Diferencias cliniconeurológicas en pacientes con enfermedad cerebrovascular isquémica de edades menores y mayores de 65 años

Introducción: La enfermedad cerebrovascular isquémica tiene una alta frecuencia debida, fundamentalmente, al envejecimiento poblacional. Objetivo: Comparar las características clínicas de pacientes con enfermedad cerebrovascular isquémica de dos grupos etarios. Métodos: Se realizó un estudio descriptivo, transversal y retrospectivo en 36 pacientes con enfermedad cerebrovascular isquémica correspondientes a dos grupos etarios (65 y menos años y mayores de 65), quienes fueron atendidos en el Instituto de Neurología y Neurocirugía, La Habana, de enero a diciembre del 2017. Al respecto, se analizaron variables demográficas y clínicas y se aplicaron diferentes pruebas estadísticas para comparar. Resultados: Se obtuvo un aumento significativo de pacientes hipertensos (88,9 %) en el grupo etario mayor de 65 años. La mediana de la escala de ictus del National Institute of Health fue superior en estos pacientes (mediana [10-90 percentil]: 9,5 (4-19]). Hubo incremento estadístico de los mayores de 65 años con parálisis parcial de la mirada y ataxia; en tanto, la monoparesia y la extinción visual predominaron en los de 65 y menos años. Dicha escala mostró un aumento estadístico en el ictus aterotrombótico y cardioembólico en comparación con otras causas en ambos grupos. Los pacientes mayores de 65 años con solo un factor de riesgo o ninguno y los que eran hipertensos tuvieron mayor puntuación de la escala. Conclusiones: El grado de afectación neurológica fue superior en los mayores de 65 años que tenían un factor de riesgo y en aquellos con hipertensión arterial. Puede sugerirse que los mecanismos moleculares y fisiopatológicos de estos pacientes varían según la edad.

Introduction: The ischemic cerebrovascular disease has a high frequency due to the population aging mainly. Objective: To compare clinical characteristics of patients with ischemic cerebrovascular of two age groups. Methods: A descriptive, cross-sectional, retrospective study was carried out in the Neurology and Neurosurgery Institute in Havana, from January to December, 2017 in patients with ischemic cerebrovascular disease; 36 individuals of both age groups. In this regard, demographic variables, risk factors, clinical manifestations, coma scale and neurological deficiency, etiology and localization of the ischemic ictus were analyzed. Results: The 65 years group had a significant increase of hypertensive patients (88.9%). The average of the National Institute of Health stroke scale was superior in these patients (median [10-90 percentile]: 9.5 [4-19]). There was statistical increment of over 65 years patients with partial paralysis of the look and ataxia, but monoparesis and visual extinction in the age under 65 years. Such a scale had a statistical increase in the atherothrombotic and cardioembolic ictus in comparison with other etiologies in both patient groups. The over 65 years patients with just one risk factor or and those with hypertension had a higher punctuation of the scale. Conclusions: The degree of neurological affectation was higher in over 65 years patients that had a risk factor and in those with hypertension. As a result it could be suggested that the molecular and pathophysiolologic mechanisms of these patients vary with the age.

Methodological Study of Doshopakramaniya Adhyay of Ashtanga Hridaya

Ashtanga Hridaya is one of the Brihat Trayi of Ayurveda. Sutrashana of Ashtanga Hridaya is stated as best among all the Samhita. Sutrasthan is a string which is connected with other Sthanas of Samhita. It provides brief idea about fundamental concepts which are described detail in other Sthanas. Secret majors are described in Sutrasthana of Ashtanga Hridaya. So study of Sutrasthana is most important to understand Samhita. Acharya Vagbhata stated that he created Ashtanga Hridaya from the essence of all previous treatises. The name of chapter Doshopakramaniya suggests it is related to treatment of vitiated Doshas. Doshas are most important entity for Normal functioning of body. Normal condition of Dhatu and Mala and Agni is depends on Dosha. All these functions they do in proper way when they are in balance condition. So it is most necessary to maintain the balance condition of Doshas. Acharya Vagbhatta also mentioned Doshas are only cause for all diseases. Imbalance state of Dosha is considered as a disease. Vitiated Doshas also vitiates Dhatu and Mala. Hence treatment of vitiated Doshas should be first priority of physician. All the Samhitas have described the way to cure the imbalance condition of Doshas. But these concepts are in scattered manner. So Acharya Vagbhata has created one whole chapter for the treatment of Doshas. In this chapter he has described the way to cure the Doshas in very elaborative manner along with some miscellaneous concepts. Hence this chapter has been selected for study to understand the treatment principles of vitiated Doshas and by this way we can stop the chain of disease formation.

Validation of Glasgow-Blatchford Score in Predicting Management of Upper Gastrointestinal Bleeding

Background : Upper Gastrointestinal Bleeding is a common emergency with varying degrees of severity. Haemorrhage is managed by Therapeutic Endoscopy, Radiological Intervention or Surgery and Blood Transfusion which are available only in Tertiary Care Centre. So, when patient presents in primary healthcare setting, it is important to recognize the patients who need this treatment. Glasgow-Blatchford Score is a score which is used for this purpose. The purpose of this research was to validate its reliability in identifying such high-risk patients. Materials and Methods : This study was prospective and observational, conducted in Medical College and Hospital, from December, 2017 to May, 2019. All adult patients presenting to Emergency Department with sudden onset Upper Gastrointestinal Bleeding were included. Glasgow-Blatchford Score was computed. Patients were followed up till their discharge (or death) from the hospital. The therapeutic management needed and its relationship with the score and treatment modalities were noted. Area under Receiver Operating Characteristic (ROC) Curve was calculated. Results : Total 100 patients were included in study. 85% were male and 15% were female. Glasgow-Blatchford Score was found as a good predictor in discriminating patients. Patients with score 14. Interventional radiology or surgery was never used. The area under ROC Curve was 0.738 suggesting fair reliability. Conclusion : Glasgow-Blatchford Score is good predicting tool in cases of Upper Gastrointestinal bleeding and patients with score >7 should be transferred to speciality centres

