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.

Surgical treatment of left-sided infective endocarditis in Hanoi Heart Hospital

Objective: to evaluate the short-term outcomes of surgical treatment of left-sided infective endocarditis (IE) in Hanoi Heart Hospital. Patients and Methods: A retrospective, cross-sectional and descriptive study on all patients underwent surgery for left-sided IE from 3/2015 to 3/2019 in Hanoi Heart Hospital. Result: 56 patients underwent surgery for left-sided IE in 4 years; the mean age was 45.8 ± 16.0; male-female ratio was 3.3/1. 9 patients (16.1%) had prosthetic valve endocarditis. Preopeative blood cultures were positive in 35.7%, the mainly microorganism was Streptococcus (21.4%). Emergency and urgent surgery was performed in 14.3%; the most frequently postoperative complication was kidney failure, the in-hospital mortality rate was 5.4%. During the average follow-up time of 36.6± 14.2 months, the recurrence rate of IE was 17.8%. Conclusion: surgical treatment of left-sided infective endocarditis is still a great challenge, the early recurrence and motality rate are high.

Histopathology of Polyps and Cancer of Colorectum: A ten years study from a tertiary care center

Introduction and objectives: Polyps and colorectal cancer have overlapping clinical presentation and may be difficult to diagnose on clinical grounds alone and close clinicopathological correlation is required for correct diagnosis and management. This study was aimed to see the spectrum of polyps and cancer in colorectum, see the percentage of colorectal cancer in younger individuals, see association between histologic grade and pathologic stage at presentation and compare site of tumor and pathologic stage at presentation in younger and older age group. Methods: This study was carried out on 138 consecutive cases of polyps and malignant lesions of colorectum during a time period of 10 years from January 2011 to December 2020. Results: Age of the patients ranged from 2 – 90 years with mean 45.1 years and a male female ratio 2:1. There were 58 (42.0%) cases of polyps and 80 (58.0%) cases of malignancies. 37 (46.3%) malignancy cases were seen in individuals ≤ 50 years of age. Most common site of involvement was rectum in 80 (58.0%) cases. Most common non-neoplastic polyp was retention polyp comprising 25 (67.6%) and most common neoplastic polyp was adenoma comprising of 18 (85.7%) cases. Most common malignancy was adenocarcinoma comprising 75 (93.8%) cases. Conclusion: Significant number of malignancies is seen in younger individuals stressing the need for suspicion and surveillance in this age group. Histologic grade is an important prognostic parameter and there is no difference in site of tumor and stage at presentation between younger and older age group.

Analysis of Fracture Midshaft Clavicle Treated by Intramedullary Device Versus Conservative

Clavicle fractures account for about 2.6 to 4 % of all fractures. The best method to treat the displaced midshaft fracture of the clavicle remains a topic of debate. Although there is a large number of studies published about this topic, it is still relatively unknown as to which modality provides better long term functional outcomes and low complications rates. In our study, we have analyzed midshaft clavicle fracture treated with intramedullary device versus conservatively in terms of clinical, functional and radiological outcomes. The mean age of the patients in our study was 35.766 years. Male: Female ratio was 5.0:1.0. The mean time interval between injury and intervention was 2.1 days. Out of 30 patients, 11 patients (36.666%) had left sided fractures, while 19 patients (63.333%) had right sided fractures. Out of 30 patients, 12 patients (40%) had type 2B1 fracture according to Robinson's classification, followed by type 11 patients (36.666%) type 2B2, 6 patients (20%) type 2A1 and 1 patient (3.333%) type 2A2 fracture. Inoperative group, the mean Constant and Murley score before the intervention, at 1 month follow up, 3 months follow up and at 6 months follow up were 47.46, 76.73, 82.8 and 90.73, while in a conservative group, it was 47.53, 71.66, 79.2 and 89.46 respectively. Inoperative group, the mean Q-DASH score before the intervention, at 1 month follow up, 3 months follow up and at 6 months follow up were 29.33, 19.33, 16.86 and 13.8, while in a conservative group, it was 31.266, 22.533, 18.8 and 15.66 respectively. The final outcome, on the basis of the final Constant and Murley score in 13 patients (43.33%), was excellent, 11 patients (36.66%) was good and 6 patients (20%) was fair. Inoperative group, complications were seen in 6 patients (40%), while in the conservative group, complications were seen in 10 patients (66.66%). Thus, the functional, clinical and radiological outcome of the patients managed surgically with an intramedullary device was significantly better when compared with patients treated conservatively.

