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Osteoarthritis (OA) of the knee significantly disrupts daily activities and reduces quality of life due to pain. The primary treatment involves anti-inflammatories, which can cause stomach issues. Alternative therapies, including glucosamine, chondroitin, chitosan, and phytoestrogens, are being explored, but their effects need further study. While some benefits may be due to the placebo effect, researchers conducted a literature review to determine their actual benefits. A review of seven meta-analyses found that glucosamine and chondroitin can alleviate pain, reduce stiffness, improve function, and reduce joint space narrowing (JSN) in OA patients. Chitosan's use in intra-articular injections for OA has been studied in four observational studies and clinical trials on animals, but the effects of oral chitosan supplements remain unknown. A literature review on phytoestrogens in OA, particularly in post-menopausal women, identified four relevant studies. The review suggests that glucosamine, chondroitin, chitosan, and phytoestrogens have significant therapeutic benefits for OA, such as reducing pain (measured by VAS score), relieving stiffness, and improving functionality due to their anti-inflammatory and chondroprotective effects. Therefore, additional randomized controlled trials are needed to confirm their effectiveness in managing knee OA.
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Osmotic demyelination syndrome (ODS), also known as central pontine myelinolysis, is a disorder that affects the pons and extrapontine regions. This condition clinically presents with a multitude of neurological manifestations. The pathogenesis of ODS is not yet clearly understood. Most common cause of ODS is iatrogenic rapid correction of hyponatremia with a bolus of hypertonic saline. Very rarely it can be directly caused by alcohol intoxication and disrupted neuronal metabolism due to deficiency of essential substrates. A 34-year-old chronic alcoholic male presented with neurological symptoms and signs for 2 days. Clinical examination suggested multifactorial encephalopathy which was attributed to hyponatremia, Wernickes and hepatic encephalopathy substantiated by abnormal lab reports and unremarkable initial magnetic resonance imaging (MRI) findings. Although his sensorium improved over the next 3-4 days following slow correction of hyponatremia, parenteral thiamine and vitamin B12, B6 and B3, he suddenly went into a mute state followed by quadriparesis which aroused the suspicion of locked-in syndrome. Since his quadriparesis was accompanied by mutism and emotional incontinence, a lesion above cervical spine was suspected. So a repeat MRI brain was taken which showed development of demyelination of ventral pons, bilateral lentiform and caudate nucleus, posterior limb of internal capsule and both thalami which were conjunct with pontine and extrapontine ODS. Outcome of an established ODS cannot be predicted. Early diagnosis of ODS is a serious challenge as demyelination can be missed in initial MRI scan. So, a repeat MRI based on meticulous clinical assessment is crucial for early diagnosis and timely intervention.
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Background: Lung cancer is the most common cause of cancer mortality worldwide. Smoking is undoubtedly the major risk factor of lung cancer in both genders. Adenocarcinoma is the most common form of lung cancer in both men and women and the most prevalent subtype in non-smokers. Lung cancer in never-smokers is a distinct entity with sparse studies. We studied the clinico-pathologic profile of lung adenocarcinoma and pattern of p53 expression in smokers and non-smokers. Methods: A prospective study involving 100 lung adenocarcinoma cases from January 2020 to June 2021 examined p53 expression using immunohistochemistry. Trucut biopsies, fine needle aspiration cytology (FNAC) cell blocks, and pleural effusion were analyzed to identify the predominant morphological subtype of the lung adenocarcinoma. Results: The most common histological pattern of lung adenocarcinoma was solid, and the presenting symptoms were cough and dyspnoea in both smokers and non-smokers. The incidence of lung adenocarcinoma was higher in non-smokers in the study. p53 expression had a significant correlation with smoking but not with stage of disease or morphological subtype of lung adenocarcinoma. Conclusions: p53 mutation has a statistical correlation with smoking in adenocarcinomas in our population. Among the adenocarcinoma cases in our study, non-smokers predominate (n=53). Even though our study showed the p53 mutation has no statistical correlation with the stage of the disease or histological subtype in adenocarcinoma, more cases need to be studied to prove this observation.
