Correlation between Bath Ankylosing Spondylitis Disease Activity Index Score and body mass index in the patients suffering with ankylosing spondylitis

Background: Ankylosing spondylitis (AS) is a chronic inflammatory disease of the axial spine that can manifest with various clinical signs and symptoms. Chronic back pain and progressive spinal stiffness are the most common features of this disease. It is an autoimmune disease which also leads to the involvement of skeletal, cardiac, nervous tissues, and other systemic organs. Aim and Objectives: This study was conducted to assess the correlation between the Bath AS Disease Activity Index (BASDAI) score/visual analog scale (VAS) and various age groups in the patients suffering with AS using standard questionnaire. Materials and Methods: Forty-eight AS patients having BASDAI scores of ?4 were included in this study. The height and weight were taken and responses to the standard questionnaire were recorded. BASDAI Score, body mass index (BMI), and VAS were computed. The patients with history of chronic diseases such as hyper/hypothyroidism, diabetes mellitus, and hypertension or the use of any medication such as ?/? blockers, calcium channel blockers, and antiepileptics were excluded from the study. Results: The patients were divided into six different age groups, i.e., 15–20 years, 21–25 years, 26–30 years, 31–35 years, 36–40 years, and 41–45 years. The mean ± SEM values of the BASDAI score in various age groups were 6.8 ± 0.34, 6.3 ± 0.33, 6.2 ± 0.26, 7.1 ± 0.41, 6.5 ± 0.30, and 5.8 ± 0.48, respectively. The mean ± SEM values of VAS are shown in relation to the various age groups, i.e., 15–20 years, 21–25 years, 26–30 years, 31–35 years, 36–40 years, and 41–45 years and the values were 6.88 ± 0.312, 6.58 ± 0.22, 6.55 ± 0.66, 6.00 ± 0.23, 6.72 ± 0.25, and 6.0 ± 0.50, respectively. Conclusion: This study indicates that in the young age group, patients BASDAI score is higher and BMI is lower, and in the older age group, patients BASDAI score is lower and BMI is higher than each other indicating higher disease activity in the younger patients than older patients. An inverse correlation between VAS and age further substantiates our previous finding.

Bradykinin-induced nociceptive responses are more potent than capsaicin-induced responses in rat models

Background: Peripheral blood vessels are concerned with sensing the perivascular nociceptive information and signaling it to the higher centers through ipsilateral somatic nerves, thereby regulating the cardiorespiratory parameters by means of vasosensory reflex responses. Aims and Objectives: The present study was conducted to compare the potency of nociceptive responses elicited by bradykinin (BK) with the capsaicin-induced responses. Materials and Methods: Charles-Foster rats were anesthetized with urethane and injected intraperitoneally. After tracheostomy, the right femoral artery was cannulated with a 24G, double ported cannula for administering the chemicals/saline through vertical port and to record the blood pressure (BP) through horizontal port. BP, Electrocardiogram, and respiratory movements were recorded. Results: Injection of capsaicin into a segment of femoral artery evoked instantaneous transient tachypnoeic, hyperventilatory, and hypotensive responses. BK also produced similar pattern of nociceptive responses along with a transient fall in heart rate. In addition, the vasosensory responses produced by BK are of greater magnitude as compared to the capsaicin. Conclusions: BK is more potent in eliciting reflex nociceptive responses as compared to capsaicin. Further, BK has an additional cardioprotective role by slowing the heart, in the events of acute inflammation.

Autism Spectrum Disorder Categories and Social Responsiveness among Adults with Autism Spectrum Disorder.

