scholarly journals Clinical profile and outcome of pelvi-ureteric junction obstruction (PUJO) in children presenting above 1 year

2018 ◽  
Vol 5 (9) ◽  
pp. 3066
Author(s):  
Pramod S. ◽  
Ashwath Narayan Ramji
Keyword(s):  
Renal Damage ◽  
Left Kidney ◽  
Treatment Protocol ◽  
Clinical Profile ◽  
Paediatric Surgery ◽  
Delay In Diagnosis ◽  
Pain Abdomen ◽  
Diuretic Renogram ◽  
The Mean ◽  
Functioning Kidney

Background: Pelvi-ureteric junction obstruction (PUJO) is defined as anatomical or functional obstruction to the flow of urine from the pelvis to the upper ureter. With the advent of ultrasonography most of the cases of PUJO are identified in antenatal period. The treatment protocol for antenatal diagnosed PUJO is standardized. Few children present later in life. Present study was done to evaluate clinical profile and outcome of children presenting with PUJO above 1 year.Methods: A retrospective observational study conducted by the department of Paediatric Surgery, KIMS hospital Bangalore.  All children with PUJO above 1 year of age from January 2015 to January 2018 were included. Clinical, biochemical and imaging findings of these children were tabulated. A diuretic renogram was done to confirm the diagnosis. The children underwent either pyeloplasty or nephrectomy, depending on the function of the kidney. In children with calculi, pyelolithotomy with pyeloplasty was done. The children were followed up post-surgery.Results: Twenty-six children were included in the study. Mean age of presentation was 6.86±4.13years. Most common presentation was pain abdomen. Left kidney was commonly involved. The mean anteroposterior pelvic dimension (APPD) of involved kidney was 38.96±17.7 mm. 5 children presented with poorly functioning kidney with split renal function less than 10%. In three children PUJO was associated with pelvic calculi. Out of the 26 children simple nephrectomy was required in 4 (15%) children. The remaining 22 children underwent pyeloplasty. Mean duration of stay was 6.19±1.8 days. Post-pyeloplasty diuretic renogram showed improved drainage with improved function.Conclusions: PUJO is common cause of urinary obstruction in children. Delay in diagnosis or presentation leads to increased chances of renal damage and loss. Hence it is important to diagnose PUJ obstruction at the earliest and receive prompt treatment. 

scholarly journals Clinical profile of patients with Seronegative celiac disease

2022 ◽  
Author(s):  
Elham Rahmanipour ◽  
fahimeh attarian ◽  
Mohammad Ghorbani ◽  
Bijan Shahbazkhani ◽  
Vahid Ghavami ◽  
...  
Keyword(s):  
Celiac Disease ◽  
Poor Prognosis ◽  
Clinical Symptoms ◽  
Challenge Test ◽  
Iga Deficiency ◽  
Clinical Profile ◽  
Positive Serology ◽  
Mucosal Atrophy ◽  
Delay In Diagnosis ◽  
The Mean

Abstract Background Celiac disease (1) mostly diagnosed base on positive serology and duodenal mucosal atrophy, but some patients have negative serology and their diagnosis have some limitation, it delay in diagnosis likely accompanied a poor prognosis and high risk of developing complications of CD. The aim of this study was determent clinical profile of patients with Seronegative CD (SNCD). Methods in this retrospective study, 1115+8 patients, that evaluated for CD with mucosal atrophy included between 2010 to2020. All patients with IgA deficiency other IgG based serology for diagnosis of celiac was done and if these antibodies were negative consider as possible SNCD. If they had positive DQ2-DQ8, and clinical symptoms or had positive challenge test after12 months of GFD were considered as SNCD. Results of total 1115 patients 27 (2.4%) had seronegative mucosal atrophy of duodenum and diagnosed as a SNCD (96.2% marsh3), the mean age and BMI in SNCD patients were significantly higher than other CD patients (p<0.05). Conclusion The prevalence of SNCD was 2.4% that likely related to over weighting, so clinicians should be considered high possible of seronegative CD in patients with over weighting and mucosal atrophy of duodenum.

