Caracterización de los aspectos etiológicos, fisiopatológicos, clínicos y terapéuticos de la sepsis y shock séptico / Characterization of the etiological, physiopathological, clinical and therapeutic aspects of sepsis and septic shock

La sepsis es un síndrome clínico basado en una compleja y dinámica interacción entre patógeno y huésped. La identificación de diferentes fenotipos y la heterogeneidad de la sepsis obligan a cambiar paradigmas en el diagnóstico-tratamiento. El shock séptico o septicémico se define como la hipotensión inducida por sepsis que persiste a pesar de la reanimación adecuada con fluidos, acompañada de alteraciones de la perfusión o disfunción de órganos. O la necesidad de fármacos vasoactivos para corregir la presión arterial. Es un tipo de shock distributivo, con reducción de las resistencias vasculares sistémicas y generalmente aumento del gasto cardíaco. En los últimos años, ha evolucionado la atención de la sepsis con especial enfoque shock séptico (SS) por su gravedad y su mayor morbimortalidad. En consideración a lo anterior, esta revisión tiene el propósito de realizar la caracterización de esta patología en los aspectos etiológicos, fisiopatológicos, clínicos y terapéuticos más importantes

Sepsis is a clinical syndrome based on a complex and dynamic interaction between pathogen and host. The identification of different phenotypes and the heterogeneity of sepsis requires a paradigm shift in its diagnosis and treatment. Septic shock is defined as a sepsis-induced hypotension that persists despite adequate fluid resuscitation, accompanied by perfusion abnormalities or organ dysfunction. It may also involve the need for vasopressor drugs to correct blood pressure. It is a type of distributive shock, characterized by reduced systemic vascular resistance and typically increased cardiac output. In recent years, the management of sepsis has evolved with a special focus on septic shock (SS) due to its severity and higher morbidity and mortality. Considering the above, this review aims to characterize this condition in terms of its etiological, pathophysiological, clinical, and therapeutic aspects

COVID-19: presentación clínica inicial y su correlación con la gravedad de la enfermedad / COVID-19: initial clinical presentation and its correlation with the severity of the disease

Los pacientes con COVID-19 tienen un amplio espectro de presentación clínica y las tasas de mortalidad en los casos graves son relativamente altas. La identificación tem prana de los factores de riesgo que se relacionan con la gravedad de la enfermedad es de vital importancia. Con el objetivo de correlacionar los síntomas iniciales de COVID-19 con la gravedad de la enfermedad, se realizó el presente estudio de cohorte transversal retrospectivo y observacional de 413 pacientes con diagnóstico de COVID-19 entre enero y marzo 2021. De todos los síntomas iniciales estudiados, la disnea (p < 001), fiebre (p 0,001), tos (p 0,002), odinofagia (p 0,01), cefalea (p 0,01) y síntomas gastrointestinales (p 0,03), se asociaron con el desarrollo de una enfermedad grave. Las comorbilidades que se asociaron con peor pronóstico fueron: hipertensión arterial (p < 0,001), obesidad (p < 0,001), EPOC (p < 0,001), extabaquismo (p < 0,001), diabetes (p 0,01), enfermedad cardiovascular previa (p 0,03), y enfermedad oncológica activa (p 0,04). En conclusión, los pacientes con diagnóstico de COVID-19, cuya manifestación inicial es disnea, fiebre, tos, odinofagia, cefalea y síntomas gastrointestinales, deben ser monitoreados de cerca para prevenir el deterioro de la enfermedad.

Patients with COVID-19 have a broad spectrum of clinical presentations, and mortal ity rates are relatively high in severe cases. Early identification of risk factors that are related to the severity of the disease is of vital importance. In order to correlate the initial symptoms of COVID-19 with disease severity, the present retrospective, cross-sectional, observational cohort study was conducted, including 413 patients diagnosed with COVID-19 between January and March, 2021. Of all the initial symptoms that were studied, dyspnea (p < 001), fever (p 0.001), cough (p 0.002), odynophagia (p 0.01), headache (p 0.01), and gastrointestinal symptoms (p 0.03) were associated with the development of severe illness. The comorbidities that were associated with the worst prognoses were: arterial hypertension (p < 0.001), obesity (p < 0.001), COPD (chronic obstructive pulmonary disease) (p < 0.001), former smoking (p < 0.001), diabetes (p 0.01), previous cardiovascular disease (p 0.03), and active oncological disease (p 0.04). In conclusion, patients diagnosed with COVID-19 whose initial manifestations include dyspnea, fever, cough, odynophagia, headache, and gastrointestinal symptoms should be closely monitored to prevent disease deterioration.

