Cortical Thinning in High-Grade Asymptomatic Carotid Stenosis / 대한뇌졸중학회지

Background@#and Purpose High-grade carotid artery stenosis may alter hemodynamics in the ipsilateral hemisphere, but consequences of this effect are poorly understood. Cortical thinning is associated with cognitive impairment in dementia, head trauma, demyelination, and stroke. We hypothesized that hemodynamic impairment, as represented by a relative time-to-peak (TTP) delay on MRI in the hemisphere ipsilateral to the stenosis, would be associated with relative cortical thinning in that hemisphere. @*Methods@#We used baseline MRI data from the NINDS-funded Carotid Revascularization and Medical Management for Asymptomatic Carotid Stenosis–Hemodynamics (CREST-H) study. Dynamic contrast susceptibility MR perfusion-weighted images were post-processed with quantitative perfusion maps using deconvolution of tissue and arterial signals. The protocol derived a hemispheric TTP delay, calculated by subtraction of voxel values in the hemisphere ipsilateral minus those contralateral to the stenosis. @*Results@#Among 110 consecutive patients enrolled in CREST-H to date, 45 (41%) had TTP delay of at least 0.5 seconds and 9 (8.3%) subjects had TTP delay of at least 2.0 seconds, the maximum delay measured. For every 0.25-second increase in TTP delay above 0.5 seconds, there was a 0.006-mm (6 micron) increase in cortical thickness asymmetry. Across the range of hemodynamic impairment, TTP delay independently predicted relative cortical thinning on the side of stenosis, adjusting for age, sex, hypertension, hemisphere, smoking history, low-density lipoprotein cholesterol, and preexisting infarction (P=0.032). @*Conclusions@#Our findings suggest that hemodynamic impairment from high-grade asymptomatic carotid stenosis may structurally alter the cortex supplied by the stenotic carotid artery.

Correlation of Anthropometric Measurements of Proximal Tibia with Its Length for Stature Estimation in Forensic Analysis

Background: Estimation of stature is one of the commonly used methods in forensic analysis to establish identity of individuals. Estimation of stature from fragments of long bones is done by deriving linear regression equations. The objective of the present study was to derive a simple regression equation for estimating length of the tibia using the morphometry of proximal end of tibia. Materials and methods: In this descriptive study carried out in the department of anatomy of a medical college, anthropometric measurements of proximal end of 150 dry human tibiae were collected irrespective of the sex and side. The parameters measured included the mediolateral length of the proximal end, the anteroposterior length of the medial and lateral condyle of tibia, anteroposterior length of the intercondylar area, and the circumference of proximal end of tibia. The measurements were done using Vernier calliper and measuring tape. Length of the tibia was estimated by using simple regression analysis. Results: The following linear regression equations were derived. Length of tibia can be calculated by, 29.2749 + (1.1925 × Mediolateral length) ±1.1926, 27.6418 + (2.333 × Anteroposterior length of lateral condyle) ±1.132, 21.8342+(3.2614 ×Anteroposterior length of medial condyle) ±1.328, 33.542 +(0.8952 × Anteroposterior length of intercondylar region) ±1.474, 23.1902 +(0.76379 × Circumference of proximal end) ± 1.134 Conclusion: The study revealed that there is a positive correlation between the measurements of proximal end of tibia and its length. The equation derived would help in forensic analysis to estimate the stature of an individual.

Prevalence and correlates of microvascular complications among patients with diabetes mellitus: a cross sectional study

Background: Diabetes mellitus is a metabolic disorder of multiple etiology, characterized by chronic hyperglycemia and associated with various microvascular, macrovascular and nonvascular complications leading to increasing morbidity and mortality. Microvascular complications are daibetes specific and their relation with associated comorbidities studied worldwide. To estimate the prevalence of microvascular complications in diabetic patients and to find their relation with various comorbid conditions.Methods: A total of hundred diagnosed patients of diabetes mellitus with age ranging from 18 to 75 years were enrolled in the study. Patients were assessed for the presence of microvascular complications and associated comorbidities. The effect of various comorbidities on frequency of microvascular complications was also determined. Data collected was statistically analyzed.Results: In this study, the mean age of the study group was 55.77±11.75 years. Mean age of onset of the disease was 48.89±11.50 years. Mean duration of the disease in the study group was 6.86±5.02 years. Diabetic retinopathy, neuropathy and nephropathy was found in 76%, 63% and 69% patients, respectively. Among patients with hypertension, 91.7%, 83.3%, and 81.7% cases were found to have retinopathy, neuropathy and nephropathy, respectively. The corresponding figures for those with comorbid IHD were 91.1%, 83.9% and 76.8% respectively whereas among patients with coexisting metabolic syndrome, 92.5%, 80.6%, and 79.1% were found to have retinopathy, neuropathy, and nephropathy, respectively.Conclusions: The most frequent microvascular complication reported by this study was diabetic retinopathy. comorbid conditions like hypertension, ischemic heart disease, and metabolic syndrome were associated with higher prevalence of microvascular complications in diabetic patients.