Artificial intelligence and machine learning in ocular oncology: Retinoblastoma

Purpose: This study was done to explore the utility of artificial intelligence (AI) and machine learning in the diagnosis and grouping of intraocular retinoblastoma (iRB). Methods: It was a retrospective observational study using AI and Machine learning, Computer Vision (OpenCV). Results: Of 771 fundus images of 109 eyes, 181 images had no tumor and 590 images displayed iRB based on review by two independent ocular oncologists (with an interobserver variability of <1%). The sensitivity, specificity, positive predictive value, and negative predictive value of the trained AI model were 85%, 99%, 99.6%, and 67%, respectively. Of 109 eyes, the sensitivity, specificity, positive predictive value, and negative predictive value for detection of RB by AI model were 96%, 94%, 97%, and 91%, respectively. Of these, the eyes were normal (n = 31) or belonged to groupA (n=1), B (n=22), C (n=8), D (n=23),and E (n=24) RB based on review by two independent ocular oncologists (with an interobserver variability of 0%). The sensitivity, specificity, positive predictive value, and negative predictive value of the trained AI model were 100%, 100%, 100%, and 100% for group A; 82%, 20 21 98%, 90%, and 96% for group B; 63%, 99%, 83%, and 97% for group C; 78%, 98%, 90%, and 94% for group D, and 92%, 91%, 73%, and 98% for group E, respectively. Conclusion: Based on our study, we conclude that the AI model for iRB is highly sensitive in the detection of RB with high specificity for the classification of iRB

Toda linha tem um ponto de partida: relato de um psicólogo residente sobre a construção da Linha de Cuidado em Saúde Mental Infantojuvenil de Dias d'Ávila/BA / Every line has a starting point: a report by a resident psychologist on the construction of the Dias d'Avila/BA Health Care Line for Children and Youth / Cada línea tiene un punto de partida: un informe de un psicólogo residente sobre la construcción de la Línea de Atención Sanitaria Infantil y Juvenil Dias d'Ávila/BA

INTRODUÇÃO: As Linhas de Cuidado têm-se mostrado como importantes ferramentas para a gestão do cuidado, facilitando o fluxo assistencial, integrando serviços, instituições e atores responsáveis pelo cuidado àquela população específica; no campo da saúde mental infantojuvenil, essas ferramentas mostram-se como objetos importantes na luta pelo cuidado integral, humanizado e em liberdade. OBJETIVO: Descrever o processo inicial de planejamento, discussão e elaboração da Linha de Cuidado em Saúde Mental Infantojuvenil do município de Dias d'Ávila-BA. METODOLOGIA: A experiência relatada ocorreu durante estágio na Rede de Atenção Psicossocial (RAPS) do município, quando o autor era residente no Programa de Residência em Saúde da Família (FESF-SUS/FIOCRUZ). Para tal, foram utilizadas anotações e registros pessoais do autor, além de fichas e livros de registro do Centro de Atenção Psicossocial (CAPS). Trata-se de um estudo descritivo, de abordagem qualitativa, no formato de relato de experiência. RESULTADOS: Durante as discussões, além do debate de temas centrais, como racismo e sexismo, foram levantadas possibilidades assistenciais e critérios de encaminhamento, tendo como referência o CAPS. CONCLUSÃO: Os objetivos da pesquisa foram cumpridos e, além disso, relatar essa experiência proporcionou ao campo, de modo geral, um olhar mais cuidadoso em relação ao tema proposto.

INTRODUCTION: The Lines of Care have been shown to be important tools for care management, facilitating the flow of care, integrating services, institutions and actors responsible for care to that specific population. In the mental health field for children and adolescents, these tools are important objects in the fight for integral, humanized and free care. OBJECTIVE: To describe the initial process of planning, discussion and elaboration of the Line of Care in Children and Youth Mental Health in the city of Dias d'Ávila-BA. METHODOLOGY: The experience reported occurred during an internship in the Rede de Atenção Psicossocial ­ RAPS (Psychosocial Care Network) of the city, when the author was a resident of the Programa de Residência em Saúde da Família ­ FESF-SUS/FIOCRUZ (Family Health Residency Program). For this purpose, the author's personal notes and records were used, as well as records from the Centro de Atenção Psicossocial ­ CAPS (Psychosocial Care Center). This is a descriptive study, with a qualitative approach, in the experience report format. RESULTS: During the discussions, in addition to the debate on central themes, such as racism and sexism, assistance possibilities and referral criteria were raised, using the CAPS as a reference. CONCLUSION: The research objectives were fulfilled and, in addition, reporting this experience provided the field, in general, with a more careful look at the proposed theme.

INTRODUCCIÓN: Las Líneas de Atención han demostrado ser herramientas importantes para la gestión del cuidado, facilitando el flujo de la atención, integrando servicios, instituciones y actores responsables de la atención a esa población específica. En el campo de la salud mental de niños y adolescentes, estas herramientas son objetos importantes en la lucha por una atención integral, humanizada y gratuita. OBJETIVO: describir el proceso inicial de planificación, discusión y elaboración de la Línea de Atención en Salud Mental Infantil y Juvenil en la ciudad de Dias d'Ávila-BA. METODOLOGÍA: La experiencia relatada ocurrió durante una pasantía en la Rede de Atenção Psicossocial ­ RAPS (Red de Atención Psicosocial) de la ciudad, cuando el autor era residente del Programa de Residência em Saúde da Família ­ FESF-SUS/FIOCRUZ (Programa de Residencia Salud de la Familia). Para ello se utilizaron notas y registros personales del autor, así como registros y libros del Centro de Atenção Psicossocial ­ CAPS (Centro de Atención Psicosocial). Se trata de un estudio descriptivo, con enfoque cualitativo, en formato de informe de experiencia. RESULTADOS: Durante las discusiones, además del debate sobre temas centrales, como el racismo y el sexismo, se plantearon posibilidades de asistencia y criterios de derivación, tomando como referencia el CAPS. CONCLUSIÓN: Los objetivos de la investigación se cumplieron y, además, el relato de esta experiencia proporcionó al campo, en general, una mirada más detenida sobre el tema propuesto.