Introduction: Autism spectrum disorder (ASD), refers to a broad range of conditions characterized by challenges with social skills, repetitive behaviors, speech and nonverbal communication. Individuals with autism spectrum disorder usually have problems with social responsiveness which in turns effects their social communication and results in confined repetitive pattern of behaviour and interests. However the existing literature is limited in demonstrating the importance of social responsiveness and its impact on gender and ASD categories. Objective: The purpose of this study was to determine the impact of ASD categories on social responsiveness in adults with ASD and investigate social responsiveness among male and female adults with ASD. Methodology: The study utilized data from 60 adults diagnosed with autism spectrum disorder with categories mainly, mild, moderate and high functioning. Adults of both genders (male and female) participated in this study with Social Responsiveness (SR) as a variable over 7 months from October 2021 to February 2022, using the Social Responsiveness Scale-2 (SRS-2 Adult Relative/Other online form). Results and Conclusion: One-way ANOVA test showed significant difference (p<0.001, df=2) between ASD categories. Tukey's Post Hoc Analysis revealed significant (p<0.001) difference between ASD categories from each other. Gender had no significant impact on ASD, and the severity of ASD varies between groups. Thus, this study fills a large knowledge gap on the influence of gender, categories and social responsiveness on adults with ASD.

Paravertebral block: anatomy and relevant safety issues / 대한마취과학회지

Paravertebral block, especially thoracic paravertebral block, is an effective regional anesthetic technique that can provide significant analgesia for numerous surgical procedures, including breast surgery, pulmonary surgery, and herniorrhaphy. The technique, although straightforward, is not devoid of potential adverse effects. Proper anatomic knowledge and adequate technique may help decrease the risk of these effects. In this brief discourse, we discuss the anatomy and technical aspects of paravertebral blocks and emphasize the importance of appropriate needle manipulation in order to minimize the risk of complications. We propose that, when using a landmark-based approach, limiting medial and lateral needle orientation and implementing caudal (rather than cephalad) needle redirection may provide an extra margin of safety when performing this technique. Likewise, recognizing a target that is not in close proximity to the neurovascular bundle when using ultrasound guidance may be beneficial.

Clinical and angiographic profiles and six months outcomes of smokers with acute ST segment elevation myocardial infarction undergoing primary percutaneous coronary angioplasty

Background Outcomes of primary percutaneous coronary intervention (PCI) for acute STEMI (ST-segment elevation myocardial infarction) in smokers are expected to be better than non-smokers as for patients of acute STEMI with or without fibrinolytic therapy. Objectives This comparative study was designed to evaluate the outcomes of primary PCI in patients with acute STEMI in smokers and non-smokers. Clinical and angiographic profile of the two groups was also compared. Methods Over duration of two year, a total of 150 consecutive patients of acute STEMI eligible for primary PCI were enrolled and constituted the two groups [Smokers (n = 90), Non-smokers (n = 60)] of the study population. There was no difference in procedure in two groups. Results In the present study of acute STEMI, current smokers were about a decade younger than non-smokers (p value = 0.0002), majority were male (98.9% vs 56.6%) were male with a higher prevalence of hypertension and diabetes mellitus (61.67% vs 32.28% and 46.67% vs 14.44%, p = 0.001) respectively. Smokers tended to have higher thrombus burden (p = 0.06) but less multi vessel disease (p = 0.028). Thirty day and six month mortality was non-significantly higher in smokers 4.66% vs 1.33% (p = 0.261) and 5.33% vs 2.66% (p = NS) respectively. Rate of quitting smoking among smokers was 80.90% at 6 months. Conclusion The study documents that smokers with acute STEMI have similar outcomes as compared to non smokers with higher thrombus burden and lesser non culprit artery involvement. Smokers present at much younger age emphasizing the role of smoking cessation for prevention of myocardial infarction.

Luxacion traumatica aguda de la articulacion tibioperonea proximal: Reporte de un caso y revision bibliográfica / Acute traumatic dislocation of the proximal tibiofibular joint: case report and review

La luxacion tibioperonea proximal es poco comun, se relaciona con lesiones deportivas, como consecuencia de un trauma en rotacion con el pie en inversion y flexion plantar, la rodilla en flexion y la pierna en rotacion externa simultaneamente. Provoca dolor en la region lateral de la rodilla y la pierna, con arcos de movilidad completos de la rodilla, pero dolorosos. El diagnostico es clinico y radiologico. Es una entidad que pasa inadvertida en el Servicio de Urgencias (60%), con consecuencias funcionales y biomecanicas si no se diagnostica oportunamente. El objetivo es describir la experiencia diagnostica y el tratamiento ortopedico de una entidad inusual en trauma de rodilla. Se presenta a un paciente de 23 anos que sufrio una caida patinando y refiere protuberancia proximal en la cara lateral de la pierna izquierda, edema, dolor y limitacion para extender la rodilla. Nivel de Evidencia: IV

