Role of Computed Tomography in Blunt Abdominal Trauma

Introduction: Blunt abdominal trauma is one of the commonly encountered surgical emergencies. The diagnostic modality that helps in optimum management of these patients includes chest and abdominal x-rays, Focused Assessment Sonography for Trauma scan and Computed Tomography. In selected hemodynamically stable patients who are candidates for non-operative management, Contrast Enhanced Computed Tomography is not considered essential and hence avoiding its own radiation hazards and decreasing extra financial burden to the patients. Aims: To evaluate whether Contrast Enhanced Computed Tomography is necessary or not in case of blunt trauma abdomen. Methods: This is a hospital based prospective study done in the department of surgery at Nepalgunj Medical College, Kohalpur conducted from October 2020 to March 2021. The patients with blunt abdominal trauma who were hemodynamically stable at the time of presentation and those who became stable after resuscitation were included. These patient’s detailed history was taken, clinical examination done. Focused Assessment Sonography for Trauma scan was done at the time of presentation along with chest x-ray and other necessary blood investigation. Data were analyzed with Statistical Package for Social Sciences version 25 and p-value <0.05 was taken as significant. Results: Out of total 53 patients, age group between 11-20 and 21-30 years comprising of 13 patients with male: female ratio of 1.94:1 were affected more. Fall injury, being the most common mode, comprised 20 patients. The commonest organ involved was spleen seen in 17 patients (32.1%), liver in 16 patients (30.2%). In 44 (83.0%) patients, Computed Tomography scan was done only in nine patients who were also managed conservatively, except one who underwent laparoscopic evacuation of collected blood. Seventeen (32.1%) patients underwent repeat ultrasonography without any new findings. Conclusion: Patients with blunt abdominal trauma with stable hemodynamics can be managed conservatively with limited use of Contrast Enhanced Computed Tomography scan.

Clinical profile of anterior uveitis in tertiary health centre of central India

To study the clinical profile of anterior uveitis in patients attending the Ophthalmology department of tertiary health centre of central India A cross-sectional, observational study was done in the department of Ophthalmology of tertiary health centre from January 2017 to July 2019. A total of 199 cases of anterior uveitis were studied to assess their clinical presentation and etiology. After thorough history taking, demographic data and clinical pattern were documented. Comprehensive ophthalmic evaluation, necessary laboratory investigations and radiological imaging were performed to establish the etiology. The maximum number (n=79; 39.7%) of patients were in the age group of 21-40 years and the mean age of the study subjects was 36.9+21.8 years. The male to female ratio was 1:1.42 (117 females, 82 males). Uniocular disease was found in 91.95% cases and majority (n=175; 87.93%) of the patients had acute presentation with 95.47% cases having non granulomatous uveitis. A specific diagnosis could not be made in 62.8% cases. Trauma (21.7%) was the most common cause in patients with a specific diagnosis. Persistent posterior synechiae was the most frequently seen complication (21.08%) although majority of the patients (66.8%) did not reveal any major complications.Patients with anterior uveitis most commonly had acute presentation. The disease was rarely bilateral and was mostly non-granulomatous in presentation. It was mostly idiopathic and among the known etiological factors, trauma was the most common cause.