Graft-versus-host disease and other cutaneous manifestations in pediatric patients transplanted for Fanconi anemia / Doença do enxerto contra o hospedeiro e outras manifestações cutâneas em pacientes pediátricos transplantados por anemia de Fanconi

ABSTRACT Objective: The aim of this study was to elaborate a specific protocol for the assessment and early identification of skin lesions in pediatric patients with Fanconi anemia undergoing hematopoietic stem cell transplantation. Methods: This is a longitudinal, retrospective, and descriptive study. The medical records of 136 pediatric patients with Fanconi anemia who underwent hematopoietic stem cell transplantation between 2008 and 2018 at the Clinical Hospital of the Federal University of Paraná were reviewed. A specific protocol was created for data collection, which included age, sex, skin color, age at diagnosis of Fanconi anemia, transplantation data, family history of consanguinity, and pre- and post-transplant complications. In addition, the data included the presence of graft-versus-host disease of the skin and other organs, its classification, type of lesion, location, and also skin lesions not related to graft-versus-host disease. Results: Among the skin manifestations in pre-transplant period, café-au-lait spots stood out (32.4%). At least one organ was affected by graft-versus-host disease in 55.1% of patients; the most common involvement being the mouth, followed by the skin. Rash and erythema were the most frequently observed cutaneous manifestations of graft-versus-host disease. Conclusion: A high prevalence of cutaneous manifestations of the disease was observed, as well as cutaneous manifestations of graft-versus-host disease. The protocol developed gathers relevant and standardized information for the follow-up of patients with Fanconi anemia undergoing hematopoietic stem cell transplantation, ensuring greater reliability of the information, and its implementation will allow the prospective evaluation of patients.

RESUMO Objetivo: Elaborar um protocolo específico para a avaliação e identificação precoces de lesões de pele em pacientes pediátricos com anemia falciforme submetidos ao transplante de células-tronco hematopoiéticas. Métodos: Estudo longitudinal, retrospectivo e descritivo. Foram revisados os prontuários dos pacientes pediátricos com anemia de Fanconi submetidos a transplante de células-tronco hematopoiéticas entre os anos de 2008 e 2018 no Hospital de Clínicas da Universidade Federal do Paraná, totalizando 136 pacientes. Foi criado um protocolo específico para a coleta de dados, que incluiu: idade, sexo, cor, idade ao diagnóstico da anemia de Fanconi, dados do transplante, história familiar de consanguinidade e complicações pré e pós-transplante. Além disso, foram verificados a presença de doença do enxerto contra o hospedeiro da pele e de outros órgãos, sua classificação, tipo de lesão, localização e, também, lesões de pele não relacionadas à doença. Resultados: Entre as manifestações de pele no período pré-transplante, destacaram-se as manchas café com leite (32,4%). Pelo menos um órgão foi afetado pela doença do enxerto contra o hospedeiro em 55,1% dos pacientes, sendo o acometimento mais comum o de boca, seguido pelo de pele. Exantema e eritema foram as manifestações cutâneas mais frequentemente observadas. Conclusões: Observou-se alta prevalência de manifestações cutâneas próprias da doença, bem como de manifestações cutâneas de doença do enxerto contra o hospedeiro. O protocolo elaborado reúne informações relevantes e padronizadas para o acompanhamento dos pacientes com anemia de Fanconi submetidos ao transplante, garantindo maior confiabilidade das informações, e sua implementação permitirá a avaliação prospectiva dos pacientes.

Impact of surgical treatment on the gait of patients with cervical myelopathy / Impacto do tratamento cirurgico na marcha de pacientes portadores de mielopatia cervical / Impacto del tratamiento quirúrgico en la marcha de pacientes con mielopatía cervical

ABSTRACT: Objective: To analyze the impact of surgery on gait characteristics of individuals with Cervical Spondylotic Myelopathy (CSM) after one month of the procedure. Methods: Observational, cohort type study, with a quantitative analysis approach. Two assessments were performed, the first one week before surgery and the second 30 days after the decompression procedure. The following space-time variables were analyzed: steps per minute, step length, cycle time, speed, steps per minute, support time, swing time, step time. The kinematic variables obtained were analyzed by Gait Profile Score (GPS) and Movement Analysis Profile (MAP). Results: comparing pre and postoperative values, there was a decrease in the number of steps per minute (p=0.006), an increase in support time (p=0.011) and an increase in cycle time (p=0.004). Other variables did not present statistically significant differences. The patients' total GPS average in the pre-surgery assessment was 10.41 and 1 month after the procedure, an average of 10.56 was obtained, which does not characterize a statistical difference between the assessments. When establishing a comparison between the two assessments specifically on each joint movement of the lower limbs using the MAP, it was observed that the obliquity and rotation of the pelvis showed some improvement immediately after the surgical procedure. Knee flexion and extension were significantly (p=0.018) more compromised after the procedure when compared to the value of the same population before surgery. Conclusion: the preliminary analysis of the gait of these patients after one month of intervention did not show immediate benefits of the procedure. Level of Evidence II; Therapeutic studies - Investigation of treatment outcomes.