Prevalence of mental health problems by using strength and difficulty questionnaire in school going adolescents (11-17 years) of Jaipur city, Rajasthan

Background: Adolescents constituting 21% of India’s population. Most mental disorders begin before age 14, though they are often first detected later in life. Detecting these disorders and individual prone to these disorders at earlier ages can facilitate better treatment. With this in mind the present study was planned to find out the prevalence and pattern of mental health problem and their association with socio-demographic factors (age, gender, religion and socio-economic status) in school going adolescents in Jaipur. Methods: A cross-sectional study was conducted on 994 school going adolescents (11-17 years) studying in 6th to 12th class of Jaipur city, Rajasthan. The simple random sampling and self reported version of Strength & Difficulty questionnaire (SDQ) were used to assess mental health. Chi-square was used to test significance. Results: The 8.35% school going adolescents had abnormal SDQ score indicating probable mental disorders. The borderline and normal adolescents on total difficulty score were 14.19%, 77.46% respectively. Conduct Problem was the most prevalent (12%), followed by emotional (10%), peer (7%), hyperactivity (6%) and prosocial problem (5%). Impact of total difficulty was abnormal in 13.78% adolescents. The age and SES were found significantly associated with mental health problems (p<0.05). The mental health was not associated with gender, religion and school type. Conclusions: The proportion of borderline and abnormal adolescents was more than one fifth on total difficulty score that need further evaluation and appropriate counselling/treatment by psychiatrist.

Fatigue and diabetes mellitus: a prospective study

Background: Fatigue is a common complaint among patients with diabetes mellitus (DM) that can undermine the daily functional activities of a person. The objectives of the study were to assess the fatigue in patients of newly diagnosed type 2 DM and to relate fatigue with blood glucose parameters (BGP) and glycemic control.Methods: A total 50 patients of type 2 DM, diagnosed as per American Diabetes Association 2011 criteria, were enrolled in the study group. Each subject was evaluated two times for fatigue using Multidimensional Fatigue Symptom Inventory-Short Form (MFSI-SF) scale. 1st assessment was at the time of enrollment and 2nd was done after achieving target control of type 2 DM. Values of Fasting blood glucose (FBG), postprandial blood glucose (PPBG), blood glucose variability (BGV) and glycosylated hemoglobin (HbA1c) were obtained for each subject at each assessment. Data collected was analyzed statistically.Results: Mean age of study group was 50.7±8.9 years with male to female ratio of 1.17:1. Mean values of MFSI-SF score at 1st and 2nd assessment were 14.10±17.97 and 4.64±14.06, respectively indicating a statistically significant improvement in fatigue (p<0.05) after achieving target control. Overall fatigue, general fatigue, emotional fatigue, and vigor score correlated significantly with glycemic control (HbA1c) with correlation coefficient (r) of 0.337, 0.351, 0 .339, and - 0.281, respectively (all p <0.05).Conclusions: Fatigue had a positive correlation with FBG, PPBG and BGV and HbA1c. A significant improvement in all the parameters of fatigue was noted after control of diabetic status.