Ileosigmoid knotting: A review of 923 cases

Objectives: Ileosigmoid knotting (ISK) is a rare intestinal obstruction form worldwide. The aim of this study was to investigate changing trends in ISK. Methods: The Web of Science and PubMed databases were electronically searched to find all publications to evaluate all epidemiological, etiological, clinical, laboratory, radiological, therapeutic, and prognostic factors in ISK. Results: Most of the cases were reported from Asian and African countries. Mean age was 43.9 years with a 79.9%/20.1% of male/female ratio. Main symptom period was 48.1 hours, while the most common clinical features were abdominal pain/tenderness (99.1%), distention (88.3%), and obstipation/constipation (58.8%). Abdominal X-ray radiography, computerized tomography (CT), and magnetic resonance imaging (MRI) were diagnostic in 8.2%, 96.2%, and 100.0%, respectively, while the total diagnostic accuracy rate was 20.8%. Bowels were gangrenous in 85.6% of the patients. Ileum resection was applied in 14.0% of the cases, while sigmoid colon resection in 7.6%, and both segment resection in 67.1%. The mortality rate was 22.7%, while the morbidity rate was also 22.7%. Conclusion: ISK is a rare disease, but it is still catastrophic despite its two-century recognised past. As an exception, diagnostic convenience arising from CT or MRI looks like the most important change over the last half-century. doi: https://doi.org/10.12669/pjms.38.3.5320 How to cite this:Atamanalp SS, Disci E, Peksoz R, Atamanalp RS, Tatar Atamanalp C. Ileosigmoid knotting: A review of 923 cases. Pak J Med Sci. 2022;38(3):---------. doi: https://doi.org/10.12669/pjms.38.3.5320 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Congenital Lobar Emphysema in a 17-Day-Old Male Neonate: The Plain Radiographic Features and a Case Report

Congenital lobar emphysema (CLE) is a rare respiratory disorder which allows air to enter the lungs but can’t escape causing over-inflation of the lobes of the lung. This condition (CLE) is commonly detected in the newborn or young infants but some cases are diagnosed in adulthood. Congenital lobar emphysema is a rare congenital malformation with a prevalence of 1 in 20,000 to 1 in 30, 000, and more prevalent in males, with a male to female ratio of about 3:1. This is a 17 day old male neonate that presented with respiratory difficulty and .had a supine chest radiograph that showed an overinflated left lung field more on the upper and middle zones with flattening of the left hemi diaphragm, marked shift of the heart and mediastinum to the right with some degree of loss of volume involving the right lung. We report the radiographic findings of this case due the rare nature of congenital lobar emphysema.

Pattern of Cytogenetic Abnormality by Fluorescence in Situ Hybridization (FISH) in Multiple Myeloma Patients in a Tertiary Hospital

Background: Multiple myeloma is a plasma cell neoplasm with acquired genetic abnormalities of clinical and prognostic importance, with survival duration ranging from a few months to more than 10 years. Cytogenetic abnormalities (CA) detected by fluorescence in situ hybridization (FISH) are of major prognostic significance since e.g. patients with del(17p), t(4;14) or gain 1q21 show dismal outcome. Objective: To evaluate the cytogenetic patterns by fluorescence in situ hybridization (FISH) of clinically diagnosed cases of multiple myeloma.Methods:This cross-sectional study was conducted in Department of Haematology, Dhaka Medical College Hospital, Dhaka, from January 2018 to December 2018. A total number of 30 patients with multiple myeloma were analyzed cytogenetically by interphase fluorescence in situ hybridization (iFISH). The collected data were analyzed by using the Statistical Package for Social Science (SPSS-24) for windows version 10.0.Results:Out of 30 diagnosed Multiple Myeloma cases the mean age was 56.37±10.38 years and male to female ratio was almost 3:1. Sixteen (56.7%) of 30 patients. Among 30 cases of 8 cases were thyrogenicity positive of 7(23.3%) patients was detected del 13q positive. Isolated del 13q was found in 4 cases. 2 cases were found coexistence of del 13q and del 17p positive ;1 case was found coexistence of del 13q and t(4;14) positive and rest of 1 case had del 17 p positive. There was no detectable t (11; 14) and t(14;16) in any of 30 cases.Conclusion:FISH panel for Multiple Myeloma including del (13q); t(11;14); t(4;14), del(17p), t(14;16) is very important molecular test for the prognosis , risk stratification, treatment modality of the patient. On the basis of cytogenetic abnormality Multiple Myeloma risk stratification is modified now a day. This Revised International Staging system R-ISS is a simple and powerful prognostic staging system.