RESUMO: Objetivo: Analisar o impacto da cirurgia na marcha de indivíduos portadores de Mielopatia Cervical Espondilótica (MCE) após um mês do procedimento. Métodos: Estudo observacional, longitudinal, com abordagem de análise quantitativa. Foram realizadas duas avaliações, a primeira uma semana antes da cirurgia e a segunda 30 dias após o procedimento. Foram analisadas as variáveis de espaço-tempo: avanços por minuto, comprimento do passo, tempo de ciclo, velocidade, passos por minuto, tempo de apoio, tempo de balanço, tempo do passo. As variáveis cinemáticas obtidas foram analisadas pelo Gait Profile Score (GPS) e Movement Analysis Profile (MAP). Resultados: comparando os valores pré e pós-operatórios, houve diminuição do número de passos por minuto (p=0,006), aumento no tempo de apoio (p=0,011) e aumento no tempo de ciclo (p=0,004), outras variáveis não apresentaram diferenças estatisticamente significativas. A média do GPS total dos pacientes na avaliação pré-cirurgia foi de 10,41 e após 1 mês do procedimento obteve-se a pontuação média de 10,56 o que não caracteriza diferença estatística entre as avaliações. Ao estabelecer uma comparação entre as duas avaliações em cada movimento articular dos membros inferiores utilizando o MAP, observa-se que a obliquidade e a rotação da pelve apresentaram alguma melhoria imediatamente após o procedimento cirúrgico. Já a flexão e extensão do joelho mostrou-se significativamente (p=0,018) mais comprometida após o procedimento quando comparada com o valor da mesma população pré cirurgia. Conclusão: a análise preliminar da marcha dos pacientes com MCE após um mês de intervenção não evidenciou benefícios imediatos do procedimento. Nível de Evidência II; Estudos terapêuticos - Investigação dos resultados do tratamento.

RESUMEN: Objetivo: Analizar el impacto del tratamiento quirúrgico en las características de la marcha de personas con Mielopatía Cervical Espondilótica (MCE) después de un mes del procedimiento. Métodos: Estudio observacional, longitudinal, con enfoque de análisis cuantitativo. Se realizaron dos evaluaciones, la primera una semana antes de la cirugía y la segunda 30 días después del procedimiento de descompresión. Se analizaron las siguientes variables espacio-temporales: pasos por minuto, longitud de paso, tiempo de ciclo, velocidad, pasos por minuto, tiempo de apoyo, tiempo de balanceo, tiempo de paso. Las variables cinemáticas obtenidas fueron analizadas mediante Gait Profile Score (GPS) y Movement Analysis Profile (MAP). Resultados: Al comparar los valores pre y postoperatorios, hubo una disminución en el número de pasos por minuto (p=0,006), un aumento en el tiempo de soporte (p=0,011) y un aumento en el tiempo de ciclo (p=0,004), otras variables no presentaron diferencias estadísticamente significativas. La media del GPS total de los pacientes en la evaluación prequirúrgica fue de 10,41 y 1 mes después del procedimiento se obtuvo una puntuación promedio de 10,56, lo que no caracteriza diferencia estadística entre las evaluaciones. Al establecer una comparación entre las dos evaluaciones específicamente sobre cada movimiento articular de los miembros inferiores mediante el MAP, se observó que la oblicuidad y rotación de la pelvis mostraron cierta mejoría inmediatamente después del procedimiento quirúrgico. La flexión y extensión de la rodilla estuvieron significativamente (p=0,018) más comprometidas después del procedimiento en comparación con el valor de la misma población antes de la cirugía. Conclusión: Los pacientes con MCE presentan deterioro de la marcha en comparación con la población típica, el análisis preliminar de la marcha de estos pacientes después de un mes de intervención no mostró beneficios inmediatos del procedimiento. Nivel de Evidencia II; Estudios terapéuticos - Investigación de resultados del tratamiento.

Assistência de enfermagem na prevenção da gravidez na adolescência: uma revisão integrativa / Nursing care in prevention of pregnancy in adolescence: an integrative review / Cuidados de enfermería en la prevención del embarazo en la adolescencia: una revisión integradora

A adolescência é um período da vida repleto de manifestações genuínas e emocionais, caracterizadas por uma confusão de papéis e mudanças de valores. a gravidez nessa fase da vida, é muitas vezes encarada de forma negativa e recheada de conflitos do ponto de vista emocional, estrutural e financeiro, alterando drasticamente suas rotinas e descobertas que são inerentes dessa fase da vida. Desse modo a pergunta de pesquisa foi como a equipe de enfermagem poderá prestar assistência voltada a evitar-se a gravidez na adolescência? O objetivo Geral foi descrever a importância da assistência de enfermagem como forma de prevenção a gravidez na adolescência. A metodologia utilizada na pesquisa foi uma revisão integrativa na qual a busca foi realizada nas bases de dados Biblioteca eletrônica on-line (SCIELO), Biblioteca Virtual em Saúde (BVS), Bases de dados em enfermagem (BDENF), Google Academic e Literatura Latino- Americana e Caribenha em Ciências da Saúde (LILACS). Os dados foram apresentados utilizando fluxograma do processo de seleção dos artigos incluídos na análise de acordo com o PRISMA 2020 e a tabela com os dados: autor e ano, objetivos, método e resultados. Conclui-se que de fato, é necessário reconhecer os problemas, assim como as causas que contribuem para a gravidez precoce, analisar a eficácia e o impacto dos cuidados preventivos prestados pelos enfermeiros, a fim de desenvolver e implementar medidas mais eficazes para combater a gravidez precoce e seu impacto na vida dos adolescentes envolvidos.

Adolescence is a period of life full of genuine and emotional manifestations, characterized by a confusion of roles and changes in values. pregnancy in this phase of life is often seen negatively and filled with conflicts from an emotional, structural, and financial point of view, drastically altering the routines and discoveries that are inherent to this phase of life. Thus, the research question was how can the nursing team provide assistance to avoid teen pregnancy? The general objective was to describe the importance of nursing care as a way to prevent pregnancy in adolescence. The methodology used in the research was an integrative review in which the search was conducted in the databases Biblioteca eletrônica on-line (SCIELO), Biblioteca Virtual em Saúde (BVS), Bases de dados em enfermagem (BDENF), Google Academic and Literatura Latino-Americana e Caribenha em Ciências da Saúde (LILACS). The data were presented using flowchart of the selection process of the articles included in the analysis according to PRISMA 2020 and the table with the data: author and year, objectives, method and results. It is concluded that indeed, it is necessary to recognize the problems, as well as the causes that contribute to early pregnancy, analyze the effectiveness and impact of preventive care provided by nurses, in order to develop and implement more effective measures to combat early pregnancy and its impact on the lives of the adolescents involved.