scholarly journals Clinicopathological Features, Management and Outcome of Paediatric Solid Renal Tumours in Southeast Nigeria: The Need for Protocol and Multidisciplinary Collaboration

2021 ◽  
Author(s):  
Okechukwu Hyginus Ekwunife ◽  
Jideofor Okechukwu Ugwu ◽  
Victor Ifeanyichukwu Modekwe ◽  
Chijioke Elias Ezeudu ◽  
Thomas Obiajulu Ulasi ◽  
...  
Keyword(s):  
Left Kidney ◽  
Treatment Protocol ◽  
University Teaching ◽  
Renal Tumour ◽  
Duration Of Symptoms ◽  
Multidisciplinary Collaboration ◽  
Retrospective Audit ◽  
Abdominal Masses ◽  
Renal Tumours ◽  
The Mean

Introduction: Renal malignancies are common in children and they constitute 6-7% of all childhood tumours and nephroblastoma is the most common solid renal tumour in children. Currently, standardised institutional protocols in management of renal tumours in children are the norm. Large scale collaborative studies have started emerging, yet not much has been documented on the clinical presentation, pathology and outcome of solid renal tumours particularly in Africa. Aim: To review the presentations, pathology and the management-outcome of solid renal tumour in the centre in the absence of a coordinated protocol and multi-disciplinary collaboration. Materials and Methods: This was a nine and a half year longitudinal retrospective audit study of consecutive patients with solid renal tumours managed in a single tertiary centre: Nnamdi Azikiwe University Teaching Hospital Nnewi South-east Nigeria. It took place from January 2009-June 2018. Relevant data on demography, clinical features, management and outcome were extracted from records. Results were analysed using Statistical Package for Social Sciences (SPSS) version 22. Categorical data were tested for independence using Chi-square test and significant p-value set at <0.05. Results: Twenty two paediatric cases (15 males and 7 females) were included in the study. The mean age at presentation was 50.10±4.8 months. There were 15 males and 7 females. The mean duration of symptoms was 5.5 months; 21 (95%) presented with abdominal masses while 6 (27.3%) had gross haematuria and 13 (59%) were emaciated. Tumours involved left kidney in 15 (68%). Histological reports were available in 9 cases with nephroblastoma being the most common 6 (27.3%). The Commonest stage was stage 3, 10 (45%) and commonest procedure was nephroureterectomy, 11 (50%). Neo-adjuvant and adjuvant therapies were inconsistent. Conclusion: Late presentation, discordant treatment protocol, noncompletion of treatment and poor collaboration, were found to contribute largely to poor outcome of solid renal tumours in children in our setting. It is strongly believed that adoption of standard protocol and a multidisciplinary collaboration in management will improve records keeping and outcome.

Prevalence of Self-Medication and Its Factors among University Students in Bandar Abbas City

2018 ◽  
Vol 7 ◽  
Author(s):  
Atefeh Mohammadi
Keyword(s):  
Herbal Medicines ◽  
Target Population ◽  
Easy Access ◽  
Medical Sciences ◽  
Self Medication ◽  
Delay In Diagnosis ◽  
Consumption Culture ◽  
High Prevalence ◽  
The Mean ◽  
Bandar Abbas

Background: Self-medication can lead to the latency of the real severity of disease, delay in diagnosis, a complication of treatment, threatening side effects, and unexpected intoxication. The present research aimed to explore the prevalence of self-medication and its factors among students affiliated to Bandar Abbas universities in 2016. Materials and Methods: This Descriptive Analytic study was performed on 600 students affiliated to the universities in Bandar Abbas; Islamic Azad University, Payam-e-Noor University, and University of Medical Sciences. The sample was selected through a stratified sampling method, and the data were collected by a questionnaire comprised of two parts, demographic information (6 items), and risk factors of self-medication and self-medicated drugs (26 items). SPSS version 19 was used to analyze the data through the required tests. Result: The mean age of the students was 24.11±5.85 years. One hundred and ninety-one subjects (31.8%) were male, and 409 (68.2%) were female. The results revealed the prevalence of self-medication in the target population was 80.2%., the main reasons for self-medication were reported underestimating the disease 461(77.0%), previous experience of the disease 457(76.4%), repeated prescription 441(73.6%), and easy access to drug 423(70.6%). The most prevalent drugs self-medicated by students were acetaminophen, herbal medicines, antibiotics, other drugs, sedatives, and anti-acids, respectively. Conclusion: Considering the high prevalence of self-medication (80.2%) revealed in this research, there is a need for more attentive care for consistent education and drug consumption culture promotion. Specific approaches can help the provision of easy access to medical services in universities.