Clinico-Epidemiological Profile of Patients with Psoriasis in a Tertiary Care Hospital of Western Nepal

INTRODUCTION: Psoriasis is a common, chronic, inflammatory and proliferative condition of the skin which poses a significant health problem in general population. It is clinically characterized by erythematous plaques covered by silvery white scales, associated with systemic manifestations in many organ systems. MATERIAL AND METHODS: This is a descriptive study conducted at the Department of Dermatology, Universal College of Medical Sciences, Bhairahawa, Nepal. All psoriasis patients who gave consent were clinically examined and proforma documentation including patient’s clinical and demographic details was studied. RESULTS: Fifty two psoriasis patients were studied. The median age was 40 years and male: female ratio was 1.7:1 with 33 (63.5%) male and 19 (36.5%) female psoriasis patients. The most common clinical type of psoriasis observed according to morphology was chronic plaque psoriasis 45 (86.54%) and according to involvement of anatomical site was nail psoriasis 33 (63.5%). This study showed that 30 (57.7%) had no symptoms of pruritus and pain and 29 (55.8%) of psoriatic cases had seasonal variation. The commonest treatment modality was a combination of oral and topical medication 29 (55.8%). CONCLUSION: Psoriasis is a common skin disorder associated with systemic manifestations seen by dermatologists. This study outlines the clinico-epidemiological profile of patients with psoriasis which can provide further guidance for taking appropriate measures in diagnosing, providing adequate treatment, and undertaking various preventive measures among psoriasis patients.

No-Antibiotic-Pectin-Based Treatment Differently Modified Cloaca Bacteriobiome of Male and Female Broiler Chickens

As the information about the effect of pectin prebiotics on chicken gut microbiota is scarce, by using high throughput metagenomic sequencing with Illumina Miseq we examined the cloaca bacteriobiome of male and female chickens receiving antibiotic- or pectin-containing drinking water. The bacteriobiome was dominated by two phyla (Firmicutes and Proteobacteria) and three classes (Clostridia, Bacilli and Gammaproteobacteria), with the difference displayed by the relative abundance of 42 OTUs. At the level of the major dominant OTUs, prebiotic supplementation drastically increased Enterococcus abundance (from 0 to 11% and 23% in males and females, respectively). The better feed use efficiency and growth performance of the pectin-receiving chickens implied their better health and corroborated putative beneficial role of the altered bacteriobiome, although its ecophysiological and/or pathogenic importance could not be readily inferred. Notably, the gut microbiota response to antibiotics showed more sex-related differential OTUs as compared to the pectin prebiotic (19 vs. 4), suggesting different mechanisms of the studied supplementations in shaping the gut bacteriobiome in different sexes. Therefore, we recommend targeting sex as a separate factor in interventional studies to account for sex-specific peculiarities in the microbiome response and taking into account the male/female ratio of industrial flocks prior to choosing a production technology. The studied prebiotic (pectin) can be used in developing new pre/symbiotic preparations and supplementation regimes as alternatives to antibiotics for stimulating broiler chicken production.

Đánh giá kết quả sớm điều trị ung thư đại tràng bằng phẫu thuật nội soi

TÓM TẮT Đặt vấn đề: Ung thư đại tràng là một bệnh lý hay gặp ở Việt Nam, đứng hàng thứ hai sau ung thư dạ dày trong ung thư đường tiêu hóa. Điều trị ung thư đại tràng chủ yếu là phẫu thuật cắt đoạn đại tràng mang theo khối u kèm hạch và hóa chất bỗ trợ. Phẫu thuật nội soi điều trị ung thư đại tràng mang lại nhiều hiệu quả và ngày càng được ứng dụng rộng rãi. Phương pháp nghiên cứu: Nghiên cứu tiến cứu, lâm sàng mô tả 35 bệnh nhân được chẩn đoán là ung thư đại tràng được phẫu thuật nội soi tại bệnh viện Trung ương Huế cơ sở 2 từ tháng 1/2019 đến 6/2021. Kết quả: Tuổi trung bình 62,4 ± 17,8 (34 - 82), giới tính nam/nữ: 1,2. Vị trí u bao gồm: u đại tràng phải chiếm 31,4%, đại tràng ngang 11,5%, đại tràng trái 25,7%, đại tràng sigma 31,4%. Hình ảnh quan sát qua nội soi đại tràng thể sùi chiếm tỷ lệ cao nhất 82,9%. Nồng độ CEA tăng trước mổ chiếm 42,9%. Theo TNM u tập trung ở giai đoạn II, III chiếm tỉ lệ cao nhất 80%. Thời gian phẫu thuật trung bình: 168,7 ± 31,4 phút, thời gian nằm viện sau mổ trung bình: 10,8 ± 4,9 ngày. Tai biến trong mổ không có, biến chứng sớm sau phẫu thuật có 5/35 bệnh nhân nhiễm trùng vết mổ. Kết luận: Phẫu thuật nội soi điều trị ung thư đại tràng là một phương pháp hiệu quả, an toàn, tỉ lệ tai biến và biến chứng sau mổ ít. ABSTRACT OPERATIVE OUTCOMES OF LAPAROSCOPIC SURGERY FOR COLON CANCER Background: Colon cancer is a common disease in Vietnam, ranking second after gastric cancer in gastrointestinal cancers. Treatment of colon cancer is mainly based on surgery to excise the colon with tumor and adjuvant chemotherapy. Laparoscopic surgery for colon cancer increasingly shows its effectiveness and is widely used. Methods: A prospective, descriptive study was conductedon 35 patients with colon cancer who were treated by laparoscopicsurgery at the Hue Central Hospital - Branch 2 from January 2019 to June 2021. Result: The mean age was 62.4 ± 17.8 (34 - 82); the male/ female ratio was 1.2. The sites of cancer were: right colon 31.4%; transverse colon 11.5%; left colon 25.7%; sigma colon 31.4%. Protrusive tumors were accounted for 82.9% by diagnostic colonoscopy. Elevation of CEA serum level wasfound in 42.9% preoperatively. TNM stage of II and III were the most 80%. The mean operativetime was 168.7 ± 31.4 minutes. The mean duration of hospitalization was 10.8 ± 4.9 days. No intraoperative complications were found. The rate of wound infection was 14.3%. Conclusion: Laparoscopic surgery for colon cancer is a safe and effective surgical technique with less postoperative pain and a low rate of postoperative complications. Keywords: Colon cancer, laparoscopic.

