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Background & objectives: Developmental dysplasia of the hip (DDH), when detected early, can usually be managed effectively by simple methods. A delayed diagnosis often makes it a complex condition to treat. Late presentation of DDH is fairly common in developing countries, and there is scarcity of literature regarding the epidemiology and reason for late presentation. Through this study, we attempted to identify the reasons for late presentation of DDH in children more than 12 months of age. Methods: Fifty four children with typical DDH and frank dislocation of hip in whom treatment was delayed for 12 months or more were included. Parents were interviewed with a pre-structured questionnaire and data were collected for analysis with Microsoft Excel 2016 and SPSS version 26. Results: Diagnostic delay was the most common reason for late presentation and was observed in 52 children (96.2%). The mean age at diagnosis was 24.7 months. The mean age at treatment was 37.3 months with a mean delay of 12.5 months from diagnosis and 22.1 months from initial suspicion. Physician-related factors contributed 55.3 per cent, while family and social issues accounted for 44.7 per cent of overall reasons for diagnostic and treatment delays. Interpretation & conclusions: Late presentation of DDH in walking age is common. Physician- and family-related factors accounted for most of these cases. Failure or inadequate hip screening at birth by the attending physician is a common reason for late diagnosis. The family members were unaware about the disorder and developed suspicion once child started walking with an abnormal gait
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Age at menopause influences the severity of post-menopausal symptoms to determine the symptoms and clinicodemographic links in post menopauseal women in a representative population from eastern Uttar Pradesh. All postmenopausal women presenting with symptoms in the Gynaecological Emergency Department for a period of one year were enrolled. Age and clinicodemographic details, symptoms severity, and reasons for delay in seeking treatment were noted. The data was analysed using Chi-square test. Overall 990/17,927 (5.52%) women visiting the gynaecological OPD presented with post-menopausal complaints. Among menopausal women, the mean age ranged from 40 to 60 years old with a mean age of 46.6012.48 years. Majority were para 3-4 (52.5%), age at menarche were >13 years (58.3%), uneducated (58.8 %) , lower/upper lower SES (57.5%), married (77.3%) and had BMI<18.5kg/m2 (62.1%). Tobacco/smoking addiction was reported in 55 (5.6%) women. A total of 145 (14.6%) were working women. Severity of symptoms was mild, moderate and severe in 57.2%, 28.3% and 14.5% cases. Majority had onset of symptoms for 4- 5 years (56.4%) after menopause. Joint pains and Backache/body ache were the most common presenting complaints (81.8%). A significant association of age at presentation was seen with parity, age at menarche, BMI category and occupational status. Severity of symptoms showed a significant association with age at presentation, parity, age at menarche, BMI category, occupational status and tobacco/smoking use. Most common reasons for delayed treatment were financial problems (22.2%), family problems (18.2%) and commonness of problem (12.6%). Only 2.1% women were aware about HRT. Among the relatively less informed members of our study population, low socioeconomic status, underweight, and menopause age were all influenced by clinicodemographic factors.
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Paracetamol overdose is the most common cause of drug-related poisoning and death worldwide. Although N-acetylcysteine is the widely accepted antidote for paracetamol poisoning, much debate persist regarding the appropriate route and duration of early N-acetylcysteine therapy. There is a paucity of studies comparing the effectiveness of oral and intravenous (IV) acetylcysteine for paracetamol poisoning. Methods: A literature search was performed using the keywords [paracetamol OR acetaminophen] AND [acetylcysteine OR n-acetylcysteine] on the PubMed and Ovid database. The literature search was limited to human exposure studies published in English between 1-Jan-1966 and 1-May-2015. The proportion of patients who developed hepatotoxicity (defined as serum transaminase greater than 1000 IU/L) for each route of administration was determined using multiple regression and the studies were further stratified by early (less than 10 hours from ingestion) and late treatment (longer than 10 hours from ingestion). Results: 3,981 full studies were reviewed for data. Studies with fewer than 20 subjects were excluded. Metaanalysis revealed that the overall proportion of patients who developed hepatotoxicity was 12.3% (95% confidence interval [CI]: 9.6% to 17.2%). The percentages were similar when studies were stratified by route of administration; the proportion for IV treated patients was 12.6% (95% CI: 8.7% to 19.4%) while the proportion for oral treated patients was 12.0% (95% CI: 8.2% to 18.8%). However, there was a marked difference in the percentage of patients who developed hepatotoxicity with early as compared to late N-acetylcysteine treatment. There was a statistically significant effect due to time (p < 0.001) but no significant effect due to route of administration (p = 0.716). Conclusion: Pooled analysis of studies did not find any significant difference in outcome between oral and IV N-acetylcysteine therapy, but these findings require confirmation by randomized controlled trials. However, overall hepatotoxicity was significantly worse if treatment was delayed beyond 8 to 10 hours. ASEAN Journal of Psychiatry, Vol. 17 (2): July – December 2016: XX XX.
