Association of acanthosis nigricans with metabolic syndrome - An analytic cross-sectional study

Abstract Background: Globally, few studies have been undertaken to assess the association of acanthosis nigricans (AN) with metabolic syndrome (MS). Most of the available studies have either focused on a particular age group, gender, ethnicity or on a single component of MS. Objectives: To determine the association between AN and MS as a whole and with all individual components of MS in adult patients of either gender. Material and methods: This was a cross-sectional study with a comparative group. Eighty-one subjects were recruited in each group. Fasting plasma glucose (FPG) and lipid profile were done. MS was defined by using the international diabetic federation (IDF) criteria. Association of body mass index (BMI), waist circumference, blood pressure, FPG, high-density lipoprotein (HDL) and triglycerides (TG) with AN was assessed by Pearson's chi-square test followed by univariate and multivariate analysis. Results: The prevalence of MS was found to be significantly higher in the group with AN. On univariate analysis, a significant association of AN was found with BMI, waist circumference, high systolic and diastolic blood pressure, HDL, and TG. Multivariate analysis revealed a significant association between waist circumference, high systolic and diastolic blood pressure, and high TG levels with AN. The risk of MS was found to be eight times higher in cases of AN. Study limitations: The small sample size and single-center data are the limitations of the present study. Conclusion: AN is strongly associated with MS as a whole and with its individual components including increased waist circumference, hypertension, and dyslipidemia.

An Unusual Case of Telangiectasias

Background: Telengiectasias are defined as persistent dilatation of small capillaries in the superficial dermis Case: A 26-year-old woman presented with red lesions, epistaxis, joint pains, color changes of the hands, and breathlessness. On clinical examination and investigations, a final diagnosis of mixed connective tissue disease (MCTD), with interstitial lung disease (ILD), with telangiectasias, and epistaxis was made. Telangiectasias and epistaxis are rare presentations of MCTD.

Bilateral Nevus of Ota with Phakomatosis pigmentovascularis treated with 1064 nm picosecond laser: A Case Report

Nevus of Ota is an uncommon dermal melanosis in the Indian subcontinent and is rarely associated with capillary malformations, classified as type II phakomatosis pigmentovascularis (PPV). It usually presents unilaterally as mottled, slate blue, or dark bro wn macules; bilateral presentation is only seen in a few cases. A 20 - year female presented to Dermatology OPD of a tertiary hospital with bilateral nevus of Ota involving the cheeks, temples, nose, forehead, and sclera of the eyes for one year. She also ha d a port wine stain on the right arm, forearm, back, bittock, and thigh since birth without any other systemic involvement. We treated nevus of Ota with six sessions of 1064 nm picosecond laser every month at 0.8 J/cm 2 with significant improvement in the appearance of the lesions and no adverse effects. This case highlights the importance of thoroughly examining pigmented lesions for additional cutaneous findings and the potential use of a 1064 nm picosecond laser to tr eat such lesions.

A comparative analysis of distal locked and unlocked long proximal femoral nail antirotation (PFNA-II) in the fixation of stable intertrochanteric fractures / 中华创伤杂志(英文版)