Study of analgesic activity and effects of new dipharmacophores – nebracetam and cyclooxygenase-2 inhibitors derivatives on the cognitive abilities of rats

Introduction: The aim of the present study was to research the analgesic activity and effect of new dipharmacophore compounds consisting of substances with proven therapeutic activity, namely nebracetam–ibuprofen (NRIP), nebracetam–dexibuprofen (NRDIP), nebracetam–niflumic acid (NRNFA), and nebracetam–mefenamic acid (NRMFA), on the cognitive abilities of rats. Materials and methods: The experimental study was performed in 110 Wistar rats (male/female ratio 50/50%), weighing 180–200 g, and 50 laboratory mice (male/female ratio 50/50%) weighing 18–22 g. The study of the analgesic activity was carried out using the acetic acid writhing test and the hot plate test. The effect on the cognitive abilities of rats was studied using the pattern recognition test in a model of neurotrauma caused by a drop-weight. Results and discussion: It has been shown that the administration of dipharmacophores nebracetam–ibuprofen (NRIP), nebracetam–dexibuprofen (NRDIP), nebracetam–niflumic acid (NRNFA) as well as nebracetam–mefenamic acid (NRMFA) in the tested dosages leads to a statistically significant (p<0.05) analgesic action in acetic acid writhing tests and hot plate tests. At the same time, the analgesic activity of the compounds has been shown to conjoin with a statistically significant influence on cognitive functions in the experimental animal groups after simulating a neurotrauma. Conclusion: The dipharmacophore compounds studied in the present research, having analgesic and nootropic effects, can be used as effective and safe analgesics and can also be used for the treatment and prevention of pain syndrome, enhancing the cognitive abilities of healthy people in complicated professional conditions.

Epidemiological study of fatal road traffic accident cases

The present study is an epidemiological study of fatal Road Traffic (RTA) cases brought and admitted in our tertiary health care centre from Nov 2017 to December 2019. There were 148 fatal RTA cases involving 112 males and 36 female. In the present study males cases outnumbered the female with an approximate male female ratio of 3.1:1. Many cases of fatal head injuries were due to four & two wheelers. Most commonly seen external injuries were abrasions. Lower limbs showed fractured in 31 cases, 20.95%, and upper limbs showed fractured in 22 cases, 14.89%. So, far case fatality is concerned involvement of head plays the most important role.

A CROSS-SECTIONAL STUDY TO ASSESS THE IMPACT OF DIET & LIFESTYLE IN PREVALENCE OF HYPOTHYROIDISM IN FEMALES - AN AYURVEDIC PERSPECTIVE

Background: In India, 42 million people are suffering from thyroid disorders, out of which hypothyroidism is most common with a prevalence of 5.4%. It is more prevalent among females with the male-female ratio being 1:6. Hypothyroidism is a clinical syndrome resulting from a deficiency of thyroid hormones, which in turn results in a generalized slowing down of metabolic processes. Impaired metabolism can be compared with vitiation of Agni causing Agnimandhya according to Ayurveda. Agnimandhya further hampers the formations of Ahara Rasa and consecutive Dhatus Nirmana, diminishing the metabolism, thereby causing features similar to hypothyroidism. The objective of the Study: To assess the impact of diet & lifestyle on the prevalence of Hypothyroidism in Females. Materials and Methods: It is a cross-sectional survey study. A total of 150 female subjects were selected for the study. With the help of a validated pre-designed and pre-tested questionnaire, the interview was conducted on female subjects diagnosed with Hypothyroidism to assess the impact of diet and lifestyle on the prevalence of Hypothy- roidism in and around Mysuru city. Result: In the survey study, the majority of the hypothyroidism diagnosed subjects followed unhealthy daily regimes and the majority percentage of them practised unwholesome diet, food habits and lifestyle. Diet and lifestyle have a direct influence on the occurrence of hypothyroidism. Conclusion: Hypothyroidism is a metabolic disorder is mainly caused by Agni Mandhya and Rasa Pradoshaja as a result of faulty diet and lifestyle. One should follow Dincharya, Rutucharya and other Ayurveda principles to protect the Agni and thereby prevent Hypothyroidism. The practice of Ahita Ahara Vidhi and Ahita Vihara in the manifestation of Agnimandhya, followed by the development of features of hypothyroidism was substantiated by the result of the survey. Keywords: Hypothyroidism; Diet; Lifestyle; Agnimandhya; Rasa Pradoshaja Vikara.