scholarly journals 63 Chronic Femoral Osteomyelitis Case Series: Outcomes and Economic Impact at A United Kingdom Based Tertiary Centre

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
E Lau ◽  
Z Arshad ◽  
A Aslam ◽  
A Thahir ◽  
M Krkovic
Keyword(s):  
Economic Impact ◽  
Treatment Protocol ◽  
Case Series ◽  
Consecutive Series ◽  
Financial Loss ◽  
Patient Demographics ◽  
Tertiary Centre ◽  
The Mean ◽  
Eq Vas

Abstract Introduction Osteomyelitis refers to an inflammatory process affecting bone and bone marrow. This study reviews chronic femoral osteomyelitis treatment and outcomes, including economic impact. Method We retrospectively collected data from a consecutive series of 14 chronic femoral osteomyelitis patients treated between January 2013 and January 2020. Data collected include patient demographics, comorbidities, pathogens, complications, treatment protocol and costs. Functional outcome was assessed using EuroQOL five-dimensional interview administration questionnaire (EQ-5D-5L™) and EuroQOL Visual Analogue Scale (EQ-VAS™). Results Of these, 92.9% had one or more osteomyelitis risk factor, including smoking and diabetes. Samples from 78.6% grew at least one pathogen. Only 42.9% achieved remission after initial treatment, but 85.7% were in remission at final follow-up, with no signs of recurrence throughout the follow-up period (mean: 21.4 months). The average treatment cost was £39,249.50 with a net mean loss of £19,080.10 when funding was considered. The mean-derived EQ-5D score was 0.360 and the mean EQ-VAS score was 61.7, lower than their values for United Kingdom’s general population, p = 0.0018 and p = 0.013 respectively. Conclusions Chronic femoral osteomyelitis treatment is difficult, resulting in significant economic burden. With previous studies showing cheaper osteomyelitis treatment at specialist centres, our net financial loss incurred suggests the need for management at specialised centres.

scholarly journals AB0664 DIAGNOSIS DELAY IN ANKYLOSING SPONDYLITIS PATIENTS IN EGYPT: FACTORS, SOCIOECONOMIC AND CLINICAL OUTCOME

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1627.2-1627
Author(s):  
F. I. Abdelrahman ◽  
M. Mortada
Keyword(s):  
Ankylosing Spondylitis ◽  
Social Life ◽  
Activity Index ◽  
Diagnostic Delay ◽  
Disease Activity Index ◽  
Diagnosis Delay ◽  
Functional Index ◽  
Delay In Diagnosis ◽  
Significant Difference ◽  
The Mean