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Background: Understanding the patient flow for health-seeking patterns and utilization of AYUSH care in India has been considered essential for a greater emphasis on mainstreaming and blending into the existing healthcare systems. This study examines the morbidity profiling of patients reporting to Ayothidoss Pandithar Hospital (APH) of the National Institute of Siddha (NIS), Chennai. Methods: The study included new and old/revisit patients who attended the APH, Outpatient Department (OPD), special OPD, and Inpatient Department (IPD) from October 2004 to December 2023. Results: Through OPD and IPD, APH has treated 98,94,373 cases and 7,61,754 cases, respectively. The average number of cases treated per day at OPD was 1484, and 115 in IPD. Men were higher in OPD and IPD. The more common diseases treated during 2012-2023 at OPD were Madhumegam (diabetes mellitus) 13% and Azhal keelvayu (osteoarthritis) 12% whereas, in IPD, it was Thandagavatham (lumbar spondylosis) 9.5% and Pakkavatham (hemiplegia) 9.4%. At APH, 9 X-ray investigations, 44 Varmam therapies, 37 Thokkanam therapies, 497 pathological, 433 biochemical investigations, and 38 microbiological tests were performed each day. Conclusions: This study reveals the scope of the Siddha system of Medicine in managing Musculoskeletal disorders. The patient data generated at APH would enhance the National Health Policy (NHP) objective of strengthening and prioritizing health services' importance, promoting good health, and creating guidelines for high-quality care.
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Co-trimoxazole is a sulfonamide fixed dose combination antibiotic which is effective and widely use in treatment and prevention of opportunistic infections in people living with HIV/AIDS, but can be potentially associated with adverse drug reactions including drug hypersensitivity reactions such as Steven Johnson syndrome. PLWHA individuals have up to a 1000-fold increased risk of drug hypersensitivity reaction compared to the general population, which is associated with drug exposure, immune dysregulation, and concurrent infections. Here we present a case report of a 59-year-old man with HIV who experienced Stevens-Johnson Syndrome after taking co-trimoxazole for 18 days. Therefore, we would like to remind you to be more careful when giving cotrimoxazole to PLWHA because it can take time for a hypersensitivity reaction to occur, also in a few cases, it can occur immediately.
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Background: Formalin 10% is a fixative agent used in pathology laboratories. Formaldehyde released from formalin is a strong irritant and a carcinogen. The lab personnel are exposed to 10% formalin preserved surgical and post-mortem tissue samples during the visual examination and grossing. The present study aims to assess the exposure to formaldehyde in a histopathology laboratory unit as well as the effectiveness of existing engineering/ventilation systems. Methods: This is a cross-sectional study. Formalin levels were measured using portable air quality/pollution meter which measures formaldehyde (HCHO) in terms of mg/m3 in the morning, noon, and evening in different areas for one month. Areas of rooms and ventilation were mapped. The level of formalin was noted before, during, and after the grossing procedure and compared with the reference values given in the Occupational Safety and Health Administration (OSHA) and World Health Organisation (WHO). Results: Formaldehyde concentration ranged from 0.005 to 0.48 ppm (parts per million) in the grossing room and 0.002-0.010 ppm in the museum. Formaldehyde levels were highest in the morning and during grossing without using exhaust/ventilation and the levels reached minimum value within 15-20 minutes of switching on the existing control methods (exhaust fan of grossing station and opening of window panes). Conclusions: Formalin from the histology laboratories cannot be removed entirely but can be reduced sufficiently to lessen the risks to health by educating lab personnel and adopting appropriate control techniques.
