Estimativa da taxa de pico de fluxo expiratório em jovens indianos / Estimation of peak expiratory flow rate in young Indians

INTRODUÇÃO: O pico de fluxo expiratório (PFE) é comumente usado para monitorar a progressão de doenças respiratórias, pois fornece boas informações sobre o estado das vias aéreas. Uma boa quantidade de pesquisas está sendo feita em todo o mundo para estabelecer uma equação de previsão local. A força-tarefa conjunta da Sociedade Torácica Americana e da Sociedade Respiratória Europeia promoveu pesquisas a esse respeito. Na Índia, os dados derivados da população caucasiana ainda são usados para o PFE. OBJETIVO: Estudar a relação dos parâmetros do PFE e os dados antropométricos como idade, altura, peso, índice de massa corporal (IMC), área de superfície corporal (ASC) e estabelecer uma equação de regressão para jovens adultos indianos. MÉTODOS: PFE foi feito em 1000 sujeitos de 15-25 anos da região metropolitana de Mumbai. O coeficiente de correlação de Pearson foi usado para entender a relação dos parâmetros antropométricos e PFE. A análise de regressão multivariada foi feita para estabelecer uma equação de predição. (Alfa 5%) RESULTADOS: Idade e todos os parâmetros antropométricos foram correlacionados com PFE. O pico de fluxo expiratório médio da população masculina foi de 515 ml / seg, enquanto a feminina foi de 399 ml / seg. Para o PFE, a maior correlação foi observada com a ASC seguida de altura, peso e idade, enquanto o IMC apresentou o menor coeficiente de correlação. TPFE teve a melhor significância com a idade, ASC, altura e IMC. Teve menos significado com o peso. No sexo feminino, a TPFE teve a melhor significância com altura, peso, IMC e idade. CONCLUSÃO: Existem diferenças de gênero na TPFE. Portanto, equações específicas de gênero são necessárias para a estimativa da TPFE

INTRODUCTION: Peak expiratory flow rate (PEFR) is commonly used to monitor the progression of respiratory diseases as it gives good information about the status of airways. A good amount of research is going across the world to establish a local prediction equation. The joint task force of the American thoracic society and European Respiratory Society has promoted research in this regard. In India, data derived from the Caucasian population are still used for PEFR. OBJECTIVE: To verify the relationship between PEF levels and the variables age, sex, anthropometric and body surface area, and establish the regression equation for young Indian adults. METHODS: A cross-sectional observational study was conducted in 15-25 years aged 1000 subjects from the Metropolitan region of Mumbai. Pearson's correlation coefficient was used to understand the relation of anthropometric parameters and PEFR. Multivariate regression analysis was done for establishing a prediction equation (Alpha 5%). RESULTS: Age and all anthropometric parameters were correlated with PEFR. The mean PEFR of the male population was 515 ml/sec, whereas, for females, it was 399 ml/sec, for PEFR highest correlation was observed with BSA (.696) followed by weight (.667), height (.630), age (.504) whereas BMI shown lowest correlation coefficient (.445). PEFR had the best significance with age, BSA, Height, and BMI. It had less significance with weight. In females, PEFR had the best significance with Height, weight, BMI, and Age. CONCLUSION: Gender-wise differences exist in PEFR. Hence gender-specific equations are needed for the estimation of PEFR.

Delay for pentavalent vaccine: a hospital based cross sectional study

Background: Young children are often at increased risk for illness and death related to infectious diseases, and vaccine delays may leave them vulnerable at ages with a high risk of contracting several vaccine-preventable diseases This study examined delay for each pentavalent vaccine in the universal immunization programme and the factors that influence untimely vaccinations.Methods: This was a hospital based cross sectional study done on 45 days to-12 months aged children attending the immunisation clinic held at government medical college and hospital Aurangabad, Maharashtra. Data was collected from the records on health card as well from mother with the help of pretested pre-structured questionnaire for predictors of delay.Results: Total 411 children aging 45 days to 12 months were enrolled in the study. For pentavalent 1 vaccine, 83.69% received vaccine without delay and 16.31% were delayed. 43.53% were delayed for pentavalent 2 vaccine, 224 children received pentavalent 3 vaccine, out of them 80.35% received within time whereas 19.65% were delayed. We found birth order, parent’s education, working status of mother, mother’s age below 18; parity had statistically significant association with delay. Unawareness about the right timings of vaccination and immunization schedules held at periphery, parents delaying vaccine for minor sickness of baby, were the main reasons observed for delay.Conclusions: A total 83.69% children received vaccine within the recommended time. Still 16.31% children experience delay for the vaccination. Reasons for delay observed can be overcome by appropriate counselling of mother by health care workers at the first time of vaccination which will improve the adherence and avoid delay in future to immunisation schedule.

