated with two to four fold increased incidence of coronary artery disease. The major risk factors for CAD are hypercholesterolemia, hypertension, diabetes mellitus, and cigarette smoking Objectives: To study the level of serum uric acid in type 2 diabetes mellitus and the correlation between elevated serum uric acid level and the component of metabolic syndrome like obesity, hypertension, dyslipidemia.Methods: The study was done as descriptive analytical study among the diabetic patients in a tertiary care setting during the period January 2018 to February 2019. The inclusion and exclusion criteria were clearly defined and the study participants were recruited for the study after getting the informed consent. The socio demographic profile, clinical and laboratory data were collected from the blood sample obtained from the patients with the standardized procedures. Data was entered in Microsoft excel spread sheet and analyzed statistically using SPSS statistical software. Student ‘t’ test and Chi-square test values were applied for significance.Results: Serum uric acid in the study population and control varied from 3.0 to 8.1 and 2.7 to 5.5 mg/dl respectively. The mean and standard deviation of uric acid among cases was 5.08±1.42 while in control it was 3.55±0.62 respectively. The serum uric acid level of diabetics was very much elevated compare with controls and it was highly significant. Significant correlation was noticed between serum uric acid and BMI as well as WHR. Elevated uric acid levels were significantly noticed among those with hypertension, dyslipidemia, coronary artery disease and chronicity of the diabetes.Conclusions: Uric acid was significantly elevated in diabetic population and the mean value of serum uric acid level was higher in longer duration of diabetes, hypertension, dyslipidemia, central obesity which are the components of metabolic syndrome.

Study of Surgical Management of Diabetic Foot in Telangana Population

Introduction: The foot is highly entity to cope with a large degree of repetitive stress. Fatty tissue on the plantar surface and a thickened dermis and epidermis cushion and absorb repeated forces of compression, torsion, and shear during locomotion and standing. Materials and Methods: Eighty-nine patients between 35 and 65 years visiting MediCiti Institute of Medical Science, Ghanpur, Medchal-501401, Telangana, suffering from diabetic foot were selected for study. The patients belonged to middle socioeconomic status; due to illiteracy and poverty, they were not regularly taking antidiabetic drugs. Results: Clinical manifestations were the duration of onset of diabetic was 23 (25.8%) newly diagnosed, 17 (19.1%) had 1–5 years, and 49 (55%) had >5 years. Duration of diabetic foot ulcers was 21 (23.5%) had >4 weeks, 39 (43.8%) had 4–52 weeks, and 29 (32.5%) had >52 weeks. Anatomical sites were 44 (49.4%) had forefoot, 12 (13.4%) had mid foot, 9 (10.1%) had hind foot, 24 (26.9%) had whole foot, and foot affected were 45 (50.5%) right foot, 19 (21.3%) left foot, and 25 (28%) both foot. Types of ulcer were as follows: 52 (58.4%) were neuropathic, 26 (29.2%) had ischemic, 4 (4.49) had neuroischemic, and 7 (7.86%) was unclassified; Wagen’s classification was as follows: 3 (3.37%) had Stage I, 32 (35.9%) had Stage II, 26 (29.2%) had Stage III, 13 (14.6%) had Stage IV, and 15 (16.8%) Stage V. Types of operations were as follows: 33 (37%) had debridement, 44 (49.4%) had lower limb amputation, 23 (25.8%) had minor amputation, 21 (23.5%) had major amputation, 5 (5.6%) had skin grafting, and 7 (7.86%) had incision and drainage. Conclusion: A surgeon the having complete knowledge of foot anatomy can justify the proper management of diabetic foot surgery. Early recognition and proper treatment are mandatory to avoid poor outcomes. Surgery must always be combined with antibiotics and revascularization