La adolescencia es un período de la vida lleno de manifestaciones genuinas y emocionales, caracterizado por la confusión de papeles y cambios de valores. El embarazo en esta fase de la vida muchas veces es visto negativamente y lleno de conflictos desde el punto de vista emocional, estructural y financiero, alterando drásticamente las rutinas y descubrimientos inherentes a esta fase de la vida. Así, la pregunta de investigación fue ¿cómo puede el equipo de enfermería prestar ayuda para evitar el embarazo en la adolescencia? El objetivo general fue describir la importancia de los cuidados de enfermería como forma de prevención de la gestación en la adolescencia. La metodología utilizada en la investigación fue una revisión integradora en la cual la búsqueda fue realizada en las bases de datos Biblioteca eletrônica on-line (SCIELO), Biblioteca Virtual em Saúde (BVS), Bases de dados em enfermagem (BDENF), Google Académico y Literatura Latino-Americana e Caribenha em Ciências da Saúde (LILACS). Los datos se presentaron mediante el diagrama de flujo del proceso de selección de los artículos incluidos en el análisis según PRISMA 2020 y la tabla con los datos: autor y año, objetivos, método y resultados. Se concluye que, efectivamente, es necesario reconocer los problemas, así como las causas que contribuyen para el embarazo precoz, analizar la eficacia y el impacto de los cuidados preventivos prestados por las enfermeras, a fin de desarrollar e implementar medidas más eficaces para combatir el embarazo precoz y su impacto en la vida de las adolescentes involucradas.

Dengue and Chikungunya viruses Co infection: A serological based study from tertiary care center, Ahmadabad, India

Introduction: Dengue and Chikungunya (CHIK) infections appear to be increasing in all parts of India. Aedes aegypti mosquitoes are common vectors for dengue virus (DENV) and CHIK virus (CHIKV - Chikungunya Virus). In areas where both viruses co circulate, they can be transmitted together. Aim: The present study was undertaken to study the prevalence of dengue–CHIK co infection and compare with monoinfection. Methods: IgM antibody capture ELISA (Enzyme linked immunosorbent assay) for dengue IgM and CHIK IgM and ELISA for dengue non structural protein 1 antigen was performed on serum samples obtained from suspected patients. Results: Out of total 1071 samples from suspected patients for dengue & chikungunya infection, 212 (19.7%) samples were positive for DENV while CHIK IgM antibodies were positive in 145 (13.53%) patients. Total 44 sera were positive (4.10%) for co-infection of dengue and CHIK. Conclusion: Increase in the number of Dengue and Chikungunya infections and their cocirculation is an important public health concern which warrants the implementation of strict control measures

Masseter muscle flap for reconstruction of intra-oral defects in patients with early cancer of posterior-inferior parts of the oral cavity / Retalho do músculo masseter para reconstrução de defeitos intraorais em pacientes com câncer inicial de partes póstero‐inferiores da cavidade oral

Abstract Introduction Early carcinomas of the oral cavity in the posterior-inferior regions poses a challenge for reconstruction due to the lack of muscle support underneath and the limited space available to use some of the frequently-used flaps. Objective This study was done to evaluate the efficacy of the superiorly based masseter muscle flap in reconstruction of intra-oral post- ablation defects in patients with early oral carcinoma of the posterior-inferior part of the oral cavity. Methods A superiorly based masseter muscle flap were used to reconstruct the post-surgical intra- oral defect in 60 patients with early squamous cell carcinoma (T < 4 cm) of the posterior-inferior part of the oral cavity. The patients were followed up at 1-week and 1-month postoperatively to check for flap viability, complications, change in mouth opening and deviation of the mandible on mouth opening. To rule out any recurrence in the oral cavity masseter flaps, the patients were followed up for 1 year. Results The flap was viable in all patients and underwent mucosalization. 7/60 patients had postoperative infections, while 2/60 patients developed an oro-cutaneous fistula which required a secondary corrective procedure. The mean ± standard deviation of change in mouth opening at 1 week postoperatively was +1.917 ± 3.36 mm, which increased to +2.633 ± 2.95 mm at 1 month after surgery. The Friedman test revealed that there was a statistically significant change in mouth opening from preoperative period to the1 week and 1 month postoperative periods (p = 0.000). Female patients showed better improvement in mouth opening postoperatively. The ipsilateral deviation of the mandible on mouth opening was between 0-5 mm in 39 patients, 5-10 mm in 17 patients and more than 10 mm in 4 patients. There were no recurrences noted in the masseter flaps used. Conclusion The study infers that the superiorly based masseter muscle flap is a reliable method for reconstruction in early oral cancer patients yielding good functional results and acceptable cosmesis with nominal postoperative complications.