Prevalence survey of clinical manifestations following COVID-19 / 中华麻醉学杂志

Objective:To investigate the clinical manifestations of population following COVID-19 by using questionnaires.Methods:COVID-19 among anesthesia workers and the surrounding population was investigated between 11 November 2022 and 31 December 2022 in China.The Tencent electronic questionnaire(ID.11492813) was sent to different WeChat groups of the Association of Anesthesiologists or Society of Anesthesiologists via the WeChat platform of the medical personnel in China. The survey was conducted between January 7 and January 15, 2023. Results:A total of 17 000 questionnaires were issued for this survey, 11 060 valid questionnaires from 31 provinces and autonomous regions were collected all over the country, with a recovery rate of 65.059%.There were 10068 (91.037%) participants diagnosed as having COVID-19, and among of them, 47.606% were male and 52.394% were female. The main post-COVID-19 clinical manifestations included fever (85.777%), cough (83.731%), fatigue (75.338%), parasomnia (64.352%), limb soreness (58.890%), dizziness, headache, tinnitus (38.617%), loss or abnormality of taste (37.763%), and loss or abnormality of smell (30.960%); peripheral neuralgia was usually found within 3 days after positive nucleic acid test or positive antigen test; there were 2 963 cases accompanied with sweating, and among of them, 47.25% were male and 52.75% were female, and 37.80% of these participants continued to sweat after the nucleic acid test or antigen test became negative. There were 1 151 cases with premature heart beats among the study population, and the symptoms aggravated following COVID-19 were found in 34.32% of these patients.Conclusions:In addition to the respiratory system, the central and peripheral nerves of patients are also affected following COVID-19, and the peripheral and central nerve disorders last until several days after negative nucleic acid test or antigen test, suggesting that anesthesiologists should pay more attention to monitoring of various nerve function and impact of surgery and anesthetic drugs on the stress response of the body in such patients.

DELIRIUM: NARRATIVE REVIEW

Delirium is a neuropsychiatric syndrome characterized by acute onset of de?cits in attention and in multiple aspects of cognition. The prevalence of delirium varies considerably by patient group and setting, tending to be more common in hospitalized older adults or the critically ill. Three phenotypes of delirium are recognized depending on psychomotor activity (hyperactive, hypoactive, mixed). Its diagnosis is based on the criteria established in the DSM V, however we have diagnostic tools used in clinical practice such as 4A, CAM and ICDSC. The pharmacological management of delirium is still a matter of debate, treatments with antipsychotic drugs have been shown to reduce motor activity, but they do not seem to affect the dura

Lupus eritematoso sistémico en una población pediátrica hospitalaria Presentación clínica, diagnostico, manejo y sobrevida

RESUMEN Introducción: El lupus eritematoso sistémico (LES) es una enfermedad autoinmune, que tiene una evolución más severa cuando se inicia en la niñez. Objetivo: describir las manifestaciones clínicas, laboratoriales, tratamiento y sobrevida de los pacientes pediátricos con LES, en seguimiento en el Servicio de Reumatología Pediátrica de un hospital. Materiales y métodos: Estudio observacional descriptivo de seguimiento de una cohorte, retrospectivo, que incluyo a una población pediátrica con Lupus Eritematoso Sistémico Juvenil (LES) en seguimiento en el hospital, en el periodo de enero del 2019 a diciembre del 2020. Variables estudiadas fueron demográficas, tiempo de evolución hasta el diagnostico, manifestaciones clínicas, métodos de diagnóstico, complicaciones, tratamiento y sobrevida. Los datos fueron analizados con SPSS, utilizando estadísticas descriptivas. La sobrevida se determinó por la curva de Kaplan Maier. El comité de ética institucional aprobó el protocolo. Resultados: Cumplieron con los criterios de inclusión 52 pacientes, el 85,5% tenía más de 12 años, el 78,8% se sexo femenino, mediana de tiempo de evolución hasta el diagnostico de 2,3 meses. Predomino manifestaciones generales 78,8% y alteraciones hematológicas y renales se presentaron en 76,5% y 51,9% respectivamente. El 92% tenía Anticuerpos antinucleares positivo. El 25% ingreso a la unidad de cuidados intensivos pediátricos. La supervivencia fue de 65 meses con un IC 95% 59,9-71,5. Conclusiones: El grupo etario predominante fueron mayores de 12 años, con gran predominio de niñas. Las manifestaciones clínicas más frecuentes fueron las constitucionales, hematológicas y musculoesqueléticas. El 51,9% presentó alteraciones renales. Casi todos los pacientes presentaron ANA positivo. Todos recibieron terapia inmunosupresora. La supervivencia fue de 65 meses. (IC 95% 59,5 - 71,5)