Study of Seroprevalence of SARS CoV2 antibodies in children in a diagnostic centre of Central India-a retrospective study

It is said that children are less affected by SARSCoV2 infection because of their young immune system, so they have relatively milder symptoms as compared to adults. So the true incidence of SARSCoV2 is not known in this age group. Serosurveys in the paediatric age group can give a much better estimate of the incidence of SARSCoV2 infection in asymptomatic and symptomatic childrenThe present study was undertaken to study the seroprevalence of SARSCoV2 antibodies in children below 18 years of age, by measuring the S1RBD domain of spike protein neutralizing IgG antibody levels.This was a retrospective study carried out from August 2020 to August 2021 in a private diagnostic centre of Central India. 539 children of both genders from newborn babies upto 18 years of age were included in the study. US FDA Emergency Use Authorized [EUA], Atellica Solution SARS-CoV-2 IgG assay that detects anti S1-RBD antibodies including neutralizing IgG against SARS-CoV-2 was used for antibody estimation. Antibody level ≥1 was termed reactive or seropositive and below 1 were considered to be non reactive or seroneagtive There were 321 males and 218 females with a male to female ratio of 1.47 :1. 57% male children were seropositive while 61.9% female children showed seropositivity with an overall positivity rate of 58.99%.The findings of our study suggest that chidren below 5 years and adolescents exhibit higher antibody responses as compared to children between 5-10 years of age. The results of our study would be of help in formulating surveillance and vaccination strategies for children and in implementing public safety guidelines.

An Observational Study on Idiopathic Intracranial Hypertension (IIH) in a Tertiary Care Hospital in Bangladesh

Background: Among the risk factors of cardiovascular diseases, hypertension is one of the major reason. Intracranial hypertension (IIH) is a pressure buildup around the brain. It can happen unexpectedly, as a result of a severe head injury, stroke, or brain abscess could be occurred. It could also be a chronic, long-term condition, known as IIH. It results in the signs and symptoms of a brain tumor. Which is also known as benign intracranial hypertension. Cerebrospinal fluid, or CSF, is the fluid that surrounds the spinal cord and brain. CSF can accumulate if too much fluid is produced or not enough is reabsorbed. This can induce symptoms similar to a brain tumor. Intracranial Hypertension can be classified into three categories, they are Acute, Chronic and Idiopathic. IIH is recognized when the increased intracranial pressure cannot be explained by any other underlying cause.Aim: The aim of the study was to observe idiopathic intracranial hypertension patients in a select tertiary care hospital of Bangladesh.Methods:This cross-sectional observational study was conducted at the Department of Neurosurgery, Sylhet M. A. G. Osmani Medical College Hospital, Sylhet, Bangladesh. The study duration was from January 2012 to December 2020. A total number of 47 participants had been recruited as study population.Results:Male: female ratio was 1:10.75, and 91% of the total participants were female. 40.43% of the participants were aged between 21-30 years. 46.81% were overweight and 34.04% were obese. Most common symptom was nausea, followed by visual impairment and double vision.Conclusion:The prevalence of Idiopathic Intracranial Hypertension is much higher among the female. Female and high BMI are significant risk factors of IIH. It is more prevalent among young adults, and results on various vision related symptoms.

Serum IgG4 Concentration is a Potential Predictive Biomarker in Glucocorticoid Treatment for Idiopathic Retroperitoneal Fibrosis