Background:Ankylosing spondylitis (AS) is a destructive inflammatory disease which was reported to have the longest diagnostic delay among the inflammatory rheumatic disease. This lag period have a great impact on the clinical outcome and socioeconomic state of the patients. With the advent of tumor necrosis factor-α (TNF-α) inhibitors, early diagnosis in AS has become important(1).Objectives:to evaluate the period from symptom onset to diagnosis of AS in Egyptian patients and to examine possible reasons for delayed diagnosis and its impact on the economic and social life of the patients.Methods:The study included 87 AS patients diagnosed according to the Assessment of Spondyloarthritis international Society (ASAS) criteria (2). A face-to-face interview was applied to take medical history, and a questionnaire that contains some clinical aspects of disease was used. Diagnosis delay was described as the gap between first AS symptom and correct diagnosis of AS. Clinical and functional assessment of axial SpA measured by Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Metrology Index (BASMI). The direct medical cost during years of delay (including costs of medical consultations, medications, investigations, physiotherapy and surgical treatment) had been estimated by Egyptian pound.Results:The study included 87 AS patients with mean age (30.03±8.3), 70 male (80.5%) and 17 female (19.5%).Mean delay in diagnosis was(5.7 ±4.9) years. Mean of diagnostic delay for patient diagnosed before 2010 is (14±4.4) and that of patients diagnosed after 2010 is (3.5±1.8) with significant difference between both (p value<0.0001). The main cause of delay was incorrect diagnosis as follow degenerative disc disease (43/87, 49.4%), non-specific back pain (31/87, 35.6%), rheumatoid arthritis (10/87,11.5%), rheumatic fever (2/87, 2.3%) and tuberculosis of spine (1/87, 1.1%). The mean of the medical visits was (6±5.4). Most incorrect initial diagnoses were made by orthopedicians (57.9%), followed by neurologists (22.2%) followed by rheumatologist (10%) and general phyisicians (9.9%). Absence of extra-articular manifestations, negative family history and juvenile age are significantly associated with diagnostic delay. Delay in diagnosis is significantly associated with higher disease activity index(BASDAI), functional index (BASFI), and damage index(BASMI). The mean of the costs during years of delay is (15671.3±546.1) with the mean of cost per each year delay (660.9±6.6) with high significant association between the cost and longer delay in diagnosis (<0.0001). Regarding work ability, we found that(32.2%) are fit for work, unfit (29.9%), partially fit (37.9%) with high significant difference between ability of work and shorter delay. Regarding social effect, 40.2 % of patients developed negative effect on social life with significant association to diagnostic delay (0.004).Conclusion:Our study confirmed the importance of early diagnosis of AS due to its impact on patient’s health outcome and socioeconomic state.We recommend to increase the awareness about the disease among healthcare professionals in our region.References:[1]Sykes M. et al: Diagnostic delay in patients with rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis; Ann Rheum Dis.2015;74:e44.[2]Rudwaleit M. et al: The development of Assessment of Spondyloarthritis international Society classification criteria for axial spondyloarthritis; Ann Rheum Dis, 68 (2009), pp.777-783.Disclosure of Interests:None declared

Abdominal Laser Lipolysis Using a Microprocessor-Controlled Robotic Arm with Non-Contact Heating and Cooling

2021 ◽  
Author(s):  
Thomas Fiala
Keyword(s):  
Cooling System ◽  
Subcutaneous Fat ◽  
Treatment Protocol ◽  
Abdominal Fat ◽  
Abdominal Circumference ◽  
Ordinal Scale ◽  
Robotic Arm ◽  
Ultrasound Measurement ◽  
Fat Thickness ◽  
The Mean

Abstract Background A novel FDA-cleared device uses a 1064 nm laser to non-invasively induce apoptosis for lipolysis of subcutaneous abdominal fat while maintaining comfortable skin temperatures with a proprietary jet cooling system (eon ®, Dominion Aesthetic Technologies, Inc.; San Antonio, TX). A programmable articulated robotic arm moves the treatment head without any subject contact, maintaining an appropriate three-dimensional treatment path, compensating for patient movement. Objectives The goal of this prospective, single center, open-label study was to demonstrate the safety and effectiveness of this device for reducing subcutaneous abdominal fat using an updated power delivery curve. Methods Male and female subjects with Fitzpatrick skin types I-VI (N=26) were treated. Four abdominal zones up to 150 cm 2 each, customized in size and location for body habitus were treated. Each zone underwent a single 20-minute treatment session. Follow-up visits occurred after 6 and 12 weeks. Using a standardized protocol, ultrasound measurement of subcutaneous abdominal fat thickness, abdominal circumference, reported patient satisfaction and digital images were obtained. Results The mean treatment area was 378.5 cm 2. At Week 12, there was a 21.6% mean reduction in abdominal subcutaneous fat thickness and a 4.1-cm (1.6-inch) mean reduction in abdominal circumference. Most subjects (84.6%) were satisfied or very satisfied with their results. The mean pain score was 2.5 on an 11-point ordinal scale. There were no non-responders. Only two adverse events were noted: mild transient erythema (n=1, 3.8%) and localized subcutaneous firmness (n=1, 3.8%) which resolved without intervention within 12 weeks. Conclusions This contact-free device is safe and effective for reducing subcutaneous abdominal fat and represents an improvement on the prior treatment protocol.