ABSTRACT Introduction: Systemic lupus erythematosus (SLE) is an autoimmune disease, which has a more severe course when it begins in childhood. Objective: to describe the clinical and laboratory manifestations, treatment and survival of pediatric patients with SLE, under follow-up in the Pediatric Rheumatology Service of a hospital. Materials and methods: This was a retrospective, observational, descriptive and follow-up study of a cohort, which included a pediatric population with Juvenile Systemic Lupus Erythematosus (JSLE) in hospital follow-up, from January 2019 to December 2020. Variables studied were demographics, time of evolution until diagnosis, clinical manifestations, diagnostic methods, complications, treatment and survival. The data was analyzed with SPSS, using descriptive statistics. Survival was determined by the Kaplan Maier curve. The institutional ethics committee approved the protocol. Results: 52 patients met the inclusion criteria, 85.5% were over 12 years old, 78.8% were female, median time to diagnosis from presentation was 2.3 months. General manifestations were predominant in 78.8% and hematological and renal alterations were present in 76.5% and 51.9% respectively. 92% had positive antinuclear antibodies. 25% were admitted to the pediatric intensive care unit. Survival was 65 months with a 95% CI of 59.9-71.5. Conclusions: The predominant age group was older than 12 years, with a greater predominance of girls. The most frequent clinical manifestations were constitutional, hematological and musculoskeletal. 51.9% presented renal alterations. Almost all patients were ANA positive. All received immunosuppressive therapy. Survival was 65 months. (95% CI 59.5 - 71.5).

Retinitis pigmentosa in Usher syndrome in India: Electronic medical records driven big data analytics: Report III

Purpose: To describe the clinical presentation and demographic distribution of retinitis pigmentosa (RP) in patients with Usher syndrome (USH). Methods: This is a cross?sectional observational hospital?based study including patients presenting between March 2012 and October 2020. In total, 401 patients with a clinical diagnosis of USH and RP in at least one eye were included as cases. The data were retrieved from the electronic medical record database. For better analysis, all 401 patients were reclassified into three subtypes (type 1, type 2, and type 3) based on the USH criteria. Results: In total, there were 401 patients with USH and RP, with a hospital?based prevalence rate of 0.02% or 2/10,000 population. Further, 353/401 patients were subclassified, with 121 patients in type 1, 146 patients in type 2, and 86 patients in the type 3 USH group. The median age at presentation was 27 years (IQR: 17.5–38) years. There were 246 (61.35%) males and 155 (38.65%) females. Males were more commonly affected in all three subtypes. Defective night vision was the predominant presenting feature in all types of USH (type 1: 43 (35.54%), type 2: 68 (46.58%), and type 3: 40 (46.51%) followed by defective peripheral vision. Patients with type 2 USH had more eyes with severe visual impairment. Conclusion: RP in USH is commonly bilateral and predominantly affects males in all subtypes. Patients with USH and RP will have more affection of peripheral vision than central vision. The key message of our study is early visual and hearing rehabilitation in USH patients with prompt referral to otolaryngologists from ophthalmologists and vice versa.

Retinitis pigmentosa in Laurence-Moon-Bardet-Biedl syndrome in India: Electronic medical records driven big data analytics: Report II