Proximal tibiofibular dislocation is uncommon, and it is related to sport injuries as a result of an external rotation trauma with the knee in fully flexed position, and foot pointing inwards and downwards. It causes pain in the anterolateral aspect of the knee, motion is complete but painful. Diagnosis is clinical and radiological. This entity goes unnoticed in the emergency department (60%), with functional and biomechanic consequences if diagnosis is no immediate. The objective is to describe diagnostic experience and orthopedic treatment of an unusual knee condition. We present a 23-year-old patient who fell while skating. He refers a proximal protuberance in the lateral face of the left leg, edema, pain, and limitation for knee extension. Level of Evidence: IV

Laparoscopic Port Entry methods - A Critical Review

Background: Laparoscopy involves insufflation of the abdomen by gas so that the endoscope can view the intra-abdominal contents without being in direct contact with the viscera or tissue. Access to the abdomen is the one challenge of laparoscopy that is particular to the insertion of surgical instruments through small incisions. Materials and Methods: The study was a prospective, randomized, double-blind, and comparative study conducted on 100 consenting patients who underwent laparoscopic surgeries at Father Muller Medical College Hospital, for a period of 3 years from December 2014 to 2017 for various conditions needing laparoscopy who fulfilled a pre-determined the inclusion and exclusion criteria. Results: In our study, the least age was 20 years, and maximum age was 61 years. Age ranged from 18 to 65 years with mean age of 40 years. Most cases were males 86%. There was no difference in the two groups in terms of demography and perioperative factors such as type of surgery and body mass index; hence, the data were statistically comparable. The mean time needed to create pneumoperitoneum was 2.31 ± 1 min in Veress needle technique and 3.99 ± 1 in open method (P = 0.000) gas leak was observed in 11 patients in open group whereas no patient had a gas leak in Group B (P = 0.000). Pneumoperitoneum was achieved in all 100 cases. There were 7 cases of abdominal wall hemorrhage 4 acute that was managed laparoscopically by harmonic cauterization. No vascular injury, bowel, omental was noted in both groups. Neither open nor closed needed with conversion to open due to inadequate access into the peritoneal cavity. One closed as access could not be gained was converted to open method. 3 (6%) patients had post-operative hematoma at the umbilical port site in open Group A whereas no one developed this complication in a closed group 9 (9%) patients presented with surgical site infection at the umbilical trocar site and 4 in the closed group

Liver Enzyme Changes in Lap Appendectomy a Reason for Concern

Introduction: Abdominal pain remains the foe runner of complaints’ presenting to the general surgeon in the present world. Acute appendicitis is the most common of the acute abdominal conditions presenting which requires immediate surgical intervention. Materials and Methods: The study was a prospective experimental study conducted on 100 cases evaluated and diagnosed as acute appendicitis and was admitted to Father Muller Hospital who underwent laparoscopic appendectomy from the time period September 2014 to August 2016. Results: In present study, the enrolled patients above the age of 16 years, in our study most patients who were treated with laparoscopic appendectomy were in the age group 21–30 years with 39%, females accounted for 51% of the study. In our study, we found that the serum glutamic pyruvic transaminase levels serum glutamic oxaloacetic transaminase levels, unconjugated bilirubin levels increased postoperatively statistically significantly with a P < 0.001 and returned to the baseline levels 7th day postoperatively.