Resumo Introdução Os carcinomas iniciais da cavidade oral nas regiões póstero‐inferiores representam um desafio para a reconstrução devido à falta de suporte muscular abaixo da região e ao espaço limitado disponível para o uso de alguns dos retalhos mais empregados. Objetivo Avaliar a eficácia do retalho do músculo masseter de base superior na reconstrução de defeitos intraorais pós‐ablação em pacientes com carcinoma oral inicial da parte póstero‐inferior da cavidade oral. Método Um retalho do músculo masseter de base superior foi usado para reconstruir o defeito intraoral pós‐cirúrgico em 60 pacientes com carcinoma espinocelular inicial (T < 4 cm) localizado na parte póstero‐inferior da cavidade oral. Os pacientes foram acompanhados após uma semana e um mês de pós‐operatório para verificação da viabilidade do retalho, complicações, alteração na abertura bucal e desvio da mandíbula na abertura bucal. Para descartar recidiva nos retalhos do masseter, os pacientes foram acompanhados por um ano. Resultados O retalho foi viável em todos os pacientes e foi submetido à mucolização; 7/60 pacientes tiveram infecções pós‐operatórias, enquanto 2/60 pacientes desenvolveram uma fístula orocutânea que exigiu um procedimento corretivo secundário. A média ± desvio‐padrão da alteração na abertura da boca em uma semana de pós‐operatório foi + 1,917 ± 3,36 mm, que aumentou para + 2,633 ± 2,95 mm em um mês de pós‐operatório. O teste de Friedman revelou que houve uma alteração estatisticamente significante na abertura da boca do período pré‐operatório para os períodos de uma semana e um mês de pós‐operatório (p = 0,000). Pacientes do sexo feminino apresentaram maior melhoria na abertura da boca no pós‐operatório. O desvio ipsilateral da mandíbula na abertura da boca ficou entre 0 a 5 mm em 39 pacientes, 5 a 10 mm em 17 pacientes e mais de 10 mm em 4 pacientes. Não foram observadas recidivas nos retalhos de masseter usados. Conclusão O retalho do músculo masseter com base superior é um método confiável para reconstrução em casos de câncer oral inicial, produz bons resultados funcionais e resultados cosméticos aceitáveis com complicações pós‐operatórias insignificantes.

DENGUE HEPATOPATHY AND ITS CORRELATION WITH SEVERITY OF DISEASE FROM WESTERN PART OF INDIA

Background and Objectives: The global incidence of dengue hasgrown dramatically in recent decades affecting children and young adults mainly intropical and subtropical countries.Dengue has a wide spectrum of clinicalpresentations, often with unpredictable clinical evalution and outcome. While mostpatients recover following a self-limiting non-severe clinical course, a smallproportion progress to severe disease, mostly characterised by plasma leakage with orwithout haemorrhage.Methods: It is a Prospective ,observational study including 150 serologicallyconfirmed Dengue fever in a tertiary care centre. The main objective was tostudy patterns of hepatopathy in dengue fever and to determine whether thepatterns of hepatic involvement correlate with clinical , laboratory profile andoutcome in Dengue fever according to WHO classification .Results: Younger age groups were found to be more prone tohepatopathy with 46.7 % of patients having hepatopathy(transaminases >3x UNL) belonging to ages 21-30 yrs. AST levelcorrelates maximum with severe Dengue ,followed by abnormal PTand APTT value .AST is more useful than ALT and AST:ALT Ratiois even more reliable indicator than using the values alone.Riskfactors which were statistically significant for mortality :PositiveTourniquet test, Abnormal CNS Examination, BleedingManifestations, and thrombocytopenia.Hepatic dysfunction Grade 3and 4 were not directly related to mortality.Interpretation and Conclusion: Even though hepatopathy does notcorrelate with the severity of disease directly, its significantassociation with warning signs ,thrombocytopenia and bleedingmanifestations make it very important factor to predict which subsetof patients will develop severe Dengue fever.Timely diagnosis ofhepatopathy in patients with dengue fever and its management mayimprove patient survival rate

Study of Epilepsy and its Correlation with Neuroimaging and Drug Therapy

Background: Thousands of people in the world suffer from epilepsy. Inspite of modern advances, it can be controlled in only 80% of treated once. Diagnosis and treatment of epilepsy is still challenged. The present study is attempted to highlight the importance of clinical findings and role of EEG and CT scan and MRI in diagnosis of epilepsy2.Aim:To study the incidence and epidemiological profile, various types of epilepsy and correlation with MRI, CT SCAN, EEG and the effectiveness of various Anti epilepticdrugs in different types of epilepsy. Settings and Design: This is a prospective study carried out at Civil Hospital, Ahmedabad.Methods:All the patients having 2 and/or more unprovoked seizures and already enrolled patients in epilepsy clinic in 1 year duration from January 1,2020 to December 31,2020 were included.Results &Conclusions:Out of 6930 total admissions, 163 patients with epilepsy were enrolled in this study from age group of 1 month to 12 years. Out of 163 patients, 97 were male and 66 were female. Most common age group affected is of 1-5 years. 128 patients (78.62%) were of generalized epilepsy and 35 patients were of partial epilepsy. Most common precipitating factor in epilepsy is inadequate drug dosages (45%). 45 patients (22.7%) have developmental delay. Abnormal EEG findings were present in 123 patients (75.46%). Abnormal MRI findings were present in 37 patients (22.7%). CT scan was done in 56 patients, 20 were abnormal. 107 patients were on monotherapy and 56 patients were on polytherapy. Valproate is most commonly used drug (76.6%).

Spinal Anaesthesia for Caesarean Section in a Morbidly Obese Parturient: A Case Report

The population of obese individuals is increasing worldwide.Maternal obesity is an important risk factor in pregnancy and problems such as difficulty in endotracheal intubation, risk of aspiration, and hypoxia may occur 2 during generalanaesthesia.A 28-year-old woman (height 1.6 m, body weight 126 kg, BMI 49.2 kg/m ) visited GCS Hospital, Ahmedabad for selective caesarean section at a gestational age of 37 weeks. Patient was diagnosed with PIH. Spinal anaesthesia was selected because of the high possibility of endotracheal intubation failure due to super morbid obesity.Considering the possibility of hypotension, an arterial cannula was placed in the right radial artery for invasive arterial pressure monitoring. After sterile preparation, spinal anaesthesia was performed through the L3–4 interspinous space using a 90 mm 24-gauge spinal needle. During surgery,Blood pressure was maintained between 160/88 and 86/38 mm Hg and heart rate was maintained between 70 and 104 beats/min. The surgery was completed uneventfully. The block level of spinal anaesthesia was maintained at the T8 dermatome level during the operation and was also confirmed at the end of operation.