Purpose: To describe the clinical presentation and demographic distribution of retinitis pigmentosa (RP) in Laurence–Moon–Bardet–Biedl (LMBB) syndrome patients. Methods: This is a cross?sectional observational hospital?based study wherein 244 patients with RP in LMBB syndrome presenting to our hospital network between March 2012 and October 2020 were included. An electronic medical record database was used for data retrieval. Results: There were 244 patients in total, with a hospital?based prevalence rate of 0.010% or 1000/100,000 population. The mean and median age of patients was 15.22 ± 7.56 and 14 (IQR: 10–18.5) years, respectively, with the majority being in the age group of 11–20 years (133/244 patients; 54.50%). Males were more commonly affected (164 patients; 67.21%), and the majority (182 patients; 74.59%) were students. All 244 patients (100%) complained of defective central vision at presentation. More than one?fourth of the patients had severe visual impairment to blindness at presentation. Prominent retinal feature at presentation was diffuse or widespread retinal pigment epithelial degeneration in all patients. Conclusion: Patients with RP in LMBB syndrome present mainly in the first to second decade of life with severe visual acuity impairment to blindness early in life. It is important to rule out LMBB syndrome in early?onset RP with central visual acuity impairment. On the contrary, all patients diagnosed or suspected with LMBB syndrome systemic features at physician clinic should also be referred for ophthalmic evaluation, low vision assessment, rehabilitation, and vice versa

Neurocircuit models of obsessive-compulsive disorder: limitations and future directions for research

Obsessive-compulsive disorder (OCD) is a common psychiatric condition classically characterized by obsessions (recurrent, intrusive and unwanted thoughts) and compulsions (excessive, repetitive and ritualistic behaviors or mental acts). OCD is heterogeneous in its clinical presentation and not all patients respond to first-line treatments. Several neurocircuit models of OCD have been proposed with the aim of providing a better understanding of the neural and cognitive mechanisms involved in the disorder. These models use advances in neuroscience and findings from neuropsychological and neuroimaging studies to suggest links between clinical profiles that reflect the symptoms and experiences of patients and dysfunctions in specific neurocircuits. Several models propose that treatments for OCD could be improved if directed to specific neurocircuit dysfunctions, thereby restoring efficient neurocognitive function and ameliorating the symptomatology of each associated clinical profile. Yet, there are several important limitations to neurocircuit models of OCD. The purpose of the current review is to highlight some of these limitations, including issues related to the complexity of brain and cognitive function, the clinical presentation and course of OCD, etiological factors, and treatment methods proposed by the models. We also provide suggestions for future research to advance neurocircuit models of OCD and facilitate translation to clinical application.

Diagnosis and treatment for acute phase of suppurative meningoencephalitis / 中华神经科杂志

Suppurative meningoencephalitis is the kind of intracranial infectious disease which exhibits comparatively more severe clinical manifestations, more expensive diagnostic and treatment costs and poorer prognosis. Early diagnosis and effective treatment are essential for better improvement of disease prognosis. Clear identification of intrinsic and extrinsic factors causing the acute phase of suppurative meningoencephalitis, as well as its epidemiological and pathogenic characteristics, clinical manifestations and classifications, imaging features and laboratory tests explanations, may contribute greatly to the diagnostic correctness and treatment efficacy, thus promoting diagnostics and medical treatment of this disease which remains ultimately critical to patients′ prognosis.

Assessment of Variation in Clinical Presentation of Visceral Leishmaniasis Among Patients Attending the Tropical Diseases Teaching Hospital in Sudan

Background: Visceral leishmaniasis (also known as Kala-azar) is a systemic parasitic infection with many clinical presentations. The present study assesses the variation in presentations among patients who attended the Tropical Diseases Teaching Hospital (TDTH) in Khartoum, Sudan. Methods: This analytical cross-sectional, hospital-based study was conducted at the TDTH between November 2019 and September 2020. Medical records of patients who presented at the TDTH were reviewed using a structured data extraction checklist. The Chi-square test was used to determine the associations between sociodemographic and clinical presentations of patients. P-value < 0.05 was considered as statistically significant. Results: Out of 195 patients, 79.5% were male and 48.2% were <31 years old. Fever was the main clinical presentation (90.2%) while 53.3% presented with weight loss and 72.3% and 39% presented, respectively, with splenomegaly and hepatomegaly. HIV was detected in 4.6% of the patients. RK39 was the main diagnostic test. We found a significant association between the abdominal distention and the age of the patients (P < 0.05) ­ age groups 11­20 and 41­50 years were more likely to present with abdominal distention than other age groups. Conclusion: There is no exact clinical presentation or routine laboratory findings that are pathognomonic for visceral leishmaniasis; therefore, it should be considered in the differential diagnosis of any patient with fever, weight loss, and abdominal distention, and among patients with HIV.