Study of Intestinal Obstruction in Telangana Population

Introduction: Intestinal obstruction occurs when there is an interruption in the forward flow of intestinal contents. This interruption can occur at any point along the length of the gastrointestinal tract and clinical symptoms often vary based on the level of obstruction. Materials and Methods: A total of 86 patients between 19 and 68 years were regularly visiting the hospital (Mediciti Institute of Medical Sciences, Ghanpur, Medchal-501401, Telangana) were selected for study because the clinical evaluation of intestinal obstruction is a surgical emergency and treatment would largely depend on early diagnosis and skillful management. Results: The clinical manifestations were 100% pain in abdominal, 100% distention of abdomen 72 (83.7%) had vomiting, 69 (80.2%) had tenderness, 62 (72%) had constipation, 64 (74.4%) had dehydration, 16 (18.6%) had fever, 24 (27.9%) had palpable mass, 63 (73.2%) had increased bowel sound, and 11 (12.7%) had decreased bowel sounds. The etiology of intestinal obstruction was, 30 (34.8%) had adhesion and band, 16 (18.6%) had hernia, 15 (17.4%) had tuberculosis (TB) stricture, 13 (15.1%) had volvulus, and 12 (13.9%) had malignancy. Types of operations were 21 (24.4%) had resection and end to end ileo-ileal anastomosis, 24 (27.9) had release of adhesion band, 16 (18.6%) had hernia repair, 6 (6.97%) had 13 (15%) had untwisting volvulus, 4 (4.65%) had resection and end to end jejunoileal anastomosis, and 2 (2.32%) had tube caestomy. Post-operative had were 7 (8.13%) had wound infections, 5 (5.18%) had respiratory infections, 3 (3.48%) had entero-cutaneous fistula, 4 (4.65%) had prolonged ileus, 8 (9.30%) deaths due to septicemia. Conclusion: Intestinal obstruction, which still remains an important surgical emergency, obstructions due to adhesions is increasing due to abdominal and pelvic surgeries; obstruction due to TB stricture will have post-surgical complications. Early operation is mandatory to avoid development peritonitis and systemic sepsis associated with multi-organ failure.

A study on the clinical spectrum and electrocardiographic changes in scorpion sting envenomation

Background: Scorpion stings, though not a big problem in many developed countries, it is a major public health problem in underdeveloped and in some developing countries all over the world. Objectives was to study on the clinical spectrum and electrocardiographic changes in scorpion sting envenomation.Methods: This study was conducted in a tertiary care institute after obtaining the IEC clearance and informed consent from the patients for a period of 6 months from January 2018 to June 2018. All the patients admitted to the toxicology ward and general ward with scorpion envenomation during the study period were included in the study. A total number of 53 cases of scorpion envenomation and 20 healthy patients from the outpatient department of General medicine, were taken as controls.Results: Fifty-nine percent of the patients presented with Grade 1 envenomation, seven percent with Grade 2 and thirty four percent with Grade 3 envenomation. Local pain (83%) and tachycardia (19%) were the commonest presenting symptom and sign respectively. Sinus tachycardia (6%) was the commonest ECG abnormality seen in the study. There was statistical significance in the relationship between ECG change and biochemical marker CK-MB.Conclusions: Scorpion envenomation in adults needs to be studied to identify the high-risk groups and to assess the morbidity caused it. There was no mortality due to scorpion sting in the study period and significant correlation between the time delay and severity of envenomation was found which indicates a need for immediate medical care following scorpion sting.