Wellen's syndrome (ST-T variant-clinician's dilemma)

Wellen's syndrome is a preinfarction clinical entity which describes characteristic ECG pattern which suggests high degree proximal LAD stenosis that will soon result in an acute anterior wall MI if patient is not urgently catheterised and occlusion is opened. This case report discusses an elderly male without any cardiac history with no chest pain came with lower abdominal pain and diagnosed to have urinary bladder calculi and was referred to us for preoperative fitness for open cystolithotomy and ECG changes. His ECG showed deep T wave inversion in V1-V5 with upward slopping of ST segment in V2-V5 (wellen's pattern). He was then transferred under cardiology unit and urgent CAG done and it showed 90% stenosis in proximal LAD and successful PTCA was done with placement of 2 drug eluting stents.

Apoio Matricial e Saúde Mental: relato das potencialidades e desafios no fazer do NASF por uma psicóloga em uma Residência Multiprofissional em Saúde da Família / Apoyo Matriarcal y Salud Mental: relato de las potencialidades y desafíos en hacer el NASF por una psicóloga en una Residencia Multiprofesional en Salud de la Familia / Matrix Support and Mental Health: report of the potentials and challenges in the making of the NASF by a psychologist in a Multiprofessional Residence in Family Health

| INTRODUÇÃO: Uma das principais ferramentas do NASFAB é o Apoio Matricial (AM), sendo uma estratégia de organização do trabalho, buscando a integração de equipes de referência e equipe especializada. Por ser uma estratégia essencial para o desenvolvimento de um cuidado integral é que temáticas como a Saúde Mental têm sido incluídas nas ações desenvolvidas na AB. Nesse sentido, o apoio matricial em saúde mental deve propiciar que os profissionais de referência possam qualificar a produção de cuidado em SM. OBJETIVO: Refletir sobre as potencialidades e desafios vivenciados na prática de apoio matricial em saúde mental na AB a partir da experiência de uma psicóloga do NASF em uma Residência Multiprofissional em Saúde. METODOLOGIA: A prática descrita neste artigo refere-se a um estudo qualitativo, do tipo relato de experiência, onde buscou-se refletir sobre as atividades desenvolvidas ao longo do período de dois anos em uma Residência Multiprofissional em Saúde. Foram utilizados como fonte de dados escritos em portfólios e diários de campo da autora. RESULTADOS: Foram desenvolvidas ações que propiciaram a aproximação entre a equipe com as discussões relacionadas a Luta Antimanicomial, consultas compartilhadas e construção de PTS. Ao longo do processo de trabalho foi interessante perceber a apropriação dos profissionais na equipe de referência na condução das ações em saúde mental, demonstrando o papel essencial do AM para efetivar a clínica ampliada. CONCLUSÃO: O percurso traçado neste relato permite refletir sobre a importância de se estender e consolidar o cuidado em saúde mental na AB, promovendo mudanças importantes na lógica de atenção.

INTRODUCCIÓN: Una de las principales herramientas del NASF-AB es el Apoyo Matriarcal (AM), siendo una estrategia de organización del trabajo, buscando la integración de equipos de referencia y equipo especializado. Por ser una estrategia esencial para el desarrollo de un cuidado integral es que temáticas como la Salud Mental han sigo añadidas en las acciones desarrolladas en la AB. En ese sentido, el apoyo matriarcal en salud mental debe propiciar que los profesionales de referencia puedan calificar la producción de cuidado en SM. OBJETIVO: Reflejar sobre las potencialidades y desafíos vividos en la práctica de apoyo matriarcal en salud mental en la AB a partir de la experiencia de una psicóloga del NASF en una Residencia Multiprofesional en salud. METODOLOGÍA: La práctica descripta en este artículo se refiere a un estudio cualitativo, del tipo relato de experiencia, donde se buscó reflejar acerca de las actividades desarrolladas a lo largo del periodo de dos años en una Residencia Multiprofesional en Salud. Fueron utilizados como fuente de datos, escritos en portafolios y diarios de campo de la autora. RESULTADOS: Fueron desarrolladas acciones que proporcionaron el acercamiento entre el equipo con las discusiones relacionadas a Lucha Antimanicomial, consultas compartidas y construcción de PTS. A lo largo del proceso de trabajo fue interesante percibir la apropiación de los profesionales en el equipo de referencia en el manejo de las acciones en salud mental demostrado el rol esencial del AM para efectivar la clínica ampliada. CONCLUSIÓN: El camino delimitado en este relato permite reflejar sobre la importancia de extenderse y consolidar el cuidado en salud mental en la AB, promoviendo cambios importantes en la lógica de atención.

Per-vaginal Management of a Fetal Ascites Intended Dystocia in a Cross Breed Cow: A Case Study

This article discussed about a case of per-vaginal management of dystocia in a cross breed cow due to fetal ascites cause. A 3.5 years old cross breed cow was presented at Mobile Veterinary Clinic, Gosaba Block, South 24 Paragans, West Bengal with a history of prolonged labor. The water bag was ruptured but there was no progression of parturition. Per-vaginal examination revealed that the cervix was completely dilated and the fetus was in anterior longitudinal presentation with an extremely distended abdomen. The case was diagnosed as dystocia due to fetal ascites. After epidural anesthesia, the abdominal wall of fetus was punctured with a fetotomy knife and about 5-7 liters of clear straw colored ascitic fluid was evacuated. Finally fetus was removed by gentle traction. Post operative therapy with antibiotics, analgesic, intravenous fluid and multivitamin successfully cured the animal.