Síndrome coronario agudo atípico, un reto diagnóstico: revisión de tema / A review on Atypical Acute Coronary Syndrome, a diagnostic challenge / Síndrome Coronariana Aguda Atípica, Um Desafio Diagnóstico: Revisão De Tópico

El síndrome coronario agudo (SCA) es la principal causa de muerte, por esta razón, es fundamental reconocer sus características clínicas. Tradicionalmente ha sido descrito un cuadro denominado típico, consistente en dolor torácico retroesternal o en la región izquierda del tórax, explicado como una sensación de presión o pesadez, de duración superior a 20 minutos, que se puede irradiar a la extremidad superior izquierda o derecha, cuello o mandíbula, asociado a diaforesis y náuseas. Diversos grupos de pacientes como mujeres, diabéticos, ancianos y con antecedentes de falla cardiaca o accidente cerebrovascular presentan cuadros llamados atípicos, que en gran proporción no manifiestan dolor torácico. Varios estudios plantean que no hay síntomas suficientemente sensibles y específicos para ser considerados típicos en el contexto del SCA, por lo que el diagnóstico debe incluir además de la evaluación clínica, el electrocardiograma, los factores de riesgo y los biomarcadores. El uso de puntajes de riesgo como el HEART ha demostrado ser útil en este escenario.

Acute coronary syndrome (ACS) is the main cause of mortality around the world; the-refore, it is essential to recognize the clinical characteristics that increase its diagnostic suspicion. Traditionally, it has been defined as a so-called typical condition, consisting of retrosternal chest pain or pain in the left region of the thorax. It is described as a feeling of pressure or heaviness, lasting more than 20 minutes, which can radiate to the left or right upper limb, neck or jaw, and can be associated with diaphoresis and nau-sea. Various groups of patients such as women, diabetics, the elderly, and those with a history of heart failure or cerebrovascular accident, have so-called atypical clinical sets of symptoms, which in a large proportion may not present chest pain. Various studies suggest that there are not sufficiently sensitive and specific symptoms to be considered typical in the context of ACS, thus, the approach must include the electrocardiogram, risk factors and biomarkers in addition to the clinical evaluation. The use of risk scores such as the HEART has proven very useful in this scenario.

A síndrome coronariana aguda (SCA) é a principal causa de morte, por isso é fundamen-tal o reconhecimento de suas características clínicas. Tradicionalmente, é descrita uma condição dita típica, que consiste em dor torácica retroesternal ou na região esquerda do tórax, explicada como uma sensação de pressão ou peso, com duração superior a 20 minutos, que pode irradiar para a esquerda ou direita membro superior, pescoço ou mandíbula, associado a sudorese e náusea. Vários grupos de pacientes como mulheres, diabéticos, idosos e com história de insuficiência cardíaca ou acidente vascular cerebral apresentam condições atípicas, que em grande parte não manifestam dor no peito. Vários estudos sugerem que não existem sintomas suficientemente sensíveis e específicos para serem considerados típicos no contexto da SCA, de modo que o diagnóstico deve incluir, além da avaliação clínica, o eletrocardiograma, fatores de risco e biomarcadores. O uso de escores de risco, como o CORAÇÃO, tem se mostrado útil nesse cenário.

Características clínicas, demográficas y acceso a los productos sin gluten de pacientes con enfermedad celíaca registrados en la FUPACEL / Clinical and demographic characteristics, and access to gluten free products of patients with celiac disease registered in the FUPACEL

La enfermedad celíaca (EC) es una enfermedad inflamatoria autoinmune que afecta la mucosa del intestino delgado que lleva a un estado de mal absorción en pacientes genéticamente susceptibles desencadenada por la ingesta de gluten. Tiene síntomas inespecíficos, complicaciones asociadas y no existe a nivel nacional una ley de apoyo económico para las personas con dificultad para seguir una dieta libre de gluten. El objetivo de este estudio observacional, descriptivo, de corte transversal fue describir las características clínicas, demográficas y acceso a productos sin gluten de 237 pacientes con enfermedad celíaca registrados en la Fundación Paraguaya de Celiacos (FUPACEL) en el 2020 y que aceptaron responder una encuesta en línea publicada en la página oficial de la FUPACEL. El 70,4% de los participantes era del sexo femenino, la edad de diagnóstico fue en el 34,5% entre 20-30 años, 48 % tenía algún familiar con EC, el 69,1% presentó distensión abdominal como sintomatología inicial, 16,8% presentó hipotiroidismo como patología asociada, y 42% fue hospitalizado al menos una vez. El 82,7% de los encuestados respondió que la dieta era suficiente como tratamiento, 48% tenía un trabajo y podía solventar los gastos, sin embargo, el 79,3% opinó tener acceso limitado a los productos sin gluten, el 92% que los alimentos sin gluten eran costosos y que se necesitaba una ley de apoyo económico para solventar los gastos. La mayoría reconoció que la dieta sin gluten como tratamiento era suficiente, sin embargo, por su alto costo se necesita una ley de apoyo económico para las personas con enfermedad celiaca