Etiology, outcomes and co-morbidities among cerebral palsy children attending tertiary care hospital, India: a prospective study

Background: Cerebral palsy is the most common aetiology for motor dysfunction among children worldwide. It is associated with range of co-morbid conditions that affects the quality of life. Cerebral palsy has been studied extensively in western countries and there are only few articles available on epidemiological information in developing countries and low resource settings. This study focuses on the aetiology, risk factors, types and co-morbidities in cerebral palsy.Methods: Cerebral palsy children attending tertiary care hospital were prospectively recruited into the study. The study was conducted during January 2017 to July 2018. The cross-sectional study included complete prenatal, natal and postnatal history of the participants, BERA and Ophthalmological examinations were done.Results: One hundred and fifty children with cerebral palsy were enrolled. The mean age of participants were 36'30 months.' Male to female ratio was 2.19:1. The most common maternal risk factor among study participants was consanguinity in marriage (23.33%). 16% had prolonged labour and 10% had toxaemia during pregnancy. 47% of the children were born by institutional normal vaginal delivery. The most common neonatal risk factor was Birth Asphyxia (23%), low birth weight (20%) and neonatal sepsis (21%). 122 had spastic type of cerebral palsy. The most common morbidity associated with cerebral palsy was Gastro intestinal disturbances in 61% of the participants.Conclusions: History of prolonged labour and birth asphyxia were risk factors for cerebral palsy. Spastic CP is the most common type. Malnutrition, Gross Motor delay, Seizures, Mental retardation were the most common morbidities associated with CP.

A study on diastolic dysfunction in asymptomatic type 2 diabetes mellitus with normal systolic function

Background: Diastolic heart failure, otherwise called as heart failure with preserved ejection fraction, is common finding of hypertensive heart disease, but various studies report a high incidence of diastolic heart failure in patients with type 2 diabetes mellitus in spite of the absence of coronary artery heart disease and hypertension. The objectives of the study were to determine the prevalence of dysfunction of left ventricle in diastole in type 2 diabetes mellitus patients and to compare with the non-diabetic individuals with that of asymptomatic type II diabetes patients. To assess the correlation of diastolic dysfunction in diabetes with age of patients, HbA1c levels, duration of diabetes, retinopathy, autonomic neuropathy.Methods: A prospective cross sectional among them 50 patients were diabetics and 50 were non-diabetic controls. Diastolic dysfunction was measured with standard echocardiographic parameters and the results were computed with corresponding variables of the patients. All the variables and their data were analysed for percentage, mean, standard deviation ‘t’ test and chi square test. The ‘t’-test was used to study the quantitative data while chi square test was used to study the qualitative data.Results: Among the study population 60% had diastolic dysfunction and 14% had diastolic dysfunction among cases and control group respectively. Diastolic dysfunction was present among 23.3% and the 76.7% of the age group groups of less than 45 and more than 45 years of age respectively. In this study poor glycaemic status was significantly associated with diastolic dysfunction, whereas duration of diabetes, retinopathy and autonomic neuropathy were not statistically significant.Conclusions: Present study reveals moderately high incidence of diastolic dysfunction in asymptomatic diabetic; subjects and, this finding was correlated with the HBA1C levels but not with retinopathy and autonomic neuropathy.

Comparison of Plasma Glucose, Serum Ferritin, HbA1c and Serum Nitric Oxide Levels between Diabetic and Non Diabetic Individuals: An Indian Scenario.

Aims: To estimate fasting plasma glucose (FPG), serum ferritin, HbA1c and serum nitric oxide levels in type 2 diabetes mellitus (DM) subjects and compare the values with non diabetic individuals and also to assess the correlation analysis between the biochemical parameters in type 2 DM subjects. Study Design: A case control study. Place and Duration of Study: Study was carried out from June 2012 to June 2013 in Bapuji Hospital and Chigateri General Hospital, Davangere, Karnataka, India. Methodology: A total of 87 subjects were included in the present study of which 56 type 2 Diabetes Mellitus patients and 31 control subjects. FPG, serum ferritin, HbA1c and serum nitric oxide were estimated in all subjects. Results: Intergroup comparison of biochemical parameters was done by unpaired “t” test and correlation between the parameters by Pearson’s coefficient analysis. The estimated mean levels (mean  SEM) of FPG, serum ferritin, HbA1c and serum nitric oxide in control group were 98.06±1.30, 84.6±6.61, 5.46±0.15 and 39.0±0.84 respectively. Similarly, in type 2 diabetic patients mean levels of 179.5±7.11, 457.9±53.7, 9.49±0.25, and 100.9±3.5 were obtained for respective parameters. Mean values of all parameters were found to be significantly increased In DM subjects (P=.001) when compared to control group. Moreover, Serum ferritin has shown significant positive correlation with HbA1c and serum nitric oxide in type 2 DM patients with ‘P’ value of .05. Conclusion: The present study suggests that iron over load is one of the major factors in the pathogenesis of type 2 DM. Decreasing iron stores may reduce the oxidative stress, improve the vascular endothelial dysfunction and also improves insulin sensitivity in type 2 DM subjects.

