Elastography evaluation of normal thyroid gland and its comparison with diffuse non nodular enlarged thyroid gland using strain ultrasound elastography

Background: The thyroid gland is located in the anterior part of neck, spanning between C5 and T1 vertebra and is located anterior to the thyroid and cricoids cartilage of larynx and first three tracheal rings. Ultrasonography has been widely used for diagnosis of thyroid disease it is highly regarded for its ease of use, real-time capability, portability and low cost.Methods: The current observational study was conducted in Department of Radiology, Dr. BRAM Hospital, Pt. JNM Medical College, Raipur, India. Consecutive sampling method was used for the study. All the cases coming to radiology department during the study period were taken as study subjects.Results: Of the normal subjects, author found 107 normal thyroid subjects and 53 patients were categorized into cases with diffuse non-nodular thyroid swelling groups. Of the diffuse thyroid swelling group about 85% of the study population is between 20-50 years of age group, 13.2% were <20 years of age and one patient is >50 years of age. Females to male ratio for diffuse thyroid disease is 3.4:1.Conclusions: Ultrasound elastography (USE) is a newly developed non-invasive method to evaluate and compare the elasticity of the thyroid gland and other organs like liver, prostate, parotid, breast pathologies. Its use is based on the principle that pathological changes in a tissue also changes its elasticity.

Cytokeratin Positive Cystic Epithelioid Gastrointestinal Stromal Tumor Mimicking Gastric Carcinoma- Immunohistochemical Analysis and Review of Literatures.

Gastrointestinal stromal tumor is biologically heterogeneous in both morphological appearance and clinical behavior. Immunohistochemical analysis and literature review was done to explore the necessity of mutation study. We present a case study of a 40 year old male presented with upper abdominal lump, exploratory laprotomy done and a large cystic mass involving transverse colon, omentum, stomach along with gross hemoperitoneum was found. Ruptured large cystic tumor mass measuring 19X16 cms was received for histopathological examination. Grossely the cystic mass show variegated outer nodular surface with attached piece of stomach and a segment of colon. Bright field microscopy show striking perivascular arrangement of tumor cells and geographical necrosis and the report signed out as undifferentiated carcinoma stomach. Battery of immunohistochemical markers was done. Tumor cells displayed diffuse positivity for CD117, DOG1, and pan-CK along with more than focal positivity for CD34 and negative for SMA, desmin, S-100, synaptophysin, chromogranin, Bcl-2, Ki- 67. Tumor turned out to be Cytokeratin positive epithelioid gastric GIST. Cytokeratins may be expressed in high grade GISTs rarely and CK positive GISTs must be differentiated from carcinomas, melanomas and a range of CK- positive sarcomas. A panel of immunohistochemistry markers is required for diagnosis and prognostication of the tumor.

A new experimental community pharmacy internship module for undergraduate pharmacy students in western Nepal: overview and reflections / 보건의료교육평가

Community pharmacies in Nepal and other South Asian countries are in a mediocre state due to poor regulation and the fact that many pharmacies are run by people with insufficient training in dispensing. This has led to the inappropriate use of medicines. The problems due to poor regulation and the mediocre state of community pharmacies in South Asia encompass both academia and clinical practice. In this paper, a 2-week community pharmacy internship programme completed by 2 graduating pharmacy students of Pokhara University (a Nepalese public university) at Sankalpa Pharmacy, Pokhara, Nepal is illustrated. During the internship, they were systematically trained on store management, pharmaceutical care, counselling skills, the use of medical devices, pharmaceutical business plans, medicine information sources, and adverse drug reaction reporting. An orientation, observations and hands-on training, case presentation, discussion, and feedback from 2 senior pharmacists were used as the training method. A proper community pharmacy internship format, good pharmacy practice standards, and a better work environment for pharmacists may improve the quality of community pharmacies.

Acute normovolemic hemodilution is not beneficial in patients undergoing primary elective valve surgery.

The objective of this study was to evaluate the effectiveness of acute normovolemic hemodilution (ANH) as a sole method of reducing allogenic blood requirement in patients undergoing primary elective valve surgery. One hundred eighty eight patients undergoing primary elective valve surgery were prospectively randomized into two groups: Group I (n=100) acted as control and in Group II (n=88) autologous blood was removed (10% of estimated blood volume in patients with hemoglobin (Hb) >12g% and 7% when the Hb was <12g%) in the pre-cardiopulmonary bypass (CPB) period for subsequent re-transfusion after protamine administration. The autologous blood withdrawn was replaced simultaneously with an equal volume of hydroxyl-ethyl starch solution. Banked blood was transfused in both the groups when Hb was ≤6g % on CPB and ≤8g% after CPB. Platelets were transfused when the count fell to <100´10 9 /L and fresh frozen plasma (FFP) was transfused whenever there was diffuse bleeding with laboratory evidence of coagulopathy. The two groups were comparable as regards demographic data, type of surgical procedures performed, duration of CPB and ischemia, duration of elective ventilation and re-exploration for excessive bleeding. The autologous blood withdrawn in patients with Hb≥12g% was 288.3±69.4 mL and 244.4±41.3 mL with Hb<12g% (P=NS). The Hb concentration (g %) was comparable pre-operatively (Group I= 12.1±1.6, Group II= 12.4±1.4), on postoperative day 1 (Group I =10.3±1.1, Group II= 10.6±1.2) and day 7 (Group I = 10.9±1.5, Group II=10.4±1.5). However, the lowest Hb recorded on CPB was significantly lower in Group II (Group I =7.7±1.2, Group II=6.7±0.9, p0 <0.05). There was no difference in the chest tube drainage (Group I =747.2±276.5 mL, Group II=527.6±399.5 mL), blood transfusion (Group I=1.1±1.0 units vs. Group II=1.3±1.0 units intra-operatively and Group I=1.7±1.2 units vs. Group II=1.7±1.4 units post-operatively) and FFP transfusion (Group I =581.4±263.4 mL, Group II=546.5±267.8 mL) in the two groups. We conclude that low volume autologous blood pre-donation does not seem to provide any added advantage as a sole method of reducing allogenic blood requirement in primary elective valve surgery.

Linking general health with oral health in ageing societies: a review

This paper highlights the factors that interact and determine the oral and general health of older adults. It also describes in brief various components of staying healthy in ageing population. Nutrition, systemic conditions and pharmaceuticals play vital role in determining good oral health care of elderly population. This article also explains various age related changes in the oral cavity and the role of care givers to detect and report these changes to oral health care providers. Thus this article not only provides an insight on the oral health and its significance in geriatric population but also mentions the ways to develop a senior-friendly dental officer

Acute bilateral vision loss as the presenting feature of subacute sclerosing panencephalitis.

A 12-yr-old boy with an atypical presentation of subacute sclerosing panencephalitis (SSPE) is described. Bilateral macular chorioretinitis preceded the neurological symptoms by 3 weeks. Both visual and neurological features had an acute onset. Clinicians need to be aware that macular chorioretinitis in a child may be the heralding feature of SSPE.