​Perinatal Outcome of the Second Twin with Respect to Mode of Delivery – A Prospective Analysis

Aims and Objectives: The aim of the study was to study the perinatal outcome of the second twin with respect to mode of delivery.Materials and Methods: Consecutive pregnant women having twin pregnancies beyond 28 weeks of gestation admitted tothe department of the institute during the period from April 2016–May 2017 were included in the study.Results: A total of 50 cases were enrolled in the study. Vaginal, ventouse/forceps, and lower segment cesarean section (LSCS) werethe different modes of delivery consisting of 48%, 2%, and 50% of cases, respectively. Perinatal loss of the second twins was higher inLSCS group consisting of 61.11% of cases. Perinatal loss of the second twins was 100% for monochorionic monoamniotic pregnancieswhereas 33.33% for monochorionic diamniotic and 29.03% for dichorionic diamniotic pregnancies. The delivery time interval of <10 minbetween the first and second twin had the higher second twin perinatal loss, i.e., 37.14% and less poor APGAR score, i.e., 57.14% incomparison to time interval of 10–30 and >30 min groups but statistically insignificant. For second twin, vertex presentation had higherpoor APGAR score compared to non-vertex presentation, i.e., 65.63% versus 55.56%. Poor APGAR score was found to be higher incesarean section, outlet forceps and vaginal mode of deliveries consisting of 60%, 100%, and 62.5%, respectively. In overall, 64% ofsecond twins and 84% of first twins were alive, and the difference had P = 0.034. About 62% of second twins and 34% of first twinswere having poor APGAR score of <7, and the difference had P = 0.005. About 67.44% and 76.92% of second twins were found tobe alive higher in maternal age group of ≥20 years and multigravida group, respectively, having P < 0.05. About 64.52% and 100% ofsecond twins were alive higher in <37 weeks gestational age group and birth weight of second twin ≥2500 kg groups, respectively, withP < 0.05. Second twins were having higher alive in vertex-non-vertex presentation, vaginal mode of delivery for both the twins, DCDAgroup and intertwin delivery interval of 10–30 min groups consisting of 71.43%, 72%, 70.97%, and 77.78%, respectively, with P > 0.05.Conclusion: The perinatal mortality of 2nd twin is higher than that of 1st twin in terms of monochorionic, prematurity, and lowbirth weight. Intensive labor monitoring, safe delivery, and improved neonatal care facilities appear to be the major areas toimprove the perinatal outcome.

Evaluation of Acceptability, Safety, and Efficacy of Intrauterine Device Insertion during the Postpartum Period: A Prospective Analysis