scholarly journals Management of ureteropelvic junction obstruction in horseshoe kidneys by an assortment of laparoscopic options

2015 ◽  
Vol 9 (11-12) ◽  
pp. 775 ◽  
Author(s):  
Pejman Shadpour ◽  
H. Habib Akhyari ◽  
Robab Maghsoudi ◽  
Masoud Etemadian
Keyword(s):  
Ureteropelvic Junction Obstruction ◽  
Left Kidney ◽  
Operation Time ◽  
Ureteropelvic Junction ◽  
Laparoscopic Pyeloplasty ◽  
Referral Centre ◽  
Laparoscopic Management ◽  
The Mean ◽  
Crossing Vessels

Introduction: We report our experience with laparoscopic management of ureteropelvic junction obstruction in horseshoe kidneys.Methods: Between February 2004 and March 2014, 15 patients with horseshoe kidneys and symptomatic ureteropelvic junction obstruction underwent laparoscopic management at our national referral centre. Depending on the anatomy and presence of obtrusive vessels or isthmus, we performed either dismembered, Scardino or Foley YV pyeloplasty, or Hellstrom vessel transposition. Patients were initially evaluated by ultrasonography, then diuretic scintiscan at 4 to 6 months, and followed by yearly clinical and sonographic exams.Results: This study included 11 male and 4 female patients between the ages of 4 to 51 year (average 17.7). The left kidney was involved in 12 patients (80%). Operation time was 129 minutes (range: 90–186), and patients were discharged within 2.8 days (range: 1–6). Although 8 (53.3%) patients had crossing vessels, of which 6 required transposing, the Hellstrom technique was solely used in 3 cases, of which notably 1 case failed to resolve and required laparoscopic Hynes within the next year. Eight cases underwent dismembered pyeloplasty, 2 Foley YV, 1 Scardino flap and 1 required isthmectomy and vessel suspension. At the mean follow-up of 60 (range: 18–120) months, the overall success rate was 93.3%.Conclusions: To our knowledge, this represents the largest report on laparoscopic pyeloplasty for horseshoe kidneys, providing the longest follow-up. Our findings confirm prior reports supporting laparoscopy and furthermore show that despite the prevalence of crossing vessels, transposition alone is seldom sufficient.

scholarly journals When To Start Tacrolimus Ointment For Vernal Keratoconjunctivitis? A Proposed Treatment Protocol

2021 ◽  
Author(s):  
Roee Arnon ◽  
Irit Rozen - Knisbacher ◽  
Tal Yahalomi ◽  
Nir Stanescu ◽  
Yulia Niazov ◽  
...  
Keyword(s):  
Clinical Signs ◽  
Treatment Protocol ◽  
Topical Steroid ◽  
Case Series ◽  
Topical Steroids ◽  
Line Treatment ◽  
Tacrolimus Ointment ◽  
Disease Remission ◽  
The Mean ◽  
Topical Treatments

Abstract PurposeThe aim of this study was to compare treatment regimens of tacrolimus and of topical steroids for VKC and suggest a treatment protocol according to our clinical experience.MethodsThis retrospective, nonrandomized case series enrolled 85 Patients with VKC. Patients were classified clinically according to severity (mild, moderate, severe) and were treated according to a suggested protocol. Analysis was made according to treatment received: tacrolimus ointment as first line treatment (tacrolimus 1st line), tacrolimus ointment after topical steroid drops treatment (tacrolimus 2nd line) and topical steroid drops or artificial tears alone (topical steroid and tears group). Results Significant improvements in clinical signs and symptoms were achieved under tacrolimus treatment 14 months in the moderate group and 5 months in the severe group. The longest duration of treatment was for tacrolimus 2nd line group (p=0.031) and the mean number of visits in the clinic was the highest. The mean number of topical treatments per day was higher in the topical steroid and tears group (2.6 times) than in the two tacrolimus groups (1.3 times for both). The mean time needed to achieve disease remission or relief did not differ between the tacrolimus 1st line and 2nd line groups.ConclusionTacrolimus treatment is effective and safe for VKC. Tacrolimus as 1st line treatment may be preferred for severe cases, for faster disease remission compared to tacrolimus as 2nd line treatment; and with fewer topical treatments per day compared to topical steroids.