A comparative study of oral manifestations of HIV among pediatric patients

Introduction: The HIV pandemic has become a human, social as well as economic disaster, with far reaching inferences for individuals, communities and countries. The distribution of some of the specific oral manifestations is reported to differ between adults and children. Thus, the present study was carried to compare the oral manifestations in HIV positive children and HIV negative children. Materials and methods: The present study comprised a total of 90 subjects, divided into 3 groups, 30 HIV positive pediatric patients with HAART, 30 HIV positive pediatric patients without HAART and 30 healthy controls (HIV negative patients). The present study was conducted in the ART centre in Ranchi, Chattisgarh, India. The details to be taken from these children for subsequent analysis include age, CD4+ T cell count and oral lesions. Chi- square test was used to compare the lesions with Pvalue of 0.05 or less was considered for statistical significance and a P-value of 0.02 or less was considered for statistical highly significance. Results: Statistical analysis showed that patients with low CD4+ T cell counts (Group IA) had more number of lesions when compared to the patients with higher CD4 T cell count (Group IB). Dutta N, Gupta VK, Shetty R, Roy A, Dani G, Pandey V. A comparative study of oral manifestations of HIV among pediatric patients. IAIM, 2016; 3(5): 46-52. Page 47 According to individual lesion percentage distribution, it was observed that except hyperpigmentation most of the other lesions where more prevalent in group II than in group I. Mucocele was seen in group III and was not seen in group I and II. Dental caries was prevalent in all the three groups. Conclusion: HIV infected patients receiving HAART, had a significantly lower prevalence of oral lesion as compared to patients without HAART therapy

Prevalence of metabolic syndrome in Central America: a cross-sectional population-based study / Prevalencia del síndrome metabólico en Centroamérica: un estudio transversal basado en la población

OBJECTIVE: To report the prevalence of metabolic syndrome (MetS) as found by the Central American Diabetes Initiative (CAMDI) study for five major Central American populations: Belize (national); Costa Rica (San José); Guatemala (Guatemala City); Honduras (Tegucigalpa); and Nicaragua (Managua). METHODS: Study data on 6 185 adults aged 20 years or older with anthropometric and laboratory determination of MetS from population-based surveys were analyzed. Overall, the survey response rate was 82.0%. MetS prevalence was determined according to criteria from the Adult Treatment Panel III of the National Cholesterol Education Program. The study's protocol was reviewed and approved by the bioethical committee of each country studied. RESULTS: The overall standardized prevalence of MetS in the Central American region was 30.3% (95% confidence interval (CI): 27.1-33.4). There was wide variability by gender and work conditions, with higher prevalence among females and unpaid workers. The standardized percentage of the population free of any component of MetS was lowest in Costa Rica (9.0%; CI: 6.5-11.4) and highest in Honduras (21.1%; CI: 16.4-25.9). CONCLUSIONS: Overall prevalence of MetS in Central America is high. Strengthening surveillance of chronic diseases and establishing effective programs for preventing cardiovascular diseases might reduce the risk of MetS in Central America.

OBJETIVO: Notificar la prevalencia del síndrome metabólico (SMet) observada en el estudio de la Iniciativa Centroamericana de Diabetes (CAMDI) llevado a cabo en cinco importantes poblaciones centroamericanas: Belice (nacional); Costa Rica (San José); Guatemala (Ciudad de Guatemala); Honduras (Tegucigalpa); y Nicaragua (Managua). MÉTODOS: Se analizaron los datos de estudio obtenidos de las encuestas poblacionales dirigidas a 6 185 adultos de 20 años de edad o mayores con determinaciones antropométricas y de laboratorio relativas al SMet. En términos generales, la tasa de respuesta a las encuestas fue de 82,0%. Se determinó la prevalencia del SMet según los criterios del tercer informe del Grupo de Expertos en el Tratamiento de Adultos (Adult Treatment Panel III) del Programa Nacional de Educación sobre el Colesterol. El protocolo del estudio fue examinado y aprobado por el comité de bioética de cada uno de los países incluidos en el estudio. RESULTADOS: La prevalencia general estandarizada del SMet en Centroamérica fue de 30,3% (Intervalo de confianza de 95% (IC): 27,1-33,4). Se observó una amplia variabilidad según el sexo y las condiciones laborales, con mayor prevalencia en mujeres y trabajadores no retribuidos. El menor porcentaje estandarizado de población libre de cualquier componente del SMet se observó en Costa Rica (9,0%; IC: 6,5-11,4) y el mayor en Honduras (21,1%; IC: 16,4-25,9). CONCLUSIONES: La prevalencia general de SMet en Centroamérica es alta. Se podría reducir el riesgo de SMet en Centroamérica mediante el fortalecimiento de la vigilancia de las enfermedades crónicas y el establecimiento de programas eficaces de prevención de las enfermedades cardiovasculares.