PURPOSE@#Long proximal femoral nail anti-rotation (PFNA-II) is a preferred implant in recent years for fixation of pertrochanteric fractures, especially in osteoporotic patients. The purpose of this study is to prospectively investigate the effect of distal locking in long PFNA-II fixation of stable intertrochanteric fractures.@*METHODS@#A total of 58 patients with isolated stable intertrochanteric fractures and treated in our hospital during the study period of 2017-2019 by distal locked or unlocked long PFNA-II fixation were included in this study. Patients who had multiple injuries or open fractures were excluded. There were 40 female and 18 male patients, with 33 affecting the left side and 25 the right side. Of them, 31 belonged to the distal locked group (group A) and 27 to the unlocked group (group B). Surgical procedures and implants used in both groups were similar except for the distal locking of the nails. General data (age, gender, fracture side, etc.) showed no significant difference between two groups (all p > 0.05). The intraoperative parameters like operative time, radiation exposure and follow-up parameters like functional and radiological outcomes were recorded and compared. Statistical tests like the independent samples t-test Fischer's exact and Chi-square test were used to analyze association.@*RESULTS@#The distribution of the fractures according to AO/OTA classification and 31A1.2 type of intertrochanteric fractures were most common in our study. All the included fractures united and the average functional outcome in both groups were good and comparable at the end of one year. The operative time (mL, 107.1 ± 12.6 vs. 77.0 ± 12.0, p < 0.001) and radiation exposure (s, 78.6 ± 11.0 vs. 40.3 ± 9.3, p < 0.001) were significantly less among the patients in group B. Fracture consolidation, three months after the operative procedures, was seen in a significantly greater proportion of patients in group B (92.6% vs. 67.7%, p = 0.025). Hardware irritation because of distal locking bolt was exclusively seen in group A, however this was not statistically significant (p = 0.241).@*CONCLUSION@#We conclude that, in fixation of stable intertrochanteric fractures by long PFNA-II nail, distal locking not only increases the operative time and radiation exposure but also delays the fracture consolidation and increases the chances of hardware irritation, and hence is not required.

Comparison of onset of action of Intrathecal Clonidine vs Intrathecal Fentanyl as an adjuvant with hyperbaric Bupivacaine and Bupivacaine alone under spinal anesthesia for lower limb orthopedic surgeries

Background: Adjuvants are added to a local anesthetic solution to prolong the duration of analgesia. There is a paucity of studies comparing the onset of action of adjuvants like Clonidine and Fentanyl. In this study, the time of onset of action of intrathecal clonidine and intrathecal fentanyl as adjuvants to bupivacaine and bupivacaine alone were compared in the subarachnoid block for lower limb orthopedic surgeries. Materials and Methods: 90 adult patients posted for orthopedic surgery of the lower limb were divided into three equal groups of 30 each. Group A being the control group was given hyperbaric Bupivacaine(3ml) +0.5ml of Normal saline, Group B was given Intrathecal hyperbaric Bupivacaine (3 ml) +30 ?g Clonidine and Group C was given Intrathecal hyperbaric Bupivacaine (3 ml) + Fentanyl 25 ?g. The primary objective was to compare the time of onset of block and duration of analgesia. The secondary outcomes were the duration of sensory and motor block, duration of analgesia, hemodynamic parameters, and side effects. Results: The time of onset of the sensory blockade was 4.83 ± 0.64, 1.72 ± 1.47, and 3.4 ± 1.43 mins in groups A, B, and C respectively. The time of onset of the motor blockade as estimated by the time to reach level 2 on the Bromage scale, was 6.07 ± 0.55, 2.38 ± 1.32, and 5.06 ± 1.28 mins in groups A, B, and C respectively. The duration of postoperative analgesia was prolonged in the Clonidine group compared to the Fentanyl group. Conclusion: The study reveals that the time of onset of action of sensory and motor block was faster and the duration of analgesia was prolonged with adjuvants like Clonidine when compared to Fentanyl when added to Bupivacaine.

Curious Case of Acoustic Schwannoma of Middle Cranial Fossa: A Case Report

Acoustic neuromas are the most common lesion in the cerebellopontine angle. The authors report a unique case of acoustic schwannoma, presenting in middle cranial fossa masquerading as meningioma in a 24-year-old man, presenting with headache and focal seizures. Contrast-enhanced MRI of the brain revealed a mass lesion of the right middle cranial fossa consistent with features of meningioma.Intraoperatively a well-defined tumor with attachment to anterior petrous bone was excised. In the immediate postoperative period, the patient developed right-sided hearing loss, which was proven to be retrochoclear hearing loss on brainstem evoked response audiometry. Histopathology findings were consistent with benign schwannoma. Acoustic schwannoma originating in an unusual location middle cranial fossa is a plausible explanation of such unusual occurrence. Such a case has never been reported in the literature.