Multiple internal resorption in permanent teeth associated with hyperparathyroidism.

Internal resorption has been described as a resorptive defect of internal aspect of tooth. It is caused by transformation of normal pulp tissue into granulomatous tissue with giant cells which resorb dentin. Though mostly idiopathic in origin, trauma, caries and restorative procedures have also been suggested to be contributing factors of internal resorption of pulp. Most of the internal resorption cases were found on isolated individual tooth. There are few case reports on multiple root resorptions. External root resorption have been frequently associated with systemic disorders like renal diseases hyperparathyroidism, rickets etc. A rare association of multiple internal resorption of permanent teeth (including lateral incisors, canines, premolars, sparing 2 nd and 3 rd . Permanent molars and missing 35,36, 42) with elevated levels of PTH and uric acid was evident in a 28 year old female patient who presented with fracture of crowns of permanent teeth. Though many cases related to dental manifestations of chronic renal disease and internal resorption of permanent teeth have been documented in literature, there is no evidence on association of hyperparathyroidism with multiple internal resorptions of teeth.

Ewing's Sarcoma of the Lesser Sac Masquerading as a Pancreatic Tumor

Extraosseous Ewing's sarcoma/primitive neuroectodermal tumor (ES/PNET) is an uncommon, aggressive, and malignant tumor with a poor patient outcome. Its occurrence in the lesser sac is a rare event and to the best of our knowledge, has not been previously described. The present case was clinically and radiologically misdiagnosed as a pancreatic tumor/gastrointestinal stromal tumor. Histopathology revealed a tumor with "small round cells" that were positive for CD99, confirming the diagnosis of ES/PNET. This report highlights the importance of considering Ewing's sarcoma in the differential diagnosis of intraabdominal, extraintestinal masses.

Mechanism of spasmolytic activity of a fraction of Sarcostemma brevistigma Wight.

The effect of chloroform soluble fraction (F-A) of twigs of Sarcostemma brevistigma on contractions induced by KCl, histamine, and acetylcholine in the isolated guinea pig ileum and taenia coli smooth muscles has been evaluated. F-A (19.5 microg/ml) significantly inhibited the contraction induced by 40 mM KCl to the extent of 87.6% in the isolated guinea pig ileum. In the isolated guinea pig ileum, F-A (64.3 and 59.2 microg/ml) significantly inhibited the contractions induced by acetylcholine and histamine to the extent of 85 and 83% respectively. In the isolated guinea pig taenia coli, F-A (65.2 microg/ml) significantly inhibited the contraction induced by 40 mM KCl to the extent of 96.0%. The inhibitory effect of F-A (40 microg/ml) on the isolated guinea pig taenia coli was reduced by Bay K 8644 (10(-6) M) to the extent of 61.6 from 73.6%. These results suggest that the F-A may exhibit smooth muscle relaxant activity by blocking the Ca2+ channels.

Pharmacognostical studies on abutilon indicum [Linn.] sweet leaves

Abutilon indicum [Linn.] Sweet [Family: Malvaceae] is traditionally used in the indigenous system of medicine and other folklore remedies. The present paper deals with pharmacognostic study of the leaves in a systematic way. These findings will contribute additional information for the authenticity of the plant to the natural herb users and to the future investigators