Study Of Distal Dimensions Of Tibia In Correlation With The Length Of Tibia

Background: In forensic analysis, the estimation of the stature is key in identification of an individual. Thestature of an individual can be estimated from long bones especially the tibia and the femur as these have directcorrelation to the height of an individual. The tibia is ideal in this application as it resists erosion and keeps itsanatomical shape for long even after burial. Mechanical loading is especially high in the distal ends of longbones of the lower limb and as such they display significant inter-individual differences. The use of distaldimensions in estimation of the length of the tibia from skeletal remains has not been reported.Materials and methods: 150 dry and processed tibias irrespective of side, grossly normal and complete wererandomly collected from a medical college of south India. Unossified bones, bones with diseases and injurieshave been excluded.Results: In our study, the mean and standard deviation was calculated for each of the dimensions. The resultswere analysed with simple regression analysis. Pearson’s coefficient determined for each parameter andtabulated. Simple linear regression equations were then deduced from the obtained data which would predictthe expected maximum length of the bone from its various other parameters.Conclusion: Simple regression equations are deducted from the obtained data, which would predict the expectedmaximum length of the tibia from its various parameters

Endoscopic Third Ventriculostomy: Success and Failure

Endoscopic third ventriculostomy (ETV) has now become an accepted mode of hydrocephalus treatment in children. Varying degrees of success for the procedure have been reported depending on the type and etiology of hydrocephalus, age of the patient and certain technical parameters. Review of these factors for predictability of success, complications and validation of success score is presented.

An audit of cytoreductive surgeries in ovarian cancer from a rural based cancer center.

BACKGROUND AND OBJECTIVE: Ovarian cancers are frequently seen at an advanced stage in our center. This audit was planned to see the morbidity and efficacy of different types of cytoreductive surgeries (radical vs. ultra‑radical) done in such patients. METHODS: This was a retrospective analysis of all ovarian cancer patients who underwent cytoreductive surgery at our center from January 2009 to August 2013. The case records of these patients were reviewed and the demographic, disease‑related and treatment‑related data were extracted. RESULTS: Fifty‑fivepatients were identified. Ten (18.2%) patients underwent primary cytoreduction while 45 patients had (81.8%) interval cytoreduction. The resections achieved were optimal in 50 patients (90.9%) and suboptimal in five patients (9.1%). The postoperative median blood loss was 400 (350–600) mL. The median time interval for surgery was 4.0 h (3–5 h). The type of resection achieved (optimal vs. suboptimal) was the only factor affecting the progression free survival (PFS) (Hazard ratio = 0.08 95% confidence interval 0.02–0.3). There was no significant difference in postoperative morbidity in patients undergoing the ultra‑radical surgery as compared to those who underwent radical surgery. CONCLUSION: Optimal cytoreduction may improve PFS in advanced ovarian cancer patients and needs to be done even if it mandates an ultra‑radical surgery.

Evaluation Of Changes In The Oral Environment With Lingual Orthodontic Appliances.

Background & Objective: Lingual orthodontics is gaining more popularity in orthodontic centers. The purpose of present study is to evaluate changes in the oral cavity with lingual orthodontic appliances. Methodology: The epidemiological study was conducted among 45 patients with lingual orthodontics. Before the start of orthodontic treatment all the patients received proper oral prophylaxis. The incidence of White Spot Lesions (WSLs), plaque accumulation and gingivitis were evaluated at the interval of one, six and twelve months using WSL index developed by Gorelick et al., (1982), Silness & Löe plaque index and Löe & Silness gingival index respectively. The Student’s t test and ANOVA test were used with a significance level of 5%. Results: The frequency of WSLs increased with the procedure of lingual orthodontics from first month (3.2%) to six (6.7%) and twelve months (7.9%). A significant increase in the plaque index (PI) and gingival index (GI) was observed from month one to twelve months. Overall mean of PI and GI was 2.07±0.809 and 1.67±0.929 respectively among the patients. Conclusion: The occurrence of dental plaque and gingival inflammation was mostly noticed in lingual orthodontic cases as it is difficult to remove the plaque deposits around the brackets in the lingual side.

Development of Lipid Based Nanoparticulate Drug Delivery Systems and Drug Carrier Complexes for Delivery to Brain.

Many neurotherapeutics are unsuccessful in treating CNS disorders because they cannot be effectively drug delivered. Drug delivery to the brain is a challenge even though there is relatively high blood flow. There are two physiological barriers likes blood-brain barrier and blood-cerebrospinal fluid barrier which separates the brain from its blood supply controlling the transport of compounds. Many of the brain or CNS associated diseases remain untreated by effective therapies. This is not because there is a lack of candidate drugs but due to the inability of many therapeutic molecules to cross the BBB, the BCSFB or other specialized CNS barriers to reach the specific areas of brain. Hence there is a need in the modern approaches and present insights into using ligand conjugation and nanotechnology to target the BBB via different transport pathways and mechanisms. The field of novel drug delivery system has fully emerged and came into existence as an ideal approach of drug targeting and delivery to brain. The new approaches of drug delivery to brain help in successful transporting drugs across the BBB.