Celiac disease (CD) is an autoimmune inflammatory disease that affects the mucosa of the small intestine that leads to a state of malabsorption in genetically susceptible patients triggered by the ingestion of gluten. It has nonspecific symptoms, associated complications, and there is no national financial support law for people with difficulty following a gluten-free diet. The objective of this observational, descriptive, cross-sectional study was to describe the clinical, demographic characteristics and access to gluten-free products of 237 patients with celiac disease registered in the FUPACEL in 2020 who accepted to answer a online survey published in the official FUPACEL webpage. Seventy-point four percent of the patients were female, their age of diagnosis was between 20-30 years in 34.5%, 48% had relatives with CD, 69.1% presented abdominal distension as initial symptoms, hypothyroidism was present in 16.8% as associated pathology, and 42% were hospitalized at least once. Eighty-two-point seven percent of those surveyed answered that diet was sufficient as a treatment, 48% had a job and could afford expenses, however, 79.3% said they had limited access to gluten-free products, 92% that gluten-free foods were expensive and a financial support law was needed to cover the costs. Most recognized that a gluten-free diet as a treatment was sufficient, however, due to its high cost, a law of financial support is needed for people with celiac disease

Extrapulmonary onset manifestations of COVID-19

Coronavirus disease (COVID-19) usually starts with pulmonary signs and symptoms. However, in some cases, the initial clinical presentations are extrapulmonary. This literature review aimed at summarizing and discussing the extrapulmonary onset manifestations of COVID-19. The most frequent initial extrapulmonary manifestations include hypogeusia, hyposmia, non-specific abdominal symptoms, corneal congestion, and deep venous thrombosis. Several rarer extrapulmonary manifestations in locations such as the brain, peripheral nerves, muscles, eyes, ears, myocardium, intestines, skin, or vessels have been additionally reported as onset presentations of COVID-19. In conclusion, it is crucial for clinicians and health care providers to consider extrapulmonary presentations at the onset of COVID-19 to avoid overlooking the infection and contributing to the spread of the disease.

Clinical and laboratory findings of acute Zika virus infection in patients from Salvador during the first Brazilian epidemic

Abstract Several major epidemics of Zika fever, caused by the ZIKA virus (ZIKV), have emerged in Brazil since early 2015, eventually spreading to other countries on the South American continent. The present study describes the clinical manifestations and laboratory findings of patients with confirmed acute ZIKV infection during the first epidemic that occurred in Salvador, Brazil. All included patients were seen at the emergency room of a private tertiary hospital located in Salvador, Brazil from 2015 through 2017. Patients were considered eligible if signs of systemic viral febrile disease were present. All individuals were tested for ZIKV and Chikungunya infection using PCR, while rapid test was used to detect Dengue virus antibodies or, alternatively, the NS1 antigen. A diagnosis of acute ZIKV infection was confirmed in 78/434 (18%) individuals with systemic viral febrile illness. Positivity was mainly observed in blood, followed by saliva and urine. Coinfection with Chikungunya and/or Dengue virus was detected in 5% of the ZIKV-infected patients. The most frequent clinical findings were myalgia, arthralgia and low-grade fever. Laboratory analysis demonstrated normal levels of hematocrit, platelets and liver enzymes. In summary, in acute settings where molecular testing remains unavailable, clinicians face difficulties to confirm the diagnosis of ZIKV infection, as they rely only on clinical examinations and conventional laboratory tests.

