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Background/Aims@#Extended wireless pH monitoring (WPM) is used to investigate gastroesophageal reflux disease (GERD) as subsequent or alternative investigation to 24-hour catheter-based studies. However, false negative catheter studies may occur in patients with intermittent reflux or due to catheter-induced discomfort or altered behavior. We aim to investigate the diagnostic yield of WPM after a negative 24-hour multichannel intraluminal impedance pH (MII-pH) monitoring study and to determine predictors of GERD on WPM given a negative MII-pH. @*Methods@#Consecutive adult patients (> 18 years) who underwent WPM for further investigation of suspected GERD following a negative 24-hour MII-pH and upper endoscopy between January 2010 and December 2019 were retrospectively included. Clinical data, endoscopy, MII-pH, and WPM results were retrieved. Fisher’s exact test, Wilcoxon rank sum test, or Student’s t test were used to compare data.Logistic regression analysis was used to investigate predictors of positive WMP. @*Results@#One hundred and eighty-one consecutive patients underwent WPM following a negative MII-pH study. On average and worst day analysis, 33.7% (61/181) and 34.2% (62/181) of the patients negative for GERD on MII-pH were given a diagnosis of GERD following WPM, respectively. On a stepwise multiple logistic regression analysis, the basal respiratory minimum pressure of the lower esophageal sphincter was a significant predictor of GERD with OR = 0.95 (0.90-1.00, P = 0.041). @*Conclusions@#WPM increases GERD diagnostic yield in patients with a negative MII-pH selected for further testing based on clinical suspicion. Further studies are needed to assess the role of WPM as a first line investigation in patients with GERD symptoms.
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Background: Taste is the perception produced when a substance in the mouth reacts chemically with taste receptors located on taste buds in the oral cavity. The five basic taste modalities are sweet, salt, sour, bitter, and umami. Disorders of taste can result from various diseases and use of various drugs. Hyperthyroidism is one among them which affects the taste sensation and threshold. Aim and Objectives: The study was conducted to assess the physiological taste threshold for the five primary taste modalities in hyperthyroid patients and to compare their taste thresholds with that of the normal healthy controls. Materials and Methods: Investigations were carried out in 30 hyperthyroid patients aged between 20 and 50 years and in age, sex, and anthropometrically matched control groups of 30, who were apparently healthy. The statistical analysis was done by student’s t-test. Results: There is no difference in the physiological threshold of the all the basic tastes but salt. A significant (P < 0.05) increase in the taste threshold for salt taste can be seen in hyperthyroid patients compared to that of controls. Conclusion: The threshold for salt taste was altered in hyperthyroidism, which can be detected by proper screening. Taste dysfunction leads to reduced food intake and poor nutrition. Proper treatment and counseling can help them to get back their normal taste threshold along with normal thyroid status.
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Background: Taste, one of the five special senses, is the sensory impression of various substances on the tongue. There are five basic taste modalities such as sweet, salt, sour, bitter, and umami. The physiological taste threshold of the individual gets altered in hypothyroidism. Aims and Objectives: The present study was undertaken to test and compare the physiological taste threshold for the five primary taste modalities such as umami, salt, sweet, sour, and bitter in hypothyroid patients and the normal healthy controls. Materials and Methods: Thirty hypothyroid patients aged between 20 and 50 years and 30 age, sex, and anthropometrically matched apparently healthy individuals as control were included in the study. The tests for the threshold of all the five primary tastes were performed in both the groups and the results were compared. Results: The taste threshold for the sweet taste modality has been increased significantly (P < 0.05) in hypothyroid patients compared to controls. No difference could be observed in case of other taste modalities. Conclusion: The significant increase in the physiological taste threshold of sweet modality in hypothyroid patients compared to the controls suggests that hypothyroid patients may have a decreased sensitivity for the sweet taste. Thus, the taste dysfunction should be detected in them by proper screening. Timely management/treatment and counseling can help them to get back their normal taste threshold along with attaining the euthyroid status.
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We evaluated the diagnostic utility of sonication of antibiotic loaded cement spacers comparing with periprosthetic tissue cultures for the detection of persisting infection in 14 patients undergoing staged procedures. Sonication improved microbial detection of intraoperative cultures from 14.2% to 28.5% (P = 0.481). Routine sonication of spacers is recommended.
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Total joint arthroplasty (TJA) is one of the most common and reliable orthopaedic procedures that has significantly improved the quality of life of patients with degenerative joint diseases. Following the increase in the ageing population, availability of trained orthopaedic surgeons and advances in implantation procedures, demand for TJA both globally and in India is significantly increasing. Though TJA is one of the most cost-successful orthopaedic procedures, prosthetic joint infection (PJI) is one of the major complications of joint arthroplasty. Accurate diagnosis of PJI is challenging. Since total hip and knee arthroplasties comprises the majority of TJAs, this review focuses on the current understanding of incidence, risk factors, pathogenesis, causative microorganisms, diagnosis, treatment and prevention of PJI related to these two procedures.
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Background. Calcific uraemic arteriolopathy (calciphylaxis) is an unusual and potentially fatal condition characterised by small-vessel calcification and ischaemic skin necrosis. It mainly affects patients with end-stage renal disease (ESRD) on haemodialysis, but may rarely occur in the absence of ESRD in conditions such as primary hyperparathyroidism, malignancy, alcoholic liver disease and connective tissue disease.Methods. We reviewed the records of all patients diagnosed with calciphylaxis while on renal replacement therapy at Tygerberg Hospital, Cape Town, South Africa, between 1990 and 2014, to describe its presentation, course and final outcome.Results. Nineteen patients developed calciphylaxis over this period. Their median age was 34 years and 13 (68.4%) were female. Fifteen (78.9%) had received a kidney transplant. All patients had painful skin lesions that rapidly progressed to infarction. Small-vessel calcification was seen on skin biopsy in 13 patients. Twelve patients had hyperparathyroidism. Several of the transplanted patients had been treated for graft rejection in the year preceding the diagnosis. Treatment consisted of good wound care and efforts to normalise serum calcium and phosphate levels. Five patients received an urgent parathyroidectomy. The outcome was fatal in 17 patients, with sepsis being the main cause of death.Conclusions. In our patients, calciphylaxis carried a worse prognosis than previously reported internationally. It should always be considered in the differential diagnosis of painful skin lesions in the dialysis or transplant patient
Subject(s)
Calciphylaxis , Necrosis , Renal Replacement Therapy , South Africa , TransplantationABSTRACT
We report the first case of prosthetic joint infection caused by Lysobacter thermophilus which was identified by 16S rRNA gene sequencing. Removal of prosthesis followed by antibiotic treatment resulted in good clinical outcome. This case illustrates the use of molecular diagnostics to detect uncommon organisms in suspected prosthetic infections.
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A 30-year-old lady presented with a 6-month history of recurrent partial intestinal obstruction associated with intermittent fever, anorexia and weight loss. Barium meal follow-through and colonoscopic evaluation suggested ulceration of the ileum and caecum with small bowel obstruction. Histology of the lesions showed marked acute and chronic inflammation consistent with ulceration and granulation tissue. Abdominal CT revealed circumferential thickening of the ascending colon, caecum and terminal ileum with extraluminal air pockets. Surgical exploration revealed a large conglomerate mass involving the terminal ileum, caecum and ascending colon. Histopathology of the resected specimen revealed perforated appendix with nonspecific ulceration of the surrounding bowel. She recovered completely after surgery and did not suffer from gastrointestinal symptoms in the 14 months of follow-up.