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A systemic inflammatory disease known as rheumatoid arthritis (RA) is distinguished by excessive cardiovascular disease (CVD) morbidity and death. Traditional CV risk factors may partially contribute to CV disease in RA. Shared inflammatory mediators, post-translational modifications of peptides/proteins and subsequent immune responses, changes in the composition and function of lipoproteins, increased oxidative stress, and endothelial dysfunction are some of the mechanisms that link RA and CVD. The detailed pathogenetic pathway by which this association between RA and CVD might be explained is still not entirely known. It is crucial for controlling cardiovascular risk in people with RA. Optimizing care of traditional risk factors in addition to those inherent to RA is necessary to lessen the burden caused by CVD. The potential effect of planned Cardiac risk management in these individuals is highlighted by findings for under diagnosis and inadequate treatment of conventional CVD risk factors in RA. Present cardiovascular standards suggest RA patients to be examined for and treated for CVD risk factors without appropriate treatment goals. Utilizing potent anti-rheumatic medications that can reduce disease activity and treating the conventional CV risk factors should both be part of the therapy of CV risk in RA. There is currently insufficient scientific data to develop therapy targets for RA-related CVD risk factors. Thus, more study is required on the traditional CVD risk factor screening and management in RA patients.
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Background: Tumor budding refers to single or small cluster of tumor cells detached from the main tumor mass in histological sections. In colon cancer high tumor budding is associated with worse prognosis and correlates with metastatic lymph nodes. We studied tumor budding in modified radical mastectomy specimens to evaluate its utility as a prognostic factor by correlating high tumor budding score with known prognostic markers of breast cancer like axillary lymph nodal metastasis, clinical staging, tumor size, lymphovascular invasion, hormonal status and pathological grading. Aim was to evaluate tumor budding in invasive breast carcinoma and to describe clinical features and histopathological spectrum of Invasive Breast Carcinoma with/without lymph node metastasis on H&E slides. Secondly, to find association between grades of tumor budding and various clinical, gross, microscopic and immunohistochemical variables. Methods: The present study is a cross sectional study of 70 modified radical mastectomy specimens from June 2018 to Dec 2022. Along with tumor budding various prognostic parameters like hormonal markers, pathological grading and clinical grading were evaluated. Immunohistochemical marker Pancytokeratin was utilized for counting the tumor buds, wherever necessary. Statistical Analysis: Chi Square test was utilized to study significant differences between variables, p<0.05 was considered statistically significant. Results: A high tumor budding score (?4/HPF) had significant association with axillary lymph node involvement and clinical staging. Conclusions: In our study we detected the association of high tumor budding, PTB in invasive breast carcinoma with axillary lymph node involvement and clinical staging. Hence our results highlight the importance of tumor budding as a prognostic factor and submit that this histological feature could be included in diagnostic protocols just as in carcinoma of the colon.
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One of the frequent and dangerous aftereffects of stroke is post-stroke depression (PSD). About one in three stroke survivors had depression following their stroke. It had a significant impact on functional recovery, which resulted in a low standard of living. Even worse, there is a clear correlation between it and a high death rate. Our goal in doing this evaluation was to come up with a thorough and cohesive knowledge of PSD based on both recently released research and well-known works. We discovered that the incidence of PSD varies from 11 to 41% within a two-year period, based on a significant number of researches. The severity of the stroke, the location of the lesion, past history of depression, and other factors all has a role in the development of PSD. The DSM criteria are currently the primary basis for diagnosing PSD, and they are often coupled with different depression scales. However, there isn't a single, cohesive process that explains PSD which now include aberrant neurotrophic response, elevated inflammatory markers, lowered monoamine levels, glutamate-mediated excitotoxicity, and dysfunction of the hypothalamic-pituitary-adrenal (HPA) axis. Pharmacotherapy and psychosocial therapies are currently used in the treatment of PSD. Even though researchers have made significant progress, many problems still need to be solved. In particular, the PSD's mechanism is not entirely understood.