Background: Intrauterine contraceptive devices (IUCD) are a rapidly reversible method of contraception. It is necessary toassess the acceptability and uptake of IUCD in parturients elaborating its safety and success.Aims and Objectives: The aim of the study was to evaluate the acceptability, safety, and follow-up of postpartum insertion ofIUCD both in vaginal and cesarean section deliveries among parturients with the ultimate goal is to avoid unplanned pregnanciesand to expand the usage of IUCD.Materials and Methods: The study was a prospective one conducted during the period of January 2014–January 2015. All theantenatal patients at their visits after 30 weeks of gestation were taken in the study and parturients accepted for postpartumIUCD (PPIUCD) insertion constitute the study population.Results: A total of 202 patients were included in the study population. Majority of cases accepted for PPIUCD had at leasta primary level of education, were primiparous, and had their last childbirth >2 years age consisting of 90.10%, 46.53%, and44.55%, respectively. About 27.72% of the parturients were aware of the PPIUCD and 58.91% of parturients accepted PPIUCDdue to its long-term effect. PPIUCD insertion done for the study was three types such as: Within 10 min, immediate (within 24 h),and trans-cesarean consisting of 23.76%, 15.35%, and 60.89%, respectively. About 96.04%, 79.70%, and 60.90% cases wereattaining for follow-up at 6 weeks, 3 months, and 6 months, respectively. At 6 week follow-up, pelvic inflammatory disease,irregular cycles, and pain were the chief concerns consisting of 34.16%, 23.27%, and 16.83%, respectively, whereas bleedingper vagina, lost string, and expulsion were less seen. PPIUCD expulsion was seen in 14.85% of the parturients.Conclusions: Awareness of the PPIUCD among women was poor despite high acceptance and needs strategies to increaseawareness. The PPIUCD was demonstrably safe, having no reported incidence of perforation with low rates of expulsion, pelvicinfection, and few lost strings.

Detection Of Accessory Renalarteries In North Indian Population: A Ct Study

Presence of supernumerary renal artery (accessory renal artery) is the most common anatomical variation of renal arterial systemand is seen with varying frequencies among different ethnic and racial groups. Prior knowledge of these variations is of great surgical importance as it influences the selection of donor kidney, partial nephrectomy and other urological procedures. Aim of the present study was to observe the prevalence of accessory renal artery (ARA) and their distribution pattern with relation to gender and side in adultNorth Indian population. One hundred normal healthy adult (16 males and 84 females; mean age of 43.5±10.42 years) who were prospective voluntary kidney donors underwent MDCTand CTangiography evaluation for the presence of accessory renal artery. Accessory renal artery (ARA) was present in 25.0% kidneys. The prevalence of accessory renal arteries in males and females was similar (25.0%) respectively. On the right side the prevalence of accessory renal artery was 26.0% and on left side it was 24.0%. In males 25% kidneys had unilateral single accessory renal artery. In females 14.3% of left kidneys and 16.7% of right kidneys had a single unilateral accessory renal artery. In 9.5% femalesubjects bilateral accessory renal arteries were present in the kidneys. The prevalence of accessory renal artery in our North Indian population was 25.0%, which is similar to studies from other Asian countries. The distribution pattern was not affected by gender and side. These findings need further validation in a larger cohort of subjects.

A Computed Tomography (ct) Evaluation Of Renal Artery Evaluation In Healthy Adult North Indian Population

Aims and Objective: In 70% of normal population, each kidney is applied by a single renal artery. Renal arteriesare known to present with wide range of anatomic variations. These variations are frequently related to thenumber of renal arteries, level of origin, length, diameter and branching pattern. Renal transplantation is theonly curative option for end stage renal disease. Laparoscopic donor nephrectomy has become the preferredtechnique in renal transplant programs. The transplant surgeon requires at least 2 cm of renal artery lengthbefore hilar branching and diameter of 3 mm to ensure adequate vascular anastomosis. Therefore, a priorknowledge of number of renal arteries, the length and diameter of renal artery and branching pattern has becomeessential for renal transplant surgeons.Material and Methods: One hundred prospective healthy voluntary kidney donors (16 males and 84 females;mean age of 43.5±10.42 years), were evaluated for the renal artery anatomy by MDCT and CT angiography as partof preoperative assessment prior to donor nephrectomy. The number, level of origin, the diameter and length ofrenal artery on either side was recorded.Results: Single renal artery was present in 75.5% kidneys. The right MRA originated from aorta at the level of L1vertebra in 78% cases and left MRA originated from aorta at lower level( L2 vertebra) in 47% of cases.The meanlength of left and right renal artery was 26.2±10.6 mm and 29.6±12.8 mm respectively; mean diameter was5.8±1.2 mm and 5.2±1.0 mm respectively. The difference between length and diameter of both sides was statisticallysignificant. The mean diameter of left MRA was 5.8±1.2 mm and right MRA 5.2±1.0 mm and difference wasstatistically significant (p=0.001). Both in males and females the mean diameter of left MRA was more than thatof right MRA.Conclusion: In the present study it was observed that single renal artery was present in 75.5% kidneys. The rightMRA originated from aorta at a higher level compared to left MRA. The left renal artery was shorter and widerthan right renal artery. In 22.5% cases the length of renal artery was less than 2.0 cm.