scholarly journals Tumor-induced osteomalacia: experience from three tertiary care centers in India

2019 ◽  
Vol 8 (3) ◽  
pp. 266-276 ◽  
Author(s):  
Rimesh Pal ◽  
Sanjay Kumar Bhadada ◽  
Awesh Singhare ◽  
Anil Bhansali ◽  
Sadishkumar Kamalanathan ◽  
...  
Keyword(s):  
Indian Subcontinent ◽  
Somatostatin Receptor ◽  
Tertiary Care ◽  
Tumor Resection ◽  
Surgical Excision ◽  
Serum Phosphate ◽  
Mesenchymal Tumors ◽  
Elevated Alkaline Phosphatase ◽  
Delay In Diagnosis ◽  
The Mean

Tumor-induced osteomalacia (TIO) is a rare paraneoplastic syndrome characterized by recalcitrant hypophosphatemia. Reports from the Indian subcontinent are scarce, with most being single center experiences involving few patients. Herein, we conducted a retrospective analysis of 30 patients of TIO diagnosed at three tertiary care hospitals in India. Patients with persistent hypophosphatemia (despite correction of hypovitaminosis D), normocalcemia, elevated alkaline phosphatase, low TmP/GFR and elevated or ‘inappropriately normal’ FGF23 levels were labeled as having TIO. They were sequentially subjected to functional followed by anatomical imaging. Patients with a well-localized tumor underwent excision; others were put on phosphorous and calcitriol supplementation. The mean age at presentation was 39.6 years with female:male ratio of 3:2. Bone pain (83.3%) and proximal myopathy (70%) were the chief complaints; 40% of cases had fractures. The mean delay in diagnosis was 3.8 years. Tumors were clinically detectable in four patients (13.3%). The mean serum phosphate was 0.50 mmol/L with a median serum FGF23 level of 518 RU/mL. Somatostatin receptor-based scintigraphy was found to be superior to FDG-PET in tumor localization. Lower extremities were the most common site of the tumor (72%). Tumor size was positively correlated with serum FGF23 levels. Twenty-two patients underwent tumor resection and 16 of them had phosphaturic mesenchymal tumors. Surgical excision led to cure in 72.7% of patients whereas disease persistence and disease recurrence were seen in 18.2% and 9.1% of cases, respectively. At the last follow-up, serum phosphate in the surgically treated group was significantly higher than in the medically managed group.

scholarly journals Clinical profile of patients with acute ischemic stroke receiving intravenous thrombolysis (rtPA-alteplase)

2018 ◽  
Vol 5 (1) ◽  
pp. 164
Author(s):  
Shiva Prasad Jagini ◽  
Suresh I.
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Prospective Observational Study ◽  
Primary Outcome ◽  
Intravenous Thrombolysis ◽  
Clinical Profile ◽  
Favorable Outcome ◽  
Nihss Score ◽  
The Mean ◽  
Centre Hospital

Background: Stroke patients are at highest risk death in the first few weeks after the event, and between 20-50% die within first month depending on type, severity, age, co-morbidities and effectiveness of treatment of complications. Objective of this study was to clinical profile of patients with acute ischemic stroke receiving intravenous thrombolysis (rtPA-alteplase).Methods: Prospective Observational study of 26 cases of acute ischemic stroke receiving IV thrombolysis using rtPA-alteplase at Kovai Medical Centre Hospital, Coimbatore over a period of 1 year 9 months.Results: 21 cases had NIHSS score of range 10 to 22. The mean NIHSS score at admission is 13.5. 15 subjects (57.7%) had achieved primary outcome in this study. MRS Score of 0 to 2 is considered as favorable outcome. In this study 20 subjects (76.92 %) had favorable outcome at the end of 3 months.Conclusions: Majority of the patients receiving rtPA-alteplase had favorable outcome.

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