Risk Factors and Outcomes Associated with Intraoperative Fractures during Short-Stem Total Hip Arthroplasty for Osteonecrosis of the Femoral Head

Background@#Young age in osteonecrosis of the femoral head (ONFH) demands bone-preserving, short-stem arthroplasty. Several designs including neck-preserving stems and neck-resecting, shortened, standard stems are classified as short stems. There is a paucity of literature investigating risk factors and outcomes of intraoperative complications of neck preserving, short-stem arthroplasty in ONFH. @*Methods@#A total of 107 hips operated with METHA short-stem arthroplasty for ONFH were retrospectively evaluated. The mean age of patients was 43.7 years (range, 27–60 years). Nine patients had an intraoperative fracture. Seven hips received prophylactic cerclage wiring for poor bone quality. Patients were invited for clinical and radiological evaluation at the latest follow-up. @*Results@#The mean follow-up of patients was 47.2 months. Significant association with intraoperative fractures and the need for prophylactic cerclage wiring were found in steroids-, alcohol-, and chronic renal failure-induced ONFH. However, patient sex, body mass index, traumatic/idiopathic ONFH, previous implant in situ, prosthesis size, and single-sitting bilateral total hip replacement (THA) were not the risk factors. All hips showed signs of osteointegration at final follow-up. No revision was done during the study period for any cause. @*Conclusions@#METHA short-stem THA offers excellent functional and radiological outcomes in ONFH. However, precaution must be exercised in patients with steroids-, alcohol-, and renal disorders-induced ONFN due to poor bone quality and higher chances of intraoperative fractures. Also, additional measures such as the use of a high-speed burr and prophylactic cerclage wiring in ONFH may allow predictable and safe use of short stems.

Oral healthcare-related perception, utilization, and barriers among schoolteachers A qualitative study

Background: Health perceptions play an important part influencing health care utilization. Oral health messages and practices advocated by teachers can ensure better compliance by the students. Aims and Objectives: The present study aimed to assess qualitative insight regarding the perception and outlook of the school teachers understanding probable barriers regarding oral health care seeking behavior. Materials and Methods: Phenomenology type of qualitative research design was used amongst 44 school teachers of a Senior Secondary Government School of Delhi selected through convenient sampling. One to one in-depth interview was taken in 03 sections: demographic details, knowledge of oral health and its significance in life along with commonly followed and recommended oral hygiene practices and their views regarding barriers to oral health. Summative content analysis was conducted. Frequency distribution of the observed keywords was analyzed using SPSS version 21. Results: The mean age of teachers was 33.7 + 7.02 years (27-41 years). Every participant in the study felt that “oral health is integral part of overall health”. On inquiring the prime reason; it was quoted 'Awareness/affects general health' (15.2%) followed by 'Bad oral health affects academic performance' (9.6%). Regarding perceived barriers for dental service delivery l; the major roadblock perceived was “lack of awareness” (47.7%) followed by “financial barrier” (29.5%).Conclusion: The responses gave an insight regarding the basic need for further subject specific oral health education programs as a key for changing the current scenario. Future seminars and workshops remain the mainstream to appraise the knowledge for school staff.