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Pancreatic hydatidosis is a rare infection with a frequency of less than one percent. Most of the abdominal hydatid cysts occur in liver. The purpose of this study was to present our experience of few rare cases of isolated pancreatic hydatid cyst, its presentation and management. Five pancreatic hydatidosis patients admitted in Gandhi Medical College, Secunderabad between 2021 to 2023 were reviewed. Demographic characteristics, clinical findings, and laboratory data were collected. Commonest symptom was pain in left upper quadrant followed by jaundice. The preoperative diagnosis was established in 3 patients by combination of ultrasonography, computed tomography, endoscopic ultrasonography and serological tests. Surgical treatment was done in three cases and two were medically treated. None of them had recurrence during a follow-up of 1 year. Pancreatic hydatid cyst even if rare should be considered in any pancreatic cystic mass in endemic countries like India.
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Background: Vitiligo, a chronic skin disorder characterized by depigmentation and white patch formation, not only poses a cosmetic challenge but also imposes a significant psychological burden. The relationship between vitiligo and depression remains underexplored, despite growing recognition of their potential association. This observational study aimed to investigate the prevalence of depression and assess the quality of life (QoL) among patients with vitiligo attending a tertiary care center. Methods: A cross-sectional study was conducted at the dermatology and psychiatry departments of SRVS Medical College, Shivpuri, involving 150 vitiligo patients aged 18 to 60 years. Participants were assessed using the patient health questionnaire (PHQ-9), vitiligo area scoring index (VASI), and dermatology life quality index (DLQI). Statistical analyses were performed using statistical package for the social sciences (SPSS) version 26. Results: The mean age of participants was 38.55±14.82 years, with 69.3% being female. Nonsegmental vitiligo accounted for 84% of cases, and 42.6% had active disease. The mean DLQI score was 8.45±6.12, with female gender and active disease significantly associated with lower QoL scores. A strong correlation was observed between depressive symptoms and impaired QoL (DLQI). The prevalence of depression (PHQ-9 score ?9) was 14.6%, with employed individuals showing a significantly higher prevalence compared to other groups. Conclusions: Our findings highlight the significant burden of depression and impaired QoL among vitiligo patients attending a tertiary care center. Addressing the psychosocial aspects of vitiligo alongside its dermatological manifestations is crucial for optimizing patient care and enhancing overall well-being. Further longitudinal research is warranted to elucidate the complex relationship between vitiligo and depression.
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Preclinical testing hepatoprotective potential of hydroalcoholic leaf extract of Calycopteris floribunda against liver damage caused by atorvastatin and clopidogrel. Atorvastatin and clopidogrel were delivered intraperitoneally for 14 days at 80mg/kg and 20mg/kg respectively, while leaf extract was given orally for the same period at 200mg/kg and 400mg/kg. To evaluate the impact of the leaf extract on the atorvastatin and clopidogrel-induced liver damage, many biochemical markers, Serum glutamate pyruvate transaminase (SGPT), serum glutamate oxaloacetate transaminase (SGOT), total protein, and serum alkaline phosphatase were measured. Blood samples from mice given hydroalcoholic Calycopteris floribunda leaf extract showed a noteworthy decrease in serum indicators, suggesting that the leaf extract had an impact on the hepatocytes' ability to operate normally again. On the other hand, the mice receiving atorvastatin and clopidogrel treatment showed increased levels, which suggested serious liver injury. Silymarin (100 mg/kg) was given as a benchmark. The current investigation found that Calycopteris floribunda hydroalcoholic extract significantly protected the liver against atorvastatin and clopidogrel-induced hepatic damage.
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This study explores the increasing prevalence and negative impacts of excessive smartphone use. It emphasizes the detrimental effects on academic performance, mental health, and physical well-being, highlighting the need for intervention strategies. The review aims to summarize evidence demonstrating the significant influence of smartphone addiction on dietary behavior and lifestyle, as well as the complex interplay between mobile phone usage patterns and mental health outcomes. The document suggests that mindfulness practices, self-reflection, and seeking professional help can be effective strategies to combat smartphone addiction. Through a systematic literature search using databases like Google Scholar, NIH, and PubMed, the review gathers information on smartphone addiction's effects on health, academics, and adolescence. The conclusion calls for longitudinal studies to track the long-term impact of smartphone usage on academic performance and overall well-being. It recommends identifying at-risk groups for intervention and promoting responsible smartphone usage to prevent adverse effects. Overall, the document underscores the importance of understanding the factors contributing to smartphone addiction and implementing measures to foster genuine human interactions, balance technology use, and mitigate the hazards of smartphone addiction among adolescents.