Clinical Profile of Hand, Foot, and Mouth Disease and its Associated Complications among Children in Shimoga City, Southern Karnataka: A Hospital-Based Study.

Hand, foot, and mouth disease (HFMD) is one of the important public health problems. It has become a common childhood illness in our part of the country. In most instances, this is a mild self-limiting illness. The affected children are often given outpatient care. However, over the last decade, HFMD has emerged as a growing health problem in Asian countries following frequent outbreaks of deaths associated with HFMD caused by a more virulent member of human enterovirus (HEV), namely, HEV71. A hospital-based descriptive study about the clinical presentations and complications of HFMD at the hospitals of Shimoga city between March 2013 and August 2013 is documented and presented here. HFMD was more common in the 1-3-year old age group, with aseptic meningitis being the most common complication. Surveillance of HFMD must be maintained as there is no effective chemoprophylaxis or vaccine available.

Impact of monitoring cerebral oxygen saturation on the outcome of patients undergoing open heart surgery.

Aims and Objectives: We studied the usefulness of regional cerebral oxygen saturation (rSO 2 ) monitoring during cardiopulmonary bypass (CPB) and evaluated effects of cerebral oxygen desaturation on the postoperative neurological outcome. Materials and Methods: 100 patients were randomly allocated to either control or intervention group. In the control group rSO 2 was recorded continuously, but the attending anesthesiologist was blinded. In the intervention group specific interventions were initiated in case of cerebral desaturation. Neurocognitive testing was done using a simplified antisaccadic eye movement test (ASEM) and mini-mental state examination (MMSE). Data was analyzed using Chi-square test, and unpaired t-test. Results: In both the groups rSO 2 declined during CPB. The decrease in rSO 2 was significant ( P < 0.001) in the control group compared to the intervention group. In the intervention group the rSO 2 mainly responded to an increase in mean arterial pressure. The area under the curve below threshold rSO 2 was significantly more ( P < 0.0001) in the control group compared to intervention group and a significant decrease in the MMSE and ASEM scores occurred in control group at one week and three months postoperatively. Conclusions: Monitoring of rSO 2 during CPB can significantly decrease the incidence of postoperative neurocognitive decline.

Glandular odontogenic cyst: Report of an unusual bilateral occurrence.

Glandular odontogenic cyst (GOC) is a recently recognized rare developmental odontogenic cyst having an aggressive behavior and accounting for 0.012% to 1.3% of all jaw cysts. GOC usually presents as a painless, slow-growing swelling that tends to affect the anterior part of the jaws. It chiefly occurs in the fourth and fifth decades of life and presents as an expansion of jaws with or without pain or paresthesia. Aggressive nature of the lesion has been reported, as supported by the fact that 25 to 55% of cases recur following curettage. So far only just over 113 cases of GOC have been reported in the literature. Here, we report a case of bilateral GOC in the posterior region of the maxilla, in a 29-year-old male patient, which is unique, being the first case of bilateral GOC to be reported in the literature.

Spectral domain optical coherence tomography features of multiple subfoveal retinal pigment epithelial tears after intravitreal bevacizumab.

Retinal pigment epithelial (RPE) tear has been described to occur spontaneously, after laser photocoagulation and in recent times, after intravitreal injection of anti-vascular endothelial growth factor (VEGF) agents. In the latter case, the rapid contraction of the choroidal vascular membrane underneath a serous RPE detachment is believed to be the underlying cause. Preservation of good visual acuity after the occurrence of RPE tear with continued use of intravitreal VEGF agents has been reported. In this case report, we describe the occurrence of multiple RPE tears with the use of intravitreal bevacizumab and also correlate the preservation of visual acuity with features seen on spectral domain optical coherence tomography.