Navigated Unicompartmental Knee Arthroplasty: A Different Perspective

Background@#Anteromedial osteoarthritis is a recognized indication for unicompartmental knee arthroplasty (UKA). Favorable postoperative outcomes largely depend on proper patient selection, correct implant positioning, and limb alignment. Computer navigation has a proven value over conventional systems in reducing mechanical errors in total knee arthroplasty (TKA). However, the lack of strong evidence impedes the universal use of computer navigation technology in UKA. Therefore, this study was proposed to investigate the accuracy of component positioning and limb alignment in computer navigated UKA and to observe the role of navigation in proper patient selection. @*Methods@#A total of 50 knees (38 patients) underwent computer navigated UKA between 2016 and 2018. All operations were performed by the senior surgeon using the same navigation system and implant type. The navigation system was used as a tool to aid patient selection: knees with preoperative residual varus > 5° on valgus stress and hyperextension > 10° were switched to navigated TKA. We measured the accuracy of component placement in sagittal and coronal planes on postoperative radiographs. Functional outcomes were also evaluated at the final follow-up (a minimum of 16 months). @*Results@#Nine patients had tibia vara and 14 patients had preoperative hyperextension deformity. We observed coronal outliers for the tibial component in 12% knees and for the femoral component in 10% knees. We also observed sagittal outliers for the tibial component in 14% knees and for the femoral component in 6% knees. There was a significant improvement in the functional score at the final follow-up. On multiple linear regression, no difference was found in functional scores of knees with or without tibia vara (p = 0.16) and with or without hyperextension (p = 0.25). @*Conclusions@#Our study further validates the role of computer navigation in desirable implant positioning and limb alignment. We encourage use of computer-assisted navigation as a tool for patient selection, as it allows intraoperative dynamic goniometry and provides real-time kinematic behavior of the knee to obviate pitfalls such as significant residual varus angulation and hyperextension that predispose early failure of UKA.

A preliminary study of sperm identification in microdissection testicular sperm extraction samples with deep convolutional neural networks / 亚洲男科学杂志(英文版)

Sperm identification and selection is an essential task when processing human testicular samples for in vitro fertilization. Locating and identifying sperm cell(s) in human testicular biopsy samples is labor intensive and time consuming. We developed a new computer-aided sperm analysis (CASA) system, which utilizes deep learning for near human-level performance on testicular sperm extraction (TESE), trained on a custom dataset. The system automates the identification of sperm in testicular biopsy samples. A dataset of 702 de-identified images from testicular biopsy samples of 30 patients was collected. Each image was normalized and passed through glare filters and diffraction correction. The data were split 80%, 10%, and 10% into training, validation, and test sets, respectively. Then, a deep object detection network, composed of a feature extraction network and object detection network, was trained on this dataset. The model was benchmarked against embryologists' performance on the detection task. Our deep learning CASA system achieved a mean average precision (mAP) of 0.741, with an average recall (AR) of 0.376 on our dataset. Our proposed method can work in real time; its speed is effectively limited only by the imaging speed of the microscope. Our results indicate that deep learning-based technologies can improve the efficiency of finding sperm in testicular biopsy samples.

Effectiveness Of Met V/S Marhythe In Individuals With Chronic Lateral Epicondylitis: A Randomized Clinical Trial

Background: Lateral Epicondylitis is the tendinosis of the extensor musculature of the forearm that has their common origin from the lateral epicondyle of the humerus due to angioblastic degeneration. The study aimed to determine and compare the effectiveness of MET and MaRhyThe in individuals with chronic lateral epicondylitis concerning pain, grip strength, and function. Methods: The study was a randomized clinical trial with 30 subjects divided into two equal groups, with 15 subjects in each group. Group A received MET for seven sessions, and Group B received MaRhyThe for one session. Both the groups received hot moist pack and conventional exercises for seven sessions. Visual Analogue Scale (VAS), Patient Rated Tennis Elbow Evaluation (PRTEE) Questionnaire, and Pain-Free Grip Strength (PFGS) were taken as the outcome measures. Results: Within-group paired sample t-test showed statistical significance in VAS at rest, VAS on activity, PRTEE, and PFGS with a p-value of 0.001 for all. However, between-group analysis using independent sample t-test showed statistical significance in VAS on activity and PRTEE with a p-value of 0.049 and 0.029, respectively, and clinical significance for VAS at rest and PFGS for Group B. Conclusion: The study concludes that both MET and MaRhyThe are effective in treating chronic LE concerning pain, improving function, and strength. However, MaRhyThe is more effective in pain reduction and improving functional activities.

ViVan Ratio for Maxillomandibular Tooth Material Discrepancy.