Clostridium difficile outbreak in Costa Rica: control actions and associated factors / Brote de infección por Clostridium difficile en Costa Rica: medidas de control y factores asociados

OBJECTIVE: To describe interventions implemented during a nosocomial outbreak of Clostridium difficile in a general hospital in Costa Rica from December 2009 to April 2010 in order to achieve outbreak control and the factors determined to be associated with C. difficile infection. METHODS: Laboratory-confirmed cases of C. difficile were analyzed to describe the outbreak pattern and intervention measures implemented. Cases were selected and recruited in a case-control study. Controls were selected from the same services and time period as the cases. Evaluated exposures included underlying medical conditions and treatments administered before the onset of symptoms. RESULTS: The mean ages in case and control groups were 62.3 and 55.3 years, respectively. Control measures included a hand-hygiene campaign, deep disinfection of hospital surfaces, strict isolation of cases, use of personal protection equipment, and restriction of antibiotic use. The adjusted attributable risks associated with the outbreak were diabetes [odds ratio (OR) 3.4, 95% confidence interval (CI) 1.5-7.7], chronic renal failure (OR 9.0, 95% CI 1.5-53.0), and prescribing ceftazidime (OR 33.3, 95% CI 2.9-385.5) and cefotaxime (OR 20.4, 95% CI 6.9-60.3). CONCLUSIONS: Timely implementation of control measures resulted in reduced infection transmission and successful control of the outbreak. Conditions associated with C. difficile infection were similar to those found in previously described outbreaks of this bacterium.

OBJETIVO: Describir las intervenciones ejecutadas durante un brote intrahospitalario de infección por Clostridium difficile en un hospital general de Costa Rica desde diciembre del 2009 hasta abril del 2010 para lograr el control del brote y de los factores asociados a la infección por C. difficile. MÉTODOS: Se analizaron los casos de infección por C. difficile que se habían confirmado mediante pruebas de laboratorio a fin de describir las características del brote y las medidas que se tomaron. Se seleccionaron los casos y se incluyeron en un estudio de casos y testigos; se seleccionaron los testigos en los mismos servicios y el mismo periodo que los casos. Las exposiciones evaluadas incluían las afecciones médicas subyacentes y los tratamientos administrados antes de que comenzaran los síntomas. RESULTADOS: La media de la edad en los grupos de los casos y de los testigos fue de 62,3 años y 55,3 años, respectivamente. Las medidas de control incluyeron una campaña de promoción de la higiene de las manos, la desinfección a fondo de las superficies hospitalarias, el aislamiento estricto de los casos, el uso de equipo de protección personal y la restricción del uso de antibióticos. Los riesgos atribuibles ajustados que se asociaron al brote fueron la diabetes (razón de posibilidades [OR]: 3,4; intervalo de confianza [IC] de 95%: 1,5-7,7), la insuficiencia renal crónica (OR: 9,0; IC de 95%: 1,5-53,0) y el uso de ceftazidima (OR: 33,3; IC de 95%: 2,9-385,5) y cefotaxima (OR: 20,4; IC de 95%: 6,9-60,3). CONCLUSIONES: La aplicación oportuna de medidas de control redujo la transmisión de la infección y permitió controlar satisfactoriamente el brote. Las afecciones y los factores que se asociaron a la infección por C. difficile fueron similares a los que se encontraron en brotes de esta infección descritos anteriormente.

Can Neonatal Pneumoperitoneum be Managed by Conservative Management Alone.

Common causes of pneumoperitoneum in neonates includes necrotising enterocolitis (NEC), specific infections, gastro intestinal obstruction, iatrogenic causes, idiopathic focal intestinal perforation, perforation secondary to intra thoracic pathology, mechanical ventilation etc. Primary peritoneal drainage and exploratory laparotomy remain the definitive management of pneumoperitoneum in neonates. Here we report a case of suspected spontaneous idiopathic intestinal perforation managed conservatively with monitoring of vital signs. The neonate had an uneventful recovery. This case highlights the need to identify infants with benign or non surgical causes of pneumoperitoneum thus avoiding unnecessary laparotomies and referrals in these vulnerable neonates.