Evaluation of modified retinopathy of prematurity screening guidelines using birth weight as the sole inclusion criterion

The purpose was to determine if birth weight [BW] alone can be the sole criterion for screening infants at risk for retinopathy of prematurity [ROP]. In this retrospective, observational case series, 208 infants were screened for ROP using the American Association for Pediatric Ophthalmology and Strabismus [AAPOS] Guidelines [1997]. Variables examined included gestational age [GA], birth weight [BW], and a composite variable BWGA Index [[grams x weeks]/1000], which takes into consideration both the birth weight and gestational age of the infant. Infants were divided into two groups: Group 1, BW 1250 g. Multivariate analysis was performed to detect factors predictive of ROP. Receiver operator characteristic [ROC] curves were generated to determine the efficacy of screening using the BW, GA, and BWGA Index. Statistical analyses were performed with logistic regression with a P-value of 0.05 or less indicating statistical significance. Varying stages of ROP were present in 116 of 416 eyes. Of the 105 eyes in Group 2, only 1 eye developed stage 1 ROP. Only Group 1 eyes developed stage 3 or higher ROP. The ROC curve for BW alone gave an area under the curve [AUC] of 0.797 [standard error [SE]=0.0329, P<0.0001]; for GA, AUC was 0.801 [SE=0.0340, P<0.0001] and for the BWGA Index, the AUC was 0.808 [SE=0.0324, P<0.0001]. Using 1250-g BW as a criterion for ROP screening would have decreased the number of screenings by 24%, and did not exclude any ROP higher than stage 1. Data from our neonatal intensive care unit suggest that birth weight

Mysore Childhood Obesity Study.

We conducted this study to document the prevalence of obesity, overweight and underweight in the school children aged 5 to 16 years from Mysore. 5 Principal Investigators and 13 Co-Investigators trained the teachers of 139 schools (Private -111, Govt-28) to record the vital statistics of the children studying in their schools. A total of 43152 school children (23527 boys and 19625 girls) were surveyed. 36354 children were from private schools and 6798 children were from Government (Govt) schools. Indian Academy of Pediatrics growth charts were used as reference. The prevalence of obesity, overweight and underweight were 3.4%, 8.5% and 17.2%, respectively. The prevalence of obesity was maximum in the age group of 5-7 years and in those from private schools.

Monitoring airborne iron oxide fumes in beam rolling mills factory, in Ahwaz, Iran

To determine the indoor iron Oxide [FeO] concentrations in two production lines 630 and 650 and compare them with REL- NIOSH. National Institute for Occupational Safety and Hygiene [NIOSH] No 550 is used for the determination of FeO concentrations in Beam Rolling Mills Factory. The total size sample was 80 for indoor FeO in each production Line 630 and 650 respectively. Samples [FeO] were collected using Low volume sampling pump operated at flow rate of 2 L/min-1 on membrane fitters with pore size 0.5 micrometer and 27mm diameter. CTA 3000 Atomic Absorption Spectrophotometer was used. There is a significant difference between mean FeO concentrations in Lines 650, 630 and NIOSH [5 mg/m3] [Pc 0.05]. It is not a serious health problem for workers. 100% Mean value of Iron oxide concentrations i.e., 20 stations in production Lines 650 and 630 are at a safe level

Clinical and demographic features of infection caused by Acinetobacter species.

BACKGROUND: Recently, Acinetobacter emerged as an important pathogen and the prevalence of isolation has increased since the last two decades worldwide. AIMS: To determine Acinetobacter incidence, their clinical demography, antibiotyping and speciation. SETTINGS AND DESIGN: A study of the clinical samples submitted to microbiology laboratory of a teaching hospital over a period of 3 years (December 1994 through November 1997). MATERIALS AND METHODS: Identification, speciation and antibiotyping were performed for the isolates of Acinetobacter recovered from infective samples. Clinical demographic characteristics were studied retrospectively. RESULTS: Total 510 of 5391 (9.6%) of isolates were Acinetobacter, responsible for 71.2% (363 of 510) monomicrobial and 28.8% (147 of 510) polymicrobial infections. The organism was responsible for 156 (30.6%) cases of urinary tract infection and 140 (27.5%) cases of wound infection and was most prevalent in the intensive care unit (30.8%, 140 of 455). The crude mortality rate due to multi-drug resistant Acinetobacter septicemia was 7.9% (36 of 455). The isolates could be classified into 7 species, with A. baumannii being most predominant. No peculiar pattern during antibiotyping was observed, but most of them were multi-drug resistant. CONCLUSION: Multi-drug resistant Acinetobacter nosocomial infection has emerged as an increasing problem in intensive care units of the hospital, responsible for 7.9% deaths. The analysis of risk factors and susceptibility pattern will be useful in understanding epidemiology of this organism in a hospital setup.