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Objective To investigate the neuroprotection of delayed treatment of thoracic acute spinal cord injury with recombinant human erythropoietin (rhEPO) in rat model of compressive injury. Methods Sixteen adult male Sprague-Dawley rats were randomly divided into two groups: control group (compressive injury group) and experimental group (rhEPO group), In the compressive injury group,the animals recived 0.9% saline treatment at 2 h, day 1 and day 3 after the injury, while in the rhEPO group, rhEPO (3 000 U/kg) was given to rats at 2 h, day 1 and day 3 after the injury. All the rats were observed in 4 days after the injury. The primary outcomes were evaluated by BBB scale, apoptotic index, inflammatory index and electron microscopy. Results Delayed treatment of thoracic acute spinal cord injury with rhEPO could reduce apoptosis, regulate inflammation, improve motor function and promote regeneration of the spinal cord. Conclusion Our study suggests that delayed treatment of thoracic spinal cord compressive injury with rhEPO could exert neuroprotection.
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BACKGROUND: Delayed treatment of pulmonary tuberculosis is an important problem because it results in greater mortality and the nosocomial transmission of tuberculosis. This study was conducted to analyze the factors that contribute to the delayed treatment of pulmonary tuberculosis in a university hospital and we wanted to provide basic data for instituting an effective management program for tuberculosis. METHODS: we retrospectively reviewed the medical records of 155 patients with smear-positive or culture-positive pulmonary tuberculosis and who were treated between May 1999 and October 1999. A case-control study was performed to analyze the factors. We then tried to follow up the patients in delayed treatment group via telephone for the purpose of assessing the therapeutic interventions. RESULTS: Among 150 patients, 55 (37%) were included in the delayed treatment group. The factors associated with delayed treatment on the univariate analysis included age (61 vs 40 years old; p<0.001), a smear-negative sputum test for acid-fast bacilli (AFB) (85% vs 55%; p<0.001) and no visits to a private clinic before the patient presented to the university hospital (56% vs 36%; p=0.014). Multivariate analysis revealed that old age (p=0.001), a smear-negative sputum for AFB (p=0.001), and lower lobe infiltrate on chest X-ray (p=0.041) were the independent predictors of delayed treatment. Of the 22 patients who did not receive any treatment, 20 of them 91%) consented to our suggestion of revisiting the hospital. CONCLUSION: Delayed treatment of patients with pulmonary tuberculosis is not uncommon in a university hospital. Old age, smear-negative for AFB, and lower lobe infiltrate on chest X-ray are the risk factors for delayed treatment. A more systematic management system is required for achieving better control of tuberculosis.
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Adult , Humans , Case-Control Studies , Follow-Up Studies , Medical Records , Mortality , Multivariate Analysis , Retrospective Studies , Risk Factors , Sputum , Telephone , Thorax , Tuberculosis , Tuberculosis, PulmonaryABSTRACT
A retrospective study was made of 334 consecutive cases of traumatic hyphema in the rural Chonbuk population. The average age of these patients was 26.2 years with the majority being male(91.9%). The major causes of traumatic hyphema were blow injuries(166 patients, 49.7%). The only 13 aptients(3.9%) had agriculture related injuries. Secondary hemorrhage occured in 23(6.9%) of all patient, and mainly between the second and fourth day following admission. A separate group of 88 patients(26.3%) who were admitted to hospital 24 hours or more after sustaining injury were found to have a secondary hemorrhage rate of 10.2%(nine of 88 patients). No secondary hemorrhage occured in Grade 0 hyphema. 22 eyes(6.5%) had a final visual acuity of 0.3 or worse. Retinal pathology,not hemorrhage, was most often responsible among those patients suffering poor visual outcome. In this study on the population of Chunbuk province, some patients were treated late, and had a high incidence of secondary hemorrhge.