According to the guidelines of the American and Indian Boards of Orthodontics, it is essential to include second molars, while managing an orthodontic case. Therefore, the present study was planned to determine maxilla-mandibular tooth material discrepancy.METHODSThe study sample consisted of study casts of 300 subjects in the age range of 18-30 years. Samples having a full complement of teeth with Angle’s Class I molar and canine relationships, good intercuspation, normal overjet and overbite and minimal crowding and spacing were included in the study. Tooth dimensions were measured using digital vernier caliper (accurate to 0.01 mm) and overall ratio was calculated. The data was statistically analysed for range, mean, standard deviation and coefficient of variation.RESULTSViVan ratio was found to be 90.79 with standard deviation of 3.13, variance of 9.81 and range was 83.55 - 95.82.CONCLUSIONSIdeal tooth proportions play an important role in achieving good occlusion at the end of orthodontic treatment. The ViVan ratio obtained in the study included second molars and this would benefit the orthodontist in proper treatment planning. This ratio will add importance for improved results at the finish of orthodontic treatment.

Evaluation of procalcitonin as a predictor of severity of acute appendicitis

Background: Acute appendicitis is the most common surgical emergency worldwide. The treatment of choice is emergency appendectomy. A delayed diagnosis and hence a delayed treatment increases the complication rate. Despite the best efforts negative appendectomy rate is still high since there is no single best test available to reach the diagnosis.Methods: This was an institutional study conducted at DRPGMC Tanda, comprising of 28 patients and 7 healthy controls. The patients with clinical diagnosis of acute appendicitis were subjected to appendectomy after taking a blood sample for serum procalcitonin and performing an ultrasonogram of abdomen.Results: We observed that mean levels of procalcitonin (PCT) were significantly higher in patients of acute appendicitis in comparison to healthy controls. The range of PCT levels in group 2 i.e., patients with uncomplicated acute appendicitis were from 0.54 to 0.74 ng/ml with mean value of 0.61 ng/ml, whereas in group 3 i.e. patients with complicated acute appendicitis, the range were from 1.14 to 2.56 ng/ml with mean value of 1.62 ng/ml. PCT levels were significantly higher in group 3 as compared to group 1 and group 2 (p<0.0001). In group 2, mean PCT levels were significantly higher in comparison to group 1 (p<0.0001). Statistical analysis of our data shows a cut-off value of procalcitonin to be 0.203 ng/ml. We observed sensitivity and specificity of PCT to be 96% and 100% respectively.Conclusions: This study concludes that levels of serum PCT can be used as a laboratory marker for making a diagnosis of acute appendicitis and also for predicting its severity.

Comparison of Bolton s Ratio for Evaluation of Tooth Size Discrepancy between Maxillary and Mandibular Arches in Vidarbha Population

Bolton’s ratio is an indispensable parameter used in orthodontic diagnosis to evaluate the tooth size discrepancy. However, these norms have been established for Caucasian population and population variations necessitate the evaluation of these ratios for Vidarbha population. The objectives of the present study were to determine Bolton’s ratio for Vidarbha population, compare them with original Bolton’s ratios and determine the clinical significance of these differences.METHODSThe study sample consisted of study casts of 300 subjects in the age range of 18-30 years, all belonging to Vidarbha population, having a full complement of teeth. Tooth dimensions were measured using digital vernier caliper and Bolton’s overall ratio and anterior were calculated. The data calculated was statistically analysed for range, mean, standard deviation and coefficient of variation. Unpaired t-test was applied to draw a difference between the results of this study and the results from Bolton’s study.RESULTSBolton’s overall and anterior ratio norms for Vidarbha population sample were found to be 88.15 and 78.50, respectively, with standard deviation of 3.27 and 3.19, respectively. The range of overall ratio noted was 80.36–98.44, and the range of anterior ratio was 67.74–89.70.CONCLUSIONSIn general, the values obtained from this study for the Vidarbha population differ from the data of Caucasian population. So, it can be inferred that the established Bolton’s values for Caucasians cannot be used for the Vidarbha population. Hence, population specific standards are necessary for clinical assessment.