Objectives: To evaluate the management and outcome of idiopathic retroperitoneal fibrosis (iRPF) in Japan, and identify its clinical biomarker. Methods: We retrospectively analyzed 129 patients with iRPF treated between January 2008 and May 2018 at 12 university and related hospitals. Patients treated with glucocorticoid were analyzed to identify a predictive biomarker. These patients were classified into three groups according to overall effectiveness (no change: NC, complete response: CR and partial response groups: PR), and each parameter was compared statistically.Results: Male-female ratio was 5: 1, and median age at diagnosis was 69 (33-86) years. Smoking history was reported in 59.6% of the patients. As treatment, 95 patients received glucocorticoid therapy with an overall response rate of 84%. As a result, serum concentration of IgG4 was significantly decreased in NC group compared with the other two groups (56.6mg/dL vs 255mg/dL, 206mg/dL, P=0.0059 and 0.0078). ROC analysis was performed between the non-responder (NC) and responder groups (CR+PR) to identify the cut-off value of serum IgG4 as a predictive marker. As a result, AUC was 0.793 and the values of sensitivity and specificity were 0.85 and 0.64, respectively, under the cut-off values of 67.6mg/dL. Conclusions: In the majority of iRPF patients, glucocorticoid therapy resulted in a favorable response. Pre-treatment serum IgG4 concentration may have potential as a predictive biomarker of steroid treatment.

Effect of Sex Sorted Semen in Synchronized Estrus on Pregnancy Rate and Female Ratio in Gir Cows

Background: At present there is huge demand for Gir cow females however, prolonged inter calving period, more inseminations per conception and post-partum anestrus are the predominant reproductive disorder along with use of unsexed semen limit the birth of more females in Gir cows. The present research study was conducted to study the effect of sex sorted semen in synchronized estrus with Ovsynch protocol on pregnancy rate and gender ratio in Gir cows. Methods: Total twenty Gir cows that have completed post-partum period of sixty days with normal reproductive genitalia, without clinical as well as subclinical infection were selected and divided into two equal groups. The cows from both the groups were synchronized with Ovsynch protocol. In Group- I (n=10), the cows were inseminated with sex sorted semen while in Group-II, the cows were inseminated with coneventional semen. The pregnancy rate and gender ratio was recorded. Result: Efficacy of estrus synchronization was 100.00 per cent for Gir cows treated by Ovsynch protocol in both groups. The pregnancy rate was numerically lower after AI with sex sorted semen (40%) than conventional semen (50%) and results are non significant (P less than 0.05) with 100% calving rate. The proportion of female calves born from sex sorted semen AI was 75% and from conventional semen was 60%. The proportion of live calves born from sex sorted and conventional semen AI was 100%. The sex sorted semen may be used in Ovsynch protocol in Gir cows.

A systematic review of current trends in pharmacologic management after stent placement in nonthrombotic iliac vein lesions

Objective Stenting of the iliac vein is increasingly recognized as a treatment for chronic venous insufficiency (CVI). However, the pharmacologic management after stent placement is unclear. This review was conducted to illustrate recent trends in anticoagulation and antiplatelet regimens following stent placement for nonthrombotic iliac vein lesions (NIVL). Methods The MEDLINE database was searched using the term “iliac vein stent.” Retrieval of articles was limited to studies conducted on humans and published in English between 2010 and 2020. Studies were included that described iliac vein stent placement. Studies were excluded that contained fewer than 25 patients, performed procedures other than stent placement, did not specify the postoperative anticoagulant used, or treated lesions of thrombotic origin. Results 12 articles were included in this review, yielding a total of 2782 patients with a male-to-female ratio of 0.77. The predominant CEAP classification encountered was C3. The most common stent used in the included studies was the Wallstent (9/12), and the most common pharmacologic regimen was 3 months of clopidogrel (6/12). Warfarin, aspirin, cilostazol, and rivaroxaban were among other agents used. Primary stent patency ranged from 63.1 to 98.3%. There was no apparent correlation between pharmacologic agent used and stent patency or subjective patient outcomes. Conclusion Multiple different approaches are being taken to pharmacologically manage patients following stent placement for NIVL. There is no consensus on which agent is best, nor is there a formal algorithmic approach for making this decision. Additionally, the findings in this study call into question whether anticoagulation following stenting for NIVL is necessary at all, given the similar outcomes among the different agents utilized. This review underscores the potential value of undertaking a multi-institutional prospective study to determine what is the best pharmacologic therapy following venous stent placement for NIVL.