Development and in vitro characterization of mebendazole delayed release tablet for colonic drug delivery

The main objective behind this study was to formulate delayed release colon targeted tablet of Mebendazole by using different polymers. The precompressional parameters of powder blend were studied. The wet granulation method was used for the preparation of tablets. The tablets of all formulation were subjected for different physicochemical evaluation. The drug-excipient interaction study was carried out by using Fourier transforms Infrared spectroscopy [FTIR]. The in vitro evaluation was carried out at different pH ranges [0.1M HCl, 6.8 and 7.4 Phosphate buffer] for the prepared tablets. From the stability, Fourier transform infra-red spectroscopy studies Mebendazole tablet does not show any interaction between drug and polymer. The prepared tablets were complied all the physicochemical test as per official limit. The formulated [M3] batch shows better sustained release 99.89% over a period of 12 hours and the data was fitted into Korsemeyer-Peppas kinetic equation. The result indicates that Mebendazole colon targeted matrix tablet remain stable in the stomach and shows better release into the colon with the help of pH dependent synthetic polymers

Delayed migration of K-wire into popliteal fossa used for tension band wiring of patellar fracture / 中华创伤杂志(英文版)

Breakage of K-wires and stainless steel wires which are used for fracture fixation is not uncommon, but migration is rare. We report a case of migration of broken K-wire used for patella tension band wiring to the popliteal fossa. The broken hardware was removed surgically. We would like to suggest that K-wire and wire fixation used for treatment of patellar fractures can migrate into the posterior compartment of the knee and cause clinical symptoms. Close clinical and radiological follow-up after internal fixation to identify the presence of hardware breakage or movement and removal of wires once fracture has united can avert such complications.

Pseudopapillary Tumor of Pancreas.

Solid pseudopapillary tumor of the pancreas is a rare neoplasm usually seen in young females and is usually misdiagnosed as pancreatic pseudocyst. Awareness of clinical, microscopic and macroscopic features alongwith sufficient sampling of tumor is necessary for correct diagnosis of SPPT. We present three rare cases of SPPT of the pancreas.

Desmoplastic round cell tumour of the abdomen

Desmoplastic round cell tumour is a very rare tumour of childhood and young adults, and is not usually suspected as an explanation of intraabdominal or pelvic tumour. We report two cases of desmoplastic round cell tumour of the abdomen in the paediatric age group, occurring in two boys, an 11-year-old and a 13-year-old. We aim to demonstrate the imaging findings and to emphasise the importance of including this tumour in the differential diagnosis of childhood intraabdominal and pelvic tumours.

Clinical experience of ovarian neoplasm in childhood and adolescence.

Clinical behaviour of 12 cases of ovarian neoplasm in childhood and adolescence was reviewed. Diagnostic work-up required a great deal of time, gentleness and patience. Of all ovarian tumours, 58.4% were epithelial, 33.3% were germ cell group and 8.3% were sex cord stromal tumours. Pleuripotent nature of gonads is reflected by the complex variety of ovarian tumours in children. Seventy-five per cent among the tumours were malignant. Amongst the epithelial tumours 85.7% were malignant. Because of certain reasons, comparison of results was felt difficult.

A neonatal intestinal obstruction with unusual presentation.

A two days old male child was admitted with features of neonatal intestinal obstruction. Straight x-ray abdomen showed distended small intestinal loops with few air fluid levels. After resuscitation abdomen was explored. There was distal ileal atresia with duplication cyst. Resection of atretic segment along with duplication cyst was performed and end to side ileo-ileal anastomosis with proximal ileostomy was done. Patient recovered uneventfully. Till now patient is doing well.

Diagnosis and management of foetal nomalies.

Prenatal diagnosis of foetal anomalies and their management by invasive and non-invasive techniques are discussed. Early diagnosis allows the parents to organise appropriate neonatal management for sublethal and correctable anomalies while termination of early pregnancy is an option for lethal anomalies.