Ultrasonogram in Acute Appendicitis, A Surgeon’s Perspective: Original Article

Introduction: The diagnosis of acute appendicitis has essentially been clinical, but USG abdomen has been said to be highly accurate in diagnosing AA. The surgeon’s perspective may not always be the same. Materialsand methods: Appendectomy data of 106 patients from two hospitals of Kangra region was retrospectively analysed. The data was collected for age, sex, initial pre-operative diagnosis, USG findings, intra-operative findings, Histo-pathological examination (HPE) report, post operative hospital stay. Observations:It revealed a sensitivity of about 54% and specificity of 100% for diagnosing AA with the help of USG abdomen. AA was seen most commonly in males as compared to females. Mean age of presentation was 29.34 +/-14.4 years. Mean hospital stay was 3.68 +/-2.25 days. Most common initial preoperative diagnosis was AA (84%). Most common position of the appendix during surgery was retrocecal (53.7%). HPE report revealed AA in 105 patients. Conclusion:USG abdomen is often falsely assuring, leading to unnecessary delay in effectively managing a patient of AA further leading to increased complications. Only the clinically equivocal cases require further radiological investigations where CECT abdomen is the preferred investigation, but it should be used judiciously.

Evaluation of Adhesions Underneath Laparoscopic Sterilization Scar in Patients Undergoing Abdominal Surgery

Introduction: The minimally invasive approach has become the method of choice for treating most benign abdominal diseases that require surgery. However, it is obvious that laparoscopic procedures are not risk free. The aim of this study was to evaluate the prevalence of intra abdominal adhesions underneath umbilical scar following laparoscopic sterilization, in patients who are undergoing abdominal surgeries. Materials and Methods:The present study was a hospital based prospective observational study conducted in the Department of Surgery, Dr Rajendra Prasad Government Medical College (Dr. RPGMC), Kangra at Tanda (HP). The study group consisted of patients admitted to department of surgery during a period of one year and who fulfilled inclusion criteria. During intraoperative period, they were examined for presence or absence of adhesions at the site of previous laparoscopic sterilization scar at Periumblical area.Results:Total of 60 patients were taken in this study. Two out of 60 (3.3%) patients had adhesions underneath previous Laparoscopic Sterilization scar around umbilicus and adhesive structure was omentum in both cases.Conclusion:Adhesion formation is expected in any abdominal surgery whether open orlaparoscopic surgery. In our study only 3.3% of patients had adhesions underneath previous laparoscopic sterilization scar in periumblical region. Therefore umbilical port can be considered for re-entry of index port in next laparoscopic surgery, in patients with history of laparoscopic surgery through umbilical region.

Establishment of Cephalometric Norms for UCLP Cases from Central India Population Falling Under Goslon 1 and 2 Based on Burstone Analysis.

This study was done as there is a need to evaluate separate hard and soft tissue parameters for UCLP as we cannot compare the deformity with normal. A study by Abhilasha Yadav has defined the Burstone norms for class I subjects in Central India as compared to Caucasians. The objective is to derive norms for UCLP itself as the pattern of growth and development of bone, muscle is not normal that can be compared with any population and needs to treated, based on specific norms.METHODS75 cases of UCLP from Central India, with an age range of 18-25 yrs. were selected for the study. The COGS analysis values for Central Indian UCLP cases (falling under GOSLON 1 and 2) was established and compared with class I Caucasians and class I Central Indian subjects. The cephalograms were traced, analysed and interpreted using the landmarks and values established in Burstone analysis (cephalometric analysis for orthognathic surgery). The mean, standard deviation and Z values were calculated to compare the values between three groups.RESULTSThe Central Indian UCLP cases demonstrated decreased anterior cranial base length, upper third height of face, decreased anteroposterior maxillary length, decreased upper and lower incisor height as well as molar height, retroclined upper anterior, significantly decreased facial convexity, nasolabial angle and reduced maxillary prognathism while mandible showed prognathism.CONCLUSIONSThe study reported significant differences in certain cephalometric parameters of UCLP cases from central India population with that of Caucasian and class I central Indian population. The results obtained for central India’s UCLP cases can be used as cephalometric norms for planning orthognathic surgery specifically for cleft cases.