Clinical and diagnostic profile of patients with anal fistula: a cross sectional study from Vilasrao Deshmukh Government Institute of Medical Sciences, Latur, Maharashtra

Background: Anal fistulas are one of the commonest causes for a persistent discharge seropurulent in nature that irritates the skin in the neighbourhood and leads to discomfort. Fistula-in-ano is seen quite frequently in perirectal perianal suppuration. The objective of this study to study the clinical profile and diagnosis of anal fistula at surgical OPD of VDGIMS.Methods: The present cross-sectional observational study was carried out in patients with fistula-in-ano admitted at surgical department of VDGIMS, Latur during the period of 2017-19 in 50 diagnosed patients. Data was analysed by using SPSS 24.0 version IBM USA.Results: Majority of the patients with anal fistula were from 41-50 years age group i.e. 15 (30%) and males were predominantly affected 40 (80%) compared to females i.e. 10 (20%). Male to female ratio was 4:1. Perianal discomfort was the commonest symptom in all patients i.e. 100%. It is followed by perianal discharge complained by 54% and perianal itching in 38% cases. The anterior position of external opening is found to be significant (p<0.05). Fistulogram showed external opening in all patients i.e. 50 cases whereas internal opening in 46 (92%) cases. Findings of MRI revealed that anal fistula was intra sphincteric in 28 cases i.e. 56%, extra sphincteric in 2 cases i.e. 4% and trans sphincteric in 20 cases i.e. 40%.Conclusions: Commonest age group affected in our study was 40-50 years with male predominance. Perianal discomfort and discharge were the commonest symptom. E. coli was the predominant organism isolated. Fistulogram and MRI is useful in detecting the aetiology of fistula in ano.

Clinicopathological Correlation of Sinonasal Masses with Pre-operative Computed Tomography Findings

Aim of the Study: The aim of the study was to study the clinical, radiological, and histopathological correlation of sinonasalmasses.Materials and Methods: This was a descriptive study conducted on 72 patients with sinonasal masses at Government T DMedical College, Alappuzha, over a period of 18 months from January 01, 2014, to June 30, 2015.Results: Age group was from 13 to 85 years with a male to female ratio of 1.3:1. Nasal obstruction was the most commonsymptom followed by nasal discharge and headache. Of the 72 cases, 59 belonged to the non-neoplastic group and 13 to theneoplastic group of sinonasal masses. Clinically, nasal polyp was the most common presentation. Sinonasal polyps (65.3%)formed the majority of the non-neoplastic lesions, vascular lesion (6.9%) was the most common benign neoplastic mass, andmalignancy was seen in 6.9% of cases. After clinical examination and computed tomography scan of the nose and paranasalsinuses, patients underwent surgery. Finally, clinical, radiological, and histopathology correlation of all the sinonasal masseswere done. The clinical diagnosis with computed tomography (CT) scan correlation was the same except in three cases andin one case with histopathology. Histopathology and CT scan result correlated well except in three cases. It was found thatthere was a significant association between the clinical, radiological, and histopathological diagnoses (P < 0.05) and that thesemodalities were complementary to each other. It was also possible to classify the lesions as non-neoplastic, neoplastic benign,and malignant using these modalities. This was important because even though initial presentation of these masses was similar,management of each of them varied significantly.Conclusion: Histopathology still remains the gold standard in the diagnosis of sinonasal masses, while CT scan is indispensablein studying the anatomical variants and providing the route map before and during endoscopic sinus surgeries.

Clinico-histopathological Assessment of Patients Undergoing Thyroidectomy

Objective: To determine the clinical presentation and histopathological evaluation of patientsundergoing thyroidectomies at tertiary care Hospital. Methodology: This cross-sectional study was done at department of general surgery of LUMHS/Jamshoro. Duration of the study was 1 year from October 2017 to September 2018. All the cases with a diagnosis of thyroid disorder and underwent thyroidectomy were selected and above 25 years of the age were included. All the surgeries were carried out by senior surgeons along with the cooperation of the ENT surgeons. After surgeries specimens of all the cases were sent to the diagnostic laboratory for the histological assessment. Data was collected via self-made proforma. Results: Of 58 patients majority i.e. 43.10%were found with age group of 35-44 years. Females found in the majority 63.80%. The swelling was noted among all of the cases, followed by pain, difficulty in swallowing, difficulty in breathing and others 8.62%, 10.34%, 20.68% and 25.68% respectively. Adenomatous goiter was the most common histopathological finding in 82.75% cases, papillary carcinoma was found 8.62%, follicular carcinoma was only in one case and anaplastic carcinoma was also in 1 case

Study prevalence of risk factors and clinical presentation of ventral incisional hernia an observational study