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Background: Premature ejaculation is the most common cause of sexual dysfunction. There is no consensus on the treatment protocol due to poor understanding of the underlying mechanisms. Therefore, the present pilot study was conducted to compare the efficacy of topical eutectic mixture for premature ejaculation (TEMPE) spray with lidocaine gel for the treatment of premature ejaculation. Methods: After obtaining ethics approval and written informed consent, 100 patients meeting the inclusion and exclusion criteria were included. Baseline values of intravaginal ejaculation time (IELT) and international index of erectile function (IIEF) were recorded. Patients were randomly assigned into group A (lidocaine plus prilocaine spray) and group B (lidocaine gel). After 4 weeks of treatment IELT and IIEF score were recorded. The findings were noted and analysed. Results: Both the groups were similar in terms of demographic and baseline characteristics. There was a significantly higher improvement in IELT and IIEF score following treatment in group A as compared to group B. The incidence of side effects was lower in group A as compared to group B. Conclusions: We recommend that the use of TEMPE spray for the treatment of premature ejaculation as it is better than lidocaine gel.
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Background: Pain in the postoperative period is of particular concern. It is a major barrier in the uptake of circumcision. There are various systemic and local analgesics for the management of postoperative pain. However, data regarding efficacy is scarce. Therefore, the present pilot study was conducted to compare the efficacy of lidocaine and prilocaine spray with oral analgesics for the relief of pain. Methods: After obtaining ethics approval and written informed consent, 100 patients meeting the inclusion and exclusion criteria were included. After circumcision, patients were randomized into group A (Lidocaine and prilocaine spray) and group B (Oral analgesics). Pain was assessed by visual analogue scale (VAS) score and patient reported comfort levels were assessed in the postoperative period till 72 hours. Findings were noted and analysed. Results: Both the groups were similar in terms of demographic characteristics and baseline characteristics. The VAS score was significantly lower in group A and the patient-reported comfort level was significantly more in group A. Conclusions: We recommend that the lidocaine and prilocaine spray is better in relieving pain in the postoperative period following circumcision as compared to oral analgesics.
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Background: Hypertension is a commonest cardiovascular disorder and is major cause of premature death worldwide. An estimated 1.28 billion adults aged 30-79 years worldwide have hypertension, most (two-thirds) living in low and middle-income countries. So present study was undertaken to assess the risk factors for hypertension among First year MBBS students so that suitable preventive measures may be undertaken. Methods: It is cross sectional study conducted among first year MBBS students in DRKGMC Hamirpur. The duration of study is three months. The tools of study used were modified structured pretested self-administered questionnaire; WHO stepwise approach to chronic disease risk factor surveillance (STEPS). Weighing machine, measuring tape, digital BP apparatus and steadiometer. Results: A total of 115 students of MBBS first year participated in the study. There were a total of 31.3% (36) boys and 68.7% (79) girls. Thirty three percent (38) had a family history of hypertension. 16.52% (19) had a BMI more than the normal. Among the study participants only 5 students (4.35%) used to consume alcohol and smoke cigarettes. Most of study participants consume fast food and junk food. Conclusions: High prevalence of different modifiable risk factors for hypertension revealed among the study subjects.There is need to screen the modifiable risk factors from very early age.
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Mediatinal mature cystic teratoma is a rare type of extra gonadal teratoma, comprising 1-5% of all mediastinal tumors. Its atypical presentation can sometimes lead to misdiagnosis, highlighting the importance of careful evaluation and intervention. We report a case of a 57-year-old male patient presenting with the complaints of chest pain and dyspnea on exertion associated with cough since 2-3 months prior to admission. Chest x ray showed a well-defined opacity in the right hemithorax. Patient underwent mass excision by median sternotomy approach. Histopathology confirmed the diagnosis of mature cystic teratoma. While anterior mediastinal teratomas are uncommon, complete surgical excision is often the primary and effective treatment. In many cases, successful removal without complications can lead to cure.