Successful C-section of a Non-descriptive Goat to Relieve from Dystocia

Present case study was associated with successful management of a pregnant doe from dystocia by caesarean section. A 1.5 years old pregnant non-descriptive doe was admitted in the TVCC, C.V.A.Sc., Pantnagar, Uttarakhand with a history of complete gestation period and prolonged labor (more than 12 hours). There was protrusion of both fetal forelimbs from the vaginal opening. Gynaecological examination revealed that the fetus was in Nape presentation. The case was diagnosed as dystocia due to abnormal fetal disposition. The animal was subjected to caesarean operation. The operation was performed under light sedation with 0.1 ml of xylazine and regional inverted L- block was also done with 2% Lignocaine. An oblique incision was given at left flank and recovery of one dead male fetus occurred. Post-operative treatment was done with Inj. Amoxicillin-sulbactum @10 mg/kg intramuscularly, Inj. Tribivet® 5 ml intramuscularly, Inj. Chlorpheniramine maleate @0.5 mg/kg intramuscularly, Meloxicum@0.5 mg/kg intramuscularly and NS 250 ml for five days. Local antiseptic dressing and fly repellant spray was advised for every alternative day. The skin suture was removed on 10th day post-surgery.

Cardiovascular risk comorbidities in rheumatoid arthritis patients and the use of anti-rheumatic drugs: a cross-sectional real- life study

Abstract Background: Rheumatoid arthritis (RA) is a common autoimmune systemic inflammatory disease. In addition to joint involvement, RA patients frequently have other comorbidities, such as cardiovascular diseases. Drugs used for RA treatment may increase or decrease the risk of a cardiovascular event. This study aims to analyze cardiovascular risk comorbidities in patients with RA and the correlation with the use of anti-rheumatic drugs. Methods: Cross-sectional study conducted based on the real-life rheumatoid arthritis study database - REAL, a prospective observational cohort study. Associations between the use of anti-rheumatic drugs and the presence of comorbidities were represented by their prevalence ratio and evaluated using the Chi-square or Fisher's Exact tests. Results: We assessed 1116 patients, 89.4% women, mean age of 55.15 years and predominance of seropositive disease. 63.3% had some cardiovascular comorbidity, predominantly hypertension (49.9%). The use of glucocorticoids was observed in 47.4% of patients and there was a significant tendency of lower use of these drugs in the presence of dyslipidemia (PR: 0.790; p = 0.007). We observed that the presence of cardiovascular comorbidities was associated with higher use of bDMARDs (PR:1.147; p = 0.003). Conclusions: The presence of cardiovascular risk comorbidities was confirmed to be higher in RA patients. Different treatment strategies using less glucocorticoids in the presence of dyslipidemia and more common use of bDMARDs in patients with cardiovascular comorbidities suggest that rheumatologists are aware of the potential influence of the DMARDs in the risk of cardiovascular event. Reinforcing these results, we highlight the need for a better baseline assessment to guide the choice of anti-rheumatic drugs in RA patients who have comorbidities.

Use of radioguided surgery technique for the treatment of thyroid cancer recurrence: clinical, surgical and anatomopathological aspects

Introduction: Surgery is the treatment of choice in locoregional thyroid neoplasia recurrence. The intense tissue healing process observed after surgery changes the neck anatomy, makes reoperation difficult, and interferes with surgical success. The use of the Radioguided Occult Lesion Localization (ROLL) technique has become a viable option to localize thyroid tumors. Objective: To analyze the use of the ROLL technique for the treatment of thyroid cancer recurrence with respect to its clinical, surgical and anatomopathological aspects. Methods: A descriptive cross-sectional study that analyzed 56 medical records and anatomopathological examinations of patients of both sexes who had thyroid neoplasms, underwent previous surgeries on this topography, and were submitted to the ROLL technique for recurrence removal from March 2011 to March 2019. Results: Most patients were women aged 46.05 years, on average. Papillary thyroid neoplasm was the most prevalent histological finding. In 100% of the cases, application of the ROLL technique identified and removed the lesions marked with suspicion for malignancy. Conclusion: Radioguided surgery has proved to be a very effective and safe tool to assist with lesion localization for the treatment of thyroid cancer recurrence. This technique has brought no additional side effects to patients, required minimal radiation and made surgery less invasive, reducing postoperative complication rates.

Ross Syndrome - A Rare Disorder of Sweating, Areflexia, and Tonic Pupil.

Sweating is a physiological process that is essential to maintain the temperature of the human body. Any derangement with this process leads to not only physical disturbances but can also cause psychological and social disturbances. Localized hyperhidrosis can have many causes. It can be a normal physiological response to local heat and pressure or it may be secondary to some pathological conditions causing local vasomotor disturbances (peripheral neuropathy or spinal injury) or sometimes it's secondary to neurological problems like tumour, inflammation and damage affecting the central nervous system, autoimmunity, viral infections and genetic disorders. Classically, Ross syndrome was described in 1958; it is a triad of Adie's pupil, areflexia and segmental hypohidrosis or anhidrosis.1 Anhidrosis is secondary to damage to the postganglionic cholinergic fibres that supply the sweat glands and in compensation, to the absent sweating in the affected segments there is over sweating elsewhere.2 Most of the times it is this excessive sweating that bothers the patient the most, in our case report we describe a patient who had excessive sweating over the left trunk and left lower limb which was, in fact, anhidrosis on the opposite side.Ross syndrome is a rare entity, (defined a clinical trial of segmental anhidrosis or hypohidrosis, areflexia, and atonic pupil. It is a progressive and complex disorder of Thermoregulation. The first component of the triad defines Harlequin syndrome and the last two defines Holmes-Adie syndrome). Ross syndrome has an unpredictable course. Usually, it presents with the absence of sweating in a particular area of the body which causes heat intolerance to the patient. There are only a few cases in the literature, here we present to you a case of Ross syndrome presenting with hyperhidrosis on the left side of the trunk and left lower limb. We intend this case report to inform academics and clinicians of various modalities about this entity, especially to the dermatologists, physicians and neurologists as patients usually present with this complex disorder to them.