Background: Incisional hernia is the second most common type of hernia after inguinal hernia. It is a complication of abdominal surgery, reported in up to 11% of patients generally and in up to 20% of those who developed post operative wound infection. The list of predictive factors associated with development of incisional hernia is obesity, diabetes mellitus, steroid, smoking, old age, malnutrition, COPD and type of incision.Methods: This was a hospital based cross sectional observational study carried out from February 2018 - October 2019 in surgery department of Dr. B.R.A.M. Hospital Raipur C.G, with diagnosis of incisional hernia. Total 100 patients were included in the study.Results: In present study the mean age of study subjects was 47.27±13.16 years. Around two-third 64% were females. 40% of perforation and 35% of LSCS cases later develop to Incisional hernia.  Risk factors profile showed that 31% were alcoholic, 27% smokers, 48% pre-obese and 5% were obese. 36% were hypertensive, 48% diabetic, and 12% had constipation. 25% had prolonged cough, 35% had surgical site infection, 45% had anemia. Clinical presentation of study subjects showed that 63% had swelling, 33% had swelling and pain and 4% had obstruction.Conclusions: Incisional hernia is more common in female than males and in cases above the age of 45 years. It is more common in patients who underwent the previous surgery on an emergency basis especially in perforation and obstruction and LSCS cases. Risk factors associated with incisional hernia are smoker, alcoholic, obesity, hypertension, diabetes, constipation, prolong cough and anemia.

Clinical Profile of Cutaneous Tuberculosis in a Tertiary Care Teaching Hospital in Eastern Bihar

Introduction: Sleep-deprivation is a state of combinedabsence of sleep and extended wakefulness. Notoriouslyknown to be associated with slowing of cognitive processeslike attention, working memory, and executive functions, it isalso a consequence of insomnia which in turn is an infamoussymptom of depression. Depression has adverse effects onsocial functioning, which further shape its course and outcome.Material and Methods: This systematic review is basedon a systematic search of electronic database PubMedand provides an overview of literature defining cognitiveimpairment and depression, followed by their associationswith sleep deprivation, entailing possible mechanisms ofthese inter-relationships along with the networks in the humanbrain which are susceptible or resilient towards the effectsof insufficient sleep. A total of 47 such articles and studiesconsidering all these aspects were reviewed.Results: Reductions in functional MRI signals in thedorsolateral prefrontal cortex in sleep deprivation are thoughtto account for attention deficits. Impaired working memoryseconded by an overall increase in reaction times wereobserved, while scanning efficiency was claimed to remainunaffected,by some authors. Long term potentiation wasseen to decrease due to sleep deprivation. Alterations in theHPA axis, stress and high cortisol levels, low brain-derivedneurotrophic factor levels were also interlinked with bothsleep deprivation and depression.Conclusion: Sleep deprivation interrupts physiologicalfunctions, neurocognitive processes, and worsens depression.Hence sleep for upto six to eight hours each night isrecommended on the lines of this review.

Sobrepeso y obesidad en la enfermedad celiaca activa: posibles mecanismos fisiopatológicos / Overweight and obesity in active celiac disease: possible pathophysiological mechanisms

RESUMEN La enfermedad celiaca (EC) es una enteropatía crónica del intestino delgado, mediado por una respuesta inmune, gatillada por la exposición al gluten en individuos genéticamente susceptibles. La presentación clínica de la EC es variada y conduce a mala absorción. El estado nutricional en el momento del diagnóstico de la EC depende del tiempo en que la enfermedad ha estado activa, la extensión de la inflamación intestinal, grado de mala absorción e ingesta alimentaria. Sin embargo, en los últimos años se ha observado un cambio epidemiológico del estado nutricional en los pacientes celiacos al momento del diagnóstico. La presente revisión tuvo por objetivo realizar un análisis descriptivo de la presencia de obesidad en pacientes celiacos y de los posibles mecanismos fisiopatológicos que la explicarían.

ABSTRACT Celiac disease (CD) is a chronic enteropathy of the small intestinal, mediated by an immune response triggered by exposure to dietary gluten in genetically predisposed individuals. The clinical presentation of CD is varied and leads to malabsorption. Nutritional status at the time of diagnosis of CD depends on the time in which the disease has been active, the extent of intestinal inflammation, degree of malabsorption, and dietary intake. However, in recent years an epidemiological change of nutritional status has been observed in celiac patients at the time of diagnosis. The objective of this review was to perform a descriptive analysis of the presence of obesity in celiac patients and the possible physiopathological mechanisms that would explain it.