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Mental health, commonly known as behavioral health, is the psychological, emotional, and social well-being of an individual. It mostly affects a person’s ideas, emotions, behaviors, and relationships with other people. The idea that social media use and mental health are inextricably related appears to be the most intricate and varied. The effect of social media on mental health is a complicated topic with many moving parts. According to a countrywide survey carried out in India, as of 2023, approximately 67.5% of adults in the country utilize at least one social networking site; this percentage may be steadily increasing over time. Despite its numerous benefits, social media has also been connected to problems in society and poor mental health outcomes. People need to be aware of the potential risks of social media like disinformation, addiction, cyberbullying, data security and privacy concerns, and its possible effects on mental health. This review offers a thorough analysis of social media’s effects on mental health, and it demonstrates how crucial it is to develop a thoughtful and balanced relationship with our digital life to ensure that the advantages of connection do not come at the expense of our mental health.
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Background: Research is crucial for the scientific progress of the health of individuals and communities. Understanding the concept of evidence-based medicine needs strong research knowledge. Research assures understanding of the subject and improves the knowledge of the students. This study was aimed to assess the level of knowledge, attitude and practices among medical post graduate students and to study the sociodemographic factors. And to determine the association of knowledge with various sociodemographic factors. Methods: An analytical cross-sectional study conducted during a period of two months among the medical post graduate students studying in a private medical college. Knowledge, attitude and practice were assessed by using self- administered questionnaire among 117 post graduate students. Likert scale was used to assess the knowledge component. Results: Among 117 study subjects 47% were first year 27.4% were second year and 25.6% were third year among which the overall adequate knowledge was 86.3%, positive attitude was 95.7% and good practices according to the study scale was only 29.1%. Level of knowledge and practices were found to be having significant association with the academic year studying in (p value <0.05). Conclusions: The post graduate students had adequate knowledge and positive attitude but had poor practices towards research. Adequate research helps to bridge the gaps in research and help the future generations in developing new interventions.
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Ceftaroline fosamil, a cephalosporin approved by the FDA for treating infections caused by methicillin-resistant Staphylococcus aureus (MRSA). Staphylococcus aureus, particularly MRSA strains, poses a significant health risk due to antibiotic resistance. Ceftaroline fosamil is unique in its ability to bind to penicillin-binding protein 2a (PBP2a) found in MRSA, inhibiting bacterial cell wall synthesis and causing bacterial death. The pharmacokinetics of ceftaroline involve rapid conversion to its active form, primarily excretion through the kidneys, and a plasma protein binding rate of approximately 20%. Ceftaroline is effective against complex skin and soft tissue infections (cSSTIs) and community-acquired pneumonia (CAP), especially when MRSA is suspected. However, its efficacy against gram-negative bacteria is limited. The safety profile of ceftaroline fosamil is generally good, with reported adverse events comparable to other comparator agents in clinical trials. It is contraindicated in individuals with hypersensitivity to cephalosporins. Comparative efficacy with other antibiotics like vancomycin and daptomycin is discussed, emphasizing the importance of considering individual patient characteristics and local prevalence of resistant bacteria. The use of ceftaroline fosamil in special populations, such as pediatric and adult patients. While its efficacy in pediatric MRSA infections is explored, the lack of large-scale clinical trials for certain conditions like MRSA bacteremia is acknowledged. Clinical outcomes, including successful treatment of MRSA bacteremia, infective endocarditis, central nervous system infections, and nosocomial pneumonia, are discussed, suggesting ceftaroline fosamil's potential as a valuable therapeutic option. The conclusion underscores its breakthrough status, offering hope in addressing MRSA infections and improving patient outcomes.