A Study on Comparative Evaluation of Add-on Pralidoxime Therapy over Atropine in the Management of Organophosphorus Poisoning in a Tertiary Care Hospital.

Since its discovery in 1956, pralidoxime has been used in the management of organophosphorus poisoning (OP) in addition to atropine. While efficacy of atropine is proved beyond doubt, clinical experience with pralidoxime has led to widespread controversies about its efficacy in treatment of OP poisoning. In this study we compared the efficacy of add-on pralidoxime therapy over therapy with atropine alone in OP poisoning. In this open-label, parallel-group clinical study, patients of OP poisoning, presenting in emergency department of a tertiary care district hospital, were randomly allocated to receive either atropine or atropine plus pralidoxime. The parameters used for efficacy assessment were: mortality rate, requirement of ventilator and duration of stay in the hospital in either of the two treatment arms.The mortality rate, requirement of ventilator and duration of hospital stay in the two treatment arms failed to show any statistically significant difference. Add-on pralidoxime therapy over atropine monotherapy, does not offer any significant advantage in the management of OP poisoning.

Burkitt’s Lymphoma in a 5 year old Bengali Girl: A Case Report.

Burkitt’s lymphoma (BL) is a rare monoclonal proliferation of B-lymphocytes and is classified as a poorly differentiated lymphocytic lymphoma. This tumor was first noted in Africans. The cause of this tumor is debatable, but strong evidence implicates Epstein-Barr virus in its development. This tumor predominantly affects children and is probably the fastest growing tumor in humans, with exuberant proliferation. It is a very rare malignancy accounting for only 0.76% of solid malignant tumors among Indian children. A case of BL of the right hemimandible in a 5-year-old Bengali girl is reported.

Feasibility study of stroke surveillance: Data from Bangalore, India.

Background & objectives: Stroke is a leading cause of deaths, and disabilities in India. Reliable and good quality data on epidemiological characteristics of stroke are essential to plan, implement and evaluate stroke prevention and control programmes. A feasibility study was undertaken in Bangalore to examine the possibility of establishing stroke surveillance and to develop methodology for a larger programme. Methods: The study adapted WHO STEPs-STROKE methodology to collect data on hospitalized stroke events and fatal stroke events in the city of Bangalore. In STEP I, Information was collected from 1,174 stroke patients in three large hospitals and were followed till discharge and 28 days; outcome was measured as death or disability. Stroke cases fulfilling diagnostic criteria, evaluated by neurologists and CT/MRI confirmed cases were included. Brief information on major risk factors was collected from all stroke patients / family members and from medical records by trained research officers. In STEP II, death records of Bangalore Mahanagara Palike for 2004 (n=23,312) were analyzed to identify stroke related deaths. Results: Using WHO-STEPs approach, a methodology was developed for stroke surveillance in a geographically defined population. By STEP 1 method - 7 per cent of medical and 45 per cent of neurological admissions were due to stroke with a fatality rate of 9 per cent at hospital discharge and 20 per cent at 28 days. With a mean age of 54.5 (± 17.0) yr and male preponderance, nearly half had one or more risk factors. Weakness or paresis (92%) was the commonest presentation and ischaemic stroke was most frequent (73.8%). One third of total stroke patients were dependent at both discharge and 28 day follow up. By STEP II method the proportional mortality rate for Bangalore city was observed to be 6 per cent and more than 50 per cent of total stroke deaths had occurred in 10 major hospitals. Interpretation & conclusions: The present study has shown that stroke surveillance is possible and feasible. Institution based (hospitals and vital registry data) stroke surveillance supplemented with periodical population based information can provide comprehensive information on vital aspects of stroke like mortality, risk factors, disability and outcome. There is a need to develop stroke surveillance in a phased manner along with mechanisms to apply data for prevention and control programmes.

Hemothorax--a rare presentation of congenital strangulated diaphragmatic hernia.

We report the case of a 7 years old previously asymptomatic child who initially presented with respiratory distress because of massive left-sided hemothorax but was subsequently diagnosed to be having strangulated small intestine through a diaphragmatic rent on laparotomy. The case is being discussed in detail and the possible causes of hemothorax in such a scenario discussed.